6. Will the Cabinet Secretary make a statement on the consistency of care funding within the care homes system in North Wales? OQ61377

Diolch. The local authorities have statutory responsibility for planning and putting in place care for their local citizens, which would include the provision of care homes. On an annual basis, local authorities set and agree their own commissioning fee rates for services, including care homes.

A number of care homes across north Wales have contacted me recently raising concerns about the state of the sector's funding. Care homes receive less funding from Betsi Cadwaladr for the provision of continuing healthcare than they receive from local authorities for caring for individuals who have less intensive care needs; in Conwy, for example, it's £6,000 per annum less for every resident. Now, the health board has made the funding decision for the current year without consulting with the sector, although now, by the way, as a result of the angry response from the sector and intervention from politicians, it has agreed to a meeting to find a way forward.

But can I ask whether you agree with me that not funding care homes properly is a false economy? That is to say that if these care homes refuse to take residents or close because of underfunding from the health board, then it's the health board itself that will then have to deal with the situation, with more hospital beds blocked, and it's they who will pay the price. So, what steps are the Government taking to resolve this unsustainable situation? What advice do you have for Betsi Cadwaladr in terms of paying fair fees to care homes to avoid a situation where the care system is deteriorating, which would cost far more to Betsi Cadwaladr in the long term?  

Diolch, Llyr, for that supplementary question. There are two things that you referred to there: there are the care home fees and there are the charges for continuing healthcare, and they are different things, and, actually, they sit in different ministerial portfolios as well, but I'll come to that in a moment. I think the starting point is, and you will understand and appreciate this, that we provide funding to local authorities that goes into their rates support grant, and they determine how that funding is then allocated to all of their services, including social care, and that includes the provision for care home provision. The statutory responsibility is theirs to make sure that they're meeting the care and support needs of their local citizens, and it's for the local authorities to set and agree their own fee rates for the provision of homecare placements on that annual basis and to publish these.

What I would say, however, is that local authorities are encouraged to work within the 'Let's agree to agree' framework, and I don't know if the local authorities that you're referring to are doing that. But they are encouraged to do that when setting care home fee rates, because that includes working in partnership with providers to understand costs, and then rates are then set using a fee methodology that is used either by the local authority at local authority or at regional level. So, that is the approach to setting care home fees and why there is, sometimes, inconsistent care home fee setting across each local authority, because each local authority will set their own.

However, you asked, then, the question about what we're doing to try to resolve that particular issue. What we can't do is we can't tell local authorities how to spend their money—that's in the rates support grant; they determine what that spend looks like. But what we have done is developed a new code of practice. So, we've got the national framework for commissioning care and support, which is currently laid before the Senedd, and it's intended that that will come into force in September. Now, the national framework is going to be setting the principles and the standards for commissioning practices aimed at both reducing complexity and facilitating national consistency of commissioning practices and rebalancing the commissioning focus on quality of outcomes. So, what I would like to see is that, when that national framework comes into place later in the year—we're hoping that that will come in in September time—that will give an impetus to having more consistency of approach, not only in practice, but in actual care home fee setting as well. I would like to see that being rolled out fairly quickly, and that local authorities engage with that, and that we see, as I say, the consistency of both practice and fee setting.

Mark Isherwood. You'll need to be unmuted before you start your question, Mark Isherwood. If you can start again. You're fine now.

Okay. During the business statement yesterday, I called for an urgent statement on care home fees after Betsi Cadwaladr University Health Board wrote to providers in north Wales setting out a care home fee uplift of just 3.71 per cent for 2024-25. As I stated, Gareth Davies and I met Care Forum Wales last Friday, and they told us that north Wales now has the lowest care home fees in Wales, putting pressure on providers to stop accepting new continuing healthcare patients and to give notice to their current continuing healthcare funded residents, a distressing outcome that nobody wants to see at the very time when need has never been greater and health boards so desperately need these care home beds. In her response, the Trefnydd stated

'that's something that the Cabinet Secretary for Health and Social Care is actively addressing' on a cross-ministerial basis. How, therefore, do you respond to the call for urgent intervention with the health board to ensure both a sustainable settlement and a national approach to fee setting, to provide a baseline figure that's acceptable to the sector and delivers good value for the taxpayer?

I thank Mark Isherwood for that question. I refer you back to the answer I gave to Llyr Gruffydd, which was relating to the overall process for the setting of care home fees. You've come—. Sorry, Llyr, I didn't address the point you raised about continuing healthcare, which I will do now in response to Mark's question. Continuing healthcare and the setting of policy around that is a matter for the Cabinet Secretary for Health and Social Care, but what I would say is it is the responsibility of the health board to set the appropriate rates of fees for providers under the continuing healthcare. There isn't a national methodology for agreeing the CHC rate. That weekly rate is paid by the health board for CHC, and it might vary depending on the needs assessment for the individual that is in receipt of that care. So, the care that's required and the residential care fee rates are set in accordance with the particular needs.

I will speak further to the Cabinet Secretary for Health and Social Care about that, because, of course, there is an overlap. The CHC fund setting is not in my portfolio; care homes fee setting is. So, we'll have a conversation, and I'm sure we'll be able to get something together and submit it to the Senedd, or circulate it to Members, so that they have a better understanding of what's going on.