Wales thinks differently in seeking more efficient social care

Social services minister may reduce Wales’ 22 council providers of social care to improve efficiency and integrate with health boards

Wales’s deputy minister for social services Gwenda Thomas refuses to be drawn on whether Wales runs social care better than England. Her cautious assessment: “We’re doing things differently.”

But one fundamental disparity, Thomas says, “is that we see the future (as one) of integrated family services within local government – very much our society, communities, families.” The inference is clear: east of the border, communities and families risk being hung out to dry.

With the NHS in Wales “reset” – internal markets abolished, the language of competition and contracts excised, services returning to the hands of professionals – social care reorganisation is high on the agenda for the new Labour administration in Cardiff.

Underlining this, Thomas’s role has expanded since elections last month to what some say amounts to a full ministerial portfolio. The Labour assembly member for Neath retained responsibility for social services, a position she has held since 2007, and gained children’s services. She also got a new boss: Lesley Griffiths, who takes over as health minister following the tough restructuring work done by Edwina Hart.

Manifesto commitments bind the new Welsh Government (it has dropped the ‘Assembly’ part) to producing a Social Services Act and Children’s Act; to annual health checks for the over-50s; to improving cancer, cardiac, stroke and ambulance services, maternity care, evening and Saturday GP access; and to tackling alcohol, obesity and smoking.

But the healthcare budget, which accounts for 40% of public spending in Wales, is shrinking: the King’s Fund calculates a real terms cut of 8.3% over the next three years. The Wales Audit Office (WAO) puts the figure closer to 6%.

Despite this “less than satisfactory settlement” social services are protected, Gwenda Thomas says, and will receive a further £35m over the next three years. Health spending has not been ring-fenced, so cutting duplication is one way to make savings.

“We are committed to changing the process where everything needs to be done many times over – do we really need 26 adoption agencies, 22 local safeguarding children boards? The challenge is to decide what’s best done on a national, regional or local level,” she says.

Wales currently has 22 social services authorities run by 22 local authorities; the plan is to cut these to seven to match the number of its local health boards. Tony Beddow, visiting professor at the Welsh Institute for Health and Social Care, University of Glamorgan, suggests this could trigger a shake-up of local government.

“Social care is one of the bigger, more complex and politically challenging bits of local government, interfacing as it does with many other policy areas,” he says. “The Welsh Government may feel it can be dealt with without upsetting the rest of local government, or – if other of council functions need reappraising – may take the view that having 22 local authorities is no longer sensible or sustainable.”

Regulatory differences already exist between Wales and England – the Care Standards Act 2000 is still in force in Wales, for example, while the new regulatory system for health and adult social care set out in the Health and Social Care Act 2008 supersedes it in England.

In policy terms, Wales’s vision for the next decade is set out in the framework document Sustainable Social Services for Wales, (http://wales.gov.uk/topics/health/publications/socialcare/guidance1/services/?lang=en) including the formation of several new national bodies: an independently chaired safeguarding board for children and adults, a national adoption agency, leadership college and social care research centre of excellence. Monies will be distributed by a newly established Welsh Social Services and Social Care Improvement Fund.

By the end of the year councils must also develop proposals for regional social care teams, and uniform assessments and eligibility criteria for the non-residential care they supply or commission. Charges for this have been capped at £50 in Wales. English councils have discretion to design their own charging schemes and levy charges of up to £150.

Gwenda Thomas’s personal priority is protection. “Our framework commits us to moving towards a statutory safeguarding forum to cover children, adults and vulnerable and disabled people. We can’t close every door, but we can certainly get to a better place.”

Beverlea Frowen of the Welsh Local Government Association says the big challenge will be managing residential care (Thomas acknowledges this is “a huge issue”) and dealing with Westminster’s proposed welfare reforms – another example of how Wales’s self-determination in health and social care comes unstuck down the long flank it shares with England.

“Because of our demographic we have a large proportion of people claiming benefits,” says Frowen. “The accumulative effect of any adjustment to welfare in England will have a significant impact on a range of people in Wales.”

Dave Thomas, director for health and social care at WAO, adds that demographic changes and financial constraints are likely to put significant pressure on social care provision generally. Some parts of Wales have a greater dependency on welfare benefits and public services than other parts of UK and there is a risk that downward pressure on health and social budgets can affect these communities disproportionally.

“NHS and local government bodies will need to work together to form coherent, whole-system plans to deliver integrated services in their localities, but the issue will be how effectively they deal with the different sets of budget pressures they are facing,” he says.