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Partnership with 3rd
Sector Services. This growing area of partnership working has
provides exciting opportunities to provide community support in a
flexible, creative way.
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The clear recognition of the role
and value of carers in delivering effective community
care.
There are however a number of areas
that are at risk of diverse interpretation that may cause tensions
in providing joint agency services. There is a lack of clarity in
relation to equipment provision. This is described currently for
Social Services as part of the Chronically Sick and Disabled
Persons Act 1970. These responsibilities are not described
explicitly in the Social Services and Well-being (Wales) Bill and
could be seen as having been forgotten. Similarly it would be
helpful to clarify whether the Social Services and Well-being
(Wales) Bill will have an impact on access to Disabled Facilities
Grants.
Both access to equipment and home
adaptation impact on the capacity of vulnerable adults to remain in
their own homes and function independently with dignity. Should
these services be restricted further than the constraints of
current provision, then the health and wellbeing of those people
needing to access this type of support will be compromised.
Hospital services have historically been used as a safety net for
the frail elderly who have breakdown of social support. The success
of HDHB modernisation strategy is dependent on community services
being strengthened by both health and social care. Provision of
community equipment and home adaptation is part of this network of
care.
The Social Services and Well-being
(Wales) Bill also makes repeated reference to eligibility criteria.
The recent DoH Guidance “Prioritising need in the context of Putting People
First: A whole system approach to eligibility for social
care” applies in England only. For integrated services, even
minor changes in social services eligibility criteria can have a
significant impact on the balance of care available. Welsh guidance
regarding eligibility should be developed in partnership with the
NHS to support the establishment of reciprocal/integrated community
support systems. Similarly the responsibility for and ownership of
registers for disabled people could be considered as a component of
partnership working.
Consultation
Questions
General
1. Is there a need for a Bill to
provide for a single Act for Wales that brings together local
authorities’ and partners’ duties and functions in
relation to improving the well-being of people who need care and
support and carers who need support? Please explain your
answer.
The current legislation in
relation to local authorities’ duties has been built up over
time through a range of legislation. It is complex and challenging
for organisations working in partnership to combine
responsibilities and deliver cohesive integrated services. It is
timely to establish a single Act for Wales that frames partnership
responsibilities. It would be helpful if some aspects were
considered in greater detail in order to ensure reliable
interpretation.
The fact that recognition,
support, voice and equity for carers are central to the proposed
bill is encouraging. Organisations such as Carers Wales have long
campaigned for the needs of family carers, alongside those of
service users, to be at the heart of social services. It has
been argued consistently that carers need to be identified at an
early stage in their caring journey so that they are better
equipped to deal with the complexities and difficulties they are
likely to face. Services need to be reconfigured towards earlier
preventative support so that carers, and the people they look
after, are able to maintain their health, wellbeing and sustain
lives of their own.
The principles behind the bill
are to give the people who use social services, including carers, a
strong voice and real control over the services they may receive by
focussing on the personal outcomes that people wish to achieve. It
will also enable earlier intervention and prevention for carers and
for people who need care and support in order to improve their
well-being
2. Do you think the Bill, as
drafted, delivers the stated objectives as set out in Chapter 3 of
the Explanatory Memorandum? Please explain your answer.
The purpose and intended effect
of the Bill support the development of integrated services, but the
responsibilities described no not reliably reflect a partnership
approach. For example, where integrated community teams are
established, social care staff are unable to delegate
responsibility for assessment to NHS staff due to the
responsibilities described in current legislation. Whilst this
leads to inefficiency and duplication of effort, the opportunity is
not acknowledged or addressed by the Bill.
For health boards discharging
patients to a number of counties, variation in the eligibility
threshold generates uncertainty regarding discharge planning and
arrangements. People are still commonly transferred to a local NHS
bed when there are significant community care needs. This practice
has been established in response to the complexity of negotiating
care on discharge where there are inconsistencies in the thresholds
and processes to access care. The description of eligibility fails
to recognise the need to consider this longstanding inefficiency
when people are discharged from hospital.
The intention of the Bill to
ensure that wellbeing is enhanced and that services respond
flexibly to the developing needs of individuals, their family and
carers is excellent. The Bill needs to identify more clearly
the steps envisaged to provide proportionate support to
people.
The Bill identifies the
importance of providing advice, information and signposting to
anyone who requests it. The Bill is clear that preventative
services should be provided to prevent people developing needs for
care and support or to reduce those needs but it lacks clarity
about who would have access to preventative services; the
difference between when a person ‘needs’ some targeted
intervention to prevent them needing care and support and the point
at which they are deemed to have ‘care and support’
needs; the difference between NHS and Social Care preventative
services.
It would be helpful if the role
of reablement was described. There are significant variations in
the way this service is perceived. It is most successful when it is
an integral feature of integrated working arrangements, but this
relationship is currently ad hoc.
3. The Bill aims to enable local
authorities, together with partners, to meet the challenges that
face social services and to begin the process of change through a
shared responsibility to promote the well-being of people. Do you
feel that the Bill will enable the delivery of social services that
are sustainable? Please explain your answer.
Whilst the intention to deliver
sustainable social services is applauded, HDHB would welcome the
added requirement of delivering reliable services. In rural areas
there are ongoing difficulties in recruiting care staff to private
agencies as well as social care. This continues to impact on the
viability of people remaining in their own homes. A requirement to
confirm reliable access to services may lead to more creative and
proactive solutions.
Delivering preventative services
in the context of eligibility and means testing may be challenging
and consideration may need to be given to the infrastructure for
this area of responsibility. Free preventative services may lead to
greater savings in the delivery of care costs than a preventative
service with charges, which have a more limited uptake.
The
establishment of equivalent rights for carers to those they look
after and a single duty for local authorities to undertake
carers’ assessments will have a positive impact on the
sustainability of informal care arrangements. The removal of the
requirement that a carer must be providing “a substantial
amount of care on a regular basis” before they can be
assessed, will enable support to be provided earlier in the caring
process and will have a positive impact on carer strain.
4. How will the Bill change
existing social services provision and what impact will such
changes have, if any?
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The lack of clarity regarding the
provision of equipment has already been discussed.
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The relationship between Social Care
and Housing regarding adaptation has already been highlighted as a
concern.
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There may be tensions created by an
assessment on a client and their carer being undertaken by the same
person. There may be times where the assessment becomes biased
towards one person’s needs.
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Adopting a common approach to
safeguarding (for adults and children) may dilute rather than
strengthen the process.
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Greater clarity is needed regarding
social services responsibility for delivering preventative services
to gauge the impact
5. What are the potential
barriers to implementing the provisions of the Bill (if any) and
does the Bill take account of them?
Costs continue to be a challenge
when service change is required in the context of a limited
financial flexibility. Additionally, lack of clarity regarding some
responsibilities is likely to generate dispute between agencies
which will delay effective implementation.
6. In your view does the Bill
contain a reasonable balance between the powers on the face of the
Bill and the powers conferred by Regulations? Please explain your
answer.
A
significant amount of detail is left to regulation. This makes it
difficult to analyse the true impact of the Bill and the extent to
which it will deliver the intended vision and impact.
Powers to make subordinate
legislation
7. What are your views on powers
in the Bill for Welsh Ministers to make subordinate legislation
(i.e. statutory instruments, including regulations, orders and
directions)?
In answering this question, you
may wish to consider Chapter 5 of the Explanatory Memorandum, which
contains a table summarising the powers delegated to Welsh
Ministers in the Bill to make orders and regulations,
etc.
As above, a significant amount
of detail is left to regulation. This addition detail is needed as
a matter of urgency.
Financial
Implications
7. What are your views on the
financial implications of the Bill?
In answering this question you
may wish to consider Chapter 8 of the Explanatory Memorandum (the
Regulatory Impact Assessment), which estimates the costs and
benefits of implementation of the Bill.
Please see our
response to question 5.
Delivering the
transformational change envisaged by the Welsh government will
generate additional cost, such as, developing preventative services
which are not currently available; of developing new Boards and
bodies such as National Safeguarding Board.
Other
comments
8. Are there any other comments
you wish to make about specific sections of the Bill?
None.
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