Health and Social Care Committee

Item 5 is our continued work on the Health and Social Care (Wales) Bill, and we have an evidence session with the Minister for Social Care. So, I'd like to welcome Dawn Bowden, as the Minister for Social Care and as the lead Member for this Bill here today.

I'll introduce, myself, your officials as well, if you don't mind, Minister. So, we have Anthony Jordan joining us as the head of programme and legislative implementation, social services and integration directorate for the Welsh Government. We also have Chloe Marong as a lawyer within Welsh Government joining us online as well; and we have Penny Hall, who is the policy lead for the improving outcomes for children branch in Welsh Government as well. So, thank you all for joining us here this morning, we very much appreciate it.

So, Minister, I'll just start off with a few questions, and first of all, from my side, just to understand why you think that this legislation is necessary for us here in Wales.

Yes, I suppose it takes us back to the first evidence session, doesn't it, in terms of what we were seeking to achieve by introducing this legislation. So, the objective of the legislation, primarily, is to take profit out of the care of looked-after children, so that any profits that are derived from the care of those children are reinvested back into the sector rather than paid out to shareholders. So, that's the primary reason for the legislation.

The second section of the legislation also deals with the introduction of direct payments for continuing healthcare, which will bring it into line with the direct payments for social care. And then we have a number of miscellaneous items at the end, which are about regularising the legislation, but those two first areas are the primary reasons for the legislation being introduced.

Thanks, Minister. And can you help us understand why you think that these things can't be achieved without legislation? Why can't the Welsh Government just direct local authorities, for example, to only engage with maybe third sector or local-authority-run organisations to remove that element that you're seeking to remove?

So, again, I think we did touch on this last time, Anthony, didn't we, in terms of the discussions with the sector, and the way in which the current legislation is framed would not allow us to do this without moving towards new legislation. I don't know, Anthony, if there's anything you want to particularly say about that, but there is a very specific reason why the current legislation doesn't fit and requires new legislation.

Yes, absolutely. I think in terms of the point you made about directing local authorities, we have powers of direction in relation to local authorities when they are not performing their social care functions in an acceptable way. We wouldn't be able to use that power in order to direct the way that they exercise their commissioning functions or their placing functions in the absence of an actual primary legislative touchstone that says, 'This is what you must do.' So, that, in a nutshell, I think, is the reason why we've concluded that primary legislation is necessary in this space. But if I may, I'll just pause in case my colleague Chloe has anything to add on that particular head.

Thank you, Anthony. I don't have anything to add to that. I think you've covered that. Thank you.

Okay, thank you for those responses, then. There has been concern raised in our evidence sessions so far about the possibility of loopholes being used, such as arm's-length arrangements involving perhaps a profit-making company elsewhere in the UK. So, can you give us a guarantee that the provisions in the Bill that will require providers to be not-for-profit are completely watertight and will completely prevent for-profit delivery in Wales, the very ambition that you're seeking to achieve?

Well, again, that is the way that the legislation has been constructed, to avoid those loopholes, because we have learned from the experiences of Scotland, where we saw for-profit providers trying to get around the provisions there, so we've made that very clear in the legislation, that the four models of not-for-profit are the ones that will be acceptable, and only those will be acceptable. And anything that we see as seeking to get around that, like the introduction of management fees or similar sorts of arrangements, would be seen to be for-profit and therefore not fitting within the terms of the legislation, and would not then be eligible for registration. Again, Anthony, is there anything you want to add to that, because that was something we specifically changed in the legislation to avoid that, wasn't it?

Yes, absolutely. And the thing that we've done, in addition, is taken powers to look at the question of unreasonable payments, so that is designed to be a way in which we can maintain an oversight and satisfy ourselves that money is not being taken out of provision in a way that disguises the extraction of profit. And as the Minister's alluded to, there's also a lock in terms of the models that we've chosen.

Okay, thank you for that. And in terms of the timescale within which existing for-profit entities can convert from their current status as for-profit to a not-for-profit entity, what's the shortest sort of timescale do you think that will happen over? Are we talking a year or two, or do you think it will be a longer period than that? Over what sort of timescale do you think that's going to happen?

Well, what I would say is that we are very ambitious for this programme, Chair. We've set out in the legislation that new providers registering with Care Inspectorate Wales have to have not-for-profit status from 1 April 2026 and existing for-profit providers will be subject to some transitional arrangements, but from April 2027, that sort of represents the start of their transition period. So, we would be looking to see, from April 2027, existing for-profit providers transitioning to one of the four models that we've set out in the legislation.

Thank you for that. From our understanding, there is no mechanism to allow a company limited by shares to change into a company limited by guarantee or any type of charitable entity. They'd have to set up a whole new charity and completely move all their assets and liabilities into a whole new organisation, which, obviously, is a significant amount of work around Transfer of Undertakings (Protection of Employment) Regulations 1981 negotiations with staff and trade unions, potentially. I'm just trying to understand whether there's been an appreciation of that shift and how long and arduous that could be for some organisations.

Depending on the size and the nature of the organisation, it will be simpler for some to do that than it will be for others. This is a particularly ambitious programme. We're very aware of that, but we are absolutely determined that this is the programme that we need to introduce for all the reasons that we've previously set out, and for all the reasons that I've explained previously. It is also important to say that we have set up an elimination board, and the for-profit providers and the not-for-profit providers are part of that transition programme, so they're very much involved in discussions with us about how they can transition to one of the new models. I don't underestimate the challenges that it will present to some, but this is not something we've just pulled out of the hat in the last couple of weeks. This has been something that we've been making very clear to the sector for some considerable time, that this is our ambition and this is what we're going to deliver, and we're very keen to work with those providers to ensure that they can be part of that new arrangement.

Thanks, Minister. I appreciate the ambition and the desire, but, of course, there are legal thresholds to pass and issues to work through. I'm not sure if there's a legal perspective from your officials on this, but just to understand the timescale it would take legally for these things to take place. We can have all the ambition in the world, but if you physically can't move from one thing to the other within a legal timescale, then that becomes impossible. So, I'd just be interested to understand it from a legal perspective, if that's been considered properly, with all the ambition you may have.

I'll ask Anthony to respond to that.

Thank you, Minister.

Thank you, Minister. So, I think before I just bring in a colleague, if I may, it's also worth saying that we are working on the minimum really, realistically, that there will be a two-year period between the Bill, with the will of the Senedd, receiving Royal Assent and the first restrictions coming in on existing providers and their ability to take placements. That, we think, is a reasonably generous amount of lead-in time, and, of course, it's not a cliff edge. Providers will still be able to operate in their legacy for-profit mode for a period of time, but that will be controlled by provisions we have put in the Bill around approval of placements. I think it's important to stress that it isn't a cliff edge in that sense. If I may, I'll just invite my colleagues on screen to supplement that.

Thank you.

Thanks, Anthony. Just in terms of the barriers that you said that stakeholders had raised in terms of closing down a business and setting up a different entity, just to reassure Members, I suppose, that we are working very closely with providers, trying to really understand from them what those barriers are. You've mentioned there are potentially some legal barriers, but we understand that there are also concerns around the costs and just accessing legal advice, et cetera. So, we've had some meetings this week, and we are working with those providers to try and understand some of those barriers and how we can support them, whether that's in a practical sense or in a financial sense, as we move forward, to try and facilitate that process of moving to a not-for-profit entity.

Okay. Thank you for that. So, it's clearly still being worked through in terms of understanding what that may look like. I guess, for these organisations, having a clear line by when that may take place would be, at the very least, helpful to them, because I'm sure they don't want to be breaking any laws in terms of what's been intended with the legislation.

No, and I think it is important that we do continue those discussions with them. We don't want these providers to leave the sector. Some of them are providing excellent care for children and we would want to retain that expertise and that excellence in the system. So, it is in our interest to work with them and to work with them in the process of transition, but we are very clear that that will happen. And interestingly enough, despite the fact that we've been very clear about our position on this, we actually have seen, in the system, over the last year or so applications for another 24 or 25 for-profit providers wanting to come in and set up in Wales in the full knowledge that they may well be expected to transition to a not-for-profit model at some point in the future. So, it's really not putting anybody off at the moment and we certainly haven't seen any for-profit providers exiting the sector yet.

Okay. Thanks, Minister. I just want to move on slightly, but linked to this general theme, because there are calls for some of the smaller or medium enterprises to be, perhaps, considered differently in the Bill's approach, compared to a big, corporate organisation. So, are there any circumstances in which you would consider changing the Bill's approach to reflect those calls to treat small and medium enterprises that provide specialist residential care placements differently from the large providers owned by public limited companies or private equity firms, especially in light of residential care providing 83 per cent of current provision and, on average, being less expensive than local authority provision, as well? How would you respond to the Chartered Institute of Public Finance and Accountancy view that this Bill has taken an all-or-nothing approach, not necessarily differentiating between a very small firm, technically, legally set-up as a business, versus a large equity firm?

Well, we had to set out in the Bill—. So, if we're moving towards achieving an objective, we had to set it out very clearly in the Bill. And one of the things that providers asked us to do was, rather than defining what 'not-for-profit' meant, they told us that it would be more helpful for the Bill to set out what the acceptable models were, so that's what you've got in the Bill. Now, there are continuing conversations with the sector around employee-ownership organisations, for instance. That's one example. Now, we haven't—and we deliberately haven't—put that in the Bill, because once you bring in one model of provider that is for-profit, you can't then—. Despite the fact that it's almost like an acceptable model, and it's a kind of co-operative model that we would want to see, it does have employee owners and, therefore, they are extracting profit. So, we don't feel that that is an acceptable model because, as I said, once you introduce one for-profit model, how can you then justify not allowing other for-profit models? So, we're very clear about that, although, again, I'll ask Anthony to say a bit more about the conversations that have been taking place with these organisations about the potential around some other models that still meet the objective and are not-for-profit.

Thank you, Minister. Yes, we've been having conversations—as well as in the programme board, as the Minister referred to previously, we've also been speaking directly with the Children's Commissioning Consortium Cymru, which represents the children's social care commissioning effort and also Cwmpas, formerly the Wales Co-operative Centre. And we have been discussing with them quite specifically what exactly it is, in terms of the qualities that come with, for example, an employee-owned trust vehicle that they think might make it aligned with our policy imperative, and how does that differ, how do those qualities differ from the qualities that are inherent in our four models. And those conversations, I think, have been useful—not breakthrough conversations yet, but they are informative and we will, of course, be reflecting on them once they've come to a conclusion, which I'm hopeful they will do fairly shortly. But I think the touchstone point is, as the Minister has already articulated, that the Bill and the policy principle is very much about preventing the extraction of profit from this type of children's care and, obviously, anything we do needs to be consistent with that, and we think our models are—

Sorry, just a point to the Minister on this, on this line being used around extracting profit from the care of children, we've heard no evidence so far that the costs of what's going to be introduced will have any savings for the public purse whatsoever. There seems to be no guarantee that, as you describe it, the profit being extracted would be reinvested into the care of children. Indeed, when we heard from children and young people who are either in care or have left care, whilst they echoed some of the comments you made, their priorities seemed far different in terms of the issues that they’re facing at the moment. So, I’m just interested to know what actual difference this will make to the children who are in care when this legislation goes through.

The difference it’ll make, Chair, is that the profit that’s extracted will be reinvested in the services that we’re looking to provide to those children. Some of the providers in the sector in Wales are drawing between 20 per cent and 25 per cent in profits that are paid to shareholders—

If I may, Minister, the WLGA told us that savings are likely to be cost avoidance rather than cashable savings, so, therefore, not going back into the care of those children. Especially, local authorities have got a £40 million overspend in children’s services, and £26 million of that is on residential placements alone. So, for you to say that the investment will go back into those children’s services and the care of those children, it seems hard to add those two together.

I don’t accept that. I think we need to be very clear about this. This is not going to produce savings overnight. Nobody is suggesting that this would produce savings overnight. This is also about ensuring that we have the right type of placements in the right places, because this is not just a piece of legislation that stands alone; this is part of a wider programme of transforming children’s services, and this is one element of that. Part of our ambition here is to reduce the number of children that require to be looked after. So, it isn’t to look at this in isolation; it’s to look at it as part of a wider transformation programme.

But, to deal specifically with the point, we’re working very closely with local authorities. We know that this will require some initial investment. We know that, for local authorities and the third sector, this may require quite a significant upfront capital investment, and we’re working very closely with them on how we can support that and how local authorities themselves can use their borrowing powers to support that. So, those conversations are ongoing and we hope that we will get to a point where we will be able to see the way in which the investment can be used to the benefit of the sector. But, I don’t accept the premise that this will end up costing local authorities more, when we have private providers at the moment that basically dictate the market because they are so big. You know, 80 per cent of children are placed in for-profit providers and, basically, they can charge what they like to local authorities. So, this is about really giving the control back to local authorities in terms of the ongoing costs. We would anticipate that we would start to see those savings being seen by local authorities within a 10-year period.

Before I bring Mark and Mabon in, I guess the point is that CIPFA said that other options could be explored, such as introducing a cap on profits, rather than having to go through primary legislation. So, if that is the ambition, in terms of trying to control the market somewhat, then there are other measures that could or should have been used. It’s still not clear to me why more simple measures or policy decisions haven’t been used, rather than going through primary legislation, to try and control this.

Because I think it still fails to address the fundamental issue that profit being made out of the sector should be reinvested in the sector. That still doesn’t allow that to happen. If you cap profits, it just means that you have slightly lower profits that go to the shareholders instead of going into the sector. I think we need to be very, very clear—and I don’t think I could be any clearer—about what the purpose of the legislation is.

Okay. Thank you. Mark.

Minister, isn’t the WLGA’s point a distinction without a difference? The Bill will allow local authorities to avoid the ever escalating costs of running the current system. That is money they will not have to spend. That money becomes available to invest in services directly for children. Isn’t that what this Bill sets out to do?

That is exactly what this Bill is set out to do, and that is exactly the ambition that we share with the WLGA, because that is what they want to see as well. In times of extremely difficult financial hardship for local authorities, they are looking at every which way they can to make the most of the money that's available to them, and they very much see this as the long-term answer and response to the provision of looked-after children.

Minister, we also heard from WLGA that the measures of profits used are not the same as amounts extracted from the care of children, and they suggested that there's a misunderstanding of the differences in terminology between profit and extraction of profits. Do you think the Welsh Government have an understanding of that difference?

I'm pretty sure we have an understanding of that, Anthony, don't we?

Yes, I think we have worked through this very carefully via the Association of Directors of Social Services, who, in their turn, had a working group, which included WLGA representatives. That informed all of the calculations that we've come up with in terms of the regulatory impact assessment. So, I think we do understand the distinctions, and I think we're happy to stand behind the calculations within the RIA, but, obviously, as I think the Minister said before, we're happy to continue engaging with stakeholders to evolve our understanding of what the cost might be, and looking ahead to a revised regulatory impact assessment to be laid at the end of Stage 2. So, I don't think we see this as the end of the story, but we've come forward with something we believe is robust, based on the evidence that we have.

Thanks. One final point, before I bring Mabon in. I'm sorry, I just want to get down to the roots of this here, because the fundamental point you're making, Minister, is that this money can or should be reinvested in supporting the care of children. You wrote to us—I'm actually not sure it was you, Minister, but a Minister wrote to us to show the cost of the care of an independent provider versus the equivalent placement within a local authority setting, and that difference was £3,800 a week with an independent provider, but the equivalent placement with a local authority setting was about £5,200 a week—so, £1,400 a week difference. So, going back to the point that the premise of this is to reinvest that money in the support of children, with that significant level of increase of cost of caring for those children with a local authority, are you confident that that reinvestment will actually take place, or is it just an ideological position?

It is both ideological and a financial position. We are absolutely ideologically saying that we don't believe that looked-after children should be a source of profit for the private sector. I make no apologies for saying that is an ideological position. But it is also a position that makes financial sense to local authorities, and that is what we are pursuing with them. As I said at the beginning, it won't be something that they will see an immediate saving on, but it will give more control to the local authority, and we will have the—. Because they have to work on the sufficiency of placements, and you might want to come to that a little bit later. We will very closely with local authorities about they build resilience into their system. We've seen a huge increase in the number of local authority places that have been made available over the last few years, again in anticipation of this legislation, and we're continuing to work with those local authorities to do that.

We've had the elimination programme that we've invested in, working with local authorities, helping them to build that resilience. As I say, we've seen a number of new places come into the statutory sector. We've got a number of funds that are still supplying the sector, if you like—the state sector: the housing-with-care fund, the integration and rebalancing capital fund. All of these funds that we still have, which are joint integration funds, are being used at the moment to improve the resilience and the capacity within the statutory and the third sectors, and that's going to continue. So, I am not convinced by the arguments of people that are trying to protect their interests around continuing to extract profit.

It's the letter you wrote to us, Minister, not a private company. Mabon.

Thank you. I'll be asking in Welsh.

Sorry, Mabon. Apologies.

Gan roi i un ochr egwyddorion craidd y Bil sydd o'n blaen ni, mi ydyn ni wedi derbyn tystiolaeth yn dweud bod rhai o'r darparwyr presennol, neu hyd yn oed nifer o'r darparwyr presennol, o bosib, yn mynd i adael y sector yn ddi-drefn, oherwydd y pryderon ynghylch hyn. Mae yna risg, felly, ein bod ni'n mynd i golli llefydd gofal a darparwyr. Lle mae'r risg hwn yn gorwedd efo chi ar eich asesiad risg o impact y Bil?

It's a fair point, and it’s a reasonable concern. I’d go back to what I said earlier in response to a question from the Chair: we’re seeing more new providers, actually, registering in Wales. They’re not exiting the system. New providers are coming in over the last couple of years in the full knowledge that we're introducing this legislation. This is for-profit providers I'm talking about. And we have seen no for-profit providers exit the system knowing that this legislation is around the corner. So, again, I am not convinced by the argument that we're going to see a mass exodus, disorderly or otherwise. I think if we were going to see those providers leaving, we would be starting to see it now. I'm not suggesting that none of them will leave—they may. But I would hope that there will be orderly transition, because for many of those providers, they will still be contracted to continue to look after children in Wales. And there will still be a role for some specialist placements. But that doesn't detract from the overall objective of what we're trying to say. Anthony, is there anything you want to add to that?

Thank you, Minister. Just to reinforce, we have been liaising with our Care Inspectorate Wales colleagues over the last three years, I think it is. We've seen one adoption service, one adult and children's home without nursing and a total of four children's homes voluntarily exit the sector, which is a very low number. Our proposals have been known throughout that time. So, as the Minister said, we're not seeing an exodus. All of the statutory framework we've put around transition has been designed in order to avoid any need for providers to exit, certainly in a disorderly way, and actually in any way at all, if they can get behind our agenda. We think there are ways in which they can do that. So I think we've got that controlled. And of course, local authorities are also well versed in managing transitions of providers out of the sector. Generally, that's for financial reasons, not, obviously, for things to do with this Bill. So there are mechanisms in place in the hopefully unlikely event that there is such an exit. But there shouldn't need to be, as the Minister said, because they can continue to provide services under permission of Welsh Ministers for as long as those are needed.

Gaf i wirio, felly, yn sydyn iawn—? Mi ydych chi wedi cyfeirio at dystiolaeth anecdotaidd o'r profiad dros y flwyddyn neu ddwy ddiwethaf. Does gennych chi ddim, felly, cofrestr risg ar gyfer hyn, a dydych chi ddim wedi mesur beth ydy'r risg a pharatoi ar gyfer hynny.

Sorry, I misunderstood the thrust of your question. Yes, we maintain two risk registers: one for the Bill, which is primarily about Bill matters, and then there's another risk register that is for the wider transition programme for children's services, in which the eliminating profit provisions are embedded. And I believe, although I will just double-check with my colleague Penny, that that is very much a risk that is on the register and is being monitored. Because although we have an assessment of how likely we think it is to eventuate, obviously it's something that we need to be mindful of and work with providers to manage.

Just on that risk register, of course, there are all sorts of ratings. So this particular risk is a red risk—is that what you're saying—in terms of its RAG status.

I'd like to just defer to my colleague Penny, if I may, because it's on her side of the business.

Thank you, Anthony. Yes, just to confirm, there is a risk register for the whole of the eliminate programme, not just in relation to the legislation, which has its own. And that risk register is considered by the eliminating profit programme board at every meeting. It's a standing item on that agenda. There are a number of risks, as I'm sure you're aware, but this is very much on that register. I think it is red; there are a couple that are red on there. But, again, it's about the provisions in the Bill that mitigate this particular risk. Also, we have market intelligence reports that we get from the Children's Commissioning Consortium Cymru, which are also considered alongside the risk register at those programme board meetings. So, we have a clear approach and framework in place to constantly monitor the market and what providers are doing. We also have a number of work streams under the programme board, one of which is the for-profit providers. So, again, we have that ongoing dialogue that enables us to gain the insight that we need in terms of providers' intentions and what's going on in the market.

Wrth gwrs, mae yna gyfnod pontio yn mynd i fod ar gyfer terfynu cytundebau preifat. Fe ddywedoch chi wrth y Pwyllgor Deddfwriaeth, Cyfiawnder a'r Cyfansoddiad yn ddiweddar ynghylch y cyfnod yna—dwi'n mynd i ddarllen y fersiwn Saesneg rhag ofn bod yna drafferth efo'r cyfieithu—y buasai'r cyfnod pontio yna

'would be open to Welsh Ministers to bring the transition period to an end in a staged way, allowing local authorities whose task of removing reliance on for-profit providers is more difficult to have more time but introducing full implementation for other areas sooner.'

Dyna ddywedoch chi, Weinidog. Ynghylch hynny, pa risgiau, unwaith eto, ydych chi'n meddwl sydd wedi cael eu hasesu gennych chi yn gysylltiedig â gwneud hyn fesul cam? Ydy'r ffaith eich bod chi'n mynd i drin awdurdodau lleol yn wahanol yn mynd i fod yn rhyw fath o perverse incentive iddyn nhw gadw'r sefyllfa bresennol, ac ydych chi'n meddwl fod trin awdurdodau lleol yn wahanol yn mynd i olygu bod gweithredu hyn yn mynd i fod yn wahanol ym mhob awdurdod lleol?

I don't see it as a disincentive, Mabon. I think I see it as a process because different local authorities are in different places with their transition programme at the moment. In Joyce Watson's area, for instance, there's been significant progress in Carmarthenshire with moving towards not-for-profit providers; virtually all of their children's services are now not-for-profit. Then, you compare that, of course, to somewhere like Cardiff, where 80 per cent of their children are looked after in the private sector.

Local authorities are at different stages of the process, and so you can't force everybody to get to the same place at the same time; that's part of what we're trying to do. It's part of what the elimination programme is about with local authorities that we're investing in to give them the resources to be able to build that capacity. So, I think that's just an accepted part of the process that we're following at the moment. Is there anything you want to add to that?

Yes. Thank you, Minister. From our perspective, the point that was being made there was more that if we find that some authorities are genuinely struggling in order to eliminate profit within the sort of timetables that Ministers have in mind, we can, potentially, make some allowance for that, rather than expressly setting out from the outset to treat authorities differently. So, it's more about making an allowance than a position of difference across the board.

The other thing I might add, if I may, is we're also thinking about that provision in terms of making a distinction between different types of service. So, it might be that, actually, we could bring the transition period for fostering services to a close rather more quickly than we could for residential care services, because I think the signs are more positive there that fostering services will wish to transition. I think the balance between for-profit, not-for-profit and local authority is more in favour of the provision there. So, those are all reasons why we might be able to do it more quickly and the provision in the Bill would allow us to do that, and the same with secure accommodation services where there are, currently, no for-profit providers of secure accommodation. So, we might want to bring that in more quickly again still. That's essentially the way we're thinking of using that particular power.

Yn olaf o'm rhan i, un o'r sesiynau mwyaf pwerus ddaru i ni ei gael oedd wythnos diwethaf, pan ddaru i ni glywed gan bobl ifanc oedd yn flaenorol mewn gofal, a gwrando ar eu tystiolaeth nhw—roedd honna yn sesiwn arbennig o bwerus. Ond yr hyn sydd wedi dod yn amlwg ydy nad ydy nifer o'r bobl ifanc a'r plant sydd mewn gofal ar hyn o bryd yn ymwybodol o'r newidiadau sydd yn yr arfaeth. Ac mi ydym ni wedi clywed galw gan rai yn y sector y dylid sicrhau bod yna eiriolaeth ar eu rhan nhw, a bod eu llais nhw'n cael ei glywed a'u bod nhw'n ymwybodol o'r hyn sydd yn mynd i ddigwydd, a bod eu dyheadau nhw, felly, yn cael eu cyfleu yn hyn. Felly, ydych chi'n fodlon ystyried rhoi cynnig gweithredol uniongyrchol—active offer—ar gyfer y bobl ifanc a'r plant yma mewn gofal, er mwyn sicrhau bod eu lleisiau nhw'n cael eu clywed a bod eu dyheadau nhw yn cael eu hadlewyrchu yn y Bil wrth iddo droi'n ddeddfwriaeth?

Thank you. Statutory advocacy is not contained within the Bill, although we are the only nation of the UK, of course, that does have statutory advocacy services for children in the care system. But it is about best practice, and it is about making sure that children have a voice throughout this. We've been very clear that the voices of children are central to everything that we're doing. The best practice in terms of delivering advocacy is that if children need access to that level of support then we should seek to facilitate that. But it wouldn't be a part of this legislation, if you understand what I'm saying. But I'm very keen to ensure that children's voices absolutely remain central.

I think my colleague Penny has something to add on this, if that's acceptable.

Thank you, Anthony; thank you, Minister. Just to add to that, organisations that represent children and young people are part of our programme board. We have Voices from Care, we have the children’s commissioner's office on the programme board. They are very much part of the ongoing discussion and conversations around this. Also we have an advocacy provider: TGP Cymru is also on our programme board. We have had conversations around what advocacy children and young people might need as we go forward. I just wanted to make the point that that is something that is very much on our radar and that we are talking to advocacy providers about.

Thank you very much, Mabon. Mark.

Diolch, Cadeirydd. Three relatively quick questions from me, Chair. We heard last week from young people themselves. They were extraordinarily powerful advocates for the Bill. You dealt very effectively earlier on with questions about the ideological position of the Bill, and, of course, those witnesses who have used that term in an accusatory way in front of the committee often act as though the current system had no ideology. Whereas what young people explained to us was that the current system has the ideology of marketisation at its heart. They explained to us what it felt like to be regarded as a commodity to be put up, to be bought and sold by different providers, depending on how cheaply they could provide that. But, nevertheless, some children did raise two or three points, which I wanted to put to you. One is the issue of unregistered placements. We know that the system is under huge pressure, that unregistered placements have been used more extensively recently. Do you think there is a risk in the Bill that the use of unregistered placements will somehow become normalised within the system?

I don't share the view that that is a real danger. Unregistered places are there. It's certainly a very dynamic picture, isn't it, with unregistered places, but we have seen the number of unregistered places reducing significantly over the last couple of years [Correction: the number of unregistered settings reducing over the last couple of years]. We now only have something like 24 in the system, and it's staying steady, and it's coming down. I know you've got Care Inspectorate Wales coming in to talk to you this morning, so you might want to have a discussion with them about that, because I certainly had that discussion with them last week. We are very much working towards the minimal use of unregistered placements. Part of that is reducing the demand, isn't it? It goes back to what I was saying about the wider transformation programme on children's services, and that we don't just see this legislation sitting in isolation, that we see it as part of the wider programme of reducing the demand on places for children. So, yes, I understand the concern, but I don’t share that the concern is a major one.

Okay. Thank you, Minister. The Bill amends the current position where local authorities must take 'all reasonable steps to secure' accommodation inside a local authority’s area to

'within, or near to, the authority's area'.

Some witnesses have suggested to us that this may allow local authorities to place children further away from their homes than they currently do, whereas my understanding of the Bill was that it was intended to have the opposite effect, allowing local authorities to place children just over the border in another local authority rather than much further away within their own boundaries. Did I understand that correctly?

That is absolutely the correct interpretation of what we're seeking to do. If you take a county the size of Powys, you could see somebody could be placed in Ystradgynlais, or could live in Ystradgynlais and be placed in Machynlleth or up in Welshpool or wherever, whereas near to where they live could literally be just over the border of the county boundary. So, we're very clear that what that means is it's near to where the child lives and that that is more important than whether it actually sits within a county boundary.

Thank you, Minister. And finally from me, you answered questions in your last appearance here as to why the Bill did not include a provision for mandatory reporting, a duty to report on specific individuals in relation to child sexual abuse. Have you heard anything since, in the evidence provided to this committee and in some recent remarks by the children's commissioner, that has led you to alter your view on that, and, if not, whether you'd just, one more time, restate for the committee why you came to your conclusion?

Yes. So, we haven't heard anything that is changing our policy direction at the moment, but that is not to say—you know, never say 'never'. That is not say that, if something is brought to our attention that requires us to look at that again, we wouldn't. But we have stated that, the current safeguards that we have in place, we feel are the right fit for Wales. We have an obligation on organisations to report any concerns, and that has worked well for us. Now, we know that the UK Government did have some legislation around this, which fell when the general election was called. We don't yet know if the new UK Government will want to resurrect that piece of legislation. If they do, it might be an opportune time for us to have the conversation with them around that. But, at the moment, our position, as stated when I last gave evidence, hasn't changed.

Thank you, Chair.

Yes, no problem. Joyce.

This is an area of significant need to get it right. We've seen that, when these things go wrong, they go very wrong, and they ruin the lives of the people involved, not the just the moment in which it happened. So, I would particularly want to know, Minister, that—. There are two things that connect this, in my view. One is the advocacy for the child, so that the child is listened to if they make a complaint, and that that is followed through with zeal so that we don't have years where things get undetected and unnoticed and many more children are treated in that way. So, for me, of all of the things in the Bill that I agree with, I would want a real focus on marrying up the fact that children are listened to in the first place, that the inspection of the unregistered accommodation is robust, and that the mandatory reporting of issues is at the forefront and centre of anything else that we do, because, whilst I agree that we take out the profit, if there's one area that profit, in my view, needs to be reinvested in, and I'm sure everybody in this room would agree, it's keeping people safe.

Of course, yes. I absolutely agree with what you’re saying, Joyce, and safeguarding very much falls into my ministerial portfolio, so I’ve got a very keen interest in making sure that we get this right. So, the reporting process—. The difference around what was being proposed previously was that individuals should have a responsibility, and what we have is the responsibility on organisations, and that has worked well for us.

But I absolutely agree, the voice of the child—. Coming back to what we were saying to Mabon about the delivery of these services, but, within our safeguarding system, the voice of the child has to be central as well, which is why we have, again, mandatory advocacy services for children in Wales. And I think it’s important to say that we’re bringing in new processes for dealing with safeguarding in the autumn, which I think will help. And those are the unified safeguarding review, so that anybody involved in safeguarding—so, this is not just about children—anybody involved in potential safeguarding issues are not going to be forced into a position of having to repeat their story over and over and over again. They will have to tell their story once, and all the agencies involved in that will be involved in that safeguarding review. And I think that’s a really positive move forward, and we’re continuing to have conversations with the new UK Government now about how we can do more on things like domestic homicide reviews and the time that it takes the UK Government justice system to deal with that when we want to get on with doing the bits that—. Because although some of those things are determined by the UK Government, the way in which we respond to those is devolved. So, there’s a bit of a crossover there. But—

And, finally—. Can I, finally—

Yes.

Of course, within all of this—and it’s been highlighted again—are stringent processes and clearly understood processes for whistleblowers within the system, so that they get heard, as the people who—. Because, sometimes, children aren’t in a place to be able to advocate by themselves, to express themselves. So, others will be expected to do it on their behalf. And I know we’re talking about removing profit from the system, which I fully agree with, but you’ve already alluded to other—. It sits within other policies.

Yes, of course.

If we’re changing who’s providing care, then we have to be sure that those systems in that provision are robust equally.

Yes, I think that’s an absolutely fair comment, and those kinds of issues should get drawn out of things like child practice reviews, those areas. We know the situation that’s currently the subject of a child practice review is the Neil Foden case and all of the issues associated with that, and people saying to statutory agencies that they had tried to raise concerns and those concerns had not been acted on. Now, that is now the subject of a child practice review, and I would expect all of those things to be dealt with in that review, so that we have lessons that we can learn around the voices, not just of children, but people who advocate for children, being listened to, so that we don’t have a repeat of these things.

One of the things that I find so frustrating, and anybody, I guess, who has—. And I know Mark has a social services background, so would appreciate this, but one of the things that I find hugely frustrating as a kind of layperson, if you like, albeit Minister, is when we see reviews and reports that say, ‘These opportunities were missed’, and ‘We have to learn the lessons from the last time from this.' And every review seems to come up with the same thing, doesn’t it: ‘Opportunities were missed. We must learn from this for it not to happen again.' So, I’m absolutely determined that that has to be the case.

Thank you, Minister, and thank you, Joyce Watson, for those further questions. We’re going to just move the direction of the questioning on the Bill slightly, onto the direct payments provision elements of the Bill, and I'd like to bring in John Griffiths to ask some questions on this, please. Thank you.

Diolch, Cadeirydd. Bore da, Gweinidog. Yes, the direct payments provisions and the social care workforce and personal assistants are the subject matter of my questions. We’ve heard concerns from stakeholders that care worker shortages are a potential barrier. The older people’s commissioner told us that:

'Insufficient access to suitable domiciliary care will make it hard for the Bill to achieve its aims in practice'.

Is this something that concerns you, Minister? And, if so, how would you plan to overcome it in terms of this legislation and its intended impact?

Thank you, John, for that question. What I would say is that I think the issues around the social care workforce and the difficulties that we have around recruitment and retention in the social care workforce is not unknown to us and is something that we have been actively working on to improve. So, we've not been sat on our laurels and saying, 'Well, isn't this awful? We can't do anything about this.' Social Care Wales—. So, what we've got to try and do is to fill all the vacancies that we've got for a start. We know that we've got many, many hundreds of vacancies across Wales throughout social care. So, we have established, through Social Care Wales, something called WeCare Wales, which is a body that is promoting the recruitment, training, career development, pay progression and all of those areas in the social care workforce. And we are seeing some results from that, where we're seeing more people now coming into the sector. But it still remains a huge challenge. So, I don't underestimate it, and, really, I suppose the point I'm trying to make in response to your question is that we are alert to that and we are working on trying to improve the recruitment and retention of the entire social care workforce. Do you want to add anything?

Thank you, Minister. Just, perhaps, to add a bit of detail there, our anticipation is and our projections are that, in the first instance, this will impact upon people who are already in receipt of direct payments through local authority social care and who are moved by the changes we're making to undertake a CHC assessment. And a large part of the essential concept is that, when they do so, assuming that they are deemed to be eligible, then the provision of direct payments for CHC will enable them to bring their current PA arrangements over to the new arrangement. So, we're not expecting that there will be a big additional demand for PAs because it is serving an existing need. And then, as the Minister has said, in the longer term, as we see existing CHC recipients some of whom may choose to move over to this new way of receiving support, or new people coming on line who are eligible for CHC, in the longer term, then my policy colleagues are weaving in considerations around the need for additional PA workforce into the wider work that's being done on the social care workforce globally.

And it's also probably worth just adding, finally, that they are captured by the WeCare Wales running recruitment campaign. The website, at the moment, is advertising 300 posts, of which some are actually for personal assistants already. So, there is a connection already in there with trying to recruit more PAs into the workforce.

John.

Yes, okay. Despite that and, indeed, your previous discussion in this committee on these issues, Minister, we heard from the Homecare Association that workforce displacement is a real concern and has happened in England, and they are worried about shortages in domiciliary care, with staff moving to become personal assistants. And they cite the example of Somerset, where regulated providers have lost over 2,000 care workers, who have become personal assistants. Are you aware of what has happened in Somerset, and is that something that you've considered?

Do you want to take that?

I think we are aware that there are potentially issues that will be posed of displacement. As I said, though, I think, in answer to the previous question, we think that we're talking about small numbers in the first instance. We've calculated that probably about 110 people across Wales will be looking to move from their current direct payment arrangements with the local authority to direct payments under CHC. Obviously, some of them will have more than one PA, but we would anticipate that they bring them across, and then we think it will be a slow burn in terms of new people coming into the CHC system or people transitioning across. But, obviously, it is something that we will be keeping an eye on with providers and with LHBs, as commissioners of these services, as we plan towards implementation, which we’re thinking will be taking place in 2026. So, there’s a fair amount of time, I think, to develop our understanding of patterns in this regard and make plans in order to address them.

Okay, thank you. John.

Yes, could I just also mention the issue of pay and the rates that apply in terms of personal assistants? Because we’ve heard from people with disabilities, and stakeholders, that it is difficult to recruit and retain personal assistants and a lot of that is to do with pay. In fact, we’ve heard from health board representatives that personal assistants are 'gold dust', and despite everything you’ve said, they’re not convinced the workforce is there to meet the demand, and particularly for the next wave of direct payment recipients. So, again, it would be good to hear your response to those concerns in that evidence that we’ve received.

Thank you, John. I think what I would say—. I mean, we are aware of those calls for consistency of pay rates for personal assistants and care workers, which I’m well aware does vary across Wales, and varies between health and social care. But what I would say is that I think those issues are really beyond the scope of the Bill. This is an enabling Bill, which is giving choice to people to have a direct payment for their continuing care costs. But I think what we have to do is to give consideration to that with other teams across Welsh Government and stakeholder groups, and organisations like Care Inspectorate Wales and Social Care Wales, to see if we can bring some regularity into the system. As I say, it doesn’t form part of this Bill; it’s a much wider issue for Welsh Government and employers, but I think we are alert to those concerns.

Thank you, Minister. John, anything further from your side?

No, that's fine. Thank you, Cadeirydd.

Diolch yn fawr iawn. Thank you very much. Altaf Hussain.

Thank you very much. Thank you, Minister. My area of questioning is implementation issues, and stakeholders have stressed that direct payments must always be a choice and must not be used as a last resort in the absence of available services. However, Carers Wales, the Older People’s Commissioner for Wales and others say this is already happening in rural areas, where there is no homecare provider available. Now, were you aware of this issue and what action will you take to ensure that this does not continue with CHC direct payments?

Yes, so, you're talking about people living in rural areas not having access to personal assistants. Again, we are aware and alert to that as being a particular difficulty, as it is for those in receipt of direct payments for social care, so the difficulty is no different to that, in that sense. And that, again, is not within the scope of the Bill, because the Bill is just about enabling people to have access to direct payments for their care. The wider issue of sufficiency is something that we have to take account of, but is not specifically related to the provisions of the Bill. Is there anything you want to add to that?

Thank you, Minister. I think just to underline and reiterate that direct payments are very much being offered as an option that people can choose to take if they feel confident that, with the appropriate support, they can actually benefit from them. They won't be suitable or of interest to everyone and there is no way in which people can be compelled to take a direct payment if it doesn't meet their needs, and I think that is an important point.

I think there will be people for whom direct payments are incredibly important, and our provisions very much respond to what they’ve been telling us consistently over the years, and there will be people for whom they are of no interest whatsoever, and there’s nothing within the Bill that would compel them to take one up if it wasn’t of interest or of appropriate use to them.

Thank you, Minister. You did mention about the pay rates. We’ve heard a lot of concerns about the pay rates that will be applied in providing direct payments for CHC. Stakeholders told us about the current variation in age across Wales. Now, what are your plans around improving sufficiency, as you pointed out earlier, and consistency of pay rates, and are there plans for all-Wales rates for personal assistants?

Thank you, Altaf, and as I said in response to the question from John Griffiths: that’s not within the scope of the Bill, but we are aware of the inconsistencies and the concerns that have been raised, and I think this is something that we have to address; not as part of the Bill, as part of the wider discussions around consistency of pay for social care workers and personal assistants. So, as I say, although it’s not within the Bill, it’s something we’re alert to, and it’s something that we will have those discussions on across Government in terms of trying to improve that where we can. We have very good partnership working arrangements in social care with our trade unions, through the social care workforce forum. These issues are regularly discussed there; we’ve done an awful lot in terms of trying to improve pay across social care, but I appreciate that personal assistants are slightly different to that, and the pay rates vary more widely on that. So, as I say, not part of the Bill, but certainly a consideration for wider Government discussion.

Thank you very much. Thanks, Chair.

Thank you, Altaf. Before I bring Joyce Watson in, I just want to be clear on something, Minister. So, I accept your point that some of the questions that have been raised are not necessarily within the scope of the Bill, but I’m sure you’d accept that the impact of the Bill will drive certain either behaviours or actions to take place. So, I just want to have assurances that you are fully aware of—whilst not strictly within the scope of the Bill, some of those issues—that there are impacts that the Bill will have on the services that some people will receive, and that you’re taking the right mitigating actions to deal with the impact of the Bill.

Well, I just need to reiterate and be very clear that all the Bill is doing is giving people with a continuing healthcare need the opportunity to have a direct payment for the provision of that continuing healthcare need; that is all it is doing. So, people currently have continuing healthcare needs that are provided for directly by the local health board. What this is doing is just saying, 'If you would prefer to have a personal assistant to deliver that continuing healthcare need for you at home, then you can have a direct payment to do that rather than have that provided by the local health board.' That is all that this Bill is doing. So, any wider kind of policy implications are not impacted on by the Bill. It is purely about the methodology of paying for the provision of that service.

Okay, thank you. Joyce Watson.

Moving on from what you’ve just said, we’ve heard from disabled people and stakeholders on their behalf that what they would want in that choice is the right to return. So, should they decide to be a recipient of direct payments in a personal capacity, but they found it wasn’t working, that they would like to return to the local authority direct payment system, but the local authorities are saying that they don’t think that they will be able to deliver that on behalf of disabled people for legal reasons. So, what assessment have you made of that?

There isn’t a simple answer to that, Joyce, as you probably would guess, because what’s at the root of this is what is the individual’s need. So, if the individual has a health need, as opposed to a social care need, they will have been assessed as requiring health support. They may have health and social care support, and if it's health and social care, it would be under the continuing healthcare package, but they would have social care elements of that. So, it would be determined by the assessment of that individual's need and the health need. If they did not meet the criteria for continuing healthcare, they would still be with social care.

Yes, but the issue is, having met it all and the system's been put in place, their concerns are that they can't manage it, and they might want to revert back to the local authority providing it, rather than an individual. I think your—

Can I come in on that point—

Yes, please do.

—if it's all right, Minister? I think that the issue there is there's unlikely to be any difference in terms of the management requirements between direct payments under social care and direct payments under CHC. One of our aims is that it will be a seamless transition, so it will feel the same. So, I don't think it should be the case that there will be a difference in the requirements upon the individual to manage, because they should be getting the support they need in order to do that. If their condition changes such that they can no longer manage it in the previous way, then what we would expect LHBs to do, by extension of what we'd expect local authorities to do, is to work with that person in order to find a way that they can still keep on receiving the direct payment. Maybe, for example, they might contract out the employment of a PA to a co-operative or similar in order to do that management for them. So, there should be ways of adapting the way the direct payment is delivered in order to respond to the changing abilities and attributes of the individual. Where that would end up though is that if there was a point at which they said, 'I just don't want a CHC direct payment any more', for whatever reason, then they would be supported by what we've called traditionally commissioned continuing healthcare, so it would be commissioned by the LHB, obviously listening to the voice of the person, but without the direct payment.

What is the case, as local authorities have said, is that once a person has stepped over the threshold of their need being a primary healthcare need, then that is the responsibility of the NHS to meet that need, and the legislative position is quite clear. Conversely, the legislative position for local authorities under the Social Services and Well-being (Wales) Act 2014 is that they cannot provide for needs that are principally needs that should be met under another enactment. So, local authorities wouldn't be able to, as it were, repatriate the responsibility back, because that person no longer has primarily social care needs, they have primarily health needs, and, actually, it wouldn't be in the person's best interests to have that repatriation, we would argue, because local authorities are, understandably, not geared up to meet people's complex health needs, but the NHS is. So, that's essentially the position.

What we would expect, obviously, is that, throughout this process, LHBs would be working very closely with the person to help keep them in that space where they were happy to continue getting their direct payment through those means, and liaising with the local authority during the transition period from local authority direct payments to CHC direct payments, to make it as clean, neat and simple for the person in question as possible. Sorry, that was quite a long answer, but I hope it was helpful.

No, it's—

Sorry, Joyce, before you come back further on that point, Altaf Hussain had his hand up to speak to—

Yes, I just want to ask you about this. It could create an imbalance between those providing social care and healthcare, when our aim is to create balance between the providers of the social care and the healthcare. So, what are your thoughts about that?

Thank you, Altaf. I think, as Anthony was saying, it's about assessing what the person's need is. So, it's not just about trying to create a balance between health and social care, it's about what the need is of that individual: do they have a social care need or do they have a health need, or do they have both? If they have both, then they will be assessed by continuing healthcare and will have both health provision and social care provision paid for by the continuing healthcare payments. If they just have a social care need, so no ongoing complex health issues, then they will be supported by social care and would have a social care package and so on. It will be determined by the assessment as to which is the appropriate care that they need. Of course, if they have continuing healthcare, there is absolutely no cost to the individual. If they are in social care, of course, there are limits, there are certain caps on some services, and people have to contribute to some of those services. So, there is that consideration as well. But it is not about just striking a balance between the two, it's about ensuring that the appropriate care is provided to the individual.

Thanks, Minister. Joyce Watson.

I want to move on now, and again, I'm talking specifically about disabled people.

Yes.

We've heard of the need that they are supported through the system, and you've described it as being quite complex in some cases, and feel that the Bill would be strengthened if people had a clear right to support, rather than—. And that it would strengthen the Bill, making it a 'must have support' rather than 'should have support'. It's just terminology, but it changes the emphasis. And they felt also that that support should include specialist independent advocacy services.

So, we talked about advocacy a little earlier, didn't we, and the code of practice for advocacy is under the Social Services and Well-being (Wales) Act and what that talks about—. This is where the legal speak comes in, so I may be turning to Anthony again in a minute. But that's where it talks about 'as far as is practicably possible' that those services are provided. So, I think what we'd be looking to do is to use that as best practice, so it's not written within the legislation, but we do have legislation that sets out best practice in the code of practice. So, we would be looking to use that because the code's provisions don't extend to local health boards. So, we can't use the provisions of the social services and well-being Act because they don't extend to LHBs, but we have best practice set out there, and that's what we would want to translate and we would want to underpin in terms of the discussions with LHBs.

Okay—. Sorry.

Only to add, this is something that my policy colleagues who lead on CHC direct payments are actively engaging in with local health boards and organisations that are experienced in providing support and advocacy for disabled people in order to get this all set up, so that, hopefully, through the hub-and-spoke arrangements that we're envisaging will be put in place to support implementation, there will be appropriate consideration of advocacy and support for the person within that structure.

Also, going back to issues with continuing healthcare, there is a review—. Under the current CHC framework that became operational as of 1 April 2022, five years later, there would be a review, which will take place in 2026-27. There is an ask, would it not be better if you brought forward that review so that the CHC systems bring in direct payments in tandem with any changes within that review that might be needed—that they come in at the same time as the system becomes operational that we are currently talking about?

Yes, so I'm aware of that review, but that sits within the remit of the Cabinet Secretary for Health and Social Care—continuing healthcare does; it doesn't sit within—. That review and what is happening with that review, and even the outcomes of that review don't sit within the provisions of this Bill, and so wouldn't impact on the provisions of the Bill, which is just about access to direct payments for continuing healthcare. But what I'm happy to do, Chair, is ask my colleague the Cabinet Secretary for Health and Social Care to update the committee on where things sit with the CHC review. Because, as I say, that very much sits in her portfolio.

And finally from me, it says that health board representatives told us that there is no performance framework for CHC, as it’s being revised, and it’s critical with metrics to capture and measure progress and success. So, can you give us some assurances when that will be resolved and put into place?

Well, again, Joyce, I wish I could, but that sits with the Cabinet Secretary for Health and Social Care, I’m afraid, and isn’t part of the provisions of the Bill. But, again, I’m more than happy to speak to my colleague the Cabinet Secretary for Health and Social Care and ask her to update the committee on that.

Okay, thank you.

Thanks, Minister. I guess the point is understanding where those things interact and the potential impact of the Bill on the future of that.

I absolutely understand the point that’s being made, but I keep coming back to what the Bill is doing is simply saying, 'If you have continuing healthcare needs, you can access a direct payment for those needs.’ That’s the only provision of the Bill, it’s not about CHC policy.

I understand that. Okay, thank you. We'll look forward to that further detail as it comes through. I'm conscious we are getting close to the end of our time together. There are a couple more questions from my side, Minister, before we do, but I just want to thank you again for the time that you've given us so far.

Just in regard to the preparations needed with our health boards taking on responsibility here, stakeholders have raised concerns about the safe delegation of healthcare tasks to those personal assistants and felt that increased governance arrangements are needed. Health board representatives told the committee that there needs to be a framework for clinical governance and that further work is needed to consistently define what 'safe to delegate' is. There seems to be variation across health boards as to what is defined as 'safe to delegate'. I'm just wondering if you would agree with that assessment, and what measures are you looking to put in place to have those stronger governance arrangements with our health boards?

I’m sorry to come back to this again, Sam, but that’s not within the parameters of the Bill. In relation to CHC, the Bill is about enabling access to direct payments; you’re talking about policy areas of continuing healthcare that don’t fall within the remit of the Bill, and I’m afraid I’m not in a position to answer those questions. They would be for my colleague the Cabinet Secretary for Health and Social Care.

Okay. I’m sure that you appreciate the impact the Bill will have on those health boards, whether that sits with a different Cabinet Secretary or Minister or not. So, what conversations, therefore, are you having with the Cabinet Secretary to ensure that the impact of the Bill on her remit is being properly understood and managed?

I meet regularly with the Cabinet Secretary for Health and Social Care, as you would imagine. She’s fully well aware of the provisions of this Bill and the provisions as they apply to continuing healthcare. But, as I say, within this Bill, there are no policy directions for continuing healthcare. Those policy directions remain with the Cabinet Secretary for health.

I may be able to add something here, Minister, if that would be helpful.

Please do, yes.

Just to reassure, we are in close contact at official level between the teams planning for implementation of these provisions and wider CHC policy, and a lot of what you’re alluding to, Chair, is being picked up in the planning that’s being made for implementation. Obviously, there are certain points that have been made, for example by Joyce Watson, regarding connection with the review she referenced, which we’ll also be taking away as officials and working on. So, there is work and thought being put into this particular issue.

And if I may, Minister, just to go back directly to Anthony on that point there, we heard from health board representatives and others, and local authorities, actually, as well, willing to share knowledge and skills—those health boards acknowledging that they don’t necessarily have all the knowledge and skills necessary at the moment to deliver some of this on the ground. I expect, Anthony, some of those conversations are about how health boards learn from local authorities and are able to share information. Perhaps you want to speak to us for a moment about how some of that work is going and how confident you are that, by the time this does come into play, actually those health boards will be in a position to deliver on these.

I think it is going well. They're certainly constructive conversations, and we're very pleased with how keen local authorities are to support this process. One of the considerations that we have is potentially giving local authorities and/or organisations that are involved in advocating for direct payments an actual formal role in the implementation process, or in support for the CHC direct payments hub. So, I think we are in a good place; we're making satisfactory progress towards implementation of the commitment. There are many things that I think we can learn also from practice across the border, where these have been successfully in place for about 10 years now, and building on existing practice. For example, there was a reference earlier to delegation of healthcare tasks—that already exists in the current system. The difference will be the employment status of the people delegated to. But I think these are all issues that we can work through with stakeholders, and are doing so at the moment.

Thank you for that further response. We're going to draw our time to a close. I just want to double-check, Minister, if there's anything else that you wanted to just share or pick up on that you may have missed off in terms of the questions we've asked.

No, I don't think so.

Okay, thank you very much. Thank you for your time, it's very much appreciated, especially in this turbulent time.

We're going to take a break, committee, for 10 minutes, whilst we prepare for our next evidence session in a few moments. Thanks very much.

Good morning, everybody. Welcome back to our meeting of the Health and Social Care Committee. We're on agenda item 6 now, which is our continued evidence gathering on the Health and Social Care (Wales) Bill. We have an evidence session with Care Inspectorate Wales and Social Care Wales today. I'd like to welcome Gillian Baranski, who's the chief inspector at Care Inspectorate Wales. We also have Margaret Rooney, who's the deputy chief inspector at Care Inspectorate Wales. We also have Sue Evans online joining us, who's chief executive of Social Care Wales. Thank you, all three of you, for joining us here today for our final evidence session—we've saved the best till last.

I'd like to just open up with some questions before colleagues will also ask some questions as well. Perhaps a fairly open question to start off with is to understand briefly what you think are the biggest challenges facing the children's services workforce in Wales and what ways might they be a barrier to delivering the Bill that we're scrutinising here today. Who would like to respond first?

Shall I start? The roles of the children's workforce in Wales are very demanding. They're very skilled roles, and the importance of the role can't be underestimated. They are incredibly rewarding, and there have been many positive developments to support people who undertake these roles. But parity of esteem, pay, conditions, as for much of the social care workforce, don't always reflect the importance of the roles.

We did a piece of work with 44 young commissioners in October half term of last year to help us develop guidance for people who are interested in setting up children's care homes in Wales, to try and provide some guidance as to what an excellent quality home for children looks like, making sure that children and young people would be happy to live in those homes. It was a very poignant piece of work, as it often is when you're speaking directly to young people. What the young commissioners stressed to us is that people make a home. The people who care for them are key to making children and young people happy in their home, and forming positive relationships with their carers is critical and crucial.

They shared some particular things. They said they wanted understanding people who listen to the story: ‘Nice people make it good’ and—no surprises here—'I don't want to live with people who shout, because I'll shout back’. They want to build relationships with those caring for them. They need to be treated kindly and fairly and to be listened to. I'm aware—we've heard the previous evidence—that the committee has already heard that from the young people you've spoken to. We know that there are recruitment and retention issues currently. Our hope would be that the skilled workforce that already exists in the for-profit sector now will be looking to continue those important roles in the future.

I think underpinning some of this at the moment is that uncertainty is never easy, and with so many employment opportunities available to this workforce, uncertainty can and could result in some of these valuable members of staff leaving the sector. And so now we're at this position of where the Bill is at, heightened communication, heightened engagement, so that providers and their staff are very clear as to what's going to come next, is an important way to help reduce some of this uncertainty, so that people understand what opportunities are available to them and the certainties we now have at this stage in the Bill's development.

Thank you for that response. We're aware that a 2022 report from Social Care Wales showed that there were 639 vacancies for children's social worker roles at the moment, and that around 17 per cent of social care workers in children's services are agency staff. So the point you made, Gillian, is absolutely right, and what children and young people want is that consistency of care and the attention that they need. It's perhaps more difficult for agency workers to provide that on a consistent basis. Do you think those matters alone are a barrier to delivering this Bill—that there are so many vacancies, and we have such a significant reliance on agency workers?

Sue will have more of the detail, but the recruitment and retention issue for the children's workforce predates the issues surrounding the Bill. It has been one of our calls to action over several years now that they're invaluable, they're essential, they're necessary, but if conditions are equal, it's more attractive for people to come in. If you look across to our colleagues in health, sometimes similar roles are undertaken by social care workers and healthcare workers, and yet healthcare workers will, traditionally, be paid better. And there's a lot of work that's gone on to try and remove those barriers to introduce better pay and conditions.

I think it's also interesting—the pandemic didn't create it, but it highlighted it—that NHS staff are rightly appreciated by the public, they're revered by the public. We don't always find a similar value placed on our social care workforce, because I think until you need the services, people don't understand the invaluable role the children's workforce provide, the adult social workforce provide. Some of the issues have been issues for several years. It's one of the reasons why Social Care Wales has worked so hard around its campaign—sorry, Sue, if I'm taking some of your thunder—WeCare Wales, the support they've provided. But they're not easy roles, and part of the issue is how we publicise the reward that people feel when they do them, and the value they feel. I'm not sure, Margaret, if there's anything you can add to that.

Before I bring Margaret in, I think it's fair to bring Sue in first to answer these specific points around the vacancy numbers and the potential barrier of that to delivering this Bill. But also, Sue, perhaps you could expand on some of the additional responsibilities that Social Care Wales will have as a result of the Bill, and then, also, how significant that may be in terms of Social Care Wales's workload.

Thanks very much, and thank you, Gillian, for the comments. I absolutely concur with all that Gillian has said. These are vital roles that people play in supporting our most vulnerable children, and that's the critical thing that I want us to make sure that we're focusing on. As the Bill is implemented, the needs of children being safeguarded and their right to be protected during the transition, for me, is absolutely paramount. And I know that that is our endeavour collectively. The extraction, then, of profit should enable us, over time, to redirect some of those resources into preventative services, as well as improving the quality and sufficiency.

I think it's worth noting that, using 2023 as the last date for which we have the figures, the percentage of children accommodated by local authorities in a residential care setting ranged from 5 per cent to 16 per cent of their looked-after population. So, most children—84 per cent to 95 per cent—are supported by foster carers or kinship carers. One of the things we did recently, last year, is we did the first workforce survey. I just wanted to share some of the findings of that survey with you, because I think it demonstrates some of the frustrations those working in the social care sector have. This was global across adult and children's services; we didn't break that down.

I think it is worth noting that, in that survey, 63 per cent said that they started working in social care to make a difference to people's lives. It's very much a value-based profession. I think that's a really strong indicator of the quality of the people we have in the sector. Seventy-eight per cent feel supported by their colleagues. However, 37 per cent have experienced bullying, discrimination and harassment. Twenty-six per cent are satisfied with their current levels of pay. We have evidence now that that is leading to people thinking about leaving. And 44 per cent in that survey said they're quite likely to leave the sector in the next five years.

There are some positives there to build on. We have a social care workforce forum, which is now led by the Government, with trade unions, Social Care Wales and other partners around the table, and it's really trying to think about that pay and progression framework that the Minister mentioned earlier, to see if we can start aligning a career pathway that is more explicit and enables more people to join the sector, knowing that there is a long-term obligation and career prospect for them.

I think that there's great work that we're starting to do, and the real living wage was a fantastic bonus for the sector, but the cost-of-living experience is almost diminishing the impact of that. But I think there is a genuine commitment, with the Government and partners, to really try and improve the situation for all of the care workforce, but particularly thinking about the children's workforce here.

Sue, just to be really clear on this, we're aware of not just very recent challenges in terms of recruitment and retention, but it's been going on for quite a long time, to say the least. The Bill appears to put even more pressure on that need for recruitment and retention, because there'll be more requirements on local authorities to have those people in place. But you're confident that that lack of people on the ground to deliver these things won't be a barrier to delivering this Bill.

It won't be a barrier to the Bill, but it is a barrier anyway, currently, to the provision of good-quality care. But I think if we can ensure that, with TUPE arrangements and other arrangements, we encourage providers to transition into those new models, and give the staff that confidence that there will be work for them and their role is valued, and if we all make that continuous effort to ensure that they feel valued, then the risk of those workers moving into other sectors outside social care would be minimised. I think if we manage it well, with some of the conversations we're having about that transitional phase to enable providers to make those arrangements, we should be able to reduce that risk.

Thank you, Sue. Just one more quick question from me before I bring others in, and perhaps a brief response to this question. The Bill as drafted does not include the mandatory reporting duty for specific individuals to report a child at risk. I know both your organisations were previously supportive of the proposal to include that requirement. I'm just wondering what your response is now that that is not in this legislation.

Due to the fact that we have those arrangements in place already, with safeguarding arrangements well established now in Wales, I'm not concerned. As long as we maintain that organisational responsibility to respond, I'm satisfied that we will have those safeguards in place.

Thank you. Gillian, do you want to respond as well?

In Wales, there are existing duties to report on organisations; they will continue. The principle of reporting in Wales is enshrined in national safeguarding procedures, codes of practice for social workers, social care workers. And there's been a lot of further work undertaken, for example the introduction and strengthening of safeguarding requirements for independent schools and the recent legislation to regulate special school residential services. Imposing statutory duties on individuals is a significant shift, and I'm not convinced it would add anything more to the protections that we already have in place.

Thank you. It's quite a shift in position for both organisations, but you're satisfied that that's going to be okay.

Yes.

Okay. Mark Drakeford.

Diolch, Cadeirydd. Un cwestiwn penodol ac un cwestiwn cyffredinol. Dwi'n mynd i holi yn Saesneg.

I've got one general question and one specific question for both organisations. The Bill is one strand in a much wider programme of activity that the Government has undertaken to help reduce the flow of children into public care in Wales. What contribution does CIW and Social Care Wales make to the Government's ambition, and will this Bill help or hinder you in making that contribution?

I'll start, if that's okay. The legislative framework is always for Government to determine, and, as the inspectorate and regulator, whatever framework the Government puts in place, we will work within it. We think the principle behind the Bill is unarguable. To reinvest profits into improving the sufficiency of placements, which is an issue at the moment, to provide more capacity for residential and foster care places, and more specialist residential placement in particular, is much needed. But we do see this as part of a wider programme of transformation and not a stand-alone. For example, more support for parents and families, more effective prevention, which stops people coming into the care system in the first place, is a particular interest for us, because once children are in that system—. We don't, from our work, see people unnecessarily placed into care, but the work that could have happened earlier just hasn't been happening. This is, for us, a significant shift in provision.

Ultimately, the services that we regulate and inspect exist to support and nurture some children who've had some very difficult experiences, and we want to improve their outcomes. For Care Inspectorate Wales, our focus is to provide assurance, both to the public and Ministers, on the quality and safety of services, and also to encourage services towards 'excellent'. It's fair to say we currently see excellent and good for-profit providers, and excellent and good not-for-profit providers, and, sadly, we also see poor not-for-profit and poor for-profit providers.

Would it help? It's a significant shift, in terms of the numbers. So, over the last three years, if I take residential care homes, back in 2022—this is as of 31 March every year—we had 256 care homes, with 1,061 places; in 2023 we had 277 services, 1,106 places; and then, as of 31 March of this year, we had 314 services and 1,149 places. So, every year, the residential children's sector has grown, but not enough for some of the children with more complex needs.

If we look, then, at the difference between our not-for-profit and for-profit services over the last three years, our for-profit services, over the last three years, have grown from 207 to 225 to 240. So, there has been no reduction in the for-profit services. The not-for-profit services have grown from 49 to 52 to 74. So, the shift in provision from private to not-for-profit is a significant one. What's particularly interesting in those figures, though, is the local authority response. Back in 2022 there were 34 services of local authorities. There are now 58, and with 10 further applications that are currently in train for us this year. So, local authorities, last year, registered 24 children's care homes, as opposed to previous years, when they've been quite significantly different. So, in terms of this shift that's got to happen, it's quite significant. For Care Inspectorate Wales, we have experience already, when we re-registered services under the Regulation and Inspection of Social Care (Wales) Act 2016, of offering re-registration. I think we re-registered 1,600 services in a year. So, that's a process we're familiar with.

Before we just move on to—[Inaudible.]—lots of really useful information there, Gillian, in terms of the numbers. Perhaps you'd be able to write in to us as well, as a committee, just to make sure we don't lose any of the information that you've shared there.

Of course.

Did you want to comment, Margaret?

I was just going to say, in terms of the direct question about the contribution we can make, it’s the experience we have at—. First of all, the experience: we register services all the time; we've just gone through the RISCA experience. So, we've got experience of re-registering services, and the services that transition from for-profit to not-for-profit will have to go through a re-registration process, but we're experienced at making that not a full process, because, obviously, we hope they're going to be the same providers, they'll just be different legal entities, and we can make that a relatively painless process. So, I think there's work that we can do to help demystify for some of the not-for-profits, certainly around the registration process. I think we can also contribute in terms of the work that we do at local authorities, in our reviews, and talking to local authorities about the extent to which they are meeting their statutory duties—so, in terms of sufficiency planning moving forward, sharing where we’re seeing things going well. So, I think there are things we can do to contribute, to help ease the transition.

Thank you. And, sorry, Mark, before you jump back in, Mabon ap Gwynfor has a quick question.

Os caf fi, yn sydyn iawn. Jest ar y pwynt ddaru i chi, Gillian, ei ddweud ar y diwedd yn fanna, roeddech chi’n dweud, o ran yr uchelgais o roi’r adnoddau yn ôl i mewn i’r gwasanaethau, mai dyna'n union yr hyn rydych chi eisiau’i weld. Ond ddaru i chi ddweud mai eich prif bryder chi oedd y shifft, a chlywais i ddim mwy wedyn. Felly, beth ydych chi’n ei olygu wrth hynny? Beth ydy’r pryder yna am y shifft?

I think it’s the scale of the numbers. So, currently, as things stand at the moment, we have 240 for-profit—let’s just take children’s homes, 240—and we have 74 not-for-profit. To get to where the system needs to be, that 74, the 240 need to join that 74 to strengthen the base, because, as I said earlier, most care in Wales is good care, and our ratings work, which we’re in the middle of—we do silent ratings at the moment—demonstrates that. And so what we would want is that the for-profit homes transition, because we would not want to lose the good work and some of the excellent service they provide. And so if the shift was the other way around, it would be easier, but, with 240 services who’ve got to transition, that needs to happen quickly. And I think that’s why, at this stage, this heightened engagement with the for-profit sector, I think the time is now to—. There have been lots of meetings, they’ve been part of boards, but now there’s a lot of clarity around this all of that needs to be heightened, because the shift from for-profit to not-for-profit is not unsubstantial.

Briefly, Mabon, then Altaf wants to come in.

Felly, ydy’r amser sydd wedi cael ei neilltuo ar gyfer y shifft yna, y cyfnod transition yma, ydy hwnna'n ddigonol?

I think one of the things that we particularly value about the provisions is that there is no hard end. So, as from 1 April 2026, no for-profit provider can register with Care Inspectorate Wales to provide services. But the transition of the April 2027, which means that, with a supplementary placement agreed by Welsh Ministers, a child can be placed in a for-profit service, means that we’re not facing a cliff. There’s time. I don’t know legally—your lawyers would be best placed to answer that—how long it would take a for-profit to transition into one of the four models. But the advantage of the system as described is we don’t have an absolute cliff edge for Care Inspectorate Wales. We know, from 1 April 2026, everyone who registers with us will have to be a not-for-profit service. But the leeway that the transition gives means that we are not at risk of losing the good services we’ve got while they’ve got children in them, because, ultimately, these are children’s homes. These are places where children thrive and are nurtured, and the whole ethos of the Welsh legislation is the voice of the child at the heart of everything. And so what the transitional provision enables is that the voice of the child can still be heard while the system moves to the new world.

Okay. Thank you. Altaf, briefly, and then I'll go back to Mark.

Just a question about that. You’re going towards the transitional period at present, and, between them, profit and non-profit groups were at 74 and 240. Can you predict where they’ll be in five years' or 10 years’ time?

I think if I could do that I would be writing the textbooks for people. [Laughter.] Our hope is—. We have some very good provision for children in Wales in our care homes, both in our not-for-profit and our for-profit. Our hope would be that the good, excellent providers we undoubtedly have will transition into this new world. I don’t think anyone has a sense yet of what numbers there will be, but it's why—. And I know I've said this now several times, so apologies, but this engagement now with our for-profit providers and this clarity about how they move from A to B, because—. I listened to the evidence and you will have seen that there's as much passion for children on the for-profit and the not-for-profit providers in Wales. We're very fortunate. And we don't want to lose that, because these children—. These 1,149 places we currently have, we need those and we need more, unless other reductions and other prevention helps.

Thank you very much. I'm very conscious of time, so if we could keep questions and answers as concise as possible. We'll go back to Mark Drakeford and go from there.

Just one specific question. Gillian, you just set out the advantages that the supplementary placement provision provides in the transition. Some witnesses have said to us that the supplementary placement provision in the Bill will act to legitimate and normalise unregistered placements in Wales. Do you think that it will be the case?

No. I think the transitional provision doesn't enable the Minister to agree an unregistered placement in Wales. I think there might be a typo on the Bill, which talked about that she could place in unregistered; it meant unregulated. I think that might be clarified at some stage. At the moment, as you know, Mark, there is pressure on local authorities to find places for children. They have a duty to place and they have a duty to place in a registered care home, and sometimes those duties place an impossible situation on local authorities. We don't know of a single director, head of children's services, who wants to place a child in an unregistered setting. And we've done a lot of work in Care Inspectorate Wales to try and highlight the scale of the problem and to work with our partners in local authorities to try and ensure that, if children are placed in services operating without registration, it's for as short as possible a time, because they're often emergency placements; we have no period of grace in Wales.

We will be watching it as an inspectorate, as you can imagine, very closely to make sure that those figures don't climb, because the safety that registered provision provides—it's a home where the person who runs it is fit, it's a home that's inspected, it's the safeguard for the children that we would worry about with any increase in services operating without registration, and we'll be monitoring it particularly carefully as we go through this transition period.

Thank you very much. Diolch yn fawr.

Thank you, Mark. And just to be clear on the point made in terms of the terminology, it seems quite clear in the explanatory memorandum that the ways in which looked-after children are to be accommodated—. It clearly says 'in unregistered accommodation' within the EM.

That's a point that we picked up on in the explanatory memorandum, so we made a query to Welsh Government about that. And my understanding is that that is an incorrect use of the word. So, sometimes, the words 'unregulated' and 'unregistered' are mixed up. So, what we've been told is that the intention was that that reference should be 'unregulated'. So, the intention was that that it would be—. So, an unregulated service is a service that doesn't need to be registered—so, for example, post-16 supported living. An unregistered service is quite a different thing; that's a service that should be registered and is actually operating illegally. So, we were content with the response that we got that that was an unintentional reference within the explanatory memorandum, and sure that will be—I'm hoping that will be—altered.

Yes, that's something that, I'm sure, as a committee, we can keep an eye out for as well. So, thank you for that. Could I—? Anything else from Mark, from your side? No. Okay, thank you very much, Mark. Could I move on to John Griffiths, please, who is going to talk about direct payments?

Diolch, Cadeirydd. Yes, your overall views, please, on the provisions in the legislation to enable direct payments in continuing healthcare and the new requirements that would be involved for health boards.

Gillian, do you want to come in first?

We're very supportive of direct payments for local authorities. We see them as a tangible part of putting into practice one of the key principles of the Social Services and Well-being (Wales) Act 2014, which is about giving people voice and control. I should explain that our role here is a limited one in terms of direct payments. We inspect local authorities and we do consider how well direct payments are promoted. And we know that many people who are in receipt of direct payments from local authorities really value the greater voice and control this gives them. They get to choose the what and they get to choose who provides the support that they need. We view the extension to continuing healthcare as a good thing. But we would say that there is learning that the health boards would benefit from as a result of the experiences of local authority colleagues. Our inspection activity currently identifies inconsistencies in how well direct payments are promoted across local authorities. The best practice examples are the local authorities that have invested time in establishing, publicising services through websites and where direct payments are regularly offered or signposted.

We think, in summary, the extension is a good idea and it actually ends a current anomaly that, for many people, when their needs exacerbate the extent that they need continuing healthcare, we hear anecdotally that some people are reluctant to take that next step because they’ll lose the direct payment flexibility, and we think that this is another way of ensuring that the principles of the Act are very tangible across Wales.

Thanks. I'm going to check if Sue has anything she wants to add to that. Yes. Sue.

Thank you. Sorry, I was expecting to be called in to respond to Mark’s questions earlier about what impact this has on Social Care Wales. So, would you mind if I just responded to that?

No, please do. Apologies if I missed you.

Okay, thank you. I think one of the critical things to know is that we register and regulate the workforce and anyone who is providing that residential childcare, as a manager or a direct care worker, will have to have the relevant knowledge; will have to adhere to the codes of practice, irrespective of what model of employment or the business is. So, that’s a safeguard for us—that they’ll have to adapt the same standards, and, in 2019-20, we completely redesigned all of the vocational qualifications. COVID put a bit of a spanner in the works in terms of implementation, but they are now well embedded and in place. We’ve also developed a well-being framework because we know that the pressures on the sector in all parts of the sector are significant on the workforce. So, workforce well-being has become a key feature of some of the work that Social Care Wales is doing to support the sector.

And specifically, then, for residential care workers and the transition that the Bill is implementing, we’ve set up a community of practice where heads of children's services come together and they start using some of the evidence about therapeutic approaches to preventing children from needing to go into a residential setting, or for new models of care. And we will host that community of action during this transition period so that we can work with the heads of children's services and their colleagues to understand what is happening to put that monitoring position in place, so that if we need to develop new learning tools, new resources, we can try and do that quickly as we learn what’s happening on the ground and implement any learning and resources and support needed. So, we want to be part of this transition to make sure that it is a safe transition, an effective transition, for those children who are the most vulnerable citizens we are supporting. Thank you.

Thank you, Sue. I want to double check, in terms of the question from John Griffiths about the overall views around direct payments in continuing healthcare and new requirements on health boards, was there any response you wanted to provide on that or not?

Yes, please. I'm quite fortunate—I previously was a director of social services and, before that, a director of commissioning in a health board, so I've seen some of the frustrations from individuals from both sides. I see it as a very positive change. It will give individuals that voice, that choice and control, and I know, from speaking to individuals when I was a director, they found it very frustrating that they would have to abandon their existing arrangements because their needs had increased and they had a primary health need, and they had to give up, if you like, their choice and their voice. So, I see it as a very positive enabler for people.

Thanks, Sue. John Griffiths, anything further you wanted to ask at all?

Only if there's anything our witnesses would like to add in terms of issues that need to be considered with health boards taking on the administration of direct payments for the first time, and that transition from the current systems. Anything to add, in addition to what's already been stated?

I guess, if I could come in first there, it's about learning from England. They've been doing it very well for a long time, and also learning from local authority colleagues, and I'm sure that they will be happy to support health boards in managing that transition.

Thanks, Sue. Gillian.

Just listening to the evidence from the health boards, they talked about the possibility of setting up a hub, which seems like a really good idea, to try and ensure consistency across the health boards. And I would echo Sue's point: there's a lot of learning from local authority colleagues as to what works, what doesn't work, and I'm sure health boards are already in contact to try and make sure that they avoid any pitfalls.

Yes, all right. Thank you very much.

Hapus iawn, John?

Ie, hapus. Diolch yn fawr, Cadeirydd.

Thank you. Mabon.

Diolch, Gadeirydd. Yn ôl dwi'n ei ddallt, beth bynnag, ar hyn o bryd dydy cynorthwywyr personol ddim yn gorfod bod yn atebol i'r un gofynion cofrestru a rheoleiddio â staff eraill yn y gweithlu gofal cymdeithasol neu hyd yn oed y gwasanaeth iechyd. Felly, o ystyried hyn, oes yna risg, ydych chi'n meddwl, y gallai ansawdd y gofal sy'n cael ei roi i bobl sy’n derbyn gofal iechyd parhaus ddioddef os nad oes yna gamau rheoleiddio a llywodraethu gan yr NHS? Ac os oes yna risg, felly, pa drefniadau ydych chi'n credu y dylid eu rhoi mewn lle er mwyn lliniaru hyn, os gwelwch yn dda? Ydych chi'n meddwl y dylid cael mwy o gamau llywodraethu a reoleiddio?

Does Sue want to—?

Do you want me to come in?

Let's go to Sue first, then, yes.

Shall I come in first, yes?

Yes, please.

I think it's something that comes up regularly, whether PAs should be registered by Social Care Wales and, therefore, regulated, and that will be a ministerial decision, not for us, and if that decision was made, we'd be happy to support the Government in implementing that. But I guess, just to give some assurance, it's not that many years ago that adult care home workforce and domiciliary care workers weren't registered and regulated either, so that's been a positive step to put that wraparound safeguarding into the system. And any of our resources that we develop and our learning opportunities are available—most of them are available online—and PAs can access them. When we describe the workforce in our workforce strategy, we think about PAs and we think about unpaid carers as well. There is a whole-system approach needed, so there are safeguards in place, and that's where the choice and control of the individual who's managing the direct payments and employing their own PA—. They are the ones, if you like, who will ensure that those individuals are of the right calibre and the right quality. So, that's the voice and control that I think the direct payments enable those individuals to have.

Thanks, Sue. Do you have anything to add, Gillian?

Just that, as I'm sure you can appreciate, as a regulator, we always like the principle of registration. We think it provides public assurance and safeguards. It can help professionalise and it potentially improves the status of the role in the public's perception. But I do have to say, in respect of personal assistants, one of the key things is the flexibility it provides. Care Inspectorate Wales has a national advisory board and we have service users that sit on the board, and they regularly tell us how much they appreciate the work of personal assistants, but how difficult it can be to recruit them. Therefore, we would be concerned that people may be dissuaded from undertaking these really important roles unless further work was done to understand a lot more about how many PAs we have, the nature of the work that they do, and anything that cuts the flexibility down. Without that piece of work, I think we would be concerned that it might limit the numbers that are doing this really invaluable work now.

Yn sydyn iawn, felly, ar y pwynt yna—roeddwn i’n mynd i ofyn y cwestiwn yna, felly dwi’n ddiolchgar eich bod chi wedi gwneud y pwynt—ydych chi’n meddwl bod angen gwneud y darn yna o waith o ran dealltwriaeth o ofalwyr neu gymorthyddion personol, a bod angen i’r darn yna o waith gael ei wneud rŵan, cyn bod y Bil yma, hwyrach, yn dod yn ddeddfwriaeth?

I think, always with legislation, it depends on the problem that we're seeking to fix, and if we don't think there's a problem—and we certainly, in our inspections, are constantly told by the public how much they appreciate the work of personal assistants—. The frustration at the moment is if only there were more, particularly in some of the more rural areas. So, it would be difficult to see, as well, how that piece of work would actually be scoped, because Social Care Wales doesn't have a register and we don't have a register. What we do know is there is a significant amount of support and work done by personal assistants that people in Wales appreciate, and if there isn't a problem we're trying to fix, then why would we start that piece of work unless there's a very clear endgame in sight?

I think what I would add as well is that the term 'personal assistant' is not a protected title, and I suspect that some people will use that title where someone's paying privately for their care—someone decides they need someone to help them, they may want to pay for themselves and they have a friend down the road to do that for them. So, I struggle to know how we would go about finding out the breadth of it. I'm someone who likes numbers, and I've often thought, 'Wouldn't it be great to know how many PAs are out there? What do they do?' But I suspect that it's a bigger sector than we probably suspect it is, although we hear people complaining a lot that they can't find PAs.

Okay. Thank you. Mabon, anything further on this point?

Un peth yn ychwanegol, os caf i. Mae’r Gweinidog wedi dweud wrthyn ni ei bod hi’n rhagweld y bydd y mwyafrif helaeth o gynorthwywyr personol sy’n cael eu defnyddio ar gyfer gofal iechyd parhaus, y cynorthwywyr personol presennol, yn trosglwyddo i’r rôl yma yn y sector cymdeithasol. Ydych chi’n credu bod y rhagdybiaeth yma’n gywir? Ydy hi’n gywir yn dweud hynny?

All we can answer is anecdotally, because this is not an area we register or inspect. But what we are told is that people appreciate the PAs they have, and one of the barriers they feel in the current system is that they can't take a personal assistant with them. But that's anecdotal.

Okay. Thank you. Sue, is there anything further you want to add to this from your side?

Yes, I was going to concur, really, that we would anticipate that the individual, who now has the choice of the PA, under the new arrangements, if the Bill is passed, will be able to take their selected individuals with them. It shouldn't change that, and that's really what people have been crying out for and why they wanted the Government to consider making direct payments available for CHC.

Thank you. Altaf Hussain.

Thank you very much. I'll take it further. My area is about the adult social care workforce. So, we have staff shortages in social care that could result in not being able to source services. There are also concerns it could cause labour market displacement. A person who is well qualified to be a social care worker may go as a personal assistant, so that pool of social care workers you won't have there. So, what are your thoughts on this and how can it be mitigated?

Thanks. Sue.

Thank you. It's interesting, isn't it, because I think the change in this legislation won't alter the need for more workforce. It's a transitional arrangement in terms of where people are managed or which sort of organisation they're employed by, but the need for the workforce to increase has been with us for a while and, with the demographic changes approaching, it will continue, to be a need. But I think displacement in terms of the risk of people moving into the NHS is, again, already there, and some of the work that we're trying to do to support the Government with the pay and progression framework, we're hoping that that will reduce that risk and eliminate it over time. But we are aware that there are similar roles within the NHS that do attract a higher salary than those doing similar roles within social care, and you don't have, within social care, a single brand, a single employer, Agenda for Change, where every role is calculated to be of equivalent value no matter where you work. So, I think the pay and progression framework should help with that.

Thanks, Sue. Anything further to add, Gillian or Margaret, at all? You don't need to.

I think it's just, and I referred to it earlier, that what was highlighted in the pandemic, and beyond, is that the NHS workforce is, quite rightly, valued and appreciated by the public. The adult social care workforce is similarly committed, hardworking, doing skilled work, but it doesn't attract that public approbation. Registration of the social care workforce has been a good thing, as part of the professionalisation, and we're aware of the work of the fair work forum. But however rewarding the role in social care is, people's personal circumstances will necessitate, and some will leave to work in the health sector. And I think there are a couple of things we need to do as a society. We need to stop describing social care work as unskilled and celebrate more the significant difference that this workforce can make to both the people who receive services, but as importantly, their family and friends. And this isn't just about pay and conditions, although we heard the young people who gave evidence and they identified to you that they saw this as a significant issue and we agree with that, but this parity of esteem and the appreciation and value of the roles, they're essential to retain and to attract this really important workforce. I think that's organisations across the piece talking in very different terms about, 'I'm just a social worker.' You never hear anyone say, 'I'm just a nurse' or 'I'm just a doctor', but you do hear people saying, 'I'm just a social care worker.' Well, thank goodness they exist and the terrific work that they do across Wales.

Absolutely. Thank you very much. Altaf, briefly, and then over to—

Yes. I won't ask about the disparity in the pay, really, which we talked about. My last question is: are there likely to be any unintended consequences arising from the Bill, or potential barriers to successful implementation that we have not yet discussed in relation to the direct payment provisions?

Not in relation to the direct payment provisions, no.

Thank you. Sue, anything from your side? No, you're shaking your head.

No, I don't think so.

Thank you very much. That was a fantastic response in terms of brevity. Thank you, everybody. Joyce Watson.

I'm going to talk about the fact that the Bill places a duty to submit and publish annual returns on service providers themselves, rather than Care Inspectorate Wales—yourself—and it makes failure to publish them an offence. What are your views on those changes? Do you think they're necessary, and if you do, why?

Yes. Margaret, do you want to—?

Yes.

Margaret is our guru.

Good delegation. [Laughter.]

Well, this is an aspect of the Bill that we very much welcome—transferring that responsibility. It's actually, yes, it's Care Inspectorate Wales, but we act on behalf of Welsh Ministers, so it transfers the responsibility from Welsh Ministers to publish annual returns to the provider to publish the annual returns. And that means that Welsh Ministers, through us, are not responsible for the data protection aspects of those annual returns, and the responsibility for that lies with the provider who, after all, owns the information within the annual return.

Annual returns came about as part of the Regulation and Inspection of Social Care (Wales) Act 2016—I was going to call it RISCA; that's my short term for it—and they're really important, because what they do is provide the public with transparent and comparable information about services that helps them make decisions, reasoned decisions. Now, in terms of the fact that it's an offence, I know some people might be concerned about that, but what I would say is that we always take a proportionate approach to how we would enforce something. Our aim is to support providers through a change and to encourage improvement. So, any use of a criminal power, which might be, in this case, a fixed-penalty notice, would be an absolute last resort, but at the same time, it is useful to have something like that to be used in those circumstances, hopefully very rarely—very rarely—where a provider might persistently either not submit an annual return or publish an annual return. So, we welcome the provisions in the Bill in this respect.

I think that's it.

Nothing further from Joyce. Okay. Thank you very much. I'll double-check with committee members if there's anything else you wanted to pick up at all. No. Okay. Well, that leaves me to thank you for your time this morning, Gillian, Margaret and Sue. Thank you very much. That's the end of the item. Thank you.

Thank you for your invitation.

Thank you.

Thank you.

Okay, committee, we have a few items left on our agenda together this afternoon.

Item 7 is for us to consider papers to note. I wasn't going to go through those individually. Are we comfortable to note those papers en bloc? Yes, okay. Diolch yn fawr iawn. Thank you very much. They're noted.

Item 8 on our agenda is a motion to appoint a temporary Chair until the first meeting in the autumn term, in accordance with Standing Order 17.22. As Members are aware, the Chair of the committee is absent at the moment. The agreement that we currently have in place is for myself to be temporary Chair until the end of today's meeting. We do, though, need to have arrangements in place to cover the summer recess period in case correspondence, et cetera, may take place.

I'm in a slightly strange position here, but I propose, in accordance with Standing Order 17.22, that the committee resolves to extend my appoint as temporary Chair until the first meeting in the autumn term. Are all Members content with that? Yes. Okay, thank you very much; I appreciate that.

Okay, so we move on to agenda item 9 now, which is a motion under Standing Order 17.42(vi) and (ix) to resolve to exclude the public from the remainder of this meeting and also for the meeting on 26 September 2024, for a stakeholder event as part of the committee's inquiry into general practice, and the meeting on 9 October, for a stakeholder event as part of the committee's area of research interest on innovation for improvement in healthcare. I move that motion. Any objections? No. Okay, thank you, that's moved. We're now into a private session.