Cynulliad Cenedlaethol Cymru The National Assembly for Wales Y Pwyllgor Iechyd a Gofal Cymdeithasol The Health and Social Care Committee
Dydd Mercher, 3 Hydref 2012 Wednesday, 3 October 2012
Cynnwys Contents Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions Papurau i’w Nodi Papers to Note Cynnig dan Reol Sefydlog Rhif 17.42(vi) i Benderfynu Atal y Cyhoedd o’r Cyfarfod Motion under Standing Order No. 17.42(vi) to Resolve to Exclude the Public from the Meeting Craffu ar Waith y Dirprwy Weinidog Plant a Gwasanaethau Cymdeithasol Scrutiny of the Deputy Minister for Children and Social Services
Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included.
Aelodau’r pwyllgor yn bresennol Committee members in attendance
Mick Antoniw	Llafur Labour
Mark Drakeford	Llafur (Cadeirydd y Pwyllgor) Labour (Committee Chair)
Rebecca Evans	Llafur Labour
Vaughan Gething	Llafur Labour
William Graham	Ceidwadwyr Cymreig Welsh Conservatives
Elin Jones	Plaid Cymru The Party of Wales
Darren Millar	Ceidwadwyr Cymreig Welsh Conservatives
Lynne Neagle	Llafur Labour
Lindsay Whittle	Plaid Cymru The Party of Wales
Kirsty Williams	Democratiaid Rhyddfrydol Cymru Welsh Liberal Democrats
Eraill yn bresennol Others in attendance
Rob Pickford	Cyfarwyddwr Gwasanaethau Cymdeithasol a Phlant, Llywodraeth Cymru Director of Social Services and Children, Welsh Government
Martin Swain	Dirprwy Gyfarwyddwr, yr Is-adran Plant, Pobl Ifanc a Theuluoedd, Llywodraeth Cymru Deputy Director, Children, Young People and Families Division, Welsh Government
Gwenda Thomas	Aelod Cynulliad, Llafur (y Dirprwy Weinidog Plant a Gwasanaethau Cymdeithasol) Assembly Member, Labour (the Deputy Minister for Children and Social Services)
Swyddogion Cynulliad Cenedlaethol Cymru yn bresennol National Assembly for Wales officials in attendance
Stephen Boyce	Y Gwasanaeth Ymchwil Research Service
Llinos Dafydd	Clerc Clerk
Catherine Hunt	Dirprwy Glerc Deputy Clerk
Dechreuodd y cyfarfod am 10.00 a.m. The meeting began at 10.00 a.m.
Cyflwyniad, Ymddiheuriadau a Dirprwyon Introduction, Apologies and Substitutions
[1] Mark Drakeford: Bore da a chroeso ichi gyd, fel arfer, i’r Pwyllgor Iechyd a Gofal Cymdeithasol. Fel y byddwch i gyd wedi clywed, bu damwain ar y draffordd ac mae’r Dirprwy Weinidog ar yr ochr orllewinol i’r ddamwain honno. Felly, mae hi ar y ffordd, ond nid wyf yn gwybod pryd y bydd yn gallu bod yma. Felly, rwy’n awgrymu ein bod yn symud at eitem 3, gan ein bod mewn sesiwn gyhoeddus, ac wedyn at eitem 5 i ystyried yr adroddiad ar atal thrombo-emboledd gwythiennol. Ar ôl gwneud hynny, cawn weld lle mae’r Dirprwy Weinidog a faint o amser fydd gennym ar ôl hynny. A ydych i gyd yn hapus â hynny? Gwelaf eich bod.		Mark Drakeford: Good morning and I welcome you all, as usual, to the Health and Social Care Committee. As you will have heard, there has been an accident on the motorway and the Deputy Minister is on the western side of that accident. So, she is on her way, but I do not know when she will get here. So, I suggest that we move to item 3, as we are in public session, and then on to item 5 to consider the report on venous thrombo-embolism prevention. We will then see where the Deputy Minister is and how much time we have left. Are you all content to do it that way? I see that you are.
10.01 a.m.
Papurau i’w Nodi Papers to Note
[2] Mark Drakeford: Mae nifer o bapurau i’w nodi. Mae llythyrau gan y Gweinidog a’r Dirprwy Weinidog. Hoffwn dynnu sylw at bapur 6, sef llythyr gan Gadeirydd y Pwyllgor Craffu ar Waith y Prif Weinidog, David Melding, yn gofyn a oes gan aelodau’r pwyllgor hwn unrhyw eitemau i’w rhoi ar y rhestr o bynciau i’w trafod gyda’r Prif Weinidog. Os oes gennych unrhyw bynciau i’w codi, dylech anfon e-bost at y clerc, fel ein bod yn gallu eu bwydo i David Melding.		Mark Drakeford: There are several papers to note. There are letters from the Minister and Deputy Minister. I wish to draw your attention to paper 6, which is a letter from the Chair of the Committee for the Scrutiny of the First Minister, David Melding, asking if members of this committee have any items to put on the list of subjects to be discussed with the First Minister. If you have any issues to raise, please send an e-mail to the clerk so that we can feed them in to David Melding.
10.03 a.m.
Cynnig dan Reol Sefydlog Rhif 17.42(vi) i Benderfynu Atal y Cyhoedd o’r Cyfarfod Motion under Standing Order No. 17.42(vi) to Resolve to Exclude the Public from the Meeting
[3] Mark Drakeford: Cynigiaf		Mark Drakeford: I move that
yn unol â Rheol Sefydlog Rhif 17.42(vi) fod y pwyllgor yn penderfynu cwrdd yn breifat ar gyfer eitem 5 ar yr agenda.		the committee resolves to meet in private item 5 on the agenda in accordance with Standing Order No. 17.42(vi).
[4] A yw’r Aelodau i gyd yn fodlon? Gwelaf eich bod.		Are all Members content with that? I see that you are.
Derbyniwyd y cynnig. Motion agreed.
Daeth rhan gyhoeddus y cyfarfod i ben am 10.03 a.m. The public part of the meeting ended at 10.03 a.m.
Ailymgynullodd y pwyllgor yn gyhoeddus am 11.04 a.m. The committee reconvened in public at 11.04 a.m.
Craffu ar Waith y Dirprwy Weinidog Plant a Gwasanaethau Cymdeithasol Scrutiny of the Deputy Minister for Children and Social Services
[5] Mark Drakeford: Bore da a chroeso i’r Dirprwy Weinidog. Diolch yn fawr am ddod yma ar ôl y bore rydych wedi’i gael. Gan ei bod wedi mynd ychydig yn hwyr, rydym am fynd yn syth i gwestiynau. Rydym wedi derbyn y papur, felly diolch yn fawr am hynny.		Mark Drakeford: Good morning and welcome to the Deputy Minister. Thank you for attending after the morning that you have had. Given the time, we will go straight into questions. We have received the paper, so thank you for that.
[6] Gyda’r Dirprwy Weinidog mae Rob Pickford—mae pawb yn adnabod Rob—cyfarwyddwr gwasanaethau cymdeithasol a phlant Llywodraeth Cymru, a hefyd Martin Swain, dirprwy gyfarwyddwr Is-adran Plant, Pobl Ifanc a Theuluoedd Llywodraeth Cymru. Diolch yn fawr i chi i gyd am ddod y bore yma. Trof at aelodau’r pwyllgor i holi cwestiynau.		With the Deputy Minister is Rob Pickford—everyone knows Rob—director of social services and children in the Welsh Government, and also Martin Swain, deputy director of the Welsh Government Children, Young People and Families Division. Thank you all for attending this morning. I now turn to committee members to ask questions.
[7] Vaughan Gething: Good morning, Deputy Minister. I am glad to have you with us this morning after a longer than usual journey for you.
[8] I want to question you on aspects of paying for care, which is a matter that you have made mention of, including in a statement in the Chamber. Could you provide us with a further update on the current position and on your discussions with the UK Government? We know that there has been a change of Minister, so has there been a change in emphasis between those two Ministers? Are we any further forward in terms of knowing what the UK Government’s likely response will be to the Dilnot report and to having a debate across the whole of the UK, and across each of the political parties, in trying to find some consensus on how we build a new model for paying for care?
[9] The Deputy Minister for Children and Social Services (Gwenda Thomas): Thank you for your question. I want to thank you as well for rescheduling this morning. I am sorry about that; there was not much I could do about it. So, thank you for allowing me to come to committee a bit later than planned.
[10] The issue about paying for care is fundamentally about the state contribution and the individual’s contribution. I have not yet met with Norman Lamb—he has only been in post for a short time—but I was regularly in touch with Paul Burstow, and both he and I shared the recognition that this issue affects all of us and that we need a resolution to it. There has been some press coverage as to what Paul Burstow’s view is now, of course. I welcome the fact that the coalition Government has accepted all of Dilnot’s recommendations; the two that stand out most perhaps are, first, a cap on a lifetime contribution towards residential care of £35,000 and, secondly, upping the capital limit to £100,000. Those are the two recommendations that stuck out the most.
[11] The coalition Government has accepted all of the recommendations, but has delayed a decision on how that will be paid for. It has deferred it to the comprehensive spending review, which will happen in the autumn of 2013. So, we are unclear with regard to the fundamental issue of funding. We know that the extent of the funding requirements to fund Dilnot’s recommendations is £1.74 billion per annum in England and £100 million per annum in Wales. So, there is obviously an issue for us as to how that is going to be affordable. I am pressing the point very hard with the coalition Government that there must be a consideration of consequentials in this, whatever it decides. Paul Burstow is suggesting through the press that there might be a Dilnot ‘light’ recommendation, but that is speculation as far as I am concerned. However, that does not take away our responsibility and our need to pave the way in Wales.
[12] Paying for residential care and its principles are based in law—on an England and Wales basis—but it is nevertheless something that we have to face as a country as well. If you recall, we had a Green Paper on this issue. I have reconvened the group that advised me on that Green Paper. It has worked on that for a while now and its report is imminent. I will take advice from that and I am more than willing to share that with you. That is a comprehensive view of where we currently stand with regard to that.
[13] Vaughan Gething: I will follow up with two points. I am interested in your view on timescales for reaching a consensus across the UK. Is there a realistic prospect of us reaching a consensus before another general election? If we are honest, it will be a difficult issue if there is no consensus at that time on which to make progress. Does the comprehensive spending review allow us to do that? I am a bit concerned that we will not be able to do that.
[14] Secondly, on paying for care in Wales and on the cap that has been introduced on residential care, I am interested in what work you are doing with local authorities that have overspent. I know that they gave estimates to provide the funding envelope, and that is how it was created. However, what is the relationship and dialogue between your officials and those local authorities that have overspent or say that they are well over their budgets? One of those is an authority that I represent, namely the Vale of Glamorgan, so, it is a direct concern to me.
[15] Gwenda Thomas: Perhaps I omitted to say that Dilnot was a report for England only. It was not commissioned on an England-and-Wales basis, although, as I explained, the funding issue is based in law on an England-and-Wales basis; so, it is a report for England. There have to be issues for us arising from that; the consequential rule alerts us to that very issue.
[16] I cannot give any idea of timescales on how the coalition Government responds. It has said, as I have already explained, that it will be part of the CSR and I have no more of an idea about timescale than that. However, we are in the process of seeking a meeting with Norman Lamb, to see if we can get further clarity on its intentions there.
[17] On the overspend, as on the cap, the introduction of the £50 cap has been beneficial to many people in Wales who paid more than that and who are now able to benefit from good quality non-residential care and from knowing that it is capped at £50 a week. I must stress that the £10.1 million that we made available on the introduction of the policy was based on the estimates of local authorities themselves. It was not a figure that I or officials plucked out of the air; it was the estimate that local authorities gave us. We always intended, including the time that I presented the Measure, to monitor this annually. In the first year, we introduced monitoring processes on a half yearly basis followed by a full year. That is where we are now. Some local authorities are telling us that they have overspent significantly, while others have overspent a little and some have not overspent at all. So, there is a diversity of effects on local authorities.
[18] There is some evidence that more people are seeking non-residential care. I cannot comment further. I have seen the press coverage on this, but I will wait until I get a report on the overspend of each local authority and until I am satisfied with the reasons for that, because we have finance officers in local authorities—I do not know what they are called—who look at the issue and how local authorities have spent this money. This is ongoing and I intend to negotiate openly with local authorities on this. If more people are benefiting from good quality non-residential care, then we have to ask whether that will result in a saving of more expenditure on residential care. There are many ways of looking at this, but until I get the final estimate and advice from officials, I do not think that I can comment further this morning.
[19] Mark Drakeford: Does anyone want to follow-up this issue of paying for residential and non-residential care?
[20] William Graham: Without wishing to sound a sour note, the Assembly has been here before, has it not? There has been anticipation that there would be much more money available and that has proved not to be the case, even at a time when record borrowing occurred, which is not the case now. What are your real grounds for optimism that there will be any money at all?
11.15 a.m.
[21] Gwenda Thomas: Do you mean for social services or this specific issue?
[22] William Graham: This specific issue.
[23] Gwenda Thomas: If you remember, we estimated that the requirement would be for slightly more funding, even at that time. This was what local authorities said, so we have to see. I want to know what policies there are in different authorities. You know that we are through the social services Bill, requiring national eligibility criteria, which will bring consistency and assessment to that. So, I see this as a whole picture; that is the only way to look at it. It is my intention to be absolutely open about this. I have had some indications from officials, of course, but I have not seen those final returns. I also want the reports of the internal financial officers.
[24] Kirsty Williams: Deputy Minister, could you give us an update on the national adoption service and particularly your comments on post-adoption support? I have had a lot of correspondence with adoptive families who have found post-adoption support to be wholly inadequate, or, most of the time, non-existent. I have received evidence that the lack of this support is stopping some foster care families, who perhaps aspire to adoption, from adopting those children, because, while they are foster carers, they get a great deal of support and assistance from the local authority and they are fearful of that being taken away should they move on to adopt. Could you give us an update? How do you see this working? Will it be a truly national service, or a ‘nationally badged’ service with local delivery?
[25] Gwenda Thomas: The Bill will set out a statutory proposal to set up a national service. The directions that follow from that will develop it. We are preparing the ground for what that national adoption service should do. I have set up a national group of experts on adoption to advise me, which is chaired by Dr Kevin Fitzpatrick, whom you know is the chair of the St David’s Children Society. That group has met twice and Dr Kevin Fitzpatrick has now asked for a meeting with me, which I believe will take place on 18 October. So, after 18 October, I will have the first piece of advice from that group and I will look to its members, because they are experts in their fields, as to what the national adoption services should do.
[26] At the moment, it is intended that it be headed by an individual, who would be a head of service and accountable to local authorities. That post holder would be responsible for providing national leadership and overview of adoption services; driving standards, performance and continued improvement; a framework for adoption approvals—to me, that is important, and we might want to expand on what exactly that means; establishing a resource for potential adopters; providing information on training programmes, assessment processes and an advice line; promoting adoption if it is in the best interests of the child; recruiting prospective adopters; and the development of a specialist and highly skilled workforce. This would be a head of service who would have the autonomy to take independent decisions regarding those proposed responsibilities.
[27] I am open to suggestions, certainly from this committee and the Children and Young People Committee on the governance. Do we think that it would be more appropriate for the post holder to be accountable to a national board or are there other ideas I should be considering? The board example is what we have in the integrated family support service and it is working quite well. However, we really are debating the role of the national adoption service. What I am absolutely clear about is that we cannot continue doing things 23 times. We must develop this national service. The point you make about post-adoption support is a very real concern of mine because that provision is patchy. You might want to tell me that I should consider a voluntary service to provide this. So all of this is open. We have time and we need to get to the best place we can possibly get to. However, we must also link this to the review of the family justice system. This was a joint review and this is a joint negotiation that, if I may say so, has worked very well between us and the coalition Government.
[28] Our people were on the family justice review. There are lessons for us all to learn, the coalition Government included, from the wisdom of including people from the Welsh Government on reviews it conducts. We were included in the Norgrove review, and I believe that the input we have had to that has had a big influence on the final review that was published. We can support that review and we are doing so. It has led to our setting up a national family justice network in Wales. That is up and running; it has met a few times. Three judges sit on that, so we have had significant interest in it. We have had the first set of regulations, which set out clearly that development of the adoption plan, the decision on adoption being in the best interests of the child and the preparation of papers for court will have to be completed within 26 weeks. That can only be extended by eight weeks at a time if there are extenuating circumstances for that to happen.
[29] Therefore, it has addressed the issue of working within timescales and deciding what is in the best interests of the child. There are other things that the family justice review embraced, and I see these two issues as linked so closely that we must look at both when considering the best way forward for us in developing the national adoption service. I believe that we are ahead of the game on this, and that is where we want to be. I am open to suggestions on exactly what this national service should do.
[30] Kirsty Williams: Deputy Minister, what evidence have you received that convinces you that more children will be adopted more quickly if you set up this organisation, the function and form of which you, by your own admission, are unclear about? Therefore, on what basis are you making the decision that this organisation—when you do not know how it will be set up and you are not clear on what it is actually going to do—will actually lead to more children being adopted more quickly than at present?
[31] Gwenda Thomas: I do not think that I have given the impression that I am not clear about it. I hope that the impression I have given is that we all need to consider this together. I need to listen to experts. I am not the expert. I am prepared to listen. I have given you quite a clear outline of my thinking at the moment. If there are people who can tell me that it would be better done in a different way I would be the first person to listen to them. I do not think that there is any ambiguity about that at all. It would be a shame if children who are waiting to be adopted or prospective adopters got that message from this committee. What we want to tell them is that we have listened to them, that we know that the service is currently patchy and that there are inconsistencies, that we are not prepared to put up with that and that we are not prepared to continue to do things 23 times. That is not the way to do it. There are things that will be best done locally, Kirsty, and I am sure that you will agree that the statutory role of local government in preparing for that court work will be absolutely critical to the process. I am not being ambiguous; I am saying that we are in the process of considering the best way forward.
[32] Kirsty Williams: Is it your intention that there will be a statutory obligation to provide post-adoption support for longer than is currently available?
[33] Gwenda Thomas: It is certainly my intention that that will form part of the directions or possible regulations that we develop once the Bill has had Royal Assent. I do see that, but do not think that we need to wait until then. With good intent, and with all our partners, I think that we can get these things moving before we develop these directions, and the directions or regulations will then firm that up. I think that we can move towards it and, indeed, there are indications. We must not think that the process is rubbish at the moment, because it is not. We need to build on the strengths of the process that we have. We do not want to lose that, as it would not be in anyone’s interest. However, I believe that more consistency, particularly with regard to post-adoption support, will benefit from the strength of legislation.
[34] Mick Antoniw: One of the big problems with an adoption service, whatever its format, is the length of time that children linger in the fostering sector, and the inconsistency in decision making as to when they go for adoption. How would you envisage a national adoption service actually resolving that impasse and that inconsistency that exists? It seems to me that the key is to get a clear decision taken as soon as possible rather than however many years down the road.
[35] Gwenda Thomas: We have started that process already, of course. I introduced the directions on 1 September. Should I call it a regulation or a direction? Whatever I call it, it has a statutory base. On 1 September, we did away with the need for adoption panels to look at whether adoption was in the best interests of the child. That has happened because that was a process that was being repeated. The adoption panel considered whether adoption was in the best interests of the child, and the court considered the very same thing. That, in itself, caused a delay in establishing whether adoption was in the best interests of the child. I hope that that will speed up the process. It certainly should, but I think that we need to look further at the role of the panels. I did say that I see that as part of the national adoption agency’s remit, but we have to speed this up. As I have said, coupled with the family justice review, there are very strong requirements now for that to happen.
[36] Mark Drakeford: As Chair, I need gently to speed up our proceedings, because I have many Members wishing to ask you questions. We know that, on the adoption issue, the Children and Young People Committee is doing work, and we look forward to seeing the results of its conclusions. I will now call on Lynne, and then Darren and Elin.
[37] Lynne Neagle: I just want to ask about resources, Deputy Minister. Obviously, the Welsh Government put in some protection for social services, but the money went through the revenue support grant as usual. How has that protection been monitored across Wales? Speaking of my own local authority, I know that, notwithstanding that protection, there are some fairly severe financial pressures on the departments. What discussions have you had with local government and the Association of Directors of Social Services in the run-up to this to inform the Welsh Government’s budget? Linked to that, can you provide an update on attempts to improve cross-boundary working between local authorities in order to reduce duplication?
[38] Gwenda Thomas: The £34 million was added to the resource base of local authorities for three years from last year. That is a commitment that brings our funding resource for social services to 1% above the norm. The indications that I am getting are that actual expenditure has gone up by 4% across local authorities. That is the most recent advice that I have on local authority investment in social services. I hope that that is helpful.
11.30 a.m.
[39] There are stringent monitoring processes with regard to expenditure on social services, but there are also positive indications that local authorities are grasping this nettle and are realising that it is in everybody’s interests to take this collaborative approach. I believe that some of their investment is going into good services that are developing across boundaries—and this is across parties. So, on the issue of what we are doing about any duplication, or whatever, in regard to local authorities, ‘Sustainable Social Services’ was quite clear: we cannot keep doing things 22 times. You see the examples of integrated family support services and Families First, and there is some good cross-border working in regard to that. You also see the determination of some authorities to deliver better services on that basis. Specifically, we see Powys and Ceredigion sharing a director of social services, and Blaenau Gwent and Caerphilly have extended that to the whole of the social services function. So, there are good examples, but I do not think that we are there yet. By establishing the six geographical footprints, we move safeguarding children towards those footprints and the new adult protection board, so those footprints will dictate the way in which things move forward, in the main. However, we have to bring local authorities with us, and I think that the policy forum over the past four years, which includes all political parties, the Welsh Local Government Association, the private sector and the care council—all of us together in one room—has really got that message across, and has brought a good resolve from local government to move in that direction.
[40] Darren Millar: Deputy Minister, one issue that has been prominent in the press this week has been the whole smacking debate. We had a debate in the Assembly and the Assembly had a view on smacking, and the one thing on which there was a clear consensus across the Chamber was the need to promote other forms of discipline and to support parents in being able to use those within the family. I just wonder what work you and your officials have done to integrate that desire, which was shared across the Assembly—and I know that it is your desire as well—to promote those other forms of discipline through Families First and some of the other programmes that the Welsh Government has in place.
[41] Gwenda Thomas: There were some disturbing elements to that report, if I may say so. We need to look at co-judgments of that nature to see how the judiciary is viewing these cases, and that is a good example. This case is very new, and I do not know whether my officials here know that I have asked for this, but I think that we need to study that judgment and understand what, in a legal sense, is being said here. Nevertheless, you know that the position of the Welsh Government is that we will not introduce the smacking ban during this fourth Assembly, but we will develop guidance. I do not believe that we have had good enough or strong enough parenting support policies, but we have done a lot of work in recent months, and I will shortly be able to publish guidance on parenting.
[42] I know that we have elements within Flying Start and the parenting aspect of that. Last week I was in Blaen-y-Maes, for example, and what the parents there were telling me was really encouraging, in the way that they feel that they have been supported, including within Families First. However, if we are talking about the wider smacking ban, we cannot give the impression that this happens exclusively in disadvantaged communities or families. This rises above class and we have to look at the wider aspects of what this would mean. I believe that we need to develop our thoughts on parenting, and even grandparenting—why not? However, I think that a lot of this will involve familial issues and developing respect between generations. To be specific, I think that we need to be clear about what we mean by supporting parents, and we are well on the way to doing that.
[43] Darren Millar: Obviously, we have some excellent home-grown charities in Wales that support parents and positive parenting. In fact, we visited one together before the summer recess, called Care for the Family, which is just down the road. I wonder what work you might be planning with the third sector in particular in helping to deliver a positive programme for parenting across the country. You are quite right to say that it is not just disadvantaged communities that suffer from bad examples of parenting. Many affluent areas do, too. Opening access to all parents to allow them to elect to participate in a positive parenting programme is really important. So, what work might you be doing with your officials to engage positively with the third sector in particular?
[44] Gwenda Thomas: I do not think that we can proceed without talking to the voluntary or third sector on this. I appreciate the visit that I paid with you to an organisation that you are interested in, and I think that the third sector is fundamental to all our thinking now—it has to be. That will be no less a strand of thought in the development of the parenting plan.
[45] Darren Millar: Is the third sector involved in the development of that plan at present?
[46] Gwenda Thomas: It is, yes.
[47] Mr Swain: We actually have one of the parenting leads from Children in Wales on secondment at the moment. They sit as part of my team for two to three days a week, and are helping us to look at the whole approach to parenting, doing some international comparisons, as well. They are very involved.
[48] Darren Millar: That is great, thank you.
[49] Elin Jones: Ddirprwy Weinidog, byddaf yn gofyn dau gwestiwn i chi.		Elin Jones: Deputy Minister, I have two questions for you.
[50] Yn gyntaf, ydy’r cydweithio rhwng adrannau gwasanaethau cymdeithasol a byrddau iechyd ar hyd a lled Cymru yn ddigon da yn eich barn chi, neu a oes lle i wella a chryfhau’r cydweithio hwnnw, yn enwedig o ystyried bod y byrddau iechyd ar hyn o bryd yn ailgyflunio gwasanaethau i symud y pwyslais oddi ar wasanaeth yn yr ysbytai i wasanaeth yn y gymuned ac mewn cartrefi, ac y gallai hynny arwain at fwy o bwysau ar adrannau gwasanaethau cymdeithasol?		First, is the collaboration between social services departments and health boards across Wales effective enough in your opinion, or is there room for improvement and for making that collaboration more robust, particularly given that the health boards are currently reconfiguring services to move the emphasis away from hospital-based services to services based in the community and in people’s homes, and that that could lead to further pressures on social services departments?
[51] Yn ail, rwy’n credu mai chi, fel Dirprwy Weinidog, sydd â’r cyfrifoldeb dros ddatblygu gwasanaethau cyfrwng Cymraeg yn y gwasanaeth iechyd a’r gwasanaethau cymdeithasol, a bu ichi ymgynghori ar gynllun iaith Gymraeg ychydig fisoedd yn ôl, a oedd yn gynllun clir a rhesymol iawn yn fy marn i. A allwch roi diweddariad inni o ran pryd yr ydych yn rhagweld y byddwch chi’n cyflwyno’r cynllun hwnnw ac yn ei weithredu?		Secondly, I think that it is you, as Deputy Minister, who has the responsibility for developing Welsh-medium services in the health service and social services, and you went out to consultation on a Welsh language scheme a few months ago, which was a very clear and reasonable scheme, in my opinion. Can you give us an update on when you anticipate introducing that scheme and implementing it?
[52] Gwenda Thomas: O ran integreiddio rhwng y gwasanaethau cymdeithasol a’r byrddau iechyd, nid wyf yn meddwl ein bod wedi cyrraedd lle boddhaol, ond mae llawer o waith wedi’i wneud i ddatblygu’r integreiddio hwn. Yn bersonol, rwy’n teimlo fod rôl bwysig iawn i wasanaethau cymdeithasol drwy gydol bywyd, i geisio osgoi neu ddileu’r angen i fynd i ysbytai, gan gefnogi pobl i fod yn annibynnol, pa un ai gofal i deulu ifanc sydd â phlentyn anabl sydd dan sylw, neu ofal drwy gydol bywyd neu wrth inni heneiddio. Fodd bynnag, rwy’n meddwl bod amser yn dod pan fydd frailty yn dod ar ein traws ni a bod lle i integreiddio llawer mwy—ac mae hwn yn bolisi sy’n gwneud y peth yn ofynnol. Mae’n rhaid inni integreiddio ar y pwynt hwnnw mewn bywyd. Rwy’n meddwl y byddai hynny’n helpu—dyna fy marn i. Os ydym yn symud i’r sefyllfa honno, mae’r Bil gwasanaethau cymdeithasol yn ymestyn y tu allan i wasanaethau cymdeithasol a bydd y gwasanaeth iechyd yn rhan ohono hefyd. Byddai’r Bil yn rhoi’r hawl i ni ddeddfu pe bai’r angen neu’r ewyllys i wneud hynny yn codi. Mae hynny’n bwysig.		Gwenda Thomas: On integration between social services departments and health boards, I do not think that we have reached a satisfactory position, but a great deal of work has gone into developing that integration. Personally, I feel that social services play a very important role throughout an individual’s life, in trying to avoid or in preventing the need to access hospital services, by helping people to be independent, whether it is care for a family that has a disabled child that is concerned or care throughout lives or as we grow older. However, I think that a time comes when frailty comes our way, and that there is room for much more integration—and this is a policy that makes that a requirement. We have to integrate at that point in an individual’s life. I think that that would help—that is my view. If we are moving to that situation, the social services Bill extends beyond social services and the health service will also be part of that. The Bill would give us the right to legislate if either the need or the will to do so should arise. That is important.
[53] Mae esiamplau lle’r ydym wedi deddfu i’w gwneud yn ofynnol i wasanaethau cymdeithasol a byrddau iechyd weithio gyda’i gilydd. Un enghraifft yw’r timau integredig i gefnogi teuluoedd. Roedd hynny’n fater o ddeddfu, ac mae ef wedi rhoi eglurder i’r bobl sy’n gweithio ar y prosiectau hynny, ac maent wedi croesawu hynny. Felly, credaf fod hynny’n hwb i ni.		There are examples where we have legislated to make it a requirement for social services and health boards to collaborate. One example is the integrated family support teams. That was a matter of legislating, and that has provided clarity to the people who work on these projects, and they have welcomed that. I therefore think that it is a boost for us.
[54] Hefyd, rydym wedi deddfu fel bod angen gweithio ar y cyd rhwng y gwasanaeth iechyd, y gwasanaethau cymdeithasol a’r sector gwirfoddol i ddatblygu’r strategaethau i ofalwyr. Rydym bron yno ar hynny, ac, ym mis Ionawr, bydd y strategaethau hyn yn real, a bydd hyn yn esiampl arall o’r modd y mae deddfu’n gallu datblygu polisïau ar y cyd a hybu’r integreiddio sydd eisiau rhwng y gwasanaethau.		We have also legislated to ensure collaboration between the health service, social services and the voluntary sector to develop the strategies for carers. We are almost there in that regard, and, in January, the strategies will become a reality, and this would be another example of how legislation can develop joint policies and promote the integration required between the services.
[55] O ran cyflwyno gwasanaethau drwy gyfrwng y Gymraeg, mae tasglu wedi bod wrthi ers blynyddoedd, fel y gwyddoch. Cawsom grŵp llywio, sydd wedi gweithio’n galed gyda’r gwasanaeth iechyd, y gwasanaethau cymdeithasol a’r sector gwirfoddol, ac rydym yn awr ar drothwy cyhoeddi’r strategaeth. Rwy’n credu bod hyn yn gam mawr ymlaen. Nid ydym yn erfyn i bob doctor yng Nghymru allu siarad Cymraeg neu wybod y termau meddygol yn y Gymraeg—nid dyna’r pwrpas. Y pwrpas yw i ofyn, ‘Sut ydych chi heddiw—how are you today?’, neu ‘Would you like a cup of tea?’, gan fod hynny’n gwneud gwahaniaeth mawr.		On the introduction of Welsh-medium services, a taskforce has been working on this for a number of years, as you know. There was a steering group, which has worked hard with the health service, social services and the voluntary sector, and we are now on the threshold of publishing the strategy. I think that this is a major step forward. We do not expect every doctor to be able to speak Welsh or know all the medical terms in Welsh—that is not the point. The point is to ask, ‘Sut ydych chi heddiw—how are you today?’, or ‘Would you like a cup of tea?’, as that can make a very real difference.
[56] Byddwn yn datblygu bwrdd gweithredu i’r strategaeth hon, ac mae dau gynllun gwaith, y naill i’r gwasanaethau cymdeithasol a’r llall i’r gwasanaeth iechyd, a byddant yn rhan o’r cyhoeddiad pan gyhoeddwn y strategaeth.		We shall be developing an implementation board for this strategy, and there are two work schemes, one for social services and the other for the health service, and they will be part of the statement when I announce the strategy.
[57] Elin Jones: Hoffwn ofyn cwestiwn dilynol. Diolch i chi am yr atebion clir hynny. O ran y cynlluniau sydd gan y byrddau iechyd ar hyn o bryd i ailgyflunio gwasanaethau iechyd yn eu hardaloedd, a yw’ch adran chi, neu adrannau gwasanaethau cymdeithasol llywodraeth leol, wedi gwneud asesiad o impact tebygol y newidiadau hynny ar wasanaethau cymdeithasol?		Elin Jones: I would like to ask a follow-up question. Thank you for those clear answers. With regard to the schemes that the health boards have at the moment for restructuring health services in their localities, has your department, or have local government social services departments, made an assessment of the likely impact of those changes on social services?
[58] Gwenda Thomas: Rydym ni—Rob Pickford, y cyfarwyddwr gwasanaethau cymdeithasol, David Sissling, y Gweinidog a minnau—yn cwrdd yn gyson i drafod y materion sy’n codi ac i drafod integreiddio’r ddau wasanaeth. Rwy’n credu bod rhaid i’r datblygiad o wasanaethau cymdeithasol fod yn rhan o unrhyw ystyriaeth o’r gwasanaeth iechyd. Rwy’n meddwl nad ydych yn well o gael un gwasanaeth gwych os nad yw’r llall yn wych.		Gwenda Thomas: We—Rob Pickford, the director of social services, David Sissling, the Minister and I—meet regularly to discuss matters arising and to discuss integrating the two services. I think that the development of social services has to be part of any consideration of the health service. I do not think that you are better off in having one service that is excellent if the other is not.
[59] Credaf fod y ddau wasanaeth yn mynd law yn llaw. Fodd bynnag, wedi dweud hynny, rwy’n credu bod y gwasanaeth i osgoi mynd i’r ysbyty y mae’r gwasanaethau cymdeithasol yn gallu cynnig yn hollbwysig hefyd.		I believe that both services work hand in hand. However, that said, I think the service to prevent the need for hospitalisation that social services can offer is extremely important, too.
[60] Mark Drakeford: Hoffwn ofyn un peth arall ar gefn cwestiwn cyntaf Elin. A oes gan y Llywodraeth unrhyw waith ar y gweill ynglŷn â dementia a gwasanaethau yn y gymuned i bobl sy’n dioddef ohono lle rydych yn dod â gwasanaethau cymdeithasol a gwasanaethau iechyd ynghyd i’w helpu? Rydym wedi derbyn lot o dystiolaeth yn ein gwaith ar gartrefi preswyl ar ddementia, ac mae lot o bobl wedi dweud i ni bod problemau yn cael y ddau wasanaeth i weithio gyda’i gilydd.		Mark Drakeford: I would like to ask one further thing on the back of Elin’s first question. Does the Government have any work under way on dementia and community-based services for people affected by dementia whereby you bring social services and health services together to assist them? We have received a great deal of evidence in our work on residential homes on dementia, and many people have told us that there are problems in getting the two services to work together.
11.45 a.m.
[61] Gwenda Thomas: Nid wyf yn siŵr pwy a ddywedodd ‘I have a dream’, ond mae hyn wedi bod yn freuddwyd i mi ers cetyn yn awr. Pam na allwn ddefnyddio’r egwyddor o dimau integredig i gefnogi teuluoedd neu’r tîm o amgylch y teulu? Nid wyf yn gweld un peth sy’n dweud na allwn ddefnyddio’r egwyddor hwnnw i ddatblygu timau o amgylch teuluoedd lle mae dementia yn y cwestiwn. Mae gwaith wedi cael ei wneud ar ddatblygu hwn. Mae grŵp llywio wedi edrych arno ac mae gwaith wedi cael ei wneud. Gallwn yn awr cymryd y cam nesaf i ddatblygu’r cynllun hwn a chael gwaith peilot.		Gwenda Thomas: I am not sure who said ‘I have a dream’, but this has been a dream of mine for some time now. Why can we not use the principle of integrated family support teams or the team around the family? I do not see anything that says that we cannot use that principle to develop teams to support families where dementia is concerned. Work has been done on developing this. A steering group has looked at it and work has been done. We can now take the next step to develop this scheme and have pilot projects.
[62] Bydd y ddau brosiect peilot yn ardal ddaearyddol Gwent. Rydym yn edrych ymlaen at weld beth y gallwn ei ddysgu o’r prosiectau peilot hynny ac i werthuso a monitro’r hyn sy’n digwydd yna. Byddwn yn sefydlu grwpiau gweithredu lleol ar egwyddor y gwasanaeth integredig cymorth i deuluoedd yn lleol i gefnogi datblygiad y gwaith hwn. Credaf y bydd yn talu’i ffordd. Os gallwn ymyrryd yn gynnar pan fydd diagnosis o ddementia, credaf y gallwn wella ansawdd bywyd y teulu yn gyfan gwbl, yn enwedig y gofalwr neu ofalwyr o fewn y teulu. Mae hwn yn ffordd bendant ymlaen. Byddwn yn fwy na hapus i roi’r wybodaeth ddiweddaraf i’r pwyllgor yn ôl y galw ac i gymryd unrhyw syniadau yr hoffech fwydo i mewn i’r broses.		The two pilot projects will take place in the geographical area of Gwent. We look forward to seeing what we can learn from those pilot projects and to evaluating and monitoring what happens there. We will establish the local implementation groups in line with the principle of the integrated family support service locally to support the development of this work. I believe that it will pay dividends. If we can intervene early on when there is a diagnosis of dementia, I think that we can improve the quality of life of the family as a whole, especially the carer or carers within the family. This is a definite way forward. We will be more than happy to update the committee as required and to take on board any ideas you would like to feed into the process.
[63] Mark Drakeford: Diolch yn fawr. Mae cwestiynau gan Lindsay a Kirsty ar y pwnc hwn. Ar ôl y cwestiynau hynny, rwy’n awyddus i Rebecca a Mick i gael cyfle i siarad.		Mark Drakeford: Thank you very much. Lindsay and Kirsty both have questions on this subject. Following their questions, I am keen for Rebecca and Mick to have a chance to speak.
[64] Lindsay Whittle: Minister, you have almost pre-empted my question. One of the visions is to have dementia-friendly communities. I think that we have all had an e-mail this week to the effect that York is now regarded as a dementia-friendly city, and is one of the first in Britain to be declared as such. However, it would be super if we could have a town, village or city in Wales that was dementia-friendly. You mentioned the two pilot schemes in Gwent; is that what those are? Nothing breeds success like success. When local authorities were considering becoming nuclear-free, as soon as one declared that they were nuclear-free, they all wanted to make the same declaration. The same is true of fair-trade towns; once one made the declaration, they all wanted to do the same. So, if we could just have one or two towns or villages in Wales declared as dementia-friendly communities, then I think that that would be superb.
[65] Gwenda Thomas: I absolutely agree with that. There is an example, namely Ammanford. Here, once again, I must refer to the excellent work of the voluntary sector, particularly the Alzheimer’s Society. I was delighted to open the Alzheimer’s centre in Ammanford. The whole thrust of that work is to develop Ammanford as a dementia-friendly community. I hope I have time to speak about this. I could go on about it all day, but I will not do so. One of the attendees in Ammanford was the local police community support officer, who told me about one of the things that they have produced—and we might want to share this with the committee, because I think that it is an excellent example. They have developed, in partnership with the Alzheimer’s Society, a little card for people affected by Alzheimer’s who want to carry them. They carry this card and local tradespeople are trained to deal with anyone who comes in wanting a paper, for example, but asks for something else or forgets the way home. I thought that that was an excellent example. I have those in printed form and I would not mind sharing them.
[66] Kirsty Williams: Deputy Minister, one of the barriers to integrated working between health and social care in the field of dementia is the issue of who pays for that care and who pays for the service. In England, where cognitive impairment is assessed for continuing healthcare, there is a ‘severe’ category; that category does not exist in Wales and the true nature of someone’s cognitive impairment is not, in my view, adequately represented in assessments for continuing healthcare. What discussions have you had with the Minister for health to look again at the way in which we recognise and assess cognitive impairment with regard to the question of who pays for care?
[67] Gwenda Thomas: That is a very important question, Kirsty, and I thank you for that. My view is that diagnosis cannot be a once-and-forever situation for a person with dementia. We know that it is a deteriorating form of disability, and we need to have an ongoing process to monitor the effects of dementia as it progresses. The cognitive issue is a very sensitive issue with regard to how we get to the bottom of how much it affects people.
[68] With regard to benefits and attendance allowance, it was introduced quite a few years ago that sensory impairment should be included in that process. Whether we consider cognitive issues as being sensory or physical should not matter. The real issue is whether a person needs a service and to be cared for. Our continuing healthcare assessments have improved, and we have issued new guidelines on that; I know that the Minister has been involved with that. However, the issue of what understanding people have is very important to the assessment of their needs. This needs to form part of the development of uniform assessments and the discussion on eligibility criteria. We also need advice on how we come to terms with needing to assess the cognitive issue of dementia.
[69] Mark Drakeford: Rebecca is next, and I hope that we will get Mick in as well before we have to let you go, Deputy Minister.
[70] Rebecca Evans: Deputy Minister, could you give us an update on the delivery of the autism spectrum disorder strategic action plan, with particular regard to your priorities for adults and children?
[71] Gwenda Thomas: You will know that we had the report in 2008 on the autism plan and work has been done since then on the development of better diagnosis. I do not think that we have become the best that we can be. We have invested £200,000 in children’s diagnosis to develop the network. We have also invested £500,000 in the diagnosis for adults. I am pleased to say that Wales’s national charity for autism, Autism Cymru, and another organisation whose name slips my mind at the moment, have agreed to come together to support us in consulting further on the way forward for the autism plan. We need to refresh the way forward after a wide consultation with service users and carers, particularly with young people and children who want to feed into that process.
[72] Rebecca Evans: The autism employment ambassador has been in post for at least two years. How many more people with autism are in employment as a result of that post, and how are you measuring the improved awareness of autism in the workplace?
[73] Gwenda Thomas: A lot of work has been done through the work of the autism ambassador. I do not have up to date figures with me today, but I will write to the committee to bring you up to date about the participation of employers and the number of people who have benefitted from it.
[74] Mick Antoniw: I have a very quick question. What is your current thinking on the extension of direct payments, particularly the challenges that it poses to people who go down that route?
[75] Gwenda Thomas: We have seen a low uptake of direct payments in Wales. We need to do yet more work to raise awareness of people’s right to ask for a direct payment and to consider how we support local authorities in raising awareness of this. There is an issue here of how we support people who would like direct payments, but are still afraid about what it means. We know that people who want direct payments become employers and that service givers become employees. So, there is a scope here to consider how best to support that process. We have an example in Neath Port Talbot and Bridgend, where the Shaw Trust offered that support and gave people the confidence to consider whether this was for them. However, this is one issue that we can think of in terms of social enterprise and in developing this support, but I feel that the support mechanism has to be there in order to give people more confidence to choose this way forward.
[76] Mick Antoniw: We had some evidence a while back on the Canadian experience and particularly with regard to social enterprise and establishing some sort of co-operative system and so on. Is that something that you are thinking positively about as a way of filling this fear vacuum that exists around direct payments?
[77] Gwenda Thomas: We made that clear in ‘Sustainable Social Services for Wales: A Framework for Action’ and the sustainable social services programme. This is about officials highlighting around 24 strands within ‘Sustainable Social Services for Wales: A Framework for Action’. They report to me regularly on that programme and they have established a project to review social enterprises and the potential of social enterprises to deliver social care. An internal review has been completed and that report is almost ready for me to consider. That is a big step forward. I also hosted meetings with the Canadian expert and someone from Bologna. I see potential in the commission that has been set up by the Minister for Business, Enterprise, Technology and Science; I have written to her to ask if I can have an early meeting with the chair of that commission to see how we can contribute to that process.
[78] Mark Drakeford: Thank you, Deputy Minister, for a wide-ranging session for which we are grateful. We look forward to receiving the extra information that you will be sending us by correspondence. That is the committee over for today. Diolch yn fawr.
Daeth y cyfarfod i ben am 11.58 a.m. The meeting ended at 11.58 a.m.