Yeah , it's quite a simple L_C_D_ screen. I think they don't need that big of C_P_U_.

Yeah but it the the remote control has to know whether you're in a settings menu or just uh you just want to turn up the volume.

So it has to have some kind of a calculation unit or C_P_U_


Yeah but it the the remote control has to know whether you're in a settings menu or just uh you just want to turn up the volume.

So it has to have some kind of a calculation unit or C_P_U_

to know uh in which state you are and uh which button you are pressing in at the right moment.


So it has to have some kind of a calculation unit or C_P_U_

to know uh in which state you are and uh which button you are pressing in at the right moment.

Mm-hmm.  Because we're projecting projecting the buttons on the L_C_D_ screen.


to know uh in which state you are and uh which button you are pressing in at the right moment.

Mm-hmm.  Because we're projecting projecting the buttons on the L_C_D_ screen.

And a touch screen makes it uh possible to uh to get the co-ordination of your finger on the screen.


Mm-hmm.  Because we're projecting projecting the buttons on the L_C_D_ screen.

And a touch screen makes it uh possible to uh to get the co-ordination of your finger on the screen.


And a touch screen makes it uh possible to uh to get the co-ordination of your finger on the screen.

And the case , yeah we already discussed the case ,


And the case , yeah we already discussed the case ,


It bounces back from the floor where you  throw it.


So the shapes is something between the square shapes with round colo corners and a round shapes ? No I don't think , I think it's more round than square.


So the shapes is something between the square shapes with round colo corners and a round shapes ? No I don't think , I think it's more round than square.

Yeah it's a bit. But I think it should be a bit longer , perhaps.


So the shapes is something between the square shapes with round colo corners and a round shapes ? No I don't think , I think it's more round than square.

Yeah it's a bit. But I think it should be a bit longer , perhaps.

So it meets I think it meets more the young people than the older people.


Yeah it's a bit. But I think it should be a bit longer , perhaps.

So it meets I think it meets more the young people than the older people.


So it meets I think it meets more the young people than the older people.


Well and how about my idea uh of making it um with one single curve ?


Well and how about my idea uh of making it um with one single curve ?

Oh yeah that that  I think  I thought that was a quite good


Oh yeah that that  I think  I thought that was a quite good


Oh yeah that that  I think  I thought that was a quite good

Because it's a gadget and you want to show it off , of course.


Because it's a gadget and you want to show it off , of course.

Yeah yeah you have a fancy design , then , right away.


Yeah yeah you have a fancy design , then , right away.


You can put it on your table with the L_C_D_ screen ,


You can put it on your table with the L_C_D_ screen ,

you don't have to put it  get it in your hand , you can put it next to you


you don't have to put it  get it in your hand , you can put it next to you


Did you write that down ? Uh got a single curved uh rubber f uh fancy coloured  remote control.


Did you write that down ? Uh got a single curved uh rubber f uh fancy coloured  remote control.

You can't you You can't oh , you c you can draw it on your paper and then load it on the


You can't you You can't oh , you c you can draw it on your paper and then load it on the


What about the user interface , there are also some some questions uh about the concepts I think you have some ideas on that .


What about the user interface , there are also some some questions uh about the concepts I think you have some ideas on that .

I had what I just uh I should  again. I miss a few buttons , but. Well. At least uh   what we should also have on , I just remembered , um a menu to go back through the first uh  if if you touch options , you can't go back to this uh right away now.


I had what I just uh I should  again. I miss a few buttons , but. Well. At least uh   what we should also have on , I just remembered , um a menu to go back through the first uh  if if you touch options , you can't go back to this uh right away now.

Mm-hmm. Yeah , you have to go back. Yeah uh uh.


I had what I just uh I should  again. I miss a few buttons , but. Well. At least uh   what we should also have on , I just remembered , um a menu to go back through the first uh  if if you touch options , you can't go back to this uh right away now.

Mm-hmm. Yeah , you have to go back. Yeah uh uh.

Isn't it better to have the sound and the general buttons horizontal ?


Mm-hmm. Yeah , you have to go back. Yeah uh uh.

Isn't it better to have the sound and the general buttons horizontal ?


Isn't it better to have the sound and the general buttons horizontal ?


I don't know. I I thought it was uh easier to handle this way ,


Would you like the the buttons horizontal or v vertical ?


Would you like the the buttons horizontal or v vertical ?

Depends on the screen. If you make the screen vertical it doesn't matter. If you make it uh in a rectangle


Depends on the screen. If you make the screen vertical it doesn't matter. If you make it uh in a rectangle

Right well if we make it like this , I think if you


Right well if we make it like this , I think if you


I think it's it's easier to have it something like  Oh a button uh minus here , plus over here. A minus here , plus over here.


The options and then you have something like uh the P_ over here ,


The options and then you have something like uh the P_ over here ,

I think that's a matter of what you're used to.


I think that's a matter of what you're used to.


I think that's a matter of what you're used to.

I think I would put a plus and a min uh here. And then the P_ in the mid in the middle and the sound uh in the middle.


I think I would put a plus and a min uh here. And then the P_ in the mid in the middle and the sound uh in the middle.


but I think when you are holding it , you could press the minus and the plus and with the other finger the minus and the plus.


but I think when you are holding it , you could press the minus and the plus and with the other finger the minus and the plus.

Yeah I think you're going to s you're going to use it with one thumb.


but I think when you are holding it , you could press the minus and the plus and with the other finger the minus and the plus.

Yeah I think you're going to s you're going to use it with one thumb.

Yeah but I think  Yeah I don't know.  Perhaps I have some examples.


Yeah I think you're going to s you're going to use it with one thumb.

Yeah but I think  Yeah I don't know.  Perhaps I have some examples.

We'll leave that to the usability engineering then.


Yeah but I think  Yeah I don't know.  Perhaps I have some examples.

We'll leave that to the usability engineering then.


We'll leave that to the usability engineering then.


But I'm going to look if I've got some examples


But I'm going to look if I've got some examples

'cause perhaps you should choose what's most often used.


'cause perhaps you should choose what's most often used.


Channel selection. Per hour one hundred and sixty eight. Volume selection four times an hour


Channel selection. Per hour one hundred and sixty eight. Volume selection four times an hour

Yeah but   But I mean if it's usually plus or min above each other or next to each other on a normal remote.


Channel selection. Per hour one hundred and sixty eight. Volume selection four times an hour

Yeah but   But I mean if it's usually plus or min above each other or next to each other on a normal remote.

Yeah. So not how much  n not how often it's used , but


Yeah but   But I mean if it's usually plus or min above each other or next to each other on a normal remote.

Yeah. So not how much  n not how often it's used , but


Yeah. So not how much  n not how often it's used , but

Yeah , that depends on on on the remote.


Yeah , that depends on on on the remote.

Yes I'm looking here. But here's it's below ,


Yeah , that depends on on on the remote.

Yes I'm looking here. But here's it's below ,

here also , and now here's here's next to each other.


Yes I'm looking here. But here's it's below ,

here also , and now here's here's next to each other.


here also , and now here's here's next to each other.

I think  because I have two televisions at home. One is horizontal , one is vertical ,


I think  because I have two televisions at home. One is horizontal , one is vertical ,


I think the the the volume was usually uh above each other , because you go higher and down.


I think the the the volume was usually uh above each other , because you go higher and down.

And the the pay the the the program is next to each other , because you would go further and back.


I think the the the volume was usually uh above each other , because you go higher and down.

And the the pay the the the program is next to each other , because you would go further and back.

That's how it's is usually  when I look here


And the the pay the the the program is next to each other , because you would go further and back.

That's how it's is usually  when I look here


That's how it's is usually  when I look here


Yeah well I think we have we don't have to decide about that now how where we will put the buttons


This concept is in the actual design , but you should know where you would place a


This concept is in the actual design , but you should know where you would place a

And the speech uh shall we implement that ? Or uh


This concept is in the actual design , but you should know where you would place a

And the speech uh shall we implement that ? Or uh

Yeah well we just heard about the new uh technology , huh ?


And the speech uh shall we implement that ? Or uh

Yeah well we just heard about the new uh technology , huh ?


And the speech uh shall we implement that ? Or uh

Yeah well we just heard about the new uh technology , huh ?

Yeah I think it's it's easy for that , where are you , but then it says I'm here.


Yeah well we just heard about the new uh technology , huh ?

Yeah I think it's it's easy for that , where are you , but then it says I'm here.


Yeah I think it's it's easy for that , where are you , but then it says I'm here.

Yeah. But then you should also find a place


Yeah. But then you should also find a place


Yeah. But then you should also find a place

You could if you do it like this you could put it in a corner or something. You can talk into the corner.


You could if you do it like this you could put it in a corner or something. You can talk into the corner.


because a lotta  you can make a very sensitive microphone , so it makes it possible to uh  just put it arou uh underneath it or on the on the bottom of the uh remote.


because a lotta  you can make a very sensitive microphone , so it makes it possible to uh  just put it arou uh underneath it or on the on the bottom of the uh remote.

Yeah maybe at the bottom where you can can hel hold it with you hand that there's also a microphone uh


Yeah maybe at the bottom where you can can hel hold it with you hand that there's also a microphone uh


But that's not import I think that's not im very important


But that's not import I think that's not im very important

because yeah , it doesn't matter where the microphone is.


But that's not import I think that's not im very important

because yeah , it doesn't matter where the microphone is.

but you should uh decide where you want to put it.


because yeah , it doesn't matter where the microphone is.

but you should uh decide where you want to put it.


but you should uh decide where you want to put it.


Underneath ?  Indeed. It shouldn't be uh very uh visible.


Underneath ?  Indeed. It shouldn't be uh very uh visible.

You could p you could put it in a logo of the company.


You could p you could put it in a logo of the company.


maybe just in the the spot you just pointed out


maybe just in the the spot you just pointed out

because I think it should be in a in an important position where people can see it ,


because I think it should be in a in an important position where people can see it ,


because I think it should be in a in an important position where people can see it ,

because it is the the unique uh idea of our remote , huh , the the speech control.


because it is the the unique uh idea of our remote , huh , the the speech control.


Yeah but it doesn't makes it uh any more fancy because you get to see uh


Yeah but it doesn't makes it uh any more fancy because you get to see uh

Yeah actually it does  because it you can you can find it better if you use it.


Yeah actually it does  because it you can you can find it better if you use it.


So it makes more sense just 'cause other remotes don't have that.


So it makes more sense just 'cause other remotes don't have that.

But are we talking about the button , or about the microphone ?


But are we talking about the button , or about the microphone ?

Yeah because a microphone is very small thing ,


Yeah because a microphone is very small thing ,

but you can make it look like it's big so as its its really an important function of the remote.


but you can make it look like it's big so as its its really an important function of the remote.

I think the left s under corner should be the best.


I think the left s under corner should be the best.


type , supplements , anything. Yeah , well we already s discussed that , huh , the the L_C_D_


uh supplements well the supplement is to


uh supplements well the supplement is to

I think  I thought the , like you said , like scroll  next to the remote isn't that handy.


I think  I thought the , like you said , like scroll  next to the remote isn't that handy.

I think it's better to just  up what you'd like to do on the screen. If you want to go back you have to back button go back ,


I think it's better to just  up what you'd like to do on the screen. If you want to go back you have to back button go back ,


I think it's better to just  up what you'd like to do on the screen. If you want to go back you have to back button go back ,

if you want to choose audio settings you press audio settings and it goes to that s sub-menu.


if you want to choose audio settings you press audio settings and it goes to that s sub-menu.


if you want to choose audio settings you press audio settings and it goes to that s sub-menu.

the the young people do like uh scroll uh


the the young people do like uh scroll uh


Or at least  Yeah I don't know if it's really the scroll , but the menu  they like most , and I think you can never get through a menu great with a scroll uh


Or at least  Yeah I don't know if it's really the scroll , but the menu  they like most , and I think you can never get through a menu great with a scroll uh

Fast , yeah. So if you've got a settings , if you


Or at least  Yeah I don't know if it's really the scroll , but the menu  they like most , and I think you can never get through a menu great with a scroll uh

Fast , yeah. So if you've got a settings , if you

Yeah I think it is is faster. Becau I think the scroll's easier if you have a lot of options ,


Fast , yeah. So if you've got a settings , if you

Yeah I think it is is faster. Becau I think the scroll's easier if you have a lot of options ,

but if you don't have a lot of option then


Yeah I think it is is faster. Becau I think the scroll's easier if you have a lot of options ,

but if you don't have a lot of option then


but if you don't have a lot of option then


because when you use  Yeah you get w when you use uh the settings menu for example to look up some uh uh some channels on your uh on your television , you should scroll scroll down uh on a menu which probably does not fit on your screen.


So then it's uh very handy to to scroll down ,


So then it's uh very handy to to scroll down ,

you make just a rubber just like uh on your mouse or. Just put it on the side and it's very easy to use.


you make just a rubber just like uh on your mouse or. Just put it on the side and it's very easy to use.

And I think I would it would make even more fancy because you have another interesting thing on the side


And I think I would it would make even more fancy because you have another interesting thing on the side


Okay. Well there's our five minutes uh warning. Um any more uh questions about about the design or the user interface or different components , everyone ?


Black. Yeah , black I think is is the standard.


Black. Yeah , black I think is is the standard.

But if you want to be different , then uh


Black. Yeah , black I think is is the standard.

But if you want to be different , then uh

Dark grey , something like this this colour or something.


But if you want to be different , then uh

Dark grey , something like this this colour or something.


Dark grey , something like this this colour or something.

And then have uh different covers uh to use.


And then have uh different covers uh to use.

Or or silver. I think it's better to have silver nowadays.


Or or silver. I think it's better to have silver nowadays.


You see a lot of t uh silver televisions.


You see a lot of t uh silver televisions.

Yeah the the silver black are our main colours. Yeah.


Yeah the the silver black are our main colours. Yeah.

silver is new but also traditional , so uh


Yeah the the silver black are our main colours. Yeah.

silver is new but also traditional , so uh

I think we have silver , black and between those  is like I dunno s five colours between them or something.


Yeah the the silver black are our main colours. Yeah.

silver is new but also traditional , so uh

I think we have silver , black and between those  is like I dunno s five colours between them or something.

Yeah w what about a yellow thing , I mean it


silver is new but also traditional , so uh

I think we have silver , black and between those  is like I dunno s five colours between them or something.

Yeah w what about a yellow thing , I mean it


I think we have silver , black and between those  is like I dunno s five colours between them or something.

Yeah w what about a yellow thing , I mean it

Yeah yeah yeah it'll be a banana yellow , we have.


Yeah w what about a yellow thing , I mean it

Yeah yeah yeah it'll be a banana yellow , we have.

could be ugly , but it's definitely fancy.


Yeah yeah yeah it'll be a banana yellow , we have.

could be ugly , but it's definitely fancy.


could be ugly , but it's definitely fancy.


But if you use uh silver , uh rubber s silver rubber isn't fancy.


But if you use uh silver , uh rubber s silver rubber isn't fancy.

When you use titanium , silver is fancy ,


When you use titanium , silver is fancy ,

but when you use silver rubber , it isn't fancy. Silver has to shine , and rubber doesn't shine.


but when you use silver rubber , it isn't fancy. Silver has to shine , and rubber doesn't shine.

Especially when it's made of soft rubber like this.


Especially when it's made of soft rubber like this.


Yeah I would think about colours like uh red , yellow , green , blue ,


The fruity colours and the autumn colours , like red and brown ,  dark red and brown.


And and do we have to have a normal black one , or uh


Okay , so uh that wraps it up ? Everybody knows uh what to do ?


Okay , so uh that wraps it up ? Everybody knows uh what to do ?

Well I wrote it down here. I wrote it down here what to do um.


Well I wrote it down here. I wrote it down here what to do um.


Good morning, everyone, and welcome to the Children, Young People and Education committee this morning. We've received apologies for absence from Siân Gwenllian and there is no substitute this morning. Can I ask if Members have got any declarations of interest they'd like to make, please? No? Okay. Thank you. Item 2 this morning, then, is a further session on our follow-up on our 'Mind over matter' report. I'm very pleased to welcome Carol Shillabeer, who is chief executive of Powys Teaching Health Board, and who manages the Together for Children and Young People programme. Thank you very much for attending, and thank you for the written update that you provided in advance to the committee. We've got a lot of ground that we want to cover this morning, so if it's okay we'll go straight into questions. If I can just start and ask you if you're satisfied with the progress that's been made since the programme was established in 2015.

Thank you very much for that question, Chair. I've got to say 'yes', in many regards. So, the key focus of the programme in the early stages was about improving access to specialist child and adolescent mental health services. We developed the windscreen model—or we lifted the windscreen model. Other models that are very similar have been talked about as well, and our big focus was on ensuring that we could make immediate progress around access to specialist CAMHS. It's some years ago now since this committee did the original report, and obviously Healthcare Inspectorate Wales and the Wales Audit Office had done reports in the past, and I think there was a need for a programme that could focus on action. You'll see in the written update that we covered quite a large number of areas, and so therefore had to make a prioritisation. The prioritisation was at the specialist CAMHS end. We have provided the committee with a red, amber or green rating of where we feel that we were, and that was just before submission of the evidence. Overall I would say we have made progress. I recognise you recognise that in your 'Mind over matter' report, and that is pleasing. What I would say, though, is that there's a still a lot to be done. Certainly over the last nine months or so, we've seen a real momentum around the whole-school approach work, which we're not actually leading now as a programme, although we facilitated the workshop held in September. But that's got a real momentum, and the absolute priority now is the early help and enhanced support part of the work moving forward, and I'm sure we will come on to that in more detail. But we know there is more community workforce in specialist CAMHS, we know we're seeing children in a shorter time frame, and we know we're accepting more referrals, so our indicators are telling us we are making progress.

Thank you. And you referred to the work on the whole-school approach, which is very welcome, and I recognise that the programme has been involved in driving that as well. But I'm sure you'll also recognise the emphasis that the committee has placed on this being a whole-system approach to children and young people's mental health, and we feel very strongly that if any of the areas get out of balance, then it will jeopardise the progress in other parts of the programme. Are there any particular areas where you feel you haven't made enough progress that you'd like to draw the committee's attention to?


Thank you very much for that question, Chair. I've got to say 'yes', in many regards. So, the key focus of the programme in the early stages was about improving access to specialist child and adolescent mental health services. We developed the windscreen model—or we lifted the windscreen model. Other models that are very similar have been talked about as well, and our big focus was on ensuring that we could make immediate progress around access to specialist CAMHS. It's some years ago now since this committee did the original report, and obviously Healthcare Inspectorate Wales and the Wales Audit Office had done reports in the past, and I think there was a need for a programme that could focus on action. You'll see in the written update that we covered quite a large number of areas, and so therefore had to make a prioritisation. The prioritisation was at the specialist CAMHS end. We have provided the committee with a red, amber or green rating of where we feel that we were, and that was just before submission of the evidence. Overall I would say we have made progress. I recognise you recognise that in your 'Mind over matter' report, and that is pleasing. What I would say, though, is that there's a still a lot to be done. Certainly over the last nine months or so, we've seen a real momentum around the whole-school approach work, which we're not actually leading now as a programme, although we facilitated the workshop held in September. But that's got a real momentum, and the absolute priority now is the early help and enhanced support part of the work moving forward, and I'm sure we will come on to that in more detail. But we know there is more community workforce in specialist CAMHS, we know we're seeing children in a shorter time frame, and we know we're accepting more referrals, so our indicators are telling us we are making progress.

Thank you. And you referred to the work on the whole-school approach, which is very welcome, and I recognise that the programme has been involved in driving that as well. But I'm sure you'll also recognise the emphasis that the committee has placed on this being a whole-system approach to children and young people's mental health, and we feel very strongly that if any of the areas get out of balance, then it will jeopardise the progress in other parts of the programme. Are there any particular areas where you feel you haven't made enough progress that you'd like to draw the committee's attention to?

This is maybe about what the programme's done, but really around the broader sense as well. I'm going to be very straight and say we should have made more progress on psychological therapies. I'm disappointed that we haven't. I'm assured that we've got capacity in place now and the drive in place to get the Matrics Cymru framework developed for children and young people. I've had discussions with the national psychological therapies committee, who have owned this, and we're working together more on this area. That's not to say for one minute that health boards and local areas haven't been working on psychological therapy service provision and changing the models, but that is an area we should have made, I think, earlier progress on. There's been a general reflection from myself and the Together for Children and Young People programme board over the phase of the programme. I think we started very strongly; I think we probably had a bit of a lull in the middle, if I'm truthful about that—we had a change of personnel, and we really gathered a momentum over the last year or 18 months, and that has helped to push us from a focus on specialist CAMHS into that whole-school approach. But, if I could just agree with your comments about the whole system, it has to be the whole system and that's why the real focus now on early help and enhanced support is critical. If I can just say, in case I don't get a chance to say this later, I was delighted to see the focus on youth work yesterday, because what is clear is for that part, the early help and enhanced support, this isn't just about the NHS and it's not just about education, it's about every part of the system, really, which does make it more complex. But I just wanted to say that I think that youth work has perhaps not have the recognition that it's needed and yesterday was a positive step.


Thank you very much for that question, Chair. I've got to say 'yes', in many regards. So, the key focus of the programme in the early stages was about improving access to specialist child and adolescent mental health services. We developed the windscreen model—or we lifted the windscreen model. Other models that are very similar have been talked about as well, and our big focus was on ensuring that we could make immediate progress around access to specialist CAMHS. It's some years ago now since this committee did the original report, and obviously Healthcare Inspectorate Wales and the Wales Audit Office had done reports in the past, and I think there was a need for a programme that could focus on action. You'll see in the written update that we covered quite a large number of areas, and so therefore had to make a prioritisation. The prioritisation was at the specialist CAMHS end. We have provided the committee with a red, amber or green rating of where we feel that we were, and that was just before submission of the evidence. Overall I would say we have made progress. I recognise you recognise that in your 'Mind over matter' report, and that is pleasing. What I would say, though, is that there's a still a lot to be done. Certainly over the last nine months or so, we've seen a real momentum around the whole-school approach work, which we're not actually leading now as a programme, although we facilitated the workshop held in September. But that's got a real momentum, and the absolute priority now is the early help and enhanced support part of the work moving forward, and I'm sure we will come on to that in more detail. But we know there is more community workforce in specialist CAMHS, we know we're seeing children in a shorter time frame, and we know we're accepting more referrals, so our indicators are telling us we are making progress.

Thank you. And you referred to the work on the whole-school approach, which is very welcome, and I recognise that the programme has been involved in driving that as well. But I'm sure you'll also recognise the emphasis that the committee has placed on this being a whole-system approach to children and young people's mental health, and we feel very strongly that if any of the areas get out of balance, then it will jeopardise the progress in other parts of the programme. Are there any particular areas where you feel you haven't made enough progress that you'd like to draw the committee's attention to?

This is maybe about what the programme's done, but really around the broader sense as well. I'm going to be very straight and say we should have made more progress on psychological therapies. I'm disappointed that we haven't. I'm assured that we've got capacity in place now and the drive in place to get the Matrics Cymru framework developed for children and young people. I've had discussions with the national psychological therapies committee, who have owned this, and we're working together more on this area. That's not to say for one minute that health boards and local areas haven't been working on psychological therapy service provision and changing the models, but that is an area we should have made, I think, earlier progress on. There's been a general reflection from myself and the Together for Children and Young People programme board over the phase of the programme. I think we started very strongly; I think we probably had a bit of a lull in the middle, if I'm truthful about that—we had a change of personnel, and we really gathered a momentum over the last year or 18 months, and that has helped to push us from a focus on specialist CAMHS into that whole-school approach. But, if I could just agree with your comments about the whole system, it has to be the whole system and that's why the real focus now on early help and enhanced support is critical. If I can just say, in case I don't get a chance to say this later, I was delighted to see the focus on youth work yesterday, because what is clear is for that part, the early help and enhanced support, this isn't just about the NHS and it's not just about education, it's about every part of the system, really, which does make it more complex. But I just wanted to say that I think that youth work has perhaps not have the recognition that it's needed and yesterday was a positive step.

Okay, thank you. We've got some questions now on early help and enhanced support from Janet Finch-Saunders.


Thank you. And you referred to the work on the whole-school approach, which is very welcome, and I recognise that the programme has been involved in driving that as well. But I'm sure you'll also recognise the emphasis that the committee has placed on this being a whole-system approach to children and young people's mental health, and we feel very strongly that if any of the areas get out of balance, then it will jeopardise the progress in other parts of the programme. Are there any particular areas where you feel you haven't made enough progress that you'd like to draw the committee's attention to?

This is maybe about what the programme's done, but really around the broader sense as well. I'm going to be very straight and say we should have made more progress on psychological therapies. I'm disappointed that we haven't. I'm assured that we've got capacity in place now and the drive in place to get the Matrics Cymru framework developed for children and young people. I've had discussions with the national psychological therapies committee, who have owned this, and we're working together more on this area. That's not to say for one minute that health boards and local areas haven't been working on psychological therapy service provision and changing the models, but that is an area we should have made, I think, earlier progress on. There's been a general reflection from myself and the Together for Children and Young People programme board over the phase of the programme. I think we started very strongly; I think we probably had a bit of a lull in the middle, if I'm truthful about that—we had a change of personnel, and we really gathered a momentum over the last year or 18 months, and that has helped to push us from a focus on specialist CAMHS into that whole-school approach. But, if I could just agree with your comments about the whole system, it has to be the whole system and that's why the real focus now on early help and enhanced support is critical. If I can just say, in case I don't get a chance to say this later, I was delighted to see the focus on youth work yesterday, because what is clear is for that part, the early help and enhanced support, this isn't just about the NHS and it's not just about education, it's about every part of the system, really, which does make it more complex. But I just wanted to say that I think that youth work has perhaps not have the recognition that it's needed and yesterday was a positive step.

Okay, thank you. We've got some questions now on early help and enhanced support from Janet Finch-Saunders.

Thank you. Good morning. In terms of local primary mental health support services, what is your understanding of the issues leading to some health boards not meeting the Mental Health (Wales) Measure 2010 targets for assessment and therapy for children and young people, and how much of this is due to an increase in demand?


This is maybe about what the programme's done, but really around the broader sense as well. I'm going to be very straight and say we should have made more progress on psychological therapies. I'm disappointed that we haven't. I'm assured that we've got capacity in place now and the drive in place to get the Matrics Cymru framework developed for children and young people. I've had discussions with the national psychological therapies committee, who have owned this, and we're working together more on this area. That's not to say for one minute that health boards and local areas haven't been working on psychological therapy service provision and changing the models, but that is an area we should have made, I think, earlier progress on. There's been a general reflection from myself and the Together for Children and Young People programme board over the phase of the programme. I think we started very strongly; I think we probably had a bit of a lull in the middle, if I'm truthful about that—we had a change of personnel, and we really gathered a momentum over the last year or 18 months, and that has helped to push us from a focus on specialist CAMHS into that whole-school approach. But, if I could just agree with your comments about the whole system, it has to be the whole system and that's why the real focus now on early help and enhanced support is critical. If I can just say, in case I don't get a chance to say this later, I was delighted to see the focus on youth work yesterday, because what is clear is for that part, the early help and enhanced support, this isn't just about the NHS and it's not just about education, it's about every part of the system, really, which does make it more complex. But I just wanted to say that I think that youth work has perhaps not have the recognition that it's needed and yesterday was a positive step.

Okay, thank you. We've got some questions now on early help and enhanced support from Janet Finch-Saunders.

Thank you. Good morning. In terms of local primary mental health support services, what is your understanding of the issues leading to some health boards not meeting the Mental Health (Wales) Measure 2010 targets for assessment and therapy for children and young people, and how much of this is due to an increase in demand?

Yes, thanks very much. So, it's important to say, I think, at the outset, just by way of reminder, that the target, quite rightly, changed for children and young people. The target changed some years ago for adults, so it was only right that there was an equalisation around children. So, the services were working, a couple of years ago, with significant demand and then a change in the standard. I think you're absolutely right; your question alludes to the fact that some health boards are struggling to maintain the full performance around seeing children, particularly within the 28 days. I would say—. And we've had some discussion about whether the impact of the mental health Measure has actually drawn perhaps some of the workforce, the staff, who would have been working at that earlier stage in local primary mental health, into a bit more of the secondary element, which is why the review being undertaken by the NHS delivery unit into primary care CAMHS is so critical, because, actually, if we don't have—and I believe we don't have—enough capacity in that part of the system, then referrals will move towards the more specialist end of this. So, I think we will have seen, by the evidence submission, that demand has increased, not just in Wales but in the UK, and it has increased significantly. We are doing reasonably well at meeting that demand—so, we have more contacts, more staff, shorter access times, so that is a good news story. We've not got it completely sustained at this stage, and therefore the focus of the delivery unit's primary care CAMHS report is what more can we do in that part of the system to help to see children and young people or provide consultation and liaison to others and support people at that level of intervention.


Okay, thank you. We've got some questions now on early help and enhanced support from Janet Finch-Saunders.

Thank you. Good morning. In terms of local primary mental health support services, what is your understanding of the issues leading to some health boards not meeting the Mental Health (Wales) Measure 2010 targets for assessment and therapy for children and young people, and how much of this is due to an increase in demand?

Yes, thanks very much. So, it's important to say, I think, at the outset, just by way of reminder, that the target, quite rightly, changed for children and young people. The target changed some years ago for adults, so it was only right that there was an equalisation around children. So, the services were working, a couple of years ago, with significant demand and then a change in the standard. I think you're absolutely right; your question alludes to the fact that some health boards are struggling to maintain the full performance around seeing children, particularly within the 28 days. I would say—. And we've had some discussion about whether the impact of the mental health Measure has actually drawn perhaps some of the workforce, the staff, who would have been working at that earlier stage in local primary mental health, into a bit more of the secondary element, which is why the review being undertaken by the NHS delivery unit into primary care CAMHS is so critical, because, actually, if we don't have—and I believe we don't have—enough capacity in that part of the system, then referrals will move towards the more specialist end of this. So, I think we will have seen, by the evidence submission, that demand has increased, not just in Wales but in the UK, and it has increased significantly. We are doing reasonably well at meeting that demand—so, we have more contacts, more staff, shorter access times, so that is a good news story. We've not got it completely sustained at this stage, and therefore the focus of the delivery unit's primary care CAMHS report is what more can we do in that part of the system to help to see children and young people or provide consultation and liaison to others and support people at that level of intervention.

Thank you. I know, from my own experience as a constituency AM, I have families who tell me that they can't get into the early interventions and eventually things just become so—they end up in the more specialist ones and believe that that's—. And I don't like to put it in resource terms, but it's false economy in terms of the impact on the child and the family, but, obviously, in terms of cost as well. Do you find that that's a common theme across Wales?


Thank you. Good morning. In terms of local primary mental health support services, what is your understanding of the issues leading to some health boards not meeting the Mental Health (Wales) Measure 2010 targets for assessment and therapy for children and young people, and how much of this is due to an increase in demand?

Yes, thanks very much. So, it's important to say, I think, at the outset, just by way of reminder, that the target, quite rightly, changed for children and young people. The target changed some years ago for adults, so it was only right that there was an equalisation around children. So, the services were working, a couple of years ago, with significant demand and then a change in the standard. I think you're absolutely right; your question alludes to the fact that some health boards are struggling to maintain the full performance around seeing children, particularly within the 28 days. I would say—. And we've had some discussion about whether the impact of the mental health Measure has actually drawn perhaps some of the workforce, the staff, who would have been working at that earlier stage in local primary mental health, into a bit more of the secondary element, which is why the review being undertaken by the NHS delivery unit into primary care CAMHS is so critical, because, actually, if we don't have—and I believe we don't have—enough capacity in that part of the system, then referrals will move towards the more specialist end of this. So, I think we will have seen, by the evidence submission, that demand has increased, not just in Wales but in the UK, and it has increased significantly. We are doing reasonably well at meeting that demand—so, we have more contacts, more staff, shorter access times, so that is a good news story. We've not got it completely sustained at this stage, and therefore the focus of the delivery unit's primary care CAMHS report is what more can we do in that part of the system to help to see children and young people or provide consultation and liaison to others and support people at that level of intervention.

Thank you. I know, from my own experience as a constituency AM, I have families who tell me that they can't get into the early interventions and eventually things just become so—they end up in the more specialist ones and believe that that's—. And I don't like to put it in resource terms, but it's false economy in terms of the impact on the child and the family, but, obviously, in terms of cost as well. Do you find that that's a common theme across Wales?

Yes. I think that the thrust of that is absolutely right. So, we absolutely need to see children and families at the earliest intervention and that's why this is a whole system, not compartmentalised. I think there have been really good attempts in a couple of areas of that greater reach out and that earlier help—hot clinics and those sorts of initiatives that help people not to get in a long queue for specialist CAMHS, but can be supported, often by telephone, at that earlier stage. My sense of where we go next, in terms of, you know, you talk about early help and enhanced support for all the 'missing middle', as you referred to it in your report, is to make sure we've got a fully joined-up, multi-agency team approach to that. And I think that will need some resourcing to support that, yet to be fully determined. But yesterday's announcement about youth work, the Government's commitment to primary care, CAMHS, et cetera—that's all going to be very helpful to prevent those young people having to go into specialist CAMHS. And just a final note on that, if I may—at the beginning of the programme, we had a report from Hafal called 'Making Sense' and there were 10 key asks, if you like, of the system and the service from young people who had experience of the service. They said, 'Please don't medicalise it'—I'm paraphrasing now, of course—'Please don't medicalise it; please focus on supporting teachers and others who can support us at an earlier stage and then, when we really need help, please ensure that it is there at that more specialist level.' That's been a bit of a guiding principle for the programme. So, that reflects the questions that you were asking, really.


Yes, thanks very much. So, it's important to say, I think, at the outset, just by way of reminder, that the target, quite rightly, changed for children and young people. The target changed some years ago for adults, so it was only right that there was an equalisation around children. So, the services were working, a couple of years ago, with significant demand and then a change in the standard. I think you're absolutely right; your question alludes to the fact that some health boards are struggling to maintain the full performance around seeing children, particularly within the 28 days. I would say—. And we've had some discussion about whether the impact of the mental health Measure has actually drawn perhaps some of the workforce, the staff, who would have been working at that earlier stage in local primary mental health, into a bit more of the secondary element, which is why the review being undertaken by the NHS delivery unit into primary care CAMHS is so critical, because, actually, if we don't have—and I believe we don't have—enough capacity in that part of the system, then referrals will move towards the more specialist end of this. So, I think we will have seen, by the evidence submission, that demand has increased, not just in Wales but in the UK, and it has increased significantly. We are doing reasonably well at meeting that demand—so, we have more contacts, more staff, shorter access times, so that is a good news story. We've not got it completely sustained at this stage, and therefore the focus of the delivery unit's primary care CAMHS report is what more can we do in that part of the system to help to see children and young people or provide consultation and liaison to others and support people at that level of intervention.

Thank you. I know, from my own experience as a constituency AM, I have families who tell me that they can't get into the early interventions and eventually things just become so—they end up in the more specialist ones and believe that that's—. And I don't like to put it in resource terms, but it's false economy in terms of the impact on the child and the family, but, obviously, in terms of cost as well. Do you find that that's a common theme across Wales?

Yes. I think that the thrust of that is absolutely right. So, we absolutely need to see children and families at the earliest intervention and that's why this is a whole system, not compartmentalised. I think there have been really good attempts in a couple of areas of that greater reach out and that earlier help—hot clinics and those sorts of initiatives that help people not to get in a long queue for specialist CAMHS, but can be supported, often by telephone, at that earlier stage. My sense of where we go next, in terms of, you know, you talk about early help and enhanced support for all the 'missing middle', as you referred to it in your report, is to make sure we've got a fully joined-up, multi-agency team approach to that. And I think that will need some resourcing to support that, yet to be fully determined. But yesterday's announcement about youth work, the Government's commitment to primary care, CAMHS, et cetera—that's all going to be very helpful to prevent those young people having to go into specialist CAMHS. And just a final note on that, if I may—at the beginning of the programme, we had a report from Hafal called 'Making Sense' and there were 10 key asks, if you like, of the system and the service from young people who had experience of the service. They said, 'Please don't medicalise it'—I'm paraphrasing now, of course—'Please don't medicalise it; please focus on supporting teachers and others who can support us at an earlier stage and then, when we really need help, please ensure that it is there at that more specialist level.' That's been a bit of a guiding principle for the programme. So, that reflects the questions that you were asking, really.

Thank you. What are the outcomes of the stakeholder workshop held last week on early help and enhanced support? And how are the actions going to be taken forward and implemented? And also, given that the Together for Children and Young People programme comes to an end in October of this year, who, in your view, is best placed to forward this work stream, and what will be the biggest challenges? It's a bit of a long question, so, break it up however you like.


Thank you. I know, from my own experience as a constituency AM, I have families who tell me that they can't get into the early interventions and eventually things just become so—they end up in the more specialist ones and believe that that's—. And I don't like to put it in resource terms, but it's false economy in terms of the impact on the child and the family, but, obviously, in terms of cost as well. Do you find that that's a common theme across Wales?

Yes. I think that the thrust of that is absolutely right. So, we absolutely need to see children and families at the earliest intervention and that's why this is a whole system, not compartmentalised. I think there have been really good attempts in a couple of areas of that greater reach out and that earlier help—hot clinics and those sorts of initiatives that help people not to get in a long queue for specialist CAMHS, but can be supported, often by telephone, at that earlier stage. My sense of where we go next, in terms of, you know, you talk about early help and enhanced support for all the 'missing middle', as you referred to it in your report, is to make sure we've got a fully joined-up, multi-agency team approach to that. And I think that will need some resourcing to support that, yet to be fully determined. But yesterday's announcement about youth work, the Government's commitment to primary care, CAMHS, et cetera—that's all going to be very helpful to prevent those young people having to go into specialist CAMHS. And just a final note on that, if I may—at the beginning of the programme, we had a report from Hafal called 'Making Sense' and there were 10 key asks, if you like, of the system and the service from young people who had experience of the service. They said, 'Please don't medicalise it'—I'm paraphrasing now, of course—'Please don't medicalise it; please focus on supporting teachers and others who can support us at an earlier stage and then, when we really need help, please ensure that it is there at that more specialist level.' That's been a bit of a guiding principle for the programme. So, that reflects the questions that you were asking, really.

Thank you. What are the outcomes of the stakeholder workshop held last week on early help and enhanced support? And how are the actions going to be taken forward and implemented? And also, given that the Together for Children and Young People programme comes to an end in October of this year, who, in your view, is best placed to forward this work stream, and what will be the biggest challenges? It's a bit of a long question, so, break it up however you like.


Yes. I think that the thrust of that is absolutely right. So, we absolutely need to see children and families at the earliest intervention and that's why this is a whole system, not compartmentalised. I think there have been really good attempts in a couple of areas of that greater reach out and that earlier help—hot clinics and those sorts of initiatives that help people not to get in a long queue for specialist CAMHS, but can be supported, often by telephone, at that earlier stage. My sense of where we go next, in terms of, you know, you talk about early help and enhanced support for all the 'missing middle', as you referred to it in your report, is to make sure we've got a fully joined-up, multi-agency team approach to that. And I think that will need some resourcing to support that, yet to be fully determined. But yesterday's announcement about youth work, the Government's commitment to primary care, CAMHS, et cetera—that's all going to be very helpful to prevent those young people having to go into specialist CAMHS. And just a final note on that, if I may—at the beginning of the programme, we had a report from Hafal called 'Making Sense' and there were 10 key asks, if you like, of the system and the service from young people who had experience of the service. They said, 'Please don't medicalise it'—I'm paraphrasing now, of course—'Please don't medicalise it; please focus on supporting teachers and others who can support us at an earlier stage and then, when we really need help, please ensure that it is there at that more specialist level.' That's been a bit of a guiding principle for the programme. So, that reflects the questions that you were asking, really.

Thank you. What are the outcomes of the stakeholder workshop held last week on early help and enhanced support? And how are the actions going to be taken forward and implemented? And also, given that the Together for Children and Young People programme comes to an end in October of this year, who, in your view, is best placed to forward this work stream, and what will be the biggest challenges? It's a bit of a long question, so, break it up however you like.

And what will be the biggest challenges that they will face?


Thank you. What are the outcomes of the stakeholder workshop held last week on early help and enhanced support? And how are the actions going to be taken forward and implemented? And also, given that the Together for Children and Young People programme comes to an end in October of this year, who, in your view, is best placed to forward this work stream, and what will be the biggest challenges? It's a bit of a long question, so, break it up however you like.

And what will be the biggest challenges that they will face?

Yes, I think that's helpfully laid out in three stages. So, you're absolutely right, there was a highly successful workshop last week really focusing on early help and enhanced support. It brought all of the agencies together, which was—and actually had a bit of a waiting list, apparently, for places. So, there was a lot of demand and a lot of interest in this. In relation to the next steps, there is a planning group reflection in early July, in terms of the outcomes of the workshop or the outputs of the workshop, and there are three commitments that have been made to this stage. One is that we develop those values-led approaches that will bring multiple agencies together to have that common purpose. The second one is to develop the ingredients for successful working in this area, and then, thirdly, to determine or propose priorities and sequencing of next steps. So, that's the next stage of that. I'm pretty sure we'll come on shortly—or hopefully—to the potential of the regional partnership boards. There is some work that we are doing as a programme with the children's commissioner in terms of working more with the regional partnership boards in taking forward this work. So, that will run alongside. But during the summer, then, we will be developing that framework approach, and we will be participating in the Association of Directors of Social Services conference in September, and then a follow-up workshop in October on this matter. On your question of 'Well, what happens after the programme?' we are currently working on legacy arrangements for the programme. I'm pretty secure on the specialist CAMHS element. That will move, most likely, to the CAMHS network, which is part of the NHS mental health network. I actually chair the mental health network and that's one part of that. The whole-school approach element is already settled in Government and we've got a connection in to that. The question that's outstanding is where the early help and enhanced support and the neurodevelopmental will go. I am currently in discussions with Welsh Government officials around that. I can be very clear of my own view that there needs to be a confident and clear legacy arrangement for this work. We cannot afford that we've come so far for this not now to proceed. I think there's a huge momentum behind this. I don't see there would be any obstacles—I hope—in getting that commitment translated into a strong approach, as we move forward. So, I'm not in a position to say, 'And the legacy arrangements will be—', but I am in a position to say that I'm having those discussions with Welsh Government officials. They know my view that we've got to put something in place that is strong and secure as we move forward, and I believe that they are supportive of that.


And what will be the biggest challenges that they will face?

Yes, I think that's helpfully laid out in three stages. So, you're absolutely right, there was a highly successful workshop last week really focusing on early help and enhanced support. It brought all of the agencies together, which was—and actually had a bit of a waiting list, apparently, for places. So, there was a lot of demand and a lot of interest in this. In relation to the next steps, there is a planning group reflection in early July, in terms of the outcomes of the workshop or the outputs of the workshop, and there are three commitments that have been made to this stage. One is that we develop those values-led approaches that will bring multiple agencies together to have that common purpose. The second one is to develop the ingredients for successful working in this area, and then, thirdly, to determine or propose priorities and sequencing of next steps. So, that's the next stage of that. I'm pretty sure we'll come on shortly—or hopefully—to the potential of the regional partnership boards. There is some work that we are doing as a programme with the children's commissioner in terms of working more with the regional partnership boards in taking forward this work. So, that will run alongside. But during the summer, then, we will be developing that framework approach, and we will be participating in the Association of Directors of Social Services conference in September, and then a follow-up workshop in October on this matter. On your question of 'Well, what happens after the programme?' we are currently working on legacy arrangements for the programme. I'm pretty secure on the specialist CAMHS element. That will move, most likely, to the CAMHS network, which is part of the NHS mental health network. I actually chair the mental health network and that's one part of that. The whole-school approach element is already settled in Government and we've got a connection in to that. The question that's outstanding is where the early help and enhanced support and the neurodevelopmental will go. I am currently in discussions with Welsh Government officials around that. I can be very clear of my own view that there needs to be a confident and clear legacy arrangement for this work. We cannot afford that we've come so far for this not now to proceed. I think there's a huge momentum behind this. I don't see there would be any obstacles—I hope—in getting that commitment translated into a strong approach, as we move forward. So, I'm not in a position to say, 'And the legacy arrangements will be—', but I am in a position to say that I'm having those discussions with Welsh Government officials. They know my view that we've got to put something in place that is strong and secure as we move forward, and I believe that they are supportive of that.


And what will be the biggest challenges that they will face?

Yes, I think that's helpfully laid out in three stages. So, you're absolutely right, there was a highly successful workshop last week really focusing on early help and enhanced support. It brought all of the agencies together, which was—and actually had a bit of a waiting list, apparently, for places. So, there was a lot of demand and a lot of interest in this. In relation to the next steps, there is a planning group reflection in early July, in terms of the outcomes of the workshop or the outputs of the workshop, and there are three commitments that have been made to this stage. One is that we develop those values-led approaches that will bring multiple agencies together to have that common purpose. The second one is to develop the ingredients for successful working in this area, and then, thirdly, to determine or propose priorities and sequencing of next steps. So, that's the next stage of that. I'm pretty sure we'll come on shortly—or hopefully—to the potential of the regional partnership boards. There is some work that we are doing as a programme with the children's commissioner in terms of working more with the regional partnership boards in taking forward this work. So, that will run alongside. But during the summer, then, we will be developing that framework approach, and we will be participating in the Association of Directors of Social Services conference in September, and then a follow-up workshop in October on this matter. On your question of 'Well, what happens after the programme?' we are currently working on legacy arrangements for the programme. I'm pretty secure on the specialist CAMHS element. That will move, most likely, to the CAMHS network, which is part of the NHS mental health network. I actually chair the mental health network and that's one part of that. The whole-school approach element is already settled in Government and we've got a connection in to that. The question that's outstanding is where the early help and enhanced support and the neurodevelopmental will go. I am currently in discussions with Welsh Government officials around that. I can be very clear of my own view that there needs to be a confident and clear legacy arrangement for this work. We cannot afford that we've come so far for this not now to proceed. I think there's a huge momentum behind this. I don't see there would be any obstacles—I hope—in getting that commitment translated into a strong approach, as we move forward. So, I'm not in a position to say, 'And the legacy arrangements will be—', but I am in a position to say that I'm having those discussions with Welsh Government officials. They know my view that we've got to put something in place that is strong and secure as we move forward, and I believe that they are supportive of that.

Janet, I think those two questions have been touched on, the remaining questions. We are going to discuss in more detail the legacy arrangements, but if I could just ask on psychological therapies: you referred to the fact that you were a bit disappointed with progress in this area, and the area hasn't been directly led on by the Together for Children and Young People programme. Do you think that means now that there is more of a threat to progress in this area, because, you know, we've got different compartmentalising of actions, and this is absolutely key, isn't it, really?


Yes, I think that's helpfully laid out in three stages. So, you're absolutely right, there was a highly successful workshop last week really focusing on early help and enhanced support. It brought all of the agencies together, which was—and actually had a bit of a waiting list, apparently, for places. So, there was a lot of demand and a lot of interest in this. In relation to the next steps, there is a planning group reflection in early July, in terms of the outcomes of the workshop or the outputs of the workshop, and there are three commitments that have been made to this stage. One is that we develop those values-led approaches that will bring multiple agencies together to have that common purpose. The second one is to develop the ingredients for successful working in this area, and then, thirdly, to determine or propose priorities and sequencing of next steps. So, that's the next stage of that. I'm pretty sure we'll come on shortly—or hopefully—to the potential of the regional partnership boards. There is some work that we are doing as a programme with the children's commissioner in terms of working more with the regional partnership boards in taking forward this work. So, that will run alongside. But during the summer, then, we will be developing that framework approach, and we will be participating in the Association of Directors of Social Services conference in September, and then a follow-up workshop in October on this matter. On your question of 'Well, what happens after the programme?' we are currently working on legacy arrangements for the programme. I'm pretty secure on the specialist CAMHS element. That will move, most likely, to the CAMHS network, which is part of the NHS mental health network. I actually chair the mental health network and that's one part of that. The whole-school approach element is already settled in Government and we've got a connection in to that. The question that's outstanding is where the early help and enhanced support and the neurodevelopmental will go. I am currently in discussions with Welsh Government officials around that. I can be very clear of my own view that there needs to be a confident and clear legacy arrangement for this work. We cannot afford that we've come so far for this not now to proceed. I think there's a huge momentum behind this. I don't see there would be any obstacles—I hope—in getting that commitment translated into a strong approach, as we move forward. So, I'm not in a position to say, 'And the legacy arrangements will be—', but I am in a position to say that I'm having those discussions with Welsh Government officials. They know my view that we've got to put something in place that is strong and secure as we move forward, and I believe that they are supportive of that.

Janet, I think those two questions have been touched on, the remaining questions. We are going to discuss in more detail the legacy arrangements, but if I could just ask on psychological therapies: you referred to the fact that you were a bit disappointed with progress in this area, and the area hasn't been directly led on by the Together for Children and Young People programme. Do you think that means now that there is more of a threat to progress in this area, because, you know, we've got different compartmentalising of actions, and this is absolutely key, isn't it, really?

Yes. I think there's—. There is some refinement to be done, I think, in making sure the connections are there. So, I think, as we move to programme end, we'll want to be absolutely assured that there are no strands left hanging, so to speak. I am confident—I mentioned the mental health network board that I chair—that we have those strands nailed down, but recognising that the early help and enhanced support and the provision of psychological support is beyond the NHS. So, this will be an area that needs to be very much seen as a key part of that. My own sense is that—. There's been quite a lot of other developments through the life of the programme. So, in the evidence that I've provided, you'll see the First 1000 days, all the adverse childhood experiences work, the Cymru Well Wales partnership, et cetera, et cetera. So, there is a bit of what I would call tidying up of the landscape to be done, and this is the ideal opportunity to do that.


Janet, I think those two questions have been touched on, the remaining questions. We are going to discuss in more detail the legacy arrangements, but if I could just ask on psychological therapies: you referred to the fact that you were a bit disappointed with progress in this area, and the area hasn't been directly led on by the Together for Children and Young People programme. Do you think that means now that there is more of a threat to progress in this area, because, you know, we've got different compartmentalising of actions, and this is absolutely key, isn't it, really?

Yes. I think there's—. There is some refinement to be done, I think, in making sure the connections are there. So, I think, as we move to programme end, we'll want to be absolutely assured that there are no strands left hanging, so to speak. I am confident—I mentioned the mental health network board that I chair—that we have those strands nailed down, but recognising that the early help and enhanced support and the provision of psychological support is beyond the NHS. So, this will be an area that needs to be very much seen as a key part of that. My own sense is that—. There's been quite a lot of other developments through the life of the programme. So, in the evidence that I've provided, you'll see the First 1000 days, all the adverse childhood experiences work, the Cymru Well Wales partnership, et cetera, et cetera. So, there is a bit of what I would call tidying up of the landscape to be done, and this is the ideal opportunity to do that.

Okay. Thank you. We've got some questions now on specialist CAMHS—if I can just ask about the impact of the specialist CAMHS framework, and how effective you feel that has been in promoting a consistent delivery of care for young people.


Janet, I think those two questions have been touched on, the remaining questions. We are going to discuss in more detail the legacy arrangements, but if I could just ask on psychological therapies: you referred to the fact that you were a bit disappointed with progress in this area, and the area hasn't been directly led on by the Together for Children and Young People programme. Do you think that means now that there is more of a threat to progress in this area, because, you know, we've got different compartmentalising of actions, and this is absolutely key, isn't it, really?

Yes. I think there's—. There is some refinement to be done, I think, in making sure the connections are there. So, I think, as we move to programme end, we'll want to be absolutely assured that there are no strands left hanging, so to speak. I am confident—I mentioned the mental health network board that I chair—that we have those strands nailed down, but recognising that the early help and enhanced support and the provision of psychological support is beyond the NHS. So, this will be an area that needs to be very much seen as a key part of that. My own sense is that—. There's been quite a lot of other developments through the life of the programme. So, in the evidence that I've provided, you'll see the First 1000 days, all the adverse childhood experiences work, the Cymru Well Wales partnership, et cetera, et cetera. So, there is a bit of what I would call tidying up of the landscape to be done, and this is the ideal opportunity to do that.

Okay. Thank you. We've got some questions now on specialist CAMHS—if I can just ask about the impact of the specialist CAMHS framework, and how effective you feel that has been in promoting a consistent delivery of care for young people.

Thanks very much for that. Without wanting to go back too far in history, I remember coming into this area back in 2014 as I was asked to establish a CAMHS network. My observation was there wasn't really a strong and well-connected clinical community in this area. When we spin forward five years, I can confidently say that there is a strong and well-connected clinical community around specialist CAMHS. The programme has helped; the emphasis and the focus of the programme has helped to bring people together with that more common endeavour to understand, actually, there is a good case for consistency in the main, with local variation. There has been a case for much greater learning between organisations. If I just give you an example—you'll know that the community intensive service teams were put in place in 2015-ish. Some areas have them, but a lot of areas didn't. We do have inconsistency in that, but the consistent part is there is a service now right the way across Wales for more intensive support to children and young people and their families in their own homes, which helps to prevent admissions and then, where there are admissions, helps to support people to be at home. They're all called slightly different things. So, I might have referred in my papers to CITT, CATT, COT and CITE. So, they've all got slightly different names and they've got slightly different opening hours. The key thrust of this is that there is a backbone, if you like, of a consistent approach with that local variation. We have to check. So, things like frameworks for improvement—there is a coming together of the clinicians and the professionals to agree what that framework for improvement is. That then gets implemented, with some local variation. So, I think the process of moving in that way has been extremely helpful. There will be some variation. We want some variation, to some extent, as places try new things and evaluate new things. So, if I just refer to the previous question that I had, and I talked about hot clinics and different ways of reaching out; that's been tried in one area, been evaluated—let's see the spread of that. So, you'll know my view on internet counselling, for example; I feel that is quite a strong offer for children—not necessarily in the specialist end. If that works in one area, why aren't we rolling that out to other areas? So, I think the framework for improvement has provided a vehicle for those clinicians and professionals to come together. It's in a stronger place—a much stronger place—than it was five years ago.


Yes. I think there's—. There is some refinement to be done, I think, in making sure the connections are there. So, I think, as we move to programme end, we'll want to be absolutely assured that there are no strands left hanging, so to speak. I am confident—I mentioned the mental health network board that I chair—that we have those strands nailed down, but recognising that the early help and enhanced support and the provision of psychological support is beyond the NHS. So, this will be an area that needs to be very much seen as a key part of that. My own sense is that—. There's been quite a lot of other developments through the life of the programme. So, in the evidence that I've provided, you'll see the First 1000 days, all the adverse childhood experiences work, the Cymru Well Wales partnership, et cetera, et cetera. So, there is a bit of what I would call tidying up of the landscape to be done, and this is the ideal opportunity to do that.

Okay. Thank you. We've got some questions now on specialist CAMHS—if I can just ask about the impact of the specialist CAMHS framework, and how effective you feel that has been in promoting a consistent delivery of care for young people.

Thanks very much for that. Without wanting to go back too far in history, I remember coming into this area back in 2014 as I was asked to establish a CAMHS network. My observation was there wasn't really a strong and well-connected clinical community in this area. When we spin forward five years, I can confidently say that there is a strong and well-connected clinical community around specialist CAMHS. The programme has helped; the emphasis and the focus of the programme has helped to bring people together with that more common endeavour to understand, actually, there is a good case for consistency in the main, with local variation. There has been a case for much greater learning between organisations. If I just give you an example—you'll know that the community intensive service teams were put in place in 2015-ish. Some areas have them, but a lot of areas didn't. We do have inconsistency in that, but the consistent part is there is a service now right the way across Wales for more intensive support to children and young people and their families in their own homes, which helps to prevent admissions and then, where there are admissions, helps to support people to be at home. They're all called slightly different things. So, I might have referred in my papers to CITT, CATT, COT and CITE. So, they've all got slightly different names and they've got slightly different opening hours. The key thrust of this is that there is a backbone, if you like, of a consistent approach with that local variation. We have to check. So, things like frameworks for improvement—there is a coming together of the clinicians and the professionals to agree what that framework for improvement is. That then gets implemented, with some local variation. So, I think the process of moving in that way has been extremely helpful. There will be some variation. We want some variation, to some extent, as places try new things and evaluate new things. So, if I just refer to the previous question that I had, and I talked about hot clinics and different ways of reaching out; that's been tried in one area, been evaluated—let's see the spread of that. So, you'll know my view on internet counselling, for example; I feel that is quite a strong offer for children—not necessarily in the specialist end. If that works in one area, why aren't we rolling that out to other areas? So, I think the framework for improvement has provided a vehicle for those clinicians and professionals to come together. It's in a stronger place—a much stronger place—than it was five years ago.

Okay, thank you. You've referred to there being some inconsistencies in terms of crisis care, but are you able to assure the committee that all young people are now getting at least a consistent service, especially in terms of interventions in the instances of young people self-harming. Wherever you live in Wales, is that help there for you now?


Okay. Thank you. We've got some questions now on specialist CAMHS—if I can just ask about the impact of the specialist CAMHS framework, and how effective you feel that has been in promoting a consistent delivery of care for young people.

Thanks very much for that. Without wanting to go back too far in history, I remember coming into this area back in 2014 as I was asked to establish a CAMHS network. My observation was there wasn't really a strong and well-connected clinical community in this area. When we spin forward five years, I can confidently say that there is a strong and well-connected clinical community around specialist CAMHS. The programme has helped; the emphasis and the focus of the programme has helped to bring people together with that more common endeavour to understand, actually, there is a good case for consistency in the main, with local variation. There has been a case for much greater learning between organisations. If I just give you an example—you'll know that the community intensive service teams were put in place in 2015-ish. Some areas have them, but a lot of areas didn't. We do have inconsistency in that, but the consistent part is there is a service now right the way across Wales for more intensive support to children and young people and their families in their own homes, which helps to prevent admissions and then, where there are admissions, helps to support people to be at home. They're all called slightly different things. So, I might have referred in my papers to CITT, CATT, COT and CITE. So, they've all got slightly different names and they've got slightly different opening hours. The key thrust of this is that there is a backbone, if you like, of a consistent approach with that local variation. We have to check. So, things like frameworks for improvement—there is a coming together of the clinicians and the professionals to agree what that framework for improvement is. That then gets implemented, with some local variation. So, I think the process of moving in that way has been extremely helpful. There will be some variation. We want some variation, to some extent, as places try new things and evaluate new things. So, if I just refer to the previous question that I had, and I talked about hot clinics and different ways of reaching out; that's been tried in one area, been evaluated—let's see the spread of that. So, you'll know my view on internet counselling, for example; I feel that is quite a strong offer for children—not necessarily in the specialist end. If that works in one area, why aren't we rolling that out to other areas? So, I think the framework for improvement has provided a vehicle for those clinicians and professionals to come together. It's in a stronger place—a much stronger place—than it was five years ago.

Okay, thank you. You've referred to there being some inconsistencies in terms of crisis care, but are you able to assure the committee that all young people are now getting at least a consistent service, especially in terms of interventions in the instances of young people self-harming. Wherever you live in Wales, is that help there for you now?

Well, in your work to produce the 'Mind over matter' report, I clearly listened to the views from the police and the recommendations in relation to the police. We've taken that as a further piece of work under the specialist CAMHS umbrella, to truly understand what the experiences of the police are and what some of the root issues may be in relation to that. For example, is it that because the CIT, CAT, COT, CITE—the community intensive service—closes at 10 o'clock in a certain area, that actually it's after that that the network of support isn't as strong, and, if that is the case, what are we going to do about that? There's certainly potential in working more regionally or even working between adults' and children's in terms of the crisis resolution services that work beyond those hours. So, we are taking an extra look at this, because I could not be 100 per cent confident that, throughout the 24-hour period, we've got this fully settled. I continue to hear some stories from the police that they are picking up young people and feeling that they've not got that solid place to go, and we're following those through.


Thanks very much for that. Without wanting to go back too far in history, I remember coming into this area back in 2014 as I was asked to establish a CAMHS network. My observation was there wasn't really a strong and well-connected clinical community in this area. When we spin forward five years, I can confidently say that there is a strong and well-connected clinical community around specialist CAMHS. The programme has helped; the emphasis and the focus of the programme has helped to bring people together with that more common endeavour to understand, actually, there is a good case for consistency in the main, with local variation. There has been a case for much greater learning between organisations. If I just give you an example—you'll know that the community intensive service teams were put in place in 2015-ish. Some areas have them, but a lot of areas didn't. We do have inconsistency in that, but the consistent part is there is a service now right the way across Wales for more intensive support to children and young people and their families in their own homes, which helps to prevent admissions and then, where there are admissions, helps to support people to be at home. They're all called slightly different things. So, I might have referred in my papers to CITT, CATT, COT and CITE. So, they've all got slightly different names and they've got slightly different opening hours. The key thrust of this is that there is a backbone, if you like, of a consistent approach with that local variation. We have to check. So, things like frameworks for improvement—there is a coming together of the clinicians and the professionals to agree what that framework for improvement is. That then gets implemented, with some local variation. So, I think the process of moving in that way has been extremely helpful. There will be some variation. We want some variation, to some extent, as places try new things and evaluate new things. So, if I just refer to the previous question that I had, and I talked about hot clinics and different ways of reaching out; that's been tried in one area, been evaluated—let's see the spread of that. So, you'll know my view on internet counselling, for example; I feel that is quite a strong offer for children—not necessarily in the specialist end. If that works in one area, why aren't we rolling that out to other areas? So, I think the framework for improvement has provided a vehicle for those clinicians and professionals to come together. It's in a stronger place—a much stronger place—than it was five years ago.

Okay, thank you. You've referred to there being some inconsistencies in terms of crisis care, but are you able to assure the committee that all young people are now getting at least a consistent service, especially in terms of interventions in the instances of young people self-harming. Wherever you live in Wales, is that help there for you now?

Well, in your work to produce the 'Mind over matter' report, I clearly listened to the views from the police and the recommendations in relation to the police. We've taken that as a further piece of work under the specialist CAMHS umbrella, to truly understand what the experiences of the police are and what some of the root issues may be in relation to that. For example, is it that because the CIT, CAT, COT, CITE—the community intensive service—closes at 10 o'clock in a certain area, that actually it's after that that the network of support isn't as strong, and, if that is the case, what are we going to do about that? There's certainly potential in working more regionally or even working between adults' and children's in terms of the crisis resolution services that work beyond those hours. So, we are taking an extra look at this, because I could not be 100 per cent confident that, throughout the 24-hour period, we've got this fully settled. I continue to hear some stories from the police that they are picking up young people and feeling that they've not got that solid place to go, and we're following those through.

Okay, thank you. We've got some questions now from Hefin David on neurodevelopmental services.


Okay, thank you. You've referred to there being some inconsistencies in terms of crisis care, but are you able to assure the committee that all young people are now getting at least a consistent service, especially in terms of interventions in the instances of young people self-harming. Wherever you live in Wales, is that help there for you now?

Well, in your work to produce the 'Mind over matter' report, I clearly listened to the views from the police and the recommendations in relation to the police. We've taken that as a further piece of work under the specialist CAMHS umbrella, to truly understand what the experiences of the police are and what some of the root issues may be in relation to that. For example, is it that because the CIT, CAT, COT, CITE—the community intensive service—closes at 10 o'clock in a certain area, that actually it's after that that the network of support isn't as strong, and, if that is the case, what are we going to do about that? There's certainly potential in working more regionally or even working between adults' and children's in terms of the crisis resolution services that work beyond those hours. So, we are taking an extra look at this, because I could not be 100 per cent confident that, throughout the 24-hour period, we've got this fully settled. I continue to hear some stories from the police that they are picking up young people and feeling that they've not got that solid place to go, and we're following those through.

Okay, thank you. We've got some questions now from Hefin David on neurodevelopmental services.

I think, Chair, I should have declared an interest here, as my daughter has been diagnosed with autism and is currently going through the process of receiving neurodevelopmental speech and language support particularly. We're seeing an increase in neurodevelopmental referrals, and that will increase further in the future. Can you give us an explanation as to why this demand is growing and how we're going to meet capacity to deliver and for support for those children?


Well, in your work to produce the 'Mind over matter' report, I clearly listened to the views from the police and the recommendations in relation to the police. We've taken that as a further piece of work under the specialist CAMHS umbrella, to truly understand what the experiences of the police are and what some of the root issues may be in relation to that. For example, is it that because the CIT, CAT, COT, CITE—the community intensive service—closes at 10 o'clock in a certain area, that actually it's after that that the network of support isn't as strong, and, if that is the case, what are we going to do about that? There's certainly potential in working more regionally or even working between adults' and children's in terms of the crisis resolution services that work beyond those hours. So, we are taking an extra look at this, because I could not be 100 per cent confident that, throughout the 24-hour period, we've got this fully settled. I continue to hear some stories from the police that they are picking up young people and feeling that they've not got that solid place to go, and we're following those through.

Okay, thank you. We've got some questions now from Hefin David on neurodevelopmental services.

I think, Chair, I should have declared an interest here, as my daughter has been diagnosed with autism and is currently going through the process of receiving neurodevelopmental speech and language support particularly. We're seeing an increase in neurodevelopmental referrals, and that will increase further in the future. Can you give us an explanation as to why this demand is growing and how we're going to meet capacity to deliver and for support for those children?

Thank you. They're very big questions in terms of 'why'. I'm not sure that anyone really knows why, if I'm honest, although there is a lot of academic research going on. What we do know is that we are starting to see the scale of those referrals coming through. So, in the information provided, I refer to the NHS digital prevalence report in England, which indicates that about 5.5 per cent of two to four-year-olds have a mental disorder. Now, that sounds a bit shocking when we say that, but that's in the international classification scaling, and, of that, certainly, 2.5 per cent is around autism. I can just testify, in real life, that demand is absolutely growing. So, if I just take my own health board for a moment, we usually have about 75 referrals per year. Last year we had 300. So, that has felt very difficult to manage. If I can just give you a sense of what we've done so far and then what I think is next, I want to recognise the work of Dr Cath Norton and the steering group that's been established on neurodevelopmental issues under the programme. They had a standing start. They've done a lot of very, very good work. We now have seven teams in place across Wales. We now have a national pathway. We now have a community-of-practice-type environment, and we're really getting into this. Good progress has been made. More people have been seen. More people have been assessed. So, we have made progress. But I've got a long list of considerations that I think respond to your question. One is that most referrals that come through, the clinicians tell me, are seeking support to move through what they perceive to be a gateway for educational support. So, that is often the reason why people come. Now, that is obviously going to be linked to the whole-school approach and how we can support that. Demand is outstripping supply. So, our clinical teams are concerned about how do they keep up. So, if I just take my own example of 300 in the last year, we're looking to try and put some additional capacity in to support seeing those families, but also then to understand what the long-term trajectory is going to be. Because we've put these teams in, because we've got the new pathway, has that opened a gate and we've got a lot of backlog or is that the pattern?


Okay, thank you. We've got some questions now from Hefin David on neurodevelopmental services.

I think, Chair, I should have declared an interest here, as my daughter has been diagnosed with autism and is currently going through the process of receiving neurodevelopmental speech and language support particularly. We're seeing an increase in neurodevelopmental referrals, and that will increase further in the future. Can you give us an explanation as to why this demand is growing and how we're going to meet capacity to deliver and for support for those children?

Thank you. They're very big questions in terms of 'why'. I'm not sure that anyone really knows why, if I'm honest, although there is a lot of academic research going on. What we do know is that we are starting to see the scale of those referrals coming through. So, in the information provided, I refer to the NHS digital prevalence report in England, which indicates that about 5.5 per cent of two to four-year-olds have a mental disorder. Now, that sounds a bit shocking when we say that, but that's in the international classification scaling, and, of that, certainly, 2.5 per cent is around autism. I can just testify, in real life, that demand is absolutely growing. So, if I just take my own health board for a moment, we usually have about 75 referrals per year. Last year we had 300. So, that has felt very difficult to manage. If I can just give you a sense of what we've done so far and then what I think is next, I want to recognise the work of Dr Cath Norton and the steering group that's been established on neurodevelopmental issues under the programme. They had a standing start. They've done a lot of very, very good work. We now have seven teams in place across Wales. We now have a national pathway. We now have a community-of-practice-type environment, and we're really getting into this. Good progress has been made. More people have been seen. More people have been assessed. So, we have made progress. But I've got a long list of considerations that I think respond to your question. One is that most referrals that come through, the clinicians tell me, are seeking support to move through what they perceive to be a gateway for educational support. So, that is often the reason why people come. Now, that is obviously going to be linked to the whole-school approach and how we can support that. Demand is outstripping supply. So, our clinical teams are concerned about how do they keep up. So, if I just take my own example of 300 in the last year, we're looking to try and put some additional capacity in to support seeing those families, but also then to understand what the long-term trajectory is going to be. Because we've put these teams in, because we've got the new pathway, has that opened a gate and we've got a lot of backlog or is that the pattern?


I think, Chair, I should have declared an interest here, as my daughter has been diagnosed with autism and is currently going through the process of receiving neurodevelopmental speech and language support particularly. We're seeing an increase in neurodevelopmental referrals, and that will increase further in the future. Can you give us an explanation as to why this demand is growing and how we're going to meet capacity to deliver and for support for those children?

Thank you. They're very big questions in terms of 'why'. I'm not sure that anyone really knows why, if I'm honest, although there is a lot of academic research going on. What we do know is that we are starting to see the scale of those referrals coming through. So, in the information provided, I refer to the NHS digital prevalence report in England, which indicates that about 5.5 per cent of two to four-year-olds have a mental disorder. Now, that sounds a bit shocking when we say that, but that's in the international classification scaling, and, of that, certainly, 2.5 per cent is around autism. I can just testify, in real life, that demand is absolutely growing. So, if I just take my own health board for a moment, we usually have about 75 referrals per year. Last year we had 300. So, that has felt very difficult to manage. If I can just give you a sense of what we've done so far and then what I think is next, I want to recognise the work of Dr Cath Norton and the steering group that's been established on neurodevelopmental issues under the programme. They had a standing start. They've done a lot of very, very good work. We now have seven teams in place across Wales. We now have a national pathway. We now have a community-of-practice-type environment, and we're really getting into this. Good progress has been made. More people have been seen. More people have been assessed. So, we have made progress. But I've got a long list of considerations that I think respond to your question. One is that most referrals that come through, the clinicians tell me, are seeking support to move through what they perceive to be a gateway for educational support. So, that is often the reason why people come. Now, that is obviously going to be linked to the whole-school approach and how we can support that. Demand is outstripping supply. So, our clinical teams are concerned about how do they keep up. So, if I just take my own example of 300 in the last year, we're looking to try and put some additional capacity in to support seeing those families, but also then to understand what the long-term trajectory is going to be. Because we've put these teams in, because we've got the new pathway, has that opened a gate and we've got a lot of backlog or is that the pattern?