6. 6. Statement: Integration and Partnership Working in Health and Social Care

Part of the debate – in the Senedd at 5:23 pm on 10 October 2017.

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Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 5:23, 10 October 2017

(Translated)

There are two main elements to the statement and I thank the Minister for that statement. The first of those elements is that there’s been some praise of some elements of the integrated care fund—previously the intermediate care fund. I will take this opportunity, if I may, to remind the Chamber that that fund was part of a budgetary agreement with Plaid Cymru, and we’re pleased that we brought that idea to the table because of the way in which we have seen it being developed. The main element of the statement is this broader context of pooling budgets and working in partnership, and I have a number of questions arising from that. The statement suggests that local authorities and health boards somehow aren’t fully committed to these regional boards:

Nid oes modd i’r canlyniadau hynny......gael eu cyflawni drwy ddim llai nag ymrwymiad llwyr i gydweithio.

What do you think is the main barrier to getting that kind of full commitment to the success of the boards? You remind us that, after consultation, there was a deferral in the need for pooled budgets to care homes until 2018. I agree with you, or with the suggestion, that this provides sufficient time, but, in reading between the lines, it appears that some partners are finding this difficult, still. And in that context, do you, as Minister, regret extending that deadline on the basis that it appears that, whatever the deadline is, certain partners will have difficulty in committing to it?

Do you also acknowledge that the separation of health and social care, and the lack of statutory responsibilities, mean that there is always a risk that what partnership working would mean would be managers meeting to argue what their contribution to the pooled budget should be and to ensure that it was as small as possible, and that the limitations of partnership working without statutory obligations are quite clearly displayed? And I may ask, too, for your comments on the alternative option, namely providing a specific budget to the regional boards, rather than the local authorities and the health boards separately.

The next question is that the Welsh Government has been against introducing structural changes to merge health and social care, arguing that such changes would be expensive and disruptive too. So, why, then, are you planning to change health in Bridgend from Abertawe Bro Morgannwg to Cwm Taf and not even taking that opportunity to create a more integrated body, where resources would be targeted at front-line services, when you have taken that decision to make a structural change?

Next I will remind you of a few Plaid Cymru amendments that were rejected by the Government when the social services Act was discussed. One of those was to allow local authorities to directly employ registered nurses, thereby providing opportunities for them to develop stronger social care. Do you regret not agreeing to those amendments? Also, referring back to what I said earlier, our amendment 2 in order to strengthen the real duty that should be placed on health boards and local authorities to collaborate on merged or pooled budgets; that is, we were saying that they should, rather than ‘they should consider’ or ‘they should be able to’.

And finally, today we hear local authorities the length and breadth of Wales responding with some understandable concern in terms of the announcement on their draft budget, that they are facing years of cuts—more cuts. Do you, as Minister, believe that it is possible for social services to maintain the level of service that they currently provide, never mind strengthening and improving those services, within the context of a shrinking budget for local authorities, whilst simultaneously there is an increase in demand for their services? Shouldn’t we, if truth be told, be thinking in earnest about a single budget for health and social care? Because I would argue very strongly that it is misleading to highlight an increase of £200 million in healthcare if social care, which has such a knock-on impact on the NHS, is to see reductions or is at risk of seeing reductions in future years.