Plaid Cymru’s shadow health and social care secretary warned that new Wales-wide standards for commissioning care may be unachievable due to financial pressures.
Mabon ap Gwynfor raised concerns about the national rules for councils and health boards on commissioning care and support, which came into force on September 1.
He welcomed the reform’s overall aims but cautioned that councils, which will primarily be responsible for implementation, are already “hurtling” into an existential crisis.
Mr ap Gwynfor said councils are contending with a 3.8% increase in spending pressures this year compared with a 0.3% rise in funding, with a projected £750m shortfall by 2027.
He told the Senedd: “There remains widespread concern that the principles and standards outlined in this framework, as worthy as they are, will be unachievable in practical terms.”
‘Complexity’
Mr ap Gwynfor, who represents Dwyfor Meirionnydd, said non-ring-fenced parts of the Welsh budget, which include social care, are facing a £683m real-terms cut over five years.
Dawn Bowden, Wales’ social care minister, argued the bulk of the reforms ask councils and health boards to do things differently rather than to do more.
“It’s about moving away from complexity towards simplicity,” she said in a statement to the Senedd on September 24.
“It’s about moving away from price towards social value and quality, and it’s about moving away from reactive commissioning and towards managing the market.”
Altaf Hussain, the Conservatives’ shadow social care minister, described the new code as a welcome step in ensuring a uniform approach to care commissioning.
But Dr Hussain was concerned that moving away from price-driven contracts could have a detrimental impact on council and health board budgets.
‘Overwhelmed’
Jane Dodds, the Liberal Democrats’ leader in Wales, broadly backed the reforms but raised concerns about social care recruitment and retention in rural Wales.
She warned: “People in our care sector and our health sector are really overwhelmed at the moment and to pile on them, yet again, another change is a real challenge.”
Labour’s Julie Morgan, who was previously social care minister, described the reforms as a building block towards the vision of a national care service.
She stressed the importance of better pay, saying care workers can get much more to do a similar job in the NHS which makes retention difficult.
Ms Bowden said the new national office for care and support within the Welsh Government, which was established in April, will play a key role in implementing the framework.
How does this fit into wider reforms?
Wales-wide commissioning rules form part of a swathe of reforms proposed by the Welsh Government in an effort to tackle the social care crisis.
The ambition, agreed as part of the cooperation deal with Plaid Cymru, is to establish a national care and support service – free at the point of need, similar to the NHS.
An implementation plan was published by the Welsh Government in December, with the reforms expected to take at least 10 years.
Phase one includes establishing national commissioning arrangements, a voluntary pay framework, and a national office for care and support.
Political opponents have cautioned of the potential negative consequences of imposing a litany of changes on a sector already struggling to cope.
How should we pay for social care?
A lack of funding is the crux of the crisis but it is often the elephant in the room.
The scale of the issue means Wales is reliant on Westminster bringing forward reforms in England, which would result in consequential funding for the Welsh Government.
But, for decades, successive Conservative- and Labour-led governments appear to have kicked social care into the long grass.
Before a u-turn in September 2022, Boris Johnson’s UK Government proposed a health and social care levy which was expected to raise about £13bn a year.
And Carwyn Jones’ Welsh Government, which cut health to protect social care spending, commissioned independent research on paying for Wales’ social care needs.
Gerry Holtham, an economist, proposed a similar levy or tax increase in 2018.