Monday, November 27, 2006

damn right its wilful neglect

Hi Mr. Thompson n Everybody

Hopefully soon these blogs will turn into a pod cast Mr. Thompson and hopefully more and more people will read them and see the pod cast and come to their own conclusions as to whether the bbc has had a hand in the wilful neglect of the vulnerable adults in this society.

You will I hope by now have seen the Skelator banner and the wording the Welsh Assembly in Disgrace as its wilful neglect of vulnerable adults finally hits the headlines, what is attached below I believe confirms that statement especially in light of the email placed below it sent on the 12/1/06.

They are the minutes of the Assembly debate on Mental Health services which took place on the 21/11/06 one of the few occassions this year when I have placed myself in that den of shysters.

Jonathan Morgan the Assembly member for my area kicks off the debate, yet you will find little reference to the issues that this mental health sufferer has brought before him, in any concrete demands from either the health Minister or of Rhodri Morgans Government to tackle the living standards of those with mental health issues.

He goes on to praise the work of Mind in Wales I trust that you have read what I think of Mind Cymru who have blocked emails from me and who have done nothing to support the changes necessary to make the day to day life of the mental health sufferer a little more comfortable, or have the client lead services they claim, from this individuals perspective they really ought to have their charitable status removed, as yet another bunch of careerists who sup at the trough of the mental health charitable status label , yet refuse to demand certain changes for their client groups. One wonders why Eh Crazydave?

Jonathn Morgan Knows full well that this constituent has issues like those of Mr. Isherwoods, with health officials bearing false witness against patients or clients as they like to call us service users, yet he continues to remain silent on that score, he is well aware that the local council have in truth victimized this constituent yet I have read no email from him chasing Rodney Berman the Chairman of Cardiff County Council for a corporate complaint number something in itself that is yet another example of Council officials protecting one another to the detriment of the citizen.

To have helen Mary Jones of Plaid acting like she is working dilligently on behalf of mental health sufferers made me laugh. because inthe summer of 2005 when I interupted the media bulldoodying the public I raised my voice to ask her where was the letter she agreed to send the Health Minister on my behalf, and in front of witnesses one being another assembly member a Mr. Glyn davies one of the four mentioned in the intellectual property theft blog that letter has still not been forth coming even when she had asserted to that calling out that she would do it.

We do not live in a democracy Mr. Thompson but a Shamocracy. I wonder what further evidence is really needed for the chief constable to act on the behalf of this vulnerable who are systematically being swindled by government legislation and totally ignored, or WILFULLY NEGLECTED, you will see mention of the invisiblity of MHS's by Mr. Nick Bourne the leader of the conservative party in Wales, well maybe he ought to ask Jonathan Morgan why that is?

I did tease Mr. Alun Pugh about an arts council grant for an exhibition of my banners, or to have the sculptures I have made this year cast in Aluminium a slight dig at yet another closure in manufacturing in Wales. My latest banner I call grapes and tulips from crazydave it just advertizes my blog with an I DARE U TO READ TO READS THAT BLOG, slogan.

I often wonder how many employment opportunities would be created if the solutions to some of our social issues I have been promoting were taken on board by National Government, but then they seem to have another adgenda talk the talk but do Jack to ensure that talk leads to action.

Well how many Mr. Thompson I suspect thousands, and every one of them would be valued by the community at large jobs. Thats it for today.

Love n Light People Crazydave.

Dadl Plaid Leiafrifol (Blaid Geidwadol Cymru)
Minority Party Debate (Welsh Conservative Party)
Mental Health Services

Motion (NDM3332): to propose that

the National Assembly for Wales:

condemns the dire state of mental health services and instructs the Welsh Assembly Government to fully re-examine the priorities set out in ‘Raising the Standards’ and set targets which will truly improve the mental health and wellbeing of the people of Wales.

Amendment 1 in the name of Jocelyn Davies. After ‘Raising the Standards’ insert:
and ‘Everybody’s Business’,
a copy of ‘Everybody’s Business’ can be located on the internet using the attached hyperlink:
Amendment 2 in the name of Kirsty Williams. Add a new point at the end of the motion:

notes that the children’s commissioner has repeatedly drawn the attention of the Welsh Assembly Government to the urgent need to improve mental health services for children and adolescents.

Amendment 3 in the name of Jocelyn Davies. Add as a new point:
regrets the failure of the Labour Assembly Government to reverse the failures of Conservative and Labour UK Governments to adequately resource care in the community.

Amendment 4 in the name of Jocelyn Davies. Add as a new point:
believes that all legislation affecting mental health services in Wales should be devolved to the National Assembly for Wales.

The Deputy Presiding Officer: I have selected amendments 1, 3 and 4 in the name of Jocelyn Davies, and amendment 2 in the name of Kirsty Williams.

Jonathan Morgan: I propose that
the National Assembly for Wales:
condemns the dire state of mental health services and instructs the Welsh Assembly Government to fully re-examine the priorities set out in ‘Raising the Standards’ and set targets which will truly improve the mental health and wellbeing of the people of Wales. (NDM3332)

I am delighted to lead this important debate focusing on mental health services and looking at a variety of actions that are being undertaken by the Assembly Government to improve mental health services in Wales. I hope that the Government will send out the right message this afternoon by supporting the motion, and I hope that other parties will also support what, I hope, will be a constructive debate, looking at where we are with mental health services in Wales and where we need to be. The reason for the debate is absolutely clear. The national service framework published last year contains an ambitious, but, for many, an unachievable list of objectives. Eight standards were achieved; there are 44 key actions and 93 performance targets—all to be met by 2012, so, to be fair, there is not long to go.

Many of those performance targets were to be achieved this year, next year, and in 2008. Therefore, we are rapidly getting to a position where many of the targets set out in the national service framework were meant to be achieved. It is time that we examined where we are with the national service framework—we need to look at what is being done and whether the Assembly Government is on course to implement what is outlined. That is why we felt that it was important that mental health services should be brought to the attention of the Assembly today, giving Members an opportunity to debate this important matter.

We are happy to support amendments 1, 2 and 4, and I am delighted that Helen Mary Jones has included the amendment recognising the concern about child and adolescent mental health services. It is right that we also focus on that as a way by which we can assess how successful the Assembly Government has been.
Reforming mental health services, and investing in them, is a challenge to commissioners, who lack capacity and experience in planning effective services with local health boards whose fragmented status and competing priorities push mental health down the list, although the national service framework was supposed to deal with this as one of its objectives.

David Lloyd: Last week, during the neurosurgery debate, you said that Assembly Members should not have a view on health matters or vote on it, and should leave everything up to clinicians. You are opening today’s debate on mental health, so what has changed? Have you changed your mind or have you gained a psychiatric qualification in the last seven days?

Jonathan Morgan: You should leave health matters to your official spokesperson. Is that the best intervention that we can get from Plaid Cymru on what is a serious debate about the strategic framework for mental health services? This has nothing to do with the neurosurgery debate, during which you tried to get the Assembly to determine whether services should be in Cardiff or Swansea. We are not saying where services should be provided; we are saying that we want world-class services for the people of Wales. A national service framework has been voted on here, supported by opposition parties, including your spokesperson, and it is meant to be implemented by the Assembly Government in order to reach those world-class services. I am saddened that Plaid Cymru cannot engage in what is a serious debate about the future of mental health services, because that is what we are seeking to do this afternoon. I hope that the contribution from your official spokesperson will be slightly more grown up than that contribution.
Therefore, this is a challenge to commissioners and to the Government, which promised, through the NSF, to deliver those high-quality services; however, it has already ditched that strategy, and has replaced it with another. A sum of £5 million was allocated by the Government to build the achievement of that national service framework, but, as per usual, it was a bidding process, with local health boards, local authorities and others having to bid into that pot to put forward projects that could deliver the NSF. It is also a challenge to patients, their families and carers, and those who feel excluded from the planning process, either when restructuring occurs or when their own care pathway is altered. That was a powerful message that we received in the Health and Social Services Committee when we looked at adult mental health services. Many users and carers came to us with their evidence and advice about what suits them best, and also, the way in which they are treated by people who work within the mental health field.

As I said, the 2002 national service framework was ditched very quickly by the Assembly Government, which introduced a revised version just over a year ago. The Children’s Commissioner for Wales has already been critical of the Government’s approach to its child and adolescents mental health services strategy, stating that the Government should either fund it or give up the pretence of supporting it. That is an interesting but damning criticism of the Assembly Government. However, for many people—patients, carers and those who work in mental health, in the statutory or voluntary sector—the same could be said about the mental health strategy and that which is set out to be achieved in the national service framework. It is high time that we looked at what was set out, and how or whether it is being achieved.

I agree with what the national service framework says. I agree with the eight standards, and I would like the Minister to focus on four standards in particular. The first of those is standard two, on empowering users and carers. It is absolutely fundamental in delivering a coherent health service, particularly when dealing with sensitive issues, such as mental health, that people are involved in planning their care pathway. These people will often have a say, and they will often be able to explain what works best for them, and what works best for their communities. Often, these people feel excluded. It is easy for managers, clinicians and NHS trusts to ignore the views of people who suffer from a mental health problem, simply because of the nature of their condition. Put simply, this is wrong, and it must stop. It is up to the Assembly Government to enforce the rules that we have set out—that there is statutory consultation with users and carers—because those people need to inform the type of health system that we have.

The targets are clear. By March of this year, local authorities and LHBs should include service users on all relevant planning groups. Has this happened, Minister? We need to be certain that various bodies in Wales are achieving this target, which should have been reached by March of this year. By October of this year, the Assembly Government was going to review all of this, in light of the Health and Social Services Committee review that I mentioned a few moments ago. Have you done that work, because you set it out in the national service framework? If it has been done, we would like to know the results of that. By March 2008, another target that should be reached is the inclusion of service users in staff recruitment and monitoring; has that started? Are we seeing the relevant bodies in Wales putting forward plans and a structure that will allow that target to be reached by March 2008? These are targets that should be achieved quickly, and I am not certain that we are doing sufficient work to get to those early targets.

On standard four, on the equity of services and access to services, the Assembly’s Audit Committee said in July that it saw little evidence to indicate any positive action. We know that access to the quality of services will vary across Wales, depending on geography, the priorities of local health boards, the recruitment of professionals, and the funding that is allocated. Mental health users, carers, professionals, and the voluntary sector, have confirmed to us—they did so last week at the MIND mental health conference in north Wales—that equity of services and access to services remains as important now as it did when the NSF was written.

Standard five is another crucial aspect of the national service framework—the ability of commissioning. We have touched on this on more than occasion. The Welsh Assembly Government must ensure that the delivery of adult mental health strategy, and the national service framework, is implemented, that progress is monitored, and that targets are achieved. That is what you have said in the national service framework, so, Minister, it is your responsibility as an Assembly Government. It is up to you to say what the progress has been. There are targets to establish regional commissioning, effectively, admitting that the 22 local health boards are struggling. We would like to see progress on a greater degree of collaboration, because it is clear that local health boards do not have the capacity, the experience, or the money to commission effective services.
Standard six deals with delivery, which is essential. I will support you in this one aspect—most of the key actions, and most of those objectives and targets that are allocated, fall within the ‘delivery’ category, which is right. However, people are now asking how much has changed, what developments have taken place since last year, and whether you are on target to reach those aspirations that you wrote into that national service framework.

Last October, the Wales Audit Office said that there were significant gaps in service delivery and community-based services, that six out of 22 LHBs had outreach teams—the others did not—and that fewer had early intervention teams. That is crucial for delivering effective mental health services—building the advocacy that people need, building those outreach schemes, and building the community teams that people need to access if they are going to feel that mental health services are there to deliver for them. You need to explain to the Assembly whether or not this is being achieved, which is why we believe this motion is important. As I said, in July, the Assembly’s Audit Committee had similar concerns.

There is practical evidence around Wales of where problems are occurring, and where mental health users and carers are being excluded from the process. This morning, Nick Bourne and I visited the Tegfan Day Hospital in Cardiff; that issue demonstrates how carers and users have been excluded, up until now, when it comes to designing and restructuring mental health services. We need to involve people, and we need to recognise that, just because they have a condition, it does not preclude them from taking an active part in designing the healthcare that they need.

In conclusion, providing world-class mental health services could be a defining achievement for this Assembly and this Assembly Government, and it is one that could provide for thousands of people, the length and breadth of Wales. It is a challenge, but it is also an opportunity that we need to seize.

Helen Mary Jones: I propose the following amendments in the name of Jocelyn Davies: Amendment 1: After ‘Raising the Standards’ insert:
and ‘Everybody’s Business’,

a copy of ‘Everybody’s Business’ can be located on the internet using the attached hyperlink:

I propose amendment 3. Add as a new point:
regrets the failure of the Labour Assembly Government to reverse the failures of Conservative and Labour UK Governments to adequately resource care in the community.

I propose amendment 4. Add as a new point:
believes that all legislation affecting mental health services in Wales should be devolved to the National Assembly for Wales.

I am grateful to the Conservative group for choosing this important topic and for tabling its motion, which we will support. I trust that, on this occasion, Jonathan Morgan will have had more success in persuading his group to vote for it than he did in persuading his group to support our carefully worded joint motion on reconfiguration last week.

That said, as time is short, I will not seek to repeat many of the points that Jonathan Morgan made, with which I would concur. I will confine myself to addressing my remarks to our amendments. Our amendment 1 seeks to include child and adolescent mental health services within the scope of this motion, and I am grateful to Jonathan Morgan for his support for this amendment. This is an area for profound concern. Like ‘Raising the Standard’, ‘Everybody’s Business’ is a document that, if not perfect, has much to commend it. However, its delivery has been woeful. The community health councils’ study in September this year, for example, was damning. I will use one quotation from that study. A senior nurse practitioner told the commissioners of that study,

‘We haven’t had a penny invested in this county in the five years since "Everybody’s Business" came out’.
Not a penny.

The children’s commissioner’s views on this matter are well known. He has said, as Jonathan Morgan mentioned, that, if it does not commit resources to child and adolescent mental health, the Government should publicly accept that it has abandoned its strategy. That is a shocking indictment of this Government’s performance on child and adolescent mental health from children’s official voice; in that regard, we will support the amendment tabled by the Liberal Democrats.

Our amendment 4 arises from the approach taken in the Assembly to the Draft Mental Health Bill 2004 at Westminster. As fellow Members will remember, concerns were expressed across parties about certain elements of that legislation, particularly the elements of compulsion that were not balanced by a statutory right to receive treatment that had been prescribed. These issues raised their ugly heads again in the Queen’s speech last week. I believe that there is strong reason to believe that there is a political will in Wales for a different and more supportive legislative framework than that currently proposed by the Westminster Government, and as was proposed before. I hope that all parties in the Assembly will feel able to support the call to have these matters devolved. There will be the possibility of making that a reality post 2007, and seeking that devolution will certainly be a commitment in Plaid Cymru’s manifesto for the next election—I suspect that it may also be included by other parties.

That brings me to our amendment 3. The Government has little to be proud of in the field of mental health. It has had seven years to address the underfunding and to give leadership. It is almost worse for a Government to keep making commitments that it fails to resource and deliver upon than it is for it to make no commitments at all. That said, some of us may find it a little difficult to take handwringing on mental health issues from the Conservatives. I accept that this was probably back in the days when Jonathan Morgan was still at primary school, and that he cannot be held responsible for all the actions of previous Governments, but some of us, particularly those of us working in the field of social care at the time, cannot forget that it was a Tory Government that shut—rightly—long-stay mental health hospitals and wards, but without putting in place the necessary community care. Thousands of patients were left utterly lost; in my professional experience, I have come across examples of former patients, some of whom were very young, who deliberately committed offences at that time in order to get into prison, because they were unable to get any help and support to deal with their condition in the community. They could not get that care outside.

This is a legacy that this Government has failed to reverse, and I am sure that nice Mr Cameron would have us believe that he would be different, as does the Conservative Party here, but some of us have long memories. There is no place for Government complacency— [Interruption.]

If Alun Cairns would like to make an intervention, I would be happy to take it.

Alun Cairns: It is interesting that Plaid Cymru says that it has long memories; it is easy to blame many people for many problems. We are a party that is happy to look forward to the future rather than look back at the past as you do.

Helen Mary Jones: I think that it is absolutely appropriate, Alun Cairns, that we should look forward to the future. However, in doing so, we have to look at past records. Just as I believe that mental health service users will take a dim view of this Government when they come to vote next year, I am suggesting that we will need to see some substantial commitments before they will be able to trust you. However, that is a matter for the voters, not me.

There is no place for Government complacency or self congratulation on this issue; it is close to being a national disgrace. Reference has already been made to the Mind conference in Llandudno last week, and those of us who attended that—there were representatives from the four major parties—will have been moved and troubled by the profound sense of disillusion and disappointment that we found there. Service users and those who support them, either professionally or as individuals within families or groups of friends, feel very let down; indeed, they feel deceived—and that is a strong word—by a Government that has promised so much and delivered so little. No-one is saying that it will be easy to change the situation or that there are quick fixes, but ‘Raising the Standards’ and ‘Everybody’s Business’ set out much of what needs to be done and that work has not been done. We can only condemn the Government’s failure to do what it set out to do. In that context, and in the context that we must all find examples in our constituency caseloads that prove that the situation—

The Deputy Presiding Officer: Order. The light has not gone red, but you need to wind up because you have had six minutes.

Helen Mary Jones: I will finish with one sentence, Deputy Presiding Officer: we can only condemn the Government’s failure to do what it has promised to do, and I commend the motion and the amendments to the Assembly.

Jenny Randerson: I propose amendment 2 in the name of Kirsty Williams. Add a new point at the end of the motion:
notes that the children’s commissioner has repeatedly drawn the attention of the Welsh Assembly Government to the urgent need to improve mental health services for children and adolescents.

As has already been mentioned, the review of the national service framework revealed that adult mental health services in Wales are in need of fairly drastic reform and, unfortunately, that reform has not yet taken place. The review made it clear that reform is needed at all levels and that there need to be improvements in in-patient services, community services, primary care, secondary care and so on. The facilities, particularly those for in-patient services, are outdated and reform has not taken place. It was quite obvious at the Mind conference in Llandudno—to which reference has already been made—that immense frustration, disappointment and anger were felt by those who have a mental illness, their carers or family members, and those involved in the professional care of those with a mental illness; they feel those sentiments very strongly. The truth of the matter is that the Government has had seven and a half years in which to have an impact on this problem, which I think that we all agree is a thorny and difficult issue.

I want to draw particular attention to the issue of child and adolescent mental health services, which is an issue that the Children’s Commissioner for Wales has highlighted in his report in subsequent years, and which the Children’s Commissioner for England has also recently highlighted as an area of concern. The children’s commissioner highlighted, in his 2004-05 report, that concerns about the continuing failure in Wales to provide an adequate CAMHS response were still being brought forward by professionals working in the field, and that individual cases confirm that there is a long way to go. Among the issues associated with CAMHS—and there are loads of them, although I only want to raise a few—there is a specific concern around access to appropriate services for 16 to 18-year-olds. CAMHS is commissioned for children and young people up to the age of 16, unless they are in full-time education, and adult mental health services are commissioned for those aged 18 and over. Therefore, if you are not in full-time education and are aged between 16 and 18, you are in what can best be described as a black hole. You can hardly imagine that situation existing for any period of time, however, the fact that it has continued for years is absolutely unforgivable. The gap must be addressed properly and the new service must be properly resourced.

The second issue to flag up is one that the children’s commissioner has raised, which is that of some children having to go to England for services that are not available in Wales. Although these are tier 3 and tier 4 services, they are for problems that are not uncommon, such as eating disorders, which, sadly, are all too common. The fact that we do not have adequate resources and facilities in Wales is a tremendous condemnation of our health service. I am aware that some places are coming on-stream, but, so far, they are too little, too late. These are the words of the children’s commissioner:

‘It is a disgrace that sick children and young people have to be placed so far from home, out of Wales, and usually detained under the Mental Health Act in order to receive treatment, therapy and services. These children are probably the most vulnerable in Wales and yet are probably the least safeguarded.’

These comments were made in his annual report for 2004-05—forgive me for repeating them at the back end of 2006, when we are all looking forward to 2007.
Finally, on local services in Cardiff, I attended a recent meeting with the local trust at which it expressed its concern that the crisis teams could not be set up until it has saved money by closing facilities at Whitchurch Hospital. It talked about managing risk, and I think that that is an unacceptable approach. Minister, the NSF review, at this moment, should be filed under ‘Fiction’ at the local library.

Mark Isherwood: I am sure that Helen Mary would agree that we must learn from the past, and not live in it. Care in the community was a disaster; we admit it, but, unfortunately, the Assembly Government proposes to duplicate it on a broad canvas with its so-called care-closer-to-home proposals.

The reality is that some 250,000 people in Wales are thought to be experiencing depression, with 9 per cent of Welsh health survey respondents reporting that they are receiving treatment for mental illness. Only 17 per cent of people who have a diagnosis of serious mental health problems are economically active, only six of the 22 local health board areas have outreach teams, and even fewer have early intervention teams.

In 2001, the Welsh Assembly Government made mental health one of its top-three health priorities, but, as Mind says, it is still a cinderella service. The Audit Committee, in July 2006, saw little evidence to indicate any positive action. Mind urged the next Assembly Government to support preventative and early intervention measures to help minimise the impact of mental health problems on individuals and communities, to address the wider needs of people who have mental health problems and to ensure that the implementation of new mental health legislation reflects the reality of the availability and quality of services in Wales.

The care programme approach devised by Hafal, the charity that works for people with serious mental illnesses, has the intention of giving ownership of the care process to the service user. By contrast, the reality is illustrated by a constituent of mine in north-west Wales who, having been sectioned under the Mental Health Act 1983, was taken to an NHS ward where, she alleges, she was subjected to serious physical and verbal assault and denied her rights. She alleges that her complaint of assault has never been properly investigated and that her attempts to secure an independent investigation led instead to her being labelled a vexatious complainant. When I wrote to Brian Gibbons about this, I stated that I am in possession of a copy of a letter to my constituent from the ministerial support team, which states:

‘We would expect that, at the time of your assault, you would have access to a telephone and would have had the right to report your assault to the police directly yourself. In general terms, the trusts have in place procedures to investigate any alleged assault on a patient.’

My constituent’s allegations apply to named members of nursing staff. She states that they did not call the police, that they obstructed her when she tried to call the police, and that they did not record her injuries. In his response, the Minister states that the Welsh Assembly Government has no direct role to play in the handling of individual complaints and advising her of the options open to her in taking forward her concerns. He also states that, given this position, he was sorry, but he could not agree to her request for a meeting.

This exemplifies the problem that people in Wales face, when all avenues for independent investigation are closed to them. The Welsh Assembly Government washes its hands of responsibility for even the most vulnerable. This can also apply in local government. I refer to a constituent in Flintshire, who was portrayed to me during a meeting with the county council in the summer as someone who was unreliable, unrepresentative and putting ideas into the vulnerable mind of others. This person, as a service user and a volunteer member of the local mental health advocacy service and the representatives group, first raised with me the serious concerns about the county’s mental health services. The concerns related to breach of data protection, failure to audit accounts and evidenced allegations of bullying. The first of these concerns has been upheld. The second concern has been addressed by the resulting recommendations made by the Auditor General for Wales, which vindicated my constituent’s concerns and endorsed her reliability. Had it not been for her, the actions outlined would not have been taken. She has also led the fight by mental health service users against the loss of their local day-care services, but a report sent to the council executive strongly misrepresented their strength of feeling.

The number of young people in custody in England and Wales has reached a record high, prompting warnings of a youth justice system in crisis. Youth justice boards say that the rise in numbers has caused an increase in self-harm and suicide among youngsters. Thirty-five per cent of people under the age of 17 with anti-social behaviour orders have accepted learning difficulties; 70 per cent of offenders have learning needs; and 85 per cent of those in young offender institutions have mental health issues. That is a failure of the system.

Meanwhile, the UK Government’s Mental Health Bill threatens to extend coercive measures to a wider range of people, with the likely consequence that some people with mental illness will be fearful of presenting themselves for treatment in the first place. The Bill is designed to do the work of the Home Office, instead of protecting people in severe mental distress.

Cuts in and a shortage of beds for the elderly mentally infirm have been repeatedly highlighted by Care Forum Wales. Only last Friday, at a surgery in Flintshire, a lady came to see me in tears telling me that her husband, who had Alzheimer’s disease, had only been able to secure accommodation in Rhyl; there was nowhere closer to home, and it was destroying her. This reflects the concerns that were raised with me by the Alzheimer’s Society, namely that when people can no longer care for themselves, or their carers can no longer care for them, there is nowhere for them to go.

The system is approaching crisis point, and we must address the concerns raised by Mind. As Mind states in its manifesto, the next Welsh Assembly Government must act immediately to address the dire state of mental health services for the one in four people in Wales who experience mental health problems.

Nick Bourne: This is an important issue, and I thank other Members for their contributions. There is a measure of agreement among the opposition parties, which are the only parties to have contributed to this debate so far. I would like to comment on a point that Jonathan touched upon, namely this morning’s visit to the Tegfan day hospital on the Whitchurch Hospital site, which Jenny also referred to. It provides a fantastic service for the patients that use it, but there is a threat of its withdrawal. This morning’s visit probably exemplifies some of the issues that we see when we consider this general topic regarding the invisibility of the patient. That is not so much in terms of the front-line carers, but the management team of that hospital is putting the service under serious threat by not properly consulting with service users. Some patients have been using that service for 30 to 40 years, and there is a threat of its withdrawal, with no offer of an appropriate alternative. It is a serious situation, and some of the patients are watching this debate from the public gallery, and I welcome them.

The example that I have given underlines what Mind is talking about when it refers to this being a cinderella service. It goes to prove how far the Government has yet to go, and how little it has done in terms of the actions in the national service framework, which Jenny Randerson correctly referred to as a work of fiction. There is need for increased spending, and there has been a failure to deliver on key action in the NSF, specifically within the proposed timetable. It has slipped in terms of its timetable for delivering the mental health action plan. All of these concerns are extremely serious. The result is huge gaps in parity and equality of access to mental health services in Wales, and people suffering as their care plans are not properly implemented. People who have mental health needs deserve better. As Mark Isherwood rightly said, up to one in four people during their lifetime may need to access these services.

As a party, we would like to see more funding invested in mental health services, and that will be a key priority for us in the next Assembly, to ensure that the national service framework can be fully implemented. We want to see the gaps in service provision addressed, particularly in rural areas. In my own area, there are many significant problems that are going unaddressed by this Assembly Government.

Most importantly, we would like the Welsh Assembly Government to provide more leadership, more partnership working in public sector bodies, and more collaborative working with voluntary sector organisations to ensure a coherent and bureaucratic-free approach to mental health service delivery throughout Wales. That will ensure that patients who have mental health problems, many of whom I met this morning, receive effective, accessible and appropriate care, and are treated with the respect, dignity and understanding that they rightly deserve, but which they are sometimes, sadly, denied. Only then will we as a nation be able to hold our heads up high on this important area, and say that we are delivering the mental health needs of Wales.

The Minister for Health and Social Services (Brian Gibbons): It is interesting that the motion specifically addressed the matter of reordering priorities, but, having listened to the substance of the debate, I note that that point was not made. Indeed, the debate seemed to be about a different subject from that which was tabled in the motion. If one tried to describe the debate so far, one would say that it was about a failure to achieve targets rather than about priorities and targets being wrong, which was the substance of the motion.

The Assembly Government considers mental health services to be important, which is why my colleague, Jane Hutt, set up a wide-ranging review of mental health services in 2003 and why, 13 months ago, we announced the outcome of that extensive review, with a revised national service framework for adult mental health services in Wales launched in October 2005. Many of the key recommendations of the auditor general’s report were specifically incorporated into the revised national service framework. They included, for example, better therapeutic environments for people in hospitals, including new mental health units at Haverfordwest, Llanelli, Carmarthen, Port Talbot, Bridgend, Llantrisant and Llandough, and a range of evidence-based psychological therapies made available to people with mental health problems throughout Wales. As an indication of our prioritisation of this issue, five of this year’s 22 service and financial framework targets are made up of mental health targets. If that is not clear evidence of our commitment to prioritising mental health services, it is difficult to know what would constitute proof.

Better co-ordinated care is needed through the care programme approach that we are driving forward, particularly since the re-launch of the national service framework last year. The newly appointed director of mental health has just conducted a review of the care programme approach and has concluded that it is available right across Wales—contrary to some assertions made in the Chamber this afternoon. Twenty-one out of 22 local health boards have crisis resolution teams in place. That, again, is significant evidence of progress. A greater voice is being given to people who use mental health services in their own individual care settings, given the contribution that they can make to the planning and delivery of services.

Jonathan Morgan: Thank you for giving way. Standard 2 of the national service framework is clear that local health boards and local authorities were to include service users and all relevant planning groups by March 2006. Could you confirm whether that has happened? Earlier, you seemed to nod your head when I said that the Assembly Government was committed to reviewing that in October 2006. Can you confirm whether that has happened and, if so, what were the results?

Brian Gibbons: We are carrying out specific data collection exercises on a number of the SAFF targets and the NSF targets. Those data are not routinely collected, such as waiting times. However, in an effort to indicate what is going on, special data collections are being undertaken to deliver that.

Links to the wider social care agenda are central to our understanding of mental health, and we are working with a wide range of employment and housing agencies to ensure that a holistic approach is being taken. Our priorities have been supported by voluntary sector organisations and service-user groups, which have been represented on the external advisory group that advises the Assembly Government on what our priorities should be.

Helen Mary Jones: Will you accept an intervention?

Brian Gibbons: Let me finish, Helen Mary.
The work on moving towards developing regional commissioning is already in hand, and is established in relation to child and adult mental health services. Tier 2 and tier 3 commissioning is taking place on a regional basis and adult regional commissioning is being taken forward by a working group, chaired by Hilary Peplar, who is also looking at the key issue of transitions.

Amendment 2 in the name of Kirsty Williams accepts the point—and it is clearly a statement of fact—that the children’s commissioner has drawn attention to various issues in relation to mental health services, particularly for children and adolescents. Therefore, just as we had a thorough, honest, broad-ranging review of adult social services initiated by my colleague, Jane Hutt, we are engaging in the same exercise for CAMHS services, so that we have the evidence base on how far we have moved the agenda forwards. We must also bear in mind that we have the common commissioning resource centre in place to try to keep children as close to their homes as possible, that there is a capital programme in place for tier 3 and tier 4 of CAMHS, that the waiting times targets for access to CAMHS specialist services are being achieved, and that referral from the youth offending team is ahead of target in terms of its implementation. Therefore, while more progress needs to be made in CAMHS, it is a travesty to describe the progress that has been made in the terms used in the motion.

On Jocelyn Davies’s amendment 3 about resources, approximately 12 per cent of local health board programme budgets relate to mental health service, compared with a figure of 11 per cent in England. Indeed, mental health services are the single biggest area of programme expenditure in Wales, ahead of cancer services, cardiovascular services, and respiratory services. In relation to the £5 million recurrent revenue spending, contrary to what was asserted in this debate, every local health board has received an allocation, ranging from just under £100,000 in Anglesey and Merthyr, to just under £0.5 million in local health board areas such as Rhondda Cynon Taff. We must also not forget the £3 million that we have put in place for the carers of people suffering from chronic mental illness. As part of ‘Designed for Life’, we have also announced a £75 million-worth capital programme, which is available to modernise the capital facilities to deliver mental health care services in Wales. At its inception, the Assembly’s total capital budget was £75 million; now, £75 million-worth of capital expenditure is available to modernise mental health services in Wales. That is significant progress and significant evidence of our commitment to this issue.

Rhodri Glyn Thomas: Will you take an intervention?

Brian Gibbons: I do not think that I have time, Rhodri.
Jocelyn Davies’s amendment 4 deals with mental health legislation being devolved, and I looked at this very carefully. Despite the attractions of looking for framework legislation in several areas, in relation to the recently published Mental Health Bill, the practical difficulties and the discontinuities that could occur over the border between England and Wales suggest that, on balance, it would not be practical to seek full devolution in all areas of mental health. In fact, it would probably end up being detrimental to patients rather than helping them.

In conclusion, I do not think that anyone is pretending that our mental health services are at the stage of having achieving all that we would wish them to have achieved. The same is true of child and adolescent mental health services, but the phraseology and the terminology of the motion before us do not reflect anything like the reality of the situation, or the improvement taking place in Wales.

David Melding: I thank everyone who has taken part in this debate, although I am being very generous in thanking Dai Lloyd for his intervention. Interventions are a skilled art and, when done well, are perfect cameos that add something to a debate. However, I think it fair to say that Dr Lloyd has yet to grasp, or even start to grasp, that particular task. Not being able to distinguish between mismanagement and political interference, and holding Governments to account for broad standards in the scrutiny function that we apply in the Chamber was a sad misunderstanding of the governmental process. I have to say that he was answered admirably by the broad sweep and the control of detail of my colleague, Jonathan Morgan, in holding the Government to account for its lack of progress in implementing the national service framework.

I thank Helen Mary Jones for being far more constructive—once she got through the ritual attacks. The reform of mental health law is important, but the Minister says that the Labour group will not support amendment 4, because it refers to ‘all legislation’, and it suddenly has some objections to that. We are talking about the fundamental reform now proposed by the Government at Westminster to the England-and-Wales Mental Health Act 1983, which itself updated earlier law from the 1950s. That is clearly what Plaid Cymru is referring to, and we certainly support calls for that to be devolved, so that we could deal with it as an Assembly Measure—perhaps as the first major item of work in the next Assembly. What a triumph it would be if that stood as an example of how we could make legislation in Wales. We will accept the broad way in which the amendment has been drafted, and we will vote in support of it. We will also support the other two amendments, but not amendment 3 in the name of Jocelyn Davies.

Jenny Randerson concentrated on child and adolescent services and reminded us of the work of the Children’s Commissioner for Wales, and also the work of the Children’s Commissioner for England, which was reported today, I think. In England, the focus is on the situation of many adolescents and even children having to be placed in acute adult units, because there is simply nowhere else to put them; clinicians are so desperate to admit them somewhere that they use those units. Unfortunately, that also happens in Wales, and that is where we are at until we have comprehensive services that do not fail. It is a real problem and challenge for us.

Mark Isherwood concentrated on issues of economic inactivity, relevant to many people who suffer mental illness. In fact, fewer than 20 per cent of them are in gainful employment, and that is a real problem. He also reminded us that, for years, mental health and the improvement of services has been one of our three key priorities—or, strictly speaking, one of the Welsh Assembly Government’s key priorities, supported right across the Assembly. It is not a political issue, but it has full support and a deep consensus, yet there is still evidence of poor and slow progress. That is what we have to address this afternoon.

Nick Bourne referred to the need for effective services in the community and also day-care services. That is very important to support people and to give them gainful purpose during the day, even if they are not necessarily in full-time work.
One area that has not been touched upon in any detail is the number of looked-after children who have mental illnesses. That figure is something like a half of all looked-after children, and is massively above the proportion for mental illness in the general population. I am pleased to say that an all-party group on looked-after children is being launched this evening, and I commend Voices from Care Cymru for being the inspiration for that group. I am very pleased to say that it is being enthusiastically supported by all parties and by Members of the Welsh Assembly Government. We are very grateful.

The Minister talked about the reordering of priorities, and asked where the examples were. We would just like some of your priorities to be achieved, Minister. We would start with that. Perhaps that is a compromise, so that you can support our motion, even late in the day. He did refer to the consultation that has recently concluded. It is important that we take on board the messages from users and carers. He was right to point to the need for better therapeutic services. We are modernising acute units; that is well overdue, and there is still a great deal to be done. However, I support the current priority, using the capital estate for new units, such as the one to which you referred in Llandough. There is a need for a range of therapies; we all know that people with mental illnesses often emphasise the importance of cognitive therapies and the like. We all welcome the Minister’s emphasis on a holistic approach. People with mental illnesses are people first and foremost: they want jobs, families, entertainment and leisure. Therefore, I commend this motion and three of the four amendments to the Assembly.
Gwelliant 1: O blaid 25, Ymatal 0, Yn erbyn 28.Amendment 1: For 25, Abstain 0, Against 28.

The email below was sent to the following people,,,,,,,,,,,,,,

mental health issues

Hello everyone

It was interesting to hear the minister for health talking about mental health issues yesterday the 11/1/06 in the Assembly. As well as Victoria from the Bevan foundation, once again I note that the finacial hardships suffered by mental health patients living in the community are not being addressed.

While it may be nice for the building companies to take their rake out of thye £75 million in capital expenditure, and while more money is being made available for mental health proffessionals, still the client is left in poverty.

Everyone wants to see us back in the employment market yet there are many like myself who do not trust other human beings enough any more to ever want to take that step. In a converstion with Mike German I did mention that in the not to distant past those who nolonger felt able to deal with the pressures of the working world would go into monasteries or nunneries away from society, I should imagine that if you corrilated the percentage then with now the figures of those who feel in a similar fashion now would be very close.

I trust it will not be all that much longer when you as Assembly members will indeed take on board the solutions that I have been putting forward, so that those who do suffer in this manner will have a little more financial relief, and not just be conduits of wealth to the proffessional elite, who do rather nicely out of their misery, whether they be the water companies, T.V. license fee, landlords both private and social, or even incompetent psychiatrist or Doctors who are willing to purjure reports because a patient had the timerity to tell him as a representative of Bro Taff Health authority where to go.

yours as ever Crazydave.