16/05/2017 Welsh Assembly

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Live coverage of the day's proceedings in the Welsh Assembly including the business statement, statements on end of life care, educational leadership and dementia.

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I think professional sport is looking strong in Newport at the


moment and I wondered if you would join me in paying tribute to all of


those people involved in making that a reality and particularly the


grassroots support? Absolutely. I saw the scenes at the


end of the game, the scenes of joy when the second goal went in against


Notts County so I am more than happy to congratulate Newport county. The


dragons have a bright future as well. The financial stability seems


to be coming together and I fully recognise the importance of sporting


development. The FA W over the past two years has been transformed, an


organisation that now has a training facility in place. In terms of the


importance of individual physical activity, I know how important this


is and I know indeed that the member has spent the last 18 years telling


me how important it is and I failed to follow his advice! We continue to


take a broad range of actions to support the manufacturing industry


against Wales. UK industrial output shrank for a third month in a row


with the manufacturing industry falling by 5.6%. As a country, in


Wales, with a proud manufacturing and industrial past, it is sad that


the proportion of apprenticeships in manufacturing fell from 6% in 2006


to a dismal 2% in 2014 and those are stats Wales figures, including the


First Minister wants to accuse me again of misrepresenting the facts.


Does he agree with me that it is acceptable to did for over a year


with a new economic and industrial plan for this country and what hope


is there for a future in industry in Wales on a global level when we're


not providing the next generation with the skills to deliver? We will


fund 100,000 apprenticeships in this Government, something we think is


very important. He is right to put out manufacturing is of greater


importance to the Welsh economy than it is to the UK as a whole. I do not


accept what he says about dithering. We brought Aston Martin into Wales,


we brought Qatar Airways into Wales. We currently work with 88 companies


looking to expand or locate in Wales. We have been hugely active


and investment figures speak for themselves. Question ten, Russell


Jones. Superfast Cymru scheme in Montgomeryshire.


It will be rolled out. We are now eight months away from the job dead


date when the superfast Cymru projects, it seems to have


continuing issues with residents. We were contacted by one constituent


who complained that even though he had confirmation of superfast


broadband via fibre to the premises technology in February this year, he


also confirmed in writing by the Minister, he has now been told the


situation has changed and the technology to be used is eager for


the Cabinet and now he is too far away from the Cabinet to benefit


from the upgrade. That situation is unacceptable and one minute he is


told he will receive up to 330 megabytes and then the goalposts are


changed and he finds he will not benefit at all. In February, they


could have been other solutions but they are no longer available. Would


you agree that it is important people are given the right


information in the first place. Absolutely, perhaps if the member


could write to me with the details of a problem I will of course


investigate. The next item is the business statement and announcement


about Korber Leader of the House, Jane hunt. The business committee


has agreed to table a motion to suspend standing orders immediately


after the business statement to allow tomorrow's short of eight to


take place after today. I recently visited my GP and I had


to go very early in the morning, 8am, and what I saw is unthinkable,


I had to go past a couple of surgeries and people were waiting,


7:30am to 8am, outside with children, able and disabled and


senior people, with of course sickness. You have to make an


appointment to see the doctor before 8am and the surgery door never


opens. That is a surprisingly 21st-century. People waiting outside


and not getting into it in this weather earlier in the morning and


the surgery staff are already inside. So would you kindly make a


statement about GP appointments in Wales, that includes, it will


definitely have many surgeries in this country that all stood outside


without shelter in this weather, could not some matter allow these


patients to wait inside the surgeries and possibly a use of


ticketing or numbers to be given and they can have a lot of numbers to


see the nurses or the people who are inside give the appointments for the


doctors. I think it would be great help for sick people, young and old,


to make sure that statement is made on doctor appointment surgeries in


Wales. The member raises an important question and it gives me


the opportunity to say that our GPs in Wales provide a first class


service to the population, the national survey continues to show


high level of satisfaction, patients satisfied with GP services. We are


continuing to invest new money in private care, 42.6 million this


financial year alone. In terms of GP practices working together,


collaboratively, we are investing 64 primary care clusters across Wales.


That all means that in terms of access to GP surgeries, this Welsh


Government is not only investing, supporting, but also patients


increasingly satisfied with those services. Play-offs for a Government


statement in the importance of universities and what the Government


is doing to support the university sector. The importance as you say of


universities is quite clear. The higher education sector makes a


substantial contribution to the economy of Wales. University of


Wales contributes more than ?3 billion a year in gross expenditure.


Employee over 20,000 people and turnover in excess of 1.5 billion.


Of course also contributing to sustainable, economic growth in many


ways. Developing a highly skilled workforce through engagement with


local communities. Clearly, there are examples the university sector


can learn from across the world but I think we have real opportunities


as the diamond review recognises, investment in higher education can


bring those benefits for the economy. Thank you, if I can ask the


Cabinet secretary for two statements. The first is quite


simple, we have just announced that all parties in Wales are in favour


of scrapping the Severn Bridge tolls. I look forward to that but it


does leave one bridge in Wales which does have a toll and that is the


Thamwong -- that is the Cleddau bridge and that is wholly in the


hands of the Welsh Government. What is the Government's intention in


terms of scrapping the Severn Bridge tolls and I believe the only bridge


in Wales where it a bridge goes from one part of an enterprise to another


so let's make sure Wales is free of tolls following, realising the


dreams of the daughters of Rebecca at last. The second statement is a


little more complex, relating to a planning application for a cabin


holiday part in Bedd Gelert. The campsite in Bedd Gelert is to be


done away with and there is a planning application for holiday


cabins in the place which includes hot tubs and also some things, as


well as a shop and visitors centre. The plan under pinning this is part


of something that has emerged from the old Forestry Commission and


therefore, I want a statement from the Government on the role of an RW


in this application, as I understand it, NRW as the successor body to the


Forestry Commission, has a 20% stake in this scheme and if it does


proceed and is successful, in terms of its planning application, NRW


will receive ?48,000 per annum in rent for 16 holiday cabins. That is


3000 per cabin. The problem here is that NRW is also a regulator for the


site and NRW as a regulator, has raised any objections of the


development. -- has not raised any objections of the development. I


would like to hear from the Government how exactly they expect


NRW the balance that position and to make sure everything is done


properly to make sure local people can be assured they are doing the


proper work and safeguarding the local environment. It is a


breakthrough that the Welsh Labour Government and indeed your cells


have been crying out for, the Severn Bridge tolls to be removed and now


the Tories are responding to our calls here from the Welsh Government


and from parties in this chamber. It is very important therefore, we look


at how this can progress. Your point about Cleddau bridge is well made


and I am sure the Minister will want to update you about. Your second


question, it draws attention to a whole range of issues which touch on


powers and responsibilities of NRW. You have put it on the record now in


terms of this application which does crossover issues relating to Tories


and forestry and planning which the Minister has two reserve comment on


but you have put it on record. Could I call for two statements, firstly


on an issue I first raised 14 years ago and possibly earlier. That is


deaf school pupils in Wales. In this UK deaf awareness week 2017, the


latest Welsh Government figures have shown deaf school pupils are


underachieving at every key stage with the national deaf children


society for Cymru saying these pupils are being left behind without


urgent action. The figures suggesting the attainment gap having


temporarily fallen, has widened again at GCSE level. Having launched


to close the gap following a poor set of results four years ago, the


society has said the latest figures are unacceptable. Deafness is not a


learning disability or difficulty and there is no reason why these


people should be underachieving unless and only because they are not


access in the appropriate support. As we call for 14 years ago, that


means raising deaf awareness, improving acoustics in the classroom


and making sure deaf children are supported from the start. I hope the


Welsh Government will respond with a statement on this very serious


issue. Having given it deep and serious consideration and considered


how we might now move forward. Secondly, could I call for a


statement on the Health Secretary on rare conditions in Wales, once he


has read the spring 2017 edition of vasculitis UK's magazine. An article


within it entitled what's up with Wales? This article says we have a


really good relationship with all the leading medical vasculitis


people in England but in Wales it is a different situation. Having been


given diagnosis by the leading people in England, over the border,


the advice seems to be ignored. There are various problems in


England for people with rare diseases but this seems to be a last


century attitude in Wales. Even if that is not 100% accurate,


the fact that these people hold that as their experience of treatment in


Wales and put it into a national magazine merits attention and hope


it will justify a statement accordingly. I am grateful that Mark


Isherwood has kept faith, as you do, with these very important issues you


have raised with me, I am sure not just 14 years ago, an issue not just


for health ministers and responsibilities, but also education


ministers and responsibilities as well. Our mission is to raise


standards and improve attainment at all levels. We do aim to achieve


this through the range of educational reforms that are


currently under way. Our ambitious additional learning needs Bill, if


passed, will completely overhaul the system for supporting pupils with


additional learning needs, including learners with hearing impairments. A


20 million package of funding will support implementation and build on


our wider plans, including developing workforce, but I do


recall again, and I'm sure the Cabinet Secretary for will be able


to update us on this, on the ways in which we ensure that in our capital


investment programme, 21st century schools will particularly be looking


at these issues, when we were developing that ambitious programme,


to ensure that we can take this on board in terms in the ways those


buildings could assist that and that is very much part of raising deaf


awareness for policy makers, as well as for those who are delivering the


services. On your second point, in terms of where conditions... I have


certainly over the vet met -- over the years met with groups, as you


will have done, and with professionals who were delivering in


terms of addressing the needs of people with rare conditions and I


don't recognise that statement that was given, I know that the Cabinet


Secretary will be taking very serious consideration of how we are


progressing in terms of meeting those needs. Some six weeks ago,


Julie Morgan and I wrote to the Cabinet Secretary for the


environment and planning about the threat to the most vibrant live


music venue in Cardiff, which is at one in the street, because of the


threat of planning applications for a hotel and residency applications


-- Womanby Street. I am is ??DELETE alleged she is back after the life


changing injuries she suffered in the accident but now she is back, I


wonder with a she is able to tell us if it is able to introduce new


planning guidelines so it is absolutely clear to any developers


that the agent of change in any development has to be met by the


person who's making the applications, because under the


current planning laws, the whole of Womanby Street could be put out of


business if these applicants are successful, and they could then


insist that the live music venue has to pay the soundproofing, etc, which


in any case is likely to be ineffective because people on the


street will cause noise whether they are inside or outside of a venue.


There is over nearly 1,000 jobs at risk here, as well as many millions


of pounds from music tourism, so I wondered if we could envisage an


early statement on how we can change the law to ensure that any new


development has to make it clear that they are going to have to pay


for the costs of any mitigation that is resulting from a new development.


I thank Jenny Rathbone for raising this very important issue, again,


this important campaign that Julie Morgan also raised with you. Lesley


Griffiths is back in business, certainly wanting to meet with you


to discuss this issue. She certainly is very concerned to make sure that


the principle of making agents of change responsible for managing the


impact of new development is made very explicit in any future revision


to planning policy in Wales. It is already there, already contained


within planning policy Wales, but clearly needs to be more explicit


and I think the Cabinet Secretary, now of course for environment and


rural affairs, is willing to meet with you to discuss how it can be


taken forward. TRANSLATION: Thank you. I was very


pleased a few days ago to see the Welsh Government noting can guess


the station is one that could be reopened if in the future, the work


my predecessor did on the feasibility study on opening the


line through Llanelli which would bring huge benefits to Anglesey and


I know that we would be more than happy to discuss this issue further


with Government, but would it be possible to have a statement from


the Cabinet Secretary for transport on the additional work that needs to


be done now in order to transform this exciting idea into reality? The


Cabinet Secretary, as you have acknowledged, recently announced the


prioritisation of 12 new railway stations across Wales. That decision


was made assessing a number of proposals against the well-being


goals set out at the well-being and future generations act. And clearly


now, it is about working with local authorities, partners and all those


who can progress proposals for those stations, including the station in


your constituency, with a view to future considerations, so I know the


Cabinet Secretary will want to update the Assembly on this matter.


Can I call the two statements, please? One in relation to the


regulation of drones and light aircraft. I've received a number of


complaints recently from residents in my own constituency about the use


of drones in residential areas hovering over people's back gardens,


filming local residents and invading their privacy and in addition to


that, there have been complaints about the use of light aircraft on


beaches which are right adjacent to the rail infrastructure and indeed


the trunk road network and, of course, if any of those microlights,


etc, had an accident, that could cause a serious problem on those


particular pieces of infrastructure, so I would appreciate a statement


from an appropriate Cabinet Secretary about the way we can best


regulate these whilst still allowing people to use them for leisure


purposes. Can I also call for a statement on access to GPs. I know


my colleague has also raised this as an issue but the National pensioners


a report recently on access to GP services in Wales and it found there


was significant problems with accessing some appointments in some


surgeries and it was largely due to the inconsistency around appointment


arrangements. So it reported that while some surgeries were offering


same-day appointment only, others were allowing people to book in


advance and offering a more flexible approach, which seemed to be much


better for patients in terms of their patient experiences, so I do


think it is about time we had a statement on GP access and how to


improve that overall and I would appreciate it if one could be


scheduled. I think the importance of access to GPs, I've already


commented on that in response to an earlier question, but I think the


changes to the GP contract for 2017-18 is important in terms of the


ways in which you can provide for new, enhanced services and also to


take forward the quality and outcomes, which is where ready to


see the consistency in terms of delivery. That's going to free up


more capacity for GPs and also access to practice nurses, which we


must of course remember is equally important in terms of the primary


care team and services provided. And also, it means patients can be seen


by the most appropriate professional for their needs. This is an issue


that in terms of GP surgeries, we are addressing. On your first


question, I will obviously take back and identify which Cabinet Secretary


is appropriate to answer your important question. Indeed, if we


have powers at all in terms of the use of drones and the impact in


terms of invasion, if you like, of Private space and the use of them as


well. Could we find time for a statement on the detrimental impact


on Welsh Government policies of well-being and promoting prosperity


of cuts, existing cuts and possible future codes to disability benefits


in the South Wales valleys and throughout Wales? A ?30 a week cut


to some new claimants of the employment and support allowance


came into effect last month, so disabled people put in the


work-related activity group will now receive ?73 a week. I will just


repeat that, ?73 a week. I wouldn't be able to live on that and also


cope with the additional challenges and costs that people with


disabilities have. The Prime Minister Theresa May says this lower


rate of support will, in her words, "Encourage disabled people to find


work." Yet over 30 disability charities, authoritative disability


charities, said the cuts do not incentivise work at all but they do


make life harder for disabled people who face extra costs of living and


they mean some people will be unable to afford basic necessities. Last


week, the Prime Minister refused to rule out further cuts for people


with disabilities, so if things are bad now, we can only imagine what


things might be if a Conservative Government is elected for the next


five years. So can we have a statement to shine the light on


effect of these prove who you delete -- of these punitive decisions and


the communities they live in. I am very grateful it has been brought to


our attention in the chamber today and I have to say that in my


constituency capacity, I am being approached by people who are now


suffering directly as a result of the further cuts to welfare benefit,


particularly affecting disabled people, the 1st of April. People who


are struggling and are losing access to notability, for example, and then


having contradictory expectations, which, of course, cannot be


delivered, and all reducing their income levels. We Remain deeply


concerned about UK Government's changes for employment support


allowance claimants assigned to the work-related activity group, which


started in April this year. It will see new claimants receive


approximately ?29 per week less, existing claimants -- than existing


claimants and it is the cuts on new claimants, we have to remember that,


the DWP estimate 500,000 families in Great Britain will be affected and


in the longer term, 35,000 affected claimants will be in Wales and it is


the local authority areas in the South Wales valleys, particularly


those claimants, affected on the higher PSA rates. And as a Welsh


Government, we are taking action to help people to manage the effects of


the UK Government's welfare benefit changes and we will continue to


analyse the impacts of such cuts and monitor those impacts, putting more


money into our advice services, credit unions and support services


is crucial. It would be very helpful is crucial. It would


for us to bring to the wider for us


discussion a statement by the Cabinet Secretary, it would be very


helpful to this chamber and disassembly. Three brief areas, if I


may. Firstly, can I support Mark Isherwood's earlier call for a


statement of support given by the Welsh Government for rare diseases.


You mentioned vasculitis, an area of concern close to my heart. Many of


these sufferers of the rarer diseases do often feel left out. It


is natural for large diseases, cancer, heart disease, to get the


lion's share of funding but over time, it is important that we do


send a signal to sufferers of rare diseases that they are being taught


about and policy is filmed around them too. Secondly, I think it is


six months now since the Cabinet Health Secretary made a statement


giving the go-ahead for the specials and critical care centre income


bran. I think 2022 was the date given for a solution backstreet


completion for that project. Can we have an update -- was the date given


for completion of that project Chris Watt can we have an update on that?


Finally, I drove along the heads of the valleys road on the weekend and


it is good to see that coming on. That's a fantastic piece of road and


there are many economic potential benefits, I can see the member


nodding vigorously at that. However, just down the road, you have got the


a 40 that links Abergavenny to Raglan and Monmouth in my


constituency, which is an ageing concrete road causing hassle for


commuters and people living in adjacent areas, so if we are going


to have this fantastic piece of road kit up at the heads of the valleys,


it doesn't make any sense to have a poorer piece of road infrastructure


feeding into it, so I wonder if we could have a statement from the


Cabinet Secretary of the transport are Harry intends to build on the


development of the heads of the valleys and make sure the


surrounding network is also build up to standard.


The Cabinet secretary for health and well-being and sport is sitting here


listening to your first two questions, one of which I did


respond to in terms of rare diseases and the importance of the priorities


we give to that. But also to the state of play in terms of critical


care centre. Wonderful new heads of the valleys roads with more funding


coming through innovative finance to complete it. Also, seeing the sign


which you will have seen, saying, funded by the European Union, I


think strikes me as a back road would not be built without us being


a member of the European Union. As well as Welsh Government funding as


well. That has made a huge impact in terms of the Welsh economy and


access to your constituency and then of course, nick Robinson, you


mentioned the roads that came up to be a full 65 and that is a matter of


our work and partnership together with your local authority. Thank


you, Leader of the House and the next item is the motion to


temporarily suspend standing orders, to allow the short debate scheduled


for the 17th May to be debated as the last item of business today. I


call a member of the business committee to move motion. The


proposal is to suspend standing orders. The motion is therefore


agreed in accordance with standing order 12.36 and the next item is a


statement by the Cabinet secretary for health, well-being and sport on


end of life care. I call on the Cabinet secretary. On 27th of March


this year, I published the updated palliative and end of life care


delivery plan. This plan reaffirms our commitment to make sure people


have a realistic, healthy approach to diet and can plan appropriately


for the event. We want people to be able to end their days in the


location of their choice. Be that home, hospital or hospice. And we


want them to have access to high-quality care wherever they live


and die, whatever the underlying disease or disability. This plan


covers all aspects of palliative and end of life care. Delivered by both


primary and secondary sectors and involving specialist palliative care


by the NHS and third sector providers. To build on the success


of the first plan, it has been updated to reflect the latest change


and has strengthened children and young people and research sections.


We no care at the end of life has improved greatly since the


publication of the first delivery care plan in 2013. Consultants in


palliative medicine are now available on call 20 47 across Wales


to provide advice and support to other professionals and visit


patients where required, enhancing the service provided by clinical


nurse specialist at weekends. The support is now in place for


specialist teams the work seven days a week. This provides front line


staff with valuable support at weekends, enabling patients with end


of life care needs to avoid hospital admission where appropriate and


patients with complex needs to remain at home. Also we are


improving hospice at home provision. All general practices have a ratio


of patients with supportable palliative care needs. We have


established a 24 hour out of our telephone advice service which is


now available across Wales. Dying is of course an inevitable event. I


fully appreciate it is not a subject many people are comfortable talking


about but it is vital people let their loved ones know how they wish


to end the days when the time comes. Planning for the end of life through


open conversations can result in a better death and certainly help the


grieving process for those left behind. Last week, I attended a


conference and was pleased to launch the new website for advanced care


planning. Today, you can find most of the information online and it


will be useful to have that resource on the internet at their fingertips.


We have provided ?150,000 to train staff in end of life care. This


enables colleagues to begin and manage serious illness conversations


with parents, families and carers. The end of life care implementation


board provide strong leadership and oversees the delivery of the plan.


As is the case with all major health conditions, the board sees ?1


million annually to support the priorities. The Welsh Government


allocated an additional million pounds to further enhance end of


life care provision. The board has identified provisionally this


funding will be used in a compassionate community approach for


palliative care. Supporting the development for an all Wales


development record and take research priorities and the poor GP clusters


in Wales. The Government provides also ?6.4 million in funding support


specialist palliative care services provided by hospices and health


boards throughout Wales. This significant investment is a


reflection of the importance of this Welsh Government places on end of


life care. It is vital individuals receive the best possible care in


the location of their choice at the end of the days. Direct feedback


from patients and their families about specialist palliative care


services in Wales have shown that year, these services make a huge


difference to people's quality of life in the closing days. 93% of


responses to the patient evaluation of the experience of palliative care


was positive and the average score was 9.5 out of ten across all


domains. This would not be possible of course without the dedication and


professionalism of our workforce. I do want to take a moment at the


stage to acknowledge the work of our clinicians, nurses and other staff


providing care for people at the end of their lives. They can be fewer


jobs, more or mostly demanding yet more necessary. I'm sure you'll all


join me in recognising and thanking our staff for work. Dying is a


social matter. How well we care for people who were dying reflect on how


we care as a society. Advances in modern medicine and treatment have


resulted in a growing population living longer with incurable


diseases. It is vital good end of life in palliative care is made


available across Wales. The delivery plan was developed through effective


partnership working, that continued cooperation between the Government


of Wales, implementation board, NHS, professional bodies at the third


sector is key to delivering outcomes at a greater pace and with greater


impact. We should recognise the challenges ahead are many other


significant but we can look forward to the future with a sense of shared


direction and confidence. This week is dying matters awareness week


2017, placing the importance of talking about dying, death and


bereavement firmly on the Welsh and UK agenda. I very much welcome as


chair of both the cross-party group on hospices and palliative care at


the cross-party group on funerals and bereavement, with an estimated


32,000 people dying in Wales each year, that is affecting somewhere


between 160,000 and one third of a million people directly. In Wales


each year. Many vulnerable to serious additional problems,


suicide, lonely dice, social isolation, anxiety, depression and


social problems. The majority of end of life care in Wales is provided by


hospices across a range of settings including inpatient units and


hospice and home services. There are lessons the NHS could learn from


hospices, especially about the integration of care services in the


home Community Hospital and hospice. I've been asking successive health


ministers and our Health Secretary for many years, to start asking or


making sure NHS will start asking our wonderful community, hospice


movement, how it can help them deliver more for the resources


available in modern Wales, delivering services with them. And


too many still feel that is not the case. I wonder if you could respond


to that point. Hospices Cymru, as you will be aware, are receiving


Welsh Government funding on a ring-fenced basis through health


authorities over three years period. That period finishes in 2018. Can


you provide assurance to them whether that funding will continue


to be ring fenced when the existing funding expires because they need to


go for the forward planning, and if not, can you indicate when you might


be able to provide that assurance or at least information? 16 to 20%


hospices in Wales still receive far less Government funding, that's


Welsh Government and Welsh NHS funding, than the English and


Scottish counterparts. They also highlight a postcode lottery of


hospice services with the disparity of care available between different


parts of Wales. When will the Welsh Government finally in the context of


my previous question, recognise that by discussing and designing and


delivering with them on a more balanced funding basis, it is win-


win for everybody and a means of delivering in a strict budget


environment? At the end of life implementation board, as you


indicate, has been allocated an extra million pounds in 2017-18 and


one of the provisional areas identified for that is developing a


compassionate community 's approach the end of life care. To a half


months ago, I went to a lecture on a compassionate community approach the


end of life care. Highlighting the need to provide people near the end


of their lives with the support they need to remain in their communities


by providing health, promotion and community development principles,


and providing support to those who are dying and those who are


bereaved. How therefore do you respond, not just in terms of a


provisional part of ?1 million for one year, but to the call by married


here for Wales to become a compassionate nation following the


lines of the compassionate community model, that has successfully been


developed in numerous towns and communities in the UK, including


Somerset. It is not about more money but using the existing money wisely


to improve outcomes and lives. How would you respond to the calls by


age Cymru on end of life care for the Welsh Government to provide


direction on effective collaboration between local health boards and


local authorities, to make sure equal access for all the people in


hospice care and for the Welsh Government to carry out a robust


monitoring of the fermentation, delivery and outcomes of it end of


life care delivery plan to determine whether it is delivering real


improvements in palliative care and end of life care for older people in


Wales is to mark how do you respond to Macmillan's calls for people


approaching the end of their life, who will benefit from the support of


palliative care services, to be identified said that earlier


discussions may start about their care. For people's preferred place


of death to be recorded early and for health and social care services


to be coordinated so that people can die well in the place of their


choice? Are you coming to the end? Thank you for allowing this.


Hospices Cymru is supporting the ambitions for palliative and end of


life care framework... This has ambitions for each person seen as an


individual, to have the access to care and coordinating care and much


more. How would you respond to the call for this model to become more


integrated into the Wales end of life care delivery plan, so that we


can all learn from each other and benefit together? Thank you for the


series of questions which I'm aware the member has raised on a number of


occasions in the past. He is consistently interested in this


area. It was dying matters week last week which is when I attended a


conference. I spoke to them about their work and recognise what they


have done in promoting this as a more national and natural


conversation to have. There is more work to be done with them but also


among all of us and the community we represent. I certainly don't


underplay the contribution of the hospice movement. And the variety of


hospices around the country which was the main focus of the questions


and comments made. Most members in this chamber Wardle


the local hospice their constituents attend, if not having hospices in


constituencies oral regions and I have regularly visited a number of


hospices in this role but have two in my own constituencies, so I


understand perfectly well the role they play in engaging with


clinicians and the public and designing the care that better meets


a person's needs. One of the significant steps forward in the


last plan and carrying on in an Exxon is promoting the hospice at


home movement, so people don't need to go into a hospice but can run


their hospice care at home, there have been real strides made forward.


In the way the carers commission and boards do, hospices are very much


part of the design and delivery of this plan and I don't necessarily


share the member's rather pessimistic approach and assessment


of the contribution designing this strategy, but also understand the


success its impact on palliative end of life care. And in terms of the


financial matters raised, well, as I've indicated, the million pounds


goes to each of the major conditions, each has ?1 million


allocated and I mentioned the 6-4p spent recurrently in this area. I am


aware of the issues in fruit that he mentioned about the pastoral


community approach and approaches have been made to see what happens


in that particular community and it is something to build upon here in


Wales and I look forward to having the ongoing concession I will have


with the end of life care board and all of its members and supporters,


for us to be a more compassionate notion. And I will end with your


point about outcomes and delivery, because part of the strength of the


delivery plan approach that we take is that we take an issue of major


significance. We bring together people from Government, from the


health sector and the third sector and leading clinicians in the field,


and there is a constructive and helpful tension created both an


understanding and agreeing priorities and the priority is being


carried forward and of the dialogue is open and honest and there are


times when the delivery plans, there are times when the delivery plans,


their associated delivery wards, recognise they haven't made all the


approach is needed. I look forward to honest reporting on how we have


not done and priorities in the future. TRANSLATION: May I thank the


Cabinet Secretary for his statement and for all of work done by staff


and volunteers in the Health Service and the third sector in providing


end of life care and palliative care across Wales. I don't think there is


much new, if truth be told into Dave's statement, although it is


always useful to have an update, so may I refer perhaps to what should


happen in the mind of one of the organisations involved in this area


and I will list some of the requirements they have set out. They


want palliative and end of life care to be an entirely central part of


care planning for those with chronic and long-term conditions. They want


better coordination between local authorities and health boards in


order to give equal opportunity for everyone in the population to have


access to hospital care. They want end of life care commissioned by


local health boards to include comprehensive care for people in


care homes. They want every institution and professional work to


get the necessary training and ensure continuity of training


throughout their working lives. They want to see or rather, they want the


orders to not attempt resuscitation or ceasing to provide food and drink


not to be put in place without full consultation with family or other


carers and finally, they want an assurance of very careful monitoring


on the implementation and delivery of end of life care plans, so that


it does deliver better care, so we are in a situation where some steps


have been put in place by Government, there is clearly more to


be done in the eyes of those involved in this area, so three


questions emerging. One, do you disagree with any of those


recommendations and if you don't, when can we be given an assurance


that those will have been implemented. Secondly, the annual


report mentions improvements in palliative care for children and


naturally, that is something that we welcome, but there are far too many


children who can't spend their last days in their own homes. Would you


agree that there is some work to be done in that area and do you


acknowledge that we need to strengthen services to support the


siblings of those who have suffered bereavement. And finally, minority


ethnic groups are particularly identified by Marie Curie as an area


where services need to improve, so what are the Government intend to do


about that specifically? Thank you for the series of questions and


comments and in terms of the priority that age country


identified, it is in the work I outlined of the board is taking


forward. Part of the strength of the work we are doing is having that


cross-section of people with a genuine interest in the area setting


a list of priorities. We often get different bids and not having a


cohesive approach. But the things you mention, they are priorities for


the board in the year ahead. The second particular issue, paediatric


palliative care. There was a concern about whether this had been properly


taken account of in moving forward and I met a group of paediatric


palliative care conditions and it was a very constructive conversation


and I think they have moved forward and her understanding that their


issues are properly taken account of and there is a definite step forward


in this iteration of the plans, progress has been made, but in


almost every area which I attend this chamber to speak, there is


always more to be done and there has to be an essential honesty about


that as well. That includes bereavement support, again


identified in my opening contribution, as an area for


improvement, for the family left behind. That is part of our


challenge and it is also why having a national conversation is somewhere


where we should take time in this chamber to do that. If we don't


normalise a conversation in this place about the importance, we are


unlikely to have a national conversation in the wider part of


society, so that is a normal conversation that takes place about


what we want. It is also why the advance care plans website has been


launched, so people have that conversation at a time when they can


make choices, much more active choices, about what they want, it is


really important because of people know they are coming to end of life


care. All those people on the end of life care registers and receiving


palliative care and primary care, there should be efforts to improve


the number of people that have come forward and had an advance care plan


drawn up that they have contributed to. We made real progress leisure to


improve the numbers of people who have a plan like that but we


understand it is only just over a third of people are primary care


register who have an advanced care plan in place. So significant


progress last year but lots more to do to get people into a place where


they can receive the care they want at the end of their life. On black


and Asian communities in Wales, there is a real challenge about some


of the care they want to receive. Some of this is a vote to differing


nature of family support that exists in those communities and the way


they feel about looking after relatives but also the work that


Marie Curie themselves have done. I attended the launch both of the


consultation stage and the final Report Stage and they recognise that


the hospice movement, as well as the Health Service, need to promote the


opportunities that exist for end of life care and different choices.


Something about the Health Service and hospice that provide care going


out and be more proactive with the committees that don't take


palliative care in the wake other communities do to say this is an


option and I am pleased to see they recognise they had a problem and


want to do something about it and certainly interested to see whether


that does take place. Over the time of this plan, you will see more


people in different communities having more access to palliative


care and making active choices about their end of days. I declare an


interest in the subject, as I'm the vice president of George Thomas


Hospice care based on the grounds of a hospital in Cardiff North that


delivers specialist palliative care to allow people to live in their


homes and maintain independence for as long as possible and I think it


is a good example of partnership working between the voluntary sector


and the statutory sector, written the Welsh Government and the local


authority and also, I think we would all want to pay tribute to the


long-standing investment of the voluntary sector in the hospice


movement from which you screw. I think that this plan is a very


important plan, the palliative and end of life care delivery plan, and


a crucial plan and I would like to play show view to professor and


Baroness Laura Finlay who has been so instrumental in this plan and is


standing down as a national clinical lead for end of life care in July. I


have worked for many years with Laura and I think she has made a


tremendous contribution to this area of work. One of the issues I am very


concerned of, which the Cabinet Secretary did referred to in his


introduction, was the really crucial issue of people when they are very


ill being moved into hospital for treatment when, basically, it would


be better if they were to stay at home if the support services there


could be given for them to Remain at home and this does happen with many


seriously ill people who have been receiving this report but when the


situation becomes much worse, they then go into hospital, so it is


fairly managed to keep people in that situation at home and I have


had several examples of that in my own constituency where, actually, at


a weekend, someone who was very near the end of their life was taken into


hospital AMD because the on-call doctor was so concerned about their


condition, whereas I think with a bit more collaboration and working


together, they could have remained at home with a bit to increase


support. So I think that is one of the crucial areas and I don't know


if the Cabinet Secretary can save a bit more about that? I welcome the


point made that we need a review of the capacity of existing bereavement


services. I think these are a vital part of planning for end of life


care. And in George Thomas Hospice care, the consultant has described


to me about how they are providing free bereavement counselling, the


children who have a parent or grandparent or perhaps a sibling who


is dying, and she says that this helps enormously if you do it before


the loved person dies and that that does mean you tend to need less


frequent follow-up sessions afterwards. So I wondered if the


Cabinet Secretary had any news about that and whether this was something


that was happening to any extent throughout Wales. And then of


course, there is the whole issue of Children's Services for the small


but very important group of children who do need palliative care and I'm


sure is aware of the work of the Short-lived body, which has put


forward several proposals. And then the final point I wanted to make was


in terms of advance planning. We have to take account now the number


of people diagnosed with dementia who will lead end of life care and


we're having a on that later on in the afternoon, about dementia, but


in George Thomas Hospice care, 75% of their patients have cancer and up


until now, the next group that they were working with other people with


heart disease. But now, the next biggest group is people who have


dementia and I think that is something we have really got to take


into consideration in planning for palliative care, if people do have


dementia, and I do note that, I think it was Macmillan, has said we


need to do a lot of preplanning with older people and I think we have got


to take into account the fact that a large number of people have


dementia. And then I just want to say that I do agree with all of the


issues about trying to learn from the compassion of communities


movement and we do need been conversation and to move onto make


that much more part of life. -- to make death much more part of life.


Just took speak on the pivot adventure and advanced planning,


people can make choices to actively do so and decide what they want,


rather than leaving it for other people to second-guess what they


might have wanted at a different time in their life and actually,


supporting people with dementia is politically difficult. The process


of going through and losing someone losing the personality, or parts of


it and then to lose them physically, it is a particularly challenging


time for the individual who is going that and their families as well. I


already mentioned the progress on paediatric care but what I haven't


mentioned is the additional work we have had done on a transition


between paediatric and adult services. It can be really difficult


time for the individual young person, as well as their family and


this can be particular difficult when relations are built up through


paediatric service and how it is transferred on but we have a


particular post within Wales which is a first base in the Children's


Hospital in Wales that looks of the transition from paediatric


palliative medicine into adult. It is recognised, that the earlier


the conversation, the better prepared people are for the


bereavement. Your point about George Thomas hospice, you are right,


individual and community investment and sustaining it is a huge


important part of what keeps the hospice movement special and well


funded. I want to recognise a point you made about Laura Finlay, much


respected right across the UK as a clinician. She says that Wales has


much to be proud of but also much more to do and I think it is a fair


reflection of where we are. The final point I make is the point you


make about maintaining support for people on the last months and year


of life. We know too many of those people have unnecessary hospital


admissions and so it is something that is part of the focus for


improvement. The latest figures show 65,000 admissions of people in the


last year of life, 65,000 emissions into hospitals. -- 65,000 admissions


into hospitals. Those people can sometimes be cared for in their own


homes that is a large part of the improvement for the year ahead.


Hopefully next year we will be able to report back on progress that has


been made for people across the country. Caroline Jones. Thank you


for your statement, the sad fact is that while everyone will eventually


die, we don't all die well. Because of the latter, it is essential we


have excellent end of life care. I welcome the Welsh Government's


palliative and end of life care plan and the commitment to improve the


care given to those approaching the end of their lives and those they


leave behind. If current trends continue, the number of people dying


in Wales will increase by 9%. We know that around 6200 people die


each year, do not get the palliative care they need but these figures


come from Marie Curie and they are not coming from the NHS. Therefore,


they don't feed into the workforce planning. We need an all-round


approach to palliative care as for the whole family are involved.


Therefore, it is essential staff are properly trained to deal with


sensitive situations such as this and it is pleasing to see that


?150,000 is provided to train staff in advanced communication skills and


end of life care. Although this is a start, a good start in recognising


the specialist skills needed, could you provide more information on how


many staff you anticipate? And what area will be covered in Wales? Some


may be more than others due to logistic situations? Funding to


provide access to hospice at home provision is welcome, along with


palliative care registered for all GPs who have a register of all


patients with supportive palliative care needs. Could you also tell me


how these registers are, child because there are some people


obviously without families who go unnoticed and become ill and they


are reluctant to visit their GPs. I wonder how we can reach these people


who sometimes and very often actually, die at home and are


discovered days or weeks later. Can we do more to make sure people like


this are included? Also, to bring back something said earlier, a Marie


Curie report has highlighted, as I indeed highlighted in the last


statement, additional barriers faced by bereaved LGBT communities beyond


the universal pain experienced after losing a partner. Despite this,


there are no specific actions outlined in the delivery plan aimed


at addressing these issues. Cabinet secretary, do you agree with me that


if we are to improve the end of life care for LGBT and BME communities,


we must address the shortcomings in this plan? In England, the NHS


conducts a survey of bereaved called Voices, and this shows the level of


care and support given to families at the end of their loved ones'


lives. We don't conduct such a survey in Wales and if we are to


make sure that everyone who needs specialist palliative care gets it,


and we are going to make sure that an individual needs and priorities


and preferences for end of life care can be identified, documented,


reviewed, respected and acted upon, then we must conduct a survey of the


bereaved also in Wales. I see there is no privilege for this in the


statement. Rather than relying on data collected through the


programme, which many patients are unaware of, does your Government


have plans to introduce a comprehensive survey of bereaved


families in Wales? The website launch is welcome and definitely is


the way forward. However, we must not depend on this statement that


nowadays, most people find most of the Reformation online. Although


this is true, there are many people without access to online services


and therefore, we need to be inclusive. It is important this plan


is inclusive and beneficial to all. I note consultants and palliative


care are now available on-call 24/7. Can you tell me how people will


become aware of this service? And the work with the children's


hospice, Ty Hafan, and an out of hours telephone service is essential


and is very welcome. I thank all hospital staff involved in this


extremely sensitive area, whilst also acknowledging the dedication of


families to their loved ones. I recognise the positive ongoing work


and the commitment shown by the Welsh Government and the Cabinet


secretary in this statement, however, I look forward to working


with you positively and constructively to further improve


the services in palliative care. Thank you for the series of


questions and comments. On the point about serious illness conversations,


I'll happily provide an update for members about how many staff have


gone under trading in the last year and how many more we expect to have


that trading over the next year. And more as a result of the additional


resources we are putting into it. On your point about the survey, of


bereaved families and all patients, I would be happy to consider whether


there is a better way forward but in this point in time, no one has


suggested to me, it has not been asked from the board, that we have


to have a different means of understanding feedback from people


directly involved in the care, people involved in receiving the


care as well. I would have expected if there was a real call for that,


that would have come through the board both from clinicians who are


still champions for the patients, as well as for the campaigning third


sector as well. If there is real evidence, there is a need to do


something different, I am open-minded about it but I would


need to be persuaded we don't currently have an adequate way of


understanding the quality of the care provided. The point you made


about the organisation of palliative care, we have got more people


available at different times in the day. We have a service enabled


throughout the week. I would need to be persuaded there is a different


way in which that should be accessed. Part of the challenge of


calls is what happens to those people who die alone. In their own


homes. Those people are few and far between but there is a broader


challenge as to how we as a society engage...


Thank you for coming to join us today, our very distinguished and


honourable guest the Prime Minister the reason may. She will just say a


few words and an open the floor to the general questions. Can we give a


big welcome to the Prime Minister Theresa May. Thank you very much


indeed, a great pleasure to be with


Live coverage of the day's proceedings in the Welsh Assembly including the business statement, statements on end of life care, educational leadership and dementia, followed by Stage 4 proceedings on the Public Health (Wales) Bill.