Item 4 this afternoon is a statement by the Deputy Minister of Social Services—an update on the health and social services regional integration fund. I call the Deputy Minister, Julie Morgan.

Good afternoon. I'm delighted to be here to give you an update on our regional integration fund.  

The pressures on our health and care system continue to challenge us, and I remain hugely grateful for the tireless work and dedication of our health and social care delivery partners and, of course, their incredible workforce.

The Welsh Government wants people to be able to live their best lives as independently as possible in their own communities. The ability of health and social care organisations to work together as a whole system is essential as more people live for longer, sometimes managing multiple health conditions and with diverse care and support needs. I am committed to driving change and transformation and, to enable this, learning about best practice needs to be shared across Wales.  

These are the reasons why, a year ago, alongside my ministerial colleagues, the Minister for Health and Social Services and the Deputy Minister for Mental Health and Well-being, I launched the new and ambitious five-year health and social care regional integration fund, as one of the ways the Welsh Government is supporting health and social care system transformation. Managed through regional partnership boards, over the last 12 months, nearly £145 million has been invested.  Despite the significant system pressures experienced over the last 12 months, and an increasingly challenged financial landscape, RPBs have continued to build on the foundations of 'A Healthier Wales' and create an environment in which health and social care partners actively embrace and deliver service transformation.

The design of the regional integrational fund builds on the progress made under the previous integrated care fund and transformation fund, whilst also responding to the recommendations from the respective independent evaluations and Audit Wales reports. This vital learning has helped us to shape the fund, which includes several key features, such as a greater focus on six specific models of integrated care; a clear outcomes and measurement framework; opportunities to share learning through communities of practice; and a longer term investment horizon, making use of tapering and match funding levers to support mainstreaming and sustainability.

For our regional partnership boards, this first year has been one of transition, as we amalgamate previously separate funding streams to create greater alignment of resources, so that we maximise impact and reduce administrative burden. Each RPB has designed its regional integration fund investment plan and is making good progress towards testing and developing critical components of our six national models of care. As we increasingly evidence the best practice from across the country, this will be built into national service specifications that will ensure greater consistency of standards and experiences across Wales.

Whilst predominantly a longer term transformation programme, the fund is delivering for people now. Over the winter months, funded projects have contributed an additional 360 step-down beds to help people leave hospital quickly and safely and alleviate system pressures as part of our community care capacity-building programme. Another good example of the positive impact of the fund includes the West Glamorgan RPB's admission avoidance project. This project has been providing short-term, low-level community support for people, such as decluttering people's homes to avoid unnecessary falls at home, providing unpaid carer support and arranging home adaptations to enable people to stay at home for as long as possible.

The Cardiff and Vale RPB's Get Me Home Plus project is another good example of a fast-track pathway in which multidisciplinary teams work with patients requiring a more intensive packages of support and reablement at home. This project is known locally as 'the pink army', and it provides a single access and co-ordination point within the hospital for a range of community services that can provide a higher level of intermediate care for people at home, supporting earlier discharge until the right level of longer term support is arranged. These are just two of many regional integration fund projects that are helping people to live well at home, to avoid admissions to hospital, and supporting safe and quick discharge home.

RPBs continue to commit over 60 per cent of their regional integration fund to models of care that provide greater community capacity both for now and in the future. The investment over the remaining four years will also greatly support our ambitions to move further faster towards an integrated community care system for Wales. The regional integration fund is also helping us to deliver other key priorities including the NYTH/NEST model. This is leading a whole-system approach to mental health and well-being services for babies, children and young people. And with the continued expectation that a minimum of 20 per cent of the regional integration fund is invested in delivery through social value sector organisations, it is also helping to support our agenda on rebalancing the care and support market.

I do recognise that RPBs and their partners have been working to maximise the impact of the fund at a time when wider system pressures and recovery from COVID have impacted massively on statutory partner resources and capacity. In this context, and at the request of our partners, Welsh Government officials reviewed the tapering and match funding requirements of the fund. In December, Ministers agreed to relax these arrangements in the short term, but not losing sight of the longer term aspirations of the fund to establish longer term mainstreamed services.

Learning and improvement is an important part of our ethos for the development of health and social care. I'm therefore pleased to announce today that, after a competitive tendering process, we've secured the services of the University of South Wales, in a collaboration with Old Bell 3 and Bangor and Swansea universities, to undertake the evaluation of our regional integration fund. It's evident that in its first year the regional integration fund has started to further a true partnership approach to investing in integrated services for the long term. I will continue to meet regularly with RPB chairs to discuss progress and will be taking a keen interest to see how our national models of integrated care continue to evolve over the next year.

Thank you very much, Deputy Minister, for your statement to the Senedd this afternoon.

I note that the programme for government outlines 10 well-being objectives that all RIF-funded activity should be mindful of and seek to contribute to, including providing effective, high-quality and sustainable healthcare. Well, that would be nice, wouldn't it, as it's been a long time since the NHS, under this Government, has been close to matching that description. But what seems a little odd is how regional integration fund cash needs to be mindful of all 10 objectives. The one I just mentioned should obviously be a part of the context, but others feel as if they speak to completely different areas of policy, like pushing towards a million Welsh speakers and embedding a response to the climate and nature emergency. Is there not a danger that by trying to tick all of these boxes, Deputy Minister, the implementation of this fund becomes subject to mission drift, as the chase to fulfil all the necessary requirements means it becomes less effective and watered down, effectively, at meeting the most important and relevant goals of all?

Indeed, integrating health and social care makes a lot of sense in theory. By bringing both together we get a far more efficient system that should prove to be cost-effective over time. However, as we've seen elsewhere on regional scales, COVID has thrown a big spanner into the works, making it incredibly difficult for the practice to live up to that theory. This is most evident in delayed discharges. While this aims to make the whole health and social care system smoother, without addressing this issue it will simply be a case of throwing more good money after bad. Finding the right reform is not easy, but is the Minister really confident that this regional integration fund will actually mean change or will it be more of the same?

Finally, the regional integration fund obviously engages with the Labour and Plaid policy ambition of a national care service. If this fund is as effective as the Minister believes it can be and should be, is there a need for such a national service? Is a national care service even achievable? There is supposed to be an integration plan ready by the end of this year, but its actual implementation won't happen overnight. With less than half of the Senedd term left to run, is it not the case that the regional integration fund is actually the end goal here? Because a national care service will never see the light of day under this Welsh Government. Thank you very much.

I thank Gareth for those questions. Certainly, I said in the speech I made that we had established six national models of integrated care, and those are the models that the regional integration fund are working to. Those are: preventative community co-ordination; complex care closer to home; promoting good emotional health and well-being; therapeutic support for looked-after children and helping families to stay together; home from hospital; and accommodation-based solutions. So, we're concentrating the money that we're putting into the RIF on those six areas, and in the first year of the RIF, I think we've seen very promising results. Ccertainly, I don't think that some of the things that he mentioned are in conflict with those aims, such as a million Welsh speakers; I think that is a great advantage to the sort of work that we are doing here, and certainly is the Wales that we want to see. So, I don't see any conflict there at all.

We are integrating health and social care, and the regional boards are where we actually have a place where health and social care are at the table. So, it is actually making decisions jointly as well as other elements being there, such as housing, with the third sector and carers represented. So, it is the place where you can make the best integrated decisions. 

On delayed discharges, we've worked all the winter trying to tackle the issue of the shortage that we do have of social care workers and the issues that that has caused with delaying people coming from hospital. It does look as if those delayed discharges are now going down. The worst of the winter, we hope, is over, and the delayed discharges are going down. But a huge effort was made to create community capacity, and the regional integration fund played a major role in that. 

In terms of a national care service, that is the joint ambition of Labour and Plaid Cymru, and we're working together in the co-operation agreement to make that happen. We will be announcing an implementation plan by the end of this year, where I hope we will see staged proposals to reaching a national care service. The regional integration fund is bringing those elements together now, and is delivering now, but our ultimate plan is for a national care service. 

May I echo the comments of the Deputy Minister in terms of our thanks to the health and care workforce for their tireless work? Thank you for today’s statement. There are very important principles here that we can all hopefully support, on the importance of supporting people to live independently in their communities and the need to transform services in a meaningful way to allow that to happen. This fund, of course, replaces the integrated care fund, which took the place of the intermediate care fund, if I’m right, which was subject to an agreement many years ago between Plaid Cymru and the Government. So, there are principles here that are ongoing and are being developed.

The question is to what extent are we seeing the kind of transformation that is needed. To be fair, it’s at quite an early stage still. The Minister has described this as a period when we move into a new modus operandi, but time is short, of course. We do need to see that transformation actually happening. With the six models of integrated care, for example, I would be grateful if the Minister could provide us with an update on the kind of spending profile that she anticipates. In terms of delivering against those principles, how will revenue and capital funding, which is scarce, be spent on delivering the new six models that are being developed?

For the second question I have, I don’t apologise for turning once again to the need for a revolution in attitudes in terms of preventative care, to make us a healthier nation and to get people to prepare to live independently within their communities over the long term. Plaid Cymru published five action points for health and care recently and that preventative element was one of the five points. In launching this fund last year, the Minister said that preventative community solutions were already being developed. Can the Minister, therefore, provide us with an update on how this fund is being used to develop that preventative element, which is so crucially important? Because unless we can tackle the issue of the preventative, we won’t be able to resolve the pressures on health and care services ultimately, and we will tend to go around in circles in such a scenario.

Thank you very much, Rhun, for those questions and comments. This certainly does replace the ICF and the transformation fund. It is a consolidation and is making sure that some of these ideas and projects that have been so successful are moving towards consolidation, because I think the main thing we have to try to do is to mainstream these projects. I think I can reassure you that some of them have been transformational, but what we have to do now is to move beyond that and to make them embedded so that they're right throughout the whole of the system. We are learning from them. There are communities of practice, communities looking at each different area that we're looking at. We're trying to make absolutely sure that these are not just isolated projects, but are projects that are shared throughout Wales. 

In terms of the spending, well, last year's spending was nearly £145 million, which is a large amount of money that we're putting in, and we're putting that in for five years. The largest percentage of that money was spent on community capacity building, and three of the six models were on that. So, we had, for example, home from hospital—18 per cent of the funding went on that; community-based care, prevention and community co-ordination—27 per cent. I think, on those sorts of projects, about 60 per cent was spent on that. So that was, basically, building up the capacity, the community care capacity, which I think is very crucial. 

And a lot of it is preventative, because the more that we can support people at home to live independent lives, to live successfully, that's where we will prevent the need for having to go into hospital, where people do become weaker, and it's more difficult to get people home. So, we have got ambitious plans to develop this preventative work in the community much more, and, of course, we do want to move towards a national care service, where we will build upon all this work that is actually being done now. 

And finally, Russell George. 

Thank you, Deputy Presiding Officer. Now, Deputy Minister, you touched upon, in your statement today, the sharing of good practice. So, I wondered if you can give us, or perhaps let us know where you think that health and social care is working best in Wales—tell us the health boards or the regional partnership boards that are doing the best, and also, give us a sense of where you think, or which health boards need to up their game. Perhaps it would be useful to get that sense from you. 

And whilst we're on health boards, of course, with regard to Betsi Cadwaladr health board, as we know, returning to special measures under direct control of the Government, can I get a sense there of whether there's going to be an acceleration of work with regard to the integration of health and social care, or is it the opposite? Is it the fact that there are so many other hurdles to overcome that this will be less of a priority?

I thank Russell George very much for those questions. We've got good examples all over Wales, so I'm not going to say one health board is outstanding and another one isn't, because I've got a list of project examples here from, as I say, right across Wales. Well, in north Wales, of course, there's the iCAN project, which tries to support people with mental health difficulties. And many of these support activities are delivered by third sector providers, with volunteers, and community hub staff providing mental well-being support, with a plan to place people in GP surgeries to try and address these issues. So, that's a very good example in north Wales, and, certainly, we wouldn't want—. There is no question of stopping these sorts of things happening because Betsi Cadwaladr has gone into special measures. It's absolutely crucial that we work on the integration of health and social care throughout the whole of Wales.

And I've got examples, as I say, of excellent projects here throughout the whole of Wales. And we certainly wouldn't want anything to stop the development of those projects because of any difficulties in any local health board.