Y Pwyllgor Iechyd a Gofal Cymdeithasol
Health and Social Care Committee25/05/2023
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Gareth Davies MS||Aelod o'r Pwyllgor Iechyd a Gofal Cymdeithasol|
|Member of the Health and Social Care Committee|
|Jack Sargeant MS||Aelod o'r Pwyllgor Iechyd a Gofal Cymdeithasol|
|Member of the Health and Social Care Committee|
|Joyce Watson MS||Aelod o'r Pwyllgor Iechyd a Gofal Cymdeithasol|
|Member of the Health and Social Care Committee|
|Mabon ap Gwynfor MS||Aelod o'r Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus|
|Member of the Public Accounts and Public Administration Committee|
|Mark Isherwood MS||Cadeirydd y Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus|
|Chair of the Public Accounts and Public Administration Committee|
|Mike Hedges MS||Aelod o'r Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus|
|Member of the Public Accounts and Public Administration Committee|
|Natasha Asghar MS||Aelod o'r Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus|
|Member of the Public Accounts and Public Administration Committee|
|Rhianon Passmore MS||Aelod o'r Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus|
|Member of the Public Accounts and Public Administration Committee|
|Rhun ap Iorwerth MS||Aelod o'r Pwyllgor Iechyd a Gofal Cymdeithasol|
|Member of the Health and Social Care Committee|
|Russell George MS||Cadeirydd y Pwyllgor Iechyd a Gofal Cymdeithasol|
|Chair of the Health and Social Care Committee|
|Sarah Murphy MS||Aelod o'r Pwyllgor Iechyd a Gofal Cymdeithasol|
|Member of the Health and Social Care Committee|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Dr Alison Tarrant||Ysgol y Gyfraith a Gwleidyddiaeth Prifysgol Caerdydd|
|School of Law And Politics, Cardiff University|
|Professor Fiona Verity||Ysgol Iechyd a Gofal Cymdeithasol, Prifysgol Abertawe|
|School of Health and Social Care, Swansea University|
|Professor Luke Clements||Ysgol y Gyfraith, Prifysgol Leeds|
|School of Law, Leeds University|
|Professor Mark Llewellyn||Athrofa Iechyd a Gofal Cymdeithasol Cymru, Prifysgol De Cymru|
|Welsh Institute for Health and Social Care, University of South Wales|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Claire Morris||Ail Glerc|
|Rhiannon Williams||Dirprwy Glerc|
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.
Roedd hwn yn gyfarfod o’r Pwyllgor Iechyd a Gofal Cymdeithasol a’r Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus ar yr un pryd.
The meeting was a concurrent meeting of the Health and Social Care Committee and the Public Accounts and Public Administration Committee.
Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.
Dechreuodd y cyfarfod am 09:31.
The committee met in the Senedd and by video-conference.
The meeting began at 09:31.
Bore da. Good morning. The Health and Social Care Committee and the Public Accounts and Public Administration Committee have agreed to meet jointly today, under Standing Order 17.53, for the first six items on the agenda today. For the purposes of today's session, the Chair, Mark Isherwood, and I have agreed that I will chair the business for today. We're a hybrid session, so some Members are joining us over Zoom today, and, as always, we operate bilingually.
I move to item 1, and there are no apologies today, or substitutions. If there are any declarations of interest, please say now. Mabon ap Gwynfor.
Diolch yn fawr iawn, Gadeirydd. Dwi jest eisiau datgan diddordeb. Mae fy ngwraig yn gweithio i elusen sydd yn eirioli i blant a phobl ifanc sy'n cael eu heffeithio gan y ddeddfwriaeth rydym ni'n ei thrafod heddiw. Diolch.
Thank you, Chair. I just want to declare an interest. My wife works for a charity that advocates for children and young people who are affected by the legislation that we're discussing today. Thank you.
Thank you, Mabon.
I move to item 2. This is our evaluation of the Social Services and Well-being (Wales) Act 2014. The Social Services and Well-being (Wales) Act came into force on 6 April 2016. The Welsh Government commissioned an independent evaluation of the Act, which concluded at the end of last year. Today's joint session provides an opportunity for both committees to discuss that evaluation and the Act and consider the next steps and any other areas that need attention. I'm very pleased to welcome our two witnesses for this first panel today. I'd be very grateful if you could just introduce yourselves for the record.
Diolch yn fawr ichi i gyd. Thank you, Chair. My name is Mark Llewellyn, I'm professor of health and care policy at the University of South Wales.
Bore da. My name is Fiona Verity, professor of social work at Swansea University.
Thank you very much, both, for being with us today. The first set of questions, and an opening question, from Mark Isherwood.
Bore da. Good morning. Obviously, time is short, and we'll go through the findings in more detail later in this session, but I'd be grateful if perhaps you could start by briefly outlining your main findings of the evaluation and the main conclusions you reached.
Thank you. I think it's probably helpful if we do that by addressing three things, and we'll do that jointly. The first is about the approach that we took, so you've just got a grounding in that; secondly, something about the context; and then something about the evidence that we collected. So, Fiona—between us, we're going to provide that perspective—on the approach.
Thank you, Mark. In undertaking the evaluation, we used an approach called a principles-focused evaluation, developed by Michael Patton. We did that for two particular reasons. One is that his approach is about how do you evaluate interventions, whether it's a project, a programme or a service, in environments that are changing quickly at a pace, environments that are complex, and how do you then understand whether something implemented is having the desired result in this complex, changing world. We thought that approach fitted this evaluation. The Act is a complex piece of public policy. There's diversity across Wales, historical variations, provider differences, complex needs, so all of that fitted. And then we considered that the Act has, within it, five key principles, so there was a match there in terms of this particular Act, as what ought to happen, the duties, and what might happen, is informed by principles as guidance. So, we put that together and we thought that was a good fit for our approach. So, that was a methodological approach we took in the evaluation, and that led to us having 11 separate studies devised and developed and implemented, undertaken by different experts.
Thanks, Fiona. The approach was, essentially, a collaborative one; we were trying to replicate the co-production principle and that was a separate part of our study that we’ll come to later, I’m sure, but we were very keen to ensure that it was a collaborative piece of work, so, working in partnership with a range of stakeholders. The second thing was about the context. We wouldn’t be good academics if we didn’t relate this back to the context, and when we started the evaluation, we were in the pre-COVID world, and COVID struck right in the middle of it, so the context shifted very, very dramatically through the course of the study. We paused for six months, so, as Fiona has alluded to, that very challenging situation for everyone across social care was right at the heart of what we were trying to do, and was a very disruptive force in both the practical work that we were doing around evidence gathering, but what it also meant when we restarted that data collection, and we’ll reflect more on that as we go through the session, I’m sure.
The other thing that’s worth mentioning around the context is that this was not a meta-inspection of social services in Wales. You and we have bodies to do that, and we were not ever wanting to tread on the toes of Audit Wales, Care Inspectorate Wales or any other regulatory bodies, like Social Care Wales, in our work. So, we were very clear that, whilst we had to understand the experiential nature of social services through what people had experienced as service users, as carers, as family members, that was a means for us to reflect on the key focus of our study around the policy and the legislation, the way it was framed, and the way it was conceptualised, which is the first of Michael Patton’s questions. Secondly, on how that had been implemented in practice, so, reflecting with the workforce on that journey from legislation into practice. And then thirdly, whether those two things lined up and provided for people the desired results—were they experiencing the transformative potential that the principles were offering?
So, those three things were our questions. We weren’t, as I say, trying to do an inspection of social services, but we will provide, and do in our work, an analysis both of that policy strategy piece, but also the bit that sits in the middle—that implementation space between policy and experience.
And then, the third thing that’s worth mentioning about is the nature of the evidence that we collected.
Yes. So, 11 independent studies, or separate studies. Just to take you through, we did literature review, we analysed literature on the Act's principles, comparative studies and research undertaken elsewhere. We did a process evaluation, so, we looked at the workforce perspectives on the implementation of the Act. We talked to people pre COVID and then we talked to people post COVID, so we’ve got two snapshots there from different time windows. We talked to service users and carers. We talked to black, Asian and minority ethnic service users and carers about their expectations and experiences, and then, for each of the principles of the Act—well-being, prevention, early intervention, co-production, voice and control, multi-agency working—we did separate studies. We used different ways of collecting data, different methods for those various studies. We did a report on financial and economic implications of the implementation of the Act, and then we pulled all of that together in a final report. We took such a lot of material that we gathered, primarily qualitative data, we pulled that together, and synthesised it in a final report that was structured according to Michael Patton’s three questions.
The final report concludes with 19 test questions that we have set for the sector. We didn’t write those as recommendations for the Welsh Government. We felt that was far too narrow a focus for a piece of work like this. What we wanted to do was to encourage a dialogue across stakeholders, so those test questions, we hope, will act as useful reference points, both in terms of acknowledging where we see strengths in the evidence we’ve collected and where there are some deficits, but also provide a bit of a road map for future developments. We’re conscious that the consultation’s been launched this week, against which those types of developments can be judged. So our view would be that, if we can provide better answers to the questions that we’ve set as we move forwards, this will have been a worthwhile exercise and we’ll be able to see development and change over time.
Thank you very much indeed. What specific issues highlighted relating to different groups of service users—examples being, perhaps, children and young people, disabled people or older people—need to be considered? If I can give you, perhaps, just two brief examples that I've been asked to highlight, the Act refers to reablement and habilitation, but I'm advised by vision impairment charities that delivery is falling far short of what is set out in the codes of practice. You'll know that reablement is helping people to do things for themselves to maximise their ability to live independently. Habilitation is central to enabling children and adults who have an impairment to live as independently as possible. But, I understand, for example, that three local authorities have no children's specialist, one specialist is shared between four authorities in north-east Wales and habilitation, for example, is not mentioned in any of the population-needs assessments conducted by the regional partnership boards; further, there's a shortage of qualified children's specialists working in these areas.
The second example: just over a week ago, I was asked to attend, with an autistic young adult—an autistic service user—and her autistic mother, a care and support review. It concluded—well, given the Act's requirements and the public sector equality duty's requirements to prevent a crisis occurring beforehand by preparing in advance, establishing trust and identifying the individuals' communication, sensory and environmental processing needs, although that was done to a certain extent—it was in their home—from the very beginning there was clearly, although there were good intentions, a failure to understand the autistic needs of the individuals. One of them became visibly more and more anxious—that was missed and they eventually had a full autistic meltdown in the meeting. Yesterday, I was copied in on a letter from the director of social services blaming them for language, for their conduct and setting the terms for the future over where and how they would communicate with them. Again, could you comment on that in the context of the codes of practice?
Do you want to start, or shall I start? There's one, in particular, part of our study that I think, perhaps, is commensurate with the issues you were talking about around sensory loss. So, we did undertake a specific focus group with people who were experiencing sensory loss, working in partnership with a third sector agency. I think the messages from that really focused on the lack of voice and control, which I think speaks very clearly to what you're describing there.
There are a couple of particular issues that were raised. Firstly, that, on the communication barriers—I'm talking now about the evidence that we've collected, which I think will speak to the example you've given us—the opportunity to ensure that their voice is heard is, obviously, a genuine challenge, both physically and in the sense that it's meant in the legislation. So, sufficient time to prepare—the ability to ensure that translators are available was a challenge that was routinely identified in the work that we undertook with that group.
Secondly, this was a conversation that we had post COVID, so all of those issues had been intensified by the pressures on the workforce. Given the paucity of resource that had been able to be deployed in order to support deaf people in this instance, those challenges were exacerbated post COVID.
Thirdly, there is an issue around the role of third sector providers in the examples that we gathered through our study. So, whether those organisations have sufficiency and sustainability of funding in order to provide the kinds of support that people are looking for is a challenge, and, fourthly, that varies very significantly by geography. So, there will be areas of good practice; you're clearly identifying areas of poor practice. What we don't have in our evidence or, clearly, in yours, is what we would seek to have, which is a consistent level of provision that is commensurate with the aspirations of the legislation. I hope that helps. Fiona may want to talk about reablement and some of the other aspects.
Yes, thank you very much for your question. A couple of things. So, in the prevention report, we had a look at initiatives across Wales, across local authorities, and reablement does come through—that there are a whole range of reablement initiatives happening. But I think, just picking up one of Mark's points, what we've picked up in the study, because it's a large study and we've looked at patterns, really, we've got a mixed picture, we've got pockets of good practice. When we talk to service users and carers, there are stories about good things that happen, good practices, responsive services, services that do meet people's needs and support them, but, then, we also hear stories—. And it's probably true to say from the data, from our interpretation of the data, the dominant story is a disconnect between the promises of the principles of the Act and what people's experiences are. And it does come through—looking at my notes—that the need for accessible information and support for people living with sensory loss is something that does come through this particular study. I think it's important to say that we have got a mixed picture from our data. So, it's not a single story about what's happening, from the data that we've collected.
Okay. Thank you.
Diolch, Cadeirydd. The evaluation reports a view from the workforce that statutory care services are 'reactive' and a 'last resort'. I speak as somebody who believes in early intervention, but what do you think needs to change?
Would it be possible to repeat the question? I didn't quite catch it. It was a bit quiet.
We all found it a bit quiet. We'll just try and get a bit of volume, Mike, but if you can just perhaps speak up a little bit more.
I have no problem with speaking loudly, Cadeirydd.
We can hear you loud and clear now, Mike. Thank you. [Laughter.]
The evaluation reports a view from the workforce that statutory care services are 'reactive' and a 'last resort'. I believe in early intervention. What needs to change?
I can answer that. Thank you very much for your question, and I share that belief. I think early intervention, prevention, is one of the strengths of the legislation, that has that focus on prevention. We've got different windows through the different studies on prevention and early intervention, so service users and carers talking about how important it is to them that things are prevented. So, it's not that, when there is a crisis, all of a sudden things have to be put in place, but there is support for them, building supportive environments around them and supportive services. So, it's coming through there. The workforce talking about prevention—. For some people, they were saying, in our first process evaluation when we talked to the workforce, that they've been doing prevention; it's not new, they've been doing it. The Act has allowed for an acceleration of that endeavour of prevention. It's really put it out there that we have to—sorry, local authorities and providers have to have a preventative wherewithal.
But, there are things coming through our data about some of the issues—. Actually, before I say that, we found that there's a rich tapestry of preventative activities happening across Wales, so things like dementia-friendly communities, community connectors, community catalyst programmes. So, there are different examples across Wales of prevention, working with local authorities, working with civil society, working with the third sector, working with social enterprises and co-operatives. All of that speaks to this architecture for prevention, which is really positive, but there are things coming through our data, as people articulate them, about prevention in terms of budgetary considerations, so when budgets are tight and there are pressures, questions about, 'Is it prevention that is the first thing to go when there are limited resources?'.
The need for better models of prevention—. Often, prevention—we can talk about prevention, but do we think about it the same way? Are we understanding prevention in the same way? So, conversations and models to, really, I suppose, get a bit more clarity about what it is that's being prevented in the context of social care. And the final thing is about not letting the prevention agenda go. So, it's certainly something, for me, as being part of that particular study, that I think is really critical that the prevention agenda is one that is taken forward and not lost.
If I could just add two things, very quickly, to that, to build on that point about conceptual clarity, I think there is something quite evidential in our work about the need to understand what we mean by 'prevention'. It's an oft-used term. Everyone supports the notion, but when you get into the detail of what really are we preventing, as Fiona said, what the counter-factual is, what the system response would have been, it gets very, very tricky, sometimes, to be clear that we're talking about the same thing when we use a catch-all term like 'prevention'. Prevention in healthcare terms is relatively simple to define, if you take that medical model thinking of primary prevention and secondary prevention, so you can see a disease pathology being either stopped from happening entirely, or at least delayed. In social care, that's much more nuanced, so what it is that we're preventing also needs to be questioned and problematised, and we've got evidence in our work around that.
The second thing that I would just finally add is something about the lines of sight. So, this is one of the most contested areas, I think, around data and measurement. Probably the hardest thing to measure is that issue around counter-factual, and the recognition of that is evident in all of our reports. There is something underlying our evidence through the whole study about the quality and the sufficiency of data and measurement in social services, which is not new to anyone, but it is something, I think, particularly when it comes to prevention, that matters tremendously. So, how do we measure it? What are the relevant metrics? Are they financial? Are they outcome based? Are they quality of life? Are they something else? Our report steps off—. One of our test questions is about that sense of the principles themselves are great, as the underlying architecture, but do they have sufficient clarity and precision to be able to allow the system to transform in, perhaps, the way that it needs to?
Mike, do you mind if Mark comes in with a quick question? I'll come back to you.
No problem at all.
Thank you. Mark Isherwood.
It was just on the point you raised, because clearly monitoring and evaluation, which you were alluding to, are key to the Public Accounts and Public Administration Committee. To what extent should that, in your view, incorporate the voice of lived experience or involvement directly in that monitoring and evaluation of the service user to ensure that we're getting a more balanced picture of how the outcomes are or are not being delivered?
I think it absolutely should. The underlying logic of the performance and improvement framework was that it would, that that experiential data would have much more of a place within public policy. The challenge always is how that turns into action and what data sets there are. So, our colleagues who ran the co-production study identified most significant change as the methodology that they were using, which is being adopted by some local authorities, we understand, as a means for getting that precision around, 'This is the difference it made for me, these were the things that mattered.'
The trick, as always—I speak to the Chair of the Public Accounts and Public Administration Committee—is: how do you turn that into something that is understood in other terms, so financial terms, budgetary terms, staffing terms? I think there is the prospect, and certainly our data would aspire to support that point that the qualitative voice really does matter. It's very much what we think we've provided through these reports, much more the qualitative voice than the quantitative perspective. So, we would certainly support that. I think I'm speaking for the two of us there.
Absolutely. In terms of voice and control, co-production, understanding what it is to be prevented, it has to come from the people themselves, and whether it's worked has to come from people's experiences.
I'm just checking, Mike, Jack wanted to come in on this. Is it on this point as well?
Then I'll come back to you, Mike, if that's all right with you.
Diolch, Mike; diolch, Chair. Professor Llewellyn, you said 'some local authorities' use that as an evaluation technique. Why is it only some?
That's a brilliant question. I think we would recognise that, as Fiona said in her introductory remarks, local authorities started this journey of implementing the Act in very different places. So, some have a history of approaches like this that others, perhaps, don't. So, there is a recognition in our data of that context. I think then, within particular authorities, it will rely on individuals. There will be people, perhaps, in managerial positions who understand and appreciate this sort of data in ways that others—and that's not a value judgment about anyone, but it's the nature of people's backgrounds, either as practitioners, perhaps, or as managers, that leads them to this.
But I think the point about where national policy is on this is a really interesting one. So, we have got a performance and improvement framework that does provide for the voice of people to be recognised. I don’t know, genuinely don’t know, how mature that is as a data set now coming through local authorities into Government.
Thank you. Back to you, Mike.
My experience, and you can tell me if it’s unusual, but early intervention, especially with elderly care, where you take action within social services that reduces the chance of somebody having a fall, will then reduce the chance of them ending up in hospital after a fall. And my experience has always been, people coming out of hospital need more social services intervention than they did before, and a number will end up in residential accommodation because they’re no longer able to look after themselves, whereas early intervention could have meant they were able to look after themselves.
And just to finish off for me, the report said there are service gaps; this includes specialist services for children. Could you tell us more how you think the gaps should be addressed?
Shall I have a first go at that? That’s where you push against the limit of our expertise, I think. We recognise our role here. I wouldn’t be so callous as to say that’s a question for you to answer as politicians, but I certainly think it’s very difficult for us to be able to offer a kind of meaningful insight on gaps. Because of the very complex nature of service provision and delivery, we weren’t able—nor were we asked—to look in detail at those sorts of gaps. We could offer a view, but it would probably reach beyond the evidence of our work. Happy to do that, but just to be clear, and sorry that that sounds a bit slippery, but I think that’s an important context for the answer, if that’s fair.
In terms of ensuring where gaps are filled, I think the first thing is clarity about what those gaps are. So, that piece of work, to an extent, exists, I think in relation to population assessments, and matching those up with local area plans. I think there’s the mechanism that exists there within the kind of legislative framework to be able to do that. I think in the consultation documents, there is some talk of a slight change to some of those plans and reports coming forward, so it will be interesting to see how that plays out.
But, yes, I’m going to stop waffling now, I’m afraid, because I fear I am treading into territory I don’t feel it’s got anything to add.
No, I think it’s right. I think we can speak to what we’ve got, really, in terms of our evaluation data.
But just the point on reablement: just a thought came to mind there. I think what you’ve just said, I really agree, and I just think, the more we can build the evidence base, because there’s a sort of intuitive understanding, anecdotal understanding about the value of prevention, but we need—. I think the more we get the rigorous evidence base, then it’s like we can draw that line, and the Senedd say, 'We know that services like blah, blah, blah are going to help prevent falls,' and so I think there’s something to be done. And I say that to us, I suppose, too, as researchers, to sort of keep building that robust evidence base.
Thank you, Fiona. Any further questions from you, Mike, or have you concluded your questions?
Lovely. Just before I move on to Sarah, I just wanted to raise a question myself. I know the Children, Young People, and Education Committee have just published their report on services for care-experienced children and young people, and one of the conclusions that they reached was that families are not receiving the support and services that they’re entitled to under Part 6 of the Act. So, your evaluation generally talks about some disillusionment amongst service users, and I wonder what more you can talk to that point about, about whether service users are actually receiving the core services and support that they’re entitled to, and whether you think that the issue has been adequately addressed, I suppose, or given sufficient attention.
Yes, I think that’s a really important question. The report that speaks most clearly to the service user and carer perspective is 'Expectations and Experiences', and we—. Just to begin the answer, we deliberately chose that as a title because of the gap that the evidence that we collected pointed to. So, I think we engaged with people who had a very difficult time. People’s narratives were quite emotional when we were asking them about their experiences of social services, given that we were about 12 months into the first lockdown by that stage. So, it was a very—. I’ve never personally, in my professional life, experienced such an emotional set of conversations with people. I think the difference, though, that we were pointing to was that the Act is very strong in the aspirational picture that it lays out in front of people. It is valued for that. I think we feel, on balance, it’s incredibly strong in the architecture and the way in which its vision is created.
Our evidence, however, pointed to people who felt quite distant and disconnected from those principles of co-production, of voice and control, of well-being. So, there is this disconnect, and I think we question in our final report, through our 19 questions, how we might be able to close that gap collectively. Because it’s a very, very, complex thing. It’s very individualised, I would say. There are some broad themes and we can talk to them in a bit more detail, but I think, on the whole, the promise of the Act isn’t being matched up by people’s experience. That’s not to lay blame at any one part of the sector, because it isn’t as simple as saying, ‘If only that was better, then everything would be fine'; it’s quite a nuanced issue. But there is something about people wanting to achieve those principles in their everyday experience and being frustrated that they can’t.
Okay, that's useful. Thank you. Sarah Murphy.
Thank you, Chair, and thank you, both, for being here today and for what I think is an invaluable evaluation. And you touched a little bit there on how people—service users and carers—are frustrated with the service that they're receiving, and I wanted to ask a few more questions about that and drill down into it. So, the evaluation found that for the majority of service user and carer respondents, their experience with social services was one of frustration. Your response has highlighted not being listened to, having to chase and fight for support, and feeling ignored unless they were facing a crisis. So, could you reflect on the experiences you heard and the reasons behind these negative experiences? And also, if possible, it would be very helpful if you could give us an idea of: was this across the board, or are you finding that it's different for different user groups? Were there any notable differences, please?
Shall I take start? Thank you very much for your question. Yes, in the expectation in service users report, that is the key summation of the findings. Just to counter that, it wasn't the totality of the evidence. So, there were some people giving examples of positive experiences in having the care assessment and then the support following through, and things that happened during COVID—the heart of the pandemic—where services were responsive and supportive. So, that's there, just to make that clear.
The people who we spoke to, by and large, exactly as you were saying: so, feeling that the Act had given this sense of a promise, the sort of ideals, captivating people in terms of their well-being and of social services to meet their well-being, but they're not having that as a lived experience. I think one of the things that I might say from analysing, and part of writing that report, is that I was struck by the people we spoke to and their interpretations of what is going on. So, I thought a really good insight—and it goes to your point too, Mark, about the value of people's lived experiences and insights—is, really, their insights about the fragility of the system, about what was happening in terms of workers. So, a real empathy, looking at the totality of the data, about what's going on for services, when workers are under pressure, workers are leaving—there's that churn phenomena happening. So, some of those things are exposing the fragility of the system in terms of sustained issues that—. The heart of the pandemic opened up some of those fragilities. So, some of those things. Mark, do you want to come in?
Yes, I think, in addition to that, it's worth saying that the evidence we've provided, I don't think it's new, really. I think it builds on quite a large body of evidence—work that the antecedent committee to this one had done around carers' experiences under the Act. I think lots of our evidence adds weight, and perhaps—well, we hope—adds some value to that as well. So, none of these are brand new. At the end of that report, and I won't repeat them for the sake of taking time, the 12 statements and the commentary that we have around them, right at the end of the expectations and experiences report, pages 98 and 99, I think those 12 statements provide the best summary we can offer as to the cross-cutting experience.
Just to pick up on your point about variation, and whether there are some specific service groups affected more than others, inevitably, I think, there are. Our work wasn't designed in such a way that we would be able to substantiate those in quantitative terms, but what we did do, and I alluded to it in response to the first question from Mark Isherwood, was in relation to people with sensory loss. We also had a focus on people from black and ethnic minority backgrounds, as service users and carers, and their experiences and their perspectives on the support or otherwise that they'd received through the system. So, there are some particular, I think, groups that we focused on, but it's difficult, I'm sure you can appreciate, to be absolutely clear about provable differences between the different groups.
Thank you, both. You are right to bring in that balance—this is not all negative. However, my following questions are focusing on what's going wrong, I suppose, because that's what we want to be able to get right. So, you are right; there is a balance with this report, and there were good experiences as well.
My colleague Joyce Watson is going to come on to talking about people from ethnic minority backgrounds, so I won't go into that now. But I also just wanted to ask: the report has highlighted individuals' concerns about not being included in the discussions and decisions about their support and difficulties receiving support in the Welsh language. Obviously, this is really crucial—very central, really—to the legislation. So, can you talk us through these points and why the principles of the Act are not being delivered in practice? Do you think, again, it's the fragility, it's the time, it's the staff under pressure?
I don't think we've got any evidence that the system is trying to do those things. There's absolutely no evidence whatsoever that we can identify of this being a conscious act in any way. This is a reflection of the pressure that exists, that we all recognise and we all know. And when the system is as time poor as it is, there are inevitably trade-offs that are made about the quality of the support and the assessment and the lead-in to some of those things. Some of the evidence that we gathered from service users and carers talked about not having sufficient lead-in, or simple things like being able to contact people just to ask simple questions, which goes back to the point about prevention, I think, that Mike Hedges asked about—moments of being able to offset further need or peaks of crisis. So, the ability of the system to respond is challenged at this time. That isn't going to resolve itself anytime soon. The nature of the pressure across the whole of the health and social care system is reflected in this evidence. It's not just about social services in isolation.
I think there are some real challenges for the workforce. What we have got, just to broaden that out slightly, in the post-COVID workforce report—. When we did our first process evaluation, looking at the workforce experience of implementing the Act, it was gathered absolutely fortuitously just before the pandemic struck. The last interview I did was on 1 March, and lockdown happened on 20 March, I think, or 21 March, something like that—23 March, maybe. So, two or three weeks before, I was talking to people about the social services system, so much so that in that very last interview, the person I was speaking to had just read a briefing for the first time on this thing called coronavirus. When we came back to that workforce, in the post-COVID period, I think there was a real reflection that two forces of acceleration and deceleration were simultaneously being applied to the way in which they were working. I think the experience under COVID has meant that for some people the workforce offer has been better, possibly, than it would have been other than for COVID. So, people who don't want that kind of traditional model of social work, maybe, have had a better outcome. A number of other people, though, will have found that that's been compromised, and compromised in ways that both the workforce recognise, and they recognise as well. So, yes, it's quite contextually specific.
Thank you. Can I just ask as well, specifically, about people being able to challenge the decisions that are made? So, for example, is there a route to redress if it's decided a person is ineligible for services? What did you find around that?
I'm so sorry to cut across, but because we've got so many questions, could you just be a bit—
A bit briefer?
Sorry for asking.
No problem. Okay. Do you want to—?
I can take that quickly. We did find—and it's in our final report, page 53—that awareness about advocacy rights under the Act have increased. We picked that up across a number of our reports—the increased awareness, increased use by a broader group than before. And that comes through the workforce—as I said, it's across different studies. So, that's there, but there is a point about having systems that are not so adversarial.
Yes. It's one of our test questions. Just very, very quickly—taking the steer from the Chair—the Equalities and Human Rights Commission's report on this exact issue that was published about six months ago, I think—maybe a few months before that—is worth a read as well.
Thank you. And just my very final question, then. The report identifies that more needs to be done to support unpaid carers as a priority, and carers too often feel they're unable to have their voice heard, or listened to and acted upon. So, can you tell us more about what you've heard from carers, and what action you believe is needed to better support them?
Yes. I'm conscious of trying to be brief. I think the evidence is absolutely clear that carers, unpaid carers, are the mainstay of our social care system, and not to recognise that would be an oversight on our part. I think there are a number of organisations that are very, very active in this space, so I won't go into what they are planning to do. I think what I might say is that our evidence exposes the nature and the fragility of the system that carers on a daily basis serve to hold together. I perhaps won't say any more than that, unless you want me to; I'm getting looks from the Chair.
Can I just say one thing, sorry? In the expectation and experiences report, there are respondents, carer respondents, talking about having an assessment done, but they're not having the follow-through, or talking to people in their social networks who didn't know about carers assessments. So, from our evidence, there's work to be done to ensure that people are aware of their rights under the Act.
Thank you; that's really helpful. Thank you very much, Chair.
Thank you, Sarah. Mark, a very brief question.
Very brief. In reference to advocacy rights, I've got casework at the moment, where, say, a director of social services has told people that they can't choose their own advocates. I've had to explain they have a right under the law to choose their own advocates. They're being steered towards particular advocacy groups that don't have expertise in their particular condition or impairment, particularly where that might be cognitive or neurodiverse, and then battling and trying to direct the service user away from particular chosen advocates, where those advocates are doing the job they should be doing, which is representing the needs of the individual. And yet that director of social services would claim that they were compliant with the Act. How would you propose that we address barriers like that?
Goodness, that's a big question. I think we certainly recognise that situation. I think it's particularly acute in other work that we've done around continuing healthcare and the advocacy role that gets played through decision support meetings there. I think it is a very complex issue around the nature of provision, the levels of advocacy that the Act lays out, from self and peer and group advocacy, through to independent professional advocacy. And I think our evidence suggests, on the whole, that that may need to be looked at as to whether the right level of provision is available to people across Wales in the way that the Act intends.
To help with the rest of the session, we've got 45 minutes and there are six Members who have got a set of questions each, so that probably leaves us about seven or eight minutes for each set of questions from Members. So, we might be a little but curtailed on allowing supplementaries. I'll ask each Member to bear that in mind. Thank you very much. Joyce Watson.
Good morning. I want to dig down a little bit about the experience of people from ethnic minority backgrounds. In your report, you highlight the negative experience of people from that group of people, being let down by social services, that they've got no voice, the support that they needed wasn't there for them, and, most concerning of all, that the colour of their skin had been considered in their interaction with the system. I'm sure you have examples that we'd like to hear about, and the reflections on how we improve it going forward.
I think there's a really important point I'd like to make before I address that question, if I can, just very, very quickly, which is that we are very clear in the report that this is the reflections of one group. We're not trying to make claims that this is representative. I think it would be fair to say, however, that because we did this piece of work in partnership with the Ethnic Minorities & Youth Support Team Wales as an organisation, they felt very strongly that this was reflective of broader trends that they were aware of.
Those points that you reflect on are the conclusions of that report. I think the content of the discussions was quite troubling for people to disclose. It was quite challenging, I think, for them to talk about their experiences, and I think, on occasion, they felt, perhaps, that they wouldn't want to give voice to some of the experiences they'd had. I think the fact that they did speaks volumes for them as individuals, but also for the nature of the challenge. So, this may not be widespread, this may not be a universal experience, but the fact that a small number of people, echoed by an organisation, feel these are issues that need to be taken account of, I think, means that it's important.
I'm conscious of the race equality action plan, and I'm not over the detail of that, but, as a committee, I'm sure connecting this evidence up with that to ensure that the aims of that plan are met over the course of time to try and avoid these sorts of situations happening again is probably what I would leave you with as a thought.
Can I just explore—? Was there any evidence about the workforce that was serving them, in terms of reflecting them as a group of people being somewhat missing from that workforce, and maybe the understanding, much like Mark and others have been exploring?
That's a really good question. I don't recall it. I'd need to reread the detail of the transcripts, but I don't recall them talking about people from the same communities as they are in the workforce being part of their experience. I don't know what the data is on the ethnic diversity of our social care workforce, but that's certainly, I think, an interesting area to explore, and finding people from communities like the ones they were in in that workforce, I'm sure, would go some significant way to addressing some of the challenges they described and experienced. But they certainly did reflect on their own perceptions that their ethnicity, their colour was a factor in the care and support that they received, and negatively.
Okay, thank you.
Could I just add to that that, in the expectation and experiences report, there is comment about service gaps for people from ethnic, Asian and minority backgrounds? So, there's not a lot of detail there, but that's a theme that's coming through about gaps.
Okay. So, the actions you have outlined—is there anything further that we need to take on beyond what you've said?
You clearly have a role in scrutinising the Minister in a number of different areas. I think these are questions that could be asked of her and her officials. I don't know quite what the response has been, if I'm entirely honest, other than as part of the action plan. So, I think that's probably a line of enquiry that you might want to put through the Welsh Government to the Minister when you next get the opportunity to.
Thank you. Jack Sargeant.
Diolch, Cadeirydd. You recognise in your report the importance of providing support and promoting direct payments, but it is the case that the take-up and awareness of direct payments in Wales is particularly low. I wonder if you could set out why you think it is particularly low, and how we can address that problem.
Sorry—that's you, Mark.
Yes, no worries. We kind of spread the load, and it's sitting on me at the moment. That's fine.
Yes, there is a specific piece of work that we did that feeds into the voice and control report—so, it's a separate study that we did, which, I think, speaks to some of this—as well as some generic comments that we've got from the workforce and from service users and carers. So, there is a particular piece of work that we did for Welsh Government on the experience of personal assistants, obviously employed by those people with direct payments. There's a detailed exploration of the workforce challenge there, which is referred to in the voice and control report, which exposes a number of the challenges about the sufficiency, the issues around whether you register that workforce, so thinking about the perspective of the direct payment user. I think there are some challenges about, 'How do I ensure that the worker that works with me is the right one, at the right level, and has got the right sorts of skills and approaches that I want?' We recognise the importance of micro-enterprises in helping to do some of that across Wales. So, I know Flintshire is often talked about as a really positive example of that. I think there are some possible solutions to that that could be learnt from that for the rest of Wales. I know there are networks trying to do some of that.
From the individual's point of view, I think we collected evidence that will be quite familiar to you about the potential burden and the worry about direct employment of people, and I certainly recognise both in this, and the work that I fed into as part of the expert group on the national care service, that we might need to offer a greater range of options. So, we have a pretty singular option around direct payments as they are at the moment, and whether there is scope for thinking about things that go beyond that, so giving people even greater control over their budget than they have under a direct payment, but also offering ways in which they might have less control, so, using those kinds of micro-carer type experiences a bit more generally.
So, just to—. Thank you for those comments. There's a separate piece of work around this that has been done. That has set out recommendations that we could, perhaps, quiz the Minister on.
Yes. So, the—. Yes, and I can share the links with you if they're not apparent. But linked to the voice and control report, there is a separate document, and I think there were—. We reported to the social care workforce, the fair—I can never get the acronym, I'm so sorry—the fair workforce task group, that group, which I know have been taking forward workforce issues more generally. So, we reported to them. So, yes, there is a detailed report there.
Perhaps it's something we might want to look at, Chair, away from this session.
Moving on, perhaps, to one of your evaluation questions under the 19 test evaluation questions around social enterprises, Audit Wales themselves have found that local authorities are not, perhaps, promoting social enterprises effectively enough. You mentioned Flintshire as a, perhaps, shining example, which is obviously pleasing for myself and, I'm sure, Mr Isherwood as well. Your question is around what needs to be done to make improvements. I wonder if you have a view on answering that question.
I think, if we do, it probably goes beyond the evidence that we've collected—so, understood in that context. I think there is something about—. There's quite a considerable amount of evidence that's been generated by the Wales Co-operative Centre, now Cwmpas, over a number of years—a report a couple of years ago on supporting commissioning for social value; the Care to Co-operate programme has been well understood and well valued. I think we know what to do—
It's more implementation, then.
Yes. I think it really is a question now about, 'Well, why isn't that translating into practice?', and it's probably a function of the very complex nature—and I won't go over that answer again. But, yes, I think we know how to go forward on this a bit further than we are now.
And if I could just add to that, Jack, in the prevention report, we did pick up, through looking at what was happening across local authorities—as they articulate in their own report—we did pick up engagement with the third sector, civil society, all sorts of initiatives. So, my assessment of that is that there's work afoot, but it's how that's consolidated, accelerated, made more visible and moved along, really.
And a final very quick comment is about linking that to the current consultation. So, there's quite a significant emphasis on changing the partnership arrangements, as proposed by Welsh Government currently. So, I think you—. It's not for me to lead your business, but we've got a lot of evidence, I think, thinking about the scrutiny role that you will have in that consultation process and about finding the links between the evidence and what it is that Welsh Government's saying; it's, again, something that you might want to explore.
Thank you, Jack. Rhianon Passmore.
Thank you. Diolch, Chair. There's obviously a huge amount of cultural change that's been engendered by the Act, but, let's be honest, there is a massive holistic workforce capacity issue behind all of this. So, within a lens of improving well-being and person-centred outcomes, can our witnesses outline briefly the challenges, further to what's already occurred, in implementing and measuring the efficacy of the legislation?
That's a big question to answer briefly, but—
I know that. I apologise.
—I'll try and give you some highlights.
Encapsulate it for me.
Okay. I will try my best. I think there is something clear, in our post-COVID workforce report particularly, about where principles have been taken forward really effectively and where some perhaps haven't. So, there's an analysis in that report. So, some have been accelerated and some have been decelerated, and, often times, taking the example of prevention, both processes have happened simultaneously. So, I think there is—. We can't, as a system, be absolutely clear, I don't think, that 'this has progressed' and 'this hasn't progressed'. I'm going to stop answering that question at that point, if you'll forgive me, because it is so very challenging to be able to give you a simple answer to that. I'm very happy to take a supplementary, if that would be beneficial.
Yes, please, if you could. I'm just looking for your overall summation of the challenges in implementing this legislation fully.
Yes. Can I start with one of the things? I think our interpretation of our evidence is the soundness of the principles as an interconnected framework, and that comes through. It comes through from comments from service users and carers, it comes through from the workforce perspective. So, I think there's something there that I think is important to state. A lot of the people we spoke to, both in the pre-COVID talking to the workforce, and then post COVID, the metaphor of a journey kept coming up. So, 'We're on a journey. The principles of the Act speak to us, they provide an interconnected framework, they provide a vision, they provide some way that we can do the cultural'—
To interrupt you and to get to the nub of this, what is your opinion, based on what you've fulfilled in this regard—what is your opinion, then, in terms of the challenges in implementing the legislation?
I think there are issues to be done about system issues in terms of workforce issues, the valuing of the social care workforce. Some of those structural issues are the things that I think are going to impede the acceleration of this journey that needs to happen. So, I think attention to, isn't it, the resourcing, the workforce stability, promoting people to come and work in social care, all that leadership that needs to be firmly there about, 'This is where we need to go.' So, I think—. Yes.
I've got a very short answer for you, if that's okay. I think those 19 questions are our assessment. I think the questions we're posing point to the challenges that we perceive. So, I'd reference back to those 19.
You're going to refer back to that.
That's not a problem. That's fine. Thank you for that. So, as you know, there's always a direct pushback, isn't there, when there's any request for any type of ring-fencing of resources. Could you extrapolate briefly on why you would recommend that community-based resourcing is ring-fenced?
That's the prevention ring-fencing? Yes. And partly, that's based on evidence from elsewhere, from other parts of the planet, that, when systems are under pressure, funds for prevention—. Because it's about the long term, sometimes it's about things that can't be seen very directly, the crisis has to be dealt with, the prevention resources can be put to one side. So, that's the argument there for ring-fencing it, because, if this is about sustainable social services and about some of the things that were referred to earlier from one of the committee members, the argument is that investment needs to stay there for a long-term gain, a long-term benefit.
And what would you say in regard to the pushback around that?
I think what I might suggest is just a thought about, again, the consultation proposal around pooled budgets. So, having looked at that, and Welsh Government recognising the insufficiency of the focus on care homes for older people and now proposing to expand that to a range of other service contexts, which could include reablement and others, I may not use the word ‘ring-fencing’ outside of the context that Fiona’s used, but I certainly think there is some real potential for exploring pooled budgets much more robustly and much more effectively in the areas that—
Pooled budgets are the way forward. Could you briefly give me your current assessment of the appropriateness of implementation of those preventative services in the community?
So, assessment of the implementation of the preventative services?
What's actually currently being delivered across our communities in Wales? What is your snapshot that you can give us as a committee as to where you feel that is on that journey analogy that you gave us at the beginning of my questions?
From my reading of the data that we've collected, I think it’s on its way. Some of the initiatives, I think, are quite exciting in terms of the links with civil society. I think a lot of the third sector organisations, they're leading some of the way. I think kind of learning from them—. So, I think the architecture, the groundwork, is coming together.
Okay, thank you for that. I'm going to move on to my final questions. Your findings seem to underscore that the process of the actual person-centred co-production, and that voice of that individual, is not lived experience, despite the expectations within the legislation, from what you've told us this morning and from what we have in front of us. There's been a theme, hasn't there, of the fragility of the system being core to your evidence so far. So, what is required, then, to improve advocacy? And I'm sure we're going to go back to workforce issues. What is required to improve both advocacy and that community-anchored, organisational civil society base that you've just spoken of?
I think it goes back to the answer we gave to Mark Isherwood a few moments ago around advocacy. There are a number of challenges there, so I won’t repeat that, for the sake of time. I think the broader issue around civil society—again, that’s a really interesting one, and timely, given where Welsh Government’s consultation is now taking us forward. So in respect of partnership arrangements and a growing role for civil society in the third sector, clearly there is a huge value placed on the contribution that third sector organisations have made. I think there are some areas of further development that we’ve talked about in relation to co-ops and social enterprises, and that may be a good test case for the seriousness of the system’s response, perhaps, to some of these issues. So, if we are serious about having the third sector as a key third partner—statutory, independent and third sector as the pillars of what our social and community care system offers—a marker of that, I think it would be reasonable to suggest, might be that we see a growth in social enterprise, we see a growth in co-operatives being more part of the landscape.
And that's a whole other session in itself. So, finally, then, I've got two very short questions. Are the care assessments and care support working? What improvements are needed? And then, in regard to boards, in terms of the joint committee that we've got today, your main barriers to multi-agency working being embedded.
I think, with very great respect, that's a short question, the first one, and a huge answer—a huge answer.
Try and see if you can boil it down. Or perhaps write to us, Chair, if that will help.
Yes. If you'll permit us to reflect on that one, I think that would be quite good.
I'd be very happy with that, thank you.
In respect of multi-agency—
Yes, if you could write to us in terms of regional partnership boards, in terms of your actions that you've asked to be further embedded, that would be great. But also, I think, the question around care assessments and care support, and what's missing, I think if you could write to us, that would be useful. Thank you, Chair.
Thank you, it's very good of you both to agree to that—that helps with time a little bit, thank you. Gareth Davies.
Thank you, Chair. Good morning, everybody. I want to focus my questioning on the social care workforce and wider reforms. The evaluation notes the context of the social care workforce and some of the pressures around that, in terms of recruitment and retention, and to ensure the workforce's quality, sufficiency and sustainability. Can you reflect on this point and give some remarks and comments on your own views and what we need to do to address this problem?
I'll kick off there. I think one of the key aspects is part—I keep referring to the consultation, but it is very timely that that was released this week, ahead of this session. So, the proposals around pay, I think, are a significant part of this, but by no means the sole part of this. We recognise through the evidence that we generated from the workforce that pay is often not the motivation for people joining this workforce, and understanding that, I think, is absolutely key. We want to recognise, I think, as well, the difference and the value of the entire workforce—so, the paid and unpaid elements of the workforce, which we alluded to earlier on, to blur that boundary a little, but not in a trite way, as I'm sure you'll understand.
I think in terms of the sustainability of that workforce, going forward, it's a very, very complex thing. Our reading of the landscape is as yours is, which is one of very great challenge for a number of providers. We are optimistic that the pay issue will help, but I think there are some real grounds for—I don't know whether 'optimism' is the right word, but certainly hope that—. I'm conscious of the We Care Wales campaign and the work that they're doing, so I think there are some possible green shoots in some of the evidence. I had a very, very quick look at the evaluation—their annual report—a couple of weeks ago, so I think there is some prospect and, hopefully, with the pay proposals as well—they're there.
There are, however, I think, in other aspects of the workforce—talking about personal assistants—I think there are some real questions that we need to think very, very carefully about, about how well that's managed. That's not necessarily an argument for regulation of that workforce, because finding the right balance between the principles, around voice and control, and ensuring a safe and sustainable workforce is a really tricky judgment call, and I think there's lots of evidence in our work that would suggest that.
Can I just add, about recognition of the workforce, one of the things that came out of the post-COVID workforce study is just, in the face of adversity, people talking a lot about the massive shock of COVID and having to adjust and do things so quickly in different ways, but people's creativity and their adaptiveness, pulling things off in the face of adversity—. So, I think there's something about recognising and validating the workforce and what they do that is certainly coming through the data.
I appreciate those answers, obviously, because a lot of my work in the Senedd is fairly involved in this subject; I've raised it a few times with the Minister in Plenary. It is promising to see an uplift in the pay, but I think as well, you touched on it briefly, it's also the access to training and, perhaps, career timelines so that people can see career progression within some of those areas, which I think would be a good addition to that.
But, obviously, a lot of the staffing problems have been exacerbated by the COVID-19 pandemic over the last few years, so what sort of practical efforts can be taken, because, obviously, the social care sector incorporates a lot of different sectors, in terms of the public sector, third sector and private sector? A lot of what I deal with is around care homes as well, and there's a big issue in terms of filling the workforce in care homes. So, how do you think we can best make those careers more attractive and, perhaps, get those levels back up to what they could have been pre COVID-19 to give some reassurance that, you know, social care can be a rewarding career?
Yes, that's a really insightful question. If you'll permit, thinking about our evidence just in the background for a moment, I think there are a number of things that the leadership role that the national care office might have, and, again, as part of the future proposals, I think there's a huge responsibility there.
There are a number of functions that might need to be thought about really carefully, and, you'll forgive me, I haven't read the consultation papers in sufficient detail to know whether they're there, but certainly, national pay rates, terms and conditions. It's not just pay, but terms and conditions really, really matter to this as well. It's too simple to think about pay rates, as important as they are, it's the package of employment support that we're talking about. National workforce standards commissioning, as part of this—. And, again, I know there are proposals, going forward, around that, but ensuring that commissioning creates the right preconditions for organisations to employ a workforce and provide them with sufficiency and sustainability, I think is really, really important. Ensuring that quality is measured and matters, because the workforce is engaged often in providing high-quality care—. Whether that aspect of the work that people do is celebrated and valorised, I think is something, again, that there's a role for leadership around, and there are a number of other aspects. But I certainly think your role as a scrutiny committee in taking that consultation—I was going to say 'apart', I don't mean that, but looking at that in a very detailed way, such that the national care office starts its work with the right sort of agenda around the workforce is absolutely crucial to the future development of that workforce, I would argue.
The only one I'd add to Mark's list, which I agree with, is just something about culture—risk adverse cultures. It came out in the co-production study. But just something about—. If the system is to have spaces for innovation and creativity, and looking at the complex problems and how to solve them, having cultures that will allow that, as opposed to ones that are more blame kind of cultures—.
I appreciate that. Thanks. And just finally, I'm just going to seek some thoughts over the policy direction and pace of change for social care reforms, and obviously, the work with the developments of the national care service free at the point of need. I'm seeking a view on whether you see this as an opportunity or a benefit to addressing some of the recruitment problems. I know that Rhianon Passmore mentioned in her questions before myself about the pooling of budgets, and obviously such a move as a national care service would provide that opportunity for that to be achieved. So, do you think there's any benefit in dealing with some of the workforce pressures in some of these social care reforms?
Yes, is the short answer. The slightly longer answer, but I won't be too long, I promise, is, I think, in understanding what a national care service really means from the workforce point of view. So, if we draw the analogy with the NHS, people think they're employed by the NHS, but they're not, really; they're employed by a variety of different organisations that constitute the NHS, which is not that different to what being part of a national care service might mean—they wouldn't be employed by the national care service, they'd be employed by a local authority, like they might be employed by a health board in exactly the same sort of way. So, I think, there is is something about the positioning of what we mean by a national care service that could be a really vibrant and enthusing means of getting somewhere that we've struggled to get previously. I certainly think, as part of those discussions within the expert group, we talked an awful lot about what that might mean and how that could be used really positively as part of a wider range of reforms. So, form has to follow function. We've got to be very clear about what a national care service is, but I think there are some real grounds for optimism around that type of reform being able to excite a workforce that needs to be celebrated and valorised in a way that all too often it isn't.
Thank you, Gareth.
Thank you, Chair.
Rhun ap Iorwerth.
Bore da i chi. Mae gen i ychydig o gwestiynau ynglŷn â phrosesau o hyn ymlaen ar gyfer y sector ac ar ein cyfer ni fel seneddwyr. Rwy'n ddiolchgar i chi am eich gwaith ar y gwerthusiad. Mae gosod amcanion a chwestiynau prawf, dwi'n meddwl, yn ffordd o herio'r sector, yn sicr, i ganfod atebion eu hunain. Ond beth ddylai ddigwydd nesaf? Sut mae troi'r cwestiynau yna yn gamau gweithredu? Beth dŷch chi'n disgwyl ei weld?
Good morning to you. I have a few questions now in terms of processes for the sector and for us as parliamentarians. I'm very grateful to you for your work on the evaluation. Setting objectives and test questions, I think, is a way of challenging the sector, certainly, to find their own solutions. But what should happen next? How do we turn those questions into action? What do you expect to see?
Diolch yn fawr i chi. I know a number of times I've said that's a really good question, but that's a really good question. Our aspiration, I think, Fiona, it would be fair to say, was that this would create a conversation. Speaking personally, just for myself now, I would hope that you would want to be able to see a very clear connection between this evidence and the consultation that's been proposed by Welsh Government. On my limited reading of it, I can sort of see some of those connection points, but they're not perhaps as clear as I might have hoped they would be. So, I think there is a question there about the extent to which this evidence feeds into that, as a way of engaging the sector in a conversation about the future of social care.
I can see elements of it feeding through, and one or two of our reports are referenced in the detailed consultation papers. I think that's a really positive step. That is one means by which the work that we've done can be taken forward. There are a range of other opportunities. I think the new citizen voice bodies are another opportunity, and, again, you may want to have a role in understanding some of the connections between this evidence and their work. Linked to that, I go back to the comment I made a moment ago about the role and functions of the national care service. So, we are at a place where there are a number of opportunities to take this forward.
In a more granular way, I think we are engaging. We've had conversations, as you would imagine, with a range of our stakeholders already about the findings. So, the Association of Directors of Social Services Cymru have been engaged in this and fully briefed on the findings, not quite in the way that you are being today. In no small way, I think this opportunity and having a detailed exposition of our findings through the means of this committee as a resource for the sector might be quite useful. So, certainly, we would hope to use this as an opportunity to identify, 'What are the means?' Ultimately, I think it's your call as political leaders as to what expectation you might make of the Minister around this, but we think we've prepared the ground for you.
I'll ask you to help us. My last question—I'll bring it forward—is: what would you like us to do as parliamentarians with this now? What would help you see this through, because you're posing these questions with a view to having them answered? How can we push that agenda forward best?
Thank you. I agree it's a wonderful question, thank you. One of the reasons why we didn't do recommendations is what we found in the study was this disconnect, this growing away from the ideals and principles and people's experiences. So, we were thinking about creating a dialogical space, for want of a better word, to try and close that gap. If we just came up with recommendations, that could just be put on a shelf, but if there's a process where people can talk, based on their experiences—and I think Mark's point is so important, people's lived experiences have to be in this discussion, otherwise, one scenario is that that gap can grow. But we were thinking that to try and pull it together on the basis of the principles being seen as positive, it's a place to go from on that journey.
One very practical suggestion might be about the questions. There's nothing stopping them becoming a regular check-in with a range of leaders. They're questions that could be put across the sector to say, 'Well, look, if you and we think they're the right sort of questions that we need to address, do we need to use them as part of inspection?' Not to impose them on the inspectorate, we're not trying to tell them how to do their work, but to what extent might they inform the work that's done by people like the inspectorate, people like Audit Wales, your role in scrutiny and a range of the infrastructure around Welsh Government committees and—I don't mean that, but the groups that might exist within Welsh Government. Our hope would be that they could percolate through and would be useful as reference points back to say, 'We provided an evidence base, a bit of a line in the sand. Where are we now?' Let's just ask that question again six months on, 12 months on. Are we any further forward on addressing that? If so, great, why and how, and if not, why not?
I think you're right, it really could help us if we're told these are the key questions. Our scrutiny work is about asking questions and seeing where we're at in the development and roll-out of policy. Would you be able to prioritise within the 19 questions that you’re asking, to focus it down even more?
This was a longer list to start with. So, in one sense, these are the priorities from a longer list of questions, as you can probably imagine, that came from 750 pages of evidence that we’ve collected prior to this point.
And I think it speaks to the complexity, I think, of the Act, and of what well-being means in how to deliver social services.
We might struggle to but others might not. I think that would be the point I would make. So, I think, if you, for example, look as a committee at this list, and think, ‘Actually, there are seven or eight that we think are the most important for us', then that’s a helpful thing. But marking our own homework in that way might be quite tricky.
I’m not suggesting for a second that you try to let the Government off the hook, but not having recommendations that Government have to accept or reject, in a way, can be letting them off the hook. They can just carry on asking the questions themselves now. But given that they haven’t given a full response to a set of recommendations that you could have made, would you have expected a fuller response to your evaluation than the quite brief statement that we had from the Welsh Government, really?
That’s quite a tricky question, so we need to be quite thoughtful in our response to that. I think the comment I made a few moments ago about the connection between the consultation and our evidence—it's one area where we had anticipated, perhaps, it might be fair to say, to see some connections. So, conscious that this is a contribution at a time of continuing change in the public policy context in Wales, it may well be, and I think I can detect some strands of our work coming through that, but perhaps it’s not as explicit as it might be. I may be doing people a disservice. I think there are some implicit connections.
You’re right to say, I think, it would be fair to say, that we chose not to make recommendations. I think recommendations from researchers are limited in their power, if I’m entirely honest, and we recognise that the alternative that we took might have been a more powerful contribution on the whole. We are just researchers at the end of the day, and I think whilst our evidence is strong, we know our place within the system, and we can’t hold the Welsh Government to account for those; we're conscious that you can, as a committee, and the questions we feel are a good basis for doing that, perhaps.
Thank you very much for that, Mark. I think that’s a very interesting point, that we’ll have to keep an eye on how the consultation addresses those 19 questions. I think that’s key. You’ve gone to a heck of a lot of trouble to identify those 19 questions. We need to make sure that they’re explored. Thank you, both.
Thank you so much, Chair. We were having a bit of a tussle unmuting me. Good morning, everybody. I’m going to try and keep my questions short, sweet and simple. Thank you so much for all the answers you’ve given so far. Overall, would you consider that this legislation is actually fit for purpose?
Another brilliant question. I think on the whole, as a piece of legislation, we think it is. Going right back to the beginning of this session, the evaluation approach that we took asked three questions: how the principles were conceptualised, how they were implemented, and whether they delivered the desired results. I think the analysis we’ve come to is that the greatest strength of the evidence, where it’s best, if you like, is in that first conceptualisation. So, our view is that the principles are very, very sound; they are universally accepted, no-one challenges them as being the right strategic agenda. So I think we do feel that the legislation and the framework around the legislation is sound. The challenges come in relation to implementation and then the delivery.
Okay, great. Are there any additional points that you wanted to make today, that you feel like you haven’t had the opportunity to do so?
That’s a good question as well.
Is there anything else you’d like to say that’s perhaps not been drawn out through questions today?
I know it’s a funny thing to say at the end, but just something about limitations. This is a study that was at a particular point in time, primarily qualitative. There are inevitably some limitations to that. So, just to put that on the record.
A final comment from me. It really picks up on the thread from the last couple of questions about next steps. Our hope and aspiration is that this is a meaningful contribution. We recognise that it augments a huge body of evidence that you'll be very, very familiar with. We're very grateful to everyone who took the time to speak to us about their experiences. It's not an easy thing to do, so we're hugely grateful to them for having done that and we hope that we've repaid that commitment in the evidence that we provided.
Can I, please, Chair, if you don't mind, just to go back? You've mentioned the limitations element. Obviously, as Members from all parties and all different groups, we want to ensure that, when anything goes forward, we don't have limitations going into anything that we do—any research projects or policies. Can you just specify what particular limitations you felt that you had within this area?
It's sort of what researchers always say. So, when you write a paper, you always have—. When you asked your question—. It's data collected at a particular point in time. So, it's not a longitudinal study that we're following on. So, I suppose, it's not limitations as in flaws, but it's just caveats, I suppose; it's just setting out what it is and what it isn't. So, it's not a longitudinal study over time. And that might be something that could be good to do—that we revisit things over time. So, it's more, I suppose, just the caveats about describing what it is and what it isn't, if that makes sense.
The final thing I'd just say to amplify that a little is about the nature of the data—not the data that we collected, but the national data or the local data that feed that national data picture. And by everyone's recognition, it isn't where the system wants to be, or where it needs to be, to give us those kinds of lines of sight over a period of time around things like the outcomes within the national outcomes framework. I think there is an underlying inherent limitation in doing the study in this context around that data—particularly troublesome for things like prevention, as we alluded to earlier on. So, that's, I think, something that might be worthy of mention. I think we touched on it a few times, but it's worth saying, I think.
Thank you so much for your responses. Chair, I'll pass back to you now.
Thank you. The last question of the day is from the Chair of the Public Accounts and Public Administration Committee, Mark Isherwood.
Thank you. The co-production revolution that we're effectively talking about began in Western Australia over 30 years ago in mental health services, and that not only improved lives, but liberated resources to better focus on working with people to help them meet their aspirations. When I was a guest at the launch of the Co-production Network for Wales, one of the speakers was a director of social services from south-east Wales, who told us, 'They used to tell people what they can have; we now ask people what they want to achieve'. And one of the beneficial consequences of that was that their absenteeism rates and labour turnover rates had reduced because people, instead of coming in depressed, and all they were going to expect to do all day was deal with complaints and problems, now felt they were actually able to help people as social workers. And yet, the director of social services I referred to earlier a couple of times somewhere in north-east Wales, I know, just from my own casework from constituents, let alone others, spends a massive amount of time dealing with formal complaints processes, ombudsman investigations, freedom of information requests, and adversarial correspondence going, which invariably is written up by the legal department. So, here, it's not the policy or the legislation or, as you say, even universal failure to practice; it's how we can break through those barriers where certain people don't want to lose control and share that control with their partners, who are their service users.
I think there are two very, very quick things I'd say that come directly from our evidence from the workforce post COVID. COVID imposed a whole host of peculiar and unprecedented conditions on how people practice. There are quotations in the report around direct payments being given to people without the kind of oversight that is normally imposed on direct payments, and the consequences of that, and the consequences being incredibly positive, in that (a) people were far more resilient than we thought perhaps they were to be able to cope. Now, whether that was particular to that moment in time, I think, is a question, but the overall sense from the workforce that we were speaking to was, actually, that when people were given greater control, they were more resilient than we thought they were going to be. And (b), when we didn't have the kind of oversight over that money that we normally have, people didn't exploit it, they didn't waste it, and they didn't use it inappropriately. So, I think there are a couple of lessons, just to amplify that point that—
On that particular director of social services, I've had several cases where he and his department have written to people who had those direct payments in those circumstances, demanding that they repay significant sums, because they've exercised choice too widely.
I wouldn't get into the detail of the case, but I think it provides a really good line of sight into the challenge that voice and control in particular throws to our statutory bodies. Thank you.
Can I thank you, Professor Llewellyn and Professor Verity, for your time this morning? Congratulations—you've managed to follow what I asked, to be brief, when at the same time we've been asking questions from Members that demanded longer answers. But you've managed to balance that so well. Thank you so much for your time this morning. We really appreciate it.
Thank you. Diolch yn fawr ichi i gyd.
Thank you very much.
You also agreed that we could write to you on some points as well, so we're grateful for that. We'll send you a copy of the Record of Proceedings, and if you think you want to add something to that, then we'd obviously welcome that as well. Thank you very much for your time this morning. We really appreciate it—thank you.
Thanks everyone. Diolch yn fawr ichi i gyd. Thank you.
Diolch yn fawr iawn. We'll take a short break, ready to start again at 11:15.
Gohiriwyd y cyfarfod rhwng 11:01 ac 11:17.
The meeting adjourned between 11:01 and 11:17.
Croeso, bawb, welcome back to this joint committee this morning. I move to item 3, and this is with regard to the evaluation of the Social Services and Well-being (Wales) Act 2014, and we have our second panel of today, and our two witnesses before us. I'd be very grateful if you could introduce yourselves for the public record.
Thank you. Bore da. Good morning. My name is Dr Alison Tarrant. I am a lecturer in law at Cardiff University, where I'm located in the Wales Governance Centre. My key areas of research are adult social care policy and law. I have a particular focus on adult social care in the devolved context, and particularly the Welsh devolved context. My research focuses, in the main, around working-age disabled adults, but what I have to say, I think, would extend beyond that to all adults using social care.
I would just like to point out that I am not a social care user myself. I'm sure you'll be hearing from people who are social care users, because, obviously, their expertise is very different.
Thank you. Diolch yn fawr.
Thank you for asking me here today. My name is Professor Luke Clements. I'm the Cerebra professor of law and social justice at the University of Leeds. My chair in law is funded by a disabled children's charity, Cerebra, which is based in Carmarthen. I was formerly at Cardiff University; I was the expert adviser to the Westminster Parliament on the Care Act 2014, well, the Bill that became the care Act, which preceded the social services and well-being Act in Wales.
Diolch yn fawr iawn. Thank you, both, for being with us, Professor Clements and Dr Tarrant this morning; we really appreciate your time. I should say at the beginning of the session that we've got an hour and a quarter, but we know from the last session that time goes so quickly and we've got a lot of questions to get through. Do you mind if Members interrupt, politely? Is that okay with you?
We're lawyers, we're used to being interrupted. [Laughter.]
Thank you very much. Diolch yn fawr iawn. The first set of questions are from Mark Isherwood.
Good morning. In summary, because, obviously, there will be a lot more time to tease this out later, but, in summary, what are your overall views of the legislation? What, if any, concerns do you have? And how well do you consider that it's being implemented?
That's a very, very big question. Obviously, there are multiple problems. I would suggest that there are various problems with the legislation and, in particular, with the guidance under the legislation. Implementation is a very significant issue. I have read the evaluation reports, and I know that you've previously received evidence from Mark Llewellyn and Fiona Verity. One of the things that struck me in one of those reports in particular, the one about the workforce, is a number of mentions of what are apparent breaches of local authority duties under that legislation, spoken about in a matter-of-fact way. That is really problematic if we're seeing consistent breaches of the Act. We need to bottom that out and to hold people accountable for it.
One other point that I would like to make, and I can elaborate on this in future if you want, is that I think that there is a mismatch at the moment between the Welsh Government's broad policy discussion about social justice in Wales, and equality and inclusion, and their policy narrative around social care, which is more about people not needing social care and not using social care, rather than social care being a vehicle to enable social inclusion.
Yes, I completely agree with what Alison has just said. The Act is fine, it's a good Act, so there's no real issue there. There regulations are, in parts, problematical, and the guidance is lamentable, in that order. And that, really, is my main concern. It's about implementation. It's about delivery, which is my main concern. I think, by and large, the Act is a good piece of legislation.
I'm also particularly concerned, and I've put in a short paper, late, I'm sorry to say, and with typographical errors, but I'm concerned about the relationship between social services and the NHS seriously hampering implementation.
Thank you. How do you react to the evaluation of the Act that we were discussing during the first section? And to what extent does it chime with your own views on how this is working in practice?
I think you're better at that than me.
I think the first thing to say here is that I really commend the Welsh Government for undertaking this evaluation. It has undertaken or funded two significant pieces of work looking at how the Act is being implemented, and that really is commendable.
In terms of the evaluation, it has raised a number of very interesting points, particularly in relation to the workforce, as we all know. As I said before, I'm concerned about content in the evaluation that appears to indicate breaches of the duties under the Act.
I would have liked, perhaps, a little bit more—. Most of the comments that were put into the evaluation came from carers rather than service users—informal carers—but it is difficult to hear service user voices. I think it is a really solid piece of work, and it's produced a lot of really important points, particularly, again, perhaps around the issues of voice and control and co-production.
I don't really have anything much to add to that, if that's okay.
Thank you very much indeed. Are there any areas where you would have liked to have seen the evaluation go further, and, if so, what are they?
I would like to see an evaluation, or more work, further work, being done that looks at whether people who use social care are living equal and inclusive lives—or equal and included lives, I should say. When I talk about social care as a vehicle for social inclusion and equality in Wales, I quite often get blank faces—people haven't heard this before. We tend to talk about people's experiences of the Act in terms of personal outcomes, and that is, of course, the language used in the Act, but life is more than personal outcomes; life is about being able to do things that people who don't need social care can also do, and I don't see that discourse around the documentation around the Act or really in the evaluation either. I would like to see some work done on that.
Yes. I mean, there's been lots—. I really do commend the Welsh Government for commissioning and publishing independent reviews; I think that's incredibly refreshing. There have been quite a few of those, in my opinion, and I suppose what I'd like to see is some of the wicked details that really do exist, the problems, being addressed. I only have a small list of things, but I know that that is just illustrative and not an exhaustive list, and I would have liked to have seen some sort of focus on those, perhaps, in recommendations.
Thank you. Well, as you know, the Act places a statutory duty on local authorities to provide a preventative approach, including minimising the barriers faced by people with impairments—the social model of disability. Concerns, for example, have been raised with me by vision impairment charities that, although the Act and the codes under the Act specifically refer to rehabilitation, reablement and habilitation, particularly habilitation for children with vision impairment, it's not happening as required, or falling far short of what the codes state.
Because I chair things like the cross-party group on disability and cross-party autism group, and have done for very many years, I get a lot of casework in these areas, and constituents frequently send me case notes from Professor Luke Clements, which I then refer to in casework correspondence because they're public documents. For example, one I frequently get sent is your case note on CWR versus Flintshire County Council in 2018, which related to failure to meet the requirements of care and support plans for the parents or carers of an autistic young adult. I continue to get identical casework, and sat in on a meeting at a constituent's request two weeks ago, where a complete failure to understand and prepare for the autistic needs of the individual in terms of communication, processing and so on, led to a meltdown, and I was copied in on a letter yesterday received from the director of social services blaming them for that, and criticising the use of language during the meltdown, and stating that, in future, the council would dictate how they would communicate with them, where, and in what form. So, how do we address that in practice within the context of the legislation, but also in the context of good social work practice, where people's conditions or impairments mean that there's an obligation in the legislation on the service provider to know your service user first, and adapt your approach and understanding accordingly?
A nice simple question. [Laughter.] First of all, I apologise for your constituents contacting you with my stuff.
It's good stuff.
It's useful for me. I do get an enormous number of e-mails in England and Wales, and so it gives me quite an interesting insight into what's happening, because I no longer practise as a lawyer. They're very distressing cases, and they must be for you, and all of you who are involved in these things.
The first thing I should say is that social workers are not trained in the law; they're trained in the new computer systems that come out or the new assessment forms, but they don't know the law and they shouldn't be condemned for getting it wrong. Their senior officers should know the law, but they don't have to be social workers. So, there is a problem of ignorance. As you describe, you get these situations where there's a meltdown, and those meltdowns are normally incredibly expensive for local authorities, as I'm sure you know very well. You move from a situation where something could've been resolved, at cost, but that would come out of a budget that's quite small. And so there's a meltdown and it goes into a different budget called a crisis budget, which is unlimited. And I'm sure that no social workers want to do that, but I think there is a command-and-control regime within social care, where social workers' freedom to make sensible decisions is very constrained.
On the idea of preventative services—I've written about this—I think it's a curious idea in social care. I can understand vaccines in the NHS or salting roads in transport, but in social care, most people come in to social care in crisis, and although preventative services could be used, I think it's a different idea. It's addressing low-level needs; not preventing them, but addressing them at a low level. Often, that can be quite imaginative and it can be quite cost effective, but those low-level needs are not met, because the budget is all spent on the acute crisis, which I'm sure you're all very aware. And although front-line social workers, it seems to me, are very aware of that, their command and control, their managerialistic arrangements are that they don't really have any flexibility and they have to say 'no' in those situations.
You then have those breakdowns—I didn't quite gather what you were saying; I may have misunderstood this—and then the family can become quite hostile, and a young person can be hostile, and then the local authority label them as difficult families. And, of course, they are difficult families, but they're only difficult because the system has made them difficult. I call them, often, 'warrior mothers'—that that is the only way you're going to get somewhere. But then, the system identifies them as being problematical and therefore will not communicate with them, which doesn't, in cost-effective terms, make a lot of sense. And very often, when the ombudsman becomes involved—and I've spoken to the ombudsman—they say, 'I was told that this is the most difficult person we've ever had, but when I met her, we had a conversation and we resolved it in 30 minutes'. So, that's a bit of a scattergun response, but hopefully it helps.
When I used the term 'meltdown', I was referring to an autistic meltdown—
Oh, I see, yes.
—because of a failure, as I saw it, to recognise the indicators of heightened anxiety in response to the type of conversation, the 'what matters' conversation, that was happening. But to my final question, Professor Clements. You've studied both this Act and the English Care Act 2014. How do the two compare, in your view, and do you have any thoughts on how the English legislation is or is not working, and whether there are any similarities or lessons to be learned across the border?
I was very involved in the Law Commission process that led to the proposal for reform in England and Wales, and, as I've said, I was the expert adviser to the joint committee on the English Bill, which preceded the Welsh Bill. They started off identical. What I say in the submission—. I should say the submission is primarily prepared by my colleague Ann James; it's going in both of our names, and all the typographical mistakes are mine. The Bills are almost identical, and so this idea of Welsh exceptionalism, which keeps coming out about the Social Services and Well-being (Wales) Act 2014 being this amazing Act—it's really indistinguishable from the English Act, except in one respect, and that respect is in relation to the target duty to promote social enterprise providers, which I think is one of the most innovative aspects of the Welsh Act, and which we have spoken about in our submission. But in other respects, the legislation is pretty much the same. It’s good legislation, it was drafted by a parliamentary draughtsman, effectively. The English regulations are infinitely better than Wales's, and the English guidance is, if you could have it, ‘infinitely infinitely’ better than the Welsh codes. The Act is not working in England any more than it is in Wales because of austerity, and I think that’s the big difference. In Wales, Ann and I don’t doubt for a moment the sincerity of the Welsh Government to a socially just community. In England I wouldn’t necessarily say that. But in delivery, it hasn’t worked in either country.
Could I add something to that? In the main, I agree with Luke. There are some differences in England in the Care Act that look very minor, but I think do have a significant impact. One is that, in the English Act, we have the concept of well-being written into certain elements—for example, the provision on assessment. You have to assess in the light of the person’s well-being, in the light of the well-being duty. It’s actually written into the assessment provisions there, and that has been incredibly helpful in the courts. So I think that is something that is working well in England. In the Care Act there are also certain requirements for advocacy written into the Act at certain places, and I think that is a valuable provision to have as well. I absolutely agree with Luke that the Care Act is not working in England. There are very similar difficulties in the gap between the Act and the implementation, but I think those two points in the Care Act are of value, and it would be perhaps worth considering those in the Welsh context.
In contrast, one thing that we have in Wales that we don’t have in the Care Act is we have the human rights conventions on the face of the Act in Wales, with the absence, of course, of the UN Convention on the Rights of Persons with Disabilities, and that is an omission that I think needs to be rectified in Wales. If we are going to have the conventions on the face of the Act, the CRPD needs to be up there with them.
Thank you, both. It might be that some Members want to dig in to some of what you said a bit further later in the session. Professor Clements, in your paper you highlight the lack of detail in the guidance for the Act. I suppose the question from me there would be, what are the consequences of this? Should we as a committee be calling for additions or changes to the guidance? Are there particular areas where you think there's more urgency for amendments or additions to the guidance?
The guidance is crucial—guidance that is intelligible to ordinary humans, not lawyers. That's what the purpose of guidance is—to guide when the way is uncertain. In Wales, it simply doesn't do that. I've given you the example of the guidance on direct payments. When I have somebody e-mail me about a problem with a direct payment, which is increasingly common, because the law is identical in England and Wales, I'd be saying, 'Well, this is what the English guidance says. Unfortunately, the code says nothing, or it just says something very ambiguous.' Or I will refer to the guidance that was repealed by the Social Services and Well-being (Wales) Act. I'm sure most of you haven't had the chance to read this, but I think it's a crucial point. If we got some decent guidance in Wales, people would know their rights and would be able not to e-mail me, but to just look at it, which you can do in England. It's 500 pages, you download it, and it's accessible. The Welsh guidance is half the English guidance. If I may, I just want to read that, because I think it's a big issue. Of course, I can't—
So, the Welsh guidance is half the English guidance.
On direct payments.
On direct payments, right.
It's also in separate volumes.
Is that good or bad? Because sometimes, if a member of the public is looking for guidance, they want it condensed and easy to understand. I'm playing devil's advocate.
Yes, but they want it to deal with their particular problem, and their problems are all slightly different. I think it needs to be detailed, but in plain English or Welsh. So, when there's a problem, you know it's wrong, what the local authority is doing, but you can't say, 'And it's contrary to the guidance'; you would just say, 'This is clearly going against the spirit of the Act', whatever that means. But if you look to the English legislation, which is phrased in exactly the same way, because these Acts are pretty much identical, it spells out, 'This is an unacceptable form of behaviour'.
In Wales, you not only have that problem, but you've also got to find the code that this is in and you've also got to find out whether that code has been replaced. I personally find that very difficult. I don't know how many codes there are—it's about seven. There's not one on direct payments. So, I say, in this note:
'it is incontestable that the overall depth and detail of the guidance provided in England to the Care Act 2014 is (by many degrees) more informative and accessible than that provided in Wales to its 2014 Act.'
There's one consolidated thing, which you can search; you know, with Ctrl+F, you can find it immediately. I give the example of direct payments: it will be seen that, in Wales, that
'runs to 10 pages (just under 4,000 words). This is half the length of the guidance on the same topic in England. A response to this analogy might be that a country the size of Wales has not the Civil Service resources'—
and I think this is the key point—
'of England to produce such guidance. If this is the case, then it clearly raises more questions than answers',
if you haven't got a civil service that is capable of writing guidance. But it would also fail to explain why the 2011 Welsh Assembly guidance on direct payments ran to 81 pages and 27,000 words, compared to the 10 pages and 4,000 words at present.
So, I don't know what happened, but there is this big problem. Direct payments are complicated. The Act won't tell you anything, the regulations won't tell you anything and most of the individuals won't know where they are in that. So, you need a set of really good guidance so that people can say, 'This is my right; it's spelt out by the Welsh Government that this is what is expected of a local authority'—it's just not there. That's implementation.
Dr Tarrant. I'm just conscious of time, by the way, so—
No, no, thank you. I apologise in advance for asking you to be brief, because I don't want you to be brief at the same time. Dr Tarrant.
If I could just very briefly add to what Luke has said, the problem with the guidance is that it doesn't guide—it doesn't actually say, and it doesn't tell local authorities, 'This is what we expect you to do and this is how you do it'.
Right, that's clear.
We have 22 small local authorities in Wales with less capacity than many local authorities have in England. They absolutely need this very, very clear statement. What we have of guidance tends to be very fuzzy—quite general. We need precise direction.
That's clear and helpful, thank you. I appreciate both of your answers on that. Rhianon Passmore.
Thank you. I do hear what is being said about breaches and the equality emphasis. How much do you, though, feel that the Act generally—although it's fully accepted that it's sound in principle, and I hear your points about the guidance—is actually, in practice, unable to succeed because in implementation the sheer capacity and resilience of the workforce and appropriate delivery infrastructure just isn't there? Somebody mentioned austerity earlier. Is the need for investment the real elephant in the room, if we think about pay, training, recruitment and retention, and a need for that infrastructure? Is there any comment, briefly, around that point? Is it set up to fail?
Yes, I would say, in brief. You cannot operate social care without resources. It is as simple as that. The Act, as Luke said earlier, is sound. There are problems with it, particularly in relation to the eligibility criteria in the regulations—
I was going to come on to that, yes.
—and particularly in relation to the guidance, as we've been talking about, but the Act is sound. But you absolutely—. You know, we have examples in Wales of providers handing back contracts to local authorities because they are not able to carry them out at cost, at the price that the local authority is able to pay, and they don't have the workfo