FMQs: Circuit of Wales, Stressed Teachers & Gambling

Here are the highlights of this afternoon's First Minister's Questions which, as you might expect, was dominated by the Welsh Government's decision earlier today not to underwrite the Circuit of Wales project in Blaenau Gwent.

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Committees Bite Size #4: May 2017

A brief break from the general election today for summaries of some of the reports that have come out of the Senedd's committees over the last couple of weeks.

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Automation: Resistance is Futile?

Continuing the running theme of the backbench members debates this term - the "Fourth Industrial Revolution" - AMs turned to automation, something that was once science fiction but fast becoming science fact.

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Trade Union Bill: Senedd picks a fight

(Pic : Wales Online)

The latest - and slightly controversial - Welsh law was introduced by Finance & Local Government Secretary, Mark Drakeford (Lab, Cardiff West) earlier this week.

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FMQs Extra : Pembrokeshire, Heathrow & Orgreave

First Minister's Questions....without the First Minister.
(Pic : Wales Online)

As promised, I'm going to return to yesterday's plenary session and cover the four urgent questions asked following FMQs.

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Ta-ra Tata : What future for Welsh steel-making?

(Pic : The Independent)

This is an immediate follow-on from the National Assembly debate held earlier today. This post will look in more detail at some of the options facing Tata and other interested parties (like the UK and Welsh governments), as well as what the next steps might be.

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Assembly rejects Trade Union Bill

It's a no from the Assembly....
(Pic : BBC Wales)

Earlier today, the National Assembly voted on the UK Government's highly-controversial Trade Union Bill, which most AMs – and the Welsh Government - roundly criticised last year (AMs take swipe at Trade Union Bill).

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AMs take swipe at Trade Union Bill

The post-devolution "partnership working" between unions, employers and employees
in Wales looks set to be threatened by the UK Government's draconian Trade Union Bill.
(Pic : Wales Online)

Shwmae. Yesterday, the Assembly held another backbench members debate, this time related to one of the most controversial laws introduced for a long time in the UK Parliament.

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Tawel Fan : Betsi Cadwaladr's Shame

Little Ward of Horrors.
(Pic : BBC Wales)

Just so you've been warned, the following makes for depressing reading.

Within the last week, a catalogue of serious care failings were revealed in a damning report into the Tawel Fan mental health ward at Denbighshire's Glan Clwyd Hospital, which specialised in "care" for elderly patients with dementia. The ward closed in December 2013 as soon as the seriousness of the allegations became clear, and there are echos with what happened at the Princess of Wales and Neath Port Talbot Hospitals (Abertawe Bro Morgannwg : Trusted to Care?).

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Westminster 2015 : The Manifestos Part II

• Westminster 2015 : The Manifestos I (Conservatives, Greens, Labour)

Following yesterday's look at the party manifestos (linked above), today it's the turn of the Lib Dems, Plaid Cymru and UKIP.

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Westminster 2015 : The Manifestos Part I

The following two posts are the most important of the lot this election campaign : What are we voting for in May? Or, more accurately, what might be on the table during negotiations in the event of a hung parliament?

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The Green, Green Glas of Home

The National Assembly's Public Accounts Committee have said that while the Glastir
scheme is well-intentioned, there are problems with how it's been managed.
(Pic : Nanhoron Estate)

I don't normally cover farming issues, mainly because such posts often go unread and I don't know anything about farming in the first place.

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Mo' money, mo' problems

They asked the audience....then completely ignored them.

Last year, the Independent Remuneration Panel for the National Assembly proposed a change in AMs' and ministers' pay (The £64,000 Question).

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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.

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Carmarthenshire : The Rot Laid Bare

The eagerly-anticipated Welsh Local Government Association (WLGA) report into the governance arrangements, culture and practices at Carmarthenshire Council (CCC) has been published (pdf).

Jonathan Edwards MP and Rhodri Glyn Thomas AM (both Plaid, Carms E. & Dinefwr) issued a joint statement. The Western Mail describe the report as "damning", while the Carmarthen Journal put a slightly positive spin on it.

Meanwhile, as you might expect, the Carmarthenshire blogosphere are keen to give their own views. The full list of recommendations is available on Carmarthenshire Planning – as well as Jacqui's thoughts on the report itself. Y Cneifiwr provided an extensive account of the report, adding his scepticism whether things can change due to the political leadership, and Pat Racher from West Wales News Review calls for CCC's councillors to "wake up and take control of the wheel".

The report's 39 recommendations can be summarised as :

• CCC should implement an immediate managerial "cultural change programme" to promote transparency and openness.
• CCC should review its media and public engagement protocols, and promote/support the use of social media by councillors.
• CCC should hold an annual register of interests (published on its website).
• The Local Service Board (LSB) should consider broadcasting its meetings and update its website regularly.
• CCC should introduce a new constitution and provide guides for councillors and the public.
• The new constitution should :
• allow councillors to ask supplementary questions
• relax requirements for signatories for motions
• should not allow motions to be referred to another committee or the Executive Board
• place greater prominence on the role of Chair
• CCC should promote the opportunity for the public to table questions at council meetings, have an online petition system, review its approach to the public gallery and commit to continuing council meeting broadcasts.
• CCC should publish the Executive Board's forward work programme, consider broadcasting Executive Board meetings, allow non-executive members to remain for exempt items and allow non-executive members to be present for decision meetings.
• Executive Board members should only attend scrutiny committee sessions when invited, and their role should be confined to presenting policy and reports.
• CCC should revise its "call-in" procedures.

Culture, Leadership & Values

The report hints at a "leadership clique" that - directly or indirectly -
placed barriers on moves towards openness and transparency.
(Pic : Carmarthenshire Planning)

CCC has a clear commitment to openness and transparency as a result of several internal and external reviews, and this was praised.

However, the report says there were several "behavioural, cultural and procedural barriers to achieving the Council's ambition", and rebuilding relationships will take some time. For starters, the change will have to be councillor-led with officers only offering support.

Interviewees spoke of "internal tensions" between councillors, and a lack of trust was said to be a key theme, partly due to the fact wards, Assembly and UK Parliament seats in the authority are hotly contested meaning the political groups are often at each others throats.

CCC's constitution has contributed to problems, with limited opportunities to "call-in" decisions and ask supplementary questions as well as restrictions on tabling motions. It's said the constitution "is neither conductive to nor encourages challenge from within the council".

In terms of the relationship between the Executive Board (Cabinet) and officers, it's described as "constructive and positive". But it's implied the Executive Board are distrustful of non-executive members and non-executive members were equally hostile to officers, with the role of officers and Executive Board members "becoming confused".

This suggests a "ruling clique", and many responses focused on the role of the Chief Executive, Mark James – who has a much higher profile and role in council affairs than he should, resulting in media attention focusing on unelected officers as opposed to the elected Executive Board. There's a culture of defensiveness, where CCC, "doesn't deal with negativity well", and was "deemed to react....aggressively to challenge, particularly from the media".

Relations with the Media & Public Engagement

"Do you agree or disagree that you can influence decisions in your local authority?"
(Pic : National Survey for Wales)

In case you didn't know, CCC "invests significant resources into public relations". Despite this, there's a "strained relationship" between CCC and the local media, with concerns that press releases were one-sided, politically-motivated and backed by threats to withdraw advertising from certain publications.

There are "a number of local bloggers with a particular interest in the business of the authority" with a "disproportionate interest in the activities and perceived influence of bloggers in Carmarthenshire" amongst interviewees – mostly as a result of the libel trial and its outcome. The report says things like social media can be a double edged sword as it's a tool for engagement, but also the accuracy of reporting is likely to fall short of mainstream media standards.

In terms of wider public engagement, Carmarthenshire residents are amongst the least likely in Wales to say they can influence the authority's decisions and "do not feel empowered" – Bridgend doesn't do much better, by the way.

The Council's Workings

There were concerns about senior officer appointments, especially appointment of senior officers on an interim basis. The current management team is described as "stable", but several senior officers are seeking severance agreements, and this "upheaval" is described as "unprecedented in a Welsh local government context".

Although there was praise for councillor training, the report said it wasn't "member led or designed", with mixed attendance levels at training sessions because they're inconveniently timed. There were also concerns that the Business Management Group was an "unconstitutional decision-making forum" which didn't take minutes and excluded non-executive members.

Council Meetings

Although recent reforms have been praised, the council's constitution
placed unnecessary restrictions on the public and councillors.
(Pic : The Telegraph)

CCC were the first local authority in Wales to record council meetings, and the review team were impressed by the in-depth discussions the council had on various reports. However, the procedural rules within the constitution are not user friendly, though CCC has committed to adopting the Association of Council Secretaries and Solicitors' "modular constitution" (pdf).

Many councillors are dissatisfied with council meetings, and believe they should be the "crucible for local democratic debate" and "focus for public engagement", as opposed to the current stage-managing. Some also believe that meetings should be held at a time that's convenient for the public and should be as long as they need to be (there's a limit of 3 hours, and standing orders need to be suspended to go beyond that).

CCC were praised for starting to take questions on notice, but lack of supplementary questions was described as "peculiar" and "inconsistent with other local authorities".

The rules for motions on notice are described as "restrictive" by requiring seven signatures, while opposition councillors were concerned they couldn't table motions on controversial issues, as the scope of motions was often set out by senior officers.

Then there's the public gallery. CCC infamously take a register of details for people attending in the gallery "for fire safety purposes", which the review team said could be seen as "officious" and "deter people from attending". There was also the issue of members of the public filming meetings – which is allowed in England, but there are concerns that it could be "disruptive".

The issue of the Chief Executive "advising" the Chair was also raised, with varying policies across Wales. Some councils have a monitoring officer to provide constitutional advice, and the role of other officers is to advise on policy. In CCC's constitution the "Proper Officer" – who just so happens to be the Chief Executive – has a role in determining the validity of motions and questions. The review team believe this responsibility should be the Chair's.

The Executive Board & Scrutiny

Carmarthenshire's Executive Board are secretive, hold too much power and
the call-in processes for scrutiny committees were roundly criticised.
(Pic : Carmarthens Journal)

Some councils broadcast cabinet meetings, and although Carmarthenshire's Executive Board are starting to go "on the road", the review team believe online broadcasting should be extended to board meetings held at County Hall.

The Wales Audit Office say the issue of "exempt items" needs particular improvement, with some authorities said to be "working towards a more open approach" where fewer items are considered exempt.

The review team were "surprised" that non-executive members had to leave Executive Board meetings, along with the press and members of the public, during the discussion of "exempt items". Only 5 other councils do this, and of those, some are reconsidering the policy while others say exempt items are rare.

There were concerns over transparency of Executive Board decision meetings, with no opportunity to call-in decisions and seemingly sweeping powers to Executive Board members to approve spending – including the recent "Meryl's Millions" (c/o Y Cneifiwr). There were also concerns that decisions were rubber-stamped during the Executive Board meetings and the real discussions took place in behind closed door "pre-meetings".

Although there were said to be good examples of scrutiny work - and such work was often highly-regarded - there were also major worries.

The arrangements for Executive Board members attending committee meetings seems unclear, with some attending even if not invited, while others are unsure if they should attend at all. Best practice is for Executive Board members to only attend when invited so the relationship between the Board and committees doesn't become "cosy" and impact objective scrutiny.

Scrutiny committees also have the power to "call-in" decisions. However, CCC's call-in procedures are arranged in such a way it makes it very difficult to trigger one, which requires the approval of more than half of a committee's membership within a three day deadline. Other local authorities have more relaxed requirements and longer deadlines, while CCC's is described as "onerous".

Winds of Change?

#DaftArrest marked a turning point that's led to these proposals. Despite being
largely vindicated, "victory" - touch wood - is coming at a heavy price.
It didn't have to be like that.
(Pic : New Statesman)

The first step towards recovery is admitting you have a problem. In many ways the commitment to reform from CCC is admirable, so I won't be too snide.

As Jacqui Thompson said, although the language of the report was "professional and polite", when you read between the lines, the report paints a picture of a local authority that's no longer fit for purpose, stuck in a self-congratulatory bubble and keeps digging itself into holes.

It's a shame its taken court cases, legal injunctions and the full force of the Wales Audit Office to get things done, when Jacqui herself and others (up to and including councillors) have flagged up these issues and have been calling for the measures outlined in the report for the best part of a decade.

If this review had happened years ago, CCC really would be towards the top-performing local authorities in Wales. But there was a breakdown in trust due to the paranoid and excessively autocratic rule of Mark James, the Executive Board and other senior officers.

Ultimately, we're only here because of a domino effect caused by #DaftArrest (perhaps earlier), and because a handful of concerned citizens, politicians and whistleblowers kept picking away at the council's record in the face of legal threats, obfuscation and a distinct lack of action and concern from the Welsh Government.

If – and it's a big if – these changes are implemented then it'll be a (Pyrrhic) victory for long-standing "critics", and arguably the most significant thing the Welsh blogosphere has ever contributed to, as a reformed Carmarthenshire will likely be a model post-Williams Commission local authorities will work from.

Jacqui Thompson and others are vindicated. Although there's not much anyone can do about the libel verdict, if CCC are keen to pursue the reform agenda, they should admit the libel action was on behalf of CCC as a whole (which is unlawful), negotiate a token settlement with the Thompsons which would allow them to keep their home, and allow Mark James to move on to pastures new with a bit more dignity than his Pembrokeshire counterpart.

The libel cases, the bluster in the press and the defence of the indefensible – it wasn't worth it, was it?The political leadership of Carmarthenshire Council now face a critical choice.

On one hand, there's a chance to create a "New Model Council", and after all the mistakes they've made, Kevin Madge et. al. can restore some pride and gain respect by leading the reforms, and perhaps even going above and beyond the recommendations in the report.

On the other hand, CCC can dismiss the recommendations or take a "pic n' mix" approach, which after the positive feedback from the WLGA will result in them losing friends and credibility pretty quickly, and put a return of Dyfed firmly back on the table.

Based on their track record so far, I think you all know which way this is going to go....

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Why are Welsh ambulance response times so poor?

The Wales Ambulance Service Trust (WAST) has failed to hit and maintain its response time targets (65% of the most serious [Category A] 999 calls responded to within 8 minutes) for around 24 months in a row.

The latest figures, from August 2014 (pdf), show that 56.9% of Category A calls were responded to within 8 minutes; that rises to 66.8% within 10 minutes and 83% at 15 minutes. That means for 17% (almost 1 in 5) of life-threatening calls in Wales, an ambulance takes near double the target time to reach the patient. Summer is traditionally quiet in terms of demand for ambulance services, so these figures are particularly bad.

Although this is one of those issues which Assembly Members get very hot under the collar about, nobody's ever considered the precise reasons why the ambulance service is missing its targets so consistently. Opposition AMs huff and puff over the figures and turn it into a political football, while ministers almost never give straight answers.

Most of this is going to be guesswork and inductive reasoning with very little hard evidence to back it up. But I do believe that – concerns from the McClelland Review about management aside - some of the reasons might not be sexy enough for politicians to score points off each other in the Senedd chamber or press, but do make sense.

Where are the problems?

Before considering why response times are poor, it's worth looking at performances at a local level to see if there are any patterns we can draw conclusions from. As you can see from the map below, response times vary wildly across Wales.

Ambulance response times by local authority - August 2014
(Pic : StatsWales/Welsh Government)

Four local authorities actually hit or exceeded the target – Swansea (65.1%), Conwy (65.9%), Bridgend (69.3%) and Wrexham (70.3%). Neath Port Talbot (62.8%) and Denbighshire (63%) came close. So despite criticism elsewhere, it looks like ambulance response times in the Abertawe Bro Morgannwg local health board are significantly better than the rest of Wales.

In terms of poor responses, there are two distinct clusters.

The first cluster are rural local authorities, with Monmouthshire (50%), Anglesey (51.5%) Powys (53.3%), Vale of Glamorgan (53.5%) and Carmarthenshire (54.7%) standing out, with the likes of Pembrokeshire, Ceredigion and Gwynedd not doing much better.

The second cluster consists of Cardiff (58.1%) and the south Wales valleys. Response times in Caerphilly (44.8%), Rhondda Cynon Taf (46.4%), Torfaen (47.6%), Merthyr Tydfil (51.3%) and Blaenau Gwent (52.8%) are much, much worse than the rest of Wales. The difference between bordering local authorities like Bridgend and RCT is stark, though – as I'll come to – there may be unorthodox explanations as to why this is the case.

What might the problems be?

These aren't exactly ambulance friendly street layouts.
(Pic : Wales Online)

The quality of the road network - The poorest response times are in the south Wales valleys where there are a lot of very narrow side streets consisting of tightly-packed terraced houses, usually on steep inclines. There's often very little room to park if you live on these roads, let alone enough room to attempt to get an ambulance up them at high speed.

Local authorities which have the better response times, like Swansea, Bridgend and Wrexham, are quite car-friendly. Swansea city itself, for example, has been designed with road traffic in mind since the Luftwaffe flattened it, while Bridgend and Wrexham have large housing estates served by high-quality spine roads and dual carriageways.

So as much as AMs might want to pin the blame on the government or the WAST's management team, it could be equally down to dodgy junctions, potholes, poor car parking, ill-considered one-way systems or unnecessary sets of traffic lights and speed humps.

Perhaps consideration should be given to the creation of designated "ambulance-friendly routes" in the valleys that are cleared of any and all obstructions where practical.

Rurality and the distance travelled to 999 calls – This is something you can easily infer from the map, and it's so blindingly obvious even the harshest critic of the Welsh NHS will have to accept it as an unavoidable hazard.

The further you are from a hospital or ambulance station, the longer the ambulance will take to reach you – simple. The problem will be more acute in north west, mid and west Wales (as well as some south Walian local authorities like Monmouthshire and Vale of Glamorgan). The catchment areas for Ysbyty Gwynedd and Bronglais Hospital, for example, are huge, and often cover difficult terrain.

Farming and fishing are probably the most dangerous jobs around. Workers in these sectors are at higher risk of suffering serious accidents, and these jobs are also more densely concentrated in these areas.

Also, people who move to idyllic-looking farmhouses to retire don't factor in that – as they get older and inevitably get sicker too - ambulances might struggle to reach them at the end of gravel tracks off a picturesque winding B-road in the Welsh Desert. And air ambulances might be tied up elsewhere.

Ambulances are too heavy and too slow - In 2013, around £9.5million was spent upgrading the Welsh ambulance fleet. Although they now carry very high-tech (and heavy) equipment – before factoring in the weight of paramedics themselves and patients – the ambulances are still glorified transit vans that can't negotiate corners particularly well and accelerate slowly. Over longer distances this will add up.

If you want an analogy, it's a bit like refurbishing the interior of a train or bus to business class standards, but the bus/train itself remaining a clapped out diesel from the 1970s.

There's little the Welsh Government and Ambulance Trust can do here, and the onus is on ambulance manufacturers to create faster, lighter vehicles. Perhaps there should be more use of motorbikes and cars for first responders, while using larger ambulances solely to transport patients to hospital and stabilise complicated conditions.

There's at least 8 ambulances I can see that can't go on another urgent 999 call.
(Pic : Morriston Hospital via cardifflocalguide.co.uk)

Delayed transfers at Accident & Emergency departments – Now this is something you really can criticise the Welsh Government for. It's their job to ensure there are enough medical staff, and that hospitals are well-resourced enough, to see whoever comes through the door.

Every minute an ambulance spends outside A&E departments waiting to discharge patients is a minute that ambulance is out of action. There are acute problems in Cardiff in particular, and it occasionally happens at other hospitals, such as Morriston Hospital in Swansea and Princess of Wales Hospital, Bridgend.

With the forthcoming centralisation of specialist services in south Wales, I'll actually expect this problem to get worse, as treating capacity hasn't been dealt with. They might stand a chance of being seen by staff quicker, but as far as I can tell there'll be the same number of beds to treat them.

This is the main reason why, in my opinion, you end up hearing of extreme cases of people waiting hours for an ambulance to show up. It's simply because all the ambulances are tied up outside A&E departments waiting to offload patients.

Compassion fatigue & "false alarms" - "Compassion fatigue" is a mild form of post traumatic stress disorder that affects people who deal with harrowing things every single day (like paramedics and A&E doctors), and it even affects the general public when we're bombarded with bad news or sob stories. We eventually get used to it to such an extent we don't care anymore. How many times have we been told the Wales Ambulance Trust are over-worked, under-staffed and poorly-managed?

For medical staff this becomes cynicism and a lack of genuine compassion for patients. This in turn may lead to complacency in care and poor morale. I doubt you would ever get paramedics to admit it because the trade unions will go ballistic and on the defensive. But I'm willing to bet on some calls they'll let standards slip because they've had enough crap for one day.

Then there are people calling for an ambulance when they don't really need one, tying up more resources. It's easy to criticise people who do this as time-wasters or hypochondriacs, but it's often better to be safe than sorry. Welsh Government public information campaigns on this have clearly failed.

The McClelland review recommended that the 8 minute target be ditched.
- something AMs have conveniently forgotten.
(Pic : Telegraph and Argus)

The targets are too ambitious – Not all Category A 999 calls need to be responded to within 8 minutes. With improved medicines and treatments, things that would've once killed people – like heart attacks and strokes – are now increasingly survivable, even if a patient doesn't reach hospital in the "golden hour" (which some academics and medics have called a "myth").

That's no reason to be complacent, and there is evidence that suggests the sooner an ambulance reaches a patient who's suffering a heart attack, the greater the chance of survival (Pell, Sirel, Marsden et. al 2001).

However, just to point out how silly the 8 minute target is (as pointed out in the McClelland review), if an ambulance reaches a patient within 8 minutes and they die, they've met the target. If they reach them in 8 minutes 30 seconds and save the patient's life, they've missed the target. That's ridiculous, and no wonder paramedics must hate their job (Price, 2006) when those are the twisted standards they're held to by managers and politicians.

Echoing what was said in the McClelland review, the target should be based around the patient's outcome (for argument's sake, all Category A patients should be admitted to hospital within 40 minutes of the 999 call with a chance of survival), not a stopwatch.

What are the Welsh Government doing about it?
                                  

You've got to say that if these are the sorts of problems facing the ambulance service, then there's very little the Welsh Government can do other than implementing some of the recommendations from the McClelland report and keeping their fingers crossed.

Ditching the 8 minute target – however rational it would be - would be an absolute god-send to opposition AMs. It would probably send the Tories in particular into screams of ecstasy on the Senedd benches, as it'll be on every election leaflet in 2016, accompanied by a photo of an elderly actor/actress having a "chest-clutcher" on the stairs. So it's unlikely to happen due to politics, even if shifting the goal posts is in vogue at Cathays Park.

However, in the last fortnight or so, the new Deputy Minister for Health, Vaughan Gething (Lab, Cardiff S. & Penarth), made a major announcement on this.

The Welsh Government have earmarked around £5million towards the creation of an Emergency Medical Retrieval and Transfer System (EMTRS) service. In English, that means an expansion (you could even say a part-nationalisation) of the Wales Air Ambulance - dubbed "Flying Doctors" after the cheesy 1980s Australian drama, though it's probably more comparable to M.A.S.H. It'll operate for 12 hours a day, and will be based in Swansea and Welshpool.

The idea's that trained doctors and consultants will be airlifted to serious incidents with equipment so patients can be treated at the scene instead of waiting for an ambulance to take them to hospital to be treated. If it works, it's said 95% of the population will now be within 30 minutes of doctor-led emergency care.

The EMTRS is probably an act of desperation, but as an idea it's incredibly sensible, practical and I'm surprised it hasn't been attempted a lot sooner.

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NHS Wales : Who watches the watchers?

Welsh Labour might've been concerned about Ann Clwyd MP giving
evidence to an Assembly committee, but the inquiry produced
productive and sensible proposals for the NHS complaints system.
(Pic : BBC Wales)

While there's a lull in Assembly activity until AMs return from recess, it's worth returning to the committees and what has become one of the more high-profile and contentious inquiries of the Fourth Assembly due to the dirty laundry it aired and embarrassment caused to the Welsh Government.

The Assembly's Health & Social Care Committee undertook a short inquiry on the last day of the Assembly year (16^th July) into the NHS Wales complaints system. As a result, Committee chair David Rees AM (Lab, Aberavon) sent a 17-page letter (pdf) to Health Minister Mark Drakeford (Lab, Cardiff West) on August 5th outlining the key issues raised during their investigation.

The inquiry made headlines for more than one reason, the most notable headline being that Labour MP for Cynon Valley, Ann Clwyd, accepted an invitation to give oral evidence following well-publicised personal experiences of patient care at Cardiff's University Hospital.

It was doubly pertinent as the complaints system was one of the main grievances arising from the Andrews Report into care standards at the Princess of Wales Hospital and Neath Port Talbot Hospital in Abertawe Bro Morgannwg Local Health Board (Abertawe Bro Morgannwg : Trusted to care?).

The Key Issues

Fear of reprisals against whistle-blowers and inadequate resources to deal
with complaints were just a few of the concerns thrown up by the inquiry.
(Pic : Daily Mail)

Insufficient independent regulation of complaints – The police, for example, have the Independent Police Complaints Commission (IPCC), but there's no similar body for NHS complaints. The need for such a body was highlighted for those cases where complaints handled by local health boards (LHBs) don't result in any concrete actions. LHBs accept the need for an independent regulator, while the Welsh Government have launched a review of the functions of Healthcare Inspectorate Wales (HIW) as a result of a previous committee inquiry. The Committee recommended that independent complaints regulation be considered by the Health Minister if LHB governance arrangements are "inadequate".

The role of Community Health Councils (CHCs) – This was another area picked out for criticism in the Andrews Report and I've often said myself that I consider CHCs to be largely useless; both as a mechanism of accountability for LHBs and as a result the paralysis caused by a Welsh obsession with setting up committees instead of coming up with new policies. The performance of CHCs was "variable", and there were calls for improved training, improved leadership and greater public awareness of what CHCs are supposed to do (represent patient's views).

Accountability & Leadership – There were two parts to this. The first part dealt with local health boards and trusts. It's said there've been insufficient resources made available to improve management, and a "gap" had developed between the complaints process and boardrooms. Ann Clwyd agreed that the responsibility ultimately lay with LHBs, calling for more openness in how they operate and use of easy to understand language. LHBs have taken steps to improve matters down the years, such as : "ward walks", proactively encouraging patient and staff feedback, meeting with complainants etc. This was welcomed, but the Committee recommended that LHBs take complaints more seriously.

The second part looked at the Welsh Government's role. It was agreed that complaints handling should be considered alongside financial and clinical targets when evaluating the performance of individual LHBs.

Sharing best practice – Due to the variation in performance between individual LHBs, the importance of sharing examples of good complaints handling was flagged up. LHBs said they were keen to learn from each other, but there were concerns that the structure of NHS Wales prevented quick sharing of new ideas.

Staff concerns – UNISON warned that complaints handlers were "under-resourced" and subsequently "under immense pressure". Staff need to be highly trained due to the complex situations they deal with, ranging from dealing with bereaved relatives to co-ordinating complicated clinical information. Cardiff and Vale LHB were, therefore, open to the idea of a national complaints team to deal with the most complex cases. Poor communication from front-line staff was also flagged up as a reason for complaints relating to poor customer service.

Primary care complaints – The current complaints system didn't adequately cover GPs and dentists. LHBs and the British Medical Association (BMA) said that the focus was often on secondary (hospital) care and was therefore not useful enough for primary care. The Committee asked for reassurances from the Health Minister that recommendations from various reviews will apply to all levels of the NHS.

Recording of incidents and complaints – Ann Clwyd said many minor complaints could be "resolved by the bedside". It was also said that lots of minor complaints could be a symptom of bigger issues that could lead to "catastrophic disasters" down the line. The BMA, however, added that logging every minor complaint would be "burdensome". The Committee recommended comment books as a way to log smaller complaints.

Staff support – It's said a "blame culture" in the NHS makes staff afraid to speak out when things are going wrong, with nurses said to be reluctant to fill out incident reports or give their names. Abertawe Bro Morgannwg LHB have subsequently instituted a "See it, say it" campaign to encourage staff, patients and relatives to report issues. Ann Clwyd added that honesty was important so everyone feels they're empowered enough to speak out if something is wrong. Staff should also be able to raise issues openly, but it's said 44% of staff would think twice before whistle-blowing for fear of reprisals.

Complaints data – There's little analysis of complaints data at an all-Wales level and such data is rarely made public. There was support for making complaints data available to the public via the My Local Health Service website – as long as individuals can't be identified.

Response times to complaints – LHBs recognise their response times (there's a 30 day target to issue a final response to a complaint) simply aren't good enough. However, they say quality of response is as important – if not more so – than speed. Face-to-face contact with complainants was said to be important too, as well as maintaining communication with complainants throughout the process. In Powys LHB they've tried to do this by contacting complainants as soon as a complaint has been received to tell them it's being dealt with.

Time for an Independent NHS complaints regulator?

After the committee's recommendations, has the time now come for a national
NHS complaints system to help prevent sad scenes like this being repeated?
(Pic : Wales Online)

The Health Minister hasn't responded to the letter yet, and I presume he'll respond to the committee once the Assembly returns from recess. Most of the recommendations and suggestions from the inquiry are common sense and it's depressing and frustrating that a lot of this hasn't already been done. It could've saved the Welsh Government, AMs, LHBs and families a lot of trouble.

The Public Services Ombudsman is supposed to act as an independent regulator (of sorts), but I suppose we should consider whether all but the most minor NHS complaints need to be dealt with independently at an all-Wales level - perhaps as part of Healthcare Inspectorate Wales' remit. I don't think LHBs and CHCs can be trusted to deal with complaints anymore as too many people have been let down by the current system and there's too much variation between health boards. It's also putting too much pressure on front line staff.

All that was hinted at in the inquiry, and having a team of fully-professional complaints handlers and analysts might take the heat off front-line staff and make it easier to notice trends and patterns which indicate deeper problems at specific hospitals. Making senior charge nurses (aka. matrons) the single point of contact for minor complaints on each ward might make things easier too.

Hopefully it would all feed in to a single transparent complaints system that people know won't be bogged down and shuffled around on bits of paper in board meetings, will be independent of LHBs and won't victimise either staff or complainants.

If the Welsh NHS can start to deal with complaints with candour - and, more importantly, actually deal with problems no matter how small - maybe it'll begin to rebuild the trust that's been lost over the last few years.

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It's trough at the top for little piggies

This little piggy went to the High Court,
This little piggy got too much compo,
This little piggy awarded themselves a massive pay rise,
This little piggy had a tax-friendly pension pot,
And this little piggy went wee, wee, wee didn't see anyfink, guv.
(Pic : michaelkonkik.com)

I'm coming to this late, but as reported by Y Cneifiwr, Carmarthenshire Planning, Inside Out, National Left and others last week, auditors have uncovered foul-ups in the annual accounts of Carmarthenshire, Pembrokeshire and Caerphilly councils.
Carmarthenshire Council frolics in own filth

Two payments relating to Carmarthenshire Council's (CCC) Chief Executive Mark James were – in the auditor's unqualified opinion (an auditing term generally meaning "without reservation") – unlawful :

• £23,217 of indemnity funding used by CCC in libel action (against Carmarthenshire Planning's Jacqui Thompson).
• £16,353 paid directly to Mark James in lieu of employer pension contributions to the Dyfed Pension Scheme.

The first one probably breached Welsh Government regulations outlawing the use of public funds by local authorities to undertake (rather than defend) libel actions.

Local Authorities (Indemnities for Members and Officers) (Wales) Order 2006 :

6 (3) No indemnity may be provided under this Order in relation to the making by a member or officer indemnified of any claim in relation to an alleged defamation of that member or officer but may be provided in relation to the defence by that member or officer of any allegation of defamation made against that member or officer.

Jacqui Thompson was lumbered with CCC's costs, not only of their defence but their counter-claims too. As she said herself last week, it's probably best not to comment on the ramifications of the auditor's findings for the time being.

The second payment would've been made anyway. Pension contributions can be paid directly to the employee (or rather, the employee's private pension) instead of an occupational pension fund, but that's sometimes ofset by salary cuts (known as a salary sacrifice).

CCC highlight "changes to the tax system" that make occupational pension schemes unattractive to high-earners (Mark James currently earns ~£209,000 in salary + other contributions).

If it's been deemed unlawful then it might relate to how the payment was made (i.e. not following standard accounting/governance procedures) rather than the payment itself. Carmarthenshire residents now have a very useful list of the councillors who approved these changes in 2011. I'm sure the names will be familiar.

It's worth touching on the mystery of the just over £20,000 advance Mark James received for his role as returning officer in the 2012 local elections too.

CCC don't know precisely when it was paid, which is odd, as returning officer payments are usually (but not always) made after an election when the precise number of candidates is known (as that's what the payment's based on). Those sums of money, you would've thought, would've been rigorously tracked too - receipts and things like that.

It appears Carmarthenshire are the only local authority in Wales having trouble providing this information, as highlighted by this thread on Aberdare Online.

The advance wasn't picked out by the auditor. However, considering the timing (towards the end of the tax year) of both the advance and changes to the pension rules, there's the possibility the two could be linked, who knows?

Pembrokeshire pork : Littlest tax haven beyond Wales

In Pembrokeshire, BBC Wales report the Wales Audit Office refused to sign off their audit of Pembrokeshire's annual accounts because of a similar pensions arrangement for their Chief Executive, Bryn Parry-Jones (salary + other contributions ~£194,000), and other senior officers. There's a more detailed account on this from Independent Cllr. Jacob Williams.

Pembrokeshire Council have since, as reported by Y Cneifiwr, signed off the annual accounts themselves following a narrow vote in favour by councillors, carried by the ruling Independent Plus Group and opposed by Cllr. Williams himself, other non-affiliated Independents, Conservatives, Labour and Plaid Cymru.

Both Pembrokeshire and Carmarthenshire councils point to similar schemes run by housing associations and universities, but they're not public sector organisations run by public servants from public funds.

Entering into arrangements like this during a time of austerity, trying to do it in secret, and expecting it to go unnoticed is both arrogant and idiotic. It also appears Pembrokeshire and Carmarthenshire are the only local authorities doing it in Wales. Even Caerphilly weren't that dumb, and they're up to their necks in it as I'll return to later.

These are prominent people at the top of the Welsh public sector, earning significantly more than the First Minister (who's currently entitled to around ~£135,000, not including expenses and pensions), opting-out of the same pension scheme their employees pay into - many of whom have seen their own pay, working conditions and jobs under threat. By doing so, they're avoiding tax obligations too.

I wonder what ordinary council employees, the public and trade unions think about that?

The Wales Audit Office are carrying out their own separate investigation following complaints, but CCC dispute the findings, claiming they had an "OK" from the Wales Audit Office and independent legal advisers for the first two payments, and seem disappointed the auditors have "changed their mind."

You've also got to question why independent legal/financial advice was sought to cut the head honcho  tax bills. As others have pointed out, independent advice doesn't come cheap. If it's about retaining experienced, top-performing staff, these cock-ups show the current recipients are hardly a ringing endorsement for that line of thinking at the moment, are they?

The local AM, Rhodri Glyn Thomas (Plaid, Carms. E & Dinefwr), described it as "exceptionally damaging for the reputation of Carmarthenshire", and here's an edited transcript of what was said in the Senedd last week:

Rhodri Glyn Thomas – Minister....You will know that I have raised the issue of the use of public funding for indemnifying officers.....the report....refers to two issues of unlawful expenditure by the council—one being the issue of indemnity to the chief executive in a libel case. I know you have not had an opportunity to read the report, but will you investigate this matter, because they are very serious allegations?

Local Government Minister, Lesley Griffiths (Lab, Wrexham) - The allegations you mention are serious, if that is the case. I met the Auditor General for Wales on Monday of this week, and that issue was not raised with me. Obviously, it would not be appropriate for me to comment if it is an ongoing audit.

Rhodri Glyn Thomas - The report has been published by the auditor appointed by the Wales Audit Office, but the next step will be for it to be considered fully by the Wales Audit Office....I hope that you will read it and I hope that you will raise this matter with the auditor at some point.

Lesley Griffiths - I will certainly read it, and I will raise it with the auditor general in due course.

Plaid in Caerphilly distracted by frying sausages

Rule #1 of political point scoring : If you're going to criticise another
party/politician, be 100% sure you can't be criticised for the same thing.
NB : Ensure your reasoning is better than "I didn't see nuffink."
(Pic : psychologicalscience.org)

Next, it's time to move to Caerphilly, and what a whopper we have there!

In addition to an ongoing (and largely unrelated) fraud investigation by Avon & Somerset Police, auditors ruled that £218,000 of compensation payments made to two senior Caerphilly council staff in return for withdrawal of car allowances were also unlawful. What were they driving? Bugattis!?

As much as Independents in particular, and Labour, are involved to varying degrees in all three authorities, Plaid Cymru are complicit in the Caerphilly car allowances as they ran the council in coalition between 2008-2012.

The notion that a former council cabinet member in charge of finance would have "no knowledge" of £218,000 is - to be frank - taking the piss, regardless of whether that's wilful ignorance or not being informed properly.

The £218,000 is (presumably) in addition to £1.1million in senior officer salary rises after May 2012, when - I'll helpfully point out - Caerphilly became a Labour-controlled administration, and the pay hikes were passed by Caerphilly Council's elected boneheads earlier this year. They saw you coming!

These issues are not political as they could've happened anywhere because of how local authorities are governed. Those with ultimate responsibility for what goes on in our local authorities are officers and the senior councillors who approve their decisions - regardless of party. All you have to do is follow the money and deal with the facts at hand.Appeals to hypocrisy, even if it's logically fallacious and lazy, is one of the most popular political defences there is. Pity those who give opponents the opportunity to use it against them, descending into a bunfight and race to the gutter over whom is worse than whom. It's not going to get the money back.
The collective common sense of a bacon roll

Councillors generally just spinelessly rubber-stamp whatever's put in front of them (though they should damned well pay attention to what is put in front of them) because "officers know what they're doing."

You rarely (if ever) hear of councillors from ruling parties/coalitions telling officers "no" - which should happen in a healthy democracy. I'd go as far as say that cabinet positions in Welsh local government are a sham, and even if we had no councillors at all I doubt it would make any difference to how local authorities are run on a day-to-day basis.

The irony here that the chief executives in question might not have done anything wrong personally, but could be implicated by the actions of those around them. The more cynical amongst us could also call those around them "fall guys", "human shields" or use the term "plausible deniability".

They're not running personal fiefdoms. They'll be found out the moment the arrogance that results from "little mistakes" not being investigated properly, bad advice, lack of transparency, or favourable verdicts by auditors or elsewhere, morphs into big mistakes where they've painted themselves into a corner through laziness, stupidity, self-serving nefariousness or a toxic combination of all those things.

Ignorance is gross incompetence, because officers and senior councillors should be following basic accounting procedures and keeping a grip on what goes on under their noses.

Doing it knowingly or willingly (i.e. keeping information from councillors, attending meetings and not declaring interests when they should be declared) is misconduct in public office, possibly fraud. The sums of money involved are good grounds for immediate dismissal, or at the very least suspension (as proposed by Labour's leader in Pembrokeshire), and you would expect heads to roll.

In Wales? Yeah right, and pigs might fly.

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Whipperines & Class Clowns

I'm on a "break" of sorts, mainly because there's not much to write about. I still have big posts to come before Assembly returns from recess though.

I'm working on a "little something" for September. I think most reading this will be interested, you'll just have to be patient and hope I don't suffer a mental breakdown in the next few weeks. "Stay tuned" for that - hint, hint.

There's a bit of Assembly-related news from last week, with the Children & Young People's Committee publishing a report into their attendance and behaviour inquiry (pdf).

I would've normally glossed over that, but because of the "lull", I decided to take a closer look and it threw up some interesting evidence and conclusions.

There were 12 recommendations, summarised as :

• The Welsh Government should develop new frameworks and strategies relating to attendance and behaviour, and should investigate bullying's links to poor attendance.
• Improvements to teacher training, with "evidence-based" behaviour management training as part of their ongoing professional development.
• Explore the possibility of delivering services relating to educational welfare and behavioural support at a regional level.
• A rejection of fines for parents of persistent truants, based on evidence presented against that measure which the committee received.

Whipperines : School Attendance

Although the stereotype is of feral youths who don't want to learn,
cited causes of truancy include bullying, home problems and
difficulties with lessons.
(Pic : Daily Post)

If pupils don't go to school regularly, they don't attend lessons, they don't get homework and so they don't learn anything, setting them up for failure.

Absenteeism in schools is described as "stable", with unauthorised absences running at roughly 0.6-1% since 2002-03. Absence rates are used to determine school bandings (My Local School), so rates have improved since banding was introduced.

During the inquiry's focus group, the main reason for unauthorised absence given by pupils themselves were bullying or a general "lack of desire to attend school". Boredom during lessons and difficulties with schoolwork were also cited, along with home life problems like caring for relatives and drugs. They called for more understanding about their individual needs instead of a "one size fits all" policy.

Specific problems with attendance were highlighted during the period between primary and secondary schools (ages 8-14) and it's said that this period is where pupil attainment "follows a downward trajectory".

One thing cited by Estyn as a successful way of reducing absenteeism amongst "difficult-to-reach families" are so-called "first day response" procedures, where schools contact a parent directly on the first day of any absence. The committee decided they want more evidence on the effectiveness of this approach.

There was evidence of a shortage of Education Welfare Officers (aka. whipperines) in Wales, or at the very least a "considerable variation in service between local authorities", hence the suggestion of a regional approach to use EWOs better.

The evidence presented against fixed-penalty notices for truancy introduced by Leighton Andrews (Lab, Rhondda) was brusque.

A school governors representative described the truancy fines proposal as "disastrous", for undermining the "good relationship between staff, parents and pupils." None of the witnesses are said to have supported it, and evidence presented to the committee pointed towards "reward systems" for good attendance rather than punishments.

The fines are set to be introduced from September 1^st and could be between £60-120.

Class Clowns : School Behaviour

Although permanent exclusions are becoming less common,
extreme behaviour is said to be becoming more common amongst
primary-age pupils and those with special needs.
(Pic : educationviews.org)

Good pupil behaviour is essential to ensure a decent learning environment for pupils, and enable teachers to get on with their jobs without having to deal with "distractions".

Pupils themselves agreed that : bullying, being disruptive in class, being disrespectful to staff, smoking and vandalism counted as "bad behaviour". They also agreed that bad behaviour from other pupils prevents them from learning. Suggestions to reduce bad behaviour included more outdoor and "fun" lessons, and more one-on-one time with teachers.

Fortunately, permanent exclusions are said to be decreasing, and currently run at a rate of around 0.7 pupils per 1000. The main reasons for exclusions are said to be assaults against staff or persistent "defiance of rules".

Less fortunately, "extreme behaviour" is said to be increasing in primary schools, with greater prevalence amongst boys and those with special needs (who made up to half of all exclusions in 2010-11).

With regard exclusions procedures themselves, there was worrying evidence that schools were "illegally excluding" pupils by simply telling them to stay away, without officially notifying parents/guardians of the exclusion (or presumably recording it). A 2007 report from the Children's Commissioner said that the practice was "widespread".

There was contradictory evidence regarding ongoing illegal exclusions, with the National Association of Headteachers saying they would be "surprised" if the practice was still happening in 2013. Meanwhile, SNAP Cymru – a children's charity - claimed they had worked on 92 cases of illegal exclusion, including one highlighted case where a pupil with Asperger's Syndrome was asked to take an "early holiday"  during an inspection period.

AMs themselves have come across similar cases through their constituency work, but there was little official evidence of the practice. That's perhaps for obvious reasons - schools want it hushed up, and it's off the official record.

For those who are excluded, or moved to out-of-school Pupil Referral Units (PRUs), Estyn said specialist teaching staff at these institutions were "well trained and confident" about working with troubled pupils. However, there were issues regarding the management of individual pupil's needs. Teaching unions called for a "properly resourced national network" of PRUs.

PRUs based within school sites are said to be too old in terms of facilities. Also, some pupils ending up in on-site PRUs for long periods instead of returning to normal classes.

In terms of the wider issue of education for excluded pupils, education is still compulsory for them, and they're entitled to 25 hours per week, starting within 15 days of exclusion. SNAP Cymru say this simply doesn't happen, and excluded pupils are "lucky to get 5 hours a week"- if that. It's usually then left to parents.

The introduction of trained school counsellors is said to be important, with a "positive impact on attainment, attendance and behaviour" amongst children who've received help.

One other big issue raised was that of parental attitudes towards punishments. There are varying levels of engagement and support, with some parents outright refusing to support any measures taken against their children, or unwilling to accept any wrong-doing. This usually results in lengthy compromises instead.

Conclusions

It's a basic duty of every parent to make sure their child behaves themselves at school and attends regularly. It's disappointing to read that some parents don't accept their little angels might not be the cherubs they think they are, but it's not a surprise unfortunately.

As you can tell by the tone of the language used in the report, this was unusually critical of some aspects of the Welsh Government's approach and policies here.

The headline-grabber was the rejection of truancy fines. It was clearly part of Leighton Andrews' more aggressive approach to driving up standards, but it remains to be seen if that's going to be Huw Lewis' style. With only a few weeks until the fines are set to be introduced and regulations drawn up, time's running out for the Education Minister to pull the plug if he's convinced by this report.

The warning is that several perfectly good things Leighton did during his tenure could end up being overturned if a u-turn here encourages teaching unions to press for more policy reversals.

I believe fines are appropriate with regard persistent truants, but only when all other options have been completely exhausted. I don't like reward schemes, as pupils shouldn't be "bribed" to go to school, as it could teach them that they should expect prizes for doing something they should be doing anyway.

On school behaviour, the "illegal exclusion" issue borders on scandalous. That could be in part because schools have become so wound up about inspections and bandings that they might feel the need to shunt misbehaving or difficult pupils out of sight. It could also be that headteachers and local authorities are just too damned lazy to sort out the core problems themselves. It's one area where the "Third Sector" should perhaps become more involved in if individual schools can't cope.

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