The 2019 Co-operation Agreement between Welsh Labour and Plaid Cymru committed the Welsh Government to establish an expert working group to chart the path towards a National Care Service in Wales. The Expert Group reported in October1922 with the Welsh Government responding to the report in December 2023 with a further update in March 2024
The Welsh Government agreed with the Expert Group that the future vision was best described by a “National Care and Support Service (NCSS)”. Implicit was the expectation that the service would not be delivered to users in a passive consumerist way but the addition of the word ‘support’ would reflect the aim of supporting and empowering people to live happy, independent lives in line with what matters to them.
Progress towards a National Care and Support Service will be achieved over three implementation phases extending over a decade with the first phase beginning immediately to 2025. The final phase will involve putting in place the vision for a National Care Service free at the point of need.
A key aspect of building a National Care and Support Service is a range of values and practice which will have a transformative effect for service user and their carers as well as for the staff. It must start with a NCSS having a parity of esteem with the National Health Service. The NCSS must deliver what matters to its users and actively involve them in the way services needs are assessed, planned and delivered. Earlier intervention, with a strong preventive focus, must replace the crisis intervention model with predominates at the moment. None of this will happen spontaneously. These changes must be built into social care and support the system to become the norm.
At the heart of the service delivery is the workforce and the Welsh Government is committed to building on the work that the Fair Work Forum has achieved to date including achieving the National Living Wage and getting rid of mandatory zero-hours contracts. The next steps including working to create a national collective bargaining structure for the care sector.
These are fundamental challenges as the Social Care Wales workforce survey shows that there up to a third of registered care workers are finding it “very” or “quite” difficult to manage financially. More reassuringly most of the survey’s respondents felt that they were getting the training they needed to do their job well and that they had good colleague support though management support was weaker. It was felt that service users greatly valued the support they received compared to a much lower level of appreciation by the general public and other partner agencies.
The commissioning and delivery systems need to be strengthened with the development of a National Commissioning Framework, creating a national performance and outcomes data set and new models of integrated care being delivered through the use of the Regional Integration Fund. This enhanced system will be expected to work towards the necessary realignment in the way services are planned and delivered.