Consultation Questions Rebalancing Care and Support 2023

Consultation Response Form    

Your name:        S G Milsom

Cymru Older Peoples Alliance

email / telephone number:

029 2043 1570

Your address: c/o Age Cymru Offices, Mariners House, Trident Court, East Moors Road, Cardiff, CF24 5TD  

Chapter 1 – Part 8 – Code of Practice – National Framework for Commissioned Care and Support

Question 1.1: Do you think the principles and standards set out in the Code will help to ensure Wales-wide consistency in commissioning processes and practice and reduce duplication and complexity?

Emphasis on co-production and prevention is welcomed but very ambitious given the large gap in meeting current requirements for delivery on the ground now.

Question 1.2 Do you think the standards set out in the Code will help to ensure Wales-wide consistency in commissioning processes and practice and reduce duplication and complexity?

They will help but depend more on the change of culture and practice in commissioning departments. On para 1.56 there is a need to reflect that for some service users, they will want to choose not to use technology. Alternative non-digital options should always be available. 

Question 1.3: Do you think the requirements in relation to Welsh Language will help to bring about consistency around the provision of Welsh language services and the active offer?

Yes- but only if more resources are devoted to increasing the recruitment of Welsh speakers and  investing in support for learning.

Question 1.4: Do you think the requirements in relation to Equalities will help to promote and improve the rights of individuals receiving care and support and carers?

No – there is nothing explicit as to how the social services deficits for older people and their carers will be addressed. The overall investment in older people’s services is not meeting needs nor keeping pace proportionately year on year compared to other services. Waiting times for assessments and to receive services are at an all-time high and help is concentrated on those with the most critical care needs, leaving families to cover more than they should. The new Code of Practice must be explicit about the principles of how this age discrimination will be addressed.

Question 1.5: Do you think the statutory requirements and guidance in the Code will help to reduce complexity and bring about national consistency in the commissioning of care and support?

They will help but not just in themselves. The framework of support envisaged to be provided by the National Office and its resourcing will be vital to bring about national consistency.

Question 1.6: Do you think the statutory requirements and guidance in the Code will help to improve outcomes for individuals receiving care and support and carers?

It is difficult to see how that can happen unless there are new and additional resources made available to implement the statutory requirements and guidance.

Question 1.7: Do you think the statutory requirements and guidance in the Code will help to refocus the fundamentals of the care market away from price towards a value measure based upon service quality and overall cost?

They have the potential to do so but only if additional investment by Councils is given in the commissioning function, with innovation and higher relative priority. Any risks to market stability and further erosion of the viability of care providers must be avoided. If the in-housing of services is considered, then the true overall costs must be used i.e. All costs of local government employment, delivery, and management of services and best value achieved. A mixed market with improved co-production with providers and users is needed.

Environment – the impact on users’ needs to be considered and their dignity must not be compromised e.g., by restrictive use of continence products.

Question 1.8: Do you think the statutory requirements and guidance in the Code will help to facilitate the provision of a seamless health and social care service, reducing barriers to joint planning and delivery.

Did you mean to leave blank?

Chapter 2: Pay and progression framework proposals.

Question 2.1 The principle of the pay and progression framework is to offer a national framework that can support the principles of fair work. Do you believe it can support that ambition and the benefits outlined above?

Good framework but will require agreement between Councils to ensure consistent implementation and avoid poaching of staff.

Question 2.2 Do you have any suggestions about how the framework might be improved to help meet its ambitions?

Does not address the important relationship between NHS care workers’ pay and social care workers and the better remuneration and terms they enjoy.

Question 2.3 What may be the barriers to the framework achieving its ambitions?

Additional resources, reluctant providers, differential impacts,

Chapter 3: National Office for Care and Support proposals

Question 3.1: Do you agree with the design for the National Office? If not, what design would you suggest?

The design needs to be clearer about how NOCS relates to achieving the national purpose, direction, and expectation.

Question 3.2: Do you agree with the vision for the National Office? If not, what vision would you suggest?

The vision would seem to support the policy of statutory duties remaining with Councils but added value of investment in function could be clearer. Avoiding a restructuring of social services will benefit older people in that disruption to services will be avoided.

Question 3.3: Do you agree with the proposed functions for the National Office, and the relationship described with key statutory organisations, particularly local authorities, Social Care Wales, and NHS Wales? If not, what functions do you disagree with and why?

Further information is required to assess how it will all work and improve the experience of the service user.

The question asked assumes that all the necessary functions have been proposed. Additional functions may be required.

Question 3.4: From the proposed functions of the National Office, do you envisage any duplications of work already carried out by other national bodies or organisations and are there further opportunities here for simplification?

Bringing the market assessment functions of SCW into NOCS would seem sensible.

Question 3.4a: If yes, how do you propose this is resolved? For instance, would you support certain functions being absorbed by the National Office?

Yes – as above. There may be others – a pragmatic approach is needed.

Question 3.5: In its positioning within the Welsh Government and providing for a ‘bird’s eye view’ of the social care system, what are the main opportunities, working with local authorities, Social Care Wales, and other key partners, to drive service change and improvement? Please give reasons for your answer.

Question 3.6: What do you see as the specific opportunities for the National Office to lead culture change in relation to Welsh language? In particular, the ‘More than just words’ five-year plan (2022-27).

A new programme by the National Office with resources would be required to implement the change of culture and practical application.

Question 3.7: What practical steps can the National Office take to ensure equality of opportunity through social care? Noting the diversity of Wales’ communities and people’s own circumstances, how can it add value at a national level to ensure people’s wellbeing outcomes are consistently met?

Outcomes for older people are not currently being met and need to be given greater priority.

Chapter 4 – Part 2 – Code of Practice (general functions)

Question 4.1: Do you have any comments on the detail of the revised draft Code, including any suggestions about what is missing, what could be omitted or where wording could be improved?

There is a strong reliance on Council cooperation in making all this work happen. What if local democratic decision-making takes Councils in a different/competing approach – what are the resolution mechanisms and ultimately penalties for non-compliance?

Question 4.2: In particular, do the revisions to Chapter 4 help clarify the duty on local authorities to promote social enterprises, co-operatives, user-led services and the third sector? Is anything missing or unclear?

Yes, but Advocacy should be a “must” requirement. In general, these structures have not developed as envisaged in 2014 in respect of older people, and a significant programme of work led by the Welsh Government with partners is needed to make it all a reality. The ADSSC Report in April 2020 – Mapping Co-operative Provision – Domiciliary Care provides a good baseline for progression.

Question 4.3: Does the new Chapter 5 give the right messages about the duty on local authorities to promote the involvement of service users and carers? Is anything missing or unclear?

The final report of the evaluation of the 2014 Act highlights the gap between policy rhetoric and delivery on the ground. Whilst enhanced involvement of older people and their carers would be very welcome, how will this be resourced and policed?

Chapter 5 – Statutory Guidance (partnership arrangements)

Question 5.1: Do you agree with our proposals to amend the Partnership Arrangements Regulations 2015, and to the Care and Support (Area Planning) (Wales) Regulations 2017? Are there any other amendments you feel we need to make?

Whilst the proposals for the involvement of users and carers para (66-70) would strengthen the current arrangements, they do not go far enough. Experience suggests that it is the extent to which the views of the Citizen Panel are listened to and acted upon that is the problem. There should be some accountability mechanism that requires a formal record and response as to whether the service users’ and carers’ views have been considered and how, and why any proposals have been rejected. Transparency needs to be strengthened in the regulations.

Question 5.2: Have you any comments on the proposed revisions to the Part 9 Statutory Guidance, including any suggestions about what is missing, what could be omitted or where wording could be improved?

In relation to commissioning care homes for older people, the requirements set out at para 141 should be established as a “must” not a “should”.

Question 5.3: Do you agree that the proposed amendments to the regulations and statutory guidance will help to strengthen regional partnership arrangements and the role of Regional Partnership Boards? Do you have any other suggestions about what could be included?

The arrangements set out and the related structures look very comprehensive and could improve engagement and coproduction with service users. Given the potential for the requirements to add to the costs of administration, there should be a general “must” duty to ensure economy and efficiency and best value in the way these arrangements are implemented and operated.

Chapter 6 – Part 8 – Code of Practice on the role of the Director of Social Services (social services functions) and the changes to the Local Authority Annual Report Regulations.

Question 6.1: Are there any barriers in implementing the new guidance for the production of the Local Authority Social Services Annual Reports?

The requirements will cost money and time – commodities in short supply currently and where front-line services are best prioritised.

Question 6.2: What support/training is required in implementing the new guidance?

No comment

Question 6.3: What outputs or analysis of the Local Authority Social Services Annual Reports would you want to see undertaken?

  • para 3.13 offers the option for LAs to publish a separate plain language version of the report for the public. This should be a “must” requirement if transparency and accountability is to be evident as the largely professional nature of the reports are not meaningful to the public including older people.

Question 6.4: Do you consider that the combination of the Performance and Improvement Framework, National Outcomes Framework and Local Authority Social Services Annual Reports provides sufficient guidance and structure for local authorities in achieving the outcomes?

No comment

Chapter 7 – Integrated Impact Assessment

Question 7.1: We would like to know your views on Sections 1 and 8 of the Integrated Impact Assessment. Are there any specific areas where you feel further detail is required, or any specific issues you wish to highlight which may have an impact on a specific group?

  • Funding challenges – more should be included about how this central issue will be addressed and the options that might be considered.
  • Early Intervention and Prevention – further details should be included about how progress from “aspiration to reality” will be addressed and especially the role of the third sector.
  • Whilst LGBTQ and Racism is addressed, nothing is included about age discrimination which is the most neglected “ism” in society despite age being included as one of the protected characteristics in equalities legislation.
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