I now move to the short debate, and I call on Eluned Morgan to speak on the topic she has chosen.

Diolch yn fawr, Lywydd. We all want to see older people get the best care possible. However, here in Wales, as elsewhere in the UK, we have a social care time bomb, and before it goes off it’s absolutely critical that we have an honest, challenging conversation about how the future of care in Wales is going to occur and how we’re going to pay for it. Otherwise, we risk facing a social crisis the likes of which we haven’t seen in this country since the days of the workhouse.

Now, this is a challenge for us all; it’s a challenge for the Assembly, for the Welsh Government and for the people of Wales. But I think rather than see this as a problem, we need to see it as an opportunity. What I’d like to suggest today is that we start the discussion on the establishment of a national care service for Wales—a service that will, in time, be as loved and respected as our national health service, but a service that will be integral to the health service and work hand in hand with it. We need an overarching framework, where people will know what to expect and will receive a quality of service that is consistent across the whole of Wales.

It’s essential that we work cross party and cross departmentally, and that we develop a consensus between the generations. We need to reflect on a new funding model that develops a fair balance between the state and the individual. We need to rethink our building policy to provide for the elderly, which could promote economic development in our communities. But, most of all, we need to develop a new and deep respect for the people who work in this essential service and give them the training and financial support that they need and deserve.

The fact is that, when the NHS was set up by the Labour Government in 1948, life expectancy for men was 66 years of age and women 71. Now, these poor men retired from work at 65, so they were lucky if they lived for a year.

We’re now living into our eighties and children born today can expect to live until they’re 100. But with people living longer and surviving with more complex conditions, more specialised care and support is required. Care services are struggling to keep up and the state is struggling to pay for it.

Report after report has noted that something needs to be done. The amber lights have been flashing for a long time, but I’ve got to tell you that they’re about to turn red. We can’t deny the evidence of recent statistics, which warn us that the current system is unsustainable. In August alone, over 455 patients were recorded as delayed care transfers in Wales.

The situation is only going to get worse. Population forecasts for Wales predict a dramatic increase in over-85s in the next 25 years, with numbers set to soar from 80,000 to over 180,000. That’s the equivalent of all the people who live in Carmarthenshire. These are our friends, they’re our family members, they’re our loved ones and we have a duty to care for them.

Almost £300 million was spent on looking after our elderly in Wales in 2013. By the time I’m 85, we’ll need to be spending almost £1 billion. That equates to 7 per cent of the entire Welsh budget. Our Labour policy will see the state contribute towards the cost of care should an individual’s savings fall below the £50,000 threshold. Those with capital exceeding this amount will be expected to pay the full costs of their care. Now, care’s not cheap. Across Wales, local authorities pay on average £450 to £500 for residential care and £500 for nursing care per week. Those with additional requirements can expect to pay even more. Now, if someone needs to go to a care home, the average time a person will spend there is just over two and a half years, incurring costs of over £75,000. This far exceeds the average pension pot and the £35,000 lifetime contribution cap proposed by Dilnot. Women are particularly hard hit, as they’re more than twice as likely to need long-term care and more than twice as likely to retire without their own pension pots. Thanks to Welsh local government—they have capped weekly domiciliary care contributions at £60. So, that means that homecare is more affordable in Wales compared to England, where there is no cap. But with these projected demographic changes some seriously hard questions will have to be faced.

And there are economic implications, not just for the elderly, but for those with ageing relatives. With more people leaving jobs or working less to assume those care responsibilities, our economy is taking a hit. The challenge is how to construct a system that is fair to all generations. Many older people, but of course not all, have benefitted from huge house price increases. Many did not pay for further and higher education. Many had a job for life and have protected inflation-proof pensions. In the meantime, the next generation who, through their work and taxes, will meet the costs of caring for their elderly, will never be able to afford a house of their own. Many will be facing substantial student debts or living on zero-hours contracts. Our increasingly ageing population means an increasingly larger number of older people are going to be supported by fewer younger taxpayers. Although this may seem inequitable, we must not lose sight of the fact that financial differences within the generations are just as stark as those between the generations. So, we’ve got to ask the question: do we think that we all deserve the same care and opportunities, whether we are grandparents or grandchildren?

Wales has an additional problem, we live in a beautiful country with attractive prospects for those seeking cheaper retirement opportunities compared to other parts of the UK, and they’re coming, in their thousands. Now, let me be clear, I welcome the fact that people want to retire here, but in the longer term, can we hand on heart say that we can pay for anyone who arrives without any mechanism to plan for them financially? Whilst we must appreciate that they may have paid generously into the UK general taxation system, we and they need to understand that payment for care homes comes from a local authority budget—a different pot. So, the extent to which the state can support the elderly in Wales will depend on how thinly we spread the jam.

We need to consider seriously the need to develop a more contributory-based system, but one that ensures that those who cannot self-fund are also protected whilst incentivising those who work to save and contribute. These are really difficult and sensitive issues and they’re not easily resolvable. But we could and we should start a conversation about the mechanics of how such a system might work.

To what extent should we be expecting people to release equity from their homes, buy insurance and unlock pension funds? And yes, I’m going to say the unsayable: should we consider a new Welsh tax to pay for this now that we have the powers to do so? None of us knows what care we’ll need in future, so we need to ask whether we need, as a society, to collectively pool the risk as we do with healthcare.

In looking ahead, we need to think about building policies and planning for houses with the elderly at the forefront of our minds. Could this be an opportunity to promote economic development in our communities? Could we consider rolling out building programmes in co-ordination with colleges and apprenticeship schemes? Let’s develop the skills of our local bricklayers, electricians and plumbers and revitalise the Welsh workforce. Understanding the level of demand for future care services and the associated costs is vital in planning for an efficient and equitable social care system, and given the current pressures on the NHS, we must strive wherever possible to move away from high-cost, reactive and bed-based care to care that is preventative and proactive, focusing as much on wellness as on responding to illness. We should look to the examples of other countries such as Holland, where students are offered free accommodation in exchange for their time spent with elders. Could we too develop a state-sponsored voluntary scheme to assist with minor tasks such as changing light bulbs or simply helping to combat the issue of loneliness? Solva Care in my own constituency is an excellent example

We also need to ensure that appropriate respect is offered to those in the care profession. Their work is complex; it requires skill, experience and knowledge. These people are dealing with emotionally vulnerable people in challenging environments with limited resources and support. More action needs to be taken to combat poor pay and conditions within the sector. We need to nurture ambition in our experienced care workers and encourage them to become managers of the future.

Let’s not forget the implications of the Euro referendum. With almost 6 per cent of our care workforce comprised of non-UK nationals, we’re likely to be facing significant reductions in staffing levels in a sector that already struggles with high turnover and recruitment difficulties.

Now, during my recent visit to care homes, I’ve been told repeatedly that private homes are giving up nursing care. They claim it’s not economically viable and that they have extreme difficulties in recruiting nurses. The private model appears to be in trouble. So, should the state now step in and provide more nursing homes to cater for the increasing demand? We need to act not react when it falls apart. Let’s use this as an opportunity to develop partnerships with private care homes to stop these providers failing. Let’s reduce the reliance on bank nurses at triple the cost to support these services and work with NHS nurses and provide them with the same rates and conditions. We can’t, however, have a system where the state owns care or nursing homes only to see a future right-wing government come in and sell them off, like they’ve done with the housing associations in England. We need to develop a model that can’t be privatised by the state to ensure that the next generation of elderly are protected. This would complement the proposal for a more contributory-based mechanism, which could even be part-owned by individuals or by co-operatives.

We’ll need to offer additional consideration to the complex issue of delivering care in rural settings, where running costs and low recruitment levels for both residential and nursing homes continue to be problematic, and consequently deter private investors.

Finally, we need to break down the artificial barriers between health and care. At the moment, arguments over who pays and how to pay are clogging up the system and are causing delayed transfers of care. The intermediate care fund is a step in the right direction. However, £60 million in a budget of approximately £7 billion for health is but a drop in the ocean. We need to ask how far we should go to integrate health and social care, perhaps even thinking the unthinkable and merging both funds, but this will need a sensitive conversation with local authorities.

I hope today that we can make a start on this opportunity. I think it’s our responsibility as elected representatives to bring about change on this extremely sensitive issue. The Welsh Labour manifesto rightfully emphasised that the care sector should be a sector of strategic national importance, so let’s build on that and make it a reality. This problem is not going to go away. We must act now, and we must establish the national care service for Wales.

Thank you. Would you like to give a minute of your time to other speakers?

Yes, I would like to.

Okay. I call on Mike Hedges.

Diolch. Can I first of all thank you, acting Presiding Officer, and, more importantly, can I thank Eluned Morgan for a minute in this debate, and raising the issues? Let me state at the outset I don’t necessarily agree with everything she said, but I think the issues are worth raising, and they are important.

Most social services departments in Wales are under more financial pressure than any other service area in the public sector, and that includes the health service. We know that the population is ageing and that people are living longer, often with substantial care needs that have to be provided outside of hospital. We also know that whilst health deterioration and hospitalisation needs normally occur in the last two years of life, whatever age that is, social care can be needed for decades and the amount needed can and usually does increase as people become more frail and in need of more support.

Can I just add two quick points? I think loneliness is something that is really the curse of an awful lot of elderly people. If I could actually do one thing by using a magic wand, I’d deal with loneliness because it really is probably the biggest killer. The other thing is: Eluned talked about merging health and social care funding. All I can say is that when primary and secondary care got merged, primary care didn’t do very well.

Can I thank Eluned Morgan for a most enlightening and challenging debate? I wholeheartedly support the idea of a national care service. We’re having to deal with the proceeds of success—the success of our health service—but how are we going to deal with that? In 1950, King George VI signed 250 cards for people who were 100. By 1990, Queen Elizabeth had to sign 2,500 cards for centenarians, and two years ago Queen Elizabeth had to sign 13,000 cards for centenarians. So, how are we going to deal with that level of success?

Before the NHS came along, the health service was fragmented between the private sector, charitable organisations and local authorities, and we’re in that situation now with care. Care needs to have the parity of esteem with health, and I believe that we should be challenged to form a national care service because at the moment care is fragmented between the private sector, the charitable sector and local authorities. It needs to be brought together, and let’s have a sensible debate about the way forward. Diolch yn fawr, Eluned.

I call on the Minister for Social Services and Public Health to reply to the debate.

Diolch. I’m pleased to be able to respond to this debate, and I thank Eluned, Mike and Dai for their contributions. This Government has been strongly focused for a number of years now on building a care service fit for the pressures of the modern world. We have brought forward groundbreaking legislation to reform care, based on a person-centred approach. We have protected social services budgets despite the austerity of the UK Government, and we’ve led the sector towards new approaches of collaboration and integration. We have, since 2011 and the launch of ‘Sustainable Social Services for Wales: A Framework for Action’, delivered a coherent and strategic response to the issues of an ageing population, and enhanced public expectations and limited financial growth.

We know, of course, that the population in Wales is growing older. Life expectancy is increasing, and the proportion of older people aged 75 and older is projected to increase each year. Society is changing, and social services must change in response. There has been, and will continue to be, a shift in the public’s expectation of public services. Social services need to alter and respond in the light of a difficult financial outlook.

The Welsh Government has, since 2011, transformed the fundamental basis of the social services system to meet these challenges. ‘Sustainable Social Services for Wales’ has changed the foundations of social care, placing the citizen at the centre and recognising that effective services are those shaped by the people who receive them.

The focus on challenge now is on ensuring that the changes underpinned by the two major statutory levers for transformation, the Social Services and Well-being (Wales) Act 2014 and the Regulation and Inspection of Social Care (Wales) Act 2016 are fully embedded. Our new programme for government, ‘Taking Wales Forward’, explicitly recognises this imperative. That programme for government also recognises the very real challenges of the costs of care. The Government will more than double the capital limit for residential care in this administration, ensuring that people are able to keep more of their hard-earned resources should they need to go into residential care.

At the core of service delivery is partnership and co-operation. The challenge here is making health and social care work in a collaborative way to provide good-quality care and support for people with needs, recognising that local authorities and partners, including the third sector, housing and communities, need to work together in order that preventative services can be put in place to help people live independently.

Statutory regional partnerships boards have been set up to bring together health, social services and the third sector to assess, plan and provide jointly for the needs of their populations. This includes agreement on the capacity of services they need from care homes, and integrated commissioning arrangements. This Government has invested significantly to support innovative new models of care. The intermediate care fund, this year alone, has provided £60 million to regions, to promote prevention and integration approaches. I’ve personally seen the results of that investment across Wales in step-down facilities, in health and social care information services working together, in professionals from different sectors working together. This money is significant and it is making a difference.

Let me turn to the market in social care. Members will be aware of the provisions of the Regulation and Inspection of Social Care (Wales) Act 2016, which requires local authorities and the Welsh Government to look ahead and think about the future of the social care market. It also gives new powers to the regulators to monitor the health of the market, particularly those big players whose departure could cause significant problems for those receiving care. I’ve met with providers to discuss these matters and will continue to look at ways we can support a strong, vibrant and resilient sector going forward.

Those providers, together with other stakeholders, sit on the Government’s care home steering group. That body recently requested the national commissioning board to undertake a market analysis of the care home sector. This work is crucial, and I expect to see the results of the research shortly. It will give us the clearest picture we’ve ever had of the existing provision and capacity within the sector, and I am sure it will help the regional partnership boards meet the Government’s requirements that, from April 2018, they establish pooled funds in relation to care home accommodation for adults.

In terms of the workforce, we know that the care sector is facing significant pressure in relation to recruitment and retention. This Government invests over £8 million every year in training that workforce and is committed to taking action to improve the attractiveness of the sector to the potential workforce. The overriding view of respondents in the Government’s recent consultation on improving the quality of domiciliary care was that terms and conditions of employment for domiciliary care workers should be improved. The national living wage provides a welcome improvement to the terms and conditions of employment for social care workers. However, we do recognise that this poses challenges to the financial health of the sector. I reaffirm this Government’s commitment to work with the sector to explore and respond to the challenges of the national living wage.

We have undertaken significant research into the links between the terms and conditions of the workforce and the quality of care, and that link is now well established. I’ll be publishing a report on that consultation shortly, alongside a written statement setting out the direction of travel that this Government will take in this regard. I’ll be working with the sector in the period ahead to consider how to limit the use of zero-hours contracts, as promised in our manifesto.

This brings me to a final challenge that has only recently emerged, and that is the impact of the Brexit vote and the fact it will have far-reaching consequences for our society. But, actually, the social care risks may be more immediate. Our sector relies on a workforce drawn from across the European Union and I want those staff to feel secure in their roles and not to feel threatened by the outcome of the referendum. As a Government, we will continue to press the UK Government to recognise the valuable contribution made by those from outside the UK and to ensure that we are able to attract an able and passionate workforce for our social care system.

So, a lot has been delivered by the sector in response to the transformational change set out in recent legislation. The sector still faces challenges and we will continue to work with the sector to meet those challenges in the future. We can and we will grow a sustainable system of care and support in Wales, which has the well-being of, and good outcomes for, people at its heart. Diolch yn fawr.

Thank you, Minister. That brings today’s proceedings to a close.

The meeting ended at 18:03.