Health and Social Care Committee

Bore da. Good morning. I'm Gillian Baranski, and I'm the chief inspector of Care Inspectorate Wales.

Bore da. Good morning. I'm Vicky Poole, I'm the deputy chief inspector for Care Inspectorate Wales.

Diolch yn fawr. Thank you, both, for being with us this morning. So, perhaps I could ask just a few overview questions, just to set the scene this morning. Can you give us your assessment of the current state of social care services, and perhaps what do your inspectors tell us about the overall management and performance of both children and adult social services?

Before I come to the main part of that question, I think it's quite useful to set some context about perception of social care, and public perception of social care. The size and fragmented nature of social care is not easily understood by the public. The NHS has a very strong brand and is hugely esteemed—quite rightly so. But social care, because most of the public, until they actually need it, don't understand the complexities of it, it places social care in a slightly different position. And it was interesting, as we've been recently to the social care accolades—the social care awards—which highlight the astonishing work that goes on across Wales every day, with absolutely no media coverage, apart from in the social care world. We Care Wales, which aims to increase awareness and understanding of social care, is a terrific campaign, but, again, it doesn't necessarily make the splash that you see with other campaigns. And so, fundamental I think to any look at social care is a question as to whether we need to reframe what social care is and what social care does.

I don't know if any of you saw it—there was a day-in-the-life-of with Rhod Gilbert some time ago, and he'd decided to do some work experience in a care home. And he was very blunt. He said, initially, his feeling was that social care is about—and forgive the term—just wiping people's bottoms. And at the end of his time there, he was impressed at the skill and dedication of the staff. We had hoped that the pandemic, which had shone such a spotlight on social care, would actually help raise the profile, and mean that some of the issues that have been endemic for many years would be dealt with, but that seems to have been quite short-lived for social care.

In terms of the actual detail, it remains extremely challenging for all the services that we regulate and inspect. And current pressures in the system have been intensified over the last few months by the cost-of-living crisis. And the pressure, we fear, threatens to undo a lot of the good work that we saw in the pandemic, when agencies worked very collaboratively together, pulling together in partnership to support people. It's fair to say the pandemic didn't create the current problems, but what it has done is expose and exacerbate them. And some of the main issues that we've found is there has been an unprecedented increase in demand for social care. Now, that's partly because, during the pandemic, people didn't feel they could access systems. In Wales, we've been very successful at supporting people in their own homes for as long as possible, which must be a hugely positive outcome. But then, by the time they need care and support, people's needs tend to be more complex, and what we are faced with at the moment is a recruitment and, as seriously, a retention crisis for social workers and for social care workers, which is leading to significant fragility for services, and particularly in homecare and domiciliary support. We found, through our inspections, there's a lack of suitable care and support placements for children with the most complex needs.

And so, all of these, together with making sure that people's voices are at the heart of everything we do, and the need for advocacy has never been more essential, the combination of some of those things has put, as well, a huge pressure on unpaid carers who do astonishing work across Wales every single day. And so, what we see at the moment—the combination of the huge increase in demand, the recruitment and retention issues, some of the fragilities that the pandemic has exposed—what we see is essentially a health and care system that is gridlocked. Many social care leaders are describing it in terms of crisis, and we don't use that word lightly, and many local authorities are also experiencing an increase in the volume of safeguarding referrals, and, in part, this is due to a lack of availability of care and support and treatment services to meet people's needs.

And so, there are also issues around costs. Because of the recruitment and retention issues, there's a significant use of agency staffing. Now, some of these agency staff members are excellent, and we're aware of one local authority whose front of house is entirely an agency-run team, but they're very experienced social workers. But it's very expensive. The cost-of-living crisis, the increased energy costs for care homes—and if you've ever been in a care home, they're lovely and warm; they need to be lovely and warm, but that comes as at a cost—and the general impact of inflation on the financial sustainability of many care services is quite worrying.

Despite all that, the privilege we have is, every day, we see compassionate care done by people who are dedicated to ensuring that the people they look after receive the care and support they deserve. But the workforce is very tired and it's depleted. This will be the third winter that's been significantly pressured for this sector, and we are therefore concerned as to the resilience, despite the enormous goodwill, and despite the excellent care that never ever gets press. Most of the care in Wales is good care, but you don't hear about that so much.

Thank you, Gillian, and I think your opening comments—. I think, we as a committee, can align ourselves with your views, and you've gone on then to expand and give us your take on the wider overview of the sector. Many of the issues you mentioned I know have already been picked up by committee in some of our committee reports, so very helpful to set the scene for this morning's session. Perhaps I could ask you just for a brief answer, but how well do you think local authorities are currently carrying out their functions, both in adult and social care services?

I think it's mixed across Wales, as you will be aware. I think there is a huge commitment to getting it right, even in local authorities that we've been in recently and which had problems. What we are finding is that the commitment of both the executive and the political leadership to try and resolve this is significant. But if you can't get social workers and if you can't get domiciliary support, it does mean there will come a point when local authorities will struggle to fulfil their statutory duties, and it's not for want of trying. Some local authorities are doing work around grow your own social workers. Some local authorities have been recruiting from abroad. It's just a very difficult market, and, for a social worker, the pressures are such, I am concerned about at the moment, with this increased demand, that for some I suspect they're choosing to become agency social workers because they don't have to do every day, all day, with all that comes through the front door, and they can decide how they work and where they work. So, there's a lot of work going on with looking at bursaries to try and encourage people into social work, but the danger is always that any hostile media surrounding tragic incidents can lead to, quite understandably, a sense of, 'Is this work I want to do?' So, the fear could be that a young trainee social worker at the moment is thinking, 'Do I want to be a children's social worker? Are there other aspects of work that we can do?' And there is no easy solution to the recruitment and retention issue.

What is particularly important is around partnership working. We talk about how a local authority is working; they don't work in a vacuum. Some of the work we do is around the joint inspections of child protection arrangements, which we do with the police inspectorate, the probation inspectorate, Estyn, HIW. Ultimately, it's a system that looks after its frail, vulnerable, elderly, its young children, its people with learning disabilities. And so, the role of the regional partnership boards and strong partnership between health and social care is particularly important, but there are real pressures in the system around recruitment and retention—

Can I just—? Sorry—on recruitment and retention, I think we're just about to come on to some questions on that, if it's all right.

We'll pause that, then.

Yes, that's fine, thank you.

I was just going to say that, for social workers, its quite demoralising at the moment, because if you assess somebody's needs—and social work values are to help people—and what they're doing is assessing people's needs and then not being able to offer them the care and support that they want, and the Social Services and Well-being (Wales) Act 2014 is all about what matters to people. So, they're having conversations with people about what matters, about what's important, and they can't provide the domiciliary support that people want to be able to go home. So, people are moving into care homes who don't necessarily want to do that, and then the impact on the workforce is huge.

Sure. Why don't we come on to that? I know, Jack, you wanted to come in. Are you happy to wait a moment? And then, so, Rhun.

Diolch yn fawr iawn i chi. Rydyn ni wedi cael atebion cynhwysfawr iawn yn barod. Rydych chi wedi ateb llawer o'r cwestiynau roeddwn i eisiau eu gofyn, mewn difri. Rydych chi wedi adnabod cynnydd mewn galw fel un o'r rhesymau mawr dros y pwysau sydd wedi creu'r argyfwng yma o ran staffio. Ydych chi'n gallu olrhain y broblem yn ôl i'w graidd? Pa bryd wnaeth y creisis yma ddechrau mewn gweithlu? Eisiau gwybod ydw i er mwyn inni drio chwilio am atebion iddo fo. Mae'n bwysig deall beth sydd wedi achosi'r broblem.

I think it's fair to say that the issues, as I said earlier, predate the pandemic. But one of the impacts of the pandemic is that a lot of people did not seek services, and so by the time they came to seek the services, their needs had become much more complex, because sometimes earlier intervention and earlier care and support can be quite preventative of things developing into something more serious. The pandemic, from a social care point of view, was devastating in many ways, but prior to that what we found with the social care workforce is that those that work in it talk about their personal satisfaction, how incredibly rewarding it is, and when you go into a home—. I went into a home and there was a very young 19-year-old, and, I have to confess, I thought, 'How can a 19-year-old do this sort of work?' and she was amazing. But her dream had always been to work in social care, because her mother worked in social care. I'm not convinced that, in the conversations we have about career opportunities—. I appreciate I was in school a very long time ago, but I never heard about social care and what it did. And so, the problem around it started prior to the pandemic, because there's this sense of low pay equating to low skill. Sometimes you see reports, which make us very angry, and they talk about an unskilled workforce. This is not an unskilled workforce; this is a dedicated, committed one. If you've seen someone coax and nurture someone with dementia and help them to feed and eat their meals properly, it's just hugely skilled. So, this tag of 'unskilled, low-paid', it has just not helped. And so, the problem pre-dates the pandemic, that's fair, and some of it is pay, and some of it is also equality of terms and conditions.

So, when people and some political parties—including mine, as it happens—have been talking about the need to ensure parity of esteem, not just in the way we talk about social care but in the terms and conditions offered to workers in social care, is that something that Government really has to make a priority, still, if they are to bring in enough people and people with the right skills for social care?

What we see is that, when our colleagues in health recruit, it's often social care workers who move into it, because the conditions are better, the pay is better, but the public esteem is significantly better. And so if we are going to develop the workforce, this parity of esteem and parity of terms and conditions is essential. Because people who do it love it, but they have to pay their bills.

So, the idea of a national health and care service, or a national care service, building up a brand similar to health would be important.

It's a very attractive option. We've been reading the plans and, as you know, it's early days, and it's always the detail that's interesting, but it's an interesting concept, of a national care service and what that would do. Because, in the public's mind, there's the NHS and then there's this organisation over here, which is not really understood.

I think it's also about making sure that there's a career pathway. So, if you go into the NHS, you can see a really clear pathway, that's not always clear, I think, for people working in social care. And one of the things that we've been talking about is even about the culture and about what we call people—so, 'care professionals'. People say, 'I'm only a care worker', but nobody's 'only' a care worker; it is about this being a professional career for people. So, that branding is really important. But, knowing that you can progress your career is very important for people.

And in and out of care/health—

Yes.

—zipping between the two. A quick question on the impact of Brexit, perhaps. We've heard in the past few days about the impact of Brexit on the health workforce. Are you able to identify an impact on the loss of potential workers in social care due to that?

Well, from work that others have done, we were told that about 6 per cent of the workforce in care was from Europe. I can't imagine that that wouldn't have had an impact, because certainly in some parts of Wales, a lot of the staff would have been from Europe.

But you haven't quantified it as such.

No, it's—

Is that work that's ongoing, perhaps?

We're not the regulator of the workforce, so Social Care Wales would have more detail on that.

Okay.

I think there's a wider impact as well, because there are just generally fewer people to employ. So, people who are now working in hospitality at one time might have worked in care. So, there are just fewer people generally, I think.

And, this isn't just a problem for managers in having enough people in the right roles; it's a problem for those who need the care, and I'm thinking of continuity of care in particular. What measures are you eager to see to be able to ensure that continuity of care for people, when there are such pressures on the workforce?

I think it's fair to say that, at the moment, through our inspection work, most of the services that we're going into are still delivering good-quality care, and if they're not, they would be on one of our enforcement pathways. And so, I think what we're seeing is that people are doing longer shifts, working more hours, but that's not sustainable, and that's the worry for this winter, because this is the third winter where people have gone over and above in health and social care. It has been heroic—I think that's the word I'd use to describe how most people have behaved. And so, when we do an inspection, one of the things we look at is obviously sufficiency of staff, the care that goes on in the home. And it's been interesting that we encourage people to raise concerns about care homes with us. And in last year's annual report, 47 per cent of the concerns in adult and children came from staff. So, it's an indication of the pressure that they're feeling. But we monitor it, we regulate it, and if we find that the care of individuals is being impacted, then that will lead to enforcement in some form.

Has there been an increase in issues of, or problems of, care and how the workforce crisis is affecting people?

It's fair to say that we have a significant amount of enforcement at the moment, but that's partly because we have prioritised services that we're receiving concerns about. We're prioritising services that we've not done inspections of because of the pandemic, for some time, so, we would expect, when we go in for a concern, that that would raise issues. What we're hoping, by the end of this year [Correction: 'financial year'] when we'll have finished this programme, is that we'll also get to the homes that we're not so worried about and then the picture might be less skewed. I think our current picture is quite skewed on what's going on, because of the nature of the prioritisation that we're doing.

And I think it's fair to say, in terms of domiciliary support where continuity is even more important really, because in a care home, you might have one familiar member of staff, but that's very different if it's in your own home, what providers are doing in order to make sure that they can still have continuity of staff is they're saying, 'I can't care for 100 people anymore; we can only care for 50 people'. And they're saying to the local authority, 'You're going to have to find an alternative way of meeting people's care needs', and that causes a problem. But that domiciliary support agency is trying to make sure that they can still provide continuity of care and that, in itself, is really challenging and for local authorities to find alternative care packages, and more local authorities are providing direct care themselves than they were pre pandemic.

Thank you.

Jack wanted to come in and then I'll come to Jayne also. Jack.

Yes, thanks, Chair. Good morning, both. I just want to go back to your conclusions on the local authorities in the partnership boards. Obviously, some local authorities or some partnership boards are rated higher or better in certain aspects of the work that they do and some are rated lower. Is there a route for sharing that best practice? Does that happen, or is there a need for one? Because we hear often, certainly on the health side, that best practice doesn't get shared between health boards, so, I just wanted to try and understand, in your area—.

We publish all our reports on local authorities. We also do national thematic reports. We finished one recently on services for disabled children, and what we would expect is that every local authority would be reading our reports. The fact that it's a Gwynedd report—we would still expect other local authorities to be reading them. And as part of the review work and assurance work that we do with local authorities, these are part of the discussions that we have in terms of, there is best practice, it may not be immediately transferrable, but the sense of, 'Here's a piece of work that's been done; we know it's worked, it delivers, look at that'. And I think it does go on to an extent, but whether it goes on as much as we would like—. Because I was re-reading some of our reports on children. We published two in 1919—in 2019; yes, it wouldn't have been 1919—and sadly, some of the issues that we saw there are some of the issues that we see when we go back.

So, we know that many local authorities do look, explore, talk and the regional partnership boards are more local authorities together, so, that's a real opportunity. But some of this work is quite embryonic and I think we do need, in fairness, to stress that the two years of the pandemic caused such a delay. We had just finished re-registering our services and you felt that the full impact of the Social Services and Well-being (Wales) Act 2014 and the Regulation and Inspection of Social Care (Wales) Act 2016 and the move from 'tick box' into 'outcomes' and what matters to people—. I actually made a speech to my staff in February 2020 and I said to them, 'This is going to be a really good year for social care because we're going to embed all this learning, all this change', and then we were in the maelstrom of the pandemic. And so, earlier this year, you did feel, as COVID was abating, that this was, again, a really good moment for us to move forward on some of these things, and that the energy crisis and the cost-of-living crisis on top of what's been the most difficult of years have really caused issues within the system and the sector.

And specifically in terms of regional partnership boards, we did two pilot self-assessments; we contributed to two pilot self-assessments of regional partnership boards. So, one the recommendations in 'A Healthier Wales' was for CIW and Healthcare Inspectorate Wales to review the effectiveness of regional partnership boards, and we've contributed to two, which is about self-assessment, so that's about the health board itself, or the regional partnership board itself assessing itself, but we act as a critical friend in that. That's going to be rolled out to all regional partnership boards, and what we hope is that there will be learning that comes out of that that RPBs can share between themselves and across from one RPB to another. But they are so different, so, Cardiff and the Vale regional partnership board is one health board and two local authorities; north Wales is Betsi Cadwaladr and six local authorities. So, the issues that they're grappling with are very different.

There is a forum there—

There is, yes.

Yes.

And the way I see it, there is encouragement for local authorities and regional partnership boards to go, and there's an expectation for them to go. Circumstances, in previous years, and including now with the cost of living, may be preventing that, but it does happen, and it's the expectation. Okay. That's fine with me, Chair.

Jayne, do you want to come in on this point? Jayne Bryant.

Diolch, Chair. I just wanted to say thank you to you and also to the committee members for allowing me to be part of this committee today and this session. I just wanted to come in on the issue around childcare workforce. There's been a significant rise in the number of concerns received by CIW regarding childcare, mostly around leadership and management, and you've suggested that providers are finding it difficult to recruit and retain staff. What more do you think that the Welsh Government can do to increase the resilience of the childcare workforce, particularly with the commitments in the co-operation agreement to increase free childcare to two-year-olds?

So, the childcare and play sector, like general social care, is facing similar problems with recruitment and retention, and what we find is that the good childcare and play service will have a model of care that it uses to promote independence. It has a vision that's shared by the workforce and the leadership, and again, we need to encourage people into working in childcare and play, because again, it's seen as 'something less than'. And what we know, of course, is that those early work years, done well, transform the life chances of a child, and when you visit an 'excellent'— because we rate our childcare and play services—and when you visit an excellent service, and you see the clear leadership, a very clear ethos of how they're promoting children's independence, imaginative play led by children, and the voice of the child at the heart of what the sector does, it's just very encouraging.

But there again, the churn in staffing in childcare and play has been quite an interesting one, and although most services reopened after the pandemic, they didn't all reopen. And so, the good ones are very, very good. Where we find poorer services, then we will work with them to try and improve what they're offering. But the umbrella bodies as well are also very impactive in this space. There are a lot of opportunities for childcare and play services to learn about good theories of play, what works, what helps children. And so, the recruitment issue is a difficult one, but I think it's fair to say that we're probably less worried about our childcare and play sector than our social care sector, other than the recruitment and retention issues around it.

I think it's also that Social Care Wales are doing more work with early years providers now than they were previously, so I think some of the learning that we've got from social care, albeit it hasn't fixed everything, is being rolled out and looked at in terms of early years well. But I also think it's a really important point, because social care workers rely on good-quality childcare as well to get to work, so, where there are pressures in childcare and play, that is also having an impact on the social care workforce.

We run regular provider events with the childcare and play sector. They're so much easier to run. In the old days, we would have made people travel across Wales to them. We now hold them virtually in the evenings, drop-in centres, and we work with the umbrella organisations to come up with a programme of what we're all learning is the support that they need. We've just finished our most recent section [Correction: 'session'], and the feedback is astonishing. I think people need something where they don't feel alone, and those provider events help people to share, network and discuss issues that are common to all, but here's a forum that we've created for people to have those discussions.

Thank you. Sarah Murphy.

Thank you, Chair. Good morning, both. Thank you for being here. I just wanted to ask a few more questions about safeguarding and rights. You touched on, earlier, that because of the care, support, treatment and services, there are going to be more safeguarding referrals coming through. Obviously, this could be where people are at risk of harm. So, could you expand on this for us? Could you just tell us a little bit more about the nature of the safeguarding referrals and what is the appropriate action required to address the rising number of referrals to you, please?

Putting people at the heart of what we do is a fundamental premise for Care Inspectorate Wales, and safeguarding is an issue that's looked at in every inspection of a local authority. We wrote to the chairs of the regional safeguarding boards back in February 2022, seeking assurance as to what they were collectively doing around safeguarding. We've run a series of 'speak up' comms for staff within services, because it's important that people feel that if they can't go to their local management, there's an organisation that wants to know about safeguarding concerns.

Our inspectors are all trained and we work closely with the Older People's Commissioner for Wales. She's been doing some really, really good work around human rights and people moving into care homes and living in care homes, and our head of adult and children's services is part of that group. We've also contributed to the work of the human rights commission, and, of course there's been the IICSA reports, the Independent Inquiry into Child Sexual Abuse. So, there's a lot going on.

But what we know is, of course, being on a waiting list for assessment or for provision of a care place puts people at risk. We know many local authorities are experiencing an increase in the volume, and we regularly discuss with each local authority how they're managing their risks to people and how they're regularly reviewing people's needs during this period.

During our inspections, part of what we do is focus on a person's experience, so we spend a great deal of time talking to people or their families, and if they have dementia, we use an observational tool that our inspectors are all trained in to try to make sure we understand how well their needs are being met. We've also introduced QR codes in care homes, so that people can feed back, not just when we're doing an inspection, but all year round. So, between 1 November 2021 and 31 October [Correction: '31 October 2022'], we had just under 2,000 feedback surveys returned. So, we're regularly engaging. We also survey with people who use local authority services. So, we're having these communications.

I think, for us, one of the ways we help get the voice and understand what's going on with safeguarding is that we have a national advisory board. It's made up of some of the usual suspects, representatives of the older people's commissioner and the children's commissioner, but what we have on there are people who receive services. I have to say that that's the most driving part of that committee; to hear directly from members of the public what it feels like to receive social care is hugely impactive for Care Inspectorate Wales. So, there's a great deal of work going on.

During COVID, we took a particular rights-based approach to the visiting of care homes, because that was a very, very difficult issue. And so, we worked with care providers, we worked with other partners, and although what we developed in Wales wasn't a perfect solution, it was infinitely better than what was delivered elsewhere, because it was co-produced. And so, we're looking forward to working with the new citizen voice body, which will also help ensure we get the voice of the citizen at the heart of what we do.

There's a lot of work that's gone on across Wales about safeguarding practices, development of standards, and there was, during safeguarding week, a launch of some of the new e-learning, and what we will be looking at is making sure that the embedding of this work is taken forward. We meet regularly with the chair of the national safeguarding board and share information, share concerns, share what's going on, because, ultimately, it's about learning from the things that have happened to try and work towards making sure that we put right anything that a review or a safeguarding inspection pulls together.

But with safeguarding, I think a key factor is this work across the system. So, we've done two of these joint inspections—one in Newport, then in Neath Port Talbot. We have others—I can't remember if we've actually announced where they are yet. We haven't, so I won't say where they are. We have others coming up. The aim is that we will, hopefully in the next period, do one in each regional safeguarding board, and what that should give is assurance of how safeguarding is working across agencies, so that it's not one agency blaming another, but it's an overview of how together we'll make sure people's needs and well-being are safeguarded.

For children.

Those are for children.

That's a wonderful idea. Also, to pick up on some advocacy comments that you made as well, evidence highlights the importance of advocacy services, and you said that, 'We have been concerned about the erosion of some people's rights during the pandemic.' So, which specific rights are you referring to, and are you satisfied that that has now been rectified? I suppose, with children in particular, that would be the active offer.

Yes. I think what we were thinking of then is the element of choice, so when people have to move from home into residential care, it's where they go, how much choice there is. That was very difficult during the pandemic, but that is moving back. I think we're satisfied now, Vicky, that the choice issue in terms of where people go is slightly different. Our concern comes, though, where people who are in hospital, and they're ready to be discharged, and they can't have a package of care at home and they may need to, therefore, be supported in a care home, which may not be their choice. And in some ways, we understand all the difficulties surrounding this, and we know there's a great deal of work going on to try and provide solutions and answers, but, at some level, that's the least worst option, rather than the best option.

Absolutely. Thank you. And you've answered my supplementary as well, so thank you very much. Chair.

There we are. Thank you.

Just on that, advocacy for children, I think, is well developed, because of the active offer and the statutory duty to do that. We find it a lot less for adults, and so that is a feature in our report to local authorities, the importance of the offer of advocacy to people, and that links around mental capacity as well.

I have to say that I've had three or four cases in the last few weeks where I don't think the active offer has been given. I think it is one of those things that needs to be consistently reinforced; it shouldn't be coming from my office, 'Has the active offer been given?'

No.

Please share the details.

I will.

And we are working—. The Equality and Human Rights Commission is doing a review at the moment about how people can challenge decisions about adult services, and that's across England and Wales, and we've contributed to that review. I think it'll be interesting to see the findings of that as well.

Did you want to come in, Joyce?

Thank you for everything you're doing. We talk about the reports that to go local authorities, and talk about multi-agency work, but, of course, a lot of—. And you do inspect residential care areas for children, as well as adults. So, I want to focus back on children, and an awful lot of children's needs are met out of county, and I'm assuming that those reports that you do, and others do, get fed back to the place where those children would normally reside, and also at the same time, to the area in which that provision is being provided, that county. So, what I'm really interested in—and I've asked this question of many people—is how often is that discussed at a local authority area. Because my concern is that they're out of sight and out of mind, and yet we know that all of us elected representatives have a duty of care under legislation for looked-after children. So, that's my question. And where are their voices in all of this?

Before you answer, I'm just conscious we've got quite a few sections to get through as well, so—

Be brief.

That's it. I hate to ask that, because it's so helpful to have the longer answers.

I think the brief answer is the role of the local authority for its children who are in care is pivotal, because they are the corporate parent, and that's a duty that's enshrined and you would hope is taken incredibly seriously. And so I would expect the local authority to absolutely be reading all the reports we publish on their children who are in residential care. We don't publish care reports of children's homes on our website because of the danger of identifying children. These care homes are small and it could be easy to identify them, but they are available for people who ask for them, and we would expect local authorities to be reading those reports and taking note of what we find in them.

And we do routinely share them with the local authority. Even though we don't publish them, we send every report up to the local authority.

Just very briefly—and you can write to me if we're short of time—that's all good, what you're doing, but the bit is the action after the report, whether they're discussed in a committee in that local authority. Where is it going? A report is all well and good, but if it doesn't have any action after it in that local authority area to address issues or to highlight good practice, which is what we're all about, then it's lost, potentially. So, if you could write to me—

I suppose to add to that, it's what oversight you have of what local authorities do with reports after they've been sent those reports.

We see the role of the scrutiny committees of local authorities being absolutely fundamental and pivotal. Now, it isn't for us to dictate to a scrutiny committee what it looks at, but we would like to think that a local authority scrutiny committee has this very much on their radar. And shall we write to you separately, because I can see that the Chair—?

Yes.

Thank you. Please do write to us. If you've anything further to add on that point, then please send that additional information via the committee. Thank you, Gillian. Gareth Davies.

Thank you very much, Chair. Good morning. I want to focus on adult care homes, and in your latest annual report you noted that there are continued limitations on visiting within care services. Is it still the case that there are restrictions and refusals of visiting in care homes across Wales?

There shouldn't be, unless there's a severe outbreak in the home. There shouldn't be, and we would be very interested in knowing of any care homes that are imposing those restrictions.

Why would that be happening, then? If it was the case that this was occurring.

If you've lost during the pandemic people who've lived in your care homes for many years, the pain for the care home—it's a bereavement. It's not like someone that you've had care of for a few weeks; these are people who've become part of the care home family. In the early days of COVID, the not knowing how this was transmitted and not understanding what would happen was actually devastating for the staff and the management of care homes, and although we're through that, there is still some nervousness. So, when omicron started at the beginning of the year you could sense the tension rising in care homes again, and we know we're expecting quite an interesting flu season, and hopefully, with the vaccination levels that we have amongst our elderly population in care homes, we won't be returning to that. But I think some of it is sheer nervousness, concern and terror that they could move back into that period. And so, when we're notified, our first port of call is we would talk to the provider and talk them through this issue. Because our view is that people have a right to visitors. People need visitors. Care homes, when they operate as they should, are lively, interesting places—people come and go; there's a lot of hustle and bustle. It must have been unimaginable during the pandemic when that normal flow and conversation couldn't happen. So, I think it's that—it's protectivism, it's nervousness. And we've not had an instance yet, where we've been notified of an issue, when we've had a conversation, that it hasn't been resolved. So, what we would ask is that, if you become aware through your constituents that it's happening in an individual care home, we would really value being told.

They're not necessarily observations of mine, but it is noted in your report, so I'm just interested to try and understand why it's in the CIW's report, because there certainly must be evidence of that if it's contained within.

Yes. And there was, because that was—. The report ends in March 2022, and it's hard to remember sometimes what phase we were at with COVID, because the last two years, let's face it, just blurred a bit, but it was still quite a tense time until we moved further into the summer. And I think it was also—. For me, it was a reminder to care homes that we recognise the tensions, we recognise their concerns, but people need visitors, people need their family. It helps. It helps their mental well-being, it's just—. And for the families, it's enormously helpful. So, in one way, it was an observation of what we were finding, and a reminder to care homes that we expect care homes to be receiving visitors.

Okay. I appreciate that. Thank you. And you mentioned in parts of your answer there about the trauma the staff have gone through, and residents' families. Do you think they're being supported enough now we're a couple of years on and we're in better times now? Do you think that hangover, if you like, from those times—? Do you think people are being supported enough through that, or do you think there's more that could be done?

There is support out there, and Social Care Wales has developed some well-being support. I guess the problem is, as for all of us, we have all reacted differently to COVID. Some people are back as if it never happened; other people, particularly older people, are very nervous about leaving their homes, and the social care workforce is no different. There is support, but to have lived through what the social care workforce who worked in care homes lived through on a day-to-day basis, and the risks they took to themselves and their families by heroically working and caring and looking after, that's going to have taken a toll. Support is there. We certainly encourage people to access the support that's available; Social Care Wales has done a really good job with trying to make sure that that is there. But I suspect, like most of us, people are at different stages of recovering from what it felt to them individually, going through those two years.

And what the pandemic saw as well was a halt or certainly fewer services being available for people in terms of activities and therapeutic services. So, do you think we're back up to where we need to be after COVID with that, or do you think there's scope to do more to achieve person-centred care and get a tailored service that's right for that individual or individuals?

Yes. Yes.

I think, when a care home is short-staffed, the things that go are activities and things to occupy people, because they're focusing on meeting people's personal care needs. And I was talking recently to Age Cymru, and that's one of the things that they're finding. So, they do a lot of work with activities co-ordinators in care homes, but what they're finding is that people can't have tailored individual activities all the time, in the way that they did pre pandemic, because of the pressures on staffing. So, that is absolutely having a toll, and it is something that, if we find that on inspection, we do talk to people about how you do that. And lots of care homes do really great things in terms of doing individualised activities with people, but that is one of the pinch-points at the moment, absolutely.

Okay. Thank you very much.

Thank you. Jack Sargeant.

Diolch, Cadeirydd. We've received evidence about individuals seeking advice about social admissions into hospital, due to care packages being broken down and so on, do you have a formal position on social admissions into hospital due to care packages being broken down?

We're aware of the problems, but we wouldn't have the detail.

No, we don't.

We don't.

Okay. So, if there's further to add to that, you could follow up, or if that is—.

Yes. We do meet with colleagues in health on a regular, monthly, basis, and we meet regularly with Healthcare Inspectorate Wales, so we are aware of the problems.

Okay. Okay, moving on then. You have repeatedly stressed the increasing concerns of people being discharged from hospital into care homes. As we know, it's often intended as a temporary measure, often it isn't the case; people rapidly deteriorate. I think Age Cymru very much share that position. Can you tell the committee how frequently is that happening, and also what specific actions are needed to help address this problem?

So, you'll be aware there have been many, many reviews on safe hospital discharge, because it's one of those pivotal moments; people need to be discharged from hospital with sufficient support that they need, it needs to be done in a managed way, and there's currently some work going on with Audit Wales and Healthcare Inspectorate Wales on this again, and we're looking forward with interest to see that.

It is a difficult problem, because hospital is not a great place for a frail, elderly person who's ready to be discharged, because, if you're in a ward, you're not going to be having activities, you're not going to be having what you need, with the care that you want. And there isn't an easy solution to this at the moment. If we had the domiciliary support services that we need, then this could be, hopefully, much more seamless. But they don't exist at the moment at the level that is necessary, and therefore I suspect that what we're having is something that's, as I've described before, the least worst option. It's better for people not to be in hospitals who are ready for discharge; far better for them to be at home receiving domiciliary support in the comfort of their homes. But where that can't happen and people are in care homes then the issues surrounding that are: they need to be monitored; if this is temporary, how temporary is temporary; where will they be going. And I know that colleagues are trying to put structures in place to look at that, but that wouldn't be our remit in terms of the overall position, because there is a significant shortage of hours of domiciliary support in the community at the moment.

Thank you for that. Just finally, the work you mentioned that's ongoing at the moment to address that issue—and perhaps I should know this already—do you have any indication of a timeline when that may be done? Not to hold you to account to it; just an indication.

The aim is to try and get things ready for this winter.

Thanks, Chair.

Joyce Watson.

I want to ask about delays. You've mentioned that there's a backlog; we know there's a backlog in delays in care assessment services. Are you seeing any reviews, and are you able in any way to assist people to address those backlogs?

I think this is another of those areas that's very staff dependent. Because we know at the moment, in many local authorities, too many people are waiting for an assessment of their needs, and Vicky related the impact on the workforce when you do an assessment, and if the assessment is 'you need 30 hours a week domiciliary support at home' and you can't do that, that's really painful for the social workers. But it's not just domiciliary support; it's also waiting for occupational therapists or physios. There's a whole tranche of support that's needed.

We're also aware that this means that people's care and support plans are not necessarily being reviewed in line with the Social Services and Well-being (Wales) Act 2014, and that means that, when people's needs change and they may require more care, that's not necessarily being provided. And I think, for us, one of our main concerns is, obviously, the individual, but also the pressure this puts on unpaid carers, because their needs need to be assessed, their needs need to be supported, and they need to be treated as an equal partner in the social care family.

What the solutions are—. We know that there's a new commissioning framework and work is taking place to support small providers to thrive. That's part of the rebalancing work that's going on. That's very interesting and, hopefully, will create results. But, ultimately, without staff to provide the services in the community, this gridlock, it's difficult to see how it can be unlocked in a way that both meets the needs of that individual and what they want and makes sure that people are not sitting in hospital wards when they're ready to be discharged, which is not a place for a frail and elderly person when they have no medical needs the hospital can deal with.

So, basically, it's all coming back to a lack of staff in all of those departments that you've described.

I think it's probably the biggest issue that social care is wrestling with at the moment.

And of course, the unpaid carers do such sterling work and never ever seem to get recognised as equal partners in this. If it is the case that, because of staff shortages, they're going to have to continue for longer and also meet much more complex needs when they may already have some needs themselves, because they're of an age—most carers are elderly anyway, themselves, and have health problems—

Yes, many.

—what do you think could be done to help to meet the needs and expectations of the unpaid carer so they feel valued?

Well, carers organisations in Wales are doing an amazing job in supporting carers, and I think they need sustainable funding to help them do that. Access to direct payments is invaluable in this area, but I think the engagement with carers needs to be improved and assessments of the carers' needs need to be consistently offered, because this will help to ensure that services are more co-ordinated. And there needs to be a relationship of equals between the practitioner and the people who need care and support and their carers, who will need care and support. And it does come back to making sure that carers are equal partners. They're doing an incredible job to look after the people they love, and they do it willingly and they do it time after time, but they need to be able to access flexible support tailored to their needs, and they need short breaks. And I think one of the things a member of our national advisory board said about two years ago just resonated ever since. She said, 'I have a disabled daughter and, for 40 years, I have been fighting for the support she needs.' And I think what carers are looking for is seamless support, and they don't care whether it's health or social care—what they want is seamless support and a recognition that their voice is being heard, which is back to carers being treated as an equal partner in recognition of the sterling work they're doing, constantly.

And part of that, you briefly mentioned, is respite.

Yes.

Because if the care that's being delivered by the unpaid carer breaks down, very often, from what I hear through my casework, it's lack of respite, because they just simply need a break to be able to carry on. So, in terms of the respite services—and I've also heard that some of them haven't restarted—have you done any work around respite services?

Not as such, but our 'National Overview Report of Assurance Checks' in local authorities, which we published in November of last year, looked at the impact of the pandemic on carers. What we found is that practice is variable across Wales, with some very positive practice, and then other areas where there needed to be improvements.

I think part of the issue about short breaks as well is that where care homes, during the pandemic, were closed, they would only look after the people who lived there permanently, and bringing somebody in for a short break wasn't something that they wanted to do. At the moment, there are vacancies in care homes where you think somebody could go for a short break, but, actually, they haven't got enough staff to meet that person's needs as well as the people who already live there. That has absolutely been a real problem. And for younger people with learning disabilities, their short break services were closed during the pandemic. We are seeing those reopen now.

I think the other thing that local authorities are telling us is that, in terms of some of the more traditional day services that they used to operate, during the pandemic people found different ways to occupy themselves, and maybe day services isn't what they want anymore. There is sometimes a tension between what a carer may want, particularly an older parent, and a younger person with a learning disability. They might not want to go back to a day centre. They may like the new activities that are being provided for them. There is some real innovative work going on in local authorities about providing meaningful activities for people, and that you also give a carer a break.

I know that you inspect the care element, but there's another aspect to this, and that's going to be funding—you mentioned, briefly, funding. We're going forward with what is going to be huge restrictions in public service funding. I don't know whether you're even able to answer this, but you know, because you've answered, about low pay leading to low esteem, and all of those things that go with that. Have you any concerns about further restrictions on the budgets to deliver the care that we all want to see, and to reward the people who justly deserve that?

I think the next year, looking at—. Well, you try not to watch the news these days when it talks about the funding crisis. I think there's no part of the public sector that's going to be immune from a really very difficult period. It will impact social care in the way it is going to impact every single aspect of public life.

Thank you.

Thank you. Jayne Bryant.

Diolch, Cadeirydd. Perhaps you could just give us a brief overview about what your inspections tell us about the overall management and performance of children's social services across Wales at this time.

I think we can answer for the local authorities that we've been in. I think it's been mixed. In some local authorities, we have found areas that need improvement, though it is fair to say that when we have gone back, we have found improvements have been made—not necessarily all the improvements you'd look for, but that things have improved. It's the same as I talked about earlier—what we are seeing is significant commitment in the leadership of social services, both by officers and politicians. But it is fair to say that it's a difficult time for local authorities in respect of some of the issues that are coming forward.

Overall, our inspections of care homes for children are not of significant concern generally. One of the main issues we have is about the pressure on children with the most complex needs. What has happened there is that, for children with the most complex emotional, and, often, mental health needs, finding a service that can meet their needs is putting a great deal of pressure on local authorities. So, we have done quite a lot of work—actually triggered by Vicky and her passion for this—on services that are operating without registration. There are two problems with that. The first, of course, is that if a service is a care home, it should be registered with Care Inspectorate Wales, and a service that isn't registered with Care Inspectorate Wales but is providing care services is illegal. We're concerned about that, but our biggest concern is for the child who is placed in that home.

That is an area where we've seen a significant growth—the number of children who've been placed in services operating without registration. That's concerning for many reasons. Partly, it's concerning because: are they having the access to education and health services that they need? And most significantly, they will have to move again, because that's a temporary respite. We understand that for a local authority, if there's a placement breakdown, it's usually when it's late, it's a Friday, and either the placement they're in breaks down or the family situation breaks down, and there may be a need to put a child into some sort of temporary accommodation whilst more permanent is sorted out. But where this becomes something that goes on for a period, then that's very concerning.

It's often a child with agency staff on a one-to-four or one-to-two basis, which is very resource intensive, but not necessarily in the best interests of the child. But it is one of the biggest issues that I think local authorities are facing at the moment. We are aware that regional partnership boards have received integrated care funding and are trying to develop services on a regional basis that provide much more therapeutic mental health support and training. I think there is one that's in our system at the moment for Gwent. That seems to be a really excellent idea, because not every local authority needs that level of intensive children's home, but it certainly needs access to it.

Absolutely. I think we'll be following your work closely on this. Thank you for highlighting that.

You've mentioned it in some of the answers earlier on in terms of the importance of advocacy and the voice of the person coming through everything. How do you ensure that children and young people's experiences are reflected in your inspections of local authorities' children's services—for example, looked-after children and disabled children? In the Children, Young People and Education Committee, we've taken part in some visits across south Wales, and we've met with care-experienced young people who have sadly painted quite a bleak picture of high social work case loads and their perception that care-experienced parents are stigmatised within the safeguarding system. Perhaps you could touch on that, please.

In our local authority reviews, the voice of the child is an important element. Did you want to pick up on some of that, Vicky, on how we make sure that the voice of the child in our inspections is enshrined?

The starting point for our inspection of children or adult services is to look at people's social care records to see if in there it's clear that the voice of the child is represented, and if it isn't then we will feed that back to the local authority as an area for action. We do try and engage with care-experienced children. It's fair to say that they don't always want to talk to us; not a lot. But we do, and we work with organisations like Voices from Care. When we carried out our review of disabled children, we worked with third sector organisations that supported parents and disabled children and asked them to provide feedback for us. We use a range of different mechanisms. We try and use online ways of engaging with children and young people, because what we found was in the past we used to invite them to a focus group, and they don't want to come, but actually if we do it through this medium then they're more likely to want to talk to us. We try and be innovative in the ways that we engage with care-experienced children. We meet regularly with the children's commissioner as well. Gillian meets regularly with her, and we meet with her office to get feedback from the experience of children and young people. But it is an area that we're always looking at how we do that and how we do it successfully. So many people talk to care-experienced children, from their social workers to the local authority wanting feedback, to corporate parenting boards. We also work very closely with the children's commissioning consortium, who have young commissioners who they work with and we get feedback from them as well. So, we use a range of sources, not always directly from children and young people.

Thank you. Your annual report refers to multidisciplinary teams providing intensive support to children and families to reduce the risk of children entering the care of local authorities. As we know, as I think Joyce Watson said earlier, there is a difference, a variation, in children being taken into care in different local authorities. We know it's different in other parts of the UK as well. Do you look at all of those differences, as Jack Sargeant said, around sharing good practice? Are you concerned around that?

Prevention and early intervention are critical, and support for families. I think with local authorities, particularly as the financial crisis deepens, the worry is always that it's the early intervention, the prevention work, that may suffer as a result of what's likely to happen, going forward. The rates of care are something we also look at. It's hard to just compare with England, though, because if you look at England, when England in the south-west compares to the north-east, the figures are very stark and very different across England. The work that's going on, I think, around rebalancing social care and encouraging a child to stay with family where it's safe for them to do so looked very promising. Again, the last couple of years have caused issues. But what we do know is that, when there is a spotlight on an area, it tends to lead to an increase in referrals and an increase in activity within that local authority area. It happened in Ynys Môn, it happened in Wrexham, and it will doubtless be happening in Bridgend now. Was there anything further you wanted to add?

We're in the middle of doing a national review at the moment about the public law outline, because there was a working group from the family justice division across England and Wales looking at that. It had 47 recommendations, which children's services are now embedding in Wales. We're interested in how far they've progressed with that, and I'm sure when we produce that, which will be spring next year, that the committee will be interested in the findings of that report as well. We've done a national survey and we're doing field work in six local authorities to find out what's happening. That's very much about when children enter the public law system and how that is being managed. So, we are looking at that.

Thank you. And finally from me, Chair, can you just tell us briefly more about your concerns about those insufficient placements for children with care and support needs? We know, as has been said, that some children are being placed far from home and sometimes out of Wales.

It's interesting, because for some counties, being out of county actually can mean being closer to home than being in county, particularly for Powys, which has many local authorities bounding it. We would be concerned about children being placed outside of Wales, particularly Welsh-speaking children being placed outside Wales, because we know the impact of being away from your roots.

The problem is not unique. England, ourselves, we all struggle with this issue of adequate placements to deal with those most complex children. The work that's going on, as funded by the integrated care fund, will hopefully mean that every regional area in Wales at some point will have a therapeutic service that can deal with some of those most complex issues.

The problem is, for some of the most damaged and vulnerable children, the level of expertise needed can't be recreated on small, local footprints. There have been instances of children being placed at a significant distance, which is never to the child's advantage. But, at some stage, if that's the support that will give that child the best opportunity to deal with the issues that they're facing, then the local authority has little alternative but to do that.

Out-of-county placements, though, we would be less concerned about, because it would depend how far away from their home that is. But it is something that we look at, we talk to our policy colleagues about, and it’s something we talk to local authorities about as well.

I think it’s fair to say that that’s a discussion we have with local authorities frequently: is it better for a child to be in a service that’s operating without registration—so, it doesn’t have any of the protections that registration gives? Or is it better that they go to Scotland, but it’s in a registered service? And that is something that heads of children services are flagging with us all the time. Obviously, as a regulator, our position is that services shouldn’t operate without registration and you need to register that service as soon as you can if there’s a need for the service.

I think the other gap, and that's what sometimes results in children moving out of county, is access to mental health support. Children need trauma-informed practice. We’re often talking about children who’ve had multiple traumas in their lives and they need really specialist placements, and that isn’t just a social care placement—that needs specialist education and specialist healthcare as well. And that, in our discussions with local authorities, is one of the biggest gaps—accessing child and mental health support as well.

Jack Sargeant.

Thanks, Chair. Just picking up on your points, Vicky, on 'trauma informed', a few years ago, we spoke about adverse childhood experiences and a trauma-informed approach quite a lot. Do you think we're speaking about it enough now and are we having enough attention on it?

Yes, I think we do. And I think a lot of providers of children's social care are trained, and their staff are trained in it—definitely.

Yes, okay. And in the other partnerships, then, does there need to be more attention, not just children, but talking about the wider partnerships? Do you think other areas need to be more trauma informed or is that okay at the moment?

I think it's ongoing, because, I mean, we talk about churn in the workforce, don't we, and, as staff go, new staff need training, so we always need to have a focus on trauma-informed practice.

Okay.

And, Jayne, just to ask, did you manage to get through all your questions you wanted to ask, Jayne?

Yes. Thank you, Chair.

Yes. No problem, thank you. Rhun.

Just a short question. I'm glad that you put the needs of Welsh-speaking children in the spotlight. What steps are being taken, or need to be taken, in order to give assurances to those who do need care through the medium of Welsh? And it's not just children; there was one constituent of mine—there was a fair bit of focus on the fact that he had been moved way, way away from his family, with dementia and unable to get the care that he needed in Welsh.

Yes, it is a significant issue. We have an invaluable tool called, the data tool, which is accessible—we can send a link, Chair, to the committee if you wish. What that enables us to do is we can plot across and people can access the system and see where the Welsh-speaking services are—the percentage of Welsh-speaking services. We have seen some closures, we have seen some reduction, but what we've also seen is that when people move into a service where they can receive care in Welsh as their first language, it's transformational for the individual. And there's a lot of work that goes on to try and make sure that people can receive care in the language of their choice. And there are some lovely examples, even in care homes that are trying to improve their Welsh—they will use phrases, putting phrases up on walls and using and practising their Welsh with individuals. It's not ideal, but it shows the willingness of the home to meet the needs of that individual. Ideally, every person who wants to receive the service in Welsh as their first language should have that service. But, where we are, it's nice to see the innovation that goes on, but the data tool is really useful for you to see where the services are and where the gaps are.

And every inspection report we publish, right at the front we say whether there's an active offer of the Welsh language or not and we talk to providers who are not offering that. In fact, we've got a provider event tomorrow with adult and children services and that's one of the things that I'm going to be talking to providers about—about the importance of the active offer and starting from where you are. So, if that is about encouraging staff to speak Welsh, and Social Care Wales have got some really good tools for staff to be able to talk to people using the odd word, and it is really important when people have dementia or for children to be able to access a service in their first language, but it is restricted.

Diolch.

I've got a few quick questions, but we're over time, so, I'm looking for bullet-point answers, if it's possible. From my own constituency casework bag, there is a recurring theme when it comes to your reports, and the recurring theme is it's leadership, management, leadership, management.

Yes.

So, how do you believe that leadership and management in general can and should be improved? Perhaps you can bullet point that quickly.

Yes. It makes all the difference. We talked earlier about positive cultures, and we've seen reports recently—the fire service—of what the impact of a toxic culture is. There's a lot of work going on around compassionate leadership with us and Social Care Wales. Moving the responsibility to the RI is pivotal, but, as you've identified, I think the biggest concern we've had in care homes is around their leadership and management. Where it works and works well, it's astonishing the difference it makes.

So, tell me what works well. Tell me what is it that needs to be—. What does good leadership and management look like?

Okay. Good leadership is a vision for the care home, and care for the workforce where the well-being of the workforce is central. There are clear procedures, rules. The whole atmosphere is about reinforcing the good practice, encouraging people to go over and above. There's a whole raft of work. I can send you links to the positive culture stuff that we're dealing with, but it's very hard to bullet point what is quite a big subject.

Sorry, yes.

But there is exciting work happening, because part of our feeling is that it's often the small things that make the difference, and we have pages and pages of stuff that we're happy to share with you about how leadership empowering staff, making staff feel valued and pivotal and creating—. Sometimes it's as small as the manager goes around and says, 'good morning' to everyone in the care home, and the atmosphere that is created, or it's the way the lunch is done. When you go into a good care home, it's tangible, the feel of it. But I could go on for a long time on this subject.

No, you've done a really good job. I asked you to bullet point, and you did a really good job in summarising that really helpfully. Thank you. And there's an increase in referrals to you, I note, as well, from staff.

Yes.

So, why is that? Does that tell us that staff are not being listened to elsewhere?

We've done a lot of communications with staff through the pandemic. We had a Speak Up campaign jointly with Healthcare Inspectorate Wales, because we were concerned, with the normal throughput not happening in care homes, about where some of that intelligence would come. And so, we wrote to staff on a few occasions and asked them to tell us about positive things that they were witnessing, but also not to be afraid to share with us things that they were concerned about. Now, we'd like to think that the increase is as a result of the campaigns we've run, rather than concern that they're not able to talk to their managers.

Okay.

But we do follow up on every single concern that comes to us, and often these can be resolved in discussion with the RI. So, I'm hoping it's a result of the campaign, and people beginning to realise that when they raise things with us, we will take action.

That's helpful. Finally, and I think this hopefully could be a brief answer, but the social care services are a statutory duty for local authorities. Are you satisfied with the overall quality of social care services, in both children and adult services?

The vast majority of services we inspect, we have no concerns about—the significant majority. And where we do have concerns, we take action. And so, if you look in the annual report of the figures last year, many services that we had concerns with improved. Our aim is always that a service improves, because, for regulated services, these are people's homes and we want them to be the best possible home they can be. Usually, improvement comes; where it doesn't, then we take action.

And I think also, to answer it in terms of a local authority, it's very difficult to give a blanket answer for a local authority, because they may be very good at supporting people with a learning disability, but there may be room for improvement for people with mental health needs, or they may be very good at safeguarding, but there may be room for improvement in supporting carers. So, it's very difficult to give a blanket answer. There's always room for improvement, we encourage continuous improvement and we're always looking at what local authorities' improvement plans are, what they're good at and where they need to improve. A good local authority should recognise the areas that it needs to improve. That's what we want to know—'Are you sighted on those areas for improvement, and have you got good plans in place to address those?'

That's helpful. Thank you. Thank you, both, for attending this morning. It's been a really useful session. We'll send you a copy of the transcript from this morning as well. If there's anything that you want to add to what you've said or expand upon, or give us any additional notes, then we welcome that, of course, as well.

I just think it is important that we recognise that, every day, we witness good, compassionate care delivered by dedicated individuals, and poor care, thankfully, in Wales is rare. But where it does happen, we will and we do take action.

That's good. And is there any advice you have for us as a committee whose job it is to make recommendations to Government and scrutinise Government?

Well, hopefully, what we've given you today and our annual report—. What we do in the beginning of the annual report now, every year, is a section we call 'Reflections', and the whole point of that is, 'These are things we would like resolved.' It's our shopping list. [Laughter.]

Thank you. Thank you, both, for being with us this morning. It's very much appreciated. Diolch yn fawr iawn.

Thank you.

Thank you. Diolch yn fawr.

Thank you for your time.