The Leader opened debate on this item.

He confirmed that COVID-19 highlighted just how essential social care is in supporting people to be as independent as possible. The issues facing social care – particularly the increase in demand, scale of funding pressures and workforce challenges – are just as pressing now as they were before COVID, with many having been exacerbated by the pandemic.

           Increasing need for services is clearly evident post Covid, and as we reported to Cabinet yesterday, we are providing 8% more domiciliary care than at this time last year. This is as a result of delays in people accessing NHS treatment due to the pandemic, the deconditioning as a consequence of lockdowns and shielding and the impact of long covid. There is therefore a need for much greater funding to support greater levels of social care over the next 5 years

At its centre, social care is first and foremost about human relationships and supporting the care and support needs of individuals and their families, including older people, those that are vulnerable and those with complex needs, to improve their quality of life. An important feature of discussions about the future of social care should be around improving the quality of care and achieving outcomes for the individual, based on ‘what matters to them’. This starts at the local level and should build on the strength of local authorities in their role in place and community, addressing the needs of individuals and families, building resilience and focusing on wellbeing. 

Health and social care are equally important and are often inter-dependent in terms of ensuring flow through the health and social care system. Decisions and prioritisations about the future of each service should reflect that and the need to plan and work together, embedding far more preventative approaches to wellbeing that work closely with public health and housing. Councils are best placed to convene partnerships locally to bring these services together, in a locally focused and democratically led way.

When considering the future of social care and support, addressing the most urgent priorities should be the starting point, these include:

·         The provision of long-term, sustainable funding that is sufficient to meet the predictable additional demands on social care driven by demographic and other pressures, including of course a rapidly ageing population.

·         Additional funding is also needed to tackle unmet need. There is a need to place greater value on an approach to social care which is person centred and recognises the desire of people to continue to live in their communities, mainly in their homes, with meaning and purpose.

·         Improving outcomes for children. There remain significant challenges in providing the right placements for children in care, particularly for those with the most complex needs locally. The past 18 months has also put many children and families under immense pressure and strain, with concerns about increased exposure to ‘hidden harms’ as well as lost learning and the impact of social distancing on children and young people’s development and on their mental and emotional health and wellbeing too.

·         value and investment in the social care workforce is also urgent, valuing the need of parity of esteem with NHS workers, including ensuring the workforce is appropriately and fairly rewarded for the invaluable work they do and have a pathway to career progression within a professionalised care sector.

·         Integration of health and social care, where social care is at last seen as an equal partner to the NHS. This requires trusting and empowering local government to deliver and meet the needs of local communities and accelerating the move, away from health systems centred around hospitals to ones where health and social care systems focus on place-based communities; primary and community services and wellbeing, addressing people’s physical health, mental health and social needs together.

When looking at the future of care and support, the Welsh Government also need actively promote the ‘principle of subsidiarity’ as a necessary underpinning feature of effective health, care and wellbeing and consider how this can be most effectively reinforced as part of the system.

The inadequacy of the current funding model for social care is now well known and there is a real need to invest time and resources to bring coherence and to design a system which is able to effectively meet both the demands which social care will face in the future.

A long-term, sustainable solution to the way social care is funded is essential if we are to deliver a system that is organised around the individual and their family which meets their needs and promotes their wellbeing with safe and high-quality services.

Given the immediacy of the severe economic challenges facing Wales and its communities, councils have previously called for an ambitious programme of investment in several capital programmes which could help rebuild Wales’ community and economy. There remains a need to invest in our social care infrastructure. This is essential to help bring buildings up to modern standards. ‘Extra-care’ facilities have also been developed by a number of local authorities including in BCBC, at Maesteg, Ty Llwyn Derw, Ty Ynysawdre and Llys Ton, Kenfig Hill.

We believe there is scope for further investment in these if capital and revenue were made available at a national level. The 21st Century Schools initiative provides a model that could be used to support a jointly devised programme of work of long-term investment in the improvement and development of our social care infrastructure.

Local government has been broadly supportive of the commitments made in the Welsh Government Programme for Government that relate to social care and is committed to working with Welsh Government to achieve these ambitions. This includes the need to find a sustainable funding solution that enables us to meet our long-term care needs, something that local government has long been calling for.

The UK Government’s announcement on 7 September which set out their plans for healthcare, adult social care and their funding plan, will result in Wales benefitting from around £700m from the additional funding raised. This additional funding provides the prospect of a significant opportunity for Wales to reform the social care system and help tackle the urgent priorities set out. Increased investment brings opportunities to develop sustainable long-term solutions.

Local government, through the WLGA, continue to meet with and discuss the need for long-term and sustainable funding with Ministers on a regular basis to help shape Welsh Government’s thinking on how the additional funding could be used, reflecting local government’s ambition and priorities for the future. In addition, WLGA Spokespeople for Health and Social Care continue to meet with the Minister for Health and Social Services to highlight the increasing concerns about the current pressures being experienced in social care and seeking discussions on potential actions now, that could be taken at a national level to help tackle and address the challenges being identified now across the Council.

As part of this we believe there is a need to develop a balanced approach that does not give one part of the system primacy over the other in dealing with the pressures facing social care and health in the short and long-term, with health and social care being treated with parity in the budget considerations, recognising that health and social care are equal partners in the aspiration of delivering one seamless health and social care system for Wales, organised around the individual and their family.

Local government does not want to be in a position where we compete with health for investment in local services that address the health, social care and wellbeing needs of our citizens. We are partners and work together to deliver services, although we all know that we could and should do more to ensure there are seamless services from the citizen’s point of view. But it must be recognised and addressed that the social care services that local authorities and our partners provide are not valued or understood by the public sadly, in the same way that citizens view the NHS – this is reflected in the fact that the public understand the need for further investment in health but do not call for the same investment in social care. We must continue to raise awareness with the public about the value of social care and its impact on people’s wellbeing and independence.

A Member pointed out that every local authority and most providers have changed their recruitment practices. Having previously worked in Social Care, he explained how rewarding this is, ie the relationships you build, the staple feature you become in making a difference to people’s everyday lives. In spite of all that, we were facing the biggest recruitment and retention crisis in living memory.  

He advised that social care in this country has been underfunded for decades and the chickens are coming home to roost with an increasingly ageing population and significant numbers of people living longer with health needs.  

A fair day’s wage for a fair day’s work, is fair. In too many situations, however, that simply was not the case. Social care colleagues in the past 18 months have done extraordinarily well, but their wages reflect differently. While there are many ethically responsible third sector and private providers, there are still that come where contractual obligations are less than favourable, for example employees having to pay for their own uniform, or the Real Living Wage not being paid.  

He stated that pay needs improving, terms and conditions need improving and funding of the system needs improving.  

It has come at no suprise, that successive UK governments have, since 1996, commissioned seven policy papers, five consultations, and four independent reviews into social care. Successive UK governments have also kicked recommendations into the long grass and not grasped the nettle in ensuring there is a unified health and social care system, where nobody falls between the gaps.  

He explained there was a case here to look at, economies of scale.

The Leader mentioned that Councils are best placed to provide care and, while he did not disagree with this principle, he wondered if there is a half-way house whereby packages can be devised and delivered locally, but perhaps overseen more on a regional basis. He absolutely understood that bigger isn’t always better in terms of service delivery and outcomes, but did think it needs analysis on a similar basis to Wales’ economic footprint with regional deals.  

He challenged UK and Welsh Governments to look internationally and learn from others, in particular, our neighbours in Scandinavia who properly recognise and their fund social care and health system, in this case by up to twice as much as the UK currently does. Hence part of the reason that Scandinavians enjoy the best quality of life in the world.

A Member pointed out that he was not an expert in Social Care, nor did he have the answers in terms of sustainable long-term solutions with regard to adequate support being provided in this crucial work area. He too paid tribute to staff in due to their extraordinary efforts during the pandemic.

 Whilst the subject of today’s debate was how Social Care can be funded in future, Covid-19 had undoubtedly demonstrated the fragility of the Social Care system as a whole and that the experience should be a catalyst for some change.

Welsh Government had stated that future funding of the system would be challenging and that even if annual spend increased in the support of Social Care by 6%, as if did between 2017 and 2019, this was unlikely to meet future costs of demand for Social Care. Therefore, if this demand continues, as was expected, together with financial and workforce pressures also increasing, the need for a solution to the problems being experienced overall would be greater than ever.

He was aware that the Welsh Government had focussed on joining up Health and Social Care and attempting to preventing problems occurring or getting worse in the first instance. He therefore believed that with an ageing population likely to see a further increase in Social Care support being required, further funding avenues being sought for preventative measures to be put in place were critical for this Authority.

Audit Wales had recently published a report on Social Care which found that some Council’s had increased their preventative services by starting a shift from Social Care per se, to preventative and community based provision. But to make this move successfully, there was a need to have sufficient preventative measures in place in the first instance.

He asked therefore, how well the Council was performing in preventative and community based provision, which ultimately over the longer term, will alleviate pressures in Social Care and also, how will funding be diverted in future to support preventative measures, while we still continue to be responsive to residents more immediate Social Care needs.

The Corporate Director – Social Services and Wellbeing confirmed that funding of Social Care was a political consideration which gave rise to very important political decisions having to be made, both in the past and the present time. This would undoubtedly continue to be the case also in the future.

One of her duties as a Statutory Officer, was to ensure that the Council had the level of resources required to adequately support the statutory duties in terms of providing Social Care, Safeguarding and Wellbeing services, the latter of which, where the Authority had made some significant progress in terms of fulfilling its Wellbeing Objectives, both through a Council and through some award winning and exemplar schemes obtained with third sector partners, an example being the ‘Super Ages Scheme.’ There was more work to do however, including putting together a Business Case in order to move to more preventative services, which are crucially important going forward.

In a professional capacity, she wished to advise that there was still a need to invest in Social Care provision as well as preventative services, brought about as a result of the pandemic and previous to this.

Pre-Covid-19, local authorities were still coming to terms with supporting an ageing population, the complexity of needs, through those individuals with a disability and those who as they get older in life develop health problems. As a result of the pandemic, now added to these issues were Long-Covid support requirements and delays in obtaining treatment for this and other medical ailments and diseases. People had also experienced long periods of isolation during Covid, as well as whilst shielding and had experienced de-conditioning as a result of being inactive for long periods during lockdown. So a twinned track approach was needed in terms of investment in both Social Care and preventative services, in the short, medium and long term future, particularly since the pandemic.

Investment was also a priority she felt, to address the robustness of the Social Care workforce which was reaching a critical point, due to challenges regarding the recruitment and retention of staff across the board. Career pathways had to be developed to mitigate this, such as more effective pay and grading structures being put in place. ADSS Cymru have worked with officials from both Welsh Government and the WLGA, so that consideration can be given as to the best way to invest in Social Care in the future. This if realised, will give a better quality of care and lead then to better outcomes for those who received it.

The Leader picked up on some of the points made earlier in debate. He was pleased to confirm that regional solutions to regional problems surrounding Social Care were being looked at, through work which was effectively ongoing with Cwm Taf Morgannwg University Health Board, in conjunction with Rhondda Cynon Taf and Merthyr Councils and the third sector, in relation to commissioning of services at that level, through initiatives such as ICF Welsh Government funding.

Issues such as terms and conditions of staff were also being looked at with the assistance of partners, including the introduction of the Real Living Wage, as a minimum salary offering to Social Care staff. There was a problem however, in that there was not the level of interest being shown by members of the public seeking employment, in this type of work as there had been previously. Also to compound that, the private sector were still offering better terms of conditions both in this and other similar areas of employment which had not helped the situation. This was resulting in some  shortages in labour across the economy in what was a competitive environment. This all culminated then, in difficulties in terms of both recruitment and retention of the workforce.

In terms of financial support, the Leader highlighted that there was a genuine and real opportunity, with £800m funding having been committed to Wales and he felt that this should focus upon Social Care including preventative services, as well as the NHS, based upon reasons of parity and need. Statutory Social Care support avenues continued to be very much available he added and importantly, such support was also continuing to be provided in recipients homes and community settings also.  

A Member said that she did not dispute some of the points made today on this item of business and she was conscious of the fact that Welsh Government have endeavoured to reward Health and Social Care staff in Wales. She seen care providers making an easy profit at the expense of public money, due to them refusing all the complex packages of care requirements that are needed. Debate today had included the disparity of pay and terms of conditions for Health and Social Care staff when compared to NHS staff. The NHS staff received 41 days leave entitlement each year and had been offered a 4% pay rise.

Local Government staff were paid under the Green book and we have been informed, that our employers are not negotiating any further regarding this year’s pay claim, which stands at 1.75% which is unacceptable, given that if this was not at 5.6%, it would actually mean a pay cut. Most of the staff were also in part time posts also in the Health Service, she added.

A Member concluded by stating how important it was to maintain both the quality and quantity of staff in the field of Health and Social Care, as employees there faced tough conditions in terms of the work they had to do. A considerable number of them on top of these hard working conditions, were also working a lot of extra hours, due to the high sickness levels experienced in the workforce due to the pressures of work, that had inevitably increased as a result of the pandemic.