Senedd Cymru (Welsh Parliament), 7 December 2016

296 contributions from 47 members. The official report.

Elin Jones (Plaid Cymru, Ceredigion)

I call the National Assembly to order.

1. 1. Questions to the Cabinet Secretary for Economy and Infrastructure

Elin Jones (Plaid Cymru, Ceredigion)

The first item on our agenda this afternoon is questions to the Cabinet Secretary for Economy and Infrastructure. And the first question, Lynne Neagle.

Lynne Neagle (Labour, Torfaen)

1. Will the Minister provide an update on progress with regard to the Circuit of Wales? OAQ(5)0092(EI)

Ken Skates (Labour, Clwyd South)

Yes. The Circuit of Wales is close to submitting a revised bid, following my challenge to them in July to ensure any support provided by the taxpayer is proportionate and fair. Once a formal bid has been received, I will provide a further update to Members.

Lynne Neagle (Labour, Torfaen)

Thank you, Minister. You will be aware of the significant cross-party support for the Circuit of Wales, with local authorities throughout Gwent, and many Labour Assembly Members, backing what this project can achieve. Do you recognise the enthusiasm and excitement for delivering this transformational infrastructure project, to demonstrate what Wales has to offer?

Ken Skates (Labour, Clwyd South)

Yes, I do recognise the enthusiasm and support for the project. And, of course, I share the frustration of many about how long the project is taking. But it’s important to realise that this is a privately financed project, and the pace is not being driven by Government, nor is it in the control of Welsh Government. So, I would like to see a clear decision point by the company as early as possible in the new year. I can tell Members that, over the past few months, my officials have been working with the company, meeting with them on a weekly basis, and the company has confirmed that it has everything required of it from Welsh Government.

David Melding (Conservative, South Wales Central)

Cabinet Secretary, can I urge all appropriate support from the Welsh Government? This will be a wonderful project for Blaenau Gwent, Gwent as a whole and all of Wales, because the marketing potential would just be vast. You’ve chosen there a highly popular, innovative sport, really the sort of image we want to project—that Wales is open for new and exciting business.

Ken Skates (Labour, Clwyd South)

I agree. The advertising potential or the advertising equivalent for major events is huge. We know that when we host major events, such as rugby, such as the Ashes, the focus of the world coming on Cardiff, and on Wales, is immense. And, for an area such as the Valleys, it would be incredibly valuable to have a regular raft of major events taking place there, promoting it, not just as an attractive place to visit, but an attractive place in which to work and live.

Steffan Lewis (Plaid Cymru, South Wales East)

To follow on from the comments by the Member of Torfaen, there’s support across parties for this project, and on these benches too. I’m sure the Cabinet Secretary is aware of the reported financial difficulties facing Silverstone, with key figures in the Formula 1 sector questioning whether it will host the UK Grand Prix beyond 2026. Many of those same key figures in the sector are openly talking about the prospect of Wales hosting the UK’s Grand Prix, at the Circuit of Wales. Would you not agree with me, therefore, that it’s a fantastic opportunity to showcase Wales to the world, with the exposure that Formula 1 gets on an international stage, building on the fantastic sporting and global recognition of Wales, especially after the successful summer of sport we’ve had already?

Ken Skates (Labour, Clwyd South)

I wouldn’t wish to comment on the current position of Silverstone. But, with regard to Formula 1, it is, of course, one of the biggest annual sporting events that takes place in Britain, currently at Silverstone. The Circuit of Wales team have assured Welsh Government that any potential future bid for Formula 1 would not require funding in any shape or form from Welsh Government. It would be an extraordinarily expensive major event to host, but one that would be pretty unprecedented in terms of automotive sport in Wales.

Neil Hamilton (UKIP, Mid and West Wales)

Can I acknowledge the interest the Cabinet Secretary is taking in this project, and the assistance he’s given to bringing it to the stage where it’s at now, and to re-emphasise the point, which Lynne Neagle made, that there is support right across this Chamber—certainly includes my own party—for this project?

Will he also acknowledge that the guarantee that is being sought is a commercial guarantee, for which the Government would be paid, and that it would actually be called upon only in extreme circumstances where, in due course, all the assets that are proposed to be built on the site will have been completed, and it would be, in a £380 million project, only a guarantee on £190 million, so there’ll be 100 per cent security, at a 50 per cent exposure? Given that it’s a commercial guarantee, for which the Government would get £3 million a year, that does counterbalance, to a great extent, the risk that the Government is being asked to take. And, therefore, I ask the Cabinet Secretary to give it the fairest possible wind.

Ken Skates (Labour, Clwyd South)

And the Member is broadly right in his assertions. I think the figures have risen slightly, but, nonetheless, the actual return, provided that the circuit operates for the full duration, would return something in the region of £2.5 million in terms of the benefit-cost ratio for the taxpayer. So, the Member is absolutely right in that regard.

Just reflecting on what other Members have said, when I was Deputy Minister for Culture, Sport and Tourism, I believe I might have hosted, but I certainly spoke at, an event on behalf of the Circuit of Wales, talking about the value of facilities of this type and major events in the automotive sector and indeed in extreme sport in promoting Wales. In terms of extreme sport, it’s playing an incredibly important role in promoting 2016 as the Year of Adventure and it will do so next year as well as the Year of Legends and in 2018 during the Year of the Sea.

Siân Gwenllian (Plaid Cymru, Arfon)

2. Will the Minister make a statement on the government’s efforts to support small businesses in Arfon? OAQ(5)0089(EI)[W]

Ken Skates (Labour, Clwyd South)

Wide-ranging support is available for small and medium-sized businesses in Arfon and indeed across Wales through the Business Wales support network.

Siân Gwenllian (Plaid Cymru, Arfon)

Last week, I visited a very prosperous small business in my constituency. They are trying to purchase the building that they lease from Welsh Government at present and they’re on an industrial estate at the edge of Caernarfon. They want to acquire the building in order to expand their business. The company that came to value the unit on behalf of the Government came from Bristol. Their price for the value of the property was much higher than the price given by the local company from north Wales that had been used by the tenant to determine the price. So, there was one price from Bristol, one from north Wales and tens of thousands of pounds of disparity in the cost. The first question is: why is the Government using a company from England? That, presumably, is contrary to the procurement policies of this Government. Do you agree that the local valuation company has a much better understanding of the local prices? Do you agree also that this company is under great disadvantage because of this situation? They can’t proceed to purchase on the valuation given. So, please, will you look at this again?

Ken Skates (Labour, Clwyd South)

I don’t think it would be right for me to comment in any detail on what is clearly a commercial matter, but if the Member would wish to write to me with details of both valuations, I’ll certainly ask my officials within the property team to take a look at why there is such a clear and sizeable difference in the values that have been applied to it.

In addition, I will endeavour to get Business Wales officials to make contact with the company to ensure that there is all the necessary support in place to assist the company in purchasing the property, should it wish to carry through with such a transaction.

Mark Isherwood (Conservative, North Wales)

Given that the Welsh Government promised to cut taxes for small businesses and instead extended the small business rate relief scheme, which had been temporary, this was described by the North Wales Federation of Small Businesses, which represents businesses from Arfon right across the region, as you know, as

‘blatantly misleading and the worst form of spin-doctoring.’

How, therefore, will you respond to the extra £16 million announced in the autumn statement for the Welsh Government to spend on business rates? I believe they said that they remain a huge financial burden for small businesses. At present, the rateable value of each business that pays business rates in Wales is only half that in England and the size of the firm, unlike England and Scotland, is not taken into account, putting smaller firms at direct disadvantage. So, how will you engage with small businesses in Arfon and their sector representatives, such as the Federation of Small Businesses, to address those concerns?

Ken Skates (Labour, Clwyd South)

I’d like to thank the Member for his question and say that that was one person within the FSB and many others in the FSB in north Wales have welcomed the Welsh Government’s cut to business taxes for small and medium-sized businesses in Arfon. The Member mentions the English scheme, but that applies to far fewer businesses. Our scheme will apply to around 70 per cent of businesses and around half of all eligible businesses will pay no rates at all. In terms of the support that we give to businesses in Arfon, I think it’s pretty clear that our assistance is paying dividends, as the number of enterprises operating in Gwynedd has reached a record high, with 15,786 businesses operating in that part of Wales. That’s reflected across the whole of north Wales as well, where a record number of businesses are now operating—just shy of 62,000.

Elin Jones (Plaid Cymru, Ceredigion)

Questions now from party spokespeople. The spokesperson for the Welsh Conservatives, Russell George.

Russell George (Conservative, Montgomeryshire)

Thank you, Presiding Officer. Cabinet Secretary, I welcome the 1.6 per cent rise in Welsh exports. However, it is concerning to me, on looking deeper into the figures, that trade to North America has significantly declined from over a quarter share of Welsh exports in 2012 to just 15 per cent in 2016. In the same period, the volume of exports has declined by 15 per cent. Furthermore, over the last four years, the First Minister has made a number of high-profile trips to the US, the latest being in September. Have they been a success?

Ken Skates (Labour, Clwyd South)

Yes, they have, because data show that the return on the investment of those trade missions is approximately 40:1. So, a great success in terms of the return for the taxpayer. We are planning two more trade missions to the United States in the spring of next year, to San Francisco and to New York. I think it’s quite clear that the additional £5 million that has been secured for Visit Wales, as a consequence of the budget agreement with Plaid Cymru, will also help in promoting Wales in the key market of the United States, but I would say to Members that the United States is a vast country and we do have to focus our resources and activities in key areas. So, it may well be that we focus in specific cities or states of the United States as we look to exploit opportunities to increase our export potential there.

Russell George (Conservative, Montgomeryshire)

I’m pleased to hear that there will be further trade missions to the US—that’s welcome—but of course what’s important is the success of those missions. The Welsh Government is, of course, currently developing a new economic strategy, which is even a greater priority, I would say, given the vote to leave the European Union. We’ve already seen a decline in exports to North America. Whilst there is a modest growth in exports overall, your Government, I would say, should be proactively working to seek out those new opportunities. So, will you therefore commit to making this a top priority in 2017 and incorporate the boosting of trade with North America within that strategy?

Ken Skates (Labour, Clwyd South)

Yes, indeed. Exports, we’ve said on a number of occasions, are going to be a key feature of our work in the coming years. We will be intensifying both investment and activity in this area, not least because currency exchange rates clearly give us a competitive advantage in many markets at present. I should say as well that, in terms of exports, the figures that the Member has pointed to show that only five of the 12 UK countries and English regions had increases in export values. Wales was one of them. The remaining seven saw falls against this period with Scotland having the largest percentage decrease. Wales is well positioned to build on recent success in exports and I intend to do just that.

Russell George (Conservative, Montgomeryshire)

While I also recognise the EU is an important market for Wales, there should be a warning, of course, of an over-reliance on trading with one area. From 2012 to 2016, the EU share of the Welsh export market has risen from 44 per cent to 67 per cent. That accounts for two thirds of Welsh exports. The UK average, by contrast, is 49 per cent, which is about where it was four years ago before North American trade started to decline. The President-elect has indicated a willingness to trade with the UK. What discussions have you had about this and will you act on that invitation and make sure Wales is at the front of that queue?

Ken Skates (Labour, Clwyd South)

I’ve had no conversations as of yet with the President-elect and no invitation to attend any trade events in the United States. Of course, we would consider them, should they come forward. Yes, the President-elect has given indications that he would wish to forge favourable agreements with the United Kingdom. That said, throughout the entirety of the campaign that he’s just fought, he was saying that he wishes to draw up the drawbridges, rather than reach out to partners around the world. So, we’ll need to wait until January to actually see whether his willingness or his seeming enthusiasm to embrace some of the United Kingdom is actually genuine.

Elin Jones (Plaid Cymru, Ceredigion)

UKIP spokesperson—David Rowlands.

David Rowlands (UKIP, South Wales East)

Diolch, Lywydd. Turning to some more mundane matters, but nonetheless important in their own right, Cabinet Secretary, could the Cabinet Secretary inform us as to who is responsible for clearing litter from the trunk roads in Wales?

Ken Skates (Labour, Clwyd South)

Yes, that would be Welsh Government.

David Rowlands (UKIP, South Wales East)

Well, I thank you for your answer, Cabinet Secretary, but the reason for my inquiry is that the general condition of the verges of such roads is, quite frankly, appalling. Nick Ramsay raised the matter of the A449 with your predecessor, and a temporary clean-up took place. However, soon after, it returned to its usual deplorable condition. Now, I know that the Cabinet Secretary is fully committed to the tourism industry in Wales, so given that many of these trunk roads either traverse or lead into areas of outstanding natural beauty, does the Cabinet Secretary not agree that it is an intolerable state of affairs, especially as the plethora of flotsam and jetsam is not only environmentally unacceptable but also extremely hazardous?

Ken Skates (Labour, Clwyd South)

I would agree that littering is utterly unacceptable, but the way that we respond to such a problem is not just to clear up litter, it’s to persuade people to change their attitudes, their behaviours and their culture. Indeed, under the Well-being of Future Generations (Wales) Act 2015, it’s imperative that we find ways to avoid such problems emerging in the future. So it’s not just for us to clear up on trunk roads; we are having a very difficult time to find the resources to do just that, just as local authorities are struggling, given this continued period of austerity. But, longer term, we need people to change their behaviours in order to keep our landscapes clearer and more attractive, not just for visitors but for people who live in them.

David Rowlands (UKIP, South Wales East)

Well, again, I thank the Cabinet Secretary for his reply, but this is such a fundamental part of what we want to sell Wales as to the tourists who come here. And to see the verges in the absolute state that they are, that does not encourage or give a good impression of Wales generally. Something ought to be done about this, and quite urgently.

Ken Skates (Labour, Clwyd South)

Quality of place is absolutely essential in ensuring people have pride in the place that they live, and I would agree with the Member that it does need to be improved in terms of not just trunk road verges, but streets in general and town centres. Many local authorities are having difficulty with an increase, in some parts, of littering and anti-social behaviour. But the key, the long-term key, to improving our built environment is in ensuring that people change their behaviours, and we are trying to do just that. Indeed, right from primary school upwards, with the introduction of the new curriculum, we hope that people will become more responsible and respectful adults and stop littering.

I find it particularly frustrating in my constituency, where there is a well-known fast food outlet on the side of one of our trunk roads. We often see considerable litter being dropped, but I have to say that that particular outlet is very responsible in actually paying for, and often organising, litter-picking sessions. Of course, they can’t go on the trunk road, but in the surrounding areas. And I would like to see more corporate responsibility of that nature right across our towns and cities and, indeed, along roadways, where there is currently a problem with littering, particularly with fast food.

Elin Jones (Plaid Cymru, Ceredigion)

Plaid Cymru spokesperson, Adam Price.

Adam Price (Plaid Cymru, Carmarthen East and Dinefwr)

Diolch, Lywydd. It was expected for the regional gross value added figures to be released today by the Office for National Statistics, but they’ve been postponed for a week—perhaps realising the Welsh Government have already had a tough enough week with yesterday’s PISA results. However, I would like to bring to the attention of the Cabinet Secretary a report released by Ernst and Young this week on regional growth projections for the next three years. Slower growth is predicted across the UK, with an average UK growth of 1.5 per cent. Wales, however, is even worse, with growth expected to be at just 1 per cent—growth in GVA over the next three years. If you factor in this projected growth rate, then Welsh GVA would then fall below the 70 per cent average, compared to the UK GVA, for the first time ever in recorded economic history. Isn’t this the Maginot line, if you like, of Welsh economic policy—a line that should never be crossed? We don’t currently have an upper target from the Welsh Government in terms of GVA. We did once; it was 90 per cent. It was abolished. Could we at least have a lower target, a national poverty line that we should never accept? And if that line—I hope it never happens—is crossed, will we have a public commitment that someone in Welsh Government will take ultimate responsibility for it?

Ken Skates (Labour, Clwyd South)

Well, the Member makes a number of important points. First of all, I was very disappointed that those statistics were delayed. It was out of our control, as the Member is aware, but I was very much hoping that they would be published this week. I can’t comment on what I have seen within the statistical release. That said, projections are based often on science that subsequently is proven to be wrong. We know that from a number of recent elections and referenda. What we can do is rely on existing figures and they show that, in terms of GVA per head, since devolution, Wales had the fifth highest increase compared to the 12 UK countries and English regions. Since the recession, GVA per head has increased more quickly in Wales than the UK. In terms of GVA per hour worked, we had the fourth largest percentage increase in GVA. In terms of the index of production in the last four quarters, production output has increased more quickly in Wales than in the UK as a whole: 3.9 per cent to 1 per cent. Based on our performance to date, I think we should actually be a little more positive about the predictions. But that said, we cannot be complacent, which is why we’ve worked this year relentlessly to attract high-value companies such as Aston Martin to Wales, whilst also investing in facilities such as the Menai science park and the advanced manufacturing institute to grow and expand existing indigenous companies and to ensure that they can collaborate to compete at the highest level.

Adam Price (Plaid Cymru, Carmarthen East and Dinefwr)

I’m all for optimism and enthusiasm and passion. I admire that in the Cabinet Secretary, but we have to remind ourselves, don’t we, that we’re at 71.3 per cent of the UK average already. The first step in turning around our abysmal economic performance is a reality check on where we currently are.

As he devises his new economic strategy, could I urge him to read the recent CBI report on unlocking regional growth? One of the key areas that they focus on there is the issue of transport infrastructure and the absolutely critical role that it plays. Could I say to him that I think this is one of the key constraints now in our economic performance? You only have to read social media at the moment on a daily basis to see our creaking transport infrastructure: passengers on Arriva Trains Wales complaining about appalling experiences. Just this morning, Jac Larner at 8.58 a.m. said,

‘For 2nd time this year my train has caught fire. I suppose it’s good it’s only been twice, but I feel this is still too often’.

Leon Williams: ‘This morning. Literally no exaggeration but this is the first time in 11 months that I’ve had a seat on my commute to Neath Port Talbot.’

Hannah, yesterday:

‘Someone passed out again on the Bridgend - Aberdare 07.42 train.’

Would the Cabinet Secretary accept that this is now a national crisis and we need urgent action by the Welsh Government? This is completely unacceptable. No-one in any country should have to put up with this.

Ken Skates (Labour, Clwyd South)

It is unacceptable the way that some people are having to tolerate public transport at the moment and we have taken a very firm line with the operators. We’re also taking a firm line with Network Rail, who have, in recent years, hugely underfunded the Welsh route network. We also believe firmly that now is the time to devolve all responsibility for rail services, to make sure that we can get the investment where it is needed. In the longer term, once we have the new franchise in place, we will have a new and transformed rail service. But it’s important in the meantime that there is the capacity to be able to meet travellers’ needs. For that reason, the Welsh Government has and will continue to invest in services and we are exploring ways, as I outlined in my statement on 9 November, to increase rolling stock provision as well.

One of the major problems that we are finding right now is that there is simply too little money being spent removing trees from tracksides. This is a responsibility that is not ours. It’s non-devolved and it’s unacceptable, because what it’s led to are cancelled trains, particularly—I know that Mark Isherwood has raised this in the past—in the north, and also on the Valleys lines. It’s causing significant problems in terms of delays and cancelled services, and capacity problems. It’s down to one thing: underfunding of the rail network. I’ll be meeting with Network Rail tomorrow to outline, again, my disappointment at the lack of action. But it is absolutely right that, as we move forward, we get devolution of responsibilities for this and we invest where travellers expect us to invest.

Adam Price (Plaid Cymru, Carmarthen East and Dinefwr)

The other area that is highlighted by the CBI report is skills. It’s absolutely vital that we get workplace training right, and we can only do that if we talk to the employers. There’s a worrying lack of information and clarity at the moment about how the apprenticeship levy is going to be operated. The UK Government did hold an initial consultation, Scotland and Northern Ireland have held their own formal consultation, but there’s been precious little, actually, from the Welsh Government. There was a skills consultation some two years ago. Can we have some real dialogue with our employers?

The quid pro quo, where compulsory training levies have ever been introduced, whether it’s through the old industrial training boards, or actually on the continent, is that they are led by employers—in that case by the chambers of commerce—and yet we’re having none of that engagement. Surely we should be introducing a system whereby, if we’re taking money from employers, we should at least be asking them where we should be investing it.

Ken Skates (Labour, Clwyd South)

This relates largely to the skills strategy and the work that the Minister for Skills and Science has been undertaking. Sometimes projections do come right; we predicted that this might happen today, this question, so I’ll pass you over to the Minister.

Elin Jones (Plaid Cymru, Ceredigion)

Oh, we have a tag team. That’s a new innovation. I’m all for that. [Laughter.]

Ken Skates (Labour, Clwyd South)

We’re going to go into gambling as a consequence of this being right.

Elin Jones (Plaid Cymru, Ceredigion)

Julie James.

Julie James (Labour, Swansea West)

Diolch, Lywydd. The apprenticeship levy is very much in my portfolio, and so I thought it would be helpful, if—

Elin Jones (Plaid Cymru, Ceredigion)

You can sit down Cabinet Secretary. [Laughter.]

Julie James (Labour, Swansea West)

I thought it would be helpful, if this question did come up, if I was in a position to say what the latest position is. The Treasury have announced a further £13.7 million, having recalculated the settlement slightly differently from the basis of the original settlement, which was included in the Barnett formula. They imply that this is all extra money, but that in fact is not the position. Previously I’ve gone through the statistics, and I’ll do it again. Basically—[Interruption.] No, it’s very straightforward, as I said. Basically, what’s happened is we got £114 million for Wales as a result of the Barnett formula for the apprenticeship levy, and £90 million of that was immediately removed because it had been placed in the baseline for the Barnett formula, and £90 million is the reduction in apprenticeship money funding in England as a result of the move between the apprenticeship levy and general taxation. There’s been an announcement of another £13.7 million as a result of the recalculation of the formula, based on the moneys arising from Wales, after a lot of lobbying from Wales, from both businesses and from the Government. However, the situation still is that this is an employer tax levied by HMRC without consultation with the Welsh Government.

HMRC, as you know, is not devolved to Wales in any way, and the money directly contradicts our apprenticeship levy. We have been very clear that the consultation that we undertook extensively, just before the levy was announced, and which was well received by all employers in Wales, stands. We have delayed the announcement of our final apprenticeship policy, which I’m hoping to do towards the end of December, as a result of trying to figure out exactly what’s happening. But the bottom line is that this money is not coming back to Wales in the form that the employers would like. It is a tax, pure and simple. Taxes are not devolved, as you know, and neither is it hypothecated in England either—taxes are not hypothecated—so it’s just the current Government’s policy to spend it in this way. That could change tomorrow. We will be holding fast to our well-tried, well-tested and well-consulted-on apprenticeship programme.

Mohammad Asghar (Conservative, South Wales East)

3. How will the policies contained in the Welsh Government’s ‘Taking Wales Forward’ programme improve rail services in Wales? OAQ(5)0077(EI)

Ken Skates (Labour, Clwyd South)

We will be delivering the south Wales metro in tandem with the development of the new Wales and borders franchise, which will bring significant improvements to rail services across Wales. Passengers can expect to see a step change in terms of the quality of rail services provided.

Mohammad Asghar (Conservative, South Wales East)

Thank you very much for the reply, Cabinet Secretary. Data provided by the Department for Transport show that rail passengers in South Wales East and south Wales are faced with some of the worst overcrowding in England and Wales. Nearly 40 per cent of train services arriving in Cardiff during the morning rush hour in 2015 had passengers who were forced to stand during the journey. What is the Welsh Government doing to address the issue of overcrowding on commuter train services, and will he comment on reports that spare rolling stock from the Gatwick express could be transferred to Arriva Trains Wales next year?

Ken Skates (Labour, Clwyd South)

I would hope the Member would recognise that the historic underfunding of the rail network in Wales, as I outlined to Adam Price, has certainly not helped matters, especially at this time of year. Indeed, this is not a new occurrence; historically, we have fared worse during winter months because the investment has not been forthcoming where it should be. In terms of what we as a Government—we are not yet in control of the franchise; that will come with the new franchise—are able to do right now, there is very limited diesel rolling stock. I’m afraid I didn’t quite catch the details of where the Member believes there may be existing diesel-powered stock that could be utilised, but certainly if he could provide information to me I’ll consider it. There is very limited diesel rolling stock currently available, but we are, as I mentioned earlier, in dialogue with the rail industry to try to identify solutions that could deliver additional capacity in the short term whilst we move towards the new franchise. Capacity on some Valleys lines, as I’ve said, including the Ebbw Vale line, has, no doubt about it, in recent weeks been adversely affected by leaf fall, which is unacceptable.

Hannah Blythyn (Labour, Delyn)

The Welsh Government’s Taking Wales Forward programme makes it clear that there will be an additional £50 million to advance the development of the north Wales metro system. This is welcome, but, in anticipation of bringing in the metro system in north-east Wales, I think steps need to be taken to ensure that the current system we have there is metro-ready, so to speak. I’ve previously spoken in this Chamber and in the community about the need to have better connectivity in the area—better connectivity in terms of train services on key routes, not just north to south traffic but, more importantly, east to west, because that’s the crucial route with our regional economy. I think we also need to ensure that trains link up with bus services, that buses actually stop at train stations and that both bus and train timetables are synchronised to ensure each journey is as efficient as possible. So, Cabinet Secretary, can you tell me what steps are being taken in the short term to allow the longer term ambition of the north Wales metro to be implemented?

Ken Skates (Labour, Clwyd South)

The Member is absolutely right that we need to ensure that the transport network is fully integrated. Yesterday, I outlined to Llyr Huws Gruffydd how we are supporting the bus network in north-east Wales in the area where the metro’s origins will be formed in terms of the approach that needs to be taken since the collapse of GHA Coaches. It’s absolutely essential that we stabilise the bus network in the short term whilst we put together the vision for the north Wales metro. Fifty million pounds has been secured for the development of the metro, and the initial scoping of the work has focused on an integrated hub concept in the Deeside area encompassing, as the Member outlines, rail, bus, active travel and road enhancements. In addition to the development of the north Wales metro, which will, of course, span the border, we are committed to proceeding to public consultation in the new year on a major upgrading of the A494/A55 to relieve congestion on that route.

David Rowlands (UKIP, South Wales East)

We meet again, Cabinet Minister. ‘Taking Wales Forward’ includes plans for transport in Wales, with the metro being the most comprehensive and ambitious project ever envisaged by the Welsh Government. I am sure the whole of the Chamber applauds you for your vision on this, but will the First Minister please tell us when will the major works included in this project—[Interruption.] I’m sorry. I do apologise; you’re not there yet, but maybe in the future, sir. Will the Cabinet Secretary please tell us when will the major works included in this project actually begin?

Ken Skates (Labour, Clwyd South)

Okay, yes, absolutely. It is a hugely ambitious project and I’d like to thank the Member for his very kind question to me. The cost of the south Wales metro is currently estimated at over £700 million and the timescales are as follows—I’ll go through each of the key points. We’re going to be awarding the operator and developer partner for the franchise and the metro by the end of 2017. We’re going to award the infrastructure contracts by the spring of 2018. By October of 2018, the new franchise will begin. The metro design will take place in 2018-19. Infrastructure delivery will be on site from 2019 and services will be operational from 2023. As the Member outlines, this is a hugely ambitious project, one that we should be excited about and proud of and I’m hopeful that we’ll be able to meet all of those key deadlines and markers. To date, we haven’t missed any of the key timings of this project.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

4. Will the Minister make a statement on the impact of high street banking on businesses in Anglesey? OAQ(5)0090(EI)[W]

Ken Skates (Labour, Clwyd South)

Whilst banking is non-devolved and branch closures are a commercial matter for the banks, we are keen to ensure that businesses and individuals across Wales have access to banking facilities, including cashpoints and cash deposits and collection facilities. We have put in place measures to support this.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

The Minister will be aware, I’m sure, of the announcement of NatWest of its intention to close three branches on Anglesey next June in Holyhead, in Amlwch and Menai Bridge, leaving Amlwch with just one limited-opening-hours bank and no bank in the booming town of Menai Bridge. This follows a series of recent bank closures, leaving large parts of the island with no bank service. The Minister will know how important these services are to businesses. Will the Cabinet Secretary join me in condemning what seems to be the abandonment of large parts of Wales by the big high street banks and will he give an undertaking to do whatever it takes, working with UK Government, to try to prevent the further haemorrhaging of these vital services?

Ken Skates (Labour, Clwyd South)

Can I say to the Member that I am most sympathetic to what he is going through and what his communities are going through at the moment? In my constituency of Clwyd South, I have just one bank remaining—just one bank. That’s a Barclays bank. So, I’ve been through, over the past five years, repeated so-called consultations, which always conclude with the closure of a bank. I think it’s absolutely essential that the Griggs review recommendations are implemented in full and that we move away from artificial consultations and to meaningful ones that could result in the retention of banking services.

Insofar as what we as a Welsh Government, in addition to pressing for implementation of the recommendations of the Griggs review, can do, I think we need to make sure that post offices continue to provide banking facilities. At the moment, I believe something in the region of 95 per cent of customers can access their banking facilities through post offices, so it’s vitally important that we support that network as well. I think it’s absolutely imperative that NatWest listens not just to you but to, I’m sure, the people you will take to the bank, particularly business customers, because business customers often find it difficult to access the full range of services available from the post office that they expect to be able to access within their local branch. I’d be happy to meet with the Member to discuss any additional assistance that I could possibly give, but, again, the Member has my sympathy in this area and I would very much like to work with him to find solutions for the three communities affected by the NatWest decision.

Nick Ramsay (Conservative, Monmouth)

5. Will the Minister make a statement on the Welsh Government’s plans for infrastructure in light of the Chancellor’s Autumn Statement? OAQ(5)0083(EI)

Ken Skates (Labour, Clwyd South)

Yes. The additional funding is welcomed but it does not reverse the cuts to our capital budget over recent years. Our priority will be ensuring that we use this additional funding to support the creation of a prosperous and secure Wales.

Nick Ramsay (Conservative, Monmouth)

Thank you, Cabinet Secretary. The autumn statement will deliver over £400 million extra capital funding over the next five years for infrastructure projects in Wales. We know that there have been concerns surrounding funding for the metro, particularly in the wake of the European referendum. What plans have you to use some of this extra money to support the metro, particularly in rural areas like my constituency, where outlying areas such as Monmouth could be connected to the proposed transport hub at Celtic Manor?

Ken Skates (Labour, Clwyd South)

I’m very interested in the proposed transport hub at Celtic Manor, particularly given the development of the convention centre there and its increasing significance as a major destination in south-east Wales. In terms of costs and resources for the metro project as a whole, we expect every penny that was to come from Europe to come from the UK Government when we exit the EU. The guarantees that we have been given we will hold the UK Government to. This is a hugely ambitious project. It’s designed to be a dynamic project as well that can grow and expand. Certainly, insofar as the proposed Celtic Manor hub is concerned, I’d be very keen to examine this prospective development.

Lee Waters (Labour, Llanelli)

6. What assessment has the Minister made of the potential impact of the fourth industrial revolution on jobs in Wales? OAQ(5)0088(EI)

Ken Skates (Labour, Clwyd South)

This is an extremely interesting subject matter and the Welsh Government is fully committed to harnessing the opportunities that the fourth revolution presents. Our support for cutting-edge technology, research and development will ensure that innovation is a major economic enabler for Wales.

Lee Waters (Labour, Llanelli)

Thank you, Cabinet Secretary. The coming automation and robotics present huge opportunities, but also very real threats to jobs in Wales. On Monday night in Liverpool, the governor of the Bank of England, Mark Carney, gave a speech in which he said some 15 million jobs could be affected by automation. Using the formula that the Bank of England used in coming up with that figure, I’ve calculated that some 700,000 jobs in Wales could be at risk from automation. This is a crude calculation, but would the Cabinet Secretary commit to doing a proper study of the impact to understand the threat, but also the very real opportunity from this fourth industrial revolution?

Ken Skates (Labour, Clwyd South)

Yes, I most certainly would. I’m pleased to be able to tell the Member today that the Wales European Funding Office understands that Industry Wales, who, can I put on record, have been incredibly helpful in teaching me something about industry 4.0, are working in partnership with a number of Welsh universities and are planning to submit an industry 4.0-related bid for funding under the current European regional development fund round and call for research and innovation proposals, which will close on 31 January. I hope that that bid is successful, because I think it would deliver exactly what the Member has called for.

In addition to this, I’m pleased to say that the innovation team within Welsh Government is actively engaged with the recently launched UK knowledge transfer networks for manufacturing initiative, which is aimed specifically at realising the potential of the fourth industrial revolution. The Member is absolutely right to highlight both the opportunities and the challenges and threats posed by I4, and if we look to France, perhaps, as a model where we could learn some very significant lessons in how to move towards an automated economy, provided we can make that shift fast enough, I’m firmly of the belief that we can stand on the side of greater opportunities rather than threats.

Mike Hedges (Labour, Swansea East)

7. Will the Minister make a statement on grade I listed buildings in Wales? (OAQ(5)0079(EI)

Ken Skates (Labour, Clwyd South)

Yes. Some 30,000 buildings across Wales have been protected through listing as nationally important buildings of special architectural or historical interest. Four hundred and ninety three of these are grade I.

Mike Hedges (Labour, Swansea East)

Thank you, Cabinet Secretary, for confirming that there are 493 grade I listed buildings in Wales. We also know that they have a variety of different types of ownership. I personally take an interest in the great chapels of Wales created in the nineteenth century. I believe we need a strategy to protect all the grade I listed buildings in Wales. Will the Cabinet Secretary look into creating such a strategy, preferably not involving Cadw?

Ken Skates (Labour, Clwyd South)

Local authorities are able to put together local lists of historic interest, but, in terms of what Cadw is doing—and I think it’s important that we recognise that Welsh Government is there to support, both in terms of statutory functions and non-statutory functions, the historic environment—we’re leading on three key initiatives. One is the places of worship action plan, another is the support that Cadw offers local authorities in preparing buildings-at-risk registers, which I think is absolutely crucial, given that places such as Morriston Tabernacle in my friend’s constituency has recently been funded for an options appraisal for the building, which is helping to map and secure its future. That couldn’t have been achieved without close collaboration with the local authority. Thirdly, we are improving the protection of grade I listed buildings and nineteenth century chapels in particular, through protection by the law. The 2016 historic environment Act is designed to enhance protection of grade I listed buildings and, indeed, grade II and grade II* buildings as well.

David Lloyd (Plaid Cymru, South Wales West)

8. Will the Minister make a statement on promoting Welsh arts and culture abroad? OAQ(5)0093(EI)

Ken Skates (Labour, Clwyd South)

Our culture sector has an important part to play in promoting Wales as an outward-facing nation that values cultural exchange. We will press for a cultural exemption clause to restrictions on freedom of movement, and for any loss in EU funds for culture to be replaced by UK national funds.

David Lloyd (Plaid Cymru, South Wales West)

Thank you for that answer. Can I direct the Cabinet Secretary to the annual Lorient inter-Celtic festival, held each year in Brittany? It’s the biggest festival in France and the largest celebration of Celtic cultures in the world. The festival has invited Wales to be the honoured nation in 2018. Next year it’s to be Scotland. Can I ask what the Welsh Government is doing to support the year of Wales in Lorient?

Ken Skates (Labour, Clwyd South)

I’m very pleased to be able to inform the Member that I am funding our activity at that festival. I am absolutely delighted that we’ve been chosen to be a key partner in 2018, the Year of the Sea, but also the year of friendship with our partners across Europe.

Joyce Watson (Labour, Mid and West Wales)

9. Will the Minister provide an update on the Superfast Cymru scheme? OAQ(5)0095(EI)

Julie James (Labour, Swansea West)

We continue to make solid progress on Superfast Cymru. We have provided access to superfast broadband to over 620,000 premises that would not have been able to receive fibre fast broadband without our intervention.

Joyce Watson (Labour, Mid and West Wales)

I thank you for that answer. This has been a significant investment by the Welsh Government, with European money, for the people of Wales. There is another £20 million earmarked for the next phase. Clearly, delivering Superfast Cymru does remain a top priority of this Government, and it has helped businesses grow, expand and develop within my region. But could you tell me, Minister, how many businesses in Mid and West Wales have benefited from the Superfast Cymru scheme?

Julie James (Labour, Swansea West)

We don’t have the information on individual businesses in that way, because the way that we let the contract is that it is on an all-Wales basis to premises passed. So, each individual premise that gets more than 30 Mbps is accepted onto the Superfast Cymru programme. We don’t have any way of differentiating whether they’re residential or business, I’m afraid. But we do have a £12 million superfast business exploitation programme in place to ensure businesses across Wales, including many in very rural locations and rural locations, maximise the benefits of superfast broadband and, indeed, take up superfast broadband when it arrives, because, often, unless people have seen it working, they haven’t got any understanding of what it can actually bring you. I’ll give you one example: a hotel I visited in Fishguard was delighted to have got Superfast Cymru and they invited me there to see how well it was working. They’d got themselves onto one of the voucher schemes that allow people to get a relatively good price for a weekend break, for example, and they were delighted because the hotel was completely full and totally delighted with the amount that they’d got in place so far. However, once they got it there, they soon realised that they could also then have weddings where WedPics could be used and so on, and that people were passing that information on on online, and very soon, the amount of superfast that they wanted was much bigger than the one that they’d originally envisaged. So, what we’ve been doing is encouraging both locally and regionally, and, actually, internationally. So, this particular hotel in Fishguard was attracting international visitors for the first time. So, it’s a fantastic programme that really helps business exploitation and, indeed, we also let a contract with Airband in 2015 to target nearly 2,000 premises, specifically in business parks and industrial estates across Wales that had been left out of the original programme, if you remember. When we did the new open market review, we were able to include those businesses. So, it’s been tremendously successful, and everybody who’s got it has seen a real increase in business productivity.

Elin Jones (Plaid Cymru, Ceredigion)

And finally, question 10—Darren Millar.

Darren Millar (Conservative, Clwyd West)

10. Will the Minister make a statement on visitor numbers from overseas to Wales for the past five years? OAQ(5)0082(EI)

Ken Skates (Labour, Clwyd South)

Yes. I’m delighted to say that international visitors to Wales have grown strongly, with trips increasing by 10 per cent and spend by 25 per cent between 2011 and 2015. Figures from the international passenger survey for the first six months of 2016 also show growth in both trips and spend.

Darren Millar (Conservative, Clwyd West)

It’s very encouraging news to note those figures, Cabinet Secretary, and, of course, the value of the pound now is also helping to encourage visitors to the UK as well. But north Wales has a unique offer in terms of tourism, and, as we know, it’s a world-beating offer. It’s up there in the top 10 list of destinations as far as Lonely Planet is concerned. But one of the disadvantages that we have is that we do not have an international airport in north Wales. Now, I’m not going to call for you to build one, but I will ask you to tell us what you are doing to improve links to the international airports in Liverpool and Manchester, between north Wales and those destinations. It is really important that, if we want to drag the important visitors into north Wales, those links to those two particular airports are absolutely crucial. What are you doing to work with the UK Government and others in order to deliver some improvement to those links?

Ken Skates (Labour, Clwyd South)

Can I thank the Member for his question and say that I am also pleased that north Wales is the fourth greatest region on the planet? This week, I’m pleased to be able tell the Member that Wales won another award. We won the best in UK for youth, student and educational travellers, and that was at the British Youth Travel Awards. North Wales, without a doubt, has a unique offer, and I am keen to make sure that it becomes more accessible to travellers from abroad and from other parts of the UK for that reason.

We are going to be going out to consultation, as I said, on improvements to those key access points—the A494 and the A55—so that travel by road is improved. We are developing the vision for a cross-border metro that will link into Manchester Airport and also Liverpool airport. Last week, I was particularly pleased to attend the ‘Daily Post’ business awards dinner at Bangor University, where the tourism award was sponsored by Liverpool John Lennon Airport. Of course, this has become a very significant airport for the visitor economy of north Wales, so I have asked my officials to engage with that airport and, again, with Manchester Airport, with which we already do a lot of business in promoting Wales. I am in agreement with the Member that we can improve links with those airports; we can improve the road links and the rail links as well.

Elin Jones (Plaid Cymru, Ceredigion)

Thank you, Cabinet Secretary.

2. 2. Questions to the Cabinet Secretary for Health, Well-being and Sport

Elin Jones (Plaid Cymru, Ceredigion)

The next item is questions to the Cabinet Secretary for Health, Well-being and Sport. The first question is from Llyr Gruffydd.

Llyr Gruffydd (Plaid Cymru, North Wales)

1. Will the Minister make a statement on non-respiratory sleep disorders? OAQ(5)0092(HWS)[W]

Vaughan Gething (Labour, Cardiff South and Penarth)

Thank you for the question. It is important that the cause of non-respiratory sleep disorders is identified early as there can be a wide range of underlying issues ranging from diet, neurological disorders, psychiatric disorders or more. The underlying cause will determine where the condition is best managed, but primary care will be the starting point for management.

Llyr Gruffydd (Plaid Cymru, North Wales)

Thank you for that response. As you say, as things stand at the moment, the majority of sleep disorders are treated across departments within our hospitals. There isn’t a specialist centre for such disorders. Those who have these conditions are complaining about diagnosis and treatment for non-respiratory sleep disorders, and you referred to disorders emanating from neurological problems, for example. Diagnosis in Wales is very low in terms of conditions such as narcolepsy. Do you have any plans to improve diagnosis and treatment for such conditions in Wales and what is the prospect of developing a specialist centre, particularly for that wide range of sleep disorders here in Wales?

Vaughan Gething (Labour, Cardiff South and Penarth)

Thank you for the follow-up question. I’m sure that all of us at some point in our lives will suffer some sort of challenge with our sleep. Most of them, though, do pass, as I’m sure you know, with a houseful of young children. But, in terms of the particular disorders and the wider challenges, we know that narcolepsy is a particular challenge, not just on sleep but in daily life. There is no currently known cure; it’s about managing the condition successfully. We do have a tertiary centre in Aneurin Bevan university health board, but I have asked the neurological conditions delivery implementation group to consider what greater emphasis we could have on those who are affected by neurologically affected sleep disorders. So, there is work in train and we know it’s an area where we need to expand our understanding, and then understand where and how we manage the condition and help and support people in the most effective way possible.

Nick Ramsay (Conservative, Monmouth)

Cabinet Secretary, I am really pleased that Llyr Gruffydd has raised this very important question. There are strong links between sleep disorders and mental health, so in dealing with sleep order conditions, you are providing a valuable preventative measure in terms of mental health and other areas of the health service. I think you just mentioned the Aneurin Bevan sleep centre, which is based at Nevill Hall in Abergavenny. I believe it’s the only sleep centre of its kind in Wales—certainly dealing with the scope that it does. It’s only partially funded by the NHS, and I don’t think that that funding is guaranteed from year to year. I appreciate that funding is tight, but could you look at giving the sleep centre a little bit more assuredness in future as to its funding, and look to roll out that best practice across the rest of Wales, because it is, as I say, a preventative measure that really will do a lot to reduce spending in other parts of the health service?

Vaughan Gething (Labour, Cardiff South and Penarth)

I think there are two issues you raise in your question. The first is the point about treating the underlying cause, so whether that’s different forms of activity, and where there is a mental health challenge that leads to people having a sleep problem in the first place. The second, then, is what happens afterwards in terms of the treatment, and I think the Aneurin Bevan centre is a good example of where we have some specialism. There’s more work being developed with the Brain Research Imaging Centre at Cardiff University as well, and it’s important to understand what the evidence tells us about what we should then do.

I will consider, but the service in particular is a first in understanding the level of demand that exists, what it could and should do, and then how it funds that accurately with other partners as well. So, I understand why you make a bid for extra funding on this particular issue, but I need to see the evidence on what we could and should do and how that matches up with the need and demand that we have, and how we can probably meet that within the system.

Leanne Wood (Plaid Cymru, Rhondda)

2. Will the Minister provide an update on the on-going work to ensure equality of care for NHS patients across Wales? OAQ(5)0093(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the question. I’ll start by recognising and congratulating her on her award last night in the Welsh Politician of the Year awards. The biggest challenge with equality of care in Wales remains the health inequalities between our wealthier and poorer communities. That’s why we’re rolling out the inverse care law programme more widely, following successful pilots in the Aneurin Bevan and Cwm Taf health board areas. This broad issue was, of course, the focus of this year’s chief medical officer report.

Leanne Wood (Plaid Cymru, Rhondda)

Thank you for your answer, Minister, and for your congratulations. Earlier this year, a constituent of mine, a young mother of three, lost her fight against cancer. Before dying, her partner tried desperately in vain to secure a drug for her that may well have prolonged her life. You may have seen recent media coverage of this case. Her application was rejected on the grounds that her case was not deemed to be exceptional enough, despite the patient’s genetic counsellor telling her that she was the only person in Cwm Taf health board’s boundary to be diagnosed with what I hope is pronounced as Li-Fraumeni syndrome, which is a rare genetic predisposition to cancer. The patient’s oncologist said that they’ve not seen a patient like her, and doubts that she will again. In a heartbreaking account by her partner that I submitted on his behalf to the independent funding request review, he poses the question: what does it take to be clinically exceptional in Wales?

As well as implementing the recommendations from the IPFR review, will you be taking steps to ensure that people with rare forms of illness, including cancer, get the best possible care?

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the question. The case you highlight again reiterates how incredibly difficult these choices are—difficult for clinicians, difficult for the health service in meeting all the various and differing forms of need, in particular the highly specialist and individualised care that you point to, but most of all, incredibly difficult for the individual and their family. I think that’s why it’s important that we’ve agreed to have the review on the independent patient funding request, and that, together with the new treatment fund, demonstrates the commitment we do have to ensuring we do provide the best possible care where medicines are the answer—because they aren’t always the answer. So, I do look forward to what the review has to say about both the national process and the local processes for understanding how the individual patient funding requests are made. In particular, you’ll know that clinical exceptionality is a specific area of the review, and I look forward to receiving the report.

But this Government remains committed to providing the very best care possible, and we will remain committed on the very best basis, the very best evidence base, available to us. That won’t take away from the incredibly difficult decisions that individual clinicians and teams have to make, and that individual families make and have to face up to themselves. But I’m determined we will do the very best possible for each family, wherever they live in Wales.

Andrew RT Davies (Conservative, South Wales Central)

Cabinet Secretary, obviously the ability to attract staff into the Welsh NHS is a critical component of providing a modern and dynamic NHS here in Wales. The Royal College of Physicians brought forward their survey recently that indicated that of the jobs advertised at consultant level, at least 40 per cent went unfulfilled, and many of them didn’t even have any applicants applying for those jobs. How confident are you that, when this assessment is made in 12 months’ time, the Welsh Government, along with the health boards, will have made progress in attracting more consultants into Wales, and importantly getting applications for jobs wherever those consultant jobs exist in Wales?

Vaughan Gething (Labour, Cardiff South and Penarth)

Well, the point about the recruitment to the medical workforce are challenges, as you know, across the UK system. Here in Wales, we’re certainly not immune to those challenges, and they vary slightly, but often we see exactly the same challenges in every nation within the UK. So, that’s why our strategy on recruitment and retention is important and that’s why it’s allied to training within Wales and, indeed, encouraging people to come to us to see about the whole package. So, training looks at all those different factors.

But it always goes back to comments I’ve made before, and I’ll make again, about needing to understand what are attractive models of care for people to come to. For example, in Aneurin Bevan, following the reconfiguration of their stroke services, which was difficult—not everyone wanted to see stroke services centralised into a specialised centre—actually we’ve seen outcomes improve for patients. We’ve also made it easier to recruit consultant staff into that new and up-to-date model of care. So, there’s a range of different things that we need to balance.

And part of what we have to do is not just to have an ambition from the Government, but we have to listen to people within the service and work alongside them in understanding how we make Wales a more attractive place for people to come to live in and to work, and what we then need to do for the training and the wider support around that. I also think that the creation of Health Education Wales will put us in a better position to have that broad, strategic overview, to make sure that we have the very best prospects to encourage and recruit and retain all of the staff we need to run a high-quality, modern healthcare system.

Elin Jones (Plaid Cymru, Ceredigion)

Questions now from party spokespeople. The Plaid Cymru spokesperson, Rhun ap Iorwerth.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

Thank you, Presiding Officer. There will be a debate held in the Chamber this afternoon on obesity, and that underlines the threat that this poses to public health in Wales. How much does the Government spend and what resources is it investing in trying to tackle and prevent obesity in Wales?

Rebecca Evans (Labour, Gower)

Well, it’s very difficult to give a particular answer in terms of pounds and pence as to what we spend on this agenda, because it is so wide ranging. Our approach to it takes in active travel, for example, so there’s all the work that we’re doing through the department that Ken Skates leads, but also work that we’re doing in terms of our support for public health more generally—our work through the healthy network of schools, for example. So, it’s very hard to put a particular figure on this, given the fact that the work we are doing ranges from schools, through local authorities, and through the NHS, and aspects of the NHS such as our exercise programmes, and so on. So, in terms of putting pounds and pence on it, it’s very difficult to say.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

Thank you very much, Minister, rather than Cabinet Secretary. Considering the cost of tackling and treating people because of conditions caused by obesity, considering the cost to the health service, however much is spent by the Government isn’t enough, and I hope that the Minister would agree with that. If somebody wants to give up smoking, there is a wide range of support available: nicotine-related products, support groups, there is also heavy taxation, of course, on produce, and the prevention of advertising and so on. As we can see that such steps have worked—have taken time, but have worked—and that’s reflected in the numbers that smoke now, does the Minister agree with me that we need to take a similar approach as we try to tackle this huge challenge in terms of public health, namely obesity?

Rebecca Evans (Labour, Gower)

Well, I’m pleased that you have recognised the success that we have made in terms of driving down smoking levels, which are at their lowest level since records began. And we’re making really good progress towards our target of 16 per cent by 2020.

You’re absolutely correct that tackling obesity is a very complex issue, and it does involve things such as taxation and advertising. We’re very pleased that the UK Government is committed to the sugar levy, for example. However, we are concerned that there doesn’t seem to be any demonstrable progress in that area. So, this is something we continue to push on, as we do with pushing for further and stronger action in terms of advertising as well. And, again, this is something that we make regular representations to the UK Government on. There is work here for Government to do, both at Welsh Government level and UK Government level. There are also things that the industry itself can do; for example, the work that the industry has done on a voluntary basis in terms of reducing salt levels in food is actually held up as a global example of good practice. So, there’s a role there for the industry to see what more it can do in terms of sugar and fat content too.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

With respect, even though I acknowledge the work that is being done in Wales to tackle smoking, when I’m talking about the successes that have happened over the past decades, I’m talking about successes that have happened on a worldwide basis as this problem has been recognised. It’s clear to me that we need to take a long-term approach, starting now, with regard to obesity too.

I hope that the debate this afternoon will be a way to bring a number of ideas to the table with regard to further steps that could be taken here. But the parallel with smoking, I think, does give us one other warning, I believe. A huge amount of money has been invested over the years in preventing action by governments on smoking. Can you and the Welsh Government give an assurance that you will be restricting the influence of the corporate world on public health policy in Wales with regard to obesity too, so that we won’t have to wait for decades for action as we had to with smoking and also with preventing climate change?

Rebecca Evans (Labour, Gower)

I thank you for that question and I’m very pleased that Members have chosen to have a debate on public health with regard to the individual Members’ debate this afternoon. I’m really looking forward to hearing the ideas that Members from all parties will come forward with, because we are interested in what works and we’re interested in innovative ideas, so I look forward to the debate this afternoon. In terms of learning lessons from what has happened in terms of tackling smoking, obviously we’re keen to see what has worked in that area and what we can read across to tackling other public health challenges, not least physical activity and smoking, but also issues around substance misuse more widely, such as the over-consumption of alcohol, for example.

Elin Jones (Plaid Cymru, Ceredigion)

The Welsh Conservatives’ spokesperson, Angela Burns.

Angela Burns (Conservative, Carmarthen West and South Pembrokeshire)

Thank you, Presiding Officer. Cabinet Secretary, the Royal College of Paediatrics and Child Health have highlighted that bronchiolitis in babies is a major winter pressure on the Welsh NHS. I’m sure you’re aware that the Joint Committee on Vaccination and Immunisation recommends palivizumab and Synagis as vaccinations that should be offered to high-risk groups to help protect against the effects of bronchiolitis. What advice has been provided to the health boards to ensure that a consistent approach to this matter is employed?

Vaughan Gething (Labour, Cardiff South and Penarth)

We expect all health boards and the wider NHS Wales system to follow consistently the advice of the Joint Committee on Vaccination and Immunisation. That’s a stance this Government takes on each of these issues.

Angela Burns (Conservative, Carmarthen West and South Pembrokeshire)

I’m very pleased to hear you say that Cabinet Secretary because, in fact, in England, the NHS uses a centralised route of funding to pay for these injections, which ensures that at least the minimum guidelines are met. I’m sure you’re aware, but evidence is demonstrating that by considering small cohorts of at-risk babies, there’s a clear economic case for using Synagis due to the subsequent reduction in hospital admissions. However, there is widespread variation on the decision making in Wales with regard to babies being able to access medicine, with health boards taking different approaches and it’s slipping between the gaps in specialities. So, will you consider looking at a change in either the way the vaccine is funded or looking at changes in how you might be able to issue more guidance on this matter?

Vaughan Gething (Labour, Cardiff South and Penarth)

Yes, and if the Member wants to write to me with the information that she believes she has, I will be happy to look at that and take it seriously and consider what we can do next to improve the position in Wales.

Angela Burns (Conservative, Carmarthen West and South Pembrokeshire)

I’m even more delighted to hear you say that. I just want to run past you one particular family, whose 12-month-old twin girls were 28 weeks premature. They’ve both suffered from bronchiolitis on four occasions this season alone, resulting in nine hospital admission days and six separate visits to A&E. These babies have been denied the vaccine as they do not fall within the strict vaccination criteria. However, the constant admission to hospital and having to persistently fight the virus has put a huge strain on the family as well as stunting the babies’ development, particularly one who has got cerebral palsy due to her being so prem. Is it possible for us not just to look at the health boards obeying the guidance issued by the JCVI, but also enable them to be a little bit more lateral in their thinking in such circumstances so that they would look at the overall picture and demonstrate the flexibility allowed to help alleviate the pressure on their hospitals, on NHS finances and on that family, families like them, and those babies? It is £600 per injection compared to nine hospital stays and six visits to A&E. I would have thought that it’s patently obvious.

Vaughan Gething (Labour, Cardiff South and Penarth)

Thank you for the follow-up question and the example. As I regularly say, we take an evidence-based approach and we look at the evidence and the expert guidance that the JCVI provides. I think it’s important to understand whether or not the vaccine would be effective in avoiding the admissions and the course of treatment that you outlined in the individual case. It’s also important to understand whether there is an alternative route to treatment, whether it’s the vaccine or another form. And of course this goes back to the treating clinicians understanding and advising on what is the best course of treatment. We know that there are individual patient funding request routes for treatment that falls outside the normal routes. But I think the most helpful thing is for us to receive the correspondence from you outlining the current position, so that I can look at that properly and seriously and I’d be happy to have a follow-up conversation with you.

Angela Burns (Conservative, Carmarthen West and South Pembrokeshire)

Thank you.

Elin Jones (Plaid Cymru, Ceredigion)

UKIP spokesperson, Caroline Jones.

Caroline Jones (UKIP, South Wales West)

Diolch, Lywydd. Cabinet Secretary, it was extremely distressing to read in the papers of a family’s torment of an 86-year-old man who killed his dementia-suffering wife, aged 85, and then, himself unable to cope, stepped in front of a train. He was his wife’s devoted carer and they leave six children who feel let down and claim social services provision was inadequate. This is unacceptable and we need to improve collaboration as well as communication between departments to prevent people, like this couple from Cardiff, from slipping through the cracks in our system. Whilst our condolences go out to the family, what lessons can we learn and how can we prevent this tragic situation from happening again?

Vaughan Gething (Labour, Cardiff South and Penarth)

I recognise the particular example that the Member highlights. It is a truly tragic case that I understand the family will be incredibly upset about. The challenge in learning lessons not just from this individual matter, but the broader societal challenge we face, is where is the division of responsibility between individuals and their families, between social care and the healthcare service as well. What can we each expect from each other and how do we then make sure that we become a generally dementia-friendly nation?

You will know that I’ve given a commitment in this Chamber to a range of Members who have taken an interest in this particular area that the dementia action plan that we are consulting on will have a draft for consultation issued before the end of this calendar year. That will set out the position of the Government, having worked with and listened to stakeholders, the third sector and individuals themselves living with dementia, to try and understand what we have now but also what we could do in the future. I expect to make a statement to the Chamber at some point in the new year as well.

Caroline Jones (UKIP, South Wales West)

Thank you for your answer, Cabinet Secretary. In 2014, a review of residential care, ‘A Place to Call Home?’, was completed. It concluded that too many older people living in care homes had an unacceptable quality of life. Although a series of requirements for action on care homes has been implemented by Sarah Rochira, our older people’s commissioner, who is dedicated and has a team of dedicated staff, it is clear that her resources will be much overstretched to cover the whole of Wales. Now, more than ever, there is a need for the voluntary sector to become engaged. However, how can we ensure that our most vulnerable in society are treated with the dignity and respect that they deserve?

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the second question. In terms of resources, we’ve just had a debate about the budget and we have to allocate budgets to each of our areas, recognising the reality of the restricted finance we have available to us. The challenge is not always about money, but I think the points that you finished on are really about the culture in the care that we provide and the way that that is commissioned, largely by local authorities, but in terms of the commissioning of healthcare as well, and what we would all expect for ourselves and our own loved ones too.

That point about the dignity with which people are treated, that really is about listening to and properly engaging with the individual and their carers. That goes in to the direction of travel of this Government’s policy over a long period of time. It was started off previously by Gwenda Thomas in bringing a range of matters together about the citizen’s voice within social care. And actually, for the health service too, there is something about catching up some of the ground that social care has made. It’s not on an even basis—it’s uneven within social care; we recognise that—but it’s about generally having a greater engagement with and listening to the individual and their family and working with someone to deliver healthcare, rather than simply providing healthcare to or at a person.

So, there are real challenges here, but I think we should all take some comfort in the fact that, the overwhelming majority of the time, health and social care deliver great dignity and compassion in the care that’s provided. But there shouldn’t be any reason or expectation that we’ll become complacent about the quality of care that is delivered.

Caroline Jones (UKIP, South Wales West)

Finally, Cabinet Secretary, there is much publicity and concern at present regarding top-up fees in care homes and what these fees are being used for. How can we assure relatives and, indeed, residents in care homes that their fees are being used appropriately?

Vaughan Gething (Labour, Cardiff South and Penarth)

Well, where individuals pay top-up fees, it’s because they’re assessed, and either they want to pay a contribution on top or they’re assessed as being able to make a contribution. This is something about the commissioning of care, and it’s about who commissions that care and what standards are provided. There is something for the public sector in the way that care is commissioned, and you will be aware that the Minister is leading the implementation of the Social Services and Well-being (Wales) Act 2014 and the joint commissioning of a range of services between health and local government partners in the future as the Act is progressively implemented. You’ll also be aware of the role of individual families, too, because there’s something about the quality of care and how we get to that point.

So, the public sector definitely have a role, but equally individual families have a role as well in the sort of care they wish to provide with and for their loved ones, but equally people going into care—it isn’t as if people are always in a position where somebody else is making those decisions for them. Where people are paying their own fees, those fees are paid by individuals who often do have capacity to make choices, and it’s about how we equip people to make those choices. That’s why the information and guidance provisions in the social services and well-being Act are so important. I remember, with a range of other people in the Chamber, going through the scrutiny and having exactly these sorts of issues highlighted when the Bill was going through its scrutiny and became an Act. So, we’re well aware of the challenges, there’s no pretence that we’ll resolve them simply by a certain point in time, but it is an issue we recognise exists and one we’re determined to see improve.

David Melding (Conservative, South Wales Central)

3. Will the Minister make a statement on the availability of common ailment schemes in pharmacies in South Wales Central? OAQ(5)0078(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the question. The initial pilot for the common ailment scheme, labelled Choose Pharmacy, which is also the name of the IT platform that helps to deliver it, included a number of pharmacies in Cwm Taf within South Wales Central. There are now 19 pharmacies in Cwm Taf who are already running the common ailment scheme, with a further 19 expected to come on-stream and have the IT platform enabled. Cardiff and Vale expects to enable more pharmacies to come on board to deliver the ailment scheme within the next financial year.

David Melding (Conservative, South Wales Central)

Minister, I’m encouraged about Cwm Taf, but, as you know, 20 of the most common illnesses can be treated in pharmacies very well, and this relieves pressure on GPs. There is an advertising scheme—I think probably run by NHS England, but it still has application here in Wales—encouraging people to seek early advice, including visiting their pharmacies. Now, as I understand, there is there no common ailment scheme yet in Cardiff. I think this is a really good model, and it’s one that really should be used in urban areas, where access to pharmacies is usually very easy.

Vaughan Gething (Labour, Cardiff South and Penarth)

I agree. That’s why this Government is committed to working with the health boards to ensure that at least half of pharmacies in Wales do deliver the common ailments scheme. We’ll then have broader coverage. Cardiff and Vale is not currently delivering the scheme, but it will be, over the next financial year, rolled out within the area. And I recognise exactly the point you make. It’s what was in our manifesto and it’s in our programme for government to make sure that we do deliver more services through community pharmacies, to free up GPs’ workloads and GPs’ time. We estimate that up to 18 per cent of GPs’ workloads and 8 per cent of emergency department consultations are for relatively minor ailments. I’m sure you’ll recall that, when we launched the scheme, I attended a pharmacy, a Sheppards pharmacy, and I managed to have conjunctivitis, coincidentally, at the time. Again, a common ailment that some people do go to their GP for when they don’t need to; it’s perfectly treatable within a community pharmacy setting. What’s been important, though, has been the sharing of a version of the GP record to allow the scheme to go ahead. There’s much more potential than just common ailments in that sharing of the record, and I’m genuinely excited and encouraged about where we are with community pharmacies in Wales and what more we can do within the health service.

Jenny Rathbone (Labour, Cardiff Central)

As the scheme is entirely aligned with prudent healthcare, I wonder why it’s taking so long to implement. Where is the resistance coming from, and what are the ways in which the Welsh Government can get over them?

Vaughan Gething (Labour, Cardiff South and Penarth)

Well, we actually ran a pilot on this before deciding on the roll-out, and I announced the roll-out in March last year. That actually came with an investment of £0.75 million to enable the IT platforms to go up. There are practical things to do to make sure the GP record can be shared. We’ve got sign-off and buy-in from partners, in particular our GP partners, to make sure that the record can be shared, because we want to make sure that the care that is provided within pharmacies is actually shared with the record, so people understand the treatment that is taking place. And I think that is the most transformational part of the scheme that we’re implementing. There should be more that we can do in the safe sharing of that record, with a proper login and with proper audit trails as well. So, I expect that we’ll make real progress over the next year and more. We’ve said that we want at least half of pharmacies to be able to deliver this scheme within the next few years; we actually think that we may be able to go further than that. There are health boards showing real ambition in making sure that community pharmacies are delivering more and more on health, because it is a convenient way to receive healthcare for the individual, but also for the health service a more efficient way of delivering many forms of the different care we’ve talked about.

Huw Irranca-Davies (Labour, Ogmore)

Indeed, one of those health boards that has great enthusiasm for this is Cwm Taf. In fact, David’s question puts me in mind of my visit last week to Sheppards pharmacy in Llanharry where I was hugely impressed with the way that community pharmacies are now embracing these new opportunities with the support of Welsh Government to deal with common and minor ailments and, as the Cabinet Secretary has said, reducing the pressure on GPs and A&Es too. There was a real welcome on my visit for the restatement by the Welsh Government of its commitment to the community pharmacy sector with a £20 million investment to support and enhance pharmacy services in Wales. So, whilst I understand that the details of the funding announcement are currently being negotiated between Welsh Government and Community Pharmacy Wales, would he agree with me that there is a quiet confidence within the sector that, in contrast with England, where the funding is being cut over the next two spending cycles in fact—being cut—here in Wales we could see a significant expansion of the number of services you can obtain in a local pharmacy and not least, as the Cabinet Secretary alluded to, with the new Choose Pharmacy IT programme being rolled out by the Welsh Government, this might be the key to unlocking that sharing of data that will allow more people to be treated for common and minor ailments at their local trusted community pharmacy and less workload on GPs and even on A&Es?

Vaughan Gething (Labour, Cardiff South and Penarth)

I quite agree, that is a direction of travel for this Government and there is a palpable difference in attitude between this Government and the UK Government to the community pharmacy sector. And it’s recognised and reflected back regularly from community pharmacy itself. In England, there’ll be a 4 per cent cut within this year for community pharmacy, going up to 7 per cent the year after. The millions of pounds that are coming out of the sector in England are not taking place here. We’re maintaining our funding for the community pharmacy sector and they’ve responded positively to the challenge that I set out about having a more quality-based system of payments. So, we’re not simply going to provide payment on the basis of volume and dispensing volumes, it will really be about a quality based element too. That is about them providing greater value and greater services to individuals. You’re right to point out that community pharmacies are embedded, they’re local, they’re available and they’re trusted by people. We need to take advantage of the fact that is the position of the highly skilled professionals working in those settings. So, I’m generally enthusiastic and positive about their role now and we expect to develop even more with them in the future as well.

Simon Thomas (Plaid Cymru, Mid and West Wales)

4. Will the Minister make a statement on orthodontic services in the Hywel Dda University Health Board area? OAQ(5)0094(HWS)[W]

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for his question. The health board is working to improve the provision of orthodontic services that meet the clinically assessed dental health needs of their population. This includes developing an outreach service, which means that children needing orthodontic treatment are being assessed closer to home.

Simon Thomas (Plaid Cymru, Mid and West Wales)

Well, they certainly need to improve the service some considerable matter. Can I bring your attention and that of the Chamber to my constituent and the Presiding Officer’s constituent as well, Sheila Joseph, whose 15-year-old son was referred to an orthodontist for consultation for braces? He was told, living in Ceredigion, he would have a three-year waiting list to get braces fitted, whereas in Powys the waiting list is 8 weeks. She decided to spend £3,000 to have private treatment as she couldn’t wait for him to be an adult before he got braces. She now has to travel a round trip every few weeks to Carmarthen simply to have a five minute appointment to have them adjusted, because there is no outreach clinic for orthodontics available in Ceredigion. So, what steps are you taking with the health board, Minister, to ensure that first of all we get an outreach clinic, so that we don’t have the ridiculous three-hour journeys just to get braces adjusted and, secondly, to cut the waiting list in Ceredigion so it’s more commensurate with the waiting lists in other parts of mid Wales?

Vaughan Gething (Labour, Cardiff South and Penarth)

I recognise there is a challenge, as the health board do as well, around the provision within the health board area, including in the county of Ceredigion. There has been a range of assessment clinics across the health board area including a number of clinics in Aberystwyth and I’ve answered a written question to you recently on this particular topic. So, I recognise that all is not as it should be, that some people do wait too long and it is a real challenge for the health board to confront and manage effectively. I’m actually looking forward to receiving a report on the state of orthodontic services across the country—an update on where we are. That should be provided at the end of January, with a greater explanation of where we currently are and where the need for improvement is. But Hywel Dda understand this will be an element that we’ll return to. They can expect that not just from yourself but families themselves who are waiting longer than they should do for the treatment that you outline and identify. So, there’s no sense of complacency and a recognition of improvement needed.

Paul Davies (Conservative, Preseli Pembrokeshire)

Cabinet Secretary, I’m sure you’ll agree with me that the importance of good oral health care can’t be understated and this is particularly important in a social care setting where poor oral health care can affect people’s ability to speak, to communicate and even to eat. Hywel Dda university health board’s local oral health plan update recognises this issue, but outlines very little on what progress has been made in this particular area. Therefore, can you tell us how the Welsh Government monitors the effectiveness of Hywel Dda university health board in ensuring that oral care is integrated into general health and social care plans, so that those in social care settings are receiving the best possible services available?

Vaughan Gething (Labour, Cardiff South and Penarth)

Thank you for the question. I recognise that this is moving on from the specific point about orthodontic services to general oral health care, but this is an issue I’ve discussed with the new chief dental officer in Wales and, indeed, made the point with the British Dental Association as well—that we recognise that oral health care is an important part of the whole person. It’s why we launched an improved scheme for oral health care within residential care settings in the last Assembly. I expect to receive updates on what action is actually taking place, because there is something about recognising the commissioning of care within a residential care setting and about the primary care delivery for that person as well. So, this is something that is in my mind. It is part of the conversation I had with the chief dental officer, and I expect to see further progress made within this term.

Elin Jones (Plaid Cymru, Ceredigion)

Question 5 [OAQ(5)0087(HWS)] has been withdrawn. Question 6, Steffan Lewis.

Steffan Lewis (Plaid Cymru, South Wales East)

6. Will the Minister make a statement on maternity services in Wales? OAQ(5)0079(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the question. We aim to ensure pregnancy and childbirth is a safe and positive experience for every mother in Wales, wherever they live and whatever their circumstances.

Steffan Lewis (Plaid Cymru, South Wales East)

Previously, the Cabinet Secretary suggested to me that Wales did not need a specialist mother and baby unit because such services were being delivered in the community, but on further investigation it appears to me that all but two health board areas in this country have no provision for specialist perinatal mental health care. Presumably, the Government, maybe even the Cabinet Secretary, conducted an impact assessment on the decision to close Wales’s last specialist mother and baby in-patient unit in 2013. Will the Cabinet Secretary make copies of that assessment available in the Assembly library?

Vaughan Gething (Labour, Cardiff South and Penarth)

I’m happy to provide further information on the decision not to commission in-patient provision in Cardiff. It really came from concerns about the ability to provide the right quality of care and the safety of care. This is a highly specialist area for a very small number of mothers, and our challenge was whether we could safely do that in Wales or not. What I’m not prepared to do is to commission care that is of poor quality and to simply highlight the fact that it’s local as opposed to the right quality of care. We’re currently commissioning that service either within the English system in the north-west of England or, indeed, in Bristol for south Wales. Most of the care, though, could and should be provided within the community; that’s the point that I’m trying to make. We need to improve the community provision of care, because we do recognise that for a range of mothers, there are mental health challenges that come after the birth of a child. So, it’s a real need that we recognise. That’s why we’re investing additional sums of money in community provision, but I’m more than happy to make available to Members the assessment that we undertook, or the assessment undertaken by the Welsh healthcare specialist commissioning group on why that service was decommissioned within Cardiff at the time, and the most recent assessment of need and ability to do that safely and to the right quality for mothers here in Wales.

Siân Gwenllian (Plaid Cymru, Arfon)

7. Will the Minister make a statement on the progress of the Bangor medical school plans? OAQ(5)0088(HWS)[W]

Vaughan Gething (Labour, Cardiff South and Penarth)

As the Member knows from our previous exchanges, I have agreed to consider the case for a medical school as part of the work considering the wider workforce requirements for health professional education and training in north Wales. Any decision needs to be supported by clear evidence that change would help deliver on our priorities to train and retain more staff for NHS Wales.

Siân Gwenllian (Plaid Cymru, Arfon)

A medical school for Bangor has been included as a high-level project in the north Wales growth bid, which has been agreed and supported by each of the six local authorities in north Wales. A letter that I received from you recently notes that you are expecting a briefing from officials on this issue. I note that the words ‘business case’ have disappeared from the letter, but that’s what was pledged before the summer—a business case rather than a briefing. Can you give me an assurance, as well as people in the north-west of Wales, that the case to develop a medical school in Bangor is being given priority by you and your Government?

Vaughan Gething (Labour, Cardiff South and Penarth)

Yes, I’m happy to confirm that a range of active discussions have taken place with stakeholders in north Wales, including with local government, Bangor University, Glyndŵr University and Cardiff University, who all take part in the current north Wales clinical school. We need to receive a business case setting out the evidence for a potential medical school. I expect to receive a briefing on the updated work that is ongoing. The important point here is doing the right thing to ensure we actually provide greater opportunity for training to take place within Wales, for recruitment and retention to take place in Wales, and how we give people different opportunities and enhanced opportunities to undertake their medical training within north Wales and across the country more broadly. The North Wales Clinical School has helped to do some of that. It means there are more fourth and fifth year placements taking place within north Wales, and that’s practically led to more juniors choosing to come to Wales after a placement within north Wales. We need to understand what’s been successful about that and what more we could do. That fits into our shared expectation and desire to have a healthcare system that has the right quality of training, retains and recruits the right staff that have the sort of healthcare skills that we want, and really recognises and reflects on those, not just Welsh-domiciled students who may not want to train within Wales and may go to other parts of the United Kingdom for their medical training, but how we attract them back as well as attracting them from other parts of the UK and more broadly afield to come into Wales for their medical training. So, I’m genuinely open-minded about the potential case for a medical school in north Wales. I simply need the evidence about what is the right choice to make to meet those ambitions to deliver the sort of healthcare that we need.

Andrew RT Davies (Conservative, South Wales Central)

8. Will the Minister make a statement on what steps he is taking to improve health services in South Wales Central? OAQ(5)0089(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

We continue to work with all the health boards and trusts in the South Wales Central area to improve standards. This includes strong governance, leadership and performance management systems, the monitoring of incidents and concerns, quality improvement initiatives like our 1000 Lives Improvement programme and, of course, the robust inspection of services.

Andrew RT Davies (Conservative, South Wales Central)

Thank you for that answer, Cabinet Secretary. I’m sure you, like me, would have been pretty horrified by the number of ambulances that are outside the A&E department at the University Hospital of Wales and the pressure that puts on the staff and the concern it puts in patients’ minds. I know I’ve asked for an urgent question on this particular matter because the issues around the A&E department are ongoing in Cardiff, around staffing issues. What measures are you taking to work with Cardiff and Vale to make sure that those pressures are alleviated, especially as we go into the busy Christmas period because it cannot be acceptable to have that many ambulances parked outside an A&E department, which are basically off call and unable to do the job that they’re doing around South Wales Central, of bringing people into our hospitals when they have an emergency.

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for the follow-up question. On ambulances, it’s important not to lose sight of the fact that we have a much improved service compared to where we were two years ago. But it’s part of a whole healthcare system: those that don’t need to call for an ambulance could be safely and properly treated within primary care—potentially going back to Choose Pharmacy; we still have relatively minor ailments arriving in our emergency departments—and what then happens to make sure people, if they do need to be in hospital, are safely transferred in a timely manner into the hospital setting, and, also, that they’re then able to leave hospital safely and go back into the community as well. So, it isn’t just one part of the system we’re concerned with.

I think the photos of ambulances outside A&E departments always raise an element of interest, but I’m much more interested in how long does it take to safely transfer someone to the next point of their care, and the necessary part of the care journey. So, how long does it take a large number of ambulances to offload their patients to make sure they get into where they need to be and for those ambulances to then be released into the system? So, this is work that we’ve undertaken. Actually, there’s much more scrutiny on this since we’ve introduced the new model because of the quarterly figures that highlight the number of lost ambulance hours on handover. So, there’s been guidance sent to the whole healthcare system about improving handover, taking on board the excellence and the best practice in Cwm Taf within the South Wales Central area. So, there are a range of improvement actions and there’s no complacency about it. We expect there to be more challenge within the winter period, as you would expect in every part of the healthcare system, but I am confident that, over the next year, we’ll still see continuing improvement and scrutiny and challenge within the system as we understand more of what needs to work. If we don’t look at it as a whole healthcare system itself, then I think we’ll have the wrong answers at the wrong time and we’ll just transfer the pressures to different parts of the system. So, I think we have the right approach, but let’s not pretend this will be easy. The hardest part of the job is not for me as a politician; it’s for people working on the front line in very real and very difficult circumstances.

Dawn Bowden (Labour, Merthyr Tydfil and Rhymney)

9. Will the Cabinet Secretary make a statement on any discussions with health boards over the safer use of prescription medicines? OAQ(5)0086(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

I thank the Member for her question. It is the responsibility of the prescribing healthcare professional to ensure an individual understands what it being prescribed and how it should be taken. Community pharmacists have an important role in ensuring the patient understands the medication regime at the point of dispensing.

Dawn Bowden (Labour, Merthyr Tydfil and Rhymney)

Thank you, Cabinet Secretary, for that response. Can I highlight some work that’s going on in Cwm Taf Local Health Board at the moment, who’ve been running a campaign to promote public education and awareness of the effective use of prescription medicines over about the last 15 or 16 months? Since the health board started its campaign, support and advice has been given to more than 7,000 individual regular medicine users around clearing out old medicines, identifying, if any, which patients are not taking prescribed medicines, bringing medicines into hospital if admitted, and taking when on holiday. One impact of the campaign has been the return of unwanted medicines in a quantity that would fill three double-decker buses.

This may also highlight an issue around over-prescription, as well as patients not taking their medication, for whatever reasons there might be. Of course, the costs associated with that would also need to be addressed. But would the Cabinet Secretary join me in applauding this excellent campaign on the part of Cwm Taf university health board and encourage other health boards to consider similar initiatives?

Vaughan Gething (Labour, Cardiff South and Penarth)

Yes, I’m happy to do so. It’s a very visible figure to think about—enough to fill three double-decker buses. We recognise that there are real challenges here and real areas for further improvement. The points you make are about old medicines and people returning those so that they can be safely disposed of, and, in particular, points about polypharmacy and understanding how different medications interact with each other or whether they’re actually counteracting the things they’re trying to treat. It’s why I’ve been encouraged by the fact that primary care clusters have indeed hired and actually employed a range of clinical pharmacists to do this for them, so it’s freed up GP time as well as improving the quality of care that the individual receives.

It also goes back to the previous question about making sure that, within the community pharmacy system, we reward quality, and this is part of a quality measure to understand not just how we dispense by volume, but to improve the quality of care that is delivered. In fact, Cwm Taf have taken a lead in this, for example, with their electronic discharge letters from the hospital service, as well. So, there is a real gain to be made with discharge from the hospital setting, through the hospital pharmacy service, and a bigger role for community pharmacies there as well. So, I’m encouraged by where we are and where we’re going, but this does highlight that there’s certainly much more improvement we could and should make, and I think individual people see a real benefit as a result of that.

Mike Hedges (Labour, Swansea East)

10. Will the Minister provide an update on the ‘A Regional Collaboration for Health’ programme? OAQ(5)0080(HWS)

Vaughan Gething (Labour, Cardiff South and Penarth)

Thank you for the question. The Welsh Government is supporting Abertawe Bro Morgannwg University Local Health Board and Hywel Dda Local Health Board, together with Swansea University and Trinity university in the development of a strategic business case, which we expect to be completed in the spring of next year.

Mike Hedges (Labour, Swansea East)

Can I thank you for that response? I am also supportive of the principle of closer working between the two health boards and the two universities. I want to highlight the importance of Morriston Hospital as a regional centre for the area covered by the two health boards. What progress is being made on greater use of the hub-and-spoke model that has worked so well in renal services and could be applicable to other services, such as the orthodontic service that was discussed earlier?

Vaughan Gething (Labour, Cardiff South and Penarth)

There’s real learning to take from renal services within south-west and mid and west Wales. Investments are being made across the patch in terms of the dialysis provision, but, in particular, I think it’s a useful opportunity to highlight that there’s genuine UK-wide leading practice taking place within the renal unit in Morriston, in particular dialysis at home and overnight dialysis as well. It makes a really big difference to individuals. If they’re able to dialyse at home, they get a much better quality in terms of the outcomes of their patient care, and particularly so for those people who are younger and those people who have the most active lives, and for parents, with the ability not to have their normal day-to-day life or working life interrupted by the need to go into a dialysis centre during the day. So, there’s an awful lot to learn about the way that’s already been developed.

I’ve been really clear with the health service that this greater collaboration between health boards on the delivery of services across health board areas is part of what we need to see developed and progressed and implemented across the whole healthcare system within NHS Wales. So, there is lots of learning to take, and I’m generally encouraged by the progress that’s already been made by the two health boards and the university partners.

Elin Jones (Plaid Cymru, Ceredigion)

Thank you, Cabinet Secretary.

3. Urgent Question: The Wales and Borders Rail Franchise

Elin Jones (Plaid Cymru, Ceredigion)

I have accepted two urgent questions under Standing Order 12.66, and I call on Dai Lloyd to ask the first urgent question.

David Lloyd (Plaid Cymru, South Wales West)

Will the Minister make a statement on devolving the Wales and Borders rail franchise, following comments yesterday by the Secretary of State for Transport in Westminster suggesting that the UK Government will not devolve the franchise as a whole? EAQ(5)0098(EI)

Ken Skates (Labour, Clwyd South)

Yes. The Secretary of State’s comments relate to how legal functions might be shared in the future, and final agreement in this area is yet to be reached. What we would stress, as the Secretary of State has confirmed, is that Welsh Government will either receive functions in respect of cross-border services, or be able to exercise them on his behalf. The details of the agreements reached on legal functions will not affect the range of services delivered through the next Wales and borders franchise.

David Lloyd (Plaid Cymru, South Wales West)

Thank you very much to you for that response. Naturally, there was a great deal of talk yesterday following the comments made by the Secretary of State for Transport, Chris Grayling, who made it clear that full control of the franchise will not be devolved to the Welsh Government. That was contrary to what we came to understand was your situation, from your Government, and also the Westminster Government. We’re not talking about legal responsibility alone. He talked about more than that. He also mentioned day-to-day management yesterday. The Secretary of State said clearly, and I quote,

nid ydym yn datganoli cyfrifoldeb dros y fasnachfraint gyfan ar gyfer Cymru... rydym yn gwneud hynny’n rhannol. Rwyf wedi dweud wrth Lywodraeth Cymru fy mod yn hapus iddi gymryd rheolaeth dros reilffyrdd y cymoedd, gyda golwg ar ddatblygu’r system fetro y maent yn gobeithio ei rhoi ar waith.

Nawr, mae’r sylwadau hyn yn amlwg yn tynnu sylw at ddatganoli rhan o’r cyfrifoldeb dros fasnachfraint Cymru a’r gororau ac nid at ddatganoli llawn, sy’n gwrthddweud yn llwyr y sicrwydd a roddodd Ysgrifennydd Gwladol Cymru a Llywodraeth Cymru ar achlysuron blaenorol. Mae’n werth pwysleisio’r gair ‘rhannol’ yma gan fod hwn, os yw sylwadau’r Ysgrifennydd Gwladol yn gywir, yn gytundeb datganoli gryn dipyn yn llai nag oedd unrhyw un wedi’i ddychmygu hyd yma. Efallai y bydd Ysgrifennydd y Cabinet yn fodlon ymhelaethu ymhellach ar y trafodaethau y mae ei Lywodraeth wedi’u cael gydag Ysgrifennydd trafnidiaeth y DU ynglŷn â datganoli’r fasnachfraint. Er enghraifft, a fydd map y fasnachfraint yn parhau yr un fath, fel yr addawyd neu a fydd Llywodraeth Cymru yn etifeddu gweddillion masnachfraint? Mewn ymateb i gwestiwn ysgrifenedig gennyf ar 11 Hydref, dywedasoch eich bod yn disgwyl, ac rwy’n dyfynnu;

y bydd y fasnachfraint nesaf... yr un fath ar y cyfan.

Os na allwn, fel y dywedodd yr Ysgrifennydd trafnidiaeth ddoe, ac unwaith eto, rwy’n dyfynnu:

gael sefyllfa lle rydym ni, y Llywodraeth yn San Steffan, yn ildio’r rheolaeth dros wasanaethau yn Lloegr i Lywodraeth Cymru,

beth y mae hynny’n ei olygu ar gyfer gwasanaethau trawsffiniol cyfredol? Pwy fydd yn gyfrifol am oruchwylio gweithrediad y gwasanaethau hyn—Llywodraeth Cymru neu’r Adran Drafnidiaeth? Neu a fyddant yn cael eu hollti ar y ffin? Beth y mae hyn yn ei olygu ar gyfer gwasanaethau trên rhwng gogledd a de Cymru sy’n gorfod teithio drwy Loegr? Nawr, mae’r rhain yn gwestiynau pwysig y mae angen eu hateb os ydym am gael unrhyw eglurder ynglŷn â dyfodol y fasnachfraint. Bydd y Siambr yn gwybod, wrth gwrs, fod proses gaffael ar gyfer y fasnachfraint nesaf ar y gweill ers amser, gyda phedwar cwmnï gweithredu trenau wedi cyrraedd y rhestr fer ym mis Hydref.

Ysgrifennydd y Cabinet, rwy’n gobeithio y byddwch yn gallu fy argyhoeddi, yn eich ymateb, fod Llywodraeth Cymru yn gwybod beth sy’n digwydd. A yw’r cwmnïau trenau hefyd yn gwybod beth y maent yn gwneud cais yn ei gylch bellach? Oherwydd, a bod yn onest, boed yn wleidyddiaeth amlwg neu’n anfedrusrwydd amlwg, mae’r modd y caiff y broses hon ei chamreoli ar hyn o bryd yn dangos bod Llywodraethau ar bob pen i’r M4 yn gwneud cam â Chymru unwaith eto. Mae eich plaid yn San Steffan wedi methu â sicrhau y byddant yn datganoli’r cyfrifoldeb dros y rhwydwaith rheilffyrdd i Gymru fel rhan o Fil Cymru, ac yn awr mae’n ymddangos na all eich Llywodraeth sicrhau y bydd y rheolaeth dros fasnachfraint Cymru a’r gororau yn cael ei datganoli’n llawn. Mae’r sefyllfa hon yn bygwth datblygu i fod yn dipyn o draed moch. Felly, gofynnaf i chi: ai canlyniad anfedrusrwydd Llywodraeth San Steffan a’r Blaid Lafur yng Nghymru yw hyn, neu a yw’n tynnu ôl yn ddifrifol ar un o bileri allweddol y rownd nesaf o ddatganoli i Gymru?

Ken Skates (Labour, Clwyd South)

I was intending to be, unlike the Member, generous in my response and suggest that it was a mistake of his rather than a mischief that has led him to assert many factual inaccuracies. But I’m going to begin with the quote that he repeated, from Chris Grayling, which he did not repeat in full. Chris Grayling said,

‘I need to correct the hon. Gentleman on that: we are not devolving responsibility for the whole Welsh franchise’,

and you then stopped, but Chris Grayling went on to say, ‘as he describes’. He went on to say, with regard to giving up control to the Welsh Government, ‘without checks and balances’. What this regards is ensuring that there is accountability for passengers that travel between English locations on the English side of the border within the Wales route. These are agreements that are yet to be reached, but I am on record as saying that it is absolutely right and proper that we should have accountability in place for those elements of the service. We’ve agreed with the UK Government—let me be absolutely clear, again, today—that all services operated under the current Wales and borders franchise will be included in the next Wales and borders franchise and that we will lead on the procurement of these services. The four bidders know that. The map, I said, would largely be unchanged. In fact, subject to us being able to secure train paths, we’ve also secured the Secretary of State’s agreement to operate services to Liverpool and Bristol under a future Wales and borders franchise. So, actually, even more so than saying the map will remain unchanged, in the future it looks as though we will be able to extend services.

Elin Jones (Plaid Cymru, Ceredigion)

Thank you, Cabinet Secretary.

4. Urgent Question: Avian Flu

Elin Jones (Plaid Cymru, Ceredigion)

I now call on Simon Thomas to ask the second urgent question.

Simon Thomas (Plaid Cymru, Mid and West Wales)

Will the Minister make a statement on steps the Welsh Government is taking to protect birds in Wales from avian flu? EAQ(5)0075(ERA)

Lesley Griffiths (Labour, Wrexham)

Diolch. I declared Wales as an avian influenza prevention zone, a precautionary measure to help prevent infection from wild birds. Working closely with England and Scotland, we are monitoring the situation and have increased surveillance. I have urged keepers to improve biosecurity and be vigilant for signs of disease.

Simon Thomas (Plaid Cymru, Mid and West Wales)

I’d like to thank the Cabinet Secretary for that brief statement. There was some confusion this morning when we heard on the news that there was a ban on keeping poultry in the open air in England and Scotland, without any mention of Wales. It’s clear now that the rule is being implemented in Wales also. Can I ask the Minister, therefore, just a few questions that I think are relevant?

First of all, has this been agreed jointly? The Minister said that there is collaboration, but was anything jointly agreed between the Welsh Government, the Westminster Government—DEFRA, which is responsible for England—and Scotland? And for how long, therefore, will this prohibition, or these rules, be in place? As we are approaching Christmas and perhaps the life expectancy of some of this poultry isn’t particularly long anyway, but, having said that, there are important businesses in Pembrokeshire producing turkeys, such as Cuckoo Mill Farm, and there is a free-range company in Cardigan—Postance and so on. All sorts of companies are preparing for Christmas and preparing to sell this produce. Does the Government need to take any specific steps to establish the public’s trust in the food chain, because the Government will know that, in the past, any risk of avian flu has raised concerns about produce, particularly meat in our shops? I hope we can avoid any sort of fear of that kind. The final question is: are there any specific steps that the Government is recommending, or intends to recommend, to food producers involved with poultry that could be taken during the next few weeks?

Lesley Griffiths (Labour, Wrexham)

Thank you. Well, the press release did go out from my office last night, so I’m not quite sure why the press release wasn’t picked up. That’s not something, obviously, I have control over. The decision wasn’t taken jointly with UK Government, with DEFRA, or with Scotland. I had conversations with our chief veterinary officer yesterday. She has been in very close contact with, obviously, the CVOs from Scotland and England also. The order I signed last night is for 30 days, so it will last until 6 January. During that period of time, we will continue to monitor very closely. As I said, it is a precautionary measure that we’ve taken. I think the issue you raised about public trust in the food chain is very important, so it’s very good to have the opportunity here. I know the Food Standards Agency has said that the current scientific evidence or advice is that bird flu does not pose a food safety risk to UK consumers. Eggs are safe, for instance. I think it’s also very important for me to say that there have been no cases of avian flu found in Wales or in the UK, but we are monitoring the situation very closely.

Paul Davies (Conservative, Preseli Pembrokeshire)

Cabinet Secretary, the outbreak of this virus is not a new issue, and, as you know, I already tabled questions on this very matter last week, so I welcome the opportunity to hear more about the Welsh Government’s action on this particular matter. I’m pleased that today you’ve announced that a 30-day prevention zone across Wales will now take place. Now, it is crucial that there are adequate funding and resources in place to ensure that agencies are confident that they have what they need to deliver disease control measures in Wales in the event of an outbreak. So, can you tell us what additional support and funding the Welsh Government is considering should the disease threat escalate? The Welsh Government also has a duty to effectively communicate any precautionary measures within the poultry industry and the wider animal welfare network in Wales. So, can you tell us what guidance and support the Welsh Government is giving to those affected by this announcement to ensure they fully understand the situation and what is required of them? Cabinet Secretary, you have made it clear that your department is monitoring the situation across Europe. Perhaps you can tell us a bit more about the specific work that has already been undertaken in Wales to identify the level of disease threat. I know that work has taken place elsewhere in the UK, but it is crucial that the Welsh Government also establishes its own monitoring arrangements to ensure that no stone is left unturned. Therefore, can you update us on the work that your department has done in recent weeks?

Lesley Griffiths (Labour, Wrexham)

Thank you for those questions. I should say that the risk level of avian influenza incursion into the UK is at ‘medium’ for wild birds—that has been raised from ‘low but heightened’—and is at ‘low but heightened’ for domestic poultry. As I say, I do want to say very clearly that this is a precautionary message. I haven’t been asked for any additional funding. I think, when a decision like this is taken, there are obviously, again, precautionary measures in place with our poultry keepers et cetera to make sure that they are able to react very quickly to these decisions.

I mentioned that the chief veterinary officers work very closely together. When I was talking to our chief veterinary officer yesterday, it was very clear that she had been having discussions with her team. There are no cases, as I say, in Wales or in the UK. As far as I am aware, the nearest case to us is Calais in France, and that’s been there for a little while. There are 14 countries across the EU and Russia that have cases of avian influenza, and I thought it was really important to bring this prevention zone forward. I know that England and Scotland did it. As I say, the decision wasn’t taken very jointly, but I thought it was good to have a GB-wide decision in this case. I do want to assure Members and the public that we will continue to monitor this very carefully.

Elin Jones (Plaid Cymru, Ceredigion)

Thank you to the Cabinet Secretary.

5. 3. 90-second Statements

Elin Jones (Plaid Cymru, Ceredigion)

The next item on our agenda is the 90-second statements. David Melding.

David Melding (Conservative, South Wales Central)

Llywydd, 100 years ago, David Lloyd George became Prime Minister. The Government he formed led the allies to a hard-won victory, massively extended the franchise, and established health and housing as governmental priorities. Wales seemed to find a hero figure—the Arthur of legend. The first man without independent means to become Prime Minister, Lloyd George demonstrated that the Welsh could reach the highest offices of state. Although the Tudors occasionally thought of themselves as Welsh, or at least Shakespeare had those thoughts for them, Lloyd George was Welsh to the core. It was the very source of his energy. As Chancellor of the Exchequer, he had already reshaped the state. After his people’s budget of 1909, the primary purpose of the state was not to protect property but to promote the welfare of the people—Llywydd, perhaps I should say the ‘gwerin’. It led to that amazing battle with the House of Lords and one of the funniest quips in our political history, when he said that the House of Lords is

‘not the watchdog of the constitution, but Mr Balfour's poodle’.

Well, perhaps it went down better in Edwardian times. [Laughter.]

Lloyd George is among our greatest Prime Ministers. Of his contemporaries, only Churchill and Atlee surpassed him—Churchill by ensuring victory in an even grimmer conflict; Atlee by forging a peacetime consensus for a welfare state. Yet, in his range, he had no equal. In periods of war and peace, Lloyd George displayed the highest statecraft. Llywydd, we live in a period of remarkable social and geopolitical change, and it is fitting that we should be inspired by the achievements of Lloyd George, which tackled challenges that were deeper still.

Elin Jones (Plaid Cymru, Ceredigion)

Leanne Wood.

Leanne Wood (Plaid Cymru, Rhondda)

Diolch, Lywydd. The struggle at Standing Rock reservation in the United States has captivated the world: the people versus the Dakota Access pipeline; an ancient and proud community versus the power of the corporations. In a year where the millionaires and billionaires seem to be winning everything, Standing Rock shows that popular resistance can still win. It shows that there are people who will not let our natural resources be damaged by those who only want to wreck the land for profit. By standing together, the people have won an initial victory in the struggle, but they and we must remain vigilant. Thanks to the power of social media, the native Americans have inspired people across the world. They asked for our solidarity and we gave it as part of the new activism where local struggles are connected globally. We in Wales know only too well the value of our natural resources. Was Tryweryn not our own version of Standing Rock? Remembering our own Welsh history, let us say today that Wales stands with Standing Rock.

Elin Jones (Plaid Cymru, Ceredigion)

Ann Jones.

Ann Jones (Labour, Vale of Clwyd)

Diolch, Lywydd. Last Friday I had the pleasure of meeting four inspirational year 11 pupils from Denbigh High School, Amy Martin, Jessica Briody-Hughes, Holly Roberts and Katie Rowlands, who are Team Tachyon. They are the world champions for the second time in the F1 in Schools challenge competition, having swept the board for awards, defending their best verbal presentation and best sponsorship and marketing awards that they had won in the world finals in Singapore last year, and successfully retained in Texas this year.

They have a cabinet full of trophies and have this year attained the FIA Women in Motorsport award to add to their impressive collection. They have fully embraced all the challenges using STEM subjects, and are gaining some valuable skills and experiences for their later life. Amy has been offered a place in the F1 Williams team academy and is keen to go on to a career in engineering. They are truly inspirational young women who have taken on the challenges of the project outside of their schoolwork. They’ve become mentors for primary school children taking the F1 challenge now, and made their families, their schools, their communities and me very proud. I hope this Assembly will also be proud of their achievements. Diolch.

Elin Jones (Plaid Cymru, Ceredigion)

Thank you to the Members.

6. 4. Debate by Individual Members under Standing Order 11.21(iv): Public Health

Elin Jones (Plaid Cymru, Ceredigion)

The next item on our agenda is the debate by individual Members under Standing Order 11.21. I call on Jenny Rathbone to move the motion.

Jenny Rathbone (Labour, Cardiff Central)

Diolch, Lywydd. One quarter of the adult population in Wales is obese, and nearly 60 per cent are overweight: a combination of too much alcohol, too little exercise and too much food laden with fat, sugar and salt. The consequences are serious in terms of diabetes, cardiovascular disease and many cancers. These three conditions are the overwhelming causes of early death and they threaten to undermine and indeed reverse whatever advances are made in medical treatment of life-threatening diseases.

The chief medical officer’s latest annual report highlights that whilst the rich are getting healthier and living longer, the poor are not. The life expectancy gap is already as much as nine to 11 years between different areas of Cardiff alone. This is unfair, avoidable and something we should be no longer prepared to accept or tolerate. We need urgent and decisive action to tackle this health epidemic, which will otherwise bankrupt the NHS. Across the UK, it already costs the NHS £5 billion a year, and that’s projected to double to nearly £10 billion by 2050. And the wider cost to society will reach £50 billion a year.

So, despite the five-a-day campaign, our vegetable consumption is in decline—no better than it was in the 1970s. Less than a third of all adults reported eating five or more portions of fruit and vegetables a day. People are simply not heeding what we’re telling them, and only 1 per cent of food advertising is spent on promoting vegetables.

Jenny Rathbone (Labour, Cardiff Central)

We’re in the grips of an obesogenic culture and we need to act now. Treating people wo have life-threatening levels of obesity is extremely difficult and complex. We must focus on prevention. And unfortunately and tragically, this is not just an adult disease. Over a quarter of our four and five-year-olds in Wales are overweight or obese, and that compares badly with 22 per cent in England. In the most deprived areas of Wales, that rises to over 28 per cent.

So, despite Appetite for Life, despite the Healthy Eating in Schools (Wales) Measure 2009, Wales still has the worst rate of child obesity in the UK. Awareness raising alone hasn’t worked. Greater action on several fronts is required, across all levels of Government. We cannot go on like this.

So, Public Health Wales, in ‘Making a Difference’, says there are three things we could do: first, we could restrict the marketing of unhealthy food, which is not a devolved matter and therefore not something we probably need to ponder on here; secondly, promote healthy eating in schools; and, thirdly, use taxes to get the message across.

‘Appetite for Life’ was introduced in 2008, and became compulsory in 2013. It got rid of the sale of fizzy drinks and sweets from vending machines, but I’m not convinced that it has produced the life change, and system change, that is required in all our schools. It’s fine as far as it goes, but it does not go far enough. How many school governors are aware that they are responsible for ensuring that the mandatory Healthy Eating in Schools (Wales) Measure 2009 is being observed? How would they go about knowing where the ingredients had come from, and what was in them? I’ve yet to see any training on this provided by my local authority, as a school governor.

At the end of last month, I visited Cornist Park School in Flint. There, they have doubled the number of school meals taken since they adopted the Food for Life charter mark, established by the Soil Association. Children order their meal at registration every day, so they choose what they’re going to eat, and are guaranteed to get it. As catering staff know exactly how many portions they have to cook for, that eliminates virtually all food waste. The menu of six dishes to choose from is supplemented by a salad bar, which is actively promoted by staff. There are carrot and cucumber sticks in little bowls on the table, which pupils can help themselves to. At least 75 per cent of the menu of six options is freshly prepared from unprocessed ingredients. Seasonal products are promoted, and many children report that lunch is the highlight of their day.

The headteacher says that the kitchen is at the heart of her school. Complementing the actual meals, the school uses food education as part of the curriculum, and pupils and their families are involved in improving the school lunch experience. At least once a year, the community is invited for lunch, helping to promote healthy eating at home, as well as at school. All of Flintshire’s 73 schools have adopted the entry-level food for catering mark back in 2002. The catering manager assured me that it is no more expensive than meeting the healthy eating in schools Measure, you just have to be a bit more careful as to where the food comes from, and why wouldn’t we want to do that, when we’re dealing with children?

The cabinet member for education says,

‘We want our parents to have confidence in the service, and this demonstrates to them our commitment to their children’s lunch time experience.’

Why is it that other local authorities have not followed Flintshire’s example? The north Wales consortium of LEAs all thought it was a good idea back in 2012, but none have followed Flintshire’s lead, nor has any other local authority across Wales. Yet, across the UK, 1.6 million meals are served every day in education and healthcare settings that meet the Food for Life criteria, including our very own canteen. Over half our universities have a Food for Life award. Why would we not want the same for all of Wales’s pupils?

There is an opportunity here for food producers too because Flintshire only has the bronze level of accreditation and, in order to get the silver and gold award, they’d need to be able to source more organic suppliers who can deliver within the price range and with the reliability that LEAs require. So, it’s encouraging to note that Organic Centre Wales has been working with the Flintshire school meals service to deliver a range of activities, including training for school cooks, farm visits, gardening support, and school-yard farm markets. So, the catering mark offers incentives for caterers to use more local produce, which would help to keep supply and demand for Welsh produce within Wales, reaping the benefits of having our own national food procurement service.

Secondly, I want to look at what we could be doing to tax what is bad for us. Finland, France, Hungary and Mexico have all started to do this. In France, a tax on sugar and artificially sweetened beverages—presumably similar to what the UK Government proposes—as well as, in Finland, a tax on sweets, ice cream and soft drinks, have already shown some benefits. But, in Hungary, they’ve gone even further. Since 2011, they have a public health product tax on sugar, sweetened drinks, confectionary, salted snacks, condiments and flavoured alcohol. The beverages are taxed if they contain more than 8 gm of sugar per 100 ml and food is taxed if it contains more than 1 gm of salt or more than 275 calories per 100 gm. Sales of taxable products have fallen by an average of 27 per cent in the first year, and consumers are either choosing a cheaper, healthier product or a healthier alternative. Two years in, the WHO observed change across all income groups and age groups, but a greater change amongst younger people and lower income groups. Three years in, the resumption in healthy food consumption has been sustained and 40 per cent of Hungary’s food manufacturers have reformulated their products in order to avoid the taxation.

Mexico has by far the world’s highest death rate from chronic disease caused by the consumption of sugary drinks—nearly triple that of the runner-up, South Africa. Excessive consumption of Coca Cola and other soft drinks kills twice as many Mexicans as the trade in the other kind of coke that Mexico is infamous for. Mexico, so far from God, but so close to the United States. Unfortunately, the United States is where most of the obesogenic food and drinks industry is based and it is the globalised, Americanisation of our diets that is the principal cause of our woes and certainly in Mexico. In the last 14 years, the consumption of fruit and vegetables dropped by 30 per cent in Mexico, and the consumption of beans dropped by half, which, along with rice and corn, used to be the staple diet. An 8 per cent tax on non-essential junk food and a 10 per cent tax on sugar-sweetened drinks has had an amazing impact in the first three years. There has been a 5 per cent reduction in the purchase of taxed food items, but a 10 per cent reduction amongst lower income households—a greater impact than that of tobacco taxes on tobacco consumption. The impact was concentrated among the poor who bear the biggest cost in terms of obesity and diabetes. As in Hungary, many companies reformulated their products to avoid the tax.

‘The BMJ’ has since said that this has had an amazing impact in terms of the amount of sugar-sweetened drinks that were consumed in the past. The impact of the tax overall on nutritional consumption and on weight gain or loss remains to be studied. But taxes, I think we already can see from these examples, do change what we eat and drink and our own health professionals are calling out for this. The British Medical Association has called for a 20 per cent tax on fizzy drinks and fruit drinks in a bid to combat our obesity crisis.

Wales should be at the forefront in developing innovative policies in this area and should recognise that tackling the burden of diet-related disease will require a series of food-policy interventions, including the proven use of economic measures and price incentives. We cannot wait for the outcome of the Health Wise Wales research, being conducted by Cardiff and Swansea universities into the correlation between health and lifestyle; we have to act now.

Rhun ap Iorwerth (Plaid Cymru, Ynys Môn)

Thank you to everyone who is participating in this important debate this afternoon. I’m very pleased to be one of the co-sponsors of this motion.

It’s no overstatement to say that obesity is one of the greatest health challenges of our age. The statistics over the past 15 years have demonstrated a very clear increase in the number of adults and children who are overweight or obese. That affects all age groups, as I say, which means that the tide doesn’t seem to be turning in the same way as evidence suggests that it has turned in relation to smoking and the consumption of alcohol, where younger people are less likely to be adopting lifestyles that are damaging to their health, as compared to young people in previous generations.

What is particularly concerning, I think, is that childhood obesity seems to be worse now than it was even just a few years ago. I am saddened to say that my constituency of Anglesey has the poorest statistics for childhood obesity in Wales, with a little under a third of five-year-olds considered to be overweight or obese. Saying that this is going to cause problems in the future and is storing up problems for the future is clichéd, but it’s entirely true. Therefore, it’s clear to me that the need to tackle this problem requires from us at least the same level of effort, commitment and resource as tackling smoking has been afforded on a global level over a period of decades.

In some ways, the parallels with smoking are very clear. The science behind smoking has been clear for many decades, despite what one former UKIP leader may think. But, of course, it was only in 2007 that the ban on smoking in public places came into force. Big tobacco had such a lot of power to limit, first of all, understanding of the science and then to prevent steps being taken to reduce the use of harmful products. It was only through heavy taxation, banning public advertising and providing consistent messages that we have managed to get smoking rates down. Even having said that, of course, the numbers are still too high.

But, in some way, tackling obesity is going to make resolving the problems of smoking, or tackling the issues around smoking, look very easy. Although people understand clearly what the health risks of smoking are, with obesity the situation is a lot more complex and ambiguous in many ways. Identifying one type of food to tackle, in the way in which cigarettes were targeted, is more problematic, not least because companies and organisations behind certain produce are always going to bombard us with messages of, ‘Don’t pick on us; pick on someone else.’ On top of that, a very significant difference is that you can’t smoke cigarettes moderately without them causing damage, but you can consume many of these foods. Those types of food only become harmful when they are over-consumed.

The NHS responds differently to people who want to give up smoking, compared with those who want to lose weight. People can be encouraged to use willpower to stop smoking, but statistics tend to suggest that that isn’t going to be particularly successful. For someone who wants to go a step further, there is assistance available, with nicotine products, support groups and so on and so forth. But, when it comes to someone who is obese and eager to lose weight, then that level of support isn’t available. The usual approach is to provide some dietary advice and to hope that willpower alone will be sufficient, despite the fact that the temptations of unhealthy food surround us everywhere we look. It’s only when the problems get worse will that patient perhaps be referred for more intensive treatment.

Whilst Governments have taken steps to make the choice not to smoke easier for people, and have prevented some environmental factors, when it comes to obesity one gets the feeling that Governments are still making decisions that encourage individuals not to be healthy—they are still planning our cities around the car, rather than using active travel and so on. Sometimes, it isn’t even easy to get hold of information about healthy diets.

Therefore, it’s clear to me, in conclusion, that efforts to tackle obesity will need an even more robust governmental response than was the case with tobacco. All departments of Government must be willing to commit to this in the long term, and to give real impetus to making sure that Wales is in shape and is a nation that is fit and healthy, because I fear that we aren’t fit and healthy at the moment.

Vikki Howells (Labour, Cynon Valley)

As Public Health Wales reminds us in ‘Making a Difference’, their priority policy areas for creating a healthy Wales, over half of Welsh adults and around a quarter of Welsh children are overweight or obese, with particular issues in disadvantaged communities, such as my own in RCT, where the figure stands at 63 per cent of adults. If the numbers of people who are overweight or obese continue to rise at the present rate, by 2050 this will cost the Welsh NHS £465 million per year, with a cost to society and the economy of £2.4 billion.

Linked to this are clear challenges around physical activity levels. Many adults don’t undertake the recommended weekly amounts of physical activity, with only one in three children meeting guidelines. Faced with these stark facts, I am happy to support this motion today, challenging us all to develop solutions that solve what has been described as an obesity epidemic and calling on all of us to use the levers at our disposal.

Welsh Government has taken action. The Change4Life campaign promotes advice on healthy eating, and schools are expected to promote healthy food choices. Policies like free swimming promote access to exercise opportunities, and I was pleased to recently meet with Ramblers Cymru to talk about the Welsh Government-sponsored initiative, Let’s Walk, which celebrates the benefits of just 30 minutes of walking a day in improving health. Other initiatives, like Healthy Child Wales, will bear fruit in coming years.

Interventions around childhood obesity are one of the cornerstones of Cwm Taf health board’s approach. The childhood obesity steering group brings the health board together with partners like Families First, Flying Start and Communities First to develop and improve services. Work completed so far includes the development of guidance for early years settings to ensure they include evidence-based information on nutrition and physical activity, a mapping exercise to determine the need for training, and a research report that considered the effective engagement of families in targeted child and family weight management programmes. Similarly, the Cwm Taf Healthy Schools scheme is another Welsh Government-funded initiative. This bridges health and education to holistically promote good health in school settings, using interventions like cooking in the classroom. I’m sure Members will join me in congratulating Glenboi Primary School in my constituency, which yesterday completed phase 4 of the programme.

Cwm Taf’s approach also includes an antenatal element. The rate of obesity in pregnant women in Cwm Taf stands at around 33 per cent, and with this being a key indicator under the all-Wales maternity strategy, the health board has developed an appropriate response. Commencing in 2015, Bump Start is a specialised antenatal service to help women with a BMI of 35 or over to limit weight gain in pregnancy to healthy levels. Appointments and undertaking routine antenatal visits involve consultations with the public health midwife and a specialist dietician. In its first year of operation, the scheme has received very good feedback. However, there remains the need to do more. Crucially, unhealthy food remains cheap and easy to access, a point made strongly when the British-Irish Parliamentary Assembly, of which I am a member, took specialist evidence on childhood obesity.

I know I am not alone in my disappointment that the UK Government has watered down the proposals that were expected in its action plan for tackling childhood obesity, especially around sugar and on the advertising of unhealthy foods. I am glad that Welsh Government Ministers have jointly written to the Secretary of State for Health pressing the case for tougher action, and have also put on the record again their commitment to using the powers that are devolved.

Finally, I want to return to another theme that I believe offers a solution to tackle the crisis this motion considers. Members will know that I have previously referred to the nature deficit disorder, whereby children and young people in Wales consider themselves to have a weaker connection to the natural world than their peers in Northern Ireland, Scotland or even London. Initiatives such as Wales’s first nature kindergarten in my constituency, in the Dare Valley Country Park, have a remedial role to play, but we need to bring about a step-change in encouraging our children outdoors. Doing so will enable them to partake of the exercise that can tackle obesity and engender the habits of lifelong activity that will lead to healthier lives.

David Lloyd (Plaid Cymru, South Wales West)

I’m very pleased to be taking part in this important debate on a very important and serious subject. It’s important that we don’t just talk about it, but try to get to grips and tackle it. Perhaps I’ve mentioned in passing previously that, in another life, I am a doctor, but also, naturally, I’ve been dealing with problems stemming from obesity over the years. And it’s a combination, as we’ve already heard, of healthy eating—even though that’s easier said than done as well, and I agree with that. But it’s very difficult, sometimes, to get hold of healthy food. If you’re trying to go shopping in some areas, especially in our large cities, it’s very difficult to find healthy food in a shop that says that they do sell food. It is very difficult, and we need to get to grips with that. Naturally, there’s an element of trying to define what the size of a portion is. Those portion sizes have increased gradually over the years. Of course, in the middle of all of this, we need to emphasise the importance of breastfeeding, as well, for our babies, to give them a sure start, as far as we can, and to promote breastfeeding to give people that good start in life. There’s research that shows that that does decrease the rate of obesity as well.

I was going to talk as well about it being a combination of what you eat and how fit you are—how much you move around. Diet is perhaps slightly more important than fitness, but we shouldn’t forget the importance of personal fitness as well. You don’t have to go to extremes, such as ensuring that you have the latest kit to go to the gym; it’s just about walking 10,000 steps a day—that’ll do the trick—avoiding the lift and so on, and walking everywhere as far as you can. We’ve heard from Vikki about the Ramblers and so on; it’s promoting walking. We used to do it much more than we do now. Just becoming a little bit fitter with that walking, you will see a decrease of 30 per cent in your blood sugar levels, as I’ve already said in this place, a decrease of 30 per cent in the level of cholesterol in the blood, a decrease of 30 per cent in your blood pressure, and also you do lose weight naturally. So, if we developed tablets that could have those effects, then we would all be calling for them to be prescribed tomorrow. But, of course, that’s natural fitness. That’s what brings those decreases in blood sugar levels, cholesterol levels and blood pressure. We just need to disseminate that information so that people can make alternative choices.

In the time remaining to me, I just want to emphasise, as well as all of this education that’s needed, the importance of legislation in this field. As Rhun has already mentioned, we have been sharing the information on the bad and disastrous effects of smoking for many years, yet the levels of smoking in Wales were still stubbornly high, running at around 32 per cent until the year 2000. What’s happened is that we have legislated to ban smoking in public buildings. That has overturned how people think about smoking. Legislation can sometimes lead the way, and can change the way that society thinks about an issue. As well as all of the education that takes place, we need to legislate in this field as well. We need a tax on sugar, we need to legislate for a minimum unit price for alcohol, and we need to legislate to get rid of some of the things like trans fats from our processed foods. So, there is a role for legislation, as the motion states. Also, these large food and drink companies, as Rhun said, behave like the tobacco companies. They try to undermine all of the messages that mean that we would do something on a minimum unit price for alcohol and on sugar. We’ve seen those problems in other countries, such as Scotland. With this Wales Bill that is on the way, there’s a danger that we’ll lose the right. We do have the right at present to set a minimum unit price for alcohol, but not for too long if the Bill is implemented, as it is expected to be implemented. If we can’t have new legislation in place before the end of the first stage of a new Bill, namely in April 2018, we need to take urgent action. That’s why I welcome this important debate, but also the importance of legislating and taking action. Thank you.

John Griffiths (Labour, Newport East)

Diolch, Ddirprwy Lywydd. I think the challenges are abundantly clear, as we’ve heard from others, and have been apparent for some time, but no doubt will be coming ever more apparent because of the ageing society that we have, because of the pressure that brings on the health service. We’ve talked for quite some time, haven’t we, in terms of trying to be more preventative as far as the health service is concerned: looking at the wider determinants of health and ill health and trying to get on the front foot rather than being largely reactive. So, I think this debate is part of that dialogue, Dirprwy Lywydd, that’s been ongoing for some time and will inevitably strengthen because of the challenge we face. But I think it’s really important to have good, hopefully strong, local examples in Wales of what can be done in meeting those challenges. I’ve mentioned before, and I’m very pleased to mention again, that in Newport for some time we’ve been holding physical activity summits to bring together key partners: public health, Aneurin Bevan health board, Newport City Council, Newport Live, which is the leisure services trust, Newport City Homes as a housing association that took the transfer of local government housing stock, sport organisations like Newport Gwent Dragons, Newport County AFC, Natural Resources Wales—there’s a long list, Dirprwy Lywydd—and we’ve come together to look at these challenges and to try and make progress locally.

So, I’m pleased to say that we’ve now reached the stage where the organisations have all committed a day a month of staff time to take the agenda forward. We’ve built an increasingly strong and active partnership. We’re looking at all sorts of issues, including how the active travel Act is effectively taken forward in Newport. We’ve strengthened the parkrun. I did the parkrun in Tredegar House in Newport a couple of weeks ago, and the energy there is absolutely tremendous; several hundred people at 9 o’clock on a Saturday morning doing the parkrun, enjoying it, socialising afterwards, talking about what else they’re going to do to stay active, fit and healthy. There will now be—it’s not yet established—a city centre parkrun along the riverside in Newport to build on the interest that’s being created.

Throughout all of this, Dirprwy Lywydd, we’re also looking at other aspects such as healthy eating, linking with healthy eating networks in schools, and there will be particular projects as part of this coming together that address those issues in schools. I hope very much that we drive forward physical literacy in our schools, because one thing that I think virtually everybody is agreed on is that if you can establish and embed good habits in our young people as early as possible, it’s very likely that those good habits will stay with them throughout life to their benefit, and to the benefit of the health service and Wales generally. So, I very much hope that that report that Tanni Grey-Thompson did on physical literacy is taken forward in whatever shape or form through the curriculum reforms that we’re about to see, and is absolutely central to life in our schools.

What I would also ask, Dirprwy Lywydd, is that, where progress is being made locally, as it is in Newport, that’s recognised by Welsh Government, it’s looked at very closely, good practice is spread and also that there might be some support. In the past, there was some discussion around possible pilot schemes where local projects were addressing these challenges of getting more physically active and a more healthy local population, and then there might be some support from Welsh Government to strengthen it, structure it and take it forward more effectively. So, I hope that will be the case, but whatever happens, I think we’ve got to the stage in Newport where there’s sufficient buy-in and sufficient energy, ideas and commitment to make sure that we do something important and valuable for our local population.

Gareth Bennett (UKIP, South Wales Central)

Thanks to the five Members listed for bringing the debate today. There’s a range of issues under deliberation here, too many to cover in one contribution, so I’ll concentrate on the issues of obesity and physical activity, active travel being part of that.

Levels of participation in active travel have not shown improvement, unfortunately, since the active travel Act was passed, and the independent charity Living Streets says that we are still dealing with a decline in the walk-to-school numbers as more and more parents drive instead of walking sometimes fairly short distances. We do need to do more to promote walking to school. I note that there has been a programme; can we offer some kind of financial inducement to schools for participating in organised walking groups? Also, there’s issue that Vikki raised first of all in her short debate that she did a few weeks back of outdoor activities. That’s another thing that schools can actively promote, which would, I’m sure, have a beneficial effect, but can the Government have any effect on this kind of thing being promoted in schools, particularly primary schools, because we need to start them off early? Can we give more support to local authorities over the funding of leisure centres, given that we now face the spectre of outsourcing, which could lead to an increase in admission fees? I appreciate that these are really local authority matters, but we could perhaps do something as a Government—well, I’m not in the Government—as an Assembly, sorry, to monitor this, at least, and perhaps to give some kind of support to local authorities in their subsidising of leisure centres, given that ultimately we could pay rather more in costs for the Welsh health service if we don’t do this now.

Regarding older people, there is the issue of bowling clubs, which is quite often their only leisure activity. We had a recent case where a popular bowling club in east Cardiff was condemned to closure. Again, it’s an issue where it’s a local authority decision whether or not to subsidise these clubs but we could take some more active role, in the Assembly, in promoting these kinds of activities for older people—similarly, things like Nordic walking clubs, which we’ve had.

Regarding active travel, I think we do have a problem in that we’ve also got now the Well-being of Future Generations (Wales) Act 2015, but there doesn’t seem to be anything linking the two pieces of legislation together. For example, there’s no active travel indicator in the Well-being of Future Generations Act that can hold public services boards or councils to account for their provision of active travel. This also affects the south Wales metro system because concerns have been raised, in the active travel board, about the requirements for active travel and whether they’re going to be provided for when we get the metro. Transport for Wales are setting the scoring for procurement and this could and should include standards to increase active travel to and from stations. I appreciate that we need to deliver the south Wales metro—that is the priority—but is the Welsh Government doing anything to ensure that when we do get the metro it does in fact include some good provision for active travel? Thanks.

Julie Morgan (Labour, Cardiff North)

I’d like to thank the Members who have brought this debate forward because, obviously, this is a critical issue. Previous speakers have described the situation in Wales, which is obviously a matter of huge concern. It’s clear that eating habits and exercise habits need to be improved—we’ve heard the statistics about that today.

I’m very proud that we do have the Active Travel (Wales) Act 2013 and that it has been passed—a unique Act by this Welsh Government—and I think we absolutely have to make every opportunity to use it to its maximum potential. For example, I know that we are consulting on the local walking and cycling routes that communities themselves feel need to be prioritised. We’ve had a good response in Cardiff, I think we’ve about 200 people giving their input so far, but I think we’ve got to do more. We’ve got to make sure that more people in Cardiff and throughout Wales put out the message that we can develop safe walking and cycling routes, which I think is very important to encourage people to get fit and to leave their cars at home, and we’ve got that legislation there now at the moment. I think we’ve got good examples throughout Wales and we’ve got great organisations like Living Streets and Sustrans, who are working hard on these issues. I know that Sustrans is also considering targeting, in particular, young mums and mums-to-be—and I think Dai Lloyd mentioned this in his contribution—because the evidence does suggest that the biggest impact on whether people adopt walking and cycling habits is whether their parents travelled actively, so the example was there.

We obviously can’t win the battle against obesity simply by promoting active travel, although I think there are great opportunities there. Changing eating habits is very hard, but I do believe it starts right at the beginning and I was pleased that Dai Lloyd mentioned breastfeeding—I expressed my concern that that was not in the chief medical officer of health’s report last week. But I know that the Welsh Government is concerned about promoting breastfeeding, but I just think that is something we’ve got to have another great push on. It is very important, as Vikki Howells mentioned—the importance of antenatal support and working with mothers. But it is very difficult to change eating habits, particularly with adults. However many public health campaigns we run, food still equals comfort for many people and also, I think one of the most important points is that poverty impacts on eating habits, and I think that’s something that I want to say a bit about now.

The Child Poverty Action Group has just published a book called ‘Improving Children’s Life Chances’, which shows that, for both girls and boys aged two to 15, there’s a greater prevalence of overweight and obesity in the 40 per cent of children from lower income groups. And we know that. We know, through the work on health inequalities, that it is the poorer families who are more likely to be overweight.

Research shows that foods that are nutrient-dense per calorie are more expensive. Data from the national diet and nutrition survey 2008-12 show that the lowest income group generally consumes less protein, less iron, fewer fruits and vegetables, less vitamin C, less calcium and less oily fish. And one of the reasons for that is that lean meat, fresh fruit, vegetables and fish are difficult and are expensive forms of calories. I think we all know that that food is more expensive. So, it makes sense that, when incomes are higher, you can afford better-quality food, which is why the effects of austerity and benefit cuts are so pernicious—because they do affect what people are able to eat.

So, I think it’s very important that we do look at this in the overall context of people’s lives and I do believe that poverty has a big impact on what we are able to do. Some of those levers of poverty are not within our power in this Assembly, but I do believe that we have levers here that we can use and should use. People have mentioned a lot of those levers today, but I think it starts with the first food that you have—or we hope you’ll have—which is breast milk. It’s crucially important what happens in school in terms of healthy eating and there have been lots of suggestions here today, and the exercise issue that we know we can promote through the active travel Act. I do believe we have many levers here in this Assembly to tackle this very important issue.

Lee Waters (Labour, Llanelli)

I only want to make a brief few remarks in response to some of the speeches here this afternoon. I’d like to wholeheartedly endorse what John Griffiths said about the potential of the parkrun. I recently took part in the new Llanelli coast parkrun, which was a terrific experience. Every time I’ve taken part in the parkrun, as somebody who is not a natural runner, I’m always warmly enthused by the support of the volunteers who really encourage you along. For most of the people taking part in the parkrun, were it not for that activity, they’d be doing nothing at 9 o’clock on a Saturday morning. For the £6,000 of investment needed to get them up and running, I think they are a no-brainer from a public health investment point of view, and I’m pleased to see them flourishing across the country.

I wanted to talk in particular about the element of the motion around the untapped potential of the active travel Act, which I think is perhaps a little harsh, given that the Act has only recently become enacted, but I think it’s right to point out that we really can’t just see this as a tick-box exercise and nor can we approach it in a half-cocked manner. This is a huge opportunity to try and get people who currently take little or no physical activity to take some. There’s plentiful evidence to show that for those people who are physically inactive, the way to get them to take some physical activity is as part of their everyday routine, and simply expecting them to go to leisure centres or gyms is likely to be ineffective. So, this is a huge chance to reach a section of the population we most need to reach out to.

I think we do suffer sometimes in this Chamber from what’s known as ‘cognitive dissonance’ when we say one thing, but we do another. We talk, in public health terms, enthusiastically about the value of active travel and physical activity, and yet, when we talk about an economic strategy, for example, or we talk about transport matters, we put this to one side, and we seem to think that physical activity is the responsibility of the health profession. When we do other activities, we don’t think about how those tasks can be used to deliver the rising levels of physical activity we need to see. So, for example, to return to a theme that I’ve talked about recently—the encouragement of free car parking in town centres. We should be encouraging town centres and towns that are cycle and walking friendly, and using scarce public investment to build in networks to encourage people to take those short everyday journeys. Some 20 per cent of car journeys are under a mile. A lot of those could be replaces by walking and cycling trips.

In my town of Llanelli, for example, there was a proposal for an urban cycling network to connect people up with those everyday destinations they want to go to. But, unfortunately, the county council—pre-active travel days, but those schemes are now on the books—are focusing their investment on longer-distance routes and tourism routes, and not on those everyday routes. It’s essential, instead of hardwiring in policies that are going to encourage sedentary lifestyles, such as free car parking, we really need to be seizing every opportunity to build in physical activity to all of our plans.

I note recently that Cardiff council has published an ambitious cycling strategy for the city, which we really must get behind and enthusiastically endorse. I know they’ve been having difficulty within the city region, for example. The city deal, which is still littered with very orthodox and old-fashioned thinking, where local authorities up and down the Valleys see an opportunity for funding and dust off road schemes that they’ve had on the shelves for 30 and 40 years in some cases. Cardiff, to be fair to them, are showing real leadership in building on the gains we’ve seen in the last 10 years in the city of increased levels of cycling, and they’ve put together an ambitious plan. But I know they’ve had difficulty within the city region in getting support for that. I’m pleased, in the case of the Swansea bay city region, that Terry Matthews’s vision hasn’t been about roads and enterprise parks—it’s been about digital connectivity. I think that’s the thinking that we must embrace.

The active travel Act, as has been mentioned, presents us with an enormous potential prize within our grasp. But it can’t simply be seen as a duty that we have to discharge. It’s something that we must embrace enthusiastically. We must push—all of us in our leadership roles within our communities—to get people to feed in the potential routes they’d like to see as part of the integrated network maps, to get those everyday journeys put into the plans so that they are the first to be delivered. It’s a huge prize, and obesity will only be tackled by actions like these. So, we really need to abandon this cognitive dissonance, and scan every opportunity to build in increases in physical activity in all of our programmes. Diolch.

Ann Jones (Labour, Vale of Clwyd)

Thank you very much. I call on the Minister for Social Services and Public Health, Rebecca Evans.

Rebecca Evans (Labour, Gower)

I’m very grateful to Jenny Rathbone, Rhun ap Iorwerth, Vikki Howells, Angela Burns and Dai Lloyd for choosing to focus on important public health issues in the individual Members’ debate they’ve tabled this afternoon, the spirit of which is consistent with our commitment to support people to be healthy and active. I really welcome all of the thoughtful contributions that have been made. Whilst we’re certainly doing a great deal to create the right circumstances and conditions for people to make healthy and active choices, we must also recognise that Government can’t do it alone. If we are to make the vision of the well-being of future generations Act a reality, we need a whole-of-society approach to maximise physical and mental well-being today, and to ensure that behaviours that benefit health tomorrow are understood and acted upon.

This is a challenging agenda. Levels of obesity in adults have risen slowly since the first Welsh health survey began in 2003, and although levels in children are now stable, they are still unacceptably high. We know levels increase with deprivation, so there’s a compelling case to act in order to address health inequalities. We want to support the public to make healthier choices. Public Health Wales recently launched its 10 Steps to a Healthy Weight campaign to support this, and this does include a focus on breastfeeding. This complements our Change4Life programme and our other campaign work. Our Healthy Child Wales programme focuses on the early years, based on the evidence that maintaining a healthy weight in the early years has a long-term impact on levels of obesity and health in adulthood.

Interactions with the health service are often opportune moments when individuals are receptive to lifestyle advice. Public Health Wales is developing its systems-based approach to this, which includes making every contact count. The aim is to equip staff with the skills needed to deliver brief advice to encourage small changes to improve health and well-being at every opportunity. But this agenda is complex. Improved education and skills, easier access to healthier food and public procurement policies all have a role to play. We also need more restriction on the advertising and promotion of high-fat, salt and sugar foods, particularly to children. Some of this work needs to be done at a UK level. We have long called for the Secretary of State for Health to deliver stronger action, such as tougher action on sugar and on the advertising of unhealthy foods to children, and we do support the UK Government’s announcement of a sugar levy on sugar-sweetened drinks, but we do need to see some progress.

The food industry itself has a role to play. UK-wide voluntary salt reduction targets, considered to be a global example of best practice, have led to a reduction of salt levels in foods by up to 50 per cent since 2012, and this is certainly welcomed, but we do need the industry to do more.

Influencing public procurement on this agenda is vital. The Welsh Government has already acted to create a national procurement service for Wales that is developing central procurement mechanisms for all public sector organisations. We are actively engaging with them to set procurement criteria that factor in nutritional specifications. NHS procurement already employs a dietician to do this. This will be a significant step in ensuring that all food and drink provided in our public sector is healthier. This will build on the nutritional standards that we’ve introduced in some of our public settings, such as schools and hospitals. We’re also developing similar approaches for other settings, such as early years and care homes, because we know how crucial good nutrition is for young children and older people.

People themselves need to have the skills and knowledge that underpin healthier lifestyle choices, and schools have a key role to play in this. Our programme for government makes clear our commitment to work with schools to raise awareness of the importance of healthy lifestyle choices. We have a good platform to build from with our Welsh network of healthy schools schemes, and we’ll maximise opportunities to strengthen work in schools further through the development of the new curriculum.

Today’s motion highlights the potential of the active travel Act to raise physical activity levels across the population, including for children. The active journeys programme, which works in schools to promote active travel amongst pupils, makes resources and support available to schools across Wales. This will be complemented by our Walk to School Wales project, which will develop a toolkit to support schools to review and improve active travel options in their areas. The Welsh Government provides funding for walking and cycling training, which is mostly delivered in schools, and these programmes will be reviewed in the coming year with a view to reinforcing the promotion of active travel.

The Act further puts in place the framework to support active travel as a key element of building physical activity into our daily lives. It does so by mandating the planning of coherent walking and cycling networks in our communities and improving them every year. This year, we saw the first key stage of the Act with the approval of the existing route-maps of all local authorities in Wales, and local authorities are now working on the preparation of their integrated network maps. We’re working with local authorities to ensure that these genuinely reflect the needs of local communities and connect the places that they need to travel between. This requires input from a broad range of perspectives. Last week, I was very pleased to speak to an audience of planning, transport, environment and health professionals who are all keen to strengthen the links between their sectors and professions to move the active travel and wider health and well-being agendas forward. Working together, we will see the active travel Act impact on the number of people making active travel journeys.

I am pleased that we can now report for the first time since records began that over 80 per cent of our adult population are non-smokers. This has been achieved by using the comprehensive approach outlined in our tobacco control action plan. This involves working with young people to prevent the uptake of smoking, working with smokers to help them quit and an increase in smoke-free environments. Legislation is part of this wider picture, including UK-wide work to introduce standardised packaging of tobacco products, and, in Wales, the newly established tobacco control strategic board will oversee continued action.

I was pleased to recently have introduced the Public Health (Wales) Bill to the Assembly. The Bill has a particular focus on addressing health inequalities and creating conditions that promote the good health of children. The aspects of the Bill that relate to smoking are particularly strong in this regard, and I have no doubt that it will help us meet our target of reducing smoking to 16 per cent by 2020. The importance of creating the opportunities and the environment in which people can make healthier lifestyle choices is clear from the contributions that we have heard in the debate today. I hope that I have reassured you that we are taking a wide range of approaches across Government to do this. But, as I said, it is not something that we can do alone, and we look forward to working with a wide range of partners to accelerate progress in this area.

Ann Jones (Labour, Vale of Clwyd)

Thank you very much. I call on Angela Burns to reply to the debate.

Angela Burns (Conservative, Carmarthen West and South Pembrokeshire)

Thank you very much, Deputy Presiding Officer. I would like to thank everyone who took part in this debate. I am sorry, I am not going to go through all your individual contributions because I don’t have a huge amount of time, but there are just a couple of points that I really wanted to make. This is, if you like, a game of two halves, so let’s look at the children first.

I am very glad that some Members mentioned the importance of getting them young. Minister, I would say to you that one of the key things that you could do today, now, within your power, without having to do huge great big strategies, would be to increase the amount of time we give to sport in school—not just increasing the amount of time that a child can undertake sport, but also to be far more creative about what physical activity means. To be frank, very few girls like team sports. Very few boys will like certain other things. There is a huge gender imbalance. Teenage girls are very conscious of their bodies, and I think that we could be very creative about looking at how we could bring on board dance, movement, running, single sports—encouraging all sorts of things rather than just saying, ‘If you’re going to do sport, you’ve got to do this kind of sport or that kind of sport.’ I think that it’s really vital that we address it. It’s also very vital that we address the amount of time that we give to sport. Let’s be really clear: in our schools, the amount of time that we give to sport has been decreasing over the last decade, and that goes in the face of everything we’ve spent the last hour talking about here.

Of course, the other thing is, if we have healthy young people, they will grow to be much healthier young adults and older adults, because they will be used to the whole concept of going out, doing things, riding bikes and so on. The amazingly wonderful initiatives that a lot of you have talked about today are great, but do you know what? I couldn’t do a parkrun. I would probably last about three yards and fall over—bump, and I’d be gone. So, fit people—Lee—off you can go, and that’s brilliant. But there’s a whole class of us out there—. In fact, let’s be clear, 59 per cent of us out there are overweight or obese. So, what do we do for the 59 per cent, and how do we change the way that we talk about it? How do we stop it from being pejorative? How do we go out there and say to those people, ‘Hey, you don’t have to lose weight by going to a gym, surrounded by Lycra-clad bunnies, while you’re sitting there, wobbling away, trying to be fit’? That’s why large people—particularly women, but men as well—don’t want to do this kind of stuff, because it’s embarrassing. In fact, if you look at obesity in the UK, there’s a lot of psychology involved in this. There’s a huge psychological report on this, and it talks very clearly about the fact that we need to look at the exercise environment. It needs to be addressed, so that there isn’t an exacerbation of social physique anxiety, and so that fat people, large people, don’t actually feel incredibly embarrassed about trying anything, so they don’t try it. I think we need to look at that. We need to be much cleverer about how we target people. We have got a lot of very overweight adolescents. How do we get to them? What do we do about them? They don’t want to go to a gym, and they probably won’t go to a park. But, if we can train our health professionals in cognitive behaviours, they might be able to find keys that help unlock certain areas of our population and bring them back into the fold.

So, in my view, the easiest things that we can do—. There’s a lot of other stuff that we talked about—taxes, sugar, this, that and the other—but they’re all big picture. Small picture: get our primary schoolchildren and our secondary schoolchildren doing a bit more activity—activity that they enjoy; activity that makes them want to carry on doing it. Give them better food. Since when has a cheese wheel been a food form, let alone good food? The people who are already overweight or obese: be kinder towards them in terms of how we bring them in and get them to do the activity they need, so they don’t feel ashamed, embarrassed and some sort of small dreg of society. A lot of overweight people just have that feeling, because of the national conversation, that they’ve become a problem. We need to help them and be kind about it.

Ann Jones (Labour, Vale of Clwyd)

Thank you very much. The proposal is to agree the motion. Does any Member object? [Objection.] Therefore, we defer voting under this item until voting time.

7. 5. Welsh Conservatives Debate: The Autumn Statement

Ann Jones (Labour, Vale of Clwyd)

We move on now to item 5, which is the Welsh Conservatives’ debate on the autumn statement 2016. I call on Nick Ramsay to move the motion. Nick.

Nick Ramsay (Conservative, Monmouth)

Thank you, Deputy Presiding Officer. I’m pleased to move this motion today noting the UK Government’s autumn statement—a statement that has seen a significant increase in capital funding for the Welsh Government over the next five years.

Although admittedly times are still very tough financially, Wales is in a stronger funding position than it was before. Not just our view on these benches, but the view of economists like Gerry Holtham. The Welsh Government capital budget will increase by over a quarter in real terms over the next five years, from £1.28 billion in 2015-16 to £1.78 billion in 2020-21. This includes an extra £436 million over five years. That’s money that can be spent here in Wales on roads, houses, schools, hospitals—important infrastructure.

We need to make sure that Wales plays a key part in the UK Government’s industrial strategy, which will pave the way for significant research and development money for our universities. This further strengthens Wales’s already cutting-edge reputation in this area. We know that there have been concerns about the effect of leaving the European Union on funding for research and development, so it’s important that we access funding where we can, prepare for the future, and develop our own industrial strategy here.

To put it bluntly, we need to prepare Wales to seize the opportunities ahead. Of course, there are certain levers that the Welsh Government doesn’t have: taxes—well, at least until 2018. From April 2017, the UK Government will cut income tax, which will reduce the income tax bill for over 1.4 million people in Wales in 2017-18 and take 61,000 people out of income tax altogether.

There are other levers that the Welsh Government does currently have—business rates, for example. Assembly Members will be all too well aware, I’m sure, of my concerns about the business rate revaluation and the effect of this on businesses in my constituency. And not just mine—there are pockets of business rate hikes proposed across other parts of Wales as well. I held a public meeting on Monday evening that was packed with worried shopkeepers and other businesses. Some businesses are facing massive hikes in their rates. Others are facing smaller, but still significant rises that they simply cannot afford. We desperately need a business rate relief scheme here in Wales that is at least equitable with that across the border, and all importantly, a sound transitional scheme. This is a question of fairness. Businesses need to be treated fairly. Can I take this opportunity to once again ask the Welsh Government to look again at this, and provide businesses with the support that they so desperately need in the run-up to next April’s revaluation coming into effect?

Now, on the bright side, we welcome the UK forecast that the economy is projected to grow, with unemployment remaining at an 11-year low, whilst the International Monetary Fund has stated that the UK economy is the fastest growing economy in the G7 this year. The Chancellor said that that growth is forecast to be 2.1 per cent this year and 1.4 per cent in 2017. I give way to Huw Irranca-Davies.

Huw Irranca-Davies (Labour, Ogmore)

I thank Nick for giving way. Certainly, having people in work is a good thing. We have to agree on that. But I wonder, what does he make of the Office for Budget Responsibility’s revised forecast now on wages, growth and investment? Because what they’re showing clearly is that a huge number, not a small underclass of people, but a large number of the people we represent who are going to be around about £1,000 a year worse off. For the people that he was talking about—the small businesses, the ones who want the business rate relief, and so on—those are the same people who won’t be able to spend the money in the shops. So, what does he make of that? What’s gone wrong here with the budget?

Nick Ramsay (Conservative, Monmouth)

The Member makes a very well-made and important point, and I don’t disagree with you that we mustn’t be complacent here, Huw. I think we would all agree with that. We know from a few years ago that forecasts can be wrong. That is the very nature of them. What I would say is that, overall, since 2010, we know that there’s been deficit reduction. We might disagree about the level of deficit reduction that was required, and that differs from party to party and Member to Member, but the economy is in a sounder position than it was before. But, that doesn’t mean that that wealth is equally spread. What I would say is that, in the wake of the European referendum, we definitely do need to make sure that the people that you represent and that I represent, the people in Wales, do actually continue to get an equitable share of the cake, because I know that that has been a big concern of Members here and in my own constituency as well. But you do make a very good point.

The UK Government is seeking to clamp down on tax evasion. Of course, we have our own take on all this here in Wales with the devolution of some taxes in 2018 and the establishment of the Welsh Revenue Authority, currently in embryonic form.

I’ve sat through—and I can see other Members who’ve done this—many hours of Finance Committee sessions scrutinising the new tax legislation, initially for the new land transaction tax. Measures to tackle evasion and avoidance are integral to the legislation. The GAARs and the TAARs are mindboggling. The Members of the Finance Committee will know what I mean by that and, when we bring it to this Chamber, you will all get your chance to see the intriguing detail of these aspects of tax legislation as well.

I do think the Finance Committee is doing a good job of scrutinising this area and providing effective safeguards and checks. Although, of course, time will tell and this is uncharted water for the Assembly and the Welsh Government and we need to keep a close eye on how it develops.

So, what extra funding will Wales get as a result of this statement? The Welsh Government capital budget will increase by over a quarter in real terms over the next five years. As I said earlier, this includes an extra £436 million for our roads, houses, schools and hospitals—vital infrastructure.

From April 2018, the UK Government will facilitate the Welsh Government’s ability to borrow up to an overall limit of £500 million to finance capital spending. The £2 billion share of Welsh income taxes soon to be under the control of the Welsh Government will allow for an increase in this capital borrowing limit set by the UK Government. This will be one of the key outcomes of the ongoing fiscal framework negotiations. Can I once again put on record the Welsh Conservatives’ support for a fiscal framework? I’ve had many discussions with the Cabinet Secretary for finance about this and I’ve discussed it with his predecessor who’s in the Chamber today as well. This is an ongoing issue of concern for all of us here. It is absolutely essential, particularly now with the devolution of taxation. It is vital that future reductions in the block grant are properly indexed and proportionate in order to avoid the so-called Barnett squeeze, which has been a significant problem in the past, but threatens to be an increased problem in the future if we do not get those reductions in the block grant right.

Although we continue to look forward to a time when the Barnett formula is replaced, the Welsh Government will continue to receive funding though the Barnett formula in the same way as the Government’s investment in areas that are devolved, including transport and housing. This places a greater emphasis on the need to scrutinise the Welsh Government’s investment decisions over the next five years to ensure that this money is being invested transparently and to deliver improvements to Wales’s infrastructure.

The tax-free personal allowance has been increased again to assist working people across the UK and across Wales. Across the UK, this has cut tax for 28 million people since 2010, taking an additional 4 million people out of income tax. The personal allowance will be raised even further to £12,500 by the end of the current UK Parliament. This should reduce the income tax bill for over 1 million people in Wales in 2017-18 and take 61,000 people out of income tax altogether.

If I can turn, in the time I’ve got left, to city deals, I think we would all accept we need to unlock growth and regional productivity, and city deals are key to doing this. We welcome progress in discussions on a city deal for the Swansea bay city region, the consideration of a growth deal for north Wales and the £1.2 billion city deal for the Cardiff capital region. There is progress on the north Wales growth deal whilst, closer to home, one of Cardiff’s iconic buildings, the old Cardiff Bay railway station, is to become a new museum of military medicine with £2 million of funding. I know that the previous Minister, Edwina Hart, backed that. I had some discussions with her back when she was an Assembly Member about that. There’s also £1 million extra funding to support the air ambulance service in Wales and an additional £1.5 million for Mind to provide improved mental health support for emergency service staff in Wales and England.

Deputy Presiding Officer, I’m pleased to have opened this debate today. We are all well aware that times are still very tough financially and we recognise that the Welsh Government has a difficult job to do. However, Government is a question of priorities and making the most of the funding that you do have available. We believe that the autumn statement does at least leave Wales in a better position than it was before. What matters now is that we grasp the opportunity before us and make the most of the additional funding available to develop our infrastructure and to build a better future for everyone living in our country.

Ann Jones (Labour, Vale of Clwyd)

Thank you very much. I have selected the five amendments to the motion, and I call on Jane Hutt to move formally amendment 1 tabled in her name.

Jane Hutt (Labour, Vale of Glamorgan)

Formally.

Ann Jones (Labour, Vale of Clwyd)

Thank you very much. I call on Adam Price to move amendments 2, 3, 4 and 5, tabled in the name of Rhun ap Iorwerth.

Adam Price (Plaid Cymru, Carmarthen East and Dinefwr)

Thank you, Deputy Presiding Officer. I’m pleased to have the opportunity to move amendments 2, 3, 4 and 5 tabled in the name of Plaid Cymru. Of course, in these amendments, we are focusing specifically on the things that were omitted from the autumn statement. It may be some sort of reflection of the different personality of this Chancellor. There is some suggestion that he didn’t want to follow the theatrical approach taken by his predecessor and make a huge number of announcements all at once. He perhaps wanted to hold certain things back. I do hope, with some of the things that I am going to raise, that that is the case and that we won’t have to wait too long for announcements that we hope to see.

Amendment 2 refers to the electrification, not only of the Great Western line between Cardiff and Swansea, where there have been delays, which is quite unacceptable and which will, of course, impact on the economy to the west of Cardiff, but also the electrification of the north Wales main line. With regard to that, it is regrettable to see that there has been no agreement that HS2 is an England-only infrastructure project. There is evidence from KPMG that suggests that Wales would be worse off in terms of competitiveness as a result of HS2. Of course, because of its categorisation, there is no Barnett consequential as a result of HS2. That’s very sad, if truth be told. I spoke to the Secretary of State about this issue at a CBI dinner, but why is Wales not treated equitably in terms of air passenger duty? There is no rationale, nor is there any ethical reasoning for that, when Wales needs it, in this post-Brexit period, when there is all this economic uncertainty. Why aren’t we being given fair play? That’s what we’re asking for—the same powers as have been granted to Northern Ireland and Scotland.

Nick Ramsay (Conservative, Monmouth)

I’m grateful to Adam Price for giving way. I neglected to mention air passenger duty in my speech, but you’ve just brought it up, and you make a very valid point, and we will be supporting the Plaid Cymru amendment on air passenger duty. I think that would be a very important tool in the Welsh Government’s toolbox.

Adam Price (Plaid Cymru, Carmarthen East and Dinefwr)

Well, I welcome that very warmly, and if this place can speak with one voice, then I truly hope that that voice will be heard in the corridors of Whitehall and Westminster.

Finally, and to the same end, if truth be told, I hope that there will be support for this too. We do need progress with this golden opportunity that we have with the tidal lagoon. Dai Lloyd insists that it should be called ‘morlyn morlanw’ in Welsh. I’m not sure whether Dai’s terminology is trying to suggest something that isn’t quite clear, but I do like the alliteration. It’s almost ‘cynghanedd’ and it’s another reason for supporting it, if truth be told. Charles Hendry has submitted his report now to the Secretary of State, and therefore I do believe that we need to make progress and see that Wales does grasp this opportunity.

There are some things in the statement that I would welcome: the additional funding for innovation, which has been mentioned by the Conservative spokesperson—the biggest increase in funding for innovation since 1979. I think it’s £4.7 billion in addition over this period, and an additional £2 billion by 2020. We must ensure that Wales benefits from this opportunity. There is talk about the creation of a DARPA, which is the American body that led, partly, to the development of the world wide web by Tim Berners-Lee. Well, why not locate that body, which will run this new fund for industrial challenges, not in the south-east of the UK but here, in Wales?