Since devolution in Wales, the Welsh Government has had policy responsibility for health and social care. It aims ‘to promote, protect and improve the health and wellbeing of everyone in Wales, by delivering high-quality health and social care services, including funding NHS Wales and setting a strategic framework for adult and children’s social care services.’
Social Services and Well-Being Act
In April 2016, its first big social care policy change came into force with the Social Services and Well-Being Act 2014. It aimed to transform the way social services are delivered in Wales, to meet the needs of the individual and ensure services are sustainable for the future.
Similar to the Care Act 2014, it set out to ensure services are available to provide the right support at the right time and people have a stronger voice and real control over the support they need.
It focuses on earlier intervention, increasing preventative services within the community and helping people maintain their independence. It provides a framework to enable people to get the help they need before their situation becomes critical. The Act also promotes integration and provides for a strengthened approach to safeguarding. Added to this it:
- Introduced new eligibility criteria focused on individual need.
- Gave carers an equal right to assessment for support.
- Ensured easy access to information and advice is available to all.
- Kept children and vulnerable adults safer by making powers to safeguard people stronger.
- Required local authorities and health boards to come together to drive integration, innovation and service change.
At the time, Health and Social Services Minister, Mark Drakeford called it, ‘A radical, made-in-Wales system for the care and support of our most vulnerable citizens, which is fairer and more sustainable.’
Reviewing the impact of the Act, one year on, Rebecca Evans, AM Minister for Social Services and Public Health explained some of the developments, ‘Seven Regional Partnership Boards are now leading the change in services – undertaking their own area population assessments to enable them to plan tailormade solutions based on firm evidence of what the people in that region want and need. As well as multi-agency representation, the citizen voice is increasingly present in the decision-making process ensuring solutions are being co-produced with input from all of those involved.
‘The population assessments will set out the range and level of preventative services necessary to meet the care and support needs of the differing population areas.’
Additional funding
To support the Act, £60m was invested over 2016/17 to ensure children, adults and older people in Wales receive joined-up services. £50m came from the Intermediate Care Fund, now known as the Integrated Care Fund, with an additional £10m of capital funding.
£30m of the Fund was invested in services to support older people to maintain their independence and remain at home. £20m was allocated to establish new integrated services for children and adults with autism. The final £10m in capital funding was to assist all groups, especially those with long-term conditions, through reablement or step-down beds in the community. The aims were to avoid unnecessary hospital or care home admissions and prevent delayed discharge.
Other policy changes
Following on from the Act, the Welsh Government has introduced a number of other social care policies.
In October 2016, it was announced that the people of Wales will be able to keep more of their money when in residential care. The Welsh Government’s five-year plan, Taking Wales Forward, committed to more than doubling the capital limit used in charging for residential care, from £24,000 to £50,000. The new limit is to be implemented in phases, starting with an increase to £30,000, which came into force in April 2017, when a full disregard of the War Disablement Pension in all financial assessments was also introduced.
In a statement at the time, the Welsh Government said that, ‘The decision to phase implementation reflects feedback from local authorities and care home providers and is designed to ensure they have sufficient time to adapt to the changes.’ The changes were based on research for the Welsh Government by LE Wales, including up-to-date costings for implementing the change.
Based on independent research on the cost of these policies, the Welsh Government has made £4.8m available in total, to support implementation of the higher capital limit and the full disregard of the War Disablement Pension.
In addition to this £4.8m, an extra £55m has been made available for social services in 2017-18. This includes an additional £10m for social care to help meet the costs associated with the introduction of the National Living Wage, and £25m extra for local authorities in recognition of the growing pressures that social services face.
Added to this, further funding was made available for local authorities as the weekly maximum charge for domiciliary care rose from £60 to £70 in April 2017. It is expected that the increase will raise more than £4m a year in additional income to address financial pressures caused by the National Living Wage.
Finally, an additional £7m, over four years, was made available for the National Integrated Autism Service, bringing the total funding allocated to support autism services in Wales up to £13m by 2021.
Has Wales got it right with its social care reform? Is the situation in England too complex to solve in this way? Is there too little money available? Is it more straight-forward in Wales? Or does the political direction of the Government have more of an impact? What can or should England take away from the Welsh social care policy?
In Wales, we haven’t seen the level of cuts to local government spending that have happened in England, but funding remains tight. We also have a much smaller private market for privately-funded care.
Care Forum Wales welcomes the principles behind the Social Services and Wellbeing Act, which place an emphasis on prevention and intervening before people require formal services: it’s probably our only hope to cope with the demographic time bomb. But it means those who our members are providing services for are increasing in frailty and require more input and staff assistance, all of which means higher costs. Too often the Welsh Government promises money, but it then goes into general local authority budgets and doesn’t make it to the frontline. We’d like to see the money promised ringfenced for use in social care.
We are also still affected by some decisions from Westminster. The sharp increases in the minimum wage over the last few years have had a significant effect on the sector. While no one begrudges care workers a better reward for the valuable jobs they do, the increases in public sector fees just haven’t covered the costs. We’re now starting to see an erosion in differentials, making it harder to recruit shift supervisors etc.
We’re pleased that there is guaranteed provider representation on the Regional Partnership Boards mentioned above. Independent providers operate in a rightly highly-regulated market, with most care purchased publicly. We are, and need to be seen as, a key part of the system and true partnership working would involve us in planning and shaping the market. We aren’t there yet – but it is a step in the right direction.
Mary Wimbury Senior Policy Advisor, Care Forum Wales
There is plenty to be learnt from social care in Wales, a country whose systems mirror England’s more closely than others in the UK, albeit with conspicuous social, economic and psycho-geographical differences.
From a provider’s perspective, one of the most successful reforms was the appointment of an Older People’s Commissioner for Wales (OPCW). This is currently the energetic Sarah Rochira, appointed in 2012 (the role was first created in 2008).
Sarah has an impressive track record. Whilst her remit and impact is much broader, she has had considerable influence on care homes for older people. In 2014, she published A place to call home? a report on the uninspiring nature of many Welsh care homes, still remarkable for its honesty and, sadly, applicable to much UK-wide care.
Not an attack but a pointing out of new directions, it was followed up with surveys and requests for action plans. They were searchingly reviewed and sent back with requests for changes if they missed or evaded vital points.
The programme of reform was linked to a series of free seminars for care home managers, other professionals, academics and service users, which were wide-ranging and often exciting events to attend. Prominent among the reforms achieved is the embedding of A Declaration of Rights for Older People in Wales in care home welcome packs. It is a genuinely useful document.
The OPCW is nothing if not practical and determined. The Green Paper should propose a similar post, with status and power – an ‘Older People’s Tsar’ if you really must. However, the role should be more than that.
Dr Pete Calveley Chief Executive, Barchester Healthcare
It seems the Welsh model of social care is all about inventing a strategy, funding it with new money and delivering it. The Welsh model is common to the needs of people across UK. It focuses on prevention, person-centred consideration and sustainable services.
The approach to policy shows that there is a common respect between the political intention and the private sector who have to deliver the care. Assessments based on individual need are welcome in the Welsh social care model. Although this can generally increase care costs in the first instance, the long-term impact is of lowering costs because of the improved care outcomes for the individual. This commissioning strategy is clearly a successful one.
In England, we have seen a takeaway system in operation, with public health funds reducing at a time that they desperately need to increase in order to develop long-term prevention outcomes for the population – obesity, poverty, education.
Also, the attitude in England seems to be one of disrespect for the private sector which has to deliver care and an assumption that it is wealthy and profiteering. Care does not seem to be commissioned in England, it is procured.
Added to this, the assessment process is based on thresholds with no distinction for varying needs, so not particularly person-centred.
In both countries, there is a common call for integration of social care and health. In England, this is through the Health and Wellbeing Boards.
However, neither make a point that the provider should be included in the integration deliberations. I think this is crucial to sustainability of the model.
Erica Lockhart Co-Chair, Care Association Alliance
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