Health and Social Care Committee’s Inquiry into Residential Care for Older People in Wales



Mark Drakeford: Yr ymchwiliad hwn yw’r darn mwyaf helaeth o waith y mae’r pwyllgor wedi ymgymryd ag ef hyd yma yn ystod y pedwerydd Cynulliad. Wrth wneud hynny, ein man cychwyn oedd ceisio gweld y system o safbwynt y defnyddiwr. Gwnaethom ganolbwyntio ar y penderfyniad hanfodol cyntaf i fynd i ofal preswyl, gan edrych ar y dewisiadau sydd ar gael i bobl hŷn, a’r cyngor y gallant hwy a’u teuluoedd ei gael. Wedyn, bu inni ystyried gallu’r sector i gwrdd â’r gofyn; ansawdd gwasanaethau gofal preswyl a phrofiadau defnyddwyr gwasanaethau a’u teuluoedd wrth ddefnyddio’r gwasanaethau hyn.
[This inquiry has been the most extensive piece of work undertaken by the committee to date during the fourth Assembly. In doing so, our starting point was to try to see the system from the point of view of the user. We focused on the first crucial decision to enter residential care, looking at the choices available to older people, and the advice that they and their families can draw upon. Thereafter, we considered the capacity of the sector to meet demand; the quality of residential care services and the experiences of service users and their families in using these services.]


Caiff ansawdd gofal preswyl ei benderfynu, yn fwy nag unrhyw beth arall, gan y rheini sy’n darparu’r gwasanaethau hanfodol hyn. Canolbwyntiodd ein hymchwiliad ar sut beth ydyw i weithio yn y sector ac effeithiolrwydd y trefniadau rheoleiddio ac archwilio o ran datblygu gweithlu uchel ei barch sydd â chymwysterau da, a rhoi arwyddion clir am ansawdd i ddefnyddwyr a darparwyr. Fodd bynnag, nid oedd y pwyllgor yn dymuno edrych ar y sefyllfa bresennol yn unig. Roeddem am edrych ymlaen, i weld beth yw’r ffordd orau o lunio gwasanaethau gofal preswyl ar gyfer y dyfodol, gan edrych ar fodelau gofal newydd sy’n dod i’r amlwg, gan gynnwys cydbwysedd darpariaeth y sector cyhoeddus a’r sector annibynnol.
[The quality of residential care is determined, more than anything else, by those who provide these essential services. Our inquiry focused on what it is like to work in the sector and the effectiveness of the regulation and inspection arrangements in developing a well-regarded and well-qualified workforce, and sending out clear signals about quality to users and providers. However, the committee did not wish to look at the present situation alone. We wanted to look ahead, to see how residential care services can be best shaped for the future, looking at new emerging models of care, including the balance of public and independent sector provision.]


Cyn troi at fanylion yr adroddiad, hoffwn gymryd y cyfle hwn i ddiolch i fy nghyd-aelodau ar y pwyllgor am eu hymrwymiad i’r ymchwiliad hwn, ac i bawb a gyfrannodd dystiolaeth ysgrifenedig a llafar i’n harwain ar ein taith. Hoffwn ddiolch yn arbennig hefyd i’r Dirprwy Weinidog. Mae’n bleser mawr inni gyd i’w gweld hi yn ôl yn ei sedd yn y Cynulliad y prynhawn yma. Nododd yn fuan yn ystod ein gwaith yr hoffai gadw mewn cysylltiad agos â’r ymchwiliad, a gwyddom o’r dystiolaeth a ddarparodd i ni, ei bod wedi gwneud yn union hynny.
[Before turning to the detail of the report, I would like to take this opportunity to thank my fellow committee members for their commitment to this inquiry, and to all of those who contributed both written and oral evidence to guide us on our journey. Let me also say a particular word of thanks to the Deputy Minister. It is a great pleasure for us all to see her back in her seat in the Assembly this afternoon. She indicated early in our work that she would like to keep in close touch with the inquiry and we know, from the evidence she provided to us, that she did just that.]


Roedd casglu barn a phrofiadau’r teuluoedd hynny sydd â phrofiad uniongyrchol a diweddar o wasanaethau gofal preswyl yn brif flaenoriaeth i ni yn ystod yr ymchwiliad hwn. Bu inni sefydlu grŵp cyfeirio allanol a oedd yn cynnwys pobl a oedd ag aelodau o’r teulu naill ai’n parhau i fod mewn gofal preswyl neu wedi bod mewn gofal preswyl yn ddiweddar. Cysgododd y grŵp hwn waith y pwyllgor ac ystyriodd yr un dystiolaeth yng ngoleuni eu profiadau eu hunain. Bu inni ystyried barn y grŵp drwy gydol ein hymchwiliad, a hoffem gofnodi ein diolch cywiraf i’r aelodau a’r hwyluswyr am y gwaith sylweddol a wnaethant.
[Capturing the views and experiences of those families who have direct and recent experience of residential care services was a key priority for us during this inquiry. As such, we established an external reference group made up of people with family members who were either still, or had recently been, in residential care. This group shadowed the work of the committee and considered the same evidence in light of their own experiences. We drew on the views of the group throughout our inquiry, and would like to put on record our sincere thanks to the members and facilitators for the substantial work that they undertook.]



Turning to the detail of the Government’s response, as a committee, we were very pleased that the Minister has accepted all the recommendations we made, at least in principle. This is an area in which we know that the Government is investing a great deal of time and energy, not least via the recently introduced Social Services and Well-being (Wales) Bill. A number of our recommendations are closely linked to the Bill. Indeed, part of our reason for choosing to undertake this as our policy inquiry was our awareness that the Bill was in preparation. We now look forward to undertaking Stage 1 scrutiny of the Bill over coming weeks. 
During the course of our inquiry, the Deputy Minister announced that issues of regulation and inspection of services were to be moved to a new White Paper. The crucial role of regulation and inspection was a clear theme throughout our inquiry, not least among the members of our reference group. Reference to the White Paper is frequent in the Government’s response to our report, and we will certainly, as a committee, want to return to these matters when it is published.
Against this broad welcome of the Government’s response to our report, I would like to concentrate on a small number of recommendations where the Government has indicated acceptance in principle rather than in full, and I am sure that other members of the committee will want to draw attention to other aspects of our report.

We recommended that the Government works with partners to develop initiatives that give residents, their families, and their carers a greater voice and control in residential care—a theme at the heart of the social services Bill. We put forward some practical proposals as to how that might be achieved. We have compulsory school councils in our schools and we have retained community health councils in Wales, so we suggested that a residential care home, once it reaches a certain size, should be under an obligation to have a forum in which residents, family and carers can get together to make their voices heard collectively. In accepting this recommendation in principle, I look forward to hearing what the Minister has to say about ways in which practical action on the ground will provide residents and their families with real confidence that their voice is to be strengthened throughout the system.
In a second recommendation, we set out the background of the Southern Cross collapse and other enduring concerns in the sector to call on the Government to improve the financial scrutiny of independent providers and re-visit arrangements for a fit-and-proper-person test for those acquiring care homes. That recommendation was accepted in principle. The recently published Francis report underlines our concerns with a new urgency. It concluded that there is a need for those holding positions of responsibility within the health service to meet fit-and-proper-person criteria. If holders of significant responsibility within direct public services are expected to meet such a test, is it not true that we should expect those whose accountability is far weaker to meet a similar standard? 
Finally, looking ahead, we provided a set of recommendations aimed at securing a greater diversity of provision in the residential care sector in Wales. Our endorsement of innovative services being developed in the not-for-profit sector has been accepted in principle by the Government. Our conclusion, however, was that while the Welsh Government’s encouragement of this sector has long been evident, there is now an urgent need to move from being simply an enabler in this field to taking a more active role in shaping and delivering a model that is fit for the future. There are important commitments in the social services Bill that will make a real difference. However, we say that there is more that could, and should, be done. 
It is the Health and Social Care Committee’s intention routinely to revisit the inquiries we have undertaken before the end of this Assembly term. This inquiry will be no exception. The Government has accepted, in full, an important set of our recommendations, which we will all want to see being delivered on the ground. By the end of the fourth Assembly, we will want to see, for example, that no older person routinely enters residential care directly from a hospital bed. We will want to know that all older people are offered an assessment of need, whether they are funded by the state or are paying for care themselves. We will also be checking that a simple but effective information service has been established in Wales.
The way in which a society looks after its older people is a measure of its civility. One day, we will all reach old age, we hope, and may need the help of others to live a meaningful and fulfilling life. For those who end their days in residential care, we, as a committee, hope that our report will contribute to that measure of civility in Wales. I look forward to hearing the contributions of others to this important debate.


Darren Millar got our debate off to an excellent start when he reminded us that the number of people going into residential care in Wales, despite the fact that the number of older people is rising—as a number and as a proportion of the population—has fallen year on year for the last 10 years, and is due to continue falling for the next five years at least. That is a trend that we as a committee endorse. Kirsty Williams referred to the importance of reablement; the evidence that we took about the contribution that reablement can make to pressing that agenda further was powerful.


Janet Finch-Saunders referred to the importance of common disabling conditions. We took really important evidence about the small things that the health service can do to help people to stay in their own homes, healthier and for longer. That is a really important thrust of our report. However, as Lindsay Whittle said, there will always be a need for residential care, and it is vital that we do not fall into the trap of believing that residential care will always be a last resort, where people are driven to it because there is nothing else for them. On every single visit that we as a committee made to residential care homes in Wales, we met people who said to us, ‘I’m here because I want to be here, and because I have chosen to be here. That means that this place needs to be as good as it possibly can be for me.’ As we have heard, that means that it should attend to people’s spiritual, physical, cultural and social needs.
Fel y dywedodd Alun Ffred, mae’n bwysig hefyd meddwl am anghenion ieithyddol. Nid oes argymhelliad ar iaith yn ein hadroddiad, ond mae’r adroddiad yn cynnwys nifer o gasgliadau. Mae casgliad 8 yn nodi’n glir bod angen sicrhau bod recriwtio a hyfforddi staff yn helpu sicrhau bod cyfathrebu da rhwng staff gofal a’r bobl sy’n byw mewn cartrefi gofal yn cael ei hwyluso. Bu i ni godi’r cwestiwn hwnnw gyda nifer fawr o dystion a ddaeth i’r pwyllgor: gofynnais i, a gofynodd Elin Jones ac aelodau eraill y pwyllgor, y cwestiwn hwnnw. Pan oeddem yn Sir Gâr, clywsom fod yr awdurdod lleol wedi cadw nifer o gartrefi preswyl yn ei ddwylo ei hunan oherwydd ei bod yn haws iddo felly sicrhau bod gwasanaethau ar gael yn yr iaith Gymraeg, ac mae hynny’n hynod o bwysig i’r bobl sy’n byw yn y cartrefi hynny.

[As Alun Ffred said, it is also important to consider linguistic needs. There is no recommendation on language in our report, but the report includes a number of conclusions. Conclusion 8 states clearly that we need to ensure that the recruitment and training of staff helps to ensure that good communication between care staff and care home residents is facilitated. We raised that question with many witnesses who appeared before the committee: I, Elin Jones, and other members of the committee, asked that question. When we were in Carmarthenshire, we heard that the local authority has kept a number of residential homes in its ownership because that makes it is easier for it to ensure that services are available in Welsh, which is very important to those living in those homes.]


Therefore, we absolutely recognise that. To take up a point that Janet raised, that is particularly important in the case of dementia, when people will be struggling with communication in any case, and where acquired language may become particularly problematic and people will wish to return to the language in which they are most comfortable in communicating. Therefore, it was very encouraging to hear what the Deputy Minister for Children and Social Services had to say about the steps that the Welsh Government intends to take in response to the report, both through the Social Services and Well-being (Wales) Bill, the White Paper, and other actions that are in the hands of the Government.


When I look back at our inquiry, if I think of the one thing that remains with me most clearly, it is the message that we heard from so many people that the decision that you make for someone to go into residential care is a lonely, difficult and often guilt-ridden one. When we make other life-changing decisions, such as those related to sending our children to school, choosing jobs and going into hospital, we are generally able to draw on our own experience or the experience of our neighbours, friends or other family members. However, making the decision about residential care is a once-in-a-lifetime decision. Knowing where to go for help, knowing how you can get reliable guidance and finding ways to make the right decision for you or for family members are things that, time and again, members of the reference group and witnesses who came before us emphasised as things that we need to improve in Wales.


This is an agenda that cuts right across politics, the committee and the Chamber. I am sure that we are all united in wanting to do the very best for older people who live in Wales. The White Paper and the Bill will be important opportunities to make sure that we get that right. We look forward to working with the Deputy Minister on this agenda to ensure that we secure in practice those improvements that we are all signed up to in principle.