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. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
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Dechreuodd y cyfarfod
am 09:30.
The
meeting began at 09:30.
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Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
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[1]
Dai Lloyd: Croeso i bawb i gyfarfod diweddaraf y Pwyllgor
Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Cynulliad. A gaf i
estyn croeso i’m cyd-Aelodau, gan gyhoeddi bod Lynne Neagle
wedi cyflwyno ei hymddiheuriadau am y bore? A allaf i bellach
egluro bod y cyfarfod yn ddwyieithog? Gellir defnyddio’r
clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg
i’r Saesneg ar sianel 1, neu i glywed cyflwyniadau yn yr
iaith wreiddiol yn well ar sianel 2. A allaf i hefyd atgoffa pobl i
naill ai ddiffodd eu ffonau symudol ac unrhyw gyfarpar electronig
arall neu eu rhoi ar y dewis tawel, ac hysbysu pawb y dylid dilyn
cyfarwyddiadau’r tywyswyr os bydd larwm tân yn
canu?
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Dai
Lloyd: Welcome, everyone, to this latest meeting of the
Health, Social Care and Sport Committee here at the National
Assembly for Wales. So, may I extend a warm welcome to my fellow
Members and say that Lynne Neagle has sent her apologies for this
morning? May I further explain that this meeting is bilingual and
you can use the headsets to hear the interpretation from Welsh to
English on channel 1, or to hear the contributions in the original
language more clearly on channel 2? May I also remind people either
to turn off their mobile phones or any other electronic equipment,
or switch them to silent, and let everyone know that they should
follow what the ushers tell them to do should the fire alarm
sound?
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Ymchwiliad i Unigrwydd
ac Unigedd—Sesiwn Dystiolaeth 11—Gweinidog Iechyd y
Cyhoedd a Gwasanaethau Cymdeithasol
Inquiry into Loneliness and Isolation—Evidence Session
11—Minister for Social Services and Public Health
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[2]
Dai Lloyd: Gyda gymaint o hynny o ragymadrodd, fe wnawn ni
symud ymlaen ag eitem 2, a pharhad i’n hymchwiliad i
unigrwydd ac unigedd. Hon ydy sesiwn rhif 11 y bore yma, ac
o’n blaenau mae Gweinidog Iechyd y Cyhoedd a Gwasanaethau
Cymdeithasol, Rebecca Evans—croeso i chi, bore da. A hefyd,
yn ogystal, mae Albert Heaney, cyfarwyddwr gwasanaethau
cymdeithasol ac integreiddio, a hefyd, Grant Duncan, dirprwy
gyfarwyddwr gofal sylfaenol. Yn naturiol, rydym ni wedi derbyn eich
tystiolaeth ysgrifenedig, ac, yn ôl ein harfer yn awr, awn yn
syth i mewn i gwestiynau. Mae gyda ni ryw awr a mwy. Awn ni’n
syth i mewn i gwestiynau, ac mae’r cwestiwn cyntaf gan Angela
Burns.
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Dai Lloyd: So, having said that much,
we’ll move on to item 2, which is a continuation of our
inquiry into loneliness and isolation. This is the eleventh
evidence session this morning, and before us we have the Minister
for Social Services and Public Health, Rebecca Evans—welcome,
good morning. And, in addition, we have Albert Heaney, the director
of social services and integration, and also, Grant Duncan, the
deputy director for primary care. Now we have received your written
evidence, and, as per usual, we will dive straight into questions.
We have over an hour for our questioning, and the first question is
from Angela Burns.
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[3]
Angela Burns: Diolch, Chair. Good morning to all of you.
Thank you very much indeed for your evidence paper. But, reading
it, I do have a real concern. There’s nothing wrong with it,
but it struck me, when I read it, that it was sort of a
pull-together of a whole bunch of strategies already in operation.
I appreciate that the topic of loneliness and isolation cuts across
great many sectors of people and touches lives in all sorts of ways
that we don’t know about, but I have to tell you, Minister,
that, when I read this, I felt that there was a real lack of
national ambition in tackling this issue. And I think that, in the
evidence that we’ve taken, not just in this inquiry, but over
the last year of being here as a Health and Social Care Committee,
it has really come to the surface that loneliness and isolation is
going to be one of the big public ills of the future. And I’d
really like to try and understand from you where you intend to take
the development of a strategy, because, for me, this seems very
light, as I say, a pulling together of lots of different elements,
but it doesn’t touch on rurality, it doesn’t touch on
transitioning, it doesn’t particularly touch on the very,
very elderly. It seems to rely on third sector organisations, which
we know are struggling anyway. And I just felt that this is an area
that absolutely has to be treated, not as a sort of a—. And
I’m not for one minute saying you are, but other people might
say, ‘Oh, loneliness and isolation—it’s a bit
sort of airy-fairy or fluffy’. But, actually, it causes
death. People will commit suicide, and a significant number of
people just live out the rest of their lives in absolute
misery.
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[4]
So, I’d like to see Welsh Government, and I’d like to
be able to support Welsh Government in, doing something much, much
more punchy about something that I think is affecting a huge number
of our older people, and, as in some of the evidence, we’ve
started to hear is trickling down into other areas of society.
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[5]
The Minister for Social Services and Public Health (Rebecca
Evans): Okay. Well, I thank you for those opening questions,
and I would completely agree with you about the importance of
tackling this issue. But I would take issue with the fact that
there isn’t a national ambition, because, actually, in our
manifesto, and in the programme of government, we committed to
developing a cross-government, national approach to tackling
loneliness and isolation. This will be the very first time that
we’ve ever done something of this scale, looking at
loneliness and isolation right across the whole of Government as
well. And perhaps the reason why we haven’t set out what the
strategy will look like in this paper is because this piece of work
is just beginning, which is why it’s so good for us to have
the committee looking at this issue at this time. And the evidence
that you’ve gathered, and the evidence that you’ve had
in oral sessions as well, has been tremendously useful to us in
starting to shape our ideas, because that’s where we are with
this at the moment—very much at the early stages of shaping
our ideas. So, your recommendations as a committee, and the
evidence that you take, is going to be absolutely critical to us in
terms of taking this forward. So, it is a very timely piece of work
that you’re looking at.
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[6]
I don’t take issue at all with the suggestion that this is a
public health issue, because in the paper I do refer to some of the
evidence that demonstrates the impact on both physical and mental
health. We all know that statistic that experiencing loneliness and
isolation can be as bad for you as
smoking 15 cigarettes a day and, when you put it in that kind of
context, then you start to see the health impact that it can have
as well. It’s linked to things like dementia, morbidity, for
example. So, there are huge health issues for us to address
here.
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[7]
I’m also keen that this isn’t
just an issue that reflects on the needs of older people. I think
that it’s fair to say that older people tend to be most
affected by loneliness and isolation and it can be very severe for
them, but, equally, the ‘Trapped in a bubble’ report
from the British Red Cross has demonstrated that it’s an
issue for young mums, for people with chronic conditions, for
example, people who have been recently bereaved, and there’s
other evidence out there as well suggesting that it’s a
particular issue for people in ethnic communities, women,
particularly, who, for cultural reasons and language barriers,
often aren’t able to access everything that is in the
community for them as well. So, it’s a huge issue affecting a
great range of people.
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[8]
As I say, we are at the early stage of
starting to form our ideas. Formally, I’m starting to think
that loneliness and isolation has to be a thread that runs through
all of that which we do in Government as a kind of theme that we
need to address. Tackling it in a specific strategy might—you
know, a list of particular actions might miss people and might not
be the kind of focused approach that we need. So, as I say, these
are very early days for this piece of work, so we are all ears to
the evidence that you receive and your deliberations as
well.
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[9]
Angela Burns: Could you just give us an indication of when you
might hope to bring such a strategy forward and also the size of
the team that you’ve got working on it and how they are
engaging with other organisations to get to this? Because
we’ve heard some outstanding evidence from very small
organisations that are really able to deliver on the ground, but
I’m sometimes concerned that they get lost in the—you
know, we always look to the big organisations, which are very vocal
and very good at lobbying us and telling us what they think, but
we’ve heard outstanding evidence from some of these smaller
organisations and I’d really like to think that you might be
able to listen to them as well, so if you could just give us an
overview about the size of the team who are working on delivering
this and when you hope that you might be able to bring this
forward.
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[10]
Rebecca Evans: I will be, and the team will be, talking to people
more informally over the course of the next year in terms of having
discussions with all kinds of groups. So, ethnic minority
groups—I had a recent interesting conversation about
loneliness in the south Asian male community; this is an issue that
affects many, many communities. So, I really want our consultation
to reach out to all parts of the community that might be affected
by loneliness and isolation. It would be a case then of coming up
with a more formal proposal on the approach, which would be
consulted on in, I would envisage at the moment, autumn 2018, with
a view to the final strategy document being launched in early 2019.
So, as you noticed at the beginning, really, this is a really early
stage for this particular piece of work, so I would be keen to
reach out to all communities.
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[11]
You did mention rural communities as
well; I think that we need to reflect on the fact that loneliness
and isolation can be particularly acute for people living in rural
communities. Equally, people in urban communities, when you are
surrounded by thousands of people, actually, if you’re not
able to get out for whatever reason, or you don’t feel that
you’re connected to your community, then those feelings can
be just as acute there as well. So, this needs, really, to reach
out to all kinds of communities, and this is something that is
cross-Government, but also national and that’s how I would
see the engagement taking place.
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[12]
Angela Burns: I do appreciate that it’s really important to
be able to assess exactly what you need to be able to do.
Sometimes, though, it can be so bogged down in red tape and
process, and I think that to deliver something like this—to
have the ambition to deliver it—by, say, 2019, is an awfully
long way down the road. Would you consider if there are short-term
measures that you might be able to take, perhaps to support some of
these smaller organisations to make sure that they have the funding
to continue, perhaps be able to run a whole series of pilots over
the next few years, using some of the work that we’ve heard
about, or some of the work that you’ll come across when you
go out to talk to people on an informal basis? Because I have a
concern that something like this could—. We get so wound up
in making sure that we can cross every t and dot every i that we
miss the doing of it and it’s always about the talking of
it.
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[13]
Rebecca Evans: Albert might want to add a little bit more about the
kind of schemes that we are funding through, for example,
the third sector grant scheme and so on. But I’m aware that,
actually, we’re not starting from scratch; there is a lot of
good work happening at the moment. You’ve heard lots of it
already in the evidence that you’ve taken.
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[14]
For example, I was recently at the launch of a project called
Ffrind i Mi in Newport. I know it operates elsewhere and it’s
something that you’ve heard about—Jayne invited me to
the launch—and it was really uplifting to hear about people
in the community coming together to match people who are
experiencing loneliness with people who actually share their
interests. So, there’s the potential then for genuine
friendships and bonds and wider community networks to grow from
that.
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[15]
There’s also work that has been undertaken by the British Red
Cross, there are numerous befriending schemes taking place on a
large scale and small scale for different communities as well, and
the work that the previous Minister for Health and Social services
started undertaking with his three-year programme on compassionate
communities as well—and that’s about not only
addressing loneliness and isolation, but also those health, and
mental health particularly, impacts that come alongside that as
well. So, lots going on. We don’t want to lose that, but we
actually want to learn from that in terms of what works.
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[16]
Dai Lloyd: Albert—go on.
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[17]
Mr Heaney: Thank you, Minister. Thank you, Chair. Thank you,
committee. The importance the committee is placing on loneliness
and isolation and recognising that a strategy and approach takes
time to develop in the kind of cohesive approach that we would wish
to take—I think it is right and proper to have that
timescale. However, I think also the comments and the emphasis from
the committee on doing things along the journey that can make a
significant difference are also right.
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[18]
So, if we take, for example, the funding that the Minister invests
in the third sector sustainable social services grant, that grant
runs now for a further period of time, but we will be reviewing in
terms of the focus of that grant for the Minister going forward.
So, I think that gives us a good opportunity to make sure that we
get our priorities and focus on supporting the third sector in
delivering around this agenda.
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[19]
But I think it’s also that we want to strengthen through
sustainable social services—and this isn’t just about
social services; this is about housing, this is about communities,
this is about public services, this is about a wider focus. Within
the sustainable social services agenda, we have created regional
partnership boards and population assessments have been devolved.
So, we’d be very keen to work with those regional partnership
boards to see how they are developing and how we can strengthen the
development around loneliness and isolation.
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[20]
I think it’s really important that cross-Government
strategies—. The importance that Government is placing on
adverse childhood experiences, as an example, is a good
illustration of how we then look at the new adverse childhood
experiences hubs and how we make sure those hubs are working on
isolation and loneliness and really address some of those key
issues as we journey forward.
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[21]
Dai Lloyd: Okay. Julie, you had a supplementary on this
point.
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[22]
Julie Morgan: When the Minister was talking about the different
types of voluntary bodies—and I expect we’re going to
look at this in more detail further on—I just wondered if
you’d had any experience of FAN, Friends and Neighbours,
which operates in Cardiff and around south Wales. I don’t
know whether you are aware of this organisation—
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[23]
Rebecca Evans: No, I haven’t had the chance to—perhaps I
could come and visit.
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[24]
Julie Morgan: I wonder if perhaps your officials could look into
it, because it is an entirely voluntary group that meets in
libraries and invites people who are lonely or people who have just
come to live in this country to join in. It’s quite a
grass-roots movement and I’ve been very impressed with it.
They meet in Whitchurch library and throughout Cardiff, so perhaps
you could have a look at that.
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[25]
Rebecca Evans: Definitely. That’s exactly the kind of thing
that we need to be hearing about that’s happening on the
ground in communities already that’s making a
difference.
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[26]
Julie Morgan: They don’t ask for funding or anything;
they’re completely voluntary.
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[27]
Angela Burns: They just get on and do it.
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[28]
Rebecca Evans: Yes. And that’s actually part of the
conversations that we’ve been having at an early stage. I
spoke at the annual conference of Active Wales, which is the oldest
organisation representing older people and run by older people in
Wales. I spoke about loneliness and isolation and our thoughts on
the way forward—how important it is to address it. And then
their president spoke after me and she said to the people in the
conference, ‘Well, actually, this is about what can we do
too’. It’s very much clear to me that this isn’t
just an issue for Government, but actually it’s an issue for
us all in the community. It’s not something we can simply
address by specific programmes and so on; it’s something that
we can all look to address as individuals.
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[29]
Dai Lloyd: Diolch yn fawr. Mae’r cwestiynau nesaf o
dan law Dawn Bowden.
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Dai Lloyd: Thank you, the next
questions will be from Dawn Bowden.
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09:45
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[30]
Dawn Bowden: Thank you, Chair. On that last point, Minister,
I think some of the evidence that we’ve received previously
from some organisations talks about the need for a cultural shift
in terms of how we address loneliness and isolation in our
communities. So, it’s something for all of us to look at.
But, in terms of the wider focus you were talking about—I
know this isn’t particularly your area of responsibility,
Minister—but I am interested to know how you feel the work
around the primary care sector can help with this. Albert, you were
talking about social services in particular and I know that,
obviously, that’s your particular area of responsibility.
We’ve been taking evidence on primary care clusters and the
need for that to be working more effectively with social services
and on that wider agenda. How do you see the new primary care
clusters really helping to drive forward this issue of
tackling—not just amongst older people but across the whole
spectrum, really?
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[31]
Rebecca Evans: Well, primary care can play—and it does
play—a hugely important role, actually, in both tackling
loneliness and isolation and identifying it in the first place.
Because often it’ll be people going, for example, to see
their GP in relation to perhaps experiencing some mental ill
health, anxiety, depression and so on as a result of being lonely
or isolated. Often, people who frequently visit—well, not
often, but sometimes, people who frequently visit their GP do so
because they have no one else and it’s an opportunity to see
a friendly face, somebody who cares about them, and a chance to
have a discussion with someone. So, I think that GPs are well
placed to spot people who might be experiencing loneliness and
isolation. But also the wider primary care team as well would have
an important role. So, for example, physiotherapists, occupational
therapists, mental health teams, health promotion teams, even
podiatrists and so on would all have an opportunity to spot
loneliness and isolation. Then, it’s the question: what do we
do next with that? So, we’re looking to see what we can do to
roll out social prescribing, for example. I think that has huge
potential in terms of what we can do to support people. And GPs, I
know, are working very closely with third sector organisations such
as Diverse Cymru, Sight Cymru, Gofal, for example, all of which
have a very strong and direct interest in spotting loneliness and
isolation and then tackling it as well. We’re also—and
perhaps Grant might want to say a little bit more about
this—looking to see how we’re using our GP contracts to
be able to strengthen the work that we’re doing in primary
care on mental health.
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[32]
Dr Duncan: Primary care is mainly the first point of contact
most people have—and how they can pick up signs—so I
was struck by some of the comments from the Red Cross about the
importance of signposting and the importance of community
initiatives. I think it is those areas in which it’s
developing both the capacity and knowledge locally of actually
what’s going on. Somewhat coming back to the previous point
about not just waiting for a strategy is things that are happening
now that can help to contribute to this agenda. So, for example, in
the contract that we’ve just concluded with GPs,
there’s a particular bit about clusters. I think we referred
to that in the previous evidence session, relating to national
priority areas—they need to sign up to one chosen locally and
two from a national basket. In the national basket, there is mental
health and dementia, and the guidance for that talks about the
importance of looking for early signs of mental health issues and
picking up on it. So, that helps promote the debate.
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[33]
Equally, we’ve also agreed with GPC Wales just about how we
can work together to improve the overall capacity and capability of
social prescribing: is that a physical form, is it knowledge of
what’s happening locally? In that context, I think what
really will help is more work on things like a directory of
services that pulls together—. There’s many different
players out there and it’s one thing talking nationally, but
it’s about, at a local level, knowing what’s going on.
So, bringing together some of the information systems—the
acronyms will defeat me, I apologise,
but—[Inaudible.]—the NHS ones and making them
work together so they can be locally accessible to help GPs or
others know what’s going on locally. They can actually help
refer their patients to the people that talk to them. I think the
thing about clusters is their potential. You heard in previous
evidence you’ve taken about the varying degree of maturity of
clusters. I think there the potential is developing in terms of
multidisciplinary teams, and I think, in that context, it’s
about the need to do local population health assessments. And I
think some do it well, but others have probably more to do on what
evidence, perhaps, gets to that—what’s happening
locally. And that will help to plan, pull in multidisciplinary
teams and get things going. So it’s an area both where things
are happening, and also where there’s more potential to help
pull it together.
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[34]
Dawn Bowden: Thank you for that. Just coming back to the
point you were making about social prescribing, and how that fits
into everything that you were talking about, again, we’ve
heard lots of evidence that has been quite anecdotal, because
there’s not been any real evaluation done of this yet. Have
you had any kind of feedback on the benefits of it, albeit that
it’s quite informal at this stage? Because I know Public
Health Wales are doing some research on this, and presumably
they’ll be feeding back to you at some point with that
evaluation. But what kind of more informal feedback are you getting
on that at moment?
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[35]
Rebecca Evans: I think the
committee might have already had some information about the
particular project that has taken place in Torfaen. That has been
tremendously successful in terms of using social prescription from
a GP surgery in terms of helping people become more connected with
the community. But then, what do we see in return for that?
It’s less reliance on mental health services locally and so
on, less reliance on GPs and more integration into the community as
well. I think that the project has been so successful in one part
of Torfaen, it’s now been extended to the whole of the area,
just because of the benefits that GP practices and so on are seeing
locally as well. There is a commitment by GPC Wales to work to find
a way in which we could possibly embed social prescription into GP
contracts, and we’re looking at ways we can encourage GPs to
have those more social conversations with the people who they see
through their doors as well.
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[36]
I have asked Public Health Wales to undertake a piece of research
looking at how social prescribing is taking place across Wales.
Actually, it’s happening in lots of different ways, with lots
of different models. So, the specific question that that research
is looking at is how, why, and in what circumstances might targeted
non-clinical interventions, services, or programmes then fit the
health and well-being of individuals and families with social,
emotional or practical needs. And that work also involves mapping
out what’s currently taking place across Wales as well. So I
think that’s really going to be helpful in terms of the next
steps as well. I know we expect a summary document of that to be
published next week, with the full technical document expected a
few weeks later after that as well. That’s work which has
been undertaken by Public Health Wales’s observatory evidence
service, because it is important that we take an evidence-based
approach to what works.
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[37]
Mr Heaney: Just to add to that, I undertook a visit to a GP
practice and spoke to the practice manager and their community
connectors. And it was interesting when we set up the community
connector scheme; they thought it might actually—there was a
bit of worry about whether it would increase their workload. And
what they found, actually, by focusing more on the prevention
side—so, before somebody becomes lonely, isolated and in a
chronic state—it was having a high impact on their health, by
getting out there early and actually reducing their referrals into
the GP practice. So I think it’s thinking differently. My
message from that, really, was thinking prevention and community
connection.
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[38]
Rebecca Evans: You’ll remember that Vaughan Gething made a
statement on social prescribing in the Chamber recently, and he
committed to a pilot scheme, which I think will be rolled out by
September, specifically looking at addressing mental health needs
as well. So, that’s something that we’ll be looking
forward to. Also, this kind of work doesn’t only take place
within primary care settings. Actually, I think you’ve heard
from the local area co-ordinator network as part of your evidence.
They work in more of a social services field, if you like, although
their funding sometimes comes from the fire service, the police and
others as well. They do absolutely fantastic work. I’m very
evangelical about local area co-ordination, having seen what it
does in my own community. But it also happens in different ways
under different names across Wales; they’ll be called
brokers, for example, in Powys and other areas as well. So,
tremendously exciting work happening. The work that has been
undertaken in Swansea has certainly had some research
undertaken into the cost-benefit of it, and it’s found,
actually, it’s tremendously beneficial in terms of investment
in preventative services, and when you talk to individuals, then,
about the difference it’s made to their lives. And it’s
often fairly low-level support that they need, just to get that
first step back into the community after becoming isolated for
whatever reason.
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[39]
Dai Lloyd: Symud ymlaen i gwestiynau nawr gan Rhun ap
Iorwerth.
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Dai Lloyd: Moving on now to questions
from Rhun ap Iorwerth.
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[40]
Rhun ap Iorwerth:
Bore da i chi. Diolch am y papur.
Rydw i’n siŵr y byddech chi’n cytuno mai rhyw
drosolwg eithaf cyffredinol ydy o, mewn difrif, o’r mathau o
bethau mae Llywodraeth Cymru yn eu gwneud a allai fod ag impact ar
unigrwydd ac unigedd. O ran y data, nid oes llawer iawn o ddata
ynddo fo mewn difrif, ond pa waith y mae’r Llywodraeth yn ei
wneud ar hyn o bryd, neu yn ei gynllunio ar gyfer y dyfodol, i
fesur sut mae unigrwydd ac unigedd yn effeithio ar y galw am
wasanaethau cyhoeddus, achos, ar ddiwedd y dydd, er mwyn gallu
cynnig gwasanaeth, mae’n rhaid gallu mesur y galw am y
gwasanaeth?
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Rhun ap
Iorwerth: Good morning, and thank you for the paper.
I’m sure you would agree that this is a sort of general
overview of the kinds of things that the Welsh Government is doing
that could have an impact on loneliness and isolation. In terms of
the data, there aren’t many data in it, but what work is the
Government doing at the moment, or planning for the future, to
measure how loneliness and isolation affect the use of public
services, because, at the end of the day, in order to be able to
offer a service, you have to measure the demand?
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[41]
Rebecca Evans: Thank you. The way in which we would measure
loneliness and isolation on a national level—actually, for
the first time—would be through the activities under the
Well-being of Future Generations (Wales) Act 2015, and that has
required Ministers to produce a series of national outcome
indicators. National indicator 30 specifically looks at the
percentage of adults who are lonely, according to the—and I
hope I get this right—De Jong Gierveld loneliness scale.
That’s an established way of measuring loneliness. The
detailed question there will be in our national survey, and that
asks people to say how they feel about six statements: I experience
a general sense of emptiness; I miss having people around; I often
feel rejected; there are plenty of people I can rely on when I have
problems; there are many people I can trust completely; there are
enough people I feel close to. That would be the way in which we
measure it.
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[42]
Rhun ap Iorwerth: I wasn’t actually asking how you
measure loneliness. I was asking how you measure the impact that
loneliness has on the need that people have for public services,
and the impact on the demand on public services.
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|
[43]
Rebecca Evans: Well, this links through to the work
that’s being taken under the Social Services and Well-being
(Wales) Act 2014, where our regional partnership boards have been
asked to undertake population needs assessments under that Act. Now
we have received all of those population needs assessments and
those regional partnership boards have identified loneliness and
isolation as a key issue that needs to be addressed. We’ll be
publishing a national population needs assessment based on what our
regions have told us, and, again, I would expect loneliness and
isolation to be a key theme in that.
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|
[44]
Rhun ap Iorwerth: And what will that tell us? Obviously you
haven’t got the numbers yet, but what kind of information
will those statistics give us on the demand on primary care, on
mental health services, of isolation and loneliness?
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|
[45]
Mr Heaney: I think the community support is very much in its
infancy. I think it’s in a development stage. I think
it’s important to be transparent at committee. I think that
it’s also a difficult area to measure, and I think,
therefore, using the loneliness scale and getting a sense of that
nationally, co-ordinating that through, then, the well-being of
future generations legislation and the requirements of public
service boards. The work that’s being done around the
population assessments is a very comprehensive piece of work
that’s been taking place across Wales. Each of those areas
has now completed their assessment. What the Minister has asked us
to do is actually to lead a co-ordination to, in a sense, aggregate
the key messages up. And I think, from that then, we’ll be
able to stand back and look at that and then analyse and see where
the next steps naturally take us, from that point. So, I think
it—to be transparent—I think it’s in that
development stage, but there’s a good baseline of information
from which we can take the next steps.
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|
[46]
Rhun ap Iorwerth: I accept that, and it’s important to
know, at this point in time, although you can start to measure how
much loneliness there is out there, you’re not quite in a
place where you know what that actually means for what we need to
deliver in terms of public services. Just breaking it down to
specific groups, there are many people who find themselves facing
mental health problems caused by loneliness and/or isolation. How
do you think mental health services are currently geared to be able
to be perhaps proactive in helping those people with specific
mental health needs?
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|
10:00
|
|
[47]
Rebecca Evans: One of the priorities within our current
delivery plan—so, 2016-19 for ‘Together for Mental
Health’—is to see people’s quality of life
improve, and that refers specifically to addressing loneliness and
isolation. So, it’s already a key theme within our work that
we’re doing on mental health. I think it’s fair to say,
as well, that we’re moving more towards a social model of
health, and in terms of delivering for people’s mental health
and well-being as well. So, there’s a wide range of work that
we’re doing to support people with existing mental ill
health, but actually also to prevent mental ill health from
developing in the first place. We know as well that, as I said at
the start, loneliness and isolation can be a precursor to dementia,
which is why, again, in our newly out-for-consultation dementia
delivery plan, loneliness and isolation is specifically referred to
and identified as a very important area within that as well.
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[48]
In terms of older people and mental ill health, we’ve got our
Commissioner for Older People in Wales leading our Ageing Well in
Wales programme. Again, that focuses on the importance of tackling
loneliness and isolation for reasons of ensuring that older people
have good mental health. But, again, it’s not all about older
people. Young people experience severe loneliness and isolation as
well, and I think that we need to be creative in terms of
understanding the best way to reach young people as well. So, that
could be part of the work that’s going on in schools in terms
of the approach to a healthy life, which is also about developing
resilience and well-being, but also even at a very young age, the
work that we’re doing on the network of healthy schools in
Wales. That also has a specific strand of work in terms of
improving mental health and resilience amongst our most young
children, as well. So, it should be something that runs through
everything that we’re doing.
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|
[49]
Rhun ap Iorwerth:
So, again, nothing particularly settled,
but as you put together a strategy on loneliness, this can form a
part of that.
|
|
[50]
Rebecca Evans: Yes. Mental health will obviously be key to
it.
|
|
[51]
Rhun ap Iorwerth:
There are longer term aspects where we
want to improve the mental health of the nation, if you like; there
are more acute issues, such as older men, in particular, at risk of
suicide, and these are things that we need to address today. Could
you tell me where you think the Government is at in terms of
strategies linked to trying to avoid suicides among older men,
perhaps with a reference to the ‘Talk to me 2’
campaign?
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|
[52]
Rebecca Evans: We do know that loneliness and isolation can lead to
mental ill health, which can often, then, unfortunately, lead
people to feeling suicidal and then taking steps to do that. And we
know that men aged 45 to 59 currently have the highest suicide
rate, so it is a particular issue amongst those people. You
mentioned ‘Talk to me 2’, and that does prioritise
older people with depression and co-morbid physical illnesses as a
particular group that needs to be targeted in terms of support for
mental health, because of the danger of suicide within that group
as well. So, I think it’s fair to say that ‘Talk to me
2’ does prioritise those groups of people where there is the
greatest danger of suicide.
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|
[53]
Rhun ap Iorwerth:
And are you confident that it addresses
loneliness and isolation as a key component of those
risks?
|
|
[54]
Rebecca Evans: Yes, it is part of that strategy, but as we move
forward with the work that we’re doing on loneliness and
isolation, we’ll be looking across what we’re already
doing to see what we can strengthen in terms of loneliness and
isolation. So, we could look at the other policies and strategies
and programmes that we have. Can they be strengthened? For example,
we’re refreshing the carers strategy at the moment, and also
our older people’s strategy is being refreshed at the moment
as well. So, loneliness and isolation for both of those groups will
be key themes that I would like to see addressed in those
strategies as we move forward.
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|
[55]
Rhun ap Iorwerth:
One last specific one from me: we also
know that loneliness and isolation can lead to increased alcohol
consumption; do you think the Government is addressing that, and
that public services provide the support to people who are at risk
of consuming more alcohol?
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|
[56]
Rebecca Evans: I think that the substance misuse delivery plan does
have specific actions in relation to dealing with people or
supporting people who have substance misuse of all sorts, but
particularly including alcohol as well. We’ve talked a few
times about Welsh Government’s aspiration in terms of minimum
unit pricing for alcohol as well. It’s something that we
continue to wish to do. We are awaiting the outcome of the
case in the Scottish courts at the moment, but it’s certainly
something that we would seek to do if we can.
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[57]
Dai Lloyd: Symud ymlaen
i’r cwestiynau nesaf, o dan law Jayne Bryant.
|
Dai Lloyd: We’ll move on to the
next questions from Jayne Bryant.
|
|
[58]
Jayne Bryant: Thank you, Chair. Good morning, Minister.
Social isolation and loneliness can happen to anyone, at any time
in their lives. Certain groups are hard to reach, and you’ve
already mentioned BME communities and people with mental health
problems, disabled people and LGBT. Perhaps you could give a bit
more information on your plans to get to those hard-to-reach
groups.
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[59]
Rebecca Evans: So, over the course of the next year,
we’ll be consulting and reaching out very widely to all of
the communities who will have an interest in this. I will certainly
seek to reach out to the communities you’ve described,
because the evidence is there, and we’ve referred to it
already in this session, about the ‘Trapped in a
bubble’ report and so on, which remind us, actually, this is
an acute problem for many people, not just older people.
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[60]
There are great examples of work already ongoing. I went to visit
Fantastic Gymnastics over in Butetown recently. I had the
opportunity to talk to women from the BME community who said that,
actually, if it wasn’t for that, they would just not have the
kind of quality of life and excellent opportunities that it had
given them, because it was an opportunity to meet with people from
their own community and learn skills, becoming coaches and so on
themselves, and, actually, to get out and socialise and have fun
with the family and so on. It’s such a simple project, but
having such a dynamic impact on people’s lives. So, I think
that we need to be creative in looking to all parts of Government
in terms of what different projects can do for loneliness and
social isolation as well. I’m quite keen on the work that we
can do within the community sports sector in terms of reaching out
to people, because sport is something that unites people and brings
people together. I think that there’s more that we can do to
target our work specifically at isolated and lonely people and
communities.
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[61]
Dai Lloyd: On this point, Angela. Then we’ll have
Albert.
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[62]
Angela Burns: Following on from Jayne’s point,
she’s identified groups of people who actually have quite a
strong sense of identity, so coalesce in communities. I appreciate
that they are hard-to-reach communities. I just wanted your view on
how we might reach the hard-to-reach elderly, immobile stuck in
their homes, who are basically not part of the technological and
digital age; they’re not on anyone’s radars;
they’re just about coping; they don’t, sort of, come
out. How do you get to those kinds of people?
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|
[63]
Rebecca Evans: Do you mean in terms of the consultation?
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|
[64]
Angela Burns: For the consultation, yes, sorry.
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|
[65]
Rebecca Evans: I think that the older people’s
commissioner would have an important role to play in terms of
helping us with this piece of work, because she does have
tremendous reach into the community, and many people engage with
her in a way in which they wouldn’t seek to engage,
necessarily, with Government. So, I think that she’ll be an
important partner as we take this forward. She, I know, is
committed to addressing loneliness and isolation; it’s part
of her Ageing Well in Wales programme, but it’s also
something that she speaks about passionately as a priority for
her.
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|
[66]
Dai Lloyd: Albert, you had a point, before I go back to
Jayne.
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|
[67]
Mr Heaney: It was back on the LGBT because I was very struck
by the Stonewall Cymru submission to the committee, because I think
they introduce some important messages for us to pay attention to
around confidence and trust, around the fear of discrimination,
around attitudes—attitudes in our workforces, attitudes that
are in our societies. I think they make a recommendation or they
suggest an action around Welsh Government working alongside the
newly formed Social Care Wales—and the care of social
services is bound to it—to actually work on some of the
workforce issues that make us, kind of, a leading-edge sector. I
think that’s quite an important theme to take forward,
because if we’re to address loneliness and isolation, then we
have to make sure we’ve got the right level of engagement and
inclusion, so that people in our societies can step forward and
talk about the issues that are important to them and we can reach
out and connect with them.
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|
[68]
Dai Lloyd: Okay, Grant as well.
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|
[69]
Dr Duncan: Two points, if I may, one in terms of the older
person’s commissioner: in the work she did on accessing
primary care services for older people, they did reach people in
different ways by going out into the communities, and that was
quite illuminating. So, that was a really useful thing to draw on
there. The other thing, in terms of going back to the BME
community, is that there is experience we can draw from during the
organ donation work. It was intense, but we spent a long time going
out into communities over a long period of time because it’s
about building trust and getting to know who people do believe and
getting underneath. Again, it took time, but I think these things
are likely to give those insights about different ways of doing
things, so, it’s not just—. You really get to the heart
of the issue.
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|
[70]
Jayne Bryant: Thank you. On Friday last week, I chaired a
round-table on this topic in Newport, and one of the issues that
were brought up—it was raised by a member of the BME
community—was the challenges to get to those communities, and
she was saying that it was very difficult because, in the past,
there had been a good project that had reached out to people, and
then, when the funding had gone, it stopped, and then there was
nothing else. So, I think it’s just a warning sign that we
really need to make sure that, once we’ve got those people,
we’re always trying to engage with them.
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[71]
We also know, from the evidence that we’ve had, that
loneliness and social isolation come at times of significant
change. What measures can the Government take to help build
resilience within the communities, such as when you’re
nearing retirement or at the loss of a loved one? Because those are
the times when we can anticipate perhaps something is going to
happen and we can try and get to them as quickly as possible.
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[72]
Rebecca Evans: Thank you. I do think that those times of
change in life are often times when loneliness and isolation can
strike and, actually, it can be hard to get out of that place then.
I know you’ve had compelling evidence specifically on the
issue of bereavement, and that’s been useful for us in terms
of focusing our thoughts as well.
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|
[73]
I think that, often, many people don’t like change, and we
don’t like to think about change. One thing that’s been
brought to my attention recently is, actually, there’s a
reason why the older people’s commissioner deals with people
from 50 plus, and that’s because of the importance of
planning for old age, and it’s what many people don’t
necessarily like to think about doing. That isolated house
somewhere, to come home to when you’re 55, might seem
wonderful after being surrounded by people in work all day, but,
actually, when you’re retired, the isolated house might not
seem such a good choice after all. So, I think that there is some
work potentially to do in terms of supporting people or encouraging
people, perhaps over 50, to start planning for the kind of
retirement that they would like, and thinking about the kinds of
networks that they will require and that they will need in order to
have the kind of quality of life that they envisage for themselves
as they get older as well. That’s something that has just
been brought to my attention recently, and it seemed to make
sense.
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[74]
Jayne Bryant: I think the other group could be people who
are older carers, who are perhaps in their 60s, looking after their
parents. Then, when they either go into a home or they pass away, I
think those people can be left and feel quite lonely and isolated
as well. I think perhaps there’s something you could look at
around that as well, because I think carers are a growing force
within our society and, I think, something you should be really
looking out for.
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|
[75]
The other point would be on community resilience. You’ve
touched on, a little bit, community resilience at a younger age, if
it’s about encouraging and supporting compassionate
communities, so what plans do you have to support this,
particularly in areas where Communities First have done quite a lot
of work and have been active in the past?
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|
[76]
Rebecca Evans: Thank you. I’ll just say something very
quick about carers. So, older carers and carers of older people as
well, that’s an area that I’m particularly interested
in. The British-Irish Council has been doing some work across the
nations on that specific issue, because we recognise that there are
particular issues that relate to people who care for older people
or are old themselves, especially if it comes to a point where the
individual is bereaved and there’s no longer that caring
role, which is how they’ve identified themselves for so long,
to undertake. So, that’s a specific area that I would like
our new carers strategy to be looking at as well, because
we’re refreshing that at the moment. So, that’s very
much on my radar.
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|
[89]
Rebecca Evans: Absolutely. That example I gave of Fantastic
Gymnastics is a specific project for women and girls in the BME
community, and, as I say, that’s a wonderful way, actually,
that we can reach out. There are great women community ambassadors,
and I think that we need to be working closely with them to hear
the voices of women who often aren’t heard as well. So,
I’m very keen that our engagement—. One of the benefits
of having a long engagement period is that it does give us the
opportunity to reach out to many communities.
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|
[90]
Dai
Lloyd: Diolch yn fawr. Mae’r cwestiynau nesaf o dan law
Caroline Jones.
|
Dai Lloyd:
Thank you very much. The next questions
are from Caroline Jones.
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|
[91]
Caroline Jones:
Diolch, Chair. Good morning. First of
all, I’d like to say that of paramount importance to
combatting loneliness and isolation is the provision of public
services, and the infrastructure is also extremely important. So,
I’d like to know what the Welsh Government is doing in
working closely with local authorities to protect public services
such as libraries and so on. Also, instead of just protecting what
we already have, in adding to these services, particularly, a
concern of mine is the provision of public toilets, as we’ve
gone over before, because this alienates such a huge amount of the
population: people with a disability, the elderly, who may suffer
from incontinence issues, and younger families with children. So,
unless we have the correct provision of public toilets, we are not
going to combat this loneliness and isolation, because people are
not going to know where they are—that lack of
provision—and they’re just going to stay in their
homes. So, I am concerned about what you’re doing to enhance
particularly this area, please.
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|
[92]
Rebecca Evans: Thank you. I’m acutely aware of the pressures
on public finances and the serious pressure the local authorities
find themselves under as well in terms of finances. So, I’m
always very wary and cautious about promising too much in terms of
new facilities and so on, because I think we have to be realistic
in terms of the settlement that we do have.
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|
[93]
But one thing that I would highlight
would be the community facilities programme, which, again, is one
of the programmes that Carl Sargeant has within his portfolio. That
is a capital grants scheme, and I understand it’s due to open
very shortly again for further applications, so I think that that
might be something that we would want to promote in our areas. That
offers small grants of up to £25,000 and larger grants of up
to £250,000. That’s for community-led projects that
will improve community facilities and provide opportunities for
learning, employment, improving health and well-being and so on.
So, it’s an opportunity for all kinds of projects. I think
there have been 60 projects so far, totalling nearly £17
million. So, it is a great opportunity for communities to see what
they can do in their local area as well.
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|
[94]
You did mention toilets, though, and I
know that this is something that you’ve been particularly
passionate—
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|
[95]
Caroline Jones:
I’m passionate about it, yes. I am,
actually.
|
|
[96]
Rebecca Evans: —about, and we had our recent public health
Bill, due to become an Act in the coming days. I think that that
has potential there then, in terms of improving access to public
toilets, given the responsibilities that local authorities will now
have in terms of mapping out the provision that they have locally
and also publishing it, which also gives people the opportunity to
scrutinise and put pressure on local authorities for additional
services, or for improved services, where they particularly see a
need for them. You mentioned, again, that it’s not just
important for older people, but you talked about young parents,
disabled people, and so on, and, actually, it’s important for
tourism, which is one of the things that we’re looking at as
well. And, again, that’s important for the local economy. So,
yes, you’ll have no argument from me on the importance of
public toilets.
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|
[97]
Caroline Jones:
Thank you. My next question is: we are
encouraging older people to stay in their own homes in the
community—how are you working to address the issue of keeping
people in their houses? Particularly, I’d like to know, for a
person who asked my advice, a person who is blind
and has physical disabilities,
doesn’t come out of her house very much at all and lives in
an area that is not conducive to her needs, really. The only person
she sees, apart from her daughter, who pays £12 each way in a
taxi to deliver her a meal daily, is a carer for 15 minutes a
day.
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[98]
I had thought that we were phasing out
15-minute visits in care, and I’d like to say that I have
personal experience of caring—it’s not just simply that
you have 15 minutes with that person, those 15 minutes include
getting out of your car, walking up the drive, getting in through
the door and going to the next visit. So, by the time all
that’s taken place and you’re on your way to the next
call, which is 15 minutes, you’re actually down to around
about 10 minutes, and there’s very little you can do in them.
So, I was wondering if you had any plans for phasing out the
15-minute visits, because I think that the issue that I’ve
just explained there—they’re not really working.
It’s impossible, particularly in bad weather, to get down
someone’s drive, unlock the door and so on. So, there are a
lot of things that we, I think, have to ask a carer what they can
achieve in that amount of time, really.
|
|
[99]
Rebecca Evans: I’ll ask Albert to start on this, and
then I’ll say a few things about different models of housing
that might support older people as well.
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|
[100] Mr
Heaney: Thank you very much, Minister. Thank you very much.
Absolutely crucial—the Regulation and Inspection of Social
Care (Wales) Act 2016 does indeed change the requirements around
visiting. It’s very clear and it was one of the amendments
that came forward during the proceeding through the National
Assembly of the legislation. It specifies the conditions, and
certainly what you’ve described today wouldn’t be
fulfilling those conditions. So, I think the first thing here is
about knowledge. It’s in making sure that we take forward
those issues and deal with them, and on a legislation basis, the
legislation is now being created to remove that.
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|
[101] Alongside that,
I think that the second point, then, to make is: I think this is
something that’s really important about how our inclusion in
terms of thinking differently as a workforce around the needs of
people who are isolated and lonely—. It’s important to
start from the base that, actually, it’s people themselves
who told us they want to live longer in their communities.
It’s not a strategy that we have developed saying, ‘You
have to live in your own home.’ It’s what people have
told us. However, what we need to be ensuring is that the attitudes
and the support around individuals connect them, and there are many
different ways in which people can be connected, and that can be
not necessarily always in terms of digital, as we’ve
talked—. For some people, it can be Skype, phoning and being
in touch with families. In other places, it will mean people having
direct, face-to-face contact, because it reduces that kind of
loneliness and isolation.
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|
[102] Caroline
Jones: Also, on the part of the carer doing these visits,
because, by the end of the day, you’ve accumulated a lot of
time for which you’re not actually paid. So, we have to look
at that angle as well, and they’re poorly paid anyway, to
start with, so it’s a double issue.
|
|
[103] Rebecca
Evans: We’ll be addressing both of those issues, because
we’ve just announced a consultation that deals with,
specifically, the importance of time and travel for care workers.
So, care providers now, under our proposals, which are out to
consultation, will have to clearly define care time and travel time
for their workforce, and they’ll have to take into account
things like rush-hour traffic and so on. So, they’ll have to
be realistic timescales, as well.
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|
[104] There’s
also the work that we’re doing in terms of restricting the
use of zero-hours contracts in the sector, as well. So, the
proposal is that an individual, having worked for three months for
a provider, will be offered a contract of the average hours worked
over that period if that’s what they would like—they
might choose fewer hours or they might choose to stay on a
zero-hours contract. But as long as there’s ongoing need for
the work, then those are the terms under which they would have to
have those contracts. So, hopefully, that will remove the abusive
and excessive use of zero-hours contracts in the sector as
well.
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|
10:30
|
|
[105] I did
want to say something about different models of housing, and the
importance of them for supporting older people, particularly in
tackling loneliness and isolation. Only yesterday, we celebrated
the expansion of the Shared Lives Cymru
scheme to older people in Wales. Shared Lives is a scheme where you
have adult placements within a family home, so it can be people
with all kinds of adult social care needs, but we’ve expanded
it to older people now. I think that hearing about those placements
where people are genuinely part of a family, and a family
community, in terms of breaking down loneliness and isolation, as
well as meeting their other needs, that’s a tremendously
exciting and new approach that Welsh Government has been funding in
various ways now since 2012.
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|
[106]
Also, I think extra care facilities can
provide a great opportunity as well for people in terms of being
able to live around people and have their needs met to the level at
which they are. If their needs grow over time then their needs can
be met in a greater way over time, but also the opportunity to be
part of a community life, I think, is tremendously important. We
have a commitment again to build more houses over the course of
this Assembly, and we’re keen that those houses are of
different types, of various types. So, it’s important that we
consider the various needs that people have over the course of
their lives. I know our building standards, for example, have
enabled people to live at home for longer, and I think that’s
something that we can very proud of. Our intermediate care fund
funding—£10 million of that is capital investment, and
again, that’s about having health and social care working
together to give the right kind of placements for people, which can
help tackle loneliness and isolation.
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|
[107]
Finally on this, I think the way the
Social Services and Well-being (Wales) Act 2014 is transforming
social care in Wales, and the way we deliver it, is really
important. This is now about putting the individual at the centre,
and having those ‘what matters’ conversations. Now,
previously, there is probably no way you would have understood that
what mattered to an individual was being able to get to church on a
Sunday, in the kind of way that we used to have those assessments.
So, putting the individual, and what matters to them, at the centre
I think can really help us address loneliness and isolation,
because probably what matters to them, really, more than anything
is being part of the community.
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|
[108]
Dai Lloyd: Angela on this point, before I move on.
|
|
[109]
Angela Burns: Just on this point, are you able to either review or
put encouragement to local authorities to review how they do all
their banding—their gold, silver and bronze
banding—when they’re doing housing allocation? Because
picking up on Caroline’s point, I’ve also had
constituents where one part of the family is separated from the
other part of the family, and it doesn’t seem very far in
terms of miles, but if you don’t have access to your own
transport, and suddenly somebody dies—so, say the mother is
moved, and the only opportunity she has to have a house is to go to
Haverfordwest, but her daughter’s living in Tenby, you know,
never the twain shall meet. I just wonder if there’s some
way—you talked about being able to go to church, or being
part of your community. County councils and housing associations
have got very strict criteria about what counts and how they judge
what kind of category you go into, and the kind of efforts and the
latitude that they’ll give you in trying to find a social
house for you. Are you able to influence that in some way to
encourage them to take note and accept that these community
reasons, or these familial reasons, are actually as important as
whether somebody should have a ground-floor flat because they have
a disability, or any other matter?
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[110]
Rebecca Evans: Well, I suspect this might be outside any of our
expertise, but I’ll certainly have a conversation with Carl
Sargeant about this issue.
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[111] Angela Burns: Yes, because it’s
about loneliness and isolation, isn’t it?
|
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[112] Rebecca Evans: And it’s about the
social model that we’re taking forward, putting the
individual at the heart of the decisions that affect them. So,
unless Albert’s got some secret housing knowledge—
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[113]
Angela Burns: I appreciate it’s not your bailiwick, but you
mentioned earlier that this needs to be a theme that runs through
all of Government, and that’s one area where you could make a
really quick difference and start tackling this problem now,
without having to wait some years before we have some
strategy.
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[114]
Rebecca Evans: I would just say, Chair, we’re completely
open-minded to suggestions as to what we can usefully do on this
issue. So, recommendations that committee has, be they for myself
or things that I can address with colleagues, I’m more than
happy to take on board.
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[115] Dai Lloyd: Caroline, did you have one
final question or has it been covered?
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[116]
Caroline Jones:
Yes, just one final question. My final
question’s on digital technology. Do you think that
there’s a risk that digital technology is replacing
face-to-face contact? You know, can you explain—? It may be
economical to use, but the face-to-face contact to some is of
paramount importance. So, how can digital technology help address
loneliness and isolation, and what is the contribution of the Welsh
Government’s digital inclusion programme, please?
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[117]
Rebecca Evans: Thank you. I think that digital inclusion is vitally
important for everybody. We shouldn’t assume, just because
somebody is an older person, that they don’t have an interest
or can’t benefit from digital inclusion. Equally, let’s
not forget about the importance of human face-to-face contact as
well. It doesn’t have to be a choice between one and the
other.
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[118]
We do have a £1 million a year
digital inclusion programme called Digital Communities Wales, and
that trains up volunteers who can work with people who don’t
have any digital skills thus far to be able to develop them. Then,
you do hear great stories about people being able to connect with
family who might be on the other side of the world, in a way in
which they hadn’t been able to before. So, it’s an
exciting project. We need to make sure that everybody can benefit
from digital technology but equally remembering it’s not a
substitute for a human.
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[119]
Caroline Jones:
Yes. Thank you.
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[120]
Dai Lloyd: Okay. Moving on to the next section—the role of
the voluntary sector. Dawn, I think some of this has been covered,
but carry on.
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[121]
Dawn Bowden: It has, yes. So, I want to focus,
really—because I think you have covered a lot of it around
the impact of preventative work and so on and the evaluation of
that, certainly in terms of social prescribing, but if
there’s other initiatives that you think are worthy of some
discussion we can come back to it. But the funding of voluntary
organisations continues to be a challenge. I think you’ve
already acknowledged that.
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[122]
You talked about the third sector grant,
but in your evidence, Minister, you talked about sustainable models
that are integrated into the heart of communities not being reliant
upon continued financial support for their existence. So, how do
you feel that those voluntary organisations are going to face those
challenges, and how are they going to really make themselves
sustainable going forward, without constant public
support?
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|
[123]
Rebecca Evans: Thank you. We definitely recognise the contribution
that the third sector can make to this agenda, but actually
to—I recognise the social services agenda more widely, and
that’s one of the reasons why the third sector has a seat at
the table on our regional partnership boards, because we see them
as valued partners in the delivery of services locally and the
shaping of services locally. Those partnership boards, between
them, through the intermediate care fund, have access to funding of
£50 million. So, there’s huge potential for the third
sector to be designing services locally and making the most of
their skills there.
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[124]
I do understand, though, how difficult it
is for many third sector organisations and particular projects in
difficult times in order to be able to access core grant funding. I
understand how joyous it is when you see project funding and how
sad it is when that project funding comes to an end as well. So, I
think that the Wales Council for Voluntary Action would be a great
opportunity for organisations to receive advice and support as to
how they might go about becoming sustainable in future. I
don’t know if Albert’s got something to say.
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[125] Mr Heaney: I
think the only thing to add to that, Minister, is we do currently
invest over £4 million through the WCVA. I think that’s
quite important in terms of co-ordination. I think this is about
getting a balance of the types of services that are crucially of
importance to people, and the third sector and the voluntary sector
play a crucial role in that. But also, I think it’s about how
do we generate the type of society that we want to have, around
community cohesion, so that people are connected. We may all have
our individual views about the type of society, our background,
where we live now.
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[126]
I’ve been a former director of
social services, out in the field, and I think it’s really
interesting because I never worried—and you might challenge
me and say I should have—but I didn’t worry when it
came to inclement weather because the Welsh community rallied
around and always responded. Probably what I worried about most
was: how do I generate that approach in our everyday working,
everyday life? So, I think, in terms of the balance, it’s
partly financial, but it’s also partly about the type of
communities and community cohesion that we are
developing.
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[127] We do have opportunities to think about the
adverse childhood experiences work that the Cabinet Secretary for
Communities and Children is leading upon as well. And that’s
about connecting differently, and there’s a pilot hub taking
place, so I think it’s important that we link into the
learning from that and see how that can build that kind of
community cohesion.
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[128] Dawn
Bowden: I am concerned that there is a sense that some of these
things will kind of grow organically, and, actually, I think
inevitably, there still needs to be structure and organisation
around how these organisations deliver some of this community
cohesion. And so I wouldn’t want us to be losing that as
well. And I think that’s the concern of a number of
organisations. One of the things that we’ve heard about is
that we’ve got lots of the larger organisations that are
actually not doing on-the-ground voluntary work anymore.
They’re more concentrated on policy work and developing
strategies, feeding into Welsh Government about the kind of things
that should be happening, but, actually, the on-the-ground stuff is
really happening with very small organisations now, and those are
the ones that are the most reliant on support and funding. So, do
you have any views on that and how we can continue to support
that?
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[129] Rebecca
Evans: I think that we do have a really rich variety of
organisations working in the third sector—for example, the
large organisations who have a really strong campaigning voice that
you referred to. But I do think that they do tend as well to be
delivering services locally as well, but, also, then the example
that Julie gave of the organisation that is working within library
settings and so on, providing very small scale, unfunded support
for people, just because people in the community realise that this
is a good thing to do. So, I think that it is good to have a really
rich patchwork of third sector organisations working anyway. But it
is important to have the structures that you talked about, which is
why, last November, we held an event for our regional partnership
boards, all of them—so, a national event. And part of that
was specifically looking at the important role of the third sector,
how they can engage with the third sector, and how they can support
organisations within the third sector.
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[130] So, I think that
there’s that reciprocal relationship between the partnership
boards, in terms of what we’re trying to do through
integrating health and social services, but also recognising the
vital role that the third sector plays. So, I think that
there’s a two-way relationship there. And, also, I would say
that Vaughan Gething and I, in our meetings with the chairs and
vice-chairs of the NHS organisations have made it clear to them
about the vital role that we see for the third sector, and the
importance that we put on them, as health boards and health
organisations, reaching out to the third sector as well, because,
with a greater focus on preventative services and so on, actually,
the third sector are often the ideal partners to deliver those.
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[131] Dawn
Bowden: Do you think that this is an opportune time, then, for
perhaps taking a different approach to some of these grass-roots
organisations? Men’s Sheds, when they spoke to us, for
instance, said that the kind of practical help they could do with
is being provided with accommodation. So, accommodation’s
lying empty somewhere, nobody’s using it—they
can’t afford to do it, but, if they could be given that
property to get their work off the ground and develop their work,
that would help enormously. So, do you see that kind of different
approach as being something that Government could look at?
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[132] Rebecca
Evans: I’m a huge fan of the work of Men’s Sheds as
well; I think they do incredible work. And I think there are
opportunities there for just, you would think, simple conversations
with local health boards or with others who have a direct interest
in supporting organisations such as Men’s Sheds because of
the preventative impact that they can have. Engaging with an
organisation such as Men’s Sheds for men experiencing
loneliness and isolation, or mental health or other
conditions—the fact of having that supportive network can
quite genuinely stop conditions from becoming exacerbated to a
point at which more formal services would be needed. So, I think
that it’s in everybody’s interest to be supporting
these kinds of organisations.
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[133] Dawn
Bowden: It’s just looking at the benefit in the round,
rather than isolating budget heads, isn’t it? That’s
the trick, I guess.
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[134] Rebecca
Evans: It is, yes. And that’s one of the reasons
we’re so focused on further integration of health and social
care particularly.
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[135] Dawn
Bowden: Okay. Thank you, Chair.
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[136]
Dai Lloyd: Ocê. Symud ymlaen nawr, mae’r
cwestiynau nesaf ar iechyd cyhoeddus, ac mae Julie Morgan yn mynd
i’w gofyn nhw.
|
Dai Lloyd: Moving on now, the next
questions are on public health, and Julie Morgan is going to ask
those questions.
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[137] Julie
Morgan: Yes. We have touched on this already, but what do you
see as the role of public health in tackling isolation and
loneliness?
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10:45
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[138]
Rebecca Evans: I know there are some debates as to whether
or not isolation and loneliness is a public health issue.
I certainly see it as a public health
issue. We talked at the start about it having the same impact on
you physically as smoking 15 cigarettes a day, and I know that
you’ve had evidence as to other physical impacts of it as
well. It’s a nationwide issue that needs to be addressed on
that kind of scale, so I recognise it as a public health issue
there as well. It’s something that can affect anybody at any
time as well. So, I recognise that it is a public health issue and
I see it very much sitting within the kind of work that we’re
trying to do in that area.
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[139]
Julie Morgan: So, in public health, they would be thinking of this
as part of all their work, integrated into all the strategies and
things that they’re doing.
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|
[140]
Rebecca Evans: Yes. Public Health Wales are very alive to the
importance of tackling loneliness and isolation. It’s one of
the reasons they’re so integrated or so critical to the work
that we’re doing on trying to develop the social prescribing
models as well. But, again, as I did say earlier, it’s not
just for Government, it’s not just for Public Health Wales,
actually, it’s an issue that all public bodies, and,
actually, voluntary groups and others, can have a big impact
on.
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|
[141]
Julie Morgan: And what about a specific role for local government?
Because that has been suggested to the committee, that there should
be—that local government should have some duty in improving
public health.
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|
[142]
Rebecca Evans: I think this is something that local authorities have
been calling for for many years, in terms of having a more
formalised role in terms of delivery of public health. On this one,
I’m not in agreement with the local authorities. I do think
it is better to have a national organisation leading on public
health issues for obvious reasons in terms of not only economics of
scale, but, actually, the knowledge and so on being situated in one
place. That’s not to say, though, that local authorities
don’t have an important role in tackling loneliness and
isolation. And, again, that’s about running through the
thread of everything that is done. So, social services will
obviously have a role to play and a keen interest in this. The work
that local authorities do through supporting community events,
community sports, community life—that will all run through
this as well. So, they have an important role, but, in terms of
formal—you know, where public health should sit in the
round—I think it’s right where it is.
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|
[143]
Julie Morgan: Did public health used to be a responsibility of
local authorities at some point? I think it did, didn’t
it?
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|
[144]
Dai Lloyd: In the last century—pre 1970. Before the
Minister was born, to be fair. [Laughter.]
|
|
[145]
Julie Morgan: No, I just—. In terms of bringing things
together, I wondered about having things as local as possible and
as integrated as possible. There does seem to be a role for local
government there, which, of course, you’re saying there
is.
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|
[146]
Rebecca Evans: Oh, there definitely is.
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|
[147]
Julie Morgan: But you think there should be an overall strategy
that is national.
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[148]
Rebecca Evans: Yes.
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|
[149]
Dai Lloyd: I would say beware the experience in England of
public health disappearing down all sorts of avenues of non-funding
when it’s taken out of health.
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|
[150]
Rebecca Evans: I just would mention the important role as well of
public health directors in each of the health boards as well.
They’re very alive to issues of loneliness and isolation and
so you’d be expecting local authorities to be working closely
with the public health directors. Because, again, it’s a
responsibility of all of us.
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|
[151]
Julie Morgan: Thank you.
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|
[152]
Dai
Lloyd: Reit. Yr adran olaf o gwestiynu ar y gwahanol fframweithiau
deddfwriaethol—Rhun.
|
Dai
Lloyd: Right. The final
section of questions are on the different existing legislation
frameworks—Rhun.
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|
[153]
Rhun ap
Iorwerth: Jest yn sydyn, a ydych chi’n meddwl ein bod ni’n
gwneud yn fawr o’r cyfleoedd drwy’r deddfwriaeth sydd
gennym ni i fynd i’r afael ag unigrwydd ac unigedd?
Rydw’n cyfeirio, am wn i, at ddau darn o ddeddfwriaeth yn
benodol, sef Deddf Llesiant Cenedlaethau’r Dyfodol (Cymru)
2015 a Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru)
2014.
|
Rhun ap
Iorwerth: Just quickly, do you
think that we are making all we can of the opportunities offered by
legislation to address isolation and loneliness? I’m
referring, probably, to two pieces of legislation specifically, the
Well-being of Future Generations (Wales) Act 2015 and the Social
Services and Well-being (Wales) Act 2014.
|
|
[154]
Rebecca Evans: I certainly think that the social services and
well-being Act offers us great potential in terms of addressing
loneliness and isolation for the reasons I mentioned earlier about
things being turned, really, to that ‘what matters’
conversation with the individual rather than a box-ticking kind of
exercise. So, there’s huge potential there in terms of what
can be done under that. And also through the—
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|
[155]
Rhun ap Iorwerth:
How much of that potential is already
being tapped into?
|
|
[156]
Rebecca Evans: Well, we’re already starting to see changes. As
you know, the Act has only been implemented since just over a year
now, so we’re already having those conversations. When you
speak to people working in social services, actually, the stories
that they have about how it’s completely changed the kind of
conversation that they have with the person receiving social care
and with their families as well, it is a big difference in terms of
the way that care is being packaged and delivered as well.
Obviously, you’ll be aware that we have a three-phase
implementation programme for the
Act. Albert might want to say a little bit more about that as well,
in terms of truly understanding the difference that it is
making.
|
|
[157]
Also, again, on a bigger scale, then,
moving away from the actual individual to the regions, our regional
partnership boards, as I said, have already completed their
population needs assessments, and they’re with Government
now. They have addressed and identified loneliness and isolation as
a particular theme within those as well, so, certainly, as a
vehicle for addressing loneliness and isolation, there are quite
exciting opportunities there.
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|
[158]
And, again, with the public services
boards, under the well-being of future generations Act, they have
also identified, through their local assessments of
well-being—I think nearly all of them have identified
loneliness and isolation as a key concern that needs to be
addressed there as well. And obviously I see an important role for
those two boards to be working seamlessly and together on issues
where there are cross interests, because we don’t want to be
going off in lots of different directions when actually the same
needs would have been identified.
|
|
[159]
Rhun ap Iorwerth:
Did you want to come in as
well?
|
|
[160]
Mr Heaney: Yes, please. Thank you. Thank you very much indeed. I
think the—no, the Social Services and Well-being (Wales) Act
2014 is making a significant contribution. It is changing the way
both that we practice and how we lead on the co-ordination of the
types of services and responses to provide care and support.
It’s not something that’s something that’s coming
to us in a cinema soon; it’s actually happening as we
speak.
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|
[161]
I’ve been working with the
Association of Directors of Social Services Cymru, on behalf of the
Minister, linking into Delivering Transformation, and, through the
work we’ve done with them, we’ve seen some very, very
tangible evidence base of the change agenda that’s taking
place. So, for our citizens, for our people, I think that is the
right focus. The Minister quite rightly mentions the regional
partnership boards. I would want to emphasise that the regional
partnership boards are statutory bodies that have been created
through the legislation, through the National Assembly, and they
bring those partners together.
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|
[162]
The population assessment is a
comprehensive piece of work that really gets to the bottom of some
of the issues that local communities are facing, and, within that,
then, the loneliness and isolation agenda very much is coming
through. The responses now as well—. We have
required—the Minister has required—the regional
partnership boards to produce, this year, joint area plans. So,
again, it gives us the opportunity and gives Assembly Members the
opportunity of looking at how those population needs assessments
are being responded to in a creative way that begins to respond
differently in terms of need.
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|
[163]
And, as the Minister quite rightly
mentions, she has developed a strategy about evaluation of the
legislation. I think one of the most important factors is that,
when we did the legislation, we co-produced it. We didn’t
just develop it ourselves. It was working with citizens and the
sector and, indeed, as part of the evaluation, citizens and the
sector will be part of directly evaluating, and, indeed,
we’re working with Co-production Wales to actually have
citizens leading on a significant part of evaluation, but looking
at how we set that up so that we evaluate going forward into the
longer term.
|
|
[164]
Rhun ap Iorwerth:
What would you make of suggestions that
resources, or lack of resources, mean the potential of the Act has
not perhaps been reached, especially in the context of preventative
measures?
|
|
[165] Rebecca Evans: Well, I’d say that one of the principles behind
developing the social services and well-being Act in the first
place was a recognition that we are facing increased pressures in
the social care sector, but also within the context of reduced
public finances as well. So, it does have a strong focus on
preventative measures and so on. So, I think that that has
been—. You know, it has informed our thinking throughout the
development from ‘Sustainable Social Services’, the
Green Paper, back in 2009, if I’m—or 2008; thereabouts,
anyway. So, it’s been a long piece of work, which has
recognised the fact that we are living in more difficult times in
terms of public finances. That said, there has been Delivering
Transformation grant funding provided to pave the way, really, for
this new way of working to local authorities, and that’s
nearly £3 million, and that’ll be transferred,
actually, to the RSG this year. Additional to that,
we’ve had funding of £1 million to support a training
programme for the implementation of the Act as well, to make sure
that we’re trying to make the absolute most of the
opportunities within the Act.
|
|
[166] Rhun ap
Iorwerth: Can you think—maybe this helps—can you
think of things that you are not able to do in terms of the
development of preventative elements because of scarce
resources?
|
|
[167] Rebecca
Evans: You can always do more when you have more money.
That’s just a fact of life. So, it’s a question really
of—
|
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[168] Rhun ap
Iorwerth: More of what?
|
|
[169] Rebecca
Evans:—targeting what we’re doing. We have this
year, as you’ll be aware, introduced or provided an
additional £55 million for social care in Wales. So,
£19 million of that will be going towards supporting the
introduction of the national living wage or the pressures that that
will put on the sector. Actually, we hope that by paying people
better, in combination with all of the other work that we’re
doing—in terms of bringing, for example, the domiciliary care
sector to be a regulated sector and so on, and the work that
we’re trying to do to improve terms and conditions more
widely, and respect for the role through Social Care Wales, for
example—that that will stop some of the turnover in the
sector, which costs. Every time you have a new member of staff,
it’s £2,500. So, there are things that we can do by
investing upfront that will actually have savings further down the
line as well. We just have to be smart in the way in which we
target our limited money.
|
|
[170] Mr
Heaney: Just to come in and support. Thank you very much for
the questions. The Minister’s just explained some of the
budget, but underneath that, the Minister also has been very
detailed in terms of, for example, the intermediate care
fund—a £60 million fund in total: £50 million
revenue, £10 million capital—and directing that into
the space of prevention and earlier interventions. Indeed, in terms
of the consequential funding—the £20 million
that’s been allocated out—again, a substantial
proportion of that, £8 million, is directly focused on some
of the critical pressure points around children and moving into the
age of care for looked-after children’s services, thinking
much more preventatively and creatively around how we support those
children and their families in their communities. So, I think
it’s one thing allocating funding, but the measure that the
Minister’s introduced is making sure that’s targeted,
moving into the prevention and early intervention, as a particular
focus.
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|
[171] Rebecca
Evans: And also the £3 million for local authorities in
terms of developing a national approach to respite, for example.
Again, that leads into the whole preventative agenda in terms of
giving carers a break and enabling them to carry on caring.
|
|
[172]
Dai Lloyd: Ocê. Rhun, ti’n iawn?
|
Dai Lloyd: Okay. Rhun, are you
content?
|
|
[173] Rhun ap
Iorwerth: I think the only other thing we need to
ask—
|
|
[174] Dai
Lloyd:—has been covered.
|
|
[175] Rhun ap
Iorwerth: Yes.
|
|
[176] Dai
Lloyd: Dyna ni. Dyna ddiwedd y
sesiwn. Diolch yn fawr iawn i chi am eich cyfraniadau a diolch eto
am y dystiolaeth ysgrifenedig ymlaen llaw. A gaf i ymhellach
gyhoeddi y byddwch chi’n derbyn trawsgrifiad o’r
cyfarfod y bore yma i gadarnhau ei fod yn ffeithiol gywir? Gyda
chymaint â hynny o eiriau, a allaf i ddiolch i chi’ch
tri, unwaith eto, am eich presenoldeb y bore yma? Diolch yn fawr
iawn i chi.
|
Dai Lloyd: That’s it.
That’s the end of the session. Thank you very much for your
contributions and thank you again for the written evidence
beforehand. May I now announce that you will receive a transcript
of the meeting this morning to check for factual accuracy? So, with
those few words, may I thank the three of you once more for
attending this morning? Thank you very much.
|
|
10:58
|
|
Papurau i’w
Nodi
Papers to Note
|
|
[177]
Dai Lloyd: Ac i fy nghyd-Aelodau, gwnawn ni symud ymlaen yn
syth i eitem 3, gyda’r papurau i’w nodi. Yn deillio
o’n hymchwiliad i ofal sylfaenol, bydd Aelodau eisiau nodi
llythyrau ynglŷn â gwybodaeth ychwanegol gan fwrdd
iechyd prifysgol Betsi Cadwaladr ynghylch arian datblygu clystyrau.
Hefyd, gwybodaeth ychwanegol gan fwrdd iechyd prifysgol Hywel Dda
ynghylch arian datblygu clystyrau. Ar yr un un thema, gwybodaeth
ychwanegol gan fwrdd iechyd prifysgol Cwm Taf ynglŷn ag arian
datblygu clystyrau, a hefyd gwybodaeth ychwanegol gan fwrdd iechyd
prifysgol Caerdydd a’r Fro ynghylch arian datblygu
clystyrau.
|
Dai Lloyd: To my fellow Members,
we’ll move on straight away to item 3, papers to note.
Following from our inquiry into primary care, Members will want to
note letters regarding additional information from Betsi Cadwaladr
university health board regarding cluster development moneys. Also,
additional information from Hywel Dda university health board
regarding cluster development moneys. On the same theme, additional
information from Cwm Taf university health board regarding cluster
development moneys, and additional information from Cardiff and
Vale university health board regarding cluster development
moneys.
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[178]
Yn benodol, felly, ynghylch ein
hymchwiliad presennol i unigrwydd ac unigedd, bydd Aelodau hefyd
wedi gweld yr adroddiad swmpus yna sy’n cynnwys rhagor o
wybodaeth gan y Samariaid, ar arolwg y Gymdeithas Frenhinol er
Iechyd Cyhoeddus ar effaith y cyfryngau cymdeithasol ar les
meddyliol pobl ifanc a chost hunanladdiad. A oes unrhyw un eisiau
codi unrhyw beth ar y papurau yna, neu fe awn ni’n syth jest
i’w nodi nhw gan eich bod chi wedi eu darllen nhw mewn
manylder, yn naturiol? Pawb yn hapus. Grêt.
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Specifically regarding our current inquiry
into loneliness and isolation, Members will have also seen the
substantial report that includes more information from Samaritans
Cymru on the impact of social media on young people’s mental
well-being and the cost of suicide. That is the Samaritans on the
Royal Society for Public Health survey. Are there any comments on
those papers, or we’ll just note them immediately as
you’ve read them thoroughly, naturally? All content.
Great.
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10:59
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Cynnig o dan Reol
Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd o Weddill y
Cyfarfod
Motion under Standing Order 17.42 to Resolve to Exclude the Public
from the Remainder of the Meeting
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Cynnig:
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Motion:
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bod y pwyllgor yn penderfynu gwahardd y cyhoedd o
weddill y cyfarfod yn unol â Rheol Sefydlog
17.42(vi).
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that the committee
resolves to exclude the public from the remainder of the meeting in
accordance with Standing Order 17.42(vi).
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Cynigiwyd y cynnig.
Motion
moved.
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[179]
Dai Lloyd: Rŷm ni’n symud ymlaen felly i eitem 4
a chynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd
o weddill y cyfarfod. Pawb yn gytûn. Rwy’n gweld bod
pawb yn gytûn, felly symudwn ni i gyfarfod preifat yn
awr.
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Dai Lloyd: Moving on therefore to item
4, the motion under Standing Order 17.42 to resolve to exclude the
public from the remainder of the meeting. All content. I see that
we are all content, so we’ll move to meet in private now.
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Derbyniwyd y cynnig.
Motion
agreed.
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Daeth rhan gyhoeddus y cyfarfod i ben am
10:59.
The public part of the meeting ended at 10:59.
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