Measuring the Mountain: response to 2020 recommendations

The Social Service and Wellbeing (Wales) Act 2014 (‘the Act’) came into force in April 2016. The purpose of the Act is to improve the way that Local Authorities deliver social care across Wales. This will improve the well-being outcomes for:

• people who need care and support
• carers who need support

We, the Welsh Government, wanted to hear about people’s experiences as part of the evaluation of the Act. The Measuring the Mountain project started in January 2018. The project used the survey tool SenseMaker and a Citizen’s Jury to make recommendations. SenseMaker combines data and human stories to understand peoples’ experiences. The Welsh Government provided a formal response to the recommendations. In 2020 we agreed an 18-month extension to the project.

The project used the same methods to understand people’s experiences of Social Care in Wales. The Jurors made a further 16 recommendations, across four core areas:

• policy
• practice
• people
• process

We welcome the work of the Measuring the Mountain team. We have provided a formal response to the recommendations. It explains how we will work with the social care sector to meet these recommendations.

Our formal response addresses the 16 recommendations of the Measuring the Mountain report.  

Recommendation 1

We recommend to the Welsh Government that they appoint a Disabled People’s Commissioner in 2021.

The Locked Out report made a similar recommendation. The First Minister agreed to establish a Minister-led Disability Rights Taskforce. Taskforce membership will include stakeholders from, different sectors. The Taskforce will also include representatives chosen by the Disability Equality Forum. Disabled people will be at the forefront of this work.

The taskforce will address the inequalities highlighted by the Locked Out report. We will work across public, private and voluntary sectors to undertake these actions. The Taskforce will:

• develop a Disability Rights Action Plan for Wales
• consider the recommendation for a Disability Commissioner at the end of this programme of work

Recommendation 2

We recommend to the Welsh Government that they establish a Task Force to explore ways to deliver Universal Basic Income to the citizens of Wales, and that it reports back to Senedd Cymru and the people of Wales on its findings in 2021.

We are supporting people living in poverty in Wales. We are aiming to make sure people have adequate financial support to be happy and healthy in Wales.

In April 2022, we started a Universal Basic Income pilot for young people leaving care in Wales. All young people leaving care who turn 18 this year, across Wales, can take part in this pilot. We expect that over 500 young people are eligible to join the scheme. Participation is not mandatory. Thus, exact numbers will be unavailable until sometime after the pilot is underway.

We hope the pilot scheme will show if this approach reduces the challenges care leavers face. The pilot will test the benefits of a Universal Basic Income such as:

• addressing poverty
• reducing unemployment and
• improving health and financial wellbeing in Wales

We have established an advisory group to support the roll out of the pilot scheme. We will test the pilot scheme to see what is working, or not working, for the participants. We will also explore the wider benefits, such as improved health and wellbeing. Researchers will make recommendations about the Universal Basic Income scheme.

We also hope that the pilot will offer real-world ideas for supporting:

• financial wellbeing,
• emotional wellbeing, and
• pathways to education and employment

Recommendation 3

We recommend that there is a national public awareness campaign about the rights people in Wales have to social care. Alongside this, every local authority should undertake a local campaign, appropriate to their area that uses clear and simple language to make people aware of their rights and the support that is available to them in their area.

Information for Carers

Our Social Services and Well-being (Wales) 2014 Act has been key to our progression towards an integrated health and social care system, and the introduction of new rights for unpaid carers.

We delivered our latest carers’ rights campaign between October and November 2021. The campaign was in partnership with Carers Wales and Carers Trust Wales. The campaign aimed to:

• deliver an integrated campaign to encourage unpaid carers to self-identify
• inform carers of their right to information, advice, and a Carers Needs Assessment
• encourage carers to find out what support is available from their local authority.

We delivered the campaign in English and Welsh. The campaign made use of a toolkit developed by Carers Wales. We shared the toolkit with local authorities (LAs) and local health boards (LHBs).

The campaign drove 8,860 clicks to the website throughout the campaign period. This resulted in more carers are accessing support.

Strategy for Unpaid Carers

The Strategy for Unpaid Carers aims to help unpaid carers to recognise their role and access the support they have the right to. We launched our Delivery Plan to support the Strategy in November 2021. We will action many priorities from the Delivery Plan during this Senedd term.

Older People’s awareness

We are working with Age Cymru to raise older people’s awareness of their rights. Age Cymru is working with older people’s groups using our co-produced publication. Together we are promoting a rights-based approach in health and social care. Age Cymru is also producing a video and toolkit. We will run a second older people’s rights campaign later this year building on the 2019 campaign.

Autism Services

We implemented the Code of Practice on the delivery of Autism Services in September 2021. The aims are:

• to improve the lives of autistic people and their families in Wales,
• to promote the key duties under the code to LAs, LHBs and NHS Trusts, and
• to support the rights of autistic adults and parents/carers of autistic children. We will do this by communicating the right to certain health and social care services under the Code

We are working with the National Autism Team and the National Autism Society. We are delivering a targeted digital campaign. The campaign is operating in two phases:

• Phase 1 -stakeholder communications, from September 2021- January 2022 and
• Phase 2 -communications with people, from March 2022 onwards

Engagement activities have as taken place. We have publicised accessible versions of the Code and its guidance. To aid understanding we have produced:

• short animated videos, and
• two one page leaflets “What does the Code mean for you?” for stakeholders and the public

We are also planning:

• social media advertising via Facebook and Twitter. This will promote key messages in the Code and include links to for further information
• to promote the information through our owned channels
• to provide key partner organisations with a toolkit to support them to do the same

Evaluation to date has been positive and suggests that the campaigns have led to increased awareness of the Code.  

Recommendation 4

We recommend that respite care should be redefined and co-produced, so that the practice of providing respite is normalised and becomes about providing flexible, tailored opportunities for both carers and those they care for.

We are working to redefine, improve and diversify respite for unpaid carers in Wales. We have published the Strategy for Unpaid Carers in March 2021. We are working with members of the Ministerial Advisory Group on Carers and key partners. 

Priority three of our four national priorities for unpaid carers is:

Supporting life alongside caring - all unpaid carers must have the opportunity to take breaks from their caring role to enable them to maintain their own health and well-being and have a life alongside caring.

We commissioned research to better understand respite and short breaks. We commissioned Carers Trust Wales, Swansea and Bangor University to coproduce this work. The A new vision for respite and short breaks in Wales Carers Trust report:

• sets out an ambitious vision for creative short breaks. These will reflect the personal outcomes people wish to achieve
• will inform the future of respite in Wales
• we shared it with LAs. We hope it will inform their work and encourage a person centred approach.

We have given £3 million to LAs in 2020-21 to provide emergency respite during the pandemic. This money is also to encourage innovative approaches to respite. LAs are using the fund in a variety of ways, for example:

• Gwynedd Council is setting up a ‘respitality’ scheme. This scheme will offer cheaper holidays to unpaid carers. The scheme is upgrading a respite cottage.
• In Torfaen, the funding is supporting an unpaid carers’ bowling club and day trips.
• A rapid response respite-at-home service has been set up in Swansea. This is allowing unpaid carers to attend health appointments or take a break. This service can also provide taster sessions. For example, for carers considering accessing support from their LA.
• In Conwy, unpaid carers experiencing stress and anxiety are being offered counselling. Counselling sessions are being offered over a six-week period. The LA is also purchasing items for carers. For example, outdoor furniture, tablets, exercise equipment or gym membership.
• 1,400 unpaid carers and young carers in Monmouthshire have applied for a £10 voucher scheme. Vouchers for garden centres, toy shops, pizza takeaways and afternoon tea are available.
• In Anglesey, young carers can access a range of respite provision. For example, many have experienced new activities.

We are also funding North East Wales Carers Information Service (NEWCIS). This is to promote their award-winning model of a short breaks fund across Wales.

We announced £3 million of ongoing funding for respite in 2022-23 draft budget.

Recommendation 5

We recommend that advocacy services receive more funding to ensure high standards in delivery are reached, more people are supported, and a greater range of services are provided in an independent manner, which should also include legal and technical advocacy.

We recognise that there is a need to build capacity for advocacy services. We intend to commission research about advocacy in care homes. The research will:

• look at how advocacy works in practice
• look at how advocacy affected the lives of residents during the COVID-19 pandemic
• guide future policy work.

We currently fund projects that support advocacy and advice such as:

• Age Cymru deliver the HOPE Project (Helping others to participate and engage). The HOPE project promotes access to early intervention support at community level. The HOPE project uses a range of advocacy models for older people and carers across Wales
• MEIC is a confidential, anonymous, and free bilingual helpline. It is a service for children and young people up to the age of 25 in Wales. MEIC provides information, useful advice, and support. MEIC is open 8am - midnight, 7 days a week, by phone, SMS text and instant messaging. We have provided funding £535,989 of funding to deliver the service until June 2022. A new contract, which will run from 1 June 2022 – 31 March 2026, is being procured.

• Race Equality first to deliver health-related advocacy services. This project supports members of diverse communities to receive appropriate health care. It also improves the understanding of health care providers. Such as the cultural and religious needs of Black, Asian and minority ethnic people. This is important for planning healthcare provision.

Recommendation 6

We recommend the development of a consistent, centralised approach for assessments across Wales. Assessments should be standardised but have a focus on local approaches to meeting need and consider the specific and unique needs of the many rural and isolated areas in the country.

The 2014 Act provides a clear approach to assessment across Wales. This ensures that assessments:

• are co-produced. Individuals and practitioners share the power to plan and deliver support together. This means that all partners have an important part to play in the process.
• allow person-centred 'what matters' conversations as part of assessments
• identify people’s strengths
• identify the resources needed to meet people’s personal outcomes
• use the assessment to create a plan to meet people’s personal outcomes.

This means there is a consistent approach to assessments, which allows for the individuals’ needs to be considered.

The statutory national eligibility criteria provide consistent rights for care and support. All-Wales training materials support staff to carry out assessments. Training materials are accessible and free of charge on Social Care Wales’ website. All training materials were co-produced with people needing care and support.   

The Performance and Improvement Framework (PIF) metrics track local authority approaches and activity. As part of this, local authorities report on:

• the number of assessments they have done
• if assessments met agreed timescales
• the outcomes of the assessments.

We publish these reports every year as part of our approach to learning and improvement.

Recommendation 7

We recommend that all training and continuous professional development for social care practitioners is co-produced with unpaid carers and those who use services and that this is evidenced annually by those who employ such staff.

We have identified actions to improve services and the experiences of unpaid carers. We have done this by working with unpaid carers and other stakeholders. We’ve published the National Strategy for Unpaid Carers and the supporting delivery plan.

Over the next four years, we will continue to work with unpaid carers and stakeholders to:  

• review the training options currently offered across Wales
• identify gaps and explore options
• develop and share best practice to support professionals to support unpaid carers  

As part of the review, we will explore:

• the inclusion of modules on Welsh language
• how to identify and meet the needs of:
  • marginalised and seldom-heard groups
  • young carers
• existing Continuous Professional Development for health and social care workers. This will focus on training to help them identify and meet the needs of unpaid carers
• introducing mandatory pre- and post-qualification training for social work professions
• the availability relevant modules in higher education. It will consider if these meet the needs of future professionals who may work with unpaid carers

We have funded Carers Wales and Carers Trust Wales to deliver the “Carer Aware” project. This is a co-produced project, co-developed with unpaid carers. It is working with staff at all levels of social care, and in health. The project’s aims are to:

• raise awareness of carers’ rights
• share good practice,
• encourage closer working.

This project includes a new ‘good practice’ guide and set of principles for social workers.

Recommendation 8

We recommend that local authorities demonstrate annually that their information is easy to understand, transparent, accessible, and is promoting exemplar projects in their area.

People need to be able to take part in conversations about their care and support needs. People needing and support also need to understand the different options available.  

We support this recommendation. It reiterates the key principles of the 2014 Act and the Codes of Practice.  The Part 2 Code sets out:

• clear expectations on the overarching duties around respect and dignity
• the wider duties under equality legislation
• duties under the UN Principles and relevant conventions relating to:
  • older people
  • children
  • disabled people
• the role practioners and organisations have in helping people understand their rights

The Part 2 Code also sets out the role of the Information, Advice and Assistance (IAA) Services. Local authorities’ IAA services share information about:

• how the care and support systems operate in the area
• the types of care and support available
• how to access the care and support that is available
• how to raise concerns about the well-being of a person who appears to have needs for care and support

Local authorities need to show their approach to providing information and advice. They do this through the Directors of Social Services Annual Reports. These reports provide a common mechanism across Wales to evidence progress. The reports also evidence working in partnership and innovation. The reports draw on the continuous training programme provided through Social Care Wales.

We have commissioned a review of the guidance and templates for these Annual Reports. Local Authorities and other stakeholders are engaging in this process. The aim is to align the reports with the Performance and Improvement Framework (PIF). The PIF states what data local authorities should be reporting every year. This includes data bout IAA services.

Our response to Recommendation 3 is also relevant here.

Recommendation 9

We recommend that unpaid carers’ opinions are sought and valued across both social care and the NHS, and that organisations involved in the provision of health and social care services show how these are being brought into decision making processes.

People who use social services should inform decisions about those services. 

The Expectations and experiences: service user and carer perspectives on the Social Services and Well-being Act report forms part of the evaluation of the Act.

The research involved collecting views from a wide range of service users and carers. Participants described how they have experienced the Act over the last year. We will use the findings from this report to shape health and care services in Wales.

Our Carers’ Ministerial Advisory Group meets quarterly and includes a range of stakeholders. Stakeholders include key carer organisations from the third sector. The group helped develop the Strategy for Unpaid Carers and the Delivery Plan. This group will be very important in delivering actions from the delivery plan.

We fund a Carers’ Engagement Group. This allows unpaid carers to give their opinions and tell their stories. The group links to networks of carers in local communities from across Wales. The group has played a key role in helping us develop the Strategy for Unpaid Carers.

Recently, members of the group have helped shape the Carers’ Charter and the new delivery plan. The delivery plan explains how we will take forward work to support unpaid carers over the next 5 years.

The Engagement Group is currently undergoing a review. This will ensure the group is able to reach a wider range of unpaid carers. In line with our social care goals, we will increase diversity and inclusion. We will also include more young carers.

Under the 2014 Act, Regional Partnership Boards (RPBs) were set up. RPB membership must include a person to represent carers. The RPBs must:

• ensure the carer members is a representative voice on the board. They are not only a representative of all carers in the region
• set up wider engagement with carers, so the RPBs listen to the views of carers
• involve carers in planning and strategy development
• engage with carers, including young carers, when developing:
  • their population needs assessments
  • market stability reports
  • joint area plans

We have also established an Oversight Board to support a new vision for children’s social care in Wales. The Oversight Board will include:

• two care experienced young people
• a range of internal and external partners
• Anthony Douglas, former Chief Executive of Cafcass, as Chair
• representatives from:
  • All Wales Heads of Children’s Services Group (AWHOCS)
  • Association of Directors of Social Services Cymru (ADSS Cymru)
  • Social Care Wales (SCW)
  • Welsh Local Government Association (WLGA)
  • Children’s Commissioner for Wales (CCFW)
  • Welsh Government officials

We are working with local authorities (LAs) to collect more information about carers. We will be doing this through the Performance Improvement Framework (PIF). The PIF includes data, as well as the experiences of carers and others requiring care and support. The PIF encourages LAs to use these experiences to shape and improve services.

Recommendation 10

We recommend that people with lived experience of using care and support services share that experience on panels, through co-produced training and through the work of the office of the new Disabled People’s Commissioner.

Understanding the lived experiences of individuals is crucial for developing future services. We asked ADSSC to undertake a review. This review asked about the impact of the pandemic on people using care and support services. Services included day services, respite care and short-term placements. The report contains recommendations for improvement. In response to the report, we will ask ADSSC to undertake a short programme of work. This work will involve those accessing services to support recovery and re-building. There will be an emphasis on:

• individual voice and control
• improved communication
• innovation, without the loss of valued services. For example, those enabling inclusion, providing opportunities to socialise and form friendships

Recommendation 11

We recommend to the Welsh Government that they provide ongoing support to third sector organisations to create and maintain localised support networks for people, particularly those that enable peer support and advocacy, and paying attention to rural and isolated areas.

We recognise the importance of peer support and its role in people’s lives. The latest report from the national evaluation of the Social Services and Wellbeing Act (2014) states:

“… peer support that carers receive from others, alongside the support of key voluntary sector organisations, has improved their quality of life and feeling of well-being just for knowing that there is someone to talk to if it is needed. This was also the case for young carers who found the opportunity to spend time with their peers – albeit in a different form during the pandemic – enhanced their sense of well-being, and was both valuable and sustaining.”

We have funded a range of projects that maintain local support for people. We provide this funding:

• direct to individual organisations
• indirectly through the Wales Council for Voluntary Action (WCVA) and Community Health Councils

Examples include projects funded for delivery by the National Youth Advocacy Service (NYAS). NYAS Cymru are receiving funding for an advocacy project. This project supports parents to engage with social services using independent professional advocacy. Independent professional advocacy assists parents by:

• helping them to navigate systems
• involving them in decision-making processes

NYAS Cymru are also receiving funding for Project Unity. This project aims to break the cycle of children of care-experienced mothers being taken into care. The project also aims to prevent children becoming subject to child protection processes. The project does this by:

• providing intensive wraparound services
• building peer support networks

Recommendation 12

We recommend representation that is more diverse be mandated within social care at a local, regional and national level, including on Regional Partnership Boards.

Regional Partnership Boards (RPBs) must include at least one member of the Board who:

• represents the interests of people who need care and support, and
• another to represent the interests of carers who need support

RPBs must also include members to represent the third sector and providers.

We are currently engaging with carer members on a Task and Finish Group. This is Phase 1 of a wider Engagement and Voice project. This group will develop a standard approach to supporting members of RPBs, including:

• carers
• users of health and social care services
• third sector members
• provider members.

The aims of Phase 2 will be:

• to increase RPBs’ engagement with users and carers
• to embed co-production in all their planning and policy development

This will also help us revise the Part 9 Statutory Guidance on partnership working. This will lead to a stronger focus on co-production, engagement, and voice. This revised guidance will be out for consultation early in 2023.

This will also help us revise the Part 9 Statutory Guidance on partnership working. This will have a much stronger focus on co-production, engagement, and voice. This revised guidance will be out for consultation early in 2023.

Recommendation 13

We recommend that the Welsh Government prioritise funding for early intervention, particularly for established good practice and practice that supports better outcomes and demonstrate how this funding will increase year on year.

Early intervention and more preventative services will minimise the escalation of critical need by:

• improving people’s well-being
• making public services more sustainable

The Health and Social Care Regional Integration Fund (RIF) is a 5-year fund. It aims to create sustainable change through integrating health and care services. It will run from April 2022 to March 2027.

Key features and values of the RIF include:

• a strong focus on prevention and early intervention
• activities funded by it must support the development and delivery of integrated care
• there are 6 national models to follow. These include Community Based Care, Prevention and Community Coordination
• delivery of these models must follow the principles of the 2014 Act. These include prevention and early intervention

The guidance document outlines the high level Outcomes Framework for the RIF. The framework will provide practical information to the RPBs and partners. It will include guidance on data gathering, presenting evidence and reporting.  

We have commissioned Institute of Public Care to set up and run a range of communities of practice. These will focus on sharing good practice from projects funded through the RIF.

Recommendation 14

We recommend that social services demonstrate how they are working in partnership with other organisations and what benefits that collaboration brings to the people they support.

We developed guidance for the Regional Integration Fund (RIF) in partnership with RPBs. We co-produced the parameters for using the fund, as well as the guidance. We have done this by learning from each other and offering a safe space for challenge and discussion.

The RIF will use ways of working that are set out in the Well-Being of Future Generations (Wales) Act 2015 (WBFG). Collaboration is a key feature of the WBFG. We expect RPBs to secure positive outcomes for individuals and communities by:

• investing in social value
• promoting collaboration and collective endeavours

We are continuing work to better integrate health and social care services. This is vital to ensure seamless services for people who need care and support. RPBs are vital for this ambition by providing strategic support and encouraging collaboration.  

RPBs develop population needs assessments, market stability reports and joint area plans. To do this they engage with a range of key stakeholders including:

• citizens
• third sector and wider social value organisations
• providers of care and support

They are also required to report on the nature, level and impact of this engagement.

Partnership working and integration is key to the Rebalancing Care and Support Programme. The Programme will aim to:

• establish a national framework for commissioning care and support
• rebalance the social care market, to focus on quality and outcomes, rather than price
• increase integrated working between health, social care and the third sector
• ensure increased engagement and voice, governance and scrutiny, planning and performance

Recommendation 15

We recommend that all complaints processes are easy to understand, transparent and accessible.

Social Services in Wales should listen to people making concerns, local authorities should:

• listen to concerns
• resolve complaints as soon as possible
• learn from these concerns
• use the experience to improve services

Details of the social services complaints processes are on local authorities’ websites. People can make complaints about services they receive or should have received. People can also make complaints about individual social care workers to Social Care Wales.

Local authorities should consider what help and support it can offer to complainants. Some people will need advice and confidential support to:

• make their complaint
• pursue their complaint
• handle the complaints process
• cope with the outcome

Local authorities must offer to discuss the complaint with the complainant. This can be face-to-face or by telephone. The aim is to resolve matters through achieving service user satisfaction. The aim should not be to resolve matters to avoid a formal investigation. This approach should allow for the quick and successful resolution of most complaints.

If a formal investigation takes place, an Independent Investigator should:

• make sure that the complainant feels listened to and understood
• be fair and as open as possible about their methods and reasons for their conclusions.

The response to the complaint should be:

• written, unless the complainant has requested an alternative method of communication. For example, a response in Braille or on audio-tape
• written in a way that is easy to understand

Local authorities must report on the complaints received. They do this using the Directors of Social Services Annual Reports. These reports will give a summary of the complaints received and the action taken as a result.

Recommendation 16

We recommend that local authorities provide data on the number of people eligible to receive direct payments in their area and information about why they are not issuing direct payments packages for eligible people requiring support.

The 2014 Act has shaped practice to promote people’s rights and the choices available to them. Person-centred planning and voice and control are central to the 2014 Act. Under the 2014 Act, we co-produce care, rather than providing or influencing solutions. This principle also applies to direct payments.

Direct payments are a personal choice of an individual or family. Individuals can use direct payments to meet any eligible assessed need. People can choose a mix of direct payments and local authority commissioned services. This enables people to achieve their stated outcomes using appropriate care and support.

A co-produced resource providing advice for practitioners and direct payment recipients is available. This is available on Social Care Wales website.

Audit Wales recently published their Direct Payments for Adult Social Care report. We will consider how their findings can further support this recommendation.

Capturing, interrogating and understanding data is important to improving services. The new performance and improvement Framework (PIF) requires local authorities to do this. The PIF includes the number of adults and children using direct payments to meet their needs. This allows local authorities to:

• understand the choice individuals make
• how people exercise voice and control over their own care and support needs
• the outcomes people want to achieve   

The PIF includes guidance to help understand experiences and outcomes. The guidance includes ideas about how to engage with people who use social services. Engagement will help local authorities to understand how people receiving care and support:

• feel about their experience of engaging with social services
• their perceptions of any changes in their social care outcomes
• feel about their wider well-being

Closing Remarks

Finally, in conjunction with these recommendations, the Jurors concluded that whilst the Social Services and Well-being (Wales) Act 2014 contained all the elements to facilitate a superb social care system, the Principles of the Act are not easily understood by ordinary people. Therefore, a ‘rebranding’ of the Principles, articulated as core values that underpin the delivery of both social care and health should be implemented, so they are clearly stated and understood across both sectors.

We recognise the importance of the people of Wales understanding the 2014 Act. We hope that the principles of the 2014 Act will be better understood by the people of Wales as a result of:

• engagement with people who need care and support
• continued promotion of the Act and its principles
• the actions already taken, or those we will be taking as a result of the recommendations above
• working in partnership with colleagues, such as the NHS, local authorities, and private social care providers