The following amendments have been selected: amendment 1 in the name of Jane Hutt, and amendments 2 and 3 in the name of Paul Davies.

We now move on to the Plaid Cymru debate on social care. I call on Rhun ap Iorwerth to move the motion.

Motion NDM6223 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Believes that good social care services play an essential role in keeping the NHS sustainable.

2. Notes that unpaid carers make a critical and unappreciated contribution towards ensuring the sustainability of health and social care and regrets the fall in the number of nights of respite care provided since 2011.

3. Believes that community hospitals could play a vital role in providing respite care, and in easing the transition back to community health settings for those who have required hospital settings.

4. Calls on the Welsh Government to reverse the practice of closing community hospitals and explore ways of restoring the availability of beds for use by both health and social care services.

Motion moved.

Thank you very much, Deputy Presiding Officer. I am pleased to open this debate on social care, carers and community hospitals. We often discuss, as we should do in this Chamber, the health service—the NHS—but it is extremely important that we always bear in mind that, behind the NHS, there is an ecosystem of support of social care, third sector groups and unpaid carers—all of them contributing to what is needed by people the length and breadth of Wales. We’ve often referred to the mistaken policy of the Conservative Government in London of safeguarding the NHS budget at the expense of local authority budgets, including social care. I’m not going to spend too much time on that issue. I do think, however, that it is fair to say that the Welsh Conservatives have a different view to their fellow Conservatives in Westminster. I think that the Member for Carmarthen west deserves praise for that. I don’t think that we could have said the same a year ago.

The Welsh Government often reminds us about the fact—and it is a fact—that expenditure on social care here hasn’t been cut to the same extent here as it has in England. It is true: if you compare with the financial year 2011-12, expenditure on social services for adults is around £100 million more in cash terms in the most recent year, and this also translates into a real terms increase, too. So, we should be seeing improvements, and I want you to bear that in mind during this debate. But I am more interested, as I hope others are, in outputs rather than budgets. So, I have been looking at the trends over this period of time in order to have an overview of how social care is performing, whilst acknowledging that the pressures are increasing because of an ageing population.

There was an increase in the number of hours of homecare provided until 2014-15, but there has been a reduction in the past year. That is something that we should be concerned about, and we should certainly be keeping an eye on in terms of the trend. It’s also worth noting that the hours of care provided directly by local authorities have decreased, whilst the hours of care provided by independent contractors on behalf of local authorities have increased. There are excellent companies providing care, of course, but we do need to be guarded in safeguarding staff and service users in a climate where zero-hours contracts and low wages are commonplace.

I will move to adaptation and personal equipment. Here, we see a reduction of 21 per cent in home adaptations, and a reduction of 15 per cent in equipment. What the Minister said in response to a question from me last week was that we need to bear in mind that everyone’s needs are different, and that we shouldn’t be jumping to conclusions, but seeing a reduction of 21 per cent at a time when the population is ageing and demands on the service are increasing is quite surprising to me, certainly.

I will now turn to delayed transfers of care, which is a very important measure of the way in which the NHS and social care interact and collaborate. The Government has highlighted this performance as an example of success, and if we look at the annual numbers of cases of delayed transfers of care for reasons of social care, then there has been excellent attainment. One has to say that in that period between 2000 and 2013, when we saw a reduction from some 5,000 cases a year down to 1,200 a year, there’s no question that that was a significant improvement, but since 2013, the figures have been creeping up slowly. Last year, there were 1,343 cases of delayed transfers of care for social care reasons, and therefore, I would warn Government—and I hope that they don’t do this—that they shouldn’t become complacent. Things at present are moving in the wrong direction, with more than 100 cases of delayed transfers of care every month, because of issues related to social care. This is a problem for the NHS, of course, but it is also something that causes anguish to patients who find themselves caught in these kinds of situations.

Thank you, Rhun. The Health Foundation report recently stated that the need for social care funding was going to double in the next 13 years. Don’t you think we should be planning now, not waiting for the next few years and then suddenly having to find all this funding? I do appreciate that £50 million has been put in to help us with winter preparedness, but the fundamental basis is, if this was a business, you wouldn’t allow it to go that length of time—you would start to plan, and you would start to fund it now. Would you agree?

I will point out, and I’m sure you’ll forgive me, the irony of a Conservative Member talking about the need to invest in social care at a time when we have seen so many cuts. Although, of course, I have noted that the party here in the Assembly perhaps takes a different approach. There are finite budgets, of course, and I’ll help the Government out in those terms, but one of the things that, hopefully, we’ll be able to do in this debate today is say that it’s not just about how much money that goes in, it’s what we do with that money in order to achieve better outcomes. But, of course, I agree, the more money that can be found to deal with increasing demand is something that is going to have to be addressed as we move forward.

Rwy’n mynd i ganolbwyntio rŵan ar ofalwyr. Mae gofalwyr, rydw i’n meddwl, wedi dioddef mewn dwy ffordd yn y blynyddoedd diwethaf. Maen nhw wedi dioddef oherwydd y newidiadau lles ar lefel y Deyrnas Unedig—ac mae’n ddrwg iawn gen i, Janet Finch-Saunders, am dynnu sylw unwaith eto at ffaeleddau’r Llywodraeth Geidwadol yn San Steffan. Mae’r effaith y mae’r cwtogiadau wedi’u cael, rydym ni’n gwybod, yn rhywbeth y mae’r Aelodau yn fan hyn yn ymwybodol iawn ohonyn nhw. Ond maen nhw hefyd wedi dioddef oherwydd perfformiad gwael mewn nifer o feysydd yma. Mae gofal ysbaid yn un penodol. Mae yna ostyngiad wedi bod o 24 y cant yn nifer y nosweithiau o ofal ysbaid sydd ar gael, ac mae’r gofal ysbaid yma yn bwysig iawn. Yn aml iawn, dyna ydy’r gwahaniaeth rhwng rhywun yn gallu cynnal cyfrifoldebau gofalu neu beidio.

Rydym ni’n gwybod o arolwg diweddar fod dwy ran o dair o ofalwyr wedi rhoi’r gorau i weithio neu wedi lleihau eu horiau er mwyn gofalu, a bod hanner y gofalwyr wedi cael trafferthion ariannol o ganlyniad i hynny. Mae 55 y cant yn dweud bod eu hiechyd corfforol nhw wedi gwaethygu a bron i hanner y gofalwyr yn dweud bod eu hiechyd meddwl nhw wedi gwaethygu—y ganran uchaf yn unrhyw le yn y Deyrnas Unedig, ac rydw i’n gobeithio y byddwn ni i gyd yn bryderus ynglŷn â hynny. Mae hanner y gofalwyr hefyd—mae hwn yn ystadegyn—wedi gadael i’w problemau iechyd eu hunain fynd heb gael eu trin oherwydd y pwysau sydd arnyn nhw fel darparwyr gofal eu hunain. Felly, mae’r ysbaid yma’n hanfodol. Nid yw, yn sicr, ddim yn help bod llai o welyau mewn ysbytai cymunedol ar gael rŵan, fel un opsiwn ar gyfer cynnig y math yna o ysbaid. Fe rown ni ragor o sylw i hynny yn nes ymlaen.

Mae’n mynd yn waeth. Mae Gofalwyr Cymru wedi cyhoeddi eu monitor nhw o berfformiad ers y Bil gwasanaethau cymdeithasol. Dyma maen nhw wedi’i ganfod: nid yw 17 o’r 22 awdurdod lleol yng Nghymru yn gallu rhoi unrhyw ddata ar faint o ofalwyr sy’n cysylltu efo nhw dros y ffôn, y rhyngrwyd, neu yn bersonol, am wybodaeth, cyngor neu gymorth. Nid yw’r rhan fwyaf o awdurdodau lleol yng Nghymru yn gwybod faint o ofalwyr maen nhw wedi’u cyfeirio at sefydliadau eraill. Fe wnaeth Gofalwyr Cymru, Carers Wales, ddarganfod nad yw 16 allan o’r 22 awdurdod yn gallu dweud faint o bobl roedden nhw wedi’u cyfeirio ymlaen at sefydliadau eraill. Mae angen i ni gael y math yma o ddata. Nid yw anghenion gofalwyr o leiafrifoedd ethnig yn cael eu hystyried o hyd ac nid oes ganddyn nhw gynrychiolaeth ar fyrddau lleol, grwpiau llywio, pwyllgorau na fforymau. Mi oedd yna amrywiaeth sylweddol yn faint o asesiadau gofalwyr yr oedd pob awdurdod lleol wedi’u cynnal, rhywbeth a oedd yn bwysig iawn fel rhan o’r Bil. Ac, o’r bobl a wnaeth gwblhau’r arolwg, nid oedd 80 y cant wedi cael cynnig asesiad anghenion gofalwyr—tipyn o syndod o ystyried y ffaith fod y bobl hynny a wnaeth gwblhau’r arolwg eisoes wedi nodi eu bod nhw yn ofalwyr, ac rydym ni’n gwybod beth mae’r Ddeddf yna yn ei ddweud.

Felly, mae’n rhaid i ni gryfhau gofal cymdeithasol yng Nghymru. Mi fydd fy nghyd-Aelodau fi yn siarad y prynhawn yma am rai o’r camau rydym ni’n credu y dylai gael eu cymryd, gan gynnwys, fel y dywedais i yn gynharach, yr angen i ddadwneud y broses yma o golli gwelyau mewn ysbytai cymunedol. Ond mae cymaint o wahanol elfennau i’r darlun cyflawn o ofal cymdeithasol mae’n rhaid sicrhau nad oes yr un ohonyn nhw’n cael eu gadael ar ôl. Rydw i’n edrych ymlaen at y ddadl ac ymateb y Gweinidog. Rywsut, mae angen cyfundrefn gofal cymdeithasol arnom ni sy’n fwy gwydn ac yn fwy cynaliadwy at y dyfodol, lle bydd yna fwy o bwysau a mwy o alw amdano fo.

Thank you. I have selected the three amendments to the motion and I call on the Minister for Social Services and Public Health to move amendment 1 formally, in the name of Jane Hutt.

Amendment 1—Jane Hutt

Delete all after point 1 and replace with:

Recognises and appreciates the contribution unpaid carers make to the health and social care system.

Believes respite care should be flexible and can take place in a wide variety of settings, including at home and in the wider community.

Notes that community hospitals are one of several settings which can play a role in providing both respite care and step up/step down care.

Welcomes:

a) the Welsh Government’s commitment to develop a national approach to respite to ensure that respite is responsive to individuals’ needs in a consistent manner across Wales;

b) the investment in extra care services made possible through the £60m Intermediate Care Fund in 2017-18; and

c) the new £40m fund announced in the 2017-18 Budget to develop new integrated health and social care centres across Wales.

Amendment 1 moved.

Formally.

Thank you. I call on Suzy Davies to move amendments 2 and 3, tabled in the name of Paul Davies.

Amendment 2—Paul Davies

Add at end of point 1:

and recognises the role of allied healthcare professionals in reducing avoidable demand for social care.’

Amendment 3—Paul Davies

Add as new point at end of the motion:

Calls on the Welsh Government to update the Assembly on the operation of S35 of the Social Services and Well-being (Wales) Act 2014, with regard to meeting carers’ respite needs.

Amendments 2 and 3 moved.

Diolch, Ddirprwy Lywydd. I welcome this debate and move our amendments. Perhaps I might also mention that Members will have the opportunity to develop the positions put forward today in a debate that the Welsh Conservatives will be tabling in the next few weeks. I think we should really keep this in our line of sight. It is something we should be discussing often, particularly with the Cabinet Secretary’s parliamentary review ongoing.

Good social care is affected by a number of complex concerns because our constituents have complex needs. It isn’t open to a homogenous solution because we’re not a homogenous Wales. Labels like ‘integration’ can’t be seen as a silver bullet any more than Welsh Government can be seen as a golden goose. Integrating systems that are themselves imperfect and unequal in status presents its own dangers as well as some really, really exciting and good examples. But, why so narrow a path to a fundamental systemic change, which is what we may actually need?

I certainly don’t want you to think that I don’t believe that integration is the wrong way to go—isn’t the wrong way to go—but how far and how broad? Do we really want everything co-located in hospitals? Are we talking about a national care service that effectively disconnects the district general hospital space from a new leviathan responsible for primary, secondary and social care, maybe even removing strategic responsibility from local authorities altogether? Do we want a network of Builth models or Prestatyn models? Do we transfer all social workers into the NHS or all occupational therapists out into local authorities? How much responsibility do we place on the individual or their family or their bank account or the public purse?

I don’t think that the Government’s parliamentary review can blink when faced with transformational visionary change, and I hope that it really uses this period of experimentation, if you like, with the intermediate care fund as evidential but not the final answer. Revolution or evolution—I’m actually quite open-minded to either course there, as long as there is resolution in both senses of the word, but we won’t get that unless we look beyond the NHS and social services.

To the motion—points 3 and 4 first. Opposition of all colours, or parties of all colours, made the case in the last Assembly, as they already have in this Assembly, that the closure of community hospitals has gone too far—manifesto commitments all round. Yes, some buildings needed modernising or replacing, but what we really mourn is not the buildings but the beds. It is the closure of community hospitals and the loss of their beds that the Welsh NHS Confederation, in their meeting with me last week, called the ‘turning point’.

Every one of us will say that an individual’s better off at home with an appropriate enabling or reabling care package, but there’s no plan B, is there? Keeping people in acute beds or commissioning step-down places in residential homes is not the flexible or wide range of settings referred to in the Government amendment. We now need the community beds to protect people from a new institutionalisation in acute beds created by delayed transfers of care. These community beds are no longer the cause of institutionalisation.

Allied healthcare professionals are likely to get a more accurate assessment of someone’s ongoing support needs from a community bed—obviously, maybe not as accurate as in an individual’s home, but that still has its risks where assessment is not met by immediate provision. Until we can fully satisfy patient need by opening new community beds as part of their respite and reablement, perhaps in new settings, then Government should listen. In this and the last Assembly, which was also in balance, let me say, all opposition parties representing their constituents have been telling you to stop closing community hospitals.

We’ll be supporting point 1 of the motion, and our amendment to that just emphasises what’s now axiomatic: reabling care or delaying the need for hospital admission in the first place—that’s what we want for our constituents and that’s what we want for the NHS. You can’t get that contribution to sustainability without these guys, not just with physical care but psychologically too, because if you feel in control of your medical and personal needs—feel that they’re being met—you may also feel confident enough to ask for help with your social needs, and loneliness is the example that we’ve all been talking about recently.

Finally, point 2 of the motion and our second amendment—well, yes, of course, unpaid carers make this contribution to sustainability, and meeting their needs is part of meeting the needs of the cared-for, which is why I’ve used section 35 of the Social Services and Well-being (Wales) Act 2014, rather than section 40, in the amendment. I hope it won’t be rejected simply because I didn’t list nine separate sections from that Act. This is my clumsy attempt to say that social care is about a group of people of all ages, however it’s chopped up in legislation—the cared-for, first and foremost, but also carers, care workers, health workers, housing providers, house builders, families, charities, neighbourhoods, energy companies and, yes, even managers and politicians. We need to lift our heads a little on this, and looking at the NHS integration agenda means that we’re just looking for half a solution. Thank you.

I welcome the fact that Janet Finch-Saunders says we need to double the amount of investment in social care, and I wish her well in her attempt to get that sort of money out of the UK Government—not likely with the current Government. But I also welcome the slightly more grounded position of Suzy Davies, that neither the Welsh Government nor the UK Government is a golden goose, and I think we have to look at this quite differently, really, particularly as there’s unlikely to be any change in the levels of funding between now and 2020.

I’m not sure that community hospitals are the answer as such, because, certainly based on my personal experience, older people nearing the end of their life want to be at home, most definitely. There is, of course, a role for respite hospices so that carers don’t collapse under the strain of looking after their loved ones, but I think that—. So, there need to be various models of support given, and it’s very important that, in line with the health and social care Act, we’re looking holistically at people’s needs and listening to what they want, and also understanding what level of support can come from their relatives, because, at the end of the day, they most want to be with their relatives or friends, where possible.

But we cannot underestimate the strain that these cause to people who provide unpaid care, which particularly falls on women aged 50 to 64, but the gender inequality diminishes once people retire and, in fact, men are slightly more likely to be providing care than women after retirement age. The health of unpaid carers deteriorates incrementally with increasing levels of unpaid care. The burden of providing 50 hours or more unpaid care a week nevertheless, in terms of impact on their general health, is greatest amongst young carers under the age of 24. But we have to applaud the over 9,000 men and over 5,000 women who are in full-time employment and providing 50 hours or more of unpaid care. It seems to me that, in those circumstances, it’s extremely important that we know who the unpaid carers are and that we’re able to give them the support to make them not also become in need of care themselves.

I think, if we look at what we are going to be able to do, the current situation, for example, in Cardiff—in Cardiff, in 2014, the last year that figures were available to me, they had 11 framework providers, plus spot contracts from another nearly 80 provider organisations. And the impact of competitive tendering drives down prices, depresses pay and conditions, and the race to the bottom, because of the return to the shareholders, is the key driver for private firms. And the continuity of care required is simply not there. If you think about the intimate care services that carers are having to provide, to not know the person who’s changing your bed linen or helping you with toileting really is devastating, and we really do need to think of—

Will you take an intervention?

[Continues.]—other ways of doing things.

Thank you very much for taking the intervention. I was just listening to your point about driving down the costs within the private sector; would you accept as well that there’s a difficulty with local authorities being able to pay more to those private contractors as well?

I wouldn’t disagree with that, but I think we need to look elsewhere for some of the solutions. I’m particularly interested in the model that’s been developed in Holland, the Buurtzorg model, because that has both massively increased the approval rate and also the job satisfaction of the nurses. In 2006, four nurses in the small town of Almelo in Holland realised that the relationship with patients had been undermined by the system they were operating under the Government-funded insurance scheme. So, Jos de Blok and three other colleagues set up their own social enterprise called Buurtzorg to look after older people in their own homes, through co-ordinated compassionate care. And, 10 years later, they have more than 9,000 colleagues who have joined them, and they look after more than half of the Dutch people who need care at home. It’s been regularly named the country’s best employer, year on year, and is a role model for the rest of the sector.

Interestingly, it has also cut costs, because nurses manage themselves in 800 different neighbourhood teams. They are engaged more effectively with other local services, voluntary carers and patients themselves, and their self-organised teams are supported not by managers, but by peripatetic coaches and an IT system designed around care-giving and collaboration. The whole national operation is run from a small back office that looks after billing and co-ordinates information and learning across the teams. Forty admin staff for 9,000 people in the field; that is something we should be aspiring to.

So, I think that this is an ongoing debate, but I welcome the fact that there is going to be a seminar on Buurtzorg at the end of March in the Celtic Manor, and I hope that many of our local authorities will be sending delegates to find out how it operates.

I’d like to begin my contribution to today’s debate by emphasising the importance of supporting people in their homes, concentrating on one aspect specifically. One specific area that can have a practical impact on improving the lives of many people is making adaptations to their homes: making it easier for people to use wheelchairs; a purpose-built shower; a stairlift; or railings to help people move round the house more easily. As my fellow Member Rhun ap Iorwerth mentioned, since 2011 we have seen a reduction of 21 per cent in the number of home adaptations in Wales and a 15 per cent reduction in cases where equipment is provided to people who need it.

All of the problems and difficulties caused by bureaucracy in terms of accessing grants in order to make home adaptations continues to be a problem, and this was highlighted by the report by the Communities, Equality and Local Government Committee back in 2013. But to date, it doesn’t appear that there’s been much effort to take action on some of the issues raised in that report and the reduction in provision does suggest that the issue hasn’t been given due attention.

Now, behind every statistic there is an individual. I met a constituent recently who was concerned about a child in the family who needs surgery. In order to care for the child after discharge from hospital, the home needs a series of adaptations. The delays in making arrangements for these adaptations means that the surgery itself is likely to be delayed too. This adds to the stress faced by the family and the child and is unacceptable. It impacts the quality of life of the child and its family and the delays can lead to further problems down the line as the child’s medical condition deteriorates, leading to the need for further adaptation, which would be more expensive, ultimately.

It’s stories such as these that lie behind the statistics. I am looking into this case at the moment, but I suspect that it’s a shortage of funding that’s the heart of the problem—that is, that there isn’t enough money available to assist everyone who needs adaptations in this current financial year and that social workers have to make decisions that are extremely difficult in prioritising who is to receive adaptations and when. But, if the Welsh Government’s agenda is moving more and more towards preventative work, then there’s room to argue that adaptations should be fairly funded, if the Government wants to pursue priorities it has set for itself in the preventative sphere.

In turning to another aspect, it’s true that the care profession isn’t given the status and recognition it deserves. The working conditions are often very poor, and there isn’t much opportunity for career development within this sector. Zero-hours contracts remain a feature within the sector, despite the efforts of Plaid Cymru to ban them—efforts that, unfortunately, were frustrated by Labour and the Conservatives on a number of occasions. These factors do combine to make recruitment in the sector very difficult, which therefore has an impact on the services provided. The failure to pay staff for travel time has a disproportionate impact in rural areas, and the shortage of Welsh speakers within the sector is a cause for concern, particularly when they deal with people who have lost the ability to understand and speak English.

So, what can we do? Well, first of all, in terms of adaptations, certainly the Government needs to accept the recommendations of committee reports and to take action on them. Unfortunately, there isn’t much evidence of this happening, looking at the most recent reports and the statistics in terms of adaptations. Without doubt, we need to give more recognition to the social care profession and give it due respect, with people encouraged to see the profession as a lifelong career, and that must include a pledge by Government to ban zero-hours contracts.

Although it’s true that expenditure has increased in real terms historically, the problem of underfunding social care persists. It’s become like a stuck record to say this, but I will say it again and again, I’m sure, in this Chamber: we need to see far more collaboration between the health boards and the local authorities. The intermediate care fund must be a starting point and not the end of joint funding between the various institutions. We must have further integration between primary care, community care and social care for adults so that we can plan and provide care in a co-ordinated and person-centred way that’s provided locally.

Suzy Davies has raised some interesting points for debate this afternoon. It would be good to have more time to air those at some point in future. May I add the Alltwen Hospital in Tremadog as an example of good practice? These examples of good practice now need to be rolled out.

We need to move to remove the artificial boundaries between health and social services, and community hospitals need to be a key part in this—

Are you winding up, please? You’re well over time.

We are calling on the Government to cease closing the patchwork of community hospitals and to move towards creating health and care hubs in our communities anew, such as the one that I hope to see in Waunfawr in my own constituency before too long. These are an important part of the care chain that we want to see in Wales for the future.

I’m pleased to take part in this debate today. With the number of people aged 65 and over set to increase by about a third over the next 15 to 20 years, and a third of the adult population of Wales having at least one chronic illness, we are becoming more and more dependent on our social care sector.Unfortunately, cuts to local authority budgets have placed additional strain on social care, and have had a knock-on effect on our NHS. Delayed transfers of care remain unacceptably high. For the latest quarter for which figures are available, we saw a 2 per cent increase in delayed transfers and there are now over 500 patients spending longer in hospital than is necessary. In fact, around 30 patients faced a delay of more than 26 weeks, and that’s half a year spent in hospital unnecessarily.

These unnecessary delays cost our NHS millions of pounds a year, but the cost to the individual is immeasurable. According to Age Cymru, the main factors responsible for delayed transfers of care include a lack of appropriate facilities for reablement and recuperation, long delays in arranging services to support people in their own homes, and the barriers that exist between health and social services. A recent survey of NHS managers by the NHS Confederation found that many felt that shortfalls in local authority spending had impacted upon their services. Therefore, it is of paramount importance that we have effective and well-funded social care services that will keep the NHS sustainable.

UKIP’s policy and, indeed, one of our earlier debates was the reintroduction of community cottage hospitals, albeit a reformed version of them. Community hospitals, or cottage hospitals, have a vital role in providing respite care and in easing the transition back to community health settings for those who have required hospital settings. Some people aren’t required to stay in hospital, but they can’t go home to be on their own, or for other reasons that they’re maybe not well enough, so cottage hospitals are vital.

We now have just under 11,000 hospital beds and occupancy rates of nearly 87 per cent. When the Labour Government took over the running of the health service in Wales, we had nearly 15,000 hospital beds and occupancy rates of 79 per cent. I do realise that things have changed and that there are more services available, but if people are released too early—and we must bear this in mind—from hospital because of these shortages of beds, there is a high chance of a relapse, which will, again, impact on the financial services of the NHS. Where there are shortages of beds, the result is longer waiting lists, winter pressures lasting most of the year and our NHS stretched to breaking point. We recognise wholeheartedly the debt owed to unpaid carers and volunteers, which we can never really repay.

So, whilst being mindful of the available moneys, and a pot that can only stretch so far, I would like to see the closure of community cottage hospitals reversed and funding for the social care sector to be increased. Diolch yn fawr.

I’m pleased to have an opportunity to take part in this important debate. Of course, the fact that we’re all living longer is a cause for celebration, as I’ve said before. The success of the NHS is cause for celebration. Back in 1950, the king at the time signed 250 birthday cards for those who were 100 that year—250 of them throughout the UK. By 1990, 40 years later, Queen Elizabeth had to sign 2,500 birthday cards for those who were 100 years old. Two years ago, Queen Elizabeth had to sign 13,000 birthday cards for those in the UK who were 100 years old, and, on top of that, 14,000 last year for those who had reached their hundredth birthday. So, it is a cause for celebration that we are in the position we’re in, although it’s a cause for concern for the Queen’s work-life balance.

But at the end of the day, this is a cause for celebration, and the question is: how are we going to deal with this explosion in the older-age population, which is to be welcomed? Yes, we’ve lost too many beds. Increasingly, now, as GPs, we keep people in their homes who are in their 80s and 90s and who are very frail and are very ill. In previous years, we would have sent them to hospital, but now we wouldn’t be able to justify that because there are no beds available, so we have to keep these people, who are old and frail, in their homes. We are very reliant on the social care that’s provided in the home, and that care is exceptional most of the time, I have to say. I’m totally reliant on it as a GP, or the system would fall apart. We have to recognise—we’re always talking about the health service here, but if the social care system disappears, it does undermine the existence of the NHS and we shouldn’t forget that.

To talk in more philosophical terms, in terms of the best way ahead, I was listening to Eluned Morgan in a short debate recently about the need to recreate our social care system. I agree with that, because we do need a revolution, as Suzy said, because we’ve gone to disregard the importance of care as a dimension. Everyone says how fantastic doctors and nurses are, and there’s this great respect—but amid all this technology and this ability and the X-rays and all the technological expertise, we’ve gone to downgrade providing care for the people. We’ve downgraded that and we’ve lost that—we can’t do it—and we don’t give the respect that those who care should have. As Sian Gwenllian said, we’ve seen that with zero-hours contracts and so forth. You don’t get that with doctors and nurses, but carers have to accept those contracts, because, as a society, we don’t show enough respect to this idea of caring for our fellow person, and we’ve lost that. In our hospitals, when we couldn’t do this amazing surgery and so forth, we used to care tenderly for our patients because there wasn’t much else we could do. But now, we’ve forgotten about the importance of caring and looking after another person and we’ve downgraded it completely and we’ve devolved that to people who, perhaps, don’t have any qualifications. Only recently, we’ve had legislation that means that care support workers are going to be registered. Well, you wouldn’t imagine a situation where a nurse who was unregistered was looking after you, or a doctor, but we allow carers who are unregistered to look after you. We need to tackle this entire system and redesign it.

Also, the sheltered accommodation aspect is vital as well. We need to change the system—yes, to be revolutionary, as Suzy said. And as Eluned Morgan has also said, we need to create a new system of social care that tackles the housing issue, and sheltered accommodation—we need a network of those—so that we can care for our older people properly in the community. Thank you very much.

I was hoping to make a more comprehensive contribution to this debate today, but the advent of an awful cough means I’m going to have to curtail it, so I don’t treat the Chamber to my epic, hacking cough.

I want to start by welcoming the additional £10 million investment into social care, recognising the additional demands on social care, but we all know how we need to address how we build on this, going forward. As my colleague Dai said, people are living longer. We should, rightly, be pleased about that and celebrate that, but we can’t ignore the consequence—the growing pressure on our services—and we’ll need to do more to work together to deliver innovative services and support against a tight financial backdrop.

I’m proud that my own council of Flintshire retains three in-house care homes, and I had the pleasure of visiting Croes Atti Care Home in my constituency just a few weeks ago and had an opportunity to chat to the lovely residents and day users, as well as the fabulous, hard-working staff. One of the residents I met there was Jessie Joy, who was 100 years young, and when I asked her about the secret of a long life and if there was any knowledge she could impart to me, the advice she gave me was, ‘Don’t show in the window everything you have in the shop.’ [Laughter.]

In all seriousness, though, we are all too aware the cost pressures for care homes and domiciliary care providers are accelerating. I think, going forward, all partners: local authorities, Welsh Government and health boards need to develop new models of public sector-led provision, but we also need to use business support, capital availability and workforce planning to work with the small and medium-sized businesses that provide care. My own authority of Flintshire has led the way on this by funding a project manager to work with homecare and care home providers to make their businesses more sustainable in the medium term, but this also should be a key issue for health boards to address the manner in which they can support care providers.

Whilst in my own experience there’s a lot more help for unpaid carers through the local authority and voluntary sector working together, we also need to build on this work to develop innovative and sustainable solutions to plug the gap that sometimes remains between acute hospitals, community hospitals and other means of respite and homecare. Through the care given to my nan, who is now in her ninetieth year—she probably won’t thank me for telling the Assembly how old she is—I have actually seen at first hand, at the moment and in the previous 18 months, the role that community hospitals play in providing step-up and step-down care. It’s not simply about relieving the pressure on acute hospitals, but it also means that the often elderly patients receive the care they need closer to home and in a less stressful environment.

And on the topic of community hospitals, I must pay tribute to the tenacity and the commitment of the Flint hospital campaign group, a group I committed to work with the representatives of, both prior to the election and since I’ve been elected as Assembly Member for Delyn, to seek a solution that best serves the community today and is sustainable into the future.

I’m grateful for this opportunity to contribute in such an important debate today, and, as my colleague Suzy Davies said, there’ll be further opportunities. I really do think it’s surely one of the most pressing and crucial issues of our time. Diolch.

I’d like to focus my contribution to this debate on the role of young carers and the part that they play in keeping our health and social care system afloat and the support, or—very often, or too often, I would say—lack of support in terms of what’s there to help them. There are estimated to be over 11,000 carers who are children or young adults in Wales, although it’s likely to be an underestimate, clearly, as many of them wouldn’t be known to us. Many, of course, wouldn’t identify themselves as having caring responsibilities. Having those kinds of responsibilities puts a child at a disadvantage in terms of their educational opportunities. Young carers often miss out on opportunities that other children have to learn and to play.

Young carers, I’m told, are losing an average of 48 school days, either missed or cut short because of their caring role each year. The figures also suggest that around 68 per cent of young carers are bullied at school, and only half of young carers have a particular person in school who recognises that they are a carer and helps them. So, it’s perhaps not surprising that one in five carers will become NEETs when they leave school—one in five. Quite why caring isn’t considered employment, albeit unpaid employment—perhaps that’s maybe part of the problem here.

So, it’s a huge sacrifice. It’s a huge sacrifice that these children are making. Remember that, if they didn’t care, it’s the NHS and social care that would be picking up the pieces and picking up the tab. But the support we’re offering these children, I have to say, is nothing short of a disgrace. I’ve already highlighted that half of carers are not having a particular person at school who can help and support a carer. Clearly, there needs to be far greater support and working between local authorities and schools to put that support in place. But we’re starting from a low base here, of course. The information provided to young people just isn’t good enough. According to Carers Wales, the website of one local authority appears to exclude the carers of anyone under the age of 18 from accessing a carers needs assessment. At the very least that needs to be updated.

It isn’t just young people, of course, with caring responsibilities who are picking up the tab for our generation’s failure to protect them. There are also parents with caring responsibilities for children who had their support cut by social security changes. We’re all familiar with the bedroom tax, of course, and recently the particular case in west Wales is an example of this. But there are also 4,000 families with disabled children who have been affected by the decision to cut the Family Fund which, of course, has been described as providing a lifeline.

There are also parents who have children on the autistic spectrum who have persistently highlighted the lack of support and the fight that is required to get the support that they need. So, there’s clearly a great deal of improvement that’s needed in our social care and our education system if we’re to really support those who are giving so much in exchange for so little.

Carers Trust Wales, which called for the introduction of a young carers in school programme in Wales—one that can be a full integral part of the new curriculum. There are changes afoot in the curriculum, and clearly an opportunity there to address some of these areas. The programme would provide a step-by-step guide to identifying, engaging and supporting young carers. It would equip schools with effective practice and accredit the work schools do to support young carers. The programme would be based on the Young Carers in Schools programme in England, developed and run jointly by the Carers Trust and the Children’s Society there. The programme has been in place in England for well over a year now, and initial evaluations have shown the programme to be highly effective. For example, of the schools that participated, 94 per cent said they had identified more young carers in their school, 91 per cent had seen a positive impact on the achievement of young carers in their school, and nearly three quarters had noticed improved attendance among those young carers as well. So, there’s much that we can learn and look to replicate in Wales in that respect.

The Scottish Government as well has funded a third sector short breaks fund since 2010, with a focus on respitality—a combination of respite and hospitality. This can bring, of course, a number of benefits—clearly benefits for those providing care and respite for them, but also providing breaks during the off-season is cheaper, so it provides greater value for money, but also the additional income is provided there as well for tourist businesses at a quieter time of year. Now, I know that the Labour manifesto committed to investigating a national respite scheme. It didn’t appear in the programme for government, but I understand that plans are afoot, and it would be good to hear an update this afternoon.

For every £1 invested in support for carers, it brings a return on investment of £4, and £8 billion pounds is saved in Wales every year by the care carers provide. So, the statistics make their own case for investing in carers, and young carers particularly. I look forward to hearing what more the Government intends to do when they respond to this debate.

I’d like to echo the comments made by other Members on the debt of gratitude that we owe to unpaid carers. It’s crucial that we value and respect them, and I think Llyr has raised a really important point about young carers in particular.

Today I want to touch on the impact of the intermediate care fund. It’s a very good example where better integration between health and social care services exists in practice, preventing unnecessary hospital admissions and delays in discharges. One example of this success is in my constituency. The Welsh Government has invested £0.5 million in capital funds and £390,000 in revenue funds to develop the intermediate care unit at Parklands residential home in Malpas. The collaborative work between the Welsh Government, Aneurin Bevan health board and Newport City Council has provided a place where patients who are well enough to leave hospital, but are not yet able to return home, can access the care and support they need at that time.

Between 1 April and 31 December 2016, 55 people were admitted to Parklands, with an average stay of four weeks. Of those who were admitted only six people returned to hospital, with 47 being able to return to their own home. The experiences of two of my constituents demonstrate the difference this facility has made to these individuals and their families. One constituent was admitted following a stroke. He had reduced mobility and speech and had lost a lot of weight. He received support from the neurological community rehabilitation team at Parklands, which consisted of an occupational therapist, physiotherapist, a dietician and a speech and language therapist. During his stay of approximately six weeks, he gained weight and his mobility and speech improved, meaning that he was able to return home to live with his wife.

Another former resident of Parklands was referred following multiple hospital stays, due to a general deterioration in her health, and she had an inability to cope at home. She felt she needed to go into residential care but had the opportunity to stay at Parklands first. She stayed at Parklands for approximately 10 weeks, but early in her stay she had built up her confidence enough to want to return home. With the help of staff, she regained her mobility, and following a meeting with her family, she realised she could live independently. A stairlift was fitted to enable her to access the whole of her property and she returned home with a care package. She has not been readmitted to hospital since.

There are many more examples that I could quote, all of which demonstrate Parklands was able to personalise the care needs to the individual. This type of step-up, step-down care is making a real difference to people and their families, as both myself and the Minister have seen for ourselves. The intermediate care fund is able to improve the quality of life for many in need of social care and alleviate the pressure put on hospital beds. With an ageing population, more accommodation like Parklands is crucial to ensure people remain in their home for as long as possible.

It is now 11 years since I launched CHANT Cymru at the request of campaigners across Wales, fighting for local beds at community hospitals. Campaigners against the closure of Chatsworth House Community Hospital in Prestatyn had asked me to form CHANT Cymru—Community Hospitals Acting Nationally Together—to bring together local groups from across Wales campaigning to save their local community hospitals, threatened by the then Labour Welsh Government’s closure programme.

Widespread opposition to closure had already generated popular public protests across the whole of Wales, and CHANT Cymru was the campaigners’ national voice in the fight to save their community hospitals. We promoted at national level the role of community hospitals in providing quality healthcare, supported local campaigns and held the Welsh Government to account over its promise to meet the health needs of its patients and to provide accessible local healthcare. I led a debate on this here, we held a rally on the Senedd steps, attended by coachloads from across Wales, and we successfully ensured that this was a key issue in the 2007 Assembly election.

The new coalition Welsh Government announced a u-turn. In March 2010, the Labour health Minister said,

‘I am not aware of any threats to community hospitals across Wales’.

However, when Labour returned to single-party power in Cardiff in 2011, they again pushed ahead with their community hospital closure programme. North Wales community health council wrote to the then health Minister expressing concerns about the robustness of the information provided by Betsi Cadwaladr university health board, which they used to inform their decisions to close community hospitals in Flint, Llangollen, Blaenau Ffestiniog and Prestatyn. Dozens of community beds were lost, despite bed occupancy levels at 95 per cent and above. The GP who set up the north Wales pilot, the enhanced care at home scheme, with the health board, said that

‘This will bring a service that is currently frequently gridlocked, further to its knees’, and that

‘a central part of the proposed shake-up of health services—providing more care in people’s homes—won’t fill the gap left by shutting community hospitals.’

This Welsh Labour Government ignored the Flint referendum, in which 99.3 per cent voted in favour of returning in-patient beds to Flint, and then ignored the Blaenau Ffestiniog referendum where an overwhelming majority voted in favour of returning beds there.

When I visited Holywell hospital, staff there told me that extra investment in our local community hospitals, such as Holywell, and NHS community beds in Flint would take pressure off our general hospitals, help tackle the A&E crisis and enable the health board to use its resources more efficiently. As the head of the NHS in England said, smaller community hospitals should play a bigger role, particularly in the care of older patients.

At last June’s Royal College of General Practitioners Wales’s Assembly event, ‘Strengthening General Practice to Support the NHS’, we heard that general practice in Wales provides 90 per cent of NHS consultations, 27.8 per cent of the budget, and that prolonged underinvestment means that funding for general practice has been decreasing compared to the overall Welsh NHS.

‘Yet we face the significant challenges of an ageing and growing population. Consultations are becoming longer and more complicated as we deal with an increasing number of patients with multiple chronic conditions.’

We also heard from them that NHS community beds add to the breadth of things GPs can do, including respite and step-down care, assisting both primary and secondary sectors. If it really means what it says about co-production in health and social care, the Welsh Government must start listening to these professionals and designing and delivering local services with clinicians and local communities.

The Well North Wales programme identifies a requirement to tackle issues around deprivation and poverty at a local, community level via co-production. As the Chief Medical Officer for Wales said in his annual report 2015-16,

‘Social prescribing can improve self-esteem, mood, social contact and transferrable skills—and decrease demand for Health services.’

The Co-production Network for Wales, All in this Together, have highlighted, for example, the Green Dreams: Creating Health through Community social prescribing initiative, established by a GP in England. As Wales’s chief medical officer states,

‘Co-production with communities is a potentially powerful way in which public sector staff can respond to the social gradient of health need.’

‘The optimal arrangement of primary and community care services may be best understood through co-production.’

‘Understanding community assets and co-productive working seems vital for GP practices, primary care resource centres and primary care clusters.’

And, may I add, vital for community hospitals and community beds also?

Can I thank Plaid Cymru for bringing forward this very important debate? I think most of the points that I wanted to cover have now been dealt with. So, I’m going to confine my contribution to this particular debate to the part of the motion that deals specifically with community hospitals and, in particular, the importance of developing the integration agenda.

I guess, like me, everybody places great value on our local community hospitals, but unfortunately, I think the wording of the motion implies that keeping every existing community hospital open is the answer to delivering community-based health services and social care. It’s quite possible that some existing community hospitals could provide the base for some community-based schemes, not just providing a range of healthcare services, such as GP practices, dental services, opticians and pharmacies, but being the base for social care provision. But, a blanket policy of keeping open every community hospital could, in some instances, actually be a barrier to initiatives for the better integration of health and care services.

There are great examples already out there, and Sian Gwenllian mentioned some in her constituency, of one-stop centres for health and social care provision. In my constituency I have two great examples, one of which is the Keir Hardie Health Park in Merthyr, and the other is the integrated health and social care centre in Rhymney. I believe that that should be the general direction of travel, in terms of community provision.

From the contributions we’ve heard from Mark Isherwood and from Hannah Blythyn, I know how emotive proposals to close community hospitals can be, but that shouldn’t deflect us from the need to take forward the process of social care and health integration, and it shouldn’t deflect us in the short term, just for political expediency, to unjustifiably keep open unsustainable community hospitals, if doing so prevents the development of local, sustainable integrated health and care services.

Would you give way? Would you agree, recognising—[Inaudible.]—out of date, buildings need to be replaced, that shouldn’t have been done without transition and without replacement beds?

I totally understand and agree with that. When moving services or closing hospital services, there need to be services in place before other services are closed. I think the point I’m trying to make is that we shouldn’t use the closure of community hospitals, and oppose the closure of community hospitals, just because the community wants to oppose that, because I think everybody wants to keep what they have. I think sometimes we have to look at the bigger picture, and that’s really the point that I was making.

So, I will be supporting the amendment from the Welsh Government that recognises the role that community hospitals may have in a wider capacity, but crucially recognises the significance of the £60 million integrated care fund and the £40 million fund to develop integrated health and social care centres, at the heart of which may or may not be community hospitals.

Thank you very much. I call the Minister for Social Services and Public Health, Rebecca Evans.

Thank you, Deputy Presiding Officer. In the few minutes I have to respond to the debate today, it would be impossible for me to put in the window everything I’ve got in the shop, to use Hannah’s phrase, because it has been such a wide-ranging debate and we are doing so much in this field.

But, I’ll start by saying that the Welsh Government has prioritised social care as a sector of national strategic importance. This isn’t a new approach, of course—our Social Services and Well-being (Wales) Act 2014 was developed in response to the Welsh Government’s 2011 White Paper, ‘Sustainable Social Services for Wales: A Framework for Action’. The Act is based on the fundamental principle that whilst demand is rising across social services, and the financial outlook for all public services is difficult, we do need to do more than just pursue the obvious efficiency savings. The Act gives us a new legal framework for the way in which we provide care and support services.

In Wales, we continue to invest in social care to ensure the delivery of high-quality care and support. The 2017-18 budget includes an additional £25 million for social services, and this extra support has been welcomed by local government and will help respond to pressures. I’ve also announced a further £10 million of recurrent funding to help to manage the impact of the national living wage.

Standards can best be raised when partners work together. In order to increase resilience in health and social care, we need to take a whole-system approach to planning and service delivery. The intermediate care fund has been developed to develop new and innovative models of integrated working between health, social services, housing and the third and independent sectors. Sixty million pounds have been set aside this year, and ‘Taking Wales Forward’ includes a commitment to retain this important fund. The ICF supports initiatives that prevent unnecessary hospital admission, inappropriate admission to residential care and delayed discharges from hospital. These initiatives have created capacity in the care system and have improved consistency in the provision of services within regions.

The Social Services and Well-being (Wales) Act provides for the establishment of seven regional partnership boards on a health board area footprint. These boards bring together health, social services, the third sector and other partners to take forward the effective delivery of integrated services in Wales. Their purpose is to improve the outcomes and the well-being of people, and improve the efficiency and the effectiveness of service delivery. ‘Taking Wales Forward’ also includes a commitment to invest in a new generation of integrated health and social care centres. Forty million pounds has been announced to support this, and organisations are in the process of prioritising plans as part of their estates and service-planning work.

So, whilst we can support point 1 of the motion today, we can’t support points 2, 3 and 4, for a number of reasons. There are approximately 384,000 carers in Wales providing dedicated support to their loved ones, and we’ve heard how, in practical terms, this care equates to more than £8 billion a year. But it’s simply not true to say their contribution is unappreciated. The Welsh Government recognises that we owe our carers a great debt of gratitude, and that’s why we’ve long sought to improve the lives of carers. In 2000, we published our ‘Carers Strategy for Wales’, which provided a framework for delivering services and support for carers. In 2010, the Carers Strategies (Wales) Measure was introduced, further improving support for carers locally, and the groundbreaking Social Services and Well-being (Wales) Act enabled us to build on our progress and strengthen our commitment to carers. The Act recognises explicitly the key role played by carers and will give them rights to assessment and support that are equal to those of the people they care for. And I’m very familiar with the survey to which Rhun ap Iorwerth referred, having already discussed it myself with our carers’ forum, and as a result, I’ve written to all local authorities in Wales on the issues that you described, and I’ve also asked my officials to look further in-depth at the findings and, of course, there will be this three-stage monitoring process for the implementation of the Act.

I also announced the intention to refresh our current carers strategy in my written statement, which was published on Carers Rights Day. The strategy will be developed in partnership with carer networks, organisations and carers themselves, building joint ownership and capturing the issues that really matter, and I give Members reassurance that young carers are a particular focus of this piece of work. The work will include examining a national approach to respite care, because carers tell us that this is a major priority for them, and discussions have already begun with third sector organisations on what the detail of this might be. And I can reassure you also that some of that work includes discussions with the Carers Trust, relating to the approach that has been described in Scotland.

In the meantime, we expect health boards and local authorities to work together to plan and deliver care and support as locally as possible. This includes respite care to support carers in their vital role. Respite care should be flexible and be able to take place in a wide range of settings, including at home and in the wider community. I’m aware that the closure of community hospitals continues to receive much attention, but I would correct Mark Isherwood: there is no Welsh Government community hospital closure programme. It’s for local health boards, working in partnership with their local communities, to determine the care that’s necessary for local needs.

I was referring to 2006, when there most clearly was. That’s why we generated a campaign, with hundreds and hundreds of mayors and residents on the steps outside. And paradoxically, and oddly, in 2011, the closure programme announced by health boards matched exactly the Labour Welsh Government closure campaign from five years previously.

Well, Deputy Presiding Officer, it’s 2017 now, and depending on local needs and circumstances, community hospitals can play an important role in delivering a range of facilities and services, including respite. However, quality care is about more than just buildings and bed numbers. A number of very old and outdated community hospitals have closed in recent years, and I do recognise that these hospitals were much loved and much cherished by their local communities, but they were no longer able to provide care that’s appropriate to meet today’s modern standards. These hospitals are being replaced with new primary care resource centres, funded by Welsh Government, and are providing an increased range of services in a modern setting, resulting in people receiving more of the care and support they need close to home. There’s often criticism that these new centres do not have in-patient beds, but it’s often far more appropriate for people to receive care through enhanced services at home. In cases where an in-patient bed is deemed to be clinically required, these are being provided through nearby modern hospitals, so the emphasis has to be on the quality of the service and meeting people’s needs, rather than where that care is physically delivered.

A pipeline of primary and community care investment is being delivered as part of health boards’ estate priorities, and this is linked to the work that we want to see done to increase the scale and pace of service shift into primary and community care settings. Some early opportunities for investment have already been identified in the NHS-owned estate as the longer-term investment programme is developed. We have approved nearly £5 million of capital funding for a number of priority schemes, and opportunities for further capital investment in 2017-18 and beyond are being discussed with health board teams as service planning work develops, and in line with their integrated medium-term plans.

We are now seeing the benefits of this approach. We saw a further fall in our delayed transfer of care figures for December, and I expect my confidence to be rewarded by a further reduction when the January figures are published shortly. I want to reassure Rhun ap Iorwerth that we’re not complacent, though, and it might be interesting for Members to know that the major cause of delayed transfers of care is actually patient choice, rather than a lack of numbers of beds. So, the situation is perhaps more complicated than it first seems.

Turning to the second amendment, tabled in the name of Paul Davies, we agree that allied healthcare professionals play a vital role in reducing avoidable demand for social care by actively working in the community and primary care. Through multi-professional teams, they’re delivering preventative care and admission avoidance, reshaping the way patients are supported to live their lives and better manage their conditions. So, we support this amendment.

And, interestingly, having considered the comments raised by Rhun ap Iorwerth on the issue of aids and adaptations with me in questions last week, I did discuss this with front-line professionals, who told me that there isn’t a major backlog in terms of aids and adaptations, and decreasing numbers may well actually be the result of the success of our Welsh Government housing standards, which are making homes more appropriate for people to live in in later ages, and also our focus on prevention is working. So, whilst it’s really good to be interested in outputs, it’s even better to be interested in outcomes.

I’m glad that Sian Gwenllian is looking into the case that she described, and, if she’d like to write to me, I’d be more than happy to also look into that case. Obviously, Members will realise that intermediate care fund money is actually being used in the field of aids and adaptations as well.

So, there’s no doubt that our health and social care services are facing challenges, but we are meeting these challenges head on, and have already increased resilience by taking a whole-system approach to planning and service delivery. We’ll continue to work with our partners and support them in working together to deliver integration and collaboration.

Thank you. I call Rhun ap Iorwerth to reply to the debate. Rhun.

Thank you very much, Deputy Presiding Officer, and thank you to everyone who’s participated in this debate. I have just a few minutes left. May I first of all thank Sian Gwenllian for highlighting how appreciative we should be of professional care workers across Wales, a point that’s been echoed by a number of Members? It is extremely important that those professionals are given the recognition that they need and deserve—many of them, of course working on very low wages. And then the point was made very strongly by many people, including Jenny Rathbone, Jayne Bryant and Llyr Gruffydd, on the immeasurable contribution made by voluntary carers. The Minister said that the Government does recognise the work that they do. On an individual level, of course, every one of us would be grateful to an individual for caring for a member of their own family or a friend, but as a sector we must do more to show our appreciation and recognition that the work that they do is carried out free of charge and supports other professional services.

Hannah Blythyn, thank you for summarising how important community hospitals are, and, yes, it’s beds that are important. In response to Dawn Bowden’s comments, we didn’t want to give the impression that bricks and mortar are the important thing here, but there has been a reduction in the number of community beds available, and we must somehow recognise that there is an important role for those community beds in the care pathway. I very much hope we can reach a point where we can achieve consensus on the need, after years of losing these beds—because that’s what happened, there are 7 per cent fewer beds in the NHS in Wales than there were a few years ago—to turn that tide and provide more beds in terms of providing choice, a broader range of options, in providing social care.

Suzy Davies started the debate by talking about integration. It’s not whether we want to see integration that’s the question, I think, but rather what model of integration we are seeking, because we must think about this as a unitary service—it must work in that way—because, on their pathway through the health and care service, a patient shouldn’t feel at any point that there is any barrier in the care provided. Once again, I hope we can agree on that. What we need to do, of course, is to find a way of implementing and delivering that the length and breadth of Wales.

I am grateful to the Minister for her comments—yes, I am more interested in outputs. The Minister listed a number of budgetary elements, financial contributions to various strategies, and, of course, I do recognise that funding, and some of that has emerged from negotiations that have taken place between the parties here. But the stresses on social services are clear—I hear about it in my own postbag and in my inbox. And whilst the evidence demonstrates that that strain is there—and the statistics also demonstrate that in terms of the recent increase in delayed transfers of care—we will continue to hold the Government to account and to insist that there is a move to strengthen this crucial sector.

To conclude, Dai Lloyd said that we needed to celebrate the fact that we are in a situation where there has been an increase in demand, because we are living longer. But the demographic change, which we do welcome, does bring responsibilities with it. That’s what we’re discussing today: how to face up to those responsibilities and to build a system that can cope with the needs of today and is prepared for tomorrow.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection]. Okay, we’ll move to voting time, then.

Voting deferred until voting time.