Questions now from the party spokespeople. Welsh Conservative spokesperson, Suzy Davies.

Diolch, Lywydd. Good afternoon, Minister. Obviously we welcome the additional £10 million in the next budget intended for social services, but that isn’t ring-fenced, so what reassurances have you had from local authorities that it will be spent on services that commentators in the sector say would be lost without it?

The budget this year gave extra allocations to social services. We gave an initial £25 million to social services, £4.5 million to reflect the uplift that we’ve given in terms of the capital limit, and a further £10 million that was specifically in grant form this year to address the challenges that local authorities and the sector are facing with regard to implementing the new national living wage. So, because that £10 million is a grant this year, it does give us that extra oversight.

My understanding, based on answers to previous questions that I put to you is that the living wage created an issue with the initial allocation of budget, and that the £10 million was to sort of make up for that, at least in some part. So, it’s not actually directly for the uplift in the living wage; it’s for filling the gap that the living wage left, if I can put it that way.

You didn’t actually address my specific question about which services were endangered, though. As this extra money was given to meet a particular need, rather than just being a general uplift to the revenue support grant, and was raised in part by increasing the maximum contribution that people pay towards their care, I think, actually, it’s in order for both of us to follow that money and make sure it’s being spent with the intentions you originally had. So, when the sector experts told you that certain services were at risk, which examples impressed you sufficiently in order for you to consider even raising this additional money?

The decision to invest further in social care this year is a direct reflection of the discussions that we have had with experts in the field. We held three round tables with local government, with providers and others, in order to listen to the challenges of the social care sector, and work out a way we can collaboratively respond to them. So, Welsh Government is providing extra funding—you’re correct in saying that—but we also require local government to commission services in a cost-effective way and to invest there. Also, there is an onus on providers themselves as well, in order to make social care the kind of career that people want to work in. It’s unacceptable at the moment that there is a third turnover in staff in the sector, and every time a new member of staff has to be appointed, it costs the provider £3,500, with all of the checks and the training and so on. So, it’s incumbent on all of us to work in partnership in order to ensure that we have sustainable and resilient social care for the future.

You referred to the increase in the cap on domiciliary care to £70 this year. That will give local authorities an extra £4 million on top of the other funding, to which I referred as well. I think it was a fair time to consider increasing that cap because the cap has been at £60 now for the last two years. So, I think that the increase is a reasonable increase to make.

Thank you for that answer, and I don’t challenge you on your answer on the rise in the cap on payments towards domiciliary care, but I’m still struggling to find out what exactly it is that this £10 million will go on. What I’m picking up from your answer is that it’s primarily to do with staff retention, and that may well be the case, but that’s what I want to be able to see happening as a result of this extra money coming into the system.

I think we probably agree that preventing avoidable reliance on social care is worth while, both to our citizens and obviously for the services that provide that care. In my meeting with members of the Welsh NHS Confederation today, the key players—and they are key players in this, there is no two ways about that—summed up the current situation like this: they said that Wales has the answers for growing demand for more complex social care, but it’s the structure that gets in the way. I heard the Cabinet Secretary’s reply to Lee Waters’s question, and to the supplementaries, about how allied healthcare professionals can be part of this and that complete understanding that they are willing and ready to take part in different ways of working.

Do you now have enough evidence about partnership working, pooled budgets and all the rest of it from local health authorities, local authorities and from the third sector even—evidence that is strong enough to start developing policy now on a Wales-wide basis, which is predicated on greater numbers and a greater responsibility for occupational therapists, physiotherapists and other allied healthcare professionals, releasing them from this silo of secondary intervention only?

I think the intermediate care fund is providing us with just that evidence. We have a £60 million intermediate care fund, which is really transforming the way that local authorities and health boards work together, including meeting people’s needs.

Just this morning, I was in Ystradgynlais, seeing the good work that they’re doing there in terms of bringing together health and social care, and they did include the allied professionals as well. I sat in on one of the team meetings where cases were discussed, and it was absolutely incredible to see how quickly packages of care could come into place when they had all the right people around the table. So, we are gathering that evidence.

Our intermediate care fund projects are providing us with information on a quarterly basis and we’re analysing that, looking at what really works. Because we’re starting to get to the point now when we can demonstrate the number of nights saved to the NHS, for example, and we have surveys of satisfaction from people who’ve been recipients of care through the intermediate care fund. I think it’s fair to say that we’ve been blown away by the success that we are seeing in the various projects right across Wales. I’ve visited projects in Swansea, Bridgend, and a couple up in north Wales as well. Although the approaches are different in different places, I think it’s important that different projects in different areas learn from one another. I think that the fact that professionals are freed up to do their jobs and to learn from one another, and not to have these artificial barriers between health and social care, is really making a difference to the care that people receive.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Llywydd. My questions are also to the Minister. Pressures on emergency departments in our hospitals have an impact on both sides of Offa’s dyke and have been in the headlines again, and there are many reasons for those problems. But, I want to concentrate on the role of social care. Does the Minister agree that good social care services play an important role in preventing people from having to go to hospital in the first place and allows them to leave sooner?

Yes, I absolutely agree that social care has a role to play in preventing unnecessary hospital admissions and ensuring that people can have a step-down service to return home as quickly as possible. We know that staying in hospital for too long is obviously bad for the individual in terms of their health and their well-being, which is exactly what the intermediate care fund is doing in terms of providing those step-up and step-down services. We’re able, as I say, to demonstrate the number of nights saved to the NHS, but behind every night saved to the NHS, obviously, is a story of an individual whose care has been improved as a result of it.

We know, of course, what percentage of our budget is spent on the NHS, but the same attention or prestige is not given to social care budgets. In England, of course, we know that the Conservatives have cut the funding available for social care and the impact of that, I think most would agree, has been clear in terms of increasing the pressure on hospitals. Here, in Wales, the Welsh Government takes pride in the fact that social care budgets haven’t been cut to such a degree as they have in England, but why, therefore, has the number of adaptations to people’s homes declined by 21 per cent since April 2011? Why has the amount of equipment provided for users of services reduced by 15 per cent over the same period?

You’re absolutely right to say that we do take a very different approach to the one that we see in England in terms of our support for social services because, of course, the UK Government has abdicated its responsibility for social services in putting the burden on councils to raise council tax to pay for social care locally, which I think is an unfair approach and one that we wouldn’t be seeking to adopt here.

On delayed transfers of care, we are seeing improvements in those figures and I think that is the result of the work that we are doing through the intermediate care fund. But with regard to the specifics on why we are seeing fewer aids and adaptations, I couldn’t tell you why we’re seeing that because people should be having their needs met through the Social Services and Well-being (Wales) Act 2014, which does require an individual assessment of each person’s needs, which will include aids and adaptations, and they should be available to the people who need them.

Perhaps the Minister should be trying to find out why those adaptations have been declining and why the equipment has not been going out at rates at which it has in the past because that all has an effect and a knock-on further down the line within our health and social care system.

Let me draw your attention to another service that is vastly underappreciated—that of unpaid carers. Last year, Carers UK found that 55 per cent of carers in Wales found that their own physical health had suffered because of their caring duties. That’s the highest percentage anywhere in the UK. The amount of respite care provided in Wales—the number of nights of care provided in Wales—has dropped a staggering 24 per cent since 2011. This has happened at the same time as this and the previous Government presided over a programme, of course, of closing community hospitals, with an overall decline in the number of NHS beds available in Wales of 7 per cent. These community hospital beds, I need not point out, could have provided a smooth transition for patients back to the community, tackling delayed transfers of care, as well, of course, as providing desperately needed respite care for the army of unpaid carers that keeps our system afloat. So, will the Minister now admit that the drive to close community hospitals has been a big mistake and that, in the main, and for the sake of strengthening our social care system, it’s time to start reversing that programme?

Well, just to pick up on the comment you made on aids and adaptations, I think that we should be looking at whether people’s needs are being met, not whether or not there has been an increase or a decrease in the percentage of certain aids and adaptations that are being installed. If you have specific examples locally as to where people haven’t had their needs met through aids and adaptations, then by all means please raise them with me.

I share your admiration for unpaid carers. They’re doing an absolutely wonderful job across Wales. We wouldn’t be where we are without them. This is why we have committed, as a Government, to introducing and to developing a national respite strategy, because we know that provision for respite locally does differ across Wales. When we listen to carers, they tell us that, more than anything, the one thing that they need and that they want is access to respite. This is why, when we asked the Family Fund to look at the kind of support they offer to families here in Wales, we asked them to focus on respite and short breaks, because these are the things that disabled families have been asking us to focus our attentions on.

You’ll be aware as well that we’re currently refreshing our carers strategy, and, again, this is through listening to carers as to what their priorities are. Early priorities that are emerging from those discussions, as you would expect, include respite. They also include young carers, older carers and carers of older people as well.

UKIP spokesperson, Caroline Jones.

Diolch, Lywydd. Cabinet Secretary, one of our most effective weapons for fighting cancer is population-level screening. I welcome the recent announcement made by the Minister for public health about the move to better methods of screening for both bowel and cervical cancer. However, no matter how we improve the screening techniques, our biggest battle is convincing the public to participate in screening programmes. What plans does your Government have to reverse the downward trend in cervical screening and improve uptake in bowel cancer screening?

I thank the Member for the question. As you know, the Minister leads on our population health screening programmes as part of her public health responsibilities. We, too, are concerned about the figures confirming that cervical screening rates have lowered, and we expect there to be more public information, but also conversations between health professionals and individuals about the real benefit of undergoing screening for a range of different potential conditions. On bowel screening, I actually think we will see an uptake because the test is easier to administer. Without going into the details of the old test and the newer test, it’s an easier test to administer, and we expect that we will see a rise in the number of men, in particular, who will undergo that particular screening programme.

Thank you for that answer, Cabinet Secretary. One area that could benefit from improved screening is prostate cancer. A recent study published in ‘The Lancet’ showed that using multiparametric MRI on men who had high prostate-specific antigen levels increases detection of aggressive tumours, and spares many from the need to have a biopsy and its associated side-effects. What plans does your Government have to roll out this new technique across the Welsh NHS?

I thank the Member for the question. Prostate cancer is a particular area of focus, and not just because there is a very active—and I welcome their activity—third sector organisation around prostate cancer, who regularly encourage us to find out more for ourselves and to encourage others to think about the current ways of understanding whether people do have prostate cancer and the potential treatment options. Part of the challenge is that we currently have a less than adequate test for prostate cancer, and it’s part of the uncertainty that goes into that. We are interested in advancing the evidence base for more effective tests to understand whether people have prostate cancer and what particular type of prostate cancer, and the evidence you cite from ‘The Lancet’ is just one of those. We need to understand all of that evidence, and understand how much of that goes into diagnosis and how much goes into screening as well. This is one of those areas where demand and a desire to have a wider screening test—we need to know whether there’s evidence that the screening test is actually the right thing to do, as opposed to different forms of diagnosis where there is a suspicion of prostate cancer. As ever, in this area and others, we will continue to be guided by the very best evidence and the very best return in terms of patient outcomes from any new form of screening or diagnosis.

Finally, Cabinet Secretary, the holy grail in cancer screening is the development of a reliable testing regime for lung cancer. Cardiff University, in a recent trial, found that the use of low-dose CT scans for lung cancer screening has no long-term psychosocial impact on patients, making it an excellent tool for detecting lung cancer early, when there’s a better chance of survival. Does the Welsh Government have any plans to look at the feasibility of using low-dose CT lung screening for high-risk individuals?

I think my closing comments to your previous question still hold. We look at all of the evidence available as to what is an appropriate way of either understanding our diagnosis where there is suspected lung cancer, or potential population screening. But I think, actually, with lung cancer, our biggest challenge is the fact that there is late presentation for lung cancer. It’s a really big concern. In particular, we recognise there is a real differential in terms of the most deprived groups and our least deprived communities, and those who are most likely to present and seek help. That is our biggest challenge, and it’s a challenge that the cancer implementation group has recognised themselves. Clinicians within the service and cancer charities and campaign groups recognise that we need to do more to get people to present at an earlier stage, on lung cancer in particular, when there is a better prospect of people having their life saved. But, as I say, I look forward to the evidence on what we could and should do, and how we then implement that progressively and successfully across the whole service.