Questions now from the party spokespeople. Conservative spokesperson, Janet Finch-Saunders.

Diolch, Llywydd. Care Forum Wales, and I do hope the Minister is fully aware of this, has undertaken a major survey into care homes across Wales. The results are startling. What has been revealed is that 16 per cent of care homes across Wales expect to close in the next five years. This is alarming, as is the fact that Care Forum Wales has estimated that more than 1,500 beds could be lost in Wales between now and 2024. To put this into context, the number of care homes for older adults has fallen by 4 per cent and the number of beds is already down 247 from 2014-15. Clearly, care home numbers have been and continue to decline. What action are you taking to reverse this and actually enable an increase in the number of appropriate care home beds?

This is a matter of concern to the Government. We are concerned about the fact that the care system is stressed and we are trying to do what we can to rebalance the care sector. One of the things we're doing is to try and encourage different models of care. So, for example, we are encouraging local authorities to consider taking more care homes in-house. We also are looking to see if we can develop co-operative models. So, we are looking at the care home system in a wider way. We're also trying to encourage the status of those working in care homes. For example, we've had a big campaign to try to attract more workers into the care section, stressing the importance of qualifications, and how to develop. And also we've improved the registration system. And we think that all those issues are going to make the care system more viable.

Thank you, Deputy Minister. A central issue that needs addressing, however, is care home funding. This is supported by Mario Kreft, who works very hard in this sector, chair of Care Forum Wales, who has commented publicly—this is what he says:

'We know that we’ve got over 80 per cent of the social care providers saying how difficult it is to attract and retain staff and the only way that be addressed is through increasing fees to realistic levels so money can be invested in the front line instead of the back office.'

The message is clear, Deputy Minister: care homes are underfunded by local authorities, and by your Welsh Government, and our health boards, to such an extent that staff—[Interruption.]—can you allow the Deputy Minister to respond to me, please—to such an extent that staff cannot be retained or paid appropriately. This is unsustainable. So, will you commit to reviewing the funding formulas used to determine fees for publicly funded individuals?

What we already have done is we have increased money to cover the living wage, so that that will help care homes in bringing up the payments to their staff to the living wage. And we're also doing some of those things that I mentioned in my earlier question—we're doing all we can to improve the status of care home workers, because I think that is one of the crucial things to do. Because looking after elderly people and children surely must be one of the most important jobs there is, and yet the status of those staff is not very high. And we do know that the wages are something that we are addressing, we've been addressing the zero-hours contracts, and we've been looking at the time that people take to travel for domiciliary care. So, I think that we are addressing these issues, but I don't deny that it is an issue, and it is a problem that we are addressing.

Thank you. Deputy Minister, you'll be aware that care homes do apply to local authorities to authorise deprivation of liberty safeguards applications. Now, according to the annual monitoring report for health and social care 2017-18, managing bodies such as care homes have been waiting an inordinate amount of time for authorisation of applications. Now, despite Welsh Government guidance stating that standard applications should have been received, and a decision made within the 28 days before it is required, the average number of days in Wales between an application being received and a decision being made by local authorities reached over 200 days in Rhondda and Flintshire, and over 300 days in Ynys Môn. Clearly, social services across Wales are struggling to process applications. What action are you, or, indeed your Government, taking to help them, so that care homes receive these very important decisions sooner?

I thank Janet Finch-Saunders for raising that important issue. This is something that I will have to go back and have to look at, to look at the details, and come back to her with an answer.

The Plaid Cymru spokesperson, Dai Lloyd.

Diolch yn fawr, Llywydd. Does the health Minister accept that the finance of the NHS and the finance of social care are interchangeable, and getting the best value for money and best outcome for patients requires investment and sensible planning of how to use that investment in both services?

Yes, we're taking an integrated approach to the future of health and social care. That's why we have, for the first time across the United Kingdom, a properly joined-up health and social care plan, 'A Healthier Wales', designed together between health, local government and the third sector. And you'll see that, in the last budget, I took a decision to put part of the moneys through the health budget, and to put it back into social care. Much of the work we're doing on delivering 'A Healthier Wales' actually looks at how we fund health and social care to work more closely together. The transformation fund and proposals that I've approved are good examples of this in practice. 

Thank you for that response, even though it is actually contrary to your Government's decision to increase the NHS budget at the expense of local authority budgets. But I'm sure the Minister would agree with me that one of the non-negotiable hallmarks of the NHS is that it is free at the point of delivery, and, of course, that means free prescriptions, free surgery, free x-rays and so on. Now, we would all be outraged if we heard that somebody, upon receiving a cancer diagnosis, was faced with a bill of hundreds of thousands of pounds and they had to sell their home to pay for their cancer treatment. We would also react to a proposal to allow them to keep £50,000 instead of £30,000 in these circumstances with sarcasm about the generosity. So, why is there still discrimination against people with dementia?

Because we still have a system where social care, as you know, has a means element within it. And we're actually looking at the future funding of social care, as you know as well. I'm the chair of a cross-ministerial group looking at social care funding options for now and the future, and you'll know from previous, very public comments that I'm interested in how we use the new powers of this place, as available to us, to have a new funding stream for social care purposes. And you can't get away there from your first point, which was about the budget allocations. You know, as I do, that we are on the back of the tenth year of austerity. It means there is no consequence-free choice. If we chose to put more money—significantly more money—into the local government settlement, then that would mean less money going into the health service. There's no way of avoiding that. That's why I think, for the future, we need to not hold back in our campaign against austerity, but also to think about how we use our new powers to have a new funding stream for social care in particular. 

The funding of social care, and the predicament faced by the recipients of social care, is a significant historic injustice caused by the failure to create a national care service funded by general taxation. Would you therefore not agree that the Welsh Government proposal to introduce a social care levy, without any guarantees that this would lead to the eradication of social care charges, is unfair, and a missed opportunity to put health and social care on an equal financial footing?

There are two points that I'd make on this one. The first is that, of course, when we're comparing opportunities to use general taxation, we're not yet in a position to do so. But I do recently note a study picked up by the BBC that noted that, in Wales, citizens have a much more generous level of support from this Government for their social care needs than citizens across the border in England. So, we are making real choices even in a time of austerity to put real money into supporting social care. 

The second point is I don't want to spike the work that I'm actually doing by peremptorily announcing before my ministerial colleagues have considered all the evidence what those options might look like. And we do need to think about maximising the level of income to come in through a levy or any other means, and what that actually means in terms of what we can then do. We need to think about what our powers allow us to do, and how then best to use them, including difficult questions around intergenerational fairness, who accesses support and at what time? There are different answers around the roles. There's a report from both the select committees in Parliament, the joint select committees—the communities committee about housing and local government and also the health select committee—that I'm sure you're aware of, which may come up with an answer that would require a rise in general taxation across the United Kingdom. They've even had Conservative backbenchers signing up to a tax rise, which is unusual. So, we need to think about what the whole taxation base is and what choices we then make. 

And the second question we can't avoid either, I think, is whether or not we're prepared to have an element of ring-fencing or hypothecation, because I think there are real issues about whether politicians should be trusted to raise taxes, or whether that money should be protected, and whether that would be acceptable to the public over a longer period of time to make different choices about how we use taxation to fund the future of social care.