National Assembly for Wales

Thank you, Chair. Good morning, everyone. Can I just start by asking you, by your estimation, how many people have taken on new caring responsibilities during the pandemic, and what are the reasons behind them having to do that?

Well, through the research work that we've done, we think that the numbers have increased from around 400,000 up to 680,000, potentially taking the number of people caring in Wales to one in five. That's largely, I think, due to the fact that with regard to restrictions on movement and reductions in services, and in some cases, complete closure of services, unpaid carers have had to take on a lot more responsibility with regard to their loved ones, friends and family. So, through research that we've done at Carers Wales, we can see that the number of people taking on caring responsibilities has increased. There are about 80 per cent saying that they're providing more care now than they were before the start of the pandemic, about 76 per cent saying the person they care for needs more support, and that's as a result, obviously, of restrictions and reduced movement, and 76 per cent reporting that they feel absolutely exhausted and worn out from their caring role. More than half were saying they're more stressed than before the pandemic, and more than a quarter were really struggling to make ends meet financially due to the extra pressures of the pandemic. I think, really importantly, 60 per cent have said that they've had absolutely no break since the start of the pandemic, and when you think that, actually, for some carers, they started shielding in January and February, even before the lockdown started, that's a very long time, obviously, for people to have no break.

Thank you.

Simon. You're on—.

Okay, can you hear me now?

Yes, go for it.

I completely agree with Claire. The findings from Carers Wales tally completely with what Carers Trust are seeing. There was some important evidence that I think we provided to everyone via the Carers Week study that was collated back in the summer. Very much the same message since then. I also think it's really important to recognise that a lot of carers have recognised their caring role during this period and evidence around what they do and where they go for support has been very scant. The access to support during this period—it's really important to say that the situation for carers, as we all know, was difficult and complex before the pandemic. Carers were struggling very, very much prior to March. As with so many other elements in society, some of the other people across society, that has just been exacerbated hugely throughout the period of the pandemic. 

Thank you. You've touched on this a bit already, in terms of stress and the impact of not having sleep. Is there anything further you want to tell the committee about the impact the pandemic and managing through it has had on carers' health and well-being?

I think it's fair to say that most carers are reporting their health is much worse than before the pandemic, due to their caring responsibilities. So, from both a mental health and a physical health perspective. And I think that's as a result of the many challenges they've faced at this time. Initially, there was real concern about lack of access to PPE, for example—people looking after very vulnerable people and having paid carers come into the home, but having no PPE. As I've mentioned already, a lack of services to support the cared-for person. Initially, access to food and medication was extremely difficult for unpaid carers, and we worked with Carers Trust Wales and Community Pharmacy Wales to try to improve that, for example. 

Balancing employment: we think that about 50 per cent of the people who took on additional caring responsibilities through the pandemic were actually working carers, balancing paid work and unpaid caring responsibilities. And obviously, the stresses around balancing your work with needing to look after somebody, particularly as many people were having to work from home, where the cared-for person is. Obviously, in some cases, that was helpful and actually enabled people to look after their loved one more easily. But I think loneliness and isolation has been a huge thing through the pandemic, with many, many carers telling us they feel very isolated, not able to see friends and family, and really feeling like they've been set adrift, completely ignored and expected just to get on with it. That placed a huge amount of strain on carers.  

Simon, anything to add? Not everybody has to answer every question, but—.

Yes. You know, Chair, that we inevitably will want to answer every question. There's so much to say, but I'll be brief. I think there's a specific issue around the build-up of emotional and mental health consequences here. We know that's the case across society. It has been hugely seen amongst unpaid carers. It is being exacerbated in the way that Llinos and Claire have described. I'll just read you a quote from a carer who wrote to us earlier in the year as part of a survey. She said, 'I have no time to myself anymore at all. I'm not sleeping. I cry every day because I can't cope. I'm not able to look after myself or my own illnesses. I'm looking after three people now, instead of one.' That's absolutely typical of the situation that we're seeing. 

Thank you. Can I just ask, then, about disruption to care and support services during the pandemic? Now, Welsh Government has told the committee that no local authority in Wales exercised their right to modify their duty to provide care and support during the pandemic. Does your experience reflect that statement, and how much disruption have you actually seen?

Okay. Claire?

I think that's right. I think there's a difference between formal modifications and what's been happening on the ground. It's hard to collate any consistent evidence on this, to be honest, but what we're hearing would link very strongly to what Llinos has said.

Yes, and I think local authorities have said that they were still able to undertake carers' needs assessments, for example. But, actually, even before the pandemic, there were huge waiting lists for carers' needs assessments. Many of the assessments that were being offered were online or over the phone, which was not ideal, obviously, for people in very vulnerable situations. So, as Llinos and Simon have said, whilst they might not have instigated those, there's been absolutely an impact on carers.

Okay, thank you. Thank you, Chair.

Simon, Claire?

Absolutely agree. I think in the survey evidence that's come back across the sector, and specifically to Carers Trust, I know that this continues to be absolutely one of the key items. Along with financial support and support for the person you care for, it's always up there, it's always been up there. That has absolutely got worse throughout the pandemic. But what I would say is that the third sector in all of this has been incredible in reaching out and trying to provide a level of engagement and some level of support in our local and regional areas. Obviously, right across the sector, Carers Trust Wales' network partners specifically, like Llinos, I know have gone completely above and beyond in terms of working additional hours, supporting their volunteers and their staff to provide additional connectivity, because loneliness and isolation and digital poverty is a massive issue for carers. So, the response from the sector has been incredible, and has helped hugely, but in terms of the expected day-to-day response, it has only got worse than what was already a very bad situation.

I think I would just add that, for some carers, they didn't actually want their loved ones or their family or friends to go into respite, because they were concerned about supplies of PPE and what have you. For example, sitting services didn't want people coming into the home. But I think as the pandemic went on, they were desperate for a break and more willing to be flexible around that. Through our 'Track the Act' research work in June, we asked local authorities what they'd done around respite support, and some local authorities had been instigating more emergency respite provision. But obviously, that was not as widespread as we would have liked to have seen.

For our own part, we did receive some funding from Welsh Government in Carers Week in June to set up some 'Me Time' sessions: online sessions to bring carers together and offer them a break from their caring responsibility for just an hour or two to do something completely different, and we've run all sorts of things, from managing stress and anxiety through to sleep therapy, through to craft and bingo. We even did a virtual walk of Machu Picchu, and got a group of carers together. We did the walk and then, after, everybody had a chat, and the feedback that we've had from carers has been brilliant, saying, 'Oh, gosh, it's really given me a break. I was a bit sceptical, but actually it's been fantastic to be with like-minded people and be able to share how you're feeling at a time that's really desperate.'

And doing it virtually means no need for quarantining, either.

Absolutely, and no walking boots or anything.

We have received evidence from the Association of Directors of Social Services about the way that people have changed their usual patterns of accessing services. They say that people have found new ways of coping. How worried are you that that will be seen as somehow being the beginning of a new period of lower demand that will morph into an expectation that people will find ways of helping themselves rather than wanting to access formal services themselves?

Very worried. I think that a lot of carers are nervous about reinstatement of care packages and the perception that they've been able to 'cope' throughout this period, and that that will be built into services in future and the support that they receive, or the fact that they may have received some emergency or additional support from a local third sector group, or what have you, and that then becomes the de facto position. I think that I certainly have serious concerns about the sustainability of carers at all to be able to continue caring as we come, hopefully, through the pandemic, and it's really essential that we work openly and honestly with our colleagues in local government and across statutory sectors to recognise what's realistic and the gaps in terms of duties under the Act, and that we move back to a position that at least is trying to reach in terms of needs assessments, care support plans and all the legal provisions that should be there for carers absolutely as soon as possible. So, I am very concerned about that situation.

I think it's a bit of a red herring, in a way, because our Track the Act research showed, even before the pandemic, that only a few thousand carers in Wales were benefiting from a support package via a local authority, and, as I said, the number of carers went up to around 680,000. So, we knew that even before the pandemic only a very, very small percentage of people were receiving support via a local authority package. I think one of the cruxes of the problem is that there's not been enough recognition of unpaid carers as the vital third area of the health and social care system in Wales. And, actually, what we need is better planning and resourcing of unpaid carer support, alongside health and social care provision. Moving forward, unpaid carers will become even more vital in supporting health and social care to function, and what we need is better long-term planning around how carers will be part of that package.

In terms of research that we've done, we've seen that the value of unpaid care since the start of the pandemic has been £33 million a day. If that care had to be replaced, that is the cost to the Welsh Government, and I think many unpaid carers are feeling that if that is the contribution that they're making, they should be better supported in their roles through services.

I think the other thing I would just say is it's not just a return to services that were there before. I think the pandemic has thrown up new needs for services and, as we've already talked about, particularly around emotional health and, obviously, bereavement support services, and what have you, as well. 

We should move towards that, and we'd acknowledge absolutely what Claire is saying. The gap in terms of what's actually delivered is not that huge. What's important is the way that duties are interpreted, and the way that Welsh Government works with local government to interpret those, to monitor and require the sort of partnership that Claire was talking about between local carers services, between the third sector, between carers themselves to actually evolve a better solution out of this. But in terms of the modifications, yes, we should move away from those as soon as possible. 

Thank you, Chair. Good morning. You mentioned at the start of your contributions that more than a quarter of carers are struggling to make ends meet. Can you tell us more about the extent of the financial difficulties that carers are currently facing, and what do you see the solutions are to ensure that carers are not facing this type of financial hardship? 

Simon.

Yes, absolutely. We've seen a number—as in, hundreds of thousands—of those heartbreaking scenarios. And while it's really welcome, as you will know, that Welsh Government have supported Carers Trust Wales with an emergency package of funding through the winter, which is really, really important in terms of supporting the most vulnerable carers financially, the evidence is absolutely there that this was there before the pandemic and it's got worse, and it's going to continue unless we address it. Particularly at the beginning of the pandemic, but also going through it, carers were at home, many were having to shop very locally and were nervous about even going out and couldn't get slots for online shopping. Because they were shopping at very local stores, that was often more expensive. They were providing more care, obviously, at home, having more people to feed, often without connection to the internet. And we in the Carers Trust saw that very, very quickly—there were immediate concerns about that—and responded with a UK-wide emergency fund, which was really desperately needed.

I can list a series of examples. Somebody wrote to us to say, 'This is incredibly important, the funding that you provided, because the pandemic has restricted me from going out and I can now only work part time. It's restricted me from using public transport. I've got more mouths to feed at home. I've started to rely on supplies from the local charity'—meaning the Carers Trust service—'such as tins, jars and dried food, and just helping with our food needs is now imperative.' That, again, is a typical situation. I really worry, because of the correlation that we already know about between carers and lower income families across Wales, that we are in a situation, as we hopefully move out of the pandemic, where that is increasing and we're not able to quantify that. With a scandalously low level of carers allowance, there is a real challenge that carers are going to be pushed to the edge, not just emotionally, but practically as well.

Okay. Claire.

I think I would just add that we did some research in the summer that showed the increasing use by carers of food banks, because of the struggling financial nature that they were in. The other thing that we've noticed is a lot more women approaching us saying that they're feeling like their independence is being reduced because they're having to rely on their spouse's income. There continues to be an assumption that women will take on the additional caring responsibility, and a lot of women carers are saying that their confidence is being undermined because they're lacking the independence to do their own work, because they've had to reduce hours or give up work altogether. The thing that's the issue around that is that where carers do give up work or reduce hours, it affects their long-term pension as well. So, we're not only creating an issue in the short term but also in the long term as well. The other issue around this is that not enough people identify themselves as a carer, and because they don't identify as a carer, they don't access the benefits they're entitled to, and so we're really pushing Welsh Government to do an awareness-raising campaign to improve knowledge about what support is available to carers, including the financial support.

Jayne.

Thank you. In terms of young carers, we know that the pandemic has had a huge impact on young people, but young carers in particular. What specific actions do you think are required to better support young and young adult carers in Wales?

Who wants to kick off? Simon.

Sure. We produced a report called 'Support not Sympathy', named by the young carers we work with in the Carers Trust Wales youth council earlier this year, and that found alarmingly high levels of deterioration of mental and emotional health. Thirty-five per cent of young and young adult carers were caring for more people than they were before the pandemic, and that was in June. We know that figure has gone up. Very little counselling or therapeutic support before the pandemic—that's got worse, particularly digitally. So, thinking about that area particularly, I know that you and other committees have looked seriously at the massive challenges in providing emotional support, and I think that is absolutely critical. Also, providing the requirements for young and young adult carers to be supported at a local and regional level and really being able to monitor how that's happening, it's still too much of a patchwork. Again, there is an assumption now that the third sector—. It's not just that there's a positive relationship that can be provided with the third sector, which there is across much of Wales, but it's how much that is actually delivering. Just because there's a relationship or a commissioning framework that supports the third sector to support young and young adult carers, for example, in one part of Wales, what is that actually delivering? Too much of that can be presented in a way, I feel, that is tick-box. Actually, what we have shown throughout the pandemic is how much worse the situation is, even than the committee, yourselves, discovered when looking at this last year and prior to the 'Caring for our future' report.

Llinos.

That's a really interesting point. Just moving on, finally from me anyway, can you give us an update on what's happened in terms of progress since this committee's inquiry report focused on carers and the impact of social services legislation? You've touched on it a little bit already. 

Simon.

Sure. So, the committee report was published, I think, just before Christmas last year, and there have been some small elements of progress in terms of the commitment, the development of the ministerial advisory group, and very welcome funding for Carers Trust Wales and Carers Wales, and others in terms of sustainable social services, our ability to work together in partnership to deliver some of the important changes in understanding that the committee called for. And, of course, now the publication of a draft national action plan.

But there needs to be a huge amount more done on—. If you go through those recommendations, which we have no time for, I could give you very many examples of where they really need to be monitored and delivered, and, obviously, we hope that the national action plan will be able to make a contribution to that, but it won't be able to do that without resources and without a really strong plan. And, of course, we will all be contributing in response to that consultation to say so. So, there is a massive amount more that needs to be done.

Okay. Claire.

You will have seen from our 'Track the Act' report that we said that we felt the response to your committee inquiry was bland and lacking commitment, and that we were very disappointed after such a thorough inquiry and what we felt were very sensible and important recommendations. So, there is a level of frustration, I think. Despite the work that Simon has given an overview on, I think there's a lot more to do. We would like to see the ministerial advisory group taking a much more strategic and forward-looking approach to the work that's needed to be done to support carers in the way I mentioned earlier around long-term planning of resource in particular. 

Llinos.

Great. Jayne, are you done?

Thank you. 

Thank you for your evidence so far, witnesses. Just a couple of questions from me in relation to the testing and the asymptomatic testing that the Government has announced the extension of to social workers and other key workers within the care settings. What is your view about extending such asymptomatic testing to unpaid carers?

Who wants to go on that? Claire.

Claire, do you want to kick off on that?

Yes. We would endorse wider testing. I think that it's an area of huge anxiety for unpaid carers when they're around such vulnerable people, and particularly when many unpaid carers are still having to go out of the house to get food or medication or what have you, to give them that reassurance that they aren't going to pass on the virus to their loved ones. And I would just add, alongside that, you may have seen that we've been very vocal in supporting unpaid carers to also receive the vaccine in the first wave of people receiving the vaccine, for the same reason. Unpaid carers currently receive the flu vaccine, and we can't understand the logic in unpaid carers not receiving the COVID vaccine for the same reason.

I was going to ask about vaccines just after this question. But I'm quite keen to hear: are there any practical difficulties in offering the asymptomatic testing to unpaid carers? Because I can understand in maybe the remunerated sector, shall we call it, where there's the discipline of employment, et cetera, and you can maybe distribute the tests that much easier. Is there an issue, do you think, that would prevent an extension of testing to unpaid carers in a realistic way, or not?

Llinos.

I was speaking to a carer yesterday who expressed frustration that the person they looked after was receiving a flu jab in the home, and they asked for their flu jab to be given at the same time and they were refused, and told that they would need to go to the GP surgery. And she was saying, 'I can't go to the GP surgery, because of the person I look after, and I've got nobody to provide replacement care, so that will mean that I will not be able to get my flu vaccine this year.' She was very frustrated.

That's a very relevant point as we're unfolding the vaccination programme now, of a quirk in the system, shall we say. Why can't that second vaccine be given in the home for the carer, because it makes life easier for all concerned, it does, surely? So, have you any views on the vaccination programme, and any evidence you'd like to give to the committee? That's a very telling piece of evidence, Claire, that you highlighted there with the flu vaccine, which could be read across for the COVID vaccine. But are there any other points that any of the witnesses would like to make around the vaccine programme when it comes to carers?

Just to endorse the point that Claire's made, that carers are asking specifically about those flaws in the system, and about why they consider that they haven't been thought of. And the priority of being able to keep themselves and the person they're looking after safe, it's certainly something that carers are speaking to us at a local and national level about, and which we've raised with Welsh Government and would seek to continue to raise and for a solution to be found.

Do you feel as a sector that you've had sufficient engagement with Government, and with the operators on the ground who are going to be responsible for rolling out the vaccine when it comes to carers, and the needs of carers?

I think it's fair to say that Welsh Government have met with us on a frequent basis. So, they've met with Carers Wales and Carers Trust Wales frequently. And we did raise the point about the vaccine a few months ago, in preparation for it becoming available. As I said, we continue to be frustrated, and we obviously spoke to media outlets last week to express the frustration that carers aren't included in the first wave. I understand some of the issues around the current vaccine, needing the two jabs, the temperature, and what have you. And we've been told that, potentially, unpaid carers will get a vaccine as part of the second wave, with the new vaccine, which is easier to transport, et cetera, et cetera, but, again, we've been given no assurances that they definitely will be included.

Just to link this with the involvement of carers and how we are able to do that at a local and regional level. And I think one of the challenges throughout this period, and I've talked about how the third sector, locally and nationally, has really stepped up, is how—. For example, regional partnership boards and other local and regional decision-making bodies, where carers, and sometimes other citizens, sit as equal members, but perhaps haven't been listened to, or if they have been listened to, they maybe haven't been heard, throughout this process. I think there's a wider set of issues there that could really inform this. Understandably, there have been practical challenges, right from the beginning; there's a kind of command and control situation, which some of the services have to go to—completely understand that. But that can't and shouldn't have been done by dismissing or ignoring the voices of carers throughout this process, and similarly now they should be—. I suppose my point is that there are local and regional bodies that are supposed to contribute to this, and really bring the voices of unpaid carers into these decisions, and for that to feed through. So, I know that's been happening at a local and regional level, and we've also been making the point at a national level, but we continue to make those points. 

So, just for clarity, it is fair to say that as a sector you have been having meetings, as Claire highlighted, with Government, but when you come out of those meetings you feel as if your voice has not been listened to and the points that you are making are being ignored. I think that's the point you made, Simon, or have I misinterpreted your words? 

I wouldn't say that in those national meetings. I think they're recognising the points we make and they're taking them off into the many, many other sets of meetings that need to be had across Welsh Government, and how they're then able to influence is a matter for those officials. What I'm concerned about specifically is, yes, that obviously we want to carry more weight in those meetings, but also at a local and regional level. There is a system that was set up to listen to and to hear unpaid carers, as partners in the decision-making process, and it appears to me that it hasn't worked as it should have done, either before, but particularly during the pandemic, and it informs the way that now we should be thinking about delivery of the vaccine, for example.

Just for clarity, if I can be clear then, it's not necessarily at the national level—the Welsh Government level—you feel that some of the points you're making aren't being listened to, it's about regional and local level, which is critical, because from my understanding of the way the vaccine is going to be rolled out, it's at that local level that priorities are determined of who gets it first and how it's distributed, if the briefings that I've been involved in are anything to go by. 

Yes, yes. 

Thank you. That's very helpful, thank you. Could I just move on to PPE, before I close my section of this questioning, and try and get an understanding from any one of you of your views on PPE and the continuing roll-out of the availability in the care sector of PPE, because obviously, at the start of the pandemic, it was a massive issue? I appreciate that lots of work went in to addressing the shortfall. Fingers crossed, we seem to have got over many of the blips in the road, but can you give us a taste of how the situation is now, and how you see it evolving in the future?

Yes, I think I'd just endorse what Llinos has said that it was very problematic, then supplies became available for carers through local authorities. The key issue for us, at that point, was that carers didn't know that these were available through the local authority. But wherever possible, when people have contacted us, we have explained where they can get supplies. 

Yes, I completely agree with that. Nothing further to add there. 

So, the supply is good at the moment. We all recognise the problems, and it will be reviewed in due course obviously, about the early part of the pandemic, but, going forward, when it comes to PPE there are no issues that you'd like to put before the committee, other than there is good supply at the moment and there is no other further comment you'd like to make.

I think the point Claire made around communications is always a point that I would like to make about communications with carers, communications with the third sector. Locally, regionally and nationally, it's always something that I think can be improved. So, I absolutely agree with what Claire and Llinos have said. I think that there isn't a practical situation now, but in terms of communicating what's available and when, that's something that can always be improved. 

Thank you. Thank you, Chair. 

Well, actually, Andrew, hang on a minute, because I think David Rees has left the screen. David, are you there? No, so I wonder if you could just carry on and finish the last couple of questions that were originally allocated to David Rees. Andrew, is that a possibility?

Yes, no trouble. About winter planning, I wouldn't mind trying to get a sense of the confidence you have around winter planning. You touched on vaccination; that's going to be a huge programme as we progress further into the winter, but are there any observations that you would like to make? I take on board the point that Simon was making about that regional and local engagement when it came to the vaccine programme, but what about other engagements that you might be having around other winter provisions that need to be put in place?

I think one of our concerns is that there are a number of medical treatments that have been postponed as a result of the pandemic. And so, many carers have contacted us, either about their cared-for person receiving medical treatment or they themselves receiving medical treatment, and there's still some anxiety about when they will be able to access operations around hip replacements and all sorts of different things. And obviously, while the pandemic continues and while there's the pressure on the system over the winter, that's an ongoing concern.

Simon.

Yes, I totally agree with Llinos and with Claire there. I would say that—again, I want to make the point without wanting to repeat it too much—the essential role of the third sector at a local and regional level is critical here. The additional Welsh Government fund to support carers during this period is going to be crucial. I think things are desperate for many, and it's not going to reach everyone, it's really highlighting the level of demand, particularly around financial support and the damage that's been done during the pandemic. And I think that co-ordinating that communication, as we're referring back to, from statutory services across the third sector at a local and regional level, which is often very good, certainly needs to continue to improve throughout the winter and as we move into recovery phase, hopefully. 

The other thing that I would add, actually, is around hospital discharge. So, winter is often a difficult time for unpaid carers because there's a pressure on family and friends to receive people back from hospital. And particularly through the pandemic, people have said that they've felt that hospital discharge has been rushed and that, as a carer, they haven't been properly consulted and there's not been a full assessment of whether that carer is willing and able to do the caring responsibility that is required. And so, that is something that we are concerned about through this winter period as well.

Respite—

It really—

Sorry, Simon. You go on.

I just think it really reinforces the level to which thousands of carers in Wales have reached, just going back to the beginning of our conversation. I think those different elements, not going out—[Inaudible.]—for months, missing routine appointments, hospital discharge, being nervous about whether to go to the supermarket or the pharmacy, financial challenges, not knowing where your local service might be that could support you, all of those things are still absolutely real and are damaging carers today, and I think it's something that really needs to be built, as the hopeful recovery through vaccination moves into the spring.

The point I was just going to ask, and you touched on a bit there ever so slightly, Simon, is about respite. And because of the restrictions, which we understand are put in place, obviously, because of the wider COVID issues—. But respite can take many forms and it can be just a quick visit out to go and visit a hospitality venue or something like that, but because you can get cover for half an hour or an hour period in the day, it just gives you that vital moment of respite, if you're an unpaid carer. Are there any particular issues that you'd like to flag with the committee around the unique situation we find ourselves in this winter around those short, brief interludes of respite that carers could have been able to get and alleviate some of the pressures that are on a lot of unpaid carers?

Llinos.

Yes, I very much agree with that. Carers Trust have called for a long time for a short breaks fund that looks specifically to support more creative ways of delivering respite and defining it. Without wishing to be seen to be copying Scotland, Scotland have an incredibly positive track record. It's not perfect, but that type of short breaks fund, while it would certainly be challenged, and it is being under the pandemic—.

I would say that throughout the pandemic, the way that we've been able to work with Welsh Government in those meetings that we've discussed has seen the guidance change and evolve and improve in many cases to recognise, as a result of what we've said, the specific focus of carers, and we've seen that, and we very much welcome that. I think it's something that needs to continue so that we stay in close contact throughout this particularly sensitive period over the next couple of months.

As we've focused very much on looking back at some of the events that have happened and maybe in the here and now, hopefully we will get to a stage of recovery and either the new normal or normality, depending on what you want to define as that as we go forward. Have you any thoughts that any of you would like to leave with the committee about the recovery model we should be entering into at the other side of this COVID outbreak?

Yes, just briefly. I think that the point that I've made about the incredible value of the third sector throughout the pandemic is an important takeaway for the committee, in terms of the agility, in terms of the commitment, but also in terms of the struggle, sometimes, around sustainability. Sustainability of funding is needed—it's just not there. The quality and the difference that has been able to be made by services like Llinos's is quite frankly life saving on many, many occasions. That's not hyperbole at all—it's absolutely essential. And I think, as we move out of this and there are conversations, for example, at a higher level, perhaps, around the foundational economy and these sorts of things, we need to be thinking about the role of the third sector as a central part of that, not just the statutory sector or colleagues in the private sector.

And then, I suppose, the other point that I would make is the national action plan that Welsh Government are delivering—and it will, hopefully, respond to many of the committee's recommendations going forward—absolutely needs to be ambitious on behalf of carers. It needs to be robust and it needs to be resourced.

I would just reiterate what I said earlier about the vital importance of unpaid carers. Thirty-three million pounds per day is a huge contribution that unpaid carers are making, and as a result, I think that unpaid carers should be better recognised and better supported as a critical element of future health and social care planning, as I said, both in terms of planning and resourcing. One thing about the pandemic is it's raised awareness about the huge contribution of health and social care workers, and alongside that, we should make sure that more unpaid carers are also better recognised. We would like to see better systematic identification of carers through the NHS; we'd like to see more responsibility on the NHS to identify carers. And also within local authorities, when carers make contact, that they are identified as a carer and there's clarity about what that carer can access. We would like to see minimum service expectations for carers across the whole of Wales, and carers being viewed as key workers—they've been absolutely essential through this pandemic. As such, I don't think we know the state—how much support, the contribution they've made, and how much we should be supporting them moving into the future.

I'm conscious time is nearly beating us, Chair, but if I could just come back to you on that, Claire. I don't know of a single politician, in 13 years as an Assembly Member, who doesn't praise the role of carers, and right the way through the pandemic, politicians of all colours have stood on their feet and said, 'Why aren't carers getting better recognition, then, for the role—the pivotal role—that they play, unpaid carers as well as well paid carers?' Because it seems that we all agree, we all laud the role that carers have in our society—in fact, society wouldn't be able to function without carers—but there does seem to be this block on doing the very things that you just put on the table, which, if I shut my eyes and went back 10 years ago, were most probably still being asked of Government or politicians or policy makers then as they are today. So, is it—?

I think it's just still that there's a presumption that family members and friends will do unpaid care. But, I think, as social care and health services struggle, the amount of responsibility on unpaid carers is increasing, and the complexity of the unpaid care that people are providing is increasing. Through the pandemic, that's really been highlighted with regard to palliative and end-of-life care, for example. More carers are administering medication and feeling very uncomfortable about doing that, and have a huge sense of guilt about whether they are managing that as best as they can. And I think, as I said, that will increase into the future, and we need to make sure that carers feel confident to care, not just in terms of nutrition and manual handling, but also some of the very sophisticated elements that they will be required to do in the future. It's only right that we support people to do that, and to look after their loved ones in the best possible way.

Thank you. Thank you, Chair.

Thank you, Chair. Good morning. Can I ask you first of all, please, about the financial pressures faced by local authorities and social care providers? You've said that there are care homes that are still at risk of closure as a result of the pandemic. Is enough being done to support social care financially, and what more could Government do to support the sector?

Who wants to kick off? Alwyn.

I'll come in, if that's okay. In terms of the vulnerability in terms of care homes that you referred to, clearly, the hardship fund has been of significant value to those providers and that was very welcome in terms of Welsh Government. This was already a sector that was under pressure prior to the start of the pandemic, so it would be wrong to consider this solely in isolation of the pandemic. So, there were challenges within the sector previously in terms of that care home sector being able to balance the cost, the pressures, the workforce costs in terms of that. Clearly, what the pandemic did was give a very quick shock to the system, and during that period local authorities, for a period of time, prior to the hardship fund coming in place, did go at risk to support some of the care homes, providing additional payments. The hardship fund has been of great value. It's really, really helped in terms of maintaining the viability of some of those care homes. It's obviously not possible for the hardship fund to cover everything, because the care homes, obviously, balance the income that they receive from local authorities with income they get from other sources as well, be it other services, be they the independent sector clients that they have coming in. So, in terms of does that mean that they are financially viable now, I suspect we know that they continue to be in a challenging position.

In terms of the message around what Welsh Government can continue to do, clearly, that hardship fund continues to be required moving forward. We are still in a very, very challenging position in terms of the pandemic. So, very specifically, one call would be that those pressures continue to be recognised and, clearly, assisting care homes to remain viable during this. But obviously, there's a longer term ask in terms of supporting us to meet the real increases in costs across the care sector over a period of time. That's very, very important. So, that's very specifically the care home sector; I don't know if that covers your question, Mrs Neagle.

Thank you. Yes, that's helpful. And is there anything you want to add in terms of the general pressures, then?

Yes. I think, in terms of general pressures—. We've covered there the actual sector. In terms of general pressures, social care is significantly under pressure from a financial perspective, and the pandemic has certainly added to that. Across all the 22 local authorities in Wales, what you will find is that the majority of us had plans and schemes in place in terms of trying to address some of the areas of high pressure. So, for example, for children's services, many of us were focusing our work in terms of prevention, early intervention with families to support and avoid children going into care. Clearly the pandemic made that more challenging and meant that actually some of the schemes that we had in place are now probably nine, 12 months further on, and the longer the pandemic's effects continue, the less we will realise some of the savings associated with that. 

We obviously have the pressure in terms of demography. That's both across children's services in terms of the nature of the population coming through, the children and families in challenging positions, and also an ageing population. And in the same way, some of the services we would have been putting in place around prevention, continuing to support people within communities, working closely with our local partners in general practice, have been delayed as a result of the pandemic.

Clearly, in terms of what we would want as local authorities, and social care specifically, clearly we would want workforce inflation recognised. So, any increase in cost as a result of rises in salary, clearly that would be of value to us. Obviously, in the short term, as we manage that demand, also some recognition of an increase in funding to support the demand increases, both in terms of older people's services and the challenge that we are going to face in terms of families coming out of this COVID pandemic.

I think there are a lot of unknowns that we are going to be facing when we come out of the pandemic in terms of the impact on families of the pandemic, the mental health pressures that this will have placed on the general population, and that actually goes across the board. So, actually, there will be a period when we and our partners in health are going to be—certainly in the period of recovery, it won't be just about recovering services in place, it will also be about robustly dealing with the impacts of that. So, clearly, any opportunity to fund and support us in managing the after-effects of the pandemic, which will be numerous, will also be greatly valued. 

One of the concerns you've raised is people being discharged from hospital with long COVID. Can you tell us a bit about how that's adding to the pressures?

I think the pressure of long COVID will be that there will be a further group of individuals who potentially, prior to COVID, wouldn't have been people we had to care for. Clearly, with long COVID, we will be part of any rehabilitation package for those individuals, both in terms of care, therapy and any healthcare they will require in the longer term. And it will be a new service offer that we will need to develop to make sure that, actually, what we do is develop a level of independence, because clearly this is a new area for us and our health partners. So, reablement or rehabilitation of an individual with long COVID will probably not be a six-week period. We're probably talking six, nine months, and I'm sure science and medicine will tell us how long that will actually be. So, yes, there will be the additional pressures of individuals with long COVID, some who we will already be dealing with, and others who will come through in the next month or two. So, yes, there will be those individuals who will effectively be a new service that we will need to be providing too.

You mentioned the pressures on children's services. Can you give the committee assurance that all safeguarding work is continuing as normal? And can I ask about—? You mentioned the drive to reduce the numbers of looked-after children, which is of course linked to the fact that the First Minister has asked for there to be a target, hasn't he, for each local authority in that area, which I've personally got a lot of concerns about. But, how is that work going to be impacted then by the pandemic?

Do you want to come in, Nicola?

Yes. Diolch. Thank you. In terms of safeguarding, obviously, for social services, that is our core business. So, from the very beginning of the pandemic, the safeguarding of children and of adults at risk has been and continues to be our priority. It's been a challenge; it has been difficult, and we have had to use different ways of working. So, where it has been possible, we have done face-to-face visits and assessments, and certainly with all child protection assessments we have done face-to-face visits, and that has been supported through the use of PPE and COVID-safe practices, and the same for adult-at-risk safeguarding assessments as well, including mental health assessments. So, that has absolutely been our focus and our priority.

It has been a challenge, certainly with some families who have not necessarily wanted to engage with us through safeguarding concerns. COVID has been an excuse that some might have tried to use, but obviously, we've worked with partners, including health and the police, where we've had to gain access where that's been absolutely necessary to ensure the welfare of the children and any adults at risk.

In terms of looked-after children numbers, it certainly has been a challenge. It's been a challenge for Wales and across the UK now for some considerable time, and all directors of social services have been working with Welsh Government to try and address and try and reduce the increasing numbers of children who are coming into the looked-after children system, and we recognise the difficulties of that on the whole system, and it's not just social care within that multifaceted issue.

Numbers of looked-after children have unfortunately increased during the pandemic, despite the plans that many local authorities had in place to try and reduce those numbers. I think it's remarkable that the numbers have only increased as they have done, because we have been in such a difficult situation, and there have been placement breakdowns due to COVID as well as other situations. So, if we consider that schools were closed for a number of months, we've had increases in the prevalence of domestic abuse, and the financial hardship of many families and children, it's quite understandable that the pressures on children's services, and child protection in particular, have been significant during the last 10 to 11 months and will continue to be so. The difficulties and challenges of finding provision that is COVID safe and secure as well has also been further exacerbated by the pandemic. So, it absolutely will continue to be our focus moving forward, and safeguarding and reducing looked-after numbers will continue to be a priority for all directors of social services.

Can I just ask one final question? Do you think there's a recognition in Government that the pandemic is going to make that numerical reduction a much bigger challenge?

I think there is an acknowledgement from all partners that there is no simple answer, or simple solution, to reducing the numbers of children coming into the care system. It is a multifaceted issue affected by so many factors: housing, employment, crime, poverty. So, there are so many factors that affect those numbers of children, and it is a multi-agency response; it's not something that social services can do on its own. So, I think Welsh Government recognises the commitment of all partners to deliver on the best possible outcomes for all of our children, and that is something that we continue to strive for.

I think it's right that we should be ambitious and that Welsh Government should challenge us all to continue to look at practice, and to ensure that we are continuing to try and meet the best outcomes for the children and their families, and make the best options for their care, but it is a very complicated matter, and as I say, no easy solutions, and something we have been trying to address for a number of years, but we will continue to try and work with Welsh Government and other partners to reduce those numbers.

Thank you. Thank you, Chair.

Bore da, diolch. Yes, there's been considerable work done between directors of social services and Welsh Government, and also with the NHS shared services partnership, around the chain of supply of PPE. I have to say that my own equipment stores, where we stock our PPE supplies, has had to move location three times now to accommodate the volume that we have had through our own procurement routes, but also, obviously, through Welsh Government supply chains. So, it's always a concern because we don't know what the future holds. Obviously, we're all very, very hopeful, and there's some positivity around vaccines, but I think we're still planning for a very challenging winter and ensuring that the supply can meet the demand. I think also we've had to adjust the supply based on the guidance. As we've started to learn more about the virus and understand the impact of the virus, we have had to adjust the guidance as to what PPE is required by which members of the social care workforce. So, we've had to adjust and learn as we've gone on, and as such our supplies have adjusted in response to that.

At the very beginning it was really difficult. I certainly know some colleagues on a Friday afternoon literally had no supply of PPE products, and there was a kind of desperation of phone calls around colleagues within Welsh Government and within NHS Wales. I have to say that the response, though, was tremendous, and stocks were provided to hold things in place until larger provisions could be available. So it was very, very difficult, very scary, and at times we did think we weren't going to have enough to actually allow staff onto the work floor, as it were. I don't think that was any different in social care to what it was within NHS services. However, obviously, our focus was on our own social care practitioners and those within the independent sector as well. So, that supply was precarious at the beginning, obviously it's improved significantly, hugely, with support from the military as well to understand the logistics of the supply chain and the provision of equipment, but at the beginning of the pandemic—and again, I think it was because we didn't quite understand, and the guidance came almost after the practice was required to have the guidance, so it was a very difficult time.

I think at the beginning, there wasn't a clear testing process or policy at all, and that was difficult. I think then when testing was developed, it was very much focused around acute hospitals, around acute hospital staff and also patients entering acute hospitals. So, it did feel, I think, early on that social care was an afterthought around testing. However, when testing did start to become available to social care, it was very much focused just on care home staff. And I think that really did highlight for me the lack of understanding of the depth and breadth of roles within the social care workforce. 

So, yes, obviously, care homes have been a priority, not just for directors of social services, but obviously for Welsh Government as well, but there has been some real concern around lack of access to testing for domiciliary care workers, for workers in supported living environments, for social workers who are going out to do face-to-face safeguarding assessments. So, a whole range of the social care workforce and difficulties in having access to testing. So, whilst we welcomed the introduction of testing for care home staff, obviously there have been issues and concerns around other members of the social care workforce who have not had that accessibility to testing that we would have wanted, and that we were asking for.

I think all of those factors were affected, certainly in terms of care home testing. And where there was weekly testing, there was a real issue in terms of the capacity of the management to continue to book the tests, to undertake the tests, to then wait for the test results to come back. So, capacity issues in addition to managing the virus and managing the day job. So, certainly issues within care homes. And we've also seen, sadly, some COVID fatigue, where some care homes have now said they don't want to continue the weekly testing of staff because of those issues, but also because of a lack of confidence in the testing system. So, certainly early on, there were some real issues around the testing system, from the delivery of results, the whole booking system, and then the return of samples or even the loss of samples. So, that has led to some real concern within the system. It has markedly improved, I have to say, but there are still examples, and when they happen, they do have a negative impact.

In terms of—. Sorry.

I don't think it's that widespread, but obviously, where there are cases of that, it is a cause for concern. Local authorities who work with those providers, colleagues within Care Inspectorate Wales, and also health board colleagues, will obviously try and work with those homes to try and promote the weekly testing regime of staff, but it's very difficult—they're not mandatory. We will try and influence as much as possible, outline all of the risks and issues related to not having testing, but ultimately it is for the individual home and their management and ownership to make those decisions, but it's been few and far between.

Should they be mandatory? If you have issues of decisions being taken not to do those weekly tests, is that referred up to Ministers, so they're aware and can try to put measures in place?

Where we've been aware of cases where homes have refused for whatever reason, those have been referred up to Welsh Government colleagues, so that they have been aware, and as I say, we've worked with partners to try and do everything we can to influence that.

Alwyn.

Sorry, my light's just gone off—apologies. Eco friendly. [Laughter.]

Yes, I think the position we're in now is better than it was at the beginning of the pandemic in terms of relationships with hospital discharges. However, there does still remain some variable interpretation of the discharge guidance. So, we have heard examples from colleagues across Wales—albeit low numbers, but when they do happen, they are of particular concern—where hospital discharges have been made, and made where an elderly person has been sent in an ambulance from a hospital to a care home, in the middle of the night, without a test result. The pressure placed on the care home to admit that resident, who is cold, upset, frightened, in the middle of the night, has been tremendous. So, it's been a very, very difficult situation, and when it happens—. It doesn't happen that frequently, but when it does it's considerable.

How could it happen at all, still?

It shouldn't happen at all. It absolutely shouldn't. I think there are pressures on the system. I don't believe that people intentionally try to cause harm, but I think the pressures sometimes lead to people making decisions that are not necessarily fully informed decisions.

Is the flagging system robust enough to draw attention to these breaches where they do happen? Are they logged? Again, are they referred up? What action is taken when this is found to have happened?

They are referred up. I think, sometimes, they get lost in the mix of the pressures of just what's happening within some of the acute hospitals. I've heard, myself, from senior clinicians that they are just too busy to keep on top of some of the policies and practices, and you know, 'Why don't you help us?' So, it has been difficult. It has, at times, caused a gap between the system that should work together between health and social care to ensure that the best outcome for our residents is achieved. But where the pressures are so great, sometimes people take actions that are not necessarily the right actions.

And the results can be catastrophic.

They can be, yes, and we've seen that, haven't we, in terms of, unfortunately, when the virus has got into a care home, it has been absolutely catastrophic.

And when did you last become aware of somebody being discharged without having been tested before? Was there something this week, last week, last month?

I certainly haven't heard anything within the last month within my own region. However, colleagues across Wales are in very different circumstances. At the moment, certainly in some parts of Wales, so many care homes are actually in a red category, so they cannot take any admissions. So, whether a hospital would want to discharge to that home or not is—[Inaudible.]

Okay. We've lost you there for a second. Chair, I'm done with my questions. I don't know if Alwyn wanted to come in. 

Thank you, Chair. And I can see that we've still lost Nicola at the moment. But you mentioned about the workforce being under extreme pressure. And, in written evidence, it has been highlighted as a positive that the demand for certain care and support services has been reduced, as many people have found other ways of coping. And it's been said that it's not clear what the reasons or longer term implications of this are. This morning, we've heard from representatives of unpaid carers and the carers trust, and that's incredibly worrying for many of us to hear that. Can you clarify the comments and views on that matter?

I'll come in in the first place. Jayne, am I right in assuming that what you're saying is that carers have reflected they're under a significant degree of pressure at this moment in time, yes?

Yes, and I think the written evidence that was sent in was saying that it was in a positive way that the demand has been reduced for the social care workforce, but, obviously, that puts a huge pressure on those unpaid carers. 

Absolutely. I think, in the short term, what you've actually described is absolutely correct. And what we've noted is, during the course of the initial period of the pandemic, and ongoing now, some individuals and their carers have made the very conscious decision to withdraw from care. They've made that in relation to, (a), wanting to safeguard themselves, their family, their other members of family, and we're aware that that has happened. What you'll find has happened in many local authorities, and what we have tried to do is, we've tried to keep in touch with individuals, we've tried to provide support digitally where that has been of any practical nature. Clearly, where we can't go in and provide physical care because the family don't wish to do that, it's a poor substitute would be the answer in terms of that.

Clearly, at the end of this pandemic, there will be some people who—I think Nicola's referred to—have got COVID fatigue, there will be carers who need some time, who will need some support. I think, in terms of our recovery planning, we will need to think very carefully around how we do support carers, how we transition back to receiving care and the trust in that care. And also, we also need to learn from the experience of the pandemic. Our partners in the third sector have played a very, very big role in terms of supporting the pandemic. They've provided a lot of role, in terms of keeping in touch with people, food parcels.

And so, we need to take the best out of the pandemic, in terms of how we're supporting people, but also then gradually get services back in place in terms of supporting people—the right service offer. I think being a carer is a challenging role; I think that's well recognised within social care. And actually, when this is completed, we will need to think around what else can we do in terms of supporting that sector, both in terms of physical care, but also in terms of the help we provide people, if only it's touching base with people, having a conversation, 'How's things going?', what we need to do to support them day by day.

And I think that's also a really important message for those unpaid carers, who have been really going through a huge amount of strain throughout this time—to know that this isn't something that's going to be forgotten about or left without services. We've heard this morning about the extreme pressures that our social care workforce is under. How do you feel that social care workers have been treated throughout the pandemic, and what changes would you want to see implemented for the workforce, both in the short term, and in the longer term?

If I just start in terms of that. In terms of how I feel the social care workforce has been treated, I think, actually, that the sector and the Welsh Government has done everything they can in terms of providing support to that sector. There's an inevitability that there's been a level of pressure across care home staff, domiciliary care staff, staff within supported living. And I think what's been challenging is they've had to—we spoke earlier about guidance around PPE, how they care for people, not only have they done then what would have been their normal job, which they were familiar with, they've also had to be conscious in every task they've carried out, around, 'How do I make this COVID-safe, how do I have a culture in terms of my working that actually is COVID-safe?' So, I think that it has been difficult for the workforce—there's no two ways about it.

In terms of moving forward and what we need to do, I think the pandemic has gone a long way in terms of reinforcing the importance of social care staff, and I think that's got to continue, moving forward. It's a very delicate balance in terms of what we can afford, but also in terms of ensuring that we are providing good wage opportunities for individuals within the sector. It's not just about wages, though. Clearly, what we need, and we are working with social care and health partners, is to ensure that what we have are very good career opportunities for individuals in care, so that the people who come into care can look at care as being a platform into working at a higher level within social care, at a higher level within health, so there's a very good career structure. I think what we have to continue to commit to, both at a national Government level and at a local level, is that, actually, a career in care is exactly that—a career, where there are opportunities for people to progress, and it doesn't become some sort of forgotten—. Because, actually, care is incredibly important; our demography tells us that care is going to be vital. I'll let Nicola come in.

I completely agree.

Diolch. Apologies, everybody, I lost internet connection. I firmly believe that social care deserves parity of esteem with our NHS colleagues. And I think, to a certain extent, the pandemic has helped to make the social care workforce visible in a way that it hasn't been before. And I would like to thank Welsh Government, and all colleagues, for acknowledging the role of the social care workforce during this pandemic. However, in order to have that parity with NHS, we absolutely have to have a sustainable, long-term funding settlement for social care. And it isn't just about the pay, it is about terms and conditions, it is about it being a career, a professional career that is valued the way that we have always valued NHS roles. So, that would be something that I really hope is something that comes out of this difficult time—is, for the first time ever, really, the recognition of our amazing workforce.

It's a common theme. Jayne.

Thank you. I think we would all support that. You mentioned—I think Nicola mentioned the lack of understanding on the depth and breadth of the social care workforce in terms of the testing prioritisation. Can you give your views on the roll-out of the vaccine, and how you believe social care staff and services should be prioritised, particularly in relation to what you've said about testing and perhaps some lessons that need to be learned? 

I think absolutely the approach around the vaccination roll-out is right and proper. ADSS Cymru has been involved at national and regional levels, in terms of the roll-out and the prioritisation of the social care workforce, but also our most vulnerable citizens within that prioritisation. So, I certainly know, from the work I've been engaged in, but also colleagues across Wales, that the social care workforce and also those most vulnerable residents have been recognised and are in that priority group for the first roll-out. So, that has been something I think that has been learnt throughout this pandemic, that the priority is those groups. 

Thank you. Thank you, Chair. 

Okay. Moving on, Andrew R.T. Davies. 

Sorry. Host, I didn't unmute in time, but technology allows for the host to do it. Thank you, witnesses, for your evidence so far. I'd like to touch on care home visits in particular, because obviously this has focused a lot of attention over the months and weeks of the pandemic and, going forward, it will continue to focus people's attention as well then. Can you give us some observations on what you think around the ability for relatives to visit loved ones in care homes and the environment that is being created in care homes at the minute, because adaptations have been made and are continuing to be made, and money has been made available for Welsh Government for that to happen? So, I'd like to seek your professional opinions, both of you, on those two points.  

Thank you. Care home visiting obviously has been something that is close to, not only our own hearts, as we have our own care homes, as well as commissioning care home places—. So, it's been very, very important, and we have been engaged with Welsh Government, with Care Inspectorate Wales and other partners, including providers themselves, in developing guidance for visitors to care homes.

The challenge is that there is no one care home alike. We're talking about such a varied plethora of different establishments, and the rights and responsibilities of those who reside in those establishments, the staff who work in those establishments and the families of all of those as well, have had to be considered within that guidance. So, there isn't unfortunately a one-size-fits-all approach, and it is very much about the individual risk assessment of each establishment and whether or not they are able to offer and provide—facilitate—COVID-safe visiting, and that is a challenge for some establishments just by the very infrastructure of the building. It's also a challenge in terms of their staffing ratios and, also, potentially, a challenge depending on the medical needs of the residents who live within those establishments. So, for example, where somebody has dementia and they may wander, that provides additional challenges in terms of ensuring that visiting can be conducted in a safe, COVID-secure manner.

So, it has been very difficult, but the guidance that has been produced has been produced in partnership with providers, with representatives of citizens who use services and, also, with statutory partners as well. But it will be a personal choice, and it very much has to be—. We have to consider the voice of the person who is being visited in terms of what is important to them. So, for some people living in an establishment—. So, take, for example, a children's home. A young person who's residing in a children's home may not want a professional visitor or even necessarily a family visitor. Their preference might be for their best friend to come and visit them. So, that will be very different to somebody who lives in a supported living environment, and, again, very different to somebody who may live in an older people's care home. So, we've had to try and develop guidance that allows for the voice of the citizen to be considered, but also, again, around the risk factors of ensuring that those visits are conducted in a safe and secure manner.

Before Alwyn comes in, if I may, Nicola, you made the point that some care homes—and I fully understand this, because each care home is different in its own capacity, layout, and everything about it—might struggle in terms of adaptations to make visits more acceptable in an environment that would be COVID-safe. So, would it be your assessment that some care homes just will not be able to make those adaptations and therefore not facilitate such meetings?

I think that where they are unable to make visits because of the fabric of the building, we are looking at the distribution of pods, visitor pods, and I know colleagues in Welsh Government have actually authorised the delivery of a number of pods across Wales to enable premises, where they are not able to either arrange safe and secure visiting within the establishment—. So, those are options being considered. But, yes, there will always be challenges and, unfortunately, when a care home is 'red', they can't have any visitors for any circumstances other than end of life.

Okay. Thank you, Nicola.

Alwyn.

Just as a positive, I think that there is lateral flow testing being rolled out to the care homes now, as we speak. That obviously provides better opportunity also in terms of safe visiting going on in the coming weeks. And I think that's a piece of good news. Clearly, there'll be some teething troubles around care homes becoming used to using that, but actually that's a real positive that has come out in the last couple of days, so, hopefully, there is some light in terms of trying to make visiting more safe, as we move forward.

Okay. Andrew.

That's a welcome initiative to say the least—much welcomed in the armoury that is available to care home operators. 

If I could move into the trauma that's been caused to some residents and staff as well by the inability for loved ones to visit—and that trauma is not going to go away with new testing, vaccination or whatever else, because people have lived that experience, they have—in your professional opinion, what assistance can be made available to residents in care homes who've experienced that trauma, that very upsetting situation they've found themselves in where they are, in effect, cut off from their loved ones—for the understandable reason to obviously control COVID infections, but there is still that trauma being lived by many residents who have gone through that experience?

I think it's really important that we recognise not only the time frame but also the longer term impact of not having had loved ones and family visit. And I think that is something that the care home staff are very alert to. We've tried various methods and I've heard some really fantastic examples where care homes have used technology to ensure that people have some visible, face-to-face contact, albeit on a tablet, where some establishments have had visiting pods and different kinds of facilities to allow for that.

But where it's just not possible because of the risks to not only the resident within the care home, but also to their relative who may want to visit, then I think that emotional support that needs to be provided is going to be crucial. But I think, prior to COVID, there was already a shortage around that kind of emotional health and well-being support available within the community, whether it be bereavement support, whether it be counselling—. So, I think that is something that there wasn't a plethora of before COVID and I think that will be further exacerbated now, as we move forward.

And I presume you'd concur with that, Alwyn.

I would. I would concur with that. I think a lot has been tried to be—. So, we've done quite a lot with the care homes to try and keep some degree of contact through iPads, electronic means. So, some good things have gone on, but there is no substitute for personal contact, is there? Let's not kid ourselves—we are social beings, and therefore care home staff are aware of this. They are supporting individuals in the care homes, but it will leave some lasting effect, yes.

Because that important point that Nicola brought in about the shortages feeds into the narrative around data and the ability for the centre, which, by and large, distributes the funding and the resource out to the regions and counties, understands what the situation is—. Do you have any observations? Because, as a committee, we, most probably on a weekly basis, take information from organisations that says that the centre doesn't collect the correct data to support decision making and policy decisions in certain areas. So, in the areas that you have an interest in, and the support that might be required going forward, do you believe there are data sets that the Welsh Government should be collecting that, at the moment, aren't being collected, or at least not being interpreted in the way that would support you and your authorities in the way that you commission services?

I think there is a gap in that data. I think a lot of the information that we have is anecdotal evidence, is qualitative rather than quantitative, so I think it is a gap not only in what is collected, but what is then available with partners to understand how we may step into that gap, if necessary.

Could you give me an example? I appreciate you're talking generally there about data across the board, I think, if I understood you, Nicola, in what you said, but, to help in the formation of maybe a report or something, that would give us an example where we could say, 'Well, here's an example of data that isn't done in the most effective way that supports development of policy and resource to help people on the ground commission services.'

I suppose it's a little bit chicken and egg, isn't it? You don't know what data, because it's not there in the first place. So, in terms of what counselling or mental health support is available to the care home sector, in terms of residents, I would imagine—and this is anecdotal—that that support is only provided through mental health practitioners where somebody has a mental health diagnosis, as opposed to a low-level mental health issue. That would be my anecdotal views on that. So, I don't think there's necessarily an understanding of what the need is to then be able to understand what, if any, gap there is in service provision.

In terms of mental health support, though, for the workforce, that has been something that has been improved. Very early on the Association of Directors of Social Services Cymru asked Welsh Government if the welfare support for NHS staff could be expanded to incorporate those working within the care sector. Unfortunately, there wasn't the capacity to do that, but now, with Welsh Government funding and support, there is resource being rolled out that is accessible now to anybody working within social care. But it took some considerable time to get there.

I see Alwyn wants to come in, but if I could, just before Alwyn comes in, make the point that, if there's something at the end of this meeting that you feel you could give an explanatory note on on this data issue—. Because it is important for us to try and nail down the specifics when it comes to data, otherwise data can mean a whole thing to a million people—a different thing to different people, it can, then. Sorry, Alwyn.

That's fine. The point I was going to make was—. It was sort of an additional point to what Nicola said, really. Clearly, there may well be service need in terms of mental health and well-being. I think there is also a wider point around the role of care homes within local communities as well. So, how much in-reach actually happens from local communities, schools, churches? And that might be something we need to reflect on; not necessarily a new service, but actually the role of care homes within their local community—the link to churches, to education, through inter-generational work, and whether there needs to be a grater focus on that. So, not necessarily a service as such, but actually things that happen naturally within local communities.

I think we need to ensure that care homes are not places—. I'm not saying that people are forgotten, but the wider community responsibility, the voluntary sector, and not only that people in their own homes are people that we link into, but actually people within care homes as well, so they retain that link with their natural community, i.e. that care home is part of that local community, whether that be churches, carol concerts—you name it—and that we make sure that is embedded. We need to make sure that is the case moving forward in all care homes.

Thank you, Alwyn. Thank you, Chair.

Diolch, Cadeirydd. Morning, both. Winter planning. Obviously, we are fully aware of the pressures that are always upon us every winter, and this winter is exceptional because of COVID-19. Are you confident the plans that are being drawn up reflect the need for social care as well as healthcare, particularly in light of the COVID we're currently experiencing? Alwyn.

If I come in, I think, in terms of your question around confidence, we're as confident going into this winter probably as we have been in other winters, be it that there is that additional challenge of the pandemic. We have worked with our health board partners in various areas around schemes to support winter pressures, whether they are schemes to strengthen domiciliary care within our local areas, funding for more things like therapy and social care. So, we have those, funding in place. It is clearly on top of the challenges that we've had within the pandemic. So, we've referred once or twice to a workforce that is probably weary in terms of the pandemic. Do I think that actually we will cope during the winter period? I think we will cope in a similar way that we have in previous winters. We will work in partnership across the health board and ourselves.

I think the one big benefit this year, and I think we are successively getting better at this, is that there is more work happening on a local level across local authorities, health boards, local general practitioners, in terms of how we manage people in the community. So, a term that is used in various—it's community resource teams. I think there is more recognition now of what the community resource team is—so, that being the local general practitioner, your district nurses and health visitors in the local area, your social workers—so, there is more planning going on now in terms of how we avoid people coming into hospital, as opposed to dealing with the after effects of someone being in hospital.

So, in response to your question, I think we do have a workforce that is tired; we have put the schemes in and are agreeing those. However, we do have the slight benefits now that there is, increasingly over Wales, a structure in most local authorities where we're working very much at community level across social care, the general practitioners and district nursing, where we are talking about people within the community, and we're saying, 'Actually, how do we support Mrs Jones to remain at home—what support do we need to put in place to actually keep those individuals at home?' So, I think we are better versed in that regard.

Nicola.

I think I would just add to that that I am increasingly concerned, as we enter winter, with the current situation that we find ourselves in, and the increasing numbers of transmission within communities in Wales. A number of colleagues are already fully in emergency-response mode dealing with COVID, and this is, really, before the winter pressures have actually begun. So, I am very concerned. I think we've done everything that we can to try and prepare for and mitigate that, but, unfortunately, as we enter this winter, with the numbers increasing at the rate they are doing, I am very, very concerned. As Alwyn said, the workforce is tired. This second wave is definitely harder than the first; colleagues are telling me it's much more scary. In the first wave, I think there was an element of adrenaline, and everybody stepped up and rallied together, which was fantastic, but, as we're now in the height of this second wave, that resilience is really starting to wear now. And I think people are not only frightened about their work, they're also frightened about their own families and their own local communities. So, it would be remiss of me not to encourage anybody who's watching to follow the rules, to take every precaution they can, to ensure that they and their families and their communities are as safe as possible during this winter.

You keep reminding them as often as possible—don't worry about that. 

You both highlighted the workforce and that they're very tired, but, of course, we're also facing—. My own health board identified that 700 of its staff are off currently, so we're facing a situation where staff are also off as a consequence of either self-isolating or because they've actually contracted COVID. Are you sufficiently, in this situation, resourced, I suppose is the best word, to handle circumstances that may well be fast coming upon us?

I think it's an area that is going to be a real challenge for us. To a certain extent, health and social care are fishing in the same pond for some of our staffing and some of the workforce. As we get closer to Christmas, the ability to mobilise volunteers will be more challenging for us. There wasn't any slack in the system before we entered the COVID pandemic, so that pressure on the workforce has been compounded in a way that we could never have envisaged.

We've done lots jointly with Social Care Wales around our We Care campaign and we've tried to recruit people to the sector, but it's a very difficult and challenging position. It's not for everybody to enter the care workforce and the care profession, without adding COVID into the mix and the fears of that, not only for your own health but for that of your family. So, it is a challenge and, as I say, I am very concerned, as we move into winter, around the capacity not only within health within their workforce, but within the whole pathway of health and social care.

Okay. We've talked about the vaccinations and vaccines. Hopefully, the vaccines will be rolled out over the next few months, but we're not going to be in a situation until at least, I would say, the spring until we've got a reasonable proportion of people who are vaccinated. The recovery plan is being put into place. Do you think social care has been taken account of seriously in the recovery plans for COVID beyond a point at which we are dealing with COVID directly? Alwyn.

In terms of whether our recovery plans have been taken seriously, well, certainly from my own perspective and each individual local authority, I think we are taking those recovery plans seriously. As part of our—

I wasn't asking whether they were taking them seriously. My concern was, within the Welsh Government, has social care really been identified as a major issue in the recovery plan?

Nicola, I don't know whether you know better in terms of that. My understanding is that there is an understanding that our recovery plan is going to be crucial. In terms of how that is verbalised at a Welsh Government level, I'm not too sure. Nicola, I don't know whether you're in a better position—

Yes, so, within the Welsh Government meeting structures, there is a social care recovery group—sorry, stabilisation; I can't remember its full title now, so apologies, as there are so many meetings. It's chaired by the deputy director general, Albert Heaney, and it's attended not only by ADSS Cymru—I attend—but by all of the stakeholders, including providers and representatives of people who use services, who are also part of that. That's actually been in place for a couple of months now, but has been paused as we've entered the second wave. So, I think, given the fact that it is chaired by the deputy director general, Welsh Government are recognising the importance of social care in that recovery.

I think it's really difficult, certainly within a local authority context, that there are elements of local authority business that are looking to recover whilst social care is still very much in emergency response mode. I don't feel, really, even in my own local authority, that I've ever stepped out of that emergency response mode, even though I am co-operating and working with my colleagues corporately to look at the overall recovery of the local authority. So, I think there are challenges for us, moving forward, to recognise that, as we're now in this second wave and as we enter the winter, there are different positions of response and recovery depending on what part of the public sector you are operating in.

Okay. I suppose, in a sense, then, as you say that you're still in emergency mode and others are starting to recover, has this pandemic created a situation where you see, or has it pushed—? In the health services, we've seen many changes happening in the way in which services have been delivered. Is the pandemic actually accelerating the way in which social care services are also being reconsidered and reviewed? If so, how can we take that forward?

I think the pandemic has actually allowed us to remove some of the bureaucracy that, perhaps, we had before and has pushed us into trying new ways of working, some of which, actually, we think, are better ways of working now for the future. And, certainly, what will be important, moving forward, is that we hear the voice of our citizens in terms of what they feel has worked well, and how services, and the changes to services, have been better or not, and we need to reflect on where things haven't been better. We need to utilise that knowledge and learn as we move forward. So, we can certainly cite a number of examples where practice has changed, and changed for the better. So, there are certainly some glimmers of hope in what has been a very difficult time. 

Alwyn.

Alwyn—[Inaudible.]

Yes, I was just going to come in with a couple of examples, and Nicola's absolutely right that there have been some really good examples where things have improved. We spoke about safeguarding earlier on in the discussion. I think, on safeguarding meetings and the ability to work across different disciplines, the pandemic has actually moved that forward. So, whereas previously you had safeguarding discussions, strategy meetings, where people probably had to come to a central location, the pandemic and the way we've adapted in terms of the use of digital means will actually influence how we hold safeguarding meetings, moving forward. So, instead of our colleagues from the police and various other sectors having come in to a central location, good, robust discussions about individual cases have happened really, really quickly over digital means. And I think that will improve our offer, going forward. Certain aspects of how we've supported people, both children and families, has been better digitally. Some people have said, some children have said, 'I actually quite liked having that conversation digitally. It allowed me to control it, be in a good position.' So, yes, there are certain things that have actually moved forward. 

I think also, and I'll say this from a workforce position, we've obviously moved to homeworking very, very quickly during this, and what the pandemic will do is allow us to get the right balance of homeworking and in-office working. So, very quickly, at the end of this, we will all be taking stock around how we ensure the well-being of our staff, how we see them often enough, but also how we can make sure they get time to work from home, where they are trusted and they've got the right systems in place. So, there are, certainly, amongst something very, very difficult, very good examples of where things will be better post the pandemic. 

And as a final question, your earlier answer to a question talked about how partnerships and community focus have been greatly enhanced. Do you think also that the relationships with health boards and the community facilities have also been enhanced, and so, therefore, changes you might have wanted to come in quickly are now there, and this is the way in which we are reforming the way in which we deliver social care?

Yes, I absolutely think they have. I think relationships have been strengthened locally, regionally and nationally. I think having a common purpose has enabled us to do that, and I think it goes much broader than just social care and health, to our relationships with our communities, with volunteers. I've met neighbours that I didn't necessarily know before, partly because I get up and go to work. So, being part of my local community has really strengthened my own relationships and my own resilience. So, I think, across the board, things have improved, and people have been connected in a way that they weren't before. But, with any relationship, you've got to work at it. It doesn't come naturally, and it relies on both partners working towards it and sustaining that relationship. 

Okay. Thank you.