|Angela Burns AC|
|Dai Lloyd AC|
|Dawn Bowden AC|
|Helen Mary Jones AC|
|Julie Morgan AC|
|Lynne Neagle AC|
|Rhianon Passmore AC|
|Claire Morgan||Carers Wales|
|David Rosser||Llywodraeth Cymru|
|Dot Gallagher||Mencap Cymru|
|Dr Leanne McCarthy-Cotter||Mencap Cymru|
|Gareth Howells||Carers Trust Wales|
|Carers Trust Wales|
|Gillian Otlet||Llywodraeth Cymru|
|Heléna Herklots||Comisiynydd Pobl Hyn Cymru|
|Older People's Commissioner for Wales|
|Jane Young||Mencap Cymru|
|Simon Hatch||Carers Trust Wales|
|Carers Trust Wales|
|Victoria Lloyd||Age Cymru|
|Wayne Crocker||Mencap Cyrmu|
|Yr Arglwydd / Lord Elis-Thomas AC||Y Gweinidog Diwylliant, Twristiaeth a Chwaraeon|
|Minister for Culture, Tourism and Sport|
|Lowri Jones||Dirprwy Glerc|
|Tanwen Summers||Ail Glerc|
|2. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau||2. Introductions, apologies, substitutions and declarations of interest|
|3. Craffu ar gyllideb ddrafft Llywodraeth Cymru 2019-20: sesiwn dystiolaeth gyda'r Gweinidog Diwylliant, Twristiaeth a Chwaraeon||3. Scrutiny of the Welsh Government Draft Budget 2019-20: evidence session with the Minister for Culture, Tourism and Sport|
|4. Effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â Gofalwyr: Sesiwn dystiolaeth gyda Gofalwyr Cymru ac Ymddiriedolaeth Gofalwyr Cymru||4. Impact of the Social Services and Well-being (Wales) Act 2014 in relation to Carers: Evidence session with Carers Wales and Carers Trust Wales|
|5. Effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â Gofalwyr: Sesiwn dystiolaeth gyda Chomisiynydd Pobl Hŷn Cymru ac Age Cymru||5. Impact of the Social Services and Well-being (Wales) Act 2014 in relation to Carers: Evidence session with the Older People's Commissioner for Wales and Age Cymru|
|6. Effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â Gofalwyr: Sesiwn dystiolaeth gyda Hafal||6. Impact of the Social Services and Well-being (Wales) Act 2014 in relation to Carers: Evidence session with Hafal|
|7. Effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â Gofalwyr: Sesiwn dystiolaeth gyda Mencap Cymru||7. Impact of the Social Services and Well-being (Wales) Act 2014 in relation to Carers: Evidence session with Mencap Cymru|
|8. Papur(au) i'w nodi||8. Paper(s) to note|
|9. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd||9. Motion under Standing Order 17.42(vi) to resolve to exclude the public|
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 rhan gyhoeddus y cyfarfod am 09:31.
The public part of the meeting began at 09:31.
Rwy'n galw'r cyfarfod yma i drefn. Bore da a chroeso i bawb i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad Cenedlaethol Cymru. Rŷm ni wedi cyrraedd eitem 2, ac rwy'n falch o groesawu fy nghyd-Aelodau i'r pwyllgor yma yn y lle cyntaf. Rŷm ni wedi derbyn ymddiheuriadau oddi wrth Neil Hamilton, ac nid oes neb yn dirprwyo dros Neil Hamilton.
A allaf yn bellach egluro bod, yn naturiol, y cyfarfod yma yn ddwyieithog? Gellir defnyddio'r clustffonau i glywed cyfieithu ar y pryd o'r Gymraeg i'r Saesneg ar sianel 1, neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. A allaf yn bellach eich hysbysu bod angen i bobl ddilyn cyfarwyddiadau'r tywyswyr os bydd y larwm tân yn canu?
I call this meeting to order. Good morning, everyone, and welcome to the latest meeting of the Health, Social Care and Sport Committee here at the National Assembly for Wales. We have reached item 2, and I'm pleased to welcome my fellow Members to this committee. Firstly, we have received apologies from Neil Hamilton, and nobody is substituting in his place.
Naturally, this is a bilingual meeting. Uou can use headphones to hear interpretation on channel 1 or to hear amplification of the original language on channel 2. I would like to inform you that you should follow the ushers if the fire alarm is heard.
Gyda chymaint â hynny o ragymadrodd, rŷm ni'n symud ymlaen at eitem 3, a chraffu ar gyllideb ddrafft Llywodraeth Cymru 2019-20. Dyma sesiwn dystiolaeth gyda'r Gweinidog Diwylliant, Twristiaeth a Chwaraeon. I'r perwyl yna, mae'n bleser croesawu i'r pwyllgor yma Dafydd Elis-Thomas, y Gweinidog Diwylliant, Twristiaeth a Chwaraeon; David Rosser, cyfarwyddwr chwaraeon Llywodraeth Cymru; a Gillian Otlet o is-adran chwaraeon Llywodraeth Cymru.
Yn dilyn y drefn arferol, mae gennym ni nifer o gwestiynau ar wahanol feysydd o'ch portffolio, felly awn yn syth i mewn i gwestiynau, ac mi wnaiff Helen Mary ddechrau.
So, with those few words, we move on to item 3, scrutiny of the Welsh Government draft budget 2019-20. This is the evidence session with the Minister for Culture, Tourism and Sport. I would like to welcome Dafydd Elis-Thomas, the Minister for Culture, Tourism and Sport; David Rosser, director of sport at the Welsh Government; and Gillian Otlet from the sport division at the Welsh Government.
As usual, we have a number of questions about different aspects of your portfolio, so we'll go straight into questions from Helen Mary.
Roeddwn i'n meddwl efallai y byddai'n help i mi jest ddisgrifio beth yn union yw ein rôl ni fel adran, gan fod y sefyllfa yn newydd. Mi wnaf hynny wrth ateb y cwestiwn, os yw hynny—
I thought it might be of assistance for me to just describe what exactly our role is as a department, because the position is new, but I will do that in answering the question, if—
Na, medrwch chi wneud gosodiad agoriadol, ac efallai y bydd hynny'n sbarduno cwestiynau amgen.
No, you can provide us with an opening statement, and perhaps that will inspire alternative questions.
Yn gryno, mae'n fraint arbennig i gael ymddangos gerbron y pwyllgor sydd yn cynnwys iechyd yn ogystal â gweithgareddau eraill. Rwy'n credu ein bod ni wedi bod yma unwaith o'r blaen. Mae gen i gyfrifoldeb am strategaeth genedlaethol a pholisi ynglŷn â chwaraeon cymunedol a gweithgaredd corfforol ar draws Cymru, ac mae hynny'n cynnwys y swm mwyaf, sef nawdd i'r corff cyhoeddus Chwaraeon Cymru, ac mae dros £22 miliwn yn cael ei wario yn y cyfeiriad yna.
Mae gennym ni hefyd gyllideb arall fwy hyblyg sydd cyn lleied â £252,000, sef gwaith a wneir ar gomisiynau uniongyrchol ac ar beilota neu gychwyn, neu ymchwil yn ogystal. Felly, dyna, yn fras, ydy fel mae'n cyllideb ni yn gweithio. Diolch yn fawr i chi, Gadeirydd.
Briefly, it's an honour to be appearing before this committee, which includes health here as well as other activities. I think that we have been here once previously. I do have responsibility for the national strategy and policy regarding community sport and physical activity across Wales, and that includes the biggest sum, which is funding for the national body, Sport Wales, and over £22 million is being spent in that regard.
We also have a more flexible budget, which is as little as £252,000, which is for direct commissions, pilots or research. So, that is how our budget works. Thank you very much, Chair.
Diolch yn fawr am yr eglurdeb yna. Yn amlwg, fe wnaiff hynny sbarduno’r cwestiynu—Helen Mary.
Thank you very much for that clarity. Clearly, that will inspire questions—Helen Mary.
Diolch, Cadeirydd. Thank you. A couple of questions about processes and how the cross-governmental approach has been addressed in the budget. Could you tell us how, in developing this budget, the Welsh Government has taken a collaborative and cross-departmental approach to promoting physical activity? There's obviously a lot more than what's in your own budget heading.
It's because I carry the overall responsibility across Government for physical activity that I'm pursuing this, and there has been a discussion, or two discussions, in Cabinet, one of which I attended, and there's also been a new way of working together between the public bodies in this field—maybe we will come to this later on.
The important emphasis is that physical activity is to be considered as a policy objective overall, throughout all departments, and there's now a working group that I will be chairing when the group meets next, which will take an overall view to ensure that we are fulfilling the obligation that rests on all of us as Ministers. And it is in the same category, as far as I'm concerned, as the Well-being of Future Generations (Wales) Act 2015. It is part of the Holy Bible of our constitution and our work as a Government.
That's useful, thank you. So, in terms of—. Can you, sort of, point us in the direction of how you'd evidence the overall financial strategy in the budget for meeting the healthy and active aims in the national strategy? It might be a chance for you to tell us a bit more, perhaps, about this new approach for working with the public bodies.
We have both a specific area of spend, which is directed towards healthy and active activity and there is a healthy and active fund that's only £5 million. It was only launched by myself and the Cabinet Secretary for Health and Social Services in the appropriate location of the Brecon Beacons earlier this year, and that is already now inviting expressions of interests, and we hope to be starting to pay out from that fund. That is for innovative activity of all kinds in that area.
As regards the overall approach, we are pursuing the physical activity responsibility by working through, as you intimated, our three important public bodies—that is Public Health Wales, Natural Resources Wales, and, of course, Sport Wales. And these bodies have met on a number of occasions, and I'll ask David, perhaps, to go into more detail as to the discussions that have taken place at the level of officials with these bodies, but I have met them formally on one occasion, and, of course, it's a strategic approach, which I strongly recommend across Government.
So, the healthy and active fund is a first and good example, I think, of two different departments actually pooling budgets. So, the health department has put budget into the fund; Sport Wales has put some of its budget into the fund; and NRW is putting access to some of its natural resources into the project too. The fund is being managed jointly by the three bodies together under the direction and supervision of the Minister and the Cabinet Secretary for health. So, I think that's one good example where, actually, two departments have put money into a single pot.
Our sports policy branch, under the Minister's direction, is also working with colleagues in education around their twenty-first century schools programme, helping to advise on new proposals that are coming in for funding through that programme; ensuring that facilities that are built as a result of it are open to communities outside school hours. We're also advising and working with education colleagues on their community hubs programme. So, I think there are a number of examples, some of which are collaborative working and advisory, which go to this agenda, and some of which are starting to get into the budget pooling area, which is quite exciting.
Yes, just on the healthy and active fund, I wondered if you could just give a quick update on, firstly, how you intend to monitor this fund. And have you set any other objectives for it, such as improving equality in terms of trying to get more women, young women, children into the whole area of a healthy lifestyle?
Well, I'm pleased to say that there are 48,000 women and girls who now play netball in Wales. That was the latest figure I was given by Welsh Netball. The equalities approach is one, obviously, that we encourage. I've personally met the women's football team twice and watched them play, and I make sure that I am similarly supporting women's rugby and all the activity that goes on surrounding that in the other sports, given that we have 62—or is it 64 now—governing bodies across all the sports in Wales. It's a message that we make sure that they all pick up.
But, then, the key part of the healthy and active fund, it will be in the next financial year that we will be starting to pay out. We've got expressions of interest already appearing, and the intention is that it should be innovative and collaborative, as you've already heard.
Yes. Because, actually, it slightly rolls into the other question I was going to ask you, which is, actually, about—. You mentioned sport, sport, sport and sport, so the healthy and active fund, how much of it is actually going to go to the physical activity side of it, which, of course, isn't sport? It's about getting people who are turned off by sport, or feel frightened of sport, who don't want to be seen in that competitive way, into a healthy and active lifestyle.
Well, I think this is where we have to be careful what we are talking about. I wasn't talking about sport. I mentioned the particular activity of Sport Wales because it is a public body that operates in a particular area to support governing bodies and support activities. We can place on these bodies, as we do in the remit letter, and if you were to—. I won't quote from it at any length this morning, but we have been able now to indicatively allocate, or indicate, that we will allocate to them over the programme of this Government, from 2018 through to 2021. They know where they are in terms of the budget. So, that's our arm of direct intervention, if you like.
But the emphasis on physical activity extends to the whole nation: 32 per cent of the population of Wales admit, in the national survey, that they don't do anything at all. That is a very serious issue, and I don't think we address that by going around hectoring and lecturing, but we go around—. We get involved in that issue by example, I think, by showing that physical activity should be intergenerational, should be family and community based. It is not the same as competitive sport. Physical activity is individuals enjoying a walk, enjoying a run, enjoying a swim, enjoying whatever they want to do, and that's a matter of choice. We think it's very important that we offer people as wide a choice as possible so that they're invited to participate, and this is where these big marathons and big half marathons are very important for that because they're a public spectacle. But equally important are the small community groups—many of them were women's groups, many of them groups of older people who meet together for the park runs. I happen to live close by one of the most important locations in Cardiff for a park run, and it's great to see the level of participation that has increased in that particular form of activity. Now, that is not competitive sport; that is a sport in which people are invited to take part. Do you want to say something more?
The healthy and active fund is intended to be a long-term collaboration between ourselves and health and our three arm's-length bodies. The first iteration of it will focus on physical activity, future iterations may focus on other health issues. The aims are explicitly to increase the physical activity of those who are currently sedentary, who have very low levels of activity, improving levels of mental well-being through social interaction, increasing or improving access to physical spaces, hence the NRW involvement.
Priority was going to be given in this first phase to projects that reduce inequalities in outcomes for children and young people, people with a disability or long-term illness, people who are economically inactive or live in areas of deprivation, and older people and those around the ages of retirement from work. Expressions of interest are being sought now; they will need to be collaborative. This is not just about giving more money to individual interest groups; it's deliberately aimed to get people to work together to come up with new approaches. And monitoring will be built into that, projects will have to set out monitoring and evaluation arrangements, which the three bodies, on our behalf, will hold them to account for. Typically, we'd expect to see an increase in the number of participants, an increase in the number of participants reporting positive change in mental well-being, for example; and there'll be an independent evaluation of it. So, we're building in, I hope, some rigorous monitoring from the outset.
If I may, Chair. Just on that, I should also have mentioned the healthy Wales 10-year plan, which is going out to consultation in the new year. We see that as a structure within which our activity and funding—the healthy and active fund—as being a collaborative way of working and that's obviously led by Public Health Wales.
Thank you very much. You've touched upon this, I think, David Rosser, slightly earlier. Bearing in mind the scarcity of the public purse across the UK and passported to Wales, and the whole emphasis around grant making that we've had from the European Union, it's never been more important that we make full use of community assets, including community schools. So, within the 10-year plan that you talked about, structurally, for Wales, what provision is there, or what understanding is there of the importance of being able to use twenty-first century schools as true twenty-first century schools, as real public assets? In my constituency alone, there has been over £52 million spent, and, at the moment, we are facing, across Wales, in my view, some excellent examples of that being opened up to the public, as intended, but there are also very many examples, including in my own constituency, where they are not opened up to the public. So, how important a plank is that in terms of the long-term strategy?
The twenty-first century schools—. The new buildings, it's not so difficult to make sure that those are opened as community assets, but—
Well, could you give us the examples and we'll get on the case? Because we have experienced a situation where, with older school buildings, there tends to be, in some communities, an attitude on the part of individuals who are responsible for those buildings or even school governors, who are not very happy to collaborate with wider community activities.
So, how does Welsh Government then use this very important element in terms of progression pathways for sport? Is there guidance to be issued?
This is properly one for the Cabinet Secretary for Education, clearly. We are in—. The Minister—
But surely, in terms of sport and your mandate, there must be a role for yourselves, as well.
Yes, we have had a number of discussions with the Cabinet Secretary and a discussion between officials. The ultimate sanction, of course, is legislation, and would I contemplate that? Yes, I would. But, of course, having time to deliver legislation in this Assembly is going to be rather difficult. But that is always a sanction I would be willing to take, because these are public buildings and public assets that should be publicly available.
Yes, I wanted actually to follow up Angela's point about access for girls and women to sport. I know Angela raised the issue of monitoring as well. I'm sure you probably heard Sally Holland, the children's commissioner's comments last week about girls having opportunities to take part in competitive sport, and the lack of opportunities. So, I just wanted to press the case for doing all we possibly can in that field. How are you actually monitoring the numbers on the increase in opportunities for girls and women, so that we do get some idea if there is an improvement or not? Because, I think, having seen it quite a lot at first hand, it is very frustrating for girls to get those opportunities that the boys do, on the whole.
Yes, I fully agree with the thrust of your question. Sport Wales does and is required to collect the relevant data on equality of opportunity for the use of sporting activity and the profile of the people who undertake the activity. The social surveys, as well, provide us with evidence of the level of participation. And we have also been in discussion with Chwarae Teg and other equalities organisations to ensure that, in the delivery of our policies, and certainly in recruitment to any public bodies we are seeking to get support or new membership for, we do have a fully compliant and effective equalities policy.
So, it's about ensuring that there are role models in all aspects of public life, where we have an opportunity to make appointments or to organise activities through the bodies that we fund, and make it absolutely clear that it is part of the funding package that people receive from public funds in Wales that they are expected to respond to the Government's strategies. And we will ensure that the message that you've taken up with us today will be reinforced in the remit letters, which will be going out soon. I note that the chair of Sport Wales, Lawrence Conway, received his last remit letter in February 2018; well, he'll be having another one soon, so we'll make sure that we put that right in there.
That would be good, but is there a mechanism for when you—? Say, for example, you give out money, is there a mechanism of feeding back directly for that sum of money, rather than an overall survey?
The money's distributed to sports organisations by Sport Wales on our behalf. We give, through the remit letter, Sport Wales direction as to some of the priorities that we want them to address, and reducing disparities in participation levels amongst different cohorts is clearly one of those. It's a responsibility they take very seriously, so whenever they then pass on funding to sports organisations, they require them to provide data as to activity levels.
Sport Wales is currently looking at developing a new strategy, and I would expect, in future, funding for sports bodies to be far more closely related to actual participation levels and removing disparities, or addressing disparities, than just membership numbers, where it currently is at the moment. So, this is an agenda that's taken very seriously. Data is collected, and some of the traditional male sports such as rugby and football are actually achieving very significant uplifts in their female participation levels. So, this is a very live and very serious area of policy for us.
Just to expand on that, really. That's really encouraging to hear with regard to the participation of women and girls, but we know that there are other social groups that are not sufficiently, as the Minister has already said, physically active. I'm thinking particularly of disabled people, including people with learning disabilities, and also the age profile of people participating. So, does what you've said, Mr Rosser, in terms of responding to Julie Morgan's question about monitoring the spend on participation by sex, by male and female—does that also apply to, for example, participation by disabled people, the broader equality of protected characteristics?
Disability Sport Wales is a major partner for us, and I think there are over 23,000 club members involved, and they provide for 1 million sport participation opportunities each year through Disability Sport Wales. Do you want to add anything?
Disability Sport Wales is one of the biggest recipients of funding. It's probably in the top five recipients of funding from Sport Wales, and I think does an excellent job. There are also programmes run with, for example, BME Sport Cymru. Some of the examples are—they're specifically providing closed sessions for BME females to swim, for example. So, there's actually quite a lot of creative work going on in this area, and the monitoring is being tightened and more focused towards those areas.
And you are, or you will be, able to track the spend, then, to say—
From the sound of it, it's pretty clear that you can see this investment is delivering this level of participation in this group that's previously struggled. That sounds really positive to me.
BME Sport Cymru is a two-year Sport Wales project, and the investment is £538,000, and the intention of this is to increase substantially the active BME participation in sport across Wales. And the project has engaged with nearly 3,000 individuals in regular sport and physical activity.
I don't know whether you want to add anything specifically on that.
No, I'm fine.
Okay. Moving on, we need some agility now in the questioning, and today's queen of agility is Lynne Neagle.
Thank you. Can I ask about the review of sports facilities in Wales, including relevant timescales, and whether it's likely to have an impact on future spending plans?
Yes. So, you were after an update, and the sports facilities review had a dual aim. It had to consider how to increase the spread of world-class facilities across the country, but it also had to consider how this would benefit local communities, as well as the elite athletes. That work has pretty much been undertaken, but the place where we are at the moment is that it's dependent on receiving greater certainty around the funding availability. So, this is final investment in capital facilities. So, the Minister is in dialogue with the Cabinet Secretary for Finance, and is going to be talking about that in the near future.
I should add, actually, that there's no timeline exactly for finishing this project because of their needing to negotiate and discuss about the capital investment, but we are taking forward a couple of things that we can do within our portfolio within our current budget next year. So, things are progressing; nothing's stopped.
But we have an emerging view that this is best tackled by assessing the effectiveness and the need for further capital investment that we've just heard about in sport facilities, through an approach that takes account of the importance of having an interrelated network of facilities at national, regional and local level. And we are very keen that the talent pathways for young athletes and young participants in sport, as well as the opportunities for the general population to participate, are spread well throughout Wales. That's an issue that is of concern.
So, we know that lots of local authorities are struggling to maintain their sports facilities. Lots of them have had to hand over pitches to community groups who are having to pay for the upkeep, the marking, et cetera, which is extremely expensive. What consideration have the Welsh Government given to the impact of issues like that in considering the budget, given the longer term importance of encouraging the community to be healthy and active?
Well, Sport Wales is very active in working with the governing bodies on any issues involving community asset transfer, and where there are resources that are being transferred into trusts or into community activities, then we ensure that they have the full range of advice and support for the activity that they undertake. But we are very conscious that it is not our role as national Government to direct local authorities as to what should be their priorities, or to substitute where local authorities have different priorities. Indeed, I won't start naming individual authorities, but I'm very lucky, north and south, to live in authorities that give priority to sporting activity; the investment that we've seen, for example, in Parc Eirias in the county of Conwy where I live is a very good example of how you can geographically locate facilities that are central to a large area of population throughout north Wales, and we want to make sure that we operate in a similar way with new facilities for the future.
But it's not just a question of prioritising, is it, because if local authorities are so cash-strapped, then it's very difficult for them to make those investments in sporting facilities.
Can I just ask about the sugar tax money? It's £57 million over three years. As far as I'm aware, none of that has been earmarked for physical activity. Is that something that you've discussed with the Cabinet Secretary for health? Have you asked whether some of that money can be used to help keep our communities sporting and active?
I haven't specifically discussed that tax. I don't know whether there have been internal discussions between officials.
We're in general discussion around the availability of finance for sports facilities, not particularly out of any hypothecated pot. This is a live discussion between the Minister, the Cabinet Secretary for Economy and Transport, health and finance—
Since you've raised it, I will raise it, I promise.
It's also worth mentioning, against this very difficult environment for local government finance, we are seeking to support community groups who want to or have been required to take on facilities through using Business Wales advice, Development Bank for Wales support. So, we're trying to use a wider range of levers where we can, but it is a tricky area.
Good. The point about the sugar tax is important, because it was widely ridiculed when that was suggested a decade ago as something worthwhile. Now, it's in, but the idea is from Westminster, but, basically, the idea is to have the funding for physical activity to tackle the obesity agenda, not other matters of Government. So, it's a good point. Julie Morgan.
Thank you very much, Chair. I'm going to ask you about the free swimming programme and the recent review. So, there's been a recent review of the programme, which I understand found that it only costs half the annual £3 million grant, and that local authorities have become reliant on this funding as an income stream. So, what steps are being taken to address this issue?
This is being pursued actively through Sport Wales, who are considering the recommendations that have arisen out of the review. I'm very anxious that any funding, especially where there is a history of ring-fenced funding, should be considered carefully, and that we should always aim to provide as wide as possible a range of physical activity for people to participate in. And I think the lesson from the review of the free swimming scheme is that we should not get into a situation where we are subsidising local authorities to undertake activity that they don't actually do, to speak frankly. Do you want to add to that?
No, that's fine.
Obviously, if only half of it is being used for the actual swimming, that would mean that twice as many people could swim if they were using it fully. I wondered whether you were aware of any efforts made individually by local authorities to increase the number of people swimming, because I think it's a great scheme, and I'm very supportive of it, but how much is it promoted?
But I think the problem now is that people seem to be—I can't really say voting with their feet, as it's not the right metaphor here, but it seems to us that people want to have a broader choice of activities that they undertake, and the take-up is, after all, a matter of individual choice in terms of taking up the scheme. David, do you want to say something?
Some local authorities do very well. Others possibly spend less effort in promoting it. So, the Minister has asked Sport Wales to work with delivery partners—that's the local authorities and the main aquatic sports—to give him some advice on what a new scheme could look like, which would still contain free swimming, but would be aimed at making sure that there is good value for money from it, and we are awaiting that report now. We expect it shortly.
Right. So, in fact, different local authorities vary in terms of how much use there is of the free swimming. Is that the case? Right. So, those that are doing well—obviously, you would want to ensure that that continued.
As I say, Sport Wales are working with the Welsh Local Government Association and local authorities and the aquatic bodies to come up with some recommendations for the Minister as to how to make this work well. And I've no doubt they'll be learning from those local authorities who already do it well.
Thank you. And then my second question is about the expectation of the Welsh Government that Sport Wales is going to explore the potential for a new model of community sport across Wales. So, I don't know if you could give us any more information about that, and what money has been set aside for it in the draft budget.
I think this is potentially very exciting, because it does mean more effective participation, again including shared funding, especially with the health boards. We are very keen, and I know that the relevant health boards that are already participating, particularly in the north, where the scheme has been more developed than in other areas at the moment, are very keen to see results of collaboration. And what we are doing—by encouraging the authorities to work together, we will produce a model, working with Sport Wales here as the lead body, that will be applicable to other regions in Wales as we indeed analyse the success of the collaboration that's happened in the north. But from my direct experience of what's happened in the north, I'm very positive about the potential of this scheme, and we'll certainly be prepared to report back to you the participation of Betsi Cadwaladr, of the universities at Bangor and Glyndwr, of the housing associations, with Public Health Wales and Disability Sport Wales. It's a brilliant way of using public funds, I think. And we hope that the engagement that there has been with this process in other regions will start early in 2019. So, this is another good-news story, we hope.
Well, the key issue is the partnership working. But to undertake that effectively, there has to be partnership funding. And that is something we will indicate in the remit letter to Sport Wales, and I know that my ministerial colleagues in other departments—certainly, the Cabinet Secretary for health—are very keen that we have further developments of shared funding, as we already have in the healthy and active fund. Do you want to add anything to that, David?
The money for this will come from within Sport Wales's existing budget. It's money they're already spending. They're already spending at the moment by direct grants to individual local authorities or to individual sports. This is about actually encouraging those bodies to come together with a range of new partners, including the health boards, housing associations, to pool that money and spend it on a regional footprint more effectively, to come up with different opportunities and increase participation. So, it's Sport Wales's budget, and it's for them to decide how they do that, and they're in the final process now of commissioning this partnership.
Thank you. Diolch, Chair. Today of all days we can calculate some of the loss of European funding to the arts and sports in Wales. So, as an aside, I'd like some comment later as to if there is an assessment of how much we've lost in Wales in terms of sports projects from European funding. But in regard to the balance of whether we've got the strategy right between funding for community sport and elite sport, if we look at the tsunami of hits between the loss of non-statutory services for local authorities, plus the scarcity of lottery funding, plus that other hit in terms of European funding around the arts and sports, that foundation level for community sport has never been more important in order to provide that progression pyramid, as we know, to elite sport. So, have we got that balance right, futureproofed against those three challenges that I've just mentioned?
'No' is the answer to that, and I would be misleading the committee if I had thought at all it was possible for us to replace the substantial funding that Wales has received in terms of European funding. We are in an extremely difficult situation. And you're also quite right about the lottery situation. I've had discussions with Camelot, and I have overall responsibility for—not for the operation of the lottery, but for the way lottery funds are dispersed in Wales. I mentioned earlier the £22.3 million that Sport Wales had allocated out of Government funds, out of our budget, but of course it becomes £34 million funding when we look at the lottery contribution. And it's key that we can, if possible, through working with Camelot, and getting a bit more sense from the UK department, if I can say that in passing, ensure that there isn't a further reduction in the lottery funding in Wales.
But I think we have to be absolutely honest with the electorate, and say the decision that was taken to leave the European Union, which is particularly in our minds at the moment, obviously is a decision that will have serious implications for the Welsh block, the Welsh budget, and serious implications for communities in Wales. And it's a deficit that they cannot expect the departments of Welsh Government, which have a very small budget anyway, and departments like our department, which was only recently re-established, within the last year—we cannot be expected to bear the additional burden of trying to replace European funding. My understanding is that we are now able to look at a transitional situation for up till 2020—that's the latest information we have.
So, with regard to the fact that our aims have never been higher with regard to where we want to be as a nation around elite sport and also activity for all—our high-level strategies, which are absolutely correct and visionary—what mitigation, then, have we got in our strategies longer term to be able to fill the gap that we must articulate, yes, but, then, in terms of health as well as the enjoyment of sport, we also know we have to fill that gap? So, what is the replacement? How are we going to meet our aims if we know that the level of finance is not going to be anywhere near as healthy as it has been?
The only thing that we can propose is more effective use of shared budgets, and that's what we're doing.
And so, how important, then, is it that community schools' public assets are then opened up to the community?
Yes, I certainly accept that and I've already threatened legislation, earlier on in this committee, and I'm prepared to pursue that. It might be that we would want to prepare a draft Bill to make it absolutely clear that we had a determination to ensure that, but I don't want to threaten public bodies with something that we will not deliver. But in terms of the level of funding, I think we have to be completely realistic and understand that this is where we are and this is the mess that we've got ourselves into as a nation, quite frankly.
So, finally, Chair, if I may ask this: you've touched upon lottery funding and the scarcity of that and the fact that, with project moneys being withdrawn across the UK and across many different programmes in terms of charitable work and voluntary organisations, that pull is very great now. What can we do in Wales to better—and you mentioned your responsibility—pull on lottery funding? What is the strategy around that, because we know we don't get what we should get?
There's nothing I can add, really. Gillian, is there anything you want to say?
Okay, we're a bit pressed for time. Thank you for that, Rhianon. Dawn is going to wrap things up.
Yes, just on the impact of investments, really, and if you could perhaps give us an overview of the performance indicators that Government uses to measure the impact of investment in sport and physical activity.
The measurement of performance is something that is requested in the remit letters very clearly. I won’t read them out, but, as I indicated, the latest one was in February 2018 and there will be another one, if I’m still in this post, obviously, within that timescale. I will certainly make sure, because of the interest raised during this scrutiny in the question of accurate statistical information that is easily available to Members, that we have all the information that we have currently available shared with this committee as a result of this scrutiny. Do you want to add anything there, David?
At the moment, Sport Wales tends to focus on chief medical office activity levels—numbers of people participating in activity at a certain level and intensity per week. That’s useful. We have actually commissioned Sport Wales to work with Public Health Wales and Natural Resources Wales on a more granular level of outcome indicators that we can use in future and that work’s ongoing at the moment, but at the moment they’re quite closely tied to the CMO—
Okay, that's helpful. It's just that I think that, given all the things that the Minister's been saying about the difficulty of budgets and the shrinking budget, we need to be very sure that what we are investing is actually delivering the outcomes that we're seeking. So, okay, thank you for that.
We've talked a lot about projects that are going to be undertaken and about the need for those projects to have the time to develop. Of course, we need to tie the funding into it. So, I just wanted to confirm whether or not you're planning your funding on a three-year rolling basis, because I think that Sport Wales only gets—although their remit letter covers a three-year cycle—a year of funding confirmed at a time, especially when you're looking at shared projects and you're talking about shared budgets where, for example, health is moving more and more to a three-year cycle. How are you dealing with that tension?
Well, I'm afraid that some of these questions need to be addressed to the UK Treasury. I would start there. And that's not a political point, but it's very difficult when you're dealing with public funds when you don't know the overall block for an appropriate period. The firm budget for 2018-19 we have now been able to stretch, as I mentioned earlier, to cover the programme of this Government, which will take us to 2021. But, as you indicate, it is indicative for the third year. I don't think there's any other way of operating that the finance Minister would countenance—I think that's the answer to that.
I think, in health boards, though, they're moving to a three-year funding cycle to tie into their integrated medium-term plans. So, I kind of assume that throughout Government there's going to be a drive to three-year, because one of the great arguments I know I hear in my constituency is of great projects that have just started and then can't get the funding for year 2. It's very difficult to recruit people or to maintain that substitutability, because otherwise we're just ripping up £1 notes—if we had £1 notes still, but we're ripping up whatever the next note is—in a park.
We recognise the issue. Most outside bodies would prefer certainty of funding over a longer period. This year, we've only been given a one-year indicative budget by the finance department, by the finance Minister, so that's what we've been able to pass on to Sport Wales. But we recognise the issue.
Okay. So, the last quick question, then: are there any projects you're working on that are joint or shared funding projects where the other partner has got a more secure budget line than you have?
Grêt, diolch yn fawr. Dyna ddiwedd y sesiwn gwestiynu. A allaf i ddiolch yn fawr iawn i'r Gweinidog Diwylliant, Twristiaeth a Chwaraeon, a David Rosser a Gillian Otlet am eu presenoldeb a hefyd am ateb y cwestiynau, a hefyd am ddarparu'r dystiolaeth ysgrifenedig ymlaen llaw? Diolch yn fawr iawn i'r tri ohonoch chi. Diolch yn fawr.
A gaf i gyhoeddi nawr i fy nghyd-Aelodau y gwnawn ni dorri am egwyl fer, ond i aros yn yr unfan am gwpwl o funudau? Diolch yn fawr iawn i chi.
Great, thank you very much. That's the end of the questioning session. May I thank the Minister for Culture, Tourism and Sport, and David Rosser and Gillian Otlet for attending this morning and also for answering the questions, and also for providing the written evidence beforehand? Thank you very much to the three of you. Thank you very much.
May I announce now to my fellow Members that we will have a short break, but if you could stay where you are for a couple of minutes? Thank you very much.
Gohiriwyd y cyfarfod rhwng 10:17 a 10:35.
The meeting adjourned between 10:17 and 10:35.
Croeso nôl i bawb i'r sesiwn ddiweddaraf o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad Cenedlaethol Cymru. Rydym ni wedi cyrraedd eitem 4 erbyn rŵan, ac effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â gofalwyr. Y sesiwn dystiolaeth ddiweddaraf sydd o'm blaenau ni, rŵan, ac mae'r sesiwn dystiolaeth yma gyda Gofalwyr Cymru ac Ymddiriedolaeth Gofalwyr Cymru. Felly, i'r perwyl hwnnw, rwy'n falch iawn i groesawu Claire Morgan, cyfarwyddwr, Gofalwyr Cymru; Simon Hatch, cyfarwyddwr, Ymddiriedolaeth Gofalwyr Cymru; a hefyd Gareth Howells, cadeirydd, Ymddiriedolaeth Gofalwyr Cymru. Rydym ni'n ddiolchgar iawn am y doreth o wybodaeth rydych chi wedi cyflwyno ymlaen llaw—y wybodaeth ysgrifenedig. Wedyn, yn deillio o hynny, mae yna rai cwestiynau y mae Aelodau eisiau'u gofyn. Felly, i'r perwyl hwnnw, awn ni'n syth i mewn i gwestiynau ac mae'r cwestiynau cyntaf o dan ofal Lynne Neagle.
Welcome back, everyone, to the latest session of the Health, Social Care and Sport Committee here at the National Assembly for Wales. We have reached item 4, the impact of the Social Services and Well-being (Wales) Act 2014 in relation to carers. This is the latest evidence session, and it's an evidence session with Carers Wales and Carers Trust Wales. So, to that end, I'm very pleased to welcome Claire Morgan, director, Carers Wales; Simon Hatch, director, Carers Trust Wales; and also Gareth Howells, chair of Carers Trust Wales. We're very grateful for the great deal of information that you have sent to us beforehand—the written information. Resulting from that, there are some questions that Members wish to ask you. So, to that end, we'll go straight into questions and the first questions are from Lynne Neagle.
Thanks, Chair. Good morning. Just for the record, can you just give us a bit of a summary about how many carers we have in Wales and the scale of the work that they do?
Yes. If we take the census figures, there are at least 370,000 carers in Wales, although that's likely to be a large underestimation, because that was people self-declaring themselves as carers. Sixty per cent are aged 50 plus; 28 per cent provide over 50 hours of care a week, and obviously that's changeable because responsibilities change; 49 per cent of carers work and care; and the peak age to care is between 45 and 64 and there are a lot of people who are what we call 'sandwich carers', so they're both caring for children and caring for elderly relatives. Every year, approximately, 125,000 people will become carers, and an equivalent number will stop caring, so there's quite a large flux within the carer population. It's estimated that there'll be a 40 per cent rise in carers by 2037, so there'll be over 0.5 million unpaid carers by then. The value of unpaid care in Wales is roughly £8.1 billion a year.
A reasonable amount. Not enough in terms of the statistics. We know that there are, according to the census, 7,500 under 16 and a further 21,000 are generally referred to as young adult carers between 16 and 25. Very clearly showing a lot of unmet need in terms of the challenges to their practical daily routines, to their emotional well-being and to their ability to live any kind of life alongside their actual caring role. Gareth, do you want to give any examples in terms of what you see locally?
Yes. Particularly in terms of young carers services, we deliver a number of young carers services and the breadth of support that they provide to both their siblings, potentially, or parents: they could be providing support to a disabled child within the home, they could be providing support to a parent with mental health problems or with a drug and alcohol issue, and the breadth of support can be from providing breakfast in the morning to that person, to providing real, intense, emotional support. There's a real range and scope of support that that young carer can be providing.
Do we know how many carers are under 16? Presumably, there are lots of young carers in that position.
The estimates from the census say 7,500 Wales wide. We know that research by Professor Saul Becker indicates that it's likely to be four times as many because of underreporting. And we know that, in terms of the opportunities for their life chances, there are some very, very clear negative impacts that have been recorded for all young carers: they're considerably less likely to go on to get a job, to leave school, to go to any further or higher education, and statistically they're four times more likely to drop out of further education or higher education if they get to that education.
And, if I may just very briefly give you an example of one of the young carers that we've supported recently, called Lucy, who is now a young adult carer and is training to be a teacher. Like many young carers, she struggled at home. She looked after her mum and her sister—her mum's very ill—just on her own. Like 26 per cent of young carers in Wales, she was consistently bullied because of her caring role. At home, she took on a range of different domestic roles, including cooking, cleaning, managing the family's finances and attended medical appointments with her mum and her sister, regularly taking responsibility for the managing of that medication. But, unlike most young carers, a teacher took time out with her to have a long conversation about her role and wrote her a letter and put her in contact with the local carers service, which resulted in her going on to higher education close to where she lived so she could do it from home. This is actually not very far from where we are. At that point, Lucy was incredibly grateful because she was in crisis. The local service supported Lucy to go to university. And I think the key thing here is that the formal systems and processes around her didn't pick any of this up; it was one individual. There was no structure that supported her until she reached crisis point, and it was a teacher reaching out to her in that circumstance. And what that teacher did was, herself, go out and find out the fact that there was a local expert carers service that did work with young carers and teenage carers every day and which was able to support her.
Apologies if this is about to be asked. Is there a need for a revised code of practice for local authorities in this regard?
In particular with regard to young carers, I think, there are some exemplar tools that are in place and there is some practice that is going on, which is called the Young Carers in Schools programme. I think that young carers, the majority of their engagement with professionals is through education, is through schools. It isn't necessarily—. There is some guidance, particularly in relation to how young carers services should be structured through local authorities, and in particular there is—
In regard to local government, local authorities' liaison with schools, training through the headteacher forum, et cetera, et cetera, is there—yes or no—a reason or need for any revision of the guidance around young carers?
You've referred to the census data. Do you think we've got enough information about carers? For example, what do the local authority health board needs assessments contribute to our knowledge of carers? Are they delivering the goods?
I think Carers Wales's Track The Act work that we've done demonstrates that there's really poor data collection about carers across Wales. That's due to different systems being used, different ways of capturing information and also systems not identifying carers when they go to local authorities. It's definitely the case that, in some areas, the information and advice service is gatekeeping as well to try and manage capacity.
Okay. So, one of the concerns you've expressed is that carers aren't identified when in contact with services, so opportunities are missed. How do you think that could be addressed so that every contact really matters and nobody falls through the gaps?
When the social services and well-being Act first came into place, there was a lot of training within local authorities that took place, but we know that those services are often in flux. People move on and that's training that I don't think is kept up. I think the ability of people in the information and advice services is not always there in terms of identifying carers and listening out for the right sorts of things when people are talking about their own personal circumstances—
Because a lot of people don't realise that they are carers, do they? That's very common.
Well, our research found that 50 per cent of people in Wales say that they don't know a single carer. That's crazy, because we know that there are a lot of carers and everybody will know a carer. It's just that they're seeing people as a wife, a mother, a son, a father, and not as a carer.
There is a considerable amount of data available about carers; it's just it sits in a range of different pockets and there's no structure or system to actually pick it up. Certainly, we should be making every contact with a carer count, and that should absolutely be via public sector professionals, and we need to find better ways of doing that. There's a lack of national data, but if we think about the sort of data that my colleague Gareth and other local carers services have around Wales, it's considerable. It's rich in its depth and in terms of the quantity as well as the quality. I don't know whether you want to flag that, because I just think that that mustn't be missed here that there is a considerable amount out there; it's just how it's used.
Definitely. In terms of data that is collected on carers, there is an awful lot of data that is actually there before the local authority line, before the statutory services are there. The majority of services that are provided for carers are now provided within the third sector. There needs to be a mechanism for how that information is used. It shouldn't just be about what is contained within the local authority remit or the health board remit. It's about what's there already. There is a wealth of knowledge across Wales in terms of the information and the support and the IA that is being provided outside of that statutory concern.
So, you're saying it's there but it's not all joined up, and nobody can use each other's information basically.
I think the other thing is that four out of five carers will be identified for the first time in a healthcare setting, in a primary care setting, and that's not always captured either, which is a huge shame.
You've touched on this already, but if you can perhaps say a little bit more about how effective you think the information and advice and assistance services provided or commissioned by local authorities are—and if you've also got any information about how effective any provision through the medium of Welsh is, because that's very important, particularly for very young carers and older carers.
Our Track The Act survey of carers showed that increasing numbers of carers are actually seeing information provided by the local authority or provided by the third sector organisation that's commissioned to provide that service and that, when they see it, they find it useful. But the issue is that not enough carers are seeing that information. We need to increase the reach of that information out.
There are numerous opportunities lost to identify and support carers. Those systems are out there, particularly in terms of health and in terms of the opportunity to be preventative and to engage with support, sustainability and sharing of knowledge across the third sector prior to crisis and prior to the need for carers to be identified or go into local authority systems potentially to try to—. The Carers Trust carried out quite a lot of work with professionals in this area. I'll ask Gareth to say a couple of words about our Young Carers in Schools programme, which builds on the first question, but there is a range of toolkits. What we're finding is that it's the third sector that are leading and pushing and providing the sets of skills and material that are actually needed out there, and that is a struggle for us both nationally and locally and regionally.
I think in terms of IAA generally, there are some very good models for how that's working, and there are also probably some poor examples of how that isn't being co-ordinated in a true partnership perspective. In terms of Young Carers in Schools, that's probably a good example of how that works collaboratively with education, with the local authority, with health, with local carers services and with carers directly about how a model can be put in place to make sure there is effective information and advice right up front for young carers. There are similar models that are then replicated, not just for young carers, but there's the Triangle Of Care. There's also the work within GP organisations across various aspects of various areas within Wales. In terms of the Welsh language, I think that that is responded to very well locally, rather than from a national perspective. So, my colleagues in north Wales respond locally and are able to respond to the demand that is there in north Wales, and that is, I suppose, responding from a regional footprint where that's needed. Rather than a benchmark where everybody does the same, it's responding to need.
I think the other issue around IAA is that there's often a lack of transparency about what—
Sorry, Chair—sorry, can you explain, perhaps to nobody on this committee, what IAA is?
Information, advice and assistance. It's often the fact that carers won't want to go to the local council for support. They'll see that almost as a failure in their ability to care, and they're concerned about what people might say, both from the local authority and other people if they know they've gone to a local authority. So, I think we've got a large piece of work to do around reassuring people what support is available and what that means in terms of their everyday experience of caring and that that should be helpful to them and not an assessment of their ability to care; it's supporting them to continue to care.
Thank you. In response to your point about the Welsh language, I would point out that, in terms of numbers, there are more Welsh speakers living in Cardiff than there are in many parts of—. So, I don't think we should be satisfied with public authorities taking a regional approach, because increasingly there are more and more both young carers and adult carers living all over Wales, and when you're under that kind of pressure certainly receiving a service through your language of choice can make a real difference to the outcome for you.
You've already talked about how the opportunities to identify carers and start the process of offering support is getting lost in the NHS, in your view—that that's not happening. How do you feel the role of the NHS has changed in relation to identifying and signposting carers since the Social Services and Well-being Act (Wales) 2014 came in, and the Carers Strategies (Wales) Measure 2010 was repealed? I should declare a bit of an interest there, because the previous piece of legislation started with private Member's legislation that I initiated, so I suppose I've got a bit of emotional attachment to the old law. But do you see there having been a change in the way the NHS is dealing with this since that legislation changed, and what do you think we could recommend to Government about how that NHS role might be strengthened, if that's necessary?
I think there's been a step back from the health sector since the social services and well-being Act came into being. It seems to me that because it says 'social services' in the title of the legislation, there is an expectation that that's a social services responsibility. And so, one of the recommendations from Track The Act was that the health sector is given more responsibilities, again through the legislative process, to identify and support carers. Having said that, for the first year this year, we did ask local health boards to provide information to the Track The Act survey, and there are pockets of really excellent work going on within the health boards, particularly around GP surgeries supporting carers, hospital discharge. So, I think we can't say that it's all awful, but there's certainly a need to improve consistency and recognition within health.
There's no strategic direction now—that's the difference. There's no requirement for health to do anything other than work in collaboration under Part 9 of the Act. So, that's all gone with the end of the carers Measure, and Carers Trust Wales co-ordinated a carers leads group from local health boards recently to listen to those people specifically to get their messages on this. They're very clear that there isn't a strategic direction. So, most of their posts are being paid from what was called the transition money post carers Measure, which is about £1 million that has gone and doesn't really sit anywhere, and it goes to support those posts. But in terms of the priorities and the roles—so, it could be patient advice and liaison roles, it could be dedicated carer leads—they're often part time. They don't have the same level of strategic influence. They were never massively strategic at, sort of, board level previously, but they've definitely gone down. And their message to us was very clearly that if it's actually going to change, it needs strategic direction from Welsh Government.
Thank you, Chair. In regard to the static level of assessments that there are is the moment, are you satisfied—bearing in mind what you said earlier in terms of the 40 per cent increase—that that is satisfactory, and what can be done, possibly in three points—that's from any of you—as to how we actually progress the numbers of assessments?
I think the first issue is probably around knowledge, so knowledge both within carers of what carers needs assessments are and what that affords people in terms of support, but also knowledge within social work—people who are actually doing the assessments, and whether that is done in the best possible way.
So, we'd like to see a national public awareness campaign around carers and caring.
And then, the next element is around the work that Social Care Wales is doing at the moment, which is around a toolkit to improve the process around the 'what matters' conversation and carers needs assessments. I think that would really help to improve the process around carers needs assessments.
I was under the impression that there already was a toolkit. Are you saying that there's not?
No, there's not. It's going to be in the new year.
Okay. So, it's on schedule to happen, so that needs to be rolled out across Wales, effectively. So, outside of knowledge and the public awareness campaign, what else needs to happen to increase assessment levels?
The critical issue is funding, because the reality is that a lot of social workers, or people undertaking the carers needs assessments, will be concerned about raising expectations about what support is available, because in many cases that support isn't available. So, I think if we had more funding, we could both increase the number of carers assessments and be confident about the fact that there would be services there to support carers.
I absolutely endorse the points Claire has made. Assessments need to be done properly, at the right place at the right time, and they need to take long enough, and they don't necessarily need to be delivered by local authority staff. Everything else that Claire has said I completely endorse. But I would also make the wider point that—again, wedded to Part 9 of the Act a little bit today, because it's so important, I think, in terms of collaboration and prevention and all the things that we've talked about—what is really important here is that we find a way to work with carers, identify and support carers in the community, prior to the need for quite often what is a crisis point and a formal assessment. Of course, there should be the requirement for the active offer from the local authority under the duty, but so much more can be delivered prior to the need for an assessment at all. And when you investigate and talk to carers—when you investigate this statistically and when you talk to carers—they very often give you that message.
There are many things that practically do need to be delivered, and the scale of that is the responsibility of the local authority, to deliver that, but in many, many cases that's not the case, and it can be provided by local third sector services, who are, let's be honest, often more public, more present, more trusted, and they are the experts. And I think that we need to be working with the carer experts, given the particular pressures that we have, as well as making sure that every contact with a carer at a professional level counts.
So, you'd obviously like to see more third sector engagement with local authorities on a more collaborative, professional level. Some carers that we were honoured to speak with at a recent round-table addressed a number of these issues with us, and one of the points that was actually made at the table that I was at was from somebody who stated that she wasn't actually clear that an assessment was taking place. What's your comment on that particular issue, because it was a theme?
It's absolutely the case, isn't it, that, basically, there's a lack of understanding when conversations take place between a social worker, or whoever is providing support, and a carer, about the status of that conversation. And it's often the case that people don't know that they're actually going through an assessment. And it might be that they're perhaps having a 'what matters' conversation, and in some local authorities that is the assessment, and in other local authorities that's the precursor to the assessment.
The other issue is—
So, I'm hoping, through this toolkit that Social Care Wales is going to create, that there'll be more clarity and more guidance about how carers should have that explained to them—the status of the conversation.
I also think that there's a big step, almost coming from what Simon was saying, before we get to that assessment stage. So, the figure of 2,000 support plans has come out of those assessments. There are actually more support plans in place across Wales than that. We supported 2,000 carers in Gwent last year. Every one of those has a support plan, but that isn't a carers assessment. So, that support plan is meeting need, and, actually, that is probably preventing the need to get to an assessment. So, there's a recognition that not everything—. Assessments are important, but at the moment they're being used at crisis point, like Simon said, but, actually, there is a level beneath that where there are support plans and there are 'what matters' conversations. The third sector have been involved in that training around what is a 'what matters' conversation and how we then put in place—
Okay. So, there's a definitive need, but we think that the toolkit—
When you do your carers assessments, do you then link in with the local authority and let them know that you're doing that, or are you doing this independently of the local authority?
So, these aren't statutory carers assessments—
No, I understand that. This is what you're doing. But are you then flagging up with the local authority that, actually, there's an issue here that they need to be aware of?
So, it depends on the local authority and the relationships between the local authority and what's been commissioned by them. I'll give you an example in Caerphilly. We are commissioned to deliver a mental health advocacy service for carers. If our service is meeting that need, we wouldn't then need to make a referral for a carers assessment. If we feel that there are needs that we cannot meet, we'll then refer to the local authority for a wider carers assessment.
So, in that regard, it's extremely preventative in terms of that spend, is it not?
I need to ask now in terms of your assessment of young carers' level of care being appropriately assessed. So, what is your view? I believe that there is a feeling that there is a lack of clarity about the extent to which assessments consider whether the level of care being provided by a young carer is appropriate. Now, that's being picked up elsewhere in terms of the forum that we attended as well. Obviously, if on somebody's list it says that this young carer has been assessed, et cetera, and is receiving care, it might be highly inappropriate. So, how can that be better identified and targeted?
The code could be revised. When you compare it to the Care Act 2014 in England and the Scottish legislation, there is a very specific difference, because they are specific about what 'appropriate' means, in terms of the expectation of the young carer themselves in that caring provision, and what is not appropriate. That is not made clear in Wales. So, that's a very practical thing that could be done. But, then, in terms of delivery, again, much of this is about funding and services and the join-up between public services and public sector bodies and the third sector. Gareth, do you want to—?
Yes. Particularly young carers' services and that support that is provided and that assessment of need. One of the biggest issues is how young carers' services are funded. There are a large amount of young carers' services funded by Families First, which actually has its own framework of outcomes and assessment, which is irrelevant to young carers' needs as it's based on the anti-poverty agenda. Ultimately, on the young carers' needs, the commissioner is saying, 'You need to asses these needs, because that's an anti-poverty need', but we're actually saying, 'Well, that doesn't match a young carers' assessment needs.' So, there is no—
So, how can that—? Obviously, this is a groundbreaking flagship policy and there's great acclaim in many circles for it and it's had a lot of evidence-based outcomes that are positive. That, to me, is worrying, so how are you in your roles actually advocating that here today and how can that be changed? Because we're obviously missing something if that information isn't being transferred in the appropriate way. How can that be improved?
We can identify more young carers, firstly, at a national scale. We're working with Welsh Government currently to try and develop a young carers identification card—partly through the identification and support that that would bring to the young carer themselves, and the support it would bring to their family, and partly because of the links that that will create with professionals. But that again needs the links that I was talking about that were absent early in the case of Lucy. We need them to be there. So, there needs to be a level of resource, certainly at a local and regional third sector level, and then a leveling up of recognition identification at a national level. But those commissioning strands do need to be more appropriate to understand young carers' needs at the regional level, and currently they don't exist.
And where it works well is when it's actually based on a strategic plan from the local authority or from a region. When it is just based on the commissioning intention of a funding stream, it doesn't work. When you actually have a strategic plan in place by the local authority, and then, actually, each part of the local authority and health board work towards that plan, it makes a big difference.
Finally, if I may, Chair, in that regard, and in terms of rolling out a high-level strategy across Wales, what needs to happen in terms of spreading those pockets of best practice into a more mainstreamed policy?
There's definitely stuff around evidence gathering and information that is already being delivered very, very well in different areas, and actually bringing that together to give that best example of how young carers' services can work and how effective they can be. I also think the biggest change is around the funding of young carers' services, and that would be much more of a strategic funding source rather than—there's no direction that it has to be funded in each local authority in how it should be funded.
So, with the £30 million announcement around social care you would expect to see some strategic thought process around this issue.
A critical issue is that we know the number of carers is going to increase in Wales, yet we haven't got a strategic plan around what we're going to do to support those carers to continue to care. Ultimately, we need more longer term planning, both at national level within Wales and at a local and regional level.
This particular question is to Carers Trust Wales, but you're more than welcome to jump in as well if you want to. You make the point in your written evidence that the provision of good local services for carers can reduce—and you've touched on this—the need for local authority assessment and formal support. Can you tell us a little bit more about that? I suppose I've got a little bit of concern, if people haven't got a formal assessment, about the risks to the sustainability of the support that's provided. You've also suggested that the use of the third sector is potentially a very cost-effective way of providing the support that carers need. So, could you tell us a little bit more about that sort of balance between a formal assessment that theoretically gives people a right to services, and the kind of more informal approach that the third sector would take to working with a carer, and a bit more about the possible cost benefits of that sort of preventative approach of you stepping in, perhaps as a third sector organisation, before a formal process is needed.
Absolutely. I'll ask Gareth to talk about some of the detail of that in terms of the formality or informality of the assessment, the processes at a local and regional level, and then I can talk very briefly about the wider picture in terms of the cost savings and the value issue.
So, just picking up the one point around a carers assessment giving you that right to the services afterwards—I think that there is a mix, actually, that doesn't necessarily happen, and, actually, when it does, all they're doing is referring back to the preventative services anyway. So, for instance, somebody might have a carers assessment that says, 'Okay, they need respite.' Well, they'll refer back to our service to go and deliver the respite when there probably wasn't a need for a carers assessment then if that was a true preventative service. So, once they get past that stage, it's actually referred back to preventative services. Preventative services are there and they are managing that waiting list for assessments in a way and stopping and helping the demand and the need for assessments. So, just to highlight that, actually, once you get there, there isn't necessarily any additional help—there's no budget that comes along. And I think that is one of the challenges of people who are carrying out the assessments—to be able to actually respond to the need once it's been identified, because services are already commissioned, so that's the real challenge on that.
In terms of the mechanisms for assessments, that does vary, particularly for young carers and young adult carers and adult carers in general, in terms of what the process is for assessment. I think we could probably sit here all day and talk about that, but there are some examples where information is given upfront and people are then referred in and there is an officer within the local authority that does that. There is somewhere that's commissioned out to the third sector and they provide the upfront carers assessments early on to understand that need quite early.
I think there's a real professionalism and expert culture in the third sector around carers, but they're struggling financially across the piece. Carers' services have closed in recent years, at exactly the time when unmet need is going up. The level of formality and the quality that I see across Carers Trust and other third sector services in supporting carers is fantastic, but it's not joined up enough and it's not well resourced. So, a young carer officer might be working on two days a week—they might be using reserves to actually manage, they might be using a lottery grant to deliver core commissioned services because it's just not there. We know, as Gareth said, that the services post assessment—the services aren't there for people. I think that's leading into a downward spiral where, actually, you're seeing—I don't want to use this because it sounds overly negative—but gaming, in terms of the amount and the type and the nature of the conversations that are going on. Plus, of course, you're getting information, advice and assistance, and the issue is that social services are very much seeing that, and they're channeling that directly back to local carers' services, which is fine at one level, but it's clearly adding pressure because there isn't sufficient resource.
But in terms of the value and the point I wanted to make around that, there is some considerable evidence around the value of investing in carers' services per se, not simply in the third sector. There was some work the department of health did in the last couple of years that talked about extra spend on this particular study that they did with local authorities in England—extra spending on unpaid carers specifically, saving local authorities £429 million—sorry, a spend of £293 million saved councils £429 million in equivalent replacement care costs. There's work that's been done by us and an organisation called Baker Tilly and the department of health that talks about £1 getting £1.47 back in terms of the spend for the local authority. There's also evidence around what's generally called the social return on investment, the support in the community, showing, again, a sort of 1:4 ratio.
So, there is evidence out there that shows that by investing in this resource upfront in the community, you can actually not just provide a more trusted professional service, and putting the necessary safeguards in place to make sure that carers' rights are safeguarded and they are identified and supported professionally, but we're in the middle of the two at the moment—. There are some fantastic services and some fantastic people in local councils trying to do and amazing job, but both are struggling. If you were to ask me where resource was to be directed, it should, absolutely, be at the preventative element of this work.
I was just going to touch very quickly on—I think one of the words you used was 'sustainability'. I think that, if you work within the third sector and, particularly, within cares services at the moment, is the biggest risk to all those services. The services that I run across nine local authorities in south-east Wales—most of those I would class as non-sustainable. They are year-on-year funding, never committed—you can never plan for them effectively. Some of the additional funding, in terms of integrated care fund funding, is completely unsustainable for a service to be able to deliver when that's commissioned, when that's part of the third sector, but also the local authority, in terms of the regularity of the money and the strategic intent of the money. We've seen local services close down where there is no sustainability. Some of that is because carers' services are being badged within domiciliary care services, and being called the same. So, then, actually, they're going within a framework of domiciliary care services, when services for carers is completely different to a domiciliary care service, and that is a real issue in terms of the future sustainability of those.
I just want to explore, Chair, if I can, a little bit about the question of assessment, because I'm slightly picking up from some of what you've said that assessments are happening almost at crisis point. And you talk about the third sector services preventing people getting to the point when they need an assessment. Going right back to the previous legislation, the aspiration was that everybody got an assessment when they first became a carer. That would then enable them to access services further down the line. I suppose I'm a bit worried that we're getting to the point, in some places, where the assessments are only coming when carers are reaching a point where they can't manage anymore.
I think there is an element of saying—I can't remember who said it earlier on, but there will be a lot of carers who say they don't actually want to get to the assessment stage anyway. They want to just be able to access the support that matters to them, which is important to them. There are some people who will always need that assessment and need that statutory support after that. But what we hear from carers is, actually, they don't want to get—. That might be because of how assessments are messaged and because of the messaging and because of the fear of social services involvement, which is absolutely right in some cases, but there are a lot of carers who will tell us, 'We don't need an assessment, we just need a little bit of help.'
It also goes back to the point about identification. So, it's often the case that a carer won't identify until they're at crisis and they enter a health setting. And then it's at that point somebody will say, 'Well, you're a carer, you should have a carers needs assessment.' So, it comes back to the fact that we need to try and get more carers to recognise earlier on in their caring journey that they are a carer.
There was a really interesting interview on Radio Wales recently, on Good Morning Wales, where, after some interesting Age Cymru evidence on the numbers of assessments, they talked to two carers that we hadn't spoken to and our organisations hadn't spoken to. There was one older carer and one carer in her twenties, and they were both talking about a formal assessment process in relation to the evidence that was provided. The older carer described going through the process and not receiving any services from that, twice, and that that being something that she would now not go back—. It wasn't a particularly pleasant or unpleasant experience, it was just that there wasn't sufficient time given to it and nothing came of it. She wouldn't be going back because of that. The young woman described the fact that, entirely unplanned, that she had local carers—. Her description was, 'We had local Carers Trust services. So, the support I need, I get locally.' And then she was describing Carers Trust sir Gâr in Carmarthenshire, as it happens. And she was saying, 'I might consider it at a point in the future, but because I was put in touch with this particular local service, they support my needs at the moment.'
It's quite an interesting snapshot of the examples—I've no idea of their respective ages—and the answers they were giving when specifically asked about their experience of a formal assessment process.
Just the other point to make on the assessment and crisis point as well is that we know a lot of carers are actually waiting a long time for an assessment. So, it might be, say somebody's become a carer and they're caring 50 hours a week—to wait six months for a carers needs assessment is a very long time, and by the time they get to that assessment, they could well be at crisis point.
Yes. I was going to ask you about the resource challenges facing local carers' support services. I think you've covered some of that already, so I don't know if you've got anything else to add on that.
Only that it's vital and it's not there. Particularly given Gareth's example around sustainability, I think that the current funding mechanisms don't support sustainable carers' services. With sustainable carers' services, and with the right profile in communities—. We know that there is a plethora of fantastic third-sector organisations, but with a higher profile then we could, actually, move towards a more genuinely preventative service, rather than the going from year to year that they have to do currently.
Right, thank you. I don't know whether there's anything about providing services in rural areas that you could tell us.
We provide services particularly in Monmouthshire and the Vale of Glamorgan, which are two reasonably rural areas. So, just to touch on that, in Monmouthshire I think, coming back to that, it's more costly—it costs more money to deliver particularly respite services in rural areas. It's also more challenging to provide the real preventative services in that area, in terms of having the locations and bringing carers together so that they're not so isolated.
There are a few models out there that work, in terms of a hub-and-spoke model to deliver services, but, again, it's about investment in those. To be able to do that, local authorities are moving towards more well-being hubs, et cetera, within each local authority, but that is particularly challenging in rural areas, where there isn't the investment in transport and there isn't the investment in the other stuff that allows people to get into those services that are there.
I wonder if it would be helpful just in terms of some of what our 'State of Caring' survey found out over the last year, in terms of carers' perspective on their own situation and, I think, the impact of not having some of the services. So, 75 per cent have suffered mental ill health from caring; 61 per cent have suffered physical ill health; 40 per cent have given up work to care; 34 per cent said that they're struggling financially; and 46 per cent expect their quality of life to get worse. I think that's just the impact of not having some of these services resourced.
There's no plan to support these services. There is no national monitoring or resource plan—even a basic one—to say that this is a good thing. It's entirely dependent on, now, the way regional partnership boards interpret their remit and the way they work, but that's it. So, these services are not working on the basis of a plan or any structural funding from Welsh Government, they are operating on their own as independent charities, with links to similar other organisations and no links, and they are struggling to meet unmet need, but, in those circumstances, doing an exceptional job.
Thank you. What about regional partnership boards and the integrated care fund? What do they contribute towards developing carers' services locally and regionally?
There's a number of examples here where there are some good examples of how ICF has worked for carers. There are, probably, many more where the use of ICF funding hasn't been strategic and where it's actually almost impossible to use because of the parameters that are set around it. I can give examples where, actually, there are multiple bids going in that have been researched for a year or two, in terms of services for carers, but, actually, the issue with ICF funding is that it's tied up within core services within local authorities, and they have to use that money to supplement an NHS ay increase. There are real, live examples of where that has happened.
I'll give you an example: I attended two meetings last week where we were asked to submit bids on Friday. I attended these meetings on Thursday, submitted bids the next day for ICF funding for this year, which has to be spent by the end of March and cannot be carried over. So, we, as a local service, are going, 'Yes, we can deliver services for carers, but not in these timescales.' So, then, I've got to think about, 'Can I release a member of staff from another service that is delivering amazing services?' I'm a service-delivery organisation—I can't turn down money to deliver services for carers. So, how do I do that strategically? There's no plan around that—we're having to respond to that every single day and every single week.
ICF has the potential to be amazing, but, at the moment, with restricted ability to plan that money, and to be in November and still not have plans to spend this year's money, and then, actually, to be asked to think about what underspend I want to use by March as well when these bids get turned down—it's just unmanageable.
So, do you think the short notice that you've been given on this is—? Were all the partners in the same boat, or is this a question of treating the third sector as last in the queue?
Both. So, other partners—health boards and local authorities—are in a similar situation. They get the allocation—there is an indicative allocation early on—but, actually, the reality is they can't commit to that spend before April. So, local authorities are then continuing to fund core posts themselves through ICF, so they are planning late. They then get the allocation later on in the year, which then has to be approved by Welsh Government, which has only just been approved now for this year. Then, what happens is the third sector are not engaged in that first part of the conversation effectively enough, so then it's, 'There's loads of underspend. The third sector respond better to underspend, so let's see whether they can spend £50,000 or £100,000 by the end of March. We can't, because our recruitment issues are such it takes us months to recruit. The third sector can recruit because they'll just make some changes and respond to it.'
But I would make the point that Gareth's organisation at least has some ability to respond—to be in that meeting room—but there are many small third-sector organisations, supported by carer experts and carer focus in Wales, that would not have the capacity currently to have been in that room. They are struggling to provide the quality of support because there is no planning or resource framework—even a basic one—that comes down from Welsh Government. That is an absolutely key point.
Yes, I think you've answered quite a bit of what I was going to ask, actually, because what I was looking at was the commissioning of services from the local authority. In your paper, you did identify a number of issues around that. You talked about—you've said it several times—the lack of strategy. You talked about the RPB membership and that you've got no financial autonomy, and that there's a power imbalance impacting on the quality. So, what is it that you think that you could do or that the Welsh Government could do—that we could do—to overcome some of those difficulties, because they're clearly writ large in your evidence? You've mentioned it a few times, so what pointers would you give us to how some of those things could be overcome?
I think one is true, meaningful engagement of the third sector. I know that's a sweeping statement—if you could solve that, it would be amazing.
Just on that point, because that is really important, you mention the fact that you don't have a seat at the partnership boards, for instance. You can't have every third-sector organisation sitting on them, so how do we overcome that? In my constituency, for instance, we've got a fantastic organisation called VAMT, or Voluntary Action Merthyr Tydfil. So, do you see an overarching third-sector body as being somebody that could perform that role?
If there was a strategic plan to prioritise preventative support for carers across Wales that required regional partnership boards to deliver that work according to a certain framework, then that would go a considerable way towards doing that. That's about prioritisation—that, in itself, would happen. Currently, we are dependent on the way regional partnership boards interpret this.
In terms of the politics of it, there's an unpaid carer representative on every regional partnership board—they are a carer volunteer in that sense. So, the commissioning processes are not working for carers, but there's no other strategic priority to say how—even that there's a spend that could be commissioned, planned and worked in partnership with the wide range of organisations in the area. It's not about our organisations—it's about all of them, and about regional partnership boards having responsibility and a requirement to do that because Welsh Government say it's enough of a priority.
I was just going to say that what the carers' representatives will often tell us is that by the time it gets to the regional partnership board it's often a fait accompli, and their ability to influence is limited. So, they're trying to link more with the partnerships below the regional partnership board to influence some of the discussion that takes place there.
No, that's fine. Some of the challenges, in terms of my sweeping statement, sorry, are that I think county voluntary councils in general have a very difficult job at the regional partnership board. If you think about the other partners around the table, they're actually representing a bigger workforce and a bigger community—one person sitting there as the chief exec of a CVC—than the rest of the people in the room.
I'll give you some real, practical examples of how I think that could change. We have one example in Cardiff, actually—in Cardiff and the Vale of Glamorgan—of how we have worked with the local authority, the health board, and the CVCs in Cardiff and the Vale of Glamorgan, to develop a model for carers services around carer engagement and carers hubs within the area. We researched that with carers. We had an expert panel of carers set up to research that, and the model was put together. This was presented to the regional partnership board. I had written that. My team had written that. We were asked to submit a bid to ICF funding for that. They came back and they had some questions about the model. So, I said, 'Okay, we'll come along to the RPB and have a chat with you about what the model means,' because you've only got so many words to write about what has been two years' worth of research. 'No, you can't come; CVCs are the only ones allowed in the room, because they're your representatives.' We're the experts here, we're the carers' services here, we're the ones that have written this model, we're not allowed to attend that meeting. So, actually, having the experts in the room—not all the time, I agree, otherwise there would just be 100 people in the room all the time—but if you're going to be considering ICF around—
So, having somebody there to have the appropriate discussion at a particular point in time would be helpful, rather than you being—
Absolutely, which would happen from a local authority, because, actually, the local authority would send their most appropriate person to present their bid. In the third sector, you wouldn't; it's, 'No, the CVCs are there; you're represented.' I feel for CVCs in that respect, but actually they don't have the mechanisms to be able to then fully consult with everybody in the third sector—
Yes. So, giving the CVC the authority to be able to say, 'On this occasion, actually, what we're going to do is bring so-and-so in.'
Okay—got that point. My final question, Chair, if I may, is around the question of service models that you've just touched on, and what is the most effective. You've set a piece out in your evidence around that. What, in your view, would good practice look like in the delivery of a service model, and how can we promote that?
In terms of the model you've described, I'm happy to speak, but I just think if—
The hub-and-spoke model really is a true partnership integrated model—
This is the English model.
So, there are some examples in England where it's happening as well, and we've taken that model to think about how it can work inside the Act, within the RPB framework. The model in particular looks at—. It isn't a stand-alone model, but it is a single point of access for carers. It is the ability to break down the barriers of having to go to Carers Trust services for one, go to a local authority for this, go to Age Cymru for this, go to Alzheimer's for this support—
A one-stop shop, but breaking down the barriers between third sector, between the local authority, where you have that single front door for a carer to come through, and then actually there is that real behind-the-scenes stuff that a carer doesn't need to see, about the politics of who funds what. That doesn't need to happen. But that there is a single front door for a carer to walk through—virtually as well, not just a physical front door.
Absolutely, so that a carer can go, 'I just need support; I don't care who pays for it.' It is just about saying that there is a single front door, there is a hub-and-spoke model here that says, 'We will reach out into communities and work with other well-being hubs that work with the local authorities, that work with GP services, that are able to just do that back-office stuff that a carer doesn't need to be involved in.'
Okay. We're nearly out of time now, so Rhianon will have the joy of rounding things off.
Thank you very much. I've got a specific question around carers and respite, and then a general question that I would like to get an answer to, if I can, before we finish. So, in regard to the pressures on local government and the extreme pressures on social services across Wales, what is your view in terms of the scenario across Wales at the moment, where respite is actually being looked at in terms of non-statutory, and is being, in some cases, looked at to be cut? Is it important to you that carers have access to respite?
Yes, massively. Carers say this. We are doing a piece of work at the moment, which you could potentially investigate, which is delivered to Welsh Government, in great detail, talking to carers across Wales about this. Their message is that, absolutely, they need a variety of different respite. It certainly needs to be more flexible, but, most importantly, it needs to be regular and consistent, and it absolutely isn't.
So, in regards to Scotland—. In regard to other nations where they have a different approach in terms of respite care, do you think we should be following their lead?
I think we should be looking at it and thinking about that, but before we look at new legal requirements, we should be looking at resources, because unless we're prepared to look at how we are able to implement the legal requirements we're putting in place without resources, it will not happen. Resources are absolutely key, with breaks, with respite, and with the regularity that people need them.
Which brings me very nicely onto my final question. In regard to the discussion at the moment around a levy for social care provision, outside of the millions that have been provided around social care within this budget scenario at the moment, do you feel that that is a way forward?
I think it may well be a way forward. I am concerned with the implication that a levy is a panacea for social care. I think social care and the issues around it—. Carers must not, firstly, be seen purely through a social care lens, as I think we've described today, in terms of all public professionals being supported, particularly across health. I think a levy is one mechanism and certainly should be reviewed, but as we keep, potentially, moving the mechanism with which we support social care to new pots, I think that there is a risk that the services—. Never mind the crisis points that the carers are getting into, their crises are often, as you can imagine, very intimately connected to the people that they're caring for and their family situation. We know that the services for those people are, clearly, not there, and there are some real problems with the eligibility criteria, both for them and for unpaid carers themselves. So, I would be concerned that we don't—. Investigate a social care levy: it needs to be done very much with our eyes open and about what it could potentially mean.
Very briefly, on the balance between resources and statutory requirements, of course, if an organisation is statutorily required to do something, they will on the whole find the resources, so I'm slightly putting it to you, Mr Hatch, that it's kind of horse and cart, isn't it? I mean, we're getting to the point when local authorities are moving towards only providing the things that they're statutorily required to do, so isn't that an argument that at some level we ought to be statutorily requiring them to provide respite, as they do in Scotland?
Excellent. It's been an excellent session. Can I thank you—the three of you? Excellent. And the excellent evidence we had beforehand as well. It's very detailed, and all of it will be amassed in the final report of this committee. You will receive a transcript of this debate as well, for you to make sure that you're happy with it—that it was actually an account of what you actually did say. Okay. So, thank you very much indeed. Thank you. Diolch yn fawr.
We'll just have a two-minute break while we get the other witnesses in. Two minutes. Okay.
Gohiriwyd y cyfarfod rhwng 11:32 a 11:37.
Gohiriwyd y cyfarfod rhwng 11:32 a 11:37.
Croeso nôl, felly, i'r sesiwn diweddaraf o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad Cenedlaethol Cymru. Erbyn rŵan, rydym ni wedi cyrraedd eitem 5, ac rydym ni'n edrych ar effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â gofalwyr. Hynny yw, roedd y Ddeddf yma i fod i drawsnewid y tirlun i ofalwyr. Rydym ni'n cymryd tystiolaeth fel rhan o'n craffu ôl-ddeddfwriaethol ni fel pwyllgor i weld os ydy'r trawsnewidiad yna wedi digwydd.
Y sesiwn dystiolaeth ddiweddaraf nawr: o'n blaenau ni, mae Comisiynydd Pobl Hŷn Cymru a hefyd Age Cymru. Felly, i'r perwyl yna, rydw i'n falch iawn o groesawu Heléna Herklots, Comisiynydd Pobl Hŷn Cymru—bore da, Heléna—a hefyd Victoria Lloyd, prif weithredwr Age Cymru. Yn ôl ein harfer, diolch yn fawr iawn i chi am eich tystiolaeth ysgrifenedig ymlaen llaw—bendigedig, mae'n rhaid i mi ddweud, ac yn fanwl—y ddwy ohonoch chi. Diolch yn fawr iawn. Yn ôl ein harfer, achos cyfyngiadau amser, yn sylfaenol, awn ni'n syth i mewn i gwestiynau, ac mae Helen Mary'n mynd i agor.
Welcome back, therefore, to the latest session of this committee's meeting here at the National Assembly for Wales. Now, we have reached item 5, and we're looking at the impact of the Social Services and Well-being (Wales) Act 2014 in relation to carers. This Act was supposed to transform the landscape for carers. We're now taking evidence as part of our post-legislative scrutiny as a committee to see whether that transformation has occurred.
The latest evidence session now, and before us we have the Older People’s Commissioner for Wales and also Age Cymru. So, with those few words, I'm very pleased to welcome Heléna Herklots, the Older People’s Commissioner for Wales—good morning, Heléna—and also Victoria Lloyd, chief executive of Age Cymru. As usual, thank you very much for your written evidence—excellent, I must say, and detailed—both of you. Thank you very much. As usual, because of time restrictions, basically, we'll go straight into questions, and Helen Mary Jones is going to open.
Good morning, both, and thank you, again, for your written evidence. I'm going to focus in a minute on respite care, but, first of all, there's a suggestion in the evidence that care services are focusing more on people with the most complex needs and that that's having an impact on older carers. So, in your view, do the eligibility criteria under the social services and well-being Act work against the interests of carers?
I think there's a couple of issues here: (1) because the eligibility criteria are quite tough in the sense of the level of need that you need to demonstrate before you get any services, that has an impact on the services that somebody gets who needs that care directly. So, it means that, if you're caring for someone, say, with moderate need, you may not get that additional support for the person you're caring for. So, if that care isn't there for the disabled person or the other older person, it falls on to the carers to pick that up. So, there's both an issue about the eligibility criteria for the person who directly needs the care and then also how the carer can themselves access support for their caring role.
I think that's quite important because the carer themselves might not actually have a need themselves, but then may also have issues that are perhaps not then taken into account in any assessment of the person that's being cared for in the first circumstance, and then, depending on what care they get, that can have a huge impact on the life of the carer, particularly if they haven't had a carer's need assessment. So, there's that kind of interaction between these two individuals, and that 'can and can only' test, I think, can have a huge impact.
Thank you. To turn to specifically looking at respite care, then, what are the particular needs of older people in terms of respite care, both in terms of what are the particular needs, perhaps, of older carers as well as an older person who's being looked after?
I think it's important to think about older carers and the diversity of older carers. So, if we're talking of people between, say, 60 and 100, you could have people in their sixties caring for older parents in their eighties or nineties, but you could have, typically, a couple in their eighties, mid eighties, caring almost interdependently for one another. So, that issue about people understanding they're carers is, kind of, a big challenge, and I know you heard earlier about that.
So, in terms of respite, what we've found from the work that my office has done over the years is, first of all, a lack of awareness around respite—so what it is, how to get it. And it's very timely, because we produced a guide just this week, actually, on accessing respite care because we know that people don't know about it, don't know the routes to get it, or the type of respite that there is. There's also, though, a big issue about, if you like, the supply of respite, and this really touches on the wider issue around the capacity at the moment within social care to have the services that people need, and respite is a crucial one. We know how important it is for carers to take a break. We know about the huge health impacts, detrimental health impacts, particularly on older carers. So, without that respite, people's health is deteriorating, people's physical and mental health is deteriorating. So, it's a really critical area, and, in a way, I think it shows up the wider issues about the current stress within the social care system.
Yes. We've heard already from the evidence session we had earlier about the amount of carers, the amount of care assessments, and, I think, for us, in terms of respite for older people, it's about not having to have that fight to get it. It needs to be timely; it needs to be at a point where it can avoid the crisis. And it's about the types of respite that are available, because not everything is suitable for everybody. The person that's receiving the respite, it has to be suitable for them. We did some work with the older people’s commissioner's office around the needs of people living with dementia, and it seems that services can be provided as a one-size-fits-all—it's about a group or it's about a session, whereas, actually, people are looking for more individualised approaches, things that stimulate on an individual level, not, 'We all go along and sing', because that's fantastic for some people but, for others, it's never been something that they've wanted to do, and it's not something that they want to start now. So, I think—
I'm not, either, no. [Laughter.]
So, I think that's really important, and then, when you get down to things like the sitting services, it's about consistency—so, particularly if you're talking about people living with dementia, having people come in that are familiar is really important in terms of that whole quality of experience. So, I think there are quite a lot of things, but it all comes back to an individualised approach of what's right for that person and what's right for that carer.
Sorry, Helen. As an aside, Members have just received a copy again of that report—well, not 'hot off the press', but, I suppose 'cold off the press', it being an older report. Sorry, Helen.
Your predecessor's report, 'Rethinking respite', called for some more creative thinking around the sorts of respite that might be available and referred to the Respitality schemes in Scotland. Could you tell us a bit more about that need for more creative forms of respite care, and what Wales can learn from that Scottish example?
Yes. I think there are some really interesting examples, not just in Scotland, but here in Wales and other parts of the UK, and, indeed, further afield, and I think it's focusing on—. If we think about what outcomes somebody wants from respite and start there rather than automatically thinking, 'Well, what services have we got?' So, the Respitality example, I think, is interesting because it's a different sector getting involved. It's the hospitality sector in Scotland who were looking at what they could do, actually, to help carers, and recognising, in low season, in down time, actually, they've got facilities, they've got hotels, spa facilities, quiet times in restaurants and all of that, working with local carers centres to offer those sorts of opportunities to carers, which is a great example, isn't it, of a community approach, recognising there's a need and engaging the commercial companies, if you like, in that. So, I think it's about thinking quite creatively and imaginatively, and maybe thinking beyond public sector and third sector indeed, to think about whether there's a role for the hospitality sector here or businesses to support. So, it's just one example really of an approach, which is to try and think from the outcome. So, if the outcome is that somebody needs a break, somebody needs some help, somebody needs to feel better about themselves, the answer to that might not be the leisure centre; it might be the gym in a hotel that is nearer to you, for example.
Thank you. The 'Rethinking Respite for People Affected by Dementia' report proposes a respite outcomes map. Can you tell us a bit more about that idea and about what sort of response you've had to that suggestion?
Yes. So, this was really to again try to think of a way to encourage commissioners and providers to think about respite in a broader way, so not starting with, 'What are the services that we have and how can they be used for respite?', but 'What are the outcomes?' So, the outcomes framework really looks at a number of those outcomes, which link into the national well-being outcomes. So, things like: I have opportunities to have a break on my own or together; I have opportunities for social contact. And we put that in the guide [Correction: 'report'] as a way of trying to encourage public bodies, assessors and commissioners to think differently. I think it's a little early to say, because the report was only out earlier this year, how much of an impact that's had. I did, for example, a workshop at the recent social services conference and had some very interesting discussions there, both with carers and commissioners of services, about the extent to which people were even beginning to think in that way. So, I think it's too early days, but it was to try and really refocus the approach much more on starting with the individual, starting with the carer and thinking about their outcomes.
That Respitality scheme sounds fantastic, doesn't it, but that depends on it coming from the community. So is there any chance of anything like that coming from the community in Wales? Have you heard of any initiatives like that that could be encouraged?
I haven't heard directly, but I think there's every opportunity, yes, I'm sure. You'll be aware that I haven't been in post that long—
—but from what I've seen and from visiting services and different community groups, I think there's a huge amount of initiative and thoughtfulness and insight into what could be done.
So, just to give you an example, last week, I was at the Pontypridd rugby club where they are doing walking rugby, which is geared to older people, older men particularly, to help them either have a break from caring or combat isolation. Now, you wouldn't think, when you're thinking 'respite' that walking rugby is the answer, but what a fantastic way of thinking about, 'What does this person enjoy?', 'What's going to make them feel better?' And we know that the Welsh Rugby Union are thinking about how they can get behind that to roll it out across Wales. Well, that would be a brilliant initiative. So, I do think that it's about maybe spotting these things, giving them some impetus, promoting it, getting those ideas going. So, I'm sure we can do it here.
Thank you, Chair. In the Age Cymru evidence, you express concern about the cost and the quality of respite care, and you highlight that we need, as does the older persons' commissioner, greater flexibility of provision. Could you just tell us for the record a bit more about what those issues of cost and quality are? And has the Welsh Government's additional funding for respite care to local authorities made any improvement in the situation from your perspective?
Okay. So, if I start off with the cost, the cost issue comes up to us most often when people are self-funding, so they're not being provided with support through the local authority, through social services. So, for example, one lady we talked to was a lady in her 80s, caring for her husband who was living with dementia; he was discharged from hospital with no care package in place, and we spoke to her some eight months after this discharge and she was paying for night-time care—it was costing £2,000 a month—so that she could have some respite two or three nights a week, so that she could care for him for the rest of the time. So, she was trying to do as much as possible as she could for him, but it's costs in those sorts of areas that we're thinking—. She didn't have a carers assessment, and we intervened and actually found—we got the individual assessment and then the carers assessment. But when we saw the carers assessment, because the family had been deemed to be coping with the night-time care, whilst it was recognised as a need, there was no provision put in place. So, if you look at an instance like that, that cost is huge and not sustainable because when the lady got in touch with us, her resources, her ability to do that, had diminished hugely. So, that's one area where you'd see cost, and I'm sure that's one person who thought to phone us. There are going to be many, many more out there with that sort of example. Even if it's not the night-time care and that cost, but it's providing care for themselves. We know many people will buy in the care themselves, so it's what they want and that they can rely on it. So, you are going to find lots and lots of instances like that.
In terms of quality, I think it refers to the whole experience. It is that getting the assessment, getting to talk to the right people, then getting some service on the back of it. People feel that they're fighting for this. It's not easy for lots of people, whether it's to get through to the gateway, as I say, to talk to the right person. It's the feel of the whole experience that seems to lack quality for people. And then, as I said earlier, it's about what sort of services then come on the back of it. Are they right for you as an individual? We hear from lots of people where respite's provided, but they have to go with the person that they're caring for, or they have to drive them there. So, it's respite of a form, but it's not giving you the break or the opportunity to have some space for your own life. So, I think that's where we'd say quality and cost.
And the Welsh Government additional funding. Have you seen that make any difference yet?
Not yet, but I wouldn't like to say that it's not, because, obviously, it's very early days and we wouldn't have any evidence around that at the moment.
Last question at this point from me. In your written evidence, you talked about the possibility of using direct payments more widely for older carers as a route to respite. Could you both, perhaps, say a little bit about how you think that might happen and what could be done to promote the use of direct payments for older carers?
I think there's pretty low take-up at the moment, and no awareness, actually, about direct payments as a route. What it can do when it works well is give people that choice, control and flexibility about putting together their own respite services or needs. We've seen some examples of where that can work well. So, for example, where it's been used by an older carer to have three personal assistants providing support on a rota over weeks, so that they get a clear break from that caring role.
There are also examples of where it's been used a little bit differently, actually, by a person with dementia themselves to access the gym in the local hotel. So, some examples of where it can help, the sort of health and well-being side, and also about giving people a clear break. I think it has a really good and important role for some people. It's not the answer for everyone, and I think maybe sometimes it's being used as a route because people feel maybe they can't get that choice and control and flexibility in any other way. So, I think it's both about looking at how direct payments can support people, but also looking at why aren't people feeling they've got the choice, control and flexibility through other routes.
I'd agree in terms of—. You've got some potential in terms of providing that flexibility. As Heléna said, they don't work for everybody, but, actually, people need to be given that choice; they need to be made aware that that's an option so that they can determine whether that's right for them or not. Because, for some people, they will be in a position to manage those direct payments, other people simply won't want to. But they need to have some choice and some flexibility too.
Ocê. Rŷm ni'n troi nawr at wasanaethau gwybodaeth, cyngor a chymorth. Lynne Neagle.
Okay. Turning now to information, advice and assistance services. Lynne Neagle.
Thanks, Chair. Age Cymru have said that some information, advice and assistance services are not tailored to the needs of older people who are often just referred to older people's organisations without providing the necessary funding. Can you tell us a bit more about what you feel the shortcomings are, and how we could try and make recommendations to address them?
I think we were referring to two issues there that are separate, I think, and linked. One is about people's ability to navigate through those single points of access and then, the second was what people get once they get through that single point of access and where they're referred to. I think, in the evidence session earlier, you heard about the conversations that people have when they get through—whether the people who are delivering the single points of access are actually trained to recognise a carer with a carer's needs and to point them in the right direction; whether they have that sort of awareness of dementia and other issues that, when you start to have a conversation, it would be useful for people to have. When people phone social services, very often, they are at a point of crisis and they need something, but they're not quite sure what they want. If you phoned our advice line, for example, you'd have a holistic conversation; we wouldn't start by responding exactly to what you said you wanted. We would take you through a conversation that explores all areas of needs and then agree with you what it was that you wanted at the end. We wouldn't jump straight to the end. We're not sure that those single points of access do that. There are other accessibility issues, too: potentially people with hearing loss and other sensory impairments, making sure that they can get the same level of access. And then, lots of information, as we know, is available online. Well, if we're talking about older carers, we'll know that lots of them aren't able to go online.
For some people, it's important to say that those single points of access work really well. We had some focus groups that we ran earlier this year. Some people told us that they worked through things and it was easy for them: they'd managed to look things up online; they'd put together their questions and they were able to navigate it. But it's not the same across the board; not everybody has the same experiences, and I'm not sure that they're all being delivered in the same way.
So, could that basically be resolved by training, then, do you think?
I think potentially training and capacity. The second issue that we referred to in our written evidence was about then, when you get through that, being referred to services that don't exist, or being referred to services that have been decommissioned or that aren't funded anymore, yet the local authority is still referring to them when they're the ones who have withdrawn the funding. I think that's a real issue for the sector, particularly.
Okay. What about the information services for Welsh language speakers? How adequate are they?
We haven't got a huge amount of detailed information on that. Earlier this week, the Welsh Language Commissioner and the Alzheimer's Society published some information about the availability of care in general for people with dementia, and I think we would suggest, our feeling would be that that's pretty similar in terms of information for carers.
Yes. I'll just pick that up. We know from work we've done with the Welsh Language Commissioner about the challenges in accessing public services. My office produced a report a while back looking at access to GP services and found, for example, that you could access in the Welsh language but you might need to wait longer. So, I think there are some real challenges there. If you're thinking about when you're in a caring situation, and it can be really difficult and you might be at a point of crisis, it's so important, then, that you're able to access services in the Welsh language if that's what you want to do.
With regard to other languages, particularly prevalent in cities, what is your narrative around that, because obviously, it would have to be equitable?
Yes. I don't think—. I don't know if we've got anything specific in terms of recent evidence on that, but I think anecdotally, I would say that those kinds of challenges definitely still exist in terms of accessing in community languages, for example.
The other point I'd make about access, which links to both of those things, is that, increasingly, the fact that so much is done online can also be a barrier to older people. Less than half of people over 75 use the internet, so that is again a barrier, so you could have both a language barrier and, if you like, a technology barrier for older people.
We heard in the previous evidence session, which I know you heard a lot of, about the weaknesses in the current collection of data on carers, and you've both highlighted that in your evidence as well. So, what specific information do you think we ought to recommend is collected and published?
I was pretty shocked, I think, when I saw the data on assessments, actually, in terms of the numbers of refusals of assessments, lack of data on what an assessment leads to and what an outcome is from that, and also where we can't be clear whether that assessment has led to the right support. So I think there's something about particularly refusal of assessment, and why that's happening, because that feels to me like a really serious issue. I had an interesting conversation with a group of carers a few weeks ago, and we were talking about carers assessments—and this is only an anecdote—and I thought it was very revealing about language and sometimes how the professional language can be a real barrier. A group of carers said to me, 'Actually, when we heard about carers assessments, we thought that meant someone was coming out to assess how we performed as a carer, to see if we were doing it well or doing it right'. Now, I wouldn't have thought of that as an issue, but I just think it showed how important it is to speak in language that people can understand, and that's just an anecdote, but I thought it was quite a revealing one.
So, I think that data on assessment, given that is the entry point, is really key, but I also think there's some data that is actually on the health side, particularly for older carers. So, I'd be really keen for us, for example, to know how many unplanned admissions to hospital are because of carer breakdown—how many dual admissions to hospital are because the cared-for person is going in, and then the carer has to go in as well, or the carer goes in and therefore the person they're caring for has to go in. So, I think there are some, if you like at the more acute end, real data gaps about what's happening, particularly to older people, particularly in their older age group, where often the interdependency between the person caring and the person receiving care is so close.
On that particular point, in terms of any longitudinal study, I think that's absolutely critical in terms of progression in that area. So, who should be doing that? Should it be Welsh Government, should it be the third sector, universities?
My view is that Welsh Government should support and instigate a longitudinal study on ageing, of which, obviously, caring would be a significant part, because I think that's the big data gap that we have at the moment. We've got some fantastic universities here doing great work, but it's not all joined up, and if we're serious about making progress, we need to understand our starting point and understand where we're trying to get to. Particularly because of our population—our older population is so diverse, and will get increasingly so—we need to understand the different communities and the different needs within them. It's difficult to do that without the longitudinal study.
I was going to say that's exactly the point I was going to broaden it out to, because I think it's not specifically a carers issue. It's actually about a longitudinal study and the importance of having that.
I think the only other point I would make is about the triangulation of data. There's data in lots of different places, but actually we need to triangulate some of that to make sure that we have got the big picture, so that we can plan strategically for social care and also for support for carers.
Reit, trown ni nawr at ran o'r dystiolaeth yr ydym ni wedi'i chael am y problemau sy'n wynebu pobl sy'n gofalu am bobl sy'n cael cyllid gofal iechyd parhaus gan y gwasanaeth iechyd, ac mae Julie Morgan â chwestiynau yn fan hyn.
Turning now to the evidence that we've received regarding the problems faced by carers who care for those people in receipt of NHS continuing healthcare funding. Julie Morgan has some questions on this.
Yes, thank you very much. I wanted to ask about carers looking after people who are in receipt of continuing healthcare funding. I think the whole field is confused in any case, with continuing healthcare funding and other types of funding. But how do you see that this affects the support for the carer? Are there any clear lines of accountability? Which public body is responsible for looking after the carer?
So, it is a really complex area, and we know it's one that people really struggle with. One of the things that we've found is that, where people move from getting support through the local authority to being assessed and becoming eligible for continuing healthcare, there seems to be a grey area there around who is then accountable and responsible for the carer. So, an example is where maybe a carer has been using direct payments to provide support to the person they're caring for, that person's condition deteriorates, they become eligible for continuing healthcare, but the carer's then left thinking, or not clear about, where their support is coming from and who is accountable. I think it's very clear that the local authority is accountable still for assessing and providing support for that carer, but I think the worry is then whether that carer gets lost in the picture, because it's now under a continuing healthcare approach. I think again it's maybe an indicator about that wider issue about the complexity of that system.
Well, we've certainly had that example that I've talked about through our casework service, yes.
Yes, but that is—. There would be frequent examples of this happening, do you think?
I don't know what the evidence says one way or another on that. Given that relatively not that many get continuing healthcare, my sense is that, I would guess, because it's so complex, that any transition is going to be a challenge for people between one system and another. I think we certainly see evidence of that, where you're transitioning from one system to another.
I think making it really clear that the local authority keeps that responsibility for assessing and supporting the carer in that situation. We obviously give that advice when it's raised with us—whether that's further guidance that's needed, I don't know, but I think it's that real clarity. It is about a fundamental right for carers to access that support and to have that local authority still responsible for them.
I think it touches that broader point about integration between health and social care as well. So, this is about the carer, but I think it cuts across care for the cared-for as well, so that we're not losing people between the gaps, and there should be responsibilities to link those things up.
This is a wider point, really, but do you think this system is satisfactory, really, where you have continuing healthcare and, on the other hand, another form of care?
It's not satisfactory at all, and the continuing healthcare system is incredibly complex to get into—the assessment process, the appeal process, what it puts families and individuals through. When people get continuing healthcare, then that's excellent, but then for the people who don't, and yet they've had to try and get through that system, that's really difficult and really hard. So, in looking at the future of social care and the future funding of social care and, as Vicky was saying, the integration between health and care, for me, that's an area to look at.
And the discrimination in continuing healthcare, because people can have equivalent needs, and one person will get it and one person won't. I think that hits—
People don't feel it's fair, do they?
No, I've had several cases in the constituency where we've had it happen. Thank you.
Okay. Unfairness, but a matter for another day, that one.
Symudwn ni ymlaen i fater pwysig arall, a dweud y gwir, sef gofalwyr sy'n dioddef cam-drin domestig, yn ogystal â'r sawl, yn amlwg, weithiau sy'n cael eu gofalu amdanyn nhw hefyd yn dioddef cam-drin domestig. Mae Dawn yn arwain ar hwn.
Moving on to another important matter, in truth, which is carers who suffer domestic abuse as well as those cared for who sometimes suffer domestic abuse. Dawn is leading on this.
Thank you, Chair. You've highlighted that issue in your evidence—both carers that can be subject to domestic abuse, but also the cared-for. And I think, actually, sometimes we probably do know quite a bit about elder abuse, and I'm thinking particularly in dementia cases, but perhaps not so much about carers that are abused. How well do you think the statutory agencies are responding to that, from both sides?
My office has done quite a lot of work on this over the last few years, and I think there is a general lack of awareness actually still about abuse of older people, how prevalent it is and what's happening, and I think that lack of awareness includes a lack of awareness amongst front-line health and care professionals. So, my office does a lot of training in this area, and we find that professionals don't necessarily know about the guidance that's there, and I think we're probably the main organisation that's doing this training in Wales, actually, on safeguarding issues and abuse.
In terms of abuse within caring situations, it's incredibly complex and difficult, and sensitive. There is some evidence that shows that there's an increased risk for people living with dementia to experience abuse from a carer, but likewise there's also a risk to the carer in terms of experiencing abuse from the person they're caring for. So, I think this is, again, a wider issue for us here in Wales in terms of the levels of abuse and that risk of abuse. So, my view is that we need to do more in terms of raising awareness, particularly amongst those front-line professionals, giving them confidence about what to do and how to act on it, and to just think about what the pressures are within that family situation that is leading someone into that abusive situation. Sometimes, it might have been something that's been in the family for many years that is coming through, but we know that some of the triggers will be those issues about stress, those issues about suffering from ill health and trauma, for example, and it feels to me like it's a real big warning bell about a wider issue around how carers are coping.
Yes. And, of course, there are particular behaviours associated with dementia that can lead to that. So, are you suggesting—I think you are suggesting, in a sense—that the social services professionals working with families in that situation—cares and the cared-for—should be a little bit more proactive in terms of what they see, and maybe rather than waiting for the carer to say, 'I've got a problem', there might be something a bit more proactive? In other words, really, what I'm asking is are all the duties under the social services and well-being Act being fully fulfilled around this area. I think what you're saying is that they're probably not at the moment.
And I think the point about awareness is really important, because for the carer potentially experiencing abuse, the ability to talk about it, the ability to raise it, is going to be really sensitive, so the awareness and somebody proactively probing, albeit gently, on that I think is a really important way of drawing it out. Because, otherwise, it can so easily go hidden, and kept hidden, because of the sensitivities.
Yes, and particularly if it's a behaviour that's only arisen as a result of that condition. Yes, I take all that.
Can I move on just to ask you about the independent professional advocacy, and why you think so few older people are actually able to access it?
I think one of the reasons so few people access it is, in terms of the independent professional advocacy, about the narrowness of the definition of where it's available to people. So, I think that's the first thing to say, because it's available to people with care and support needs in certain circumstances. We've just done some research. We've published a report called, 'Advocacy Counts'. It's the sixth one that we've done—we've been doing it over quite a long period now—to look at the availability of advocacy services to older people. We've seen a 32 per cent drop in the number of advocacy services specifically for older people. So, what we're seeing under the social services and well-being Act is that advocacy services have broadened out, so the specialisms are disappearing and, I think, the availability of advocacy has also been disappearing.
One of the things that happened, probably about eight years ago, was that the lottery in Wales put a significant amount of money into providing advocacy and funding advocacy services. That lasted for five years. Those projects have come to an end. At the same time, the duties on providing independent professional advocacy have come into being, and there's a gap somewhere—where services are ending, they haven't yet been commissioned under the Act, and expertise and services are being lost. So, I think one issue is around the supply side, but then the other issue is probably around demand. There is low awareness about advocacy amongst older people.
So, how could the advocacy services particularly help carers, because, if we're going to raise awareness, what would be saying to an older carer that an advocacy service can help them with?
So, some of it is about helping them to express voice and what they want out of something. It's about being able to express your needs without responding specifically to a menu of options, for example. It's about having somebody to support you, and not to talk in your best interests but to actually put your perspective into a conversation.
Yes. So, it's not about somebody talking in your best interests and making decisions for you, but it's about putting your perspective so that you can take those decisions.
Reit, mae'r ddau gwestiwn olaf o dan ofal Rhianon Passmore.
The two last questions are from Rhianon Passmore.
Diolch. How well, in your view, is the social services and well-being Act serving the interests of our carers and, in your view and perspective, how can any gaps be improved?
I think the Act is one thing. For me, it's not about the Act or the legislation; it's actually about the resources available there not only for carers, but for social care, because I think the availability of resource for social care impacts on what carers need because, in one sense, if all of the care that people need was being provided, there wouldn't be such a demand on our carers; they would have better opportunities to have a life of their own. So, I think those things are intrinsically linked, and I'm not necessarily sure it's about the Act; I think it is about the resource to deliver that.
So, systemically, around that—obviously, in terms of budget announcements, £30 million with regard to social care, other pots of money available in terms of transformation et cetera on mental health—how would you like to see those envelopes of money, in your perspective, spent so they can better enable the landscape systemically around carers, and the health and well-being of the cared for and those who care for them?
I think it is a systemic issue, and carers are suffering as a result of that, I think. So, I would certainly argue for issues around carers' breaks and respite, because that is fundamental to helping carers to stay well to help the person that they're caring for. From all the research I've known over the years, getting a break from caring often is the thing that comes highest when you ask carers what they need and what they want.
I think there is a big issue here also, though, about the social services and well-being Act and how that relates, then, across to health, because health has such an important part to play in this in terms of the awareness at primary care level in particular, but also at secondary care level. So, we know, for example, that for carers sometimes the most difficult moments are when the person they're caring for goes into hospital and the carer feels that their views are ignored, they're not seen as an expert in care, and when the person is discharged there isn't enough conversation and planning with the carer about coming home.
So, I think the other way we can look at it is: where are the stress points on the carers, that we want the social services and well-being Act implementation to support and help, and where it is that, actually, other public bodies need to take their responsibility seriously for this as well. I think we have a lot more to do in terms of the NHS and its support and responsibilities towards carers.
So, outside of systemic improvement holistically in this area—you may or may not wish to answer this—with regard to funding for the future, have you got any view on the social care levy?
I think it's unquestionable that we need to have more funding into the social care system, and my view is that that needs to be a mechanism that is not voluntary but is compulsory, because we know that voluntary systems don't work. Now, whether that's through a social care levy or another means I think is open to question; it's too early for me to comment on that.
Yes, and crucially, we need to pay as much attention to what it funds as to how we raise the money. We can't just go on incrementally trying to fix things. We're in a new place here in terms of our ageing society, which is something to celebrate, but we need to plan for it and we need to make a shift in the support that we're giving to carers, because we are letting them down at the moment.
In terms of the funding, I think I'd completely agree. The system as it stands is seriously underfunded. We need to see greater investment in the picture as a whole. We're currently doing a piece of work at the moment looking at the way we think that would be best funded, because it could be that there's a basket of measures that we need to put in place. I think Heléna's point about understanding how we would then spend that money is really important, because what we need is more money into the system, not changing and the displacement of the way things are funded. I think what we would like to see is a fairer distribution of who pays, because at the moment you've got people who are paying catastrophic amounts of money, and then some of us who don't need care don't end up paying that. So, I think there does need to be a fairer distribution, but it could be, as I say, through a basket of measures, not simply the one.
Pawb arall yn hapus? Unrhyw gwestiynau? Na. Pawb yn hapus. Rhyfeddol. Diolch yn fawr iawn i chi. Dyna ddiwedd y sesiwn, felly. Diolch yn fawr iawn i chi'ch dwy am eich presenoldeb y bore yma ac am ateb y cwestiynau mewn modd adeiladol iawn. Rydym ni wedi dysgu llawer, diolch yn fawr. Hefyd, diolch, fel y dywedais i ar y dechrau, am ddarparu'r wybodaeth ysgrifenedig ymlaen llaw. Bendigedig. Diolch yn fawr. Fe allaf gyhoeddi ymhellach y byddwch chi yn derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio eu bod nhw'n ffeithiol gywir. Gyda hynny, dyna ddod â'r sesiwn yna i ben—diwedd eitem 5. Diolch yn fawr iawn i chi.
Fe allaf gyhoeddi i fy nghyd-Aelodau y bydd toriad rŵan tan 1 o'r gloch. Dyna ddiwedd sesiwn y bore. Bydd sesiwn y prynhawn yn dechrau am 1 o'r gloch.
Everyone else content? Any further questions? No. Everyone is content. Miraculous. Thank you. That's the end of the session. Thank you very much to both of you for your attendance this morning and for answering the questions in a very constructive manner. We have learned a great deal, thank you very much. Also, thank you, as I said at the start, for providing the written information beforehand. That was splendid. Thank you very much. I'd like to announce that you will receive a transcript of these discussions so that you can check its factual accuracy. With that, we'll draw this session to a close—the end of item 5. Thank you very much.
I'd like to announce to my fellow Members that there will now be a break until 1 o'clock. That's the end of the morning session. The afternoon session will start at 1 o'clock.
Gohiriwyd y cyfarfod rhwng 12:19 ac 13:03.
The meeting adjourned between 12:19 and 13:03.
Reit, buasai'n well i fi alw'r cyfarfod i drefn, gan ein bod ni wedi mynd yn gyhoeddus. Felly, croeso nôl i sesiwn ddiweddaraf, ar ddechrau'r prynhawn, y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon. Rydym wedi cyrraedd eitem 6 rŵan, ac yn parhau i graffu ar effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 mewn perthynas â gofalwyr. Hynny yw, mae'r pwyllgor yma wedi bod allan dros gyfnod o fisoedd mewn gwahanol gyfarfodydd yn cyfarfod efo pobl i benderfynu a ydy'r Ddeddf yma yn gwneud gwahaniaeth i ofalwyr neu beidio. Rydw i'n falch i groesawu aelodau Hafal yma, ac rydym yn cydnabod ac yn ddiolchgar iawn i Hafal hefyd am ymgymryd â'r un un math o waith, a gofyn i'w grwpiau nhw mewn grwpiau ffocws beth maen nhw'n feddwl o weithrediad Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014. Felly, diolch yn fawr iawn i chi ymlaen llaw. Diolch yn fawr iawn hefyd am y dystiolaeth ysgrifenedig rydych chi wedi ei chyfrannu i ni.
Nawr, rydw i'n falch iawn, felly, i groesawu i'r bwrdd Kay John-Williams, defnyddiwr gwasanaeth a swyddog cyfranogiad gofalwyr Hafal; hefyd David Southway, cynrychiolydd gofalwyr Hafal; a Ceri Matthews, cynrychiolydd gofalwyr Hafal. Wedi dweud hynny am yr holl dystiolaeth yna—a diolch i chi am eich gwaith ymlaen llaw—yn nhermau amser, awn ni'n syth i mewn i gwestiynau. Mae'r cwestiynau cyntaf o dan ofal Dawn Bowden.
Right, I'd better start calling this meeting to order, since we are now in public. So, welcome back to the latest session, at the beginning of the afternoon, of the Health, Social Care and Sport Committee. We have now reached item 6, and the continuation of the scrutiny of the impact of the Social Services and Well-being (Wales) Act 2014 in relation to carers. This committee has been out over a period of months in different meetings meeting with people to determine whether this Act is making a difference to carers or not. I am pleased to welcome members of Hafal here, and we acknowledge and are very appreciative of Hafal too for undertaking the same kind of work, and asking their groups in focus groups what they think about the implementation of the Social Services and Well-being (Wales) Act 2014. So, thank you very much to you beforehand. Also, thank you very much for the written evidence that you have submitted to us.
Now, I am very pleased, therefore, to welcome to the table Kay John-Williams, service user and carer participation officer from Hafal; also David Southway, carer representative from Hafal; and Ceri Matthews, carer representative from Hafal. Having said that about all of that evidence—and thank you for your previous work—in terms of time, we'll go straight into questions. The first questions are from Dawn Bowden.
Thank you, Chair. Good afternoon, everyone, and thanks for coming in. Can I just ask you about your written evidence, because within that you talked about—for lots of carers, their priority is obviously ensuring that the person that they're caring for receives the right care and support rather than thinking about their own needs, perhaps? What do you think are the challenges currently facing carers of people with mental health problems in particular and do you think they're getting worse?
Personally, as carers, we feel isolated, we actually feel stigmatised, we are very much judged, we are angry, we are hurt, because we are parents, we are worried and we're obviously very helpless in a crisis. Services are often discourteous to us—we are seen as a pain in the backside. We are ignored, we are bullied, we are intimidated and frustrated and we often lose out on our own employment status.
Confidentiality is still a major, major issue between services and carers. In my personal experience, it's still very much a one-way system, whereas services will want to talk to you about the present situation and we say to them, 'Well, in confidence, I don't want our loved one to be made aware of this certain thing but you as a service need to be made aware of it.' And the reason for that statement is simply that our son, in particular, becomes very judgmental in his psychosis and relationships within the family break down. So, if they are aware that we have disclosed something it fragments that relationship. And time after time after time when we go to visit, the statement is, 'Oh, so you've told the social worker, then, about that, and you've told my nurse about this.' So, it's still very much them and us—'I'll have all the information off you as a professional but I'm not going to guarantee you the confidence in talking to me.'
So, you're talking specifically about social services now, are you, or the health service, or both?
Yes, in our experience, in both. And certainly—I mean, my wife and I have been carers for the past 18 years for someone who has severe mental ill health. And I know this isn't about your cared for, it's about us as carers, but he's been on a section 3 for 18 years and the last five years he's been—
Okay. So, you've never been a carer for him as a child, then. He's always been an adult since you've been caring for him.
Because we might want to explore in a moment whether there's a difference between the care for adults and children.
Yes, of course. Of course.
You know, we personally feel that severe mental ill health is a forgotten disorder and it's treated accordingly. There's insufficient funding and very little needs-led accommodation for people who come out of hospital.
I can add something when you've finished talking to Dave.
Okay. And do any of you feel that there is a difference in approach to you as carers of people with mental health conditions as opposed to carers of people with physical conditions?
If I could say something—within my professional role, I visit groups of parents who have set up their own support groups within the Bridgend locality. And people around the table, parents, will speak about autism, they will speak about physical disabilities, but they won't speak about mental health. And they ask me whether I will go outside with them and that's even, you know, with younger people coming through with transition—very often, they become like new parents of a child with a disability, when mental health overtakes the autism. So, they know everything about autism—parents whose children have Asperger's—but then, the mental health will come more prevalent than anything, and they're like new parents all over again.
What I'm finding is that people don't automatically get referred to the adult services. The service stops from children to adults, and then they have to wait for a crisis to happen to be picked back up. So, I'm setting up another group now for those people, because there are so many areas within this that people need a voice within.
No, that's what we are finding.
I was just going to say I think it's actually impossible to separate a carer's experience in terms of health and social care. So, I'm fairly new as a carer to mental health services. My daughter's 22 and she was diagnosed with a borderline personality disorder around about 12 months ago. And to answer your question as to whether I think there's a difference in terms of mental health and physical health—absolutely, because we were given that diagnosis, or my daughter was given that diagnosis after 15 minutes with a staff-grade psychiatrist. And when I asked what comes next, she said, 'What do you mean, "What comes next?"' And I had to give an example of physical health. If I've been diagnosed with cholecystitis, then I'll have a treatment plan. And, actually, she looked quite shocked when I said that. So I really do think that there is a difference between physical and mental health.
And in terms of looking, particularly, at the social services and well-being Act—has it been implemented fully? I don't think it has, because I've never been offered a carer's assessment, which is, actually, a right—that every carer should be given that opportunity to have a carer's assessment. So, actually, nobody really know whether or not I'm coping. Nobody knows whether I'm financially stable, whether I'm emotionally stable, because nobody's ever asked me that question.
And is that part of—? Again, in your evidence—. I say your evidence, but in the evidence that Hafal has presented to us, there's a section in there where you talk about the agencies being sometimes dismissive of you. Is that all of your experiences, or is it depending on individuals? Is that an individual thing?
I was a professional but, also, I adopted a little girl when she was three. She came to us with quite severe mental health ill health, severe trauma, and I had to give up my career. Nobody ever offered me a carer's assessment. Now that she's more settled, I've come back into this—
This was 2003.
It was 2003 that she came to us. But when I—.
No, and I didn't know about the carer's assessment, and it's the way that it's offered, because it's not that you're not coping—it's your right. It's the way that it's sold to people. It's the most terrible feeling when you can't make somebody you love so much better. So, if it's offered, so that you can keep on your caring role, it's—
So, it's not something—. So, what you're saying is it wasn't something that was automatically offered to you, or that once you had a diagnosis for the person you were caring for, somebody said to you, 'Well, actually, now we need to think about you and your needs.' Really, you've had to go looking for that yourself. Is that what—?