09 September 2015
Carers Trust Wales welcomes the opportunity to respond to the Finance Committee’s call for information on the Welsh Government draft budget proposals for 2015-16. Carers Trust is a new charity which was formed by the merger of The Princess Royal Trust for Carers and Crossroads Care in April 2012.
Carers Trust Wales works across Wales to improve support, services and recognition for anyone living with the challenges of caring, unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. With our Network Partners, local service providers across Wales, we aim to ensure that information, advice and practical support are available to all carers.
Our strategic aims are to
Together with our Network Partners, we provide access to desperately-needed breaks, information and advice, education, training and employment opportunities. Our Network Partners benefit from the provision of grants, advice documents and reports to improve carers' services. We give carers and young carers avenues to speak to someone and make their voices heard, offline via our carers' services and young carers' schemes and online via our interactive websites.
Our vision is a world where the role and contribution of unpaid carers is recognised and they have access to the quality support and services they need to live their own lives.
We provide support, information, advice and services for the millions of people caring at home for a family member or friend. Our Network Partners reach carers of all ages and with a range of responsibilities, in their local communities. From helping carers to access local services, to making their views heard by opinion formers and professionals, together we help carers to connect with everyone and everything that can make a difference to their lives.
With carers’ needs, choices and voices at the heart of everything we do, we strive to ensure that the enormous contribution they make to society and to those they care for is fully recognised, appreciated and valued.
1. Carers provide valuable unpaid care across Wales. Enabling carers to maintain their own well-being and the well-being of those they care for through carer-focused services is essential in promoting a healthier, more equal Wales.
2. A range of evidence demonstrates that carer-focused services, carer involvement and effective health-led strategic planning for carers improves outcomes not only for carers, but also for professionals and those that they care for. This includes delayed or prevented placement in residential care, delayed or prevented hospitalisation and quicker transfers of care.
3. Yet current funding arrangements - including commissioning arrangements nationally, through local health boards and Local Government – neither support nor sustain quality carer-focused services. Feedback from local services suggests that commissioners favour and prioritise low-unit cost over quality. Although this is in part attributable to changing policy priorities and processes in Welsh Government and Local Government, there has also been a downward pressure on Local Government budgets, currently the principal funders of such activities.
4. Carers Trust Wales welcomed the Intermediate Care Fund. However, feedback from local partners suggests that implementation of the Intermediate Care Fund has not been effective and has not included the voluntary sector as key strategic partners in the planning and delivery of the fund. We would advocate the continuation of ring-fenced funding for intermediate care but would argue for a more integrated and inclusive approach to implementation and changes to the way the Voluntary Sector is engaged.
5. Carers Trust Wales would welcome the opportunity to expand upon this response in an oral evidence session with the Finance Committee.
1.
What, in your
opinion, has been the impact of the Welsh Government’s
2014-15 budget?
1.1 Broadly, the downward pressure
on local authority budgets has had a discernible impact on the
funding and prioritisation of carer-focused services across
Wales
1.2 Carer-focused services are
evidenced to support the preventative agenda and as such the
downward pressure on local authority budgets is likely to further
impact the ability of carer-focused services to deliver quality
care that supports reablement and delays hospitalisation.
1.3 Carers Trust Wales welcomed the
introduction of the Intermediate Care Fund in the 2014-15 budget
and calls for the continuation of some form of funding for
intermediate care needs.
1.4 However, we do not believe that
the budget has had the hoped for impact.
1.5 Feedback from local service
providers regarding the allocation of and facilitated engagement
with the Intermediate Care Fund is poor. Local partners have
identified that there was little proactive engagement with the
local voluntary sector. Community Voluntary Councils (CVCs)
were used as local facilitators but unfortunately in some areas
CVCs act as competitors with rather than enablers for the wide
range of voluntary sector organisations across the
community.
1.6 The voluntary sector, which is often responsible for delivering key services that meet the criteria of the Intermediate Care Fund, should have a much stronger strategic role in the planning and delivery of those services enabling the voluntary sector to genuinely co-produce local solutions. Currently the emphasis firmly remains with Local Authorities.
Looking at the indicative budget allocations for 2015-16, do you
have any concerns from a strategic, overarching perspective, or
about any specific areas?
2.1 Despite a
number of issues around delivery and implementation, as outlined
above, we have concerns regarding the apparent loss of ring-fenced
targeted funding through the Intermediate Care Fund
2.2 This fund
aimed to encourage collaborative working between services to
support people to maintain their indepenence and remain in their
own home, to drive a step change in the way services work
collaboratively at both a strategic and operational level. It was
intended to support the avoidance of unnecessary hospital
admissions, or inappropriate admission to residential care.
2.3 From a
broader strategic perspective, we have significant concerns
regarding the ability of Local Government to adequately fund or
prioritise carer-focused services – the social return of
investment and preventative nature of such services is
well-evidenced (and referenced in response to question 4),
particularly given the downward pressure on Local Government
budgets, set to continue in the indicative 2015-16 budget.
2.4 As such, a ring-fence of funding for carer-focused services would help secure quality carer-focused services, avoiding the prioritisation of cost over quality, and in doing so sustain the wellbeing of carers and those that they care for. This would be a demonstrable example of investing early to prevent greater expenditure on health and social care later – in other words, preventing the preventable.
2.5 Should the draft budget for 2015-16 align to the indicative budget published in the final 2014-15 budget, we welcome:
-
that health and
social services budgets would, at the very least, be
maintained
- the continued commitment to the third sector, and as such a challenging, effective Welsh voluntary sector, through sustained funding in the indicative budget under ‘Supporting Communities and People’.
3. What expectations do you have for the 2015-16 draft budget proposals? How financially prepared is your organisation for the 2015-16 financial year, and how robust is your ability to plan for future years?
3.1 We would
expect the 2015-16 draft budget proposals to make adequate
preparations for the forthcoming implementation of the Social
Services and Well-being Act 2014. This Act will place greater
duties on Local Government and Local Health Boards, including the
requirement that carers be placed on an equal footing as those for
whom they care and that the definition of the carer is
broader.
3.2 We would expect these changes - including the broadening of the definition of a carer, the development of eligibility critera for a care/carer needs assessment and plans, and the focus on enabling those with care needs and carers to reach their personal outcomes – will understandably have additional cost implications for the Welsh Government and Local Government.
3.3 Carers Trust Wales continues to support the additional provisions and entitlements included in the Social Services and Well-being Act 2014, but we are keen to ensure that these provisions have a tangible positive impact on carers and those that they care for across Wales. We would welcome a greater explanation from the Welsh Government of any budgetary commitments planned to ensure these provisions are delivered effectively.
3.4 There is currently a great deal of uncertainty around a number of budgets that make it difficult to adequately plan for future years. This includes further potential budget reductions for local authorities which would place carer-focused services as delivered by our local partners at risk, the planned loss of funding for the Carers Strategies (Wales) Measure 2010 and delays in the provision of information relating to the Welsh Government’s funding of the third sector.
4. The Committee would like to focus on a number of specific areas in the scrutiny of the budget, do you have any specific concerns on the areas identified below?
a. Preparation of the Wales Bill
b. Local health board financial arrangements
c. Approach to preventative spending and how is this represented in resource allocation
d. Impact of the Welsh Government’s legislative programme and whether its implementation is sufficiently resourced
e. Scrutiny of Welsh language, equalities and sustainability
4.1 Evidence
clearly demonstrates that the strategic planning of and
investment in carer-focused services has a long-term preventative
impact on public services. Evidence demonstrates that carer-focused
services contribute to reducing the amount of time spent in
hospital by people with long-term health conditions and avoiding
delays in the transfer of care[1][2][3].
We also know that commissioning breaks and emotional support for
carers can reduce overall spending on care and their need to access
mental health services[4].
4.2 However, investment in carer-focused services, and the processes through which carer-focused services are funded by local health boards and Local Government, have not adequately supported carer-focused servies in providing key services that support the preventative agenda
4.3 Both despite and because of current and future budgetary and demongraphic pressures, the Welsh Government should be signifiantly uplifing spending on the preventative services delivered by the third sector in Wales. Third sector services are the glue holding many prevantative services together across health and social care and the planned reductions in these budgets locally means support will be reduced or removed for many vulnerable people in Wales.
4.4 In terms of the financial arrangements of Local Health Boards, we have concerns regarding the expenditure of the carer strategy funding across Wales. Currently, the effectiveness in the allocation of this funding across health boards has been variable and disparate, we remain unconvinced that all health boards have utilised this funding effectively and to the benefit of carers. It is also our understanding that the reporting process for this funding is such that the Welsh Government does not require local health boards to identify how the funding has been spent.
4.5 Carers Trust Wales is concerned about the lack of future funding allocations for carers strategies through local health boards from 2016 following the repeal of the Carers Strategies (Wales) Measure.
4.6 As outlined above, we also have concerns regarding the Welsh Government’s legislative programme and how sufficiently resourced implemnentation is – particularly in regards to the Social Sevices and Well-Being Act. Given a number of key regulations are still subject to consultation and the outcome of technical groups, it is difficult at this point to make accurate projections of additional funding required, but so far there has been little indiciation of any additional commitment to investment.
Kieron Rees
Policy and Public Affairs Manager, Carers Trust Wales
07824567813
09-09-2014
[1] Williams, E, Fitton, F (1991) Survey of carers of elderly patients discharged from hospital. British Journal of General Practice, 41, 105 –108.
[2] Conochie, G (2011) Supporting Carers: The Case for Change; London: The Princess Royal Trust for Carers and Crossroads Care.
[3] Bebbington, A, Darton, A, Netten, A (2001) Care Homes for Older People: Volume 2. Admissions, Needs and Outcomes; University of Kent: Personal Social Services Research Unit
[4] Conochie, G (2011) Supporting Carers: The Case for Change; London: The Princess Royal Trust for Carers and Crossroads Care.