Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd

Health, Social Care and Sport Committee - Fifth Senedd

02/12/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Andrew R.T. Davies
Dai Lloyd Cadeirydd y Pwyllgor
Committee Chair
David Rees
Jayne Bryant
Lynne Neagle
Rhun ap Iorwerth

Y rhai eraill a oedd yn bresennol

Others in Attendance

Heather Ferguson Age Cymru
Age Cymru
Heléna Herklots Comisiynydd Pobl Hŷn Cymru
Older People's Commissioner for Wales
Rachel Cable Oxfam Cymru
Oxfam Cymru
Sue Phelps Alzheimer's Society
Alzheimer's Society

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Amy Clifton Ymchwilydd
Researcher
Claire Morris Ail Glerc
Second Clerk
Lowri Jones Dirprwy Glerc
Deputy Clerk
Philippa Watkins Ymchwilydd
Researcher
Sarah Beasley Clerc
Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

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 drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:30.

The committee met by video-conference.

The meeting began at 09:30.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Felly, croeso, bawb, i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn rhithiol yn y Senedd. O dan eitem 1, ymddiheuriadau ac ati, dydyn ni ddim wedi derbyn dim ymddiheuriadau, a dwi'n gweld bod ein Haelodau ni i gyd yn bresennol, a chroeso iddyn nhw i gyd. Yn naturiol, gallaf i bellach nodi, fel rydyn ni wedi dweud eisoes, taw cyfarfod rhithiol ydy hwn gyda'r Aelodau a'r tystion yn cymryd rhan drwy fideo-gynhadledd—os ydy ein cynulleidfa fyd-eang ni'n pendroni ynglŷn â beth sydd yn mynd ymlaen. Mae'r cyfarfod yma'n naturiol ddwyieithog, ac mae gwasanaeth cyfieithu ar y pryd ar gael o'r Gymraeg i'r Saesneg, fel mae pawb yn ymwybodol. Efallai y bydd yna ychydig bach o oedi cyn i lefel y sain ddod yn ôl i'r lefel arferol ar ôl i rywun fod yn siarad Cymraeg, felly mae angen, weithiau, ychydig eiliadau o amynedd. Mae'r microffonau hefyd yn cael eu rheoli'n ganolog tu ôl y llenni, megis i bawb, a bydd y tystion yn cael neges i glirio'r sgrîn pan fydd angen. Gallaf i bellach nodi, ar gyfer y cofnod, os bydd yna rywbeth yn digwydd i fy rhyngrwyd i yma yn Abertawe heulog y bore yma, yna bydd Rhun ap Iorwerth yn camu mewn i'r bwlch fel cadeirydd dros dro.

Gyda chymaint â hynna o ragymadrodd, oes gan unrhyw un o'n Haelodau ni fuddiannau i'w datgan? Dwi'n gweld nad oes.

Welcome, everyone, to this latest meeting of the Health, Social Care and Sport Committee here in a virtual capacity at the Senedd. Under item 1, introductions, apologies, substitutions and declarations of interest, we haven't received any apologies. I see that all Members are present, and welcome to all of them. I also note, as we've already stated, that this is a virtual meeting with Members and witnesses participating via video-conference. And if the global audience are wondering what's going on, we are here virtually. This meeting is bilingual, and an interpretation service will be available from Welsh to English, as everyone is aware. There may be a slight delay before the level of the sound returns to normal after a contribution in Welsh, so you may need to be patient for a few seconds. The microphones are being controlled centrally behind the scenes, as it were, and witnesses may see a notice on their screens to agree to unmute as required. May I also note, for the record, if something were to happen to my internet connection here in Swansea—sunny Swansea—this morning, then Rhun ap Iorwerth will step into the breach as interim chair.

And with those few words of introduction, do any Members have any declarations of interest to make? I see that there are none.

2. COVID-19: Sesiwn dystiolaeth gyda Chymdeithas Alzheimer Cymru ac Age Cymru
2. COVID-19: Evidence session with Alzheimer's Society Cymru and Age Cymru

Rydyn ni wedi cyrraedd eitem 2, felly, ar yr agenda, parhad i'n hymchwiliad ni fel pwyllgor i mewn i COVID-19, a sesiwn dystiolaeth gyntaf y bore yma gyda chymdeithas Alzheimer Cymru ac Age Cymru. Felly, i'r perwyl yna, dwi'n falch iawn i groesawu i'n sgrin Sue Phelps, cyfarwyddwr y gymdeithas Alzheimer's yng Nghymru, a hefyd Heather Ferguson, pennaeth polisi a phrosiectau Age Cymru. Croeso i chi'ch dwy. Diolch am bob tystiolaeth dŷch chi wastad yn ei chyflwyno i'n pwyllgorau ni. Fe awn ni'n syth i mewn i gwestiynau. Mae gyda ni ryw awr fechan, a syth i mewn i gwestiynau, ac mae Lynne Neagle yn mynd i ddechrau. Lynne.

We've reached item 2 on the agenda, and the continuation of our inquiry into COVID-19, and an evidence session, first of all this morning, will Alzheimer’s Society Cymru and Age Cymru. To that end, I'm very pleased to welcome to our screens Sue Phelps, country director, Alzheimer's Society Cymru, and also Heather Ferguson, head of policy and projects at Age Cymru. Welcome to you both. Thank you very much for all of the evidence that you always submit to our committee. We'll go straight to questions. We have about an hour or so. We'll go straight to questions, and Lynne Neagle is going to start. Lynne.

Thanks, Chair. Good morning, both. Could I just ask you to tell the committee a little bit about what you think the main impacts of the pandemic have been on those living with dementia, particularly the evidence that you've seen about deterioration in people living with dementia as a result of the pandemic? And what do you think the main messages and lessons are for the committee as the pandemic continues, please?

Thank you, Lynne; of course. Shall I jump in there, Heather? Do you mind? So, Alzheimer’s Society has produced a report—'Worst hit'; it's called 'Worst hit', and the reason it's called 'Worst hit' is that people living with dementia, affected by dementia, have been disproportionately affected by the COVID-19 pandemic. I'm happy to share that report with members of the committee if it would be useful. But that report really pulls together—it surveyed people across England, Wales and Northern Ireland, really gathering their experiences. I've jotted down a few of the key findings but, as I say, you'll have the report. 

Significant impact on people living with the diagnosis, but also their carers and family members. So, we know that over a quarter of all deaths in the UK from COVID-19 have been people living with dementia, so that in itself is quite staggering. I'm going to pop my glasses on, because I can't see otherwise. So, the highest proportion is over 40—sorry, over a quarter of those deaths. What we also know—I'm going to pull out a few of the figures—is 82 per cent of people living with dementia, through our 'Worst hit' report survey, said that they had reported a deterioration in their symptoms of dementia. So, that's deterioration in their memory loss, their cognitive ability, depression, agitation, confusion. So, all the symptoms that come with dementia have been absolutely highlighted and exacerbated through the pandemic and through being isolated, and not able to access services. Forty-six per cent of those people living with dementia said that it had a direct negative impact on their mental health, so not just their physical health, but their mental health. Fifty-six per cent of people said that they felt more lonely, more isolated—that's had a huge impact, people staying in their own homes and not having that direct social contact.

We know that suspension of services, so, again—41 per cent of people reported that their support care packages had been reduced throughout the pandemic, and over 50 per cent said that they hadn't had a care support package in place even before the pandemic, so those people weren't getting anything at all, never mind just a reduction. The other thing in terms of huge impact is the suspension of services, and that's suspension of services across the board. That is routine medical appointments, access to GPs, going into out-patients, but, importantly, relating to dementia, is that lack of ability to be able to have their decline reviewed, or even, indeed, if they're worried about their memory, to have a diagnosis, because memory assessment and diagnostic services have all been suspended along with other services.

The knock-on effect of that is that we're really concerned now that the backlog of those people waiting for their diagnoses or reassessment is hugely significant. So, we're gathering little bits of anecdotal evidence. In Hywel Dda, for example, we're hearing that over 400 people are waiting, in Aneurin Bevan, over 700 people, and those memory services now are beginning to slowly reopen, but the backlog and the knock-on effect on post-diagnostic services—because those post-diagnostic services in the community are not being released from suspension in the same way, so, access to face-to-face services, information and advice, et cetera. So, what are we going to do about that?

What has come to light is—and I should say as well, the care homes, and that's a very specific issue, but those people living in care homes who have not been able to access their visits, and again, that is being approved now, thank goodness. There now is the ability for testing, and carers and family members can go in and be treated with that key worker status, but up until now, that has been hugely impactful on healthcare, health and well-being for those residents, but also carers and families.

The big gaps seem to be—and this is all about lessons to be learned—we don't keep data. So, where the question was asked, where I did pose a question, we know that in England, for example, since February, diagnosis rates of dementia have dropped from 69 per cent to 63 per cent. So, a significant drop, because of suspension of memory services. When I asked the same question of Welsh Government, there is no data. When I asked a question—it was related to some work I'm doing with falls, and people being at home and not having that mobility and getting out and about, we have no data that's collected on falls in the community. So, I think there's a big data gap that we need to do better at.

I think the other thing is where services have had to adapt, and Alzheimer's Society and other third sector organisations have done brilliantly to adapt their services to deliver them by more virtual means and through digital platforms, but that doesn't cut it for everybody. What we know is we know huge parts of Wales do not have digital access, and there is digital exclusion, and our concern, going forward, is that that virtual, digital offer, which, of course, is less expensive, arguably easier to provide, is going to be the default position as commissioning goes forward. What we would call for is, 'Please not', because that's not going to be for everybody. That face-to-face interaction, ability to connect with the community is so, so important, and that's what's been so sorely missed during the pandemic. So, I'll stop there for a minute, but that's a very broad outline. I hope that answers your question, Lynne.

09:35

Thank you, yes. Shall I move on to the next question or did Heather want to come in?

I'll come in briefly, if that's okay. Firstly, thanks for inviting Age Cymru to give evidence today. Obviously, as the experts, Alzheimer's Society have covered all the key points, really, but the only things I think I would add are for the evidence today I'm largely drawing on a recent report that we launched, which was focused on the experiences of older people, aged 50 and over, in Wales of the lockdown, the first lockdown, and also their views on recovery, which is obviously very broad and covers lots of different issues. We did this in partnership with five national older people's organisations in Wales.

But just to add and, I guess, to corroborate a couple of points, one of the things that we did pick out within that is that those who have been impacted by the cancellation of appointments for dementia assessments and also for having medication reviews as well—having medication put in place as well. That's one thing that was picked out. The other thing was around carers of people living with dementia as well. That's also come up as an issue as part of our broader feedback around unpaid carers. And some of it is, I think, just re-emphasising the point around getting back into the community and the community centres. A lot of the clients we've spoken to are really struggling because they're currently providing 24-hour care and don't have the support networks they normally have, which are often those activity groups and support networks that are in their local community centres. Like Sue said, some have been online, but it's not the same as coming together face to face. So, to ensure that those places really are reopening again. But there's not much I can add to what Sue has said already. Thank you.  

09:40

Okay, thank you. Sorry, I thought you'd lost me then for a moment. Thank you. If I can move on, then, to talk about care homes. Sue, you referred to that earlier. It's been a major concern. How do you think it's been handled so far and what do you think needs to happen, going forward?

I think the first thing to say is that obviously it's been a hugely, hugely difficult situation to navigate for care homes, because of trying to achieve the balance between safety and risk of spreading the virus with the huge impact it's having on residents in residential care and nursing homes, their health and well-being, and their carers and families has been hugely difficult. That has to be the context. However, when you hear stories—and we've been inundated, our Dementia Connect lines, since February, and predominantly since March, since lockdown began, and the stories, the hugely distressing stories where that excruciating separation, really, has caused people in care homes to give up. People have given up, and given up and passed away without having seen family members, but definitely their cognitive decline and their ability to communicate has suffered detrimentally. 

I would say as well, we have heard from care homes and care home staff as well who really feel that separation and want to do their best but there does seem to be a level of risk aversion that, again, has been disproportionate to trying to make it safe. And when we've been talking about trying to get the key worker status considered, why could carers and family members not—and I'm talking way back before it was, as now, being considered—be given that status and have the testing when it became available, given the appropriate PPE equipment and training to go in and visit families? There just hasn't been that willingness to listen and to respond, and that's been very, very difficult in terms of campaigning. 

Going forward, we obviously now do have the testing, and there does seem to be recognition now that carers—. What was interesting was that, through a lot of our platforms, we've been speaking to people with dementia and their carers and they're saying that, actually, because of lockdown and because many of them are on the shielding list, they are arguably safer in terms of the risk of spreading the virus than those people in care homes, the staff in care homes who are going out and about and going about their daily business when not on shift and getting their testing, than those providing the care. So, they've been very confused as to why they can't be seen as being safe to visit. So, I think the testing—. The programme, I know, started this week. We're hoping for a full roll-out later in December—I think from 14 December. But we are still hearing that there are some care homes that are very reluctant to go down that route and have said that they will not enable visiting until March, which is not acceptable. 

Yes, please. I guess also re-emphasising the point around that balance. And we know that restriction on care homes has had a major impact on the lives of residents and their loved ones and also put enormous pressure on care homes and their staff. It's been that balance between, like you said, the safety of all the residents, some who may not have visitors, but also upholding the rights of those older people for visitation as well.

And what we've seen is, obviously, the pressure on care homes to have that balance, and it's obviously a really difficult and complex situation. What I would say in terms of—Sue's covered a lot of points there in terms of what I would look at, but I do want to emphasise some of the good practice that's been going on in care homes as well, in terms of visitations, and also the variety of care homes we have in Wales of different shapes and sizes. I think some of the smaller homes maybe struggle to reconfigure themselves to be able to enable visitations. So, we do welcome the temporary visitation pods, which obviously are going to be in place for Christmas for 100 homes, and we also welcome the roll-out—well, hopefully, the roll-out—from December of the testing, which has taken a while to implement, and it would have been good to have that in place sooner, but we understand the difficulties in putting that in place.

I think what we'd really like to see is, too, that support of sharing of good practice—we know it's out there—to support care homes and practitioners to share good practice between themselves, doing more things like the 'care home cwtch', bringing care home managers together to share their experiences and share what's working well in their homes. Also just picking up on some of those homes that are risk averse—and we are also hearing from some places that are maybe having strict implications and implementations of the guidelines—making sure that those homes are being supported to ensure that they are upholding the rights of residents and they are making sure that everything they do is in line with the guidance and they're not being risk averse.

09:45

Okay, thank you. And just finally from me: why do you think that there has been such a large number of excess deaths of people living with dementia, who've died from dementia and not from COVID?

Well, the 'Worst hit' report, and, again, from what we've gathered across England, Wales and Northern Ireland, is that lack of contact, the lack of contact and social interaction, the communication—. People have—as I said earlier, people have given up. But also access to other services, so, primary care services, alternative therapies, suspension of those services going in and providing them with support—if it's speech therapy, physiotherapy. All of those interventions that help people to stay mobile and active, both mentally and physically, those have stopped, and it's had a detrimental effect. So, lots of reasons, but, predominantly, it seems to be that lack of contact and people just feeling abandoned, being abandoned in terms of the care and support packages being reduced, or non-existent, to support them to live their lives and live them well.

Can I just—? Sorry, can I just—I? I just wanted to pick up, finally, on the care home thing, and it's generally around Welsh Government guidance. Guidance tends to come out, but it's open to interpretation. For me, I think any guidance coming out—. And whether it be in relation to COVID, hospital visiting, care home visiting, there has been the guidance there, but it's been open, as I say, to interpretation and for local authorities, in the case of care homes, to deliver and implement as they see fit. Hence, we are getting that significant inconsistency from good to poor, and it's not helpful in our view. It needs to be more directive.

I think Sue covered the main points. Thank you.

Diolch, Lynne. Symud ymlaen nawr i gwestiynau gan Rhun ap Iorwerth. Rhun.

Thanks, Lynne. Moving on now to questions from Rhun ap Iorwerth. Rhun.

Diolch yn fawr iawn a bore da i'r ddwy ohonoch chi. Mae tipyn o'r hyn roeddwn i am ei drafod wedi cael ei gyffwrdd arno fo'n barod gennych chi. Mae'n bosib bod yna fymryn y gallen ni edrych arno fo yn ddyfnach. Sue Phelps, yn gyntaf, mi wnaethoch chi ddweud wrthym ni sut y gwnaeth gwasanaethau arbenigol ddod i stop, ac yn amlwg, mi oedd hynny—dwi'n sôn am y clinigau cof a phethau felly—yn amlwg, mi wnaeth hynny gael effaith ddofn. Mi wnaethoch chi ddweud bod rhai yn dechrau ailagor. Allwch chi ddweud wrthym ni beth ydy'r sefyllfa ddiweddaraf, a sut mae'r patrwm yn amrywio o un rhan o Gymru i'r llall, ac, o bosib, sut mae osgoi'r gwahaniaeth yna mewn gwahanol rannau o Gymru?

Thank you very much and good morning to both of you. A great deal of what I wanted to discuss has been touched on already. Perhaps there is something further that we could look at in greater detail. Sue Phelps, first of all, you earlier on said to us how specialist services came to a stop—I'm talking about memory clinics and so on. Now, that obviously had a deep impact. You said that some are starting to reopen. Can you tell us what the latest situation is, and how the pattern varies from one part of Wales to another, and perhaps how we can avoid this variance in different areas?

09:50

It's quite difficult. We're back to the data, the data bit, and gathering the evidence of what's going on out there. I do know, for example, that the first area in Wales was Cardiff and the Vale—so, the local health board there, they reopened their services about a month, six weeks ago, so they're beginning to address the backlog and are doing quite well, from what I hear.

The other thing that we've heard, and it came through the back door slightly, was that Welsh Government had released some funding, which has been led by the Royal College of Psychiatrists, to pump prime the addressing of the backlog across Wales in the memory services, and it's coming through the college of psychiatrists out to the memory teams. Now, that funding is only just coming through now, and it's going to go directly to the services. So, Aneurin Bevan is leading on that, they are beginning to open their services again— Hywel Dda, slowly, is my understanding. I don't know about Betsi Cadwaladr, we haven't heard, although anecdotally we know that their waiting list has not been as significant as in other parts of Wales, so that's good. So, I don't know what they have been able to do during lockdown that other parts haven't. So, Betsi Cadwaladr appears to have been doing relatively well. And we haven't heard anything from Powys or Cwm Taf at the minute. So, it's very hit and miss at the moment, and it's early days.

Are you confident that the direction of travel will remain positive, or is there a risk—heaven forbid, on the day when we get positive news on the vaccine—that, should there be some regression in some way, the services that are being restarted might be threatened again, or are you happy that we're on the right track?

It's difficult to say. At the moment I wouldn't say that I was happy we're on the right track, purely and simply because—. It's the backlog that I'm concerned about, because if we've got, let's say—. We've done a very rough calculation that 4,000 people, potentially, could be waiting for a review or a new diagnosis. That could be an overestimate or underestimate. The problem will be putting in place the knock-on services, the support services, afterwards, because if those don't reopen and address the need, then those people are going to be left without the support that they need right at the early stage of their dementia.

Just a small example of where the delay in diagnosis is having an effect is that I also sit on Welsh Government's dementia and hearing loss group, and what we're hearing from audiology already is that, people who have not had their review or their diagnosis, and they're now getting it and going into audiology because they're either deaf or hard of hearing, it's too late for any intervention—so, for example, the use of a hearing aid—because their dementia has deteriorated to such an extent during this period that there's nothing that can be done. So, that's a relatively small group of people but an example of where that suspension is potentially putting people at even greater risk.

Yes, it's the other consequences of the pandemic, things not being treated, isn't it? Heather Ferguson, did you want to come in on that?

I wondered if I could just expand slightly beyond some of the dementia services—I know it's what you were specifically asking about—but, particularly pertinent to the points around accessing healthcare and the implications of that, a large part of our report was focused on the difficulties that older people have had accessing healthcare, and the impact that's had in the long term on their health. We had—70 per cent of people in our survey said that they had problems and negative experiences of accessing healthcare during the pandemic. A lot of those people are finding that the implications of that are permanent and long-term health problems. So, I think Sue's touched on it there—we're finding people who maybe have missed routine appointments, which maybe, for one appointment, may seem inconsequential, but are now living with things like permanent damage to their mobility.

We're also hearing about people who would normally be having injections to treat macular degeneration, who are now having permanent loss of their sight. These are the long-term implications for people who've not been able to access services throughout the pandemic, and this is something that is really concerning, as we're moving forward, and, you know, the backlog of support. Combined with that is that we're worried about the strain on social services to support people who are either waiting longer term for operations or are now going to need extra support because of the implications for their health, and I'm really concerned about how that is going to pan out over the next few months.

09:55

On a very similar theme, actually, have we even seen the introduction of some interventions, or the strengthening of some previous interventions to deal with problems that have got worse—damage caused to people with dementia or potentially even trauma suffered from the loss of contact that we were talking about earlier? 

There's been the establishment of the 'ask a dementia expert' service. Again, it's early days, but a group of alternative therapists came together—so, speech therapists, podiatrists, physiotherapists—all of whom have been relatively quiet, shall we say, during this period and have spare consultancy hours to give. So, they've offered to give consultations virtually to people affected by dementia—that could be the person with the diagnosis or the carer—so that people can have access to a psychologist, talk about any dietary advice, like I say, speech therapy, and have that consultation online. Now, that, again, is early days. Some of those hours have been accessed already. We've been referring people through our Dementia Connect service for that service, and it's something that came through some partnership or some link-up with Scotland, because Scotland have been doing it for a little while, so we've just learnt from them and grabbed it. So, it's, I think, a brilliant initiative. The take-up has been slow, just because promotion is still in the early days, but something like that I think will make a difference.

That's the only thing that I'm aware of. I do know that organisations like Care and Repair, for example, they are going out, and the British Red Cross are doing some face-to-face visiting. So, we're working closely with partner organisations, which has been one of the huge pluses, if you can grab pluses out of this situation, where organisations have come together to support people. So, Care and Repair services are going in, doing whatever needs to be done in the home, but then seeing the situation of people living with dementia and older people, and referring them on to the Royal National Institute of Blind People or other services for deafness, sight loss, stroke, et cetera. So, the third sector has been absolutely invaluable and crucial, I would say, in supporting health and social care delivery in all this. 

And interestingly, in one of the regional partnership board meetings earlier on in the summer, I think it was the leader of Merthyr Tydfil County Borough Council, who is possibly chair of Cwm Taf Morgannwg University Health Board—I don't know what his position is, but he said we need to drop that term. If anything, COVID has thrown up that the third sector is not third—it's not a third partner in all of this. I think we're the ones that have been able to adapt and deliver and respond and have supported the health and social care sector, statutory sectors, to be able to deliver. 

Yes, you make the case well. Thank you, Sue. I'm going to ask you a question, Heather. We could spend an entire session on this one, but if you can just give us your overall thoughts. Loneliness and isolation—it's a big issue, a big concern of mine, relating to young people, actually, as well as older people, but what do you think, Heather, has been the impact on older people in terms of loneliness and isolation in particular? And what actions have you seen that have genuinely tried to be introduced to try to address that? 

Yes, obviously, like you said, it's a topic that is massive and we could talk for a long time. We know that loneliness and isolation is something that impacted older people prior to the pandemic, but it's definitely something that has been really compounded throughout this time. One of the things that Age Cymru set up at the beginning of the pandemic was a check-in and chat service, which pretty much does what it says on the tin—so, we moved our resources to support calling older people across Wales to check in on them. Initially, that was to focus on supporting services to them, so, whether that was food deliveries or medical supplies, but it very, very quickly turned into just a check-in to see how people were, because people were very isolated and lonely and worried as well. 

So, through our survey—we spoke to 1,200 people across Wales— which we launched in October, we found that a third of people were lonely during lockdown. We also found that those who are living with a disability were twice as likely to be lonely as well, so obviously there are implications there for what people are living with. We also found that the people who were reporting physical and mental health problems were also more lonely and suffering due to the lockdown. I think it's that lack of contact, as well, you know—that constant lack of contact. It's not the same—. Obviously, we're doing as much as we can by phone and digital-wise, but it's not the same as seeing people in real life. What we're finding now is that what we're really worried about is the moving forward. A lot of people are very scared to leave their homes, and people are going to need, and people have told us that they need, support to reintegrate back into society. The key thing that people have told us they need is support to build up their confidence, and that's both confidence in themselves to reintegrate and interact with people again, but also the confidence to know that places are safe for them, whether it's public services or the behaviour of other people in society. We think it's going to put off a lot of people. As doors open and hopefully if we do move forward to recovery, we're worried there's going to be a raft of older people at home who aren't connected and are going to stay that way. We've seen a real profound impact.

10:00

We know people are feeling lonely and feeling isolated, of course. Are we seeing the impact of that in any measurable way on the health of older people?

We are finding in things like mental well-being, we do know that there has been a decline because of that, because of the lack of social contact, and we are finding that people—. So, in our survey, we found that 44 per cent of people had difficulties of mental well-being and that's obviously really worrying. I think, in terms of what we found, I think it's exacerbating, maybe, previous mental health conditions and those people are finding that those kinds of issues are coming more to the fore. But in terms of our reporting, we do have some evidence but not a huge amount at the moment, because it's quite hard to quantify as well, because obviously there are all kinds of barriers like people admitting that they're lonely as well. It's not quite as easy as saying, 'Do you feel lonely today?' It's quite a difficult thing, generally, to quantify, I think, and draw data down on.

Thank you, Heather. We could go on and on, but we'll leave it there. Thank you.

No, we can't go on and on about that, and in fact there are several important issues to tackle, so some agility is required from now on, and David Rees is well versed in such talents. David Rees.

Diolch, Gadeirydd. Can I just quickly go back to one point you've both answered to Rhun and to Lynne, regarding the interruptions to routine healthcare services? Sue has highlighted also how she has seen some of that now coming back on board, effectively. But, Heather, have you seen whether the services that definitely cause some of those challenges you said—I don't know, for example, eye services and so on—are you seeing them coming back now to a level where we should see less disruption to those routine services for older people?

We're not seeing it hugely coming back on board. Obviously, now, some services are reopening. I think one of the issues we're finding as well is, where places have reopened, there is still a lot of misinformation, and people aren't necessarily getting the correct information locally about what services are available. Things like access to GP surgeries, that's been a particular issue during lockdown, and a huge amount of people have found that an issue in terms of making appointments. But I think, also, because a lot of people have previously had issues they're now not contacting their primary care services for support, so I think we do have an issue around communication. That's something that really needs to be improved, foremost, because the services might be there, but if people think they're not available they're not going to be accessing them. I think that's a particular issue at the moment.

Okay, thanks for that. Let's go on to social care, which is obviously social support. We've talked already on the healthcare support issues, and you've touched on social care aspects of this. The local authorities were given some ability to modify the Social Services and Well-being (Wales) Act 2014 as a consequence of the pandemic. Is it time, now, that those modifications were ended and they were put back to the responsibilities of delivering on the social services and well-being Act? So that people—. As you have highlighted, there are going to be more people with needs, and people waiting who have needs as a consequence. Is it now time to get that modification revoked?

That's a simple answer, yes. There are some agile answers for you, Chair. [Laughter.]

Okay, and obviously one of the consequences of the lack of support of social services in this time, because they've been prioritising elsewhere, is that older people who are carers have faced some very difficult challenges and times, and many will probably have run through the whole last nine months without any respite or support whatsoever, and may be being burnt out as a consequence of that. What do you now believe is required to help those individuals, who have done all this work? They do it because of love, they do it because they believe it's the right thing to do, but they do need that support now. So, should local authorities be looking very carefully at how they can support the carers in the home to ensure that they do not end up becoming cared for as a consequence of this?

10:05

Do you mind if I come in on this question?

Thank you, Sue. We've been in conversation with unpaid carers about the pandemic, and obviously, we know the incredible work that they do in normal circumstances let alone during the pandemic, but the pandemic has had a profound impact on those who are providing unpaid care. We've heard of a lot of people who've had their responsibilities increased when care has been pared back and a lot of people are doing things like providing more personal care. But, like I touched on earlier, not having the support networks that they may normally draw upon to support them in this time, and they're providing, some of them, 24-hour care, and people are telling us about the immense strain that they're under and the immense pressure. There are also people who've been—. We've heard from people who've had to give up work or pare back their hours because they're worried about taking the virus back to the people they care for as well. So, obviously, that has implications in terms of finance in the home.

And we know in Wales in particular, there are these, is it, 210,000 carers who are over the age of 50? So, obviously we're talking about a lot of carers, and from the recent report by Carers Wales, there are potentially 200,000 new carers who've come to the fore in the pandemic. We're talking about an awful lot of people who might need support. So, what we want to look at is making sure that local authorities have a key focus on unpaid carers, but also picking up these new carers and providing timely support and interventions, and making sure that these people who may not even be aware that they're an unpaid carer, they've just started caring for their loved one and it's something they do, because what else would you do? You support the person you love to make sure that they're safe and well. It's making sure that those people get support at an early stage and that they're getting things like those vital routine respite appointments, that they're reinstated, because so much of that has been pared back through the pandemic.

The other thing I'd add, as well, is making sure that we are picking up the voices of these unpaid carers as well, because they are experts in their experience, and making sure that we're continually listening and talking and ensuring that their voices are involved in the development of services. I just want to touch on one of the things that Age Cymru's doing at the moment in partnership with Carers Trust Wales. We have a national project, funded by Welsh Government, and part of that is that we are currently focused on listening to those carers who are not accessing services and support, to understand what they need and to make sure that that's subsumed into service development in the future. So, it's very important that we have that clear focus on unpaid carers.

A couple of points. One is what we know from the report, which is that 92 million hours of care have been provided by carers and family members during the pandemic. That's hugely significant—that's additional hours.

And added to the strain that Heather has highlighted, which, of course, we've seen, and that's the physical strain, there's huge mental strain as well of caring for somebody, whether you're an existing carer or a new carer. One of the things that has impacted on that emotional strain and mental strain is the breakdown, not just in the lack of services, but the communication between providers. So, if there is a loved one, either in hospital or in a care home, the strain of trying to maintain that contact and seeing how that person is has been huge. And there's really not much of an excuse for that. When you're trying to speak to six or seven different nurses to try and get some information about a loved one on a hospital ward, that's exhausting and tiring and hugely detrimental. So, I think we need to be looking at communication as well as the direct service delivery, and how we can keep those channels open so that people do feel supported.

Okay. I asked you the question and there was a very simple answer previously, about the removal of the modifications. Of course, they can still deliver those services as it is now, they just didn't have to prioritise them. The councils have been doing tremendous work during the pandemic and I don't want to say anything other than that, because they have put in tremendous effort. But now is the time, perhaps, to refocus and get some of those services back on. Are you seeing local authorities actually now refocusing and going back to ensuring that the services that were removed to be able to deal with the more demanding times of the pandemic are now starting to return, and therefore you're seeing those sorts of services and that support network coming back into place, or are they still part of the services that are under stress at this point in time?

I would say from our point of view, obviously touching back on what were the easements that weren't applied for, I mean, we're still seeing maybe not necessarily the services coming back to the fore as they should be. And I think one of the concerns with—. Like, we did give a very short answer, which was, yes, we do want to see a paring back a bit of the measures, but we have seen that, although they haven't been applied for, we do think, in some places, local authorities may be—. There has been some kind of maybe decision making that has impacted on services. That's one of the reasons why we do want them repealed. We're not necessarily seeing those kinds of services for assessments and people being supported in a timely manner in place currently. So, hopefully, we will see that come to the fore, but it's not something—. We're still getting a lot of calls to our advice line around people needing support relating to assessment and meeting needs for care and support for older people, and carers. Obviously, we've seen this before the pandemic, but it's definitely increased, and we haven't seen a decrease in calls around that.

10:10

And I would endorse that, Heather, that the assessment of both the person with the diagnosis, but also carers is definitely not getting back to what it was. And carers assessments, there was always a gap prior to the pandemic on carers assessments, and that's certainly gone by the by. So, carers are not, therefore, being seen as needing respite or any interventions, and, of course, that's not the case.

Diolch yn fawr, David. Symud ymlaen i gwestiynau gan Jayne Bryant nawr. Jayne. 

Thank you very much, David. Moving on now to questions from Jayne Bryant. Jayne. 

Good morning. We've touched, or you've touched on the social care workers initially. I just wonder if you could mention what your views are on care home and domiciliary care staff and how they've been treated throughout the pandemic. What would you like to see happen in the future to improve that?

Well, I think we would all agree that what the pandemic has done is completely highlighted the lack of investment in social care, and the status of social care and how important that sector is for people. I think, in the main, what we have heard is hugely positive stories from where care homes, across Wales, their staff have done their absolute best with very, very limited resources, and with not particularly useful guidance in some instances. So, I think, going forward, what should be a priority is to restart the whole conversation on social care, its place, its status and paying for care in Wales. We cannot wait any more on that. It has to be given, in my view, level status with health. There's been a lot of pump-priming and focus on the NHS, and I absolutely would support that and they're doing a brilliant job, but that equal status, status for care workers, everything that comes with that—their pay, their training—we need to get a grip and really start to address it as a priority. 

Yes, thanks. I'm obviously massively in agreement with what Sue says. Obviously, health workers have done incredible work during the pandemic, but as we had seen before the pandemic, those who work in social care have kind of been, I guess, the poorer cousin. Again, the work that care workers in domiciliary care and in care homes have done has been incredible over the past few months, and we've seen that in action. And, I think, what we really need—I'll just corroborate a point, really, around that conversation—is to make sure that we're looking at parity of esteem between social care and healthcare workers. Care workers tend to have fewer prospects in their jobs, less pay, less pension support as well, and we need to make sure that those care workers are on an equal footing. It was wonderful that we had the clap for carers, but that was very much focused on health, which again, I'm not taking away, they're doing an incredible a job during the pandemic, but I think that did show up some of that lack of balance between the two sectors.

Thank you. We're in the winter now, starting to get into that now, and we know that winter planning is really important. How do you feel that health and social care services have planned for winter? How do you think that—? Are they prepared enough for what we're about to go into? And what actions are needed to ensure that older people with dementia are really taken into account, and their needs are taken into account?

Interestingly, the winter plan has health and social care as a bit of an afterthought. So, there's lots of other planning laid out within that plan, but considerations around health and social care were going to be considered at a later date, and the status of that within that plan. So, the alliances—Age Alliance Wales, Wales Carers Alliance—have all said, 'Why? Why are health and social care services not the ones that are being prioritised as we go into the winter?' And as we know, with everything else and COVID on top, pressure on services increases. So, personally, no, I don't think enough has been done, and the organisation, the society as well feels the same, and we will be pushing for much more focus on the needs of older people and how health and social care are going to pull together to address those needs. They're going to be exacerbated by the current situation.

10:15

I don't have more to add to that, but I would just support Sue's point really, in making sure that there is that key focus, because of the extreme pressures that the service is going to be under in the next few months.

Thanks for that. The Welsh Government developed a reconstruction report. I know Age Cymru have had something to say about this. So, I'm just wondering if you could elaborate on that, and what would you like to see happen as a next step?

Thank you. Through the pandemic, Age Cymru has really welcomed the support and focus, and the funding, for older people. I think we were worried when we saw that old people weren't included as an adversely affected group within the report. Obviously, on all the other groups, I absolutely concur. But I think that was one of the reasons why we were quite surprised, because of the impact the pandemic has specifically had on older people, that they weren't included. And we understand not everyone can, but it was definitely an omission, from our point of view.

Compared with that, as well, which is glaring, is the lack of focus on social care within the reconstruction report. It covers lots of different areas, but social care was definitely something that wasn't as much focused on. And I think the social care sector, as people have already touched on, has been hugely strained before the pandemic, and that's only going to probably get worse. And I think not having a focus on that is something that we really want to see change and improved, moving forward. We've mentioned already the strain on services and people who have difficulty in terms of access, and healthcare and social care will pick that up there. I think that's something that we really want to see, moving forward, and making sure that we do have that focus on older people. They're not included, and that did worry us.

No, I'd just agree with what Heather says. Thank you.

Right. To round things off, in his usual exemplary fashion, for this session then, Andrew R.T. Davies.

Thank you, Chair. Thank you, witnesses, for your evidence so far. Just taking that point forward about the reconstruction report that Jayne introduced, I know Age Cymru, for example, highlighted in their reply on that report that they believed that older people, since the start of the outbreak, have faced ageism and age discrimination. Could you enlarge on that, because I think it's quite a strong accusation to level and something that does need some sort of meat putting on the bone?

That was, obviously, a comment on society as whole. I think a lot of the rhetoric around the beginning of the pandemic, as unfortunately is often the case, was around the issue of, 'It's okay, it's only older people that are going to be affected, it's only those who are going to be vulnerable to the virus. We'll be okay'. And obviously, as it's panned out, there have been huge implications for everyone, and there's always an othering of older people, and that has been quite pronounced. I think some of the language has been about things being split, because it's been very much the case, 'Just do these things to look after your granny', and that kind of stuff, which does kind of split society, and it's an 'us' versus 'them', when actually we're all being impacted by it. I think that's something we've seen a lot more starkly during this period and older people being pared off and, I guess, being somewhat forgotten about by society. A lot of that language is something that is used through the media as well, and it's something we do want to see addressed. But I think that has been brought much to the fore during this time.

Would it be fair to say, Heather—? You touched there on being forgotten about. Given the report was silent on older people, would you say that's an ageist act in itself—with the report not speaking to older people's concerns?

I wouldn't put it as strongly in terms of saying the report was ageist because, like I said, we would want to emphasise that we've had support for older people during the pandemic and there has been a focus. I think it's more just a fact that we feel that they need to be more specifically focused on. I think it might be a step too far to say that the report was ageist.

10:20

To both of you, Heather and Sue, obviously, we're looking forward now. We've had positive news today and, it seems that every now and again we get this glimmer of sunshine that we are moving into better territory with the vaccination programme et cetera, and there was much talk back in the summer of building back better once we get into those sunny climes. What evidence or advice would you like to give to the committee to consider about the 'build back better' slogan when it comes to older people and dementia services in particular? We have this opportunity. There haven't been many opportunities, really, when you think about the COVID crisis, but, coming out of it, there is this ability to do things differently. So, what would you like to leave as a thought or a couple of thoughts with the committee when it comes to building back better, after we get into the better climate we hope the vaccine will give us? 

Okay. Gosh, there are a few things: better data collection and actually research in pulling together, across the sectors, all of the experience that COVID has highlighted, and evaluating it and taking the learnings, and, going forward, making sure that we do capture data, should, God forbid, we ever be in another situation.

I think, in terms of recovery, it's really looking at taking into account the loneliness conversation that we've had, and inclusion and exclusion. So, it's looking at digital offer and virtual offer and whether that should or should not become the default position in commissioning. On commissioning, then, we've got an opportunity to really look at the commissioning framework in Wales for health and social services, and how we involve third sector within that; how we can use what will be, I'm guessing, limited resource—budgets are going to be tight coming out of all of this; how we can really look at how the sectors can work together to make better use of what will be limited resource and use the sectors effectively, and not duplicate.

And I think, as well, picking up on the rights issue, it's about looking at it through the rights lens as we go forward. What should we be doing to protect people's right to humane treatment, right to family life, all of those things, so that the Government's dementia action plan sees its delivery through the lens of human rights? And I would, personally, like to see everything that is delivered through health and social care through that lens to get it right. And, then, finally, it would be—I've already said it—really putting social care and the delivery of social care and the funding of social care at the heart.

Just before Heather, maybe, offers some thoughts on that, if I could, Sue, just check with you on the data side of it. In your opening comment, you said, in England, for example, you can access that data because it is collected, and, obviously, if you haven't got the understanding of how the service needs to evolve because you haven't got the data, how can you create the service? That is a gaping hole for us here in Wales, is it? Twenty-one years into devolution, now, with devolved Government responsible for health and social care, the data is that weak here in Wales that it just needs a complete overhaul. 

Yes. There was a meeting last week, or the week before, between Public Health Wales, Social Care Wales and Welsh Government to put their heads together on how that gap can be addressed. But it's certainly there at the minute, and there's work to be done. 

Yes, I'd just support all the points that Sue is making. On social care, the conversation around social care and the funding for social care needs to be had, and, like I said, the parity of esteem between health and social care moving forward is extremely important. And, yes, learning from what's happened—there's obviously been an awful lot of learning from all kinds of different sectors about what can be done better if this was to happen and, actually, what needs to be done more generally.

But I think there needs to be also a recognition, which, again, has been touched on already, about the role of the third sector in this time as well. We have all pulled together as organisations, supported each other and propped up and supported the health and social care sectors—so, making sure that the third sector is appropriately funded and supported, because we do an extremely important role within our society. And I think there's a need to make sure that all of our learning is subsumed into things like the framework for an ageing society, which is coming up for consultation soon. For older people, that's going to be extremely important, moving forward—making sure that all the learning and effort are subsumed into those frameworks coming forward. Those are my key points.

10:25

And If I may, on a final point, I think both of you, as witnesses, have talked about the parity of esteem when it comes to the third sector and the remarks from, I think Sue said, the chairman of Cwm Taf. I think that was who you were referring to. I always remember, in an earlier incarnation on the committee, during my first term here, from 2007-09, on the health committee, we did a wheelchair services review, and many of the charities came in and said that when it came to the commissioners, they just weren't looked on as equal partners in the delivery of service and so, very often, their offer was never taken up or taken seriously. Would you say that is still the case today—that there is this gulf in existence when it comes to looking at the third sector as equal partners, when it comes to working out service delivery? 

I think it has improved. I don't believe there is the gulf that there was, but it could be hugely improved, I think. And it's back to that word 'status', isn't it? I think the third sector needs to be recognised as being a key partner and a partner in a true sense—that we have the expertise, we have the ability, we have the nimbleness and we have the independence to be able to respond and also the willingness to work in partnership with others. I think what the sector, as I said earlier, has done is, whereas we seem to still have a bit of an issue between the health and social care sectors working together and in partnership—albeit integration is there as a notion, we haven't quite got there yet—I would say that the third sector has really pulled together. We know who can do what and we want to work in effective partnerships. So, just on that, to role model good practice, I think the third sector could really step into that space and influence the health and social care statutory sectors to do the same.

I don't have much to add to that really. I just think, as I said, the work that we do in the third sector in partnership is extremely important and we do it really well. We've touched on a number of things that Age Alliance Wales and Wales Carers Alliance do, which lots of us are members of, and I think we do that very well, and yes, as I say, it can be learnt from. So, there's nothing much more to add.

Diolch yn fawr, Andrew. Cadw at yr amser fel arfer. Felly, dyna ddiwedd y sesiwn. Gallaf i ddiolch yn fawr iawn, Sue Phelps a Heather Ferguson, am eich presenoldeb ac am ateb y cwestiynau mor dda ac yn fendigedig y bore yma? Felly, dyna ddiwedd y sesiwn. Fel dŷch chi'n gwybod, mi fyddwch chi'n derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio eu bod nhw'n ffeithiol gywir. Gyda chymaint â hynna o ragymadrodd, dyna ddiwedd y sesiwn yma, felly diolch yn fawr iawn i chi.

I'm cyd-Aelodau, fe gawn ni egwyl nawr i gael y tystion nesaf i mewn, felly bydd yna doriad rŵan tan 10:45. Diolch yn fawr.

Thank you very much, Andrew. You've kept to time, as usual. That brings us to the end of this session. Thank you very much, Heather Ferguson and Sue Phelps, for your attendance and for answering the questions so well and excellently this morning. That brings us to the end of the session. As you know, you'll receive a transcript of the discussions this morning to check for factual accuracy. With those few words, that brings us to the end of this session. So, thank you very much to you both. 

To my fellow Members, we'll have a short break now to invite the next set of witnesses into the meeting. So, we'll have a break until 10:45. Thank you very much.

Gohiriwyd y cyfarfod rhwng 10:28 a 10:45.

The meeting adjourned between 10:28 and 10:45.

10:45
3. COVID-19: Sesiwn dystiolaeth gyda Chomisiynydd Pobl Hŷn Cymru
3. COVID-19: Evidence session with the Older People's Commissioner for Wales

Croeso nôl i bawb i'r darllediad yma o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon, yma yn rhithiol yn y Senedd. Rydyn ni wedi cyrraedd eitem 3 ar yr agenda rŵan, parhad yr ymchwiliad i fewn i ymateb pawb i COVID-19, y pandemig. Dyma sesiwn dystiolaeth, dros yr hanner awr nesaf, gyda Chomisiynydd Pobl Hŷn Cymru. Dwi'n falch iawn o groesawu i'n sgrin felly, i'r perwyl yna, Heléna Herklots, Comisiynydd Pobl Hŷn Cymru. Bore da, a chroeso i chi. Mi awn ni'n syth i mewn i gwestiynau. Fel dwi'n dweud, rhyw hanner awr sydd gyda ni, ac mae yna nifer o gwestiynau. Mae Lynne Neagle yn mynd i ddechrau. Lynne. 

Welcome back, everyone, to this broadcast of the Health, Social Care and Sport Committee meeting here in a virtual capacity at the Senedd. We have reached item 3 on the agenda now, the continuation of our inquiry into the responses to COVID-19. This is an evidence session for the next 30 minutes with the Older People's Commissioner for Wales. I'm very pleased to welcome to our screens, to that end, Heléna Herklots, Older People's Commissioner for Wales. Good morning to you. We'll go straight into questions. We have around half an hour. We have a number of questions to cover, and Lynne Neagle is going to start. Lynne. 

Thank you, Chair. Good morning. I'd like to ask about care home visits. You've been very vocal on this issue throughout the pandemic. Can you tell us what progress you think has been made to date, and your views on the Government's recent summary of progress in terms of the care home action plan and the recent announcements on testing and pods?

Thank you, and thank you very much for the opportunity to give evidence to you all today. In relation to care homes, one of the things I wanted to see very early on in the pandemic was a clear plan of action for care homes. It's something I called for back in April. So, I was pleased when the Welsh Government produced that plan, and I think it's important that we continue to monitor progress against it, across all the different elements of that plan.

In relation to visiting, I've been very struck by how difficult this has been for families and friends, for people living in care homes, and the staff as well. And also, importantly, I think, two things. We talk about visiting as if it's something quite small in our lives, but, actually, this is about older people in care homes having the contact with people that matter most in their lives, the people that they can share a concern with, have a laugh with, that give them meaning. And equally, for friends and family who have loved ones in care homes, it's an incredibly important part of their life. And the second thing to remember is that a lot of older people in care homes do not have family. Quite often, the reason they are in a care home is they haven't got that support network. So, for them, friends and advocates are really important people in their lives as well. So, when we think about visiting, we need to think across that range. I've been pleased with the way in which the Welsh Government has undertaken the work to enable safe visiting. So, it has worked collaboratively. I've raised issues throughout it, and I feel I've been listened to. It has engaged the sector in it.

In terms of the action that Welsh Government can take—so, guidance, policy, and now funding for things like pods and work to roll out testing—I'm pleased to see that. I think the complexity of this is that it's not about one body or one organisation. A lot of different organisations need to come together, and I think they need to start from a position where enabling safe visiting is the default. The default shouldn't be, 'We've got to stop this because it's too risky'. The default should be to understand the risks, mitigate those and enable safe visiting. So, at various points, I think, we've seen some delays because maybe that view hasn't been shared across all the different organisations, from Public Health Wales to directors of public health to local authorities. And the key thing for me is that there shouldn't ever be a blanket ban. This should be about doing risk assessment within the homes, taking into account the local circumstances, and weighing up the rights of older people in this as well, and weighing up not just the risk of COVID coming into the home, but the risk and harm being done to older people who are not able to see their loved ones. 

Thank you. You say that you didn't want to see a blanket ban, and the Welsh Government's line has been there is no blanket ban. But, in reality, what we've seen is most care homes opting not to have visits. How do we stop that happening in the future, especially if there are further spikes with the virus?

10:50

I can understand where care homes are coming from, because I think it is a very difficult balancing act for them, particularly if they've had the experience of COVID in a care home and the trauma that they may have experienced. So, one of the things I did was set out a position statement, which set out eight issues that I thought—and I think—need to be tackled to make sure that care homes have every bit of support available. So, that is things like making sure they've got the right testing and fast enough turnaround times; it is things like, if they need adaptations to their homes or pods, that they can have those. There are other issues, I know, that worry care homes in relation to things like public indemnity insurance as well. So, my view is about what can we do to make it as safe as possible so that more homes can do it. And then if particular homes are refusing it for reasons that aren't valid, then we need to look into those. I think that is not where most homes are. But certainly my casework team have had some cases where some homes seem to have been not enabling visiting in a way that they could—for example in exceptional circumstances and end of life. But I should stress those are by far the minority; I think the majority of homes are trying to navigate their way through a very difficult situation.

Okay. Thank you. And you've talked about the trauma that has been caused by enforced separation. What should be done to respond to that?

I think this is about the right mental health support for older people and for families and friends. That's making sure that people can access help or counselling or support for what they've been through. I know that people are doing this themselves, so I know that talking with others who have been through the same situation is also very important. But these things might not appear for many months to come, and so this is a long-term issue that we all need to take seriously and plan for—over the longer term, how can we support people, given the mental health support that they might need, to come to terms with some of the things that they've been through. And we all know that, if you weren't able to be with your loved one, particularly at the time of their death, these things really stay with you for years. So, this is not a short-term issue, by any means—it's both short and longer term. And I would hope that, in the planning for mental health services across Wales, and for things like counselling and bereavement support, these issues are taken account of and provided for.

Symud ymlaen i gwestiynau gan David Rees. 

Moving on to questions from David Rees. 

Diolch, Gadeirydd. Obviously, the care homes issues have been very much focused on, and you've highlighted those, but you actually referred the Welsh Government to the Equality and Human Rights Commission at an early part of the pandemic. And I know the EHRC published a briefing in October, which basically stated that equality and human rights standards had not been met in areas. Where are you currently with the work with the EHRC?

We've been working with the Equality and Human Rights Commission for a number of months now, and we wrote jointly in July to Welsh Government, setting out our concerns about whether older people's rights under the Equality Act 2010 and under the Human Rights Act 1998 had been upheld. We asked for evidence to show what Welsh Government had done. The purpose of this was to make sure that older people's rights are very firmly embedded in the way in which decisions are made and policy is developed, to strengthen that decision making, and also to make sure that any lessons learned during the early phase of the pandemic were really embedded into what happens next. So, we requested information in some key areas, and that was to give us—we were seeking assurance that there was evidence to show that older people's rights had been given the due regard that they should have been given.

We had a number of meetings with Ministers and officials during the months from July to now, and then earlier in November had the Welsh Government's response to us and the Equality and Human Rights Commission. We then reviewed that very carefully against the questions that we asked. And we wrote back to Welsh Government last week, setting out—first of all, thanking them for the work that they'd done and what they provided with us—that the information that they sent through wasn't sufficient to address our concerns. So, we felt there were still gaps in relation to the evidence, to the extent to which Welsh Government could demonstrate that it had met its obligations under equality legislation and human rights. So, we've written to the Minister for Health and Social Services to say that we would like to meet to discuss the learning and embedding the learning, which is the crucial part of this. And then the Equality and Human Rights Commission, in their role as the regulator, is writing separately to Welsh Government now to request further information—so, following up on the information we feel we didn't get—so that it can continue to examine whether Welsh Government has met its responsibilities under the Equality Act and the Human Rights Act.

From my position as commissioner, the most important thing is that lessons are learnt and, if things didn't happen that should have happened, that they are taken account of and that they are built into what happens as we go forward. And this matters, because, if we don't have the right processes that are followed, in a time of crisis it can exactly be at that point where, even inadvertently, things can be done that don't respect or put older people's rights in the place that they should be. So, that's why it's important that we continue to do this work and, also, to make sure that lessons are learnt as we go.

10:55

It sounds, from you answer, that you're not confident that the response you've received from Welsh Government demonstrates that lessons have been learnt. Is that the case?  

It is the case that, at the moment, I haven't seen that clearly in terms of what they've sent through. We did ask a specific question around this and, in terms of the written information, that hasn't been provided to the level of assurance that we want, which is why we want to have those discussions. I would say, in terms of practice, more positively, I've certainly seen Welsh Government, in terms of their policy development and statements—they seem to be reflecting and talking about older people's rights in a stronger way now. And to come back to the issue of care home visiting, in relation to that piece of work, I do feel that older people's rights were taken account of appropriately. So, I can certainly see some progress there and something positive, but in relation to what has happened and giving that level of assurance that I and the Equality and Human Rights Commission want, we've not had that yet. 

Okay. If I can go beyond the care homes scenario at this point in time, to the wider scope of older people's positions. The Welsh Government initially set up modifications to the Social Services and Well-being (Wales) Act 2014 to allow authorities to not necessarily prioritise certain areas due to the pressures upon them during the early part of the pandemic. Do you think it's now time that those modifications should be revoked, and that the local authorities should be focusing very much upon the support and assessment of people's needs? 

Yes, I do. I think it's overdue. I think those provisions in the Coronavirus Act 2020, which can limit older people and disabled people, should be removed. There has been a consultation on that, which I'm pleased about, and I responded strongly on that. But we shouldn't be in a position here in Wales where we're limiting people's rights at this time, when actually having your legal rights are incredibly important. So, I would hope to see Welsh Government take swift action on that now. 

And by swift, I assume you want it done as quickly as possible, obviously, with legislation—but there should be no delay in this process now. 

Yes. They've done a consultation and I understand a report has gone to Ministers. So, I would hope that that can happen as quickly as possible. And, for me, that will be a test, really, around the issue of rights and are older people's rights and disabled people's rights fully embedded. If they remove the provisions in the Coronavirus Act that limit those, that would be a good indicator for me that older people's rights are where they should be. 

And are there any other aspects that you identified in the early stages of this pandemic that have impacted seriously upon older people generally? 

Yes, a lot of issues. I think the issue around 'do not attempt CPR' notices going out to older people, where they hadn't had those discussions—that's something that happened early in the pandemic. We've heard less about that, thankfully, but that definitely created anxiety amongst older people and that level of anxiety and fear continued. So, that was incredibly concerning to me, just in terms of what it said about how people view the value of older people's lives.

I've also been concerned about the challenges for older people where services have been suspended. So, the sorts of services that people have relied on: daycare centres, respite, help into the home—the suspension of some of those services has been very difficult, particularly for older people caring for each other. So, I've seen a lot of distress amongst older carers in particular.

Having said all of that, I think I would also want to say that our public services, our voluntary community organisations—[Inaudible.] They've also done a huge amount to support older people during a very difficult time. So, I would also want to express my thanks for what has been happening, but concerns about some of those issues still remain.

11:00

Okay. And just as a note, 'do not resuscitate' is still being discussed, by the way. I know of a patient who went in and the family were asked about it and the wife was very upset just even thinking about that question, so it is still ongoing.

Yes, I think the discussions are happening. What I haven't seen recently, thankfully, is that sort of blanket approach, where residents of a care home were just, on a blanket basis, sent these. But I think there needs to be some learning about how conversations like this happen, the importance of advance care planning for all of us, so that we can make decisions and say what our decisions want to be. So, the learning that comes from this for me is that we need to get better across society at having conversations about these sorts of areas in our lives and doing proper advance care planning, which is much more than around 'do not attempt cardiopulmonary resuscitation'—it's much more about how we want to be treated and how we want to be supported if we come to that point in our lives.

I thought the excitement was getting to you there. Right, moving swiftly on, Jayne Bryant.

Thank you, Chair, and good morning. First of all, thanks ever so much for all the work that you and your office have been doing throughout this, with important parts, throughout the pandemic, I think—important issues—that you've raised as well about the potential abuse of older people and the impact that has. Can you tell us a bit about the work of your abuse action group during this time?

[Inaudible.]—and have been fantastic during this time. So, early on in the pandemic, we were concerned about the risk of abuse of older people increasing and we brought together a number of organisations. We now have over 30 organisations that have formed an abuse action group that are working with me to raise awareness of the risk of abuse and to work to improve the support that older people can get.

I've been incredibly inspired by the way in which so many different organisations have come together and worked collaboratively on this: so, public bodies, voluntary organisations, the police, social services, the National Independent Safeguarding Board and others. And we've done quite a lot of work to raise awareness and to connect organisations as well so that referrals between organisations can happen well. 

I think we are already having an impact in terms of awareness of the risks of abuse of older people, but we have an enormous mountain to climb here. Just this week, the charity Hourglass Cymru released research showing the level of abuse in Wales, but also, worryingly, that some people don't think certain actions against older people are abuse, when in fact they are. So, there's a massive amount to do here.

We're now focusing on a particular issue, which is the need for accommodation and support for older people who need to leave an abusive relationship. So, most of that is—understandably, to some degree—geared towards young women with families, so refuge accommodation. But if you're an older person—an older woman or an older man—experiencing domestic abuse in your home, there are very few options for you either to go somewhere where you can be safe and have the right accommodation and support or, indeed, if you need the perpetrator to be taken out of your home.

So, we held an event where we pooled what we know about this, and are working on what actions we can take. We've had very good support from Welsh Government on this and, in fact, I have a meeting with Jane Hutt and Julie Morgan next week to look at what action can be done in the immediate. And I think that will be about looking to see what better accommodation support can be provided, better information for older people, and also looking at the issue of charging. So, if an older person needs to go into refuge accommodation, they will be charged for it. Now, if you can imagine all the anxieties and barriers that are there if you're trying to leave, and then you may be faced with a bill that you can't pay to go to a place of safety—that doesn't seem right to me. So, I think we need to take some urgent action in this area.

We've also, at the same time, commissioned research looking more broadly at the services and support available for older people experiencing abuse—not just domestic abuse, but things like financial abuse as well. We'll be publishing that February/March time to provide the evidence base of what there is, what the gaps are, what good practice there is, and what more needs to be done. So, I'm hoping that this will continue to be a major piece of work. It certainly will be for me as commissioner. I'm encouraged by the way different organisations have come together to work on this.

But I wouldn't be overplaying it if I called this a crisis at a moment in our society, and we need to recognise this as something that all of us in society need to face up to and need to take action on.

11:05

Yes. Thank you, Chair. I just wanted to—. It's really interesting to hear about the work that you've all been doing on this. Are there any urgent actions that you think should be taken, generally, really, apart from—? We know you've done all the awareness raising, and you've mentioned about the accommodation and support. Is there anything else, especially as we're going into Christmas and periods of people being again perhaps a bit more isolated at home and less visible in our communities?

Yes, there are two things. So, I think there's something that each and every one of us can do and should do, which is about looking out for each other, making sure that we understand what the signs of abuse are and what we would do if we knew someone or thought someone was at risk. So, this a message for everyone.

And linked to that is the communications issue. Most of the communications on abuse are not age specific. So, they are general. They rarely say specifically older people. And what we know is, unless those communications specifically say something direct to older people, they can feel it's not for them. They can feel these things are not services for them—they're for someone else, they're for younger people. So, one of the things I've asked Welsh Government to do is to communicate about the help that's available, but speak directly to older people on this, because that will actually make a difference. It will make a difference right now, and it will make a difference over winter time if older people—and, of course, friends and families and others—know that older people should not be experiencing abuse and that there is help and support available. So, I think the communications of this are actually really important.

Thank you, Chair. Thank you, commissioner, for your evidence so far. Could I just seek—as we're now eight/nine months into the pandemic and obviously several months, if not maybe a year or two, ahead of us still to come out of it—? From the lessons learned exercise that you've touched on, which is important for Welsh Government to take up and implement those lessons learned, what would be the key priorities for you at this stage of the pandemic? I appreciate that's a very broad question, but if you could be relatively concise so that we as a committee can be informative in maybe any recommendations that we would put before the Government when we pull all this together.

Thank you. Yes. So, right at the heart of it, protection of legal rights. Helping older people whose physical and mental health has deteriorated as a result of the pandemic—so, that's rehabilitation and reablement, and easy access to that close to home. That involves not just the health services and care services, but working with voluntary and community organisations as well. Specific support for older people's mental health—a lot has been said about mental health and the impacts during the pandemic, but less about that for older people. We know already that older people can struggle to get mental health services, so that needs to be a focus as well. And then, the issue in particular, I would say, of abuse and making sure that protections are in place and an awareness is there.

There's one broader issue also, which is: how can we enable older people to get back into doing the things that they were doing? So, we know that many older people are the backbone of our communities—they're doing the volunteering, they're looking after members of their own family. Many older people have shown enormous resilience during this time, but many have also lost confidence. So, one of the things I'm pushing for, and working with local authorities on, is to enable them to develop as age-friendly communities—in other words, removing the barriers that get in the way of older people being able to get out and about in their communities and take part. And that's some work I'm supporting local authorities with, and I think will actually be really important to reduce the risk of older people being left behind.

11:10

And just as a follow-up to those points, those very important points that you addressed, how confident—? And this isn't a criticism, this is an observation of Government, because the bandwidth is being soaked up by so—I mean, if we look at this week, as such, we've got vaccination today, we're going to have travel revisions at the end of the week, we've had the hospitality restrictions brought in on Monday, we have. How confident are you that the bandwidth of Government is able to take advice from you, as commissioner for older people here in Wales, and actually address some of those points head on and implement some of the recommendations that you make?

So, in terms of taking advice and listening, I think that is happening. If I look at the policy dimension, I think quite a lot of it's there, for example, on rehabilitation. The issue will be implementation, absolutely; I think that is where I have concerns, because there is so much that needs to be done. If I think about rehabilitation, for example, what about what health boards can do locally? And some of that is about have they got the staff available to do it. So, I think workforce issues are a concern to me about making some of this happen.

And then I think the other concern would be just to make sure that issues for older people don't fall off the agenda. That's clearly part of my role to make sure that doesn't happen and my scrutiny role, and I will continue to do that. On that issue of bandwidth, as you put it, Andrew, I think the danger is sometimes that older people's issues can fall down an agenda, and, clearly, I'm going to be working to make sure that that doesn't happen.

Good morning to you. Just a couple of things, really. Looking towards recovery, I know you've referred to the lack of presence of older people in the reconstruction reports published by Welsh Government, but, looking at the key issues that need to be built into the recovery that ensure that the needs of older people are not forgotten, what are those key issues?

Yes. So, I was concerned about—it felt like a lack of recognition about the full impact of the pandemic on older people. In terms of some of the issues flagged in that report that work is going to be progressed on, I think a lot of that will be very helpful. I think my main message here is that generic approaches are not always going to include older people in the way that they need to be included or given the provision that they need. And that is why I keep coming back to the issue about making sure that, in everything the Welsh Government does, and, indeed, public bodies do—so, it is not just Welsh Government, it's local authorities, it's health boards—they need to be making sure that they're properly looking at the impact on older people and properly looking at making sure that what they are doing is inclusive of older people.

So, to give one example, we know how much more is now done online, we know more services are going online, but 41 per cent of people over the age of 75 are not online. So, if we go down a digital-by-default road, we will exclude some of the people who most need the help. So, I think that's why the level of scrutiny needs to be maintained to make sure that whatever is done—. And I think a lot of the general approaches are positive; my worry will always be: will they meet the needs of older people, and older people in all their diversity? And will specific older people's needs be really taken account of, such as issues around digital inclusion, such as issues of needing care and support, particularly for people with dementia, such as making sure that people in black, Asian and minority ethnic communities have the specific support that they need as well?

As somebody who tabled an individual Member's debate on trying to address the danger of digital exclusion for older people, I certainly concur with that. Finally, I don't know how we can sum this up, but what have we learnt about the key elements of reform of social care systems that we need? And perhaps you'd like to refer to something—again, you and I actually agree on, though this is a cross-party committee—on the need to bring representation of the care sector right to the heart of Government, and what you've talked about on the need for a chief care officer in the same say as we have a chief medical officer?

11:15

So, we've learnt, haven't we, that social care is a vital service for each and every one of us—that all of us, at some point in our lives, need it. We've learnt about the skill and professionalism of people working in our social care services. We've learnt that we value them highly, and they are highly valued, but not when it comes to pay. So, if ever there is a moment where the political will to reform social care needs to happen, it needs to happen now, and I would hope that could happen on a cross-party basis so it is something that sustains. 

The other issue for me is that we need to have parity between social care and the NHS. For too long social care has been the poor relation. And that's parity in every way. That includes looking at pay across NHS and social care. It can't be right that if you're in a social care role doing something almost the same as someone in an NHS role, you get paid less—that can't be right. So, we need parity and we need a long-term funding settlement, but not just looking at the funding; looking at what sort of social care services we need, and we need to put them right at the heart of that.

And then, at the governmental level, I do think we need and what I've called for is a role like a chief social care officer. So, in the same way that we have a chief medical officer and a chief nursing officer, who are there to give professional advice to Government, at the heart of decision making, I think we need that role. This, in no way, is a comment on anyone in the civil service at all who's working in these areas; it's just to say this is a different and specific role that I think we need and potentially could have made a difference if we would have had role in place.

Diolch yn fawr, Rhun. Ie, dyna ddiwedd y sesiwn. Diolch yn fawr iawn i Heléna Herklots—cyfraniad arbennig y bore yma, a sesiwn arbennig. Diolch yn fawr iawn i chi. Dyna ddiwedd y sesiwn yna, felly. Diolch yn fawr iawn i Heléna. Fe gawn ni doriad nawr. I'm cyd-Aelod, fe gawn ni doriad am bum munud, gan ddod yn ôl jest heibio 11:20, er mwyn cael y tystion nesaf i mewn. Diolch yn fawr.

Thanks you very much, Rhun. Yes, that brings us to the end of the session. Thank you very much to Heléna Herklots—an excellent contribution this morning, and an excellent session, indeed. Thank you very much to you. That brings us to the end of that session. Thank you very much Heléna. To my fellow Members, we'll take a short break now, for five minutes. If you could return just after 11:20, so that we can get the next set of witnesses in. Thank you.

Gohiriwyd y cyfarfod rhwng 11:17 ac 11:22.

The meeting adjourned between 11:17 and 11:22.

11:20
4. COVID-19: Sesiwn dystiolaeth gydag Oxfam Cymru
4. COVID-19: Evidence session with Oxfam Cymru

Croeso nôl i bawb i'r cyfarfod yma o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn rhithiol yn y Senedd. Dŷn ni wedi cyrraedd eitem 4 ar yr agenda rŵan, sef parhad efo'n hymchwiliad i mewn i bandemig COVID-19. Dyma sesiwn dystiolaeth gydag Oxfam Cymru, ac rŷn ni'n ddiolchgar iawn am y dystiolaeth ysgrifenedig sydd wedi cael ei chyflwyno ymlaen llaw. Diolch yn fawr iawn. O'n blaenau ni ar y sgrin, dwi'n falch iawn i gyflwyno Rachel Cable, pennaeth Oxfam Cymru. Croeso a bore da ichi. Mae gyda ni ryw hanner awr ac mae yna nifer o gwestiynau, felly awn ni'n syth i mewn iddyn nhw, a Rhun ap Iorwerth sydd yn dechrau. Rhun.

Welcome back, everyone, to this meeting of the Health, Social Care and Sport Committee in a virtual capacity at the Senedd. We've reached item 4 on the agenda this morning, which is the continuation of our inquiry into the COVID-19 pandemic. This is an evidence session with Oxfam Cymru, and we're very grateful for the written evidence submitted ahead of time. Thank you very much to you for that. In front of us on the screen today, I'm very pleased to welcome Rachel Cable, head of Oxfam Cymru. Welcome and good morning to you. We have around half an hour and we have a number of questions, so we'll go straight to those questions, and Rhun ap Iorwerth has the first question. Rhun.

Diolch yn fawr iawn, Cadeirydd, a chroeso atom ni. Rydych chi wedi gwneud lot o waith dros y misoedd diwethaf yn edrych ar dlodi ac impact y pandemig ar ofal cymdeithasol. Rydw i'n gofyn ichi grynhoi, mewn ffordd, yr hyn rydych chi wedi ei ganfod rŵan. Beth ydy'r gwersi rydych chi'n meddwl rydym ni wedi eu dysgu ynglŷn â'r problemau sydd gennym ni efo systemau gofal cymdeithasol yng Nghymru a sut mae'r problemau hynny wedi dod i'r wyneb, wedi cael eu gwaethygu gan y pandemig?

Thank you very much, Chair, and welcome this morning. You've done a great deal of work over the past two months looking at poverty and the impact of the pandemic on social care. I'm just asking you to summarise, in a way, your findings and conclusions. What are the lessons you think that we've learnt with regard to the problems that we face in terms of social care systems in Wales and how have those issues come to the fore and worsened due to the pandemic?

Morning, committee, and many thanks for having me today. Just before I kick off with answering your question, Rhun, I think, for me, the key message that I want everyone to hear today is that poverty must never be a consequence of caring. So, if there's one takeaway, it's that.

I think, to kick off, we often talk about paid work as the best defence against poverty, but that simply isn't true if you are a care worker. There are about 113,000 people working in the social care sector and, of course, our ageing population means that's going to keep growing and growing. Providing paid care work is associated with low incomes, poor working conditions and a lack of agency, and, significantly, you're more likely to be in insecure forms of employment. We think that those poor pay and conditions are exposing care workers and their families to financial instability, which, of course, affects their physical, emotional and mental health, which is already under immense strain during this pandemic period. 

I have to say that the problems that we're seeing in the care sector and elsewhere are being exacerbated by the pandemic. So, these aren't new problems; these are things that we've seen previously, but the intensity at which these problems are being experienced is really exploding, I suppose. Several years ago, we commissioned some research, which was carried out for us by Chwarae Teg. They talked to a range of care workers about low pay in the sector and their experiences, and there were horrific stories about people working two and three jobs and being forced to use foodbanks to feed their families because their pay simply didn't add up. Now, we know that Welsh Government have made a range of efforts in this area—curbing the use of zero-hours contracts and that kind of thin— but it simply isn't enough. What we need is additional investment, and we are supporting the calls for a social care levy, and I know that quite a bit of work is under way to have a look at how that might work. There has to be some more money in the system, because the system is falling apart. And at a time when we need our carers to be focusing on caring, our carers shouldn't be worrying about how they're going to pay the heating bill or put a meal on the table; we want them to be worrying about how they're going to look after us all, because we all require care at some point in our lives, and my worry is that we as a society don't value care highly enough, as we should. 

11:25

The exacerbation of problems could be temporary. Lots of things have got worse during the pandemic, of course, and hopefully we'll turn a corner at some point. But let me just test how optimistic or pessimistic you are as we hopefully enter the final phase of this pandemic. Do you think some of the problems have become further entrenched, or do you think there's been a renewed realisation that we have to do something about this and that would actually help us and lead to better outcomes? 

I think one of the things that the coronavirus has delivered is a greater awareness of how care workers are experiencing this, because they are often quite an invisible workforce. We don't talk about them as being a highly valued workforce, which is incorrect, because they are a hugely valuable part of society, which, by the way, the First Minister has referenced in his leadership manifesto and the rest of it. But the problem is that lots of these problems were entrenched before the coronavirus happened, and we've had decades of underfunding and undervaluing of this sector, and I think what we're seeing with coronavirus is that we're more aware of these problems, but there has to be some more cash. And as public finances continue to be stretched, then we have to think of new ways of finding that investment.

It's not okay that many care workers are not paid the real living wage. That can't be acceptable, and so, as we look to reorganise the sector, we have to make sure that those care workers are paid appropriately. And you're right in that maybe there is a light at the end of the tunnel with the vaccine, and so on, but even when the vaccine comes and even when the coronavirus is over, I don't believe that these problems are simply going to disappear. I think the undervaluing of care is something that we see internationally. It isn't a problem that's just in Wales; this is something that Oxfam sees right around the world. We work in 67 countries, and it is something right across the board. We see this all around the globe. 

Thanks, Chair. You've spoken already in response to Rhun ap Iorwerth about some of the challenges facing carers. The committee's recent inquiry on unpaid carers found that respite care, which is already really difficult to access for carers, has got even worse during the pandemic. Do you think there's been any progress since our report, and what do you think needs to happen, really, to make things better?

Thank you, Lynne. The first thing to say that's really important is the link, not just in Wales but internationally, between unpaid caring and poverty. One of the reasons for that link is that, if you're an unpaid carer, you can often lose income, either due to having to leave paid employment, or because you have to reduce your working hours in order to manage your paid job with your unpaid care. And, of course, the committee will be aware that 96 per cent of all care in Wales is provided by unpaid carers. And before the pandemic, of course, people were struggling and in need of further support.

Now, again, we have seen more focus on this and there's been quite a bit of focus in the media on those kinds of numbers as we've gone through the pandemic, but I think behind each of those numbers are families, aren't there, who are struggling. A couple of years ago—I think it was around April 2018—Carwyn Jones announced his intention to lead a feminist Government, and ever since then we've worked with the Women's Equality Network Wales to produce a scorecard looking at measuring or tracking the Welsh Government's progress towards that. One of the things we've looked at in that scorecard is the issue to do with respite care, because it's such an important part of the picture.

There is of course funding made available to local government to provide those services, but it's not always ring-fenced for respite, so it's very difficult for organisations like mine and others to scrutinise that spend, and for us to be able to monitor how effective that pot of money is, because it's not ring-fenced for that purpose. So, it does remain a concern, and I've already talked about the impact on people's physical, mental and emotional health. We must make sure that respite care is provided, because those unpaid carers are plugging an enormous gap at the moment, and we must support those people, because if we don't support those, it puts pressure on other bits of the system.

11:30

Thank you, Rachel. And in terms of the social care workforce, are there any particular changes you would like to see implemented going forward in relation to them?

I think we have to make sure that the social care sector is supported appropriately to be able to provide the support it needs to. I've already mentioned the social care levy, which we are very supportive of, and we also are supporting the expedition of the recommendations from the Fair Work Commission to establish a fair work forum. One of the things I'm very keen on is making sure that carers' voices are at the heart of this conversation going forward. What my organisation's done is obviously looked at and analysed information from a range of organisations, but I think in whatever that fair work forum's going to look like on care, we have to make sure that those people with real, lived experience are driving what that looks like going forward.

I'm very keen that future public procurement in social care is dependent on the payment of at least the real living wage. And also that we need to be requiring local authorities who are organising care contracts to be much clearer about what terms and conditions they expect, and that includes a real living wage, because we have to make sure that this sector is resourced appropriately. It is just not acceptable that so many of our carers—paid and unpaid—are struggling to pay the bills at the end of each month, and are having to rely on foodbanks because they don't have any other way of feeding their families.

Thank you, Chair. I think basically, the question's been answered. But you've just highlighted the issues about the social care workforce and the right to have appropriate payments. We've clapped them, we used to clap them on Thursday night along with our NHS workers, but we seem to have forgotten about their needs now. What would you want Welsh Government to actually—? Because obviously, there's an issue of what Welsh Government can do compared to a whole UK approach. What do you think the Welsh Government can do to ensure that the social care workforce are treated with respect and are rewarded with the appropriate levels, to ensure that it becomes a career path that people don't want to just be in because they enjoy doing it, they want to help people, but they also see an opportunity to support their families as well?

Thank you, David. Yes, I agree with you. I think, around the world, care is not valued at the same level as a great many other jobs and yet, it is a very difficult job; it's hugely challenging, particularly during a pandemic, but even before that, it's a very tough role to carry out. So, I think there's a range of things, really. I don't think that we should ever expect those people providing that service to be living in poverty, or indeed on the brink of poverty. So, I think we need a radical shift in how we value care going forward. We're talking a lot at the moment about a green and just recovery, well I think at the very heart of that has to be how we value those care workers, and unpaid carers, I should say, as well.

We've set out a range of recommendations in the paper that we've submitted to you, but I think there's a useful framework that was originally developed by an economist called Diane Elson. It was something called the 3 Rs framework, but Oxfam and partners have expanded this to the 4 Rs framework. So, to make sure that we are appropriately valuing care going forward, we think that the 4 Rs have to be: recognising unpaid and poorly paid care work, which is primarily done by women and girls, as a type of work and production that has real value; the second R is reducing, so we need to reduce the total number of hours spent on unpaid care tasks, so that's got to be through better access to affordable quality time-saving help or care-supporting infrastructure, which has to have better investment; the third R is to redistribute, so we need to redistribute unpaid care work more fairly within the household, because it always tends to fall on women and girls to pick up that role, but also shift some of the responsibility of unpaid care work to the state and the private sector; and the fourth R is about representing care givers, and especially those most marginalised people, and make sure that they have a voice in the design and the delivery of services going forward. It's very difficult sometimes to get those voices to be heard when you're rushing from job to job providing the vital care that those care workers are.

11:35

Can I ask one final question? We talk about unpaid carers very much, and we've often forgotten—in the previous session we talked about older unpaid carers—how about young carers? Have you seen the impact this has had on young carers during this pandemic?

We haven't looked specifically at different age demographics, but it's safe to say that where particular groups were struggling before, that's become magnified through the pandemic. I think we need to be targeted in any interventions going forward, making sure we recognise that different groups have different needs and requirements. So, however we design things in the future, I think those differences have to be taken into account.

Thank you, Chair, and good morning. You've talked a lot this morning, importantly, about those people, care givers, whether that's paid or unpaid care givers. What wider reforms would you like to see within the social care system?

Good morning, and thanks for that question. For me, I think there's a whole package of things, so we can't just do one thing and this is going to fix this problem overnight. There has to be a real raft of measures and at the very heart of that has to be changing how we value care, so, the value question. I don't just mean economically, but how we value care socially and culturally has to be at the heart of what we're driving. I think, for me, we need to make sure that we're recognising that paid and unpaid care is a skilled job, and that isn't recognised, I don't think, at the moment, either financially or otherwise. We need quite a step change, I think, in changing that perspective, and that's about really shifting the thinking quite significantly. I think until we're able to do that, it's quite difficult to get all the other bits of the jigsaw to fit into place. I think we need to be working also with the private sector to make sure that where unpaid carers are struggling to balance paid work and their caring responsibilities, they need to be given reasonable flexibility to be able to deliver that.

But, crucially, in social care we've got to have more money in the system. We need the additional investment because without that we cannot improve the infrastructure, and we can't make sure that people are being paid fairly. So, that has to be a priority, and I think we are at a crossroads, I suppose, aren't we, as we're coming out the other end of coronavirus, hopefully? It's a really good opportunity to look at this going forward, and I think we know there's real public support across the UK for increased taxes to pay for increased pay for social workers. We know that support is there, so we need to galvanise that and we need to get on with it and make sure those people are being paid fairly.

11:40

Just if I could take Jayne's point on further, you've identified what you think needs to be done and, in particular, the public appetite, as you've put it, to see how that will be funded through higher taxes. I think that's to be tested yet, but that's a separate argument. From your understanding of the way Government works, both at a UK Government and Welsh Government level—because this social care reform will have to transcend political boundaries, I would suggest, to actually get real weight behind it to actually be implemented—what do you think are the main barriers that are stopping this reform, and have you any suggestions you could put before the committee that could break down some of those barriers?

Thanks, Andrew. You're right: we need reform right across the UK and Oxfam, indeed, is working in Westminster and in Scotland on this same issue. For me, the biggest barrier is the investment that we need. Now, we've seen polling—. So, we've carried out our own polling in Wales and we've seen other polling elsewhere in the UK with public support for raising income tax—obviously, that will need to look slightly different in Wales—in order to pay social care workers more fairly. But I do agree with you that this is something that needs to be right across the UK, because it isn't just in Wales where this is a problem.

And I do think we've got a moment in history to change things radically, but we really need to shift thinking that care work is a hugely valuable asset and that the people who are carrying out that care work are enormously valuable to us all, because we all require care, whether as babies, as children, if we're sick or disabled or we're ill as we get older, it's something that all of us need. We need to really shift thinking towards that, and I'd really encourage the Welsh Government and Governments across the UK to think about those four Rs in how we recognise, reduce, redistribute and then represent the voices of care workers, because I think that will move us towards a point where we can make sure that poverty isn't a consequence of caring.

Diolch yn fawr. Dwi'n credu ein bod ni wedi dod i ddiwedd y cwestiynau, felly diolch yn fawr. Diolch yn fawr iawn, Rachel, dyna ddiwedd y sesiwn. Gallaf gadarnhau y byddwch chi yn derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio eu bod nhw yn ffeithiol gywir. Ond gyda chymaint â hynna o ragymadrodd, diolch yn fawr am eich presenoldeb ac rydych chi'n gallu gadael y sgrin nawr. Hwyl fawr. Diolch yn fawr i chi.

Thank you very much. I think we've come to the end of the questions, so thank you very much, Rachel. That brings us to the end of that session. May I confirm that you will receive a transcript of the discussions this morning for you to check for factual accuracy? But with those few words, thank you very much for your attendance this morning, and you can leave the screen. Thank you very much. Goodbye.

Diolch yn fawr. 

Thank you very much. 

5. Papurau i'w nodi
5. Paper(s) to note

I'm cyd-Aelodau, rydyn ni wedi symud ymlaen i eitem 5 rŵan a phapurau i'w nodi. Mi fyddwch chi wedi darllen fy llythyr i gan y Dirprwy Weinidog a'r Prif Chwip ynglŷn â'r dyletswydd economaidd-gymdeithasol. Pawb yn hapus i nodi hwnna? Dwi'n gweld eich bod chi yn hapus i nodi hwnna. 

To my fellow Members, we move on to item 5 now and papers to note. You will have read the letter from the Deputy Minister and Chief Whip regarding the socioeconomic duty. Is everyone content to note that? I see that you are indeed happy to note that paper.

6. Cynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
6. Motion under Standing Order 17.42(ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

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.

Motion moved.

Sy'n dod â ni i eitem 6 a chynnig o dan Rheol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod yma. Ydy pawb yn gytûn? Dwi'n gweld bod pawb yn gytûn, felly diolch yn fawr iawn i chi. Dyna ddiwedd y cyfarfod cyhoeddus felly. Awn i fewn i sesiwn breifat yn awr i drafod y wybodaeth. Diolch yn fawr. 

Which brings us to item 6 and a motion under Standing Order 17.42(ix) to resolve to exclude the public from the remainder of this meeting. Is everyone agreed? I see that everyone is indeed agreed, so thank you very much to you. That brings us to the end of the public meeting and we'll go into private session to discuss the evidence we've received. Thank you.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 11:43.

Motion agreed.

The public part of the meeting ended at 11:43.