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Sunday 14 December 2014

Annus horribilis

I'm not very festive at the best of times, but this year Christmas can go f**k itself.
(Pic : Bargain Bin Blasphemy Tumblr)
It's not often I quote Bet Windsor directly, but 2014 has been a personal "annus horribilis" - so I think I've earned the right to brood.

Firstly, I somehow managed get a BBC interview but didn't even make the final edit. That's all well and good; nice experience and all that. Though it's telling me there's a "credibility glass ceiling" that a blogger can never break and I can start thinking about winding things down.

A few weeks later came the overshadowing tragedy. But what you didn't know is that while I was watching my mother die – she deteriorated so quickly I barely recognised her - I was dealing with an incredibly painful and recurrent tooth abscess that took more than a month to get fixed.

Days after starting the slow trudge towards middle age, I managed to catch chicken pox having never caught it when it made the rounds in school. My fever got so bad at one point I was on the brink of a trip to hospital myself. It looks like I've been left with a few semi-permanent scars for my trouble. On my face.

Indirectly, Jacqui Thompson's appeal loss will affect every single blogger in Wales as it appears we've not only started to draw the attention of short-tempered autocrats who want to crush dissent, but also the police and other bloggers issuing veiled threats under the guise of "investigative journalism".

With the Scots bottling it, and the Assembly descending into yet another round of constitutional naval-gazing, I don't have many fond memories of 2014 at all. At least The Arsenal won the cup, I suppose.

On to next year. The Westminster elections will dominate the first half of 2015. As you might expect I'm not going to devote too much time and resources to it because the results are likely to be highly predictable in Wales. It'll be a good practice run, and gives me a chance to try out a few ideas with the  2016 Assembly election in mind.

As it's the last full calendar year before that election, several major Welsh laws are due to be introduced, including what's likely to be a highly-controversial Public Health Bill, a law on special educational needs, a Heritage Bill, a Rent Bill, as well as legislative measures relating to the taxation powers coming as a result of the Wales Bill (due to become the Wales Act early next year).

Because of the Westminster elections, I'm only going to have one big series of posts relating to independence in 2015. I would've done it this year, but didn't for obvious reasons, and I intend to turn all of August over to it. It's one of the most important - perhaps the most important issue - and one of the main reasons nationalists are nationalists in the first place : foreign policy.

I also hope to start my "Vice Nation" series of posts in February – beginning with alcohol - but these will be spread out like the Life, Ethics & Independence series.

2014's Top 10 Posts*
  1. The Sliding Scale of Nationalism
  2. Porthcawl regeneration hopes buried under sludge?
  3. Draft law targets "Popeyes" in Wales
  4. Carmarthenshire Goes Rogue
  5. The Aberconwy Funnel-Bebb Spider
  6. Apocalypse Nawr
  7. Life, Ethics & Independence XI – Breast-feeding
  8. Independence Minutiae : Ordnance Survey
  9. Case for Bridgend-Vale merger outlined
  10. The NATO Legacy
*Excluding posts relating to my mother's health. My thanks again to those of you who were kind enough to e-mail me, or leave on here, goodwill messages during a very difficult time.

Honourable mentions :

Right, that's a mentally and physically exhausting year – blogging and otherwise - over with. Good riddance. I'll be back around 3rd/4th January.

I'll say "Merry Christmas", but I already know chances are you're going to have a merrier one than me.

Thursday 11 December 2014

What's all this then?

You probably didn't know, but the devolution of policing
was discussed at length in the National Assembly last week.
(Pic : BBC Cymru Fyw)
This is one of those rare occasions where I'm spoiled for choice in terms of what to cover from the National Assembly. It's just a shame everything was crammed into the last fortnight when my head is already on a break.

There was a pretty good Plaid Cymru-sponsored debate on TTIP (watch here – more from Plaid Monmouth), the introduction of slightly controversial new regulations on "puppy farming", the announcement that a not-for-profit company might be created to run the Wales & Borders rail franchise.

Then there's yesterday's cross-party debate on euthanasia (one of the best I can remember, and it's regretful I'm not covering it, watch here) - though the Assembly eventually rejected the motion.

It underlines weaknesses in the Welsh media in that only one of the things listed above actually got much coverage – and that's the trains. Simon Thomas AM (Plaid, Mid & West Wales) was pretty much left to publicise the euthanasia debate by himself.

I'm a bit late coming to this because I was trying to decide which one to blog about, but I've finally decided to focus on last week's debate on the devolution of policing.

Police Work




Mike Hedges AM (Lab, Swansea East), started by saying that South Wales PCC, Alun Michael, and the First Minister have both expressed support for devolution of policing in light of the Silk Commission, with "many of the levers that affect crime levels" devolved – like community safety. Mike believes devolving policing would allow a more joined-up approach between local services and the Welsh Government. He did, however, believe that national security issues and National Crime Agency should remain non-devolved as these often need to be led "at a British level" and sometimes on a pan-European level.


In response to a question from Simon Thomas AM, Mike said he wouldn't favour a Scottish-style all-Wales police force but (inexplicably) would support two police forces (as opposed to four currently). He said it was "anomalous" that policing hadn't been devolved to Wales when it has to Scotland and Northern Ireland, and this was out of step with countries with a federal system, where policing is controlled at a state level in the US and Germany whilst retaining a "national" police force.


The Welsh Conservatives don't support devolution of policing, full stop. Mark Isherwood AM (Con, North Wales), said devolving policing would be "irresponsible", saying that the cost could be as high as £57million. He said the creation of PCCs was "an act of real devolution" – prompting laughter from the rest of the chamber. He then pointed out the issues surrounding cross-border crime and cross-border co-operation between Wales and England, quoting Labour and Conservative politicians who oppose devolution of policing after expressing strategic concerns.

Later on, former police officer Byron Davies AM (Con, South Wales West) said it was a "source of annoyance" that people without policing experience propose reorganisations. He didn't believe there was any demand for devolution of policing, and PCCs have "delivered real community policing". Byron believes devolution of policing might be "divisive" and open up issues like regional pay. He said there was no similarity between emergency services – after justification for policing devolution based on the fact it was the only non-devolved emergency service – other than "999".



Jocelyn Davies AM (Plaid, South Wales East), said devolution of policing was a "fundamental step forward on our devolution journey", and she was encouraged by the "positive response" from the Welsh Government. She highlighted the issue of domestic violence, where the lack of any control over policing has left the Domestic Violence Bill without any teeth. Jocelyn also highlighted the National Assembly's rejection of PCCs, with Westminster forced it through in EnglandandWales anyway.

Ann Jones AM (Lab, Vale of Clwyd) was unconvinced that policing could be devolved without devolving the criminal justice system, believing they are "intrinsically linked". She also said that devolving powers simply because Scotland has them was "a very weak argument".

Julie Morgan AM (Lab, Cardiff North) said policing is a major public service and should work alongside other public services, many of which are devolved. She also said it was "absolutely right" to scrap PCCs due to the lack of public support (emphasising low turnout figures at the PCC elections). Nick Ramsay AM (Con, Monmouth) countered this by saying the Assembly elections often have low turnouts too.



Speaking on behalf of the Welsh Government, the First Minister said there was a "template" for devolution of policing based on Scotland, and having a "porous border" doesn't stop Wales "delivering services our own way" or preventing Wales co-operating with the rest of the UK. He emphasised the point raised earlier about PCCs being "imposed" on Wales when they haven't been on Scotland or Northern Ireland, and this "must never happen again".

Turning to Ann Jones, he said he believes policing can be devolved without the criminal justice system as police "bring people to the door of the criminal justice system, while the Crown Prosecution Service (CPS) escorts them through it." Control and funding of the police doesn't, therefore, affect the criminal justice system, but devolving something like probation could require sentencing powers to control numbers going through the system.

Carwyn said Silk II can't be "cherry-picked" by Westminster, which he said is something they wouldn't dream of doing in Scotland, adding that Wales was "being treated in a more discriminatory way than Scotland", demanding Westminster "treat Wales with the same respect".



Peter Black AM (Lib Dem, South Wales West) finished the debate saying that while some functions should still be controlled UK-wide, a strong case has been made for devolving policing to Wales and that the Welsh Government already funds some policing functions which are beyond its remit – like Tarian – and funds up to 50% of policing costs from its own budget. He said devolving policing would be "a sensible recognition of the reality of policing in Wales".

The motion was approved by 34 votes to 10 with 2 abstentions (Ann Jones & Lynne Neagle).

Detective Work
Policing might well stand apart from the criminal justice system, but
ambulances, for example, are no less separate from the health service.
(Pic : Voice of America)
At present policing is partially devolved. We have directly-elected Police and Crime Commissioners who raise funds through council tax precepts, which are controlled locally. As said during the debate, the Welsh Government also has a community safety remit, best exemplified by Welsh Labour's previous election promise to hire an extra 500 PCSOs – a commitment they've kept, to be fair, however unambitious it might be.

It's a lot easier to devolve policing because it doesn't, in itself, require a Welsh legal jurisdiction. So the First Minister is right to say that policing is insulated from the criminal justice system. Police collect evidence, detain suspects and enforce laws; but they have no role in actually changing the law or what happens to suspects once they go to court.

However, using the First Minister's own analogy, ambulances bring patients to the door of the NHS, and doctors escort them into hospital. So wanting control of policing without control of the criminal justice system is a lot like wanting control of the ambulance service without wanting control of the NHS - which would be a very confusing arrangement.

Unfortunately, creating a Welsh legal jurisdiction and criminal justice system would require a lot of work (Creating a Welsh legal jurisdiction) – and it's not due to be considered as outlined in Silk II until the 2020s.

Devolving policing on its own – with or without the probation and criminal justice systems – is a bit lazy. It's "cherry-picking" powers by itself, as policing is what the public associate most with criminal justice (and therefore it's politically beneficial to be seen to control) but it's actually a small part of a bigger machine.

What I don't get about about Welsh Labour/the Welsh Government is that they don't seem to understand that if you want to control an area of public policy, you often have to accept related powers over something you don't want in order for it to function properly.


Wales could find itself in a position where we'll control policing but won't have any powers to change criminal law itself or deal with the rehabilitation of offenders - which is useless, as the police will be enforcing laws we don't make. It would make more sense to delay the devolution of policing until work starts on devolving the criminal justice system as a whole.


Friday 5 December 2014

Kirsty's Law to set minimum nursing levels?


Wednesday saw the introduction of the fifth Member's Bill this Assembly term on behalf of Welsh Liberal Democrat Leader, Kirsty Williams (Lib Dem, Brecon & Radnor) – the Safe Nurse Staffing Levels Bill.

The Bill's available here (pdf), explanatory memorandum here (pdf).

The need for a Bill

Few local health boards currently meet the recommended minimum ratios
of registered nurses to patients and support workers.
(Pic : NHS Wales)
Safe staffing levels – defined as the minimum number of staff needed to provide a safe service – have been raised in numerous critical reports of the Welsh NHS. This is especially important with regard nurses on hospital wards and in situations where close one-to-one care is important, like care for the elderly.

The number of qualified nurses are falling - the result of recruitment freezes and an ageing workforce which will soon start to retire in greater numbers.

Research published in The Lancet showed that for every extra patient a nurse has to treat, the chances of a patient dying within 30 days of admission rise by 7%. It's the same with a lower ratio of qualified registered nurses (i.e those with a nursing degree) to health care support workers.

Increasing pressures on the workforce also reduce job satisfaction amongst staff and put, ironically, the long-term health of nurses themselves at risk.

In 2012, the Chief Nursing Officer laid down minimum nurse-to-patient ratios of 1:7 during daytime and 1:11 during nights, with a mix of 60:40 of registered nurses to support workers.

A year later, although most local health boards (LHBs) were meeting or narrowly exceeding the daytime ratio, most had 1 nurse to every 13-14 patients at night. Meanwhile, the registered to non-registered nursing staff ratios varied wildly depending on local health board and the hospital ward.

Some US and Australian states now have mandated minimum nursing requirements. In Victoria state, mandated minimum staffing ratios brought 5,000 nurses out of retirement and many now wouldn't consider working if the staffing ratios were abolished. California's similar law also works along the same lines.

What does the Safe Nurse Staffing Levels Bill propose?

As you can tell for yourselves, the Bill itself is very short. The main thrust of the proposed legislation is a series of amendments to the NHS Wales Act 2006.

The Bill :
  • Places a duty on health authorities (Welsh Government, LHBs, NHS Trusts) to have regard for, and take all reasonable steps to ensure, the levels of staffing needed to provide safe nursing care, and to comply with minimum registered nurse:patient and minimum registered nurse:support worker ratios.
  • Places a duty on the Welsh Government to issue guidance on safe staffing ratios. The ratios themselves aren't included in the Bill to ensure flexibility, and must be adjusted to ensure local needs. Protections will be included for student nursing staff, professional development, training, leave etc.
  • Places a duty on health bodies to to publish nursing numbers and their skill levels, as set out by guidance; and also places a duty on them to publish an annual report outlining how they are complying with the provisions of the Act.
  • Places a duty on the Welsh Government to review the effectiveness of the Act within a year of the Act coming into force, and no later than ever two years after that. The report must include data relating to safe nursing levels, which includes things like : mortality rates, hospital acquired infections, falls, bed sores, patient satisfaction levels, nurses' overtime and sickness, use of agency staff etc.

How much would the Safe Nurse Staffing Levels Act cost?


In short, an additional £83,000 over 5 years.

Kirsty and her team came to that conclusion based on the costs of reviewing the effectiveness of the legislation (£37,500 over 5 years) and the annual report requirement (just over £45,300 over 5 years).

Nursing acute patients itself costs around £275million per year; so although the costs of the Bill itself are small, it's likely to direct spending of a much bigger budget.


Kirsty's Law : Likely to struggle?

Politics might be a bigger stumbling block here than principle.
(Pic : Wales Online)
It's quite obvious from the outset that the Welsh Government aren't fans of this law, though they'll no doubt say they support the principle of having the right number of nurses, with the Health Minister himself saying on Wednesday that the government will "work constructively" on the Bill.

This looks as though it's trapped in a similar situation to the (withdrawn) Financial Education & Inclusion Bill : if there's little to no government support, Labour AMs will be whipped (or threatened to be whipped) into voting the Bill down and some sort of off-the-statute-book compromise will be made. That's a government's prerogative I suppose, but it's no good for opposition legislation however well-intentioned that legislation might be.

Having said that, it's clear Kirsty Williams and the Lib Dems have a better working relationship with the Welsh Government than Plaid or the Conservatives. The NHS is, however, seen as something of a Labour golden goose and I suspect they won't take kindly to anyone threatening their party's God-given right to exclusive tinkering privileges with the health service.

I suspect that one of the main arguments the Welsh Government will use against this law is that having a minimum staffing level could set a floor for, rather than increase, the number of nurses. Though the Bill specifically says that any Welsh Government guidance must ensure the ratios "are not regarded as an upper-limit in practice", how that would be done is a different question.

Then there's questions over whether there's a need for legislation on this (there probably is based on the information provided by Kirsty), and a point raised during the debate on why nursing in particular should be picked for this when health care is multi-disciplinary.

Too few cleaners and caretakers will play as big a role in hospital infections, for example, while pretty much every single politician ignores the contribution scientific (i.e. clinical & biomedical scientists) and diagnostic staff (i.e. radiologists) make to patient care because they're not seen by the public (you'll never see a lab technician or speech and language therapist on Casualty), they don't have an RCN or BMA to lobby for them in the Senedd and are therefore "politically unsexy".

But I'm willing to bet a large chunk of the problems in the Welsh NHS in terms of waiting times are down to understaffing and underinvestment in allied health professionals.

Doctors are, first and foremost, scientists who can't practice medicine without someone to do scientific tests for them, while nurses are not much use on their own. Therefore everyone should be careful to ensure the NHS isn't reduced to a infant school view of the world where hospitals are full of doctorsandnurses.

Wednesday 3 December 2014

Qualifications Bill introduced


Yesterday, Education Minister Huw Lewis (Lab, Merthyr Tydfil & Rhymney) launched the first of two pieces of Welsh legislation due to be introduced this week – more from me on the second law on Friday.

The Qualifications Bill (pdf) will create Qualifications Wales, a new body which will, funnily enough, regulate and accredit non degree-level qualifications in Wales.

Most matters relating to education and skills (apart from research councils) are devolved so there are no worries there, and it's highly unlikely that this Bill will cause any undue controversy.

Three events provided the impetus for the Qualifications Bill.
  • A major review into qualifications for 14-19 year olds, which recommended that an independent body be established to oversee non degree-level qualifications, based on the Scottish Qualifications Authority (SQA) and Ofqual.
  • The GCSE row from summer 2012, where the then Education Minister, Leighton Andrews (Lab, Rhondda), ordered a review of WJEC test papers. Pupils scored much lower in a new modulated version of the exam than expected, due to new boundaries between grades C and D introduced by EnglandandWales exam regulators (to make passing exams harder).
  • The decision to reform GCSEs in England – including a new grading system - while Wales is retaining the existing model by default. So the need for a Welsh qualifications regulator is more apparent.

What does the Qualifications Bill propose?

Qualifications Wales will be the new qualifications regulator placed above the likes of the WJEC.
(Pic : via Wikipedia)
Qualifications Wales
  • Will be a corporate body independent of the Welsh Government, made up of a chief executive, a chair and between 8-10 members appointed by the Welsh Government (all serving a three year terms).
  • Will ensure qualifications meet the needs of learners in Wales.
  • Will promote public confidence in the Welsh qualifications system.
  • Will carry out its functions while taking into consideration : economic growth, the availability of assessments and qualifications through the medium of Welsh, the needs of employers and higher education, securing value for money, the skills and knowledge required to receive a qualification.
  • Must publish a policy statement, including details of dealing with complaints.
  • Must have regard to Welsh Government policy.

Recognising Awarding Bodies (i.e WJEC)

Qualifications Wales will :
  • Set recognition criteria, and only awarding bodies that have their qualifications recognised by Qualification Wales will be able to award qualifications in Wales.
  • Have the power to revise recognition criteria, set rules for applications for recognition and set resulting fees.

Approving Qualifications


The Bill :
  • Places a duty on the Welsh Government and Qualifications Wales to draw up a list of qualifications that are a priority for regulation ("restricted qualifications") in order to to maintain public confidence due to their importance to learners (I presume they mean core subjects like GCSE Maths, English etc.).
  • Gives Qualifications Wales the power to restrict qualifications to a certain number of different versions (i.e. approving only one version of GCSE English language across Wales). It can do this to avoid inconsistency, or give them a choice when awarding bodies introduce new versions of qualifications.
  • Gives Qualifications Wales the power to approach an awarding body in order to develop a new version of a "restricted qualification", and the Bill sets out the formal process by which these new qualifications would be approved.
  • Will mean all other qualifications ("unrestricted qualifications") can be submitted to Qualifications Wales by any recognised awarding body for approval in any version.
  • Places a duty of Qualifications Wales to publish their criteria to approve a qualification.
  • Gives Welsh Ministers the power to regulate the subject content of qualifications.
  • Awarding bodies will have the ability to withdraw their qualifications voluntarily via a "surrender notice".
  • Qualifications Wales can, likewise, withdraw approval for a qualification if it no longer meets the award criteria, the awarding body is no longer recognised or the qualification has become "restricted" (as outlined above).

Recognition of qualifications

In future, only qualifications approved and recognised by
Qualifications Wales will be awarded by state schools in Wales.
(Pic : BBC Wales)
  • Only qualifications approved or regulated by Qualifications Wales ("Welsh version of a qualification") may be awarded by state schools or by local authorities.
  • An exception covers qualifications awarded to people with learning disabilities, and the Bill grants Welsh Ministers the power to designate new excepted qualifications.
  • Private schools won't be subject to the restrictions either and can award qualifications "which are not Welsh versions".
  • Ofqual recognition of qualifications will no longer apply in Wales (effectively making Ofqual an England-only body) - though this doesn't mean qualifications recognised by Ofqual will be unavailable in Wales, as long as they're not restricted (i.e. private schools in the example above).

Enforcement Powers & Other Responsibilities

Qualifications Wales will have the power to :
  • Force awarding bodies to take specific actions by giving written directions and appropriate notice.
  • Fine awarding bodies (with interest) if they fail to comply with set conditions regarding their own recognition or the recognition of their qualifications. Awarding bodies subject to fines will have a right to appeal via a tribunal.
  • Inspect premises of awarding bodies, subject to a court order.

Qualifications Wales will also be allowed to :
  • Provide commercial consultancy services in relation to its functions, or set up a company to provide such services.
  • Keep under review activities relating to its remit, and commission research into any matter relating to qualifications.
  • Award grants if it believes "it is appropriate to do so" in connection to its functions.


How much will the Qualifications Act cost?


Establishing a completely new body is always going to come with an element of cost. The Welsh Government drafted three options, included in the explanatory memorandum (pdf) : the first where the Welsh Government will retain regulatory powers, the second which would create a Commissioner role for qualifications, and the third – and chosen option – to create a stand alone qualifications regulator.

Qualifications Wales' set up costs in the first year (2015-16) – including IT, Welsh Government reorganisation, premises etc. - is around £3.44million. The operating costs for the next five years (until 2019-20) – including the set up costs above – is just over £38million. It's expected that Qualifications Wales will employ 73 people.

It's not expected there would be any additional costs to awarding bodies (like the WJEC, AQA, EDEXEL etc.) ,though it'll be down to Qualifications Wales to determine the fees they charge, meaning it might generate enough income down the line to "reduce its impact on the public purse".

How "independent" is independent?

Is allowing government to "force" certain skills and knowledge into
qualifications as much a bad thing as a good thing?
(Pic : zmescience.com)
A key theme throughout is the emphasis on how "independent" Qualifications Wales will be. This is not only Wales striking out on its own after decades of working with England and Northern Ireland on qualifications (known as three-country regulation), but this is being portrayed as an arms-length watchdog.

I'm not convinced. Nothing is ever truly "independent" when it comes to the higher echelons of Welsh politics and public policy, and the set up of Qualifications Wales reads very similarly to bodies like Visit Wales, which are hardly "arms length" of government. There's still plenty of Welsh Government "influence" and hand holding within the line-by-line provisions of the Bill.

If Qualifications Wales were truly independent it could appoint its own members, surely? Also, it's said to be independent of the Welsh Government yet still has a legal obligation to "have due regard" for government policy. There's also another selection of powers enacted via regulations.

This is justified by saying it would be a "fall back" to ensure the Welsh Government forces certain skills or knowledge into qualifications - which can be a good thing, but can be a bad thing too.

What if a hypothetical future wingnut Welsh Government demands intelligence design and/or creationism be assessed in science GCSEs? The Bill could give them the means to do that.

In principle this Bill is the correct course of action, but there's still stuff in there that demands closer scrutiny.



Monday 1 December 2014

Bridgend's Deprivation Mapped

The Caerau Park and Tudor estates are placed near the top of the most
relatively deprived areas in Wales. What about the rest of the county?
(Pic : zoopla.com)
Last week, the latest figures from the triennial Welsh Index of Multiple Deprivation (WIMD) were released by the Welsh Government and Office of National Statistics. Deprivation itself is defined, statistically, as a "lack of access to opportunities or resources".

The WIMD collects data from each of Wales' 1,909 Lower Super Output Areas (LSOAs) – there's roughly one for every 1,000-1,500 people – and compares them to each other, giving policy makers and the general public an idea how relatively deprived neighbourhoods are compared to the rest of Wales (not the rest of the local authority).

So it's important to point out from the start that ranking lowly doesn't mean a community is "affluent" and it doesn't measure precisely how deprived a community is – only how deprived a community is compared to every other community in Wales.

The WIMD has an overall ranking, but it also has 8 separate types of deprivation each LSOA is measured against, with some indicators weighing more heavily in the final ranking than others :
  • Income – Proportions of people with an income below a certain level and claiming income-based benefits and tax credits.
  • Employment – A general lack of employment, based on claims for out-of-work benefits.
  • Health – Lack of good health, including : long-term disabilities, low birth weights, cancer incidences and death rates.
  • Education – Numbers of people with no qualifications, truancy levels, university admissions and GCSE pass rates.
  • Access to Services – The ability to access everyday services essential for day-to-day living (food, GP appointments, after school clubs), and the travel times to reach such services.
  • Community Safety – Overall crime levels, based on police and fire service statistics.
  • Physical Environment – Proximity to big polluters, flood risk and air quality.
  • Housing – Lack of adequate housing, including overcrowding and no access to central heating.

In terms of the all-Wales figures, St James' in Caerphilly is now ranked as the most relatively deprived community in Wales, though many of the names towards the top are all too familiar – Rhyl West, Splott, Queensway 1 in Wrexham (Caia Park), Twyn Carno (Fochriw, I think), Penydarren 1 (Galon Uchaf area of Merthyr) and Caerau 1 in Bridgend (Caerau Park and Tudor Estates).

With the number crunching done, it's worth taking a look at the picture in Bridgend in some more detail.

Overall Ranking & Changes Compared to 2011
(Click to enlarge)
The 2014 listings aren't really all that different to those in 2011.

The areas you would expect to be more deprived were, including : Caerau, Morfa ward (which includes Wildmill), Bettws, and at a more local level the Brackla Meadows estate, Bryntirion (the area around the Labour club), the Marlas estate in North Cornelly and the Queens Avenue area of Sarn.

As you would also expect, the valleys are relatively more deprived than the coastal/Vale areas, and the suburbs of Bridgend (including Litchard, Broadlands and the Coity end of Brackla), as well as Porthcawl, come out of it rather well.

In terms of how the rankings have changed since 2011, very few areas have dramatically become relatively less deprived than they were, though Sarn 2 (the southern half of the village) fell the most places along with the Hendre area of Pencoed, Nottage in Porthcawl and Cornelly 2 (South Cornelly and Kenfig village). It looks like – despite their overall poor ranking – levels of deprivation in Caerau, Bettws and Morfa have stalled or have even improved slightly compared to the rest of Wales.

In terms of areas which have moved up the rankings, then Brackla comes off particularly badly, especially Brackla 1 (the area around Tremains Primary) and Brackla 4 (Priory Oak, Trem-y-Mor). All Garw Valley wards have slipped – and weren't in a great position in the first place – but it's Pyle 1 (a large chunk of Kenfig Hill) and Pendre – Carwyn Jones' old council ward – which have risen the sharpest in the rankings compared to 2011.

Income & Employment
(Click to enlarge)
These are perhaps two of the more important measures of deprivation as low incomes and lack of high quality employment will limit opportunities by themselves.

In terms of income, the picture perhaps isn't quite as bad as many would believe. Even in parts of the valleys – especially Pontycymer, Maesteg, Nantyfyllon (Caerau 5), Ynysawdre and Bryncethin – incomes are near enough in the middle compared to the rest of Wales, or even slightly exceeding this. These areas have lots of cheap housing and might be attractive for younger working families priced out of other areas, while Maesteg has always had a settled middle class.

Unsurprisingly, Porthcawl and the villages and suburbs of Bridgend and Pencoed do well. You need to remember though that Welsh income levels aren't great compared to the UK anyway.

With employment, however, the differences are more stark, with pronounced problems in the valleys and urban centres (Morfa, Pyle, Porthcawl East & West Central) as you might expect – Caerau 1 ranks as the 4th most deprived area in terms of employment in the whole of Wales. Bridgend doesn't do too great overall, but clearly employment opportunities are much better south of the M4 and around Pencoed than elsewhere in the county.

Health & Education
(Click to enlarge)
There are five big pockets of areas where people are more deprived in terms of health compared to the rest of Wales – Caerau & Maesteg, Nantymoel, the central Garw Valley (Bettws, Llangeinor, Ynysawdre), North Cornelly & Pyle and the big estates in and around Bridgend town centre (Wildmill, Brackla Meadows, Ystrad Fawr). Again, this shouldn't be a surprise.

As you might expect the areas with good health are Broadlands, Laleston, Litchard and Brackla. These areas are not only generally wealthier than the average, but some areas - like Brackla - are generally younger than the rest of the county.

The north-south split is starker in education than any other measure. Pretty much all of the areas with low-ranking wards in terms of educational deprivation are located in and around Porthcawl, Pencoed and Bridgend, while the valleys have numerous areas that rank in the top 20% most deprived in Wales. The M4 almost matches the boundary perfectly as even Cornelly and Pyle fit in "the north".

That doesn't mean everywhere south of the M4 is doing well (Wildmill & Brackla Meadows) or that everywhere north of the M4 is doing badly (Llangynwyd & Aberkenfig).

Access to Services & Community Safety
(Click to enlarge)
Access to services is as much an infrastructure problem as one of the facilities being in close proximity. Blaengarw and Nantymoel have quite a few shops and services close at hand, ditto the upper Llynfi valley, so these areas do well. More rural areas like Cefn Cribwr and Coychurch, as well as "overheated" areas like Broadlands, will do badly. If you're close to a town centre you're going to rank well on this, so it doesn't really tell us much.

Community safety doesn't really tell us much either, as the closer you are to a town centre, the more crime will be committed. This means urban wards like Morfa and Porthcawl West & East Central will score worse than leafy suburbs like Broadlands, Litchard, Penyfai and Newton.

Caerau, Aberkenfig and Bettws don't really count as either so their poor scores on community safety probably indicate problems other than population density - presumably high levels of anti-social behavior.

Environment & Housing

(Click to enlarge)

You would expect areas close to Bridgend and Maesteg town centres to suffer from pollution problems, but there's a strip of particularly poor-scoring areas stretching from Aberkenfig to Pencoed. I think the culprits are the M4, traffic problems caused by the awkward road layout around Bryncethin, Tondu and Sarn, the Brynmenyn industrial estate and the fact the three main tributaries of the River Ogmore confluence in this area, which is prone to floods.


Ogmore Vale stands out and I have absolutely no idea why other than the polluting industries – like car scrappage and recycling firms - on the Penllwyngwent industrial estate.

On the flipside, you would expect rural wards and Porthcawl – with its seafront and access to the sand dunes - to score well, so no real surprise there.

Housing is the category where Bridgend county on a whole does very well compared to the rest of Wales, so this is clearly one of Bridgend's core strengths. It's probably because large amounts of housing have been built since the 1970s, like Brackla, or more recently, like Broadlands and Tondu, meaning they're often of a higher spec than the terraced houses of old. It's generally the areas where Edwardian and Victorian terraced houses are the only option – like the Garw Valley, Morfa 1 & 3 and Oldcastle 1 (the area around Nolton Street and Cowbridge Road) – which score poorly.

What can we learn from WIMD 2014?
Is enough being done in Bridgend's relatively deprived neighbourhoods?
(Pic : Wildmill Communities First)

Things haven't changed dramatically – As I've said, the areas of Bridgend you would've expected to rank towards the top and bottom have done so. Although these figures are relative, it's hard to tell if Welsh Government and local authority schemes like Communities First are really targeting the core issues that result in higher deprivation : unemployment, poor education and low incomes.

A better environment doesn't mean better life chances – The Bridgend valleys boast some of the finest scenery in south Wales, and since the end of mining, the environment of these areas has improved. The people there are still broadly worse off than those living in and around the M4 though. It makes you wonder if "sustainable development" is really going to improve people's well being or not, and whether local communities are being assisted to make the most of the natural environment.

Sarn and Pencoed are on the up; Brackla and Pendre are on the way down – Again, you have to remember that these figures are relative, but what's clear is that Sarn and Pencoed are becoming relatively less deprived compared to the surrounding areas, while Brackla and Pendre are starting to slip. Brackla is also, arguably, the most diverse council ward in Bridgend, as you can go from some of Wales' most grinding deprivation to some of its swankiest postcodes in a 20 minute walk.

Something needs to be done with "the usual suspects" – Marlas, Caerau, Bettws, Wildmill, Brackla Meadows - yet again they're mentioned for the wrong reasons. I could probably write fifty blogs on the state of Bridgend, but the question remains - what can be done to turn these areas around? With regard Caerau, in the last fortnight I mentioned there were plans for a holiday resort in the Afan Valley, which might generate much needed employment in the area and make use of Caerau's strengths – but those plans have stalled. Valleys 2 Coast had/have plans for housing renewal programmes in Wildmill (pdf) and Careau Park (pdf) too, but again presumably nothing will happen without the funding. New houses won't necessarily solve problems relating to crime, unemployment and low incomes either.




Sunday 30 November 2014

Senedd Watch - November 2014

  • Former Labour peer, Joel Barnett - creator of the (controversial) Barnett Formula, which determines public expenditure levels in the devolved administrations – died age 91 on November 1st. He was described as an “extraordinary individual” who did “his best to ensure the best for the people of this country”.
  • Education Minister, Huw Lewis (Lab, Merthyr Tydfil & Rhymney), launched a campaign to raise awareness of changes to GCSEs and A-Levels in Wales, due to come into force from September 2015. Wales-only GCSEs – including the introduction of new GCSEs in English language and two new GCSEs in mathematics - have been criticised by independent schools as “lacking credibility”.
    • The Education Minister later told BBC Wales that teacher training in Wales was “chaotic”, and teachers need to “step up to the challenge” of changes to their professional development as a result of a critical OECD report into the Welsh education system.
  • A survey revealed that a quarter of Welsh workers (261,000) were being paid below the £7.85 per hour “living wage”. The Wales TUC said low pay “blighted” workers, while the CBI and UK Government supported the principle of a living wage, but not at the expense of job creation.
  • The First Minister told the National Assembly that a “veto” from the devolved nations on an exit from the European Union in a proposed 2017 referendum was “worth considering”. It comes as the incoming Scottish First Minister, Nicola Sturgeon, suggested a referendum vote should produce the same result in all home nations to be valid – a call rejected by the UK Government.
  • A deal to sell the Murco oil refinery in Pembrokeshire to a Swiss company collapsed, resulting in a possible 400 job losses. Business Minister, Edwina Hart (Lab, Gower), said the Welsh Government “did everything we could to support....the deal”. Plaid Cymru's Jill Evans MEP called for the use of the EU's Globalisation Adjustment Fund to help workers.
    • On November 12th, the Minister announced a £3.5million package of support for Murco workers, and said dualling of the A40 road will be examined. A nearby refinery run by Valero also announced they would take on Murco apprentices.
  • A petition with almost 100,000 signatures calling for a cancer drugs fund – backed by the Welsh Conservatives - was presented to the National Assembly. The Welsh Government simultaneously announced changes to its policy on “orphan drugs” for rare diseases which will create a “fairer and more transparent” system for applying and receiving the drugs.
  • A Public Accounts Committee inquiry into Senior Management Pay recommended a more consistent approach to the issue, with a clear definition of what a senior post is and better publication of senior rates of pay in the Welsh public sector.
  • The First Minister launched a four-week consultation on new Welsh language standards for public bodies as a result of the Welsh Language Measure 2011. It comes as retailer Lidl were slammed for a policy of staff speaking in English only, resulting in criticism from Cymdeithas yr Iaith Gymraeg and the Welsh Language Commissioner.
  • The Welsh Liberal Democrats proposed a “recall” system for Assembly Members which will trigger a by-election if 20% of the electorate in a constituency (or each constituency in a region) sign a petition in favour of a recall and vote yes in a referendum. Leader, Kirsty Williams, said it would “give people proper powers to hold politicians to account.”
  • Health Minister, Mark Drakeford (Lab, Cardiff West) launched an 8-week consultation on the future of Community Health Councils (CHCs), including proposals to strengthen their role and to enable them to hold local health boards to account properly – one of the main criticisms of the Trusted to Care report.
  • A complaint was made to the Wales Audit Office that land along the proposed Newport M4 bypass is owned by the Welsh Government, which could have influenced its decision to choose the controversial “Black Route”. Chair of the Public Accounts Committee, Darren Millar AM (Con, Clwyd West), said it “gives the impression of a preemptive strike by the Welsh Government in order to lead conversation around which route to take”.
    • Rhun ap Iorwerth AM (Plaid, Ynys Môn) said £11million in preparatory spending on the M4 Newport bypass should be suspended, describing the project as a “£1billion blunder” and calling for more investment in road schemes across Wales. Eluned Parrott AM (Lib Dem, South Wales Central) called for investment in new trains instead of the bypass.
  • A report for the Public Policy Institute of Wales revealed that bus companies were making up to £22million profit from Welsh Government subsidies, despite services being withdrawn. The Welsh Government said they would introduce Quality Partnerships across Wales in 2015 and negotiate directly with bus operators for routes of “national significance”.
  • The £2.4million Ynni'r Fro community energy scheme was criticised as a “waste of money” after it was revealed just one of its 102 projects was generating energy. It's hoped 22 projects would be completed by March 2015. Consultants said it was too early to judge the success of the scheme as the requirement for various permissions was often bureaucratic.
  • Office for National Statistics figures showed that crime in Wales had risen by as much as 17% since 2010, mostly due to a rise in violent crimes. However, crime levels remain half those of 1995. The reliability of crime figures in EnglandandWales has been questioned by Westminster's Public Administration Select Committee.
  • The National Assembly's Communities & Local Government Committee recommended the Gender-related and Domestic Violence Bill required “significant” changes, including amendments to emphasise women victims and calls for further clarifications on funding.
  • The Children, Young People & Education Committee concluded that Bethan Jenkins AM's (Plaid, South Wales West) Financial Education & Inclusion Bill was “unnecessary”. They instead proposed the Welsh Government ensure financial literacy provisions are improved in schools. Bethan Jenkins withdrew the Bill on November 26th to work with the Welsh Government to improve existing and future financial education measures.
  • The First Minister told the National Assembly that the future of Cardiff Airport – purchased by the Welsh Government in 2013 – was dependent on long-haul flights. The Welsh Conservatives said there were “substantial negatives” at the airport. On 19th November, the Welsh Government announced a £3.5million package to attract new airlines, after the withdrawal of services from Germanwings.
  • The National Assembly approved a Welsh Liberal Democrat motion by 28 votes to 19 calling for a minister to be given responsibility for transgender affairs, and for the Welsh Government to formulate an action plan to tackle prejudice against the estimated 31,000 (sic) transgender people living in Wales.
  • A deal between the Welsh and UK Governments for rail electrification was agreed on November 21st. The UK Government agreed to fund electrification to Swansea by 2018 and provide £125million towards Valley Lines electrification, with the rest of the funding coming from reduced costs and increased revenues. The Welsh rail franchise will also be devolved.
  • A Business & Enterprise Committee inquiry into tourism recommended a number of measures including a better online presence for Visit Wales, full assessments of the impact of major events and a stronger “brand”. Committee Chair, William Graham AM (Con, South Wales East), said “more must be done....to maximise Wales' huge tourism potential”.
  • Public Services Minister, Leighton Andrews (Lab, Rhondda), said the number of local authorities in Wales could be reduced to as few as six as he launched an independent review into local government spending. He said he expected local authorities to reduce spending on back room functions and focus on front line services. A deadline for expression of interest in voluntary mergers expired on November 28th, with only six authorities giving preferred partners.
    • Former Welsh Government economics adviser, Gerald Holtham, told BBC Wales that harmonisation of council tax rates will need to be considered before proposed council mergers. He proposed an indexed charge based on property prices which could save £20million in council tax benefit.
  • The Independent Remuneration Board for Assembly Members recommended an 18% (£10,000) rise in AMs salaries to £64,000 from 2016 to reflect new responsibilities and improve the calibre of candidates seeking election. Political parties gave a guarded reaction to the proposals, while public sector unions Unison and Unite called for AMs to reject the proposal.
  • The National Assembly approved a motion to create a special Assembly committee to look into the issue of physical punishment of children, and possible future legislative measures in the area. Plaid Cymru criticised the move, as they believe legislative measures could be taken immediately.
  • The National Assembly's Children & Young People's Committee inquiry into child and adolescent mental health severely criticised levels of funding, access to treatment and some aspects of treatment itself. Demand for the service has doubled since 2010, and the Health Minister is leading a “root and branch” review of the service.
  • The 2014 Welsh Index of Multiple Deprivation (WIMD) was released on November 26th, showing that the St James's area of Caerphilly was now the most relatively deprived community of Wales. Communities and Local Government Minister, Lesley Griffiths (Lab, Wrexham), said the Welsh Government were “continuing to invest in our most disadvantaged communities to help improve people's life chances.”
  • A third of children do not receive free school breakfast through a Welsh Government scheme, with only 8 out of 10 schools offering them despite it being available to all schools. Shadow Education Minister, Angela Burns (Con, Carms W & S. Pembs.), said parents who could afford to do so should make a contribution to ensure free breakfasts were provided to all.
  • The Environment & Sustainability Committee Stage 1 report on the Future Generations Bill called for more clarity on its sustainable development goals and stated that duties placed on public bodies were too weak to have any effect. Committee Chair, Alun Ffred Jones AM (Plaid, Arfon), said that while there was support for the intent of the Bill, “significant improvements were needed in order for the Bill to have a meaningful impact”.

Projects announced in November include : £3.5million and £10million packages to improve training of GPs and primary care staff; the launch of the National Adoption Service; an extension of the North-South air link until 2018; £500million for the 21
st Century Schools programme via the non-profit distributing model, and a pilot for community cultural schemes in seven deprived areas.

Thursday 27 November 2014

Mental health services for young people criticised



Mental health services are often inadequate for adults, being described as a "Cinderella service", meaning it's often ignored by a cruel stepmother (aka. the government).

So what about younger people with mental illnesses?

The National Assembly's Children & Young People Committee recently published its report (pdf) on their long-running inquiry into Child & Adolescent Mental Health Services (CAMHS), covering how these services are funded and resourced, regional variations, respect for children's rights and access to treatment.

In an unusual move, the Committee didn't make any recommendations as the Health Minister, Mark Drakeford (Lab, Cardiff West), is carrying out a "root and branch review" (pdf) of CAMHS. Therefore the Committee believed it would be inappropriate to make recommendations until that review has finished, instead making observations.

The evidence was shocking.

The Welsh Government's Role

The Welsh Government have no fewer than seven policies and strategies on CAMHS, but a 2009 review said CAMHS were "putting children at risk". Since then, mental health policies have changed from child-specific to all-age, which the Royal College of Nursing (RCN) said has "created an impetus for improvement" but CAMHS was now "seen as the Cinderella of the Cinderella service".

The out-going Childrens Commissioner, Keith Towler, said he was concerned about the removal of specific mental health strategies for children and young people, and this might "dilute regard to the intentions of the UN Convention of the Rights of the Child (UNCRC)".

Previous reports have also slammed CAMHS as not offering standardised delivery, not undertaking proper risk assessments and poor caseload management.

The Health Minister said Local Health Boards (LHBs) have "made progress" on improving these services. In his own evidence, he said he was in contact with LHBs four times a year, and they often give him feedback on what improvements are being made. Other witnesses say that CAMHS has had a much keener focus on it over the past 12-18 months than it had previously.

The Committee were concerned that none of these reviews have led to any significant changes, that Welsh Government targets weren't clear enough, and also – understandably – had worries about the possible negative impact a removal of child-specific mental health policies would have.

Access to CAMHS

Demand for CAMHS has doubled in four years, and in some parts of Wales even more so.
(Pic : BBC)
Everything points to an increase in the cases of diagnosable mental illnesses amongst young people – leading to an under capacity in CAMHS - but the picture across Wales is unclear as there's little to no data collection. Also, there was regional variation in access to certain specialist services, in particular young offenders.

Demand for CAMHS has doubled (+100%) since 2010, from 1,204 referrals to 2,410 referrals, with the sharpest increases in the Aneurin Bevan LHB (Gwent), which increased by 241%.

So difficulties in accessing CAMHS were a running theme throughout the evidence received by the Committee, with many parents and patients saying they had a negative experience trying to get the help they need, which put serious strain on families.

Some parents say specialist referrals have been rejected "without explanation", and some GPs said rejections occurred without even seeing the patient. LHBs only started to collect data on refused referrals from November 2013, and the figures show that since then there've been 2,835 refusals, but because this didn't include Betsi Cadwaladr LHB (North Wales), it's said to be an underestimate.

Access to specialist CAMHS often requires a diagnosable mental illness, but many witnesses believe this ignores the needs of children who endure traumas and psychological abuse which aren't officially illnesses but can permanently affect mental health. This often means CAMHS is, as one witness described, being treated as an "accident and emergency service" where treatment is only offered for urgent cases.

Early intervention programmes are said to be "limited", despite the Mental Health Measure 2010, which placed a duty on local authorities and primary care to assess mental health needs. There were concerns though that too much of the money resulting from this legislation (around £3.5million) has gone towards adults instead of children and young people.

School counsellors were said to be important, but this often meant children with serious mental health problems were being referred to them, with their limited training, instead of specialist psychologists.

The Health Minister doesn't believe that the number of young people with mental illnesses has doubled, and says CAMHS needs to be put in the context of a specialist health service which deals with the most serious cases, not a general mental health service. He did, however, recognise the long waiting times, though he insisted that, "more children are being seen within the target times than at any other time".

Resources

Staff shortages and high staff turnover are factors said to put
strain  on families of young mental health patients.
(Pic : leftfootforward.org)
The irony in all this is that mental health services (in general) are said to be the largest single area of expenditure in the Welsh NHS, with £617.5million spent in 2012-13.

It's fairly obvious where this money is going though. £82.75 per head is spent on adult mental health, £58.18 on the elderly and just £13.94 for CAMHS.

Unsurprisingly, this low level of funding raised concerns, though LHBs wanted more clarification on how much they should spend on CAMHS as specific services aren't ring-fenced. These financial problems even filter through into local authorities, where Rhondda Cynon Taf Council complained about cuts to social work budgets "eroding" the social work side of CAMHS.

Shortage of staff and high staff turnover was highlighted by parents, as this puts more pressure on them and carers, meaning patients often can't build a relationship with staff.

It's said there are 9.9 full-time equivalent CAMHS staff per 100,000 population, compared to 15.9 for adult mental health. The recommendation of the Royal College of Psychiatrists (RCP) is between 19.3 and 23.4 staff – excluding young offending and substance misuse work.

The Health Minister said mental health problems facing adults and the elderly are "more enduring" and often need closer attention and (sometimes) higher security, while he described the RCP's guideline staffing levels as "aspirational".

Delivery & Structure of Services

Despite investment in the likes of Bridgend's Ty Llidiard, in-patient CAMHS services are still
seen as inadequate, and the clinic-based nature of CAMHS was criticised by patients.
(Pic : NHS Wales)
The Committee say the evidence they received points towards there needing to be a more consistent service across Wales, especially to bridge the gap between rural and urban areas.

Current CAMHS are said to be limited by 9-5 services offered by clinics, which is said doesn't suit the needs of the most vulnerable and complex cases who need round the clock or out of hours services. Basing services in clinics also reduces access in rural areas where there's strict timekeeping for appointments and longer distances to travel.

Patients themselves said clinic-based services weren't meeting their needs, but they praised some of the voluntary sector programmes and courses. Unfortunately, these projects are dependent on sketchy sources of funding and often close with short notice.

Due to the clinic-based provision, urgent CAMHS cases are often sent to hospital accident and emergency departments as "a default setting" – usually, it's said, as a result of self-harm or substance abuse. This often meant children were admitted onto adult mental health wards, or children being discharged too early without proper follow-up support. Some patients even said that attempting suicide didn't meet the threshold to qualify for CAMHS services.

As a result of in-patient bed shortages, many CAMHS patients are being sent out of area, which is a pretty expensive option, with the practice criticised by the Auditor General in 2013. This led some patients to believe they were being "institutionalised" or "kept away". Despite investment in new in-patient facilities – like Ty Llidiard in Bridgend – these often fail to meet demand.

There were extreme concerns about transfer from CAMHS to adult mental health services, with some patients effectively "dropping out" of the system instead of making a smooth transition. Patients and their families effectively have to start from scratch.

In terms of treatments, access to psychological therapy is said to be increasingly limited, while some clinical psychologists criticised the widespread use of medication (without being used alongside other therapies/strategies) as an "easy option". One even said that in 20 years time we could be looking back on it as a scandal.

The Health Minister and his officials said operating hours of community mental health teams are being extended to be increasingly available at weekends and nights, and the Minister said community-based treatment will reduce admission rates and allow services to be delivered flexibly. They also said an extra £650,000 was found to enable current mental health staff to deliver psychological therapies.

A(nother) hidden national disgrace?

While many people – including myself, it has to be said – are preoccupied by things like the ambulance service and hospital reorganisation, this has gone under the radar as a hidden national disgrace.

I suppose in many ways, this post – easily the most important of the three blogs this week, but will probably get a fraction of the interest – feeds into the other two.

Firstly, I'm surprised the reaction to this report hasn't been stronger because it really puts the outcry over AMs pay into some much needed perspective. Secondly, the poor services offered some of our most vulnerable young people – especially when compared to the elderly - underlines an argument in favour of them being able to vote, as this is yet another policy area where they're perhaps getting shafted.

If there's a single thing out of all the evidence that worried me most of all it's children being admitted onto adult wards. That must be terrifying for them, especially if they have a history of abuse and/or if the adults need constant care or heightened security.

I'm sure it's very different in reality, but the way the Health Minister has been quoted in the report makes him sound flippant in the face of such glaring failures. So in many ways I'm disappointed the Committee chose not to make any concrete recommendations because their input, based on the evidence they've received, might've helped in the review process.

I can't really add anymore. The evidence is enough to make you depressed by itself.