Y Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus

Public Accounts and Public Administration Committee

25/05/2022

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Mabon ap Gwynfor MS Yn dirprwyo ar ran Rhys ab Owen
Substitute for Rhys ab Owen
Mark Isherwood MS Cadeirydd y Pwyllgor
Committee Chair
Mike Hedges MS
Natasha Asghar MS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Adrian Crompton Archwilydd Cyffredinol Cymru
Auditor General for Wales
Albert Heaney Prif Swyddog Gofal Cymdeithasol Cymru, Llywodraeth Cymru
Chief Social Care Officer for Wales, Welsh Government
Andrew Doughton Archwilio Cymru
Audit Office
Dave Thomas Archwilio Cymru
Audit Wales
Euros Lake Archwilio Cymru
Audit Wales
Matthew Jenkins Dirprwy Gyfarwyddwr, Partneriaethau a Chydweithredu, Llywodraeth Cymru
Deputy Director, Partnership and Co-operation, Welsh Government
Matthew Mortlock Archwilio Cymru
Audit Wales
Nick Selwyn Archwilio Cymru
Audit Wales
Philippa Dixon Archwilio Cymru
Audit Wales
Rhiannon Ivens Dirprwy Gyfarwyddwr Cynhwysiant a Busnes Corfforaethol, Llywodraeth Cymru
Deputy Director, Inclusion and Corporate Business, Welsh Government

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Elizabeth Foster Dirprwy Glerc
Deputy Clerk
Fay Bowen Clerc
Clerk
Owain Davies Ail Glerc
Second Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:48.

The committee met in the Senedd and by video-conference.

The meeting began at 09:48.

1. Cyflwyniad, ymddiheuriadau a dirprwyon
1. Introductions, apologies and substitutions

Bore da, croeso. Good morning and welcome to this meeting of the Public Accounts and Public Administration Committee. No apologies for absence have been received, although we welcome Mabon ap Gwynfor, who is deputising for his colleague Rhys ab Owen today. So, thanks, Mabon, for being with us. Do Members have any declarations of registrable interests they wish to declare? Thank you very much. Please note that headsets are available in the room you're in for translation and sound amplification, with translation on channel 1 and amplification on channel 0. Please make sure that any electronic devices you have are on silent and note that in the event of an emergency, an alarm will sound and ushers will direct you all to the nearest safe exit and assembly point.

2. Papurau i'w nodi
2. Papers to note

We have a number of papers to note, particularly a paper from Betsi Cadwaladr University Health Board. Following our evidence session on 9 March with Betsi Cadwaladr University Health Board, I wrote to them, as agreed by yourselves, seeking clarification on a number of issues. Members present will recall that some of the questions related to mental health services, vascular services, financial management and service transformation. I believe that there were also questions relating to human resources matters and whether persons still in positions of management were those criticised in the report and whether that's tenable.

The letter we received from the health board notes that the health board have approved their integrated medium-term plan, or IMTP, for the next three years, with detailed information about their plans for 2022/23. The Welsh Government's response to this plan is not yet available, and in previous years did not approve the three-year plan for the health board, only one-year plans. Well, the health board plan's early priorities are planned care, with a transformation focus on specialities, including orthopaedics, urology and ophthalmology. Their other main priority is unscheduled care, with an immediate focus on improving discharge pathways to reduce delays.

Their letter to us notes that the targeted intervention framework is, quote,

'by design, a self-assessment process.'

It also notes that the health board has

'engaged external support to give an impartial view'

of their evidence gathering and progress assessment, but they provided us with no further details.

Their IMTP's stated priorities don't include mental health services, although, of course, we raised those, but they do include some general information about the work under way in this area. Whilst their letter refers to appendix 2 of the IMTP as providing additional information on the expected improvements in this area, this appendix refers to planned care and does not appear to include the information referred to. The plan doesn't mention accident and emergency services, and it's notable that performance against the four-hour target at Ysbyty Maelor Wrecsam and Ysbyty Glan Clwyd have consistently been close to or below 50 per cent. I think, as Members are well aware, Healthcare Inspectorate Wales declared the emergency department in Ysbyty Glan Clwyd as a service requiring significant improvement this month.

In relation to vascular services, the letter refers to the process for improvement, which includes plans and correspondence from the Minister for Health and Social Services. It's notable that the board was set a three-month timescale for improvement in February, and the update for May 2022, this month, has not yet been published.

In relation to transformation and finances, the letter and IMTP notes that BC health board must make £105 million in savings over the next three years. The health board must make significant transformational changes to ensure that services can continue to be delivered when the Welsh Government's additional financial support ceases. The health board's letter and plan do not detail how theses savings will be achieved, although a broad set of, quote, 'opportunities to make savings' are listed in areas such as planned care, unscheduled care, mental health and 'other'.

There is some information in the letter on regional treatment centres, and whilst the letter notes that they will incorporate a range of services, there is no indication of whether these are new services, or whether these involve service relocations that require consultation. They state that this process will be completed by July 2025.

So, the committee will no doubt wish to revisit these issues with the health board later this year when, as agreed, we will hope to have them back before us. Do Members wish to raise any comments before we move on? You will recall that the letter we sent after the evidence session we held, and the discussion we then had about that and the concerns we raised, was very much focused on audit matters, specifics—when, where, why, where and how—and this is the response received. So, are Members content for me to note this at this point? Do you wish to comment further? Or do you feel that we should write back to the health board for more specific information ahead of our intended evidence session with them in autumn? Mabon.

09:50

Diolch, Gadeirydd. Dwi am gyfrannu'n Gymraeg. Gawn ni wirio bod y cyfieithu'n gweithio? Yr unig beth fuaswn i'n ychwanegu yw ei fod o'n bwysig, fel rhan o'r gwaith y bydd y pwyllgor yma'n ymwneud ag o yn y dyfodol, eich bod chi'n gofyn i'r bwrdd iechyd ddarparu'r data y maen nhw'n gwneud eu penderfyniadau ar ei sail—data ynghylch nifer y bobl sydd wedi cael anafiadau difrifol, neu nifer y bobl sydd wedi marw mewn triniaethau ac yn y blaen. Mae gwybod pa ddata mae'r bwrdd iechyd yn ei ddefnyddio er mwyn dod i'r penderfyniadau y maen nhw'n eu gwneud ar wariant ac ar driniaethau, a lle mae lleoli'r triniaethau yna, dwi'n meddwl yn mynd i fod yn bwysig wrth symud ymlaen. Mae gen i ychydig yn fy swyddfa i, a dwi'n fwy na hapus i'w rannu efo'r pwyllgor yma pan fydd yr amser yn dod.

Thank you, Chair. I would like to contribute in Welsh. Can we just check that the interpretation is working? So, the only thing I would add that's important, as part of the work of this committee and the way it works in the future, is that you ask the health board to provide the data that they use to make their decisions—the data regarding the number of people who have suffered serious injuries, or the number of people who have died following treatment and so on. It's important that we know what data the health board uses to come to the conclusions that they do, on treatments and where to allocate that treatment. I think it's important as we move forward, and I'm more than happy to share with the committee my information when that time comes.

09:55

Thank you, we would welcome that. Natasha and Mike, do you have any comments, because, obviously, you were present at the previous evidence session and the discussion we held afterwards?

Chair, in relation to what we discussed in the previous meeting, I do believe that we should note the points that we take from that meeting as well as this, and then afterwards perhaps decide where we're going to move forward, if that's okay.

So, do you believe that we should respond to this letter now, or simply park everything now until we see them in the autumn?

I'd like to park it until we see everything in the autumn, and then respond accordingly, if that’s okay, and Mike is in agreement with that.

Okay, that's fine. And perhaps then we could incorporate the matters that Mabon's highlighted as well. So, that's okay, Fay?

Yes, that's fine, Chair.

Yes, that's great. Thanks, Mark.

Thank you very much indeed. On a related matter, the committee has also been copied in a letter sent by Healthcare Inspectorate Wales's interim chief executive, Alun Jones, which noted that discussions had taken place with Audit Wales on Betsi Cadwaladr University Health Board's performance reporting. This letter confirms that further evaluations would be undertaken by Audit Wales. Could I please, therefore, ask the auditor general to provide more detail about what these evaluations are, and to clarify whether they will be ready for reporting before the issue more broadly with the health board is revisited in the autumn?

I'm not aware of that correspondence. It wasn't in my pack of papers, so forgive me, I'm not sure I can respond at this point, but I will definitely follow that up and come back to the committee.

Thank you. Well, I was copied in on a letter—I won't name the person who sent it to me, but I'm sure you could be copied in on it by our clerking team—it's dated 18 May, and it includes this paragraph by the person who sent it:

'Following the receipt of your emails, discussions were held with Audit Wales who also confirmed that they had reviewed the content of your emails and are planning to undertake further evaluations.'

That came from, as I say, Alun Jones, interim chief exec at HIW. So, we would be grateful if you could get back to us on that. So, before, again, we move on, do Members have any further comments at this stage, or shall we simply, as indicated, note the response for our further work on this after the summer?

I think we should wait until after the summer now, Chair.

3. Comisiynu Cartrefi Gofal i Bobl Hŷn: Sesiwn dystiolaeth gyda Llywodraeth Cymru
3. Care Home Commissioning for Older People: Evidence session with the Welsh Government

Right, well, that brings us back to our care home commissioning for older people inquiry, based upon the parallel report by Audit Wales, and our fifth evidence session on this with witnesses from the Welsh Government. So, I welcome the witnesses to the meeting. I'm not sure how many of you have been able to join us yet, but could I ask those who are present to state their names and roles for the record? And of course I thank you for being with us.

Good morning, Chair. Bore da. Albert Heaney, chief social care officer for Wales. I'm pleased to join you today, and my two colleagues—I think they're being blocked out at the moment by IT difficulties—are Matt Jenkins and Rhiannon Ivens, both deputy directors leading on some of the critical areas of policy in relation to this. So, I'm hoping, Chair, that they will be able to join, but at the moment there are technical difficulties preventing that.

10:00

Do you have any indicative time frame for that? Should we pause for a few minutes, or, if it's likely to take longer, had we better move on with you alone?

Chair, I do beg your—. Obviously, it's beyond my ability to influence. If you pause for another five minutes, I can certainly check with colleagues, because I know at the moment they're trying to get them linked in even via their phones. That would be most appreciated, Chair, of course.

Okay. I'd be grateful, then, clerking team, if you could take us back into closed session for five minutes, and if we can reconvene at 10:05. Thank you. 

Thank you, Chair. 

Gohiriwyd y cyfarfod rhwng 10:00 a 10:10.

The meeting adjourned between 10:00 and 10:10.

10:10

Gohiriwyd y cyfarfod rhwng 10:00 a 10:10.

The meeting adjourned between 10:00 and 10:10.

We're in public. Thank you very much indeed. Croeso. Welcome back. Again, could I invite the witnesses to state their names and roles for the record?

Bore da. Good morning. My name's Albert Heaney. I'm the chief social care officer for Wales. 

Bore da. Good morning. I'm Rhiannon Ivens, deputy director in Albert's team in Welsh Government.

Thank you, and I believe you have a colleague who hopes to join us a little bit later. As you'd expect, we have a number of questions, and I'd be grateful if Members and witnesses could be as succinct as possible so we can cover as wide a range of the issues as possible that the topic has generated. I'll start with the initial questions. Mine are focusing on the Social Services and Well-being (Wales) Act 2014. So, can I ask both the witnesses with us how you assess the impact of the Social Services and Well-being (Wales) Act 2014 thus far on care home commissioning and the care home market, and, eight years on, whether the Welsh Government has seen the change it wants?

Thank you, Chair, for that question. The Social Services and Well-being (Wales) Act 2014 was groundbreaking at the time of it passing through legislation within the Senedd. It was particularly strong around the citizen voice—it supported very much voice and control for citizens, and citizens have especially welcomed that. And, of course, within the legislation, partnership and co-operation, in Part 9 of the legislation, was really focusing on better joint working to enable partners—health and social care partners and wider sectors—to come together to assess needs, develop plans, and increasingly joint-commission services together. We did commission an evaluation. We had the KPMG report, as committee will be aware. From that evaluation, I think it's fair to conclude that the partnership working has increased as a response to the Act. So, we're very pleased with that. In my new role as the chief social care officer for Wales, I also conducted a listening exercise. I spoke to over 300 citizens and professionals, and overwhelmingly they felt that the principles of the Act stood the test of time and they were really now focusing on greater consistency in terms of implementation. So, I think the Act has been a positive feature in the landscape, but of course there is still further work to do in terms of developments around the partnership and co-operation, working together.

Thank you. Well, evidence we've received in other contexts, including other work by Audit Wales, and evidence certainly I've received on a regular basis as a Member and chair of, for example, the cross-party group on disability and the cross-party autism group, is that implementation is at best patchy and at worst ignored. I often have to, when representing constituents, re-remind the persons I'm writing to of the existence of this legislation and related legislation. So, what specific improvements or notable practices do you believe the Act has stimulated, and what have the chief impediments to progress been?

Thank you, Chair. I think there have been a few strong improvements around the Act. I think a starting place of the 'what matters' conversation for citizens has become, across the landscape, very important. Alongside that, the partnership working has certainly progressed. There are many now seeing their services develop across health, local authorities and third sector partners. So, we've seen in that landscape the development across the legislation and 'A Healthier Wales', but it is true to say, as you quite rightly outlined in the question, there are many areas that we still need to strengthen. And so, as you said about impediment, some of the major challenges have been linked to the change in culture, bringing together different organisations from different cultural backgrounds to work together, and so reorientating practice to focus on citizens together, increasing demand. It's fair to say, committee, that the pandemic over the last couple of years has been a particularly difficult time for health and social care, but I do believe strongly that one of the strengths coming from the legislation and the partnership working is there was real evidence during the pandemic of partners being able to move quickly together because we already had that embedded working relationship across regional partnership boards. 

10:15

Thank you. What specific monitoring and evaluation does the Welsh Government itself undertake, not just to criticise, but to ensure understanding, and to support and encourage implementation, and also to intervene if it's not working as it should, particularly if, for example, the assessments that are supposed to happen, at least annually, are not happening, notwithstanding, of course, the COVID delays that occurred, but also the fact that this is actually about asking people what they want to achieve rather than telling them what they can have?

Thank you, Chair for the question—a really important question. There are a number of areas in which the Welsh Government monitors. We have developed through the Act— and that's one of the strengths of the Act—the new national outcomes framework, which provides data and information in terms of well-being of citizens and the response of local authorities. We also have developed, across our regional partnership boards, looking very much at the work that takes places monitoring the activities and monitoring the use of our funding. Recently, of course, we have allocated additional regional integration funding, so that is monitored and evaluated to demonstrate it in terms of impact, and especially focusing on outcomes. 

We are also, Chair, moving to a—. We have the national outcomes framework, and we've improved our data collection in 2020. And we're now moving, of course, to the development around an integrated outcomes framework that will bring together some of the critical features that will tell us more around population well-being, and, of course, then hold to account those responsible for delivering services at a local level. 

How are you, if it all, ensuring that the voice of experience, the services user's voice, is heard in this? As you'll be aware, there have been a series of reports, published by a number of representative bodies over recent years, highlighting not only what's working well, but the many problems that people encounter and the things that still need to change.

That's a really important aspect to Welsh Government and to us as officials. In my role as chief social care officer, one of the starting places for that role, Chair and committee, was to have conversations with the public, with citizens using services, to hear directly from them, so the voice of our citizens is absolutely embedded in our practice. I think it's very clear to us that we've been keen to have the views at the heart of our work, and there are a number of real developments taking place now, which I'm sure we'll come on to during the course of this committee discussion. But the basis of relationship with our citizens is really working to the UN principles for older people—for example, if we think about people in care homes, to make sure that their independence, participation, care and dignity is fulfilled. 

And, as part of my role, then, I'm very much working to support, and alongside Welsh Ministers. who have a number of forums; Welsh Ministers have a number of forums where they consult and work with the public, whether that's through Age Cymru or ministerial advisory groups. And we are committed, and have remained committed, to continuing in our approach to have focus discussions with our citizens to actually inform and co-design services together. So, it's very much embedded practice that arises from the legislation you referred to in your earlier questions, driving forward, so we can actually then improve consistency of service, but also the outcomes that matter to people.

10:20

Well, certainly, we have taken evidence from Age Cymru, who, whilst acknowledging what you say, identified the need for continued improvement in this area. But, looking ahead, what do you consider, and what does the Welsh Government consider, to be the optimal balance between national, regional and local responsibilities for care home commissioning?

I think that's a really good question, Chair. We have, as a Government, viewed that there are some areas that can be better organised nationally. So, you will have seen from our White Paper, 'Rebalancing Care and Support', our focus on a national framework, national office, which we think could offer an improved approach to care homes, care home fees and commissioning et cetera. We also have learned from our experiences that we feel very strongly that regional commissioning and a regional approach across health and social services is absolutely important and an optimal level. That does not negate the fact that services will still continue to be locally delivered, but it makes sense in terms of planning and organising. Indeed, in a role before I came to the Welsh Government, I was a corporate director in a local authority, and indeed, Chair and colleagues, committee members today, there were seven local authorities that were boundaries on that local authority that I worked within. So, the relationship across boundaries, I think, in terms of service provision, care home commissioning, whether that be focusing on the needs of residential or working with health around the nursing care needs, we would strongly, and we have strongly steered and moved into thinking on a regional partnership framework.

Okay. Thank you. I'm conscious that one of our Members, Mr Hedges, has to leave temporarily, at 10:30 a.m. Could I suggest that, before I move on with the next set of questions, I invite Mike Hedges to ask his, and then I'll come back to the questions as on our paper? Is that okay with you, Mike?

Chair, just while the Member is coming on, Matt Jenkins has now joined, which means we're a full complement today. So, thank you for your patience.

Okay. Well, while we're waiting, could your colleague, therefore, formally introduce himself and his title for the record?

Good morning, Chair.

Bore da, Cadeirydd. Matt Jenkins ydw i.

Good morning, Chair. I'm Matt Jenkins.

I'm Matt Jenkins. I'm deputy director for partnership and co-operation in Welsh Government.

Thank you. And am I to understand that Mike Hedges may have already departed? Okay. I'll assume he has, and I'll move on with my next set of questions, then. It's more than a year now since its White Paper consultation, and, therefore, what are your views on the extent to which the Welsh Government is satisfied that its 'Rebalancing Care and Support' programme is keeping pace with the increasing challenges now facing the care home sector?

Thank you, Chair. The work that has taken place—. I was really pleased, Chair and committee members, that, even during the pandemic, we continued to push ahead, because we felt, going into the pandemic, that social care and the approach was seen to be fragile. Clearly, the pandemic shone an incredible light on the way that social care, and the value of social care to our citizens, and the way it was delivered, but the value of social care—. So, we were really keen to move ahead, and we did an extensive consultation around the 'Rebalancing Care and Support' White Paper. From that, we had over 140 responses, enabling us then to consider the way forward. We worked with both Ministers, and, of course, the Ministers made determinations based upon the evidence that came to them. They were really focusing around developing a stronger national framework—that commitment's been made—and focusing on the national office.

Of course, then, we have continued, I think it's fair to say, to have different waves of the pandemic, and now it seems to be a time, with great relief, that we're beginning to move more towards resuming normal services. But there's been an incredible amount of work setting up technical groups to develop the work and we're really in a good position to talk through some of that today. So, I'll just invite my colleague Matt Jenkins to come in and talk through a little bit of the detail, which I think will be very helpful to the committee.

10:25

Thank you, Albert. Thank you, Chair. In a bit more detail, we set out in our evidence paper the outline of the arrangements that we've set in place around the reform programme at a national level to develop a national framework for care and support and also to improve partnership mechanisms at a regional level. In those two areas in the first place in terms of a national framework, as the evidence paper says, we sought to set in place a technical group in order to advise officials and Ministers on the optimal way forward in terms of setting new national arrangements. That technical group has met twice. It will continue to meet through the summer with a view to providing a report to Ministers in the early autumn. 

The technical group is developing its thinking in a number of areas: in the first place, the scope of the new national framework for care and support; next, the key areas of the commissioning cycle that we would want to embed more consistently across Wales; then, importantly, standards for commissioning and service design, and also fee methodologies, which I know is a really important issue that we're trying to give some greater shape to at the national level—I'm sure we'll talk about that in more detail; then contract and performance management; procurement mechanisms, where, of course, some of the legislation at the UK level is changing, so we want to make sure we're completely up to speed with those developments; and finally, we'll impact assess all of those—that advice and the proposals that we ultimately bring forward.

Then, in terms of the other part of the White Paper, which, as I've said, was around proposed changes to regional partnership working, we've just established five task and finish groups in important areas of reform, which we signalled in the White Paper, and the first cycle of those meetings has commenced. I think we are just about on track in terms of our timescales. We would aim to fast forward a little, to be in a position to consult on a code of practice for a new national framework for care and support most likely springtime next year, so, spring 2023—April 2023 to be specific—with a view then to running that consultation in the usual way and publishing a code of practice later that year, in autumn 2023. That's subject to the scheduling of Senedd business and such like. We would look then for those arrangements both at a national level, in terms of the code of practice, and at the regional level. I should have said that the intention is to revise our Part 9 regulations, which you'll be aware is a statutory framework that governs regional partnership boards currently. So, we would look to make adjustments to that Part 9 guidance on the same timescale—so, to consult next spring and to publish in autumn and to have those new arrangements in place for the commencement of the 2024-25 operating year. Thank you.

So, new arrangements in place for 2024-25. Okay. No doubt we will be considering that as the timescale moves forward and revisit it as appropriate. How are you ensuring the bigger questions about a national care service don't divert attention from driving forward improvements today, here and now, through the 'Rebalancing Care and Support' programme?

Thank you, Chair. I'll take that one. I think the first thing to add is that we really see the national framework and the national office being complementary to the potential development now of the national care service. The expert group that arises out of the co-operation agreement between Welsh Government and Plaid Cymru has been set up. That group is operational now, and that group will report—this is important in terms of timescales for the committee—towards the end of June. I think within the last couple of weeks of June, we are expecting the report. It will be helpful to understand what that report from that independent group tells us. It will be really important in what will be the practical steps of care being provided free at the point of need, but also how do we work together increasing the sustainability of the workforce and ensuring that all care needs are met. So, within our time frame and approach, we believe that our work that's currently in progress is very much complementary and helpful to us in our shared ambitions.

But whilst we await the outcome of that, it doesn't mean, committee members, that we are standing still—we are not. We have a number of real work streams in progress. Ministers continue to lead on the care action committee to take any immediate actions that can support the sector. Indeed, you'll be very familiar with the amount of hardship funding that's been provided to care homes particularly, to support them during the COVID crisis and ensure care home stability in Wales during that period of time. But we also have a number of actions. We had the reset exercise that was held at the beginning of March to look at what partner organisations could do together, and currently there is a task group working on a number of actions that we hope could assist and strengthen the current arrangements, especially around admission avoidance to hospitals and hospital discharges.

10:30

Okay. Thank you. My final question at this point: you'll no doubt be aware of the UK Government's plans around residential care costs in England to be implemented in the future; what are the Welsh Government's views on how the position in Wales would compare for most people, if and when those changes go ahead in England, and what implications might there therefore be for Wales accordingly?

If I may answer that, Chair; that's one of my lead areas. We follow the developments in terms of the UK Government's new arrangements for people in England very, very closely. The terms of reference for the expert group on the national care service, I think, are quite important in this area. They describe the shared ambition to move towards a national care service in Wales where social care, is free at the point of need. That, I think, sets a policy objective for us in Wales. The expert group is, then, as Albert described earlier, looking at the practical steps that might be taken towards that journey, over the short, medium and long term.

I think, though, that the arrangements that we already have in Wales in terms of charging stand up well in comparison with other parts of the UK, specifically the £50,000 capital limit on residential care and the £100 domiciliary weekly cap on charging. Even when the new arrangements come into place in England—and they're quite complicated; we've been following them closely and there have been developments as that journey has gone on—I still think we're in quite a good position. If I could give you an example, let's take a person in Wales who, today, has completed a care plan, and that's co-produced, and that person will move into a residential care setting tomorrow. Let's say, for example, they have exactly £50,000 worth of assets. In Wales that £50,000 is protected in terms of capital assets. They would contribute from their income—any residual income from pensions and suchlike—but that capital is protected.

The scheme in England will work in two ways. The most commonly talked about area is the £86,000 ceiling on contributions. So, once an individual pays up to that level, the state steps in and pays beyond that. But there's also a floor as well, which means that you need to contribute your assets down towards the level of £20,000. So, that individual that I described at the moment—they go into care with £50,000 worth of assets—they would be advantaged to be in Wales at that moment, because under the new arrangements in England they would be paying in for their care through their assets until those assets reduce to the level of £20,000 for the floor, in effect, that works as one of two components of the new mechanism in England. So, it is complicated to follow. These are matters that the expert group will be grappling with. That's an independent group of course; they'll produce an independent report. We will receive that with interest, and Ministers will respond in due course, I think most likely following a significant period of external engagement on that, too, because it is, as you say, a very important area.

10:35

Thank you. Would you be able to share the figures that ultimately the independent group produce with us? I particularly, for example, would be interested to know what the impact might be on somebody who owns a house with an average value in Wales as their sole or primary asset, and whether that would mean advantages or disadvantages for them.

Indeed, gladly. One would assume that the expert group report will be published as drafted by themselves, but we'd be happy to return to committee, I'm sure, to talk about that in more detail in future.

Thank you. Could I now bring, please, Mabon ab Owen in to pick up the questions?

Diolch, Gadeirydd. Thank you, Chair. I'll be asking my questions through the medium of English because of the technical difficulties that we have. Thank you to the witnesses for coming forward and providing your evidence and presenting what you have to us this morning. The Government's evidence paper references a number of task and finish groups. We've got the 'Rebalancing Care and Support' task and finish group, governance and scrutiny, planning and reporting groups. Can you just explain a couple of things? First of all, why has it taken until now to get the 'Rebalancing Care and Support' group up and running? And regarding the other groups, how will you manage to make sure that there is no overlap between the work that they do, please?

Thank you for your question, and diolch am y Saesneg due to technical difficulties. I partly responded to this a little earlier. I think part of the balance here for us is that the timescales have also been impacted upon by the various waves of the pandemic. I think it's really important that we also work with the sector to engage. As part of the response to our pandemic planning and response to that, we've also been very aware of the sector capacity to engage. In this piece of work, given the complexity of it, it is so important that we have our stakeholders with us on that journey. As officials delivering policy, we know that policy is much more effective when our citizens and when our stakeholders have a strong voice and help shape that in terms of then developing together.

I think as Matt quite helpfully demonstrated as well, a number of the working streams that we have in place are really very active now, and progressing that work, which I think will take us to a much strengthened position. So, I think when you think about it, with the landscape at the moment that we have—22 authorities, seven health boards, all commissioning in a particular space—the more that we move towards a national framework, that will be, I'm sure, of great reassurance indeed to our provider sector, and we'll be able to work through some of the complexities of the challenges during our work as it develops.

Can I just apologise at this point? I introduced our colleague as Mabon ab Owen; it's actually Mabon ap Gwynfor. I apologise.

It's okay, Chair. There are far too many aps in the Senedd these days, I'm sure.

Thank you for that response to the question. You mentioned in your response that you were keen to work with the sector and that there was a problem with capacity within the sector and that the sector was a key stakeholder. The other key stakeholders of course are the care home residents and their families. How are you going to ensure that you include the voices of the residents and the families during the task and finish work?

Thank you very much for your question. As referenced in earlier evidence, we are absolutely committed to embedding the rights of our citizens into our work. Historically, as we developed, as you've referenced, the legislation, we have developed a number of critical interfaces. We've held citizen panels. We've had citizens involved in particular work streams, bringing expertise and experience directly. I myself have just undertaken a detailed exercise with citizens involved, ensuring their stories and their experiences and giving their expertise. So, very much we are committed, and I can assure the committee today, as we journey forward, we will be continuing to promote, to demonstrate and include. Because, ultimately, what we produce is benefited and enhanced so significantly when our citizens are at the heart of that.

And from a ministerial perspective, to the Member of the Senedd, for the very good question, we also have a number of groups with citizens who are directly involved, whether that's ministerial advisory groups or working with our partner organisations, to include their voices and make sure that we will—. And particularly in relation to our development of national framework and our future, we see the opportunity and are committed to having focus group discussions, for example with care home residents, and facilitating that voice as we develop our policy thinking further over the coming weeks and months.

10:40

Okay. Thank you very much. That's good to understand. In an earlier response—if I can just go on to look at the complexity of the services that we have—Matt Jenkins, in his response to the question from the Chair about the UK Government's plans, mentioned that the new plans that the UK Government were proposing were complex. Do you accept that the system for commissioning in Wales is complex? In my constituency, I've been following the case of an individual in Blaenau Ffestiniog who's trying to access a place in a care home, and, I've got to admit, I don't really understand everything that's going on there. It seems really complex and difficult. Do you accept that's the case?

Absolutely, I do accept that is the case. I think there are a number of things to say here. Yes, it is a complex arena. I think there are a number of particular factors and reasons for that. But I do believe as well that, the professionals responsible for discharging statutory duties, they do understand the distinctions. So, for example, residential care really is in the domain of our local authority colleagues. Funded nursing care and certainly continuing healthcare—I entirely accept the complexities. Because you're dealing with, I think, two aspects: one is part of a system that is means tested—so, if you think of social care and the funding issues that we have highlighted and the charging regimes—and then with, for example, continuing healthcare being free at the point of a primary healthcare need. So, we are interested to see what comes from the report, of course, of the expert group, and we see the opportunity to consider any opportunities to simplify and to potentially consider future arrangements. But we certainly do accept, as you've highlighted in the question, that it's a complex area. And perhaps if I ask—. I know that Rhiannon has joined us this morning. Perhaps if I ask Rhiannon just to come in, perhaps, to add a few words around some for the continuing healthcare and funded nursing care—that might be helpful. Provided technology works. Apologies.

The host has unmuted me. Diolch yn fawr. And thank you—diolch—am y Saesneg eto due to technical issues this morning.

As Albert said there, I think, as well as care home placements, we'd probably naturally point towards to continuing healthcare. CHC is an area where we're aware there can be some very significant complexity in some cases, and certainly this has come through our work both internally with policy colleagues, as well as externally with our stakeholders and service users. So, one of the things we've recently done is to publish a revised CHC framework. That was back in April, early April, which sets out guidance more clearly for practitioners, and that's in a real effort to simplify these existing processes and to support the people most affected, and those are the people who have continuing healthcare needs, and to help focus minds around the process itself and on enabling voice, choice and control, which is, of course, what people want and what they should have.

So, we've also published a new public information leaflet as well, which I think draws together a number of previous iterations that could have been considered complicated into one document, and an easy-read version will be published and available shortly. And we've also worked with stakeholders themselves to produce that booklet so that we know that we're getting to the heart of the information that they actually really want to see. So, it sets out the whole process, all the relevant information for people, their families and all their carers for people who are either going through the process now or who may be likely to go through the CHC process in the future. Diolch.

10:45

Diolch, Rhiannon. Thank you. So, you've got new CHC guidance, you've got public information leaflets and booklets, and I think that that should all be welcomed, I'd imagine, but how are they being distributed and how do you expect local authorities, the health board and others to share that information so that people on the ground get to know about the information?

Yes, thank you. That's a really good question. So, as well as a number of the shorter term measures to improve and simplify CHC and FNC, we're also working on longer term measures as well. But, as I mentioned, we are working very closely with stakeholders through our working group, so that's certainly a consideration for us. It's obviously publicly available through the usual mechanisms and host sites, but we want to be able to get that out directly to those who need it most. So, it is for consideration of our working groups at the moment; it's currently being discussed as to how best we might achieve that. And obviously, we're engaged with networks, we're engaged with CHC leads within health boards and local authorities as well. So, we meet regularly with them and ask them to cascade and, obviously, share that information. And as I say, in the meantime, there is a number of other steps that we're taking to improve FNC and CHC, which I can go into now or later, if you prefer.

Well, if you can elaborate now, that would be useful—please.

Thank you. Diolch. So, I've mentioned that the revised CHC framework is now operational, and that does include these positive messages about person-centred control and care and partnership working and integration as well. So, we really want to re-emphasise that and we did that through that guidance, but we're also looking at improving the performance framework that will support operational delivery of CHC. As I mentioned, we know that it is an area that can be considered quite complex, so we want to, obviously, simplify that as much as possible. And we'll also shortly be publishing our policy statement on FNC, which will help to provide an update around legislative changes that we've seen, and in advance of a longer term review of FNC policy itself. So, the statement will set out, again, the importance of partnership working throughout this process, joint commissioning and pooled budgets. And we're also, as I'm sure you're aware, taking forward a programme for government commitment to improve the interface of CHC with direct payments, which is clearly another area that we know can be improved, and we know that from listening to the voices of service users and what they want to see happening. So, we're looking at appropriate legislative changes and considering what may be possible in the future to enable direct payments to be made under CHC to individuals. And we're doing that through working with members of the disability rights taskforce, for example, and, as I mentioned, we've got our internal working group and our external working group with other stakeholders as well.

So, we're hoping for and aiming for a consultation to do that in the late summer and early autumn, and we'll also be looking, then, at the fee methodologies and the rates as part of the work to develop the national commissioning framework, and that's obviously under the rebalancing care agenda and that will obviously include FNC and CHC. So, we're doing an awful lot to try and simplify existing policy and guidance and also working towards some longer term reform measures as well.

Thank you. Can I just get an understanding? You mentioned that some of that work should start this summer, but there's a lot of work proposed with you there. We've got a crisis in care right now, today. Except for the summer period that you mentioned, I'm not really clear what the timescale is for delivering this, and we know that the Government have a full legislative programme already. What do you foresee as the timescale for delivering what you've just talked about?

10:50

So, those shorter term steps we're delivering now. So, as I mentioned, we've already published the improved, revised guidance in early April. We're now working on the performance framework, which we hope to have finished in the next three months. We've got the booklet that's been published, and an easy-read version to go out imminently of the booklet. We're also, with the working groups, developing additional guidance around things like pooled budgets, independent user trusts and, potentially, the ability for health boards to directly employ personnel that individuals may have previously employed under local authority direct payments. So, that's happening now; that's all ongoing at the moment. But, as I say, in the longer term, certainly over the course of this year, we're looking at potential legislative changes that will enable direct payments to be made to obviously meet that Welsh Government programme for government commitment to improve the interface between direct payments and CHC. And, obviously, we want to align that with the work, the rebalancing work, that's ongoing.

So, in terms of timescales, it's very difficult to—. You know, there are co-dependencies there on the rebalancing work. So, what we're doing at the moment is ensuring we're sighted on that programme. It's well embedded in the work streams—CHC and FNC are well embedded in those work streams. So, what we're doing is making sure that we have got that full oversight. And, obviously, there are co-dependencies. We're working alongside the work of the rebalancing and social care agenda to make sure that, in the longer term, we can look for those reforms I spoke of.

Okay, thanks. You mentioned there a key word, 'rebalancing'. Do you think that the current system leans too much towards commissioners and providers rather than empowering individuals, and do you think there needs to be a rebalancing of power there as well?

I think the—. If I may start off, I think, obviously, with the Act itself, that was the intention of the Act itself. And, as Albert articulated earlier, to give that voice and control is clearly the golden thread of the Act itself. And as I say, I do think we do still see some complications with CHC and FNC, so it's only right that we listen to what the people are telling us and what our stakeholders and service providers are telling us and we work towards improvement in that area and simplifying it. But if I may bring in, perhaps, Matt, who could talk more around the rebalancing agenda.

Thanks, Rhiannon. We would absolutely agree with the suggestion in the question, I suppose. As Rhiannon describes, voice is central to our legislative framework in the Social Services and Well-being (Wales) Act 2014. I think the evaluation that Albert mentioned at the beginning of the meeting increasingly throws some light on this subject. We've invested significantly in independent evaluation from the University of South Wales and Swansea University, and they're carrying it out together. So, there are some challenging messages, there's no doubt about that, in the most recent publication that the researchers have provided us with. The proposition in the White Paper was to rebalance many things within the care and support landscape to move away from complexity, on the one hand, to more predictable arrangements, but also to embed outcomes-based commissioning within the commissioning processes that our organisations have so that voice is much more prominent.

So, it's undoubtedly the journey the sector's been on since the advent of the social services and well-being Act. It's a big cultural change for many organisations covered by the Act, and the evaluation shows us it's very much a work in progress. But I think we're quite clear-eyed about the reform path that's ahead of us. The timescale Rhiannon described, and I've described, in terms of delivering a statutory code of practice. But maybe, in terms of primary legislation, we do have some time within the Government schedule for social care on that. So, the provisions that we're examining currently around making direct payments within a CHC envelope would undoubtedly need to be subject to that, if we were to arrive at that point.

Thank you. And my last set of questions, if I may, Chair, if you might indulge me. I've got a 15-year old, or soon to be 15-year-old, son. He's starting his GCSEs next year, and he's receiving career advice. Would you say that being a care worker is a viable and an appealing career option for my son and others?

I'll take that one. So, I grew up on a council estate in the north of Ireland, originally, and ended up being a social worker in the Rhondda valley, which was a fantastic experience. So, I think any young person who's coming into or wants to think about a career in social care, it's a real career that can give you such rewarding experiences.

So, my answer would be to actively encourage, and, I think, to help in that as well, we're looking at a number of important steps. One is how we professionalise the workforce, working with Social Care Wales around the registration, the skills, the training and the support. We've mentioned in various committees over the last year the action of the WeCare.Wales campaign to get more information out to young people and prospective social care employees. So, without going into an extensive response, my answer would be, 'Definitely, yes.'

Alongside that, then, the changes that are taking place around the sustainable funding for the sector. The Welsh Government's financial settlement this year to social care was greatly enhanced, and alongside that then we have introduced, as you know—which is a step in the right direction—the real living wage as a benchmark for all those who are working in the sector in those social care roles as well. Thank you.

10:55

Thank you. I hope that's going to be the case, and I hope that's true. Unfortunately, currently, it's not the case, is it? If you talk to constituents of mine in Llanfrothen for instance, in Llanfrothen, there's an elderly man who's stuck in a hospital and he can't come out, he can't be discharged because there are no care workers to ensure that he is looked after. Can you just elaborate a little bit, therefore, on why we've got this backlog in hospital discharges, what we can do now and what you propose to do, other than a little bit of what you've mentioned there, to resolve this crisis facing us?

Yes, thank you. I think what I'm saying, from my professional side, is that I do believe social care is a very rewarding career to work in, but, of course, I totally acknowledge the challenge that you have rightly outlined, which is that we need more workers in the sector who are paid a fair deal and see that career as I experienced it as well. But, at the moment, you're right to say that there are discharge issues, and I think some of those discharge issues are partially—not totally, but partially—the impact of increased need. I think we've seen some of that increased need following the pandemic and the impact of the pandemic. We have a number of challenges that we are trying to work together to overcome, so domiciliary care in the community is recruiting more workers.

I think it's interesting just seeing the capacity within the system, because despite the challenges, I know that in social care across Wales over 1,100 assessments are being undertaken every week and they're responding to new people needing domiciliary care at around about 370 people per week. So, there's still a tremendous amount of service and support going on. But, of course, we want to work through those challenges, and I think part of the response to the very challenging and searching discharge arrangements is to create other things. So, for example, the discharge to recover and assess is a pathway that takes people's needs first and prioritises them, and perhaps Rhiannon might wish to say a few words around that particular pathway. Thank you.

Diolch. I'm just checking you can hear me and I'm not still on mute. Diolch, thank you. At the start of the pandemic, we issued new guidance, which set out the home first approach and support that Albert mentioned and the discharge to recover then assess, the D2RA approach, which we know is based on evidence of better outcomes for people who transfer as soon as possible out of hospital to their usual place of residence or any other suitable care setting for rehabilitation and reablement. So, we know that that is an evidence-based approach, and that's before they receive assessments then for any longer term care. We're working with regional partnership boards to support delivery of D2RA patient discharge pathways for people, to continue their recovery at home if needed, if they need additional support on their return to their local communities.

We are aware that implementation so far does vary across regions, but we've got the NHS delivery unit working at the national level at the moment to support improvements across Wales, and we've also got the six goals of urgent and emergency care programme, which I'm sure you'll have heard about more generally, and that comes with an additional £25 million recurring national funding that will help support health boards and NHS trusts to deliver on it. The six goals include goals 5 and 6, so, goal 5, which is about optimal hospital care and discharge practice from the point of admission, and goal 6, which is to adopt that home first approach we've spoken of, and reduce the risk of readmission. So, together, goals 5 and 6 align with the national hospital discharge guidance. So, we know that effective partnership working and integration between health and social care is essential to ensure these timely transfers of care and positive outcomes for individuals, and so we know it takes a whole-system approach to see the positive changes that we're pressing towards.

It's probably worth also mentioning that we've got the new £144.6 million regional integration fund as well—just to remind the committee of that—which focuses on creating the six new sustainable models of care, one of which focuses, again, on home from hospital. So, RPBs are working at the local, regional and national level to establish that kind of blueprint for Wales that we want to see for the models of care. So, I think it's fair to say the pandemic, as Albert rightly mentioned there, has really emphasised the need for effective discharge practice in hospitals, and flow through hospitals. It has undoubtedly placed enormous strain on the health and social care sector for myriad reasons, and not least due to a depleted workforce and redistributed or withdrawn packages of care. But it was to enable prioritisation and meet demand that we saw so heavily throughout the pandemic.

11:00

Thank you. And my final question on this, therefore, if I may. On the discharge to recover and assess, you mentioned that there's been a funding package—I think you said £25 million or something, to help. And you mentioned that there's a problem with implementation, that it varies across Wales. Why is there a problem with implementation? If this is the route that you want to go down, if this is the best form of care that you can provide and ensure that people get care in the community, why is there a variation in implementation? Is it funding packages? Is it the fact that the money isn't available? Is it that the skill set isn't there? What's holding us back?

So, there are obviously lots of conversation on this. I think the main reason is that the introduction coincided with an unprecedented pandemic that we needed to respond to. So, the introduction, obviously, may have seen a much greater initial impact had it not been for that pandemic that we were in. So, I would say that is, first and foremost, the main reason that we haven't seen it embedded as well as we would have hoped for across Wales. 

But as I say, there has been some positive feedback about it. So, we've recently had the British Red Cross report into how it's embedded within Wales, and there are lots of positives from that that we can take away. But again, there are areas for us to work on. We're not cited on issues with funding as a reason for an inability to deliver it, but we know that it's a collection, it's a whole-system issue. So, obviously, we've cited the workforce challenges as well, but those are the things collectively that we are working on. So, we're taking on board the feedback from that report I mentioned, the Red Cross report, along with our own observations on the process, to identify and roll out more improvements to the system as part of our ongoing review of patient discharge in the round, and certainly we're considering it as a policy area in its own right at the moment. So, work is ongoing. We understand that it's not as well embedded as we would like, but that is what are working to achieve.

Okay, thank you. Can I just ask a very quick supplementary before I bring in the next questioner? I think in Rhiannon Ivens's answers she referred to the fact that, as people move from direct payments to CHC, you're looking to directly employ personal assistants via health boards. How do you ensure that the service receiver, the individual who is supposed to be in control, effectively remains in charge of that, or, more to the point, that person is accountable to their customer, to their former employer?

11:05

Diolch. So, this is something we have received feedback about and that we know can be quite a challenging area for individuals to maintain that and to understand that. So, again, I would just refer back to the fact that we are currently looking at that with the working groups. It is a subject for us to consider and to try to route-map our way to a better position that will enable that full control. Health boards understandably have some considerations because of the complex healthcare needs that people actually have, so we're working with them. We meet monthly with the health boards' CHC leads to discuss these issues as well. So, at the moment, I'd love to give you an exact timescale for that, but it's currently being worked up at the moment to look for solutions. 

Okay. Thank you. Could I now invite Natasha Asghar to take up the questions?

Thank you so much, Chair, and welcome, everyone. Speaking about solutions, it is my understanding that there was a discussion about potentially adding an additional specialist to work with officials and key stakeholders to review and reduce the current complexity of funding for older people's care homes. Has this made any progress? Has anyone been allocated this position? And, most importantly, what expertise specifically is the Welsh Government looking for from this potential appointment?

Thank you for the question. We've been looking to strengthen a number of particular areas in terms of specialist expertise, and Ministers have agreed that we can utilise our reform funding that's available to us to be able to make those appointments. And for the committee's assurance today, there are a number of current live discussions with key individuals who we feel have the skills and expertise to take up some of those particular roles, and currently those are work and discussions in progress.

Okay. And, if the position is actually secured, what key performance indicators will be put in place so that there is some assurance that this money is going to be well spent on that individual to actually achieve the results that are desired?

Absolutely. I think, in terms of any individuals that we would commission to do any particular pieces of work or employ within Welsh Government to do any pieces of work, we'd be very clear on the remit of the role, we'd be very clear on the actions to be delivered, and we'd be very clear on how we would be seeking to measure that. And there are a number of particular areas, as I mentioned in the earlier response, across Welsh Government where we're looking to use specialist and skilled capacity to really assist us in our delivery.

Okay. And how will the Welsh Government be monitoring and evaluating, moving forward, the impact of the revised national framework for the NHS continuing healthcare?

Okay, I'll just ask Rhiannon. Thank you, Rhiannon. 

Thank you. So, in terms of monitoring the impact and the revised framework, clearly, as I said, it's recent—it came out from 1 April—and officials are meeting regularly with health board and local authority colleagues, including CHC leads, to monitor issues, discuss any issues with the revised framework and support the ongoing implementation. We're also, as I mentioned earlier, looking at the performance framework as well for CHC, with the intention to align it with the national health and social care outcomes framework. So, while it's early days in terms of implementation for the revised CHC framework itself, we do have regular contact with colleagues and stakeholders, including service users and members of the disability rights taskforce, to listen to their feedback and their lived experiences of how it's actually making a difference to them. And we aim to have a timeline available soon in respect of the actual performance framework for CHC. So, we've got lots of ongoing communication with service users and stakeholders to monitor and evaluate, and there may well be scope for formal evaluation in the future. But, at the moment, we are investing in priority areas, such as those I've outlined, and the areas where we believe people will feel the most benefit from as soon as possible. Those are those shorter term sets that I was talking about earlier, such as looking at any appropriate legislative changes that might enable direct payments or focusing in and really understanding independent user trust or the allowance of health boards to employ personnel that people have previously used under direct payments through local authorities before they were assessed as needing CHC. So, we're really focusing our energy on the steps that we feel will make the biggest impacts at the moment.

11:10

Thank you very much for that. I'd love for one of you to please elaborate on something for myself and for the Members here present today: the funded nursing care policy. I'd like to know whether this is actually going to be part and parcel of the wider work to inform the national framework and what is going to be the timescale of this. If you could give us a bit more information on that, that would be really appreciated.

In short, 'yes, it will'. It will absolutely be part of that longer term work. I think I've said we are going to review the CHC and FNC policy in the longer term. Again, I can't commit to the timescales because they're certainly linked to and dependent on other areas, such as the effectiveness of the performance framework, the CHC, the FNC policy statement that we intend to publish shortly in the very near future, and obviously that programme for government commitment to improve the interface. There are, as I said earlier, co-dependencies on the national commissioning framework and the rebalancing agenda, of which CHC and FNC play a significant part. So, again, we're unable to indicate precise timescales at the moment, but we're clear that we want this work to proceed alongside and with the work of the national commissioning framework and rebalancing agenda. I hope that's helpful.

It is. Thank you very much. I'm going to move to pooled funds, if that's okay. So, in relation to this, can one of you please explain to myself and those on the committee here today why regional pooled funding arrangements for care home commissioning have not actually operated as intended, and what exactly has the Welsh Government been doing to promote improvement and hold bodies to account since the pooled budgets evaluation framework came out in 2020?

Thank you very much. It's a really important question because, as a Welsh Government, we've always expressed that pooled budgets are a means to an end, but in the context of the Social Services and Well-being (Wales) Act 2014, they were really conceived to bring health and social care together more closely, to jointly assess, to commission, deliver services together. The Part 9 guidance is really clear and it's permissive. It says that partners should look at pooled budgets in a range of areas as part of a suite of partnership activity, whether that's joint needs assessments or joint commissioning or joint delivery. What we did do, and I think the Member is really helpful in asking what we did, was we actually commissioned KPMG to look at this area for us, and they pointed to some areas of progress in relation to data sharing, needs assessment and joint commissioning, joint fees, methodologies in relation to older people. So, I think you can see where services have developed around pooled funding. You can actually see where there are benefits. So, at the moment, our position across Wales is that we will continue to consider revising Part 9, we're looking to strengthen the regional partnership boards around that. For us, I think really importantly, we are seeing progress around the developments, but we clearly want to strengthen further.

Okay. And I'd love to just know your view as to what impact COVID actually had on the progress.

I think COVID had an enormous impact. Back in 2020 we had very clear ambitions to drive forward, and I think, in truth to the committee, there were points when we thought we were emerging from COVID and then found ourselves back in the thick of the challenges. So, I would say that that clearly has delayed and had an impact on the timescales. And of course, at the moment, we're still in COVID response in some areas, for example especially around how we've developed in our care homes and supported care homes. So, I think, yes, it clearly has had an enormous impact, but the positive is we now seem to be emerging from that and, alongside that, we've continued to push ahead on some really key policy developments.

Okay. How would the Welsh Government like to respond to comments raised by representatives of the Welsh Local Government Association and the Association of Directors of Social Services Cymru that care home commissioning was perhaps not the best place to start the regional pooled funding?

11:15

Yes, I've heard this often, I have to say, over many years, so I understand the point that has been made. I guess it's important for the committee, of course, just to look and think about the wider history in relation to this. This policy intent was back in 2015, and it was developed at the time where we were clearly seeing the need to progress health, social care, the interface across care home commissioning, and the sheer amount of placements across health and social care that are needed. And, of course, working across regions was really important in terms of commissioning and strategic direction.

We did, in response to some of the early concerns around that, actually commissioned ADSS Cymru to produce a toolkit, and in their toolkit, I think it's interesting, they said, if I remember correctly, that all practical barriers can be overcome. And the advice in the toolkit itself, produced by ADSS Cymru, is clear that, as long as formal agreements and transparent arrangements are in place, then there's no real bar to pooling resources across geographies. In that toolkit, I think it set out the good reasons to focus on older people's care home places as well, because there was already a level of co-operation, and the NHS and social care both commission and need to bring that together. The financial contributions, despite the earlier discussions, are relatively straightforward because they're very clear statutory responsibilities.

So, I think, in terms of response to both ADSS Cymru and WLGA's long-standing position about the place to start, I think, given that we've moved from 2015 to 2022, and produced some helpful guides, I think really, with 'A Healthier Wales' as well, the direction—. Clearly, this is the direction for organisations, and the intention is to really bring partners together, focusing on citizen outcomes and citizen need. 

Thank you so much, Albert. If there's one thing that I have to say, and I think I can say across the board, is that we all want to have positive outcomes at the end of the day. None of us want to see any failings. We don't want to see failure, and we don't want to see a misspending of public funds at the end of the day. But from your experience, what can we be doing, or what can be done now to provide the best experience of care to those who need it the most right now?

Well, I think in relation to that, the first thing is there's a system issue. So, there's health, social care, third sector and other partners really working, pulling together, to look at how we can do radical things quickly that can make a difference. We've talked a lot today about discharge, but, in my opinion, discharge is crucial, and it really doesn't matter to me whether you're from a health setting, or a social care setting—anyone delayed in the system, we should be absolutely committed to responding to their needs. But, also, we should focus strongly—and I would advise this—we should focus strongly on admission avoidance. We still have cultural issues that are about risk and risk averse. So, I think there are things that we can do at the front end around community support and strengthening that, and I see that being our ability across partners.

I think the other part for me, then, in response to your really helpful question, is, actually, you've got to really focus on that 'what matters' conversation—what matters to an individual, and supporting them at that particular time. So, I think, sometimes, as we've seen, when we talked many years ago around prudent healthcare, we were always keen to diagnose and find other things, whereas what we need to do is have that 'what matters' conversation, and really respond, then, to the citizen and what the citizen wants in terms of achieving the outcomes that are most important to them. 

Okay. Thanks for that. Moving on from that, I'd like to ask you: reflecting on the responses to the previous policy consultation, what is the Welsh Government's starting position now on the consideration of whether creating a social care corporate joint committee would aid RPB governance going forward?

Okay, a really good question that one, I must say, so thank you indeed. At the time that the corporate joint committees and the legislation were being considered, it was clear at that stage that, for social services, social care, that was not the right time for the first phase to be considered, but it was always mindful that there may be future points where corporate joint committees could be considered and could aid governance. 

I think, as the chief social care officer role that I have, when I think of the opportunities, I think we've got to look at things that might help us in the future. And, certainly, I think exploring corporate joint committees could potentially have a number of benefits, would remove some of the barriers around cross-geographical boundaries and the worry around that. It would still mean that services would be delivered locally, but in terms of regional partnership boards, if it was set up on a regional partnership board footprint, rather than a larger footprint, then I think that might make coherent sense. But it may also, then, allow you to have really good governance arrangements across that corporate joint committee and the interface with health and other sectors.

One of the things that maybe the committee will be interested in is, citizens—. Variation—if variation is in place to meet need and achieve outcomes, then it can be a good thing; of course variation can be a good thing. But actually, a lot of citizens sometimes experience inconsistencies, and so perhaps moving on to a corporate joint committee may be a way of delivering locally but achieving more consistency in terms of the offer to the citizen as well. So, I think you're right to ask whether it would enhance, or could it enhance, regional partnership boards, but I think also it may have wider advantages or opportunities and is worthy of consideration.

11:20

Okay. Thanks for that. And has the Welsh Government ruled out any broader changes to put RPBs on a statutory—statutory; I can't speak today, my apologies—footing, and if so, why?

Thank you very much. The question was—[Inaudible.] The regional partnership boards are actually on a statutory basis, so they are a requirement. What we looked at within the 'Rebalancing Care and Support' legislation was whether we should enhance that. And at the time of the White Paper consultation, there were suggestions that we put forward as options, which were whether they could be like a corporate body that could hold budgets themselves, or they could employ staff. The wide feedback from the statutory sector was that that was unnecessary, that they would be able to, as partners, work together. So, we haven't sought to move on to a corporate body stage, given the feedback we received, but we do intend, for the Member today to be aware, to look at where we can strengthen around the regional partnership within our current codes and guidance.

Okay. There's actually a strong consensus that reporting arrangements to/from RPBs to statutory partners and establishing scrutiny arrangements for RPBs has actually not been resolved adequately before now, given previous commentary on this issue and Welsh Government guidance. What's your view on this and what can we do to ensure that this isn't a consensus anymore?

I think it's an important aspect, and the first thing I would say is that, as a regional partnership board, our expectation is around citizen participation as well. So, yes, of course, scrutiny is important to all of us in public office, but I think, actually, participation is also part of that considered wider lens that we should ensure. In terms of then looking back at it, there's nothing that prohibits, and, often, I think perhaps some of the concerns around regional partnership boards to Welsh Government are not necessarily always things that Welsh Government have put in place. They have been local choices and local determinations. So, what we will continue to do is our work with regional partnership boards, because we've strengthened our approach, we've got the regional integration fund as an illustration, which is £144.6 million per annum, over a five-year programme. So, we do want partners to be scrutinising, we want local partners to be scrutinising the actual work. We will continue to monitor, but I think there's an important aspect here about the regional and local scrutiny that adds value to the whole work of the regional partnership board.

Okay. Thanks for that. I just have two questions. I've only been in the Senedd for a year, but, every so often, new buzz words, new terms, new things are introduced. So, one thing that I've learned recently is there's a new charter, which is basically about the role of service users, unpaid carers, third sector and provider representatives on the RPBs. And it's been said that it will set out how the Welsh Government will ensure these are going to be met, moving on. What's your view on this? Is this going to change the world? Is this going to save everybody? I'd like to hear your feedback on this.

11:25

Perhaps I could respond to that question, please. I think it's a really important question because the health and care system relies heavily on unpaid carers to provide care and support for very many people across Wales, of course. When the Social Services and Well-being (Wales) Act 2014 created regional partnership boards, the requirement there was for unpaid carers and citizen representatives to be an active part of the arrangements within regional partnership boards.

In the meantime, representations made, including through the carers ministerial advisory group—directly by carers themselves and by their representative organisations, like Carers Wales and Carers Trust Wales—were that often, frankly, carers found it challenging to have their voices heard within the traditional-style meetings, the way that business was perhaps, understandably in some ways, conducted in regional partnership boards. So, I think it's important to say that RPBs and chairs have worked very hard, I think, in recent times to be able to amplify citizens' and carers' voices, but we wanted to give that some more focus. 

We convened a meeting last year between the chairs and all the citizen representatives to look at areas that we could do nationally to be more supportive of the chairs and the citizen representatives. So, 'charter', as you've said, was the word chosen, but it was something that could really signify across Wales for all our partnerships, simple to understand, what the role of carers would be within those groups and what their expectation should be about how they would be heard, and the contribution that they should make, which is not that they can represent every single carer across all geographies, but it is certainly to offer a perspective on all the important decisions that regional partnership boards make. As Albert says, there are some quite significant funds, as well as more broadly, for assessing needs and developing plans for all integrated services across their geography. 

Good progress is being made there. One of the working groups that I described earlier, in the rebalancing programme, which is the one we've made a fast start on, has been developing that thinking, co-producing it. We're at the point, I think, of being able to now release that and publish it in the coming weeks. I think we're making good progress and it has been supported, as I understand, by carers and their organisations too.

Thank you, Matt. I do have one question, but I would like to ask a sub-question on the one that you just answered. I'm delighted to hear that you had carers contributing to this, because I went to a few group meetings with nurses and doctors recently and they were often saying that when it comes to working on moving forward and creating progress, they often feel like their voices haven't been heard. So, just in relation to what you said, obviously, feedback has been taken—I understand and accept not from every carer across Wales; that won't have been possible, I get that side of things. But for those who were involved and did take part, I'd like to know who actually obtained the feedback, because often certain individuals, particularly in certain caring fields, do feel rather closed off from expressing their true feelings, if it's, for example, to their manager or to their immediate boss. I just want to know, was an external organisation used to gain their feedback, or was it just their immediate line manager who was obtaining information from them?

Unpaid carers would attend, take part in regional partnership board meetings, in decision-making meetings, as private individuals in a sense, without fear or favour, if you like, of organisations that they may work for, for example, because many unpaid carers are in the workforce. People can be unpaid carers at all ages of life, can't they? We have arranged support for unpaid carers in regional partnership boards through third sector organisations. Regional partnership boards themselves have certainly stepped up to that. The officers who work and co-ordinate matters for regional partnership boards—I know many of them will meet regularly with the unpaid carer representatives on their groups and support them to broaden the contribution that they can make through engaging with other unpaid carers in the community.

So, it's quite a challenging area, I would say, but certainly something that Ministers are absolutely passionate about. The Deputy Minister for Social Services, in particular, has been committed to this for a number of years through the ministerial advisory group that I mentioned earlier, which was established several years ago. So, we're working hard to ensure that their voice is heard, to ensure that their voice is amplified. We don't think we're all the way yet and I think the most recent report by Carers Wales still shows some real challenges in the system for an unpaid carer, so we're certainly mindful of the significant work that still needs to be done.

11:30

Okay. Thank you. My final question now is: what does the Welsh Government foresee as the future role for the new citizen voice body in respect of the work being carried out by RPBs?

Thank you. I'll pick that one up, please, Chair, if I may. In terms of the citizen voice body, obviously created under the new Act in 2020, I'm sure the Member and committee members will be pleased to know that last month the position of chair, deputy chair and the six non-execs were appointed. I was involved in the appointment of the chair process, and it was an exceptionally talented recruitment process in terms of those who came forward, which is superb. Obviously, as it becomes operational then it will be an independent body to seek the views and represent the interests of the public in respect of both health and social care, and from my perspective it would be really important for the citizen voice body to work with the regional partnership boards, although that's something they'll have to determine, but I think we will guide in that direction, as they will be seeking the voice of the citizens. Already we know that we've enhanced that voice across regional partnership boards and they have citizens involved. Potentially, I think the citizen voice body could actually play a role in supporting individuals in their roles on regional partnership boards as well, and just to make sure that they assist them in the access to wider citizen voice within regions as well. So, I see this as really a positive development for the first time in Wales to have the establishment of a citizen voice body, and I think it will be great to see how that now begins to progress and take shape.

Thank you very much indeed. A very brief question, if I may, from me, before I bring in our next questioner. I'm pleased to hear you use the term 'co-production' repeatedly. What is your definition of 'co-production'?

We will have a definition of co-production. I don't have the wording straight off the top of my head, but what I will say to you is how we describe it. In terms of co-production, co-production to us is about that active engagement with the citizen, with the stakeholders, around policy design, service design, so it's really embedded at the heart of any development that takes place. Co-production is not about sitting somewhere and then bringing policy to the citizen; it's actually doing that right at the outset and having a real meaningful discussion. I was very privileged to lead around the development of the Social Services and Well-being (Wales) Act 2014, and actually that Act, I believe, stands the test of time, because of the co-production and the real valuable input from our citizens. So, that would be my offer to committee today, but of course we could more formally send something through in terms of our formal definition. But I think that is the spirit of our engagement and our approach across Wales, and it is absolutely central to everything that we seek to do.

If I may add to that, if it's helpful to committee, I totally agree with that definition, and I think we'd also see it as end-to-end. As Albert rightly said there, we're not taking policy to people; we are creating it with people, but we're also doing it end-to-end, so they're still engaged throughout the process, throughout any monitoring and evaluation as well, to make sure that what we are doing seeks to achieve, or does achieve, the benefits that they've told us that they want to see. We certainly don't see it as a tick in the box at the start of a process and that's the end of it; it's end-to-end throughout.

Thank you very much indeed. Mike Hedges, could you take up the questions, please?

Diolch, Cadeirydd. I want to talk about regional commissioning and shaping the market. How effective have the regional partnership boards been in developing regional strategies that help partners shape the care home market to provide the facilities and services currently needed, and also those we expect to be needed in the future?

If I may respond to that important question, this is a core area of RPB work, to our minds. Strong expectations are set out in the Part 9 code in this area. Just to set a little more context for that in the first place, regional partnership boards, of course, bring partners together to consider the changing needs of their shared populations to look at those long-run changes to population needs that might then require the pattern of service provision to also adjust in a commensurate way. RPBs currently have just completed the second of those needs assessments, which, as the Member will know, roughly follow local government terms, so a new needs assessment is published every five years. That will be complemented quite quickly, as I think the committee knows, through the completion of market stability statements, and indeed, in just under 12 months through the publication of area plans. So, that's the framework that RPBs have worked to, complemented more recently by the advent of the market stability work, and will continue to work to.

I think I would draw on evidence from both the independent evaluation, which I mentioned earlier, and the KPMG report, which we commissioned, and it does point to progress in this area; that's the independent findings. There's a section in the process evaluation by the University of South Wales and Swansea University that describes progress in commissioning. This is pointed to: that rhere are commissioning strategies in place across Wales, there are commissioning hubs. The greater level of co-operation amongst commissioners is something that is pointed to here. We often see regions come together to work around fee methodologies, which is a challenging area—I think often controversial, but nonetheless, we do—and I think you've had evidence on this. Commissioning organisations are more likely to work together on this than separately, which would have been the case in the past.

So, I would say that the direction of travel is definitely the right one, though the KPMG report does highlight this as an area for further development, and certainly with RPBs, fresh needs assessments and area plans in place. We would see that as a much stronger footing for updated commissioning strategies and perhaps an inflection point, if you like, in terms of the speed of progress towards delivering on pooled funds also, which would be a logical progression, I think, from developing these planning documents into seeing the pooling of resources and the joint commissioning of services through that. Thank you.

11:35

Can I talk about how things have changed, and if you're happy with the way things have changed, in what direction you would like us to move? I remember when local authorities provided about 95 per cent of all provision; they now provide about 5 per cent. I remember when there were lots of small private providers, and there seems to have been a growth of very large providers, and a lot of the small providers no longer exist. Some have been returned to being homes and some have been turned into flats; we've had that sort of change taking place. Apart from the very big providers, who have been expanding, I've seen very little new build in recent times. Is what I'm seeing what you are seeing? I'm just talking about Swansea East, so it might not be the same across the rest of Wales. That's what I have seen, as I say, since 1989.

And the other question is: is that what the Welsh Government wants, or are you going to try and change what's happening, try and promote more small providers, trying to get more third sector providers? We have been told that some third sector providers may have to withdraw from the market because they're unable to be part of it in a cost-effective manner.

Thank you very much; a really important range of issues and questions. I think that a good starting place is that I think the picture that you've described is a true picture across Wales. I think that is really helpful. We would share that picture. Our Welsh Government policy is to rebalance the provision, so looking at social care by really increasing local authority and third sector provision, the growth of whether that be social enterprise or co-operatives. We recognise that the private sector is a really important and valuable provision in Wales. It plays a huge role, in the region of about 80 per cent reliance in relation to care provision. And so we see the ability here to look at how we would rebalance over time, to develop that next economy of care, which just supports the development of a more stable, resilient sector in delivering on the options in choice and quality of care.

I think you're right to raise the issue of small versus large. You mentioned Swansea. I worked in Swansea many years ago, and you can see the developments in different places across Wales. Wales still has, traditionally, a large small care home ownership sector, but, increasingly, in terms of being able to set up, perhaps what we're seeing is that, for smaller providers, there is an increasing challenge. And so, for larger providers of care, sometimes there's a need to be at scale to get the investment that they're seeking in terms of the financial packages, but I think, at this stage, we would certainly want to see a rebalancing. I hope I've covered most of the questions that you referenced in your very helpful question. Thank you.

11:40

You did. The only point I would raise is the third sector. We've been told that some third sector organisations are thinking of withdrawing. Are you seeing that as well? Most people in this meeting like the third sector, and we like co-operatives as a method of providing services, so we'd be disappointed if it just became private sector and local authority without anything in-between. 

Absolutely. We see the importance of such a valuable third sector, and I think the risk that you've highlighted has been identified. We see, as to our partners, when we talk about health and social care, of course there are a range of statutory partners, but there is the wider third sector and organisations that just are invaluable in terms of communities as well. And so, we are currently having discussions in terms of a number of those third sector partners, and also our housing organisations as well. And so, that, clearly, is something that we'll be seeking to address within the national framework and also the work of the national commissioning board.

Thank you. If I move on to variations in expenditure. We know that the unit costs vary—i.e. the weekly care home placement costs—across Wales. Are the Welsh Government looking to see why it's happening, and are they looking for greater consistency and transparency about fee setting, and a focus in fee setting on the needs of service users, who, sometimes, appear to come as the third and least important part of a discussion between the local authority and the provider?

Thank you very much. So, absolutely, we have been very closely linked to understanding the different fee methodology or determining different fee rates, and some of the factors around those different monetary values across different local authorities. We did actually try to assist, and we did a major piece of work that we commissioned, which was 'Let's agree to agree', which was welcomed as a good approach but, interestingly, I think wasn't necessarily the adopted model in all local areas. So, whilst it was recognised as a good approach, it still hasn't—. Where we see the future—and I think this is the value of the policy direction and the detail of the work that Matt and Rhiannon have described today—is being around the national framework and the national office. So, whilst we recognise there may be some variation in fees in the future—that could be because of cost varying potentially in relation to an individual, but probably more significantly in terms of either accommodation costs et cetera, in terms of buildings and location; there may be some variation—we see the opportunity in the national framework to really streamline that and move that into a much better deal in terms of thinking from a citizen's perspective, but also in terms of clarity for our providers in the sector as well.

Do you share the concern expressed by some people who've talked to us about top-up fees? 

Yes, we do share that concern. We are very interested in underneath the detail. The Older People's Commissioner for Wales, for example, has been very helpful in raising these issues with us, and I know that work is currently looking at where we may need to consider what actions need to be taken in relation to top-up fees, because, again, we're aware of top-up fees in relation to continuing healthcare as well.

11:45

I was going to say that it is important. Can I urge you to look at top-up fees? Can I also urge you to look at top-up fees that appear unreasonable? I've heard stories of older people having to pay a top-up fee to go into the garden. I've heard stories of people having to pay top-up fees to have their nails cut. I don't see these as things that ought to have top-up fees, so I'm asking if you could actually, with the Minister, look at saying, 'These items are not available to have top-up fees'. 

We will look at that. Those are basic human rights.

And on the real living wage to care workers, the statement from Care Forum Wales is that that money doesn't actually make its way through to the providers.

Well, that's a really important point. I have regular discussion with directors of social services and other partners. I will be seeking assurances. We have, as the Welsh Government, made that money fully available; it has gone into both—it's gone into local government but also for health board commissioning as well. It has gone into the health boards. So, just over £37 million of our funding allocation to local government covers the cost of the real living wage. So, basically, my clear message today is that that must be passed on to the workforce. And it doesn't make any sense to me it not being passed on to the workforce when we have talked about some of the critical challenges around the workforce and recruitment and retention, as other members of the committee today have raised as well.

We've had the ruling against Gwynedd Council regarding healthcare. Is that affecting how you're looking at this? Are you expecting more of those legal challenges to local authorities? It worked in Gwynedd; why wouldn't other providers go to court?

There are two things to say there. One is that we are keeping a watching brief, obviously, in terms of developments. But the second thing to say is that I really would hope, given that the settlement to local government has specifically sought to raise funding this year to support social care, that that, therefore, enables local authorities to be in a stronger position in their partnering relationships with their local providers. Having a strong relationship with local providers is absolutely essential.

Can I move on to stability and quality of care home provision in general? How do you assess the state of the care home market for older people in Wales? I know that there are going to be variations between the very rural areas and big, urban areas like Swansea and Cardiff, and those variations can be quite large. But, really, what I'm asking is: do you assess the state of the market as 'okay', 'could be okay soon', or 'oh dear'?

It's a very good question and one that we're always mindful of, and have been over many, many years. I think I've put on the record many times my appreciation of the work that social care and care homes did during the pandemic. It was absolutely outstanding in the very difficult of days. I think we also supported—. I say 'I think', but I know we did—I know that we supported the sector financially, and the hardship funding was used differently to other parts of the UK and was very welcome to our providers.

I think my honest reflection on the very helpful question is that I think that there are strengths and weaknesses, but they're more based upon market variation and geography of different local areas. I think, overall, most authorities are in a healthy position at the moment around basic residential care provision, but I think when you get into the more complex needs around nursing care, there is that ability and need to really strengthen in terms of planning for the future. So, I think, at the moment, around care home provision, clearly, that has been an important feature. And probably added to that, of course, I think it's really important that our domiciliary care capacity and our reablement capacity are real focus points as we develop enhanced community support and community services.

11:50

Thank you. I'm not quite sure whether I heard this in one of our committee meetings, or I heard it from somebody talking to me, so apologies if it wasn't from a committee meeting, but what I was told, or what I heard, was that life would be a lot simpler if local authorities would block-book beds, so the provider had guaranteed income and the local authority then had them to fill rather than paying per person. If three people die in one week and then no-one going in there, all of a sudden the care home has a serious financial problem.

I think the block-booking discussion has always been an important discussion. I know that health colleagues have also block-booked some placements as well. I would see that really being an opportunity for us to work through through the national framework and the national office to make sure we get that absolutely right, because what we want is confidence and good services to people. Care homes, for example, are people's homes—they're where people live. They need to be well supported with their loved ones visiting them, and there are some really important aspects about the quality of care that need to be at the centre. And we talked earlier on in response to your questions, you know, about things that are just basic human rights and basic entitlements that we want to make sure are available to all of our citizens in care homes.

And my final question on this area is: what do you want it to look like, the care home sector? I've sort of talked around it a bit, and you've answered a bit, but could I just push you: what do you want it to look like? Do you want to see a mixed economy? How do you want to see the mix? And perhaps more importantly, if we have a lot of private sector providers—I've got a lot in Swansea East, but three big providers probably do 60 per cent of the provision—what do you want to see occurring?

Okay. Well, the response to that question, I think, is probably more straightforward. We are very clear that we do want to see a mixed economy. We want to see a rebalancing, but that within given standards. So, we want the standards for care and the quality of care to be consistent across all of our organisations. We want to see more citizens supported in their communities, and only at the right time in their lives for them then to be supported through a care home, whether that be ending up in funded nursing care with health, nursing care support, or, ultimately, when they have a primary healthcare need, continuing healthcare.

Thank you. Moving on to the workforce, we know there are more job vacancies than there are people. We know that domiciliary care has got huge shortages. We also know that people move from care into the health service because it pays better, and has done for some time. I say 'we know', but if you don't think we know those things, tell me. So, how are we going to deal with the fact that care is not a particularly well paid occupation; it's a particularly difficult occupation, and there are better-paid and easier jobs for people to do. How do we move beyond that? Do we have to increase wages to a level at which people want to work there? I mean, when working in a restaurant or a pub can pay you more than caring for somebody, why would you do the caring job?

Thank you. I think my answer to that, focusing certainly as the chief social care officer and supporting Welsh Ministers, is that I think it was a very positive step, a very constructive, a real brave step to move to the real living wage for all social care workers in Wales. I think that was only a starting point for improved terms and conditions; it's not the end point. I think we will be delivering a dynamic evaluation of that commitment alongside that roll-out, to understand its implementation and the impact that the funding has. But I think, alongside that, we will need to prioritise wages, terms and conditions, and career pathways. I know that local authorities are moving into a different space now around potentially looking at national terms and conditions as well, which really would be, I think, a good step forward. And I think also, just to add one personal reflection from my professional role, to me, the workforce, whether it's in the private sector, in the third sector, for social care jobs, or in local authority public service, need to be on the same terms and conditions. We need to value the status and the expertise. So, I absolutely agree that that is an area to be strengthened. The social care work forum is currently prioritising areas such as pay, progression and collective voice, and we're looking forward to hearing more from the forum in terms of what steps need to be taken as well. I think that also adding the policy perspective around the rebalancing White Paper for the Member today, I think that national framework will be a really helpful tool, because if that's aligned to workforce terms, conditions and career development, you could see quite a significant shift in the Welsh landscape.

11:55

Do you see a role for professional development? I think that far too many people join as carers and when they finish working for the local authority or for the home, they end as carers, and we don't seem to have any career path, any career progression. I know you talked a tiny bit about that in answer to some earlier questions, but do you want to take it a bit further?

Yes, absolutely, and I'm happy to do so. We see through the work of Social Care Wales, and especially on a regional footprint, because, at the moment, we do have a lot of workforce who move around either local authorities or around particular employers, so there's an opportunity through the scale and the economies of scale and thinking about national terms and conditions to really get into career pathways. What I would like to see is that really being across all age groups, of course, but I think there's a real opportunity, especially with the young workforce, as the Member highlighted earlier on in an earlier question. There's a real opportunity with the younger workforce, especially if we can show that we have career pathways in which they can work through. And I think it is important to focus on the pay, I think it is important to focus on the status and how society values such roles and gives that equality of esteem across health and social care.

Finally from me, the WeCare.Wales campaign, was it a success? Quite often, campaigns like that take several iterations to be successful. Did it work and are you thinking of running it again, and how will you assess whether it has worked? Will it be the number of people employed or the number of people who you keep in employment?

Great. Yes, indeed. I think it's both of the latter: it's the number of people employed and the number of people that we keep in employment. I really think the Social Care Wales and the Welsh Government approach around WeCare.Wales has been invaluable. I've said before at committees that I think it was invaluable both in terms of how it began to show social care as a more attractive place to work, but also how it then got really positive messages about social care out across wide media audiences as well.

One of the areas that Social Care Wales are helping us with now is really to refine how we measure and how we capture that data, because one of the practical challenges was just that whilst we could see what was coming through the WeCare.Wales portal, it was harder and more challenging then to translate that into the many hundreds of employers in the sector. So, at the moment, the new social care workers are all being asked to complete an anonymised survey, which includes questions on the WeCare.Wales recruitment advertising, and we'll use those findings to help us understand what the direction is to go forward. Given all the information that we've had in front of us, I'm certainly very strongly committed to continuing the WeCare.Wales approach and really strengthening both our offer for new workers, but also helping the wider understanding of what jobs are on offer, about what people are doing and the value and the sheer strength of such valuable workers.

Thank you. Well, that brings us to the final set of questions. Are you okay to hang on for a couple of minutes, given the late start we had?

Of course, Chair, of course.

Thank you very much indeed. A quick supplementary first, following Mike Hedges's set of questions. One of the key contributors to quality and sustainable care home provision for a number of decades in Wales and to the Welsh Government's agenda on extra-care housing has been housing associations. What engagement are you having with them about the concern expressed to the committee that if things don't become more sustainable for them, they may have to pull out of provision?

12:00

Yes, very much, and I acknowledged that in response to the Member's question. We're having really active discussions with our housing association partner colleagues, so there's very detailed dialogue taking place, and we're also exploring opportunities about how we further strengthen, because we see extra care, again, working across ministerial portfolios. Extra funding has also been made available, and that really will hopefully and helpfully strengthen in relation to housing developments as well.

Thank you. To conclude, therefore, how will the national outcomes framework for health and social care be integrated into existing performance management arrangements for health and social care bodies, and how will changes to performance management arrangements ensure a stronger focus on care home service user experience and outcomes? Finally, related to that, how will regional partnership boards and individual public bodies be held to account for their contribution to achieving the outcomes you've explained to us?

Yes, thank you, Chair, for that question. So, we know that the national outcome framework as described earlier was part of the thinking of the Act, really focusing on the well-being of the people for whom we care and support, and carers who need support as well, and to provide a consistent approach to measuring well-being. We did a lot of work with our sector partners to develop the national outcome indicators, and whether they were being achieved, and in addition to the outcome framework we did an extensive piece of work to develop a new performance and improvement framework, which was introduced in April 2020. That was of course produced in co-production across local authority and key stakeholders, and I think that really sets out our ambition to use a range of methods to collect, to analyse, to understand the data and evidence around the delivery of care and support, and support for carers in Wales. So, I think, from our perspective, that framework offers new data that's being used. It's really under the national outcomes framework, but it allows us—. And we'll be moving into annual publication, and of course really focusing on what the existing indicators are, but we'll also be very open, for the committee to be aware, to the inclusion of any new indicators that would strengthen.

I think in addition to this—and this is really helpful, I think, for regional partnership boards—the Minister's recently announced the development around joint outcomes and frameworks, and that comes out of 'A Healthier Wales', our 10-year strategy for health and social care. The joint outcomes framework, I think, will really begin to focus on those common areas around population health and population well-being that are really going to be central to us as we drive forward for the future. And of course, then, in terms of our regional partnership board work, as we strengthen, we already have existing monitoring arrangements in place, but we'll be keen to really evaluate and show the strength of the work as we develop. And with the regional partnership boards, it's really important that we focus on the population needs assessments, their development of their area plans, and showing then that matching that kind of strategic direction and the intelligence of the data and using it then to really show and deliver on the outcomes that we want for people. 

Okay, thanks. I'm sure you'll agree it's important that we not only to identify the strengths, but also identify and agree the areas where further change could be required. But how will you ensure better information sharing generally between Social Care Wales, Care Inspectorate Wales, Healthcare Inspectorate Wales, health boards and local authorities?

Well, what we're going in that respect—. That's a really important question, so thank you. The Regulation and Inspection of Social Care (Wales) Act 2016, that created in law the requirement and opportunity for, for example, Social Care Wales and Care Inspectorate Wales to exchange information and ensure that they set up those pathways. I know from our work with both Care Inspectorate Wales and Social Care Wales that they have worked to do that, because it's really important that that information is shared across. I know that Care Inspectorate Wales and Healthcare Inspectorate Wales have both worked together to share information, because the sharing of information enables the intelligence to be considered in terms of how well placed we are in delivering services at a local level, but also then what opportunities there are in terms of improvements, as we journey forward.

So, in terms of progress being made, I think good progress is being made in the sharing of information. Of course, one other added feature of this is the information services, whether that be the Wales community care information system or other developments that are taking place in different local areas. It's important that health, social care and partners are able to share information in relation to planning for individuals, so that things are done in a timely, co-ordinated, supportive and enabling fashion.

12:05

Thank you. It's apparent from the recent Audit Wales report on direct payments for adult social care users that many local authorities are not doing enough to encourage the use of direct payments and to make people aware they can have support for the use of direct payments as they go forward. So, how do you plan to work with local authorities to drive improvement in response to the auditor general's recommendations in that report, including on the interface between direct payments and NHS continuing healthcare?

Thank you, Chair. I'll take that, if I may. First of all, it's important to say that we really welcomed the Audit Wales report on direct payments, and the committee has received a copy of our response to that. And that attempts to address two key areas for us. Firstly, it's about supporting choice, so, is direct payment the right solution for the person in question; and secondly, supporting people, as you say, to manage their direct payment, and that includes achieving an effective balance between autonomy and governance around public funding. We've already begun our discussions with local government about how we can secure greater consistency in terms of awareness and understanding around direct payments. So, having that clear and consistent information, as I mentioned earlier in some responses, is absolutely critical to that. And you'll have seen that the formal response from ADSS Cymru reinforces that particular point, that the information must be clear in order to achieve its aim.

So, our aim is for simple and concise public information—and we've achieved that through a number of ways so far and continue to work towards that—and to use the assessment process itself to explore if direct payment is a suitable option for that person. We know the report has confirmed a number of key areas that are positive for us. So, 91 per cent of people reported that direct payments were having a positive impact. So, that reinforces our vision that direct payment does make an important difference to people and that they're a highly valued method for service users and carers. And 85 per cent of people, for example, say that direct payments have definitely been the right option for them. We know the pandemic has definitely influenced the nature of the relationship between local authorities and direct payment recipients, and that's something we think may have contributed to Audit Wales reporting greater levels of satisfaction where support is provided in-house, rather than through one of the external commission providers.

So, I'd say, to summarise on that point, that we know that direct payments are a critical tool to support choice, voice and control and enable people to live independently, and it does reflect that social model of disability. I did touch briefly earlier on during the session about our work on the programme for government commitment to improve the interface for direct payments and CHC, but just to reiterate, we've revised that CHC framework, together with the revised decision support tool, and we're working on that performance framework and that will support the CHC assessment as well. That guidance was operational from the beginning of April, and I've already highlighted a number of interim measures to improve that interface between CHC and direct payments and, for example, the use of independent user trusts and also looking at potential legislative options that may enable direct payments under continuing healthcare.

12:10

Thank you very much for that. I think the social services and well-being Act's codes of practice do talk about the need for local authorities to promote and support, although it wasn't on the face of the legislation at the time. And I'm pleased that you acknowledge the importance of addressing or adopting the social model of disability in this process, recognising that unless we identify and agree with individuals the barriers they face, then they can't be supported to remove those barriers and achieve their goals and outcomes.

My final question before we bring this to an end: is there anything you want to add that you haven't already stated in evidence to us today regarding the subjects of today's evidence session? 

Thank you, Chair, and thank you, committee. Nothing to add, but just for your—. Just some appreciation, really, for the fact that you helped us and gave us some time to try and resolve the IT technical difficulties. And, once again, apologies for that disruption.

Thank you very much indeed for that. Clearly, the IT gremlins choose to hit usually at the worst times, and they don't discriminate between Senedd, Parliament, Government or any other body, or the witnesses that we frequently have before us. So, can I thank all of you, to Albert Heaney, Rhiannon Ivens, Matt Jenkins for being with us today, and for the evidence you have given us? A transcript of today's meeting will be published in draft form and sent to you for you to check for accuracy before the final version is published. So, thank you again, and I hope you get a chance for some lunch before you move on with your afternoon's work. So, take care, farewell, and no doubt we'll see you again.

Thank you. Diolch.

5. Cynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o'r cyfarfod
5. Motion under Standing Order 17.42 to resolve to exclude the public from the meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

Members, I now propose that in accordance with Standing Order 17.42(ix), the committee resolves to meet in private for items 6 and 7 of today's meeting. Are all Members content? I see that all Members are content. Therefore, I'd be grateful if we could now move into private session, and if the clerk could change the settings accordingly.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 12:12.

Motion agreed.

The public part of the meeting ended at 12:12.