Eitem 10 sydd nesaf, dadl y Ceidwadwyr, unwaith eto, ar ofal lliniarol, a dwi'n galw ar Mark Isherwood i wneud y cynnig. 

Cynnig NDM8239 Darren Millar

Cynnig bod Senedd Cymru:

1. Yn nodi'r adroddiad y Grŵp Trawsbleidiol ar Ofal Hosbis a Gofal Lliniarol ar brofiadau gofal lliniarol a gofal diwedd oes yn y gymuned yn ystod pandemig COVID-19.

2. Yn cydnabod bod gofal hosbis a gofal lliniarol wedi chwarae rôl hanfodol yn ystod pandemig COVID-19, a bod y gofal hwnnw wedi mynd uwchlaw a thu hwnt o ran cefnogi cleifion a'u teuluoedd.

3. Yn gresynu at y ffaith bod rhai pobl wedi wynebu anawsterau yn ystod pandemig COVID-19, o ran cael mynediad at ofal diwedd oes yn y cartref ac mewn cartrefi gofal, er gwaethaf ymdrechion gorau'r rhai sy'n gweithio ym maes iechyd a gofal cymdeithasol.

4. Yn cydnabod y rhagwelir y bydd y galw am ofal lliniarol yn y gymuned yn dyblu erbyn 2040 a bod y pandemig wedi rhoi cipolwg o sut y bydd y system iechyd a gofal cymdeithasol yn ymdopi o dan bwysau tebyg yn y dyfodol agos.

5. Yn galw ar Lywodraeth Cymru i:

a) gweithio gyda'r sector gofal lliniarol i ddysgu o bandemig COVID-19, a sicrhau bod gofal lliniarol wrth wraidd cynlluniau ar gyfer pandemigau posibl yn y dyfodol;

b) blaenoriaethu datblygu gallu gofal lliniarol yn y gymuned, uwchraddio arferion da sy'n bodoli eisoes, a dal pawb sy'n agos i gleifion, gan gynnwys plant;

c) sicrhau bod penderfyniadau gweithlu a chyllid yn blaenoriaethu llesiant, staffio, addysg ac anghenion hyfforddi'r rhai sy'n gweithio ar draws y sbectrwm llawn o ofal lliniarol a diwedd oes.

Cynigiwyd y cynnig.

Diolch, Llywydd. Our motion today notes the cross-party group on hospice and palliative care's inquiry on experiences of palliative and end-of-life care in the community during the COVID-19 pandemic in Wales. The motion is based entirely on the evidence-based report resulting from this, which sought to give people and organisations at the very sharp end of the pandemic a voice and a platform. The report summarises the written and oral responses received, detailing experiences of palliative and end-of-life care in people's homes and care homes during the pandemic. The majority of respondents gave evidence based on their own individual, personal and professional lived experience as family members, unpaid carers, social workers, nurses and doctors.

It is clear from those contributions that the COVID-19 pandemic turned the world of palliative care on its head, dramatically disrupting the lives of individuals at the end of life, their loved ones, and the health and social care workers supporting them. I express my thanks and gratitude to the family members, carers, nurses, doctors and many others who generously shared their often heartbreaking but also uplifting and insightful accounts of caring for some of our most vulnerable citizens during the most testing of times. We wanted to learn from their experiences of end-of-life care at home, and in care homes, so that we can be better prepared for any future disaster, and better placed to meet the ongoing impacts of COVID and the cost-of-living crisis. We believe this is more important than ever before, considering demand for palliative care in the community is forecast to nearly double by 2040, and the pandemic has given us a glimpse into how our health and social care system will cope under similar pressures in the not-so-distant future. Our motion today incorporates this, and acknowledges that during the COVID-19 pandemic hospice and palliative care played a critical role and went above and beyond in supporting patients and their families.

Key findings from the inquiry include that visiting restrictions in care homes and other settings caused untold pain and distress, leaving many patients and their families isolated at the end of life, leading to cases of complex bereavement. Many people had devastating experiences of caring for loved ones at home, and struggled to access adequate palliative care support. People at the end of life faced difficult and tragic transitions between home, hospital and care homes. Pandemic responses sparked a revolution in collaboration, creative working and use of communication technology across health and social care services delivering palliative care. Care home staff and those working with them were at times concerned with hospital discharge into homes and the use of 'do not attempt cardiopulmonary resuscitation' decisions.

There were widespread shortages of staff, personal protective equipment—PPE—and end-of-life medication, impacting on the delivery of vital palliative care. Infection prevention and control measures within homes added to disruption, often requiring residents to isolate in their rooms for long periods of time. As a consequence, many faced social isolation, often resulting in a significant decline in their mental and physical well-being. The use of protective masks made what little contact carers and residents had more difficult. This was particularly devastating for those with a communication difficulty or cognitive impairment, who were disproportionately affected. 

Our report found that lack of PPE and shortages of end-of-life medication, especially in the early days of the pandemic, were common issues reported by health and social care workers providing palliative care in the community. In many cases, palliative and social care workers were reliant on donations or makeshift PPE items such as visors, scrubs and masks from the local community, and described feeling fearful for their safety. Evidence from Marie Curie cited a study where almost half of healthcare respondents in Wales reported shortages of PPE and insufficient training in its use, affecting their ability to provide care to patients. The same study found respondents from Wales were more likely to experience medication shortages compared to other parts of the UK, with more than 40 per cent describing scarcities in end-of-life medication. 

Our report therefore recommends that the Welsh Government should ensure that palliative and end-of-life care is at the heart of plans for potential future pandemics, and works with families and professionals to review how future visiting regulations could be enacted in a more compassionate and consistent way for those with a palliative care need, and that the findings and recommendations of the UK COVID-19 inquiry must be informed by the lived experience of people in Wales, and recognise the impact the pandemic has had on the nation's healthcare systems, specifically for people at the end of life. 

Although the formal response to our report, received from the Welsh Government yesterday, accepted the first of these recommendations, it is concerning to note that the accompanying text makes direct reference only to 'consulting' with families and professionals whose personal experience was based outside NHS settings, rather than to working with them to review how future visiting regulations could be enacted in a more compassionate and consistent way for those with a palliative care need.

Whilst the Welsh Government response stated that the second of these recommendations is not applicable to them, they say that they're supportive of it, and state that the UK COVID-19 public inquiry is fully committed to gathering information about the lived experiences of people in Wales, and across the UK in general. However, COVID-19 Bereaved Families for Justice Cymru expressed their continuing concern to me in the Senedd last week that the format of the UK inquiry will prevent it being fully informed by their lived experience. 

Our report also found that the pandemic saw a massive increase in demand for palliative and end-of-life care in the community, with deaths at home increasing by over 30 per cent, and continuing at this level today, while deaths in care homes and hospitals have returned closer to pre-COVID levels, after peaking at the start of the pandemic; that palliative care was prioritised and redirected in communities to meet increases in demand; that hospice and palliative care services that were more community-orientated and integrated before COVID were better placed to meet the challenges of the pandemic; that despite the incredible efforts of those in health and social care, people still experienced a lack of palliative and end-of-life care support in their homes, and relied heavily on families and friends at the end of life; and that, at times, care homes faced challenges accessing palliative and end-of-life care, and often felt less valued than recognised healthcare settings. 

The cross-party group heard troubling accounts of some care homes being leaned on to take patients who had, or were suspected to have, COVID, as well as confusion over the best place to care for them. Care home staff said such situations placed them under enormous pressure, and created real concerns for residents and their families. Such experiences made them feel the care home sector and its residents had been forgotten, and were seen as less valuable in the wider Government message to protect the NHS. 

Our motion regrets that during the COVID-19 pandemic, some people faced difficulties access end-of-life care at home and in care homes, despite the best efforts of those working in health and social care. Our recommendations included that the end-of-life care funding review should prioritise the development of palliative care capacity in the community, with the aim of making care at home and in care homes equal in prioritisation to in-patient care, starting with improving out-of-hours support, and ensuring that people have a single point of access to co-ordinated care. Also, that the national programme board for palliative and end-of-life care, supported by Welsh Government, should develop a detailed implementation plan for the new quality statement for palliative and end-of-life care that ensures that people's priorities for place of care are reflected in workforce planning and investment at the local level. And that the Welsh Government should ensure that palliative and end-of-life care in the community is hardwired into the development of the new national care service and national framework for social care, and involve people with personal and professional lived experience in this process.

Although the Welsh Government accepted these recommendations, the accompanying text fails to acknowledge that non-statutory providers of vital care in the community, including hospices and care homes, must be directly involved in the design and delivery of related future services. Our motion asks the Senedd to call on the Welsh Government to work with the palliative care sector, to learn from the COVID-19 pandemic, and ensure that palliative care is at the heart of plans for potential future pandemics. And to prioritise the development of palliative care capacity in the community; and ensure that workforce and funding decisions prioritise those working across the full spectrum of palliative and end-of-life care.

As Marie Curie told us, substantial and sustained support is required to ensure that palliative care has the workforce it needs into the future. Diolch yn fawr.

Diolch am gyflwyno’r cynnig heddiw, Mark Isherwood. Dwi'n falch iawn o gael cymryd rhan yn y ddadl yma, ac yn ddiolchgar iawn am y gwaith gafodd ei wneud gan y grŵp trawsbleidiol gofal hosbis a lliniarol yn creu yr adroddiad fu’n sail i'r cynnig yma o'n blaenau ni heddiw. Ac, wrth gwrs, mae eisiau cofio am bob un unigolyn fu’n rhan o'r broses ymgynghori am rannu eu profiadau cyn ac yn ystod y pandemig. Fel mae'r adroddiad yn ei ddweud, mae mor, mor bwysig bod y ffordd rydym ni'n darparu gofal lliniarol a gofal diwedd oes, y ffordd rydym ni'n cynllunio’r ddarpariaeth, yn newid o ganlyniad i ddysgu o brofiadau y pandemig. Mi wnaeth y pandemig danlinellu mewn ffordd glir iawn y problemau mawr sydd gennym ni ar hyn o bryd efo’r system ofal lliniarol a gofal diwedd oes sydd gennym ni yng Nghymru. Nid yn unig oedd diffyg gwytnwch y ddarpariaeth i'w weld yn blaen, a'r diffyg blaengynllunio ar gyfer senario pandemig, er enghraifft, yn arwain at brofedigaethau ofnadwy o anodd—profiadau mor anodd i deuluoedd ym mhob cwr o Gymru, ond mi welwyd hefyd, wrth gwrs, bod y model cyllido elusennol hefyd yn fregus tu hwnt. Ond dwi'n ofni nad ydym ni yn gweld y mathau o wersi y byddem ni'n dymuno gweld y Llywodraeth yn eu dysgu.

It was very, very disappointing to see the announcement that children's hospices are not to receive an increase in financial support for provision of end-of-life care as part of the phase 2 funding and, with no timeline in sight for the commencement of phase 3, the hospices are growing increasingly frustrated and concerned about the future. I appeal to Welsh Government again today to remember the value that hospices offer, and that's the value in every sense of the word—the financial value, but also, more importantly, the value of knowing that we are giving the best care at the most difficult of times.

The pandemic, of course, also reminded us of the great potential that we have to deliver end-of-life care within our communities. The collective mindset that the pandemic brought out in all of us meant that, at a time when resources and space were limited, we could still provide a form of care for people in their final days, weeks of life. But we can't have a health system that over-relies on goodwill, and we shouldn't have to. As the report states, we could see almost a doubling of demand for palliative care by 2040—a doubling—and so, not only do we need to see an increase in provision in our current systems, a scaling up of the capacity that we currently have, we also have to consider how we can do things differently in future, how we could make use of communities to provide palliative end-of-life care in a holistic way that's comfortable, provides comfort not only for the patient but, of course, for their families. It'll need innovation, it'll need fresh thinking, that's why a report like this from the cross-party group is so important. But, inevitably, it will also need additional funding from Welsh Government, increasing resources, financially supporting families that are taking pressure off hospitals.

Now, from a policy perspective, the pandemic allowed experts in their field greater control over Government policy. If we have real intentions to put palliative care not only at the heart of plans for future pandemics, but also as a priority for a better health service in Wales in general, we must learn the valuable lessons of the positive impact that experts, driving ideas into the heart of the system, can have in leading and delivering on health in Wales.

I gloi, fel dywedais i, mae'r ddadl yma yn gyfle eto, onid ydy, i edrych ar y problemau penodol fu yng Nghymru yn ystod cyfnod y pandemig. Ond allwn ni ddim deall y problemau yna'n iawn, allwn ni ddim dysgu gwersi sy'n deillio o'r profiadau yna, oni bai bod penderfyniadau cafodd eu cymryd yng Nghymru yn cael eu sgrwtineiddio yn iawn yma yng Nghymru, a dyna pam ein bod ni ar y meinciau yma yn dal i alw am ymchwiliad cyhoeddus yng Nghymru. Ac, efo adroddiadau heddiw yn tanlinellu y broblem honno—y newyddion mai dim ond tair wythnos fydd yn cael eu rhoi i Gymru yn ymchwiliad y Deyrnas Unedig—sut allwn ni ddisgwyl i'r holl wersi sydd angen cael eu dysgu, yn cynnwys y maes gofal diwedd oes, gael eu trafod a'u dysgu?

I'm very grateful for the opportunity to contribute to today's debate. And firstly, may I pay tribute to the work of my colleague Mark Isherwood, and the work he's undertaken during his time in this place, to provide a voice on a subject that is often difficult and emotional to discuss? I also add my praise to those hard-working staff employed on the front line of the palliative care sector, either working hospices or providing end-of-life care in patients' homes.

My constituents in Carmarthen West and South Pembrokeshire are fortunate to be served by some excellent hospice and palliative care providers. The national providers, yes, but included in those are the local providers of Paul Sartori and Tŷ Cymorth, and I know that the staff at Paul Sartori made some valuable contributions to the cross-party group's report.

This is a subject matter that will touch a number of us and our families—mine included. The fact that demand for palliative care in the community is forecast to double by 2040, as Rhun mentioned—a date that still seems a long time in the future but is less than two decades away. The ability to meet these demands will only be achieved by ensuring that we look at new practices, offer new training and recruit and train new workforce. The cross-party group report touches on answers to many of these issues. It is certainly an impressive piece of work that resulted from the inquiry, and I commend all Members and stakeholders who contributed. Ahead of focusing on a few specific issues from the CPG's report, Westminster's health committee has this week taken evidence into their assisted dying, assisted suicide inquiry. They heard from Baroness Meacher, the chair of the Dignity in Dying organisation, who made the stark statement that, quote,

'Some people are having to choose between suicide, suffering and Switzerland'.

An emotive statement, but one that I feel rings true for a number of people entering the final stages of life here in Wales. Dignity in death is central to the findings of this report. Unfortunately, during the peak of the COVID pandemic, there were times when this was not possible. I will be interested to hear from the Minister, Deputy Minister, what lessons have been learnt from these experiences of three years ago, so that we are continually improving and best practice is shared and implemented.

I was concerned to learn that a decision was taken to wait until 2024 and the completion of another funding review before addressing the immediate cost-of-living pressures threatening hospice services right now. Staff costs are ever-increasing, with the expected NHS pay rise, which are likely to cost Welsh hospices at least £4.4 million per year. It is also worrying that a decision was not taken to approve the national programme board for palliative and end-of-life care recommendation for a £1 million one-off payment to support energy and fuel costs for voluntary sector hospice services.

Llywydd, hospice and palliative care services do not always get the priority and attention that they so deserve, but for many, they provide a vital service in the last days of life. Therefore, I'd be grateful for the Government's rationale on why these decisions have been made, given the impact on the future operation of hospices in Wales. Finally, during the last few weeks, we've seen a very public case of a terminal patient ceasing to have food and water given to them by a hospital for 28 days, expediting their passing, a practice referred to as the Liverpool pathway, which had been discontinued since 2014. This practice steals away that much-sought dignity in death. Can the Minister outline what safeguards are in place to ensure that patients on their passage from life to death are able to complete this journey with dignity and respect? Diolch, Llywydd.

I'm very pleased to take part in this important debate today. I think all Members are very conscious of the value of palliative care and end-of-life services in their own areas, and that certainly is the case with me. I'm very familiar with St David's Hospice Care; we're fortunate in Newport and around to have a really top-quality end-of-life and palliative care service through St David's Hospice Care. It's a consultant-led, in-patient hospice, with a 15-bed unit, and that can support people who have complex symptom-management needs and, obviously, provide that end-of-life care and sometimes, respite care. And the average length of stay there is, in fact, two weeks. Patients from Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen, as well as mid and south Powys, are catered for by the hospice. And, of course, what very many people really do value is the care at home that enables people to die with dignity, as other Members have said, at home, and as we know, that is the choice for very many people—to die in the comfort of their own home, surrounded by their own family. And St David's Hospice provides the quality services that enables that to happen.

I know that there are, of course, issues at the current time, and St David's Hospice has 18 nurses on permanent contracts. They pay their nurses the same rate as NHS nurses, and, of course, if NHS nurses' pay is increased, there will be major challenges for the hospice to do the same. So, I do think that we need to look at how we can support hospices like St David's in those circumstances, and also, with regard to annual energy bills—for St David's, a year ago, it was £125,000; it is now around £400,000 a year. So, obviously, a very substantial increase, and, again, an obvious need for support with those costs.

Llywydd, Tŷ Hafan is also a very much-loved charity that provides life-changing care and support for children with life-shortening conditions, and, of course, their families. They provide those specialist services in a very comfortable and welcoming environment, and they very much work with the whole family, assessing the needs of parents, siblings, and other family members, as well as the children with the particular conditions. And it's about offering personalised support, to give strength to patients and family, and to make happy memories and improve quality of life. Since they opened in 1999, they've actually supported over 1,100 children with life-shortening illnesses.

And I think we're also lucky in Wales, Llywydd, to have some good work taking place on these end-of-life services. Members have spoken about the expected increase in the need for end-of-life care as part of the ageing society that we have, and I think quite a lot of work has been done around that. The Institute of Welsh Affairs, for example, looked at dying well in Wales, and of the 34,000 people who die in Wales each year, at least 75 per cent would benefit from some form of palliative care, but, for many different reasons, 25 per cent of these people will not have access to the care and support they need. In the context of the increasing demand we know we're going to see, we really need to get to grips with that situation. And we also have the national bereavement care pathway, which is a model specification developed to improve access to high-quality bereavement care, and to reduce local and national inconsistencies. I think that really does bear close examination in terms of what's suggested to have top quality care in place right across our country.

Llywydd, in conclusion, palliative care is massively valued by those benefiting from these vital services and their families and friends, and we must continue to work with hospices in Wales to give them every support for these crucial services. 

I’m delighted to take part in this important debate today. Dying is something we all do, but dying well is, sadly, something that eludes far too many people. This needs to change, which is why I am proud to be a member of the cross-party group on hospice and palliative care. As our CPG discovered, the pandemic had a very real, very dramatic impact on palliative and end-of life care. Whilst the impact of the pandemic on end-of-life care was understandable during the pandemic phase, its continued effect as COVID became endemic is less so.

At a recent CPG meeting, we heard that accessing out-of-hours services remains diabolical. A carer took over 20 hours to get through to the 111 service during a weekend just to discuss medication. It is little wonder, therefore, that one in every 14 patients attending A&E departments is end of life. We need to drastically improve end-of-life services in the community so that patients, carers and care homes are not forced to access acute health services. This is why I am extremely grateful to all those who participated in our inquiry, and why Welsh Conservatives have tabled this motion today.

If we are to prepare for the next pandemic and ensure we can meet the rising demand for palliative and end-of-life care in the community, we have to do things differently. Whilst we can’t always choose when to die, we should all have a choice where to die. Most of us would not choose an acute hospital setting for our final moments. Whilst the COVID-19 pandemic led to a third more people dying in private homes, witnesses to our inquiry pointed to the fact that accessing palliative care was sometimes impossible. Patients and their families were often isolated, and end of life became more traumatic than it needed to be.

Marie Curie’s evidence was telling, in that they pointed to the fact that, in 75 per cent of deaths at home, patients did not get the care needed. This was despite the heroic efforts of local hospice-at-home and community palliative care teams. These teams went far above and beyond to provide much-needed care during the pandemic. And I would like, at this point, to place on the record my thanks to all those teams for their care and dedication. But we shouldn’t have to rely upon the goodwill and stellar efforts of dedicated staff going the extra mile. We have to ensure that we have a well-funded, adequately resourced and staffed system of community-based palliative and end-of-life care. This is not what we have at the moment. Our CPG has been told that far too many front-line workers are struggling with exhaustion, burn-out and the emotional toll of providing care through the pandemic. And the demands on staff are set to skyrocket in the coming years. Who knows what will happen if H5N1 makes the jump from birds to humans? We are not prepared. We have not learned the lessons from COVID. I therefore urge the Welsh Government to take heed of our CPG report and accept all the recommendations, particularly with regard to future funding. Diolch yn fawr.

Diolch yn fawr am gael cymryd rhan yn y ddadl yma y prynhawn yma. Diolch i Mark Isherwood am ei gadeiryddiaeth o'r grŵp trawsbleidiol a'r adroddiad gwych sydd wedi gerbron. 

I know we’ve heard a little about children’s hospices from Rhun, and mentioned by John Griffiths, but I’d like to focus my contribution on the fantastic palliative care that is provided by Tŷ Hafan in the south and Tŷ Gobaith in the north of the country. Both places are beacons of light for children and their families in the darkest imaginable times. I have had the privilege of visiting Tŷ Hafan in Sully, and it was an incredibly moving experience. At the time, I was part of the campaign to increase their state funding and to bring them in line with their counterparts in England, and I’m glad to say that the campaign was successful and they received a significant uplift in financial support. So, I’d like to thank the Welsh Government for doing that.

However, I understand that increased costs and inflation have eaten into much of that extra money that came their way. I’d like the Government to ensure that Tŷ Hafan and Tŷ Gobaith have sufficient money in order to continue to provide care for seriously ill children and the much-needed respite that their families require. I understand that, in correspondence with Ministers, the children’s hospices have pointed out that there has been no mention or recognition of the inflationary pressures that are faced by the children’s hospices. This has resulted in the 2020 funding agreement now being worth considerably less than when first announced. I understand they’ve made it clear that they believe this simple progressive step would have been an obvious outcome to the second phase review. It seems obvious to the children’s hospices that funding should have been raised in line with inflation; it certainly seems obvious to me that it appears to be an obvious step for Welsh Government to take. I’d appreciate it, in her response today, if the Deputy Minister could outline how the assessment of funding priorities was carried out, and why the funding of children’s hospices was not a sufficient priority to ensure that they did not suffer a real-terms cut. Can we have an undertaking here today that the vital funding for children’s hospitals in Wales will be reassessed to ensure that they are not under-resourced?

Finally, looking at the future and the third phase review of palliative and end-of-life care, in the correspondence I mentioned earlier, I understand that there is a concern that lessons aren’t being learnt from earlier phases. In fact, the concern is that the flaws that prevented the phase 2 review from delivering any outcomes of note or on time are now going to be baked into the phase 3 approach from the start. Without significant extra resource put aside to pull together the review, and without the full involvement of children’s hospices and other partners in the process, they simply cannot see how the fundamental piece of work can be delivered to the desired standard in this timescale. They would welcome some urgent assurances about how the process will be run, what the detailed timelines look like, and where and how they can be involved. They go on to indicate—and I echo their points—if past instances are anything to go by, this could be a once in a decade, even a once in a generation, opportunity to get this right.

I know that children’s hospices want to support the Government to deliver a plan and a structure that will both stand scrutiny and the test of time. With a firm commitment from the children’s hospices in Wales, will the Ministers make the same commitments so that children and families who are going through the most heartbreaking and testing times get the support they need? Diolch yn fawr.

I would like to begin by putting on record my sincerest thanks and appreciation for all those carers and palliative care workers who worked tirelessly during the COVID pandemic and made huge personal sacrifices to ensure that those they were looking after received the best possible end-of-life care. The extreme working pressures that COVID brought, unfortunately, fell upon relatively few, and we must not forget that many people suffered in a way that many of us didn't.

We all know that the Welsh Government is against holding a specific Welsh COVID inquiry because it does not want to admit that mistakes were made, and it is frightened of another damning statistic that will show Wales as the worst performer in the UK. But the truth is those mistakes are only ever truly mistakes if we don't learn from them, and the only way we can learn from them is if we know and understand how and why they were caused and what better solutions could have been provided instead. COVID was an unprecedented time in recent history, I think this Welsh Government is worried about how their performance will be viewed in the media, and, because of this, the opportunity will be lost to truly understand what improvements need to be made. COVID was an enormous stress test for our NHS and the systems and ways of working that we had in place. I think it is foolish not to thoroughly assess the response by the Welsh Government with a Wales-only inquiry, because the context of the pandemic in Wales was different to other nations in the UK. We need to move forward with action plans, such as those for palliative care, that would help us to respond better if there were ever another global pandemic.

This debate today is exceptionally important. I would like to thank my colleagues for producing such a thorough report. One of the most striking observations for me was that many people suffered needlessly because infection control systems for moving and isolating patients had not been predetermined, but rather were decided upon by constantly updated guidance, which meant that the families of and those receiving palliative care were left to needlessly experience the devastating impacts of isolation. This is why it is vital that the Government now works closely with the palliative care sector to learn from the COVID-19 pandemic and ensure palliative care is at the heart of plans for future pandemics.

Another feature of the report that concerned me is the projection of the needs for increased palliative care in the future. The report shows that levels of palliative care needs during the pandemic were not expected until 2040. Whilst I can see that we could not necessarily foresee the need for palliative care reaching this level, it does reveal that, on the whole, there is a systematic need to now build into the palliative care system options for rapidly increasing capacity and improving death literacy within communities in Wales by encouraging higher levels of advanced planning for end of life, alongside improving support for bereaved families.

Finally, in light of my questioning yesterday regarding the need to improve digitisation within the NHS, something I felt the First Minister dismissed, I would like to mention that, in terms of palliative care, the Welsh Government needs to, as a matter of urgency, develop an electronic patient record with advanced and future care preferences and decisions. The families of those receiving palliative care are often in a complete state of distress, and having care preferences recorded as far in advance as possible will be vital in helping to protect the most vulnerable. I fully support the motion presented in this debate and all the calls it makes, and I would urge everyone here to also support it. Thank you.

Y Dirprwy Weinidog Iechyd Meddwl a Llesiant nawr i gyfrannu—Lynne Neagle.

Diolch, Llywydd. Firstly, I'd like to thank the Welsh Conservatives for bringing forward this important issue to the Chamber and thank all Members who've contributed to today's debate. I've listened carefully to all speakers, and there have been many important points made.

The Welsh Government knows that good palliative care can make a huge difference to the quality of life of people facing life-limiting illness, helping them to die with dignity, and facilitating a healthy grieving process for those left behind. That is why we continue to invest over £10.5 million annually and end-of-life care remains a key programme for government commitment. Person-centred care is at the centre of our vision for palliative and end-of-life care, and we're committed to ensuring that anyone requiring palliative and end-of-life care in Wales should have access to the best possible care.

To achieve this, a broad focus across the spectrum of health and social care and third sector provision is required to make this happen as a whole-system effort. The vision is set out in our quality statement for palliative and end-of-life care, published in October 2022. It sets out the high-level Welsh Government policy intention for children and young people and adult palliative and end-of-life care. Implementation of the quality statement is being overseen by the national programme board for palliative and end-of-life care, and a work programme for 2023-24 is currently being finalised. The integrated work programme has a number of cross-cutting themes embedded throughout each work stream, including Welsh language, equality, diversity and lived experience. Workforce planning is a key issue within the work streams and this, alongside the local level discussion, will be instrumental in implementing the actions within the quality statement.

We welcome the cross-party group on hospice and palliative care’s inquiry into experiences of palliative and end-of-life care in the community during the COVID-19 pandemic. The inquiry supports our aim of providing high-quality and person-centred palliative care, which we will drive forward in collaboration with the national programme board for palliative and end-of-life care. The Minister for Health and Social Services has responded separately to the chair of the CPG, setting out responses to each of the report's recommendations.

The COVID-19 pandemic presented incredibly difficult challenges for delivering palliative and end-of-life care, and I commend all of those who went above and beyond in supporting patients and their families. It was a time of extreme pressure, and we will continue to consult with families and professionals to improve the experience of palliative care, should there be a need to tighten restrictions in the future. We have made significant investments in bereavement services during and since the pandemic, and have driven a number of activities to improve bereavement care. This includes the publication of our national bereavement framework in October 2021, and the launch of a specific bereavement pathway to support people affected by the sudden or traumatic death of a young person up to and including 25 years of age last August. In addition, we are providing a £3 million bereavement support grant to 21 third sector organisations over the three-year period 2021 to 2024. We also recognise that the number of people who need palliative and end-of-life care is increasing, and the pandemic highlighted the more pressing need to address out-of-hours and community palliative and end-of-life care provision. To help address this, the Welsh Government provided over £13 million of emergency funding throughout the pandemic.

Delivering on phase 1 of our programme for government commitment to review voluntary hospice funding, we've also provided an additional £2.2 million annually for Welsh hospices delivering core palliative and end-of-life care services since April 2023. The second phase of this review includes recommendations to increase the capacity of district nursing out of hours and community clinical nurse specialists at weekends and bank holidays. This will improve core care in the last days and weeks of life, and strengthen the support to people who wish to remain in their own homes. This fits with our wider work to build integrated community care services focused on our frail population, and seeks to strengthen community capacity. The Minister for Health and Social Services has asked that the report and these recommendations are considered as part of this work.

In addition, to understand the need for paediatric palliative care, we have supported children's hospices in Wales to commission a prevalence study to provide up-to-date information of paediatric palliative care needs in Wales. We must also understand the impact that the ageing population has on end-of-life care, both in the medium and longer term. This will be part of the final phase of the funding review, which will also look at what further support hospices need.

It is vital we put into practice the learning from the COVID-19 pandemic, and officials are working with the pandemic preparedness team to ensure that palliative and end-of-life care are a key component of our work to plan for future pandemics. In conclusion, I'd like to thank the Welsh Conservatives for raising this important subject and provide reassurance that the Welsh Government remains fully committed to the provision of high-quality palliative and end-of-life care across Wales. Diolch, Llywydd.

Russell George nawr, i ymateb i'r ddadl. Russell George.

Thank you, Presiding Officer. Can I thank the cross-party group for their work and this report? Of course, I particularly thank Mark Isherwood, as the chair. Perhaps if I start by summarising, perhaps, Mark Isherwood's opening comments—his 11-minute opening—which outlined the brief points in the report. Hospice and palliative care played a critical role in the pandemic response, supported by a wave of community engagement and action, but the massive increase in demand for care in the community revealed perhaps weaknesses in pre-pandemic planning. Many people faced difficulties in accessing end-of-life care at home and in care homes, increasing the existing inequalities that already lay there as well—something that I know we focus a great deal on in the Health and Social Care Committee—and often, of course, with devastating experiences.

It is important to say as well, I think as Sam Kurtz pointed out as well, health and social care workers went above and beyond during the pandemic to support patients and their families at end of life, and our gratitude sincerely goes to them.

To summarise some of the other points in the debate today—. Before I do move off Mark Isherwood, I should really thank Mark Isherwood for his role in chairing this cross-party group. The cross-party group has got a large number of members from right across this Chamber, cross party, and nearly all cross-party groups that are successful are supported by a secretariat, and our thanks as well to Hospice UK for their support to the group as well.

Rhun mentioned, of course, forward planning ahead of the pandemic, highlighting that point as well, and, along with a few other Members—I think it was Peredur as well as Rhun—talked about the amount of support needed for children’s hospices across Wales, with Peredur mentioning the issues around inflationary costs and the extra pressure in that regard.

I thank John Griffiths for his contribution. I think it’s so important, isn’t it, that care at home can be in comfortable surroundings with family around. This is important for all parts of Wales, but I suppose particularly for me as a rural constituency representative, it's all the more important that those facilities are available in the home setting because other options are often far away from home.

I thank other colleagues as well who spoke in the debate. I know Altaf and Joel James spoke as well; Altaf pointing out, I think, how one in 14 people, I think it was, sadly pass away in A&E.

I think today we've had—. This is the last debate before the Easter recess and we’ve had two other Welsh Conservative debates—one today and one last week—that didn’t reach consensus, but I am grateful to the Welsh Government and the Deputy Minister for not seeking to amend the motion today and I think indicating support for the motion as well. That’s really greatly appreciated, and I think a positive note to end on ahead of the Easter recess.

Y cwestiwn yw: a ddylid derbyn y cynnig? A oes unrhyw Aelod yn gwrthwynebu? Nac oes. Felly, mae'r cynnig yna wedi ei gymeradwyo.

Derbyniwyd y cynnig yn unol â Rheol Sefydlog 12.36.