– in the Senedd at 3:41 pm on 24 September 2024.
Item 4 today is a statement by the Minister for Children and Social Care: the national framework for the commissioning of care and support in Wales. And I call on the Minister to make the statement—Dawn Bowden.
Diolch, Dirprwy Lywydd. Now, as Minister for Children and Social Care, it's a great responsibility and an honour to represent and champion the sector within Government. Last week, the Prif Weinidog announced priorities shaped by the people of Wales, and she made it clear that improving access to social care is a major part of this Government’s priorities to provide iechyd da, good health. A lot has already been done to improve access to social care. We launched the national office for care and support and the first social care workforce partnership in the UK. We are making great progress transforming children’s services and introduced the groundbreaking social care Bill.
Now, over my time as Minister with responsibility for social care, I've had the privilege and the opportunity to visit services delivering real change. I've witnessed examples of progressive practice that are championing good outcomes for the people of Wales. I've also seen first-hand the talented and tireless social care workforce who are the beating heart of the system in Wales. They, and the citizens in need of care and support, provide me with the motivation to move forward to deliver on this important policy and tackle the challenges that still lie ahead. At the heart of everything we do is the simple but essential ambition to enable people to live their lives to the fullest. This is reflected in the laws and policies that govern us and our statutory partners who deliver to our local populations.
Since the Social Services and Well-being (Wales) Act 2014 came into force, we've remained steadfastly committed to achieving its aims to meet the care and support needs of people in Wales. The rebalancing care and support programme recognised that improving the way in which care and support is commissioned is one of the key ways that we can facilitate positive changes to enable the consistent and effective implementation of the Act. By applying the Act’s principles to commissioning, the national framework paves the way for a simpler system, in which the provision of care and support can be rebalanced to meet the needs of people in Wales. And that's why we've developed and brought into force on 1 September a new code of practice that establishes a national framework for commissioning care and support. The framework puts in place national principles and standards to guide and align commissioning practices to the aims of the Act. It aims to reduce complexity and drive consistency of approach and ultimately improve outcomes.
The framework will move commissioning practices away from price-driven contracts towards a system in which the principal driver for services is quality and social value. We will have a clear focus on delivering the personal and individual outcomes that matter to people, rather than taking a task-based approach. This framework will ensure that individuals are at the centre of planning the care and support services that they receive, and that those services are available. We must also create a system in which social care provision is sustainable and effectively managed to meet the current and future needs of our people.
So, what does improving access to social care mean and how will the national framework contribute to the delivery of this priority aim? It means that people all across Wales will be able to exercise their right to seek and to be provided with the care and support services that meet their individual needs and help them to achieve their desired outcomes and to live their lives to the full. The principle of what matters to individuals is embedded in the code’s principles and standards and, combined with its provisions relating to people’s rights, will help facilitate effective and efficient access to services.
There are specific provisions within the standards that require the commissioning of care and support services to be co-produced with individuals in need of care and support, with their voice and control central. This is a central principle of the Act, but the specific application to commissioning should facilitate positive changes to ensure timely and easy access to services. Local authorities, health boards and NHS trusts will be enabled to effectively plan and ensure that the full range of care and support services that are required by, and matter to, individuals in their areas are sufficiently available to everyone who needs them at the time they are needed.
It’s clear that the national framework will play a pivotal role in how we will deliver this Government’s renewed commitment to improve access to social care, which contributes significantly to our overall endeavour to provide iechyd da, good health. We will drive this transformation through strong leadership at all levels, so that relationships, fair work and value is central to commissioning care and support.
The National Office for Care and Support, which came into place in April 2024, will play a key role in supporting partners to implement the national framework to realise our joint aims and ambitions. We’ve already started delivering a package of support to help partners understand and implement the national framework. The national office, in partnership with the national commissioning board, delivered nine awareness-raising sessions, attended by over 450 stakeholders from across the sector. This has provided invaluable information to inform the support that the national office will provide to partners to implement the national framework. Building on this, we will be delivering further events across Wales this autumn.
The national office has also launched a toolkit of resources to support commissioners to work in line with the principles and standards in the national framework. This toolkit is publicly available and hosted on the Social Care Wales communities platform. As well as supporting implementation of the framework, the national office is developing, through ongoing dialogue with commissioners and the wider sector, a mechanism for monitoring the progress of implementation. This process will also inform the biannual review and revision of the national framework to ensure that it remains current whilst aligned to the aspirations of the Act. This clearly fits our renewed focus on delivery, accountability and improved productivity.
In line with this approach, I will keep Members updated on the progress of the implementation of the national framework. I look forward to sharing the positive changes it is making to social care in Wales and how it is helping to achieve the Government’s ambition of improving access to social care. Diolch yn fawr.
Thank you for your statement, Minister. This new code is an extremely welcome step in ensuring that we have a uniform approach to care commissioning across the board, regardless of where you live or who provides your care. Minister, while I welcome the introduction of the national framework, I do have a few questions on how it will impact day-to-day, front-line services.
How will the Minister ensure that the welcome move away from price-driven contracts will not have a detrimental impact on local authority and local health board budgets? You state that commissioners will be able to effectively plan and ensure that the full range of care and support is available to everyone who needs them at the time they are needed. However, unless we address the bigger barrier to care provision, namely a well-resourced and valued workforce, this is not achievable. Minister, how will the new framework address workforce shortages and enable long-term workforce planning?
Aside from the challenging workforce and budgetary issues, we also have to address other challenges facing care and support commissioners, namely enhanced training and data collection. Minister, what training and support is being provided to those who will commission care and support to ensure that they meet and exceed the standards expected by the new framework?
And finally, Minister, on the subject of data collection, without proper data, how can commissioners be expected to understand the care needs of their area and their ability to provide for those needs? The framework will require commissioners to encourage providers to complete the Social Care Wales workforce data collection. Minister, surely this should be compulsory as a bare minimum. We need to thoroughly understand the skills of the workforce if we are to have any hope of addressing skills shortages. How will we know whether we need more Welsh-speaking carers if we don't know the skills of the existing workforce? Minister, do you have any plans to increase the data collection requirements of the code?
Thank you again for your statement and I look forward to monitoring its implementation and delivery across Wales. Diolch yn fawr.
Diolch yn fawr, Altaf, and thank you for those comments and questions, and for your general welcome of the framework. As I said, we are establishing this to enable the framework to apply equally to the commissioning of care by both local authorities and health boards and trusts. So, it's a new development in that respect, because it's now, for the first time, putting a requirement on health boards and trusts as well. And that instruction has been issued to the health boards and the trusts.
In terms of the various elements or the various points that you've raised, on the impact on budgets, this is actually central to what we're trying to achieve here. There is such an inconsistency across Wales about how much care costs, depending on where you live, and what the rates are set at, and so on, and that's partly because there is no clear and consistent definition of what commissioners should be looking for. So, this national framework will set that out very clearly, will set out what the requirements are for commissioners, what they are to be looking for in the provision of care, whether it is cost, whether it is outcome, whether it is the staff workforce and whether it is the skills and sufficiency that they need. So, part of the framework will actually require all the component partners—local authorities, health boards, and so on—to develop a sufficiency plan that will identify the skills required to enable them to deliver what we are seeking them to deliver.
I don't underestimate for one moment the enormous challenge that that presents, because I think, in the question that Jane Dodds raised earlier on to the First Minister about the social care workforce, we know that there are huge challenges in that area, but we are doing an enormous amount of work to try to address the gaps, the vacancies, the recruitment and the retention, the career pathways and to develop the professionalisation of the social care workforce, so that it becomes an attractive career for somebody to be involved in.
In terms of the training that you believe that commissioners will need, I absolutely agree with you. If we are going to do this effectively and consistently across Wales, everybody needs to know what they're doing and everybody has to be singing from the same hymn sheet, and I hope that's what the framework will provide. As I said in my statement, we have already delivered a number of training sessions for commissioners, stakeholders. Over 450 people have already attended those sessions. And we are providing a toolkit for commissioners to use, so that they have something that can guide them through. The national office that we've established for care will be the key resource and support that will be available to commissioners to ensure that they have somewhere that they can go to, to make sure that what they're doing is what is expected in the framework and is actually delivering the outcomes that we need.
Thank you to the Minister for the statement. The statement and the development of this framework is a great step towards creating a national care service, and it's therefore to be welcomed. It's work, of course, that commenced following action on Plaid Cymru policy in the co-operation agreement—another sign that positive statements coming out of this Government come about as a result of following the positive lead of Plaid Cymru. On paper, of course, the core principles and standards set out in this framework are ones that we support, and it's about time that we see this happening.
However, as the responses to the consultation clearly reflect, there remains widespread concern that the principles and standards outlined in this framework, as worthy as they are, will be unachievable in practical terms. And they're right to be concerned. Without a decisive rejection of austerity and sustained increases in public spending, local authorities, who will be primarily responsible for implementing this framework, are hurtling headlong into an existential crisis. This year, they're having to contend with a 3.8 per cent increase in spending pressures compared with a mere 0.3 per cent rise in funding. By 2027, this discrepancy is projected to leave a shortfall across Wales of around £0.75 billion.
The implications for Wales of Labour's austerity agenda, therefore, are dire. Non-ring-fenced areas of the Welsh budget, which include social care, are now facing a real-terms reduction of £683 million over the next five years. When I raised this stark reality with the then health Minister at the end of the last term, I received a flippant response about taxes that was completely at odds with the social democratic values on which the Labour Party is supposed to be based. Since then, she's refused to challenge the unjust Barnett formula that is at the heart of Wales's systematic underfunding by Westminster, and has admitted that she has as much influence over the UK Prime Minister's decision making as she has over Donald Trump. Contrary to the promises made over the summer, therefore, this is a Government that is sticking its fingers in its ears rather than listening to the warnings of public service providers that are being pushed to the brink.
It's up to the Cabinet Secretary, therefore, to explain to the local authorities, who will be expected to implement this framework, how they can possibly manage to do more with less. So, can the Minister guarantee that these steps will work without a funding uplift to properly support our social care workforce? What influence, if any, does this Minister or the Government have on the UK Government to ensure proper and improved funding in order to fully deliver this framework successfully?
Can I thank you, Mabon, for those points and for your general welcome for the commissioning framework? I think we are in the same place in terms of what we're seeking to achieve on all of this. I'm not going to deal with the issues that are, quite rightly, for the First Minister, but your overall comments and points about funding and budgets, I fully understand, and we have those very robust discussions in Cabinet, as you would expect. We will soon be having the next budget round, where we will all be making our bids for where we think money for the next financial round should be going.
But I think it's important to say—in part, I answered this when I responded to Altaf—that a lot of this is not about asking local authorities to do more, it's not about asking health boards to do more, it's about asking them to do it differently. It's about looking—. We're very clear about what the rebalancing of care programme was all about. I'll just repeat it: it's about moving away from complexity towards simplicity; it's about moving away from price towards social value and quality; and it's about moving away from reactive commissioning and towards managing the market. It is providing a framework for the commissioning of those services that can produce greater value for money and greater consistency. Again, in my response to Altaf, I made the point that, depending on where you live in Wales, the cost of care is very different.
What this is aiming to do is to bring into place a consistency, so that everybody is doing the same. That doesn't mean, necessarily, that all charges will be the same and that care home fees, for instance, will be the same wherever they are. But the basic principles of how care is commissioned, which are quite different depending on what part of Wales you're in at the moment, will move us towards a much more consistent approach, which we hope will lead to improved quality and improved outcomes for individuals. That has got to be key. It is not just about price; it is about outcomes. And it's about a more effective partnership working between the local authorities and between the health boards.
What I would say as well is that there are significant roles for other partners in terms of delivering this. We look at the role of regional partnership boards, for instance. We were talking about funding pressures, but on significant aspects of social care and the delivery of social care, regional partnership boards have the ability to pool funding—the £145 million-worth of funding that the Welsh Government has given to regional partnership boards to do this very work. It is about integrating our social care system, it's about bringing consistency in our social care system, and it's about removing complexity to make sure that we get the outcomes that we want. And key to all of that is involving the individuals in the planning of their care so that their voice is central to everything that we are looking to do.
None of this is easy. Nothing is ever easy. Because if things were easy, Mabon, we'd have all done it by now. So, what we are looking to do is to rebalance, as I've said. We will have a monitoring and reviewing process, and we will look to review this every two years with a view to refreshing it and improving in areas where we think it needs improving. But there will be constant monitoring and review of the process as we move forward.
I really welcome the report that the Minister has given today. I think that the move towards a national framework, following the setting up of the national office, is a very positive step forward, and I'm very pleased that the Minister is going to keep us updated in the Chamber on the progress.
But one of the big issues that is facing the social care workforce, which has already been raised in the Chamber today, is the issue of pay. It's so important that social care workers' pay reflects the value of the work that they do. It's absolutely great that the Government has been able to bring in the real living wage, but as we know, there are challenges, in particular when you match similar jobs in the NHS and the social care service. It does make it difficult to retain social care workers in the social care service when they can get paid a lot more if they do the same job in the NHS. So, there are lots of issues like that to look at.
I wondered if the Minister could tell us how she plans to use the framework to make sure that the voices of social care workers are heard and that they're able to have their input into what I think is a huge step forward. Would she agree that the national office and the national framework are the building blocks towards a national care service?
Can I thank Julie Morgan for those points and those questions? And I also thank you, Julie, for the work that you did leading up to the formation and drafting of the national framework. I know that you were very heavily involved in that before I became Minister, so thank you for the work that you did on that.
What I would say, in terms of where we're at now, is I think all of us—. It's been raised several times and we all understand absolutely the challenges of the social care workforce, and in particular the very point that you were raising about the parity of esteem with the NHS. We know that healthcare assistants in the NHS, for instance, do very similar work to social care workers, and yet their rates of pay and their conditions are very different. And it's because they work in different Government structures—one in the NHS, one in local authorities.
Under standard 2 of the framework, there is going to be a requirement to secure sufficient skills, resources and capacity from the local authority and the health board. What that’s going to require is that all of the statutory partners have got to balance the elements of the commissioning cycle, to ensure that they have sufficient skills and capacity to co-design, plan, deliver, secure the services that we are asking them to commission. In order to do that, part of what they are going to have to look at is what they are paying staff. If they have to secure sufficiency of skills, then there will be an element of that that will require them to pay the rate that will require the skills that they need.
What I would say is that that work is quite well progressed through the social care fair work forum. We work very closely with trade union partners in that forum, as you know, and there is an awful lot of work still going on. The real living wage you have already identified. We are now into the third year of the real living wage. That was something that was prioritised initially, and it hasn’t ended there. That was the first step. We are now looking at the other areas—terms and conditions of service—and how some of those things can be improved: the career pathways for people, so that it becomes an attractive career option and gives people the opportunity to move on to different areas; potential pathways into social work, with our social work bursary; and so on.
I think that, fundamentally, we know that we have a significant issue with the social care workforce that we cannot let up on, in terms of moving to try to resolve it. I think that it is absolutely right that we have the parity of esteem with the NHS. This is a professional workforce looking after some of the most vulnerable people in our society, and we should absolutely value that. So, that is work that is ongoing. It isn’t finished, and we won’t be finished with that until we actually achieve what we need to achieve for that very valuable workforce.
Good afternoon, Cabinet Secretary. I really do welcome this. It’s a great step forward, but I have just got a couple of points, really, on pace. We continue to wait for this. The complexity in my mind is about the reorganisation and the new culture that’s needed. People in our care sector and our health sector are really overwhelmed at the moment, and to pile on them, yet again, another change is a real challenge. So, I am just wondering how the Welsh Government is going to do that, particularly at pace.
The second issue is one that I raised with the First Minister this afternoon, which is around the social care sector in rural areas. It is very challenging for us, once again, to recruit and retain carers within rural areas. I was talking to a lady whose husband needs ongoing care. They had to bring in a carer from Worcester on an ongoing basis in order to support him. That is just not appropriate and not good value for money. So, please could you just outline the pace and the scale, and also how we are going to get our carers into rural areas and build that capacity in those areas where it’s really difficult to recruit and retain? Diolch yn fawr iawn.
Thank you for that, Jane, and I absolutely hear your challenge about the change of pace. What I hope is that this won't be a huge change for people who are involved in the commissioning of services. What it is doing is introducing consistency and putting it onto a statutory footing, so that there is less leeway to do things a bit differently, so that we have a very consistent approach. If everybody is working to that same consistent approach, one of the objectives of this, very clearly, is that we should see cost savings through the process. Because as I said in the answer that I gave to Mabon earlier on, we are very well aware of the pressures, particularly on local authorities, and we need to deliver this to help address some of those issues as well.
I know that, in some regional partnership board areas, some local authorities and some health boards are further advanced in terms of their capacity to be able to deal with this than others, but they can all move very quickly to the new framework and what the requirements are of the new framework. As I said, we have run a series of workshops and training sessions with commissioners over the summer. We've got another round of training available to them in the autumn. There will be a toolkit available, and they will be able to access the national care office for support.
The challenge on social care in rural areas is a real one, and it would be foolish of me to stand here and say that I have all the answers for that, because, again, as I said in a previous response, if we had the answers for everything, we would have done it all by now. But even though things are difficult, it doesn't mean that we shouldn't be looking at it and trying to address it. The answer—. The problem, sorry—before we get to the answer, let's look at the problem—is almost self-evident, isn't it, in rural areas, because there are fewer people in rural areas to do all sorts of work. Getting people into social care in areas where we have very dense populations is difficult, so getting it in an area that's sparsely populated is even more difficult.
I'm more than happy to have a conversation with you outside of this discussion this afternoon, to see how we could perhaps look at some of the ideas for doing this, because I certainly don't have all the answers. The social care fair work forum, I'm sure, don't have all the answers, and they would like to have some help and support with that. But it is on our radar. We understand the challenges. All the things I said in response to Julie Morgan equally apply to trying to recruit social care workers in rural areas, but I do understand the added difficulty of having fewer people to draw on in the population. But I'm more than happy to have a further conversation with you about that.
And finally, Rhys ab Owen.
Diolch yn fawr, Weinidog. Do you see this as a stepping stone to a national care service? If so, when? Because you'll be well aware that individuals and families are being crippled by care costs and they're often not receiving the care that they should be receiving, that they need be receiving. Following on from the points by Altaf and Mabon, and your response, will you give a guarantee that the national office will receive the adequate resource it needs to provide effective training? And thirdly, with regard to data, data is very important, but data collection, especially sensitive data collection, is costly and challenging. We've seen, from the Electoral Commission's breach this year, what happens when data is managed on a very tight budget. Can you give an assurance today that social care data of very vulnerable individuals, families and cases will be kept secure? Diolch yn fawr.
Thank you for that series of questions. There are a couple of things. Sorry, Altaf, you did raise the issue of data earlier on, so I'll deal with it now in response to Rhys ab Owen. Data collection, absolutely, is vitally important, because it provides the baseline from which we work. I'm going to be making a further announcement next week, I think, about the introduction of the single unified safeguarding review and all the work that we've had to do on that with the Information Commissioner's Office to ensure that data can be shared in a safe way, where people's confidentiality is respected, and so on. So, we've done an awful lot of work on that, and we've got some very clear guidance from the Information Commissioner's Office about how we do that, and how we ensure that that is secure. I'll be saying a little bit more about that when I make that statement.
The national office is absolutely essential to the delivery of the national care service. It was one of the key planks of the co-operation agreement with Plaid Cymru, and I'm very grateful to Plaid Cymru colleagues for the point that we got to. I think, Siân, it was you that was involved with this, or was it Cefin? It was you. I was in a different ministerial portfolio at that time. In establishing that, we recognised the severe financial challenges that we're faced with in moving quickly to the establishment of a national care service. So, we moved towards the delivery of it in phases, and the first phase is what we're in now, and part of that phase 1 is that we're going to be commissioning research around how we can get to where we need to be, what the costs involved might be, how we would set fees, or how we move from a fee-setting service to a non-fee-setting service, because we've made a very clear statement that we are looking for a national care service that is free at the point of need.
Now, I did have a meeting with Stephen Kinnock over the summer, who's the UK Government Minister for social care, and he was very interested, because the UK Government wants to move towards the establishment of a national care service as well, and I think this is one of the examples of where we can do things across the nations because we're well advanced on that path. And so they want to learn from us about what we've established, what we've found, the way that we want to take it forward, so that they can learn from that.
So, from my point of view it is absolutely vital that the national care office is resourced adequately, because it has to drive all of these changes that we know are absolutely necessary to deliver that priority of accessing social care. So, I can give that assurance. What I can't tell you absolutely is when the national care service will be delivered, but in the agreement with Plaid Cymru we were working on a 10-year programme, so at the moment that's still the kind of timescale that we're working towards, if that helps.
I thank the Minister.