Item 7 this afternoon is the  debate on the Public Accounts and Public Administration report on care home commissioning. I call on the Chair of the committee to move the motion—Mark Isherwood.

Motion NDM8104 Mark Isherwood

To propose that the Senedd:

Notes the report of the Public Accounts and Public Administration Committee on its inquiry into Care Home Commissioning, which was laid in the Table Office on 1 September 2022.

Motion moved.

Diolch and thank you for the opportunity to discuss the Public Accounts and Public Administration Committee's report on care home commissioning. Members may be aware of the committee’s report on this matter, which made several key recommendations in what is a complex area, with the aim of making the system more equitable for all. This inquiry reflected on the Auditor General for Wales’s national summary report, 'Care Home Commissioning for Older People'.

The committee heard from a range of stakeholders about the accessibility and quality of care home provision, including oral evidence received from the Older People’s Commissioner for Wales, Age Cymru, Care Forum Wales, the Welsh Local Government Association, the Association of Directors of Social Services, and the Welsh Government itself. The committee also received written submissions from a range of regional partnership boards, the Royal College of Nursing Wales and others, and I thank everyone who contributed to what was an important inquiry.

The committee notes that, while the Welsh Government has accepted most of our recommendations, its response appears to raise questions about their understanding of some of the issues, despite these being spelled out in existing Welsh law and guidance. It is, therefore, concerning that the response is indicative of the slow pace of policy reform in those areas and, specifically, the implementation of the Social Services and Well-being (Wales) Act 2014.

We recommended that the Welsh Government should consider the voices of service users when considering policy reform in this area, where the lived experiences of residents are essential evidence as part of any reform process. Their voices should be central to the work of the Welsh Government’s task and finish group and the independent group that is developing the new national framework for social care national care service respectively. The Welsh Government accepted this recommendation and noted that the independent expert group included individuals from a range of diverse backgrounds. The committee were told that the recommendations of the independent group should have been received by Ministers at the end of April, but that there had been a delay. It is unclear from the Welsh Government's response the current status of the group’s work and when it will actually report. I'd, therefore, welcome clarity from the Minister on this, given the important role the group has in moving policy reform forward in this area.

Unfortunately, the narrative accompanying the acceptance of these recommendations falls some way short of the committee’s recommendation and the provisions of the Social Services and Well-being (Wales) Act itself, which mandates a co-productive approach, whereby, and I quote:

'Individuals and their families must be able to participate fully in the process of determining and meeting their identified care and support needs through a process that is accessible to them.'

This is in contrast with the consultative approach described in the Welsh Government’s response.

The Social Care Institute for Excellence, for example, describes co-production as

'not just a word, it’s not just a concept, it is a meeting of minds coming together to find a shared solution.'

As they state:

'There is a difference between co-production and involvement: involvement means being consulted, while co-production means being equal partners and co-creators.'

Genuine co-production of public services with users and communities is about better delivery of health, social services and other services—in this case, to an ageing population. It is not about consultation with stakeholders after a policy has been developed, regardless of who was involved in developing that policy. I seek assurances from the Minister as to how the Welsh Government will ensure that its expert group reaches those to whom it is most relevant and involves them in the process of creating and delivering a service that works for all, not just consulting them afterwards.

It's concerning that the Welsh Government does not appear to be taking a lead on this approach, despite the intent of the co-production provisions of the Social Services and Well-being (Wales) Act 2014, which I worked with the then Deputy Minister at the time, Gwenda Thomas, on developing, and particularly not just the Act itself but the relevant codes of practice, which are quite clear in this respect. So, I urge the Welsh Government to implement the committee’s recommendation in all its future work in this area and to implement the unambiguous co-production provisions of the Act and its codes of practice.

The committee also concluded that more should be done to support and encourage volunteer participation in the care home sector, to offer quality-of-life services to service users. However, the role of volunteers must not be in place of full-time, professional paid care. The Welsh Government accepted this recommendation and provided more information about a recent pilot project, which sought to recruit volunteers to support safe visiting between residents and relatives during the pandemic. The committee is encouraged to learn that this initial pilot project's aims are to be broadened, and we'd be grateful if the Minister could agree to keep us updated on this.

One of the committee's key conclusions was that more should be done to ensure parity of terms and conditions and pay with NHS staff, with the intention of retaining staff and being competitive with other industries or sectors, such as the hospitality industry. The committee welcomes the Welsh Government's acceptance of this recommendation and introduction of the real living wage for social care workers. However, we'd be grateful if the Welsh Government could advise when the increase in the real living wage, announced by the Living Wage Foundation on 22 September, will be made available to providers via local authorities, where it's understood that, currently, recipients are still only receiving £9.90 per hour.

The committee also acknowledges the work of the social care fair work forum, which is looking at working conditions for social care workers. The committee urges the Welsh Government to go further in its proposals to ensure parity with NHS staff and to be competitive with other sectors. We welcome the Welsh Government's stated commitment to evaluating the work of the WeCare.Wales recruitment campaign. The committee also welcomes the work of Social Care Wales in learning about how social care providers recruit care workers and the challenges they face in so doing. We look forward to hearing more about their work, once it's completed next April.

On the subject of care home inspections, the committee is encouraged to hear about the efforts to reflect the opinions of service users during their inspections, but believes that more should be done to expand this part of the inspection process. Whilst the committee is encouraged to note Care Inspectorate Wales or CIW's intention to inspect all registered adult care homes in the period between 1 October 2021 and 31 March 2023, it is concerning to note that this aim may not be achieved. We, therefore, encourage the Welsh Government to update the committee on CIW's progress once this period concludes, and on how it complies with the measures introduced by the Welsh Government some years ago following a very worrying report by the then older people's commissioner.

The committee is disappointed that the Welsh Government has chosen to reject three recommendations, and particularly on top-up fees. We were deeply concerned about the nature of these fees and the way they are communicated to service users. The committee heard evidence about how top-up fees were being misapplied to service users, meaning that some of our most vulnerable citizens were faced with costs for basic services. The Older People's Commissioner for Wales told the committee that service users were unclear about what services would incur top-up fees, going on to state that families had approached her office because of, quote,

'unexpected, sudden bills for top-up fees, quite often for things that you would expect should be in the standard fee'.

The commissioner told us that service users had been charged for accessing the garden, for example. So, we strongly disagree with applying top-up fees for accessing basic services and rights, and concluded that more should be done to tighten the rules around these top-up fees, along with a new independent redress system to allow decisions to be challenged. Unfortunately, the Welsh Government chose to reject these recommendations, stating that clear guidelines are in place as part of the continuing healthcare framework, prohibiting top-up fees for basic services. However, the committee has been told by sector experts that these damaging practices continue to occur.

The Welsh Government's guidance on this matter is not working and is unclear for service users and providers. We question what is being done to monitor and evaluate the impact of this framework, when it's clear from the Welsh Government response they seem unaware that this guidance is not being followed, despite the evidence to the contrary in our report. The committee urges the Welsh Government in the strongest terms to urgently review this matter, and, as part of that review, to work with users and the organisations who represent them, such as Care Forum Wales, Age Cymru and the older people's commissioner, amongst others, to develop a new approach to top-up fees that works for the social care sector, and more importantly, its users.

The Welsh Government also rejected the committee's proposal about mandatory information sharing across the care home sector, with a particular focus on service user experience and satisfaction. The committee had concluded that this information should be shared at a national level, to ensure all parties have access to consistent and relevant information, linked with the seven well-being goals for Wales. In their response, the Welsh Government told the committee they were not seeking to mandate information sharing as they did not view the 'high cost' of implementing these provisions as resulting in

'a proportionate benefit in terms of data development over and above the measures we have already taken and have in hand.'

The committee would like to know, therefore, how the Welsh Government calculated this 'high cost', and what the calculation showed. It is regrettable that the Welsh Government sees implementing such a provision as a cost, as opposed to an investment in the social care sector, which should lead to cost benefits and a better body of information, including the voice of lived experience, to influence and shape future policy making in this area.

The committee heard from the chief executive of Care Forum Wales about the challenges associated with collecting information across local authority and health board boundaries, with different information requested in different formats. A national system would streamline this process and provide a comprehensive body of information on which to base future cost-saving decisions in the sector. It is therefore regrettable that the Welsh Government has disregarded the committee's conclusions in this area. The committee will continue to pursue these issues with the Welsh Government, and we otherwise look forward to further dialogue with them on this topic, and will be closely monitoring the implementation of our recommendations. 

This investigation by the Public Accounts and Public Administration Committee is, in my opinion, timely. Care homes play a major role in the provision of care to mainly older people, but not exclusively older people. It involves a large number of providers. Some are providers with more than one site, others have only one home, and there are some major providers, but each one of them is providing care to individuals. Each of these is important.

No-one has an ambition to end up in a care home, but many of us in this room today will end up in a care home, and even more of us will have a family member, either now or in the future, who will be in a care home. So, we've all got a personal interest in getting this right. The committee report was intended to highlight and examine the challenges faced in the complex area of care home commissioning for older people, with the aim of making the system more equitable for all. I think that 'equitable' is a word that we need to use more often, because everything should be equitable. The committee heard evidence about the accessibility and quality of care home provision in Wales, the variation and complexity associated with funding care, home placements, the difficulty faced in attracting and retaining staff to the industry, and the proposed policy reforms relevant to this field.

The committee recommended that the Welsh Government consider the voice of service users as part of their policy reform in this area. The committee would welcome further information from the Welsh Government on how they have consulted with service users and their families as part of the work of the expert group on social care. I support the call that the Welsh Government task and finish group developing the new national framework for social care should consult service users as part of its work, and I would say as a major part of its work. The Welsh Government needs to provide an update about how this will be achieved as part of its consultation in spring 2023. Too often, service users and their families have things done to them, have things done for them, have things people think will be good for them. Too often, this is based on 'professionals know best', rather than the individuals and their families. And it's not just in care; the same thing happens in health.

The committee recommended that the Welsh Government consider, as part of the development of a national care service, what more can be done to review the salaries and terms and conditions of care workers, to ensure parity with NHS staff and to be competitive with other industries such as the hospitality industry. Without parity of pay and conditions, the sector will continue to face problems recruiting and retaining staff. Health and care require many of the same skills. Health pays better, and it's seen as more important by politicians and the public. Care is really the poor relation of the health and care service, and that's something I know the Minister cares a lot about, so this is not me having a go at the Minister on this, because we've got a Minister who actually understands the importance of the care system and is committed to the care system. But, care home staff leave to work in the health service, creating a vacancy problem in care homes. And why wouldn't they? It's not always about pay, but why would people not leave for a better paid job? And, especially in the times we're in now when people are under financial pressure, moving into a better paid job has a lot to be said for it. It might mean that you put the heating on half an hour earlier, it might mean that you end up with three meals a day not two, or two meals a day not one. So, it is really important that pay is there. I know that the Deputy Minister has talked about this and I know the Deputy Minister's commitment to it is as great as mine, but it is something that we desperately need to ensure, that care is not the poor relation. The Deputy Minister has already accepted the need to increase pay, what is needed now is action on increasing pay for those working in care homes.

The Welsh Government needs to mandate a more proactive approach to sharing information across the care home sector, particularly information on service users' experience and satisfaction, linked with the seven well-being goals for Wales. The mandatory requirement to share information should be implemented on a national level to ensure that providers, service users and the Welsh Government have access to consistent and relevant information. Data also needs to be shared, and perhaps more importantly, between health, social care and care homes. Far too often, everybody has their own system, everybody says they're not allowed to share, and we get two answers on that: it either costs a lot or GDPR does not allow it. The Welsh Government should work with providers to proactively seek consent from service users and their families for the sharing of information; when people provide information, getting them to approve sharing with health and social care serving the care home. This would allow data to be shared, just like the way we all allow data to be shared by organisations that we deal with. We tick that box, 'Can we share data?' We need to have that box in there when people are in health and care areas.

I share the committee's concern about the charging of top-up fees and support the recommendation that the Welsh Government should issue binding restrictions to limit the areas where such fees are charged, which should be kept to a minimum and published. Mark Isherwood mentioned earlier charging for things such as using the care home garden; that is unfair and wrong. And, finally, I am very pleased that the auditor general has investigated the care home sector and that the committee has produced this report, and I know the Minister is listening to us.

This report on care home commissioning follows the auditor general's review published in October last year, entitled 'A Picture of Social Care'. This review has looked at the whole social care sector all across Wales and it has identified three key issues and long-standing challenges for the sector. Foremost among these is the need to achieve financial sustainability and funding arrangements. It claimed that progress on addressing challenges had been slow and that the pandemic had made the need for change even more pressing. Indeed, the auditor general clearly stated that, although the pandemic had exposed the fragility of care services across Wales, most of the issues were already in existence to some degree.

Demand for adult social care is likely to increase significantly, which I know both of my colleagues have highlighted. Social Care Wales's population projection platform shows that, from 2020 to 2040, the number of people over 65 who struggle with the activities of daily living is projected to increase to 34 per cent. Faced with these challenges, the committee examined care home commissioning for older people with a view to strengthening the sector and making it more equitable. We looked at the accessibility and quality of provision, as well as variations in funding and issues regarding staff recruitment and retention, which both my colleagues, again, have mentioned.

On accessibility, the committee was guided by the principle of simplifying the process for service users. The auditor general's national summary report said that access to care homes by older people is complex and hard to navigate, which is not fair for elderly people and their families to have to deal with. The Older People's Commissioner for Wales pointed out that the overall quality of care homes was variable and Age Cymru reported issues where care is not available for service users through the Welsh language. 

On funding, we tried to find out the reasons for the variation in expenditure on residential care and continuing weekly healthcare costs. Again, to quote the auditor general, public sector funding approaches for different aspects of care can create division amongst partners. The funding landscape for social care is very, very complex and confusing because of the varying streams of funding an individual may be eligible for. I know we all support equality here across every single party that we have here in the Senedd, but we must have equality for the elderly here all across Wales. My biggest concern is that the standards vary, with privately funded patients able to access a much higher quality of accommodation.

On staff recruitment and retention, the committee noted that workers were being lost to the retail and hospitality industries due to a higher level of pay being offered and lower work pressure. Staff were also being lost to the NHS for the same reasons.

To meet these challenges, we've made 13 recommendations, and I'm pleased the Welsh Government has agreed—alongside my colleagues, as they've mentioned this as well—that 10 have been agreed. I would urge you, therefore, Minister, to seriously reconsider your rejection of recommendation 8 specifically, regarding the need for a more proactive approach to sharing information in the interest of transparency and to ensure access to consistent and relevant information.

Our recommendations 11 and 12 on the charging of top-up fees have been sadly rejected. In Wales, although we all talk about equality and fairness for all, it really saddens me to say that it's not apparent in elderly care here in Wales. In evidence, the Older People's Commissioner for Wales says that service users are often unsure about what will incur top-up fees and that the true cost of care is not fully understood as a result. They need to have that in place, Minister. Again, I would also ask you, Minister, to look once again at this matter to provide certainty in charging top-up fees in the name of equality, fairness and transparency going forward.

Therefore, Minister, this report, in its aims, the intention is fully there to make the social care system in Wales more accessible, less complex and fairer for vulnerable individuals and their families. I truly believe it has succeeded in its aims and it has my full support, but the areas that have been rejected must be looked at again as we cannot ignore Wales's increasingly ageing population. Thank you.

I welcome the report of the Public Accounts and Public Administration Committee from its inquiry into care home commissioning. I also welcome the opportunity to speak on the topic in the Senedd.

This report clearly highlights the challenges faced in the complex area of care home commissioning for older people, with the intention of improving the system so that it is more equitable for all. It's fair to say that the challenges facing the sector are wide and far reaching. The committee heard evidence about the accessibility and quality of care home provision in Wales, the variations and complexity associated with funding care home placements, the difficulties faced in attracting and retaining staff in the industry, and the proposed policy reforms relevant to its field.

The report's recommendations are aimed at addressing some of the important issues, and if implemented, will help to strengthen and simplify the process of care home commissioning. Such improvements are important for us all, as social care is a service that touches the lives of individuals and families in every part of Wales. Sadly, for a service that is so crucial, social care is criminally undervalued. Workers are not given the respect they deserve and this is reflected in poor terms and conditions. The Government will no doubt mention the introduction of the living wage, but as TUC Cymru concludes, it is not enough. It is worth pointing out that this conclusion was reached last year, and long before economic mismanagement by the Tories in Westminster exacerbated the cost-of-living crisis, which has made social care less attractive.

It is not just pay that care workers get hammered on, either: terms and conditions are weak. As the TUC also pointed out, thousands of care workers in the outsourced sector are not contractually entitled to proper sick pay. They estimate that around 5 per cent of staff are not even eligible for statutory sick pay. Apart from the immorality of this, the situation will inevitably lead to ill workers coming into contact with vulnerable people because they cannot afford to take a day off sick. How can this be in the twenty-first century?

Many of the problems identified in the report could be solved by a merger between health and social care. This has been a long-standing policy of Plaid Cymru and I'm pleased that movement towards this goal is covered by the co-operation agreement that we struck with the Government. The commitment to get a report from an expert group to explore the creation of a national care service, free at the point of need, as a continuing public service cannot come soon enough. Through the integration of health and care workers, we can raise the recognition as well as the reward that is long overdue for social care workers.

I must also mention the lack of community hospital capacity in the NHS, which is having a knock-on effect on social care as well as our health service. Just last week, my Plaid Cymru colleague Rhun ap Iorwerth mentioned the drop in the number of hospital beds in Wales from around 20,000 at the end of the 1980s to just over half that in the present day. The demise of the community hospital can partly explain the downward trend, and it's having a huge impact on the NHS, causing bottlenecks in hospitals and elsewhere. I understand the push to treat more and more people at home, as many would prefer this, but for some it's not appropriate, if they are not well enough or not mobile enough to live at home. In such circumstances, without an adequate package in place, they remain in hospital. A community hospital bed would be a much better solution. These beds do not cost as much as district general hospital beds, and I echo Rhun's call for the Government to look into the matter with urgency. Diolch yn fawr.

I'd like to thank the Chair of the Public Accounts and Public Administration Committee, Mark Isherwood, members of the committee and staff for conducting an inquiry into care home commissioning in response to the publication of the commissioner's report back in December 2021. Care homes across Wales require high levels of staffing and dedicated staff to provide the best possible care to patients. Although many carers provide the dedicated care that's needed, it's also important to highlight the role of nurses in care homes in providing care in challenging and complex circumstances. Equally, it's important to highlight how nurses in care homes play a role in reducing hospital admissions, which supports the function of the NHS and opens up more beds in our hospitals.

It's unfortunate that around two in five care homes provide nurses, and I strongly believe that the Welsh Government should be encouraging more nurses in care homes. I recognise that there is a wider nursing recruitment crisis in the Welsh NHS, and this is not something the Welsh Government can fix overnight, but it highlights that the Welsh Government must address the lack of recruitment and lack of retention amongst nurses. I agree with the committee that there should be concern over the ability of care homes to provide high-quality care due to severe shortages. Although in the ideal world we would have nurses in all care homes, this cannot be the reality at the moment.

We must recognise the right approach taken by the committee in recognising the role of volunteers in aiding the care of care home residents, but they should not be taking the place of professional staff in providing the primary care. Although volunteering can give young people the skills to begin a lifelong career in care, they must not be used as a replacement to professional staff whilst the Government tries to promote recruitment and retention.

Care homes play a vital role in ensuring that elderly people and those most in need of care can indeed receive the services they need in a safe and homely environment. But one of the biggest problems facing care homes currently is the social care staff recruitment and retention. What we need to achieve is making a career in social care more attractive. As mentioned in the Health and Social Care Committee's debate into hospital discharges last week, social care staff don't just work 9 to 5 Monday to Friday, they work weekends, nights, unsociable hours, sleep-ins. What they need is a Welsh Government that supports their and my calls for better pay for social care workers.

The Welsh Government stand up in this Chamber and bask in the glory of paying the real living wage, but £9.90 just isn't enough, particularly given the current living pressures we face. Social care workers are some of the lowest paid workers in the labour market, despite their dedication to helping our most vulnerable. Maybe if the Welsh Government stopped funding airports and pet projects, then aligning care social care staff pay with NHS pay scales might become more achievable. I believe it's achievable, and I'd be grateful if the Minister could again address this in her response to the debate this afternoon.

If we can reward our nurses, social care workers and front-line staff, not only will we be making the sector more attractive, but we will also be improving a lot of the wider concern surrounding healthcare as we struggle to tackle the problem of delayed transfers of care and giving people the care they need when they need it the most. It runs throughout the whole system, Deputy Llywydd. If we can improve discharge rates to care homes, then we'll be freeing up hospital beds, bettering waiting times in emergency departments and playing our part in improving ambulance waiting times. I'm not trying to say that this is the single, definitive path to solving all the world's problems, but I certainly believe that it will go a long way to helping some of the chronic problems we face in our health and social care systems in north Wales and across Wales as a whole. Let's be ambitious and do all we can to deliver the best possible services to the people who need it the most. Diolch

I call on the Deputy Minister for Social Services, Julie Morgan.

Thank you. I welcome the opportunity to reply to this important debate.

I've really enjoyed listening to this debate today and, as you know, we're very happy to accept the majority of the committee's recommendations.

The report rightly has a clear focus on evaluating and monitoring the impact of the Social Services and Well-being (Wales) Act 2014, and placing the voice and experiences of service users at the heart of the system. As well as the evaluation studies we've undertaken, compliance with the Act is assessed by the regulators CIW and HIW, supplemented by a national performance improvement framework and local authority reporting. And through our rebalancing reforms, we will ensure that this evolves further.

Users and carers are helping us to shape the rebalancing programme through the various task and finish groups, including one specifically looking at co-production, engagement and voice across the regional partnership boards. The outputs from these groups will be consulted upon in the spring. The rebalancing task and finish group on engagement and voice is working with a range of stakeholders to co-produce tools and standards to improve service user and carer engagement and participation in social care services, and the work will be reflected in the national commissioning framework that is under development.

The experiences and expectations of service users were also considered by the expert group, which consisted of individuals from a diverse range of backgrounds and perspectives. The chair of the committee asked me to report on how far this group had got, and I'm pleased to say that the report has now been completed. It is now in the process of being translated, and will be published next month, in November. So, I'd like to put on record my thanks to the individuals who took part in that group. Once the report has been considered by Ministers and the Plaid Cymru designated Member, because, of course, this is a core part of our co-operation agreement, there'll be a period of extensive consultation to develop an implementation plan, which will be co-produced. We will, of course, ensure these consultations include service users, unpaid carers and the third sector, and community groups that represent their views and experiences.

The report also emphasised the importance of embedding the voice of service users in inspections. Between October 2021 and August 2022, CIW undertook 705 inspections of 614 adult care homes, and spent 9,181 hours on site, providing the opportunity to talk directly to residents, their families and friends. That is a key part of what CIW does: trying to engage directly with the residents. CIW also looks for evidence that people have a voice in the running of their home, which, again, is a very important point.

CIW are acutely aware of the continuing impact of the pandemic on social care, exacerbated by pressure on staffing. Where CIW finds poor outcomes, they require action and will return to check improvements that have been made. Such additional inspections could delay the completion of the planned programme, but the aim remains to have inspected all registered adult care homes between 1 October 2021 and 31 March 2023. I hope that reassures the committee.

Many Members have mentioned the issue about recruitment, pay and terms and conditions, and the report does highlight—and many people have mentioned today—the need to address these pressing issues. These are all being considered by the social care fair work forum, which brings together key partners from across the sector to find ambitious, pragmatic and achievable solutions, and to bring about real and lasting change. The forum has initially focused on improvements to pay, including advice on how to take forward the commitment to paying all care staff the real living wage, and I am proud that we have managed to pay the real living wage to social care workers in Wales. This has been supported by funding of £43 million this year. The chair asked about the uplift to the real living wage, and that is something that we are considering at the moment. Of course we want to pay it, but I think you will be aware that the financial circumstances at the moment are not very encouraging. But this is something we would certainly want to do. 

With regard to recruitment, we’re working with Social Care Wales to ensure robust evaluation of the WeCare.Wales campaign. Social Care Wales has already commissioned research into care employers’ methods of recruitment, including their awareness of the campaign and its impact, and that will be completed at the beginning of next year. I think it is difficult to establish how successful certain recruitment campaigns are when we have such a myriad of providers providing social care in Wales because of the large number of care homes in the independent sector.

The report recognises the potential for greater use of volunteers in care homes, which a number of Members have brought up, and in our written response we detailed the work we are undertaking with our partners to broaden the role, reach and skills of volunteers in these settings and to grow their numbers. I am very keen to encourage volunteers to be more involved in care homes and a key consideration will be ensuring that volunteers’ roles are clear and appropriate, and focusing on added value.

We fully agree that citizens’ experiences must be the basis and impetus for all improvements in social care provision, and we accept the principle behind the committee’s recommendation to introduce an additional mandatory requirement to share this information. However, I’m not convinced that, at the moment, the costs of implementing this across hundreds of providers outweigh the benefits over and above the information sharing measures already in place. However, it is something that we can consider in the future. On top-up fees, I would be deeply concerned if any individual is being charged for care where that care is already provided free of charge through the public purse, and I note the comments that several Members made about having to pay top-up fees to access the garden, which is absolutely ridiculous. So, I think that would be completely wrong.

There are already clear guidelines on additional services in the continuing healthcare framework, and such personal contribution arrangements must never be used as a mechanism for subsidising the service provision for which the NHS is responsible. Therefore, we also do not think it’s appropriate to commit to amendments to regulations on top of these, or to initiate a new independent redress system, ahead of considering a report of the national care service expert group. We’d need to consider carefully how any consequential refinements we might make to the existing regulations and frameworks sit in the context of any new system, so we don’t feel able to accept that recommendation now.

Then finally, with regard to pooled funding for commissioning, the integrated services task and finish group has been reviewing existing arrangements as part of our rebalancing programme, and they’ve particularly taken into account the Audit Wales report on the commissioning of care home placements for older people. They will also review the impact of the toolkit that was co-produced with stakeholders. Recommendations from the task and finish group will form part of the consultation package next spring.

Finally, I’d like to thank the committee very much for its report, which I think is a very valuable report. There is clearly much to be done. There is a lot of work ongoing, and I look forward to continuing to work with our partners on this agenda through the various groups we have set up. We will be carefully bearing in mind the recommendations that the committee has made, and I'm happy to report back on those to the committee as they progress. Diolch.

I call on Mark Isherwood to reply to the debate.

Diolch. I have to be brief, as time is short, but thanks very much to all contributors.

Mike Hedges, as you said, this investigation was timely. Although it primarily involves older people, it is not exclusively about older people; everything should be equitable, and we need to move from doing things to or for people to doing things with them.

Natasha emphasised the need for financial stability where the funding landscape is complex and confusing and staff are being lost to the retail and hospitality sectors.

Peredur Griffiths talked about the need to simplify the process for care home commissioning, and about the lack of community hospital capacity. That takes me back to the campaign initially won and then lost, in the third Senedd term, Community Hospitals Acting Nationally Together Cymru, CHANT Cymru. We held the line briefly but then they closed them. But that's not the Chair speaking—momentarily, I became an independent Member. Right. [Laughter.] 

Gareth Davies referred to the importance of the role of nurses, and also the importance of staff recruitment and retention.

I thank the Deputy Minister for her response. She referred to the Social Services and Well-being (Wales) Act 2014, and talked about evaluation studies being undertaken, and service users and carers helping the Welsh Government to shape this via task and finish groups. We do need to know how those groups comply with co-productive principles, which is about making time to save time, and turning the power thing upside down. How is that building community resilience and capacity, so that people can be genuine equal partners and co-creators? 

As the written response that we have from the Welsh Government stated, once the expert group report is considered by Ministers and the designated Member, there will be an extensive period of consultation, including service users and their families, as part of the process to develop an implementation plan. That is the absolute antithesis of the social services and well-being Act, and its codes of practice. Where are the genuine prudential care principles—co-production, early intervention and prevention principles—running to that? 

And in terms of both accepted and rejected recommendations, I'm pleased to hear some of the Deputy Minister's response, but I still feel that perhaps there's a deficit, which is reflecting itself in public services elsewhere in Wales, in terms of really understanding what the voice of lived experience, the cost savings that can be generated through that and information sharing actually mean. And if we embrace that properly, how we can genuinely improve lives, build stronger communities and, ultimately, not add costs but save costs, too. Thank you. 

The proposal is to note the committee's report. Does any Member object? I can't hear any objections, so the motion is therefore agreed in accordance with Standing Order 12.36. 

Motion agreed in accordance with Standing Order 12.36.