National Assembly for Wales

Good morning and welcome to the Health and Social Care Committee this morning. My name is Peter Fox, the Chair of the committee. Can I welcome Members here today? Two colleagues are with us today—James Evans and Mabon ap Gwynfor—and Lesley Griffiths and John Griffiths are with us virtually. Welcome. Can I record apologies for Joyce Watson, please? The meeting will be bilingual, and there is simultaneous translation from Welsh to English. That's available for anyone who wants it. Could I ask Members if there are any declarations they'd like to declare? No. There are not. If you find any during the meeting, please let us know.

Today we are carrying on with our inquiry into improving access to support for unpaid carers. It's been a really interesting inquiry to date—quite harrowing as well in many ways. We enter our fourth formal evidence session for the inquiry today.

We're really pleased to have with us Kate Cubbage, director of Carers Trust Wales; Greg Thomas, who's joining us online, chief executive of Neath Port Talbot Carers Centre, Carers Trust Wales—welcome, Greg; and also Rob Simkins, head of policy and public affairs, Carers Wales. Welcome to you all. Thank you very much; your input will be extremely important to our inquiry.

We have a few questions, as you will be aware, and perhaps I'll kick off, if that's okay. Don't feel you all have to talk on everything, but if you wish to, you're welcome. I'll make sure I see everybody. Greg, if you just put your hand up if there's anything, or I'll come to you directly anyway.

I'd like to start, if I could, by looking at the current context of things. We've heard very powerful evidence from unpaid carers about the struggles they are facing and the desperation they feel. It was captured extremely well by Kay from Bridgend Carers Centre, who implied things are getting worse for carers. She said carers now use the words 'fight' and 'beg' for help, and it never used to be like that. I wonder if you could talk us through whether you share that view and your assessment of the severity of the problem that faces carers across Wales. Who'd like to start?

I'm happy to start. Thank you, Chair. I agree. The evidence has been really harrowing, and I think the sad thing about it is it isn't surprising to us. The people that you have spoken to are not the exception; they are what we experience day to day across Wales. Evidence from network partners of Carers Trust has really demonstrated that there are too many carers who are reaching crisis point without any support.

I want to just talk a little bit about the context that carers find themselves in today, if that would be helpful. There's a real significant complexity of need that's presenting at front-line community carers services, levels that aren't being met by others, including statutory providers. As I've no doubt Rob will share, in terms of 'Track The Act 7', the majority of local authorities are directly supporting fewer than 500 carers. Given what the committee has already heard about the level of demand, that seems really, really small, and the pressures on the system are just growing. There are really, really high levels of unmet need within our communities.

In support of this, I can certainly share that providers within our network have described needing to provide vicarious trauma training to front-line staff, and needing to take really proactive steps to support their mental health and well-being because of the levels of distress that they are seeing amongst carers and those that they work with. I'd like to draw this committee's attention to the work of Dr Siobhan O'Dwyer of Birmingham University, who demonstrated an elevated suicide risk amongst unpaid carers. Her research shows that carers have a level of suicide risk akin to that of veterans who have seen active service. One in eight carers has made a plan to end their own life, one in 10 has made an attempt. And that's one in 10 at a time where, on average, local authorities have support plans for less than 0.5 per cent of the caring population. And although it's likely to be an underestimate because of the way that death data is collected, there's one homicide every month in the UK undertaken by a carer who has reached the edge.

If I turn to poverty, poverty in Wales is deepening and the poverty rate amongst unpaid carers is at 31 per cent, which is far higher than the 22 per cent poverty rate in the wider population. More than one in six carers caring for a person in their household is living in fuel poverty. And while I'm really pleased that programmes like the carers support fund are successfully and proactively reaching thousands of carers most in need of support, it's really concerning that almost half of them accessing this emergency support for food and heating are not connected to any other service at the point that they present for support through the carers support fund.

If I can speak very briefly about young carers, when using 20 hours of care as an indicator, the proportion of young carers and young adult carers in Wales providing significant levels of care increased from 15 per cent to 27 per cent between 2011 and 2021. For those providing 50 hours of care a week, this increased from 12 per cent to 15 percent. I think we can all agree that 50 hours of care is substantial for anyone, let alone a child juggling that with full-time education. The census also made clear that young carers are more likely to live in areas of high deprivation than their peers without a caring role.

In terms of education, young carers in Wales miss more than six full school weeks each year in comparison to young people without caring responsibilities, who miss about 13 days. It's no wonder, therefore, why young carers are achieving less at school and they are less likely to go on into further and higher education, and if they do make it to university, they're less likely than their peers to actually graduate.

It's really difficult to get an understanding of what local authorities and regional partnership boards are commissioning. Statutory partners may fund a really small part of a service, but the significant charitable income that's underpinning the delivery of that service all too often goes unrecognised, and the importance of capacity building and sustaining this vital sector is really undervalued.

Because of the significant demand and the financial pressures that we're seeing right across the system, many respite services are volunteer led or saved only for emergencies or for hospital care—and I know my colleague Greg has some really strong evidence to that effect. Availability of respite provision is patchy at best, with too many carers telling us they simply cannot get a break.

So, in short, Chair, I think the context to this really important inquiry is one where too many carers are simply unable to access the support that they deserve and that they have a legal right to.

Thanks, Kate, for capturing that. That chimes with what we've been hearing. Rob, would you like to add to that?

There's not a great deal more I can add to that, to be honest, because that's a pretty effective summary. Things are getting worse. Anecdotally, we see that through our services, but also, that's what the research tells us. In the last two years, our 'State of Caring' survey has shown a 53 per cent increase in the number of carers cutting back on things like food and heating. Fifty-three per cent in two years is a shocking statistic and shows a trajectory that is going in one direction; it's not a good way. Similarly, 33 per cent more carers since 2024 are using credit cards, loans or overdrafts to try and cope with the cost of caring as a direct result of their caring roles.

And it's not just about finance and money, though that is a really important part of the support that carers need and deserve, but there's been a 39 per cent increase in the number of carers reporting bad or very bad mental health since 2023 as well. So, these are some really stark statistics. All the evidence that we're collecting shows that this is going in one direction and that's the wrong direction wholeheartedly. So, it's a bleak context.

Thanks, Rob. Greg, would you like to add to that?

Yes, Chair. I would just like to echo what has been said. Every year, we have contact with around about 5,000 carers, but we know that in our county, there's another 14,000 people who have caring roles who we aren't able to reach, just because what we have as a resource to be able to meet that need is consistently oversubscribed.

I'd echo what Kate has said and I'd echo what Rob said: we are seeing more and more people coming through our service, and we are seeing more and more people coming through with a complex need. There's a real sense, I think, that services are overloaded. People are being referred to us just as a means for those organisations and services to say that they've been able to do something for somebody. I think that's a pretty desperate place to be, where people are signposted around the system without ever really seeing anything tangible as a service that they're offered.

Just to give you an example, we have a parent carer service that works with families. It works to support the parents of young carers, and those young carers have, very often, complex needs. They're on a transition between child and adult services. We saw and had contact with about 82 families in the past year. Out of those, we completed 33 carers' needs assessments for those families. But we know, from that group, only two people ever received any form of service. One family had an occupational therapist assessment, the other family had a series of direct payments that didn't necessarily deal with their underlying issues, and I think that's the problem.

I think, for us in the third sector, we're increasingly getting asked to plug gaps. We're increasingly getting asked to meet crisis need without really having the time or resource to be able to tackle some of those deeper underlying issues—poverty, deprivation, isolation. We see an awful lot of carers who come to us who have almost been trapped in the system. As I said, they're going around, being signposted from organisation to organisation, without actually ever having a service. Or there are people, as was said earlier on, who come to us and say, 'I've had to fight, I've had to beg for everything that I need, and I'm still not able to get a service.'

Thank you, Greg. Mabon.

We would define an unpaid carer as anybody that has caring responsibilities—from taking somebody to appointments, picking up shopping, things that might feel like they tread lightly on your life, right the way through to people that are providing 24/7 round-the-clock care and doing things that you would expect medical professionals to be doing—operating equipment, administering medication—people who are not able to do anything else other than provide care because the system doesn't support them to be able to do so. We would deal with anybody within that very broad range. The census reckons there are about 310,000 unpaid carers in Wales. We think that's significantly lower than the number. We conducted research via Carers Week that reckons there's probably closer to 500,000 carers in Wales. So, it's a significant constituent part of the nation.

Thanks, Rob. Everybody was agreeing on that, so it's a really clear definition. Just recognising all of the pressures that, certainly, Greg, you outlined, and we know the context of how challenging and the increased pressure, has the third sector got the capacity it needs to deal with all of this? Who would like to come in on that?

I can start. You might have some more to say as well.

I think everybody wants to have a go, so you're welcome.

I'm just speaking for Carers Wales. It's difficult to speak for the whole sector. I know the Wales Council for Voluntary Action have some good stats on this, so I would recommend having a conversation with them as well. But we've been flat funded on the services that we deliver on behalf of the Welsh Government since 2022. We've worked out that, if we were to receive inflationary uplifts year on year, we'd have an extra about £50,000 to work with, which would help us do a lot more. We consistently overdeliver on our responsibilities, every single year, against what we're scheduled to do, but we're getting real-terms cuts every single year, and I know that that's the situation for lots of other charities across Wales doing similar work. Obviously, there are organisations and charitable organisations that are commissioned, like ourselves and like, I'm sure, the trust and network partners, to deliver services on behalf of statutory services and on behalf of Government. But all the evidence shows that, whether it's statutory services, whether it's third-sector organisations, capacity and resource is just vastly outstripped by demand, and that's only going one way as well. We're only seeing more demand and more complex demand, so the short answer is, ‘Absolutely not, no.’

Greg.

Yes, I would echo that. Just to give you an example, in one of our core funded services, we've had the core funding for about the last 10 years. It's not changed, really, that much. We've had relatively small uplifts. We receive about £119,000 a year for that core service, and that is to meet the needs of adult carers. We calculated that, in real terms, as Rob has just said, really, that if that funding had kept pace with what it probably should have done, that funding should now equate to around about £180,000 for the service. So, we often talk in the organisation about having to look at resources and spread the jam ever more thinly. That really causes us concern, because we're really keen to reach out to as many people as we possibly can, but we don't want to compromise the quality of anybody's experience when they actually come to work with us. But it's a really tough decision that we have to make where, probably for the first time in some of our services, we're not quite saying 'no' to people, but we're having to say a qualified 'yes' about what we're able to offer.

And probably the irony for me, just around the question in some respects, is that we are massively overstretched, we are massively oversubscribed across all of the services that we deliver, but we do have the expertise to be able to deliver those services. We do have the reach into those local communities, we do have the connection with people at the local level. Some of the frustration for us is that, very often, commissioners may not come to us as a first point of contact. They may look to other providers. They may look for something new when we're almost crying out to say, 'You know us. We've been around since 2009 as an organisation. We provide quality, we provide reach', and yet there's sometimes still a bit of a hiccup in how people come to us, or services are commissioned without there seeming to be a clear vision about what that service commissioning is meant to address.

So, my answer would be twofold, really, I guess: we don't have the current capacity to be able, probably, to work with significantly more people. So, as I said, those other 14,000 people who we know in our county who need our services, we're going to struggle to meet their needs, but we do have the expertise and the reach to be able to do it. It's almost, 'Give us the tools and we can do the job.'

Yes. Thanks for that. Kate, do you want to add anything before I bring James in? 

Yes, I'm happy to. So, in terms of capacity across the sector, we have network partners across Wales who consistently tell us that they're either receiving flatline funding, insufficient funding or funding that comes very late in the year. So, decisions to issue funding in the autumn with 'Please get this money out of the door by quarter four', which doesn't allow for effective long-term planning and it keeps it as very much a sticking plaster, which creates real instability in the sector. So, if we think about recruitment and retention within these vital services, it's really, really difficult when the funding streams are inconsistent and not to the level that we need them to be.

When we look to capacity, as Greg describes, these community-based services are reaching into their areas where there are high levels of need and potential distrust of the wider system and a need for a third sector interface, and they're doing amazing work, but they're having to do so where demand far outstrips supply, and that's a very hard thing to manage when we think about making sure that carers are aware of their rights and they're asking for support. That does surface the demand, and we're really seeing that, which is a very difficult thing for services to manage. As Greg described, the third sector is really efficient, creative in how we deliver differently, but we can only do so much with what we have. So, I think there's a real call to look at that across the long term: how are we seeing the third sector as a crucial part of delivering rights under the Act? We simply can't do it without them, so we need to put them on an equal footing to statutory partners.

Yes. Thanks, Kate. James.

Thanks, Cadeirydd. As you said, you've had cash-flat funding from the Welsh Government for years—since 2022, I think was what you said. I'm just interested in how much extra additional funding you would need to meet the demand that you've currently got. We all know that there's no extra money, really, in the system, but I'm just interested in whether you've done any work on where the potential money could come from to meet the additional demand that needs to go into this service.

That's a very challenging question, and I think that the number would be a scary number, because the demand is so high. But I think that we have to be very cautious about not letting a scary number put us off the small steps that would contribute to a more positive outcome in the here and now. So, even with the same amount of money, better commissioning over the longer term with that money would result in better outcomes. So, I think that that is a first step that could be taken: understanding need at a regional level, and making clear plans as to how we're going to address the need and the gaps in services would really help. Better integration between health and social care, so that there isn't waste in the system and spend when people reach crisis, would absolutely help free upfront for the more preventative work. And I think what the committee has heard through these sessions is that we're not getting to the preventative piece and that's where you can make the savings.

Yes. Greg, do you want to come in?

Yes, just a quick one really to echo what's been said, I suppose, in answer to the question. I think one of the things for us as a fundamental question—and it's probably, I think, something that'll be picked up a bit later on in the questioning—is probably the role of health in this. I think we're probably perceived purely as carrying out a social care function, but we're clearly not, because we would argue that we keep people out of more acute health services in terms of respite, in terms of the sitting service that we actually provide that keeps people out of hospital. At the other end of things, we work very closely with primary care on when people need to go back home, so working with them on a pathway.

And I know it's not always down to resources and the money—I'm not always a fan of just saying that's what it is—but I think, for us, the challenge, just to answer the question that was posed, is: where does health sit within this? We receive very little funding from health and that's just an observation. I'm not here to make any sort of further inference about that, but it does make us question health's role in tackling some of these issues, because it might be a social care need that we're addressing, but that clearly has a wider health impact. I think probably, from our point of view, we don't necessarily see the evidence, other than we are told that we're valued. But I'm not quite sure where the NHS properly sits in this whole piece of work, and we would argue: is that one of the routes that could open up some of the funding? We all know the challenges that the NHS is under, so, I just say that as a broad answer, I suppose.

Yes. James, do you want to come back?

Yes, just really quickly, there are two points you picked up on that I'm interested in: you talked about the regional funding and better commissioning, and that all links back to the regional partnership boards, doesn't it? I'm just interested in your views on this. Do you think they're actually fit for purpose for what you need them to do, or do you think that sometimes some of those people around the table have got vested interests in trying to keep some of the funding that they have centrally within their organisations, to help their own balance sheets, rather than sometimes pushing that funding out to the third sector organisations, the people who are actually delivering the really good work on the ground? I'm just interested in your thoughts on that.

There's certainly work to do. So, third sector providers will describe—

You could sit in my job with an answer like that. 

Yes. [Laughter.] But there is work to do. And I think there has been progress made, but third sector providers consistently tell us that they don't feel that they have an equal seat at the table. The example I gave in terms of being given the opportunity to take on funding late in the financial year—it just makes it impossible. So, in terms of influence and engagement through that process, the third sector consistently tell us that they don't have an equal seat, and that isn't good enough when we look at the scale of what's being provided.

I think, just to quickly add to that as well, with regional partnership boards in particular, obviously they're meant to have carer representatives on the RPB, and I think what Kate's illustrating here is a cultural issue within the RPBs that charities aren't considered equally because carers aren't, and they're not able to engage equally. In RPBs, you've got a whole range of often very highly paid, very experienced professionals who have years and years of experience, and then an unpaid carer who has lots of lived experience, lots of experience in relation to their caring role, but it is impossible for that individual, or in some cases more than an individual—there are a couple of RPBs where they share it—to engage in the same way. They're not able to read the meeting papers in the same way, they don't have the spare time to be able to do that; it's not their job, they don't have the context.

So, I think, culturally, if we're to tackle the issue that Kate's describing here, there needs to be a better level of co-production within the regional partnership boards with regard to unpaid carers anyway. Carers need better training, they need more support, they need more time. And the practice across the seven varies so wildly: there are some that literally just will not recruit carer reps to the board, despite that being a legal obligation to do so. So, I think, until we address that sort of systemic cultural issue within regional partnership boards, it's going to be very difficult to adjust that imbalance in terms of resource and capacity.

Yes, thanks, Rob. Greg, you want to add something.

Yes, it's only a quick point, really. I think, from the RPB point of view, I would echo again what's been said. And I think, for us, one of the challenges that we would probably pose is: do we see a vision coming out of the RPBs about what an overarching carers service could look like and should look like? Are we, as the third sector, recognised for the expertise that we could probably provide, or that we could put into that whole arena? And very much, yes, it does feel a little bit at times that carers sitting on those RPBs or when they're asked to do things—I mean, 'tokenism' is probably too strong a word, but you do question the role that carers have. They are supported well from our experience within it, but I think, as I said earlier on, from that point of view with the RPB: are we seen for our expertise when opportunities come up? Do they understand who we are and what we do? I know that might sound a bit fundamental, but on Kate's point about the funding coming very late in the day, it is money that's sort of desperately thrown out through the door without, seemingly, 'Where's that come from? Where does it fit with any broader vision?'

So, in that context of what we just heard, how well, then, is unmet need currently being assessed and planned for? Have you got any views on that?

Yes, lots. So, 'not very well' is the short answer. The paucity of data with regard to unpaid carers and how it's collected across Wales is shocking. If you look at our 'Track The Act' reports, you'll see that we ask local authorities and health boards the same set of questions every year, and have done since 2016, aside from the pandemic. Still, nine years on from the Act being implemented, basic questions with regard to carers in their local area and then how that fits into a regional picture are not able to be answered. There are local authorities who cannot quantify how many carers' needs assessments they could, in theory, carry out over the course of a 12-month period. How on earth are you meant to collect data from unpaid carers and plan services if you can't even figure out how many you can assess? These are basic stumbling blocks at an early stage that just completely set a system up to fail.

I think far more needs to be done to strategically collect data in a more comparable and coherent way, so that we can figure out what the issues are, where they are, apply a level of regional flexibility, but until we have a better understanding of what the issues are on a regional or a local basis, how on earth can we begin to plan services to address them? It's just not at all robust.

Thanks, Rob. I'm going to move this on—. Greg, do you want to add a point on that, please?

Just very briefly, I would again echo that. We do an awful lot of project reporting. We have seven quarterly project reports for a series of projects funded through one principal funding stream. So, we have seven sets of reports. We do an awful lot of project reporting that goes to our partner organisations and service commissioners. We do wonder what is done with that information. We get very little pushback on it. We get very little questioning about it. We're not clear how that necessarily informs service development. We're not necessarily clear how that fulfils some of the vision and the aims that, actually, those partner organisations may want to engage. [Interruption.] Pardon me, sorry.

That's all right. Thanks, Greg. Get yourself a glass of water. 

Thank you.

I'll move us on. Can I invite Lesley Griffiths in, please?

Thank you very much, Chair. Good morning, everyone. I want to talk about the identification of carers, and we've heard, certainly from listening to the carers who've given us evidence, that there are very many missed chances for them to be identified as carers. Some of them self-identified, but it took many, many years. People weren't identified, and it would have benefited them if they had been. So, I wonder what you think could be done, particularly in the field of health. So, I would say start with a GP, to be able to tell somebody that they're a carer and then, obviously, signpost them for support, because I don't think that is happening at the level that we would all want to see.

I can certainly reflect that we've done substantial work to try and support primary care colleagues to identify and signpost carers. Some of the projects and programmes that organisations like Greg's will run have been effective, but it's pockets of effectiveness. It's not systemic, and I think some of the barriers there include how information is shared and stored. So, how are we recording carer data on the system? How is that being communicated and how does that inform, not just how we signpost to third sector support or for a carer's needs assessment, but how you engage that carer as a partner in the provision of healthcare to the person that they care for? Carers are often real experts in the needs, in the healthcare needs of the person that they look after and will undertake, as Rob has already described, very complex roles in terms of managing medication and providing care and support in the home, so it's really important that GPs and all medical professionals really understand the role that the carer is taking beyond just being a family member.

And I wanted to reflect a little bit on local health boards and their role in supporting unpaid carers. As I'm sure many members of the committee will know, the obligations that are placed on local health boards changed quite significantly between the Measure and the Social Services and Well-being (Wales) Act 2014. Between all seven local health boards, they still receive just £1 million a year for their work with carers, and that's a ring-fenced part of the regional integration fund. So, that's £1 million; it hasn't changed in the last decade. In some areas, we see really strong third sector delivered and LHB commissioned programmes. So, an example of this would be Investors in Carers in west Wales and some of the work that we've delivered as Carers Trust Wales, supporting pre-registration training to make sure that the next generation of medical professionals understand what a carer is, how to engage them in the health space and how to signpost for support. However, carers still tell us consistently about missed opportunities to be signposted to support and gaps in understanding about their roles.

To give a little bit of a reflection on what medical professionals are telling us, they have concerns around consent. Consent does seem to be a challenge in terms of sharing information about the cared for, and that's something that we need to work around. As I've already said, digital records, that's been flagged as a real challenge for healthcare professionals, as well as a reluctance to signpost to the third sector, which is something I've found very interesting, and that reluctance sprang from the insecure funding. They didn't know, year on year, what services would be there and didn't want to hold responsibility for that person once they'd identified them. So, a real barrier to identification was knowing, in a busy clinical environment, what to do next and having trust that there was someone to hand that carer on to, to make sure they had the support that they deserved.

Thank you. Is there anybody else?

Greg.

We do an awful, awful lot of work in a range of primary care settings that address a range of health issues that may or may not directly touch on the lives of carers. And I think one of the things that we've observed from that is, certainly, the challenge of getting to sit regularly within GP surgeries—that can be a challenge. We do some hospital-based work as well. But I think it's a bit of a two-pronged fundamental thing for me that we see that health staff at the sharp end of things are really overrun. You know, do they have the time to be able to sit with patients about the wider social care and healthcare needs that they may have? So, what is the quality of the conversation that's going on in that healthcare setting?

Going back to what I said earlier on, I think probably there's a perception in health that we carry out a purely social care function. So, in some respects, why would they know about us? We do a lot of work, as I said, to advertise what we do, to encourage primary care staff to refer to us, to identify carers. But it almost feels—as I said, that two-pronged thing, they are really busy, so do they have the time? And we also see a kind of churn of staff as well; we will go back to various healthcare settings and teams have changed, or the exchange of information between different healthcare teams, for some of the reasons that I think Kate has flagged up, is always a challenge. So, information is not always exchanged, and that may be for a range of issues—it might be consent, it might be because somebody's moved on, it might be simply because somebody's really, really busy. So, we try to work with those healthcare professionals to see what we can do to help them create that time to have that quality conversation and to develop that trusted partnership where we say, 'Look, you can refer to us', notwithstanding some of the challenges that Kate has flagged up in terms of funding. But I think it is that fundamental thing, for me, about are we perceived as solely providing social care or are we sitting as a bridge, as I think we do, in both camps: health and also social care.

Greg, you mentioned before, in an earlier answer, how many carers you have and how many unpaid—sorry, how many unidentified—carers. I think you said 14,000.

That's right, yes. Absolutely.

Did I hear that right?

Yes, you did, yes.

Which is obviously a huge number. And those people are missing out on the support that they could have. So, I hear what you're saying about health and social care, but for me—and this was something we took from the carers—I do think that there is more that can be done in health to identify carers and then be able to provide support, even if it's just posters in the surgery. I've specifically looked in my own surgery to see if there was anything in there, and there isn't. So, I think there is a lot more that could be done.

I agree, yes.

Yes, you agree. Do you think—? There is a lot more that can be done, obviously, but do you think more responsibility should be put on health to provide that support and identify carers?

I think so, because, if they are the primary contacts, which they very often are—. We've been involved in a number of initiatives around ophthalmology, around dentistry, around foot care—some of the things where you think, 'What's the direct connection with the carer?' But carers, as we know, like the rest of us, will approach their GP or their primary care service for a range of other things. Probably health colleagues will curse me for this, because it's something extra for them to do, but I think we would probably see it as their wider conversations with people who are carers. We know that some of the people we deal with have long-standing and almost friendship-based relationships with their GPs, or staff within the GP surgery. It's still always a surprise for me that, when we work with some of those people, they say, 'I've never been referred to a carers service.'

So, I think what you say is right, but I think there is work for all of us to do about raising the profile of what a carer is and how those individuals can be cared for. There's equally the challenge as well, as you know, that people do feel uncomfortable sometimes identifying themselves as a carer. That's one of the things that we work very closely on with the people who come to our services, and we work very closely with partners about how they approach that conversation with somebody. It's not as blunt as asking, 'Are you a carer?', it might be a different way to steer that conversation. But it's that issue, isn't it, about how carers turn up in a range of other health settings, and how those health professionals can look to identify those individuals and create what I think should be appropriate pathways of referral into our services—and I don't just mean us, I mean, obviously, other organisations as well.

It seems to me, as I say, that some of the cultural blockers between, as I said, health and social care—in our experience, anyway—seem to be the challenge that we have to find a way around. We are a social care provider, but we do work within health. We can bring a health benefit to the people that those health organisations, professionals, GPs et cetera are seeing on a regular basis.

What has struck me—[Interruption.] Sorry, Peter. What struck me in this inquiry, particularly with the adult carers, was not only had they identified themselves as carers but they'd gone out and found that support. They'd found something within their area and then got peer support. That's really struck me as something—that people are doing it for themselves.

Yes.

Sorry, Peter.

It's all right. I think Rob and Kate might want to come in on your last question as well.

Yes, just very quickly. I think it's difficult to argue against a greater onus on health services identifying and supporting unpaid carers. We did some research last year for our 'Track The Act' survey, and asked carers over a 12-month period what services they'd engaged with or visited, and 53 per cent said primary care. Councils were down at 20 per cent, and carer charities were 18 per cent or 19 per cent, depending on the local or national charities.

So, it's clear—and obviously this is no surprise to, I'm sure, anyone in this committee, because the same is true of the general population—that carers are interfacing, whether it's for themselves or the people they provide care for, with primary care services first and foremost. So, it's a missed opportunity not to identify carers in that setting at an early opportunity, hopefully, if they've got a lighter caring role, so that they can access the help and support they need as their caring role changes and progresses over time.

I do think, though, there's something around—. We see that, obviously, there are responsibilities on statutory services currently under the Act, but it's one thing to put responsibilities on a set of services, it's another to see services actually delivered as a result of those. If we're going to—. And it's a live conversation as to whether healthcare should take a greater role in identifying and supporting carers, and if we're moving towards a more integrated service anyway then, surely, why wouldn't it? But this has to come with leadership and culture change. This requires somebody to take responsibility of this process, not to just lump some guidance onto healthcare professionals that will sit on a shelf and never be read because they're time poor. It requires leadership and somebody to take control of this and to drive that agenda within Wales more generally, but also locally and regionally within health services. Without that, we're just adding responsibilities that won't be fulfilled, and carers will have a terrible experience.

Anything you want to add, Kate?

I agree with everything thing Rob says, and I have two things I'd like to add. Reflecting on primary care, many years ago there used to be quality outcomes framework points for identifying carers, so an incentive and an expectation that GPs should identify unpaid carers. That doesn't exist anymore, so I think there is a reflection there as to the compulsion for GPs to identify unpaid carers.

It's also worth reflecting that unpaid carers themselves are likely to have higher health needs than the general population, so they're more likely to be presenting in these universal services. And I wanted to reflect personally a little bit not with director hat on, but with mum hat on: I'm a parent carer, and my child has accessed services over the last 16 years from ophthalmology to audiology. He's autistic, he's under the children's hospital for Wales. I have never once been signposted to anything that would suggest that I am an unpaid carer or that I can access support. I'm looking for it, I'm there looking for that poster, I'm looking for the question. I've never been asked, it hasn't been recorded and it is relevant. So, I just think that kind of lived experience is really important.

Yes. Thanks, Kate. Lesley, back to you.

Just my final question is on young carers and the roles that schools play, and the group of young carers who gave us evidence, it was really striking, the young man who had moved up a year in school—. So, whereas he'd had a very good form teacher who knew he was a young carer and I think he was with him for three years, then suddenly he's in a new class, a new year and he's not getting that support. One of the other young carers, her teacher didn't understand what a carer was. She just assumed that she went out of the class to take a phone call or that she didn't do a piece of work. There wasn't that understanding. What role do you think schools should play with our young carers to make sure that they get that support and that they understand the role that they are undertaking at home?

It's a really important question, and I think my reflection on that evidence session with those brilliant young carers was their expectations were really low, that actually what they were describing as good support was somebody listening or signposting them to a foodbank. It wasn't comprehensive support to make sure that they achieved academically to their potential and went on to further destinations that met their aspirations. That wasn't the level of support they were looking for. It was just someone to talk to.

So, I think, looking across the piece, too many young people tell us that they're not identified and supported at school. From issues such as the loss of education maintenance allowance—a number of young carers will tell us that they lose their EMA because they're missing school as a result of their caring role. Schools can use their discretion, but they don't. It's really, really inconsistent for those young people.

Young carers are also telling us that they can be asked to look after siblings at school, which I think is a really interesting challenge, being called out of their own classrooms to deal with that young person that has a care and support need and missing out on their own education as a result.

Despite a Health, Social Care and Sport Committee recommendation in 2019, young carers are still not included within pupil level annual school census data, so we can't track that cohort. It leaves us behind England and Scotland, where we have good data to understand the needs and experiences of young carers in education. I think there's a little bit of a reflection of not reinventing the wheel. So, whilst there is some really good practice through some young carers in schools programmes, Estyn's recommendations that flowed through a thematic review undertaken in 2018 are still the right recommendations; they just haven't been implemented. So, I think there's perhaps room for us now to look at school improvement plans and have a clear understanding of how schools themselves can support young carers as a specific group of vulnerable learners within their school improvement plans.

And I think, finally, so many young carers tell us that, fundamentally, their time at school and time learning outside of school is severely impacted by the number of hours that they spend caring. You heard from the young people in committee. They don't feel there's anybody else that can take on that work. And when they describe their access to respite and the things that they wanted to do, things like housework were the barriers. Now, that is something a support plan can provide for. That is something a carer’s needs assessment should direct them towards. So, it's really important that we don't just think about what goes on in school, we think about the pressures outside of school and how we can remove them.

Thank you, Kate. James wants to come in on that and then I'll move us on to the next section.

Yes, very quickly, you mentioned young carers, and that's the part I really care about. I'm just interested—. One of those young people we spoke to also said that they were considering not going on to university, even though they did really well at school, because they weren't quite sure who was going to do the caring responsibilities at home. That's damaging someone's life chances and actually makes them, in the future, potentially economically inactive as well, because they can't go on to the jobs and careers that they want to do. I'm just interested from the organisations that you represent, do you have any data around how many young carers that you come into contact with have had their life chances really changed from not going on to, say, college or university to get those higher education degrees because of their caring responsibilities back home, because other parts of the system haven't backfilled to enable them to do that? 

Yes, absolutely. We can provide you with supplementary evidence that can clearly track that young carers are less likely to go into further education, less likely to go into higher education, and less likely to succeed if they do get there. They're more likely to be economically inactive. 

That would be really welcome. If you could furnish us with that, that would be very helpful. Lesley, is there anything further you wanted to add? No. Okay. Thank you. Can I move us then on to Mabon, please? 

We ask this of local authorities every year via 'Track The Act'. The No. 1 response to that question, from their perspective, is capacity. The local authorities that do submit responses, where they can broadly quantify how many assessments they're able to deliver over the course of a year, always fall significantly short of the carer population according to the census, which, as we know, is likely to be an underestimate. Whether that's internal budgeting or whether that's a lack of resource from Welsh Government, there is a lack of capacity within local authorities to be able to deliver assessments.

As you rightly point out, an assessment itself can, for some carers, be a useful experience in terms of identifying other support, but actually most carers who get an assessment are clearly at the heavier end of their caring role. There's clearly going to be a statutory need for them to have some sort of support from the local authority, but a pitifully low number of carers then go on to get any sort of support at all.

As has been mentioned by colleagues, we often refer carers to local authorities or services to get an assessment, and we see that carer again, months down the line, when they're referred back to us after an assessment to go and get some information and advice. There is not enough capacity to be able to meet the needs of the carers at a local level.

In terms of the reasons why, there's a wealth of research behind this. This committee will probably make recommendations that will have been made in our 'Track The Act' reports over the last nine years, in the ombudsman report last year, in the Welsh Government's own evaluation of the Act in 2023, and in the Health, Social Care and Sport Committee report in 2019. We don't need to do any more research on what the issues are behind the lack of carers' needs assessments. Honestly, if you ask a carer, they will be like, 'You know what the problem is—do something about it.'

What we need to see is a good, solid plan in place. There is an improvement plan via the ministerial advisory group, which we welcome. There are some good, positive steps in that with regard to looking at good practice and scaling and spreading that across Wales, but to be very, very clear with this committee, the spread and scale of good practice alone will not go far enough to address the issues that we face. This is a significant implementation gap and requires more capacity, more resource and greater leadership to resolve.

I agree with Rob entirely.

I agree, yes. 

I think the implementation gap, as you describe, is the biggest challenge. I think it's really important to reflect—. A carer's needs assessment isn't worth anything unless it comes with a support plan, unless it changes something for someone. The obligations on local authorities are to assess when they anticipate an eligible need. The number that are having an assessment means somebody thinks there is a need. That drop-off rate between assessment and support plan—and, I should say, an already pitifully low assessment rate—is a concern. That's a measure that really matters: the number of carers' needs assessments relative to support plans.

Anecdotally, we certainly hear that social workers share they don't offer assessments when they know there's no support to forward people on to. If there isn't something that can meet the presenting need, they may not want to undertake that assessment. I think we heard really strongly from carers to this committee their frustration at the lack of outcomes from assessments. I'm sure Greg will want to come in and discuss that challenge of people being stuck in a signposting loop.

Just to close, really, if we look at the WLGA forecast—that £201 million gap they see in their budgets for 2026-27—they've indicated that they're going to have an inability to meet their statutory duties. So, to me, that's really concerning, because carers and carers services are already struggling. There isn't the support available as a result of a carer's needs assessment, so any further cuts could be really catastrophic.

Yes. I think, without additional capacity and resource, it's impossible to rectify the situation that we're in. But that also needs to come with good data, collection of data, and monitoring and evaluation of that. There are pockets of good practice that can be spread and scaled, but, fundamentally, without additional resource, there's no chance of meeting the legal obligations that local authorities have on them.

It's really difficult to say, because the data that we have available to us with regard to the gap is so poor. So, until, again, we can get a grip of how bad it is, it's difficult to put a price on what it will take to be able to address it. So, it's a bit chicken-and-egg, unfortunately.

So, we know that about 64 per cent—. So, the carers report in 2024 showed that about 64 per cent of current and former carers in Wales told us that they had no choice but to provide care, because there were just no other options available. Without it, the person that had care needs would have been in a very difficult position, and an even more difficult position as well for the carer. It comes back to capacity and resource again. Clearly, there's not enough capacity and resource within the system to be able to meet the needs of people with care needs and their carers—there's just not enough. Carers are having to step up and plug the gaps, and are just often being left to get on with it, because there's not enough capacity and resource to be able to support them.

I think, in an ideal world, where a carer is either unwilling or unable to provide care to somebody, this is what an assessment should pick up, and, therefore, a greater prevalence of assessments is needed. But, if that is the case, and it becomes clear in an assessment that a carer is either unwilling or unable, or both, to provide care, then really statutory services should put in place a package of support that relieves that carer of their duties and their caring duties, and allows them to not provide care, whether they're unwilling or unable. But, as it is, that isn't happening, and carers are having to provide care because that support just doesn't exist.

So, a lot of carers, as you'll have heard from the evidence sessions, are simply left to get on with it. Anecdotally, we know lots of carers who are refusing assessment because they're in work and they have an income. We're driving people out of the workforce, because when they ring up for an assessment, to have any sort of support, they're told, 'Well, actually, there are carers that are financially worse off than you, and so we have to prioritise them', which is just absolute insanity. But then also, on top of that, there are people who are discharged from hospital in just the most horrendous, unsafe ways—people who are literally wheeled out of hospitals and put into cars of unpaid carers, or sent home in ambulances without any communication. So, yes, we're a long way from where the Act is telling us that we should be.

Can I bring James in briefly, and then I'll come to Greg?

On this point of willing and able, the elderly population especially are under severe pressure. A lot of them have worked their whole lives, have got savings, and all the rest of it, are just getting by with a bit of a pension as well, and don't want to lose their savings. Do you find sometimes, through those carers as well, that people are being, I wouldn't say forced into doing caring, because they're worried, if they have to put that loved one into full-time care, about losing their savings, potentially having to sell their homes to pay for that level of care, especially people who I represent in rural areas? I see that as probably more prevalent, especially in the farming community as well. Is that something that you pick up through the work that you do, that people are being forced to take it on, even though they're physically probably not able to do so, because they're worried about losing their savings, losing their home and the rest of it?

I think older carers are less likely to identify themselves as carers. They're less likely to accept that as a term and therefore to understand their rights. I think there's a real importance in making sure that older carers specifically understand their rights in terms of barriers to accessing support beyond identification. Caring itself isn't a bad thing. Caring without support is a bad thing. So, I think I would reflect, particularly in rural communities, the choice not just financially, but distance-wise, physical distance to the person that you love, is a real barrier. If that older carer wants to care for the person they care for at home, they should be given the support to do so in a way that is not detrimental to their own health and well-being. This committee has heard about people having to physically carry and care for people in a way that they're not able to. You've heard about people missing appointments and not being able to look after their own well-being, and that is never more true than for older carers.

Members, we've only got—. We're not making the progress that we need to, but it's really fascinating and it's really interesting. Greg, I'm going to bring you in, and I'll ask Members to be a little bit more succinct, so we can cover as much ground in the next 20 minutes as possible. So, Greg, would you like to come back in?

Yes, just a couple of quick points, really. Going back to carers' needs assessments, I think it is a capacity issue. We've had the local authority in our area effectively concede to us they're only ever able to pick up people who we refer who have really acute and severe need. They weren't able to define what that actually meant or what that actually constituted. I know it's only an anecdotal comment, but they are clearly feeling the pressure about being able to pick up all of those people that actually have those assessments, which does lead us, or has certainly led us as an organisation, to question, 'Well, there is an awful lot of work that goes into carers' needs assessments—we used to carry them out at one point—and very, very few people, as we've said, ever get any service from that.' So it's almost like a question of: what's the point of actually going through that process if there's no end product?

And particularly on the point that was raised there about older carers, we do have a developing cohort of older carers who are caring for ageing adult children. We see issues around deprivation, around poverty, around worry and concern about what's going to happen to that adult child that these people may have been caring for pretty much all of their lives. It's a real growing concern. We know, anecdotally, that, obviously, we are an ageing population, but we are seeing that growing cohort, really. That's really troubling because those people, very often, have had to battle and fight to get care for that child, and as that child has aged, the needs have changed. And, as I said, there's a real worry within that group of individuals about what will happen, who will actually pick up the support for that child.

Mabon.

I think technically, under the auspices of the Act, carers do have a right to respite in Wales. They have a right to well-being alongside their caring role, and respite is inherently a key factor of that well-being. I mean, I guess you could make the argument that an explicit legislative right to respite would be part of a culture setting agenda, but my scepticism here is that carers have a fairly strong set of legal rights as it is at the moment, and very few of them are having those rights realised. So, I think if we're going to add any more legislation with regard to unpaid carers, we need to be able to do that in the confidence that it's going to make a difference, and there needs to be capacity and resource to follow up and underpin that legislation to be able to make a difference. There's no shortage of carers that we work with in Wales who can tell you their rights and tell you that they should be entitled to respite, who can tell you that they've cared for years without breaks, but then, asking for their rights to be fulfilled at local authorities, often it's like, 'Well, we can't, sorry.'

We wouldn't be necessarily against a legal right to respite for carers, but I think there probably is enough provision in the Act already that we don't necessarily need one. I think, again, it's more capacity and resource. The work that the colleagues in the trust do with regard to the short-break scheme is fantastic. It massively over-delivers against what it set out to do, but it's a drop in the ocean. We know that local authorities aren't delivering enough respite to go alongside that. The short-break scheme was only ever meant to supplement and add capacity to that. But are local authorities moving capacity around inside their organisations now that there's an existing source of respite? We're not sure.

I think the one thing I'd just add to this is that the Carers Week report from 2025 shows that 66 per cent of carers in Wales face disadvantages in being able to take breaks, which is significantly higher than any other UK nation. It's 50 per cent in Scotland and 54 per cent in Northern Ireland—both numbers that are too high, but that's a huge difference. We're doing respite very poorly in Wales. We know that from evidence, we know that from anecdote. And I think anything we can do has to be met with capacity and resource to be able to deliver on it regardless of what bit of legislation we put it under.

And in terms of that legal right to respite, as Rob described, if you have a support plan that captures your needs, then you do have a legal right to it. We're just not getting to that stage.

And to reflect a little bit on the national short-break scheme, we had an independent evaluation of that scheme undertaken by Bangor University, and one of the interesting findings in that, despite the fact that carers—the 65 per cent of them that had a break through that scheme—were caring for 50 or plus hours a week or more, most of them hadn't had a carer's needs assessment, and if they had, they hadn't been asked about respite. And I think that's a really interesting figure—that even if you've gone through the process, you haven't had a proactive offer. So, I think, potentially, there is something that can be done, not denying the resource and capacity piece, in that active offer—how we have good conversations with carers, who often will limit what they're asking for because they know the demand and the pressures on the system.

To speak a little bit about the short-break scheme, another interesting figure from that is that 82 per cent hadn't received a break in the previous year—really high levels of people not accessing any other support through their local authority. And, as Rob described, the short-break scheme is there to complement, to be in addition to what local authorities should be providing to carers.

And I would say that there is some level of concern about the regional partnership board element of the national short-break scheme, the transparency around how that is spent and how data is recorded and reported, and the extent to which that may be being used to backfill local authority provision—it shouldn't; it should be in addition to what was already there—and I think it's very important that we have national visibility that that investment by the Welsh Government is providing additionality, not providing backfill.

Thank you. Mabon, if you don't mind, I'll move on to invite John Griffiths in, please.

Thanks very much for coming in to give us evidence today. You've already said quite a lot about the impact on carers of their caring responsibilities, but I wonder if I could ask you about a few other matters so that you could perhaps add a little? First of all, we've often heard from carers about the struggle to prioritise their own health given their caring responsibilities, and often even attending health appointments is difficult. Could you indicate to the committee any specific changes you would suggest to us to deal with those issues?

I think there's probably a couple of ways you could go about this, aren't there? I mean, first and foremost, you have to be able to take a break from your caring role to be able to go and access appointments. You know, it's not always appropriate to take the person that you provide care for with you to an appointment. So, there's an issue here around breaks and respite, which directly feeds this problem and then creates situations where carers then present into the health services in cases of emergency, and we're inherently missing the preventative point of the Act as a result of this. So, breaks and respite is a key factor to being able to address this issue. The other one is making services more carer friendly and ensuring that carers are given more flexibility with regard to making their appointments and being able to attend treatment—given flexibility and priority even in some instances to secure appointments that are convenient for them and the people they provide care for. So, there are two ways there that you can address the situation. But, I think, until there's a point where carers are able to have the respite or break, that they can leave the person they provide care for to go and attend that appointment or receive treatment, it's never going to happen.

Replacement care is essential for unpaid carers to be able to access any kind of health appointment, and I think, reflecting on how carers cope when receiving treatment for their own ill health or recovering, they need to be able to access a carer's needs assessment quickly, not to sit on a waiting list for a carer's needs assessment whereby that time will have passed and the need will have changed. So, a more responsive system that can meet emergent or emerging need would really add value.

And I wanted to reflect a little bit on what young carers have told us specifically in terms of access to child and adolescent mental health services and therapeutic interventions. They very strongly described that they would like to see more access to mental health support for themselves and for those that they care for.

John.

I think Greg wanted to come in, Chair.

Sorry, Greg.

Yes, please, if I could. I think, on this point, it is, for me, about practical assistance for people around being able to meet some of those basic needs. Again, some of the carers that we see have their own health conditions. We see ageing carers as well who are really concerned about their physical well-being, about their mental health.

As a practical example, we actually have a sitting service that is led by volunteers. We have provided 207 sits so far this year for people that equate to around 3,000 hours of time, being able to sit with the cared for, which allows those carers to be able to attend health appointments, which allows those carers to have that very brief period of respite. And we're only talking about a two-hour break at a time, but some of that is really critical to maintain the health and well-being of the carer. So, I would say that a much wider spread of service of that type is real practical help that we know we have carers coming to us crying out for—'How can I find the time? I have urgent health appointments. I have a series of health appointments.'

And I think the other thing, linked to that for carers, as well, is wider availability just in terms of counselling. We also have a counselling service. We delivered 800 counselling appointments to 136 carers over the course of last year. Some of those counselling sessions are for, obviously, varied need, but we found that they've been a real significant practical help for people around being able to enable them to maintain their caring role. So, I think, from this, there are probably some quite simple and effective interventions that could be provided that would keep carers well, because we know that's a primary concern that they have. If we keep the carer well, the cared for is better cared for, and it avoids any breakdown in that caring relationship that may lead to people going into hospital, into more acute services, and those sorts of things.

Thanks very much for that. I think even the basic practical steps that are relatively easy and quick to achieve are really important for us as a committee, in terms of looking at the way forward.

So, Greg and Kate, you touched on some of the services available in terms of mental health and well-being, and we've heard from carers and young carers that that responsibility that they have to care does impose strain in terms of mental health and well-being. Is there anything else that you could point us towards in terms of mental health and well-being, other than what you've already mentioned, that we ought to consider?

I think it's important to reflect on the evidence that I described earlier from Siobhan O’Dwyer in terms of rates of suicide and thinking about the suicide action plan for Wales, and ensuring that carers are specifically considered there.

Greg, did you want to come back in?

Yes. I think, practically, there's probably more work for all of us to do, and, I would say, certainly in terms of our organisation, probably a better interface within our services and third sector agencies that provide that well-being support and the mental health support. We can do more work, I think, on that, on working on those relationships so we're not replicating service and duplicating service. There's a clear cross-over between our service and services that other third sector organisations actually provide. And that probably extends as well into, maybe, developing a better relationship or working partnership arrangements with mental health teams, both within social services and within the NHS as well. I think it's probably a bit of a compartmentalisation thing, where we do our caring bit and they have the expertise in terms of mental health. There probably needs to be a much better interface between those two.

Yes. John.

Just finally from me, in terms of financial hardship, again, is there anything in particular that you'd suggest to us in terms of steps that might be taken to deal with the financial hardship that carers and those who are cared for face?

Not to let the Welsh Government off the hook here, because I think that there are things that the Government can and should be doing better to better support carers in financial hardship, but, realistically, the levers to alleviate the levels of poverty and deep poverty that we see among unpaid carers probably sit at a UK level and are probably most efficiently administered in Wales via the benefits and welfare system. So, I think that we would like to see the Welsh Government take a more strident step with regard to its representations to the UK Government. There were conversations last year around the carers allowance overpayment scandal, for which the context then changed when there was a change of Government in Westminster. So, I think we would like to see some pretty practical steps with regard to making representations to the UK Government to demonstrate that the system is not working for carers in Wales. 

That said, there are some things that the Welsh Government can and should be doing. If you look to Scotland, Scottish carers receive a supplement to the carers allowance, which is equivalent to an additional £587 per year and arrives in two lump sums. Now, obviously, the devolution framework is slightly different in Scotland to here, but this is certainly something that the Welsh Government can do and should be doing. There are about 60,000 carers in Wales who receive the carers allowance—so, not all of them, and the eligibility criteria is an absolute mess, and I know that we haven't got time to get into that. But there are things that the Welsh Government can and should be doing. Just linking in to something that Kate said earlier about overarching strategies, we know that carers are significantly more affected by poverty than the general population in Wales, where poverty is already a sticky issue. When we're planning policy interventions relating to poverty, we need to make sure that unpaid carers are a central part of that planning process and that it's co-produced with carers as well to make sure that it's rooted in reality and works for them, too. 

Yes. Thank you, John. Can I bring James in? We'll try to focus on some solutions now.

I've got one question first, Cadeirydd.

Well, we're scheduled to finish in three minutes, but we'll just stretch it into the break time a little.

I have two questions, if that's okay. We saw yesterday the Welsh Government launch their dementia strategy, and we do know that there are a lot of older carers and carers who are looking after people with dementia. So, I'm just interested in how you think that that strategy links to the strategies that we've got around supporting unpaid carers across Wales and how they interface together to make sure that we're not going off on one tangent with one strategy and another tangent with another. How do you think they can interface better together?

They're not as connected as we'd like them to be. I think that we would say that for all strategies. They do tend to run in parallel. I would say that the ministerial advisory group has been looking at the draft strategy for unpaid carers, as Rob has already referenced, and there is a specific section within that draft looking at the interconnected policies. But that's very theoretical. We have to look at the practice, when services are commissioned or practice is delivered to deliver the obligations or what is set out within policies. That's where the connectivity needs to happen and be supported to happen. And I think that that comes back to Greg's point around vision—we need a stronger vision for unpaid carers, a stronger vision for our communities, and connecting it in in a more holistic way.

Lovely. My final question, to get us back on time, Cadeirydd, you'll be very pleased—

It's all right. I'm going to stretch us for five minutes, if it's okay with you.

Marvellous. There we go.

Let's not beat around the bush, we do a lot of talking, inquiries, there are a lot of warm words, we have strategies, there are warm words from civil servants, warm words from Ministers going back decades on how we need to improve things for unpaid carers and the role of caring across Wales. I've been here five years and I don't see any change from the moment I walked into this building to where I'm sitting now, hearing the same things over and over again and we're not getting anywhere. So, my question to you would be: if there are one or two things that could really make a difference quickly, what would they be?

Good question.

I'll try to keep it quick. 

You can all have a go on this one.

Data collection, monitoring and evaluation are key. Until we have a better grasp of what the data is telling us with regard to unpaid carers, how on earth can we shape interventions to begin to address the problems they face? So, better collection of data in a more coherent and comparable way across Wales. That's going to require leadership and drive from Government to co-ordinate that. That should sit with Welsh Government, not with regional partnership boards or local authorities. Then, obviously, we've talked about capacity and resource, I won't reiterate that, but just to flag it.

Then, the other thing I would add is just a general awareness of carers. We've talked a bit about the stigma of caring roles. I know the carers who came and gave evidence have said that as well. If you compare where we are with unpaid carers now, compared to where we were with, for example, mental health 10, 20 years ago, the conversation and our societal understanding and acceptance of it has moved on significantly. They're not the same. I'm not seeking to compare apples with oranges. It's that wider understanding of unpaid caring done in a culturally competent way—because caring looks very different depending on what community in Wales you're talking to—and having that greater awareness that people can identify as unpaid carers at an earlier stage, so that they know that, when they need it, if they need it, support is and should be available to them, and they can go out and seek it. That will be key as well.

Yes. Kate.

Absolutely. I'll build on Rob's call in terms of data and having the evidence we need. We need better data. There are things we already know. If we just look back to the last committee inquiry into this very subject area, we know what good models look like. We know there are some services you will always need. Every local authority should have a young carers service, I think we can all agree to that, but they don't all have a commissioned young carers service. We know that there is a range of services that we can predict there will be a population need for. For me, I would reflect on the value of organisations like Greg's, like the Neath Port Talbot carers service. We know they do an amazing job. We have the evidence to demonstrate the impact that they have. The challenge is sustainable funding and that long-term, sustainable footing. With that, the third sector can generate more income. It's something we're very good at. We're thrifty in how we spend, and we generate income to go alongside, but we need that core to keep us going.

Yes, thank you. Greg, you can have the last word.

How long have I got? Seriously.

Two minutes.

Two minutes. There we go. All right. I think absolutely, for me, for us, it's those practical solutions. It's about, as I said earlier on, if you give us the tools in terms of resourcing, we can do the job, because we can evidence that we can. What we can't do is continue to spread the jam ever more thinly. I think there needs to be a bit of a paradigm shift between—. We are filling the gaps, we are meeting the crises, we are preventing things getting worse, but not to a preventative agenda, because we're picking stuff up pretty late in the day. So, there needs to be that paradigm shift towards generally more preventative-based services that allow us to be able to intervene and provide those helpful practical solutions, some of which have been identified, to carers, because those are the things that actually make a difference to people's lives. I think we are trapped a little bit in what feels like a bit of a doom cycle. I don't mean that, necessarily, but it is all about crises, it is all about plugging gaps. It is looking to plug gaps. Are we trampling on the toes of providing a statutory service? Because sometimes it kind of feels that way. It needs to be that shift.

Yes. Thank you, Greg. Can I thank you all? It's been an invaluable session. We've covered a lot of ground; sorry we've had to rush things on a little toward the end. There will be a transcript available for you to check over. If you find anything you're not comfortable with, please let us know. Thanks again for all you do, and for taking the time to come in and talk to us today. Thank you very much. I'm going to move us into a short break now for 10 minutes. Okay.

Good morning and welcome back to the second part of our Health and Social Care Committee, where we're carrying out an inquiry into improving access to support for unpaid carers. This will be our fifth panel session, with our local authority representatives. Can I welcome you all here today? I'll ask you all to perhaps introduce yourselves. Can I start with Jane, in the meeting room?

Good morning. My name is Jane Gebbie. I'm deputy leader and cabinet member for health, social services and well-being in Bridgend, but I'm here in the capacity of the Welsh Local Government Association spokesperson for health and social care.

Many thanks. Claire.

Bore da. Good morning. I'm Claire Marchant, corporate director of social services and well-being in Bridgend, but I'm here in my capacity as cadeirydd of the Association of Directors of Social Services Cymru.

Thank you. Catrin.

Bore da. I'm Catrin Perry. I'm the chair of the all-Wales heads of adult social care. So, I'm here in that capacity today, but I'm also the head of adult services in Conwy County Borough Council.

Many thanks. And Dilwyn.

Thank you. Diolch and croeso. If it's okay, I'm going to lead us through, and start with some questions, if I may. This is a really important inquiry. We've heard a lot of harrowing evidence from carers, and there is a need for us to dig deep under some of these issues, which have been around for many, many years and we seem to be struggling to get on top of. So, if I can start with current context, as I said, we've heard some powerful evidence from unpaid carers about the struggles they're facing and their desperation—and it really is desperation we've noted, with carers talking about how they're having to use words like 'fight' and 'beg' for health, in a way that they'd never felt they had to use before. I just wondered what your response is to this and your assessment of the severity of the current situation for carers. Jane, would you like to kick off?

Thank you very much, Chair. I suppose the first thing I'll declare is I'm an unpaid carer myself. Both my parents live with me; one has Alzheimer's and the other has physical disabilities.

I think, whatever we're doing in relation to carers, we need to understand the impact on them. One of the things that we've noticed, and that's purely from my own journey, is that we always ask the person that we're giving care to what their needs are, not what the unpaid carer's needs are. So, I think that's a conversation—and I know both Claire and I have picked that up in social services in Bridgend. But, for me, we've got an ageing population, and we know that there's more and more complexity in relation to needs. We have an early intervention and prevention strategy; I would also tag on 'innovation' as part of that tagline now. We are desperately in need of additional resource and capacity in that regard.

If we know that we've got an ageing population, we know that the amount of hours that we will need to deliver is going to increase, and it's increasing exponentially. When you look at every population needs assessment, across Wales, all the indications are that, I think it's by 2030, we'll have 20 per cent more over the age of 55 that we're going to have to deliver more services to. So, there is wider context to this. During austerity years—we're all very aware of that; I've been before committee before, and I've given evidence in relation to that—we did prioritise statutory services as council leaders. We had to. And I would suggest that anybody with an unpaid status took a back seat.

I think the other thing I would say is, if you're an unpaid carer and you're offered direct payments, as an example, as part of your care package, actually accessing that support for using that money that is there, is supposed to be able to support you—we don't have the workforce now in order that we deliver that. I actually sat at the back of the room and listened to your last session, Chair, and I think one of the things that I picked up was not getting anywhere, and I am looking directly at James when I say that, because it was his comment. Actually, I disagree with that. As council leaders, we're delivering excellent services for some of our carers, we just can't deliver enough of them. And particularly around assessments, around the delivery of respite support services, we would always prioritise residential, long-term stays over respite, and that's backwards, essentially, but we need that provision and that capacity in order to deliver some of that. So, I think that's my first contribution.

Thank you. Can I bring in Claire? Would you like to come in and share your view on the context?

First of all, I'd like to say, if I may, Chair, that it's obviously really difficult to hear, isn’t it, that the experiences of many of our unpaid carers aren't as good as we would need them to be. We know that our whole health and social care system, and indeed all of our economy here in Wales, is dependent on that contribution of the many, many thousands of unpaid carers, and we have statutory duties under our Social Services and Well-being (Wales) Act 2014 that the needs of the unpaid carer are as relevant as the needs of the cared-for person in terms of assessment, in terms of development where necessary, and eligibility for off-care and support plans. So, that would be my opening statement.

I think I would echo much of what Councillor Gebbie has said, in that I think there has been significant progress since the inception of the social services and well-being Act, but I know that there remain considerable challenges. ADSS Cymru has been commissioned from Welsh Government to develop an action plan, and our colleague Alyson Hoskins, who can't join this morning, from Blaenau Gwent, is the lead in terms of that action plan, particularly around how we identify, how we record and how we support carers assessments, and how we support the workforce to do so.

So, there is some really good and innovative practice across Wales. There's particularly, I would say, good support in terms of third sector, and the information, advice and assistance that is provided through local authorities to unpaid carers. There's some really innovative work out there in terms of our young carer population, working in partnership with schools and education and leisure services. But I think one of the real challenges has been really embedding the carer's assessment as a meaningful piece of work that gives the carer themselves the opportunity to set out what their needs are, how they can, and how indeed they cannot, contribute to the care plan of the cared-for person, and for that to be really strength-based and a positive intervention in its own right. So, I think there do remain challenges, hence this action plan we're developing at a national level, and lots of work going on in individual authorities.

We'll come back to explore some of that a little further in a minute. I’ll give Catrin and Dilwyn an opportunity just to reflect from your perspectives on things. Catrin, would you like to come in? 

Yes, I would agree with the comments that have been made previously, really. As you said, unpaid carers, really, from our social care perspective are the backbone of care and support in Wales. Without informal carers, the social care system would break, and we know that, and our priorities are supporting informal carers. Unfortunately, as has already been said, we don't have the resources and the provision across Wales consistently to meet the needs of those carers. As Claire says, that's what the action plan is there to identify and to bring consistency in that assessment. And also, in terms of the support measures that carers are telling us they need that we can actually put in place, working with providers to be able to commission that support for them, and actually fund it consistently as well, rather than stop-start funding. One of the things that carers feed back to us is the fact that it's there one minute and then it might not be there next year or the year after, because of the inconsistency and the lack of sustainable funding for that support. So, yes, I agree with the previous comments.

Thank you, Catrin. Dilwyn. 

Yes, thank you. Thank you, Dilwyn. Thank you for all of that, and I know, as a past leader, how challenging this is for local authorities, but that mustn't detract from our challenge of why things aren't improving at the speed we would like to see. Because, whilst the ADSS Cymru written evidence acknowledges the challenges, it also talks about that significant progress, and, Claire, you talked about some of the innovation, and, Jane, you talked about that there's a lot of innovative stuff happening. But what we've got is a real mismatch in what we're being told from yourselves is happening, and that from the carers and the carer organisations we've heard to date. I've seen people in tears in here, where they cannot access or don't get assessments. They're not listened to. If they get an assessment, they don't get any follow-up. They're not being listened to. They're being ignored. They are almost just at their wits' end. Jane, you would have heard some of the previous evidence about people who are suicidal and everything. So, I'm trying to make sense of the mismatch between what we hear is happening and the good work, which I know will be happening in many cases—this mismatch between that and what the need is. Do you want to reflect more on what you're doing or what you're planning to do to try and change this situation?

I think, across councils in Wales, one of the things that we try and do is understand people's caring needs, because you wouldn't know, sitting across the table from me, that I'm an unpaid carer, essentially. It wasn't until somebody else identified that need that I went forward for an assessment. And I have had that assessment, they did listen to me, and I'm waiting for an outcome now. Do I think it is timely enough? No. But then I know, as the deputy leader and council member for social services, the impact and the absolute demand that is coming through our front doors. So, we can do everything we can to identify. I think one of the things that we are very cognisant of is white Welsh people are being, generally, listened to. We do know that we have a problem in ethnic, Asian, minority communities, and some of it may be cultural. How do we get in there? We can advertise as much as we like, but until somebody identifies or puts themselves forward, or another professional identifies them, then that's really difficult to achieve.

I think the other thing that I would say as statutory provision is statutory provision isn't always the first port of call for anybody in need in our communities. If I look at anybody's health and social care need, as a general rule, they start in the third sector provision, and wherever they finish up—. They might have had statutory intervention in the meantime from social services or from health boards, but they end up in the third sector as well.

We've heard about regional partnership boards this morning. One of our challenges is ensuring that we are paying for the back-office functions of our third sector colleagues. It does need to be written into those contracts, because if they're unsustainable with their chief executive, with their finance, anybody, admin, somebody answering the phone, then their community services are going to fail, because they haven't got that additionality, that support that they're requiring.

Schools—yes, I agree that we should be supporting all of our pupils, and I'm chair of governors of a school, and I know which of my pupils are young carers. But some of those we've identified, not anybody else, and we've identified them because of issues that we've seen in their behaviours or their lateness, when other things are going in their own lives. So, we've identified them to enable different support to go in. I wouldn't suggest necessarily, though, that should be an education provision. I would expect every teacher or learning support assistant to identify needs, but, as a care and support plan, that should be identified external to a school setting is my own—own—opinion. That's not a WLGA opinion; I'm just stressing that. That's my own opinion. As a chair of governors, I don't think I am there to give a health and—. My school is not there to give a health and social care intervention. That's not the same as not having a club for them at lunch time or somebody going in and doing additional activities—that's not the same thing at all. But it has to function outside of education.

Thanks, Jane. Before I bring Mabon in, I'd like to hear—. Claire, would you like to come in?

Yes. Thanks very much, and, again, apologies that I didn't hear the first session this morning. It would have been really very helpful to hear that session and hear what you've heard as a committee and be able to respond to it directly. I think it's really important at a national, regional and local level that we hear what carers are saying and that we act on what carers are saying to us. So, undoubtedly, some carers have really good experiences, that they're identified in a timely way, that they have a good-quality assessment, and, where a service is needed, that that's accessed in a timely way as well. But, you know, the evidence you've heard this morning obviously is reflecting that that isn't consistently the case. If there's one thing that we could address through our action plan, and that we're aiming to address through that action plan, it's to deliver the improvements that we've set out in terms of identification, in terms of practice and ensuring that practitioners have got the resources that they need in order to practice in the way that carers need them to do, to do that consistently across Wales, because, undoubtedly, there will be differences between different areas.

I think, in terms of the deliverables that we're looking to deliver through the work that we're doing, it's that consistency in terms of recording at first point of contact, and to make sure that we've got that early identification to make sure that we're able to intervene early—and some of that can just be signposting to third sector organisations, it can be peer support; we've got programmes that really do give that daytime respite to carers to focus on their own well-being, and with replacement care going into place—to make sure, working with Social Care Wales, that there are the toolkits and learning resources available to both practitioners and to carers, and to make sure that, through the combination of these actions, we've got the quality and consistency of carers' experiences, even within our pressured systems, that we've got systems for regularly understanding those carers' experiences and that feedback loop being a constant one.

Yes. Thanks, Claire. Mabon, would you like to come in?

Thank you, Mabon. Anybody who wants to speak on screen, by the way, put your hand up physically, not the little yellow hand—put your hand up physically and I'll try and spot you. Jane, did you want to respond initially to that?

I can respond, as chair of a regional partnership board. So, we, very much, in Cwm Taf Morgannwg, deliver services with those from lived experience. So, it doesn't matter what we're doing. It doesn't matter what service, what implementation they need, what it is that's been identified through various pieces of work. So, it might be the population needs assessment, it might be the market stability—there's all manner of measures that we use.

I think one of the problems that we have in Wales is that we don't use data consistently from regional partnership boards. I know that, as regional partnership boards' chairs, that is one of the things that we have raised with the Minister themselves, and we've said that we need a simplified version. So, for each grant funding stream, I shouldn't need to—or my board shouldn't need to—present different data sets for different bits of evidence. We should be presenting a data set for the regional partnership boards, shall we say. That would simplify things.

We do have people with lived experience, and they help deliver all our services. So, it doesn't matter whether that's for people with—just the unpaid carers per se, but also those with additional learning needs, their carers, they all come in. So, it's not just about the unpaid carers; it's about every service that we deliver as a regional partnership board. Those voices would be heard throughout. So, it makes no difference.

So, as for CTM, I would suggest that, yes, we're doing pretty well. Do I think it's all grand and rosy? Absolutely not. I don't think any service in Wales is all grand and rosy. I think we're doing exceptional work with exceptional demands that we've never seen before in Wales and we're delivering some excellent services.

Can I bring—? Dilwyn, you indicated that you wanted to come in. I'll bring James in then.

Okay. James.

Chair, just on this point, on the RPBs, because the evidence we've just received, no more than half an hour ago or an hour ago, was very clear that, yes, it may be working in some areas, but there are other areas across the country and RPBs where there is a legal requirement to have carers on the RPBs and they're not there; so, there's some RPBs that are literally breaking the law currently. And also we heard that they're not giving ample time to those people who are there, sometimes carers, to read papers—the support they need to go through some of the very technical information that the RPBs are going through. And, Jane, with your WLGA hat on, what are the WLGA doing to make sure that all the RPBs are providing that support for unpaid carers on the boards, and to make sure that those boards, which haven't got the right support, are getting that support  and representation on there and are fulfilling that as soon as possible because they're not fulfilling the statutory responsibilities that they're supposed to be doing now.

So, I think the first thing I need to advise is that—. So, as chair of the RPB, it's a voluntary role—just saying—

I was vice-chair of one.

Yes, it's a voluntary role. It's a statutory function that we've got to deliver. I think it's a new way of 'doing' is what I want to say. So, RPBs have been around for a little bit, but I would suggest that we're talking about statutory services, and we all know how long it takes to move statutory services along. As the Welsh Government, it takes you five years to get a piece of legislation through the floor, by the time you've done all the scrutiny of it. So, I think they're doing a grand job with what were limited resources and limited scrutiny functions as well in regional partnerships.  And I say that quite deliberately because we do have scrutiny of Cwm Taf Morgannwg. My CTM regional partnership board, goes before the JOSC—the Joint Overview and Scrutiny Committee—for the public services boards, because I asked the chair and the officers to pick up scrutiny of the regional partnership. And I did so deliberately because there was no outwardly public scrutiny of that agenda, I want to say. Because it is an agenda—it's not about service provision, it's about an agenda, and it's a way of doing things. And we are working in partnership, and that's not always easy, and that is a challenge, because health have different deliverables that they have to achieve, just as social services have different deliverables that they have to achieve, and so do our third sector and our voluntary sector.

Now, I'm also a third sector champion, because I don't believe that we would be able to deliver any health and social care outside in our communities without them anymore. But I don't think we recognise that enough. So, are they sitting on every board? I really couldn't tell you, James, I'm sorry, from a WLGA perspective. I can tell you what I know from my own regional partnership board, but it's a moving feast always. So, we will keep jumping into the hoop of that moving feast and try to deliver as much as we can in partnership with everybody else, but that is a challenge.

Some of the points have been put over. Mabon's question was on evidence that we took earlier. So, there's clearly, as I stated earlier, a mismatch between what the perception is and what might be happening on the ground. So, there's a mismatch. So, if anything, take that message away. I'm going to move us into the next section and invite John Griffiths in, please.

Good morning, everyone. Just some questions from me, first of all, around data—how useful current data collection is, what the issues are around its efficiency and accuracy, and also commissioning support services. So, could I just ask, maybe, Jane, to begin with, what local authorities are doing to capture unmet need and known gaps in provision? 

We should always be data led in anything that we're doing. We do have a mismatch of data. You'll all be aware of the challenges that all local government and all of health face in the implementation of new systems. We are trying to collect the same data now. And some of those data sets have been agreed with Welsh Government officials, which is really helpful. But until we finish doing some of that and we have a new system in place, I don't think we're going to have a true reflection of our data set currently. We are concerned, later on in the year, that the corporate risk to every statutory body in Wales is significant, and I do think we need that data to move things forward properly.

Claire, did you want to come in?

Yes, of course. I think it's a really important question in terms of the quality of data. We, obviously, as local authorities and working as part of the regional partnership board setting, have our population needs assessments. And then we undertake particular needs assessments around our key population groups, such as carers and our young carer population as well. We know there's a mismatch between the number of people who identify in the census as carers and undertake that substantive caring responsibility and those who come forward in any way, shape or form to access public services, be it through information, advice and assistance, or, indeed, far smaller numbers, going on to have a carer assessment or care and support plan.

One of the areas within the ADSS Cymru work plan that we've talked about, that action plan commissioned from the Welsh Government, is around improving consistency in terms of recording and in terms of improving consistency in recording of carers assessments, for example, because we know that there are occasions when carers assessments and the assessment of the cared-for person can be merged, because the service that is sought might be a respite service, and that might be reflected in the care and support plan of the individual, rather than the care and support plan of the carer themselves.

We also know that—certainly for me and my own authority—our third sector information, advice and assistance service, which we commission as a local authority, undertakes carers' assessments on our behalf, and there may be challenges in how those are reported and reflected in the local authority data. So, there's a lot of work in progress to improve the quality of the quantitative data, and also the qualitative data and that experiential data and information that are so important in terms of service planning.

Councillor Gebbie has highlighted that the system change that 18 authorities across Wales are going through in this next year presents some risk to us in terms of our ability to have the right data available for a period of time, because any system change is a period of risk. But there's a lot of optimism, I think, when new systems are in place, that we'll be in a better position. Also, lots of work is going on nationally around data standards as well, so all of the work that we're doing is feeding into that area.

Okay. Catrin, is there anything you wanted to add?

I think Claire's captured it, really. We do recognise that the scale of both the needs of the carers and the numbers of carers are under-reported, and we try and capture more of that carer voice through other means as well as the carers assessments to try and gather that intelligence in terms of carer needs, appreciating that we're not there with the carers assessments at the moment. As Claire says, the good practice guides in terms of undertaking carers assessments, how we then store those, report on them and reflect on them is a piece of work for the new system because, obviously, the information that's contained in that carer assessment is useful for us in terms of service planning and in terms of reflecting whether we're meeting the carer's needs but also what that means, going forward, and what we need to put in place, going forward. So, it's how we're using that information as well as being data driven, that information informing services and that being an effective process. As Claire says, that's what we are putting in place. Our current system with the Welsh community care information service doesn't allow us to do that effectively at the moment. 

John.

Could I ask as well what the latest data shows in terms of the gap between supply and demand for services? 

Anybody got an answer to that? Claire, have you got an overarching perspective? 

I'll try and give an overarching perspective, in that I don't believe that at a high level it shows that people are waiting for services. I think the bigger challenge, if I put it that way, is the quality and the effectiveness of the carer assessment in identifying what the care and support needs of an individual carer are. I don't have an all-Wales perspective in terms of how many carers have had an assessed need identified through a care and support plan and how many may then be waiting for that service to be delivered.

Back to you, John.

Nobody else can help particularly with that? No. Okay. Claire, you mentioned that you don’t think that waiting times are particularly a problem, and we know that data on waiting times for care and support services are collected by Welsh Government, but not published. Could you give us any indication at all of what the average waiting times for carer assessments and support plans are at the current time?

I don’t have that information, I'm sorry.

But you said, didn't you, Claire, that you don’t think waiting times are a problem, really.

What I'm basing that statement on is national surveys, overall, in terms of waiting times for social care in Wales, which don’t indicate that we have particularly long waits from the point—and this is not just for carers, this is for any individual—of assessment into that service being delivered across the board. And I'm basing that also on my intelligence from my own authority, probably more specifically.

All right. So, it's not specific to carers, then; it's from assessment, rather than the wait for an assessment.

Yes.

Okay. I don't know if anybody else could add anything on that, could they?

Yes. Catrin, do you want to come in on that?

Yes. We have data that we collect for the checkpoint return, which is about the number of people waiting for assessments, and that is assessment in general, so it'll be the cared for and the carer assessment. And, as Claire says, that data doesn't show us that people are waiting a long time for an assessment, whether that's a carer assessment or a cared-for assessment. But I think the issue is what we then do with that assessment. So, the assessment has to be meaningful to the carer, as the feedback you've had says, but it's then what happens as a result of that carer assessment to meet the needs of that carer, and that is the bit where there is a wait in terms of respite provision that they might need, or a sitting service that they might need, or a short break that they might need. That's where the waiting times come in, because of the things that we've spoken about previously around the provision that we've got available to offer on the back of that assessment, and then, obviously, the review and, 'Did that meet your needs? What else do you need?' That process, as Claire says, is part of the action plan for us to improve that review and sense checking.

Also, part of the work that we're doing around the best practice guides on how to conduct assessments is around, sometimes, the tension practitioners feel between offering an assessment and then knowing that there are things that they can't offer. So, practitioners feel a tension between raising carer expectations and then not being able to deliver on that, and we need to get better at being able to deliver on that. But also, in terms of having that conversation with carers—and, as you said previously, they're not expecting the earth, they're not unreasonable asks or anything like that—once you've undertaken an assessment, there is an expectation there, isn't there? So, it's how you have those conversations and helping carers to prepare for those conversations to value that carer assessment. The other thing that we've had, which does affect the data—to go back to your question—is carers who have declined carers assessments because of the misconception that there's a criticism of their caring abilities. And that's reflected in the data, as well, about refused carers assessments, and we're looking at why that is. And part of that reason is what I just said around us explaining to the carers what a carer assessment is for them and how they can benefit from it. But we need to make sure that those services are there for them to benefit from, and everything we've said about the sustainability of those support services then comes into train in terms of waiting times for respite and sitting services and short breaks, principally.

Thank you, Catrin. Dilwyn, did you want to come in quickly on this, and then I'll come to Mabon and move on to Mabon's section?

Yes, thank you, Dilwyn, and that's an interesting point on language—that's a good angle. It's the first time I've really thought of that. Mabon, can I invite you?

Okay. Who would like to start on that? Dilwyn.

Catrin.

Yes, so I think there are two reasons, really. One is the funding, which we've already touched on, and we've got the extension now to the national short breaks scheme and the carers support fund to 2029, and that's really welcome from Welsh Government. We've got data around what we've delivered so far in terms of short breaks, sitting services, respite provision. But the issue with it is, as Councillor Gebbie said previously, the long-term sustainability of that. The services tend to be short-term funded, so they open, they close, they ramp up, they ramp down, and that doesn't give that carer that stability that they need in their long-term caring responsibilities. So, more sustainable funding is one thing. If we could remove that start-stop funding cycle, that would be helpful.

The other thing is our provider network, particularly independent sector providers, because, especially when they provide respite care, it's very difficult for them to provide short-term flexible respite in the context of their wider—. So, if it's a care home and it's a respite bed, say, for two nights for an individual to give the carer a break, some providers find that really difficult, because of the individual coming into their care home, they've got to see how they fit with the rest of the people that are cared for there and they've got to bring in staff, et cetera. And what that does is, it doesn't make the provision as flexible. Local authorities have got to do things like, in our commissioning, minimum booking periods, and we've got to pay for unused capacity. And it makes it very difficult then for us to provide responsive breaks for carers, because we've got to do a lot of planning with the providers in order to put that provision in place.

So, it's a bit of a combination of both things really: the stop-start funding, but then the logistics of being that flexible and responsive service as well, and how we plan and commission services makes that a challenge for us.

Okay. Thank you, Catrin. Claire, you wanted to come in.

Yes, just to build on what Catrin has said and also the other contribution. I totally agree with the points being made around language, because I think that talking about an assessment can be very off-putting for the carer. I'm far more comfortable talking about carers conversations and carers support. I think the more that we can change that narrative and dialogue—. And those conversations are so critical to understanding what the needs of the carers actually are. So, in terms of that unmet need, unless we have had that really deep and meaningful conversation with the carer, we don't understand what the needs of an individual carer are and we can't aggregate those up into a position where we can commission or we can provide that service for carers.

I completely agree with everything Catrin has said in terms of formal bed-based respite, but that's not the only need that we would be seeking to meet. We've talked, I think, earlier in the meeting, around direct payments, which give more flexibility, if there is the workforce there in terms of being able to provide that flexibility. There's still quite good provision and coverage across Wales in terms of day opportunities and integrated services as well. We're focusing very much on local authorities in this discussion today, but when we think about some of the needs that our most vulnerable carers are supporting around dementia particularly, we're into the realm of integrated dementia day support for older adults. That's very much a joint health and social care responsibility, and these are the sorts of services that the dementia element of the regional integration fund is helping to support across Wales. Again, that's short term to 2027 grant funding, but it's one that is really important to be kept going and to be sustainable into the future, because it's not just the bed-based respite, it's other services that need to be in place in the daytime as well as overnight.

Thanks, Claire. James, you've got a little point you want to bring in.

Yes, very quickly. You mentioned there dementia care, and I mentioned this in a previous session, the dementia strategy that is being currently launched. I'm just interested in what feed into that process local authorities are going to have in terms of how those two strategies—the strategy that we've got for unpaid carers and the strategy that we've got now coming forward for dementia services—need to work together to make sure that services are better integrated.

Yes, I'll take it.

Claire, please, carry on.

Apologies, Chair. Yes, absolutely. So, on a regional basis, I'm sure every regional partnership board will have a dementia group that meets, and the voice of unpaid carers needs to be just as strong within that group as it is in a group that is specifically a carers group. That's certainly the case for us in Cwm Taf Morgannwg. It's been an area where I'd say we've been really quite successful as RPBs because some of our regional integration fund is ring-fenced for dementia, and that means there has been a very clear funding strategy to accompany the service strategy, and it has been able to fund services that do support carers, such as the integrated dementia service I just talked about there. So, that needs to continue, I guess, is my message. That needs to be sustainable, post 2027.

Thanks, Claire. Mabon.

Who would like to kick off? Jane.

I'll start, Chair. That's fine. Early intervention and prevention is always the best strategy for us, Mabon. One of the reasons that I say that is, the earlier that we understand people's needs, the better able we are to forward plan. In relation to the previous discussion, Carers UK came out and told us that, in Wales, 55 per cent of our unpaid carers don't even recognise that they're an unpaid carer until a year after they've been delivering a service to their own family member or friend or neighbour or whatever. It's really difficult to identify, and part of that is around stigma attached to the person that you're caring for. We know that we've got an ageing population, we also know that we've got a population with increased dementia risk. That's not expected to subside any time soon. We need to get better at having a national conversation about what is normal, and it's normal in an ageing population for them to have more cognitive impairments, whether that's dementia, Alzheimer's, or just a stroke and the outcome of that stroke is a cognitive impairment, and it might be a speech impediment or it might be a physical impairment.

But when it's your parent, is what I want to say to you, you will put their socks on or make sure that they've got their meds without even thinking about it, because they're just your mam, or they're just your dad. It wasn't until I was a lot later on down the line that I realised I was an unpaid carer. So, I'm telling you that from my own personal experience. But there's such a stigma attached. I'm a member of council, so, for me now, knowing that I have a service going into my house, it means that I have to declare a prejudicial interest whenever we're discussing unpaid carers, and I'm their champion, it's my portfolio. We need to normalise some of this, because it is a normal ageing process. We need to get better at looking after people, Mabon.

Would anybody else like to come in on that question? Claire, and then Dilwyn.

Yes, if I may, Chair. In terms of young carers, everything that Councillor Gebbie has said about identifying that you're a carer, putting mam and dad's socks on for them, equally applies to some of our children and young people, doesn't it? The role of schools is absolutely critical, and support for teachers in terms of identifying those young carers within the school population, being skilled and confident to ask the question and knowing that that support is there, that it doesn't all come onto them as teachers. This is an area where I think there really is some very good innovation across Wales, where schools have got young carer champions, there's peer support, we've got young adult carers who have been child carers who support in this area as well, and networks of ambassadors and young carers across educational settings.

In the same way as adult carers, those young carers have got the right to a carer assessment. Again, in the same way as for adult carers, it's important that there is support for those young carers coming out of that assessment. Often, that support that is requested is just to be able to be a normal young person, to come together, to do fun stuff, but often to do that with other young carers, so people who understand those pressures and the challenges that they experience within their family life. So, everything that we've been talking about in terms of adult carers applies equally to young carers, but we do have a different set of partners that we need to bring together to make sure we've got that early intervention, that early identification, and the right quality of carers assessments and support.

Thank you, Claire. I'll bring Dilwyn in, and then I'm going to move us on, because we're running short of time. Dilwyn.

Thank you, Dilwyn. Mabon, you wanted to come back.

Who'd like to have a go at that? Do I see any hands go up? Yes, Dilwyn.

Thank you. Jane.

Thank you very much for the question, Mabon. As a regional partnership in Cwm Taf Morgannwg, one of the things that we've just launched is our young persons strategy, and that covers our young carers as well, and they were involved in forming that strategy and the deliverables from that strategy. When we talk about the lived experience, it has to be a service that's going to work for them. As the professional in that space, it's no good me commissioning a service that nobody's going to use. So, we need to understand what they want, what they need from it, and we always say in social services that it should always be a need and not a want. We do expect people—. But for children it's very different. I want children to be young people, to experience and have opportunities and enjoy their life, just like I had the opportunity to do when I was younger, without any caring responsibilities. I want the same for them. But whatever service we put in for them needs to work for them. And if they're going out on an activity day, so to speak, to go to the theme park, because that was something that would be missing from their activity schedule, we need to ensure that whatever service is going in to support whoever they're caring for is adequate too. Because otherwise they go away worrying about the person that they care for all day.

So, we need to think very hard about what they need, not just what they want, and how we can deliver that effectively and sustainably going forward. Because we'd like to give every young person absolutely everything that they want. We always hear the phrase ‘children are our future’. Absolutely. But by the same token, it needs to be within our finances to be able to deliver that.

Thanks, Jane. Just before I bring Lesley in, I've got one question. It's a big question, though, because clearly it seems that many local authorities are struggling to honour their legal obligations to unpaid carers. I just wondered, is there any concerns, then, about local authorities' ability to fund the services necessary to uphold carers' rights within the Act? What is the solution to this? Claire, do you want to come in on that?

I would want to assure the committee, as far as I am able, about local authorities meeting statutory duties. We're very highly regulated and inspected as local authorities and, certainly, this is something that is of key concern to regulators when they come in and undertake local authority inspections. We know that social care is an increasing proportion of every local authority's budget, and that's services for carers as well as services for individuals with care and support needs. And of course, if we didn't, as local authorities, sustainably fund those with care and support needs, the pressure on unpaid carers would be even greater, wouldn't it? So, it is really challenging.

I think both WLGA and ADSS Cymru have made points significantly this morning around the need for sustainability of funding, particularly that grant funding on which these services are so dependent. But I would like to provide assurance, as far as I am able, on behalf of directors of social services, about our understanding of our statutory duties and the role of local authorities in resourcing them.

Thank you, Claire. We'll leave that one there, then; I'll take that one as read. I'll move on to Lesley Griffiths, please.

Thanks very much, Chair. Good afternoon to everyone. I just want to look at commissioning support, and captured in an earlier answer, you mentioned about the short-break scheme and how welcome that was. Obviously, that's been brought in not to replace any statutory provision, but to supplement it. And I was just wondering if you could all say a little bit about—. I suppose we're seeking assurance, really, that there haven't been any reductions in any other aspects of provision following the short-break scheme being introduced.

Would any of you like to start? Jane. 

I'm quite happy to, Chair. So, absolutely not, Lesley, is my first response. I always worry, however, that what we're delivering is unsustainable because no other service currently has suffered because of it. What I would say is that there's not enough of it and if we know that we've got an increasing population with additional complex needs, then we're going to need those additional resources going forward.

Now, we can always look at the way we're delivering back-office efficiencies, look at the way we structure, using AI. We talk about innovation quite often now in the early intervention and prevention space. We do so deliberately because we are not going to have the workforce, when you look at our population growth, to deliver all these statutory functions and services in future years. So, when I get to my care and dotage, Chair, what I want to understand is that my support that is available to me is as good as what's being delivered to my parents now. If it's not good enough for them, then it's not good enough for any of my residents either—that is what I want to say—deliberately not.

I don't think there's enough respite available, though, Lesley. You've heard the difficulties in commissioning that provision. It's hard to do that, to meet other people's needs when they want it. Because if we're being told we have to do it to meet people's needs, it's got to be at a time that suits them. There's no point giving them a Tuesday and a Wednesday in respite provision if they're in full-time work and they're in work that Tuesday and the Wednesday, because the only thing they're getting is a good night's sleep. That doesn't give them the opportunity for a break away from any of those responsibilities, because they'll come home from work and they'll still have those same responsibilities.

Thanks, Jane. 

So, when you're saying there's not enough respite, Jane, is that due to lack of funding? Is it due to lack of capacity? Is it a mixture of both? Anything else? 

It's not about funding and capacity, it's actually organising it. When we talk about commissioning respite care, Lesley, if, for instance, I want to go away this weekend, I need that respite care for my parents. I wouldn't be able to organise it, because it wouldn't be available from the commissioning provision on that date. It might be next Thursday or Friday that they'll offer me, but, actually, I can't go to the theatre next Friday because of X, Y—. So, there's a wider conversation. Do we have a respite facility that is just there for unpaid care provision, for people to go backwards and forwards, bearing in mind the specialties that we would need to have in that provision? I say that deliberately, because each person has individual needs, and each of those care plans will identify those individual needs. For someone that has a physical disability, if you're an unpaid carer, that's a very different care and support package to someone who has dementia or Alzheimer's, as an example. Those are very basic examples, but you're very aware, as the Health and Social Care Committee, that there are a wide range of issues in health and social care and those that particularly affect our residents.

Thank you, Jane. Catrin or Claire, would either of you like to comment on that? No. Okay.

Just to say, a large proportion of the support services—. So, the carers assessment is a statutory function and a legal duty on us, but a lot of the support functions that we put in place as a result of that carers assessment isn't statutory, and that is what we grant fund and we have the temporary funding for. That's the bit, then, that causes us a challenge in terms of the challenging landscape of local government funding at the moment. Those are the things that—. The conversation is, 'Right, we need to fund the statutory', and, absolutely, that's what we do, but then how do we fund the other things that are equally as important and support the statutory and support our statutory duty in providing a carers assessment when it's not—? Those are the sorts of things and the difficult conversations that we have to have.

Okay. Lesley, back to you.

Back to me. Thank you very much. So, we've just heard from Jane when I asked what are the factors and the constraints that are limiting your ability to be able to allocate more capacity and resource to supporting unpaid carers. Is there anything else you want to add? Anyone else? I think Jane explained it.

Claire.

Dilwyn.

Do you want me to go first? Only very briefly, just on workforce. I think direct payments have been mentioned a few times, and they do provide flexibility. Bed-based respite isn't for everybody; not all individuals cope well outside of their own home setting, and it can cause more of a challenge for carers when they return home. So, direct payments can be absolutely great, but it's the availability of that workforce, so workforce is also a challenge.

Okay. Dilwyn.

Thank you.

In our previous evidence session, we heard that 82 per cent of carers hadn't had a break in the previous year, which is incredibly high, isn't it? It's probably due to a variety of factors, which you've just explained to us now. Thank you, Chair—my final question is just around the contract values for that support that you're commissioning. We've heard that it often is much, much lower than really the true cost of that delivery—obviously, going back to the age-old issue around annual contracts as opposed to multi-year contracts and the ability to be able to provide those. Do you accept that your commissioning needs need to improve?

Claire.

I think we always need to improve. Our last population needs assessments we undertook at the height of the COVID pandemic, so we were dealing with a very particular set of needs at that point. As regional partnership boards, we're in the process of relooking at our population needs assessments. I think, because we're not now in the COVID period, there's an opportunity, and practice has really developed in terms of hearing, involving and acting on the voice of individuals. So, those needs assessments will be far more reflective not just of the demographic data, but of people's real and lived experience, and that will give us better needs assessments and that will give us better commissioning and intent. So, yes, we are continuously looking to improve.

Okay. Is anybody else burning on that or—? We're running out of time quickly. No. Thank you, Lesley. James, I think we can give you one question.

How generous of you, Cadeirydd. I'm forever grateful. Thank you very much, everyone, for your evidence today. I'll finish with a broad question probably, which will help round the session up. If there was one simple thing that you think that national Government could do here in Cardiff to improve the lives of carers across our country and also to help local authorities in the delivering of their services, what would it be? I'll start with you, Jane, because I know you.

Thanks very much. Success depends on adequate resource as a continuum, integrated working across all sectors—so, that's not just about social services, that's very definitely our health colleagues. And you've heard a lot about the third sector and voluntary organisations today—without them, we would not be able to deliver and it would greatly be a detriment to other people's lives should those third sectors go. So, we do need to look at our third sector colleagues and we need to be sustainable around them, but we also need to address wider social care funding and workforce challenges; you've heard evidence this morning around all that.

I would suggest that we need—. I do think we need to invest in some of the microbusinesses or macrobusinesses; I'm sure Claire's going to come in now and tell me off about the terminology I'm using or make sure that I'm using the correct one. But, very essentially, we've got people living in villages that have already been delivering care to family and friends over the years informally and, actually, if they took on a bit more responsibility—. We know they've already got the skills to deliver some of that and, actually, they organise their own hours: they'll go and get Mrs Jones up next door when it suits Mrs Jones rather than trying to fit into the care provision of statutory organisations or even commissioned provision.

We can see the demand increasing, we are trying to innovate our way out of certain situations—telephone calls as a reminder to take people's meds, just as one. But, until we support unpaid carers appropriately, then our economy is going to fail here in Wales. If we don't support them, if they're working carers, they will reduce their hours over the years to support their family and friends rather than deliver into our economy. So, we need to look after them. And, actually, if we look after them better, they'll stay in our community longer—anybody that needs that provision—before coming into statutory services, and that carer will still be contributing to our Welsh economy.

Thanks very much for the question, James.

Claire.

Firstly, and it's been said many times, but stable and sustainable funding for preventative support, particularly short breaks, and that's got to be part of sustainable funding for the whole of social care in Wales. Secondly, earlier identification of carers across the wider system—that's employers, health, education, community settings, as well as the social services part of the local authority. And then, thirdly, consistent high-quality practice and resources for the workforce so that carers have similar experiences wherever they live—I should have said similar good experiences.

Thank you. Catrin, anything to add?

No. I think Claire's captured it. Thank you.

Okay. Thank you. Dilwyn.

Okay. Well, thank you for that closing contribution, Dilwyn. And I think that brings us right to the end of the session perfectly. Thank you so much, everyone, for your contribution this morning, which is absolutely fundamental to this inquiry that we're conducting. There will be a transcript available for you to check over, if you wish, after. And can I just thank you once again for making the time for us this morning? And sorry if it's held anybody up from anywhere else. So, thank you once again.

Okay. Members, can I take us to the next item? And that is papers to note. Can I ask Members if you're happy to note the pack as included in the agenda? I see you are. Thank you very much.

In that case, then, we'll move to item 5, and that's the motion under Standing Order 17.42 to resolve to exclude the public from the remainder of today's meeting. Happy to do so? I see you are. Thank you. We'll move into private.