As the Chair's foreword to this report states,

'Much of the evidence referred to the Social Services and Well-being (Wales) Act 2014 and whilst witnesses were generally supportive of the Act, there was some concern over the application of eligibility criteria, the undertaking of carers’ assessments and the variation in fees across local authorities. What was also clear was the unexpected costs associated with the Act'.

In its response, the Welsh Government states that its

'programme for transforming health and social care is set out in detail in A Healthier Wales' and that it commenced a three-year

'evaluation of the Social Services and Well-being (Wales) Act, to explore the implementation of the Act and the impact on those who receive care and support, including unpaid carers,' in November 2018.

When I accepted an invitation to work with the last Welsh Government to incorporate proposals within my withdrawn Community Care (Direct Payments) Wales Bill, the subsequent Social Services and Well-being (Wales) Act 2014 code of practice put in place a system where people are full partners in the design and operation of care and support, giving people clear and unambiguous rights and responsibilities. It states that assessing the needs of individuals should be based on the principles of co-production, ensuring that it involves a relationship where practitioners and individuals share the power to plan and deliver support together, and recognising that all partners have vital contributions to make in helping to meet identified personal outcomes. And the ways of working that the public bodies listed in the Well-being of Future Generations (Wales) Act 2015 must demonstrate also include working with others, including third sector bodies and communities, to help achieve goals that have been decided together.

However, a series of reports have indicated that the legislation is not being implemented as envisaged, that the better lives and reduced costs intended are not being delivered, and that urgent intervention is required accordingly. Last winter’s Age Alliance Wales newsletter stated that

'Third sector representatives on Regional Partnership Boards have reported feeling excluded, or at least not fully engaged', and that the third sector has been seen as a bit-part player, with little or no strategic involvement in the integrated care fund and little input into programme planning. Despite their subsequent engagement with the then Minister regarding this, I'm reliably informed that this continues.

Last March’s evaluation of the integrated autism service commissioned by the Welsh Government found that although

'the focus upon co-production and prevention is expected to help improve effectiveness and reduce demand' and

'success requires a co-productive approach involving staff, service users and carers in the design, implementation and evaluation of the service', there are concerns that the top-down approach has stifled this. Only last Friday I attended a meeting with Flintshire council and members of the local autism community to discuss the north Wales integrated autism service hosted by the council, the needs of autistic service users and working together better going forward.

Last November's analysis by mental health charity Hafal of the Welsh Government’s 'A Healthier Wales' plan stated that it

'fails a test of indicating how things might actually change for individual consumers as opposed to providers', that

'it's an example of policy made by providers for providers' and that whilst the provider viewpoint should be respected,

'it is just one perspective and should be wholly subsidiary to that of consumers'.

The results of the survey conducted by the Wales Neurological Alliance on behalf of the cross-party group on neurological conditions, 'The Social Services and Wellbeing Wales Act—experiences of people living with a neurological condition', published last month, found that although the Act has been in force for two years, people living with neurological conditions are not being asked what matters to them, are not being made aware of their rights to an assessment, are not getting information about support and advice services, and are having to pay out of their own pocket for support.

Shockingly, the survey even found that guidance with this Act has been used to prohibit the direct payments that have successfully provided quality person-centred care previously. And only last week, hospices providing key front-line services told me that although health boards are expected to submit their three-year palliative care plans to the Welsh Government by the end of January, their health board has not engaged with them at all.

This is the harsh reality, and it demands urgent action to address the unnecessarily damaged lives and wasted resources resulting from this.