Y Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus
Public Accounts and Public Administration Committee12/05/2022
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Mark Isherwood AS||Cadeirydd y Pwyllgor|
|Mike Hedges AS|
|Natasha Asghar AS||Cadeirydd dros dro|
|Peredur Owen Griffiths AS||Yn dirprwyo ar ran Rhys ab Owen|
|Substitute for Rhys ab Owen|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Adrian Crompton||Archwilydd Cyffredinol Cymru|
|Auditor General for Wales|
|Dave Street||Cymdeithas Cyfarwyddwyr Gwasanaethau Cymdeithasol Cymru|
|Association of Directors of Social Services Cymru|
|Dr Andrew Goodall||Ysgrifennydd Parhaol, Llywodraeth Cymru|
|Permanent Secretary, Welsh Government|
|Heléna Herklots||Comisiynydd Pobl Hŷn Cymru|
|Older People's Commissioner for Wales|
|Maria Bell||Cymdeithas Llywodraeth Leol Cymru|
|Welsh Local Government Association|
|Matthew Mortlock||Archwilio Cymru|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Elizabeth Foster||Dirprwy Glerc|
|Owain Davies||Ail Glerc|
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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.
Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.
Dechreuodd y cyfarfod am 09:16.
The committee met in the Senedd and by video-conference.
The meeting began at 09:16.
Bore da, croeso. Good morning and welcome to members of the committee. Apologies for absence have been received—. Or is that not the case now? Fay, do we have any apologies for absence?
Yes, we've received apologies from Rhianon Passmore.
Thank you very much. Do Members have any declarations of registrable interest they wish to declare? No. Thank you. Headsets are available in the room for you for translation and sound amplification, translation on channel 1 and amplification on channel 0. Please ensure that any electronic devices you have are switched to silent, and in the event of an emergency, an alarm will sound and ushers will direct everyone to the nearest safe exit and assembly point.
We move on to our first evidence session today on care home commissioning for older people, our third session on this issue. We have two witnesses, and I welcome them to the meeting. I would be grateful if you would state your names and role for the record.
Yes, certainly. My name is Dave Street. I'm director of social services and housing at Caerphilly County Borough Council, but I'm here today in my capacity as joint chair of the national commissioning board. Thank you.
Maria Bell ydw i—I'm Maria Bell. I'm the head of policy for the national commissioning board, which is hosted by the Welsh Local Government Association.
Thank you very much. Welcome, both. As you'll expect, we have a number of questions, and I'd like to—. Well, I do; I ask Members and witnesses to be succinct to enable us to cover the wide range of issues that this topic has generated. I'll begin with the first questions myself, seeking to explore issues around making the system less complex and easier to navigate from a service user perspective. So, what in your view are the main issues that make the system for care home commissioning across Wales complex and difficult to navigate? I don't know which of you might wish to go first.
Shall I make a start, Dave?
Fine, Maria, yes.
One of the issues is the differences in eligibility for funding for care home placements across health boards or in the NHS and local government. So, obviously, there are different types of placements—residential placements, nursing care placements and complex care placements. So, I think one of the issues is the differences in policy across that, and the eligibility judgment then is around the individuals, their needs, for funding of such placements, and the difficulties, under a period of austerity, of those statutory organisations agreeing who is responsible for funding. So, I think that's one of the elements.
Thanks, Maria. I would agree. I think the other thing is that the majority of placements are actually funded via local authorities, there are some instances where people have to fund their own accommodation because of their resources, and of course we've got the added complexity for some people that they could be eligible for continuing healthcare funding from the local health board. So, it's a very complex funding pattern as well.
Thank you. You generally find in your experience—[Inaudible.] What sort of relationship do you find in practice you have between the local authorities and the health boards when it comes to working together on this?
I think generally it's very sound. Residential care is the responsibility of local authorities; there's very little input from health boards. Nursing care is clearly different, with the health boards responsible for funding nursing care. That genuinely doesn't cause any problems. I think where we do have difficulties on occasions is the whole continuing healthcare agenda, around whether people are eligible for community health council funding and the services that brings. I think that does bring a fair amount of discord between local authorities and health boards and, as I said earlier, a great deal of complexity for the people who use those services.
If I may, Chair, I think there's also complexity where there are specific grants related to short-term care provision, so, whether it be a step down from hospital six-week rehabilitation, or around about that, discharge to recover and assess, where an individual's placement may be covered by a short-term grant, and then, obviously, if there's ongoing funding responsibility, determining whether that's the right placement, if somebody's in a nursing placement and it's deemed that they don't have nursing needs, or whether it's complex. I think that adds complexity into the system as well.
Okay. Thank you. Can you suggest any potential quick wins to simplify the process that could be done easily, or could be avoided or stopped?
I know I—
If you had a magic wand that you could—.
I think, from a CHC point of view, greater clarity for people, greater consistency around the application of eligibility, continuing healthcare, would be a great help. I think, as far as the rest of the process is concerned, certainly in my experience, people seem to navigate it very well.
The intention of the pooled funds was one single funding pot for placements in care homes, but I think the policy that underpins that, which is built on eligibility for different funding streams, is what causes the difficulties around pooled funds. So, I suppose a way, if you were designing a system from scratch, would be to have a single fund that is neither local authority or health board but both, with much more straightforward eligibility, potentially, for that funding. So, that may be an option. I guess you'd have to think about it, if you were designing the system from scratch, rather than trying to change the current system that we have, but I think there's potentially a disconnect between the policy and some of the aspirations around much clearer funding.
Thank you. What do you believe are the underlying reasons and the cause of the very significant backlog in hospital discharges into care settings, including care homes, and whether public sector partners are doing enough to work collaboratively to resolve these pressures?
I'll come in there, Chair, if I may. I think the biggest issue that we have, really, is domiciliary care support. It's our inability to recruit and retain domiciliary care workers. As a consequence of that, our ability to keep people in or discharge people to their own home is affected and, by definition, that means that some people then get discharged to care homes. That's unfortunate. It's not the way the service should work; it's not the way the system is designed. But, as a director, I am far, far more worried about the state of the domiciliary care sector than I am around the residential care sector at the moment.
I would agree, Chair. Our data shows that there are a number of vacancies within the care home sector. Some care home operators are concerned about the level of vacancy and the sustainability of that, but, potentially, in some areas, in some services, we have an excess above our requirements for care home placements. The fundamental underpinning issue is the availability of workforce.
We do also have issues, or we certainly experienced issues during the period of the pandemic, where some care home placements are technically vacant, but actually can't be filled because of workforce shortages or other issues such as infections within the home. So, there may be embargoes on placements for various different reasons, but also qualitative issues where perhaps a home may be in an 'escalating concerns', and there is an agreement between the home and the commissioners that new placements won't be made. So, there's a range of different reasons, but, overall, the data suggests that there are vacancies available for people seeking care home placements. And we've also seen, over the winter period, because of the shortage of domiciliary care, that interim or short-term placements have been made in care homes, as a step down from hospital whilst individuals are waiting for care and support at home.
Okay, thank you. Can I bring Mike Hedges in to take up the questions?
Can I continue with pooled funding? The first question is: could better use of pooled funding arrangements for older people's care commissioning be made?
I don't think there's any question that that would be the case. I think the Audit Wales report reflects that, certainly, in Wales, perhaps the spirit of the pooled fund has been met, but opportunities haven't been made to maximise their benefit. I think there are two reasons for that. I think, at a local, political level, there was real concern around the prospect of some authorities cross-subsidising other authorities in a pooled fund. I think that made it very unattractive politically. I think, from an officer perspective, my main concern was, certainly in my experience, that local authority spend on residential care is reducing, and it's reducing because we are spending more and more money on domiciliary care because we're getting better and better at keeping people in their own home.
My concern around pooled funds was that, if that money is in a pooled fund, and I want to utilise that for a different purpose in the future, could it be released from the pooled fund, or would it be there forever and a day? Personally, I wouldn't have started on pooled funds in care homes for older people; it's very high volume. I think there were other areas within social care and health where perhaps pooled funds would have had a more effective impact in a shorter period of time.
I would tend to agree. I think the feeling within WLGA is that pooled funds may work better on a local level. We understand the difficulty that health boards with a number of local authorities in their areas have in operating a number of pooled funds. But, certainly, the feeling is that, if pooled budgets were the right thing, then they would be better to be at a local level, but also that it's almost the last thing that you would do in the chain of integrated working, that there are other things that we would do around collaboration, such as the joint contracts that we have in place in a number of regions, work on single fee methodologies. And so that's almost the end of the mature process of integration and collaboration, rather than one of the first activities that you would undertake, I think, because of the risk-sharing issues. The KPMG review really looked at the complexity around risk sharing.
Twenty years ago, when the first idea of pooled funds came in—and I was on both the health board and leader of the council at the time—the problem was at that stage is that health thought, 'We've got some social services money to spend', and social services thought, 'We've got some health money to spend.' Have we moved on from there?
I think we've moved on to a degree. I wouldn't say those sorts of views have gone completely; they probably haven't. I think Maria has hit the nail on the head for me. I think one of the ways we could have overcome that was by pooled funds at a local level, as opposed to a regional level. I think that would have worked quite well.
Okay. And just moving on to the most important people, the users and their families, and whether disagreements on commissioning and placements by the public sector partners, by which I probably mean health and social services in the main, cause any problems.
I don't think it causes significant problems. As I said, I think the process is very well established now. I think most people whose loved ones need to go in to residential care do a lot of work in advance, have lots of conversations in advance. I don't come across many difficulties or complaints in that sense. Maria, I don't know if you've got a view on that.
I think, again, as we've mentioned, the area of potential difficulty is that eligibility for CHC, particularly for people who have their own capital, obviously. Because if a placement is continuing healthcare funded, the individual doesn't make a contribution to that. Whereas, if somebody's care home placement isn't eligible for CHC, they will make contributions, and potentially pay for the whole cost of that placement. So, from that individual citizen's perspective, that could be an area of concern.
Moving on to another area, regional commissioning, I heard what you said earlier, Dave. But the reason for the regional partnership boards being developed was so that regional strategies could be developed that shaped the care home market to provide the range of facilities and services needed for current and future generations. And in a number of places—. I don't know Caerphilly particularly well, but I certainly know Swansea well, and Neath Port Talbot and Swansea run into each other—they are effectively one area, certainly on the borders. Is that working?
I think it is. Like you, obviously I'm very well sighted on the arrangement in Gwent—that's a big region, five local authorities. I can't quote in great detail about all the other areas. I think those relationships are strong, and getting stronger. I think things like the population needs assessment, market stability reports, they are now all coming into place. There's little doubt that losing two years to the pandemic affected progress in those particular areas, but in some ways, I think that going into the pandemic actually made those relationships closer. Clearly, we are still separate legal entities; I have my own legal responsibilities in this area. But there is very little that I do now in terms of anything around the market that I do on my own—I do that via the RPB. So, I think they are getting stronger and stronger.
And if I may add, I would agree. I think there are infrastructures underneath the RPBs, with commissioning groups, commissioning boards, which are working collectively and co-producing with individuals receiving services and providers—things like joint contracts, joint care fee methodologies, single monitoring arrangements—to try and increase consistency and standardisation of commissioning across regions.
Okay. Thank you. And, again, my knowledge is very much in a different area to where both of you come from, so could you tell me if it's normal across Wales? What we've seen in care homes in Swansea is the loss of a lot of relatively small ones and the growth of some large, and very large ones. Is that what you're seeing in the rest of Wales, and is that meeting the service needs of users? And we've got one excellent care home that has a dementia centre attached to it. Is that the direction we ought to be moving in?
If I answer your second question first, yes, I think it is. Certainly, I think there are quite a few examples in Wales of care homes that have got separate wings, separate extensions, for dementia. And you're absolutely right, it is the way to go, because, unfortunately, that is where the demand is going to be in the future. The market shape, yes, I can recognise that. Certainly, the newer homes that have come on stream, the fairly recent builds, tend to be of a larger size; I think that's purely economics, quite frankly. But equally, certainly, in the areas that I work, the majority of homes are still relatively small homes that are locally owned, and that brings both an opportunity and a risk.
I would agree with what Dave's saying. The work that Care Inspectorate Wales did in the lead-up to the implementation of the Regulation and Inspection of Social Care (Wales) Act 2016, they did a lot of engagement with individuals, and there were lots of discussions about the benefits of very small, local homes, which in some areas of Wales specifically deliver a Welsh language service, and the benefit of that. Some of the issues are that they tend to be converted rectories, converted country houses, so they don't necessarily meet the environmental standards we need for the future, and perhaps don't look as smart as the new-build, high-spec services. The feedback from communities was that they really valued those more small, local, very often family-owned services. So, I think, for me, the ideal would be a mix.
Can I come back to what you said there about the majority of them being small? I think you're absolutely right—the majority are. But the majority of places—again, I can only talk about Swansea—are in the larger ones. So, you have a lot of small ones, but you have some that are 70 or 80-bed and that's equivalent to five 15-bed properties. Do you see the same in the rest of Wales? You're on mute, are you?
Apologies. Yes, I think we do see that. As you said, I think certainly people coming in to the market for the first time are having to build to a certain size purely to make the economics work out. That's certainly been my experience. As I say, I don't think it's a question of small homes, good, big homes, bad—I think it's a lot more complicated than that—but I think there is a limit that you would want to see on those care homes. You wouldn't want them too big.
Are the regional partners working effectively and intervening earlier to reduce the demand for care home placements? Sometimes, people end up in a care home because they've reached a stage where they're unable to look after themselves at home. If, however, they'd been dealt with earlier, and had support earlier, they wouldn't have ended up in a care home.
Yes, I agree completely. As I touched on earlier, I think the biggest challenge we face in that area around prevention is the availability of domiciliary care services in people's own homes. And certainly, post pandemic, the recruitment and retention of domiciliary care staff is a real problem across Wales. And I think because of that, you're absolutely right, there are some people going into care homes who wouldn't have ordinarily done it, if those domiciliary care services were there. It's very sad; it's very unfortunate, but there are lots of people at the moment working very, very hard trying to overcome those recruitment difficulties.
If I may add, Chair, I think one of the other issues is the access to health services within the community for individuals: so, access to community nursing, access to allied therapists within communities. Those are also key areas of the workforce that could prevent people from going into care homes unnecessarily. I think very much the focus in the NHS is on the hospital system. There's a real need to look at—. And I think it's really positive that the strategic programme for primary care, and the six goals for urgent and emergency care, are really looking at the community infrastructure and that multiprofessional place-based working, which should hopefully, again, reduce that demand in the future and better serve people in their communities.
Thank you for that answer. You bring up something I say fairly regularly. Too often we use the term 'for health, see hospitals'. If you follow any of our health questions and social services questions in the Senedd, there's more about hospitals and hospital treatment than everything else combined, by a substantial amount. So, I think we need to move some of these higher up the agenda.
But the final question from me is: we've talked about the regional partnership boards, should they be put on a statutory footing?
I suppose, to a degree, they're on a statutory footing anyway—they are a requirement of Part 9 of the Social Services and Well-being (Wales) Act 2014. I'm not sure what more would be gained by changing any legislative basis. I think that the boards are there. I think they are becoming more significant in their role. I'm not sure if any kind of legislation would significantly move that forward, would be my opinion.
I actually agree with you. Thank you.
Thank you, Mike. If I just ask a quick supplementary on regional partnership boards: two weeks ago, we took evidence for this inquiry from Age Cymru, and they said there was still more work to do for regional partnership boards in engaging with the voices of older people and older people's representative organisations. I'm wondering if you could comment on that.
I think there will always be more to be done. I don't think we'll ever get to a point where we reach the panacea. Again, I can't speak for the seven regional partnership boards—I only sit on one. That regional partnership board does have citizen representation on it and it has voluntary sector representation on it. I think part of the challenge we face with regional partnership boards—. The one in Gwent has got five local authorities and a health board attached to it. The regional partnership board meeting is now in excess of 40 people. So, there has to come a point where you can limit that. It's the work that's done beyond the regional partnership board, isn't it? And I think those challenges around hearing the voice of the older person and the older person's representatives are just as acute for individual local authorities and health boards as they are for regional partnership boards. So, I think that's about our day-to-day behaviour as opposed to doing anything specifically around the regional partnership board agenda.
If I may add, Chair, I think also, the team and the infrastructure that sit under the regional partnership board are really important. So, in the work for the population needs analysis, there would have been significant amounts of engagement ongoing with various different community groups. So, I think that's important, and that that is ongoing, and that that information is fed up to the regional partnership board to support that decision making. So, it's not always so much about a seat at the table, but the activity that goes on around the board as well. And I think a number of regional partnership boards have engagement offices or link into the engagement offices of the statutory organisations to make sure there is significant ongoing dialogue and co-production.
Well, quite. I think that was the point: in addition to the broader engagement you describe, it was the people around the table being involved in the design and delivery and monitoring of services and commissioning of services, and having parity of power and genuine co-production for non-statutory sector, third sector representatives, particularly in this case, well, we heard from Age Cymru, but older people's organisations and older people themselves. So, am I to take from your response that you acknowledge, from your comments, that not always being around the table, that there may be an issue there?
I—. Sorry, Dave, carry on.
No, sorry, Maria, carry on.
I think, from my experience of working with the partnership board, there are challenges, sometimes, with information being shared, so there is some information that's commercially sensitive that you wouldn't share in a wider partnership board, so it's striking that balance, really, and being aware that if you have a citizen representative, it's a citizen representative representing a particular community or themselves. So, it's the work of the board, but also recognising that the work of the board is really quite vast. There is a significant amount of grant fund schemes to oversee. Many of the boards, in my understanding, have regional commissioning groups as part of their governance structure with some delegated functions to those. So, a lot of the work of the board around commissioning goes on within those groups, and those groups are better served to engage with a number of different citizen representatives. So, I think it's—. The work of the regional partnership boards is really vast and complex, so it's how that infrastructure works in its entirety in addition to the board that sits itself.
Okay, thank you. Could I invite Natasha Asghar to take up the questions?
Thank you so much, Chair. Good morning, Maria, and good morning, Dave. Just to start with, I'd like to know—. You did kindly mention in, I believe, your first answer to our Chair when he asked you about some of the issues that have an impact on, obviously, costing, and you mentioned domiciliary care was one of them—[Inaudible.]—per unit, weekly, and those important placement costs across Wales.
I'm really sorry; certainly on my screen you froze for a few seconds there. I probably only heard the first 10 seconds. Maria, did you hear all of that or did you have the same problem?
No, I'm sorry. I wasn't sure if it was me, but I think on my screen Natasha did freeze too—sorry.
Would you mind re-asking us the question? Apologies.
Of course. No, I have an unstable IT connection, so my apologies, everybody, if I do freeze out again. Just to ask the question again: you did mention to our Chair in a previous answer that you both gave about domiciliary care being one of the reasons that costs were different, but I wanted to know, apart from the costing of domiciliary care, what do you find are some of the other reasons to have such a variation in costs for those in care homes across Wales?
I think, to be frank, up until relatively recently, we haven't had good methodologies to actually establish what the real costs of care were. Costs of care have been historic. In some instances, they've been based on the affordability, rather than the real costs of care. Certainly, I can remember several years ago where you would simply have whatever inflationary uplift the council had from Welsh Government for its budget—that is what you would pass on to the care homes concerned. I think that has changed over the last several years. Almost all areas and regions now have a formal methodology for trying to establish those fees. There are still big challenges around affordability; there's no question of that at all. Maria will touch on, in a second, some of the work the national commissioning board has done around the potential for a national methodology across Wales, which hopefully will—. I don't agree we'll ever reach a position where there is one fee for Wales, and I wouldn't want to necessarily be there, but I think that as long as we are consistent in how we establish the cost of care, then that would put us in a much stronger place than we are now. Maria, do you want to go into a bit more detail on that one?
I'm very happy to do so. In regard to the methodologies, the inputs that you put in are really quite important. Some of the key differences might be the local employment scenarios and the rates of pay required to attract and retain workers. So, that's a consideration, and that accounts for quite a considerable amount of the actual fees. Also, some of the variability there is the level of need or complexity of need of the individuals within that home, and the number of staff hours they may need per day or per week to meet those needs. So, that's one of the variables.
We've talked a little bit about the newer build homes, the larger newer build homes versus the much older smaller homes. There is quite a significant variability there in the capital employed to build and maintain those homes. You will have some homes that perhaps paid off their mortgage a very long time ago. There is then a debate about should there be a return, which is largely profit, then, for that particular home, whereas more newer build homes will have capital employed of anywhere perhaps between £120,000 and £200,000 per bed to actually build those. So, the build costs are really quite significant. There are loans or mortgages to be serviced for those homes. You can have a home that has very little loan or mortgage against it, versus one that has a very significant loan or mortgage against it. So, that return on capital employed is really quite a significant variability.
I think one of the difficulties we have is that the perception of that return on investment is that often, that's considered to be profit, rather than understanding that actually, it's paying the rent, the mortgage, the loans associated with that property. So, there are a number of factors. Also, the actual build of the property might have a significant difference on the energy costs. Older, less insulated buildings might cost more to heat and light, whereas other more new-build properties may be cheaper per room for that. So, there's a range of variable factors that go into that methodology.
The work of the national commissioning board is to link into all of the regions and the methodologies that they're developing, but also to work really closely with the national provider forum and care operators to get a really clear evidence base of their true costs that can be anonymised. Then we can look at that range, mean and median costs, to be able to share, without some of the concerns of commercial sensitivity, anonymised information to try and inform the local development.
You may be aware of the Welsh Government-recommended policy of 'Let's agree to agree'. There are some really clear principles there about understanding where we need to gather evidence of true costs, working together collaboratively—which is the role of the national commissioning board—to create that evidence base, and then share that out with the local commissioners.
I think one of the other issues that ideally, in the ideal world, we would address, is around the funded nursing care fee, albeit we've had significant amounts of court time and discussions about that. In my personal opinion, that fee focus is only on the nursing time and continence products. It doesn't actually include any of the additional equipment, medical devices, clinical consumables that are involved in the provision of nursing care. That is completely outside of that. So, I believe, then, that local authorities are potentially subsidising that element of that nursing cost. So, there are issues and tensions there, I think, as well.
Okay. Thank you for that. I know I've picked up on answers that you've given some of my colleagues already, and also how you responded to me, but how well do you feel that bodies are working together locally, as well as regionally and nationally, including providers, when determining charges, as well as fees, being given to those who need care, and their families as well? Dave, you're on mute.
Apologies. I have to stop doing that. I think locally that work will always be there in the short term; it will vary between local authorities. I think the big progress we are seeing is at a regional level. I think that, increasingly, the whole issue of affordability, fee levels and sustainability in care homes isn't being considered locally anymore, it's being considered regionally. Nationally is more difficult. I think Maria is right; there is room for things like those national methodologies and national toolkits. But to try and look at an area that's as diverse as Wales, and that's as large as Wales, and suggest that, perhaps, one formula and one fee would work—it isn't the case. She's absolutely right. It's down to the type of care homes we've got, the age of those care homes, and also some very tricky decisions around how much profit should an independent or private provider make. I'm sure if I went around the room now and asked everyone for a percentage figure around how much profit should a private provider make out of care, there would be different answers. So, 22 ways of doing that isn't good enough. I think one way is unrealistic. But I think that going with the seven regional approaches to this is a distinct possibility, and there's an awful lot of work going on in that direction.
Sorry, Maria, were you going to say something?
Yes. Just an observation, really. I think it's really interesting that the residential element of fees, generally, is negotiated and set at a local level, the funded nursing care fee is generally set at a national level, and continuing healthcare is set at a regional level. Whether we would set a system up—. We talked earlier on about some of the complexities. I think that's a really interesting system observation. I think the work at a local level is, generally, very collaborative. I think, as Dave said, there's a lot of really positive working between providers, citizens and commissioning, planning and contracting offices. The difficulty then comes within the decisions around the affordability of the evidence that's being provided, then, of the true cost of that, and some of the judgments, as Dave mentioned, around what element of that is profit and how do we feel about private providers' profitability.
Okay. Thank you so much. I've got two more questions for you, and then I'll pass you on to the Chair again. Towards the end of the year, England is going to be introducing an £86,000 cap. It's a concept that I think the UK Government has actually brought out. And it's also going to be proposing some changes to the means-tested threshold to support those who require care in England. Obviously, that's not the case here in Wales, and I'd like to ask you what your personal and professional views are on having such a cap set here in Wales that is much lower than what we have in place at the moment.
The charging methodology that we use for care homes at the moment has been in place since around 1993. As you say, there is a threshold. There is a point below which we don't take people's savings or capital assets into account. It is a different approach to England. I'm not quite sure quite what the English approach is going to achieve and whether it will work out in the way that they envisage. Personally, I think that the system that we've got at the moment has done its job extremely well, and I would probably be reluctant to have change for change's sake, really. I think the threshold at the moment sits at around £50,000, so if someone has capital assets more than £50,000, then the difference between the £50,000 and that capital asset is taken into account for charging purposes. If the capital assets are £50,000 or below, then they're ignored for charging purposes. Personally, I think that that works really well.
I would acknowledge that it's a really emotive issue. I think that there are a number of different views around it. I guess I'm interested in the report from the expert group around the national care service and the Government aspirations around a national care service that's free at the point of delivery. What that means is that free personal care—. Will that make a change to some of that? I think the issue of changing thresholds is how the public purse meets that. It goes back to some of the early work that was done in the UK around, 'Are we prepared to pay additional tax and additional national insurance to be able to meet that cost of changing thresholds?' Again, that becomes a very emotive issue around do we ask younger people to pay for the care of older people. So, there are a number of different perspectives around that agenda, I think.
Okay. Thank you for that. My final question: we've all heard in the news at the moment about the cost of living—that sentence, I think, is the bane of a lot of people's lives at the moment. But I do want to ask you, in relation to care, going forward, for the elderly, what implications could the cost of living and the increase in the cost of living, I should say, more importantly, have on those who have contracts, for example, and who are paying for their own care? I'd love for you to explain to me how that's going to impact on them, because when it comes to their contracts, they're normally set, and I believe that they, or their family members, agree to it. So, going forward, is it going to lead to an immediate increase, is it going to be a slow and steady increase, or is it something that's just going to stay the same, regardless of what happens?
This is a personal perception. I don't think it will stay the same, I think it will go up and I think that that's inevitable. I think whether it goes up incrementally or in one large sum is going to come down to the provider concerned. I've got first-hand knowledge of this. We're currently dealing with the situation of a private provider in my own authority who is basically going to put his fees up by £150 a week. That's to the local authority and the private providers as well, and that's to mirror those costs-of-living increases.
There is nothing wrong with providers reflecting those cost-of-living increases, but it has to be affordable. If they're not affordable, it's got a potential knock-on impact on the local authority. And if those increases are unrealistic in any extreme, it can have an impact on people and on their ability to actually stay in their homes. We know about things like fuel costs, we know about food costs, but I think one of the things that has taken us aback, at a local level, is insurance costs. A lot of providers have given us evidence that their insurance costs have more than doubled since the pandemic. So, it's not just the typical cost-of-living increases that we're all seeing, there are some things that are specific to this sector that are bringing pressures.
I think most authorities have responded to that in the current settlements. I think the settlements, with Welsh Government's help, to be fair, have been higher this year than certainly in my time as director, which is quite significant. But obviously, what is worrying is that we don't know where this is going to stop or when it's going to stop. The costs are significantly higher now; what are they going to be like in a year's time? So, I think those pressures on self-funding residents and private fee payers are inevitably going to become more significant.
Just one final sub-question, please, Chair, and I promise that then I'm done. I'll be the hope and positivity; let's hope, in a year's time, that the situation improves and things resume back to pre-COVID days, with a little bit of normality and stability in the world. Let's go with that hypothetical situation. If the prices are set to increase now, at what rate and how quickly will those rates be able to decrease and come back to a rate of so-called normality once that heavy period is over?
We simply don't know. Certainly, in my experience, if you look at things like fuel companies, they seem to be very quick to put costs up and not so quick in bringing them back down when the market changes. That is what it is. I suppose we can bring some pressure on providers, as commissioners, in terms of their fee levels being realistic and reflecting those societal pressures. I don't think, in essence, what local authorities pay providers will ever go down, but what we may well do is give lesser increases because the cost of living is, hopefully, reverting to something a little bit more sensible than it is at the moment. But that will be a very complex and detailed piece of work.
Thank you, Dave. Thank you very, very much. Thank you, Chair.
Thank you. Mike Hedges, I think you're going to take up the next question.
Yes. It's very straightforward: are you happy with the performance information that you're receiving from the care home service and are there good arrangements with independent care providers to supply the necessary performance information?
In terms of quality—. When you talk about performance, do you mean quality?
I'm talking about the whole range of performance, not just quality, but how happy the residents are, how well they work with families, how good they are at discharging people from the care homes, after a certain period of time, into more suitable domiciliary care, if that becomes more suitable—after somebody recovers, for example, after an operation. Those sorts of areas.
I think there will be local arrangements in terms of contract management performance monitoring, and in some areas, there will be regional arrangements. So, I think it will differ. Again, we don't have a national oversight perspective; that's something that the Welsh Government is looking at in terms of what a national oversight scheme may be. So, I think it will very much depend on local surveys and capacity within contracts and commissioning teams, which do vary significantly across local authorities—how many workers they have to go out and undertake that activity. I think the trick for us, or what we really should be aiming to work towards is really good information sharing, so the information that's supplied by care homes and care providers to Social Care Wales, to CIW, to health boards, to local authorities—that we bring all that together into high-level oversight information that helps us to make some of those judgments.
Thank you. Peredur, you've got a supplementary.
Yes, could I just come in on that? Talking to nursing homes in the Gwent area, talking about the communications between hospitals and nursing homes and care homes, how well do you think that is happening, when it comes to moving people out of hospital beds into nursing care and that sort of element?
I think it's a challenge, and I think, clearly, the pressures on the hospitals at the moment don't help in that sense. The pressure to physically discharge people I think does impinge on that communication at times. Certainly, as local authorities, we've experienced that to a degree, where we are told, 'Can you get a placement ready? Someone's fit for discharge.' You do the work behind the scenes, you work with the nursing home, and then, for whatever reason, that person isn't fit for discharge. So, I think the pressure that is in the system at the moment and is likely to be there for a while yet is definitely having an adverse effect on that communication.
Do you think there's a parity of esteem between the nursing home staff and the NHS staff? From my personal experience of talking to nursing care homes, it's one way and it's not the other. The NHS want all the information, but they won't share back, and that impinges on that good working relationship.
I don't think there is parity of esteem. I don't think there's parity of esteem between NHS workers and social care workers in a whole variety of ways. I still think that the nursing homes are viewed as perhaps the poor relations in that relationship, and perhaps that is understandable in terms of that they are not part of the NHS. But, yes, it clearly does impact on their ability to meet needs on occasions.
And I believe the Care Inspectorate Wales-Healthcare Inspectorate Wales review in north Wales bore that out as well. So, definitely a lack of parity, and I think there's also a lack of understanding of the role of care homes. The regulations at care homes have to be met within the acute sector as well. So, some nurses don't understand that not all care homes have nurses. Some of them are residential homes and try to discharge people with nursing needs that can't be met. So, there's definitely a lack of understanding as well as a lack of parity. So, things like not wishing to share nursing assessments with the nurses of a care home. So, there are definitely systemic issues for us to address.
Diolch. Diolch, Chair.
Thank you. Mike Hedges, have you finished your questions?
Thank you. Natasha. Natasha Asghar has got a further question.
Thank you so much, Chair. Myself, I'm back again. Just a quick one, I'd like to ask you: what's your overall assessment of the state of the care homes market for older people across Wales, its overall sustainability, as well as the quality of care going forward now?
In terms of the sustainability of the care homes, I think it is still a very challenging situation. We haven't got back to normal post COVID. Probably the only reason we're in as good a position now as we are is the Welsh Government hardship fund, which really kept a lot of those care homes going through the pandemic. As we come out of the pandemic, certainly my experience is we don't necessarily have the right number or the right types of homes. We've probably got a surplus of general residential homes. Elderly mentally infirm provision is always under pressure, and we could do a little bit more, we need a little bit more, and then we always have a dearth of provision in nursing homes. We can never get enough nursing home places. That principally settles around their inability to recruit registered nurses. You will know the pressures in the NHS in terms of recruiting nurses, and if the NHS can't recruit, then the private sector are going to find it even more challenging.
As far as the quality is concerned, I think generally, the quality is good. There are way more good homes than bad homes, but as Maria touched on in her answer to an earlier question, really, the trick for us as commissioners is making sure that this isn't just about the fees we pay, it's about the work that we're doing in those homes to make sure that they provide the quality that we want. There's been great progress on regional service specifications, so the requirements of local authorities and providers are becoming more and more consistent. But the work that we have to do to make sure that they are providing us with with what we want is a crucial part of the activity.
If I may speak on behalf of the national provider forum, they've certainly raised concerns around sustainability, particularly around the costs and increasing costs and particularly workforce, so workforce availability. We touched earlier on the cost of living—you know, even the real living wage of £9.50 an hour is a real challenge for workers trying to meet all of those food and energy inflations.
I think one thing of particular note—the not-for-profit sector of housing associations are really considering whether they can continue to operate in the social care arena, particularly around care homes, because they can't make it sustainable. So, as a not-for-profit sector, they can't keep it sustainable. So, I think there are real risks and challenges ahead, albeit that we also need to manage some of that shaping, as we do potentially need a different pattern of services in the future.
As my lovely, esteemed colleague Peredur mentioned in his question earlier, I've had the privilege of meeting a lot of people who have private nursing homes, as well as meeting those who are residents in, I should say, local authority-run care homes as well. Having spoken to those in the homes run by local authorities, the one message that those carers have had is not just the pay discrepancy between those who are working in their particular homes and those working in the private sector, but it's also about time off, and time off not just to have a weekend with your family, but time off for holidays et cetera. They've genuinely felt so overworked and genuinely tired that they feel that that burden has been something that has been completely ignored by everyone. So, my question is, going forward—and I'm sure both of you have spoken to many people who have been in that position, as well—obviously, the private sector is going to have an impact, and a lot of people in the care sector will be more inclined to go towards the private sector, perhaps for the pay, for the benefits, for everything, but what are you doing specifically to help those who are working in those homes that are being run by the local authorities et cetera? How are you making sure that those all-important carers are getting the relief and the respite that they need to be able to do the job that they're doing to the best of their ability?
I'm not 100 per cent—[Interruption.] Sorry, Dave.
I'm not 100 per cent sure if I've quite understood that question. So, my understanding of both the feedback to myself and the evidence from research is that the private sector receive far lower pay and far, far lower terms and conditions. Am I understanding—? Or were you saying it was the opposite way around?
My understanding is slightly different, that if a carer is working in the private sector, they are on more money than someone working in local—
Absolutely not. Absolutely 100 per cent not. There's plenty of evidence of that. Very significantly different, and I think that in the work that we do around the care fee methodologies, there's quite a lot of—. When we base care fees, generally we base it on the real living wage of £9.50. Many local authority staff would be paid more than that. In terms of pension contributions, our fees are based on 3 per cent employer pension contributions. Local authorities are likely to pay 20 to 24 per cent towards contributions. There's statutory sick pay only in the independent sector, whereas there's occupational sick pay in the local authority sector. In terms of leave, you're likely to get a much more generous maternity leave and carer's leave in the local authority, because there are tied national terms and conditions, rather than in the private sector. So, it all relates to the fees that we pay. So, the affordability and the fees that we pay to the private sector then have to balance—balancing those books, meeting all of their costs—and it generally tends to be workers' terms and conditions that suffer if there is a lower fee than the actual cost, but, generally, our methodologies are based on much lower terms and conditions.
And if I could, Chair, I think one of the reasons that we're seeing some of the, certainly, retention difficulties in care homes is because carers are burnt out. They've had a hugely challenging two years. And, actually, are you going to stay in that environment and earn the £9.90 real living wage when probably in every high street in Wales at the moment there are cafes, there are supermarkets, there are all kinds of people recruiting at significantly higher hourly rates? So, you don't have the challenge, you don't have the burn-out, and, actually, you take more money home at the end of the week. There's a real societal issue here in terms of how we value carers.
Okay. The first of June, I believe, is quite an important day for you all because it's the time whereby a local authority is going to be hopefully submitting their stability reports. Are they all on track in Wales at the moment to be able to provide those reports? To what extent have they all been working together to make sure that this approach is viable and it's something that's going to provide positive results?
They are on track. Certainly, the several regional partnership boards and directors I've spoken to, they're all on track. And I think your second point's an important one. There's been great dialogue between those regional partnership boards in comparing approaches. So, they won't be identical, and they shouldn't be identical, but there will certainly be a lot of commonality in terms of the approach that's been taken on those stability reports. So, this isn't seven people who have locked themselves in seven dark rooms and come up with their own approach, there's been really good dialogue between the regions to just understand the various approaches that have been taken.
And the role of the national commissioning board has been to support good practice sharing, support learning, practice sharing and support templates and tools so that we reduce some of the overall effort and improve the quality of those. So, we did have five, I think it was, peer-support meetings to support those individuals working on that, bringing in Social Care Wales and other data providers and the national provider forum to work with the Welsh Government to run some workshops for that as well.
Thank you so much, Maria. Maria, in one of your previous answers to me, you mentioned the 'Let's agree to agree' toolkit. I just wanted to ask you, what are some of the positives and negatives of this?
Of the toolkit? I think the principles are really sound; they build on the co-production principles of the Social Services and Well-being (Wales) Act 2014 that we need to determine the evidence that we need to collate together, that it's very much a partnership approach rather than the more traditional contractor/contractee. And the principles are the direction for us, really. We need to see our care home providers and our domiciliary care providers as partners rather than contractors and improve those relationships. So, I think the principles are really sound. Some of the difficulties we've discussed today because also people come with their different roles—funder, with all the political and governance areas of that, and a commercial operator. So, competition and collaboration all together in the mix is a challenge, but I think that, as I say, there are the principles of collaboration and working together, recognising that there are things we won't agree on, but that, actually, there are things that we need to agree on and can agree on together, and that joint working is a really positive approach.
Fantastic, thank you. My final question is: do you believe, at present, the balance in the market between the public sector supply and the independent provision provides value for money?
It probably provides value for money in the sense that if that balance changed and it changed back towards the public sector it would cost more. Personally, I would still like to see a little bit of a better balance. I probably would like to see more public sector provision. It doesn't mean that I would lose the private sector provision that we've got, but in terms of certainly any new provision and any capital, I would like to see local authorities building care homes again. I think that the way that we've looked at it, as directors of social services, is that Welsh Government has run a very, very successful twenty-first century schools programme. Could we run a very, very successful care home building programme along those lines? If we were to do that, I think that's where the public sector could step in, with perhaps more of a balance than we've got at the moment. I think, very roughly, around 70 per cent of provision in Wales at the moment is private sector, the other 30 per cent public sector. Personally, I think if we took it to 50:50, that would be a nice place to be.
For me, I would like to see an increase in social value so that the pay for the workers and better terms and conditions for the workers would increase that social value, irrespective of who the providers are.
Thank you, Chair.
Thank you. Time is short and nearly over, but, Peredur Owen Griffiths, can I bring you in for the next set of questions?
Yes. Thank you. I think we've touched on some of the points that I was going to raise, so there's only probably a couple of questions, looking at workforce and going on from what Maria was just saying there. We've talked about parity of esteem and parity of pay. How are partners, including providers, working together to get a sustainable workforce to meet the current and future demand? How do you balance the demand across the sector with staff from health and social care? How do you work that? Have you got any insight into what we need to do to make it better?
There's a whole range of work going on at the moment trying to overcome the current challenges. Social Care Wales have got a national programme going on in terms of trying to make care more attractive as it is. I know, at local levels, we're doing an awful lot of work. We've had people out in supermarkets, we've had people out in town centres trying to sell the whole message of a carer. I must admit, when we were in the midst of the pandemic and we had everyone out on a Thursday evening clapping, I thought this would be the pivotal moment—after the pandemic, we will have people who want to be carers. And that simply hasn't panned out. In fact, I think the demands that people went through in that period meant we've lost some people that perhaps we wouldn't have otherwise. It's a really tricky issue.
Ultimately, it does come down to terms and conditions, and it does then come down to parity of esteem. Carers are not viewed in the same way as NHS employees, and some people may think that's right, some people won't. But it's a really tricky issue. I'm not in any way being critical of the move to the real living wage. I think anything that increases pay rates for carers is fine, but, quite frankly, £9.90 isn't going to cut it. The view of directors of social services in Wales is that an hourly rate somewhere akin to £12 an hour will mean that we could start being competitive with the tourism and hospitality sector.
There's work that we can do around career paths. So, people coming in to care for the first time—where can they go in the future? Could they stay in care? Could they actually go and work in the NHS? Is there an opportunity for some staff from the NHS to come across, particularly into the independent sector, and understand those services a little bit more? So, there are things that we can do to make the jobs more attractive, but, personally, the elephant in the room is the terms and conditions that these people enjoy.
Just following on from that, Dave, with regard to interchangeability, potentially, between NHS and social care, would there be a way of supporting professional development to make sure that they align, so that at least there is that opportunity to interact?
Yes, absolutely. I think it's a really, really important point. Clearly, the roles are slightly different, and whatever you do will need to reflect that, but I see no reason why that sort of interoperability, for want of a better word, can't happen. There are some professional challenges that we've got to overcome, but perhaps if people saw this as an opportunity to work in care, but as part of that they would be exposed to the NHS, and vice versa, that might mean that we've got people on career paths that we haven't had in the past.
The £12 an hour links much closer to the 'Agenda for Change' pay scales. I think that would be a really important development. An individual is an individual with social care needs and healthcare needs, so those blended roles and closer competence frameworks are really important. There's a lot of work going on in how we establish that, both within domiciliary care and care homes, with a multiprofessional framework just starting to be worked on within the strategic programme for primary care. So, I think there's lots of opportunity there, the issue being the cost of that, the affordability of that.
As part of that I'd imagine that streamlining paperwork across those—. Because if one person's paying for this and that and the other, then you've got different questions being asked of different aspects of different money pots, and having a clearer, easier way of navigating that element should be considered as well, I'd imagine.
Yes. It creates more seamless care for individuals. They don't care whether you're a social care worker or a healthcare worker when they have a dressing and they need support to get dressed. Ideally, one individual could undertake those tasks.
And then there would be efficiencies, obviously, because it would be one form rather than seven, or whatever it might be.
Yes. Right person, right time, right place.
Going on from what Dave was saying just a little bit earlier about people clapping on doorsteps and that was excellent, the WeCare Wales programme for trying to get people to be employed and recruitment into social care hasn't happened, then, or hasn't worked.
It is happening. Certainly at a local level, what I'm seeing is an encouraging number of new people coming in. Unfortunately, what we're also seeing at the moment is a lot of people retiring. We have carers in their late 60s, early 70s, and I think the whole experience of the last two years has just made some people decide, 'Well, I'm going to call it a day.' So, at the moment, we're keeping our head above water. We're not losing staff, but we're not seeing that increase in workforce, which is what we need. Hopefully, in the next few months, that could begin to change.
I think one of the other issues is that people come into the sector, work in social care for a short period of time, then have to complete qualifications to register, or they could move into the health sector, where they don't need to be registered and meet all the requirements of registration, and get more money. That's another element of the flow of the workforce. They come into the independent sector and then move out into the statutory sector, often, so you've got to keep that churn of new people coming in.
Okay. Just your indulgence, Chair, for one more question, and then I'm done. What do you think is the role of volunteers in care home settings? Are there any concerns or challenges, especially in light of some of the things you were saying earlier around assessing the real cost of care? If it's a volunteer, you're not necessarily adding to that cost, but assessing the overall real cost of it is going to be very difficult. So, do you think there's a place for volunteers in care home settings? How do you balance it?
I think there's been a lot of innovation. I think there's some really positive work through WCVA with Helpforce, and I think lots of the grants available during the pandemic have supported at a local level, with their community voluntary councils, the establishment of volunteers in care homes. I think it really adds quality, particularly to individuals that either don't have family or don't have family nearby. So, I think there's a significant opportunity for volunteers, but they're almost an additional service element, or additional quality element. We still need to have suitable numbers of workforce that are registered, that need to have all the training and induction, et cetera, which you wouldn't necessarily expect of a volunteer, to meet all of those competences. So, I think that they're really positive and add a layer of quality, but we still need that main baseline service as well.
Thank you, Chair.
Thank you. We're massively over time, so I'd be grateful if you could keep your reply to my final question now extremely succinct. Overall, how confident are you that the Welsh Government is moving in the right direction and quickly enough with its policy reform to address the issues affecting care home commissioning that the auditor general has highlighted, and what if any observations would you wish to raise about the auditor general's recent report on direct payments for adult social care, including around the interface between direct payments and access to NHS continuing healthcare?
I think, in terms of the policy reform, it's difficult to say whether it's moving ahead at the right pace. It is certainly moving ahead at a pace, we can see that, but it's tricky to see where the endgame is there. I still think there are things like the national care service where we're not 100 per cent clear, certainly within the sector, what that references, what that means, what that would look like. In terms of direct payments, I think there are opportunities with direct payments, but one of the barriers we have faced is that continuing healthcare, and it's disappointing that we haven't been more able to overcome that. Most people would want someone to care for them who they know, and if that is practically possible, then we should be doing all we can to make that happen. There are some burdens that come with direct payments that not everyone wants to take on, because effectively you're taking on the role of an employer, but I think the Audit Wales report is accurate in the sense that there is more to be done. There are opportunities that have yet to be fulfilled.
And if I may add, I think the national framework is a really positive development, and I'm delighted that the Welsh Government has asked the national commissioning board to lead on the development of national commissioning standards that will hopefully support greater consistency.
Okay. Thank you. That brings us to the end of this session. I thank both witnesses, Maria Bell and Dave Street, for being with us and for your answers and contributions this morning. A transcript of today's meeting will be published in draft form and sent to you for you to check for accuracy before the final version is published. So, again, thanks very much indeed. You can go back to your day jobs and start dealing with some of those practical issues you've explained and shared with us. So, thank you again. Members, we were due to have a 10-minute break, 10 minutes ago. But, do you want to take a five-minute break? Thank you, all.
Gohiriwyd y cyfarfod rhwng 10:27 a 10:35.
The meeting adjourned between 10:27 and 10:35.
Croeso. Welcome back to this morning's meeting of the Public Accounts and Public Administration Committee, and I welcome our new witness to the meeting. I'd be grateful if you could state your name and role for the record.
Heléna Herklots, Older People's Commissioner for Wales.
Thank you very much indeed. As you might expect, we have a number of questions and, again, I ask Members and yourself as a witness to be as succinct as possible so that we can cover the wide range of issues this topic has generated. I'll begin with the first question, seeking to explore issues around making the system less complex and easier to navigate. So, what, in your view, are the main issues that make the system for care home commissioning across Wales complex and difficult to navigate?
From older people's perspective, the system is very complex and very difficult to navigate, and, in particular, it's very difficult with the current system for older people to know what their rights are and to feel that those rights can be upheld. So, the funding system is complex, the assessment system also complex, and the interface between health and care and different funding regimes also creates difficulty for older people. So, for example, older people might find it very difficult to be assessed for a care home place, and often, of course, you're looking to move into a care home because you've had a sudden deterioration in your condition where you're at a point of crisis, where things need to move quickly for you. But, sometimes, you're actually finding that the assessment process is taking too long.
There are particular issues around moving from hospital to care homes as well. So, there are problems about the communication between the hospital staff and the social worker and the care home. So, there again, the system can get complex and difficult for an individual. And also it can be very difficult just to identify and choose an appropriate care home. Most older people will want to stay in their local area or near family, and quite often it can be very difficult to find the right home in the right place.
Thank you. How does the experience of accessing care, including issues arising from out-of-area placements or Welsh language provision, impact on older people, service users and their families?
So, it has very distressing impacts, and it's important, as you did in your question, actually, to remember this is not just about individual people; it's about families and loved ones. We all want to do our best for our loved ones, and often families are put in a position where they feel they can't do that because of the complexity of the system, or the fact that there isn't a good care home there. I think there's also a major issue around how in control older people can feel about the decisions that are being taken. Moving into a care home is a major decision for yourself, for family and loved ones, and you need support at that time. You also might need access to independent advocacy if you feel your voice isn't being heard; if, for example, you feel you're being really directed to a particular home, or you don't have any choice, or you want an alternative form of care. So, we do need to increase the provision of independent advocacy for people at these points as well.
And then, once somebody moves into a care home, issues can be very difficult for families as well. We all know over the last two years how difficult it has been for people living in care homes, people who've had loved ones in care homes and, indeed, people working in care homes. But some of those issues around the restrictions on visiting, restrictions on being able to get out and about, are at risk of changing the culture of care homes, and we need to move very quickly, I think, back to a position where, fundamentally, these are people's own homes where you can come and go and have visitors and live your life in your own home. And I think there is a risk that we've moved away from that—well, we have moved away from that during the pandemic—and we need to make sure that older people's rights come much more to the fore, both in accessing care homes and then living their lives well in care homes.
Thank you. How have you engaged as commissioner with public bodies and providers to tackle the problems raised with you by service users?
We get individual older people and their families coming to us and they are helped by my advice assistance team. So, we deal with a lot of issues around care homes, particularly at the moment, actually, and what we seek to do is to enable the older person or their family to find a solution. Sometimes, that's about giving them clarity about what the law says or about what guidance says, because it's really complicated. Sometimes, it's about advocating or working on their behalf. So, they may have found that they've got a complaint, for example, that hasn't been dealt with well and they need me and my team to come alongside to make sure that that can be dealt with in the way that it should be.
A lot of my focus as commissioner is on the rights issue. So, I'm taking action in a number of areas and I've set up a group, including key organisations in Wales and across the UK, and we're focused on how to improve the rights of older people living in care homes. Part of that is about good information and provision, which we need much more of. We've been consulting and working on a new rights leaflet for older people and their families to try and demystify and make it much more easy to understand and, therefore, uphold your rights, but also looking at some fundamental issues, for example, the contract that you have as a resident in a care home. You don't have security of tenure in a care home. You don't necessarily have your rights upheld as they should be. So, we're looking at whether, actually, contracts can change so they're much more focused on upholding people's rights in care homes and rebalancing, if you like, the power between the commissioner, the care home provider and the individual older people.
I also, on a regular basis, make representations on behalf of older people to Welsh Government both at ministerial and official level in terms of the issues that I'm hearing from older people, so that I can raise key issues of concern with them and follow those up and hold Welsh Government to account on the action that it takes.
Thank you. My final question at this stage: what, if any, potential quick wins can you suggest to simplify the system for older people? Things that could be done easily, or things that could be stopped or avoided.
Sadly, the complexity of the system is not something that's going to be dealt with by a quick win. We need some fundamental changes there. So, I think the way in which to improve it right now is to focus on how we can give increased control and an understanding of rights to older people and their families, and to look at those points where there are particular problems. So, I think a focus on hospital discharge, for example, where actually issues of communication could be improved—and this is an area where I think a quick win could happen. Quite often, a difficult situation is made worse by poor communication. Families and older people need those regular updates of what's happening. We need to get rid of some of the jargon that's used. The language around this is not very user friendly, if I can put it that way: the notion of, 'What is an assessment? What am I being assessed for? What does that mean? What does eligibility criteria mean?' So, I think we could do more, really, to look at the language and simplify that. And then also actually making it easier to question, to comment and to complain and to seek redress. That can be quite difficult at the moment. Particularly if you're living in a care home, for example, then you might be worried about the repercussions if you raise an issue or concern or if you have some fundamental issues around the contract. The place that you can go is somewhere like the Trading Standards authority, and they may not have the expertise to actually help you on some of those issues. So, I would strengthen rights, improve communication and focus in on those areas in particular where there are problems, which tend to be moving between different services, both health and social care.
Thank you very much indeed.
My colleague Natasha Asghar will now temporarily take over chairing of the meeting. So, could I hand over to the clerking team, who need to facilitate that?
Thank you so much, Chair, for that—
Sorry, Natasha, I just need to conduct the formal appointment, if that's okay. The Chair has had to temporarily depart the meeting. Therefore, in accordance with Standing Order 17.22, I call for nominations for a temporary Chair.
I nominate Natasha.
Thank you very much. I'd like to—
Great. I therefore declare that Natasha Asghar has been declared temporary Chair, and I invite her to assume the role of Chair until Mark Isherwood is able to return to the meeting. Natasha.
Penodwyd Natahsa Asghar yn Gadeirydd dros dro.
Natasha Asghar was appointed temporary Chair.
Thank you very much, Owain. Heléna, welcome to the committee. I'm Natasha; it's a pleasure to have you here. I know our Chair has begun by asking you the first question, so I'd now like to pass over to Mike Hedges with his follow-up questions.
Diolch. Can public sector funding approaches be simplified?
Yes, and they need to be. So, from the older person's perspective, I don't think that older people should be bearing the brunt of difficulties in terms of public sector funding and perhaps disagreements over that. So, one of the key areas is in relation to continuing healthcare funding and whether or not someone gets continuing healthcare funding or not. And the process of that can be quite complex, it can involve some disagreements between health and social services, and it can lead to uncertainty and anxiety about whether your care is going to be paid for. And when you need care and support to live day to day, you shouldn't also have the anxiety about whether that's going to be paid for.
So, I think, in particular, we need to move to much more seamless funding, where there isn't this division between continuing healthcare funding and social care funding. Fundamentally, I think that's going to be by moving over time to a system where social care is free at the point of need, but looking at what can be done in the meantime to simplify the arrangements.
Can I just ask you to expand on part of the answer you gave, on the impact on service users and their families when the public sector partners don't agree?
It's distressing. It's frustrating. It's incredibly worrying. It can lead to deterioration in someone's physical and mental health, and it can feel as if you're a very insignificant person in a large and complex system that doesn't really focus on you. I think it's also, quite often, really difficult for the people working in it as well, who are trying to do their utmost and trying to provide a good service. And I know from social workers that have been contacting my advice and assistance team that, often, they are also facing distress because they're not able to do what they want to do for a person.
So, this has real consequences for the health and well-being of older people, and also it creates anxieties amongst older people who have not yet needed to access that care, but know from friends and relatives and others that it can be a really difficult process to go through. So, in my view, it's urgent that these areas are improved. It seems to me we've been saying for years that the system is too complex for older people, and, frankly, not enough yet has changed to improve it.
I would agree with all of that. Moving on to regional commissioning, we've got regional partnership boards; they're meant to be developing regional strategies that help partners shape the care home market. Do you think that's working?
Well, regional partnership boards have just completed publishing their population needs assessments and are working on these market strategies. So, it's too soon for me to be able to say whether those are going to be working. My concern is that the data on which they're based is, in quite a lot of cases, not adequate, and the regional partnership boards population needs assessment reports actually highlight the deficiencies that are there. So, just to give you a couple of examples, they're using the census data from 2011 because the 2021 census data is not yet out. So, immediately, you can see an issue there in terms of accurate data on population. But also, because of the pandemic, some of that work that is needed to really understand not just population levels and making assumptions about that in terms of what's needed, but issues around what older people want and need—that face-to-face engagement—hasn't been able to happen. Some of the data collection was paused because of the pandemic, or some of the data types have changed, so, actually, it's very difficult to then compare.
So, I think what's going to need to happen, as soon as those market strategies come out, is there's going to need to be an ongoing process of review and improving the data and improving the strategies, including looking at what we mean by the market. So, there's not just one care home market in Wales, there's not even just 22, because, for an older person, the market that matters is the local market. So, in fact, there are lots of different care home markets across the country, and we need to find a way of understanding both the national and regional and local perspective, but also looking at a much more granular level, and really looking at it, in market terms, through a consumer lens, not just from a purchaser lens.
Yes, I think that the local market often depends on where relatives live rather than where the person lived before they move into a home. Talking about homes and home infrastructure, I can only talk about Swansea—Swansea East in particular—where we've had a movement to a lot of very large homes, with specialist centres for dementia, which has worked incredibly well in one of the homes in Swansea East. We've also seen some of the smaller homes, over a period of time, disappear, and go back to being either houses or flats. Is this happening across Wales, and is it having an effect on the availability of places where people want them?
So, my sense is, if you're looking at Wales as a whole, the care home market is quite fragile at the moment, and we're starting—. It was kind of an accidental market, so it doesn't necessarily mean that where you've got homes is where you most need them, and there are areas where you need care home places and they aren't there, which is why we need this market-shaping work to happen. You touched on dementia there, and, certainly, one of the areas of need is to improve and increase the number of care home places for older people living with dementia, and also to make sure that there is enough respite provision as well. So, if you're caring for someone at home with dementia, and you want to be able to access respite, that that is there as well. And we're also in a situation, I think, where care homes have had financial support from Welsh Government during the pandemic, which has been really important. As that stops now, I think we are—and we've got issues of rising costs and inflation—in a volatile situation, actually, in terms of the care home market.
Of course, developing the sites, you have to go through the planning system, which doesn't treat the need for dementia care as a part of the planning process, does it? It's based on planning rules rather than community need.
And it is about community, isn't it? Because, sometimes, these debates are characterised in a very narrow way, but, actually, we all need good care homes—we need it for our loved ones, we need it for our neighbours, we need it for people that we care about. And good care homes are part of the community: they're a community resource, they're a place where schoolchildren can go in and visit and get to know older people, they're a place where you can really have a good quality of life in later age. So, we do need, I think, to find a way of encouraging investment in care homes, in the right places, and with the right support. And of course, staffing is a crucial element of that.
Finally from me, a question about regional partnership boards: should they be on a statutory footing? And do you have a view on the impact of regional accountability to the regional partnership boards, and is it helping?
I think, on balance, there's an argument to say they should be on a statutory footing, but I don't think that, in and of itself, necessarily deals with the issues that we have now. So, I think the issue for me is about a clarity of accountability and responsibility, in terms of what the regional partnerships ought to do and what they're about. If you asked a member of the public, they would never have heard of a regional partnership board, or what it does, but they would know about the local council and what its responsibilities are, and the health boards. So, there's something there about having clear accountabilities and transparency in terms of what the bodies do. And then, joint working is so much more than just bringing people together, isn't it? It's about culture, it's about trust, and those things do take time to develop.
Okay. Thank you very much.
Thank you so much, Mike. Heléna, the next part is my section, which is going to be revolving around expenditure. So, I'd like to ask you: what do you see as some of the reasons for the variations in unit costs—for example, weekly placement costs—across Wales and whether you think this is actually justified?
So, you might expect some variation in terms of wage levels and those sorts of things, land costs potentially in terms of initial investment into a care home. But actually I think, too often, there isn't good reason for variations in those costs. And actually, I think we need a much more consistent approach to determining fee rates, for example, and what you need to pay.
We also know that, for older people, quite often, it's not clear what costs you are going to have to pay. So, for example, it might not be clear if you need to pay some top-up fees in addition to the stated cost. So, the information that care homes provide on their costs needs to be very clear, particularly around what the fee covers and what any additional costs might be, because otherwise, you don't really know the true cost of the care home. And we've certainly had families come to us where they've had very unexpected, sudden bills for top-up fees, quite often for things that you would expect should be in the standard fee.
We've also worryingly had instances of care home providers asking for top-ups on continuing healthcare funding, which actually goes against the guidance and shouldn't happen, and sometimes for the things that you really wouldn't think would be an extra, for example, access to the garden. You wouldn't expect that to be seen as an add-on or a luxury. So, the expenditure and the costs need to be much more clearly explained and itemised so that you know what you're paying for. And I think we need a much more consistent and standardised approach to what those fees are that are paid as well, so that if you're looking to move into a care home, you have an idea about what the care home is charging and whether that looks right in terms of what the national levels are.
Okay, thank you very much for that. I'm going to reiterate a question that I asked our previous attendees here in the meeting: with the cost of living on the rise, it's evident that everything in cost, whether that be gas, electric—you know, it's all going to go up eventually. But what implications do you foresee that having, particularly when it comes to old-age homes, particularly within Wales and across the board?
So, cost of living is one of the two or three issues that people are raising with me most at the moment. So, they are incredibly anxious, and I've used the word 'terrified' about the impact of the cost of living on their own income. So, the first thing I would say is that it is adding to the challenges that many older people are facing.
In relation to care homes, you'd expect to see that work through in terms of increased costs for them—anything from energy and food to staffing. So, I would expect to see the cost of good-quality care increasing as a result. So, the issue there is: will the rates that local authorities pay increase to recognise that? Will there be a greater unfairness in the gap between what some local authorities pay and what the actual cost of care is, which means that older people who pay all the cost—who self-fund—end up subsidising that? And there is an unfairness in the system at the moment, where you can end up paying more if you're a self-funder than the local authority will fund. And it shouldn't be the case that those issues end up being borne by people who are needing to move into care and using all their savings up to pay for care.
What do you think would be a good solution to create more equality in the system to stop that happening in future?
So, I think the work that's under way—the national commissioning framework—to set a clear rate—. And it needs to be a fair rate. So, it needs to be a rate that enables care homes to recruit and retain quality staff and pay their staff well and have good terms and conditions and provide quality care. So, that should be the rate. You shouldn't then have a situation where, if you're paying for yourself, you have to pay a higher rate than that, unless you're paying for some additional things, or, for example, there might be a difference in that you're having a much larger room or something, or an actual difference in the accommodation in particular. So, if we have a rate that is understood, that is across Wales, where you know that's the rate that the local authority will pay, and that's the rate that you'll pay if you're funding yourself, you get rid of that inequity.
Thank you so much. Commissioner, you kindly provided us with a lot of information, which I know my colleagues and I have all gone through prior to this meeting, and I just wanted to know—. There were issues relating to funding, cross-subsidisation and top-up fees. Are there any points that you would like to elaborate on, particularly in relation to the information that you've kindly provided to us prior to this meeting?
Yes, I think, on top-up fees. This is a very worrying area, and it's where, as an older person or a family, you feel you're slightly at the mercy of the care home provider. So, if you've moved into a care home, it's not like you can easily shop around and say, 'Well, I'm going to move somewhere else if I think I'm being asked to top up my fees inappropriately.' So, that needs much stronger attention. The issue of continuing healthcare and top-up fees shouldn't be happening at all. And as I've explained already, that issue of cross-subsidisation. At the moment, a lot of the complexity and difficulties of funding are being felt and experienced by older people and their families in a way that is very, very difficult for them to manage. And if you think about living in a care home or having your loved one in a care home, and that sense that you can manage, but actually with the top-up fees you're getting to the point where you're thinking, 'I can't afford to stay', that is just a terrible position to be in towards the end of your life. It's completely unacceptable and we need to get to a point where those things just don't happen.
Thank you for that. What are your views on the fairness of the funding model in Wales, relative to what has been proposed in England?
Well, I certainly wouldn't advocate what's being proposed in England. So, here in Wales I think there are a couple of good things in terms of the funding system. So, the fact that there is a cap on how much you have to pay per week for domiciliary care, I think that is positive. So, you know that you might be contributing, but you're not going to be asked to pay more than £100 a week. The asset threshold in Wales is also, at the moment, better than in England. I think the problem with the proposals in England is that they only deal with one very narrow element, actually, of care home funding, and the most recent amendments to what's being proposed around the £86,000 cap actually mean that, according to analysis by Age UK, more than four in five older people will not see any benefit from the cap at all, and it will particularly just help those wealthier older people who might reach the cap, say, in a couple of years, whereas someone with fewer assets could potentially have a decade or more of paying fees and will never reach the cap at all. So, it isn't an approach that I would advocate here by any means.
Okay. My final question to you, commissioner, before we go on to Mike Hedges with his next set of questions is that there's no denying, and I'm sure my colleagues here will agree, that the population here in Wales is ageing. It's ageing across the United Kingdom and health conditions are changing—they're evolving at an exponential rate. What can we as politicians here in the Senedd do, and where can we drive the Welsh Government to put their funds in order to ensure that the needs of the elderly population here in Wales are met adequately going forwards?
So, I very much welcome that question and the committee's attention on that. I think we need to be better at planning for our ageing society and to do that on the basis that this involves all of us; we are all ageing, and actually we should celebrate the fact that we're living longer, but we need to prepare for it much better. So, more investment in social care, particularly at the preventative side of things. Too many times now we're seeing older people who could be living well, volunteering in our communities, caring for others, who, because they are not able to access decent social care or get the preventative healthcare support that they need, are deteriorating more quickly. And there are some issues, I think, where older people just do not get the access to services that they should, and sometimes I think that's because of ageism, actually.
So, I'll give you an example. In terms of mental health support, the Royal College of Psychiatrists has identified ageism across the UK, actually, in terms of access to and provision of mental health services. So, better planning, more engagement with older people about what is needed and the services and support that we all need as we get older, more investment in social care, including in terms of the workforce. And then making sure that, in the work of Welsh Government, the issues of an ageing society are taken better into account across its areas of work. To give one example, we are an ageing workforce as well, so if we're going to improve recruitment and retention in social care, we need to be better at supporting us as we age in the workforce as well.
Thank you very much, commissioner. I'm now going to move over to Mike Hedges, and he'll be asking you some questions in relation to improving performance information. Mike, over to you.
My first question is: should we have more collaboration between purchasers and providers, rather than this almost two-side, 'We're buying, you're selling, and we'll negotiate from there'? Is there a role for more collaboration between the two, because at the end of the day, the person in the middle, who's the person in these homes, seems to be the one person who is left out of that discussion?
Yes, I agree. We need a collaborative approach, ideally based on trust. Providers know a lot about what good-quality care is and the challenges in providing it. And good commissioners listen and work very closely with providers, and providers have got a lot of knowledge and insight, actually, about what good-quality care is, what older people are looking for and need. At the same time, I think both commissioners and providers need to stay close to older people, in terms of listening, listening to feedback, listening to positive feedback—[Inaudible.]—as well as the negative. I think too often, it seems there's a long—. There's a big gap between the older person and this kind of machinery of commissioning and procurement, and these things need to be closer together and, as you were saying, included in a closeness of working between providers and purchasers.
Thank you for that. Again, round by where I live, of the big care home providers in Swansea East, three of them I think are very good. They invite me to things and they want to show off the quality of what they're providing. Others are less keen on having any visitors, and it always makes me feel a little worried.
I want to ask you about the quality and suitability of care homes, and are you happy—? We've had some relatively poor care homes that have been picked up by inspections, but are we moving in the right direction in that all care homes are improving and getting better?
I think we still have quite a variable picture. We have many, many really, really good care homes and huge numbers of staff working incredibly hard, particularly over the last two years, going above and beyond to protect people in their care homes. The issues about good-quality care in care homes are a lot about leadership, so the leadership in the care home, and a lot about recruitment and retention of staff and managing staff. I think there's more that can be done to build on some of the things that happened during the pandemic to support staff. So, for example, Age Cymru, Care Inspectorate Wales and Public Health Wales brought together a—it's sort of called the 'care home cwtch', which is a peer-support group for people working in care homes during the pandemic, which I thought was a really good example of the need support staff and get alongside, to understand the stresses and strains, and to enable people to share good practice across care homes. So, I think one way of improving quality is that peer learning and peer support. We need also to make sure, however, that if there are problems in care homes, all the people feel they can complain without fear of repercussions or without the threat of eviction, for example, and that if they do complain, it's a straightforward process and a process from which both the care home and the regulator, actually, can learn, because you can learn a lot from complaints. So, again, I think it's about improving people's rights in the care homes, so that they feel able to complain, or their families feel able to, as well as supporting staff to continue to develop their professional expertise in what can be a very challenging role.
Thank you for that. It's not just care homes, I've got one doctor's surgery that is very unhappy to have any complaints, and the first thing they say to somebody who complains is, 'All right, we'll kick you off our register. You can go and find yourself another GP.' Do you see that happening in care homes?
We've had some cases where people have been seen as making a fuss and have been threatened with eviction. The only reason, really, why someone should have to leave a care home is if the care home is unable to provide the level of care that they need. That's why, actually, we need care homes to be in a position where they can care, as far as possible, for someone to the end of their life, because it's very distressing to move care home. So, we do know that, sometimes, raising complaints can lead to repercussions or the threat of eviction, and again I come back to the point about needing to improve older people's rights and give people security of tenure so you can't have that eviction threat.
And, of course, we know that moving care homes can have a serious effect on life expectancy as well. Moving on to the role of the care home inspectors—is that working in helping to drive up care quality, or is it, like a lot of inspections in different places, that everybody performs doing what they think the inspector wants to see, not how they perform normally?
So, I think—. It's obviously been a very different couple of years, really, in that inspectors haven't, on the whole, been able to go into care homes, and you learn a lot from walking into the care home and experiencing that. I think, now that inspectors are going back into care homes, that's really important, and for them also to identify what's working well, as well as the areas that need improvement. So, the regulator is crucial in terms of giving assurance around safety, good care and provision. They do have a role also, I think, in spreading good practice, in supporting improvements in quality, but other organisations do as well—so Social Care Wales, for example, Care Forum Wales, as well as the umbrella group for care homes. And a lot of the issues around quality, of course, are driven directly by the provider, by the manager of the care home, of the organisation that runs the care home. Where it works well, I would agree with your point, absolutely. Care homes want people to visit and come in, of course, in a safe way, in terms of the COVID experience. I'm sure we've all been in those care homes that are very welcoming and that are encouraging people in from the local community, and that helps quality. If people have got eyes in the care home, if you like, different people coming in, relatives able, also, to visit and keeping an eye on their loved ones, so they are not closed settings, they are open settings, that really helps quality as well.
And the final question from me: should Care Inspectorate Wales and Healthcare Inspectorate Wales be merged?
I think there's an argument for that, yes. We talk a lot, don't we, about the integration of health and care, and yet we have two different regulators? I think we just need to be careful that we're very clear about the reasons why, and that we don't just assume things, then, work immediately better if we have a merged body; that doesn't always hold true. But at a point where we're looking at trying to remove divisions between NHS and social care, and working seamlessly, it would seem logical to have a single regulator.
Thank you. I'll just finish with a comment that mergers sometimes mean you have somebody in charge of both, and then you go to the next layer down and they separate back out again.
It's not a panacea. I was involved in one of the largest ever charity mergers, so these things are not easy to live through either.
Thank you so much, Mike, for that. I do appreciate it. The final comment you made was something I was going to say, which is that none of us like layers, layers and layers of bureaucracy at the end of the day. I'll move on to our next Member—Peredur Griffiths, I'll pass over to you. I know you're going to be asking about stability and quality of care home provision.
Thank you, Chair, and morning, Heléna, it's lovely to see you. As Natasha said, looking at the stability and the quality of care, what's your overall assessment of the state of the care homes market for older people in Wales, its overall sustainability and the overall care quality?
I think we're in quite a fragile position, not least because of the last two years, but also because of the issues that this committee is looking at in terms of funding and the difficulties of funding. To reiterate my earlier point, it's not just one market and I think that's the complexity as well. If it's to work for older people, it's about local markets as much as anything, and too often, older people are not able to access the care homes in the places that they want to. So, my worries about stability of the market are not just on the macro scale, but also on that local scale as well.
I worry about potential care home closures as well, because of funding issues. So, the fact that that Welsh Government financial support during the pandemic has stopped, for understandable reasons, that could create some further problems. And when care homes close, that can be a devastating experience for older people to move. People, when they've got to know friends in the care home and their relationship with care staff—all of that can go in a matter of days and that can be very distressing. I think, also, the care home market doesn't have some of the provision we need, particularly for people with dementia, which is not just about specialist homes, actually, it's about recognising that, in pretty much every care home, there will be people living with dementia, so how do we make it the case that you don't have to necessarily move to a different home as your needs change?
I think the other issue related to quality is that issue about getting back to the culture of care homes being open and part of the community and not closed. So, I worry about care homes where they still have restrictions on visiting that seem above and beyond what is needed now. So, those will be some of the issues, I think, at the moment.
Okay. So, what expectations do you have for the work being carried out by the local authorities on market stability reports and their potential to change the shape of care home capacity and services?
Well, we need that work. We need the kind of market-shaping work. We actually need it on a number of levels; we need a kind of national plan, really, in terms of what provision do we need—[Inaudible.]—age and what does that mean in terms of provision of care home places? That can't be done well without thinking about the overall kind of care provision. So, the number of places we need in care homes is also a factor of what we need in terms of home care, what we need in terms of housing. So, if we have housing where you can live well into your later years, even if you need a significant amount of care, that reduces the need for moving into a care home. So, we need that plan across care provision for older people.
We also need it to be based on better data than we have at the moment, and I indicated earlier some of the problems with population needs assessments, and I think it would be a good exercise to look at the population needs assessments that are being published right now, and in particular to look at the sections that indicate where there are gaps in data and where there are gaps in insight and knowledge, and, actually, for Welsh Government and regional partnership boards to look seriously at how to meet those gaps. In some other countries, they have what's called a longitudinal study of ageing, which is a really valuable data set, which, effectively, looks at the ageing population over time in terms of how it changes, the levels of need, the levels of the contribution we make as we age, and provides a really rich data set for all sorts of areas of activity of the Government, from care planning to economic development. We don't have that in Wales, actually, and it would improve a huge number of areas in terms of our planning if we had something like that.
Okay, thank you. Recognising the increasing costs in the sector, how do you think the Welsh Government and commissioners should respond to manage those impacts on service users?
Cost-of-living impacts are affecting all of us. We know for older people the impacts are hugely significant, actually. Many are struggling to manage even now, and that's before the next energy hike, before the winter. The state pension hasn't gone up as much as inflation, and nor have other key benefits. So, I think there's more work that Welsh Government can do, actually, in supporting older people on the cost-of-living crisis, first of all. There's more action that could be taken there, and I've highlighted to Welsh Government what I think it needs to do on that.
In relation to access to care, we need to make sure, I think, that you're not disadvantaged if you need care. It shouldn't be that the people who bear the brunt of the cost-of-living crisis are those who are in particular need of care and support. I wouldn't, for example, want to see an increase in care charges on older people; I think that would be a pretty outrageous thing. There's no sense that that's going to happen, by the way, but we certainly shouldn't be looking at that. We should instead be looking at how can we maybe mitigate more of those costs that older people might be facing, if they're having to pay towards the cost of their care.
Going on from your comments earlier that a care home is people's home and, obviously, the workforce are there to support people in their home, because they're in a care home, how well do you think that partners are working to develop a sustainable workforce for the care home sector and support professional development?
There's a huge amount of hard work going on, which I can see across all bodies. It's the thing that people raise with me a lot around workforce, and it's not just a challenge here in Wales. I think, fundamentally, actually, part of the challenge is that we don't value, as a society, care. We don't value the people who do it unpaid, we don't value the people who are paid to do it in terms of what we do to support them. Actions are louder than words on this. I very much welcome the fact that the Welsh Government is introducing the real living wage. I see that as a first step only; we need to go further on that. We need to provide more support for unpaid carers, which includes easier access to care for the people who they are caring for. And also, I think ageism is at the root of this a bit as well, that people have a very negative view, often, of older people, of growing older or of working with older people, even, and I think that's part of it as well. Some of the change is about cultural and attitudinal change. It's why one of the things I'm working on is how we can combat ageism, how we can get rid of those stereotypes, how we can get rid of the notion that, somehow, older people are a burden, and actually put much more value—and value all of us who need care. Most of us are going to need some care and support through our lives, either for us or our loved ones, so we should value that as a society, and that should be reflected in the budgets that go to social care, for example, the rights that people have. There are ways to reflect better the importance of social care to all of us.
And just finally from me, Chair, if I may, what role do you think that volunteers have in care home settings on an ongoing basis? Are they there to enhance people's lives or are they there to perform the basic functions? What are your thoughts around volunteers in that setting?
I have a positive view of volunteering, not least because my first experience of working with older people was volunteering in a care home, so it's something quite close to my heart. I think volunteers do have a really positive role to play. Importantly, they have a lot to gain as well. This is not just about people doing good for older people in care homes; it's much more, actually, about the mutual benefit for the person who gets to know an older person. They might not have an older person in their lives, but get to have a different friendship. I'm really supportive of, for example, intergenerational contacts between older people in care homes and elsewhere. There have been some lovely examples, during the pandemic, of people developing pen-pal relationships with people in care homes, because they couldn't go in, so they became pen pals. I think where volunteering is at its best is shared interests, shared activity; I think it's wholly positive. I think it needs to be supported, so volunteers need to be supported, and, obviously, care homes need to have the capacity to manage that well and to support volunteers well. What we don't want to see is where volunteers are being brought in to do basic essentials that should be done by paid staff. So, as long as that doesn't happen, I'm very supportive of volunteers in care homes.
Diolch, Heléna. Diolch, Chair.
Thank you so much, Peredur. Commissioner, I'd just like to ask you a couple of points, please, before we wind up the session. Firstly, I just wanted to ask if there are any observations that you had, particularly, that you may want to raise about the auditor general's recent reports on direct payments for adult social care, including issues that may be causing you concern around the interface between direct payments and access to NHS continuing healthcare.
It was an important report and, I think, reflected quite a bit of what we've heard through our advice and assistance team over the years. The take-up of direct payments amongst older people is low. I think that's for a number of reasons. The system can be quite complex to navigate, it puts a lot of responsibilities on the individual, for example to directly employ staff, which you might not want, and, sometimes, people who are working with older people in social services assume they're not going to want a direct payment when, actually, sometimes they might. Occasionally, more recently, we've seen where a local authority hasn't been able to provide the care and support for an older person, because of all the issues around staffing, and they've offered them a direct payment as a last resort, in a 'try and sort it out yourself' way.
We've also heard, worryingly, to your point about the relationship with continuing healthcare, that because you can't use your direct payment if you then get continuing healthcare, some people are stuck in a situation. I'll give you an example of someone who's getting direct payment and maybe they're employing a personal assistant, they've managed their package of care and support, they've got it working well for them, but their health needs are increasing, so they're eligible for continuing healthcare funding, but if they go to continuing healthcare funding, they can no longer have their direct payments, and they lose that choice and control over this package of care and support that they've arranged. That's a ludicrous situation, isn't it, that because you're now eligible for a different form of funding, you can't continue with the type of support that you had. I think that's a particular interface between continuing healthcare funding and social care funding that needs sorting out. You should be able to continue to be able to have that choice and control. We know that some people have rejected continuing healthcare funding because they couldn't maintain that choice and control over their care.
Thank you for that. Commissioner, in many of the answers you've given, you've spoken about ageism. I personally hate it, I know my colleagues do as well. Racism, sexism, we're not fans of any isms here. But I just wanted to ask you whether, overall, you're actually confident that the Welsh Government, as a whole, is moving in the right direction and quickly enough with its policy reforms to address the long-standing issues affecting care homes across Wales.
I think some of the direction is good, particularly in relation to care homes, looking at having national commissioning frameworks and more consistency over those areas. I think that's good. Implementation is the key, and speed. Older people quite often will say to me, 'We haven't got time to wait', so it matters that this stuff is done quickly, it matters that implementation is done well. We know, potentially, there's some radical reform that might be proposed in relation to the Welsh Government and Plaid Cymru agreement on the future funding of care. I think we just need to make sure that the improvements that can be made now are not delayed because of working on this new funding system or this new bigger reform. We need to improve matters right now for older people, and that's through some of the things that I've suggested. So, look at those pressure points in the system, particularly between hospital discharge and care homes. Improve rights, improve communication. Sort out the interface on continuing healthcare. That needs to have a really clear focus on it. Get that clarity about care home fees and improve people's rights as well as looking at, longer term, how we can move to a system that's much more about care being free at the point of need, and a much simpler system to access. I think a lot of time and money goes on complex assessment and eligibility systems. We need to trust people who need care and support more, we need to simplify the process, and we need to make sure that we don't just increase layers of work on this, that we actually look to how we can do away with some of that as we move forward.
Okay. Thank you so much. I just want to give Mike and Peredur the opportunity now if there's anything they wanted to add. No. Okay. Thank you so much, Heléna. Just one last remark for you: if there's anything you wish to add to any of the comments or questions that you've made today and responded to. Is there anything you'd like to add?
I think just to say that the work on improving the rights of older people in care homes and actually in accessing care and health overall is critical. We have seen during the pandemic that older people's rights have not been upheld well. This is work that I'm taking forward with others, not just in Wales but across the UK. I think this is fundamental, actually, coming back to the issue that the committee is looking at, if we're to rebalance this care home market so that it works better for older people.
Thank you very, very much. Heléna Herklots, Older People's Commissioner for Wales, I'd like to thank you so much for joining us this morning. It's been an absolute pleasure speaking with you. I'd like to also thank Members for their questions and I'd like to advise you that the transcript for today's meeting will be published in draft form. It will be sent to you and you may check it for accuracy before the publication of the final version. I believe we are now going to be heading for a 20-minute break before our next session. I would urge and request both Members to stay on screen, please, because we do need to discuss a few things before we head into that break. Thank you very much once again.
Gohiriwyd y cyfarfod rhwng 11:32 ac 11:46.
The meeting adjourned between 11:32 and 11:46.
Welcome back, everybody. This is item 5, the scrutiny of public administration of the Public Accounts and Public Administration meeting taking place today. I'd like to welcome not only our Members but also our guest here for this segment. We're joined by the wonderful Dr Andrew Goodall. I'd like you, if you wouldn't mind, please to give your introduction, and it will be followed by a series of questions by myself and also our Members here today, and we will be, I should say, jumping between each other when it comes to questions as well.
Diolch, Cadeirydd. Andrew Goodall ydw i, Ysgrifennydd Parhaol Llywodraeth Cymru. Diolch i chi am eich gwahoddiad.
Thank you, Chair. I'm Andrew Goodall, the Permanent Secretary for the Welsh Government. I thank you for your invitation here today.
Chair, also just to say thank you for the opportunity to come and speak on some correspondence that I exchanged, just about some changes that I've put into the organisation. And I'm mindful that I've had one attendance with committee members formally, and it's very good to be able to come back round, and I hope to answer and explain some of the questions.
If I could just say that I have been able to take the opportunity to make some changes that I think allow us to be more effective in our support for Ministers, for programme for government expectations, but also to ensure that the civil service is able to be effective. But I also want to make sure that the organisation demonstrates that it is able to change. We have, as an organisation, lived through the pandemic experience, alongside all of us, and it's really important that we pause and reflect on those experiences, but we are moving into a different phase and environment, and it's going to be really important that we are able to discharge change, but I think also to show that we can act as an exemplar.
But, Chair, rather than a long introduction, I'm sure there's a range of questions, and I'm very happy perhaps just to get stuck in and answer some of those.
Of course. Thank you, Dr Goodall. As you'll expect, we do have a number of questions and I'd like to ask Members and yourself as well to be as succinct as possible to enable us to cover a wide range of issues that the topic has generated. So, I'll start off, if that's okay. So, I'd just like to know, since you've taken on the role, what have been some of the priorities that the First Minister and the Cabinet have actually set for you whilst in this position?
Thank you, Chair. Diolch. It's already over six months since I was appointed and, obviously, that has gone very quickly from my personal perspective, but there have been a number of other perhaps unexpected things that have happened during that time. But, if I could outline that other than, of course, my responsibility to make sure that I lead an effective organisation of 5,500 people—and, of course, we can explore how would we measure that, how would we know that—I think there are four areas that maybe help as to how I've tried to place my time over the last six months. These things may change and adapt a little as I look at, perhaps, the next six-month period of time.
The first one is actually about ensuring that we can get the civil service to focus on and deliver progress and key milestones for the Welsh Government programme for government. Inevitably, the last couple of years have been dominated by a pandemic response. That would have diverted a lot of the civil service resource and attention, and meant that we needed to step away from some of the underpinning priorities. But, over these last few months, over this last year, we have been able to make some different judgments. But it was really important to make sure that there was an approach to ensure that the programme for government was central to the way in which the civil service responded.
The second area is just recognising that, particularly at this moment in time, we remain in a response mode to a public health emergency, albeit at a different phase, but it's really important to be able to translate the more crisis-management aspect into what do system recovery plans look like across the various ministerial portfolios and across the different sectors. So, there have to be effective arrangements to manage that kind of transition.
The third area is to step up to a responsibility, which of course is implicit in my role, about leading and implementing change and transformation across Welsh Government, which is the way in which the civil service operates, although I would argue that there are ways in which we can approach that change by looking at the way in which Wales, across public services, works together. Certainly, I think there are some opportunities to focus on what we've stated before are our principles and values around one Wales public service.
And then the fourth is actually again to ensure that there is a balance in the way I look to discharge my time, but to lead and enable inter-governmental relations, and that includes relationships of course both with the UK Government and also devolved Governments and actually a lot of my time there is building up those networks and relationships that are essential in supporting Ministers to discharge their role, but working with my colleagues in devolved Governments and also across the UK Government as well.
So, I think they probably are a good way of capturing four areas that have certainly affected the last six months, and they were the areas that I highlighted in a recent performance review, which was just looking at my first few weeks. But perhaps just two additional comments, Chair. Firstly, as I said in my introductory comments, there is a genuine opportunity for us to think about Welsh Government, from an organisational perspective, not only having a role to oversee policy and assure ourselves about progress in Wales, but actually we have to think of ourselves, with 5,500 staff and in the running and operation of an organisation, as an exemplar. That could be about our approach to diversity, to race equality action plans, about our compliance on certain expectations.
But I would also say that, over these last six months, whilst I would have liked to have just got on with the job in hand, of course we have had unexpected areas. I've been really pleased and confident in the way in which the civil service has had to respond and adapt to those, Three obvious areas that would have been visible to everybody over, again, these recent weeks and months would have been the omicron variant and the way in which we had to step back and again focus on a public health emergency, the cost-of-living approach, which will be a concern shared across Governments across the UK, and, of course, more recently, the way in which we've enabled a response to focus on support for the people of Ukraine. That clearly has been an area where we have had to put some very significant attention and, I have to say, liaise with colleagues across the UK.
Thank you very much, Dr Goodall. I'm going to ask you a sub-question, because you gave such succinct and elaborative answers. I want to go back to one of the points that you mentioned earlier about working with the UK Government. We often talk about working together and team building amongst the UK-wide nations, so I just wanted to ask you: how are you finding that relationship being built amongst us here in Wales and the UK Government, particularly moving forward, as you mentioned, with regard to COVID recovery?
First of all, I would say that I come at it with confidence about the way in which we can approach those areas from a civil service perspective. A lot of that, from my perspective, comes from the way in which I've spent two years in a crisis and response mode in my previous role, needed to liaise and link with, of course, and support, Ministers on the one hand, but actually with officials who have been able to help me make decisions on behalf of my teams, and to liaise to make sure that we could find common ground where that was appropriate and needed. So, I think there's that confidence about those relationships. I obviously come into my role with eight years of experience of being in the civil service, and that means that, again, I can rely on some excellent relationships and networks, both for Welsh Government generally but actually at a personal level.
I think we need to recognise, of course, that different political views will of course be a factor in the way in which we engage and support. But, again, whether it was through omicron, whether it's the ongoing contact and conversations that we have on Ukraine, whenever Ministers get in a room together and properly discharge their responsibilities, we will always have done so as officials ahead of that, and we will of course be alongside Ministers as well. It's really important to make sure, particularly in matters of international concern and humanitarian support, that we are able to bring through that common purpose and make sure that we are able to give the best advice and support policy. Certainly, Ministers will have their own networks and relationships, but we are part of the UK civil service, and we make sure that we use those relationships and networks and create the right advice environment.
Thank you so much, Dr Goodall. Now, with relation to the senior-level restructure that's taking place, has the impetus for change come from the First Minister and Cabinet, or directly from the civil service itself?
So, as I arrived into post—and, of course, I was previously in my director general post—I had been part of a conversation with my predecessor who had been just reviewing the way in which we were providing support in the civil service, and recognising that, usually, what will occur around a new Government being formed, which, of course, was May last year, is that we will take a view on how the civil service structure is aligned to areas of interest from Ministers and portfolios, because this is about supporting new Governments, and there will, of course, be differences around areas of focus and portfolios. I think, with the pandemic response, probably some of the natural opportunity to have made some of those decisions in terms of the civil service machinery were probably deferred, but Shan had embarked, knowing that there would be a recruitment process for a Permanent Secretary, just to broker some of those early discussions about some new and different roles and also the way in which we aligned. So, I felt I was able to come in with some of the prior thinking having been done, and, perhaps with some delay caused by responding to the omicron variant, was able to work my way into a conversation with directors general and other colleagues, and think about feedback from staff, but also my contact with Ministers.
I would say that this is really about the civil service wanting to demonstrate that it can be more effective in the way it provides support. Clearly, there was interest from the First Minister and from Ministers, and there probably would have been a couple of areas where, in Ministers' feedback, they would have felt that I could certainly demonstrate how things could be improved.
But, actually, the focus of this has been through my own oversight and role, wanting to make sure that we can recognise that we've been through a difficult two years ourselves, that the status quo isn't acceptable, that we do need to focus on the resilience and well-being of our staff, and we do need to make sure that we can describe how we are effective in supporting our Ministers. And whilst I've gathered my director general colleagues around, whilst I've been able, of course, to update Ministers on some of the changes, it's actually come from a collective discussion, which, hopefully, I'll continue to broker with staff across the organisation as well.
Thank you so much. I'd like to touch upon the co-operation agreement. It's something that, obviously, is quite new to many of us here at the Senedd. Now, a joint oversight board, joint policy committee and a co-operation agreement unit, staffed by civil servants, will be set up, if not set up already. We've been told that the parties, and I quote, that:
'The parties will rely on good will, trust and agreed procedures to facilitate the delivery of the shared programme of work whilst respecting each party's distinct identity.'
I just wanted to ask you: what will be the outcome if this beautiful thought breaks down?
So, I think it was really important to make sure that the mechanisms and the framework of how this would operate in practice were thought through in advance. And I think the environment can never be perfect, but what you can do is to try to cover off all of the bases. And I think the timing of the co-operation agreement coincided with, actually, my arrival into the Permanent Secretary role, and it was really important to make sure that very clear guidance and advice was provided.
You referred to the principles that are being set up here. That's to make sure that oversight mechanisms work, but I think one of the areas that was really important was to make sure that ministerial decision making was protected, certainly to make sure that there were clear codes in place that allowed people to understand the way in which support and conversations would take place. But I think it was a really key part to make sure that, within the mechanisms document that was, of course, put into the public domain and published, the civil service role to provide objective and impartial and honest advice was also protected. And I was really pleased—. As I said, this was very early on in my arrival, but I tried to give very clear advice to the First Minister, gave that in a very straightforward manner, and, simply, the advice given was taken. And that was represented within the mechanisms document.
We have to recognise that what is on a sheet of paper, and what the words represent, obviously has to be tracked through in practice, and I'm pleased to say that the tone and the expectations of that framework, from my perspective, have been recognised and respected. Of course, if there was an event or an environment that occurred where we needed to review that, if we felt there had been a breach, if I could use that phraseology, of course we have an approach that would be able to review that, including needing to give assurance to the First Minister. But I've tried to make sure that, in the mechanisms document, actually the role that I have to discharge that objective and impartial role of the civil service was genuinely protected, and that has been recognised in the drafting and the wording, to make sure that my leadership of the civil service, and whoever was in the role, is actually protected as well.
So, I think we wait to see whether we have to go down a different route with that framework, but, certainly, over the first six months, that hasn't been necessary; there has been engagement, and I do think that the principles of the way in which that was expected to work has happened in practice.
Okay. Thank you, Dr Goodall. And my final question is: the creation of designated Members who look like quasi-Ministers protects party independence and the resources and status that comes with it. Plaid Cymru has also secured two special advisers, which is an important win, and great for them. But it's going to be a strange and unusual role, working to a Labour-only Cabinet, and on a day-to-day basis with Labour-appointed SPAD teams. So I just wanted to ask you: what precedent exists for this kind of arrangement that we've adopted here in Wales?
Well, I think that if we look at the general arrangement, and of course, the First Minister has had to make his own decisions on how the political oversight and mechanisms work, I've had to focus on the civil service response et cetera. But there are other examples of other agreements that have been made at various stages of devolution over the last 22 years—they can range from formal coalitions, right through to budget agreements and making progress on those individual areas. This feels that this is another phase and an experience within that devolved Government experience.
What is important though is to make sure that there, fundamentally, is a protection for the ministerial decision making. And that, from my experience, has been absolutely happening in practice, and was clearly stated in the agreement that was made and what was brokered. Again, it was made very explicit in the mechanisms document. It's also really important to recognise that, of course, there are ways in which the civil service must respond to these, but I think what has been very effective again, and this gives confidence to the civil service, is that the co-operation agreement itself is actually a part of the programme for government, and it is a subset of the programme for government. And that has allowed us to make sure that our overall approach to the co-operation agreement is the umbrella arrangement. So, I think that has been a very effective response as well.
Of course, I don't have any responsibility for the appointments of special advisers. The point I would make is that the special advisers who are appointed work directly for the First Minister. And of course, they are part of an overall special adviser team as well. But they have a code of conduct in place, as do designated Members as well, and it's really important that that code of conduct applies to all. It's why we have a civil service code, and it's why Ministers, of course, have a civil service code as well.
Dr Goodall, thank you so much for answering my questions. I'd like to welcome back our original Chair, Mark Isherwood—it's a pleasure to have you back with us, Mark. Just to let you all know that the following two questions—3 and 4—will be taken now by Mike Hedges, and then I'll be happy to pass the reins back to Mark, if that's okay with everybody. Mike, over to you.
Lovely. Thank you very much indeed. Thank you.
Diolch. My first question is on the chief operating officer—I think that's a very important role. How does that relate to your role? Because you were, effectively, the chief operating officer as the position you currently hold as Permanent Secretary. How is that going to fit together?
Yes, it's really important to look at the complement of the DG roles, and of course there are directors general who will have policy lead areas, be more supporting Ministers. But the chief operating officer role is certainly different for us in Welsh Government. Fundamentally, I can't abrogate my responsibilities to be responsible for leading an effective organisation. And if I can speak very openly, I have a very significant operational experience in my background—certainly in running health services, running health boards—that means that I do have a full appreciation for how you do need to drop down structures, and put your hands on things, and make sure that we deliver and achieve outcomes as well.
But if I was comparing and contrasting my opportunity with previous Permanent Secretaries, there is a danger that previous Permanent Secretaries have, at times, had to be diverted to some of the nuts and bolts of running the organisation, perhaps have lost that broader opportunity to think of the more significant areas of impact and influence, whether it's liaising with other public services, whether it's ensuring that the delivery of programmes of government happen. And this role is directly to allow me to spend more of my time focusing on those types of issues—whether it is, as I said earlier, the inter-governmental relations—I guess, as I await a new colleague to join us.
Having said that, I have, of course, in my first six months, as you sort of indicate, been discharging that role anyway. So, I haven't left any of those areas missing in translation. And, hopefully, as I hand over to a new colleague, there will be an opportunity that I've taken to actually get to really understand those individual services. But they will not be necessarily involved in the policy space, they will be involved in the oversight of the corporate functions. And certainly, if I could just say, one of the areas I think that is an opportunity, irrespective of how they're really important to the change programme, it has also allowed me to introduce an approach, where they are more neutrally hosting our inspectorates, who've been within Welsh Government, and I think that that draws it away from some of the existing policy directors general. So, I think that's also an opportunity.
But the test will be whether I can use that time right. As I said, I'm not abrogating my responsibility, but it will give me time and attention to focus on those broader and more strategic issues, including making sure that the change and transformation in the organisation genuinely happen.
When will the appointment take place?
So, I've just been going through the process over the last couple of months. It's overseen by the Civil Service Commission. Obviously, there is approval that comes through the UK civil service mechanisms as well. But I'm pleased to say that, just at the end of last week, we came to the end of that process. And I will, I hope, shortly be making an announcement about the outcome of that post and that will be an announcement that—. Of course, I will make sure that Members are aware of the appointment.
So, there will be candidates, who, over the course of the next few days, will be aware of the outcome of that process, but if I could just say, it's been very extensive. It's chaired by the Civil Service Commission. It has had external representation on the board from Scottish Government, and I was really pleased actually to have their equivalent of the chief operating officer role. And maybe that also allows me to say that, whilst this is the first time that we have technically introduced the chief operating officer role, it is actually a pretty normal and usual role in other civil service departments and governments. And I think this is probably a little bit about us catching up with that environment as well. But hopefully I'll be able to drop you a note of confirmation next week, over to the Chair and to Members.
Thank you very much. Can I talk about the current Welsh Government's senior restructure implementation? We seem to have had an awful lot of senior restructuring in Welsh Government over recent years. I think Chairman Mao would be proud of your continual revolution and continual change. Do you think that this is going to stick?
Well, I think you always have to recognise that as a new government arrives, the civil service always needs to make sure that it needs to be agile. I mean, certainly, I will be hoping that this will be sticking in my own tenure, so I guess that is one thing to say, that by doing this very early on I know that I will have a good run of this during my tenure in the Permanent Secretary post.
I think it's really important to emphasise that our approach to this has not been to make change for change's sake. I've often, in my previous NHS roles, wanted to always make sure that there was consistency and momentum in any organisation, and it's really important to allow change to happen, but not to be distracted by that.
I've been a DG who's lived through previous versions of structures as well. I think that, on the one hand, any structure can be made to work, but I think there are structures that allow you to be more focused and actually to certainly raise the bar about achievement. But I do think that this is a necessary change. And if I just think in very stark terms: to think that, professionally, we've been through the last two years and had to adapt so rapidly, to feel that the civil service was going to carry on whatever—despite a pandemic response that has affected us in many ways and the way in which we work—I think wouldn't have been showing that exemplar status that we had before. But of course, it's a significant moment of change, and what I have to do is make sure that I keep the focus on the delivery that we're emerging.
So, in my tenure, yes, absolutely, I want to adapt and learn around the structures, but I hope we're at least very clear. And perhaps with the work that my predecessor did, I've had the opportunity to do this very early on. Sometimes it can take a little while longer.
Can I ask you about progress towards implementing the restructure? In my experience of restructuring from different levels in different places, you end up with some months of people worrying about what's going to happen, where they're going to end up, and that does tend to slow down the day job.
Well, I outlined my priorities earlier, which is this significant commitment to make sure that we are focused on the programme for government delivery, particularly as we move out of the pandemic response. But whilst the technical discussion about how the structures would be configured and getting the ownership and agreement, certainly from my director general colleagues—and making sure I have their reflections and have listened to some of the initial staff reflections in the organisation—actually having come to a point where we thought we had finalised the agreement, and then was able to update the First Minister and Ministers about the outcome of that, we actually implemented the structure within five weeks.
I was really keen to make sure that, whatever the ongoing conversations that were taking place, we made sure that we introduced the change at the beginning of the financial year. So, we did put it in place from 1 April. There was a reconfiguring of the director general roles and the group arrangements that were in place. I was able to move colleagues around and include a new appointment into those areas as well and did that very, very quickly to make sure it was available from 1 April. But you rightly indicate that there is a knock-on effect from these types of structures.
So, what I've been describing to the organisation is that we are trying to ensure that we are able to discharge fit-for-purpose support for the role of Government and for Ministers. We have more than enough to do. We have very significant expectations on our shoulders, including looking into the longer term, and actually this isn't a process about cost savings, but it is a process about making sure that we have change to occur in the organisation. And my argument has been, to the organisation, which has received support, is that everybody would say, including from a resilience and well-being perspective, that we can't stay as we are in the way that we're organised.
Having said that, I do think that a couple of things are really important to state. We've not done the change only to enjoy change; the balance that we've achieved as a result, to distribute across Ministers—. Speaking openly again, I had previous colleagues who were supporting seven or eight Ministers in a director general role within a group arrangement, and now having a balance that we've got really no more than three Ministers actually supported does provide a different balance. And you will have scrutinised economy, skills and natural resources and had previous directors general in front of you. That actually represented 50 per cent of the civil service resource of the Welsh Government, and for me, that was a very significant point of imbalance in terms of the expectations placed on that group, but certainly on the leadership.
I could ask the question, why not just one Minister, one director general, or one Minister and two directors general, or two Ministers, one director general, and two heads of service?
Well, if you do the maths and start adding up those areas, I didn't have the luxury of spreading out to have individual directors general matched to individual Ministers. Of course, directors and deputy directors and other teams, clearly, are experts who have access in their own fields to make sure that Ministers are supported. It's probably just worth a point of comparison and recognising how other devolved Governments have actually decided to embark on such changes as well and whether we're achieving the right balance or not. Northern Ireland have Permanent Secretaries rather than DGs. They have eight of them who are overseeing the portfolio of their devolved Government responsibilities. And Scottish Government have eight director general roles, which are again distributed across the respective ministerial portfolios as well.
So, I wouldn't want to detract from that Ministers of course must reach into the organisation, but I do see that the director general roles—and that has certainly been my experience over the last eight years—do have co-ordination, leadership and responsibilities to make sure that they're able to intervene, particularly where we see a lack of progress within the structures or where key issues or concerns need to be highlighted to Ministers as well.
You've talked about the senior changes; how far into the organisation are changes occurring?
Well, with the reassurances that we need to give to show that we need to use our staff differently, and there will be some knock-on effects. I mean, of course embarking on a period of change is to expect that we are going to adjust and do some things that are different, so it's not simply only moving things around at the highest level, even if I feel that better points to, for example, the programme for government delivery, I think it better reflects the climate change commitments for the organisation. But with some reassurances to staff about how we do it, of course I am expecting a ripple effect to occur from these structures so that people can adapt accordingly. I have liaised with unions to make sure that they understand that process and there will be an open engagement that happens with our staff. And in fact, as I handed over my responsibility for health and social care to Judith Paget, I'd actually brokered a series of potential changes within my previous group that Judith has now made happen. They are absolutely in line with the principles of the structural change, but we absolutely had embedded that in a conversation that took place with the staff. So, again, with the reassurances, which have happened. But what I would say is that the structure of itself is not the answer here. You know, I am more interested in how we can have momentum that occurs from the approach we are taking to our change programme for the organisation, and I think if we take the two of those things together, that's a much more effective way of having a conversation to show that change is happening.
How will you ensure that the transition is effective, and how will you review it?
So, it's been really important in making a very rapid change, because it would have been possible to have deferred the implementation of these structures for a period of months, or a year, to look for excuses on that, but I don't think the environment we were working in allowed that to happen. And if I think of actions that we've taken during the pandemic response, where we've been able to make decisions and implement in matters of days and weeks, I think it was very much in that context that I wanted to work and operate. But certainly, I've kept an eye on the feedback that we've had from staff. I'm listening to directors directly and personally, to directors general, listening to the feedback from staff more generally. I would say that it feels that it's been welcomed, positively received, that people see that it has made sense. They obviously are looking for the next step of opportunities. But it's really important to make sure that I'm able to have some key milestones in. Again, I would say that there are some outcomes I need to look at from the structures directly, but there are also some outcomes from the general—[Inaudible.]—programme. But clearly, what I'm looking to do is to make sure that our corporate functions are more effective by shifting to a director general for chief operating officer. I'm looking to make sure that bringing in education together in a single group arrangement achieves some of the milestones and outcomes expected there. I do want to make sure that we live up to the climate change brief, to make sure, actually, there is a translation there, and I am also trying to make sure that we can focus on our broader relationship with public services more generally, and I'm very happy, as I work through what some of those milestones represent, again to have an exchange with you, Chair, to allow you to understand some of the milestones and targets and outcomes, and hopefully come back in future to have a conversation with Members around the table.
Thank you. Finally from me: was that an offer to come back in 12 months' time to tell us how it's worked?
Yes. I'd be delighted to come back and to obviously make sure that that broader conversation about not just the structures bedding in but, of course, the opportunities that we have of change. I'm very happy also to give some interim updates as well.
Thank you. I believe Peredur Owen Griffiths has a question.
Yes, thank you, Chair. Good afternoon, Dr Goodall. Lovely to meet you, and I'm sure you'd expect the Chair of finance as well, sitting on here as a substitute today, to have an interest in financial implications. Could you give me an idea of the financial implications of the restructure, and is it cost neutral, or is it not, and what your thought process has been around that?
When I use the term 'effective', it's really important to recognise that I am considering all of my respective priorities about value for money, to ensure that it's good use of public resources, et cetera, in general terms, and actually the restructure is more important in the way it helps to facilitate some of the broader changes I'm looking for in the organisation, because a lot of that is demonstrating how we will do better with the resources and the funding that we actually have. But at a technical level, this is actually (a) dealt with within our budget arrangements, so we're not looking for this to be an extra pressure on the budget per se, but the only real significant issue for the moment, although I would expect that to translate differently and to manage back within the budget over time, is actually, technically, the introduction of the chief operating officer role, because that is an additional post that has been agreed, and had the agreement of the First Minister, and actually had the agreement of the UK civil service. But I would also want to say for the record that whilst that is extra for now for this year, one of the existing director general posts is actually only an interim position. That is going to be coming to end during 2023. It was extended because it has a COVID recovery role, and at that point I would hope to revert back within the existing director general budget, for example.
I think there is a broader conversation about budget management and resources and the staffing arrangements, and what I'm trying to do by instigating the range of changes happening here, which are enabled by some other structures, is to make sure that the civil service, as I said, can do more and better within the resources that are allocated to it. We have a budget that is made available to us and we obviously need to respect our responsibility, and my accounting officer responsibility to work within that as well. But there is temporarily just only one extra cost within the system that is simply the director general role.
And what is that cost?
That cost will just be the salary arrangements for the director general. So, it was advertised, for example, at £120,000 for the external recruitment that we went through, and that attracted UK-wide interest, and there was actually very significant interest in the role when we went through the process.
Okay, thank you very much. Chair, do you want me to move on to the next question as well?
Yes, please do.
Thank you. I'd like to understand a little bit about the relationship between Ministers and the civil service. How will you approach challenging Ministers, and in particular the compliance with the key legislation, such as the the Well-being of Future Generations (Wales) Act 2015?
First of all, I hope that, having been in Welsh Government for eight years, I will have personally brokered and facilitated the balance of the relationship that must be in place, and I think that we need to recognise that whilst, of course, civil servants are there to support Ministers, I believe that it is a collective and, of course, an individual relationship that should be based on mutual respect and recognition that there are different roles and objectives that are in place. We of course need to take views from Ministers, and we need to be able to be in a position to present a range of options and support in different areas. And I can say, through a pandemic response, through my eight years, and certainly it's true of the way in which I'm engaging in my role over the last six months, including with Ministers and with the First Minister, that I have been able to give my straightforward, honest and objective advice on a wide range of issues, sometimes in the most difficult of circumstances, of course, driven by a pandemic response. Having said that, it's really important that we make sure that, as we translate programme for government objectives' initiatives, we have a role to make sure that Ministers have all of the necessary information available to them to make the best decision possible. It's very important that we are discharging that objective advice.
I feel that the pandemic experience has probably raised the level of engagement around how we utilise evidence, science, knowledge and data across the organisation. I think that has been a strength—to be able to bring in more of that and to make it more visible in some of our exchanges with Ministers and on the advice, but certainly as we think about some of the key areas of compliance where we have to ensure that we are satisfying legal requirements. The future generations legislation, for example, is supported by a template, in the ministerial advice that is provided, to make sure that we have been answering some of those questions. I personally don't regard constructive challenges a bad thing; I think it's certainly been the way in which I have delivered my own civil service role and responsibility over the last eight years, and also in my previous NHS role as well. But I am very grateful for the regular contact that I have with the First Minister to ensure that we're able to review that together. And certainly, I'm very grateful that I have the access that I do to Ministers, both formally through Cabinet mechanisms, but, of course, informally if they need to express some of their own concerns as well. It's really important that there is confidence in the civil service advice, but also that there is a safe space for constructive and challenging conversations to take place.
And in what sort of circumstances would you expect to get ministerial direction?
Personally, I feel that it should be a rare and unique event. And I think that, if we look back over the last 22 years, that has been the reality. I speak, hopefully, in an informed manner of this, because I previously attended Public Accounts Committee to, obviously, speak alongside the previous Permanent Secretary about the occasion when we did introduce the ministerial direction, and I'm very mindful that I was the director general advising of the need for that to happen, because of some of the connotations around NHS and pension arrangements. One could argue that it was more of a technical issue, but I think, when you're introducing a ministerial direction for the first time in 22 years, it's obviously a very significant event, and it was really important that we had the opportunity to talk that through.
Having said that, what I've just described about the open approach that we could take as civil servants to give that constructive advice, the way in which it's received by Ministers, to make sure that we're able to give the balance of options—we aren't just focusing on the single actions, we are giving a range of different choices for Ministers. I think it should be a rare event, and it's not been our experience, probably because of an ability for us to feel that we've been able to give the advice that we needed to and that Ministers have been very respectful in their receipt of it. I say it should be a rare event and used sparingly; what I can't say is, definitively, do I think that there will never be the occasion for one? And as I hope was demonstrated when we had to introduce the ministerial direction in the NHS arena for the first time, there was a reason for it and it was important to recognise that and to discharge it, and then to make sure that that was appropriately discharged and communicated as well. So, there may well be an occasion when it's necessary, and ministerial advice would have to take account of that as well, but I really do think it should be very limited.
Because it seems to be used more so in UK Government departments than here. Is that because of the dynamic between the civil service and UK departments, as opposed to the dynamic that you've got and the relationship you've got with Welsh Government?
I think UK Government colleagues would have to describe and respond to why they go down that route and why they are necessary. I haven't been through that environment. I think there is something different between a department and a Government, and we obviously have to broker a series of actions and advice that is across a range of different areas. There would be separate ministerial portfolios within the Whitehall system and with the support that they give there. Clearly, I would suggest that the pandemic response will have raised the need for some very rapid interventions to happen. That probably is a reason why some of those numbers have increased, certainly over the last couple of years or so, and there will be some areas of justification. I was very plugged in, of course, to the pandemic response from a Welsh Government perspective, and I felt that we certainly didn't need to go down that route, because the advice that was provided was clear, the conversation that was taking place with Ministers was clear, and I think the options and choices made available were clearly there to allow Ministers to discharge their duties. But I think that, probably, the pandemic response raised an expectation that, suddenly, these are very regular occurrences. And it'll be interesting to just see how that, perhaps, settles down more over the course of the next 12 to 18 months to two years with UK Government colleagues and the way in which they provide their support to Ministers.
Diolch yn fawr. Diolch, Chair.
Thank you. If I could just slip in a quick question with reference to your comment earlier about the closer alignment between directors general and Ministers. How will you ensure that, in that closer alignment, you don't lose the Welsh Government's overarching and cross-cutting priorities applicable to all Ministers in areas, for example, such as the Rights of Children and Young Persons (Wales) Measure 2011, the tackling poverty agenda and the future generations Act?
Chair, it's a really good question and actually, to reassure you, one that we had really carefully thought through. In fact, it was one of the key principles that we set ourselves as a director general team, alongside myself, to make sure that the structures absolutely facilitate the cross-Government working. I think it genuinely represents another phase, but if I could argue that economy, skills and natural resources taking up 50 per cent of the resources, with the director general supporting seven or eight Ministers, would've removed some of the opportunity to spend time and attention on some of that cross-Government working. But I think I approach this with more confidence, again because I can't remove that we have just lived through an experience in the pandemic response where the civil service has been at its most collective and collegiate, where our ability to reach out to other public services in Wales has been at its most collegiate.
But I know that, within the mechanisms that I have in my Permanent Secretary role, and equally these will be matters that the First Minister oversees, of course, in his own role and responsibility, we are ensuring that we are keeping an overview of those cross-cutting, cross-Government areas of working, whether they will be matters around cost of living, or matters of the foundational economy and making sure that we are able to focus on those together. So, the principle was embedded about the choices we would make and the way in which we work as a director general team and also senior directors in the organisation will be really important. But, again, beyond just the structure change, I have a lot of other mechanisms in place that are part of discharging governance and assurance that will allow me to check and challenge on that. One area that I have asked our Welsh Government board members to review, and our non-executive directors there, is that they do keep an eye on some of the areas to make sure that our structures are effective, that we do focus on well-being and resilience, but equally that they make sure that we are discharging our cross-Government responsibilities. I can reassure you that I'm sure if the First Minister had any concerns that the cross-Government working was falling away, I'd probably know pretty rapidly, but I hope that I would've anticipated that as well.
Okay, thank you. We'll move on to our next set of questions. Is it you, Natasha Asghar?
Chair, I was going to pass it to you. The baton's all yours for this next section.
I've been allocated it. I had an absence from the meeting, so I'm not sure who had this. So, if this is me, I'll go for it. Looking at the Welsh Government and Plaid Cymru co-operation agreement and the relationship between designated Members under that and the senior civil service, how will you ensure ministerial and civil service accountability in the context of the co-operation agreement?
Chair, I think this may well have been touched on in some of the opening questions to me and I don't want to, perhaps, not respond there as a result, because I think that that was partly the introductory comments, but if I could, maybe, just draw on some of the earlier response that I made. For me, it was really important, and I reflected earlier, that I had come in at the time of the co-operation agreement being under development, but it was really important to make sure that the respective responsibilities were understood and that there was clarity, certainly about the way in which the civil service would need to discharge its role. I think, very significantly, the programme for government has acted as the overall umbrella for the co-operation agreement, and I think that that has actually helped to make sure that the co-operation unit arrangements in place are very small and limited, but at the same time it's allowed us to make sure that we can actually oversee the whole of the Welsh Government programme for government itself.
You'll have seen in the public domain, though, the mechanisms document that we produced, really to give reassurance but also detail on how this would work in practice. I was really pleased that, in the advice that I had to very significantly give at the outset of my tenure, around mechanisms to protect the objectivity, the impartiality of the civil service and the civil service code—that that advice was taken and simply drawn into the mechanisms framework and agreement. So, it wasn't an ongoing negotiation, it was clearly just accepted, and we've been tracking that. So, over the course of the six months, I think the arrangements have bedded in in a good way. I think we have to of course allow ourselves to understand that the framework is there to guide us, and, of course, if there were any concerns that came through any quarters, whether it was a civil servant expressing that concern, or whether it was something that the First Minister had registered, that we have a way in which we can actually review that and revisit it and make sure that these things remain on track as well. But it has actually settled in, I think, in a very professional way. But I think the programme for government oversight arrangements really have helped with that as well.
What is the mechanism for provision of civil service advice to designated Members under the co-operation agreement?
Well, we've had to ensure that there has been advice and a code that has been established, actually, for designated Members themselves. Their access to the civil service is managed via a gateway arrangement that is facilitated by the co-operation unit, who can act as a really helpful and constructive bridge to make sure those mechanisms go around. It's really important to emphasise that Ministers hold the decision-making choices. That is absolutely in line with their ministerial responsibilities, and it's important that we are able to, again, make sure that that is supported in that way. But I think the clarity of the respective roles, and having described them in detail upfront, has really helped us. And whilst there is always a tone in the implementation of these things, I can only say that that has been respected. Of course we'll need to keep those areas under review, but I have not had to highlight myself any specific concerns around this. And, certainly, I've not been drawn into any conversations that say that anything significant needs to change at this point. But I do think colleagues who are working in the co-operation unit—and it's a very small unit—have actually, I think, landed that intention and the principles very well, and act as a really good gateway and a bridge into the organisation anyway.
Okay, thank you. Again, the next set of questions, which relate to workforce—the Welsh Government workforce—did we have somebody who volunteered to take these? Mike, thank you. Mike Hedges.
Diolch, Cadeirydd. I've got three questions. The first one is: COVID showed the Welsh Government civil service at its best, and I think that you must be very proud of the role that the civil service played in that. Under this new restructuring, do you think you could do exactly the same thing again under another COVID-type event? And also, if I take you back to the Sea Empress, which you may remember, back in the 1990s, are you in a position to respond to such immediate, short-term pressures, some of which are quite disastrous?
Thank you. Well, if I could first of all just thank the Member for his comments about the civil service and the way it's reacted to the pandemic response, I'm very grateful for that, and I am proud of the way in which the civil service has discharged its own responsibilities. Of course, we've had to liaise differently, but I think that, irrespective of a central role for the civil service and to support Ministers, the civil service has been more visibly alongside other public services in Wales in discharging those duties. And, of course, we need to absolutely make sure that we learn from the pandemic response. One of the things that I'm keeping my eye on—and this will be a general concern within Wales—is to make sure that, just because we are in a different phase, we don't simply snap back to the way we were doing things before. I think, if we are not careful, we forget the tremendous way in which we have, with flexibility and agility, made very rapid decisions on a variety of fronts. So, my own personal view is that, 'If, in a pandemic response, we can change decisions to be in days and weeks instead of years, why in normal days do we need to revert to it being years again?', if I could summarise it in that way. And I'm sure we'll keep a general focus on it.
We've had to think about our resilience arrangements within the organisation. The fact that we have really good civil contingency arrangements in Wales—and, of course, we play our part in that in Wales—. It's really important to recognise that there are relationships in place. But we have to recognise that there is absolutely learning from the pandemic to make sure that we are able to discharge. And in your challenge about how do we respond to ongoing areas, whether it's flooding, whether it's been the Ukraine response, in fact, over recent weeks and months, we have had examples of these other things happening, and we've had to make sure that we've been able to step into the space in a different way. So, as an example, in respect of supporting Ukraine and the humanitarian response, we now realise that this is something that won't just be a matter of weeks; we'll need to look to some medium-term planning, and we'll be looking for resilience arrangements to be in place of the team. But I'm very grateful that, at the core of it, we have our civil-contingency role to play here, and that's also a key role that Reg Kilpatrick, as the interim COVID recovery director general, is able to oversee and discharge with all of the experience that he's had through the pandemic response himself.
Thank you for that answer. I've spent 25 years telling people that video-conferencing was the way that we were going and people weren't going to have to travel long distances, and it took one month of COVID for 25 years of lack of action to be turned into action. The other area where we've seen action during the pandemic is the number of people working from home, and I know it's Welsh Government policy that they expect 30 per cent of the workforce to work from home. Are the Welsh Government going to achieve that 30 per cent?
So, we are still just at a residual stage on the pandemic side and, as you'll have seen from the latest 21-day cycle, we've always been really mindful about the tone of our own actions in line with the 21-day cycle. With the First Minister's agreement, I've retained a progressive but cautious return to the physical office arrangement for our staff. Having said that, I think your point is exactly right; we have decided, however, that the experience that we have lived through and the use of technology represent for us now a different way of working that we wouldn't abandon. So, we will continue to develop a hybrid model. I'm sure the First Minister won't mind me saying that the Cabinet actually met in proper hybrid form earlier on this week, but that has been a remote meeting for the last 18 months or so, but it's a combination, deliberately, of Ministers able to join remotely alongside actually having some colleagues who are able to be in a room together and appropriately so. I can't see us taking these steps back.
I don't think we're likely at this stage to end up—. You say 30 per cent, but probably an upper ceiling for us is maybe no more than, say, 40 per cent to 50 per cent. Some of the numbers have started to increase, of course, as there has been some change recently, but I would hate for it to feel as though there's an insistence on people coming back to the office, although I think there are times and environments where that is needed. I think there is much more advantage in retaining that flexibility of the remote-working and the hybrid approach, and we will continue, I hope, to be an exemplar in that space. I was meeting with other agencies over the last couple of weeks, commercial and public services, and they were indicating the same thing: why would we move back from that experience?
I think that the situation is that sometimes it's useful to be in the same room as everybody else, other times it isn't, and, quite often, travelling several hundred miles for a one-hour meeting isn't necessarily the best use of anybody's time or good for the environment. So, I very much welcome those answers.
Two thoughts, if I could say. Our staff themselves have fed back to us—so, this is the civil service as an organisation—that they feel that there feels like there is a much more level playing field about the access to be able to do it, and, obviously, it helps the geographical spread across Wales. But, at the same time, our ability—and this is to think differently about our role—. If we need to reach out very, very quickly to get some expertise and policy advice from other agencies, from other public services or other sectors, we can gather everybody literally that afternoon virtually to actually have that conversation. And I think that was the pattern of the way in which we were getting support and accessing support through the pandemic response.
Yes, and you don't have to work out how long it's going to take everybody to get there and methods of travel. My final question. You support the delivery of the ambition to create a one Welsh public service, across the Welsh public service, one I agree with entirely. You've just left the health service, and I'm not quite sure you achieved a one health service view, not necessarily between the different health boards, but actually between primary and secondary health.
Yes, indeed, I'm happy to have an open conversation, and even an offline conversation, about the NHS. What I would say is that, at the national system level, we were absolutely at our most collegiate through the pandemic response, tying together the leadership right through to the front line of our system and service. You're right, however, the NHS is a large institution, and to get all of the parts to work seamlessly together will be a challenge, even for my successors, no doubt as well. So, hopefully, there's a bit of progress that I will have introduced over recent years.
I'll finish on this, just as a comment you may wish to answer or not. I'm sure if I went to Morriston Hospital and walked in there and met nurses, doctors and auxiliary staff, and I said, 'Who do you work for?' The majority of them, if not all of them, would say, 'Morriston Hospital.'
Indeed, and also from a public perspective, ultimately, the public will want to just know they have access to services in that way. So, I do think that the collegiate approach that we need to take can still feel very different.
On the one Wales public service—and I articulated that this was one of my four areas of priority, and certainly this has been a key issue that the First Minister has raised with me as well—I would hope that my background and the relationships and networks that I have across Wales help with facilitating and enabling some of that conversation. It will be a key point of focus for me about translating practical actions and the values and principles of this over the next couple of months. I have in the first few weeks and months spent time meeting with higher education—I was with chief constables last week—with NHS colleagues, with local government and with the voluntary sector, just making sure that they feel they're there. I think we've got some good practical support examples in place, like Academi Wales, but I just think that, more than anything, we can actually say that what Wales did, I hope, through the pandemic response, was that we brought together the one Welsh public service to act as the response mechanism, and that is a very strong foundation for me to come in and try and utilise.
[Inaudible.]—questions, you'll be relieved to hear. Is this—? Do we have a volunteer for this, or was this over to me again?
Me, Mark, if I can.
Thank you. Diolch.
Diolch, Mark—diolch, Chair. Just with regard to senior civil service recruitment, I understand that there's been the appointment of 20 additional senior civil servants to support the organisation, and at the Finance Committee we saw that there's an increased budget line of £19.7 million, which is almost 10 per cent up, for staffing costs. Could you give us a breakdown of how much those 20 senior civil servants are costing out of that £20 million?
Yes, indeed. On the budget arrangements, I think the £20 million there is a reflection of the costs incurred by the civil service, our overall staffing arrangements. Obviously, there are some exceptional issues in there that would have related to some areas of intervention and support that came through the pandemic response, but, yes, within the £20 million and where we had brokered agreement from both the First Minister and, of course, the UK civil service on these new deputy director roles, if I can speak, rather than individually around individuals—. If I was using the deputy director average costs, it would probably represent around £2 million, £2.3 million, of that overall £20 million, and that's why it was such an explicit decision to make sure that we weren't just doing that in the background. That was a very targeted decision that was taken in the organisation to create some resilience and to make sure that there were colleagues available for some very pressing issues.
Can I ask you just to explore a little bit about why 20 senior members of staff, rather than 40 junior members of staff who could be brought on?
Well, I think we have flexibility in overall terms in the organisation to look at how there are ebbs and flows of staffing arrangements, how staff leave. So, at the more junior levels, there is some inherent flexibility for us to do the right thing at times; I've always got to make sure that I'm managing within the budgets that I have set for me, but I have some discretion. Of course, with oversight, that happens, and it's where the board arrangements really help me to make sure that I can do that. So, I think the deputy directors are more explicit, in the sense that an expansion of senior leaders is a more visible decision. So, it doesn't necessarily mean that we've not also had to make some judgments along the way about those more junior roles, but it's just that these were an overall enhancement.
But I think your point is right. We need to always think about the shape of the organisation. What I would say at the deputy director level is that it was really important that we had individuals who were able to discharge responsibilities at the right level, give the support, make sure that Ministers were supported in the right way. And I think what liaising on the pandemic, certainly with UK Government colleagues, really showed us is that there are examples where, if there are 100 functions to be done, we still have to discharge the same functions and maybe there are 100 colleagues in the UK Government and perhaps we only have one. So, I think we do cut our cloth accordingly, but I think with the deputy director development—and that's why the First Minister, alongside the Permanent Secretary, my predecessor, supported this—we were able to put them into very significant priority roles where absolutely there was business to be done, whether it was the tail end of the pandemic response or whether it was about pushing ahead with some really critical programme for government commitments.
And just to touch a bit on those appointments and the civil service in general but more at that senior level, how diverse are those new 20 and how are you ensuring that there is gender balancing and all the other diverse aspects of a modern civil service that cover off and reflect modern life here in Wales?
Well, we, of course, have a diversity and inclusion plan and I said earlier about the civil service acting as an exemplar. We have to represent the communities that we serve. I know Ministers are very clear on that expectation, but I set the expectation myself for the organisation, and it's been a really key part of my commentary over this last six months.
On the specifics that you ask about, these 20 deputy directors—. And I would say we shouldn't lose sight of the overall balance of individual positions as well. But, certainly, our approach to the scheme showed that, for those who were applying to it, the overall pass rate for the applications—. And these were external appointments, so allowed Welsh Government and Wales-based colleagues to apply, but actually it was broader than that, in terms of external and UK civil service interest. But we had a higher pass rate for females compared to males, we had a higher pass rate of black, Asian and minority ethnic staff compared to white applicants, and we also had a higher pass rate of applicants from a minority sexual orientation compared to heterosexual staff. So, I think that we can take some reassurance from this particular recruitment phase that, actually, we were able to shift some of those dynamics.
But I wouldn't want to lose the broader picture for the organisation. I was actually part of our diversity network session earlier on this week, supporting them in their work, alongside Tracey Burke, one of my director general colleagues. But it's really important to make sure that we see the broader translation into the civil service from a general staffing perspective to a senior civil service perspective. And if I could just comment, I'm the board's sponsor, and I've retained that in the Permanent Secretary role, of the minority ethnic staff network within the organisation. But if I just go back just two years ago, we actually had no members of the senior civil service who were from a black, Asian and ethnic minority background. But we now have seven in the organisation, and that is not because seven is the right number, because we will continue to push on that.
It's also why I'm really pleased that, as the race equality action plan and the focus that we've put on acting as an anti-racist organisation is formally launched for Wales, and that will happen over the subsequent weeks, there will be some particular exemplar targets that are actually going to be in place for Welsh Government, which I was very happy to broker and facilitate. So, it's really good that we were able to use this recruitment exercise to show a change and difference. But, obviously, this all needs to add up to the way in which we configure the overall organisation, and to give that reassurance that our staff represent our diverse communities across Wales.
And just a last one from me, and thanks for your indulgence, Chair, is: do you see next year's staffing budget needing to be increasing at the same sort of rate, or is this a year of exceptions and we'll back to seeing something akin to normality next year?
There are some residual areas that will always be in the 'unexpected' area. We probably, in last year's budget, hadn't expected some of the excess costs to have come through from the omicron variant. We would have planned and prepared for it, of course, but when it happens in reality, it does change those aspects. Clearly, there are some very visible commitments that we're making and supporting now—numbers of people from Ukraine who are coming into Wales; they are smaller numbers, but becoming more visible—and I think there will always be exceptional issues that Governments need to do. I think I have to take a responsibility in my principal accounting officer role to make sure that I always have some flexibility to revisit that.
I think the budget settlement that I have gives me some certainty about my outlook. I think that has allowed me to start to make some different judgments within that budget, but I don't think it removes any examples of where I can use the money better and differently. You may not be aware, because it was something we rehearsed with previous committee members, but Welsh Government did actually bring in extra staff and transferred responsibilities for digital services into Welsh Government, going back around three years or so ago. And that meant that our overall headcount increased because we've now got staff who are physically in post. But what we were doing in that example was making sure that we were discharging our responsibility for public funds, because it meant that we were saving £2 million to £3 million and tracking that funding through, but, actually, it was a benefit within the organisation.
I think the finance Minister would certainly have an expectation that I continue to manage within my budget and my resource arrangements, but I believe that I have certainty for some choices that I can actually make and introduce, and I am making some operational decisions on the back of that. But what I am trying to demonstrate is there are still decisions that we can make within our own gift, and it's why the Welsh Government change programme is a significant issue for me and why the structural changes are really important, because they all point towards the fact that something different is happening, that we can make decisions that are within our gift and, hopefully, with the support of Ministers when that is appropriate.
Diolch yn fawr. Diolch, Chair.
Thank you very much indeed. Thank you very much, Dr Goodall, for your attendance and contribution today. That brings our questions to you to an end for this morning. A transcript of today's meeting will be sent to you, which you'll be able to check for accuracy before the publication of the final version. We will free you to go on and carry on delivering on all those things you've just been telling us about. Thanks very much again for being with us.
Diolch, Gadeirydd. Hwyl fawr.
Thanks, Chair. Goodbye.
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).
that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).
Cynigiwyd y cynnig.
I propose that, in accordance with Standing Order 17.42(ix), the committee resolves to meet in private for items 6 and 7 of today's meeting. Are all Members content? I see that all Members are content. The clerk will now change the setting from public to private.
Derbyniwyd y cynnig.
Daeth rhan gyhoeddus y cyfarfod i ben am 12:51.
The public part of the meeting ended at 12:51.