Pwyllgor Deddfwriaeth Rhif 3 Legislation Committee No. 3 Dydd Iau, 29 Ebrill 2010 Thursday, 29 April 2010 Cynnwys Contents Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions Mesur Arfaethedig Iechyd Meddwl (Cymru) 2010—Sesiwn Dystiolaeth 2 Proposed Mental Health () Measure—Evidence Session 2 Cofnodir y trafodion hyn yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir cyfieithiad Saesneg o gyfraniadau yn y Gymraeg. Darperir cyfieithiad i’r Gymraeg o rannau penodol o’r cyfarfod. These proceedings are reported in the language in which they were spoken in the committee. In addition, an English translation of Welsh speeches is included. A translation into Welsh is provided of specific parts of the meeting. Aelodau’r pwyllgor yn bresennol Committee members in attendance

Peter Black Democratiaid Rhyddfrydol Cymru

Christine Chapman Llafur Labour

William Graham Ceidwadwyr Cymreig

David Lloyd (Cadeirydd y Pwyllgor) The Party of Wales (Committee Chair)

Joyce Watson Llafur Labour

Eraill yn bresennol Others in attendance

Edwina Hart Aelod Cynulliad, Llafur (y Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol) Assembly Member, Labour (the Minister for Health and Social Services)

Claire Fife Rheolwr Deddfwriaeth Iechyd Meddwl, Llywodraeth Cynulliad Cymru Mental Health Legislation Manager, Welsh Assembly Government

Tracey Jones Yr Adran Gwasanaethau Cyfreithiol, Llywodraeth Cynulliad Cymru Legal Services Department, Welsh Assembly Government

Jonathan Morgan Aelod Cynulliad, Ceidwadwyr Cymreig Assembly Member, Welsh Conservatives

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Swyddogion Cynulliad Cenedlaethol Cymru yn bresennol National Assembly for Wales officials in attendance

Stephen Boyce Gwasanaeth Ymchwil yr Aelodau Members’ Research Service

Ruth Hatton Dirprwy Glerc Deputy Clerk

Joanest Jackson Uwch Gynghorydd Cyfreithiol Senior Legal Adviser

Carys Jones Clerc Clerk

"Dechreuodd y cyfarfod am 10.28 a.m. The meeting began at 10.28 a.m." Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions

David Lloyd: Croeso i gyfarfod diweddaraf Pwyllgor Deddfwriaeth David Lloyd: Welcome to the latest meeting of Legislation Rhif 3 Cynulliad Cenedlaethol Cymru. Diben y cyfarfod heddiw yw Committee No. 3 of the National Assembly for Wales. The trafod Mesur Arfaethedig Iechyd Meddwl (Cymru) 2010. Hon yw’r purpose of the meeting is to discuss the Proposed Mental ail sesiwn dystiolaeth. Byddwn heddiw yng nghwmni Jonathan Health (Wales) Measure 2010. This is the second evidence Morgan, Aelod Cynulliad, ac, yn nes ymlaen, , y session. Joining us today are Jonathan Morgan, Assembly Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol. Member, and, a little later on, Edwina Hart, the Minister for Health and Social Services.

Yr ydym wedi derbyn ymddiheuriadau oddi wrth Helen Mary Jones, We have received apologies from Helen Mary Jones, and we are ac yr ydym yn ymwybodol y bydd yn rhaid i William Graham adael aware that William Graham will have to leave before the end of cyn diwedd y cyfarfod. Os bydd larwm tân yn canu, dylai’r Aelodau the meeting. If the fire alarm sounds, Members should leave the adael yr ystafell drwy’r allanfeydd tân penodol, gan ddilyn room by the marked fire exits, following instructions from the cyfarwyddiadau’r tywyswyr a’r staff. Nid ydym yn disgwyl prawf ushers and staff. We are not expecting a fire alarm test, or a fire, larwm tân, na thân, y bore yma. Dylai pawb ddiffodd eu ffonau today. All mobile phones, pagers and BlackBerrys should be symudol, eu galwyr a’u mwyar duon, gan eu bod yn amharu ar yr switched off as they interfere with the broadcasting equipment. offer darlledu.

Mae Cynulliad Cenedlaethol Cymru yn gweithredu’n ddwyieithog. The National Assembly for Wales operates bilingually. Mae clustffonau ar gael ar gyfer clywed cyfieithiad ar y pryd, a gellir Headphones are provided for simultaneous translation, and the hefyd addasu’r sain os ydych yn drwm eich clyw. Peidiwch â sound can be amplified if you are hard of hearing. Please do not chyffwrdd â’r botymau ar y meicroffonau, oherwydd gall hynny touch the microphones as they can interfere with the amharu ar y system ddarlledu. Sicrhewch fod y golau coch yn broadcasting system. Please ensure that the red light is on disgleirio cyn cychwyn siarad. Mae’r cyfieithiad ar y pryd ar sianel 1, before speaking. Interpretation is available on channel 1, and the a’r darllediad gair am air, i glywed y sain yn well, ar sianel 0. verbatim broadcast, to amplify the sound, is on channel 0.

10.30 a.m. Mesur Arfaethedig Iechyd Meddwl (Cymru) 2010—Sesiwn Dystiolaeth 2 Proposed Mental Health (Wales) Measure—Evidence Session 2

David Lloyd: Byddwch yn ymwybodol mai rôl y pwyllgor hwn yw David Lloyd: You will be aware that the role of this committee ystyried a chyflwyno adroddiad ar egwyddorion cyffredinol y Mesur is to consider and report on the general principles of this arfaethedig hwn, fel y’i cyflwynwyd gan y Gweinidog dros Iechyd a proposed Measure, as introduced by the Minister for Health Gwasanaethau Cymdeithasol ar 22 Mawrth eleni. and Social Services on 22 March this year.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Rhaid i’r pwyllgor cwblhau ei waith a chyflwyno adroddiad i’r Cynulliad The committee must complete its work and lay its report erbyn 2 Gorffennaf eleni. Hon yw ein hail sesiwn dystiolaeth ar y before the Assembly by 2 July this year. This is our second Mesur arfaethedig. Yr ydym eisoes wedi clywed tystiolaeth gan evidence session on the proposed Measure. We have already elusennau iechyd meddwl yr wythnos diwethaf. heard evidence from mental health charities last week.

Mae ein hymgynghoriad yn dal i fynd ymlaen a cheir manylion Our consultation is ongoing and you will find details about it amdano ar wefan y pwyllgor. Y dyddiad cau ar gyfer cyfraniadau on the committee’s website. The closing date for written ysgrifenedig yw dydd Gwener, 14 Mai. Diben cyfarfod heddiw yw submissions is Friday, 14 May. The purpose of today’s meeting clywed tystiolaeth ar lafar mewn cysylltiad â’r Mesur arfaethedig gan is to hear oral evidence in connection with the proposed Jonathan Morgan, Aelod y Cynulliad sy’n gyfrifol am y Gorchymyn Measure from Jonathan Morgan, the Assembly Member cymhwysedd deddfwriaethol perthnasol. Byddwn hefyd yn cymryd responsible for the relevant legislative competence Order. We tystiolaeth yn nes ymlaen oddi wrth y Gweinidog, Edwina Hart, sy’n will also take evidence later from the Minister, Edwina Hart, gyfrifol am y Mesur arfaethedig penodedig o’n blaenau. who is responsible for the proposed Measure before us.

Hoffwn groesawu Jonathan Morgan i’r cyfarfod. Jonathan, fel y’i I welcome Jonathan Morgan to the meeting. Jonathan, as I crybwyllais, yw’r Aelod a oedd yn gyfrifol am y GCD ar ddarpariaeth mentioned, is the Member responsible for the LCO on the gwasanaethau iechyd meddwl a rhoddodd y cymhwysedd i’r Cynulliad provision of mental health services that gave the Assembly the i ddeddfu yn y maes hwn. Felly, bore da a chroeso, Jonathan. competence to legislate in this area. So, good morning and welcome, Jonathan.

Ein trefn arferol yw symud i gwestiynau yn syth. Mae gennym restr o Our normal practice is to move straight to questions. We have gwestiynau wedi’u paratoi, felly, gyda’ch caniatâd, symudwn ymlaen a list of prepared questions, so, with your permission, we will at y rheiny’n syth. Fel y traddodiad yn y pwyllgor hwn, gofynnaf i’r move straight to those. As is the tradition of this committee, I ddau gwestiwn cyntaf. A allwch esbonio eich amcanion wrth will ask the two first questions. Can you explain your objectives gyflwyno’r GCD ar iechyd meddwl? in introducing the mental health LCO?

Jonathan Morgan: The purpose of the LCO was to ensure that those who might be living with the effects of mental ill health could get quicker access to an assessment of their needs and a package of care and treatment, where needed, to avoid the slippery slope that many face where compulsory treatment or detention becomes the only option. It has taken over two and a half years to get to this point, but I am delighted that we are here and I broadly welcome the introduction of the proposed Measure on the back of the LCO. The competence Order, as you will remember from the debates that we had in the Assembly, sought to provide a comprehensive legal framework that would allow patients to have earlier access and the right to an early access to an assessment of their needs, where it was deemed necessary, where a package of care could be provided and where that patient had needs that were identified. However, it also sought to ensure that advocacy could become available at an earlier stage in the process. One of the most glaring gaps in legislation was where the provision of advocacy would only kick in if a patient had become so severely unwell that he or she had been detained for his or her own health and for the health and welfare of others, which did not seem to be particularly sensible to me. So, the LCO in the broader sense was to try to do those three things around assessment, treatment and care, and for those who require advocacy.

David Lloyd: Diolch am hwnnw. Yn dilyn o hynny, yn gyffredinol, David Lloyd: Thank you for that. Following on from that, in a gredwch fod y Mesur arfaethedig sydd gerbron yn adlewyrchu general, do you believe that the proposed Measure reflects the ysbryd ac amcan eich GCD? spirit and objective of your LCO?

Jonathan Morgan: As I said earlier, I welcome the introduction of the proposed Measure. It is the first opportunity for the National Assembly for Wales to legislate to the extent that it is geared towards an early assessment. There are provisions in the proposed Measure to ensure that patients are referred to an appropriate part of the NHS for an assessment. There are also provisions in the proposed Measure that place duties on local authorities and health boards to work together to secure those services that are required and it is geared towards a category of patient. I will come back to that later, if I may.

I am personally disappointed that the legislation is not as ambitious as the LCO anticipated and I have clarified some of those issues in the written evidence. It is vital that the proposed Measure is as seamless and comprehensive as possible. We need to provide a service for individuals. This should not be about trying to cherry-pick people, either because of their age, their condition, or perhaps the setting within which they receive services. So, we need to examine where this proposed Measure will take us. It is an extremely good piece of legislation from the point of view that it is a starting point for the National Assembly for Wales, but I do not think that it completely satisfies the more ambitious outlook that was contained within the LCO.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) William Graham: Sections 1 and 5 provide definitions of 'local mental health partners’ and support services. Similarly, sections 11 and 12 provide definitions of 'relevant patients’ and 'secondary mental health service providers’. Are you content that these definitions encompass all relevant parties?

Jonathan Morgan: In part, I am content. I have some concerns about sections 5 and 11. With regard to section 1, in defining what we mean by 'local mental health partners’, it is right for the Assembly Government to stipulate that we anticipate that local authorities and local health boards will be identified jointly as the partners. This is the clearest indication from the Assembly Government that it wants organisations to work together in securing the services that people need in order to secure an assessment and to provide a package of care and treatment to enable individuals to live with the effects of mental ill health. So, the definition in section 1 of 'local mental health partners’ is appropriate.

I have a few concerns with regard to section 5. Sub-section (2) of section 5 contains a definition of 'patient’. The definition is

'adults who have, or may have, a mental disorder’.

So, I am concerned that, once again, we are referring to adults. The intention of the Government through the proposed Measure is to secure a piece of legislation that does not affect those under the age of 18; it is purely for adults. That is regrettable. The legislative competence Order envisaged a situation where the provision of services would be age-blind—that was the term that we used when we designed the LCO. In doing that, we anticipated a seamless service, because we all know about the criticism around child and adolescent mental health services. We know about the work that has been undertaken jointly by the Wales Audit Office and others, and many of the annual reports of the Children’s Commissioner for Wales have pointed to some of these deficiencies. So, I am certainly concerned about the definition in section 5(2).

Gofal Cymru raised a number of issues regarding the definition last week, one of which was the way in which the legislation is limited to the provision of advice and information on housing and welfare services. I would have thought that the Government would want to keep that as flexible as possible. In its evidence last week, Gofal Cymru referred to the need for information and advice on employment, debt, finance, peer relationships and voluntary sector services, for example. So, I am not entirely sure why that particular section has been limited—point (c) of section 5(2)—to housing or welfare services. I would, therefore, raise that as a particular concern.

Again, in section 11, I am concerned with 'relevant patient’ being defined as an adult. I am, however, satisfied with the definition of 'mental health service provider’ as identified in section 12.

William Graham: You mentioned the desire for the legislation to be age-blind; is there a case for introducing separate legislation to address the distinctive mental health needs of children and young people?

Jonathan Morgan: The proposed Measure is a significant piece of legislation that could act as the vehicle to provide a seamless service. I would imagine that it is not beyond the wit of the Assembly Government and its lawyers to examine how the proposed Measure could be extended to include young people. Those health services ought to be provided to people under the age of 18. There is no reason why that could not be extended. There may be an issue around how advocacy services could be provided to people under the age of 18, simply because, if you are a child, then your parents have certain rights and responsibilities, so I suppose that that could be a sticking point.

10.40 a.m.

I do not know why young people were not included within the proposed Measure. The evidence provided last week by Sue Barnes of Hafal was that it had service users under the age of 18 who are married and have children. So, we do not just see them in the confines of being children—we see them as being people with very active responsibilities in the community, who are responsible for their own family and for children. Those families could be quite severely impacted upon if the proposed Measure did not extend to those under the age of 18. It is possible that the Assembly Government could introduce further legislation to deal with people under the age of 18, but as we have the proposed Measure before us, I imagine that it would more sensible for it to be amended and extended to those people under the age of 18 so that we can ensure that there are no gaps. If you look at some of the evidence around when young people face mental ill health, there is a body of evidence to suggest that those around the ages of 14, 15 and 16 face an increasing number of challenges with regard to mental ill health. The rise in the level of adolescent mental ill health has been reported in many medical journals. If you examine that, the potential for young people to face mental ill health but not have access to these services could be a significant problem—it would be a travesty in terms of service development in the future.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) We could also face the challenge of people falling between the gaps. One of the difficulties of introducing a separate piece of legislation for those under the age of 18 is the potential for those people to fall between the gaps of any framework for the under 18s compared with a framework provided for the over 18s. So, it would be far better for this piece of legislation to be amended in a way that takes into account those who are under the age of 18.

Christine Chapman: My questions are on the local primary mental health services in Part 1 of the proposed Measure. You say in your written evidence that:

'there is…an argument for specifying certain services which patients would expect as a minimum entitlement’.

What kinds of services should this include, and should they be specified on the face of the proposed Measure?

Jonathan Morgan: I was afraid that you were going to ask this particular question. This is one of the conundrums of providing a new framework for the provision of services. I suppose that it is not unusual for a new arrangement to provide for core services and for there to be the flexibility for health boards and others to provide those additional services. I suppose that the pharmacy contract is the clearest example of where, in recent times, the Assembly Government has provided a framework for a core entitlement of what you could expect, and the opportunity for local flexibility to provide those additional services.

One of the difficulties with the proposed Measure is that, although it focuses on joint working between local health boards and local authorities, the nature of that joint working will clearly be different depending on which area you are in. If you are in north Wales, you have one local health board but several local authorities. In the Gwent area—I am sure that William Graham will correct me if I am wrong—there are five local authorities and one health board. So, if you have a health board that is drawing up a scheme of working arrangements between a health board and a local authority, will that scheme be completely different in one local authority area compared with another? For example, would the scheme in Newport be fundamentally different to the scheme in Islwyn, because they are two different local authority areas? So, there is the potential for there to be a postcode lottery unless the Assembly Government points out where a minimum level of service would be designed.

I am uncertain as to whether that is something that should be on the face of the proposed Measure or whether that is something that could be included in regulations. From a legislative point of view, I suspect that it might be difficult. However, speaking as someone who would like to be very radical with this, it is always desirable to have as much in the proposed Measure as possible, because it means that the Assembly can have the fullest possible level of scrutiny. I suspect that the Government will argue that it is very difficult to contain all of that in the proposed Measure, because it makes it very difficult to amend in the future, without having to go back through a very complicated amendment process.

So, the framework, in whatever shape it takes, needs to stipulate what people should be able to expect as a minimum. That could include what form the assessment would take or whether or not it would involve the provision of psychiatric services in the community, because we know that there are some gaps in certain parts of Wales, where psychiatric or psychology services are difficult to provide, and we know that, in certain parts of Wales, people have to wait a significant period of time to receive those services. It is also possible for minimum entitlements or a framework to stipulate the level of occupational therapy or cognitive behavioural therapy services that might be required. There must be a way of doing this. I am not completely clear as to all the services that should be provided as a bare minimum, but we should certainly be able to raise the level of expectation. We should be able to say to people, 'If you are unwell, there is a minimum level of service that you should be able to access’, but that other services could be available, depending on the local needs. I do not think that we want something that is completely restrictive, because a strong argument may be put forward by the health board in Cardiff in negotiation with the Vale of Glamorgan local authority, and likewise throughout Wales. So, there needs to be some flexibility, but there must be a way of telling people—patients, people who run local authorities and health boards and clinicians— what constitutes the minimum standard that we would expect from those services.

Christine Chapman: To move on, you also say that it is important to ensure that

'the inclusion of local primary mental health support services running along side GP services, are used in a coordinated way and not just seen by GPs as an opportunity to off load patients’.

Do you think that the proposed Measure, as drafted, will secure this co-ordination of services, and, if not, how should it be amended?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Jonathan Morgan: The emphasis in Part 1 on getting local authorities and health boards to work together is extremely welcome. The clear intention of the Government is that there be joint working, and this is probably one of the rare occasions where we have seen a piece of legislation that drives a joint-working approach. That is welcome; there is a significant opportunity for services to be co- ordinated and joined up. What I am not clear about is how the GP services will run alongside the local primary mental health support services. I am conscious of the fact that the Chair is a GP, so I will be careful in what I say, however, as an Assembly Member, I have had constituents come to me saying that they have struggled to get their GP to see the problem that a family member has faced. They have been concerned about the level of awareness among GPs—perhaps that is a training issue or the level of general awareness—and they have been concerned that action has not been taken quickly enough in order to get that person seen by someone who may have the relevant expertise.

I would like to see GPs having a greater interest in, and a greater range of expertise and understanding of, mental health issues generally. People working in primary care would also argue for that. Where we need to be careful is in ensuring that the GPs, who are under tremendous pressure with their caseload—there is no doubt about that—do not see the local primary mental health support services purely as an opportunity to offload patient A in a rapid way, without first having taken the opportunity to see whether they are able to help the patient. You could see a significant backlog of patients being referred quickly to the local primary mental health support services simply because GPs are unsure as to what to do with them. That would be regrettable.

One other issue that may be a determining factor—I know that this was raised with you in evidence last week—is that of timescales. Is it important that we have timescales that allow people to see their GP quickly and that there is an expectation that those patients will be referred as quickly as possible for an assessment to take place—

David Lloyd: We have questions coming up about timescales.

Jonathan Morgan: In that case, I will not go on about timescales now, but timescales could be one way for us to drive that level of co-ordination. If medical practitioners, patients and families and also the people running health boards and local authorities know that there is an expectation around timescales, then it may drive that level of co-ordination more productively. Getting organisations to work together is sometimes quite challenging, but that may be one way of achieving it.

10.50 a.m.

Christine Chapman: My next set of questions is on the timescales, which you believe are important. Evidence from Hafal suggested that there should be a requirement in the proposed Measure of a maximum period of 30 days between referral by a general practitioner and the assessment. What is your view on the merits of that recommendation?

Jonathan Morgan: There are a few issues around timescales. One issue that struck me is that, when looking at the legislation, particularly Part 1, section 2, as it stands, there is no detail in the proposed Measure—perhaps this may come out in guidance or regulation—as to when a scheme decided by the local authority and the health board would need to be agreed by and when it should be implemented. There is also no clarity that states for how long a scheme would run and how and when it may be reviewed. So, in terms of the way in which a scheme could be designed, there is nothing on timescales.

There are default provisions under section 4 for the Minister to determine where there has been failure on the part of the local health board and the authority to agree to a scheme, that is, where there has been a breakdown in negotiations. That is welcome, but again, there is no timescale to set out how long that process may be. The Minister may say in her evidence that such levels of detail would follow in guidance or in regulations, but I wonder whether we need to be quite radical in hard-wiring the need for timescales in that section of the proposed Measure. If there is no clarity in the proposed Measure or in regulations to drive health boards and local authorities to deliver the scheme within a certain time, there is potential further down the line for them to continuously disagree on what needs to be provided and by whom.

Christine Chapman: So, would you be happy to have the time frames on the face of the proposed Measure rather than in the regulations?

Jonathan Morgan: In determining how the scheme looks and to get agreement on the scheme, as outlined in Part 1, between the local authorities and the health board, I think it would be advisable for the timescale to be on the face of the proposed Measure.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Returning to the specifics of what Hafal and others have stated about the timescale for ensuring that a patient gets referred to the local primary mental health support services, and then, beyond that, the time frame within which a package of care is delivered, it is sensible for timescales to be put into legislation. I am a little uncertain as to whether that needs to be put into the proposed Measure or whether that should be in regulation or in the targets of the annual operating framework, which the Government can use to drive improvements in services. Some people would argue, however, that even putting it in the AOF does not always mean that it gets delivered. Putting a target to get a patient seen by the local primary mental health support services within 30 days and then getting a care plan designed within perhaps 60 days may be quite tricky if that is not on the face of the proposed Measure. However, it should certainly be there somewhere, whether that is on the face of the proposed Measure, in regulation, guidance or in the annual operating framework.

There should be a level of expectation. If a patient is unwell, and a GP is sufficiently concerned about his or her patient, then there should be an expectation that that patient is seen as quickly as possible by the local primary care mental health service and, beyond that, a time frame within which the patient and his or her family and carers would expect that package of care to be designed. There could otherwise be a significant backlog of people waiting quite a long time for those services to be in place. We do not want health boards and local authorities using the excuse that there is nothing telling them that they must get that done within a certain time frame and, therefore, patients will have to wait a significant period of time for that to be put together.

David Lloyd: Symudwn ymlaen yn awr at faterion eiriolaeth. David Lloyd: We now move on to advocacy issues.

Peter Black: You say that there is a need to support former users of secondary care and their friends and family in requesting a reassessment of their mental health. Why is there a need for this, and how should the proposed Measure accommodate it?

Jonathan Morgan: One of the issues that we examined in some detail when the legislative competence Order was progressing was the shape of the advocacy service. We discussed the definition of 'advocacy’, how to define the independence of the advocacy and the patients’ responsibility in advising on the sort of advocacy they wanted. Apart from the independence, which is critical—and the Government has inserted provisions for the independence of the advocacy—for me, it was also about the confidence that patients could have that, whoever their advocate would be, that advocate would be capable of standing up for their needs.

An advocate could be anyone, except where there are exceptions to do with someone being a medical practitioner or being charged with the medical care of the patient. If it was me, I would have the utmost confidence in certain members of my own family who I know full well would be tough, robust and articulate enough to stick up for me and argue my corner. I am concerned about the scope of the proposed Measure, under section 29(4) in Part 4. I agree with the Minister that arrangements should, as far as is practicable, be made by a person who is independent of any person who is professionally concerned with the patient’s medical treatment. I think that is right. If we are to secure independent advocacy, that is absolutely right. I am concerned by section 29(4)(b), which states that arrangements should be provided by a person who is independent of any person who

'falls within a description specified in regulations made by the Welsh Ministers.’

I would be concerned if we were saying to patients that an advocate has to be someone who has undertaken training or someone working for one of the mental health charities, and that it could not be someone who is a close friend, a carer, or a member of your family. We need to be careful about how strictly that is defined in regulations. I am not saying that we have to outline all of this in the proposed Measure, but with regard to the way in which regulations will be brought forward, I would be really concerned if we were to say that family members will have no role at all in being able to take on the responsibility of being an advocate. We all know of situations—we have probably seen them ourselves—where a family member understands the patient extremely well, where a family member understands the condition of that person, and they understand the nature of the treatment and what works well for that person. So, we need to be careful that we are not restricting this in a way that prevents family members from engaging with this by acting as advocates. It is about getting the confidence of people who live with the consequences of mental ill health, many of whom would argue that family members are well placed to help.

One of the concerns that was expressed to me when the legislative competence Order was progressing—and I will probably get a stern e-mail from some of the organisations later for saying this—was that we need to ensure that we are not just gearing the advocacy service to those in the voluntary sector who already provide other services. Is it possible for a charitable organisation that provides services to provide an independent advocacy service as well? That is something that we need to consider. If it can provide that service and independent advocacy, we may need to look at what safeguards are required to see that there is no conflict of interest.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) David Lloyd: Before you move on, Joyce has a supplementary question.

Joyce Watson: I was thinking the same thoughts in relation to families, as family members might be the carers. So, if you are stating the case for voluntary organisations and recognising that there is a possible conflict of interest—which I assume is what you were referring to—could you not say exactly the same about families?

11.00 a.m.

Jonathan Morgan: You certainly could. I am not saying that there is a system or a framework that is absolutely perfect, but we have to recognise that there is always potential for conflict. I do not know how the framework can be amended, either in the proposed Measure or in regulations, but however it is provided, it needs to be flexible. For example, a family friend could also be fully employed by one of the voluntary organisations, so we need to ensure that it is flexible enough for the wishes of the patient to be taken into account. It may be different for people who are being detained under the Mental Health Act, because we may need to ensure that the level of expertise, knowledge and understanding among their advocates is of a different standard. I do not know whether to express my concerns now about the range of the advocacy service and where the service might apply, but one of my concerns over the ministerial statement—

David Lloyd: That is the next question.

Jonathan Morgan: I see. We will come back to that in a moment, then.

One of my other concerns involves section 10 in Part 1 of the proposed Measure, on the action that will follow a primary mental health assessment. If we are saying—as the Minister said in Plenary—that the advocacy is geared towards people who are in hospital but have not been detained, and if it is about the provision of secondary care services, how will we ensure that a patient who is concerned about the services that have been designed as a result of the actions under section 10 will be able to challenge them? If they do not feel comfortable and confident about being able to challenge what has been designed for them under the scheme, as set out by the local health board and the local authority, who will stick up for them if they want to challenge the outcome of what is in section 10?

I am concerned about that aspect of the scope of the advocacy service, and also for those people who have been discharged. If we are providing an advocacy service for people who are in hospital but who are not being detained, so if patient A is discharged from hospital but is not under a community treatment plan order, where is the advocacy service for that person? If people want to self-refer, or if they want to raise concerns about how their treatment plan is working, how they are feeling or what impact this is having on their state of mental wellbeing, they may need access to advocacy services. The way the advocacy services have been designed in the proposed Measure and, potentially, in regulations could be restrictive. I anticipated something much broader, something that would be there to assist people when they have concerns about the way their assessment and their care plan is being delivered. I suggest that it is important that the committee looks at whether or not the advocacy is too confined to people who are in a secondary care setting.

Peter Black: You have answered all three of my questions, which is fine, but to come back to section 29, you rightly identify the caveat about the regulations specified by the Welsh Ministers in relation to the definition of advocacy services. How would you rephrase that, or would you want to put some extra scrutiny in there to try to provide more safeguards to address the concerns that you have just set out?

Jonathan Morgan: First, it is right for the Government to set out exceptions. As I said earlier, setting out the exception with regard to professionals who are concerned with a patient’s medical treatment is absolutely right. However, what the Government has then done, instead of outlining other circumstances, is to say in section 29(4)(b) that it will be defined in regulations made by Welsh Ministers. Somewhere in that section, there needs to be a reference to the patient and how the patient’s view could be taken into account. It might be difficult to start listing in the proposed Measure all of the individuals who could be included as able to provide advocacy services, because there could be situations, returning to the conflict of interest question that Joyce raised earlier, where, if we try to define them too strictly in the proposed Measure, that may be too restrictive, even if we expand the list of people who could provide an advocacy service. There has to be a way of taking the patient’s view into account. I do not think that it is right for the Assembly and the Assembly Government, in legislating, to say 'Patients’ views are not important; this is what you can expect’. Looking at it from the point of view of the patient may also help to determine what goes into regulations.

Peter Black: Would you put the need to take account of the views of the patients in determining who the advocate should be on the face of the proposed Measure?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Jonathan Morgan: I would put a reference to the patient’s view on the face of the proposed Measure; that is important. I can understand why a regulation would be required to set out who could provide those advocacy services, but I think that enshrining in law the right of the patient to have a view, for them to be able to express that view and for it to be taken into account is extremely important.

Joyce Watson: Moving on to regulatory impact assessments, you say that there would be a need to increase staff capacity, including training, to deliver the objectives of the proposed Measure. Do you think that the regulatory impact assessments make sufficient provision for that?

Jonathan Morgan: The simple answer is that I do not know. On the face of it, the Minister seems to have estimated the likely costs— this was supported in evidence given last week—but there would be issues of indirect costs, staffing costs and costs for necessary training that may come with the them. One point that Ruth Coombs of Mind made last week was that the committee should, perhaps, investigate the models laid out in other countries such as New Zealand and the Scandinavian nations, but more specifically in Scotland, to see what financial impact there has been, and whether cost savings are starting to filter through to NHS Scotland in the case of the latter.

One of the arguments that we always hear from the NHS is that, where one puts new duties and responsibilities on public bodies—be they local government or health bodies—these will cost more. The reverse of that argument is that the Government will say, and has rightly said, that there is more money going into the NHS and that more money has been going into the provision of mental health services. So, one could easily argue that, if the money is already in the system, why is it not being used at the moment to drive the reforms that we need in mental health services; why is the money not being used to provide a better service? It would be very easy for me, as an opposition politician, to say that it is all about money and that a lot more money needs to go into services. There could well be an argument that there is already money in the system that needs to be better used. Where that money is better used, there could be longer-term cost savings, because the more that we do to ensure early access to assessment and treatment, and to the provision of care services and advocacy, the more that we can hopefully prevent some people from being detained later on in life because of the nature of their ill health.

When we were looking at the legislative competence Order, evidence from Hafal said that roughly half of the people who had been detained would have asked for help at some point, but would either have been ignored or their wishes would have been denied. If you work on the basis that there could well be a significant proportion of people who are currently being detained for their own health and welfare who might not have needed to be detained—because, early on in the cycle, they might have been identified, supported and cared for with a treatment plan designed for them—it may be possible that we see a cost saving in future, because the same number of people are not being detained.

The Minister for Health and Social Services has been bold enough to put money in the budget for the next financial year; costings are outlined in the impact assessment for the next few years. However, with the money that has gone into the NHS, there should be more than enough flexibility and scope to deliver these services. We could see a difficulty with indirect costs such as staffing, particularly if we are looking to recruit certain professionals—gaps currently exist, particularly in psychiatric care, psychological support and those who provide cognitive behavioural therapy—so there could be an argument in certain parts of Wales that we do not have the right numbers of professionals. We would need to address that, but I am a little unclear as to whether the NHS could cope with some of that within the cost savings that could be made or the money that it currently gets, or whether there could be a need for some of the additional resources that the Assembly Government has identified to be used for those purposes.

When the proposed Measure goes through, and when the regulations are designed and implemented, my concern would be how quickly we would expect the NHS and local government to implement the new framework, and whether or not there needs to be some lead-in time to allow them to make any necessary changes. If we say to them that this proposed Measure will hopefully become law by March of next year, that the regulations will follow, and that they will have to implement all of this in April 2011, there could well be a situation where some of them say that they are in financial difficulty, struggling to provide these services. We do not want this to fall flat on its face.

11.10 a.m.

Joyce Watson: I want to get to the end of the questions, and we are running out of time. I will ask you a pointed question and hope for a pointed answer. Given the likely pressure on public finances, which you have identified, are you confident that the proposed Measure as drafted will deliver the financial benefits of which you have given many examples? If not, can you give us a pointed answer on how you think it should be amended to maximise those benefits?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Jonathan Morgan: It is difficult to amend a proposed Measure so as to provide financial benefits. The main financial benefit will come from organisations working together, and that may mean that they pool resources, so that the resources have a bigger impact. However, the proposed Measure’s early access to treatment and advocacy should provide services sooner, so that we prevent people being detained later on—and detention costs a lot of money, in addition to all the human costs associated with it. So, I do not think that the proposed Measure needs to be amended in a way that could realise cost benefits.

Joyce Watson: Apart from the resource issues, what other barriers to the implementation of the proposed Measure do you foresee?

Jonathan Morgan: The biggest issue, which I mentioned earlier, would be the time frame within which this is implemented. If we say to public bodies, patients and families in Wales that this will start in April of next year—the new financial year—without any lead-in time, then a situation could arise where the framework simply does not work. One of the surprises that I had was when the LCO was finally approved. I had phone calls from relatives of individuals living with the consequences of mental ill health, and some from patients themselves, wanting to know what it meant for them at that point. I had to point out that it was merely a devolution of the powers from Westminster to Wales to allow the Assembly to legislate. If I was getting a flutter of telephone calls at that point, you can imagine how many people outside of this building will assume that, once this passes, it is all implemented, and they suddenly have these rights, and that these duties are placed upon public bodies. We need to ensure, and the Government needs to ensure, that the framework is in place so that this can start as quickly as possible. It is important that Government gives the clearest indication as to when it believes all of these big changes will come in. This is a big change, have no doubt about it—it is the single biggest change to the provision of mental health services that we will have seen in Wales for many decades. It is the biggest chance that we have had as an Assembly—the only chance—to legislate for the biggest single reform of mental health services, and lead the rest of the UK. It is that lead-in time, Joyce, that potentially needs to be examined—otherwise a quick, sudden implementation will be seen as a barrier, because people will be expecting services very quickly.

Joyce Watson: I am trying to get to the last question, because it is crucial. I agree with what you have said. Do you believe that the has made the best use of the powers available in the LCO in drafting the proposed Measure? If you do not agree, what other legislative changes on mental health services would you like to see?

Jonathan Morgan: Hand on heart, I do not think that the proposed Measure is as ambitious as the LCO. The LCO itself, in conferring powers to provide a whole range of advocacy services to people regardless of their age, condition or the setting in which they need to access them, made a desirable change, supported by all of us in the Assembly, and driven very well by the Minister for Health and Social Services in terms of getting this through Westminster. Hand on heart, I am disappointed, because I do not think that this proposed Measure reflects the true ambition in the competence Order. However, I do not think that we need other pieces of legislation —this is the vehicle, it is a substantive piece of law, and there is the option here for this committee and the Government to look at what amendments are required. We need to ensure that this legislation is extended to cater for people under the age of 18, and that it extends the provision of advocacy, and is seamless and comprehensive and we need to show the rest of the UK that this is how you need to reform mental health services. I have always seen this as what I would term 'the last great social reform’, because for many years we have been poor in providing services to people who live with the consequences of mental ill health. That is not a party political comment; it is something that Government and politicians generally have not engaged with. We have a significant opportunity here to do something radical and exciting, and to give those people in Wales who live with mental ill health confidence that services are there to support them. That is where we need to be focusing. We need to be ambitious, and we need to use this as that golden opportunity.

David Lloyd: A ydych yn hapus gyda hynny, Joyce? David Lloyd: Are you happy with that, Joyce?

Joyce Watson: Yes.

David Lloyd: Diolch yn fawr. Dyna ddiwedd y cwestiynau David Lloyd: Thank you. That brings us to the end of the official swyddogol. A oes gennych unrhyw sylwadau terfynol i gloi, questions. Do you have any final comments that you wish to make, Jonathan? Credaf fod y sylw diwethaf a wnaethoch yn ddigon Jonathan? I think that the last comment that you made was quite terfynol i gloi’r sylwadau y bore yma. Felly, diolch ichi am eich final in closing your comments this morning. Therefore, thank you for cyfraniad. Bydd y clerc yn anfon atoch drawsgrifiad drafft o your contribution. The clerk will send you a draft transcript of today’s drafodion heddiw i’w cywiro, os bydd angen, cyn eu cyhoeddi’n proceedings for correction, if necessary, before final publication. derfynol.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Bydd y Gweinidog yma i roi tystiolaeth yn brydlon am 11.30 The Minister will be here to give evidence at 11.30 a.m. promptly, so a.m. felly cymerwn doriad byr yn awr. Byddwn yn ailymgynnull we will now take a short break. We will reconvene promptly at 11.30 yn brydlon am 11.30 a.m. a.m.

" ""Gohiriwyd y cyfarfod rhwng 11.16 a.m. ac 11.28 a.m. The meeting adjourned between 11.16 a.m. and 11.28 a.m. "

David Lloyd: Croeso yn ôl ichi i gyd. Ger ein bron yn awr y David Lloyd: Welcome back, everyone. With us now is Edwina Hart, mae Edwina Hart, y Gweinidog dros Iechyd a Gwasanaethau the Minister for Health and Social Services. She is the Member Cymdeithasol. Hi yw’r Aelod sy’n gyfrifol am y Mesur responsible for the proposed Measure on mental health. Welcome, arfaethedig hwn ynghylch iechyd meddwl. Croeso, Weinidog. Minister. As you know, a series of questions has been prepared, and Fel y gwyddoch, mae cyfres o gwestiynau wedi’i pharatoi. so, with your permission, we shall move straight to those questions. I Gyda’ch caniatâd, felly, symudwn yn syth at y cwestiynau will ask the first two. First, can you outline the key objectives of the hynny. Daw y ddau gyntaf oddi wrthyf fi. Yn gyntaf, a allwch proposed Measure? amlinellu prif amcanion y Mesur arfaethedig?

The Minister for Health and Social Services (Edwina Hart): Y Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol It is fair to say that mental health problems are very common, (Edwina Hart): Mae’n deg dweud bod problemau iechyd meddwl yn and the proposed Measure will set out clearly what we expect gyffredin iawn, a bydd y Mesur arfaethedig yn nodi’n glir yr hyn yr mental health services to deliver in Wales. There are five ydym yn ei ddisgwyl i wasanaethau iechyd meddwl ei gyflawni yng interrelated policy objectives. The first is to provide an Nghymru. Mae pum nod polisi sy’n cydberthyn. Y cyntaf yw cynnal assessment of individuals’ mental health and, where asesiad o iechyd meddwl unigolion a, lle’n briodol, darparu triniaeth appropriate, provide treatment for an individual’s mental health ar gyfer anhwylder iechyd meddwl unigolyn o fewn gofal sylfaenol disorder within primary care by establishing a duty on local drwy sefydlu dyletswydd ar bartneriaid iechyd meddwl lleol, byrddau mental health partners, health boards and local authorities to iechyd ac awdurdodau lleol i ddarparu gwasanaethau cymorth gofal deliver primary mental health care support services across iechyd meddwl sylfaenol ledled Cymru. Yn ail, bydd yn sefydlu Wales. Secondly, it will establish statutory requirements with gofynion statudol o ran cynllunio gofal a thriniaeth a chydgysylltu regard to care and treatment planning and care co-ordination gofal mewn gwasanaethau iechyd meddwl eilaidd, a bydd yn mynnu within secondary mental health services, and it will require bod gwasanaethau iechyd meddwl eilaidd â threfniadau yn eu lle i secondary mental health services to have arrangements in place sicrhau bod defnyddwyr blaenorol o wasanaethau yn cael mynediad to ensure the provision of timely access to assessment for amserol i asesiadau, sy’n bwynt pwysig. previous service users, which is an important point.

11.30 a.m.

It will also extend the group of qualifying patients under the Bydd hefyd yn ehangu’r grŵp o gleifion sy’n gymwys o dan Ddeddf Mental Health Act 1983 entitled to receive support from an Iechyd Meddwl 1983 sydd â’r hawl i dderbyn cymorth gan eiriolwyr independent mental health advocate, so that all patients subject iechyd meddwl annibynnol, fel bod yr holl gleifion sy’n to the formal powers of the Act can receive such support, if ddarostyngedig i bwerau ffurfiol y Ddeddf yn gallu derbyn cymorth, required. It will also enable all patients receiving treatment for os yw hynny’n ofynnol. Bydd hefyd yn galluogi i bob claf sy’n derbyn mental health disorders in hospitals in Wales to have access to triniaeth ar gyfer anhwylderau iechyd meddwl mewn ysbytai yng independent and professional specialist mental health advocacy. Nghymru i gael mynediad i wasanaeth eiriolaeth iechyd meddwl arbenigol annibynnol a phroffesiynol.

The proposed Measure aims to place a range of statutory Nod y Mesur arfaethedig yw gosod ystod o ddyletswyddau statudol duties on health boards and local authorities, requiring them to ar fyrddau iechyd ac awdurdodau lleol, sy’n ei gwneud yn ofynnol make arrangements for the provision of these services in their iddynt wneud trefniadau ar gyfer darparu’r gwasanaethau hyn yn eu respective geographical areas. On the legislation, we need to hardaloedd daearyddol eu hunain. O ran y ddeddfwriaeth, mae use the proposed Measure to clearly set out the mental health angen i ni ddefnyddio’r Mesur arfaethedig i nodi’n glir y services that we expect providers to deliver in Wales. gwasanaethau iechyd meddwl y disgwyliwn i ddarparwyr eu darparu yng Nghymru.

David Lloyd: Diolch am hynny, Weinidog. O ran yr angen am y David Lloyd: Thank you for that, Minister. On the need for this new ddeddfwriaeth newydd hon, a allwch olrhain yr hyn sy’n legislation, could you outline what is missing from the existing absennol o’r drefn ddeddfwriaethol gyfredol, a pha ymdrechion legislative arrangements, and tell us what efforts you have made to a wnaed gennych i gyflawni amcanion y Mesur arfaethedig hwn try to implement the objectives of the proposed Measure using the o dan y ddeddfwriaeth sydd eisoes yn bodoli? existing legislation?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: We must recognise that the existing mental Edwina Hart: Mae’r rhaid i ni gydnabod bod y ddeddfwriaeth iechyd health legislation, the Mental Health Act 1983, deals meddwl gyfredol, Deddf Iechyd Meddwl 1983, yn ymdrin yn bennaf â predominantly with matters of compulsory detention and materion triniaeth a chadw gorfodol. Nid oes cyfraith i wneud treatment. There is no law to make specific provision for early darpariaeth benodol ar gyfer datgelu a thrin problemau iechyd detection and treatment of mental health problems before they meddwl yn gynnar cyn iddynt gyrraedd pwynt lle mae angen reach a point at which compulsory treatment or detention is triniaeth neu gadw gorfodol. Yr ydym wedi gweld angen required. We have seen a real need emerging from the sector gwirioneddol yn dod o du’r sector ac elusennau iechyd meddwl ar and mental health charities for different services in this regard. gyfer gwahanol wasanaethau yn hyn o beth.

I have the national service framework targets and policy Mae gennyf y targedau fframwaith gwasanaeth cenedlaethol a implementation guidance to help me in this area. However, chanllawiau gweithredu polisi i’m cynorthwyo yn y maes hwn. Fodd looking at this more widely, I also have powers available to me, bynnag, wrth edrych ar hyn yn fwy eang, mae gennyf hefyd bwerau as a Welsh Minister, to insist that LHBs provide these services. ar gael i mi, fel Gweinidog Cymru, i fynnu bod pob BILl yn darparu’r However, I think that the proposed Measure would be better at gwasanaethau hyn. Fodd bynnag, credaf y byddai’r Mesur achieving those aims than if I were to give directions. We also arfaethedig yn cyflawni’r nodau hynny’n well na phe bawn i yn rhoi need to recognise that creating specific mental health legislation cyfarwyddiadau. Mae hefyd angen i ni gydnabod bod cefnogaeth for Wales has wide-ranging support among the users and eang ymysg y defnyddwyr a sefydliadau ymgyrchu i greu campaigning organisations. It is key for us, as the National deddfwriaeth iechyd meddwl benodol ar gyfer Cymru. Mae’n Assembly for Wales, to welcome this. We have the support of allweddol i ni, fel Cynulliad Cenedlaethol Cymru, groesawu hyn. Mae mental health professions and service providers. I think that it is gennym gefnogaeth y proffesiynau iechyd meddwl a darparwyr important that I go for a proposed Measure, because it would gwasanaethau. Credaf ei bod yn bwysig fy mod yn mynd am Fesur be more satisfactory than any directions that I can give, as I do arfaethedig, gan y byddai’n fwy boddhaol nag unrhyw usually. gyfarwyddiadau y gallaf i eu rhoi, fel y gwnaf fel arfer.

Christine Chapman: On the consultation and the evidence Christine Chapman: O ran yr ymgynghoriad a’r gwaith casglu gathering that you have undertaken, I know that you have tystiolaeth yr ydych wedi’i wneud, gwn eich bod wedi ymgynghori’n consulted widely prior to introducing the proposed Measure, eang cyn cyflwyno’r Mesur arfaethedig, ond sut mae’r broses wedi but how has the process helped to shape its provisions, and did cynorthwyo i lywio ei ddarpariaethau, ac a ydych wedi defnyddio you draw on any examples of good practice elsewhere? unrhyw enghreifftiau o arferion da o fannau eraill?

Edwina Hart: We started our consultation at a very early stage Edwina Hart: Aethom ati i ymgynghori yn fuan iawn pan when the health spokespeople of the two Government parties ddechreuodd llefarwyr iechyd dwy blaid y Llywodraeth a’r and the opposition parties started to meet some of the mental gwrthbleidiau gyfarfod rhai o’r elusennau iechyd meddwl i drafod yr health charities to discuss what would be ideal for any hyn fyddai’n ddelfrydol ar gyfer unrhyw ddeddfwriaeth yng Nghymru. legislation in Wales. We have the 'One Wales’ commitment, and Mae gennym ymrwymiad 'Cymru’n Un’, ac aethom ati i gysylltu â we contacted 175 stakeholders in the first instance to talk 175 o randdeiliaid yn y lle cyntaf i siarad am faterion yn ymwneud â’r about issues relating to this proposed Measure on mental Mesur arfaethedig hwn ar iechyd meddwl. Bu i ni edrych ar ystod health. We looked at a wide range of issues in those eang o faterion yn y trafodaethau hynny, a dyna’r allwedd, sef ein discussions, and that is the key, namely that we have consulted bod wedi ymgynghori’n eang iawn gydol y broses. Mae cefnogaeth widely throughout the process. This proposed Measure enjoys gyffredinol i’r Mesur arfaethedig hwn, felly yr ydym wedi gallu general support, so we have been able to engage with all ymgysylltu â’r holl randdeiliaid yn ei gylch a derbyn sylwadau stakeholders on it and get positive comments about its cadarnhaol am ei gyfeiriad. Yr wyf yn gwerthfawrogi y gall pobl fod direction. I appreciate that people may want something am gael rhywbeth gwahanol, yn ogystal â’r hyn yr wyf yn ei gynnig, different, on top of what I propose, but we have learned from a ond yr ydym wedi dysgu gan ystod eang o bobl. wide range of people.

My officials have also been out and about looking at examples Mae fy swyddogion hefyd wedi bod allan yn chwilio am enghreifftiau of good practice in Wales and elsewhere, so that we can deliver o arferion da yng Nghymru ac mewn mannau eraill, er mwyn i ni allu something really different in implementing the proposed cyflawni rhywbeth gwirioneddol wahanol wrth weithredu’r Mesur Measure. So, there is a consensus out there and we have done arfaethedig. Felly, mae consensws ein bod wedi gwneud ein gorau i our best to consult throughout the process. ymgynghori gydol y broses.

Christine Chapman: On the powers to make subordinate Christine Chapman: O ran y pwerau i wneud is-deddfwriaethau, legislation, there are a number of sub-sections in the proposed mae nifer o isadrannau yn y Mesur arfaethedig sy’n rhoi’r pwerau i Measure that give the Welsh Ministers the powers to make Weinidogion Cymru wneud rheoliadau. A ydych yn fodlon bod y regulations. Are you content that the proposed Measure Mesur arfaethedig yn cyflawni’r cydbwysedd cywir rhwng pwerau ar achieves the correct balance between powers on its face and ei wyneb a’r rhai a roddir i Weinidogion Cymru i wneud rheoliadau? those given to the Welsh Ministers to make regulations?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: I think that the balance is correct, but I am sure Edwina Hart: Credaf fod y cydbwysedd yn gywir, ond yr wyf yn sicr y that the Constitutional Affairs Committee will want to question bydd y Pwyllgor Materion Cyfansoddiadol am fy holi ymhellach ar me further on that. Regulations have been chosen for those hynny. Mae rheoliadau wedi’u dewis ar gyfer y manylion hynny sydd details that need to be kept under review as services continue angen eu hadolygu wrth i wasanaethau ddatblygu a gwella. Felly, to develop and improve. So, there are reasons for that, and I mae rhesymau am hynny, a chredaf fod y cydbwysedd yn iawn. think that the balance is about right.

Peter Black: Minister, I want to talk about the scope of the Peter Black: Weinidog, yr wyf am siarad am gwmpas y Mesur proposed Measure, particularly the fact that the Assembly has arfaethedig, yn enwedig y ffaith bod gan y Cynulliad y cymhwysedd, competence, as a result of Jonathan Morgan’s LCO, to legislate yn sgîl GCD Jonathan Morgan, i ddeddfu yn y maes hwn er mwyn in this area to ensure provision across all ages. Why, then, did sicrhau darpariaeth ar draws pob oedran. Pam, felly, y you decide to limit its scope to adults only? penderfynasoch gyfyngu ei gwmpas i oedolion yn unig?

Edwina Hart: We looked at it from the point of view that we Edwina Hart: Bu i ni edrych ar y mater o’r safbwynt bod gennym already have primary care and care planning services for under- eisoes wasanaethau gofal sylfaenol a chynllunio gofal ar gyfer plant a 18s within CAMHS, the child and adolescent mental health phobl ifanc dan 18 oed o fewn CAMHS, gwasanaethau iechyd service. These points were raised with me in the debate in the meddwl plant a'r glasoed. Codwyd y pwyntiau hyn gyda mi yn y Chamber, and I look forward to seeing what emerges from your drafodaeth yn y Siambr, ac edrychaf ymlaen at weld beth ddaw i’r fei evidence-gathering sessions, to see whether I should look at o’ch sesiynau casglu tystiolaeth, i weld a ddylwn i edrych ar gynigion seamless proposals with regards to under-18s as well. I have an di-dor o ran plant a phobl ifanc dan 18 oed hefyd. Mae gennyf open mind on this matter, and I look forward to receiving the feddwl agored ar y mater hwn, ac edrychaf ymlaen at dderbyn y evidence gathered by the committee. dystiolaeth a gasglwyd gan y pwyllgor.

Ms Fife: I think that Mr Morgan indicated in his evidence this Ms Fife: Credaf fod Mr Morgan wedi nodi yn ei dystiolaeth fore morning that the advocacy provisions do not relate to children, heddiw nad yw’r darpariaethau eirioli yn ymwneud â phlant, ond but they do. It is Parts 1, 2 and 3 that do not cover children at maent mewn gwirionedd. Rhannau 1, 2 a 3 sydd ddim yn cynnwys this point in time, but the provisions on advocacy do cover plant ar hyn o bryd, ond mae’r darpariaethau o ran eiriolaeth yn eu them. cynnwys.

Peter Black: So, what you have is a proposed Measure that Peter Black: Felly, yr hyn sydd gennych yw Mesur arfaethedig sy’n relates only partly to adults and only partly to the whole age ymwneud yn rhannol yn unig ag oedolion ac yn rhannol yn unig â’r range. holl ystod oedran.

Edwina Hart: It covers advocacy but not the other areas. Those Edwina Hart: Mae’n cynnwys eiriolaeth ond nid y meysydd eraill. points were made to me in the Chamber when we had the Gwnaethpwyd y pwyntiau hynny i mi yn y Siambr yn ystod ein general debate. trafodaeth gyffredinol.

Peter Black: We have already had a couple of evidence Peter Black: Yr ydym eisoes wedi cael ambell sesiwn dystiolaeth, ac sessions, and all the witnesses so far have expressed particular mae’r holl dystion hyd yma wedi mynegi pryder penodol am yr concern about the need for seamless provision and the fact that angen am ddarpariaeth ddi-dor a’r ffaith fod plant, i bob pwrpas, children have, in effect, been excluded from this. If you were to wedi’u heithrio o hyn. Pe baech yn edrych ar gyflwyno deddfwriaeth look at introducing separate legislation to address the ar wahân i fynd i’r afael ag anghenion iechyd meddwl unigryw plant a distinctive mental health needs of children and young people, phobl ifanc, a fyddech yn ymestyn cwmpas y Mesur arfaethedig hwn would you extend the scope of this proposed Measure or would neu a fyddech yn ceisio cael Mesur ychwanegol? you look for an additional Measure?

Edwina Hart: I have to be honest with you and say that I am Edwina Hart: Mae’n rhaid i mi fod yn onest gyda chi a dweud nad not certain whether I would look for an additional Measure; I wyf yn sicr a fyddwn yn ceisio cael Mesur ychwanegol; credaf y think that I would look at the scope of this proposed Measure byddwn yn edrych ar gwmpas y Mesur arfaethedig hwn a derbyn and take advice on that, if that is the evidence that the cyngor ar hynny, os mai dyna’r dystiolaeth y mae’r pwyllgor wedi’i committee has received. I would ask the lawyers to look at that. derbyn. Byddwn yn gofyn i’r cyfreithwyr edrych ar hynny. Byddai’n We would have to look at the scope of this proposed Measure, rhaid i ni edrych ar gwmpas y Mesur arfaethedig hwn, gan na as it would not necessarily be a good idea to introduce another fyddai’n syniad da i ni o reidrwydd gyflwyno Mesur arall os oedd Measure if we already had one that could deal with such gennym un eisoes a allai ddelio â materion o’r fath yn llwyddiannus. matters successfully.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Joyce Watson: Good morning, Minister. I want to ask Joyce Watson: Bore da, Weinidog. Yr wyf am ofyn cwestiynau ar Ran questions on Part 1, on local primary mental health support 1, ar wasanaethau cymorth iechyd meddwl sylfaenol lleol. Mae Adran services. Section 2 of the proposed Measure provides for joint 2 y Mesur arfaethedig yn darparu ar gyfer cynlluniau ar y cyd ar gyfer schemes for the provision of local primary mental health darparu gwasanaethau cymorth iechyd meddwl sylfaenol lleol i support services to be agreed by local mental health partners. bartneriaid iechyd meddwl lleol gytuno arnynt. A allwch egluro pam Can you explain why more detail on the services that must be na ddarperir mwy o fanylion ar y gwasanaethau sy’n rhaid eu included in those schemes is not provided on the face of it? cynnwys yn y cynlluniau hynny?

Edwina Hart: We need to be clear about what the schemes Edwina Hart: Mae angen i ni fod yn glir ynglŷn â’r hyn y mae’n rhaid must deliver. We want a national service model developed by i’r cynlluniau eu cyflawni. Yr ydym am i BILlau ac awdurdodau lleol the LHBs and local authorities, and we want flexibility. The key is ddatblygu model gwasanaeth cenedlaethol, ac yr ydym am weld that we want flexibility not variability, and that has been a hyblygrwydd. Yr hyn sy’n allweddol yw ein bod am weld hyblygrwydd theme in what has come through to us. Section 5 sets out the nid amrywioldeb, ac mae hynny wedi bod yn thema yn yr hyn yr services on the face of the proposed Measure, but I would not ydym wedi’i glywed. Mae Adran 5 yn nodi’r gwasanaethau a fyddai’n necessarily want to put treatment and delivery on the face of cael eu darparu ar wyneb y Mesur arfaethedig, ond ni fyddwn o the proposed Measure. I do not know whether that would be reidrwydd am roi triniaeth a darpariaeth ar wyneb y Mesur deemed to be appropriate. I do not know whether Claire wants arfaethedig. Ni wn i a fyddai hynny’n cael ei ystyried yn briodol. Ni wn to add to that. i a yw Claire am ychwanegu at hynny.

Ms Fife: That level of detail is more appropriately based on a Ms Fife: Mae’r lefel honno o fanylder yn fwy priodol yn seiliedig ar clinical judgment, and that needs to come out of the national farn glinigol, ac mae angen i hynny ddod o’r model gwasanaeth service model to which the Minister referred. cenedlaethol y cyfeiriodd y Gweinidog ato.

Joyce Watson: What will be the relationship between joint Joyce Watson: Beth fydd y berthynas rhwng y cynlluniau ar y cyd ar primary care mental health schemes and the health, wellbeing gyfer iechyd meddwl gofal sylfaenol a’r strategaethau iechyd, lles a and social care strategies that are currently produced by local gofal cymdeithasol sy’n cael eu llunio ar hyn o bryd gan awdurdodau authorities, health boards and other partners? lleol, byrddau iechyd a phartneriaid eraill?

Edwina Hart: We must recognise that the health, wellbeing Edwina Hart: Mae’n rhaid i ni gydnabod bod y strategaethau iechyd, and social care strategies are high-level policy documents that lles a gofal cymdeithasol yn ddogfennau polisi lefel uchel y mae are agreed between the partners. When we go into the next partneriaid yn cytuno arnynt. Wrth i ni fynd i’r cylch nesaf o round of guidance on health, wellbeing and social care ganllawiau ar strategaethau iechyd, lles a gofal cymdeithasol, byddwn strategies, we will address more closely the two purposes of yn mynd i’r afael yn fanylach â’r ddau ddiben sydd wrth wraidd yr what we want to do with mental health schemes under the hyn yr ydym am ei wneud â chynlluniau iechyd meddwl o dan y proposed Measure and with the strategies. Mesur arfaethedig a chyda’r strategaethau.

Joyce Watson: Which provisions are contained within the Joyce Watson: Pa ddarpariaethau sydd wedi’u cynnwys yn y Mesur proposed Measure to ensure that the primary mental health arfaethedig i sicrhau bod cynlluniau iechyd meddwl sylfaenol yn schemes take into consideration the equality needs of their local ystyried anghenion cydraddoldeb eu poblogaethau lleol? populations?

11.40 a.m.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: This is a key area, and the explanatory Edwina Hart: Mae hwn yn faes allweddol, ac mae’r memorandwm memorandum sets out the support that we will give to mental esboniadol yn nodi’r cymorth y byddwn yn ei roi i bartneriaid iechyd health partners in establishing their primary schemes. We have meddwl i sefydlu eu cynlluniau sylfaenol. Yr ydym wedi ystyried yn taken full account of the inclusive policymaking principles that llawn yr egwyddorion llunio polisi cynhwysfawr yr ydym wedi’u we have developed with the Equality and Human Rights datblygu gyda’r Comisiwn Cydraddoldeb a Hawliau Dynol yn y maes Commission in this area. You will be aware that we have already hwn. Byddwch yn ymwybodol ein bod eisoes wedi llunio cynllun had to do a race equality action plan for adult mental health gweithredu cydraddoldeb hiliol ar gyfer gwasanaethau iechyd services as part of the mental health national service framework. meddwl i oedolion fel rhan o’r fframwaith gwasanaeth cenedlaethol My officials will be having key meetings with everybody about iechyd meddwl. Bydd fy swyddogion yn cynnal cyfarfodydd allweddol race equality action plans and the related issues. It is quite gyda phawb am gynlluniau gweithredu cydraddoldeb hiliol a’r important that we drafted this proposed Measure as we have materion cysylltiedig. Mae’n bwysig iawn ein bod wedi drafftio’r to ensure that local mental health partners are able to provide Mesur arfaethedig hwn gan fod yn rhaid i ni sicrhau bod partneriaid services to individuals who may not be registered with GP iechyd meddwl lleol yn gallu darparu gwasanaethau i unigolion nad practices, because that might have been overlooked. We have ydynt o bosibl wedi cofrestru gyda meddygfeydd teulu, oherwydd i looked at this issue, paying particular regard to vulnerable hynny gael ei esgeuluso o bosibl. Yr ydym wedi edrych ar y mater groups such as asylum seekers and homeless and roofless hwn, gan roi sylw penodol i grwpiau agored i niwed fel ceiswyr lloches people, which are groups that are very hard to reach, as well as a phobl ddigartref a phobl heb do uwch eu pennau, sy’n grwpiau Gypsies/Travellers. This is therefore very inclusive in terms of anodd iawn eu cyrraedd, yn ogystal â Sipsiwn/Teithwyr. Felly mae what it does on the equality strand. hwn yn gynhwysol iawn o ran yr hyn y mae’n ei wneud ar yr elfen gydraddoldeb.

Joyce Watson: Thank you for that answer. Could you tell us Joyce Watson: Diolch am yr ateb. A allwch ddweud wrthym pam why there is no timescale in which partners must agree a nad oes amserlen y mae’n rhaid i bartneriaid gadw ati wrth gytuno ar scheme for their area, and are you satisfied that that will not gynllun ar gyfer eu hardal, ac a ydych yn fodlon na fydd hyn yn lead to inconsistent services across Wales? arwain at wasanaethau anghyson ledled Cymru?

Edwina Hart: I have already indicated that, in terms of Edwina Hart: Yr wyf eisoes wedi nodi, o ran dechrau arni, ein bod yn commencement, we are looking at 2012-13, and we have the edrych ar 2012-13, ac mae gennym yr amserau paratoi priodol i ni appropriate run-in times for us to be able to deal with those allu ymdrin â’r materion hynny’n foddhaol. Nid wyf am gael amserlen issues satisfactorily. I do not want a legislative timetable. There ddeddfwriaethol. Mae dyletswyddau yn dod i rym, a byddwn yn are duties coming into force, and we will work with the partners gweithio gyda’r partneriaid i sicrhau bod y dyletswyddau hyn yn dod to make sure that these duties come into force when we want i rym pan fyddwn ni am iddynt ddod i rym. them to come into force.

Peter Black: My first question is on the same section, section Peter Black: Mae fy nghwestiwn cyntaf ar yr un adran, adran 2(4), 2(4), which provides that the scheme 'may’ include an sy’n nodi y 'gall’ y cynllun gynnwys cytundeb y gallai unigolion nad agreement that individuals not registered with a GP, or those ydynt wedi cofrestru gyda meddyg teulu, neu rai sy’n derbyn receiving secondary mental health services, could be entitled to gwasanaethau iechyd meddwl eilaidd, fod â hawl i asesiadau gofal assessments for primary mental health care. Why is there no iechyd meddwl sylfaenol. Pam nad yw hyn yn ofynnol, ac a ydych yn requirement for this, and are you content that this will capture fodlon y bydd hyn yn cwmpasu pawb sydd arnynt angen mynediad i all those who need to access primary mental health services? wasanaethau iechyd meddwl sylfaenol?

Edwina Hart: Yes, we are content. Claire, would you like to add Edwina Hart: Ydym, yr ydym yn fodlon. Claire, a hoffech ychwanegu anything? unrhyw beth?

Ms Fife: The Minister has already touched upon the flexible but Ms Fife: Mae’r Gweinidog eisoes wedi crybwyll y dull hyblyg ond nid not variable approach. It is really important that partners can amrywiol. Mae’n bwysig iawn y gall partneriaid ddatblygu cynllun ar develop a scheme for their local area. Section 2(4) gives some of gyfer eu hardal leol. Mae Adran 2(4) yn rhoi rhywfaint o’r that flexibility. We do not anticipate that all of the schemes will hyblygrwydd hwnnw. Nid ydym yn rhagweld y bydd angen i’r holl need to make provision for some of these groups; provision for gynlluniau wneud darpariaeth ar gyfer rhai o’r grwpiau hyn; efallai na patients in secondary care or patients subject to compulsion fydd angen darpariaeth ar gyfer cleifion mewn gofal eilaidd neu may not be needed in some cases. However, where an area has gleifion sy’n destun gorfodaeth mewn rhai achosion. Fodd bynnag, a homeless centre, for example, it would be appropriate for the pan mae gan ardal ganolfan i bobl ddigartref, er enghraifft, byddai’n scheme to include provision, as the Minister has said, for people briodol i’r cynllun gynnwys darpariaeth, fel y dywedodd y Gweinidog, in those hard-to-reach groups. This is about bringing in that ar gyfer pobl yn y grwpiau anodd eu cyrraedd hynny. Mae hyn yn flexibility, and, by coupling that with the national service model, ymwneud â sicrhau’r hyblygrwydd hwnnw, a thrwy gyfuno hynny â’r we will not see the variability that the Minister— model gwasanaeth cenedlaethol, ni fyddwn yn gweld yr amrywioldeb yr oedd y Gweinidog—

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Peter Black: Is there provision in all 22 authority areas, not Peter Black: A oes darpariaeth ym mhob un o’r 22 o ardaloedd just in those particular areas with a centre? awdurdodau, nid yn yr ardaloedd penodol hynny sydd â chanolfannau’n unig?

Ms Fife: There is, but in those areas where there is a centre, it Ms Fife: Oes, ond yn yr ardaloedd hynny lle mae canolfannau, gallai might be particularly appropriate. Schemes may deal with this in fod yn arbennig o briodol. Gall cynlluniau fynd i’r afael â hyn mewn other ways; that is the flexibility. I am using a case where there ffyrdd eraill; dyna’r hyblygrwydd. Yr wyf yn defnyddio achos lle mae is a centre as an example. canolfan fel enghraifft.

Peter Black: In cases where you have a homeless centre— Peter Black: Mewn achosion lle mae gennych ganolfan i bobl there is a very good example of this in Swansea with St ddigartref—mae enghraifft dda iawn o hyn yn Abertawe yn Eglwys Matthew’s Church of the Cyrenians—it is likely that those Sant Mathew y Cyreniaid—mae’n debyg bod y bobl hynny sy’n people who are homeless are registered with a GP through that ddigartref wedi’u cofrestru gyda meddyg teulu drwy’r ganolfan centre. However, where there is no centre, many of those honno. Fodd bynnag, lle nad oes canolfan, ni fydd llawer o’r bobl homeless people will not be registered with a GP, and they are ddigartref hynny wedi cofrestru gyda meddyg teulu, a hwy yw’r rhai y the ones whom we need to pick up. mae angen i ni eu canfod.

Ms Fife: Section 2(4) gives the schemes the flexibility to provide Ms Fife: Mae Adran 2(4) yn rhoi’r hyblygrwydd i’r cynlluniau that. ddarparu hynny.

Peter Black: Is there no requirement? Peter Black: Onid oes gofyniad?

Ms Fife: It is a 'flexibility’ at the moment. Maybe this is Ms Fife: 'Hyblygrwydd’ ydyw ar hyn o bryd. Efallai fod hyn yn something that the committee views differently. rhywbeth y mae’r pwyllgor yn ei weld yn wahanol.

Edwina Hart: At the end of the day, you will take evidence and Edwina Hart: Yn y pen draw, byddwch yn casglu tystiolaeth a byddaf I will certainly consider this. We want to capture those groups yn sicr yn ystyried hyn. Yr ydym am gael gafael ar y grwpiau hynny who are at risk and are hard to reach, such as the homeless. sydd mewn perygl ac sy’n anodd eu cyrraedd, megis pobl ddigartref. Given the levels of mental illness within those groups and the O ystyried y lefelau o salwch meddwl yn y grwpiau hyn a’r materion related issues, this proposed Measure should try to capture as cysylltiedig, dylai’r Mesur arfaethedig hwn geisio cael gafael ar many of those people as possible. gymaint o’r bobl hynny â phosibl.

Peter Black: My concern is that, in some areas, the local Peter Black: Fy mhryder yw bod awdurdodau lleol a byrddau iechyd, authority and the health board are in denial about mewn rhai ardaloedd, yn gwadu sefyllfa ddigartrefedd yn eu homelessness in their area, and they may think that they do hardaloedd, ac efallai eu bod yn credu nad oes yn rhaid iddynt not have to make that provision. That is a concern. gyflawni’r ddarpariaeth honno. Mae hynny’n bryder.

Moving on, section 5 provides a definition of local primary Gan symud ymlaen, mae adran 5 yn darparu diffiniad o wasanaethau mental health support services. Are you satisfied that that is cymorth iechyd meddwl sylfaenol lleol. A ydych yn fodlon bod hyn yn sufficiently clear, and that it includes the full range of necessary ddigon clir, a’i fod yn cynnwys yr amrywiaeth llawn o wasanaethau services? angenrheidiol?

Edwina Hart: Yes. I listed previously the five services that we Edwina Hart: Ydwyf. Rhestrais yn flaenorol y pum gwasanaeth yr were looking at. I am aware that Gofal Cymru has given you oeddem yn edrych arnynt. Yr wyf yn ymwybodol bod Gofal Cymru evidence; I have been looking with interest at what evidence wedi rhoi tystiolaeth i chi; yr wyf wedi bod yn edrych gyda diddordeb has been given about the role of voluntary organisations in this. ar ba dystiolaeth sydd wedi’i rhoi am swyddogaeth sefydliadau I think that the proposed Measure is appropriate, but I gwirfoddol yn hyn. Credaf fod y Mesur arfaethedig yn briodol, ond understand what Gofal Cymru was saying. We must not deallaf yr hyn yr oedd Gofal Cymru yn ei ddweud. Ni ddylid tanbrisio underestimate the important role of other services in dealing swyddogaeth bwysig gwasanaethau eraill wrth ymdrin â materion, ac with issues, and I strongly support the work of the voluntary yr wyf yn cefnogi i’r carn waith y sector gwirfoddol. Yr wyf yn sicr os sector. I am sure that if anything further comes out of this, we oes unrhyw beth pellach yn deillio o hyn, y byddwn yn edrych ar y will look at the proposed Measure to see what more can be Mesur arfaethedig i weld beth arall y gellir ei wneud o ran dangos y done in terms of signposting and so forth. ffordd ac ati.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Christine Chapman: Regarding primary mental health Christine Chapman: O ran asesiadau iechyd meddwl sylfaenol, assessments, Minister, could there be any cross-border Weinidog, a oes unrhyw oblygiadau trawsffiniol yn bosibl, er implications, for example, for Welsh patients with a GP in enghraifft, ar gyfer cleifion o Gymru sydd â meddyg teulu yn Lloegr? England? What arrangements would be in place to address the Pa drefniadau fyddai ar waith i fynd i’r afael ag anghenion yr needs of those individuals? unigolion hynny?

Edwina Hart: Patients who are living in Wales but who are Edwina Hart: Mae cleifion sy’n byw yng Nghymru ond sydd wedi registered with a general practitioner in England are included in cofrestru gyda meddyg teulu yn Lloegr wedi’u cynnwys yn y cynllun. the scheme. So, there should not be any real difficulties, as far Felly, ni ddylai unrhyw gwir anawsterau fodoli, cyn belled ag yr ydym as we are concerned, with regard to how the proposed Measure ni yn y cwestiwn, o ran sut bydd y Mesur arfaethedig yn mynd will proceed and assist those patients. rhagddo a chynorthwyo’r cleifion hynny.

Christine Chapman: Witnesses have expressed concern about Christine Chapman: Mae tystion wedi mynegi pryder am asesiadau primary care assessments, including the lack of a timescale gofal sylfaenol, gan gynnwys diffyg amserlen i’w cyflawni. Pam nad within which they should be undertaken. Why are there no oes amserlenni wedi’u cynnwys yn y Mesur arfaethedig? timescales included in the proposed Measure?

Edwina Hart: I was interested that witnesses had expressed Edwina Hart: Yr oedd yn ddiddorol i mi bod tystion wedi mynegi concerns about this issue. Assessments should always be based pryderon am y mater hwn. Dylid seilio asesiadau ar anghenion on clinical need, not on legally based time limits and that is an clinigol bob amser, nid ar gyfyngiadau amser sy’n seiliedig ar y important matter that we have recognised within the proposed gyfraith ac mae hynny’n fater pwysig yr ydym wedi’i gydnabod yn y Measure. In the NHS, we have always tried to prioritise Mesur arfaethedig. Yn y GIG, yr ydym bob amser wedi ceisio according to clinical need, because that ensures basic fairness blaenoriaethu yn unol ag anghenion clinigol, gan fod hynny’n sicrhau and equity for all users of the NHS. I attach importance to tegwch a chyfiawnder sylfaenol i holl ddefnyddwyr y GIG. Yr wyf yn clinical need in the proposed Measure, not legally based time rhoi pwyslais ar bwysigrwydd anghenion clinigol yn y Mesur limits. That could be quite perverse in a way, because people arfaethedig, nid ar gyfyngiadau amser sy’n seiliedig ar y gyfraith. marching towards time limits are not looking at the clinical Gallai hynny fod yn eithaf amheus i raddau, gan nad yw pobl sy’n needs of the patients, which is why the proposed Measure is gweithio yn ôl cyfyngiadau amser yn edrych ar anghenion clinigol focused in the way that it is. cleifion, a dyna pam mae’r Mesur arfaethedig yn canolbwyntio yn y ffordd y mae.

Christine Chapman: Jonathan Morgan expressed the opposite Christine Chapman: Mynegodd Jonathan Morgan farn wahanol yn view earlier. He felt that if timescales were not included in the gynharach. Teimlai pe na bai amserlenni yn cael eu cynnwys yn y proposed Measure, things could slip through the net. So, there Mesur arfaethedig, y gallai pethau ddisgyn drwy’r rhwyd. Felly, was a concern expressed about that today. Do you have any mynegwyd pryder am hynny heddiw. A oes gennych unrhyw comments on that? sylwadau ar hynny?

Edwina Hart: I do not share his concerns about this. Edwina Hart: Nid wyf yn rhannu ei bryderon am hyn.

Christine Chapman: Okay. Thank you. Section 9 identifies the Christine Chapman: Iawn. Diolch. Mae adran 9 yn nodi’r mathau o types of services that could improve or prevent a deterioration wasanaethau a allai wella neu atal iechyd meddwl oedolyn rhag in an adult’s mental health that may be taken into account dirywio y gellid eu hystyried wrth asesu. Mae’r rhain wedi’u cyfyngu’n during an assessment. These are specifically confined to primary benodol i driniaethau iechyd meddwl sylfaenol a gwasanaethau mental health treatments and secondary mental health services, iechyd meddwl eilaidd, y gwasanaethau hynny a ddarperir fel arfer those services normally provided by a primary care provider, gan ddarparwr gofal sylfaenol, a gwasanaethau gofal cymunedol. Pa and community care services. What consideration did you give ystyriaeth a roddwyd gennych i ehangu ystod y gwasanaethau i to broadening the range of services to provide a more holistic ddarparu asesiad mwy cyfannol? assessment?

Edwina Hart: I know that some of the mental health charities Edwina Hart: Gwn fod rhai o’r elusennau iechyd meddwl wedi have expressed concern about this. They have expressed mynegi pryder am hyn. Maent wedi mynegi pryder am faterion sy’n concern about issues around housing and welfare services, on ymwneud â gwasanaethau tai a lles, ac ymatebais yn eu cylch i Peter which I responded to Peter Black. I will consider that further in Black. Byddaf yn ystyried hynny ymhellach yng nghyd-destun adran the context of section 9, and I may return to it at a later stage 9, ac efallai y byddaf yn dychwelyd at y mater yn ddiweddarach wrth in the Assembly’s consideration of the proposed Measure. i’r Cynulliad ystyried y Mesur arfaethedig.

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) However, assessments are and will be holistic, because that is Fodd bynnag, mae asesiadau yn gyfannol a byddant yn parhau’n the clinical good practice at present. We must recognise the gyfannol, gan mai hynny yw’r arfer da clinigol ar hyn o bryd. Mae’n good practice is happening at present. This proposed Measure rhaid i ni gydnabod bod yr arferion da hyn yn cael eu gweithredu ar does not seek to overturn any of that, but to enforce it through hyn o bryd. Nid yw’r Mesur arfaethedig hwn yn ceisio newid unrhyw its operation. agwedd ar hynny, ond ei orfodi drwy ei weithredu.

Joyce Watson: I have some questions on section 10, on action Joyce Watson: Mae gennyf rai cwestiynau ar adran 10, ar y camau following a primary mental health assessment. Why, in section gweithredu yn dilyn asesiad iechyd meddwl sylfaenol. Pam, yn adran 10(1)(a) and 10(3), does the proposed Measure give discretion 10(1)(a) a 10(3), mae’r Mesur arfaethedig yn rhoi disgresiwn i to responsible authorities over whether or not to provide the awdurdodau cyfrifol ynglŷn ag a ydynt i ddarparu’r gwasanaeth arall other service identified in primary mental health assessments? a nodir yn yr asesiadau iechyd meddwl sylfaenol ai peidio?

Edwina Hart: This proposed Measure is major a departure for Edwina Hart: Mae’r Mesur arfaethedig hwn yn garreg filltir bwysig i us in the health and social care provision field, because we are ni ym maes darpariaeth iechyd a gofal cymdeithasol, gan ein bod yn making specific legal provision for a specific condition. gwneud darpariaeth gyfreithiol benodol ar gyfer cyflwr arbennig. Therefore, we have had to strike a balance in drafting the Felly, yr ydym wedi gorfod sicrhau cydbwysedd wrth ddrafftio’r proposed Measure. The current legislative framework in relation Mesur arfaethedig. Mae’r fframwaith deddfwriaethol cyfredol mewn to the provision of services by the health boards and others is perthynas â darpariaeth gwasanaethau gan y byrddau iechyd ac eraill usually of a general nature, and there are few requirements on yn un cyffredinol fel arfer, a phrin yw’r gofynion ar y llyfrau statud i the statute books for Welsh Ministers or LHBs to provide Weinidogion Cymru neu BILlau ddarparu gwasanaethau penodol, fel specific services, as I indicated earlier. This proposed Measure y dywedais yn gynharach. Felly, mae’r Mesur arfaethedig hwn yn therefore goes much further in placing specific duties. There mynd lawer ymhellach wrth osod dyletswyddau penodol. Mae angen needs to be a balance. There is also the issue of clinical cydbwysedd. Mae hefyd y mater o farn glinigol ac ystyriaethau judgment and further considerations such as the provider’s own pellach fel penderfyniadau’r darparwr ei hun am yr adnoddau a’r decisions about the availability of resources and services. I gwasanaethau sydd ar gael. Rhagwelaf y bydd llawer o’r manylion yn expect that much of the detail will be set out in the schemes, cael eu nodi yn y cynlluniau, a fydd yn rhan o fodel gwasanaeth which will be part of a national service model. They will have to cenedlaethol. Bydd yn rhaid iddynt gydymffurfio â’r model adhere to the national service model and my officials will be gwasanaeth cenedlaethol a bydd fy swyddogion yn gwneud gwaith doing further work in that area. Claire, do you want to pellach yn y maes hwnnw. Claire, a ydych am wneud sylwadau comment further, given that this is quite a difficult area? pellach, o ystyried bod hwn yn faes cymharol anodd?

Ms Fife: I just want to echo the Minister’s evidence. The current Ms Fife: Yr wyf am adleisio tystiolaeth y Gweinidog. Mae’r provision is generic in nature, and we are now moving towards ddarpariaeth gyfredol yn gyffredinol ei natur, ac yr ydym yn awr yn a much more specific provision in mental health, and, as the symud tuag at ddarpariaeth lawer fwy penodol o ran iechyd meddwl, Minister said, it is about a balance between that and allowing ac, fel y dywedodd y Gweinidog, mae’n ymwneud â chydbwysedd professionals to exercise judgment on appropriate levels of rhwng hynny a chaniatáu i weithwyr proffesiynol leisio eu barn ar treatment and organisations making decisions about the levels lefelau priodol o driniaeth ac i sefydliadau wneud penderfyniadau am of provision available. I think that much of the detail about y lefelau o ddarpariaeth sydd ar gael. Credaf y bydd llawer o’r levels of provision will be set out in the schemes, on which joint manylion ynglŷn â lefelau darpariaeth yn cael eu nodi yn y cynlluniau, partners must come together, but we must not override a bydd yn rhaid i gyd-bartneriaid gytuno arnynt, ond ni ddylem professional judgment either. ychwaith anwybyddu barn broffesiynol.

11.50 a.m.

Joyce Watson: I now have some questions on Part 2, about Joyce Watson: Mae gennyf gwestiynau ar Ran 2 yn awr, am the co-ordination of and care planning for secondary mental gydgysylltu a chynllunio gofal ar gyfer defnyddwyr gwasanaethau health service users. Witnesses have suggested that there iechyd meddwl eilaidd. Mae tystion wedi awgrymu y dylid cael should be a timescale for the period between someone amserlen ar gyfer y cyfnod rhwng i rywun gymhwyso fel claf yn Rhan qualifying as a patient in Part 2 and the completion of his or her 2 a chwblhau ei gynllun gofal o dan adran 17, ac y dylid cynnwys care plan under section 17, and that that should be included on hynny ar wyneb y Mesur arfaethedig. Pa ystyriaeth a roddwyd the face of the proposed Measure. What consideration did you gennych i gynnwys amserlenni yn y Mesur arfaethedig? give to including timescales within the proposed Measure?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: I do not believe that timescales will achieve Edwina Hart: Ni chredaf y bydd amserlenni yn sicrhau bod gofal yn strong care co-ordination and effective care planning. That risks cael ei gydgysylltu’n gadarn ac yn cael ei gynllunio’n effeithiol. Mae perverse incentives and poor planning, with staff spending all of hynny’n arwain at berygl o gymhellion amheus a chynllunio gwael, their time worrying about the 60-day deadline from referral gyda staff yn treulio’u holl amser yn poeni am y terfyn amser 60 rather than looking at what is clinically required and what diwrnod o’r pwynt atgyfeirio yn hytrach na edrych ar yr hyn sy’n services the individual receives. That is why I have drafted the ofynnol yn glinigol a pha wasanaethau y mae’r unigolyn yn eu proposed Measure in that way. I have concerns about the derbyn. Dyna pam i mi ddrafftio'r Mesur arfaethedig fel hynny. Mae constant emphasis on timescales and putting those into gennyf bryderon am y pwyslais cyson ar amserlenni a rhoi’r rheini legislation. What we have to ensure is that the right treatment mewn deddfwriaeth. Yr hyn sy’n rhaid i ni ei sicrhau yw bod y is given to the individual and that the right clinical judgments driniaeth iawn yn cael ei rhoi i’r unigolyn a bod y penderfyniadau are made in respect of the individual’s treatment. clinigol iawn yn cael eu gwneud mewn perthynas â thriniaeth yr unigolyn.

Joyce Watson: Can you clarify the relationship between the Joyce Watson: A allwch egluro’r berthynas rhwng y dull rhaglen ofal existing care programme approach and the proposed secondary sy’n bodoli eisoes a dyletswyddau’r cynllun gofal eilaidd arfaethedig? care plan duties?

Edwina Hart: The proposed Measure has been developed in Edwina Hart: Mae’r Mesur arfaethedig wedi’i ddatblygu yng nghyd- the context of our continuing commitment to the care destun ein hymrwymiad parhaus i’r dull rhaglen ofal, ac mae’n programme approach, and it reflects the components of it. adlewyrchu elfennau ohono. Mae Claire wedi bod yn ymdrin â’r Claire has been dealing with these issues. Do you want to give materion hynny. A ydych am roi gwybodaeth bellach i’r pwyllgor am some further information to the committee on that, Claire? hynny, Claire?

Ms Fife: The Welsh Assembly Government issued guidance on Ms Fife: Cyhoeddodd Llywodraeth y Cynulliad ganllawiau ar y dull the care programme approach back in 2003, and services have rhaglen ofal yn ôl yn 2003, ac mae gwasanaethau wedi bod yn been working alongside that. The delivery support unit recently gweithio ochr yn ochr â hynny. Yn ddiweddar paratôdd yr uned prepared a report on the CPA and its implementation. You cymorth cyflawni adroddiad ar y dull rhaglen ofal a’i weithrediad. asked about the evidence that had led to the proposed Gofynasoch am y dystiolaeth a oedd wedi arwain at y Mesur Measure; some of the delivery support unit evidence has arfaethedig; mae rhywfaint o dystiolaeth yr uned cymorth cyflawni shaped the way that the proposed Measure has been drafted, wedi dylanwadu ar y ffordd y mae’r Mesur arfaethedig wedi’i particularly this part. We are developing new CPA guidance to ddrafftio, yn enwedig y rhan hon. Yr ydym yn datblygu canllawiau reflect the proposed Measure, which we will submit to the dull rhaglen ofal newydd i adlewyrchu’r Mesur arfaethedig, a byddwn Minister shortly. If she is content, that will be published with a yn eu cyflwyno i’r Gweinidog yn fuan. Os yw’n fodlon, byddant yn view to it being expanded and improved as the proposed cael eu cyhoeddi gyda golwg ar eu hehangu a’u gwella wrth i’r Mesur Measure proceeds. So, the final form of guidance, the arfaethedig fynd rhagddo. Felly, byddai ffurf derfynol y canllawiau, y regulation-making powers, would reflect the regulations. There pwerau gwneud rheoliadau, yn adlewyrchu’r rheoliadau. Felly, mae is, therefore, a very close nexus between the CPA process and cysylltiad agos iawn rhwng proses a fframwaith y dull rhaglen ofal a’r framework and the proposed Measure. Mesur arfaethedig.

Peter Black: Moving on to discuss assessments of former Peter Black: Gan symud ymlaen i drafod asesiadau cyn ddefnyddwyr users of secondary mental health services, what benefits do you gwasanaethau iechyd meddwl eilaidd, pa fanteision yr ydych yn eu envisage arising from the proposed new arrangements that will rhagweld yn deillio o’r trefniadau newydd arfaethedig a fydd yn enable former users of secondary services to request galluogi cyn ddefnyddwyr gwasanaethau eilaidd i ofyn am asesiadau? assessments?

Edwina Hart: The aim of this part of the proposed Measure is Edwina Hart: Nod y rhan hon o’r Mesur arfaethedig yw galluogi cyn to enable former service users to have control over the ddefnyddwyr gwasanaethau i reoli’r cyfleoedd i gael mynediad i opportunities to access secondary services. It is anticipated that wasanaethau eilaidd. Rhagwelir y bydd hyn yn cynorthwyo cleifion i this will support safe and effective discharge from services, gael eu rhyddhau’n ddiogel ac effeithiol o wasanaethau, sy’n amlwg which is obviously everyone’s aim and will benefit service users. yn nod i bawb a bydd hynny o fudd i ddefnyddwyr gwasanaethau. It will also reduce the current burden on service users. That is Bydd hefyd yn ysgafnhau’r baich sydd ar ddefnyddwyr gwasanaethau what we see as the aim. It is important as it will support ar hyn o bryd. Dyna’r nod yn ein barn ni. Mae’n bwysig oherwydd recovery, which is an important aspect of the proposed bydd yn cynorthwyo pobl i wella, sy’n agwedd bwysig ar y Mesur Measure. arfaethedig.

Peter Black: Section 24 outlines the purpose of assessments Peter Black: Mae adran 24 yn amlinellu diben asesiadau tra bod while section 25 states that the assessments must be adran 25 yn datgan bod yn rhaid cynnal yr asesiadau

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) 'carried out as soon as is reasonably practicable’ 'cyn gynted ag y bo’n rhesymol ymarferol’ after the request has been made. Why is no specific timescale ar ôl i’r cais gael ei wneud. Pam nad oes amserlen benodol ynghlwm attached to this provision? wrth y ddarpariaeth hon?

Edwina Hart: I do not believe that it is clinically appropriate to Edwina Hart: Ni chredaf ei bod yn glinigol briodol gwneud hynny. do so.

Christine Chapman: Minister, I would like to ask a series of Christine Chapman: Weinidog, hoffwn ofyn cyfres o gwestiynau ar questions on advocacy—Part 4 of the proposed Measure. Part eiriolaeth—Rhan 4 y Mesur arfaethedig. Mae Rhan 4 yn ymestyn 4 extends the provision of independent mental health darpariaeth eiriolwyr iechyd meddwl annibynnol i gleifion dan advocates to Welsh qualifying compulsory patients and Welsh orfodaeth sy’n cymhwyso yng Nghymru a chleifion anffurfiol sy’n qualifying informal patients. What consideration did you give to cymhwyso yng Nghymru. Pa ystyriaeth a roddwyd gennych i extending the advocacy provision within the proposed Measure ymestyn y ddarpariaeth eiriolaeth yn y Mesur arfaethedig yn fwy more widely? Why did you decide not to make these services eang? Pam y penderfynasoch beidio â gofalu bod y gwasanaethau available under Part 1? hyn ar gael o dan Ran 1?

Edwina Hart: Do you want to deal with Part 1, Claire? Edwina Hart: A ydych am ddelio â Rhan 1, Claire?

Ms Fife: A range of non-statutory advocacy is currently Ms Fife: Mae ystod o eiriolaeth anstatudol ar gael ar hyn o bryd available across Wales. Our meetings with advocacy providers ledled Cymru. Mae ein cyfarfodydd â darparwyr eiriolaeth a and advocacy planners suggest that it currently supports chynllunwyr eiriolaeth yn awgrymu eu bod ar hyn o bryd yn primary care as well as community care services within cynorthwyo gofal sylfaenol yn ogystal â gwasanaethau gofal secondary care. So, the proposed Measure is focusing cymunedol o fewn gofal eilaidd. Felly, mae’r Mesur arfaethedig yn particularly on in-patient advocacy, because we want to canolbwyntio’n benodol ar eiriolaeth cleifion mewnol, gan ein bod am strengthen that, reflecting what came out of changes to the gryfhau hynny, gan adlewyrchu'r hyn a ddeilliodd o’r newidiadau i 1983 Act. However, that is not to take away from the existing Ddeddf 1983. Fodd bynnag, ni ddylai hynny dynnu oddi ar y provisions around advocacy. So, this is supporting in-patient darpariaethau cyfredol sy’n gysylltiedig ag eiriolaeth. Felly, mae hyn advocacy, and the explanatory memorandum makes it clear yn cynorthwyo eiriolaeth cleifion mewnol, ac mae’r memorandwm that is not to the detriment of other forms of advocacy. esboniadol yn nodi’n glir nad yw hynny ar draul ffurfiau eraill o eiriolaeth.

Edwina Hart: I think that advocacy will continue to grow and Edwina Hart: Credaf y bydd eiriolaeth yn parhau i dyfu a datblygu. develop. We might want to look at future legislation that pays Efallai y byddwn am edrych ar ddeddfwriaeth yn y dyfodol sy’n rhoi specific consideration to community advocacy—that is not part sylw priodol i eiriolaeth gymunedol—nid yw hynny’n rhan o’r Mesur of this proposed Measure, but we can keep that as a wider arfaethedig hwn, ond gallwn gadw hynny fel opsiwn ehangach i’w option and a consideration for future Measures that will ystyried mewn Mesurau yn y dyfodol a fydd yn deillio o’r pwerau emanate from the powers that we have. So, it is not a door sydd gennym. Felly, nid yw’n ddrws sy’n cau, ond yn ddrws sy’n agor. closing, but a door opening. It will have to be returned to, but Bydd yn rhaid i ni ddychwelyd at y mater, ond nid yn y Mesur not necessarily in the proposed Measure. arfaethedig o reidrwydd.

Christine Chapman: To follow that up, what is your view of the Christine Chapman: I ddilyn hynny, beth yw eich barn ar yr awgrym suggestion that the inadequate provision of advocacy services y gallai’r ddarpariaeth annigonol o wasanaethau eiriolaeth wanhau may weaken the ability of service users to access support under gallu defnyddwyr gwasanaethau i gael mynediad i gymorth o dan y the other Parts of the proposed Measure, for example Part 3? Rhannau eraill o’r Mesur arfaethedig, er enghraifft Rhan 3?

Edwina Hart: I do not support that at all. Edwina Hart: Nid wyf o blaid hynny o gwbl.

Christine Chapman: Finally, have you considered widening the Christine Chapman: I gloi, a ydych wedi ystyried ymestyn y rhestr list of those who could request advocacy services under the o’r rhai hynny a allai wneud cais am wasanaethau eiriolaeth o dan y new provisions being inserted by section 130H of the Mental darpariaethau newydd sy’n cael eu mewnosod gan adran 130H o Health Act 1983 to include others who may be professionally Ddeddf Iechyd Meddwl 1983 i gynnwys eraill a allai gyfrannu’n involved in the person’s care, such as support workers? broffesiynol at ofal unigolyn, fel gweithwyr cymorth?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: We have extended the range of professional Edwina Hart: Yr ydym wedi ymestyn yr ystod o unigolion individuals included in the list in the proposed Measure who proffesiynol sydd wedi’u cynnwys yn y rhestr yn y Mesur arfaethedig may make either a formal or informal request for an a allai wneud cais ffurfiol neu anffurfiol am eiriolaeth iechyd meddwl independent mental health advocate on behalf of a qualifying annibynnol ar ran claf cymwys, ond mae materion sy’n gysylltiedig â patient, but there is stuff around the 1983 Act, is there not, Deddf 1983, onid oes, Claire? Claire?

Ms Fife: Yes, there is. Ms Fife: Oes, mae hynny’n wir.

Edwina Hart: Do you want to go into that in detail? Edwina Hart: A ydych am fanylu ar hynny?

Ms Fife: For patients who currently qualify, there are provisions Ms Fife: I gleifion sy’n gymwys ar hyn o bryd, mae darpariaethau o on who can make a reasonable request and we have extended ran pwy all wneud cais rhesymol ac yr ydym wedi ymestyn y rheini: i those: for compulsory patients, and not just the new gleifion dan orfodaeth, ac nid y cleifion newydd dan orfodaeth yn compulsory patients, we have included registered social unig, yr ydym wedi cynnwys gweithwyr cymdeithasol cofrestredig, workers, hospital managers, and donees and deputies—it is rheolwyr ysbytai, a rhoddwyr a dirprwyon—mae’n bwysig o dan important under the Mental Capacity Act 2005 to bring them Ddeddf Galluedd Meddyliol 2005 i’w dwyn ynghyd a gweithredu’r in and to take that safeguard. All the provisions about who can mesur diogelwch hwnnw. Mae’r holl ddarpariaethau ynglŷn â phwy make an informal request are entirely new. We have included all wneud cais anffurfiol yn newydd sbon. Yr ydym wedi cynnwys donees and deputies and carers—we have not limited it to the rhoddwyr a dirprwyon a gofalwyr—nid ydym wedi ei gyfyngu i’r nearest relative, as would be the case for patients detained berthynas agosaf, fel y byddai’n digwydd gyda chleifion sy’n cael eu under the Act. I know that the inclusion of nearest relatives as cadw o dan y Ddeddf. Gwn fod cynnwys perthnasau agosaf fel y rhai those who would be able to make an informal request was hynny a allai wneud cais anffurfiol wedi’i ystyried, ond yr ydym wedi considered, but we have taken it much wider by including ymestyn hyn llawer mwy drwy gynnwys gofalwyr. Yn hanfodol, yr carers. Crucially, we have added hospital managers for both ydym wedi ychwanegu rheolwyr ysbytai ar gyfer y ddau grŵp. Wrth groups. When we have met advocacy providers, they have gyfarfod darparwyr eiriolaeth, maent wedi dweud bod mwyafrif eu indicated that the majority of their referrals come from nursing hatgyfeiriadau yn dod gan staff nyrsio a ward. Felly, drwy gynnwys and ward staff. So, by including hospital managers, we have rheolwyr ysbytai, yr ydym wedi egluro’r sefyllfa gyfreithiol ar eu cyfer, clarified the legal position for them, because hospital managers oherwydd gall rheolwyr ysbytai ddirprwyo hynny i weithwyr can delegate that to professionals, and that is where a lot of the proffesiynol, a dyna o le y bydd llawer o’r gweithwyr proffesiynol yr professionals that you may have been referring to will come ydych yn cyfeirio atynt yn dod, sef y rhai hynny sy’n gweithio mewn from, namely those working in a hospital. It is now quite a ysbyty yn bennaf. Mae’n ddarpariaeth cymharol gyflawn bellach. rounded provision.

Peter Black: What discussions have you had with advocacy Peter Black: Pa drafodaethau yr ydych wedi’u cynnal gyda service providers about the impact of this extension of advocacy darparwyr gwasanaethau eiriolaeth am effaith ehangu’r services? gwasanaethau eiriolaeth fel hyn?

Edwina Hart: I appreciate that there is some concern out there, Edwina Hart: Gwerthfawrogaf fod rhywfaint o bryder, ac yr ydym which we have also heard, about the impact of the proposed wedi clywed hyn hefyd, am effaith y Mesur arfaethedig ar ddarparwyr Measure on advocacy providers and whether the proposals are eiriolaeth ac a oes modd cyflawni’r cynigion. Mae fy swyddogion wedi deliverable. My officials have held discussions with advocacy cynnal trafodaethau gyda darparwyr eiriolaeth wrth ddatblygu’r providers during the development of the proposed Measure. Mesur arfaethedig. Ers ei gyflwyno, yr ydym wedi cynnwys byrddau Since its introduction, we have involved local health boards in iechyd lleol wrth ei drafod ar lefel leol ac wedi darparu rhywfaint o discussing it at a local level and we have provided some gyllid ychwanegol yn rheolaidd i gynorthwyo’r gwasanaeth estynedig additional funding on a recurring basis to support the expanded —oddeutu £1.5 miliwn. Felly, mae trafodaethau cadarn ar y gweill, yn service—it is about £1.5 million. So, there are strong discussions enwedig gyda’r BILlau, ac mae’n rhywbeth yr ydym yn cadw llygad going on out there, particularly with the LHBs, and it is barcud arno. something that we are keeping a careful eye on.

Peter Black: Sections 130F and G, which will be inserted into Peter Black: Mae adrannau 130F a G, a fydd yn cael eu mewnosod the Mental Health Act 1983, both include a provision that yn Neddf Iechyd Meddwl 1983, yn cynnwys darpariaeth a fyddai’n would enable Welsh Ministers to make other help available to galluogi Gweinidogion Cymru i sicrhau bod rhagor o gymorth ar gael Welsh qualifying compulsory and informal patients, using i gleifion anffurfiol ac o dan orfodaeth sy’n gymwys yng Nghymru, regulations. How do you anticipate the role of the independent drwy ddefnyddio rheoliadau. Sut ydych yn rhagweld y bydd mental health advocates expanding under the proposed swyddogaeth yr eiriolwyr iechyd meddwl annibynnol yn ehangu o Measure? dan y Mesur arfaethedig?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: As I indicated in my reply to another question, Edwina Hart: Fel y crybwyllais yn fy ateb i gwestiwn arall, mae advocacy is developing and expanding and we need the eiriolaeth yn datblygu ac yn ehangu ac mae angen i’r Mesur proposed Measure to be in place so that we can respond to arfaethedig fod yn ei le er mwyn i ni allu ymateb i ddatblygiadau yn y future developments in that area. The proposed Measure will maes hwnnw yn y dyfodol. Bydd y Mesur arfaethedig yn ymestyn broaden the role of the independent mental health advocate, swyddogaeth yr eiriolwr iechyd meddwl annibynnol, ac mae’r adran and the new sections in the Act—130F and G—recognise and newydd yn y Ddeddf—130F a G—yn cydnabod ac yn caniatáu ar allow for future flexibility in drafting future regulations, which is gyfer hyblygrwydd yn y dyfodol wrth ddrafftio rheoliadau’r dyfodol, important in response to your question. sy’n bwysig mewn ymateb i’ch cwestiwn.

Peter Black: Would extending the service have an impact on Peter Black: A fyddai ymestyn y gwasanaeth yn effeithio ar bwy who could qualify to become independent mental health fyddai’n gymwys i fod yn eiriolwyr iechyd meddwl annibynnol? advocates?

Edwina Hart: The existing position is working quite well and Edwina Hart: Mae’r sefyllfa bresennol yn gweithio’n dda a bydd yn will continue to do so. When the Act was amended to introduce parhau i wneud hynny. Pan gafodd y Ddeddf ei gwella i gyflwyno advocacy, we made regulations that covered who could be a eiriolaeth, gwnaethpwyd rheoliadau gennym a oedd yn cynnwys pwy mental health advocate. Do you want to come in on this, Claire? a allai fod yn eiriolwyr iechyd meddwl. A ydych am gyfrannu yma, Claire?

Ms Fife: Yes. Those regulations might help to inform the Ms Fife: Ydwyf. Gallai’r rheoliadau hynny gynorthwyo i hysbysu’r committee. I know that Mr Morgan’s evidence this morning pwyllgor. Gwn fod tystiolaeth Mr Morgan y bore yma wedi crybwyll touched on this, but those regulations set out that, before a hyn, ond yr oedd y rheoliadau hynny’n nodi, cyn y gall bwrdd person can be approved by a board to act as an advocate, they gymeradwyo unigolyn i weithredu fel eiriolwr, bod yn rhaid iddo have to meet certain qualifying requirements: they have to have gyflawni gofynion cymhwyso penodol: mae’n rhaid iddo fod â appropriate experience and training, have sound integrity and phrofiad a hyfforddiant priodol, bod yn gwbl ddidwyll ac o gymeriad be of good character. They also have to work to standards set da. Mae hefyd yn gorfod gweithio i safonau a nodir mewn canllawiau out in guidance and work towards the national advocacy a gweithio tuag at gymhwyster eiriolaeth cenedlaethol. Mae’r qualification. The Minister has set out in the explanatory Gweinidog wedi nodi yn y memorandwm esboniadol sut mae’n memorandum how she intends to use those regulations as a bwriadu defnyddio’r rheoliadau hynny fel sail i reoliadau yn y dyfodol. basis for future regulations. As the Minister said, the position Fel y dywedodd y Gweinidog, y sefyllfa sy’n gweithio’n dda heddiw that is working well today is the one that we are going to yw’r un yr ydym am ei dilyn. follow.

12.00 p.m.

Peter Black: When Jonathan Morgan gave evidence this Peter Black: Pan roddodd Jonathan Morgan dystiolaeth y bore yma, morning, he referred to a section that is going to be inserted cyfeiriodd at adran sydd i gael ei mewnosod yn y rheoliadau y bydd y into the regulations that the Minister will be making in relation Gweinidog yn eu gwneud mewn perthynas â phwy fydd yn cael eu to who will be excluded from being an advocate. I will start with heithrio rhag bod yn eiriolwr. Yr wyf am ddechrau gydag adran section 130E(4), which states that 130E(4), sy’n nodi:

'the Welsh Ministers shall have regard to the principle that any 'the Welsh Ministers shall have regard to the principle that any help help available to a patient under the arrangements should, so available to a patient under the arrangements should, so far as far as practicable, be provided by a person who is independent practicable, be provided by a person who is independent of any of any person who— person who—

(a) is professionally concerned with the patient’s medical (a) is professionally concerned with the patient’s medical treatment; treatment; or neu

(b) falls within a description specified in regulations made by the (b) falls within a description specified in regulations made by the Welsh Ministers.’ Welsh Ministers.’

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) I think that Jonathan was expressing a concern that those Credaf fod Jonathan yn mynegi pryder y gallai’r rheoliadau hynny regulations might exclude family members, for example, or eithrio aelodau teulu, er enghraifft, neu bobl eraill a allai fod â other people who might have a strong interest in the patient, diddordeb mawr yn y claf, ond nad ydynt yn cael eu hystyried yn but who may not be considered to be independent in that way. annibynnol yn y ffordd honno. Beth yw bwriad y rheoliadau hynny, a What is the intention of those regulations, and how will you sut byddwch yn nodi pwy fydd ac na fydd yn cael bod yn eiriolwr? specify who will be allowed to be an advocate and who will not?

Edwina Hart: We will read Jonathan’s evidence with interest, Edwina Hart: Byddwn yn darllen tystiolaeth Jonathan gyda and perhaps we will want to reply later. diddordeb, ac efallai y byddwn am ymateb yn ddiweddarach.

Ms Fife: As I said, the regulations will follow the pattern of Ms Fife: Fel y dywedais, bydd y rheoliadau yn dilyn patrwm y rheini those that work now; that level of independence and sy’n gweithio yn awr; mae’r lefel honno o annibyniaeth a professionalism is important, so we intend to continue on that phroffesiynoldeb yn bwysig, felly bwriadwn barhau ar y sail honno. basis. This position is well supported by advocacy providers and Mae darparwyr eiriolaeth a chynllunwyr eiriolaeth yn gefnogol iawn i’r advocacy planners. That element of independence has a great sefyllfa hon. Mae cefnogaeth frwd i’r elfen honno o annibyniaeth deal of support among service users at the moment. ymysg darparwyr gwasanaethau ar hyn o bryd.

Peter Black: So, if a patient had confidence in a family member Peter Black: Felly, pe bai gan glaf hyder mewn aelod teulu yr who was considered to be good enough to advocate on his or ystyriwyd ei fod yn ddigon da i eirioli ar ei ran, ni fyddai’r rheoliadau her behalf, that family member would not be precluded from hyn yn atal yr aelod teulu hwnnw rhag gwneud hynny. doing so by these regulations.

Ms Fife: The regulations currently do preclude that: you can Ms Fife: Ar hyn o bryd mae’r rheoliadau yn atal hynny: ni allwch fod only be an advocate if you are approved by the board. The yn eiriolwr oni bai bod bwrdd yn eich cymeradwyo. Mae’r rheoliadau regulations that the Minister has already made set out that y mae’r Gweinidog eisoes wedi’u gwneud yn nodi’r gymeradwyaeth approval, and family members are not included. That is not to honno, ac nid yw aelodau teulu wedi’u cynnwys. Nid yw hynny’n say that family and friends cannot be involved and cannot golygu na all teulu a ffrindiau gyfrannu ac na allant gynorthwyo support patients. That is part of the way that it works, and a lot cleifion. Mae hynny’n rhan o’r ffordd y mae pethau’n gweithio, ac of advocates work not only with the individual, but with that mae llawer o eiriolwyr nid yn unig yn gweithio gyda’r unigolyn, ond individual’s wider family, to ensure that people are given a voice gyda theulu estynedig yr unigolyn hwnnw hefyd, i sicrhau bod pobl and are supported. However, family and friends would not be yn cael llais ac yn cael eu cefnogi. Fodd bynnag, ni fyddai teulu a considered as independent mental health advocates under the ffrindiau yn cael eu hystyried yn eiriolwyr iechyd meddwl annibynnol legislation. o dan y ddeddfwriaeth.

Peter Black: We will take that into consideration. Peter Black: Byddwn yn ystyried hynny.

Joyce Watson: Section 41 requires local health boards to act Joyce Watson: Mae adran 41 yn mynnu bod byrddau iechyd lleol yn under the general guidance of Welsh Ministers. Why is there no gweithredu o dan ganllawiau cyffredinol Gweinidogion Cymru. Pam corresponding provision for local authorities? nad oes darpariaeth gyfatebol ar gyfer awdurdodau lleol?

Edwina Hart: Section 40 covers local authorities and it achieves Edwina Hart: Mae adran 40 yn cynnwys awdurdodau lleol ac mae’n a corresponding effect to section 41. sicrhau effaith gyfatebol i adran 41.

Ms T. Jones: Section 40 amends Schedule 1 of the Local Ms T. Jones: Mae adran 40 yn gwella Atodlen 1 Deddf Authority Social Services Act 1970, and it has the same effect. Gwasanaethau Cymdeithasol Awdurdodau Lleol 1970, ac mae ganddi’r un effaith.

Joyce Watson: Finally, are you content that the regulatory Joyce Watson: I gloi, a ydych yn fodlon bod yr asesiad effaith impact assessment makes a realistic assessment of the financial rheoleiddiol yn gwneud asesiad realistig o oblygiadau ariannol y implications of the proposed Measure? What additional funding Mesur arfaethedig? Pa gyllid ychwanegol a fydd ar gael gennych i will you make available to support the objectives that you have gefnogi’r amcanion yr ydych wedi penderfynu arnynt? arrived at?

LC3(3)-06-10 :Trawsgrifiad (29-04-2010) Edwina Hart: I have already indicated that I will make £0.5 Edwina Hart: Yr wyf eisoes wedi nodi y byddaf yn sicrhau bod £0.5 million available in each of the two years before Part 1 of the miliwn ar gael ym mhob un o’r ddwy flynedd cyn i Ran 1 y Mesur proposed Measure comes into force, and £3 million will be arfaethedig ddod i rym, a bydd £3 miliwn ar gael i gefnogi available to support the operation of Part 1 in 2012-13, when gweithrediad Rhan 1 yn 2012-13, pan ddisgwylir i’r dyletswyddau the duties are expected to commence. That has already been ddechrau. Mae hynny eisoes wedi’i gytuno. Yr ydym yn cyfrannu at agreed. We are engaged in financial modelling on this matter, fodelu ariannol ar y mater hwn, sy’n broses barhaus, ac mae which is an ongoing process, and officials are working carefully swyddogion yn gweithio’n ofalus gyda’r gwasanaethau i berffeithio’r with the services to refine these models and ensure that we modelau hyn a sicrhau bod gennym ddigon o arian yn y system i ni have the right amount of money in the system so that we can allu eu gweithredu. Yr ydym wedi bod yn realistig gyda’r asesiad implement them. We have been realistic with the regulatory effaith rheoleiddiol fel y mae ar hyn o bryd. impact assessment as it currently stands.

David Lloyd: Dyna ddiwedd y cwestiynau swyddogol. Diolchaf David Lloyd: That brings us to the end of the official questions. I i’r Gweinidog a’i swyddogion am eu hatebion a’u cyfraniadau. A thank the Minister and her officials for their answers and oes gan y Gweinidog unrhyw sylwadau terfynol i gloi’r sesiwn contributions. Does the Minister have any final remarks to conclude hon? Yr ydym yn ymwybodol y byddwch yn ymddangos o flaen this session? We are aware that you will be appearing before this y pwyllgor hwn eto mewn rhai wythnosau i drafod y pwnc committee again in a few weeks’ time to discuss the issue further, but ymhellach, ond os oes gennych sylwadau i gloi, dyma’ch cyfle. if you have any closing remarks to make, this is your opportunity.

Edwina Hart: I thank you, Chair, for the way that this matter Edwina Hart: Diolch, Gadeirydd, am y ffordd yr ydych wedi ymdrin has been dealt with today, because I think that there is â’r mater hwn heddiw, oherwydd credaf fod unfrydedd ar draws y unanimity across the Assembly about getting a very good Cynulliad ynghylch cyflwyno Mesur arfaethedig da iawn. Mae’n proposed Measure through. It is important that we recognise bwysig ein bod yn cydnabod ein hymrwymiadau i gleifion iechyd our obligations to mental health patients. meddwl.

David Lloyd: Diolch yn fawr ichi. Bydd y clerc yn anfon David Lloyd: Thank you very much. The clerk will send you a draft trawsgrifiad drafft o drafodion heddiw atoch i gael ei gywiro, os transcript of today’s proceedings for you to correct, if necessary, bydd angen, cyn iddo gael ei gyhoeddi’n derfynol. before the final version is published.

I gloi, yr wyf yn datgan i’m cyd-Aelodau y bydd y cyfarfod nesaf To close, I inform my fellow Members that the next meeting of this o’r pwyllgor hwn ddydd Mawrth nesaf am 9 a.m. Datganaf fod committee will be held next Tuesday at 9 a.m. I declare the meeting y cyfarfod ar ben. Diolch am eich presenoldeb, a diolch i’r closed. Thank you for your presence, and thanks to the interpreters. cyfieithwyr.

"Daeth y cyfarfod i ben am 12.05 p.m. The meeting ended at 12.05 p.m. "

LC3(3)-06-10 :Trawsgrifiad (29-04-2010)