Could I also thank the older people’s commissioner for her work? I’d much rather, as you all know, have her be directly accountable to this Assembly rather than the Welsh Government, but her report is really, really valuable and I thank her for that, as well as the others referred to within it. I also thank her for—and Julie mentioned this—the very visible and direct contact that Sarah Rochira has with older people and, in particular, for making us look very hard at what we mean by ‘outcomes’.

Key to this is a strong voice, as referred to in our second amendment, and older people being empowered to secure what they need, as referred to in the report itself. And I think this is quite a tricky job for the commissioner, because older people, of course, aren’t a homogenous group: older people fighting, shall we say, covert discrimination in the workplace have very different challenges from those designing their own domiciliary care, and there’s a different type of advocacy needed for people who are elderly, frail individuals who find themselves in that revolving door between hospital and their care home, or maybe even someone with dementia or sensory impairment having to negotiate public transport. I think if we are to embrace the rights-based approach to policy making, which might be able to deal with a lot of these issues—an approach that’s actually encouraged by the commissioner—then I think we also have to recognise that every right gives rise to a responsibility. And an older people’s rights Bill would help clarify where that responsibility might lie.

For as many people as possible and for as long as possible, that responsibility for deciding on how they live should lie with an older individual themselves—or anybody, regardless of how old they are. There’s more than one way of meeting needs, and if an older person isn’t at the centre of those pertinent decisions, then the chances are that those needs won’t be met as well as they could be, whether they’re carers or cared-for people, or anyone, really. While the Social Services and Well-being (Wales) Act 2014 provides parity for carers and those they care for in terms of assessment, we’re yet to see the evidence that assessment leads to meeting need in the best possible way. I hope that the commissioner will be able to guide us to evidence to help us see how that Act works in practice over time. I suspect that the same evidence will also help us, and older people, find a more individualised, co-productive way to balance rights and responsibility for care to be safeguarded in some new legislation, so that no-one is stuck with services that don’t fit, no-one is left in that purgatory where no-one takes responsibility, and so that competing rights and responsibilities are worked through by those affected by them.

That leads me to the commissioner’s work on understanding the integration of health and social care. Absolutely, qualitative outcomes are what matter to an older person needing services. Inevitably, though, I think there is going to be a great deal of focus on the logistics of integration and how to accommodate local difference. Wales, of course, may be small but its geography and demographics don’t allow for a single, centralised response. So, I’m very keen to see how the commissioner can help Welsh Government and existing managers of services in this period to keep the focus on outcomes and what ongoing engagement with older people about their experiences, to quote the report, will actually look like.

I have some real concerns about whether social care will be able to shout loud enough in this process. Twenty-one per cent of local authorities in Wales don’t even know whether they already have enough social care. And just by way of a contrasting example, really, Salford, in England, is going through their process of integration now, and their social workers have already been transferred from the local authority into the NHS. So, they’re already competing with a range of NHS priorities for status and funding. What chance will issues like social isolation, carer support and respite, care worker terms and conditions, dementia awareness and homecare provision get to rise to the surface in this integration agenda? More importantly, how will the qualitative way of measuring success—the ‘How do I feel?’ criteria—promoted, quite rightly, by the commissioner, hold up in a world of process and numbers-driven evaluation? I see from the report that health boards are doing some work on that now, and I hope that the next report by the commissioner might be able to comment on the success of this. I certainly expect the Welsh Government’s parliamentary review of health and social care to give full weight to any evidence provided by the commissioner to avoid being defective in meeting its essential aim.

Finally, I look forward to the follow-up on the review of care homes that was mentioned in the report, and I hope that there’ll be evidence available by then that changes to the inspectorates will be clearly visible and that there’ll be good news, especially regarding the use of medication. I certainly hope that the extension of dementia training will provide a better experience for older people in care homes who have dementia, but also for those caring for them. It would also, I think, be quite interesting to hear whether those with dementia who are not living in a home are having a better experience generally in communities because of the growth in dementia-awareness training. Thank you.