The next item is a statement by the Minister for Health and Social Services on the launch of the new health and social care regional integration fund. I call on the Minister to make the statement, once she has removed her mask. Eluned Morgan.

Thank you, Llywydd. It's great to be back in the Senedd and to see everyone face to face again for the first time in a while. 

In August 2021, I approved a new five-year regional integration fund to support the continued development of integrated health and social care services in Wales. Today, I am pleased to be able to provide more detail on the fund and to officially launch the guidance that my officials have co-produced with regional partnership boards in order to prepare for the launch of the new fund on 1 April.

'A Healthier Wales' is our long-term plan for health and social care in Wales. It sets out a future vision of a whole-system approach to health and social care, which is focused on health and well-being, and, critically, on preventing illness. It recognises the regional partnership boards as key drivers of integration, empowering them to pool resources and expertise to deliver seamless, preventive models of care at a local, regional and national level.

During the COVID-19 pandemic and with support from the integrated care fund and transformation fund, regional partnership boards have developed new models of care that have proved invaluable, including rapid discharge from hospital to home and admission avoidance models. We know there's a problem already in terms of delayed transfer of care. Had we not had these models in place, the situation would have been a lot worse. Now, more than ever, joined up, integrated planning and delivery of services is crucial to help us as we continue with our COVID-19 response, that we build for recovery and we transform our health and care system.

I want to see Wales build on the good practice and partnership working that has developed across health, social care and the third sector over the past two years, and embed effective and preventative community solutions. The new regional integration fund will support this activity by further embedding existing national models of care, and by developing new ones for the identified priority population groups. The new fund will run from April 2022 to March 2027, and will develop national integrated models of care around six key thematic priorities. These are: community-based care, prevention and community co-ordination; secondly, place-based care, complex care closer to home; thirdly, promoting good emotional health and well-being; fourthly, supporting families to stay together safely and through providing therapeutic support for care-experienced children; fifthly, home from hospital; and sixthly, accommodation-based solutions.

I've listened to feedback from regional partners and to the findings from the independent evaluations into previous funds, which stated that short-term funding made transformation and integration difficult to achieve. In response, I have committed to an annual investment of £144 million for five years.

The five-year investment period from April 2022 will ensure that longer-term investment plans can be established and delivered against a framework of set outcomes. To truly demonstrate a partnership approach to integration, the Welsh Government and regional partnership boards have co-produced a tapered approach to investment, with partners expected to sustainably source match resources throughout the life cycle of the fund. That will lead to ongoing support at the end for the integrated national models of care.

I have been clear that this new fund is not a continuation of the previous funds. Regional partnership boards will need to demonstrate that the money is being used for integrated services that will help to develop the six stated national models of care. This will help us achieve the ambition set out in 'A Healthier Wales', namely for people to be able to access the right care and the right support in the right place at the right time, and for people to take control of their own health and well-being to prevent the escalation of needs.

The regional partnership boards bring together health, social services, housing, the third sector, citizens and carer representatives and other partners to take forward the effective delivery of integrated services here in Wales. Under the Social Services and Well-being (Wales) Act 2014, their purpose is to improve the outcomes and well-being of people with care and support needs, as well as their carers. The regional integration fund will support those people in Wales who would most benefit from integrated models of care. Priority population groups will include older people, including people with dementia, children and young people with complex needs, people with learning disabilities and neurodevelopmental conditions, including autism, unpaid carers and people with emotional and mental health well-being needs.

To ensure that the objectives of the new fund are being met, a clear framework of outcomes will be implemented, with key outcomes and measures. Communities of practice will be established that will play an essential role in sharing learning and supporting partners with the development of the national models of integrated care. Our response to the pandemic has shown what we can achieve by working together. With the launch of the regional integration fund, I am determined that we will build on these experiences as we deal with the ongoing challenges ahead of us. 

Thank you for your statement this afternoon, Minister; it's good to see you in person after several weeks of more Zoom meetings than you can count. Integrating care should be about the outcomes, so why are we integrating care if not to provide top-quality care to every citizen of Wales? Healthcare needs and social care needs are so intertwined, both on a patient level and an organisational level. Minister, how will this new fund and new models of delivering care ensure better, more timely care for patients? How will co-produced plans with regional partnership boards address the shortage in care provision?

One only has to look at the dropping-off points outside our accident and emergency departments across the country to see the impact the crisis in social care is having on our NHS. In health committee last week, as part of our inquiry into hospital discharge, we took evidence that highlighted and underlined the impact delays were having. The Royal College of Emergency Medicine pointed out that during the past year, excessive waits at A&E may have contributed to nearly 2,000 excess deaths; 1,946 Welsh patients died because they couldn't be treated in time. Minister, how soon will the people of Wales see improvement and an end to these totally preventable deaths?

I welcome the emphasis being placed upon prevention, but that will not help the tens of thousands of people waiting for treatment today. We currently have hundreds of patients who are medically fit for discharge but can't be released home or into a care facility, simply because they have no care package available. I was shocked to learn that for a number of patients the delays have been measured in years, not weeks. Minister, do you agree with me that it's a damning indictment of where we are when local authorities are putting out adverts calling for volunteers to provide homecare services?

Successive Governments have so undervalued the caring profession that it's little wonder we struggle to fill vacancies. Without carers, we can't provide care packages; without care packages, we can't discharge patients; and without discharge we can't admit new patients. So, Minister, do you believe that regional partnership boards will be able to eliminate delayed transfers of care, or DToCs? Will they be able to address the staffing crisis?

Forgive me if I do sound a bit sceptical, but regional partnership boards have hardly covered themselves in glory in recent times. The auditor general found issues with the integrated care fund and raised concerns that regional partnership boards were failing to share best practice. Do you believe that regional partnership boards have delivered value for money? Minister, what safeguards will be in place to ensure that this new fund fares better than previous funds? How will this expenditure be managed and monitored? I welcome the position on developing new models of care and providing care closer to home, so how will regional partnership boards bring care closer to home? Will they adopt a hospital-at-home approach as suggested by the Royal College of Physicians and supported by my party?

And finally, Minister, you state that the fund will support the identified priority population groups. What about others with complex needs? Would they not benefit from such a step change in care? Thank you very much.

The Deputy Presiding Officer (David Rees) took the Chair.

Thank you, Gareth, and it's lovely to see you in person as well. I think it's really important to make sure that the outcomes framework is something that we are very focused on. The whole point here is that we've got to see deliverables at the end of this process. What is absolutely clear is the interrelationship between health and care, as you've pointed out. That is something that we've been very aware of. That's why we brought in an opportunity for that closer integration back in 2014, with the social services and well-being Act, and of course, the whole approach of the well-being of future generations Act is all also about long-term prevention, integration. So, all of those things are in place, and it's good to see that the UK Government is at last catching up with that philosophy and approach and we're seeing at least an aspect of that being developed in the Bill that's going through Westminster at the moment.

What's clear is that we have come a very long way through what we've learnt through the integrated care fund plans and the transformation fund plans. We are very keen, though, to learn from some of the lessons that were made clear and that were highlighted, as you suggested, by the auditor general. We are taking on board all of the points that they've made: timeliness on guidance, which is why you're seeing that guidance being published today, an alignment of multiple short-term funds, so we've knocked off several different funding channels here and we've put it all into one package, minimising duplication, strengthening those governance arrangements, better scrutiny, agree key outcomes, shared learning; all of that is absolutely now embedded into the next phase of the regional integration fund.

You talk about the difficulties with hospital discharges; there's nobody more aware of the problem than I am. We're still in a situation where we have about a 1,000 people in our hospitals who are ready for discharge. It's about that interconnection between the hospitals and the need to get them out into communities, making sure people are talking to each other. The Deputy Minister and I have been meeting on a weekly basis with local authorities to make sure everybody is singing from the same hymn sheet, to make sure everybody understands what needs to be done here. I think it is probably worth underlining that fundamental to this is the need for respect for people who are giving that care within our communities, and that means actually paying them properly. That's why we, from April, will be bringing in the real living wage, a manifesto commitment that we will be delivering from April—I'm very proud to see that happening—and the beginning of that process, to give respect to those people who are doing such sterling work in our communities.

However bad and difficult it is in Wales, I can assure you that it's a damn sight more difficult in England. I think it's been fascinating to watch in recent days how there's been this u-turn when it comes to vaccinations and now saying that actually, people who work in the NHS who haven't been vaccinated don't have to stop their jobs. But it's too late; they've already kicked out a whole load of care workers, so if there was a problem before, it's an even greater problem now in England. Of course, we are in a position where we already have very high numbers of our care workers who've been vaccinated; we'd like more of them to be boosted, but it's really important that we just keep on that pressure.

We do, of course, have lots of examples of things like hospital at home already across all parts of Wales. The whole purpose of this is to take those best practices and see how we can embed them and roll them out across the whole of Wales. Those kinds of examples, we do have lots of those already in Wales, but this is about embedding what works well.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Deputy Llywydd. I also feel the need to say that it's nice to see the Minister face to face again after some weeks of working virtually.

Thank you for this statement today; I give a careful but general welcome to the principle. We're certainly agreed on the need to integrate as much as possible. Plaid Cymru for many years has supported putting funds in place in order to encourage collaboration between health and care. I think, although the Minister said that this isn't a continuation of the old funds, I do think that the intermediate care fund was something that emerged from a budgetary agreement between Plaid Cymru and the Government some eight years ago. That was an integrated care fund and this is following the same design; it's the latest incarnation. I'll return to the question as to whether this is entirely new or a continuation of what's gone before. But I certainly agree that, where there is innovation and where there is good practice, that should be passed from one area to another more effectively and should be able to be delivered in the longer term. I think there are too many problems with short-term funding, which means that good projects are cut just as they're getting established, and, in that regard, I welcome the fact that five-year funding is being put in place as a result of this announcement.

One question that was raised by the auditor's report in 2019 was this question of what exactly do we get out of this. Yes, the principle works, but what was said in a report some three years ago was that

'the overall impact of the fund'—

the integrated care fund at that time—

'in improving outcomes for service users remains unclear, with little evidence of successful projects yet being mainstreamed.'

So, what will be different this time in order to ensure that the outcomes for patients are better? Because we can agree all day long on principles, but, unless those principles become tangibles that make a difference to patients, then there's not much purpose to them. 

To turn to this question as to whether this is a continuation of something that's gone before or something new, the Minister said that it is new, but what about those things that have worked well under the current funds? How do we ensure that those can become part of this new integrated regional fund? Concerns have been raised, over the last weeks and months since this plan was first mooted, by the third sector and other groups who have posts partially funded by past funds. What happens to those? What assurance can you give that those things that have been making a difference and working well can continue for the future?

One final question from me. There is a risk under the projects that were funded under the funds to date that they encourage collaboration rather than real integration. And where collaboration works well, well, all well and good, but it's not integration. Calling this integration in and of itself won't secure integration. So, where does the Minister think that this fits in to the broader agenda that I am very eager to see progress very swiftly to truly integrate health and care services? Because surely that's what we're seeking, ultimately. I need to know how we will measure, under the plan outlined today, whether that integration is truly happening, or is it a step towards another project of real integration.

Thank you very much, Rhun. I think it's important that we don't throw everything out, everything that's happened previously, because there was good practice that was happening with the ICF and the transformation programme as well. So, it's important that we do take that and we take the innovation. But the trouble was, because people didn't see that there was any continuity, they didn't mainstream it, so that's why the way we do things this time is going to be slightly different. People will need to bring match funding to the table, and that means that they will have to put a lot more of their own funding into it. And do I hope that that, then, will genuinely work towards that integration that you mentioned, rather than just collaboration. And the idea, then, is that things are embedded. And the other thing is that there will be tapering, so they will start off with funding from this budget, but then the idea is that they will see the benefit and they will move funding from other pots to the things they know that work. So, do I hope—at least, that's the idea—that some of the measures that, as you said, were shown by the auditor general—. It's important that we do learn from what we have seen previously.

There are very good examples, I think, of where things have worked well. For example, in Cardiff, the discharge hub has done things like had a full-time occupational therapist to ensure that people can move out and that there is someone on call all the time. And social prescribing has been very successful in Cardiff, with 10 clusters working with social prescribing. In Cwm Taf, we have the  assisted technology programme, which is very interesting, because it allows older people to stay in their homes and there is a responsive system if anything goes wrong. And then in Gwent, we have a home first programme, and the idea is that we put that hospital discharge in place, and the same thing at the Grange Hospital—home first. These are all examples of where we have seen innovative things happening, they have been successful, but we now need to see that things move into the mainstream. In the north, you'll be aware of the ICAN community mental health hub, which has also been very successful. So, there are many good things that are happening, but you're right, what we need to do is to take the ICAN model and ask, 'Why can't we see this happening in other places across the country?'

I very much welcome the statement by the Minister on the social care regional integration fund. Integrated social care and health, with patients at the heart of provision, has got to be what we're all aiming for. I remember when Jane Hutt launched the first joint social services and health scheme over 20 years ago.

I've long called for focusing on preventing illness and hospitalisation. That's really got to be where we're moving towards, not waiting for people to be ill and then trying to make them better, or in some cases not, but trying to stop them needing to go in in the first place and stop them needing medication. I welcome that there is going to be a clear outcome framework; too often, money is spent on health with no measurable outcomes, it's just, 'Money spent on health is good, isn't it? It doesn't matter what it does with it.' I once said that if somebody stood outside a hospital and dropped pound coins down a drain, as long as it was health pound coins dropped down the drain, a lot of people would be saying how wonderful it is.

So, I think what I would like to ask—[Interruption.] What I would would like to ask is: will the Minister arrange for publication of the expected outcomes? I apologise to the Minister for this, because I'm going to be asking this on every single thing that the Minister and others bring forward: what are the outcomes? What are we hoping to achieve? And not, 'We've spent a lot of money; isn't it good?' What are we hoping to achieve and how can we see whether this works? And sometimes it won't, and I think that we've all got to be grown up enough, even on opposition benches, to realise that sometimes it won't work, but doing it is the right idea and we'll learn from what hasn't worked out properly.

And the last question I've got is: will the community support for hospitals at home be funded by this or will it be funded separately? Because, really, that has to be one of the best things we can do. It's been pushed forward by a number—by the Royal College of Physicians, by the royal college of geriatric medicine—that, actually, dealing with people at home, giving them the full service at home, is going to make them better quicker and it will improve outcomes considerably. So, is that funded by this, or will you be coming with another statement saying that it will be funded somewhere else?

Thanks very much, Mike. Certainly, in terms of prevention, that's very much the whole philosophy behind the 'A Healthier Wales' programme, which you will be aware of. And if the pandemic has shown us anything, it has shown that, actually, it's the people who are the poorest, it's the most disadvantaged, who've actually paid the greatest price. And so unless we start to address that issue of prevention, getting in early, getting in from a young age, we're unlikely to see any significant shift in terms of the longer term health outcomes unless we address those very early issues that are clear.

In terms of the outcomes, well, what we've got is six priority areas. So, there are six priority areas: community-based care; complex care closer to home; promoting good emotional health and well-being; supporting families to stay together; home-from-hospital services; accommodation-based services. All of those things are things that are very clear in terms of the priorities. When it comes to outcomes, what happens next is that we'll be sitting down with the regional partnership boards—we have a meeting with them tomorrow—and we'll start going through, 'Look, what are the outcomes that we're looking for?' It's really important that, actually, I think they need to own these outcomes as well. So, they need a sense of ownership; it's really important, I think, for us to develop those together.

But, certainly, in terms of hospital-to-home, you talk about the Royal College of Surgeons—you know, we're very much in agreement with them. And you can see, as one of the six priorities there, home-from-hospital services—. There's that, there is the home-from-hospital, which is key. But you're absolutely right, what we need to do is the prevention work beforehand, and that can also be funded from this funding here, the regional integration fund.

I definitely support your ambition for effective and preventative community solutions, and we doubtless need a great deal more prevention, as we've got 20 per cent of the population awaiting hospital appointments across Wales—that's a pretty devastating figure.

Anyway, two years ago, almost to the day, I visited the Cwm Taf neighbourhood nursing team just before the pandemic broke, and I witnessed the amazing specialist care delivered by and with the people who needed these services, which ranged from everything from people who needed wound care to people who needed palliative care to those who just needed support in understanding how to manage their condition, whatever it might be, in conjunction with their families and friends. Very much based on the Buurtzorg model of co-production, the pilot just demonstrated, in the evaluation, just how well this works, and I know that there is a commitment to spread that across the whole of Wales. So, how does this announcement today fit in with that ambition to ensure that every community has a self-managed neighbourhood nursing team, to ensure that people are kept out of hospital who don't need to be there?

Secondly, I'd just like to ask you about these community centres you're talking about. I was at the Co-operative Party's conference on Zoom the other day, and the First Minister was talking about 50 local community hubs, bringing health and social care together with other services, with citizens regarded as assets, to share their skills and combine in resolving the problems that that community faces. How does that—what the First Minister was talking about—link in with what you're talking about that's going to be led by these regional partnership boards?

Thanks very much, Jenny, and, firstly, can I commend your enthusiasm for the Buurtzorg model, the neighbourhood district nursing model, which I know that you're very, very keen on? What we've got in relation to neighbourhood district nursing—. We have learnt some lessons from the Cwm Taf model. There's a lead nurse who has been appointed as part of the primary and community care strategic programme, and the idea is, because we've learnt that now, we're on a once-for-Wales approach, and one of the things that we're very keen to learn, as a result of what happened in places like Cwm Taf, is the e-scheduling—so, how you schedule tasks—and that's going to be rolled out to every health board in Wales by early May, I'm pleased to say. So, a national service specification for district nursing within community-integrated teams is being developed. That's slightly separate from what we're talking about here. So, I think it is important though that we understand that, actually, on all of these things, ultimately, people need to be co-operating even if they get their funds from different pots.

The 50 community hubs that you're talking about, which, of course, are part of our manifesto commitment, I think there are real opportunities to make sure that we use these as platforms to build that kind of local community support, and there's no reason why people can't be based in those community hubs as they develop, and I'm very keen to see those. We're developing proposals for where those are going to be, how they're going to be developed, how they're going to be financed, and all of that work is ongoing at the moment. 

And, finally, Alun Davies. 

I'm grateful to you, Deputy Presiding Officer. Minister, I'm worried, and I hope you can reassure me. You're allocating £144 million a year for the next five years. That's over £700 million, and we don't know what we're going to get for it. That worries me. It worries me, because your starting point is that you're replacing previous funds, and I don't know what was delivered by those previous funds. The last plan available to us in Gwent was published for 2018-19. It didn't contain a single target, a single objective, or a single timescale.

Now, if we're to hold the Government to account for delivering on these matters, we need to know those things in advance, and we need to understand what the Government is seeking to achieve. We can all see the problem. It's the easiest thing in the world to describe the problem, and Members have this afternoon: you can see the ambulances outside the hospitals; you can see the people suffering; you can see the people who need the help and support. We can all describe the problems, but is the solution to all of those problems more committees and throwing money at those committees? I'm yet to be convinced, and I'm yet to be convinced because we've tried it before and it hasn't worked. And we've tried it before, and we've set these outcomes frameworks before, but what we've done is not set clear targets about what we want to achieve, but count what happened. And when you count what happened, you simply say, 'Well, we've done all of these different things.' And individual examples, local examples, are all very good, and it's not a criticism of any of those people who are working hard to seek to achieve different things locally—that's all admirable, to be supported—but it's not a policy, and it's not an ambition, and it's not a framework for policy, and it's not a framework for ambition.

So, my concern is that we have a broken system, but is yet another committee the way of repairing it? Twenty years of doing this has told us it isn't. And I'm concerned that we've got £700 million going into a system that desperately needs support, and before Mike Hedges corrects me, I mean the whole system not just the health part of it. It all needs support, but it needs support on the front line. What it doesn't need is another hierarchy that won't deliver on the front line.

Thanks, Alun. I've got to tell you that, actually, we have learnt a hell of a lot from the transformation fund, aspects of which have been extremely successful if you just look at some of the work that's been done on mental health in places like Gwent, some of the other examples I gave. We know that this approach works. I tell you what hasn't happened is it hasn't been mainstreamed, it hasn't been there for the long term. So, what we've had is lots and lots of good pilots. So, the issue is: how do you move from pilots to the mainstream? What we've got here is the opportunity to do that. We've got a five-year programme. We're telling them, 'If you want to play, put your money in your own pocket and you can play, because if you don't, you're not playing in this space.'

So, it's about bringing people together as well. And I think it's really important. This is not a new committee, Alun; this is a committee that's been around for a very long time that's come as a result of, actually, many, many years of people saying that we need to do things differently. This is what we've come up with. I'm certainly not in the business of throwing it all up in the air and saying, 'Let's start again.' We have something that works here. I think it's really important, and I've made it very clear to the RPBs that they need to be much more flexible, they need to be much faster, they need to be much more responsive—all of those things are absolutely crucial. And when it comes to the outcomes, that is what we're going to be discussing now, the outcomes framework—what do we get for this. And that's why what we'll be doing now in the RPB meetings is to make sure that we don't let any of this money go until we're absolutely sure about what we're going to get for it.

So, that outcomes framework, I think, is really important—that we develop that with them. It's much better if you work with people than if you impose something on them, because they're more likely to play the game with you. So, I think that, actually, we've got to take the best practice; there have been some great examples of best practice. We had that £6 million transformation fund, specifically to scale up hospital to home activity. We saw a difference there. Everybody is saying, 'We need more of this.' All of the royal colleges are saying, 'Do more of this.' That's our plan. But you're right, we need to count numbers—how many people have we managed to keep out of hospital as a result? Absolutely right, and that's what we'll be talking about in relation to the outcomes framework.

Thank you, Minister.