Gwenda Thomas, Deputy Minister for Social Services
My July statement advised Members of changes that I would bring forward through amendments to the Social Servies and Well-being (Wales) Bill in order to further strengthen the connection between assessment and the future eligibility framework. I said I would further update Members on progress on this important aspect of our transformation programme.
I have now tabled my amendments for consideration at Stage 2 proceedings. These provide for significant changes which will place duties on a local authority, at the point of assessment and when determining if a person meets the eligibility criteria, to consider other ways in which the individual’s needs can be met through the provision of: information, advice or assistance; preventative services; or any other support that may be available in the community.
Today I want to set out specifically how I will be developing our approach to eligibility.
We all acknowledge that we need to modernise the system to meet with expectations of today’s society and those who rely on it. I have been struck by the level of discussion and debate about these matters, and particularly about the strength of feeling people have voiced in respect of the current framework of eligibility for adults and the uncertainty and anxiety of moving to a new system for people even though that system will seek to empower more people to maintain their independence and well-being.
The Bill provides the legal framework for a major shift in the way the current system operates. This was acknowledged by the Welsh Local Government Association and NHS Confederation in their recent report on Transitional and longer term implication of the Social Services and Well-being (Wales) Bill . The report stated that the Bill supports a whole system change towards preventing need occurring and maximising opportunities to intervene earlier to offer people proportionate help in meeting or reducing need.
Our focus must now be on people’s well-being, their strengths and on building on their family and community networks and links. We want people themselves to be at the centre of decisions about their well-being and to remain in control of their lives. The new system must ensure people and families get the right support, in the right place, at the right time.
Our starting point must be to set changes to eligibility processes into the context of the overall changes that the Social Services and Well-being (Wales) Bill provides for.
National Eligibility Criteria in the new System
Whilst assessment and eligibility will play an integral role in the new system for well-being, care and support, the significance that this will have on whether an individual receives support to meet their need will be considerably reduced. Rather, the new system will place greater focus on prevention, transparency, and building on people strengths to enable them to exercise voice and control over what matters to them, their needs and aspirations. This will mean that more people will be supported outside the eligibility framework.
My policy to introduce a national eligibility framework to provide a consistent approach to decision making across all areas of Wales for all people with care and support needs was set out in of Sustainable Social Servies for Wales – A Framework for Action published in February 2011.
The Social Services and Well-being (Wales) Bill, provides the legal framework to put that policy in place through regulations and the Code of Practice which will themselves be developed in partnership with stakeholders and citizens, and subject to consultation in Spring 2014. I want to say now, that I would particularly welcome the views of the Health and Social Care Committee, at that stage. Their careful thoughtful and challenging contribution to the development of the Bill, through the scrutiny process, has enabled us to advance and refine our thinking at every stage. This is why I am making a firm commitment to refer the regulations and Code to the Committee at the point at which the consultation commences. Following the consultation process the regulations and Code will be brought forward to the National Assembly and will be subject to the affirmative procedures.
Working with stakeholders and drawing on the substantial evidence considered by the Committee and more widely has greatly assisted in shaping our emerging framework. As a result I intend that the regulations and the Code will:
- treat people as equal partners in designing their care, and support
- set out a minimum threshold on what needs are eligible needs for care and support for children, adults and carers that local authorities across Wales must meet
- focus on the person’s needs for care and support, the impact of those needs on their well-being, and the level of risk to the individuals if those needs are not met
- make it clearer for people what their entitlements are; and introduce a level of consistency about the threshold to give people more confidence that if they want to move to another area in Wales, and their circumstance have not changed, then their eligibility for care and support will continue
- set out the criteria for people who are to be ‘passported’ to be treated as eligible i.e. those who the local authority must protect from abuse or neglect, or risk of abuse or neglect, and also in the case of children: harm, or risk of harm
- prevent local authorities from tightening their eligibility criteria beyond that set out in the regulations
- place on-going responsibilities on local authorities to look at wider support across the new care and well-being system to ensure that a greater number of people with needs are supported in a range of ways that can be accessed outside the eligibility criteria.
The eligibility framework must be sensitive to the differing needs, context and outcomes for children, adults and carers. It cannot therefore be a one size fits all.
Children need a stable upbringing with the right level of parental care and support critical to their development. For many adults their priority will be for support to continue to live independently; preferably at home in their communities, whatever their circumstances. Carers want to be recognised for their contribution and to be able to access timely support and advice to help them care and to support their own well-being.
The eligibility criteria for each group must therefore take into account the different characteristics and circumstances, and changing needs over time, of the individuals in each group; child, adult or carer. I can assure Members that the regulations that I will bring forward will be sensitive to, and reflect the differing characteristics for children, adults and carers. I know that stakeholders will welcome this.
Where people are to be ‘passported’ in order to protect them from abuse, neglect or harm - duties also articulate a clear right to the individual (child or adult) for a local authority to meet their needs for care and support. This is a major enhancement to ensure priority action is taken to safeguard people who may be at risk.
Through my proposed amendments in this area, local authorities, at the point of assessment and when determining if a person meets the eligibility criteria, will have a duty to consider other ways in which the individual needs can be met; such as through the provision of: information, advice or assistance, preventative services or any other support that may be available in the community. This ensures that people who have a level of need are assisted to access support irrespective of their eligibility status.
We are refining the eligibility framework and the criteria that will apply to children, adults and carers. However, for adults my early view is that the national eligibility criteria will be at one level. This is likely to be based on the level ‘substantial’ in the current arrangements but I will expect the new national level to be applied with consistency across the whole of Wales.
For children and carers this will be the first time that local authorities will be required to apply an eligibility criteria and there are different implications to consider. The system will preserve local authorities responsibilities to children who in the current arrangements are defined as ‘in need’. However, local authorities will have specific duties to children in need of protection; and Looked After Children, for whom Members have a corporate responsibility.
I will continue to work with stakeholders, and people who use services, to inform the draft regulations and Code.
I know that people currently using services are very concerned about the impact of moving to the new arrangements I want to assure people that there will be clear arrangements in place to ensure continuity of care for individuals in the transition to the new system.
However, we know that people’s needs change over time and regular review of need is important. This will continue as a feature of the new system.
It is these key factors that provide the basis for our detailed work on the eligibility regulations and Code. As I have said that must be within the overall framework of the new system.
A future system that is solely reliant on whether a person is eligible or not will not realise our aims. The increased focus in the system on provision of accessible information, advice and assistance and preventative services in the community is aimed at enhancing people’s well-being. We must work with people to reduce or delay the need for care and support. We must also ensure that services are integrated locally to remove gaps and build provision around the needs of people.
The system must also provide for proportionate and flexible support to individuals who at differing times in their lives may require some additional support to retain or regain independence and family cohesion.
Many local authorities are already making headway in reconfiguring their services towards prevention and early intervention to meet the needs and expectation of their communities. One example is the reablement services that are largely delivered outside the local eligibility thresholds and are already having a positive impact in Wales. Over 23,000 people benefited from such services in 2011/12.
The priority action for integrating services for older people including our work to simplify and streamline assessment arrangements for people 65 years and older within the current legal framework, will provide further impetus and motivation for local innovation and is providing a significant bridge into the new arrangements that are provided for in the Bill.
Similarly we continue to invest and strengthen our community support to families, such as Flying Start and Families First that play major roles in supporting children and families in more informal and holistic ways. I will be making a further statement on preventative services later in this month.
I have said on a number of occasions that the Social Services and Well-being (Wales) Bill is a Bill for a generation. It will transform care and support in Wales. It is a whole system change – but I have heard the concerns that have been expressed about the specific details of the national eligibility framework.
I have set out here the key factors that will be the basis of the development of that framework, of the regulations and Code of Practice. I have made a commitment to develop the detail of these with partners, stakeholders and citizens themselves. I will consult on these in the spring of 2014, and I have made it clear that I will welcome the views of the Health and Social Care Committee at that stage and in advance of the regulations and Code being subject the approval of the Assembly.
I intend that our new system will operate to ensure the needs of the people of Wales will be met both through the eligibility criteria and more broadly within the whole system for well-being, care and support.