P 76
Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
Inquiry into the Priorities for the Health, Social Care and Sport Committee
Ymateb gan: CLlLC
Response from: WLGA
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Introduction
1. The Welsh Local Government Association (WLGA) represents the 22 local authorities in Wales, and the three national park authorities and three fire and rescue authorities are associate members.
2. It seeks to provide representation to local authorities within an emerging policy framework that satisfies the key priorities of our members and delivers a broad range of services that add value to Welsh Local Government and the communities they serve.
3. In advance of the National Assembly for Wales elections in 2016 the WLGA published its Manifesto which identifies the key priorities where we believe the Welsh Government can help councils deliver on national outcomes and prioritise services that matter most to the communities of Wales. These include:
· Commit to fully cost and fund any new Welsh Government initiatives or legislation.
· Properly commit to multiyear financial settlements so councils can plan more effectively and support the Welsh Government’s longer-term ‘Future Generations’ ambitions.
· Urgently reform the increasingly outdated finance formula which underpins funding to properly reflect deprivation, sparsity and the challenges of the future.
· Keep social care within local government as set out in the Social Services and Well-being (Wales) Act 2014.
· Establish a new Preventative Integrated Care Fund for Wales funded through the potential Barnett consequential from the £8bn annual NHS investment in England.
· Transfer Public Health Wales function and its funding into local government.
· Ensure greater democratic oversight of the NHS through locating the powers of Community Health Councils (CHCs) within local government.
· Switch investment into preventative services such as social care, economic development, transport, housing, libraries, leisure and environmental health. These services increase people’s wellbeing and keep people out of care in hospitals, that is both expensive and can lead to people losing control over their lives.
4. The WLGA welcomes the opportunity to help inform the Committee’s Forward Work Programme and we have identified a number of key priority areas we believe should be considered both over the next 12 to 18 months and in the longer term work programme. The priorities set out in our manifesto are an important starting point as these will help local authorities respond to local challenges and needs and contribute to the delivery of national ambitions and outcomes. More importantly they will help local councils deliver on the priorities of their own local communities. The consultation outlines a number of areas that the Committee may wish to include in the longer term work programme and we would support the priority areas of integration of health and social care services; primary care and in particular how local government are involved in the planning of services; and a focus on loneliness and isolation among older people.
Key Priority Areas
Impact of legislation
5. Under the previous Government we saw the introduction of two major pieces of social care legislation – the Social Services and Well-being (Wales) Act and the Regulation and Inspection of Social Care (Wales) Act. In addition, we saw legislation being passed that the health and social care sector will need to consider and link with, such as the Well-being of Future Generations (Wales) Act and the Housing (Wales) Act. There was also consultation undertaken on other potential pieces of legislation in relation to health and social care in the form of the NHS Green Paper: Our Health, Our Health Service.
6. It will be important that the Committee monitors the implementation and impact of these pieces of legislation, the linkages between them and any new legislation or changes made following the Green Paper.
7. The Social Services and Well-being (Wales) Act will have a significant impact as it is implemented over the next few years, transforming the way social services are delivered and changing the way citizens needs are assessed. One of the key elements of the Act is around greater partnership working and integration of services and it will be important to exam the role of all partner organisations in relation to delivery of the Act, ensuring that they are aware of their responsibilities and carry these out to ensure compliance.
8. Key to the successful delivery of the ambition for the future and improving quality is through a workforce which is sustainable, competent, confident, valued and capable of delivering personalised and flexible services which meet changing demands and delivering improved outcomes for people and communities. It will be essential that any examination of the legislation picks up on the progress that is being made to support the workforce and we welcome the fact that the Committee has already announced an inquiry into the sustainability of the health and social care workforce.
Increasing Demand and Demographic Challenges
9. The increasing demand for services and demographic changes at a time of austerity has been well documented and whilst the Act looks to support greater partnership working and integration of services we need to look at how best this can be achieved in light of some of the challenges that we are currently facing. In addition to the demographic changes there are a range of other issues that have increased demand for services such as the Cheshire West judgement which has resulted in a 17-fold increase in Deprivation of Liberty Safeguards (DoLS) cases in Wales, the resettlement of Syrian Refugees and potential increases in numbers of Unaccompanied Asylum Seeking Children (UASC). Recently there has been a significant focus on improving outcomes for looked after children and it will be key to ensure that the Committee is sighted on these issues as well as the Children, Young People and Education Committee.
10. The Social Services and Well-being Act does provide future direction for how services can and should be delivered, but we need to ensure that both the time and resources to support its proper implementation are provided.
11. The pressures being faced have increased the importance of providing preventative activity and services aimed at early intervention (with the intention of holding off more costly and potentially intrusive interventions at a later stage). We all agree with the benefits of early intervention and prevention in the first case, in terms of better life experiences and well-being for individuals and families, as well as reduced costs for public services, particularly in the longer term. But such services are at significant risk should local government be required to shoulder the burden of any further cuts. Local government shares the view of the importance of preventative council services and appreciate these make a vital contribution to reducing pressure on other public services in Wales, such as the NHS. However, reduced budgets have placed increasing pressure on the availability of preventative services, most of which are non-statutory. While new models of service have been established in many authorities, it is likely that any further cuts will continue to see a decline in some community services that promote well-being.
12. An examination of the role of preventative services and how best they can be provided and supported would be beneficial.
Integration of Health and Social Care
13. In Wales, significant progress has been made through partnership working in terms of enacting the Social Services and Wellbeing Act 2014, and in the introduction of factors such as an intermediate care fund (ICF). This progress has been significant, however we have also seen the policy developments and investments that have taken place in England which point to an ambitious agenda. For example, Greater Manchester’s proposals for a combined health and social care budget will see a £6bn pooled budget between the NHS and local government. It will be important that the work of the Committee ties in with the Parliamentary Review into the long-term future of Health and Social Care in Wales announced by the First Minister, but we believe that an inquiry looking at the progress made to date; and assessing the impact of Welsh Government policies and legislation on integration of health and social care services should be one of the priorities for the Committee.
14. One of the key issues for the new Welsh Government will be how to shift the priorities from hospitals to prevention and public health. It has been the WLGA’s policy that the latter function should be located in local government as is the case in England.
Health and Social Care Funding
15. In 2012 the Institute for Fiscal Studies report on local government expenditure in Wales showed that, until 2009-10, spend had been increasing in real terms by around 5% each year. This kept pace with inflation and service pressures. From 2009-10, spend has been reducing in real terms, but if expenditure had kept pace with general inflation, it would now be over £7bn. The resulting gap of £720m represents a conservative estimate of the cuts and efficiency savings achieved so far by local government. From April, councils in Wales face budget pressures of just over £200m due to inflation, demography and unavoidable financial pressures, e.g. the introduction of the single tier pension. It is likely that by 2019-20 there will be a cumulative budget shortfall of around £800m. The submission by WLGA and ADSS Cymru to Welsh Government on Social Services budget pressures last year indicated that social services departments in Wales faced unavoidable cost and demand pressures that will increase from £68m in 2016/17 to £234m by 2019/20. Clearly the ability to absorb any additional costs is virtually non-existent.
16. There have also been significant concerns raised over the fragility of the residential and domiciliary care sectors across Wales. There are a series of factors that have increased or will further increase the costs of providing care services, including:
· National Living Wage
· Sleeping in judgement
· Pension changes
· Travel costs
· Impact of HMRC changes
17. We believe that an examination of the future funding of social care in Wales in order to ensure the future sustainability of the sector is needed and should be one of the key priorities for the Committee.
For further information please contact:
Stewart Blythe, Policy Officer – Social Services and Health
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Welsh Local Government Association
Local Government House
Drake walk
Cardiff
CF10 4LG