4. Statement by the Minister for Social Care: The Health and Social Care (Wales) Bill

– in the Senedd at 3:57 pm on 21 May 2024.

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Photo of David Rees David Rees Labour 3:57, 21 May 2024

(Translated)

Item 4 today is the statement by the Minister for Social Care on the Health and Social Care (Wales) Bill. I call on the Minister, Dawn Bowden.

Photo of Dawn Bowden Dawn Bowden Labour

Diolch, Dirprwy Lywydd. Yesterday, I laid the Health and Social Care (Wales) Bill before the Senedd. Can I place on record my thanks to both my predecessor, Julie Morgan, and to the former designated Member from Plaid Cymru, Siân Gwenllian, for the work that they have done on bringing the Bill to the point where it is now? Diolch yn fawr.

The Bill sets out two principal provisions: to prevent the extraction of private profit from certain types of children’s social care, and to give people the ability to request direct payments in relation to NHS continuing healthcare. It also supports the ongoing effective operation of our two flagship social services Acts.

All the proposals set out in this Bill have been the subject of extensive consultation and engagement with the public and with stakeholders. The eliminating profit provisions will restrict the extraction of private profit in the provision of care home services provided wholly or mainly to children, secure accommodation services, and fostering services. It will do this by ensuring that any new provider of a restricted children’s service other than a local authority must be a not-for-profit entity after the provisions come into force.

A 'not-for-profit entity' is defined in the Bill as a charitable company limited by guarantee without a share capital; a charitable incorporated organisation; a charitable registered society; or a community interest company limited by guarantee without a share capital.

The children’s social care market is fragmented and complex and there is a lack of placements of the right kind, in the right places. This means that children do not have access to care and accommodation that meets their needs, and that too often they are being placed far from their local communities where they have established links. 

In developing this Bill, we have been guided by what young people have told us. They have very strong feelings about being cared for by privately owned organisations that profit from their experience of being in care. Under our proposals, the future residential care, secure accommodation and foster care of children that are looked after in Wales will be provided by public sector, charitable or not-for-profit organisations.

The Bill is one part of our wider programme to transform children’s services. We want fewer children taken into care. We want services to provide the right support for families, at the right time, to help them to stay together, wherever possible. When children are taken in care, we want them to be looked after as close to home as possible, with the right support for their needs. And when young people are ready to leave care, we will support them to plan for the future and to lead independent lives.

Photo of Dawn Bowden Dawn Bowden Labour 4:00, 21 May 2024

Dirprwy Lywydd, the second main provision in the Bill relates to the provision of NHS continuing healthcare. It seeks to amend the National Health Service (Wales) Act 2006 to allow the Welsh Ministers to make direct payments to individuals who, having been assessed as having a primary health need, are therefore entitled to receive continuing healthcare. This will enable them to directly secure services to meet their assessed needs for social care and some delegated healthcare tasks, in lieu of receiving services provided or commissioned by the NHS in Wales. This will give this group of people a greater voice and greater control over the management of their health needs.

The Bill also makes a number of amendments to the regulation of social care services and the social care workforce, to help the regulatory framework operate more effectively. Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016 provides the regulatory regime for regulated services, service providers and designated responsible individuals. Here, the proposed amendments aim to improve the functionality of the regulatory framework and assist Care Inspectorate Wales in fulfilling its regulatory responsibilities in relation to registering, inspecting and taking action to improve the quality and safety of regulated care services in Wales.

The amendments cover four main areas. These are: the duty to submit and publish annual returns; information to be provided in relation to an application for cancellation of a service provider’s registration; cancellation of a service provider’s registration without application; and a power to require information in relation to inspections. In addition, the Bill makes an amendment to the 2016 Act in relation to the functions of Social Care Wales as the registrar and regulator of social care workers in Wales. The amendment relates to the powers of Social Care Wales to review and extend interim orders. Interim orders enable temporary restrictions to be imposed upon a registered person while investigations are undertaken into allegations made against that individual.

The amendment seeks to provide an interim orders panel, or a fitness-to-practice panel before which interim order proceedings are brought, with the power to extend the duration of an interim order up to a maximum of 18 months from the date the interim order is first made, without an application being required to the first-tier tribunal.

The Bill also amends section 79 of the 2016 Act to provide Welsh Ministers with the power, by regulations, to extend the definition of 'social care workers' for the purpose of the Act to include all childcare and play workers. For the purpose of this amendment, childcare and play workers are the individuals who are employed by, or who work for, a person registered under Part 2 of the Children and Families (Wales) Measure 2010 as a daycare provider, to provide care and supervision for children. The amendment will enable regulations to be made modifying the definition of 'social care worker' as it pertains to childcare, thus providing a formal basis for the support Social Care Wales provides to all those in the childcare and play workforce.

Finally, the Bill includes provision to improve the alignment between the Social Services and Well-being (Wales) Act 2014 and current practice. Importantly, this includes an amendment to reconfigure the provisions in Part 4 of the 2014 Act that enable the making of direct payments by local authorities. This amendment will enable a direct payment to be made to a third party nominated by an individual entitled to receive such a payment, in cases where the individual has mental capacity to make that decision.

As I said in my written statement yesterday, I look forward to working with Members and to continued engagement with stakeholders during scrutiny of the Health and Social Care (Wales) Bill over the coming months. Diolch yn fawr. 

Photo of Altaf Hussain Altaf Hussain Conservative 4:05, 21 May 2024

Thank you for your statement, Minister, and thank you for briefing opposition spokespeople this morning. Let me say at the outset that there is much to be welcomed in this Bill, and it will have our general support.

I was concerned, before our meeting, that the goal of this Bill was idealogically drawn based upon an imperfect stance that profit is bad. For profit is not incompatible with caring for the most vulnerable in our society: children in care. The majority of independent care providers, which provide three quarters of all looked-after children's care services in Wales, are small operators who provide excellent care. We should not be penalising these providers because they are private businesses. Profiting, on the other hand, is something else. When you speak to the majority of independent providers, they agree that public money should not be used to benefit sovereign wealth funds and large corporate shareholders.

Qatari and United Arab Emirates private equity firms have no place running children's services in Wales, but the likes of Amberleigh Care and Landsker Child Care should absolutely be allowed to continue providing excellent care. They are not in it for profit; they run a business to invest in outstanding care for looked-after children. I was therefore relieved to hear you say that profit is not the issue; it is what happens to that profit that matters. In this you have my full support and, I dare say, the support of the majority of providers in Wales. As ever, the devil is in the detail, but we can all agree that nobody should be profiting from the wonderful children. Public money should not be taken out of Wales to benefit hedge-fund managers overseas. Minister, what steps are you taking to encourage private for-profit providers in Wales to move to one of the models outlined in your statement prior to this Bill achieving Royal Assent?

With regard to Part 2 of the Bill, the introduction of the direct payment of continuing healthcare is most welcome. This will help ensure equality for many people, particularly disabled people, giving them choice and control over their treatment. Minister, direct payments have been transformational in social care for many people. How will you encourage more people to take up direct payments?

Regarding the final part of the Bill, while much of it is technical in nature, it is nonetheless also important—ensuring the full competence test applies to the social services and well-being Act is vital for ensuring the quality of continuing healthcare services. Minister, one of the changes is the redefinition of those who provide care and supervision of children as social workers. What assessment has been made of the impact that this will have on the childcare workforce?

Finally, Minister, the Presiding Officer's note accompanying the Bill states that paragraph 4 of Schedule 2 is not within the competence of this Senedd. What discussions have you had with the UK Government regarding consent for this part of the Bill?

Thank you once again for your statement and briefing, and I look forward to working with you to deliver the aims of this Bill, namely better care and support for the people of Wales, particularly wonderful children. Thank you very much.

Photo of Dawn Bowden Dawn Bowden Labour 4:09, 21 May 2024

Diolch yn fawr, and thank you for those comments, Altaf, and I welcome very much your general support for the Bill. We've set out very clearly what we're looking to achieve in this Bill, because we just don't believe—. Our starting point is that we don't believe that there should be a market for the care of some of the most vulnerable children in our society. These are children who have been through the most traumatic of times who end up in the care system, and we have to offer them the best care that we can in whatever way we can. That means that any money coming into the system must be reinvested into the system. That's why we're looking to take the private profit out of childcare, so that that can be reinvested, because this market is not currently functioning effectively. We want to ensure that that money goes back into the system.

You're quite right, there are many good private providers out there, and what we have done is we have set up an elimination implementation board that has been operating for a couple of years now in preparation for the work that we're seeking to do through this legislation, and there are private providers on that board, there are third sector providers, there is the local authority that sits on that board, the children's commissioner, a representative from Voices from Care Cymru, who are in the gallery today, we have trade unions there, we have the service commissioners, all sat around the table working through how we model this changed approach to the provision of children's residential services. And I know that many of those private providers are in active and encouraging conversations with us about how they can transfer their operation into a not-for-profit model. There will not be a cliff edge for profit providers of children's services; there will be a transition process that we go through, and throughout that period, up to the point where not for profit will be the only provision available in Wales, those providers will be involved in that discussion.

In terms of direct payments, you're absolutely right. The direct payments for continuing healthcare, that's been available in England for about 10 years and the feedback that we have had from the recipients of direct care payments for continuing healthcare in England has been very positive. The well-being and the response and the resilience of individuals in receipt of those direct payments has been vastly improved by them having that choice and that voice over the way in which that continuing healthcare is provided to them by somebody that they directly employ to provide that support for them in their home.

So, I'm very hopeful that the few people that we have that are not in that space at the moment, when we promote what we are seeking to do, will apply for a continuing healthcare assessment from the NHS so that they can use their voice to direct the way in which their care services are provided. For many of those people, they are already in receipt of direct care payments for social care, but their care—some of those people—their care extends beyond what social care provides, but they have resisted transferring, if you like, to continuing healthcare, because that will take away the control and the direct voice that a direct payment would give them. So, I'm very hopeful that by introducing a direct payment for continuing healthcare we will see people get the appropriate care they need from their health provision.

You've noted, Altaf, that the last section of the Bill is primarily a technical one. It is about regularising the regulations in the two social care Bills to make sure that they marry up with this new legislation, and in terms of the childcare workers that you've referred to, it is about putting them on a regular footing as recognised professional childcare workers under the auspices of Social Care Wales. So, we see that as a very positive move in the professionalisation of childcare workers.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:14, 21 May 2024

(Translated)

Plaid Cymru is firm in its belief that health services and care services should be run for the benefit of the people, not for commercial gain. Unlike the Conservative Party and not unsubstantial elements of the Labour Party, including the shadow health Minister in Westminster, we totally reject the belief that the market knows best when it comes to health and social care. We therefore welcome the fact that this legislation will deliver on our core principles, and it is something that we have been working with the Government on through the previous co-operation agreement to remove the element of profit from childcare.

The need to reform this area has been clear for some time, and as a party we've often referred to the damaging impacts to the quality and provision of these services through market forces.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:15, 21 May 2024

As was made clear in the Competition and Markets Authority report of 2022, the market for the sector is currently skewed heavily and disproportionately in favour of private suppliers, who have been able to charge premium prices, as the ability of local authorities to provide their own foster care has been severely compromised by the impact of 14 years of Tory-run, driven austerity. In many cases, this has opened the door for equity firms to cash in on the plight of some of the most vulnerable individuals in our society—a shameful indictment of the creeping privatisation of our health and social care service.

From a practical perspective, the over-reliance on private suppliers in Wales, which currently account for almost 80 per cent of all placements of children looked after, has also engendered considerable insecurity in the sector. The CMA report showed how the prevalence of debt amongst private providers carries a high risk of companies leaving the market at short notice, with disruptive consequences for the children under their care.

The state of the market also pays little regard to geographic location, which is a factor of paramount importance for the well-being of children looked after. As such, whereas 84 per cent of children in local authority foster care in Wales remain in their local area, ensuring a vital degree of continuity in their lives during a period of inherent uncertainty, 79 per cent of children in private fostering are cared for outside their local area, and 6 per cent are moved out of Wales entirely.

But the most compelling case for change surely comes from the testimonies of the children themselves, which demonstrate widespread dissatisfaction and discomfort at how their circumstances can be used as a vehicle for profiteering. Their voices must always take precedence in this debate, and by creating new requirements for all care providers in Wales to register as not-for-profit entities, we can ensure they are being listened to.

But while this Government have funded local authorities over three years to prepare for the transition of this legislation, there is a question mark as to the preparedness of many local authorities. So, can the Minister give us an assurance that local authorities are in fact prepared for this change?

Turning to the other aspects of the Bill, we support the introduction of a legal duty for reporting on children and adults at risk of exploitation, in line with the recommendations of the independent inquiry into child sexual abuse. It is essential this duty is underpinned by robust support mechanisms for the affected individuals, which should include a children's rights approach in the case of minors. The reporting guidelines should also be developed so as to prevent creating a de facto hierarchy of abuse cases. The Minister will also be aware that the UK Home Office intends to legislate for mandatory reporting of child sexual abuse as part of the Criminal Justice Bill, and I would welcome her view on how this will interact with the proposals in this piece of legislation in front of us today.

Finally, while the Government is right to address the shortcomings in the current legislative framework regarding direct payments for those eligible for continuing NHS healthcare, it is vital that local authorities are provided with the requisite resources to manage this additional responsibility. So, I'd be grateful, therefore, if the Minister could give an indication of the expected annual cost to local authorities as a result of these changes, and explain how the revenue support grant will be upscaled to accommodate them.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:18, 21 May 2024

(Translated)

Thank you very much again for the statement, and I look forward to working with the Minister in order to push this Bill forward.

Photo of Dawn Bowden Dawn Bowden Labour

Diolch yn fawr, Mabon, and, again, thank you for your support for the Bill. It is a joint ambition. It has been a joint ambition of both Welsh Labour and Plaid Cymru, and I'm very pleased that we've got to this point now and, as I say, I'm very grateful for the work that we have done with Plaid to bring us to this point. And I absolutely agree with all the points that you made around the for-profit provision and the work that's been done by the Competition and Markets Authority, the work that they identified, or how they identified, the research that they produced that identified, that we're seeing these organisations producing profits in the region of 22, 23 per cent. There was an article that you may or may not have seen over the weekend in The Guardian—it was a George Monbiot article over the weekend—that was talking about this—. It was from an English perspective, but the issues are exactly the same, and this is being addressed in a very similar way now in England. I think they've recognised that they have to do something like this. The costs that were being associated with placing one child in a residential care setting for a large for-profit organisation were something in the region of £280,000 for one child—around about £5,000 to £6,000 a week. Now, if you put that in the context of how much it costs to send a child to Eton, which is £46,000 a year, we could send six kids to Eton instead of putting one child in a residential setting run by a private company.

So, we absolutely know the challenges that exist. But you make a very good point about local authorities and their resilience and their ability to be able to plug the gaps that may come from removing private providers from the market. What I would say is, in the work that we've been doing on the elimination programme, we have been factoring in different scenarios. So, we have to look at—. We could have scenario A, which could be that no private providers transfer into the not-for-profit sector, to the very other extreme, where 100 per cent do, or somewhere in between.

Now, we're having some very positive discussions with a number of these providers, who are indicating their willingness to talk to us about moving their model of operation to not-for-profit, but we do appreciate, of course, that there could be some gaps, with not all of these providers wishing to move into the not-for-profit market, and so therefore we have to work with local authorities in building that resilience into the system that will enable them to deliver a not-for-profit service, whether they deliver it themselves directly as a local authority, or through one of the models that I set out in my statement. 

But what I think is important to set out very clearly here is that this piece of legislation is not to be seen as a piece of legislation that sits in isolation. We have a whole transformation of children's services programme in Wales, which is largely preventative, and which is largely about working with families to keep families together, so that we have less demand for residential children's services, because it's the demand that's pushing the profits up. If a private provider can come in and can see a market, they will fill that market. That's what the private sector does. So, we are working with local authorities to build that resilience in through the different processes, and we know that there will be a cost to that. What I can't tell you at this moment in time, because that modelling is still taking place, for all the reasons I've just set out, is exactly how much that is going to cost. But we have made a commitment to delivering this legislation, and we will work with local authorities to find a way in which we can ensure that the resources that are required to deliver this are made available. But, as I say, this is not something that I can set out exactly at this moment in time, but through the course of the progress of this Bill, we will get a better idea, because a lot of the providers want to see more detail before they commit one way or the other.

In terms of the legal duties and the mandatory reporting, Mabon, you're quite right; we already have a mandatory reporting process in Wales. It is different to the model that they're proposing in England, but at this point in time we believe that the process that we have, which mandates organisations to report, is right for us and is right for Wales, but we will keep that under review, because we don't stand here and say that we've got everything right, but we do think that the process that we have is ahead of the process that was in place in England and which the current legislation in England is trying to address, but it is not our proposal at this stage to introduce mandatory reporting on individuals. We're retaining the organisational mandation for reporting at this stage.

Photo of Jack Sargeant Jack Sargeant Labour 4:24, 21 May 2024

I thank the Minister for this important statement today. The Bill and the ambitions of the Bill have my full support, and I should place on record also thanks to Julie Morgan and indeed Mark Drakeford for the courage to bring and start this work. Minister, if I relate my comments to a petition that the Petitions Committee is currently considering from a resident of the Wrexham constituency, Lesley Griffiths's constituency, the petition calls for an increase in clarity and rights for people on direct payments or the Welsh independent living grant to live independently. The petitioner does have concerns; despite the principles of the Social Services and Well-being (Wales) Act 2014, he calls for action to be taken, including better advocacy support, a dispute resolution process, better communication channels and a complaints procedure that has knowledge of Welsh law. I'm not sure if this has the scope of this particular Bill, but perhaps for its journey it may have. I'd be grateful for your thoughts on these calls, whether it's in this Bill or in other avenues.

Photo of Dawn Bowden Dawn Bowden Labour 4:25, 21 May 2024

Thank you for those points, Jack. And no, it doesn’t relate directly to this Bill, but the broad principles do, and I think that that’s important, because, more broadly, what we’re doing is we’re taking forward the programme of work that was set out by the disability rights taskforce, which would encompass the independent living allowance, and that brings together people with lived experience, the Welsh Government policy leads and representative organisations, and the work of that taskforce is based on that common understanding of the social disability model and co-production and so on. So, what we have done is we have introduced new guidance for local authorities that will require them to self-assess their performance and delivery against eight quality standards. That includes demonstrating with evidence how they promote the voice and control of individuals needing care and support to help them live as independently as possible, and they need to demonstrate how the views of the service users and carers are reflected in the authority’s assessment of its performance. So, we’re just continuing to work across the sector to ensure that those commitments are delivered in a timely manner, and I do expect to see clear progress made on them during the year, and I’m quite happy to report back or to write to you again, Jack, as we develop that as time goes on. Thank you.

Photo of Jane Dodds Jane Dodds Liberal Democrat 4:26, 21 May 2024

Thank you so much for your statement, Cabinet Secretary. It’s really encouraging to hear this development. I am one of those former social workers who, out of desperation, would, sadly, end up placing a child in the last possible place that I wanted to place that child. We heard—. Some of us who were at a workshop last week on missing children, we heard powerful testimonies from local authorities and children’s organisations about how, tragically, children are going missing from residential establishments because they are desperate to get home. Now, how heartbreaking is that? That is what we’d all want to do, that is what we would naturally do, so I’m glad to hear from you that this is part of a transformational process, because, actually, we should be looking at the front end, as you say. So, we need to avoid children being placed in care, and, sadly, in Wales, we’ve seen the numbers go up in the last decade— not acceptable at all. So, I really want to appeal to you: what are your measurements for ensuring that we keep children at home? What are your targets for the next three years to ensure that we reduce the number of children looked after, and that we put the money into our front-line services, because that’s where it needs to be? Diolch yn fawr iawn.

Photo of Dawn Bowden Dawn Bowden Labour 4:28, 21 May 2024

Thank you, Jane, for those comments, and I absolutely agree with everything you're saying. We are spending a huge amount of money on residential children’s services. If I tell you that, in 2017, we were spending £65 million on children’s residential services and this year that has risen to £200 million, and 80 per cent of that is going to private providers, for-profit providers, you can see the scale of the challenge that we face. And the reality of it is that, just on a financial basis, let alone the moral case for doing this—which I’ll come onto in a moment—but, just on a financial basis, that’s unsustainable. If we’re seeing those costs rising, trebling, in less than 10 years, and we carry on that trajectory for the next 10 years, we could be looking at children’s services, children’s residential services, costing us nearly £1 billion. The children’s services budget at the moment is around £350 million a year, £200 million of that on residential services, and a lot of those residential services and those residential placements, as you absolutely rightly say, are not where children want to be. And so we have to make sure that the transformation programme that we are seeking to deliver is that preventative measure that reduces the number of children that are going to require residential care, and that will include—. Because this is not just about residential homes and residential placements in that sense; this is about improving the numbers—or increasing the numbers, sorry—of foster carers that we have in the system. We know, from the statement that I made last week, that we were talking about the need for us to find another 800 foster care families across Wales to meet some of the current demand. But the key to this, and I can't put figures on it at the moment, Jane, I wish I could, is we have to see how all of these policies are working, but they have to work for us to be able to bring the numbers of children in care down.

So, I am absolutely determined that these measures will be implemented, that we will put money into the preventative services where we will work with parents and with children to keep them at home where it is safe to do so. We've just had the report come in now from the family, drug and alcohol court pilot, and I'm taking some time to consider that. We've seen that where that has been piloted, that's been very successful at keeping families together. So, I think if that has been successful, we need to seriously consider rolling that out as well. So, there are lots of things in the pipeline, and they all have to come together. This piece of legislation is the final piece of the jigsaw in terms of bringing in a repurposed and remodelled children's care sector.

Photo of Jenny Rathbone Jenny Rathbone Labour 4:31, 21 May 2024

Thank you for answering the question about the costs that would escalate if we do nothing. But, following on from Jane Dodds and, indeed, from Mabon ap Gwynfor, I am concerned about the ability of local authorities to commission the services locally, so that children who do need either fostering or residential accommodation are able to receive that service within their locality, because otherwise it makes life almost impossible for the corporate parent in that local authority to assure themselves that the service that's being provided is fit for those vulnerable young people. That particularly applies to secure accommodation. So, I really do want to emphasise the importance of the role that we all have to protect vulnerable people.

I strongly agree with legislation to allow people with enduring healthcare needs to be allowed to directly commission the services that will best meet their needs for themselves, and I applaud you for taking on the feedback from England.

In terms of childcare, what consideration has been given to transferring the regulation of childcare and play workers to Estyn? I am concerned that childcare is sitting on the jagged edge of regulation here, and I hope we all agree that we need child-focused inspections of services that promote the emotional resilience of children. As we increasingly have childcare delivered co-located with primary schools, it seems really odd to have Care Inspectorate Wales inspecting the early years service, and then a different organisation, Estyn, inspecting the nursery and the primary school. So, I hope that this will be explored by the Health and Social Care Committee.

Photo of Dawn Bowden Dawn Bowden Labour 4:33, 21 May 2024

Thank you for those comments, Jenny. I know I'm in danger of repeating some of this, but I'm very clear that we have worked very, very closely with local authorities about this. This isn't something we're just dropping on them now. We've been working with them over a number of years preparing for this. It does not come without its challenges. I am not going to stand here and pretend that this is going to be something that is going to be easy to deliver. Local authorities are under tremendous financial pressure, as we all know. But what I do know, and I have met with all the social care leads from local authorities, is they are committed to doing this. They know this is the right thing to do.

Some local authorities have been able to move quite a way already with the support that we've given through the elimination programme. If you take an authority like Carmarthenshire, for instance, they have hardly any private provision already. At the other end of the spectrum, not surprisingly, there are significant issues in Cardiff, and that's not surprising. So, I know for Cardiff that will be a much greater challenge than it will be for Carmarthenshire, but they are committed to doing it. There will be a plan that I will expect all local authorities to produce, which is about their resilience to be able to deliver this.

Now, where they can't deliver it, then we won't be able to take the private provider out of the market for that period, and the Bill does allow for Ministers to make exceptional decisions around placements that will continue in for-profit providers where that is the only alternative and where that is in the best interests of the child. But that is the key to this, because it is the interests of the child that are the most important, and the type of accommodation that they need to be in.

Direct payments—you've already made the point and I agree with you.

In terms of childcare, we haven't looked at transferring the inspection to Estyn as part of this Bill. That isn't something that we have had any discussions about through this process. It is something that I'm happy to have a conversation with the Cabinet Secretary for Education about—whether or not Estyn would want to take this on, or whether they feel that this is in the appropriate place at the moment because of the impact on very young children. This is also something that I would probably need to speak to my colleague Jayne Bryant on, as she has the responsibility for early years. I wouldn't say that we'd rule it out, Jenny, but at the moment, it's not part of the consideration for this particular Bill because I think we have a much, much wider and pressing issue that we need to deal with around the elimination of profit agenda at this point. 

Photo of Sioned Williams Sioned Williams Plaid Cymru 4:36, 21 May 2024

(Translated)

I very much welcome this move to remove profit from the care system. As you mentioned, it's one piece of work alone that needs to be done to ensure the radical reform of the care sector that we very much need in Wales. And as Jane Dodds mentioned, we have to do more to prevent so many children and young people—far too many of them in Wales—from entering the care system in the first instance, where it's possible to do so. And one way of doing that is to tackle the structural prejudice that is experienced by young mothers as a result of their experiences of care, which means they can be referred to child safeguarding services whilst they're pregnant, sometimes without explanation. NYAS Cymru, of course, with a Welsh Government grant, provides intensive support for young mothers with experience of care, through the Undod project, and it can contribute to breaking that cycle, that cycle of care, by helping to foster confidence in young mothers and empower them to voice their opinions and to access training, education and other opportunities.

The Government accepted in principle the recommendation made by the Children, Young People and Education Committee on radical reform to the care system, that a model such as the Undod project should be available as a statutory right. So, I'd like an update on that. Is it possible to have a commitment from the Minister too in terms of long-term funding for the Undod project, as this preventative work, as you have mentioned, is so important?

Photo of Dawn Bowden Dawn Bowden Labour 4:37, 21 May 2024

Thank you, Sioned, for those comments. You're absolutely right about that structural prejudice of young mothers, particularly mothers who have been in care themselves, and the predisposition to assume that, because the mother has been in care, that's the best place for the child to be in. That absolutely flies in the face of what we are seeking to do here. And you're quite right: the work that NYAS has been doing in this area has been quite transformational in a lot of places, and it has helped to keep mothers and babies together, and we would want to continue to support that.

In terms of that statutory right, Sioned, I'm going to have to come back to you on that, I'm afraid. I don't have that information at the moment. Suffice to say that, within the wider programme, we are looking to that preventative aspect of keeping mothers and babies together, keeping wider families together and keeping them together in locations as well. We heard earlier on—I think it was Jenny who made the comment—about children being placed too far away from where all their ties are and where their families are. And if we are serious about wanting to keep families together, then whilst we're going through those discussions, those kinds of offers of support, the advocacy that we can assist parents with, all of that has to be done within a location where everybody can stay together and do that. So, I think that is absolutely right. Everything you were saying is absolutely right. We have a very clear focus on what we want to do. We don't look at any of these things in isolation. But the specific point you raised, I will get back to you on that. Thank you.

Photo of Julie Morgan Julie Morgan Labour 4:39, 21 May 2024

Diolch. Thank you very much to the Minister for bringing this statement to the Senedd today. I think eliminating profit from the care of our looked-after children is a bold and clear statement that, here in Wales, we put the experiences and rights of our children first. And it's absolutely great that we've got children in the gallery today, listening to this debate.

Obviously, this is absolutely what our children want. Children and young people have told me time and time again that, in a market system, they feel as if they are commodities for sale, with people profiting from their unfortunate situations, and I know that they will have told the Minister that as well. So, I think that by bringing in this Bill, we are sending a strong message to our children in the care system that we have listened to what they have asked of us. Because they certainly asked before the last election, and they have asked at every summit that we have had since, that this is something that they want.

Does the Minister agree that listening to what children are saying and following it up will help develop a bond of trust with the children, and that that is something that is very important? And does she also agree that removing profit from the care system will also have better outcomes for children and young people? I know that it is difficult to get evidence about that because there is very little private provision worldwide. I think that we are fairly unique, with a couple of other countries, in having any private provision at all, so it is difficult to compare. But would she agree that, with what evidence there is, it is more likely that children will benefit and thrive from a not-for-profit situation than from a private profit-making situation?

Several people have mentioned the issue about being close to their own families, and prevention, and I’d just like to emphasise that I feel very strongly that those are really important issues. And finally—

Photo of David Rees David Rees Labour 4:41, 21 May 2024

Thank you, Julie. It's a statement, and therefore you have gone well over your time.

Photo of Julie Morgan Julie Morgan Labour

Okay. Can I ask one more?

Photo of Dawn Bowden Dawn Bowden Labour 4:42, 21 May 2024

You can talk to me afterwards, Julie, about your final point. Thank you, and again, I absolutely agree. The one thing that has struck me when I have been, over the last few weeks, talking to care-experienced children, whether they are children who have experienced residential care in institutions, if you like, for want of a better term, or with foster carers, the thing that has come through time and time again is their objection to their being used as a commodity; their objection to being used for the purpose of profit.

As I said right at the outset, these are some of the most vulnerable people in our society, and we are using them as market commodities—or the private sector, in certain circumstances, is using them as private commodities. And you are absolutely right: we have to have the trust of these children. We have to co-produce all of these policies, don’t we?

We have to do what we said we would do, and listen to the voices of those children who told us the way in which they want their care to be delivered. If we don’t listen to them, we will have breached that trust, and I hope that they feel—. They are here to listen to this today, and I hope that they do feel that we have listened to them, and that bringing this forward today is an indication of this.

I know, Julie, that you and the former First Minister signed this document—this declaration—last year. I and the new First Minister are going to resign it, so that we will be making our personal declarations as the new Ministers that we will carry forward this programme of work as well.

Just finally to say that, absolutely, what you are saying in terms of removing profit, how that will deliver those better outcomes, because we will then be able to see those profits that go to the shareholders being directly reinvested back into the service, to ensure that those overall objectives of providing better care for those children, in a design, in a way that suits the needs of those children, will be more affordable than they are now, and we will be able to deliver them.  

Photo of Joyce Watson Joyce Watson Labour

Diolch, Dirprwy Lywydd. I just want to welcome this Bill that is coming forward. I particularly want to mention—. I don't want to repeat anything else, but the people who are in the public sector—and I think that we want to draw this out—the private sector, sorry, providing care, the workers there do care about the children. They are putting in long hours, some of them probably beyond the hours that they are being paid for. And of course, Minister—and it will come out when you make further statements—if a placement is good for the child, even though it's in the private sector, it will continue for that child's welfare for as long as they need that placement, and also that private provider will have an opportunity to bring that into the public sector. I think it's worth saying that, because nobody else has.

The only other point I want to raise today is about the direct payment for continuing healthcare. Of course, that's a good thing, but it's not necessarily what people want all the time. So, I want to know about the safeguards for vulnerable people, whether they're disabled or elderly, to make sure that, if that decision is made, it's made in the best interest of the individual, rather than being pressurised from elsewhere.

Photo of Dawn Bowden Dawn Bowden Labour 4:45, 21 May 2024

Thank you, Joyce. I think it is absolutely right to say and to put on record that the vast majority of people that work in for-profit organisations and are delivering care for these children are doing that for the right reasons, and some of them are some of the lowest paid in the sector. Again, from my point of view, I see it as totally unacceptable that the largest profits are made by organisations that are paying the least to their workforce. Local authority organisations and third sector organisations tend to have far better terms and conditions than those in the private sector. I think it's right to say that we're talking not necessarily about the staff that are providing excellent care in many, many circumstances. It's also right to say—you're quite right to say this, Joyce—that where a child is with a for-profit provider, where that placement is considered to be in the interest of that child, that will continue. We have written into the legislation the right for Ministers to be able to authorise that. So, as I say, this is not about a cliff edge, this is not about just cutting everybody out of the system at the moment the legislation is passed; it is about a transition period, it is about taking every child's situation on its merit, looking at what the best care for them is. 

In terms of the direct payments, the thing to say and to be very clear about is that the direct payments are voluntary in terms of whether they seek an assessment for a direct payment under continuing healthcare. So, nobody is going to be forced to do this. This will be a voluntary process that they can go through if they consider that that would be in their best interests. They will be able to decide who they appoint to carry out that care, and whoever they appoint to carry out that care will, of course, be subject to DBS checks as well—if it's somebody they're bringing in from an outside organisation, or whatever. But quite often, of course, it's members of their families, it's people they trust. It's the choice they have to identify the person that they believe will deliver the best care for them. But to make this absolutely clear, this is not a compulsory route for anybody; it will be absolutely voluntary. Thank you.