Ideas and options for social care in Wales

This afternoon the Minister for Health and Social Services made a statement about the development of ideas and options for paying for social care. The Minister has identified “real options for the nation” and wants to build a consensus on the best way forwards.  You can read the statement here.

 

TITLE Update on the Work of the Inter-Ministerial Group on Paying for Social Care
DATE 4 February 2020
BY Vaughan Gething AM, Minister for Health and Social Services

“Llywydd, thank you for the opportunity to update the Chamber on the work of the Inter-Ministerial Group on Paying for Social Care.

There is broad concern over the quality and sustainability of our social care. If we are to have a meaningful conversation we have to consider seriously the funding it requires and how we raise this. Social care is a significant budget pressure for local government, with budgets rising annually by around 5.5 per cent over recent years. Across each area of Wales, and each different political leadership, there is a recognition of the scale of the challenge.

This Government has prioritised social care by making it one of the six priorities in our national strategy, Prosperity for All. We have delivered on our commitment to raise the capital limit for residential care to £50,000.  In Wales, we offer the most generous allowance in the UK for the savings and other capital a person can keep without using these to fund their care. But we believe we need to go further. This is what the Inter-Ministerial Group has been grappling with.

The existing pressures on social services are very real. We have considered Professor Holtham’s proposals for a social care levy designed to meet the needs of an ageing demographic.  However, pressures exist across each of the demographic groups, including for working age adults as well as older people. Recent research the Inter-Ministerial Group commissioned from LE Wales highlights the uncertainties in projecting future expenditure needs for social care. Using five illustrative scenarios, LE Wales estimates the need for additional funding over the next three financial years could range from £35 million a year by 2022-23 to an additional £327 million a year by the same point. These amounts are projected just to maintain, not extend, current provision.

As I said, we want to go further.  Our ambitions for social services in Wales must keep pace with people’s needs and expectations. This inevitably with require additional resources and  investment.

In previous debates we have all recognised the amazing work done by social care staff up and down the country, delivering vital care in our communities. We have discussed the need to drive up the quality of care and the vital role it plays in helping people to live quality lives, independently, in settings which meet their needs and expectations.

Social care free at the point of need is an aspiration many of us share. However, we estimate providing just free personal care, and accommodation in a care home, is likely to cost over £700 million a year. This would be well beyond our ability to provide even if we had a desire to do so. Therefore, our focus has been on developing funded options which are sustainable and deliver better quality care.

With this in mind the Group has considered a number of areas where investment could have the greatest impact, whilst looking to build on existing initiatives and policies.  This includes exploring new models of care; possibly off-setting elements of social care charges; and a consideration of how to deliver service quality improvements from investment in the social care workforce.

There is widespread recognition of the importance the workforce plays in the quality and effectiveness of social care. However, pay and terms of employment do not reflect this, resulting in an estimated annual 30 per cent turnover in the domiciliary care workforce.

In my view it is important we identify as a priority what we can do to tackle retention and improve continuity and quality of care. This should support our approach on the foundation economy and fair work.

We are already driving new models of integrated health and social care through the Transformation Fund I introduced as part of a Healthier Wales. We will draw on the learning from this as appropriate. The Group is keen to deepen the benefits of our Integrated Care Fund, where its capital programme has strengthen the link between good quality housing and good health and wellbeing outcomes. We are exploring the development of new models of housing related care with the aim of keeping more people independent and out of residential and acute care for as long as possible.

As I said we already provide a generous charging framework but we recognise we need to keep improving what we offer. The Group is exploring options around the introduction of funded non-residential care; a contribution towards the cost of residential care for those that pay the most; and the provision of funded personal care for anyone eligible.

Taking forward any or all of the options I have outlined will require investment over and above the resources required to maintain current service levels. We have previously debated the possibility of raising taxes in Wales to generate resources for social care. We need to be confident of delivering a sustainable funding solution that works for Wales.

The Group has not limited its thinking. It has considered the joint work on the funding of social care by the Select Committees on health and social care, and communities and local government, in the last UK parliament. It has also reviewed the available evidence of international models. These illustrate the challenges in establishing a new funding model for social care.  Where countries like Germany and Japan have well established models of funding social care, or models of long-term care insurance, these were based on a clear acceptance of individual contributions for social care insurance.

We have a deep-rooted respect for our NHS and remain protective of access to free health care at the point of need. The established international models reviewed required changes to remain viable, and have restricted benefits or raised financial contributions.  This would imply raising taxes to fund social care would need to align closely with the specific outcomes we want to achieve to deliver a sufficiently flexible and sustainable solution.

 

There are real choices here for the nation. Building a consensus around the need for change and the nature of that will be fundamental to delivering reform.  Therefore, I am keen to start this conversation today with you and wider stakeholders, to inform our direction of travel and build a picture of our collective vision for the social services we want in Wales”.

 

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