Context

Around 60,000 older people or roughly 10% of those over 65 – receive daily care and support through social services which are delivered in most cases, successfully throughout Wales. In addition, there are some 90,000 informal carers who look after spouses, relatives and friends for more than 50 hours a week. Many carers are also older people.

The Social Services and Well-being (Wales) Act 2014 was introduced in April 2016 and promised to have a fundamental impact on the provision of social care in Wales. The Act requires and supports a new approach which builds on existing strengths, but with these features:

• a strong voice and real control for the individual: working with people to find ways to achieve their desired outcomes linked to a national outcome’s framework
• new models of service: promoting innovation, mobilising community resources and promoting social enterprises and user-led organisations
• preventative services: a new tier of services to assist recovery and restoration and comprehensive information, advice and assistance services to prevent/delay the need for managed care
• simplicity: making systems (e.g., assessment and care planning) more accessible, reducing complexity
• integration: working across professional and organisational boundaries to achieve best outcomes
• professionalism: ensuring that services are delivered by a confident, well-trained workforce
• safety: strengthening safeguarding and improving transitional arrangements at key stages.

Whilst the legislative framework for Social Services has the potential to deliver a good care service to older people and their carers if it is fully implemented and continues to be adapted and improved through regulations and the statutory Code of Practice, there are two fundamental issues that need to be addressed i.e., meeting demand and funding

Demand

It is acknowledged that there are demands and pressures on social care in respect of an ageing population. This includes more people with chronic conditions, greater incidence of dementia and other mental health problems. There are higher levels of disability, mobility problems and frailty as well as higher risk of falls and greater risk of hospital admission. Older People need more help with self- care tasks and more older people are living on their own and enduring loneliness and isolation. These trends should not be seen as a barrier to delivery of effective services that meet people’s requirements or perceived as “older people’s fault”. Through the statutory Population Needs Assessment, Councils and their partners are required to prioritise and plan delivery of social care to older people, their carers and other client groups.

Funding

In 2018-19, £625 million was spent by Councils on social services for people aged 65 and over in Wales. There is a significant and unsustainable problem with the funding of social services in Wales. Whilst Welsh social services budgets have been afforded some protection in recent years this has not kept pace with rising demand and cost pressures. Evidence shows that while spending by local authorities on adult social services over the 5 years to 2019 has remained broadly flat in real terms spending per capita on older people has reduced by 13% in real terms. Compared to the Welsh NHS there has been a relative reduction in Welsh Social Services budgets over the same period despite the NHS being dependent on social services to relieve hospital pressures. There are particular problems in funding care homes sufficiently and “Significant reforms are needed to enable the sector to grow to meet the expected substantial increase in care needs” (Competition and Marketing Authority 2018).

What COPA Want to See

The principles that should be prominent in any debate about the future of social care in Wales include:

• As a society we must value social care. Parity of esteem and funding with the NHS is needed – equal partners
• Incentives for better joint working between social services, housing and the NHS are required – not a costly, time consuming and unnecessary structural reform of “amalgamation” with the NHS. Any available funding must be invested in improving services not on a re-organisation
• Unmet need and rationing of service availability for older people and their carers must be minimised. Older people’s and their carers statutory rights to services must be upheld as well as their Human Rights and the UN Principles of Older People
• Recognition of the value of a vibrant third sector and the role of unpaid carers should be increased
• Each of the 22 Councils in Wales should continue to have the statutory responsibility for delivering social services in their area, led by the democratically elected Councillors. It would be a huge mistake to dismantle that structure and “amalgamate” it into the NHS who are accountable only to Welsh Ministers.
• Social Services should continue to be provided locally and tailored to the needs of their local population. This is a significant asset that must not be lost. However, through the legislative framework and better joint working between Councils we want to see greater consistency in the services that are available between different areas.
• Social Care for older people is mainly delivered on a day-to-day basis by private sector providers (and mostly small businesses) – circa 85% of provision in care homes and Domiciliary Care agencies in Wales. They need to be funded properly and supported to ensure sustainable markets – not demonised.
• Care Homes and Domiciliary Care services provide vital support to over 60,000 vulnerable older people in Wales and must be given greater priority, support and funding to be efficient and cost effective and provide regulated, high quality, person-centred care and support to older people at all times.
• The full implementation of the Social Care and Well-being (Wales) Act 2014 in respect of older people and their carers must be accelerated through a new funding model that provides the resources for Councils to meet their duties and to go further to meet best practice standards.
• Councils must be funded to support older people to live independently for as long as feasible. Well-being, early intervention and prevention service options must be available consistently across Wales.
• In respect of Funding and Paying for Care, the misunderstanding and confusion about social care as a chargeable service and its relationship to NHS Funded Nursing Care and Continuing Health Care must not continue. Absolute clarity is needed to enable people to plan effectively for their long -term care. There is a tangible injustice in the care system for people with dementia. It is not right that because you develop one medical condition such as dementia over another, you can be left facing care costs of £100,000s. We want this issue to be dealt with urgency – older people do not have time to wait any longer.
• We want robust and radical change to the Paying for Care arrangements so that they are based on key principles of equity and fairness to spread the financial burden across the population – whatever financial model is utilised. We also want a new approach to ensure that Social Care in Wales is properly funded. A clear and transparent timetable with commitment to action from the earliest possible date should be agreed on a cross-party basis and involving older people’s representatives from the outset.
• Self-funders in care homes are cross subsidising council funded residents and this must be addressed. Top Up fees are sometimes being paid or families put under pressure to pay – when they should not be and this practice must be brought into line with the statutory requirements.
• There are 80,000+ people working in social care (6% of employment in Wales) i.e., much the same size as the NHS workforce. Harmonisation on pay and conditions with the NHS is a priority as minimum wage levels for many working in social care are not right as care work is a skilled and challenging job. Poor pay just leads to high turnover and unstable care for older people. We want seamless health and social care delivery but the disparity in pay between NHS front line care workers and social care workers cannot continue if that is to be achieved.

January 2021