Y Pwyllgor Cyfrifon Cyhoeddus - Y Bumed Senedd
Public Accounts Committee - Fifth Senedd18/06/2018
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Andrew R.T. Davies AM||Yn dirprwyo ar ran Mohammad Asghar|
|Substitute for Mohammad Asghar|
|Bethan Sayed AM||Yn dirprwyo ar ran Adam Price|
|Substitute for Adam Price|
|Nick Ramsay AM||Cadeirydd y Pwyllgor|
|Vikki Howells AM|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Alicja Zalesinska||Tai Pawb|
|Chris Jones||Gofal & Thrwsio Cymru|
|Care & Repair Cymru|
|Gaynor Toft||Cyngor Sir Ceredigion|
|Ceredigion County Council|
|Jim McKirdle||Cymdeithas Llywodraeth Leol Cymru|
|Welsh Local Government Association|
|Julian Pike||Cyngor Bwrdeistref Sirol Merthyr Tudful|
|Merthyr Tydfil County Borough Council|
|Matthew Mortlock||Swyddfa Archwilio Cymru|
|Wales Audit Office|
|Nick Selwyn||Swyddfa Archwilio Cymru|
|Wales Audit Office|
|Rhian Stangroom-Teel||Leonard Cheshire Disability|
|Leonard Cheshire Disability|
|Ruth Nortey||Anabledd Cymru|
|Stuart Ropke||Cartrefi Cymunedol Cymru|
|Community Housing Cymru|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Claire Griffiths||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.
Dechreuodd y cyfarfod am 14:01.
The meeting began at 14:01.
Can I welcome Members to this afternoon's meeting of the Public Accounts Committee? As usual, headsets are available for translation or for amplification. Please ensure that any phones are on silent. In an emergency, follow the ushers. We've received a number of apologies this afternoon, from Rhianon Passmore, Neil Hamilton, Mohammad Asghar, Adam Price and Lee Waters. Can I welcome Bethan Sayed who is substituting for Adam Price, and also Andrew R.T. Davies, who has agreed to sub today for Mohammad Asghar? Thanks for helping the committee out this afternoon; it is appreciated. Do Members have any declarations of interest that they need to make at this point? I suspect not.
Okay. Item 2, and we've got a couple of papers to note. First of all, the minutes from the meeting held on 11 June. Only Vikki can probably vouch to the veracity of those, and myself. Are you happy to agree the minutes? Yes.
Yes, I'll move those.
Secondly, we've received a letter from Dr Andrew Goodall on the latest position regarding NHS waiting times for elective care in Wales and orthopaedic services. That's following on from an update we received on 19 March. Happy to note that letter? Good.
Thirdly, two letters on NHS Wales Informatics Services. First of all, a letter with extra information from Dr Andrew Goodall in relation to the development and publication of information and technical standards to assist with out NWIS inquiry. Note that? Yes. And a letter from the Auditor General for Wales from 8 June 2018, which we need to note as well. So, that's noted.
Moving on to the Welsh Government's relationship with Pinewood, the auditor general published a report on the relationship on 11 June. Now, I know that the Culture, Welsh Language and Communications Committee is currently undertaking to look into this, and it just so happens today that one of our substitutes is from said committee—that's fortuitous. Did you want to say anything on this item, Bethan?
Well, I'm sure you'll have an update from the auditor general's office, but I just wanted to say that we have got the Cabinet Secretary and the Minister in on Wednesday morning as part of our inquiry on film. Because of the severity of this issue, I think we'll mostly focus on Pinewood, but I anticipate that we'll want to do some future work on it and, hopefully, we can encourage perhaps one or two of your committee members to attend some of our committee hearings on it so that we've got the link between both. Because, of course, usually, a report would've come to you, as Public Accounts Committee, but, because we're already doing this inquiry in film, I think that's why the focus has been on our committee. I wouldn't want for that link to go, so I hope that we can continue the conversation and we can carry on work, because I think there are some really important questions that have come from the work of the Wales Audit Office, which we thank you for—information that hasn't really come to light until this particular document was released in public. So, if we can continue to work together, that would be great.
Mike, did you want to say anything on this item?
Thanks, Chair. As you say, we published last week and this piece of work wasn't in our forward programme of studies; we've undertaken it in response to concerns that were raised with the auditor general by an Assembly Member. So, it was a reactive piece of work. We've worked quite quickly, given our knowledge of the culture committee's ongoing inquiry, to produce a report in time for it to be considered by that committee but, obviously, with a PAC locus as well. Conscious that the culture committee would have Ministers in front of them and could get into policy issues, the PAC takes an accounting officer around governance issues. So, as Bethan says, there may be an opportunity for both committees to have a degree of involvement here. We are happy, obviously, to support either or both committees in considering the auditor general's report and to be as helpful as we can.
Great. We've discussed this as a committee and we are pleased that your committee is going to be looking at it. It's possible that if there are any issues that you want to flag up with us at the end of the process, we would pick it up anyway, but I think that, in the meantime, it's a good suggestion that we will discuss it when we are fully formed again as a committee and we'll provide maybe a Member to come and look your proceedings and report back.
Okay. I don't anticipate us just having this one session on Wednesday. I anticipate that we will need to do some more work based on needing to gather together more information from the Government, from Pinewood and other interested parties. So, I don't think you'll hear the end of it yet.
I didn't think we would.
Can I just seek clarity, Chair, if I may? The report carries out two examples of maybe—well, one: double funding, because another company was funded in the Cardiff area to provide similar facilities; and then, secondly, there's the ongoing management agreement with Pinewood, where the figures haven't been disclosed. I understand why—for commercial confidentiality—but will it be the case that the Public Accounts Committee will be revisiting this to check the value-for-money exercise? I appreciate what the culture committee is doing as well with its investigation, but will it be the case that the Public Accounts Committee will be revisiting this?
Not as a matter of course. It was a piece of work from the auditor general's office, which we often do follow up on, but it is a stand-alone. Well, I don't know what you think, but, looking at it from afar, from this committee, I would say that it's probably something that there would be merit in us looking at, following on from your—
It depends whether we can cover those issues. I know that the precedent is for it to go to the Public Accounts Committee, but I think that if we had the support of the auditor general's office alongside one or a few AMs—. I know that workload is tight so I would urge us not to duplicate, and if there's anything that you thought—. If we carried out some work and you thought there was anything missing from that, then by all means do a piece of work, but I'd like to think that, potentially, we could probably cover it ourselves—
It would mainly be—. We're a committee that is involved with the civil servants rather than with the Ministers themselves, so it depends whether we think there could be value added from that. Mike.
It might be helpful, Chair, if this committee reserves its position until the culture committee has done its work and then decides what more, if anything, it feels it needs to do in light of where that inquiry goes, rather than deciding today necessarily.
The point I'm making is about the value-for-money exercise. I appreciate that that's the Public Accounts Committee's role. Hence the point about what I would see as the double funding of two similar companies in very close proximity to each other in the Cardiff area, and secondly the ongoing management fee that's being paid to Pinewood. None of us understands the quantum that's being given over to them, but, as it's public money, I would suggest that there is an element of public interest in understanding the value-for-money exercise as well.
Well, we can take your comments today, albeit as a sub, when we look at this again and then look back at the value-for-money angle, if that's helpful.
On to our witnesses. Good afternoon. Would you like to—. I should say first that item 3 is our evidence session on housing adaptations. Would you like to give your name and position for the Record of Proceedings? Who wants to start?
I'm Julian Pike. I'm the housing manager at Merthyr Tydfil County Borough Council.
I'm Jim McKirdle. I'm housing policy officer at the Welsh Local Government Association.
Gaynor Toft, community well-being and service manager, Ceredigion County Council.
Good. Thanks for being with us. I'll kick off with the first couple of questions. First of all, given that adaptations are critical to enabling older and disabled people to live independently and that the current arrangements for delivery reinforce rather than address inequality, how do you think these matters should be addressed by the Welsh Government? Jim McKirdle.
I'll kick off. I think that the Welsh Government have made a start—a good start—in terms of addressing some of the issues and recommendations within the report and some of those inequalities that have been identified, by bringing a clearer focus to work around aids and adaptations over the last 18 months or so with the work that they kicked off around the Enable project and the formation of a steering group overall, which gives a vehicle to both address some of those issues and now to look at the recommendations within the auditor general's report and provide a platform for taking forward the issues identified within the report and the recommendations. So, I think they've made a solid start in terms of getting that group together, and now we probably need to look at building on that with practitioners to address some of the other issues within the report.
The auditor general’s report highlights that tenure and delivery determines the service an older or disabled person receives. Should the Welsh Government set minimum standards for adaptations?
As we've said in our written response, we think that's a helpful suggestion, and I think that work is under way in order to do that. There was a meeting of the adaptations steering group just last week, where there was a first cut at looking at developing national standards. I think that organisations will certainly find that useful to contribute to the process of developing those national standards and then to look at those applied across the country, and perhaps bring, I hope, greater consistency in the experience of citizens irrespective of the tenure in which they're living, which, as the report highlights, and as previous reports have highlighted, has been a driver for some very different experiences.
Consistency has been a big problem.
It has been, and that's been driven largely by the funding streams and the different tenures that people are living in.
Yes, okay. Bethan Jenkins.
'Sayed' now, sorry. I've changed my name now.
I just wanted to ask in relation to the cuts that have been put upon the area. Care & Repair Cymru contacted me over the weekend about the fact that there has been a 4 per cent real-term cut in relation to that budget. How is that affecting your ability to deliver on the ground? Their argument would be, 'Well, if that was funded appropriately, then we potentially wouldn't be in a situation where there is so much concern about how this is being delivered across Wales'. What's your view on that?
Yes, they have approached us in terms of funding. We, as a local authority in west Wales, also fund care and repair. So, we do work closely with them in relation to recognising the strengths that they can bring to the service because their core work is about case management and working on behalf of a client. So, yes, they do have challenges as far as funding is concerned, but the funding that they receive from the Welsh Government is not the only funding that they receive. They do receive funding from other sources, such as integrated care funds in certain areas, as well as from the local authorities directly themselves. So, we work through the challenges. Local authorities similarly face budget cuts. So, we work through it in terms of what is the service that we can provide and how we can work together to actually deliver an effective service for the client.
What's the experience in Merthyr?
Very similar to what Gaynor's outlined there. In terms of austerity over a number of years, some of the services that we've lost are in terms of technical expertise. So, we've seen a significant downshift in terms of architects, engineers et cetera, which traditionally were in-house and we could call upon them quite quickly. We're finding more and more that we've got to go externally for those services, and I suppose that's just a matter of progressive cuts over a number of years.
Just picking up on Jim's point, obviously we try to progress tenure-neutral services. So, in terms of occupational health, they go out regardless of the tenure, and their service response is the same. It's just that when it goes to a point of approval, it goes down a different track, depending on the tenure. So, local authorities try to mitigate that as best as they can, but, obviously, in terms of the routes for the physical adaptations grants, the disabled facilities grant or other adaptations, they're almost set. So, from that point onwards, the service can be quite different because of the funding arrangements.
As a second follow-up, I was on a committee, when I was first elected, that looked at adaptations, and it seems to me that a lot of the issues then are still happening now, and that was at a time when, actually, funding cuts weren't as high as they are now. So, to be devil's advocate, why weren't these problems sorted when the going was good and when you had that sort of flexibility? Why has it taken another report by the auditor general for things to start to move? Steering groups are all well and good, but why hasn't this been reflected in the delivery on the ground? Still now, in 2018, there's still a lot that's going wrong in terms of the sector as a whole.
I think I would go back to something I said earlier on about the leadership from the Welsh Government in terms of pulling together a focus on this report at this time, and pulling together the Enable project, and I think that that's something that didn't necessarily happen with previous reports. You're right to identify that some of these same problems have been identified before. We've seen improvements, certainly in local authority and other performance over time, if you look at the performance information that we have. But I think that the difference this time is that we have got a leadership role from Welsh Government in bringing a clearer focus to resolving some of these issues, and that steering group, I think, will be the vehicle for taking forward the implementation of those recommendations and perhaps making improvements in a more structured way this time than has been previously the case.
If I can also pick up on customer satisfaction as well, I think you will see that—and I think it's picked up in the audit office report—customer satisfaction with the delivery of adaptations is very high, and that's what we found locally and from the reports that we've had from other local authorities as well. That's not to say that there's not significant room for improvement, but, in terms of how we deliver adaptations to vulnerable clients, the staff who are involved in doing it are very sympathetic in the way that they do it as well. So, we shouldn't lose focus of the fact that customer satisfaction, on the whole, is positive, although I acknowledge that there's always room for improvement.
Apologies, Bethan. I was in a time warp there.
It's fine. Don't worry.
Takes me back to previous committees. Andrew R.T. Davies.
Thank you very much, Nick. There are various delays in the system when people, obviously, apply for adaptations to be undertaken. The report highlights utility companies, and planning committees as well, as being some of the blockage areas and some of the time delays that feed into the system. You would've thought they'd have the capacity to deal with these adaptations, because they come through on a constant basis. Is there a requirement for more guidance from Welsh Government, or assistance from Welsh Government, to assist these unitary authorities and planning committees et cetera to actually speed up the way they handle these applications in the first place?
I think that highlighting the planning resource within local authorities follows on from the earlier point about capacity. As I'm sure you'll be aware from other investigations, that's an area where local authorities have seen resources reduced fairly significantly. So, I think it's no surprise that there's a bottleneck sometimes—
Well, I'll take you to task on that. The Welsh Government put significant money into the planning system by increasing planning fees to allow more resource to go into it. So, the planning departments have seen an increase in the resource that's been made available to them. There does seem to be an issue here in departments that should be able to tackle these blockages, and, in particular, unitary companies like water companies and electric companies as well. So, actually, simplifying what you're saying, that there's a lack of resource, that might be part of the problem, but I don't think it's much of a defence, to be honest.
I wasn't saying it was the whole of the problem; I was simply referring back to the capacity issue before.
I think one of the issues or one of the approaches that Welsh Government, through the Enable steering group, has recommended and is starting to look at is a systems-thinking review of the processes throughout the whole system—so, getting a look at the system as a whole in Wales and identifying some of those blockages and some of the actions that maybe could be taken to overcome them. To answer your question directly, I think guidance is always helpful, but focusing on the problem first of all, as the auditor general's report has done, I think is helpful in pointing the way ahead.
So, guidance would be helpful, but the recommendations in the auditor general's report are as helpful as having anything coming from Welsh Government. Is that as I take what you just said?
Combined with the priority that Welsh Government have given that by establishing a steering group and then involving people in taking forward the recommendations, yes.
There's a lack of consistency in standards and delivery across Wales, or so the report identifies. Would you think that minimum standards would be a welcome addition to wiping out this inconsistency across Wales, given that there are 22 different models of delivery?
I think it would be helpful, yes. Because we have two regional groups that focus on adaptations from a practitioner's point of view, and we have representations on them from the local authorities. The reason for those groups is to share good practice and to look at where we can iron out inconsistencies and to make sure that we are more consistent. We had one such meeting on Friday where we discussed this report and we discussed a number of cases—utilities and delays with utilities was one of those examples. Are others finding the same problem they were identifying? Yes. So, Welsh Government support in terms of guidance and service standards would be helpful. But we're mindful, from a practitioner's point of view, that we would have to be part of that process then, really, to bring to you real cases of where we do find problems and where we have got examples of good practice as well. Because there are a lot of those as well as, you know—.
Have you requested, as local authorities, minimum standards from Welsh Government? Seeing as you identify it as maybe a welcome step, have you formally requested that Welsh Government do that?
We're looking at it via Enable. This is for the last couple of years that we've been looking at it.
So, via that route rather than a direct approach to say, 'Look, we want minimum standards here'. So, there's been no request for minimum standards formally to Welsh Government.
Internally, a lot of local authorities have set their own service standards for assessment time, in terms of the various stages of the adaptations process. So, some local authorities will have set their own individual service standards and targets for themselves. Some publish them, some don't. But, in terms of nationally, we haven't got that as yet, and I think that's something that the Enable group, or the aids and adaptations group, are looking to propose going forward. Because at least it gives people a sense of what the expectation is, I suppose. Although we always try and deliver as fast as we can, there are various departments involved, as you are no doubt aware, in terms of the adaptation process, and sometimes too much of the performance element can land upon the housing element of the local authority, whereas there's always the front end in terms of occupational therapy, and they're getting stretched and pulled in various directions in terms of they don't only deal with aids and adaptations—they deal with enablement and reablement, and lots of different services—and so quite often the housing part of the authority is then trying to drive the performance, and I think that anything external that gives us a few more levers would be welcomed.
Thank you. I'd just add to that that I do find it surprising that there hasn't been a formal request to Welsh Government. I hear what you say, that you're working through Enable, but actually if you all agree this is a sensible way, why not just get it sorted and make the request to Welsh Government so they can send those minimum standards out to you? Therefore, then, you avoid this battle within local authorities of different departments, which is what you seem to have outlined there, Julian—that there does seem to be a bit of tension between local authorities, between departments, then, there does.
I'm not so sure if there are tensions. I suppose there are, not conflicting priorities, but multiple priorities for both the social services department, which primarily deals with the initial assessment, and the housing, which is more the delivery arm of the process. But, yes, if we were to get standards then, obviously, if we could inform them ourselves as practitioners, we'd welcome it.
Is that something, as Andrew said, that you could push for, or you would feel happy making a push for?
It's something that's already under way through the Enable group. So, there was a meeting last week, and there was a first stab at developing those standards, and that's something that—practitioners on the group were able to give feedback and officials are going away to further develop those. But we see that as being the forum for the development of those draft standards, and then rolling them out.
I think one of the things we've found difficult, for a long time—I've been dealing with adaptations for about 12 years—is the complexity and the varying nature of adaptations. So, quite often people think of the larger scale work where there are utility companies, et cetera. But lots of the works are very short, sharp interventions—like stairlifts. There are lots of local authorities that will put a stairlift in within 15, 20 days—so, that's from the initial assessment—because there's not much to do. An OT can say, 'Mrs Jones needs a stairlift'; we just purchase, so there's no—. There are lots of fast-track systems that local authorities have already set up on the back of previous reports that said the systems are not fluid enough, and most local authorities offer a wide range of services. The difficulty we have is quite often we pull back to [correction: we focus on] DFG performance, and that only gives—. As the report quite rightly highlights, it's a very small sliver now of all the adaptations work that we do.
But the key you hit there, Julian, is that you said that most local authorities offer it, with minimum standards, and I hear what you say about them being worked up—. That would be the expectation on all local authorities, because, as a committee, we're keen to get all local authorities—. So, wherever you live, you can understand that you get a right to that level of service, then.
Yes, I'd agree with that.
Thanks, Andrew. Vikki Howells.
Thank you, Chair. Going back to the auditor general's report, he found that many delivery bodies have not placed sufficient strategic focus on adaptations. Instead, he said they were concentrating on organisational specific responses rather than on how best collectively to meet the needs of disabled or older people. Bearing in mind your last answer, Julian, where you said that adaptations have to be very individualised, how realistic is it to have that strategic focus, and how do you think the Welsh Government and delivery bodies could help to promote the strategic value of adaptations and to improve take-up and joint working?
I think it's right to highlight that that's an area that doesn't always get addressed, and I think that, in the context of changing legislation, we've had the Social Services and Well-being (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act 2015, to name a couple. There's a much more joined-up picture between health, social care and housing that this points towards, and adaptations are for a purpose. They are to support vulnerable individuals, households, to help them achieve well-being and to live as independently as they can. I think that taking a view, as the report suggests, about predicting needs rather than just responding to individual applications is something that the partnership between health, social care, housing and other agencies should be doing, as well as looking at how effectively they're achieving an impact in terms of the adaptations. So, are we getting value for money? Are we actually making people's lives better or helping them maintain independence? And I think when you're busy with the day job around actually delivering the adaptations, that perhaps becomes the priority rather than taking the overview. I think we need to be able to do that to demonstrate effective achievement of the strategic priorities.
Okay, thanks. What do you think the main problems are that arise from having so many different organisations involved in delivering adaptations? Are there any benefits to having so many different organisations, and could performance and value for money be improved, perhaps, through regional working?
I think there are some benefits. It's different because there's a varying picture across Wales. In terms of using some other organisations like Care & Repair, sometimes they can be more responsive. Sometimes, they've got additional resources that they can call on—third sector resources such as benevolent funding and that sort of thing. So, they've got more time to do some of the stuff that staff in authorities sometimes haven't in terms of support.
So, I think it's different in different localities, but I suppose the downside is then inconsistency in terms of performance, and, going back to the earlier point about the citizen getting a clear view of what level of service they can look to receive, there will be some inconsistencies in that with so many players in the market, unfortunately. But I think—. I speak from the experience of Merthyr; there's only a very limited number of organisations that deliver adaptations locally, and we work with all of them, so we've got full knowledge of what services are available. But that may be different elsewhere; I'm not entirely sure.
I think it's the building blocks, isn't it, in terms of what the outward-facing picture should be for the client needing the adaptation. There are examples across Wales where—you know, under the duties of the social services and well-being Act, there's a duty to have a prevention service, and aids and adaptations are seen as a key preventative service. So, we have single points of access and single points of contacts being developed. There's one in Cardiff, there's one in Ceredigion, and I'm sure there are many in other local authority areas. And it's at that point that we need to make sure that, under that triage system, really, housing, adaptations and safety within the home are a key player within the assessment and the triage that takes place.
So, really, for the recipient of the adaptation, it doesn't matter which funding is being used to actually pay for that adaptation; the key is, 'Okay, what do you need, then, as far any aids or adaptations in your home are needed to meet your need?' Then, following that assessment, whichever service is needed kicks in—care and repair, the local authority. If it's a social tenant, obviously, it's the physical adaptations grants. So, it's at that point, really. It's a case of how we deliver operationally the front-line service, and then from the building blocks then in terms of—. Coming back to one of your previous points, on a regional basis, one of the suggestions was—. What's important to me is what happens to the client, really, in their house, isn't it? But, we do feed into the county team from the local health boards and then the regional partnerships as well. There is an increasing focus on having housing around the table, as far as the regional partnerships are concerned, and we welcome that opportunity, to be honest with you, especially with integrated care funding now having an increased focus on housing. But it's needing to make sure that we're looking at the condition of properties as far as being around that table as well in terms of the housing partnership. So, it depends on which level you're looking at.
I just wonder then, Jim and Julian—would you agree with Gaynor there in what she's saying about having more integrated delivery teams? It's something that seems to be working well in Cardiff and in Swansea.
I would, both at practitioner and deliverer level, but also, as Gaynor alluded to there, at a strategic level. When you asked me before about what Welsh Government can do, I think if housing currently is not a statutory partner in the regional partnership boards—. If there was a way for housing to get more universal involvement at that strategic level, then I think that would be helpful, but also at a delivery level. There are numerous examples within the report about skills and integrated teams, and those are successful where you're able to pull those together.
It's something that we're revisiting on the back of the Wales Audit Office report. It's a significant priority in terms of our internal audit plan for this coming year, and I suspect it's the same in lots of other authorities about revisiting the issue of co-located teams. We've been advocating it for a while, but again it comes down to resource pressures. There's been some resistance in some corners, but we've done it in other areas of housing in terms of homelessness et cetera, where we bring multifunctional teams together, and it's worked really, really well. So, we're looking to do that again in terms of adaptations, because it is quite a complex field, similar to many other fields. So, it's probably asking too much for one particular professional to have full oversight of the system, which is why bringing them together can only be a good thing.
Thinking about housing registers, I know in my own local authority of RCT there is an integrated housing register, which all the social landlords use, and that seems to work well in terms of matching clients with the level of adaptation that they need. Do you think that that is a good model to try and let empty homes with systems to manage applications for adaptations so that we can make better use of the housing stock that is already adapted?
Yes, definitely. We've just renewed our common allocations policy, which is very similar to what you referred to. So, all the housing associations allocate their properties through the council's policy. It varies, again, across Wales. Some have a common allocations policy, some have a semi allocations policy. So, in somewhere like Cardiff, which has got more providers in terms of social housing, roughly half of theirs are in the common allocations policy and half sit outside. But, in Merthyr, we're fortunate that the four all come through the one allocations policy. All adaptations are advertised on the system, so it's all online and the client can see, in terms of icons plus text, what the access arrangements are for each property, if there are any adapted facilities within the property, what access to the garden is like, et cetera. So, that's been working really well. It's only come in since April but we've recognised it for some time. It's taken about 18 months to build this IT system, but, in the first three of four months, we've seen significant benefits where we can quite quickly match—. The client has the choice, first and foremost, so they can see where the property is and whether the adaptations are suitable to their needs, and it only requires OT involvement for the higher level adaptations. So, if there are hoists and very specialised things within the property, an OT will have to become involved in that because there's public money being invested in those products. But for lower level adaptations such as stairlifts, wet rooms et cetera, then we leave the client to decide: 'I would certainly benefit from that.' Or, if they're due an operation, they might want to move before they have an operation, and the system allows them autonomy to do that.
Just before I bring Bethan Sayed in, Andrew, did you have a supp?
Two things, if I can. You touched on the fact that the important thing, Gaynor, is about the experience of the client, and I couldn't agree more with you on that. I'm sure everyone on the panel would agree with you on that. But I was surprised to read in the report that there's no obligation on local authorities to check the financial standing of a builder or that they've got liability insurance or warranty schemes. Am I right in saying that or have I misunderstood something? Because if you've got a builder that maybe goes bump halfway through or can't offer a warranty, that's a pretty bleak experience for the person who's having the adaptations. And secondly to that, some local authorities offer an agency scheme to help oversee the adaptations as they're being installed. Would a more general scheme that all local authorities signed up to it be beneficial? Because it's not for everyone to oversee these types of projects in their own houses. I take it some people would prefer to do it themselves, but equally, if people are in a vulnerable or challenging situation, they might well like the opportunity to have a third-party agency come in and oversee the adaptations being undertaken, which isn't available, as I understand, at the moment across Wales.
Again, from a local perspective—. I think, in the majority, local authorities do offer some agency service, as we call it. It's not universal, but I think quite a few local authorities do offer what we call an in-house agency service. At the end of the day, it's in recognition of the fact that we're dealing with vulnerable clients. To assist them in that process is what we are there for, really. We offer a liaison service in terms of filling out application forms with them, so that you take and hold their hands through the whole process. In providing such a service, as well, we are then, obviously, responsible under contract for identifying or working with builders. So, our procurement requirements as a local authority kick in. So, we always check. We've got a framework of contractors that deliver our adaptations and they've all been checked for the insurances and the warranties that you refer to. So, we do have that, and in speaking to other authorities who might not have their own agency service, there is still a duty on us to make sure that the money is being spent correctly, and that we are protecting the client in terms of their vulnerability, then, really. So, even for those authorities that haven't got an agency service, they still carry out checks to make sure that the builders are, you know—.
Could I just, maybe, ask Jim, then, from a WLGA point of view? Gaynor's touched on what would seem to be the gold standard of delivery, in that your authority, or maybe this group, by your expression, for improvement—. There is the ability for your authority to offer that agency support, and there is the background checks on builders, but you did, I think, by the answer, indicate that it's not the same in every local authority. So, would it be of benefit to have that as a minimum standard that all local authorities provide that, for that level of consistency wherever you live in Wales? Because the adaptation might be going brilliantly in Ceredigion, but it's not much comfort if you live over the border in one of the other authorities.
I would certainly agree that the development of national minimum standards is something that we'd need to look at. It's not about timescales; it's about the quality of experience and the quality of the experience citizens have and ensuring that the work meets needs. So, I would certainly see that as being a key part of national standards that are developed.
Thank you. Thank you, Chair.
I just wanted to go back, briefly, to Vikki's point with regards to an adapted housing register. I met with Tai Pawb recently and they were telling me horror stories, really, of the fact that you had an adapted house, and then they were ripping out the adaptations, putting it on the list again, and then they'd lost that particular house or flat forever then, or for a long period of time, until another adaptation was made. That person then, waiting for that particular place, couldn't go into that particular flat because they'd just ripped out the adaptation. Has the WLGA made any assessment on a value for money basis as to—? If this is something that's happening across Wales, what are you losing in relation to money and time and processes by virtue of having taken those adaptations out when you could have found somebody, in the interim, to go into those locations? I'm just wondering if you've made any national assessment of that.
We haven't made a national assessment—we haven't quantified it—but we absolutely support the principle of matching people's needs with the adapted housing that's out there and the development of adapted housing registers and systems that are either integrated or stand-alone.
So, how many local authorities are doing this adapted housing register, then?
From the most recent study that I can remember, which was a couple of years ago, there were 16 in place, with another couple being developed—
So, not very many, then, really.
Sixteen out of 22 with another couple being developed is the majority of local authorities—
Yes, but this one only started in April, so—
No, that's our new system. We were working on an older system.
Oh, a new system. So, you already had an integrated one before that.
And the report highlights some good examples, including Cardiff, but there is work to be done across Wales to bring that consistency. I absolutely understand that and agree with that. Perhaps, again, the national minimum standards might be a way of addressing the systemic approach to actually achieving that.
Just in relation to the report, in terms paragraph 2.20 and the occupational therapists saying that it's very difficult for them to manoeuvre the system, that there's limited use of mobile technology, narrow use of joint applications, the need for multiple applications to different organisations for broadly the same services—do you understand the frustrations that many occupational therapists would have in dealing with that, and what are you doing to respond to that particular area of the auditor general's report?
I think this comes back to what I was saying in terms of a single point of access for adaptations, and that being multi-agency. So, that is one response to that. Also, what we've developed locally, and what we're sharing as good practice across the area, is about having one referral form, regardless of the type of adaptation that you're having, so that, again, whether you're having a DFG or a RRAP via care and repair, it's one referral that the OT or the trusted assessor or the occupational therapy assistant—it's only referral form that they need to use, so that, again, it's easier for them to navigate the system, having one referral: 'This is the adaptation that is needed' and complete and off you go. So, that's what I would say on that.
Do you know why they're saying that local authorities seem to be adapting better than housing associations? In paragraph 2.21, they've said that
'authorities have established more effective systems and processes to deliver adaptations than those used by housing associations.'
Do you understand that comment? Because if the housing associations are not doing something as well as the local authorities, then it would be good for us to know, I guess.
I suppose it's difficult to comment, because in terms of the local housing authority—speaking from a personal perspective—we have very little to do in terms of PAGs, if anything. It's only the occupational therapist that would typically have that involvement, and then it goes over to the housing association that push on. So, we wouldn't necessarily be aware of good or poor performance. I suppose that is something that we've flagged for a long time—that the scrutiny local authorities get isn't mirrored in the housing associations.
And again, via the Enable—. Is that what you were going to say? Were you going to say that?
Via Enable, the whole purpose of that is to draw in the housing associations in terms of a performance framework, then, really. As Julian has already said, the only thing that we've been publicly judged on is our delivery times for DFGs, and how the PAGs are working doesn't have the same level of scrutiny. But via the Enable umbrella, the intention was to bring all that under the same umbrella so that housing associations were subject to the same service standards, the same targets in terms of delivery times, and the same quality in terms of the customer satisfactions. And that's what we've been trying to work on, on a national basis, really.
But you couldn't put that into legislation as you could with local authorities, because of the way that housing associations are set up, I guess. You wouldn't be able to potentially hold them to account in the same ways.
Well, we've got our monitoring responsibility, haven't we, as local housing authorities.
There's obviously just been a whole piece of legislation about the regulation of RSLs—
That's what I mean, yes.
I'm not sure about the absolute detail of doing that, but that would go against the spirit, certainly, of that legislation. And, I think, as Gaynor said, what the movement around Enable has been is about trying to develop common approaches, so that the experience of citizens is common irrespective of whichever delivery body you're dealing with or whichever tenure you've got. So, it's trying to get the front end of that right, and a common reporting framework is part of that, and also a reporting framework that looks more at the totality of aids and adaptations—the aids and adaptations story, and not just the small part that's disabled facilities grants. So, there's an awful lot about those grab rails, about the ramps, about the more common experiences that people have that doesn't get reported, and I think to have a more complete picture of people's experiences of aids and adaptations, then that's an important thing to work towards.
I just wondered if you could give a response to the issues around case officers and trusted assessors. I know they're very different things, but perhaps you could roll it into one answer. I know that Swansea, amongst others, have case officer roles and also that the trusted assessors have been put in place by the Royal College of Occupational Therapists, but there seems to be some anxiety over how they play a role in all of this, so I just wondered whether you knew anything more about it that could help us.
I think it comes down to how effective the triage system is at the front end. So, we operate single point of contact, the same as many authorities, so I suppose it's about that information that you gather at the front of house that will determine how effective the use of the trusted assessors are. So, in Merthyr, if the system works appropriately, then they will get triaged and then it'll get split into different categories of need, and the lower level would then automatically go straight to care and repair, for instance. We use trusted assessors for that immediate response, or much quicker response.
But it seems that this report is saying they don't feel empowered to make some of those decisions because of the liability involved. Would that reflect the reality in Merthyr?
I think it varies depending on the OT. Some are very comfortable. We've worked with the Royal College of Occupational Therapists for a long time and when I used to attend the regional groups that Gaynor referenced, north and south Wales, the representative from the college of occupational therapists was very comfortable and promoted the use of it for the low-level adaptations. It's only the more complex cases where there's ongoing health concerns, et cetera, and then that comes into concerns about liability if people have fits, et cetera. So, something as simple as using a stair lift might be a significant danger to someone with a complex health condition. It's those sorts of cases that, in reality, trust assessors shouldn't touch. And, in Merthyr, they refer straight back, so if a trust assessor goes out, says, 'Hang on, this is too much for me to handle, I haven't got the experience', that gets referred back to the occupational therapy team for a more comprehensive assessment.
Okay. I'm conscious of time. Just regarding the disabled facilities grant and the physical adaptations grant, do you have views as to how these could be streamlined to reduce the time taken to decide upon the delivery of an adaptation? And, also, anything to do with the test of resources: I know that that's means-tested and there's an upper grant limit. Is there anything there that you have concerns on with regard to the report here in front of us today?
I think, in terms of the means test, it's important that the evaluation that Welsh Government have launched now is comprehensive, so that it looks at all of the impacts of any change to the means test. It does act clearly as a method of suppressing demand in some circumstances, and I think that we need to be clear that, in a context where we're dealing with a limited budget, there may be some impacts in terms of budget and overall delivery. So, there are advocates both ways in relation to the means test and the impact and I just think the most important thing is that we get a comprehensive view of what those impacts may be before we make any decisions.
Any other comments on that? No?
In terms of local authorities, a number of local authorities will carry out what we call feasibility assessments. So, rather than go through what can be quite a bureaucratic process in terms of disabled facilities grants, an OT will make an assessment: 'Not quite sure whether works are actually physically possible—technically possible.' They'll make an immediate referral, it's usually a phone call to the grants department who then do a joint visit, so there are a number of cases that don't progress because they're not technically feasible, and that speeds up lots of the process. It doesn't put the client through the process of having to complete application forms, et cetera.
That initial assessment can give people alternative housing options then, like 'You need to move' et cetera, 'We can't adapt that property; it's technically not possible.' But, similarly, you can speed up the process in that the referral coming through is then very accurate and very distinct, in the sense that the grants officer has already seen the property and says, 'Send through the referral to include x, y and z.' There's not much to-ing and fro-ing in terms of changes to design, and that often speeds up the process.
Similarly, with means-testing, we do a dummy means test. So, if an OT goes to a property and pulls up outside a £350,000 house, alarm bells immediately ring that this person may—not fail the means test, but might have what's called a notional loan in terms of a contribution, and sometimes that contribution outstrips the grant. So, they would immediately inform the grants department, which would contact them for the high-level figures that they need to run the assessment, and that can be done in 10 minutes over the phone. They put it into a software package and it says immediately, 'Based on your income or savings and your age, you're very likely to fail the means test.' Then those people have the choice to either present the information and go through a formal means test or they say, 'Well, I thought I might exceed that limit because of my income or pension or assets.' So, there are various stages that people and local authorities have already put into the system to circumvent some of the administration process.
There is a considerable drop-off because people don't want to divulge their income or their savings or whatever, which is unfortunate because, at the end of the day, what we try and focus on is the fact that everybody is entitled to an assessment. Regardless of what sort of income or savings you've got, the important thing is that you've actually been assessed in terms of what your needs are to live safely within your home. Even though you might end up paying for a private contractor, you could still use the grants agency service, because we use our trusted contractors to deliver the work regardless of whether you have a grant for that work or not. Quite a few authorities do that as what we deem to be private jobs really, because they're not having a disabled facilities grant, but they're actually using the service of the in-house agency and the contractors and the supervisory service that we've got to actually deliver that scheme then.
Is that why you think it's value for money to have the means test anyway because, of course, here it says that that's questionable. You think it's value for money because you would be able to get to a point of giving that adaptation, regardless of whether they've got the means test or not.
Yes. It might be that they privately fund it because they're not eligible for a grant due to their income or savings. We've had a number of cases where people have had unsuitable adaptations done to their property because they've gone ahead and done it privately and the contractors haven't installed a level access shower and within months they're back to us saying, 'I've had this job done and it's not been done correctly', so you have to start the process again.
Thanks, Bethan. Andrew, did you have supplementary?
Yes, just one quick supplementary, if I may. The evidence you've given this afternoon has talked about the forum you call 'Enable', I think, which I presume is local authorities and other interested parties coming together. As a substitute on the committee, I'm just trying to understand how this Enable group is taking forward the work that you seem to be pinning so much hope on to get improvements in the delivery of these assessments.
The steering group that I was referring to was called 'Enable', and it's now morphing into an aids and adaptations steering group. So, the name may have caused some confusion, but that's chaired by Welsh Government with officials from a number of different departments and then some local authority representatives; some registered social landlord representatives—Community Housing Cymru; representatives from occupational therapists and other stakeholders—Care & Repair and others. So, it's trying to take a whole-system view of the issues, and in looking at the terms of reference at the meeting last week, it was specifically referencing taking forward the recommendations from the auditor general's report, as well as the continued development of the Enable scheme, which you may have seen some publicity about. So, it's trying to take a holistic view of the issues and trying to progress a whole-system response to the recommendations and overcoming any barriers that are there and achieving the kind of consistency that—
Is it doing that?
It's making progress in doing that, but it's a big piece of work.
But progress is determined in everyone's benchmarking quite differently, isn't it? Is it making the progress that it should be making, because it would certainly pull stakeholders together? It's already morphing from one name to another name now, which normally means that it's being recalibrated, because it's not doing what it originally set out to do. So, in your opinion, is it achieving what it's meant to be achieving, which is better delivery, a standardisation of delivery across Wales and, above all, ironing out the glitches in the system?
I think it provides a good vehicle for doing that, and I think, in terms of refocusing, it's responding to the issues that have been raised by the auditor general's report. I think it would be wrong not to have reflected on those and to recalibrate these terms of reference in order to meet those challenges. We would be criticising it if it hadn't.
I love that answer. Okay. Thanks very much.
Thanks, Andrew. A couple more minutes and a few more questions from me. Should public bodies and the Welsh Government be more open about performance in order to improve delivery? Who wants to take that? Julian Pike.
I think 'yes', in a word. I think that some of the difficulties are that, historically, people have been unsure what they're meant to measure. Again, going back to local authorities, we'll only measure—and are only asked to measure—disabled facilities grants. Invariably, in every local authority, I'm guessing that they will have other performance measures, local performance indicators that will measure it, but, again, they're typically not published. So, I think, coming back to the point around service standards, if there is a service standard for Wales for the various different types of adaptations, I would be all for publishing those results.
And in terms of the information that those bodies have at the moment, could that information be improved? Are the organisations capturing enough of the relevant info to improve things?
Through Enable—now the aids and adaptations group—there's been a uniform data capture sheet of about 26 fields of information, and that's been running as a pilot for about 12 months, I think, Jim—
—in terms of housing associations, Care & Repair, all agencies and local authorities, and all agencies involved with adaptations. So, that information has already started to be captured, and it needs some refinement—from reading some of the minutes recently from the meeting—but it's definitely work in progress, and I think it's heading in the right direction; it just needs to be refined. We don't want it to be too bureaucratic so that you're filling in 26 fields for a grab rail, which would take longer than fitting the grab rail. So, we've just got to be careful that we don't overdo it.
It can be a bit overly bureaucratic. The auditor general's report highlights that only seven of the 22 local authorities currently collect equalities information on recipients. Can this area be improved, and can you be confident that, without that information, you've got a fair view of access to the adaptations? Julian again?
Yes. It's something that is highlighted through the general data protection regulation work that all local authorities have had to do in terms of data processing, and so it's highlighted—presumably to most local authorities, certainly our own—which fields of personal information we are capturing and why, and then there are fields that we aren't; and we are guilty as being one of those that hasn't typically collected it for this area of work. We collect it for homelessness and everything else in housing, but for whatever reason, we've never collected it specifically on adaptations, and that's something we're looking to change immediately.
Gaynor, did you want to comment?
No, I just agree. It's something that we need to look at. We've tended to look at age and sex in the past, and that's it, more or less, as far as the adaptation is concerned, but we need to build on it.
So, collect the information, but not be too bureaucratic and not too many forms that might lead to you requiring adaptations by the time you've filled them all out.
Yes. It's also a balance to be struck. There's a good story, I believe, fundamentally, to be told about the—. You can see the figures in the report about the numbers of adaptations, about the benefit to people's lives, and I think that we're selling ourselves short by not having the performance information there that describes the fullness of that story.
Great. Any final questions? Bethan.
I just put a ring around—. It was Care & Repair's evidence that says it was inevitable that we needed to have more adaptations because of the ageing population. I just wanted to understand whether that was the case, because if you put measures in place at an earlier stage in people's lives, or we changed—you know, we're all talking about well-being and how people can look after themselves better. Is it inevitable that you would need to have a growing number of adaptations if we sort of worked with people's lives at an earlier stage? It seems to me quite depressing to see that adaptations are inevitable when, actually, we could be thinking about how we make ourselves a healthier nation. Because a lot of these issues may come from our social backgrounds and the implications of that on our population. Of course, some people will always need it, but I just wondered if you had a view on that at all.
I think, obviously, prevention and early intervention is much preferred. It was good to see last week in 'A Healthier Wales' housing, and the contribution of housing to people's health getting such recognition. But I think what you're talking about there is very early lifestyle choices, and trying to support people in making those choices as early as possible. So, yes, it is possible to make an impact, but actually quantifying those things—we're probably talking about a generation that's very young, or not born yet. Those of us who are a bit older have made some of those choices, and perhaps we're going to need some of that support and adaptations. It's part of our success about keeping people alive for longer, I think—you see the number of people who have been helped with adaptations increasing year on year—and successfully allowing people to live more independently and keep them at home. It's got to be a good thing.
Thank you. I'd like to thank our witnesses—Gaynor Toft, Jim McKirdle, Julian Pike—for being with us today, and for answering our questions so helpfully. We'll send you a transcript of today for you to check before it's finalised. Thank you for that.
Our second set of witnesses have arrived, so we'll have a quick changeover.
I see you're doing all the necessary housekeeping arrangements, so I don't need to say about phones. Okay. Great. Thanks for coming here to committee this afternoon. This is the second evidence session on housing adaptations following work that's previously been done by the Wales Audit Office. Would you like to give your name, organisation and position for the Record of Proceedings?
Hi, everyone. My name's Chris Jones. I'm the chief executive of Care & Repair Cymru.
Afternoon, everybody. I'm Stuart Ropke. I'm the chief executive of Community Housing Cymru.
We've got a number of questions for you, so I will kick off with the first couple. First of all, given that adaptations are critical to enabling older and disabled people to live independently, and current arrangements for delivery are seen to reinforce rather than address inequality, how do you think the Welsh Government could address these issues to improve things? Chris Jones.
I think it's a complex service area, as you'll all know from the background we've done, and your experience of the services anyway. I've seen some really positive moves being made by Government in terms of bringing all the right people around the table to collectively make decisions about how to improve services in the future. So, probably you're all aware of the enhanced adaptations delivery group, and the Enable work that's happening. For me, that's quite a positive experience, because of how inclusive it's been in terms of bringing the right people there who are delivering the services in terms of being practitioners and understanding what needs to change. I suppose the flip side of that is that we're it doing, again—we're reviewing this area. We've been through a number of reviews, and there have been incremental improvements, I believe, in terms of the whole service, particularly around disability facilities grant waiting times, which have improved, but they're, I think, you could all argue, still too long. So, for me, it's, kind of, a work in progress, but Government is making good strides and asking the right questions of the right people.
I think, as Chris said, it's a very complex area. I think, particularly for housing associations, when I look for the system for them, we're looking at a pretty fragmented system, actually. Obviously, disabled facilities grants are delivering a statutory part of this job, but on top of that, we have PAGs, physical adaptation grants, for tenants of what were the traditional and community-based housing associations, and that's a funding stream that's currently top-sliced from the social housing grant. And then for the stock transfer associations, that's essentially funded from their business plan. So, there's an inequity there in the way things are done. And when we look back and say, 'Well, actually, when those transfers happened, there was supposed to be, obviously, some thinking about the requirements for adaptation that would be required', we've seen demographics move quite quickly, actually, since those transfers have happened. When we expect an additional 227,000 people over 65 by 2035, an extra 100,000 over 85, and we know that 75 per cent of those are living alone, it does put an increasing burden there, clearly. And on top of that, then, you've got other funding streams, clearly, that are aimed at owner-occupiers in the private sector, including the rapid response adaptation programme. And, equally, we know that some adaptations are being directly funded from maintenance programmes currently. So, housing associations are using their maintenance programmes to do some of those adaptations as well. So, it's very fragmented.
That said, I do think there is potential, particularly around the work in Enable. I think it's fair to say that not all providers of adaptations have got to the same level of understanding of what Enable is going to deliver and what it's going to do. I'm very much keen to see the results of the systems thinking review, which is about to go out to tender, I believe, looking at Enable—it needs to be person centred. And, equally, another area where I think we need to have some focus is on better monitoring of the whole programme. Certainly, speaking to our members, their view has been that, to this point, the data collected hasn't been comprehensive enough to draw solid conclusions from it. Although, again, there is some work ongoing there. Some of our members are just perhaps raising the question that, perhaps, providers aren't completing the data collection forms for fear of performance being judged by Welsh Government, or it's coming as an afterthought. Now, actually, if we're going to really make strides here and improve, surely one of the areas we have to focus on is collecting the data about what's happening here.
So, user-satisfaction rates are still remaining high around adaptations, despite the fact that it's clearly complicated, reactive and, I would argue, inequitable, actually—partly because the range of funding streams means that, depending on where you are and who you are a tenant of, or whether you're an owner-occupier, you're not all accessing the same streams.
Should the Welsh Government set minimum standards for access?
Yes. I think one of the key things being talked about and being addressed through the enhanced adaptations group is setting service standards that apply to whatever tenure you live in or whatever part of Wales you live in. Because those are the two key problems that we're seeing. We've seen a difference in the service that's being delivered to clients, dependent on whether you're a tenant or whether you're an owner. And we're also seeing a difference in service standards, depending on which part of Wales you're living in, because there's so much flex in the system that you have different local systems that are evolving. With that, you get some good practice. So, in some parts of Wales, you're actually getting really good services, where you get minor adaptations that are done quickly—they are done without means testing, they are done without a full occupational therapist assessment. And in other parts of Wales, that doesn't happen.
So, I think that kind of uniformity of service standards is needed, but, then, holding every organisation to account is also needed. So, that monitoring piece becomes really important in terms of all the different types of adaptations as well, because, clearly, there's a massive difference between delivering a small grab rail that costs £120 and a DFG that costs £36,000. But whatever the type and size of adaptation, I think that all organisations should be held to account in terms of what that standard is and how well they meet that standard.
Great, thanks. Bethan Sayed.
I just wanted to start how I started the last session. I know that, Care & Repair, you had a 4.1 per cent real-term cut in relation to your budget to enable you to deliver these adaptations. I'm just wondering what stress that's put on you in relation to how that exemplifies itself on a local level. We had the Welsh Local Government Association in here saying, 'Well, you have other budgets that you can utilise', so, potentially, that wouldn't hit you so hard, but perhaps you can tell us yourself.
The most important part of our funding is our core funding from Government because what that does is it gives you stability as an organisation to build those local funding streams. So, without a strong base, you're never going to have strong, local care and repairs who are engaged meaningfully with health and social care. I mean, we've seen—I think the figure's something like a 35 per cent cut in our real-terms budget in the last six, seven years, and it does put significant strain on us as organisations as that level of cuts, as you'd understand it, would.
You might all be aware that we've also gone through a merger process. So, two years ago, we completed a merger journey—we went from 22 to 13—which was hard, but we did it. That has had a significant impact in terms of losing posts, albeit the aim was to lose management and non-direct front-line-related posts. So, we did that. I think we still deliver strong services, but there is an increasing strain on those services because of the increasing demand and because we try to work collaboratively and in partnership with health and social care, but that needs resource putting into it as well.
So, yes, significant strain, and, actually, I'd probably take the opportunity to say that there's a 5 per cent cut in our budget for next year in the draft budget, which is going to put an even bigger strain on how we deliver those local services, in what I think is a really important agenda: that preventative agenda, preventing people going into health and social care, helping people getting out of hospital—delayed transfers of care is a huge issue, so getting people home to a safe home environment—
Have you raised this with Welsh Government in relation to the cut, and what have they said? Because, of course, if they've got this Enable group, and you're around the table, how are they going to be able to implement streamlined policies, easier access to adaptations, if the people on the ground are struggling, potentially, to be able to deliver that?
Yes, I need to have those conversations with my colleagues in Welsh Government and with the Minister as well.
Okay. I just wanted to go on to the occupational therapist section of the report. I personally don't think it looks very good for the housing association sector in this. You can see, on page 39, the percentage complying with the application assessments, and in relation to the assessment process, whether it's client
focused and allows quick progress—well, 73 per cent of local authorities comply, and 39 per cent of housing associations. I mean, that's not good, is it? So, how are you using this report to go back to your members and say, 'Well, actually, we need to get better at doing this, so that the clients, at the end of the day, are getting the service they need'?
Yes, I think we do need to get better, and that is a stark statistic in the report. There are lots of issues around accessing OT resource and everything else in Wales, and we need to resource that appropriately. But, ultimately, it comes back to that question around thinking about minimum service standards as well, and making sure that the expectation, whatever tenure you're in, actually—whether you're in a housing association home or a local authority home—is that you can expect the same service. But we're certainly talking to our members about it. We're part of the Enable group and we've also got registered social landlord representatives around the table. It's a question of stepping up and—
I would have thought, though, that you would have had, as a housing association sector, an idea, at least, of what a minimum standard would be in relation to your work, because how are you able to analyse how well you're doing? It shouldn't have to be for somebody else to tell you that you need a minimum standard, should it?
No, it shouldn't. If you can look at works that are funded through physical adaptation grants, the PAGs, then, actually, the satisfaction rates particularly in that area are higher than elsewhere. What we need to do is understand why that is and then reflect it in the rest of—you know, where funding is coming from elsewhere. Interestingly, PAGs have high satisfaction rates—those where work is done quickly. It does require an OT to assess and apply for it. We have to iron out any differentials in performance. As I said, I don't think the fragmented system we've had, actually, in terms of funding and elsewhere, has helped us. That's why I think Enable and looking at the system review can help.
But why has the auditor general said that local authorities are able to have more effective systems and processes in place? If there are examples of good practice, surely you would have been able to have understood what they are, to improve—.
Yes. I think it's important to remember that local authorities are delivering the DFG funding scheme in particular. That's a statutory stream and we're delivering it through different streams, but that differential in performance is worrying. We are looking at it. It's a question of us using our resources, our members getting together and sharing best practice. Hopefully the work that is ongoing will help with that, and I would hope that the next time we look at this we wouldn't see such a stark difference in satisfaction rates between local authorities and elsewhere. I also think you can probably dig deeper into those stats, and, again, you'll find it reflected in different parts of Wales that different people will be performing better. We need to understand that as well.
And, Care & Repair, can you just give us some idea as to the complexity of the issue from your point of view? You know, the failure to have integrated adapted housing registers, applicants needing to make multiple applications to different organisations—how is that reflected in your daily work?
Some of this review is about the whole system. So, there's not a specific care and repair involvement. The bits that we are really highly involved in are the very small adaptations—the rapid response adaptations and direct delivery of those, which we do and we do report on, actually. We provide performance reports on waiting times for that and for outcomes as well in relation to that programme. I would say that, for the rapid response adaptations programme, it's actually really successful if you think about an eight-day turnaround as an average and, in some cases, getting works done the same day to facilitate hospital discharge. It's actually a really good news story. I think what we should be doing is more of that. That funding stream actually runs out before the end of the [correction: the end of every] year, so we're kind of—. You're either in a situation where you ration it, which we don't want to do, or you come to the kind of final quarter of the year, which then, coincidentally, is the winter pressures period, and you run out of money. That's not good.
The other thing in relation to RRAP, I believe, is that we should be doing it cross-tenure. I think the report refers to effective pooled resources in parts, and I think that's an area that it could work very smoothly in. I think that, if you increase the amount of funding into that programme from other bits of the overall programme and deliver those services across all tenures and make sure that it lasts until the end of the financial year, there'd be a significant improvement in the user experience for those really small adaptations. The other thing you would really do effectively is that, because we have probably closer relationships with health than other organisations—and in some cases we're based in hospitals—you would actually use that revenue resource on the ground for more effective use of capital resource across all tenures. So, I think there is real scope to do that a bit better.
In terms of adapted housing—this is kind of from my experience in a previous job—I think there is, in terms of system improvements, a need for good practice that happens in some areas to be rolled out across all areas, particularly where you have houses that have been adapted and had significant money spent on them in the social housing sector. They need really to be allocated when they become available to let to people who need those adaptations. I think that doesn't happen across Wales. So, in relation to the whole system, whereas it's not particularly care and repair involvement, I think that's something where significant improvements could be made.
Just to clarify, you think the money should go into the rapid response mechanism from the general physical adaptations grant, or where would that money come from?
Well, I wouldn't want to specify where, but, clearly, what you've got is a whole system with lots of funding streams. You've got a particular bit of the system that works really effectively in terms of integrated working, so, why not replicate that so that it benefits all tenures?
Okay. Just with regard to the test of resources for the disabled facilities grant, do you believe that should be retained? Obviously, we heard Ceredigion saying that they liked the means testing, because that meant that even if they couldn't help them through that particular route, they could get the work done privately anyway. So, if you didn't do that means testing they probably wouldn't know about them, potentially. What would be your view on that? Do you think it is value for money? The auditor general doesn't seem to think that it is value for money.
I think more work needs to be done on that, and my view on it is that there's a point in terms of the cost of the adaptation where it's not cost-effective. So, if you're talking about mid-level adaptations—perhaps a stairlift and a shower—to routinely do that through DFG and having means-tested all cases, I would suggest might not be cost-effective, but at higher cost levels it might become cost-effective to means-test.
And you don't think that across Wales, at the moment, there is any consistency in the approach as to how it's done?
Well, no. Again, it's a personal view here. I think the areas that do those mid-level adaptations without means testing, and some local authority areas do, and without necessarily needing the full OT assessment—you might have trusted assessors, OT assistants, doing that work, taking the burden off OTs so that they can do more complex cases as well—then that's a far more effective and efficient way of administering adaptations to people who need them quickly to keep them out of care or to help them live independently. Having that work done in a matter of a couple of months or three months rather than a year is going to make a big difference I think.
I'm certainly not convinced of the need to extend means testing further. I'm worried about the administrative burden, but equally I think one of the key stats that's emerged so far from the Enable work is we know already that 90 per cent of adaptations cost less than £500. At that level, with the vast majority, the case for means testing for me isn't really there. Obviously, if DFGs do bring some major works forward to properties—. But I think, and absolutely agree with Chris, that, in many cases around the adaptations system, means testing is probably costing more than it's potentially saving, and in terms of time as well—getting these adaptations done as quickly as possible, which enable people to either get back into their own homes or stay in their own homes, which is important.
Thanks, Bethan. Andrew R.T. Davies.
Thank you, Chair. Can I just clarify something from the opening remarks, if I may, for my own understanding? Enable has now morphed into the enhanced adaptation development group. Is that correct? I think I understood that from the last evidence-gathering session.
Yes. The system we're working towards is branded Enable—Support for Independent Living. There's also an Enable funding stream that goes hand in hand with that. The group that meets is called the enhanced adaptations delivery group.
And, Chris, I think you said you were happy, or you thought it was doing positive work, and it's working its way through the issues. Stuart, are you of the same opinion, that the work is progressing and is fit for purpose? There did seem to be some concerns in the last evidence-gathering session, I might add, but I'd be interested to know if you think, Stuart, that it is constituted correctly and it's got the right people on there—the mix of people—and it is progressing through these issues?
Broadly, yes, with a couple of exceptions. I think it is working through the issues that have been raised in the auditor general's report, which clearly it needs to do. We have representation on that group, along with others currently. We also have other housing associations sat around the table. Where we are missing a representative at the minute—and we can do part of that job for them—is particularly from the stock transfer associations. I would not normally say we need a separate representation for that but, in this case, I think we do, because the way that adaptations are funded is different, whether you are a stock transfer as compared to a traditional housing association. So, from our point of view, we'd like to see more there.
In terms of working through issues to date, as I think I've said already, the data we've collected hasn't been comprehensive enough to draw solid enough conclusions about the success or otherwise of the work that's being done, and that's something I think that does need to be addressed pretty quickly. And the stuff that I think was raised again about performance differentials between local authorities and housing associations, again, I think there can be an increased focus on that and that we do that better.
I think where I was happy is—. I think we've tried lots of different ways of improving adaptations since 2005. I think this approach is a better approach, where you're actually engaging all the practitioners, rather than doing a tendering exercise and bringing somebody in and saying, 'Examine the system and come up with recommendations.' I think that ongoing dialogue long term is going to lead to more meaningful improvements over the long term as well.
Okay, thank you.
Can I just ask, what is that fund—the Enable fund?
There was an additional amount of capital funding that was made available, I think two years ago, and it was called 'Enable'. From memory, I think it's £4 million a year, and the aim of that fund is for organisations locally—. So, it's allocated to local authorities, but the idea of the funding is that partners sit round a table and think about, 'What's the situation locally? Where are our pressure points, and how can use this fund flexibly to try and navigate some of those pressure points and ease our way through the system quicker, where it's more effective than using DFG or other funding?'
No, it's not a problem. Some of the evidence that's come forward shows that some of the delays are caused by unitary authorities' planning systems and the planning committees, blockages there, and utility companies, such as water companies, electricity companies—organisations that you would have thought would be able to get on top of these issues because, obviously, they're big organisations. Do you subscribe to there being blockages in those particular areas, and is there a way of unblocking the system so that planning departments, for example, don't act as a restriction on getting these adaptations done in a timely manner?
It's a really good question for local authorities, isn't it?
I'm just wondering about it from your experience, though.
My experience—and I worked in local government for 20 years—is that that's real. I think that those delays for large adaptations—where you need planning permission or you need building over the sewer agreements or whatever it is—can add to the delays in what's already quite a long process when you're building an extension. Naturally, it's a long process in any case in terms of procurement and getting the works done, and those add to that. So, they are real, they are there, and they kind of reflect—
How do we get over them?
I think it's for local authorities, isn't it, which are unitary authorities, to work more cohesively internally. That would be my view.
Well, anyone who can devise a plan and get a planning department to work cohesively is—
Well, I'm sure planning issues exist in other areas of work as well, don't they?
So, other than leaving it to them, there's not a view, then.
My view is that it's something that should be able to be sorted out because it's procedural.
They're issues, really, that are echoed not just in the adaptations field, of course. We're talking about housing development. We are looking at and hearing about exactly the same issues around Welsh Water, around planning and other issues. I also think we need to look a little bit further upstream as well before we get to the unitary authority level. When we talk to our members, they report that, particularly around the large adaptations that we're talking about here—extensions and the like—on many occasions there's not enough resource put into the OT function to enable a quick assessment and to get those through the door and happening quickly. So, there are delays, I think, throughout the system, but the one around local government, absolutely, I recognise that from another part of our work around new development, and it's something that we have laboured with for a long time to try and—
Well, could I ask—because we are identifying the problem, and very often, identifying it is the simplest issue; it's putting the solution in place—? Is it as simple as Chris points out—that it's for the planning departments to actually get their acts together and sort this out, because it's a known problem and so it shouldn't really be beyond the wit of them to sort it out?
No, I do think that, in terms of the planning departments across Wales within local government, we have seen them particularly suffer from a lack of resources. Cuts have bitten. It's a non-statutory service, clearly—well, some of the stuff. Our experience around planning departments is that their resource has been cut. I personally think that it's one of those areas in Wales where we should be looking at sharing resource across authorities—and expertise. That might help. It is a bit of postcode lottery here as well; it depends which local authority you might happen to live in. So, how do we best use the planning resource across Wales? It would be an easy thing to say that we need more resource in planning, we need to employ more people. Sometimes you have to say, 'Well, actually, that's not what's possible. Can we use the resource we've got better? Can we break down some barriers between authorities and share some resource and expertise?' I would quite like to see that come forward here in this area, but also around housing development as well.
Okay. I did make the point to the WLGA that, actually, if you look at the way planning fees have gone up here in Wales, the Welsh Government have increased them significantly to allow additional resource to go into specific planning departments for pre-application hearings and everything. So, I have to say I don't subscribe to just the resource issue being a problem there, but, if I could move on to minimum standards, as the Chair touched on and Bethan touched on, I think everyone's singing from the same hymn sheet when it comes to minimum standards, and I'm a bit surprised to find that that doesn't already exist. How difficult is it to create minimum standards? Because it's one thing saying we want minimum standards, but then actually laying it out so that everyone signs up to it—how difficult is it to create minimum standards?
It shouldn't be that difficult, should it?
Well, that's what I'm just thinking. To me, it seems relatively straightforward.
Look, the discussions that we've been having are around breaking down adaptations into different categories, if you like, because you're not going to have the same standard for very small as you have for large. So, small, medium, large, and, within those categories, having service standards: you would normally expect a small adaptation to be completed within 10 days of a referral. I'd say that's quite straightforward.
Can I just turn that question around? Why haven't we got minimum standards at the moment? Is it just that, as the system's grown up, it wasn't seen as necessary, or there's not been an identifiable problem or issue that justified it before?
Yes, I think that's it. I just think it's the nature of how the system has grown up and developed, and the fragmented nature of the number of organisations involved in delivering it from different sectors has led to that not being the case, but I think now that everyone recognises, actually, 'Come on, it would be quite straightforward to do that'. I do think it will be quite straightforward to do that. You could argue around the edges about, if it's in the middle range—stairlift and a level-access shower— should it be two months or three months or four months. You can have those kinds of debates on the edges, but you should be able to get to a point where small, 10 days; medium, three months; large, whatever. I'm not going to say a time for that one.
So, the big beast in the jungle here—i.e. the Welsh Government—should drive this and get minimum standards in place, then. Because you seem to be indicating that, on why haven't we got them, there's no reason, really, because there's a simple formula that could, certainly on small adaptations, put those minimum standards in place, and, really, it's more people protecting their own backs that haven't driven it into play at the moment. Therefore, Welsh Government, as the centre, should be driving minimum standards. Is that correct?
I think those discussions are actively happening in that group and we're nearly there, and Government are trying to inform those decisions through talking to the delivery organisations and getting a consensus and also by looking at past performance over the past 12 or 18 months, which they're also looking at. But I think we're nearly there. The auditor general picked it up as an issue, but the discussions are already in hand for those things. From my organisation's point of view—and I'm sure Stuart's and local authorities'—I think we want to see it. I think it's really helpful to know what standards you're working to.
I think the single access point that Enable represents to what has been fragmented and diverse funding streams and a picture really has brought this to the forefront and gives us the opportunity to do it. So, the systems thinking, really, about how the adaptations system works that is about to go out there, for me is the real opportunity to get this nailed once and for all as well, alongside running that as a person-centred approach, so that, the people who are actually in receipt of these services, we understand what their needs are, the experience they have of the systems—the varying systems we currently have—how can we increase efficiency and streamline. But, at the same time, yes, minimum service standards, I think, naturally follow a single access point. I agree with Chris. I don't think it should be beyond anyone's wit to work out what a minimum service standard should look like. It can't be right that if you're in one part of Wales you receive a better or worse service than someone in a neighbouring authority or elsewhere.
Good. It can't be right, but we do often see it, don't we, across the board in all sorts of areas. Vikki Howells.
Thank you, Chair. The auditor general, in his report, said that we need more strategic focus on adaptations. Is Enable the answer to that, or is there anything else that the Welsh Government and delivery bodies could be doing to promote the strategic value of adaptations and to improve take-up and joint working?
Yes, the strategic focus for me is about recognising the massive impact that housing and aids and adaptations have on people's well-being, their independence, and how they can reduce demand in other stretched services like the NHS and social care. I think there's a broad understanding of those issues. You've got the social services and well-being Act, sustainable social services as an idea, prudent healthcare as an idea, a real understanding of prevention. The big challenge here is bringing this particular area of work into those mechanisms. So, we have, for example, ICF, the integrated care fund, which looks at integrated working regionally, in regional partnership boards, and is focused on independence and well-being. I think the missing bit of that equation is that there isn't a strong enough third sector voice or housing voice around those regional partnership board tables. And I think, with that, there'd be a greater understanding, I guess, of the value of good housing in preventative terms, but how that should be resourced in that integration agenda—. So, a good example for me is that care and repair in Bridgend has got a fantastic relationship with health locally. They actually have case workers and a handy person service that operates at a ward level— so direct contact with health professionals and patients, linking them to the rapid response adaptation programme and other programmes. I think that kind of link between that local delivery staffing resource really close to health, and a capital resource that exists in adaptations, should be happening on a more widespread basis across Wales.
How can we ensure more consistency, then, across different local areas with regard to that?
I think that consistency is really difficult when you're talking about regional partnership boards. But the consistency would improve if you had greater housing and third sector voice on those regional partnership boards, bringing this agenda to the table, making sure that everybody understands the value of this in terms of that integration and prevention agenda, and actually bringing resources to the table to make it happen in the way it does in Bridgend, I would suggest.
Would you agree with that, Stuart?
I would agree with that. I very much welcome the Cabinet Secretary for health's announcement last week that housing will play a part on regional partnership boards. Clearly, we now need to go away and think about how the governance and representation bit of that might work. But I'd also agree with Chris about inconsistencies we see in terms of involvement around health and elsewhere. There a number of examples where we know that housing associations are involved in reablement schemes. They're schemes where, if a person falls ill, or they have an operation in hospital, they're able to stay in a sheltered scheme or an extra-care scheme while adaptations are made to their home, so freeing the bed up much quicker, obviously, helping the person regain independence and avoiding bed blocking. We know that provides great value for money. Now, some of my members around the country have been able to do that successfully; Linc and Melin would be two examples of that. But others have tried and been less successful, and the blockage there appears to be the relationship between the housing association and other partners with the health board. Some health boards are very open to it, some less so. Again, it's another example, I think, where we need to learn the lessons of what works in one part of Wales and roll it out elsewhere. There is a huge appetite, we know, certainly from the housing sector, to work much closer with health on this stuff.
Is the number of different organisations involved in delivering adaptations in Wales an issue? There are 68, according to my reading. At first glance, that looks like it would be a barrier to success, or am I being too negative? Are there good things that can come out of that?
It's 68 individual organisations, but 14 of those are care and repair, 34 are housing associations, so you're talking, in this room, about a sector that agrees. So, I think there's the ability in terms of agreement about what's needed to take it forward—you don't need 68 separate organisations to agree on that.
I see. Right, thank you. I think you've alluded to this already, Chris, but, just to clarify, with integrated delivery teams, we've seen evidence, particularly in Cardiff and in Swansea, and I think you were alluding to this with regard to Bridgend as well, that that can help to improve performance in delivering adaptations. Do you think that that's the way forward? Is that what we should be looking to achieve in all areas?
I think if you're talking about the best use of scarce resources and a strategic overview about how resources can be used most effectively in terms of that prevention piece, then, yes, it's got to be the way forward. Particularly—you know, delayed transfers of care are a big issue, aren't they, in the NHS, and here we have something that could potentially reduce that burden significantly if we operated, in good practice terms, across the whole of Wales as we do in one or two areas, yes.
Thanks. One final question to you, Stuart, about housing registers. I'm sure in Rhondda Cynon Taf there is an integrated housing register—that's my local authority—but, from evidence that we have here, that's not replicated across Wales. Should social housing landlords have to integrate their housing registers so that empty homes that already have adaptations are there for let to the right people, rather than then money being spent and time being wasted for vulnerable people in actually adapting properties from scratch?
We have to make better use of our housing stock and let it appropriately wherever possible to the right person, and that includes adapted properties. We do need to ensure that information that is held by housing associations and elsewhere about adapted properties is correct and in the right place, because that is the first thing. And, of course, you need to make an effort to let it to someone who actually needs that adaptation. It's not always possible—some adaptations can be quite specific in lots of ways, especially some of the major works, but, absolutely, the first thing to do is hold the right information and then act on it as best we can. There are some good examples where that happens, but, again, it's not consistent enough.
Who does that come down to, then? Is it the local authority? We heard evidence this afternoon from Merthyr that they are doing exactly that. Is that where we need to be putting pressure now—on the local authorities to integrate their housing registers?
I think housing registers work in different ways across Wales in terms of common housing registers elsewhere, but, yes, one standard across the piece, including a register of adapted properties in each area, has to be a bare minimum and you have to make all efforts to let those appropriately. I also think there's a question here about the homes that we build in the future, though, as well. There's a real opportunity here, I think, if we look at off-site manufacture, more moving in the direction of technology, to be able to adapt homes much more quickly. We currently have a review of affordable housing policy, which is looking at modern methods of construction, off-site construction. One of the things that we will definitely be saying, when we give evidence to that review and put our views in, is that that gives a real opportunity to allow, again, adaptations to happen more quickly on occasion and then stock to be used more appropriately. Actually, you could probably reduce the cost, ultimately, of getting the appropriate property for the right person at the right time. So, I do think that's a real area of opportunity here.
I couldn't agree with you more, actually. I've done a lot of case work on this in my constituency and I recently met with a housing association that is creating a set of apartments from scratch that will be able to be adapted as and when necessary. And there's certainly a lot of need for that out there in the community.
Can I just come in on that? Again, with the minimum standards, I'm just surprised that there hasn't been this movement already. Because I asked the WLGA if they had any information about if they are adapting homes unnecessarily because they've put somebody in an adapted house who doesn't necessarily need to be there. They didn't seem to have a comprehensive view of what's happening and how they could save money better by having these shared registers. Why is that not being done? Because I think, yes, there are some good examples, but then there are some awful examples as well across Wales. So, what's been the barrier to this piece of work happening until now?
I think one of the barriers, probably, has been the huge need we've got to get people into social housing full stop. In an ideal world, obviously, if someone who's had an adapted property leaves that property, you want to let it to someone who has the needs that that adaptation reflects. But when you've got waiting lists as long as they are, and not always the person with the needs to move into that adapted property, I think the pressure comes on to get that property let to someone who's in significant housing need. Of course, once you're in a property, whether it's adapted or not, we have—and rightly so—tenancy for life in the social housing sector. It's an assured tenancy, and it does mean that that resource is then gone. Yes, better information could help on that, but it's not always the answer. I could come back and say, 'Well, probably part of the reason is we're not building enough homes full stop', which is part of the problem.