16/05/2017 Welsh Assembly


16/05/2017

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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Transcript


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I think professional sport is looking strong in Newport at the

:00:23.:00:27.

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

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those people involved in making that a reality and particularly the

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grassroots support? Absolutely. I saw the scenes at the

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

:00:42.:00:46.

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

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

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

:00:59.:01:04.

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

:01:05.:01:08.

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

:01:09.:01:12.

importance of individual physical activity, I know how important this

:01:13.:01:17.

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

:01:18.:01:22.

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

:01:23.:01:33.

take a broad range of actions to support the manufacturing industry

:01:34.:01:37.

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

:01:38.:01:41.

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

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

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

:01:55.:02:03.

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

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

:02:07.:02:10.

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

:02:11.:02:14.

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

:02:15.:02:18.

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

:02:19.:02:21.

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

:02:22.:02:30.

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

:02:31.:02:34.

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

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

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

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

:02:53.:02:56.

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

:02:57.:02:59.

and investment figures speak for themselves. Question ten, Russell

:03:00.:03:10.

Jones. Superfast Cymru scheme in Montgomeryshire.

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

:03:23.:03:34.

date when the superfast Cymru projects, it seems to have

:03:35.:03:39.

continuing issues with residents. We were contacted by one constituent

:03:40.:03:45.

who complained that even though he had confirmation of superfast

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

:03:51.:03:54.

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

:03:55.:03:57.

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

:03:58.:04:04.

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

:04:05.:04:09.

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

:04:10.:04:13.

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

:04:14.:04:16.

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

:04:17.:04:21.

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

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you agree that it is important people are given the right

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

:04:30.:04:32.

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

:04:33.:04:38.

investigate. The next item is the business statement and announcement

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

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has agreed to table a motion to suspend standing orders immediately

:04:51.:04:52.

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

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

:04:55.:05:13.

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

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

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

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

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

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

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

:05:45.:05:48.

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

:05:49.:05:55.

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

:05:56.:06:00.

definitely have many surgeries in this country that all stood outside

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

:06:05.:06:09.

patients to wait inside the surgeries and possibly a use of

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

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

:06:22.:06:26.

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

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

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

:06:38.:06:41.

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

:06:42.:06:47.

service to the population, the national survey continues to show

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

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

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

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

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

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Government is not only investing, supporting, but also patients

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

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statement in the importance of universities and what the Government

:07:33.:07:38.

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

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universities is quite clear. The higher education sector makes a

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substantial contribution to the economy of Wales. University of

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

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

:08:06.:08:11.

Of course also contributing to sustainable, economic growth in many

:08:12.:08:16.

ways. Developing a highly skilled workforce through engagement with

:08:17.:08:21.

local communities. Clearly, there are examples the university sector

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

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as the diamond review recognises, investment in higher education can

:08:34.:08:36.

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

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Cabinet secretary for two statements. The first is quite

:08:48.:08:53.

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

:08:54.:08:56.

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

:08:57.:09:01.

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

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

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

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

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

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

:09:38.:09:42.

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

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

:09:49.:10:01.

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

:10:02.:10:07.

done away with and there is a planning application for holiday

:10:08.:10:11.

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

:10:12.:10:16.

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

:10:17.:10:22.

of something that has emerged from the old Forestry Commission and

:10:23.:10:25.

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

:10:26.:10:33.

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

:10:34.:10:40.

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

:10:41.:10:45.

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

:10:46.:10:53.

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

:10:54.:11:00.

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

:11:01.:11:08.

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

:11:09.:11:15.

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

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would like to hear from the Government how exactly they expect

:11:23.:11:27.

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

:11:28.:11:30.

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

:11:31.:11:33.

proper work and safeguarding the local environment. It is a

:11:34.:11:40.

breakthrough that the Welsh Labour Government and indeed your cells

:11:41.:11:45.

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

:11:46.:11:49.

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

:11:50.:11:56.

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

:11:57.:12:02.

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

:12:03.:12:07.

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

:12:08.:12:12.

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

:12:13.:12:17.

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

:12:18.:12:22.

terms of this application which does crossover issues relating to Tories

:12:23.:12:29.

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

:12:30.:12:35.

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

:12:36.:12:41.

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

:12:42.:12:50.

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

:12:51.:12:55.

latest Welsh Government figures have shown deaf school pupils are

:12:56.:13:00.

underachieving at every key stage with the national deaf children

:13:01.:13:03.

society for Cymru saying these pupils are being left behind without

:13:04.:13:08.

urgent action. The figures suggesting the attainment gap having

:13:09.:13:12.

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

:13:13.:13:17.

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

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

:13:24.:13:27.

learning disability or difficulty and there is no reason why these

:13:28.:13:30.

people should be underachieving unless and only because they are not

:13:31.:13:34.

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

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means raising deaf awareness, improving acoustics in the classroom

:13:41.:13:46.

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

:13:47.:13:49.

Welsh Government will respond with a statement on this very serious

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issue. Having given it deep and serious consideration and considered

:13:54.:14:00.

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

:14:01.:14:04.

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

:14:05.:14:15.

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

:14:16.:14:21.

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

:14:22.:14:29.

really good relationship with all the leading medical vasculitis

:14:30.:14:35.

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

:14:36.:14:39.

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

:14:40.:14:44.

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

:14:45.:14:49.

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

:14:50.:14:51.

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

:14:52.:15:04.

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

:15:05.:15:07.

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

:15:08.:15:10.

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

:15:11.:15:15.

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

:15:16.:15:20.

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

:15:21.:15:24.

for health ministers and responsibilities, but also education

:15:25.:15:31.

ministers and responsibilities as well. Our mission is to raise

:15:32.:15:39.

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

:15:40.:15:43.

this through the range of educational reforms that are

:15:44.:15:47.

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

:15:48.:15:51.

passed, will completely overhaul the system for supporting pupils with

:15:52.:15:55.

additional learning needs, including learners with hearing impairments. A

:15:56.:15:59.

20 million package of funding will support implementation and build on

:16:00.:16:03.

our wider plans, including developing workforce, but I do

:16:04.:16:08.

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

:16:09.:16:15.

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

:16:16.:16:20.

investment programme, 21st century schools will particularly be looking

:16:21.:16:24.

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

:16:25.:16:28.

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

:16:29.:16:34.

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

:16:35.:16:40.

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

:16:41.:16:44.

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

:16:45.:16:50.

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

:16:51.:16:54.

will have done, and with professionals who were delivering in

:16:55.:16:57.

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

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

:17:06.:17:09.

Secretary will be taking very serious consideration of how we are

:17:10.:17:12.

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

:17:13.:17:21.

Julie Morgan and I wrote to the Cabinet Secretary for the

:17:22.:17:24.

environment and planning about the threat to the most vibrant live

:17:25.:17:30.

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

:17:31.:17:36.

threat of planning applications for a hotel and residency applications

:17:37.:17:49.

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

:17:50.:17:53.

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

:17:54.:17:59.

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

:18:00.:18:03.

planning guidelines so it is absolutely clear to any developers

:18:04.:18:06.

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

:18:07.:18:12.

person who's making the applications, because under the

:18:13.:18:17.

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

:18:18.:18:22.

business if these applicants are successful, and they could then

:18:23.:18:28.

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

:18:29.:18:32.

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

:18:33.:18:34.

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

:18:35.:18:39.

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

:18:40.:18:46.

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

:18:47.:18:51.

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

:18:52.:18:54.

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

:18:55.:18:59.

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

:19:00.:19:05.

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

:19:06.:19:09.

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

:19:10.:19:15.

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

:19:16.:19:21.

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

:19:22.:19:26.

the principle of making agents of change responsible for managing the

:19:27.:19:31.

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

:19:32.:19:39.

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

:19:40.:19:43.

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

:19:44.:19:48.

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

:19:49.:19:51.

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

:19:52.:19:57.

taken forward. TRANSLATION: Thank you. I was very

:19:58.:20:03.

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

:20:04.:20:14.

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

:20:15.:20:21.

my predecessor did on the feasibility study on opening the

:20:22.:20:29.

line through Llanelli which would bring huge benefits to Anglesey and

:20:30.:20:33.

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

:20:34.:20:36.

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

:20:37.:20:41.

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

:20:42.:20:46.

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

:20:47.:20:53.

Cabinet Secretary, as you have acknowledged, recently announced the

:20:54.:20:56.

prioritisation of 12 new railway stations across Wales. That decision

:20:57.:21:01.

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

:21:02.:21:05.

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

:21:06.:21:11.

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

:21:12.:21:17.

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

:21:18.:21:21.

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

:21:22.:21:25.

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

:21:26.:21:31.

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

:21:32.:21:36.

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

:21:37.:21:40.

complaints recently from residents in my own constituency about the use

:21:41.:21:44.

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

:21:45.:21:48.

filming local residents and invading their privacy and in addition to

:21:49.:21:54.

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

:21:55.:22:00.

beaches which are right adjacent to the rail infrastructure and indeed

:22:01.:22:04.

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

:22:05.:22:08.

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

:22:09.:22:13.

particular pieces of infrastructure, so I would appreciate a statement

:22:14.:22:16.

from an appropriate Cabinet Secretary about the way we can best

:22:17.:22:20.

regulate these whilst still allowing people to use them for leisure

:22:21.:22:24.

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

:22:25.:22:28.

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

:22:29.:22:35.

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

:22:36.:22:40.

was significant problems with accessing some appointments in some

:22:41.:22:46.

surgeries and it was largely due to the inconsistency around appointment

:22:47.:22:49.

arrangements. So it reported that while some surgeries were offering

:22:50.:22:54.

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

:22:55.:22:58.

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

:22:59.:23:03.

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

:23:04.:23:06.

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

:23:07.:23:11.

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

:23:12.:23:19.

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

:23:20.:23:21.

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

:23:22.:23:31.

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

:23:32.:23:37.

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

:23:38.:23:43.

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

:23:44.:23:47.

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

:23:48.:23:53.

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

:23:54.:23:57.

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

:23:58.:24:04.

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

:24:05.:24:10.

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

:24:11.:24:14.

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

:24:15.:24:17.

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

:24:18.:24:24.

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

:24:25.:24:28.

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

:24:29.:24:36.

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

:24:37.:24:46.

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

:24:47.:24:48.

on Welsh Government policies of well-being and promoting prosperity

:24:49.:24:55.

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

:24:56.:24:59.

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

:25:00.:25:05.

to some new claimants of the employment and support allowance

:25:06.:25:09.

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

:25:10.:25:13.

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

:25:14.:25:17.

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

:25:18.:25:21.

cope with the additional challenges and costs that people with

:25:22.:25:25.

disabilities have. The Prime Minister Theresa May says this lower

:25:26.:25:30.

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

:25:31.:25:37.

work." Yet over 30 disability charities, authoritative disability

:25:38.:25:40.

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

:25:41.:25:44.

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

:25:45.:25:48.

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

:25:49.:25:53.

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

:25:54.:25:59.

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

:26:00.:26:03.

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

:26:04.:26:06.

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

:26:07.:26:13.

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

:26:14.:26:19.

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

:26:20.:26:22.

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

:26:23.:26:28.

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

:26:29.:26:31.

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

:26:32.:26:38.

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

:26:39.:26:47.

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

:26:48.:26:55.

having contradictory expectations, which, of course, cannot be

:26:56.:26:59.

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

:27:00.:27:04.

concerned about UK Government's changes for employment support

:27:05.:27:09.

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

:27:10.:27:13.

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

:27:14.:27:16.

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

:27:17.:27:23.

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

:27:24.:27:27.

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

:27:28.:27:31.

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

:27:32.:27:37.

the local authority areas in the South Wales valleys, particularly

:27:38.:27:40.

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

:27:41.:27:48.

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

:27:49.:27:55.

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

:27:56.:28:00.

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

:28:01.:28:04.

money into our advice services, credit unions and support services

:28:05.:28:10.

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

:28:11.:28:18.

for us to bring to the wider for us

:28:19.:28:22.

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

:28:23.:28:23.

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

:28:24.:28:30.

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

:28:31.:28:36.

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

:28:37.:28:40.

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

:28:41.:28:44.

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

:28:45.:28:50.

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

:28:51.:28:54.

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

:28:55.:28:58.

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

:28:59.:29:01.

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

:29:02.:29:07.

six months now since the Cabinet Health Secretary made a statement

:29:08.:29:12.

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

:29:13.:29:20.

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

:29:21.:29:27.

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

:29:28.:29:32.

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

:29:33.:29:36.

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

:29:37.:29:42.

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

:29:43.:29:45.

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

:29:46.:29:53.

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

:29:54.:29:59.

a 40 that links Abergavenny to Raglan and Monmouth in my

:30:00.:30:04.

constituency, which is an ageing concrete road causing hassle for

:30:05.:30:08.

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

:30:09.:30:11.

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

:30:12.:30:15.

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

:30:16.:30:18.

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

:30:19.:30:21.

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

:30:22.:30:24.

development of the heads of the valleys and make sure the

:30:25.:30:27.

surrounding network is also build up to standard.

:30:28.:30:33.

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

:30:34.:30:38.

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

:30:39.:30:41.

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

:30:42.:30:48.

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

:30:49.:30:56.

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

:30:57.:31:00.

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

:31:01.:31:08.

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

:31:09.:31:13.

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

:31:14.:31:19.

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

:31:20.:31:27.

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

:31:28.:31:32.

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

:31:33.:31:36.

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

:31:37.:31:41.

our work and partnership together with your local authority. Thank

:31:42.:31:49.

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

:31:50.:31:53.

temporarily suspend standing orders, to allow the short debate scheduled

:31:54.:32:00.

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

:32:01.:32:04.

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

:32:05.:32:11.

proposal is to suspend standing orders. The motion is therefore

:32:12.:32:19.

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

:32:20.:32:24.

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

:32:25.:32:29.

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

:32:30.:32:35.

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

:32:36.:32:39.

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

:32:40.:32:43.

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

:32:44.:32:48.

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

:32:49.:32:53.

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

:32:54.:32:57.

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

:32:58.:33:03.

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

:33:04.:33:06.

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

:33:07.:33:11.

primary and secondary sectors and involving specialist palliative care

:33:12.:33:17.

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

:33:18.:33:26.

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

:33:27.:33:30.

and has strengthened children and young people and research sections.

:33:31.:33:35.

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

:33:36.:33:37.

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

:33:38.:33:43.

palliative medicine are now available on call 20 47 across Wales

:33:44.:33:47.

to provide advice and support to other professionals and visit

:33:48.:33:52.

patients where required, enhancing the service provided by clinical

:33:53.:33:55.

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

:33:56.:34:02.

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

:34:03.:34:06.

staff with valuable support at weekends, enabling patients with end

:34:07.:34:12.

of life care needs to avoid hospital admission where appropriate and

:34:13.:34:15.

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

:34:16.:34:24.

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

:34:25.:34:28.

of patients with supportable palliative care needs. We have

:34:29.:34:35.

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

:34:36.:34:41.

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

:34:42.:34:46.

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

:34:47.:34:50.

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

:34:51.:34:54.

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

:34:55.:34:58.

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

:34:59.:35:01.

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

:35:02.:35:06.

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

:35:07.:35:12.

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

:35:13.:35:15.

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

:35:16.:35:21.

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

:35:22.:35:26.

enables colleagues to begin and manage serious illness conversations

:35:27.:35:30.

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

:35:31.:35:34.

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

:35:35.:35:39.

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

:35:40.:35:42.

million annually to support the priorities. The Welsh Government

:35:43.:35:47.

allocated an additional million pounds to further enhance end of

:35:48.:35:52.

life care provision. The board has identified provisionally this

:35:53.:35:58.

funding will be used in a compassionate community approach for

:35:59.:36:03.

palliative care. Supporting the development for an all Wales

:36:04.:36:08.

development record and take research priorities and the poor GP clusters

:36:09.:36:14.

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

:36:15.:36:18.

specialist palliative care services provided by hospices and health

:36:19.:36:22.

boards throughout Wales. This significant investment is a

:36:23.:36:24.

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

:36:25.:36:29.

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

:36:30.:36:33.

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

:36:34.:36:37.

from patients and their families about specialist palliative care

:36:38.:36:44.

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

:36:45.:36:46.

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

:36:47.:36:53.

responses to the patient evaluation of the experience of palliative care

:36:54.:36:58.

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

:36:59.:37:02.

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

:37:03.:37:07.

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

:37:08.:37:11.

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

:37:12.:37:15.

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

:37:16.:37:19.

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

:37:20.:37:24.

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

:37:25.:37:30.

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

:37:31.:37:35.

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

:37:36.:37:39.

resulted in a growing population living longer with incurable

:37:40.:37:46.

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

:37:47.:37:49.

available across Wales. The delivery plan was developed through effective

:37:50.:37:53.

partnership working, that continued cooperation between the Government

:37:54.:37:58.

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

:37:59.:38:02.

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

:38:03.:38:06.

impact. We should recognise the challenges ahead are many other

:38:07.:38:09.

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

:38:10.:38:18.

direction and confidence. This week is dying matters awareness week

:38:19.:38:23.

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

:38:24.:38:28.

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

:38:29.:38:33.

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

:38:34.:38:37.

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

:38:38.:38:42.

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

:38:43.:38:46.

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

:38:47.:38:52.

each year. Many vulnerable to serious additional problems,

:38:53.:38:57.

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

:38:58.:39:02.

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

:39:03.:39:07.

hospices across a range of settings including inpatient units and

:39:08.:39:14.

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

:39:15.:39:18.

hospices, especially about the integration of care services in the

:39:19.:39:23.

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

:39:24.:39:27.

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

:39:28.:39:36.

making sure NHS will start asking our wonderful community, hospice

:39:37.:39:39.

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

:39:40.:39:46.

available in modern Wales, delivering services with them. And

:39:47.:39:50.

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

:39:51.:39:57.

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

:39:58.:40:03.

Welsh Government funding on a ring-fenced basis through health

:40:04.:40:07.

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

:40:08.:40:13.

you provide assurance to them whether that funding will continue

:40:14.:40:19.

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

:40:20.:40:23.

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

:40:24.:40:28.

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

:40:29.:40:34.

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

:40:35.:40:37.

Welsh Government and Welsh NHS funding, than the English and

:40:38.:40:43.

Scottish counterparts. They also highlight a postcode lottery of

:40:44.:40:47.

hospice services with the disparity of care available between different

:40:48.:40:52.

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

:40:53.:40:59.

my previous question, recognise that by discussing and designing and

:41:00.:41:03.

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

:41:04.:41:11.

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

:41:12.:41:16.

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

:41:17.:41:19.

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

:41:20.:41:24.

one of the provisional areas identified for that is developing a

:41:25.:41:30.

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

:41:31.:41:36.

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

:41:37.:41:39.

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

:41:40.:41:43.

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

:41:44.:41:48.

by providing health, promotion and community development principles,

:41:49.:41:50.

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

:41:51.:41:56.

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

:41:57.:41:59.

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

:42:00.:42:04.

here for Wales to become a compassionate nation following the

:42:05.:42:08.

lines of the compassionate community model, that has successfully been

:42:09.:42:12.

developed in numerous towns and communities in the UK, including

:42:13.:42:19.

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

:42:20.:42:23.

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

:42:24.:42:29.

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

:42:30.:42:32.

direction on effective collaboration between local health boards and

:42:33.:42:35.

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

:42:36.:42:40.

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

:42:41.:42:43.

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

:42:44.:42:49.

life care delivery plan to determine whether it is delivering real

:42:50.:42:53.

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

:42:54.:42:58.

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

:42:59.:43:03.

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

:43:04.:43:08.

palliative care services, to be identified said that earlier

:43:09.:43:10.

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

:43:11.:43:16.

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

:43:17.:43:24.

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

:43:25.:43:30.

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

:43:31.:43:36.

Hospices Cymru is supporting the ambitions for palliative and end of

:43:37.:43:46.

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

:43:47.:43:52.

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

:43:53.:43:57.

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

:43:58.:44:00.

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

:44:01.:44:08.

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

:44:09.:44:14.

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

:44:15.:44:19.

occasions in the past. He is consistently interested in this

:44:20.:44:23.

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

:44:24.:44:27.

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

:44:28.:44:31.

have done in promoting this as a more national and natural

:44:32.:44:35.

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

:44:36.:44:40.

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

:44:41.:44:44.

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

:44:45.:44:50.

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

:44:51.:44:52.

and comments made. Most members in this chamber Wardle

:44:53.:45:02.

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

:45:03.:45:08.

constituencies oral regions and I have regularly visited a number of

:45:09.:45:12.

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

:45:13.:45:15.

understand perfectly well the role they play in engaging with

:45:16.:45:19.

clinicians and the public and designing the care that better meets

:45:20.:45:22.

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

:45:23.:45:27.

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

:45:28.:45:30.

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

:45:31.:45:35.

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

:45:36.:45:45.

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

:45:46.:45:48.

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

:45:49.:45:53.

share the member's rather pessimistic approach and assessment

:45:54.:45:59.

of the contribution designing this strategy, but also understand the

:46:00.:46:04.

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

:46:05.:46:10.

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

:46:11.:46:16.

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

:46:17.:46:21.

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

:46:22.:46:27.

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

:46:28.:46:32.

community approach and approaches have been made to see what happens

:46:33.:46:37.

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

:46:38.:46:40.

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

:46:41.:46:44.

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

:46:45.:46:51.

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

:46:52.:46:55.

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

:46:56.:46:59.

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

:47:00.:47:05.

significance. We bring together people from Government, from the

:47:06.:47:08.

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

:47:09.:47:13.

and there is a constructive and helpful tension created both an

:47:14.:47:17.

understanding and agreeing priorities and the priority is being

:47:18.:47:21.

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

:47:22.:47:25.

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

:47:26.:47:27.

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

:47:28.:47:33.

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

:47:34.:47:40.

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

:47:41.:47:44.

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

:47:45.:47:49.

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

:47:50.:47:54.

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

:47:55.:48:03.

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

:48:04.:48:06.

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

:48:07.:48:13.

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

:48:14.:48:17.

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

:48:18.:48:21.

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

:48:22.:48:26.

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

:48:27.:48:29.

better coordination between local authorities and health boards in

:48:30.:48:34.

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

:48:35.:48:40.

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

:48:41.:48:44.

local health boards to include comprehensive care for people in

:48:45.:48:50.

care homes. They want every institution and professional work to

:48:51.:48:53.

get the necessary training and ensure continuity of training

:48:54.:48:58.

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

:48:59.:49:08.

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

:49:09.:49:13.

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

:49:14.:49:17.

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

:49:18.:49:22.

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

:49:23.:49:28.

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

:49:29.:49:31.

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

:49:32.:49:36.

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

:49:37.:49:41.

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

:49:42.:49:44.

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

:49:45.:49:48.

that those will have been implemented. Secondly, the annual

:49:49.:49:55.

report mentions improvements in palliative care for children and

:49:56.:49:58.

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

:49:59.:50:03.

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

:50:04.:50:10.

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

:50:11.:50:15.

acknowledge that we need to strengthen services to support the

:50:16.:50:24.

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

:50:25.:50:29.

ethnic groups are particularly identified by Marie Curie as an area

:50:30.:50:33.

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

:50:34.:50:39.

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

:50:40.:50:46.

comments and in terms of the priority that age country

:50:47.:50:48.

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

:50:49.:50:51.

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

:50:52.:50:57.

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

:50:58.:51:01.

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

:51:02.:51:11.

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

:51:12.:51:19.

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

:51:20.:51:21.

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

:51:22.:51:27.

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

:51:28.:51:33.

palliative care conditions and it was a very constructive conversation

:51:34.:51:38.

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

:51:39.:51:41.

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

:51:42.:51:46.

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

:51:47.:51:51.

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

:51:52.:51:54.

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

:51:55.:51:59.

that as well. That includes bereavement support, again

:52:00.:52:02.

identified in my opening contribution, as an area for

:52:03.:52:05.

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

:52:06.:52:10.

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

:52:11.:52:13.

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

:52:14.:52:17.

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

:52:18.:52:24.

unlikely to have a national conversation in the wider part of

:52:25.:52:27.

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

:52:28.:52:29.

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

:52:30.:52:34.

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

:52:35.:52:38.

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

:52:39.:52:42.

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

:52:43.:52:47.

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

:52:48.:52:50.

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

:52:51.:52:54.

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

:52:55.:52:57.

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

:52:58.:53:02.

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

:53:03.:53:06.

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

:53:07.:53:09.

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

:53:10.:53:14.

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

:53:15.:53:17.

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

:53:18.:53:22.

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

:53:23.:53:24.

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

:53:25.:53:30.

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

:53:31.:53:33.

they feel about looking after relatives but also the work that

:53:34.:53:38.

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

:53:39.:53:41.

consultation stage and the final Report Stage and they recognise that

:53:42.:53:44.

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

:53:45.:53:50.

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

:53:51.:53:53.

Something about the Health Service and hospice that provide care going

:53:54.:54:01.

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

:54:02.:54:03.

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

:54:04.:54:06.

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

:54:07.:54:10.

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

:54:11.:54:15.

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

:54:16.:54:18.

people in different communities having more access to palliative

:54:19.:54:21.

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

:54:22.:54:28.

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

:54:29.:54:32.

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

:54:33.:54:37.

delivers specialist palliative care to allow people to live in their

:54:38.:54:41.

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

:54:42.:54:44.

is a good example of partnership working between the voluntary sector

:54:45.:54:49.

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

:54:50.:54:53.

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

:54:54.:54:57.

long-standing investment of the voluntary sector in the hospice

:54:58.:55:01.

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

:55:02.:55:06.

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

:55:07.:55:12.

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

:55:13.:55:16.

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

:55:17.:55:21.

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

:55:22.:55:25.

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

:55:26.:55:28.

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

:55:29.:55:35.

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

:55:36.:55:40.

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

:55:41.:55:47.

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

:55:48.:55:51.

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

:55:52.:55:55.

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

:55:56.:55:59.

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

:56:00.:56:04.

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

:56:05.:56:08.

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

:56:09.:56:12.

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

:56:13.:56:16.

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

:56:17.:56:21.

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

:56:22.:56:26.

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

:56:27.:56:29.

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

:56:30.:56:34.

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

:56:35.:56:37.

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

:56:38.:56:43.

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

:56:44.:56:48.

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

:56:49.:56:56.

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

:56:57.:57:01.

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

:57:02.:57:04.

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

:57:05.:57:08.

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

:57:09.:57:13.

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

:57:14.:57:19.

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

:57:20.:57:25.

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

:57:26.:57:31.

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

:57:32.:57:35.

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

:57:36.:57:39.

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

:57:40.:57:49.

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

:57:50.:57:53.

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

:57:54.:57:59.

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

:58:00.:58:02.

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

:58:03.:58:08.

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

:58:09.:58:16.

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

:58:17.:58:19.

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

:58:20.:58:25.

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

:58:26.:58:30.

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

:58:31.:58:34.

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

:58:35.:58:40.

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

:58:41.:58:44.

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

:58:45.:58:48.

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

:58:49.:58:53.

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

:58:54.:58:57.

issues about trying to learn from the compassion of communities

:58:58.:59:03.

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

:59:04.:59:10.

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

:59:11.:59:20.

Just took speak on the pivot adventure and advanced planning,

:59:21.:59:23.

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

:59:24.:59:27.

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

:59:28.:59:30.

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

:59:31.:59:34.

supporting people with dementia is politically difficult. The process

:59:35.:59:40.

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

:59:41.:59:44.

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

:59:45.:59:47.

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

:59:48.:59:52.

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

:59:53.:59:56.

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

:59:57.:59:59.

between paediatric and adult services. It can be really difficult

:00:00.:00:02.

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

:00:03.:00:06.

this can be particular difficult when relations are built up through

:00:07.:00:10.

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

:00:11.:00:14.

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

:00:15.:00:18.

Hospital in Wales that looks of the transition from paediatric

:00:19.:00:18.

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

:00:19.:00:30.

the conversation, the better prepared people are for the

:00:31.:00:35.

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

:00:36.:00:38.

individual and community investment and sustaining it is a huge

:00:39.:00:42.

important part of what keeps the hospice movement special and well

:00:43.:00:47.

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

:00:48.:00:53.

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

:00:54.:01:00.

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

:01:01.:01:05.

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

:01:06.:01:08.

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

:01:09.:01:17.

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

:01:18.:01:19.

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

:01:20.:01:24.

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

:01:25.:01:29.

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

:01:30.:01:38.

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

:01:39.:01:42.

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

:01:43.:01:46.

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

:01:47.:01:48.

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

:01:49.:01:55.

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

:01:56.:02:00.

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

:02:01.:02:05.

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

:02:06.:02:09.

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

:02:10.:02:13.

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

:02:14.:02:18.

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

:02:19.:02:23.

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

:02:24.:02:27.

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

:02:28.:02:33.

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

:02:34.:02:36.

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

:02:37.:02:43.

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

:02:44.:02:48.

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

:02:49.:02:52.

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

:02:53.:02:59.

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

:03:00.:03:05.

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

:03:06.:03:08.

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

:03:09.:03:15.

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

:03:16.:03:22.

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

:03:23.:03:29.

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

:03:30.:03:33.

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

:03:34.:03:38.

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

:03:39.:03:44.

how these registers are, child because there are some people

:03:45.:03:48.

obviously without families who go unnoticed and become ill and they

:03:49.:03:52.

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

:03:53.:03:58.

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

:03:59.:04:02.

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

:04:03.:04:09.

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

:04:10.:04:16.

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

:04:17.:04:21.

statement, additional barriers faced by bereaved LGBT communities beyond

:04:22.:04:29.

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

:04:30.:04:33.

there are no specific actions outlined in the delivery plan aimed

:04:34.:04:38.

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

:04:39.:04:44.

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

:04:45.:04:49.

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

:04:50.:04:55.

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

:04:56.:05:00.

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

:05:01.:05:05.

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

:05:06.:05:09.

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

:05:10.:05:14.

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

:05:15.:05:17.

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

:05:18.:05:24.

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

:05:25.:05:29.

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

:05:30.:05:34.

statement. Rather than relying on data collected through the

:05:35.:05:39.

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

:05:40.:05:46.

have plans to introduce a comprehensive survey of bereaved

:05:47.:05:53.

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

:05:54.:06:00.

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

:06:01.:06:05.

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

:06:06.:06:10.

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

:06:11.:06:13.

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

:06:14.:06:20.

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

:06:21.:06:26.

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

:06:27.:06:31.

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

:06:32.:06:42.

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

:06:43.:06:48.

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

:06:49.:06:52.

extremely sensitive area, whilst also acknowledging the dedication of

:06:53.:06:59.

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

:07:00.:07:02.

and the commitment shown by the Welsh Government and the Cabinet

:07:03.:07:05.

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

:07:06.:07:10.

with you positively and constructively to further improve

:07:11.:07:16.

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

:07:17.:07:22.

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

:07:23.:07:25.

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

:07:26.:07:29.

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

:07:30.:07:33.

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

:07:34.:07:37.

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

:07:38.:07:43.

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

:07:44.:07:48.

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

:07:49.:07:54.

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

:07:55.:07:58.

to have a different means of understanding feedback from people

:07:59.:08:01.

directly involved in the care, people involved in receiving the

:08:02.:08:05.

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

:08:06.:08:10.

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

:08:11.:08:14.

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

:08:15.:08:19.

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

:08:20.:08:22.

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

:08:23.:08:26.

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

:08:27.:08:32.

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

:08:33.:08:35.

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

:08:36.:08:38.

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

:08:39.:08:42.

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

:08:43.:08:46.

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

:08:47.:08:50.

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

:08:51.:08:56.

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

:08:57.:08:59.

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

:09:00.:09:13.

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

:09:14.:09:25.

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

:09:26.:09:28.

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

:09:29.:09:35.

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

:09:36.:09:44.

indeed, a great pleasure to be with

:09:45.:09:45.

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.