Building For The Future; A White PaperFor Wales. March 1999FOREWORD BY THE SECRETARY OF STATE

Social care is one of most important service areas which central and local government areresponsible for in Wales. A whole spectrum of social services help to support some of themost vulnerable people in the country to live as independently and safely as possible, withassistance ranging from meals on wheels to residential care.

Wales is now standing on the threshold of a whole new way of life. As we look forward tothe advent of the National Assembly and as we work to modernise local government, I wantto set out how we will capitalise on this opportunity to strengthen and revitalise social care inWales.

I want service users, and their families and other carers, to be able to find out easily what helpthey are entitled to receive, and to be able to count on receiving a professional service at afair price (whether to them directly or to the taxpayer). I want them to feel safe; to know thattheir wishes are listened to; and for them to be able to maintain their dignity. I want them tobe able to feel secure in the knowledge that they will receive the support they need, whenthey need it, regardless of how many agencies are involved in their care and regardless ofwhether services are provided by the public, voluntary or private sectors - or a combination ofthese.

I want to see social services develop to a more strategic agenda - starting with a clearstatement from the Government on the principles and priorities which we believe shouldunderpin the planning and provision of social services. And we need to embed and continueto develop Best Value, to ensure that service users get the best possible service for the moneywe put in. I also want to ensure that we capitalise on the potential for the various planners andproviders of social care to work ever more closely together - and that means joining with allthe key agencies to co-ordinate care planning and delivery. One of the most importantpartnerships for social services is with the Health Service. I want to see a new vibrant andcollaborative approach developed between these sectors, which removes once and for all thetraditional barriers which have hampered effective delivery to users of these services andtheir carers. The measures we are introducing to increase the operational and financialflexibilities available will provide the incentive to achieve more and better joint working thatit is essential to achieve.

Our most important asset is the team of dedicated staff who work hard to provide goodquality care - often in testing circumstances. That is why I want to ensure that they receivethe training they need, and why I want to set them on a more professional footing byestablishing new arrangements for registration and regulation. I want them to be able to feelproud of the work they do, and the public to be able to be fully confident that they willreceive good quality care when they need it.

[SIGNATURE]

The Rt Hon Alun Michael MP

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CONTENTS

CHAPTER 1: VISION

The opportunity for change

Our principles

Objectives for Social Services in Wales

CHAPTER 2: MANAGING FOR EFFICIENCY

Best Value

The Planning Framework

The Financial Framework

Monitoring and Review

Joint Reviews

Performance Indicators and Government Statistics

Welsh Office Monitoring

Local Voices

Public and Private Sector Provision

Summary

CHAPTER 3: PARTNERSHIP

Social Services - NHS Interface

Housing and Social Services

Education and Social Services

The role of the voluntary sector

The private Sector

Summary

CHAPTER 4: REGULATION OF SERVICES

Domiciliary Care

Regulation of Children’s services

Regulation of related services

Options for new regulation arrangements in Wales

Standards And Enforcement

Summary

CHAPTER 5: RAISING STANDARDS IN THE SOCIAL CARE WORKFORCE

Introduction

Establishing a Care Council for Wales

Setting the Standards

The Registration of Individuals

Job Reservation

The Council’s Role in Training

The Council’s Shape and Funding

Training the Social Care Workforce

Targeting Training Resources

Summary

CHAPTER 6: CHILDREN’S SERVICES

Introduction

A Strategic Approach

Getting the Framework Right

Quality of Care in Wales

Early Development: Giving Children a Sure Start

Children Looked After and Away from Home

Child Protection

Summary

CHAPTER 7: ADULT SERVICES

Introduction

National framework for service provision

Direct payments

Carers

Disability Rights Commission

Information about services

Mental Health Strategy

The Welsh Mental Handicap Strategy

Risk assessment

Drugs and alcohol

Summary

CHAPTER 1: VISION

The opportunity for change

1.1 The prospect of a new National Assembly for Wales, supported by modernised andrevitalised local government, offers us the opportunity to take a radical look at the way inwhich local services are planned and delivered for people in Wales. We are also facing anumber of demographic changes which will affect the future of social services and these needto be planned for - among them, the welcome challenge of supporting a growing ageingpopulation. We need, too, to build staff morale and to re-establish fully the public’sconfidence in the quality of social services.

1.2 The proposals in this White Paper, taken together, will provide a model for improvingquality and effectiveness and ensuring that we get real value for money from these vitalpublic services in Wales. They also complement the changes we are bringing into effect forthe Health Services in Wales. As the Secretary of State announced in December our aim is tocreate a single health service which combines acute, community and mental health services.He made clear that the principles of partnership would replace wasteful competition withinthe NHS and that greater co-operation with local authorities would be pursued by NHS Trustsand through local health groups.

Our principles

1.3 Our vision for the future of social services in Wales is built on five key principles. Theyare that we will:

• promote an inclusive society;

• support and promote effective social services, providing Best Value on a fairand consistent basis for those who need them;

• provide support, for those who need it, in a safe environment which preservesdignity;

• encourage and support those who can do so to build their independence; and

• promote the continued development of a high quality workforce.

1.4 We believe that personal social services in Wales should work to a clearframework of objectives. We propose that the National Assembly should set newstandards of service and accessibility, while also raising quality overall. We do notpropose specific targets in this White Paper because we believe that the Assemblyshould have the opportunity to devise these targets itself, following discussion andconsultation.

1.5 The standards to be set should flow from the principles set out at 1.3 above, and shoulddraw on the aims and priorities which are summarised below.

Objectives for Social Services in Wales

Social Inclusion To contribute towards securing an inclusive society in whichpeople can lead productive and meaningful lives

Independence To support individuals and families towards greaterindependence

Responsiveness To provide services which are responsive to individualneeds and choice

Staffing To ensure that staff involved in social care are appropriatelyskilled, trained and qualified and that their conduct andpractice are properly regulated

Carers To recognise and support carers of all ages in their role incaring for vulnerable people

Effectiveness To secure effective and efficient services in keeping with theprinciples of Best Value

Management To provide a management framework that monitorsperformance and secures accountability, and is built on localauthorities’ corporate responsibilities, particularly towardschildren

Safeguards To ensure that safeguards (including advocacy, complaintsprocedures, inspection and regulation) are in place and arepublicised, to protect and promote the welfare of vulnerablechildren and adults

Planning To ensure that all partners, including users and carers, cancontribute to the planning and development of services

Partnership To work closely with agencies and services, including thosein the statutory, voluntary and private sectors, to supportpeople to achieve these objectives

These principles, aims and priorities have guided the formulation of the proposals set out inthis document. They underpin the Welsh Office’s corporate objectives for social services,particularly the Secretary of State’s commitments to

improve the standards of support and care provided in the community tothe socially disadvantaged or those requiring continuing care

and to

promote the welfare of children and protect them from abuse or neglect

1.5 Our key proposals, which flow from these principles aims and priorities, aresummarised at Annex A at the end of this White Paper.

CHAPTER 2: MANAGING FOR EFFICIENCY

2.1 Personal Social Services accounts for roughly £540 million of local government spendingin Wales each year: roughly 18% of total local government budgets. If people are to receivemodern and high quality social services, then effective and reliable performance managementand information systems are essential. These must be monitored and reviewed both nationallyand locally to ensure that continuous improvement in service quality is achieved, withstandards driven up to match those of the best. Poor or inefficient delivery of social servicescannot be tolerated any longer. We are acting on a number of fronts to ensure that localauthorities work systematically towards improving local services. One of the Secretary ofState’s overriding objectives for Wales is:

to enhance local democracy and secure effective, efficient and accountablelocal government.

While the Government can set the framework and priorities for change, it is primarily a taskfor local government to work to meet this objective for the personal social services whichthey secure.

Best Value

2.2 In July 1998 we published our White Paper Local Voices - Modernising LocalGovernment in Wales. This set out our ambitious agenda for change, including a newapproach to improving the quality and effectiveness of locally provided services through theBest Value initiative. Under Best Value, authorities will be expected to deliver the qualityservices that people expect, at a price they are willing to pay. Local people will be able to seehow their council is performing. There will be external monitoring and public reporting ofeach council’s performance every year. Best Value will require councils to search forcontinuous improvements in the efficiency and effectiveness of all their services. Localpeople should have a greater say in how services are to be delivered, and there will be clearand agreed standards.

2.3 The Best Value initiative builds on the best current practice. It will require authorities tohave a planning framework, a financial framework, arrangements for monitoring and review,external evaluation and audit.

2.4 Under Best Value, authorities will have to:

Publish annual performance plans for all services. These will summariseperformance over the past year against agreed standards, make comparisonswith other councils, and set targets and objectives for the following year. Theywill reflect what local people have said about the services being provided.

Conduct a service review for each service - probably over a five yearperiod. This will involve a fundamental scrutiny of each service to find outwhether it is needed and, if so, how it should be delivered and by whom. Thisprocess will include comparisons with the performance of other authorities,and will take account of the views of service users themselves.

and

Accept external validation by auditors, and joint inspection carried out by theSocial Services Inspectorate for Wales (SSIW) and the Audit Commission.

2.5 Social Services Departments should begin now to consider the arrangements they willneed to put in place, even before legislation is introduced. The Welsh Office is alreadyworking with the authorities and the Welsh Local Government Association (WLGA) toensure that all councils in Wales are ready to introduce Best Value to personal social serviceswithin the agreed timetable. The National Assembly will be responsible for administeringBest Value in Wales. The Local Government Bill, which sets out the proposals for BestValue, is currently going through Parliament. The Bill allows for the Assembly to commencethe Best Value provisions within twelve months of Royal Assent. Within the Best Valueframework, the National Assembly for Wales will need to set performance indicators andstandards for the way in which social services are delivered. It will also need to set efficiencytargets for social services.

The Planning Framework

2.6 Planning systems are well established tools in the management of social services.Authorities are required to produce Social Care Plans for adult services and Children’sServices Plans for children and families. These plans have provided useful benchmarks forthe new authorities following local government reorganisation in 1996. They providevaluable information for service users, carers and families, service managers and staff, andfor elected members. The best plans set out a clear statement of user (or client) need, describeplans for service development and explain the allocation of resources within budgets. Theyare dynamic and indicate the overall strategy for service development in each area. Goodplans are accessible and timely, and can be invaluable management aids for securingimprovements in both the quality and the efficiency of services, while providing clearobjectives and a strategic framework for staff at all levels.

2.7 During the last year, SSIW has reviewed the Social Care Plans and the Children’sServices Plans produced by all authorities in Wales for 1997-98. These reviews have drawnout many valuable lessons. First of all they have indicated that, in general, both Adults’ andChildren’s Services Plans provide a great deal of information, often well presented, whichwill be meaningful and useful for service users, carers and families, as well as for staff andmanagers in authorities. Most plans indicate the need for close co-operation withcomplementary services - housing, education and especially health services.

2.8 But not enough of the plans demonstrate the kind of closely integrated joint serviceplanning which people have a right to expect when they are in need of support and specialisthelp. It is also clear that many authorities still have scope for improving the coverage, andformat, of their plans. Some need to re-establish their focus. Some plans could go further inmapping out the future direction for commissioning and providing services. Very many coulddo more by way of making explicit the difficult choices facing managers and members injuggling competing priorities and finite resources.

format, of their plans. Some need to re-establish their focus. Some plans could go further inmapping out the future direction for commissioning and providing services. Very many coulddo more by way of making explicit the difficult choices facing managers and members injuggling competing priorities and finite resources.

2.9 The Welsh Office intends to work closely with local authorities over the coming year, torevise and improve the statutory planning guidance for both adults’ and children’sservices. We want to secure a planning framework which contributes directly to Best Value,but which is also co-ordinated with planning requirements in the modernised NHS in Wales.The Welsh Office aims to produce draft revised social care planning guidance forconsultation in the summer and for it to be approved by the National Assembly by the end ofthe year. National Priorities Guidance for the NHS and Social Services will be produced inconsultation with the WLGA and Health Authorities for issue next year. The Welsh Officewill also be reviewing the scope for closer integration of the various plans for children’sservices in each local authority area (see chapter 6).

The Financial Framework

2.10 Good planning requires good quality financial and service information. At present,authorities use a range of financial and performance measurements, but there is littleconsistency between authorities in Wales either in the range of information they produce or inthe baselines and cost assumptions on which service plans are built. The WLGA, theAssociation of Directors of Social Services (ADSS) in Wales and the Welsh Office havejointly funded research by the Nuffield Foundation to examine the fit between assessments ofthe need for community care services for individuals, activity levels by Social ServicesDepartments in meeting those needs, and resources for community care, in authorities acrossWales.

2.11 The initial results have been very useful and further follow-up research, jointly funded,to develop an updated needs-based expenditure model has now been completed. The WelshOffice will take this into account when examining future spending needs for personal socialservices generally in Wales, and within the annual local government revenue settlementnegotiations. In addition, social services managers in authorities across Wales will be able todraw on the research data to benchmark their own service provision and to work towardsmore objective community care assessment procedures.

2.12 The Audit Commission currently sets performance indicators for all major services inEngland and Wales. It is looking closely at existing and possible future patterns of serviceand performance data, in order to produce a matrix of standard output and performanceindicators. Once the best value legislation is in place the National Assembly will, followingconsultation with the Audit Commission, decide how these performance indicators should beset for social services authorities across Wales.

Monitoring and Review

2.13 Monitoring, review and external evaluation is the final stage of the effectivemanagement process. Review and evaluation can measure the performance of authoritiesagainst their stated plans and targets, and their success in delivering services within theiragreed budget profile. The review process should inform managers, planners, electedmembers, service users and the public about the effective delivery of social services in eacharea. The process of monitoring and review and the mechanisms to secure quality and tomeasure performance should complement and inform each other: they should not be pursuedas discrete initiatives. Three distinct areas of activity will contribute to the monitoring andreview process in Wales:

area. The process of monitoring and review and the mechanisms to secure quality and tomeasure performance should complement and inform each other: they should not be pursuedas discrete initiatives. Three distinct areas of activity will contribute to the monitoring andreview process in Wales:

• joint reviews and inspections;

• performance indicators and statistics; and

• Welsh Office monitoring.

The public will also have a direct voice in reviewing service provision and target setting forfuture years through the Best Value initiative.

Joint Reviews

2.14 In October 1998, SSIW and the Audit Commission began a new programme of jointreviews in Wales. These will provide an independent assessment and overview of theperformance of individual Social Services Departments in Wales, on a five-yearly cycle. Thejoint reviews will be complemented by the more detailed inspections of specific areas ofservice which are already undertaken by SSIW and for which the forward programme issubject to annual consultation with WLGA and others. The service reviews by the DistrictAudit service will also continue. There are close working relationships between SSIW, theDistrict Audit Service and the Audit Commission and these will continue to bestrengthened in the light of the joint review programme and the development ofperformance indicators for Personal Social Services. In addition, SSIW and the Office ofHer Majesty’s Chief Inspector of Schools (OHMCI) will continue to work closely togetherand will undertake joint inspections of services for children where appropriate.

2.15 Research and development in social care can support the planning, delivery andevaluation process, by providing independent evidence about standards of service, outcomes,and good practice. Research can help authorities to develop new and more effectivemethodologies for service delivery and management. Research activity in Wales must bemore closely integrated with the needs identified by managers in local authorities. This willensure that Government-funded research increasingly supports the efforts of local authoritysocial services to improve performance and deliver measured outputs for service users. TheWales Office of Research and Development for Health and Social Care (WORD), workingclosely with the Welsh Office, the WLGA, and the academic institutions in Wales, has aforward programme of social care research based on agreed priorities. One of WORD’sobjectives is to ensure that dissemination of research findings is made more effective, so thatthe results of research can be applied effectively across Wales. The Local Government Bill islikely to provide a power of the Assembly to give guidance to the Audit Commission andSocial Services Inspectorate for Wales on best value aspects of the inspection process.

Performance Indicators and Government Statistics

2.16 The Audit Commission performance indicators are well established and widelyunderstood. Authorities are already required to develop performance targets locally for theircommunity care charters. Under the Best Value initiative, the National Assembly willprescribe performance indicators which will include social services. They will besupplemented by locally set performance indicators which can take account of localdifferences and plans. Performance indicators will be crucial for the development ofperformance plans under Best Value, and for service reviews, including the joint SSIW andAudit Commission reviews.

prescribe performance indicators which will include social services. They will besupplemented by locally set performance indicators which can take account of localdifferences and plans. Performance indicators will be crucial for the development ofperformance plans under Best Value, and for service reviews, including the joint SSIW andAudit Commission reviews.

2.17 Authorities are required to submit statistics about their activities, staffing and finance tothe Welsh Office as part of regular monitoring arrangements. The Welsh Office has recentlyreviewed some of these statistical requirements, to ensure that the data collected focuses onkey areas. A consistent and coherent information and audit database for social serviceswill be used by the Welsh Office in evaluating and monitoring the performance ofindividual authorities. We recognise the importance of consistency and coherence betweencentrally stored databases and key performance indicators. A single set of data should serveto meet the needs of joint reviews, Welsh Office monitoring, and local performance plans.The Welsh Office will be working over the next year with social services authorities and theWLGA to ensure that statistical databases focus on the key areas and do not duplicatematerial collected elsewhere, and to ensure that authorities are assisted to providecomprehensive and accurate returns on time, through the development of an executivemanagement information system for social services.

Welsh Office Monitoring

2.18 The Welsh Office has a central role in the strategic management of social servicesplanning, and the overall level of finance available. The National Assembly for Wales islikely to take a close interest in the performance of social services authorities individually andacross Wales.

2.19 We therefore plan to consult the WLGA and others to establish a performancemanagement framework which can inform the Department, and in time the Assembly,about individual and relative performance in all areas of social services provision in Wales.We will maintain regular contact with social services departments to provide a structuredbasis for performance review. Reviews will be based on information drawn from theperformance management framework. The format of these reviews is likely to be based on astandard model, which will be the subject of wide consultation. The Department intends toinvite local government to join a task group to work up proposals in this area and to examineways of collecting and disseminating key information including using new technology. Itswork will be closely integrated with the Best Value initiative and with work to revise serviceplanning, performance indicators and needs-based assessment.

2.20 Within the framework of local plans and performance targets, it will be for each localauthority in the first instance to monitor its social services provision. The Welsh Office willmonitor performance on an annual basis, as well as through the Joint Reviews and the regularprogramme of SSIW inspections. The Department will expect to discuss areas of difficultywith authorities as they arise. Every SSIW inspection and Joint Review will lead to an actionplan setting out how the authority proposes to respond to the findings. The Welsh Office willin future follow up all inspection reports to monitor progress. Where serious failures inservice are identified and where these are not addressed effectively and promptly, the WelshOffice will take any necessary steps to protect vulnerable people using statutory powersof intervention, or, in due course, through the range of interventions which it is intended toput in place under the Best Value regime. In establishing effective systems to monitor andmanage performance of social service in Wales, the National Assembly will consider thecompletion of an annual satisfaction survey as part of the Best Value framework. Goodpractice should also be recognised and the new performance management framework willidentify excellence and ensure examples of successful practice are shared between socialservices departments across Wales.

manage performance of social service in Wales, the National Assembly will consider thecompletion of an annual satisfaction survey as part of the Best Value framework. Goodpractice should also be recognised and the new performance management framework willidentify excellence and ensure examples of successful practice are shared between socialservices departments across Wales.

Local Voices

2.21 The recent White Paper Local Voices: Modernising Local Government in Wales set outour programme to modernise local government, including significant changes to thecommittee-based system which has existed in local government for over a century. Thesechanges will have a positive impact on social services but will require the Local AuthoritySocial Services Act 1970 to be significantly amended. In particular, we intend that therewill in future be no requirement for a discrete Social Services Committee, given thatcommittees will no longer be the model for decision-making in local government. However,these changes will not affect the fact that social services will remain a single, coherent set offunctions and a single programme, at both central and local level. We are committed tomaintaining the integrity of personal social services, and the Local Authority Social ServicesAct will remain intact in that regard.

2.22 Our general intention is to allow local authorities the freedom to arrange their ownmanagement structures as they feel would best serve local needs. We will, however, retainthe legal requirement for every social services authority to appoint a Director of SocialServices. In addition, it will be essential for authorities - whatever their chosen arrangements- to demonstrate that they are in a position to meet all their statutory requirements and thattheir arrangements are not detrimental to safe and effective social services. In particular allauthorities will need to identify:

• named councillors who carry the executive responsibility for the range of socialservices responsibilities;

• how the elected member scrutiny arrangements will monitor the performance of thecouncil's social services responsibilities;

• clear accountability arrangements for all social services responsibilities to adesignated Director of Social Services;

• clearly defined liaison and accountability arrangements, including where appropriatethose between adult and children's services; where responsibilities are delegatedacross a number of council functions or internal management structures.

• adequate arrangements for managing information relating to the social servicesfunctions as a whole (for example, dissemination of circulars and other materials,collection of financial and statistical data, liaison with SSIW and Joint Reviews).

2.23 While allowing authorities the freedom to manage their social services as they considerappropriate, we intend to monitor these arrangements as part of the performance managementframework described above.

Public and Private Sector Provision

2.24 Provision of social services must secure Best Value whether it is through in- housearrangements or contracted out to the private or voluntary sectors. There should be noideology or preconception about this; decisions must be based on judgements about the bestoutcomes for individuals and must make most effective use of resources. Neither do webelieve there should be any distorting effects in the system which favour one sector oranother, or which constrain flexibility. We believe there is a strong case to phase out thepayment of residential allowance for adults and to transfer the funding to localauthorities. This would not affect the individual receiving care support and it would create alevel playing field between the public sector and independent provision. Crucially, it wouldsupport the agenda set out in this White Paper.

2.25 However, we will first need to consider carefully the implications of any change onoverall costs. Implications for other areas of public expenditure will need to be assessed. Wewould certainly not want to see authorities using their own homes, at a higher cost, without again in the quality of care as a result of any change to residential allowance. The impact onindependent providers and the take-up of other DSS benefits will also need to be considered.We will therefore consider the detailed options for change in consultation with both theWLGA and independent sector representatives before reaching a final decision onwhether and how to implement any change.

Summary

2.26 Performance management is clearly an important management tool to supportdevelopment of social services in Wales. Improving our planning framework, financialinformation about service provision and assessment of need, and clear, consistent and easilyaccessible monitoring data will be vital components in delivering social services which areeffective, efficient and accountable to local communities. We will be working closely withthe WLGA and authorities over the next year to put in place this framework for effectiveservice delivery and performance monitoring for the next century. In summary, its mainelements are that:

• We will consult on new planning guidance;

• We have put in place arrangements for Joint Reviews;

• We are working to develop Best Value including the use of performanceindicators, efficiency targets and an annual satisfaction survey;

• We will consult with the WLGA and independent sector on whether to phaseout payment of residential allowance;

• We will consult on National Health and PSS Planning Guidance andStandards and on a performance management framework;

• We will monitor local authorities’ performance and take steps to intervenewhen vulnerable people are at risk from service failures.

CHAPTER 3: Partnership

Social Services - NHS Interface

3.1 Social Services are increasingly working in partnership with a wide range oforganisations and agencies - statutory, voluntary and private - to deliver the services thatpeople need in a coherent, effective and cost-efficient manner. Voluntary organisations aremajor providers of some types of service; and the independent sector has an important placein the overall range of services available.

3.2 The new National Assembly will provide a framework to promote greater partnershipworking. It will be assisted by local government’s new powers, including a general duty onlocal authorities to promote the economic, social and environmental well-being of theirpopulations. People and families needing help to maintain their independence expect that thepublic services they need will be co-ordinated and provided seamlessly wherever possible.We share this expectation and we will work to encourage better integration in the planningand delivery of services, especially between social care and health services.

3.3 We propose to alter the existing legislation as soon as Parliamentary time permits toallow health and social services authorities to develop their capacity for joint planningand working. Our consultation paper Partnership for Improvement, issued in October 1998,sets out our proposals for increasing operational flexibilities and removing the legal and otherbarriers that have been a major obstacle to effective joint working. Its three key proposals aresummarised in the box below.

"Partnership for Improvement": Government proposals

The Government intends to legislate to make it easier for health and social servicesauthorities to work together. The three key proposals are:

• pooled budgets - where health and social services put a proportion of theirfunds into a mutually accessible budget to enable more integrated care.Pooled budgets would need to operate within the context of a robustinfrastructure of management and accountability arrangements

• lead commissioning - where one authority would be allowed to transfer fundsto the other which would then take responsibility for purchasing both heathand social care. Legislation would be needed to allow the local authority orhealth authority to delegate their functions or money.

• integrated provision - where one organisation would provide both health andsocial care. It is often integrated provision (for example of health and socialcare for learning disabled people) which brings most immediate benefit tousers. This flexibility would allow NHS Trusts greater freedom to providesocial care and would allow social services in-house providers to providecommunity health services.

These powers will be permissive, which means that it will be up to the local andhealth authorities to decide between themselves which arrangements would behelpful for their joint working.

3.4 The implementation of all these proposals will need to be managed carefully andcollaboratively, incorporating robust mechanisms for accountability. The consultationexercise has confirmed that there is broad agreement, and on this basis we plan to legislate toremove constraints to joint working in the present system and to provide these new incentivesfor closer collaboration. There will be further consultation about how the operationalarrangements to implement these new measures should be taken forward.

3.5 New arrangements will also be introduced to hold to account both social servicesand health services locally for their progress in developing joint working arrangements.The introduction of a performance management framework (see chapter 2) will provide arigorous approach for ensuring that effective action is taken. Our White Paper Local Voicesand our proposals for change in the NHS to establish Local Health Groups and HealthImprovement Plans (HIPs) will all contribute to encouraging local authorities to work withthe NHS in a range of areas including public health, community safety, and regenerationplans- as well as community care. Each will have an important contribution to make in theseareas, particularly in the arrangements for Local Health Groups and their work in planningand delivering primary care services (as set out in the White Paper Putting Patients First).

3.6 We believe that a clear national framework will assist in shaping rigorous joint planningtargets at the local level. We have recently issued a statement of priorities for the NHS andfor social services in Wales for 1999-2000 and we will consult on extending this to spanthree years in due course. The statement will set out our strategic aims and objectives forhealth and social services and for the interface between them. It will be consistent withplanning guidance for social care and children’s services, which will itself be reviewed andnew statutory guidance introduced by December 1999.

3.7 At the local level, the development and implementation of HIPs will bring together arange of health and local government services to work towards common objectives toimprove the health and well-being of local communities. Guidance on HIPs was issuedrecently after wide ranging consultation with health and local authorities and other interests.

Housing and Social Services

3.8 The quality of the relationship between Housing and Social Services Departments iswidely recognised as an essential factor in delivering integrated community care services andin ensuring that vulnerable people are protected. The recent Audit Commission Report HomeAlone found that collaboration between these two areas of local government is often weakand that the full potential of Housing Departments and providers to contribute to communitycare services is not being exploited. We want to see local authorities address therecommendations made by the Audit Commission in a structured and robust mannerand we will be monitoring the progress that is made and ensuring follow up action istaken.

Education and Social Services

3.9 An effective corporate approach by local authorities requires a close working relationshipbetween education and social service departments, this is essential if children are to be giventhe best possible opportunity to fulfil their potential. Such joint working is a key factor inpursuing our objectives of reducing the level of school exclusion and truancy; and increasingthe educational attainment of children looked after.

3.10 We have already moved quickly to promote effective liaison. Education authorities andsocial services provide the foundation for early years development and childcare partnerships.Guidance issued to partnerships in February 1999 requires them to ensure that their plans forearly education provision and childcare complement each other in developing an integratedapproach. The partnership arrangements build on the National Childcare Strategy in Walesdocument published in June 1998. Education and social services departments are required toco-operate on reviews of day care under section 19 of the Children Act 1989. They were alsorequired to co-operate in the preparation of pupil behaviour support plans which came intoeffect from the beginning of 1999.

3.11 Social service interests are represented on the Welsh Advisory Group on SpecialEducational Needs, set up to advise Ministers on carrying forward the initiatives set out in theBest for Special Education Green Paper published in October 1998. "Shaping the Future forSpecial Education - An Action Programme for Wales" which sets out the Department’s plansfor the future of special needs provision arising from the Green Paper consultation and advicefrom the Advisory Group was published in January 1999.

The role of the voluntary sector

3.12 We recognise and value the enormous contribution which agencies and individuals inthe voluntary sector can and do make to the provision of social services for individuals andfamilies in Wales. We are committed to developing a genuine partnership with the voluntarysector. A Compact, developed in consultation with the sector and providing a concise andclear statement of principles, was launched by the Secretary of State for Wales in November1998. The Compact will form the basis of the Scheme to guide the working relationshipbetween the Assembly and Voluntary Sector which the Government of Wales Act requires.The Secretary of State has agreed with the WLGA and WCVA a plan to have a local compactin place for every local authority area in Wales by September this year. All parties areencouraging the necessary co-operation between each local authority and its local council forvoluntary action or council of voluntary service.

3.13 We want to see local authorities adopting local compacts with voluntary organisations,with the overall aim of securing the best level of services and support for local communities.This relationship should be built on mutual respect and understanding of the different, butcomplementary, roles of the two sectors. Achieving Shared Aims, a document developedjointly by the Wales Council for Voluntary Action (WCVA) and the Welsh LocalGovernment Association (WLGA), outlines the principles involved and offers practicaladvice on how local authorities and local voluntary organisations can make the partnershipwork by setting up Voluntary Sector Liaison Groups and developing and implementing astrategic statement. Local authorities should also involve voluntary and communityorganisations (and those in the private sector with a contribution to make) in the process ofidentifying the needs of the local population and in the planning and delivery of services tobest meet these needs to help to ensure Best Value, for instance through the production ofSocial Care and Children’s Services Plans.

The Private Sector

3.14 Private sector and not-for-profit agents are significant players in the provision of certainkinds of personal social services. Their input can vary from providing domiciliary servicessuch as home helps and meals on wheels, through family support services, fostering orchildcare services, to the provision of full time residential care for children or for adults witha wide range of care needs.

childcare services, to the provision of full time residential care for children or for adults witha wide range of care needs.

3.15 In some services, and in some parts of Wales, this sector is a major supplier of services.In other areas, its role is relatively small. Service planners will need to decide how localindependent providers can play an appropriate part in the overall planning of local services.

Summary

3.16 We intend to promote a flexible, multi-agency approach to the planning and delivery ofservices through a range of measures, including:

• Greater flexibility to allow for joint service planning, funding and deliverybetween health and social care;

• A clear statement of National Priorities for Health and Social Services;

• Supporting action to implement the Audit Commission recommendations inHome Alone on housing and community care;

• Promoting joint working between Social Services Departments and LocalEducation Authorities

• Promoting partnerships between the statutory and voluntary sectors; involvingthe independent sector as appropriate.

CHAPTER 4: REGULATION OF SERVICES

4.1 The Government’s manifesto committed us to introduce new and improved arrangementsfor the regulation of social services and to create an independent statutory mechanism forregulating the social services workforce and its training. This Chapter describes our proposalsto reform the regulation of services whilst Chapter 5 covers the workforce and trainingaspects of our plans. These are important and radical new measures which will address theweaknesses in the current arrangements, and introduce a framework designed to safeguardvulnerable adults and children. Our plans are based on the principles of good regulation setout by the Better Regulation Task Force:

• Transparency

• Accountability

• Targeting

• Consistency

• Proportionality

The Better Regulation Task Force’s own review of long-term care regulation, publishedearlier this year, concluded that the existing regulation arrangements fail on all of theseprinciples. The current arrangements for regulating care services have been developed in apiecemeal fashion and have led to problems of:

• a lack of coherence

• a lack of consistency

• a lack of independence

4.2 A Commission for Care Standards in Wales (CCSW) will be created to regulatesocial care services in Wales. The new Commission will regulate residential care homes andnursing homes, and will improve the way in which registration and inspection are carried out.Bringing nursing homes and residential homes under the same regulatory body will need verycareful handling and we shall consult as widely as possible with the NHS and with localauthorities about the best way to structure the new body so that we achieve the key aims of:

• stronger protection for vulnerable adults and children looked after by localauthorities

• new safeguards for adults receiving care at home

• greater clarity and consistency for providers about the standards they mustmeet

• improved coherence in the regulation and scrutiny of care provision acrossWales and between professional boundaries

4.3 In Wales there are already agreed standards for nursing home regulation which areworking well. New standards for regulation of both residential and nursing homes will buildon these and provide for consistent regulation across both sectors by the new CCSW. Thebenefits of a single home being able to care for a range of care needs are clear and give moreassurance for users of having a "home for life". We want to encourage this type of provisionalthough the decision about what services to offer is for homeowners to make. We hope tointroduce the greatest possible level of flexibility while retaining the scope for specialisationand particularly the robust protections that are needed. In due course it may be sensible tomove to a single registration category for all care homes and we intend that the legislativeframework should be flexible enough to allow for this at the appropriate time and with theagreement of the National Assembly.

4.4 Local authority adult residential homes and children’s homes will be required to registerand will be subject to the same inspection and enforcement arrangements by the CCSW as forindependent care homes. We will remove the current exemption for care homes which are runby organisations set up under Royal Charter or Act of Parliament. Small private children’shomes will also be regulated through the new arrangements. Independent fostering agenciesand residential family centres will be regulated by the CCSW, which will also undertakeWelfare Inspections of boarding schools, including those run by the local authority. We planto require local fostering services to meet the same standards as independent fosteringagencies.

Domiciliary Care

4.5 Domiciliary care (care provided to people in their own homes) is an essential part ofeffective community care. It can enable people to continue to live in their own homes ratherthan moving to hospital or a care home. We promised in our election manifesto that wewould introduce for the first time a statutory regulatory system for domiciliary care. Ourproposals will protect vulnerable users whilst maintaining the principles of choice andindependence. The CCSW will be responsible for the regulation of domiciliary care byregistration of agencies, inspections and any enforcement action needed.

4.6 The regulatory scheme will focus on the organisations providing domiciliary care, ratherthan on the individual carers who work in the organisations. The scheme will apply only tothose organisations which provide personal social care to people living in their own homes,and will not, therefore, cover organisations such as cleaning agencies or gardeners.

4.7 Providers will be registered by the CCSW if they demonstrate that they meet the requiredcriteria and standards. These criteria and standards will need to be developed, but they arelikely to cover areas such as:

• Fitness of owner and manager

• Personnel issues (including recruitment and vetting procedures, personnelrecords, policies on training, health and safety, equal opportunities etc)

• Information to users (eg on charges, service withdrawals, how to complainetc)

• Quality procedures (including complaints procedures, systems for monitoringuser satisfaction, supervision of care staff etc)

• Operational policies (eg administration of medicines, confidentiality, healthand safety, promotion of choice, access to users' homes etc).

• Financial viability and insurance

4.8 The standards will be developed in consultation with interested parties, and will be set atnational level in the same way as for other services.

4.9 Local authority home care services will be registered, inspected and subject toenforcement action in the same way as independent providers. Registration requirements willbe uniform regardless of whether the organisation is private, statutory or voluntary, andwhether it is a "principal" organisation or an agency. There will be no unnecessaryduplication, for example when several branches of the same organisation are to be registered.

4.10 Once a provider organisation is registered, it will be subject to annual review by theCCSW, and may also be inspected at any time. Inspection may involve a variety of methods,such as scrutiny of records, interviews with staff and sample interviews with users, in order toascertain whether registration standards continue to be met.

4.11 If a registered provider is in breach of one or more of the registration requirements, theCCSW will have powers to serve enforcement notices, and ultimately to de-register. In casesof de-registration, the provider will have right of appeal to the Registered Care Tribunal (seebelow). Registration will not be compulsory for all providers, although it is expected that thegreat majority will wish to be registered. Local authorities will be required, when makingarrangements for domiciliary care under their community care responsibilities, to placecontracts only with registered domiciliary care providers. The CCSW will be able to publishlists of registered providers to any individual making their own care arrangements.

Regulation of Children’s services

4.12 At present there are different regulation arrangements for different types of children’shomes. The Government has published its response to Sir William Utting’s report onsafeguards for children living away from home. That response included commitments toimprove the regulatory responsibilities for this group, which in future will fall to the CCSW.In future, the CCSW will be responsible for registering and inspecting all children’s homes.The additional statutory approval - by the National Assembly that is required for homes usedto secure accommodation will remain. A comprehensive range of measures will beintroduced which are summarised in the box below:

Regulation of children’s services: key measures

Types of residential setting

• Regulation arrangements for different types of children's homes will bemodernised. In future, all children's homes (local authority homes, voluntaryhomes, and private children's homes, including those with fewer than fourchildren) will be registered and inspected by the CCSW

• The level of regulation and standards which are suitable for smaller homeswill be considered as part of the current review of the Children's HomesRegulations

• Regulation of residential family centres operated by local authorities orindependent providers will be introduced. In future mother and baby homeswill be subject to the same regulation as residential family centres.

Fostering

• Independent fostering agencies will be within the regulatory framework andthey too will be regulated by the new CCSW

• The Government plans to permit local authorities to delegate functions toprivate as well as to voluntary organisations to act as fostering agencies. Theywill have to meet the standards of the new regulation system as local authorityfostering services.

Education

• Welfare inspections will be extended to all LEA maintained boarding schools,and to maintained and non-maintained special boarding schools approved totake children with special educational needs. Responsibility for welfareinspections of all boarding schools including the independent sector will betransferred to the CCSW.

Management

• There will be a senior officer responsible for the separate regulation ofchildren’s services within the CSSW

Finance

• Regulatory fees payable by providers of children’s services will be setnationally on the basis that the costs of regulation are fully recovered

Regulation of related services

4.13 We do not intend at this stage to introduce new regulation for other service areas, suchas day care for adults and sheltered housing. However, we intend that the legislationframework for the new regulation should allow sufficient flexibility to allow the NationalAssembly to do so at a future date if it considers that there is a need. In the light of ourproposals to establish the CCSW, consideration is being given to how best to improve theregulation of the independent acute health sector and nurses agencies. This work willproceed in consultation with interested parties over the next 6 months and will be co-ordinated with the wider consultation on the arrangements for the CCSW. Final decisions willbe taken by the National Assembly.

regulation of the independent acute health sector and nurses agencies. This work willproceed in consultation with interested parties over the next 6 months and will be co-ordinated with the wider consultation on the arrangements for the CCSW. Final decisions willbe taken by the National Assembly.

4.14 We have already announced that we will review the regulatory responsibilities of undereights’ day care services and early education providers. We have consulted widely in Waleson whether a more uniform approach can be developed, and decisions about future regulatoryarrangements in this area will be announced in due course. In developing our proposals forthe regulation of day care for children, and of those who provide that care, we will ensure thatprotection is improved in line with what we propose for other vulnerable groups.

Options for new regulation arrangements in Wales

4.15 The new CCSW will provide the opportunity to introduce new and consistentarrangements for the regulation of social care in Wales. Whilst the management and structureof the new regulation arrangements in Wales will ultimately be for the National Assembly todecide, we will consult widely, in the near future, about how the new arrangements willoperate and will seek views on the way forward.

Standards And Enforcement

4.16 In addition to the standards that are firmly set in legislation and others which arerequired through national directions and guidance, the Government will develop a limitednumber of well focused National Standards that can be applied by the CCSW with greaterconsistency than is feasible under current arrangements. The Centre for Policy on Ageing hasbeen commissioned to develop national standards on services for older people, and hasrecently submitted its proposals. We will consult widely on these proposals, and the outcomeof this work will be used to develop standards in other areas.

4.17 We do not consider it acceptable that there are no mandatory inspections for smallhomes for adults (those with fewer than 4 residents). A requirement will be introduced thatall small homes for adults should be inspected by the CCSW at least once per year. Wewill tighten up the definition of small homes so that these homes are provided in a setting thatis genuinely small scale and domestic in nature.

4.18 All regulated services will be subject to appropriate enforcement action. This willinclude powers to serve improvement notices, to prosecute, and, where necessary, to de-register, including emergency de-registration. The aim will be to ensure greater consistencyin enforcement practice.

4.19 Formal appeals against the CCSW’s decisions will be made to a nationalindependent tribunal. This will in future, be called the Registered Care Tribunal, and willreplace the current Registered Homes Tribunal but continue to operate on an England andWales basis. Measures will be introduced to speed up the progress of cases and to make itless expensive and simpler.

4.20 The majority of proposals described in this chapter will require primary legislation andthese powers will be sought as soon as Parliamentary time is available. In the meantime, localauthorities and health authorities who remain responsible for regulation under existinglegislation must ensure that these duties are fulfilled comprehensively. The protection ofvulnerable people remains a high priority and there must not be any dilution of regulation ofservices in the period before the new arrangements are introduced.

legislation must ensure that these duties are fulfilled comprehensively. The protection ofvulnerable people remains a high priority and there must not be any dilution of regulation ofservices in the period before the new arrangements are introduced.

Summary

4.21 We propose to improve the regulation of social services in the following key ways:

• By creating a Commission for Care Standards in Wales, which will administera new statutory regulatory system for residential, nursing and domiciliary care,backed by appropriate enforcement action;

• By consulting on how the new arrangements for the CCSW will operate;

• Creating a Registered Care Tribunal, which will simplify the appeals process;

• Developing National Standards;

• Enhancing inspection arrangements for small homes.

CHAPTER 5: RAISING STANDARDS IN THE SOCIAL CARE WORKFORCE

Introduction

5.1 More than 25,000 people work in Social Services Departments in Wales. Larger numbersstill work in private and voluntary organisations providing social care. In all, there areprobably 50,000 to 60,000 people employed in social care in Wales.

5.2 These people have to respond to some of the most demanding, distressing and intractableproblems. They have to make some of the hardest decisions required of any workers in anysector. We recognise that the large majority are caring, and fully committed to doing the bestjob that they can.

5.3 There has, however, been public concern in recent years about examples of seriousmisconduct, bad practice and abuse by a minority of staff. There is evidence, too, that thenature of the work has attracted some unsuitable people - people who have abused theirposition and exploited service users.

Establishing a Care Council for Wales

5.4 The Government is determined to strengthen public protection, and to restore publicconfidence in these vital services. We will, therefore, create a new statutory body calledthe Care Council for Wales / Cyngor Gofal Cymru to regulate the social careworkforce.

5.5 It will be the Council’s job to improve the quality of services by raising standards in theworkforce. It will have two key tasks:

• to set standards and to regulate the workforce;

and

• to make sure that more staff get the training and qualifications they need forthe jobs they do.

5.6 The Government means to set up similar bodies across the UK. Many of the detaileddecisions on the scope and operation of the new body in Wales will fall to the NationalAssembly. But there will have to be effective links between the Welsh body and the otherbodies across the UK, and we will be working to put these into place.

Setting the Standards

5.7 From the start, the new bodies will concern themselves with raising standards of conductand practice for everyone working in social care. We believe that, as soon as practicable,there should be enforceable Codes of conduct and practice for all of the social careworkforce. These Codes will help service users, carers, and the public to know whatstandards they can expect. The Codes will help staff deal with the ethical dilemmas andconflicting demands they face every day, by letting them know what standards are expectedof them. They will help practitioners and employers to work together to create the rightconditions for high standards of conduct and practice. The Codes will also underpineducation and training.

of them. They will help practitioners and employers to work together to create the rightconditions for high standards of conduct and practice. The Codes will also underpineducation and training.

5.8 We therefore plan to give the new Council powers to set standards - and we intend thatdrawing up the Codes should be its first priority. Individual practitioners should be personallyaccountable for their own standards of conduct and practice. They will therefore have to signup to the Codes as a condition of their employment.

5.9 Conduct or practice will sometimes fall short of the accepted standard. Where thishappens, service users and the public must be sure that someone will take effective action.This will be achieved by reinforcing the responsibilities of employers. We will require thenew Council to draw up and issue a Code of Practice for Employers. This Code willrequire employers to have sound recruitment and selection practices, to make sure that onlysuitable people find work in social care. The Code will also require employers to have propercomplaints and disciplinary processes, to make sure that unsuitable staff are dismissed and donot appear elsewhere in the social care workforce.

5.10 This Code will be applied even-handedly through the new machinery for serviceregulation set out in the previous chapter. Where the Code is breached in unregulatedstatutory services, we will use the default powers of the Secretary of State, and in due coursethe National Assembly, to direct authorities to put things right. We will consult further abouthow to make sure that service users can have confidence in those staff who are not employedby the service provider. These include self-employed workers, agency workers, and workersemployed through direct payments to clients.

The Registration of Individuals

5.11 Most regulatory bodies use some form of register to set and maintain standards forentering and staying in the workforce. The Government believes that the registration ofindividuals has an important part to play in strengthening public protection. We also believethat the Council should use its registration powers to drive up levels of training andqualifications across the board.

5.12 We therefore intend that the Council will have a registration function. We willlegislate to ensure that the National Assembly can develop an approach to these questionsthat fits the situation in Wales.

5.13 The social care workforce is large, diverse and mostly unqualified, and the overallapproach to registration will need to reflect this. There will have to be phasing in of one kindor another. The Government has taken soundings in Wales from users and carers, from publicand independent sector employers, from professional bodies and trade unions, and fromeducation and training interests. We have found a widespread concern to exclude from thesocial care workforce all those - whether qualified or unqualified - who have shown that theyare unfit to practise.

5.14 In Wales, almost everyone we have consulted wants the new Council to move as quicklyas is practicable towards the registration of the whole social care workforce, including thosewho presently have no qualifications. In Wales, it will fall to the National Assembly - in thelight of advice from the Council - to decide on these questions about the scope and pace ofregistration.

registration.

5.15 We expect the Council to drive up standards across the workforce as a whole by phasingin training and qualification requirements for both entry and continued registration. Therewould be consultation with employers and others, and realistic lead-in times for existingworkers. Individual workers have a responsibility to make sure that they keep theirknowledge and practice fully up to date. We will reinforce this by linking periodic re-registration to requirements for continuing professional development.

5.16 The Council will have powers to suspend, vary or remove registration where individualsare unfit to practise on grounds of misconduct, bad practice, negligence or abuse. There willbe powers for urgent suspension from the register in serious cases, prior to the full hearing ofthe issues. We expect the Council to do these jobs in ways that are robust and efficient, whichrecognise the responsibilities of employers, and which meet the requirements of naturaljustice.

5.17 The Government, through the Department of Health, runs a Consultancy Index thatincludes names of people found unsuitable to work with children. We are supportinglegislation currently before parliament, to put the Index on a statutory basis and to broaden itsscope. We have recently promised to bring forward further proposals to strengthen thesafeguards provided by this register.

Job Reservation

5.18 In some professions or occupational groups, the law restricts employment to particulargroups of people. We do not think that a blanket approach is possible or desirable in socialcare. But we will take action in situations where the public interest requires a statutoryrestriction on employment. For example, the current restrictions under the Mental Health Act1983 mean in effect that only qualified social workers can carry out some mental healthfunctions. This will continue.

5.19 In registered nursing homes, heads of homes already have to be registered nurses ormedical practitioners, and this too will continue. For other types of homes, we will look atwhether to restrict heads of home posts to people with particular qualifications. We are alsoconsidering the case for job reservation in some highly specialised areas of the children’sservices that involve using statutory powers. The Government will seek powers so that theNational Assembly can introduce job reservation where it considers this to be right.

5.20 In many other professional and occupational areas where regulation exists, there arelegal restrictions on the use of job titles. We have been consulting on whether it wouldprovide an additional safeguard to the public if, for example, only persons registered with theCouncil as social workers could call themselves "registered social workers". We have found awidespread belief in Wales that a move of this kind would help in extending public protectionagainst bogus operators and against those excluded from the register. It would certainly helpin restoring public confidence. We will therefore seek powers, so that the NationalAssembly can - on a selective basis - introduce protection of title where it concludes thatthis would be a useful safeguard.

The Council’s Role in Training

5.21 This is a time of major change in the development and regulation of social care training.We recently approved the creation of the Training Organisation for the Personal SocialServices (TOPSS) to develop and promote training at all levels. This national trainingorganisation or NTO - like those for other industries - is an employment-led bodyrepresenting the whole sector. It is located for the time being with the Central Council forEducation and Training in Social Work (CCETSW), and its functions are:

• to maintain and update the occupational standards which underpin vocationaland professional qualifications at all levels;

• to secure a clearer picture of the workforce and identify training needs; and

• to develop training strategies, to identify sources of funding for them and tomake sure they are implemented.

5.22 We have also announced our plans to abolish CCETSW. When that happens, the CareCouncil for Wales will take over from CCETSW the regulation of basic and postqualifying social work training. It will have powers:

• to lay down criteria for admission, core content and required outcomes forsocial work training programmes at basic and post-qualifying level;

• to lay down structures which require the direct involvement of social careagencies and employers in the management of training programmes;

• to approve and inspect programmes and to withdraw approval - working asnecessary with other regulators in higher education such as the QualityAssurance Authority; and

• to arrange and hold examinations.

5.23 We will give the new Council a legitimate role in regulating the supply side of socialwork education. This will be similar to the arrangements that already exist, for example, inthe training of doctors.

5.24 The Government attaches a great deal of importance to better regulation of both socialwork training and post-qualifying training. We are therefore - through a UK-wide review ofCCETSW - working to improve the system before it transfers to the Council. We are doingthis in partnership with employment and academic interests.

5.25 The Council’s interests in education and training will, however, run far beyond theregulation of professional training. It will be responsible for advising on the links that need toexist between training and registration. It will, therefore, have an interest in the availability,consistency and "fitness for purpose" of training for all of the workforce. We expect theCouncil to give a high priority to those staff who at present have no qualifications at all. Itwill need to ensure that bridges and ladders exist, so that staff can progress smoothly betweendifferent kinds and different levels of qualification.

5.26 It will be the Council’s job to develop and enforce higher standards, and it will be thejob of TOPSS to gear training strategies to meet them. The two will therefore need the closestpossible links. We have been looking at whether there is room in Wales for two separatebodies to do the two different jobs, and we have consulted widely. Most people we haveconsulted support the idea of a single body, with two separate "arms" properly accountablefor carrying out the work of the Council and the work of the NTO. The NTO "arm" in Waleswould continue to work closely with the corresponding bodies in other countries through aTOPSS UK partnership. We propose, therefore to bring together the work of the Counciland the work in Wales of TOPSS into a single body.

The Council’s Shape and Funding

5.27 We will put service users and the public interest first in deciding how the new Council isset up, how it will work and how it will be governed. The Council will be an independentstatutory body. But how it does its job will be important to the Government and the widerpublic. The National Assembly will therefore appoint the Council, and hold itaccountable for the way it performs. The Council will operate with the approval andconsent of the National Assembly, and be subject to such guidance or directions as theNational Assembly may give. We expect the Council to work in ways that are open,transparent and inclusive.

5.28 We intend the Council to be no bigger than is needed for the cost-effective discharge ofits business. It will be able to set up committees with the approval of the National Assembly.

5.29 The Council will be very different from a traditional regulatory body, run largely by theprofession itself. All of the key interests will have a voice - and service users, carers andthe general public will be in a majority. It will have a lay person as its Chair. TheAssembly will invite nominations from groups of service users and carers, and applicationsfrom the public.

5.30 The Council’s other members will represent employers, professional associations andtrade unions, and education and training interests. These will include the Welsh LocalGovernment Association, private and voluntary sector employers, the Association ofDirectors of Social Services in Wales, and the universities. The Assembly will invite theseinterests to nominate people who can bring to the Council the skills and knowledge it willneed to do its job. All appointments will be made in line with the Nolan rules on publicappointments.

5.31 The Council will need to be able to employ staff to do its day to day work, and it will beable to do so with the approval of the National Assembly.

5.32 The Government intends to meet any start-up costs and the costs of regulating socialwork training from sums currently allocated to CCETSW. We will therefore seek powers forthe Council to receive grants. We believe too that registered staff should pay a registrationfee, although we expect the Council to bear in mind that many social care workers are amongthe lowest paid in the workforce. We will therefore seek powers for the Council to levyregistration fees, to be set with approval of the National Assembly. The Council shouldalso have powers to raise income from charging for any services provided to employers,awarding bodies and educational institutions.

Training the Social Care Workforce

5.33 The quality of social care services will always depend on the knowledge, skills andattributes of the staff they employ. The most recent picture of local authority staffing - mostlyfrom September 1997 - showed the size of the training task facing social servicesdepartments:

• 95% of social workers were professionally qualified;

• only 17% of staff in children’s homes had appropriate qualifications for thework they do;

• only 7% of residential care staff working with adults were qualified; and

• only 8% of day care staff were qualified.

5.34 We do not have the same kind of information about the 30,000 or 40,000 peopleworking in private and voluntary social care in Wales. But there are indications that theindependent sector has made significant progress with NVQ registrations and awards.

5.35 The Government believes that training is first and foremost the responsibility ofemployers. It will be vital that employment interests across the statutory and independentsectors come together to own the National Training Organisation, TOPSS, and to steer itsactivities.

5.36 At the same time, the Government recognises that it too has a role to play in thepromotion of training. In 1996, the Welsh Office published a draft training strategy forpersonal social services in Wales. This proposed four objectives, and these were widelyendorsed. We believe that - as re-worded below - they remain a useful statement of intent:

• To increase the proportion of social care staff with awards which demonstratetheir competence at work, by helping more of them to acquire NVQs.

• To secure enough professionally qualified social work staff to meet the needsof employment, to broaden access to the DipSW, to ensure its relevance, andto maintain its quality.

• To improve standards of practice and management, by helping more staff tobenefit from post qualifying and other specialist training and managementdevelopment, particularly where this leads to qualifications.

• To foster working with other agencies and disciplines, by promoting sharedlearning with other professional groups.

5.37 We will take action in twelve key areas, to ensure that training is planned andundertaken in a coherent and co-ordinated way. But the Government will not be trying totake forward these developments on its own. We will seek to work in partnership withemployers in all sectors, with TOPSS, with CCETSW, with the Local GovernmentManagement Board (LGMB), and in due course with the Care Council for Wales.

Management Board (LGMB), and in due course with the Care Council for Wales.

A Strategic Approach to Training

1. Workforce planning and analysis: We will work to develop better information on thesocial care workforce - a vital first step if we are to make a success of the other tasks set outbelow. This work will ensure that staff development is geared to service needs in Wales, andit will contribute wherever feasible to a broader UK picture.

2. A National Training Strategy: We will build on the draft training strategy issued in 1996,and develop, in partnership with TOPSS Cymru, a national training strategy for social care inWales. We will seek to ensure that this is widely owned and provides a clear sense ofdirection.

3. National Training Targets: We will build on the targets issued in recent Training SupportProgramme (TSP) circular and develop further National Training Targets for the achievementof competence-based qualifications across the social care workforce.

4. National Vocational Qualifications: We will target TSP resources on training thatenables social care staff to gain NVQs. We will monitor the use of the TSP to ensure thatlocal authorities make satisfactory progress towards meeting the National Training Targetsfor the achievement of these awards.

5. Diploma in Social Work (DipSW) - relevance: We will work to strengthen theinvolvement of local agencies in managing DipSW programmes, to make sure that learning isrelevant and up to date for employment needs.

6. Diploma in Social Work (DipSW) - access: We will seek to promote greater flexibility inaccess to the DipSW by encouraging the development of part-time routes, and open anddistance learning. The aim will be to increase access for those students who find it difficult toattend on a more traditional basis.

7. Diploma in Social Work (DipSW) - supply: We will work, through the student bursariesprogramme, to secure enough qualified social work staff to meet the needs of employment inWales.

8. Diploma in Social Work (DipSW) - practice placements: We will work, through thePractice Placement Funding programme, to secure enough high quality placements to meetthe needs of every student on a DipSW programme in Wales.

9. Post qualifying training: We will work to ensure that there is an efficient and effectivemodel for promoting, delivering and validating post qualifying training. This framework willbe built on national occupational standards, and it will be the basis of future work oncontinuing professional development. The first priority will be the introduction in 1999-2000of a post qualifying award in child care.

10. Management training: We will monitor the use of the Training Support Programme toensure that investment in management training leads to externally validated managementqualifications.

11. Shared learning: We will continue to foster joint working between staff in SSDs andtheir colleagues from other agencies, by promoting shared learning wherever this is feasible.

their colleagues from other agencies, by promoting shared learning wherever this is feasible.

12. Education and training and the Welsh language: We will continue to supportdevelopmental and promotional work through CCETSW Cymru's Welsh LanguageProgramme. We will expect to find in TSP Training Plans opportunities for staff to train inlanguage sensitive practice, and to train through the medium of Welsh

Targeting Training Resources

5.38 The cost of training is an essential and integral part of the cost of the service - it is not anoptional extra. However, we will continue to supplement the resources which employersapply to training through the Training Support Programme grant. We have recentlyannounced a 30% increase in the TSP grant from £2,115,000 in 1998-99 to £2,750,000 in2001-02, and we intend to target these additional resources on training the staff who work inchildren’s services. We will also continue to show our commitment to training through oursupport for CCETSW, TOPSS and in due course the Care Council for Wales.

5.39 We can go a long way towards meeting our training objectives by careful targeting ofthe Training Support Programme. For 1996-97, we recast both the bidding and monitoringarrangements for the TSP. This shifted the focus away from inputs, such as attending trainingevents, towards outcomes, such as obtaining qualifications. In future, we will expect everclearer evidence that authorities are using training funds to secure for staff the qualificationsthey need for the work they do. We will keep the TSP allocation arrangements under reviewto make sure that this happens.

5.40 The private and voluntary sectors now employ most of the social care workforce. Werecognise that independent sector providers in Wales want to strengthen support for training,and we believe that the best way to do this is through the contractual process. We will,therefore, expect local authorities as purchasers of services to be clear about the standards ofstaff training and qualifications they expect - drawing wherever possible on the NationalTraining Targets published by the Department. We will also expect authorities to makeproper provision for staff training costs when they draw up contracts and service levelagreements.

5.41 The Government will continue to promote Investors in People and NVQ based training,through the work of the Training and Enterprise Councils (TECs).

Summary

5.42 Children and adults who use the social services in Wales should be able to rely on aworkforce that is properly trained, appropriately qualified and effectively regulated. At thesame time, the workforce itself should be able to expect proper support and recognition.

5.43 We are determined to secure higher standards in training, conduct and practice acrossthe social care workforce. Our proposals for the Care Council for Wales and our proposals fortraining will - working alongside our other reforms - provide a robust and sensible frameworkfor making sure that this happens. In summary, our main proposals include:

• A new Care Council for Wales to regulate the social care workforce and driveup standards of training and qualifications;

up standards of training and qualifications;

• Enforceable codes of conduct and practice for all of the social care workforce;

• A Code of Practice for Employers;

• A National Training Strategy.

CHAPTER 6: CHILDREN’S SERVICES

Introduction

6.1 We are committed to promoting the welfare of children and protecting them from abuseor neglect. This Chapter sets out the ways in which we will take this forward in Wales.

6.2 Children and families who need help from social services can be amongst the mostvulnerable members of society. They include many kinds of children in need- children withdisabilities, children who need to be cared for away from home, children who are at risk ofharm and who need protection, and children who are in trouble with the law. While childrenmay be the primary focus of social services action, in most cases their needs will impact onthe whole family. Work with children and families is among the most challenging for socialservices. The work is always demanding and often complex. The number and complexity ofchildren’s referrals to social services have grown steadily in recent years. Caseloads have alsoincreased.

6.3 Against this background, authorities and individual social work staff have worked hard toprovide services for very many children in Wales. When things go right, as they often do, theoutcomes for children and their families can be very positive. But in other cases, the resultsfor children are less good. Frequent changes of carer, lack of planning and poorly co-ordinated services have led to children receiving inconsistent support. In the worst cases,children have been damaged and abused by the very care system that was supposed to offerthem protection. In some parts of Wales, and in some individual cases, the quality ofchildren’s services provided in Wales has fallen well short of what a caring society has a rightto expect.

6.4 The evidence heard at the North Wales Tribunal highlighted the most appalling abuse, ofchildren and young people in the care of local authorities. Inquiries are being carried out intoother serious allegations of widespread abuse in children’s homes across South Wales, andelsewhere in the UK. These investigations have focused largely on events in the 1970s and1980s, but we cannot afford to be complacent: children in public care are particularlyvulnerable and it is clear that the quality of care they receive remains, often, unacceptablylow.

6.5 We are determined to restore public confidence in children’s services as a whole andparticularly those for children in the public care. We must make sure that we learn the lessonsfrom the past. We must set high standards and ensure that they are delivered. Localauthorities must accept responsibility at the corporate level for the services provided to theirchildren. Partnerships between social services and education, and with health, need to bestrengthened. We must raise standards of service, and outcomes for individual children,across Wales.

A Strategic Approach

6.6 The effects of social exclusion - through low income, through family breakdown, throughunemployment, lack of educational achievement, or through poor housing - impact onfamilies as a whole but particularly on children. We are committed to taking action across abroad range of fronts to address this spectrum of issues, to support families and strengthenfamily life. Action includes the Green Paper Supporting Families (published in November1998), the new Crime Reduction Programme, the development of Early Years Developmentand Childcare Partnerships and, the "People in Communities" programme in Wales.

family life. Action includes the Green Paper Supporting Families (published in November1998), the new Crime Reduction Programme, the development of Early Years Developmentand Childcare Partnerships and, the "People in Communities" programme in Wales.

6.7 Welsh Office Ministers gave a commitment in 1998 to adopt a strategic approach tochildren’s services in Wales. The strategy will embrace the whole range of services forchildren, from the universal health and education provision for all children and families,through to the very specialist services provided, largely through social services and health,for children with the most demanding special needs for protection and support. The aim ofthe strategy will be to ensure that authorities and agencies across Wales can work togethermore effectively under a common framework of objectives and priorities. The strategy shouldhelp to tackle uneven provision, to raise standards, and to ensure that investment in children’sservices is directed at quality outcomes for those most in need.

6.8 The Welsh Office intends to issue a draft strategy for consultation to assist the NationalAssembly in setting a clear framework for the development of children’s services. Theprinciples are:

• to offer early support for all children, and their families, especially those inareas of social deprivation;

• to assist all children to reach their potential and prepare them for citizenshipby support for their social and educational development, and health;

• to identify children at risk of harm or abuse and to ensure that they, and theirfamilies, are given appropriate care, protection and support;

• to support children with their needs, including children with disabilities, andthose children with emotional and behavioural difficulties and mental healthproblems;

• to raise the quality of care, and to improve the life chances of children lookedafter by local authorities, so that they may expect to do at least as well as theirpeers who are able to remain at home with caring and loving parents;

• to support young people leaving care to become socially responsible andeconomically independent adults;

• to ensure that in each local authority, both members and officers make acommitment to put children’s services, and good outcomes for children,among their highest priorities;

• to promote high standards of management, effectiveness and value for moneyin all local authority services for children; and

• to develop and implement strategic performance indicators for children’sservices.

Getting the Framework Right

6.9 Most local authorities in Wales are already well aware of the need to improve the qualityof all services for children. We share that commitment, and are determined to put in placenew arrangements, and to remove existing barriers, to assist authorities in raising standardsacross the board. The first task is to get the framework right. We will do this in two ways.

6.10 Firstly, we want to tackle the issue of planning for children’s services. Local authorities,in partnership with the NHS and other agencies, are already engaged in preparing a numberof different plans for services directed at children. As new initiatives come on stream, theplanning burden on service managers has grown. We are determined to ensure that theseplans are fully integrated so that local authorities can put together unified local responses tothe needs of all their children. As well as the Social Services Plans required under the 1989Children Act, authorities are also asked to plan for early years development, for schoolimprovement, for child health improvement, for children with special educational needs, andfor childcare. On a wider front local authorities are also required to produce plans for youthoffending, for community safety and crime reduction, and for tackling drug and alcoholmisuse.

6.11 While some of these separate plans will need to continue, we believe that it is possible tobring together many of the requirements for authorities to plan services directed particularlyat children. We recognise that it will be a major task to move to a system of unified children’splanning. However, we believe it is essential to make this change if authorities are to be ableto concentrate their resources effectively and to prioritise the development of more focusedchildren’s services that are easier for children and their families to relate to.

6.12 We therefore propose to begin consultation during 1999-2000, with the WLGA andother bodies, on ways to bring together the various separate requirements for children’sservice planning and to establish ground rules for unified Children’s Services Planswith a view to introducing them from April 2001.

6.13 Secondly local authorities also need much better management information about theirchildren’s services, about their relative performance and cost and about the outcomesachieved for children. Good quality management information and key indicators will becritical elements in a revised approach to planning for children’s services. By setting localtargets, authorities will have a clearer sense of purpose and be better able to identify commonobjectives between partners at the local level. Good management information is a crucial partof the Best Value initiative. The Welsh Office is already consulting the WLGA in developinga set of all-Wales indicators and targets for children’s services. We aim to consult morewidely on these during 1999.

Quality of Care in Wales

6.14 We want to raise standards of children’s services, and to ensure good outcomes forchildren. To do that requires that local authorities give a new priority to the management andoversight of children’s services. The Welsh Office will work with local government todevelop a wide-ranging ‘no compromises’ programme - to raise standards acrosschildren’s services in Wales.

6.15 At the centre of the programme, we will restate local authorities’ responsibility to act as"corporate parents" for the children who they look after. We will expect local authorities todemonstrate that children looked after are advantaged by their experience. Their experienceof care, and of education and health services while they are in care, ought to be at least asgood as would have been provided by a caring and loving family. The new quality of careprogramme will include:

of care, and of education and health services while they are in care, ought to be at least asgood as would have been provided by a caring and loving family. The new quality of careprogramme will include:

• objectives and targets which focus on achieving positive outcomes forchildren to enhance their life chances and ensure that they have properaccess to education and health services;

• demonstrable high levels of competence in the local management andsupervision of children’s services;

• effective management information systems and reporting arrangements forsenior officers and elected members;

• effective joint planning and commissioning of services, and interagency co-operation;

• accurate case assessment and care planning, leading to effective allocation ofresources and high quality care experiences for children;

• internal audit systems which are independent of line management, as well asrobust external audit and evaluation;

• high standards of training and qualifications for staff engaged in providingchildren’s services.

6.16 The Wales programme is being developed now, and will be subject to extensiveconsultation over the coming months. Its principles will underpin the development of qualityservices for children living at home and for children in the care of local authorities.

6.17 Much of social services work with children is aimed at supporting families and childrenliving at home. But perhaps the most specialised services are devoted to children who, for avariety of reasons, need to be accommodated outside the family home in the care of the localauthority. We will work on a number of fronts to promote better quality services for all thesechildren, to promote their development and to ensure their protection. Our programme willfocus on seven key proposals:

• a stronger role for children’s services through local authorities’ corporatecommitment to achieving high quality outcomes for children;

• better, and close integration of, planning for all children’s services;

• improving the inspection and registration arrangements for all residentialservices for children, and working to integrate standards for day care andother forms of childcare;

• improving safeguards for children by better and more comprehensive securityand police checks on people intending to work with children;

• ensuring full compliance with the Choosing with Care report on the selectionand management of staff working with vulnerable children, and ensuring thatthese principles are matched in staff selection in other agencies;

• improving the quality of staff working with children through better training andby implementing new codes of conduct and practice standards for the wholesocial care workforce through the Care Council for Wales; and

• placing community based work to tackle youth offending on a statutory basisthrough Youth Offending Teams established under the Crime and DisorderAct 1998.

Early Development: Giving Children a Sure Start

6.18 Within our overall strategy for children, we are determined to ensure that all children inWales have a Sure Start in life with access to the health, social services, education and familysupport that they need. We are committed to promoting the principles of the Government’s"Sure Start" initiative in Wales. This aims to provide a range of locally based services to offerintegrated support to families with very young children, particularly those in the mostdisadvantaged areas. Our aim is that the programme should achieve a progressive long termreduction in the numbers of children in need, including those at risk of social exclusion.

6.19 We have set aside funding to support a Sure Start programme in Wales. We are currentlydrawing up proposals for the Sure Start scheme, with advice from a broadly basedpanel of experts across Wales.

6.20 The programme will focus on children aged 0-3 - adding value to existing services,expanding the range of services and facilities available, and creating better access tochildcare, health services, early education and family support. We will be exploring how bestto integrate the principles and objectives of the Sure Start programme with other newinitiatives designed to support both children in their early years, and families, (such aschildcare and early years education services).

Children Looked After and Away from Home

6.21 An alarming number of cases have emerged, in recent years, of alleged or actual abuseof children and young people whilst they were in the care of their local authority, either inresidential children’s homes or in foster care, or in some cases at residential schools. Manydifferent errors have been made, but broadly speaking there have been five main areas wherefailures have occurred:

• through gaps in the regulation and inspection of care providers;

• in the selection, training and management of staff;

• in monitoring the progress of children in care,

• in the location and choice of placements - either too far away from home orwith unsuitable accommodation or carers.

and

and

• in not listening adequately to children’s wishes and concerns.

6.22 In Wales, we have supported local authorities to implement the recommendations of the1996 North Wales Child Care Examination Team (which was led by Adrianne Jones), whichshould help to address these weaknesses. Special funding of £880,000 has gone to localauthorities in the 1998-99 financial year to support their implementation programmes. Wehave been particularly active in promoting the Looking After Children (LAC) materialswhich have been developed specifically to assist local authorities in improving theassessment and management of the care needs of all looked after children. The SocialServices Inspectorate for Wales (SSIW) has concentrated much of its inspection anddevelopment efforts over the past two years on services for children looked after.

6.23 In June 1996 the Secretary of State at that time established the Tribunal of Inquiry intothe allegations of child abuse in North Wales, under the Tribunals of Inquiry (Evidence) Act1921. The Tribunal, under the chairmanship of Sir Ronald Waterhouse QC, heard evidencefrom January 1997 until March 1998. The Tribunal’s report is expected shortly. TheGovernment will publish the report and respond to it as quickly as possible.

6.24 In November 1997, the Government published the report of a review ofsafeguards for children living away from home, People Like Us, carried out by theformer Chief Social Services Inspector for England, Sir William Utting. A full andcomprehensive Government response was published in November 1998, andrepresented the outcome of extensive cross-Departmental discussion, led by aMinisterial Task Force, to ensure that the Government responded appropriately to SirWilliam’s report. The Government response sets out a series of measures to givemore effective protection to children in care and other children living away fromhome.

6.25 The Review of advocacy and complaints arrangements will consider options forstrengthening existing safeguards. We will consult on the options which include the possibleestablishment of an independent commissioner for the children’s services, which has beensuggested by the Welsh Local Government Association.

Key measures in response to People Like Us

• the launch of a major "quality of care" programme to re-invigorate thepublic care system.

• legislation to bring small children’s homes, independent fostering agenciesand private fostering within the regulatory system;

• new initiatives to improve school attendance and educational attainmentof children looked after by local authorities and to reduce School Exclusion;

• new initiatives to improve the range of multi-agency services for childrenlooked after, and others who have special needs;

• legislation to allow pooled budgets and other structural flexibilitiesbetween local government and the National Health Service;

• the creation of additional duties on local authorities to plan for and provideeffective support to older children leaving care which will help preparethem for independence.

6.26 The Welsh Office and subsequently the National Assembly will be responsiblefor providing the framework and resources to enable local authorities to bring aboutthe necessary changes in Wales. The Government will work with the WLGA, thehealth service and others towards the development of a series of measures toimprove the support and protection arrangements for looked after children inWales. This will be done within the framework of the children’s strategy and as partof the Government’s response to the Utting report. The following action will betaken:-

Eight actions to improve outcomes for looked after children in Wales

We will:

• develop clear objectives as part of the quality of care programme forimproving support for looked after children in Wales, which are child-centred;

• work in partnership with local government, with tighter monitoring of theperformance of authorities which will be called to account for any failures;

• work with the WLGA to explore how local authorities can provide a betterchoice of foster and residential care placements;

• review advocacy and complaints arrangements for children in care, toensure that children have a voice, are listened to and that effective complaintsprocedures are in place throughout Wales;

• consider the appropriate structures, including the option of establishing anindependent commissioner for children in Wales;

• consult the WLGA on how local authorities can improve the arrangementsfor preparing looked after children for the transition to independentliving;

• set targets for improving training for professionals who are responsible forcaring for children;

• launch a campaign for recruiting foster carers in Wales.

Child Protection

6.27 The Government is committed to improving child protection arrangements. The Englandand Wales guidance, Working Together Under the Children Act 1989, which promotes co-operation between all the agencies involved in child protection work, is being revised. Aconsultation paper was issued in February and a revised draft will be circulated in the springof 1999. A final version of the revised guidance will be published later this year,following it’s consideration by the National Assembly.

6.28 The Government is determined to take effective action to prevent dangerous people fromworking with children. The establishment of a Criminal Records Agency and improvementsto existing arrangements for sharing information about people who are unsuitable to workwith children will add significantly to the safety and protection of children in all settings.

6.29 Serious child abuse cases are reviewed by Area Child Protection Committees, which areresponsible for developing, monitoring and reviewing local child protection policies andprocedures. In Wales, case reviews are submitted to the Welsh Office for consideration.Lessons from these reviews must be learned and applied. The Welsh Office will play anactive role in ensuring that this is done by commissioning an analysis of recent casereviews and disseminating its findings widely amongst child protection practitionersand managers.

Summary

6.30 This Chapter has set out the causes for concern over children’s services in Wales, andexplains our key proposals for improving standards and ensuring positive outcomes forchildren, especially children looked after by local authorities. It links closely with proposalsin the other chapters for instance to raise standards of training. The key initiatives for childrenwill be:

• to consult on and publish a Children’s Strategy for Wales;

• to implement improved safeguards for children through enhanced inspectionand regulation of children’s services;

• to raise the quality of staff working with children through improved training,recruitment, and vetting procedures;

• to agree clear standards and performance measures for all services forchildren;

• to promote integrated planning of all children’s services at the local level;

and

• to develop innovative programmes to support families and young children tominimise the numbers of children in need in the future.

CHAPTER 7: ADULT SERVICES

Introduction

7.1 Roughly 80% per cent of social services expenditure in Wales is devoted to services foradults. Our primary objective reflects their many and varied needs:

We are committed to improving the standards of support and care provided in thecommunity to those who are socially disadvantaged or those requiring continuing careand support.

7.2 People rightly expect high quality services to be provided to the most vulnerable adults,quickly, once an assessment has been made, and with the minimum of fuss. Individuals,families and carers have the right to expect appropriate support from Social ServicesDepartments which takes account of their needs and where necessary brings together healthand social services into a seamless pattern of care. From the user’s perspective, what mattersmost is the quality of the response they are offered. They want to avoid uncertainty andfrustration when they need to use services. It is the job of Social Services Departments,therefore, to work to deliver services which meet those legitimate expectations for quality, forsecurity, for accessibility and for equitable distribution. This chapter sets out theGovernment’s plans to help local authorities achieve these objectives for adult services inWales.

7.3 The provision of services for adults has seen many positive changes as a result of themove towards care in the community. The increasing range and spread of services and themany examples of imaginative collaboration between partner authorities are all testament tothe very real commitment of Social Services Departments to provide good quality carewherever possible. However, many of the recent developments have concentrated onstructures and processes. Our priority now is to raise the standards of service, and ensurebetter outcomes for individuals.

7.4 The Government is committed to helping local authorities - and health services - byproviding a framework in which they can raise standards of care across the whole rangeof adult personal social services in Wales. We expect local authorities to do this againstfive guiding principles.

Five guiding principles to raise standards of care

Local authorities should:

• Ensure that people know what services are available and how to accessthem;

• target services and resources on those people who, after an objectiveassessment, are judged to be in greatest need;

• support carers and families and involve them in the planning of care;

• aim for greater consistency in service provision across Wales and withinindividual authorities;

and

• provide greater choice for individuals in the type of support and care theyreceive.

7.5 To achieve these ends there are six priority areas for action by central Government, whichare set out below.

The Government’s priorities for action

We aim to establish:

• a national framework for Wales for assessing people’s needs and meetingthe costs of providing services;

• clear objectives for all personal social services which will focus on outcomesfor individuals;

• greater involvement of users and their carers in service planning;

• closer and more effective partnerships between Social ServicesDepartments, health services and other agencies;

• a higher priority for prevention, rehabilitation and recuperation services tosupport vulnerable people remaining at home in the community;

and

• arrangements to improve the levels of protection for vulnerable adults, andto provide the public with assurances about the overall quality of services.

7.6 The following sections set out what we propose to do, or action we have already started totake, to deliver these objectives.

National framework for service provision

7.7 Social services provide vital support to a wide range of vulnerable and deprived peopleacross Wales. Unlike the health services, social services for adults are not, and never havebeen, a universal service available to all, free of charge. The patterns of service provisionhave varied between authorities, as have standards of care and the process of needsassessment. Authorities are able to charge service users for many of their services, butcharging policies vary across Wales. In some areas a number of agencies - social services,housing, health and social security - can all be involved in providing services for anindividual, but each may operate under different rules. This is confusing for service users andservice providers alike. It does not encourage effective joint service delivery, and can lead toseemingly inequitable decisions for individuals.

7.8 We want to address this in two ways: first in terms of access to care, and secondly inrelation to charging for services.

7.9 The Government plans to develop national service frameworks announced in the NHSWales White Paper "Putting People First", which will set national standards and defineservice models for specific services. The first framework on mental health services is beingdeveloped and the next to be taken forward will be on services for older people.

7.10 Alongside the national service frameworks, we will also produce guidance on FairAccess to Care, which will set out the principles which authorities should apply indeveloping eligibility criteria and which are compatible with NHS continuing care criteria.The framework will focus on service outcomes, rather than service delivery patterns. InWales, this work will be informed by studies which have been undertaken by the WelshLocal Government Association (WLGA) and the Association pf Directors of Social Services(ADSS), through the Nuffield Foundation, which have looked at the practice of assessingusers’ needs in authorities across Wales. This provides a sound evidence- based platform onwhich to build a national framework for the whole of Wales.

7.11 In December 1997 the Government established a Royal Commission to examine theshort and long term options for a sustainable system of funding the long term care of elderlypeople. The Royal Commission has been taking evidence from interested bodies, and fromusers and carers all round the country. On 8 March 1999 the Commission maderecommendations to the Government on how the cost of care should be shared betweenpublic funds and individuals. Careful consideration is being given to the Royal Commission’sReport and the Government’s response to it will be published in due course.

7.12 In the light of the Commission’s report and a major Audit Commission survey of localauthorities’ charging practices, we will look carefully at how the system can be improved toensure greater consistency and fairness across the UK. Taken together with the nationalframework for service provision, mentioned above, everyone will be able to see what servicesare available, how individuals’ needs are assessed, and how financial contributions aremeasured.

7.13 In the light of the Audit Commission’s Report The Coming of Age and the companionmanagement guide Take Your Choice, authorities should improve the standard of theircommissioning and progress will be monitored as part of the Best Value regime Theprimary focus of good commissioning should be on effective outcomes for service users andtheir carers. The setting of strategic objectives (based on a robust assessment of need) andrelated commissioning activity must be an inclusive process, involving users, carers andproviders (in-house and independent). Where appropriate, commissioning should be a jointundertaking between social care, health, housing and other agencies. The key features ofgood commissioning which we would expect local authorities in Wales to implement are setout below:

Four Key Elements of Good Commissioning

Needs Analysis:

Commissioning should be based on an assessment of need within the general population thatis thorough and based on local evidence. Where appropriate such assessments of need should

cover not only social care, but also health, housing and other aspects. Information aboutunmet need, service shortfalls, and provider performance (through contract monitoring)should be systematically collected during referral and assessment processes, and fed intoplanning processes.

Strategic Planning:

Planning and planned changes should be in pursuit of agreed strategic objectives, and theplanning process should be transparent to users and providers. Information about need,supply and service use should collected by commissioners, and fed into the planning process.It should be shared with providers and user and carer groups. The views and wishes of usersand carers should be systematically sought, and fed into planning processes. Providers fromall sectors should be encouraged, and provided with relevant information. Commissionersshould ensure that commissioning funds are flexible and can be switched as required fromservices that are no longer needed to new ones that are.

Contract Setting and Market Management:

A variety of contract types should be used to deliver positive outcomes for users andreasonable security for good providers. Good commissioners should have mechanisms forstimulating new services where needs have been identified, and services are not available.Such mechanisms could involve some form of 'pump priming' such as the use of a blockcontract to reward a provider for providing new service with a guaranteed level of income.

Contract Monitoring:

General contracts and specific contracts should be monitored to ensure that providers areproviding acceptable standards of care, and that individuals are receiving appropriate help atagreed prices. Commissioners should ensure that providers have their own quality assuranceand control systems in place. Good commissioners take swift remedial action when contractmonitoring or other information points to problems with individual providers or with a sectorof the ‘market’. Contracts should be so constructed and regularly monitored as to enablecommissioners to identify fraud and safeguard themselves against it.

Direct payments

7.14 Many people who need support from social services would like to be able to put theirown care packages together, and manage them themselves. For people aged under 65 withphysical or learning disabilities, this has been possible under existing legislation (theCommunity Care (Direct Payments) Act, 1996). This allowed local authorities to givefunding directly to people who they had already assessed as eligible for non-residentialsupport. Individual users were, therefore, entitled to organise their own care packages, withfinancial support from the local authority, but with the freedom to choose care and to tailorservices to meet their individual needs.

7.15 We have been monitoring the success of this initiative. We believe that this approachoffers greater freedom and independence while also increasing consumer choice. We havedecided, therefore, to extend the direct payments scheme to people aged over 65. We willwant to see more authorities offering the opportunity to use this scheme. This will extend theopportunity of choice and independence to very many more people in all parts of Wales.

Once our current review of the scheme is complete we will consider, in the light of itsfindings and a survey, whether the scheme should be made mandatory to ensure equity ofopportunity across all areas of Wales.

Carers

7.16 The Government recognises fully the vital role which carers, including family, friendsand neighbours, play in the provision of support to many vulnerable, disabled and elderlypeople in the community. Without support from carers, local authorities and health serviceswould not be able to meet the demand for services from individuals. Carers often provide avital link to fill the gaps between statutory service providers.

7.17 The Government is, therefore, committed to providing support for carers to enable them,in turn, to continue to support individuals. Carers should not be asked to cope if that is to thedetriment of their own health and well being. Achieving a proper balance between statutoryprovision and informal care requires imaginative, flexible and innovative approaches fromthe statutory authorities. Research evidence suggests that authorities generally recognise theirduties under the 1995 Carers Act, but their implementation is not consistent. Across thecountry carers are not always aware of their entitlement to support in the vital work they do.

7.18 The Prime Minister announced in June 1998 the development of a national strategy forcarers. This will look at a whole range of services affecting carers in social services andhealth, as well as their own access, to employment, leisure, education, transport and practicalsupport. The Welsh Office has been represented at both Ministerial and official level in themanaging and development of the strategy. Carers, and statutory and voluntary organisationsrepresenting them in Wales, have also been fully involved in developing the strategy toensure it reflects the needs of carers in Wales. There will also be full involvement of carersand their representatives in the action to follow up the publication in February of the nationalstrategy which was formally launched in Wales on 3 March 1999. Implementation andfunding of the national strategy will be for the National Assembly to consider taking intoaccount comments received during the consultation process which is now underway.

Disability Rights Commission 7.19 We are committed to ensuring effective andenforceable rights for disabled people and will establish a Disability RightsCommission (DRC). As we announced jointly with the Secretary of State forEducation and Employment in January, it has been agreed that:

• A DRC office will be set up in Wales;

• The Secretary of State for Education and Employment will consult theAssembly about the appointment of a commissioner for Wales;

• The DRC will submit its Annual Report to the National Assembly;

The establishment of a DRC is the final part of the three-point Disability Strategy which wehave been implementing since May 1997.

Information about services

7.20 Users and carers cannot make informed choices about service provision or quality unlessthey have adequate information, easily accessible, about the range of services, assessmentcriteria, charging regimes, and complaints procedures. We plan to make more explicit whatusers and carers in Wales can expect from the key agencies in social services, health andhousing. We will do this through a long term care charter as we promised in our manifesto.The charter will have two purposes:

• to empower users and carers, by providing information about local servicesand making it clear how agencies should respond to their needs; and byproviding information to help users and carers pose the right questions to theagencies they come into contact with;

and

• to give authorities a tool which they can use to set local standards and whichcan be used by those monitoring overall performance.

7.21 The development of the charter will be informed by the views of users and carers and awide range of representative organisations, to ensure that we have a useful and meaningfuldocument. We intend to consult formally on the charter in the near future, but it will be forthe National Assembly to agree and publish the charter.

Mental Health Strategy

7.22 The Mental Health Strategy for Wales was set out in the paper Mental Illness Services:A Strategy for Wales issued in 1989. Its aims were:

• to restrict the development and consequences of mental illness

• to ensure that people who suffer from a mental illness receive effectivetreatment, care and support

• to enable people who suffer from a mental illness to live as independent andfulfilled lives as possible

7.23 The Strategy has given Wales its own distinctive approach to mental healthand has been instrumental in achieving major improvements in the way services aredelivered. We know from research that the principles it set out still commandwidespread support and loyalty in Wales. However, the same research shows clearlythat there is general acceptance that the Strategy is now showing its age and needsto be reviewed to make it relevant to present day conditions. 7.24 In consultationwith all interested parties, we intend to rejuvenate the Strategy. We shall utilise theresults of the research mentioned above and the expertise of all sectors including theNHS, Social Services and the voluntary sector to produce, by July 1999, a Strategyfit for Wales in the 21st century. 7.25 We are in close touch with the work of theexpert group set up by the Department of Health to establish a National ServiceFramework (NSF) for mental health. The NSF will set out detailed service modelsand performance standards to address the mental health needs for adults of workingage. This should also secure an appropriate range and balance of services. Weintend to apply the NSF in Wales although there may be a difference in the

implementation methods used, to reflect the differing mental health strategies in thetwo countries. 7.26 Similarly, we are involved in the work of the group set up toreview the Mental Health Act. Any revised Act will apply in Wales and it is importantthat the expert group is kept aware of the position here so that the new Act is draftedto take account of Welsh conditions. 7.27 We need to take a different approach onchild and adolescent mental health services. Our research results, back upanecdotal evidence that there are serious deficiencies in present services anddisturbing variations in quality throughout Wales. We intend to set up a group, drawnfrom representatives of all interest groups, to establish, for the first time, acomprehensive All Wales Strategy for Child and Adolescent Mental Health Services.We aim to have completed this work by January 2000. In due course, we aim todovetail this new Strategy into the main Strategy for Wales. 7.28 This work will putin place a strategy which should facilitate the development and delivery of modern,safe, mental health services. The success of this, at every stage, will depend on thecontinuation of that good multi-disciplinary working which has been a hallmark ofmental health services in Wales since the existing Strategy came into effect. Everyeffort must be made to maintain and improve upon this good joint working practiceand full use made of other Government initiatives aimed at reducing the barriers tofull co-operation.

The Welsh Mental Handicap Strategy

7.29 This Strategy was launched in 1983 and sought to give individuals greater opportunitiesto fulfil their potential and to lead dignified lives as valued members of the community. It isbuilt on a partnership approach involving local authorities (particularly social services,education and housing departments); health commissioners and providers (including GPs anddentists); schools, further education and training organisations; the individuals themselves;and their parents and carers. All the parties work together to agree the right approach to meetan individual’s needs and to develop their potential.

7.30 We believe that the principles which underpin the Strategy remain valid but that we needto build further upon the partnership approach which is at its heart. Social Services will retainthe key role in drawing up and monitoring individual co-ordinated plans for people withlearning disabilities. The proposals set out in the Partnership and Performance Managementchapters and earlier in this chapter are also applicable to the delivery of services for peoplewith learning difficulties. In addition, there are a number of particular factors relating topeople with learning difficulties that need to be taken into account. These include :-

• the long timescales over which care plans have to be sustained in aneffective, co-ordinated way;

• the increased life expectancy and life expectations of people with learningdisabilities;

• the increasing age of many parents and family carers.

7.31 In the light of these factors and with 15 years of practical experience of the Strategy, webelieved that it was time to seek the views of stakeholders on any obstacles to achieving theStrategy’s objectives for people with learning difficulties living in the community and how toovercome them. We did this through a consultation Conference held in September. The

Conference report will inform the debate about changes to existing policies and practices forpeople with learning disabilities living within the community, across both central and localgovernment and the voluntary sector. We will study the Conference outcomes closely to seewhat changes to our existing guidance or policies should be made.

7.32 We believe that decisions should, wherever possible, be taken locally. As part of thisprocess, in 1997-98 approximately half of the Strategy’s grant resources to support theprovision of community services for people with learning difficulties was transferred into thelocal authority Revenue Support Grant (RSG). We are consulting the WLGA to identify whatfurther Strategy grant resources can be transferred into the RSG in future years.

7.33 We continue to provide direct funding to local authorities to enable them to deliver theresettlement objectives of the Strategy. Whilst resettlement has given hundreds of peoplewith learning difficulties the opportunity to live more fulfilling lives within the community, itis relatively costly to achieve. For example, between August 1994 and 31 March 1998 over200 people have been resettled into the community at an annual recurring cost of some £9.5million, an average annual cost per person of over £40,000. We remain committed to theprinciple of resettlement, and have made available resources both to complete theresettlement programmes from the Ely and Powys hospitals, and to secure their closure. Wehave also made available £2 million over the next two years to support further resettlementfrom the Llanfrechfa and Hensol hospitals. We believe that it is appropriate for the NationalAssembly to determine the speed at which the remaining resettlement programmes forLlanfrechfa and Hensol should be implemented and to review the position of Bryn y Neaudd.

Risk assessment

7.34 We believe it is essential that a balance is maintained between the promotion ofindependence on one hand, and the safeguarding of vulnerable adults and the public as awhole on the other. To achieve this, we have commissioned a guidance framework for riskassessment. Separately, we are also preparing guidance on the implementation ofprotection policies for adults, for all social services. These should provide a foundation onwhich social service departments can build to ensure that effective safeguards are in place.

Drugs and alcohol

7.35 The 5-year Welsh drug and alcohol strategy Forward Together was launched in 1996. Itcalled for vigorous action and a new emphasis both on preventing the misuse of drugs andalcohol, particularly among younger people and on providing treatment, support andrehabilitation for those misusing drugs and alcohol.

7.36 Effective multi-agency working is vital to the success of this Strategy and Drug andAlcohol Action Teams have been formed in each of the five health authority areas to providethe framework for this. Membership of Drug and Alcohol Action Teams (DAATs) includesrepresentatives of the Health Authority (HA), Local Authority, Social Services Departments,Education Authority, Police, Prison Service and the Probation Service.

7.37 At a national level a Welsh Drug and Alcohol Unit (WDAU) working to, and funded by,the Department provides advice and practical support to those involved in combating drugand alcohol misuse. The Welsh Advisory Committee on Drug and Alcohol Misuse

(WACDAM) advises the Secretary of State on issues relating to drug and alcohol misuse, andon the implementation of the Drug and Alcohol Strategy.

7.38 The appointment of a UK Anti-drugs Co-ordinator and the launch of the new 10-yearUK strategy, Tackling Drugs to Build a Better Britain, last year have clear implications forthe future of Forward Together. Parallel developments in the field of public health and in theNHS will also impact on the Welsh strategy and in view of these developments ForwardTogether has been reviewed. The outcome of this review is that the Welsh strategy will berefocused to reflect many key elements of the UK Strategy, in particular the emphasis ontackling the causes of substance misuse. It will promote more effective local partnershipinvolving local authority Social Services Departments. There is likely to be greater role forthese departments in purchasing community care services for drug and alcohol misusers and acontinuing role for social services in the provision of treatment and rehabilitation service fordrug and alcohol misusers.

7.39 Particular issues which need to be addressed are:

• working through the DAAT with partners at a local level to establishstandardised information systems to assist in planning and evaluation;

• within the strategic direction established by the DAAT, improving co-ordination of resource provision between agencies to provide betterservices for users and to minimise waste (eg co-ordinate detoxification andrehabilitation services) and ensure that a range of services is available, bothresidential and community-based, so that individual users can be providedwith a service that is tailored to their needs;

• exploring ways of minimising exclusion from school to prevent escalationof problems for children and adolescents;

• increasing collaboration between Crime and Disorder Reduction Partnershipsto tackle the issue of drug- and alcohol-related crime.

Summary 7.40 Social Services for adults respond to a wide range of needs, fromresidential care to support for those who misuse drugs or alcohol. Key proposals foraction described in this chapter are:

• A national framework for service provision, to raise quality and clarify accessto care and charging for services, and a long term care charter to publicisewhat users and carers can expect from key services;

• Improvements in commissioning;

• Extension of direct payments;

• National Strategy for Carers;

• Establishment of a Disability Rights Commission;

• Improved guidance on risk assessment and protection policies for adults;

• Review of the Welsh drug and alcohol strategy Forward Together.

Annex 1

Back to contents

Paragraph:

Chapter 1

Social services to work to a framework of objectives 1.4

Chapter 2

Best Value 2.4

WO to consult on and revise and improve statutory planning guidance 2.9

Improve working relationships through Joint Review Programme 2.14

Evaluating and monitoring social services performance of authorities 2.17

WO to consult on a performance management framework 2.19

Follow up inspection reports and intervene where necessary 2.20

No requirement for a discrete Social Services Committee 2.21

Every social services authority to appoint a Director of Social Services 2.22

Phase out payment of residential allowance for adults 2.24

Chapter 3

New legislation to develop joint working between SSDs and the NHS 3.3

Local accountability for SSDs and the NHS 3.5

A national statement of priorities for PSS and the NHS 3.6

Implementation of the "Home Alone" report 3.8

Chapter 4

Commission for Care Standards in Wales to be established 4.2

New statutory regulatory system for domiciliary care to be introduced 4.5

Regulation of independent acute health sector and nurses agencies 4.14

National Required Standards to be developed 4.17

New requirement to inspect small homes for adults annually 4.18

Enhanced and more consistent enforcement arrangements 4.19

Appeals against CCSW’s decisions to national independent tribunal 4.20

Chapter 5

New regulatory body - the Care Council for Wales/Cyngor Gofal Cymru 5.4

Enforceable codes of conduct 5.7

CCW to devise a Code of Practice for Employers 5.9

CCW to have a registration function 5.12

Powers to be able to introduce job reservation 5.19

Powers to introduce protection of title 5.20

CCW to take over CCETSW’s functions regarding regulation of training 5.22

Further work on links between the CCW and TOPSS 5.26

CCW to be accountable to the Assembly 5.27

CCW to include service users, carers and the general public 5.29

CCW to be able to levy registration fees 5.32

Twelve key tasks in training 5.37

Chapter 6

Adopt a strategic approach to children’s services 6.7

Consultation to bring together requirements for children’s services planningand establish unified Children’s Services Plans

6.12

Set indicators and targets for children’s services 6.13

Develop "no compromises" programme for children’s servicesstandards

6.14

"Sure Start" 6.19

Publication of, and response to, the Waterhouse Report 6.23

Enhanced support and protection for children looked after 6.26

Revised guidance on child protection 6.27

Enhanced dissemination of findings from reviews of serious abuse cases 6.29

Chapter 7

Framework of objectives for raising standards of care 7.4

National framework for access to social services 7.9

Guidance on Fair Access to Care 7.10

Commissioning and progress monitoring as part of Best Value 7.13

Extension of the direct payments scheme to over-65s 7.15

National carers strategy to be developed 7.18

Disability Rights Commission 7.19

Long term care charter 7.20

Guidance on Welsh Mental Handicap Strategy 7.31

Framework for risk assessment 7.34

Establish standardised information systems and improve co-ordination ofresource provision through DAATs.

7.39

Social Services White Paper

"Building for the Future" - UpdateDecember 2000

INSIDE THIS ISSUE:1. Care Standards Act 2000

2. Care Council for Wales

3. Performance Management

4. Joint Working – Increased Flexibilities

5. Children’s Services

___________________________

Introduction

The White Paper ‘Building for the Future’ was published on 31 March 1999 and set anew vision for Social Services in Wales - aiming to raise standards and deliverservices which are more responsive to users and carers. The main measures coverthe new arrangements for the regulation of social care services and the workforce, anew performance management framework for social services, better joint workingbetween local and health authorities and a strategy for children’s services.Implementing the 42 White Paper policy commitments is being taken forwardcollaboratively with key partners in the statutory, voluntary and business sectors. AProject Board and 5 task groups with wide representation have been working toensure that the policy commitments lead to effective implementation and results.Additional funding - £250,000 in 1999-00 and £500,000 in 2000-01 has been madeavailable to Local Authorities by the Assembly to support implementation locally. Substantial progress has been made already in implementing the White Papercommitments but over the next year more work will be needed. This Briefing Note isan update on the progress made so far and is intended for all working in the caresector.

1. Care Standards Act 2000The Care Standards Act received Royal Assent on 20 July 2000. This new legislationwill have a significant impact on all in the social care sector whether they are owners,providers of services, managers, social workers, care assistants etc. This Act has atits heart two key aims – first of all, to protect vulnerable people from abuse and

neglect; and secondly, to promote the highest standards of quality in the care thatpeople receive, whoever is providing it to them. Those key aims run right through theprovisions of the Act, although the coverage of the Act is very broad. The Act willhelp to deliver modern, independent arrangements for ensuring that:

• Children in care are protected from abuse and neglect;

• Elderly people and people with a disability who rely on care services getdecent standards of care and the protection they deserve;

• Private hospitals and clinics operate to proper, modern standards ofhealthcare;

• Parents who use childminders or day-care can be assured that their childrenare in safe hands.

The new arrangements the Act will introduce will:

• regulate services in accordance with national minimum standards thusensuring consistency and coherency of regulation across the country.

• will be independent and will not have the conflicting priorities of healthauthorities and local authorities who currently have to be service providers,commissioners and regulators.

• Regulate more services and so improve the quality of life and level ofprotection for more of the most vulnerable people in society.

• help to monitor services, support consumers, benchmark services andencourage the development of better services.

One of the main purposes of the Act is to reform the regulatory system for careservices in Wales and England and to improve protection for vulnerable people.These regulatory functions will be undertaken by the new Care StandardsInspectorate for Wales and by the National Commission for Care Standards inEngland. The National Assembly will take over regulatory responsibility for all thoseservices currently regulated by local authorities i.e.

• residential care homes;• children’s homes (for more than 4 children);• independent boarding schools (welfare inspections only); and• Nursing Homes regulated by Health Authorities.• Childminding and Day Care for Under 8s

The Act provides that the new regulatory authorities should take on new functions :to include

• Local Authority care homes (on the same basis as those in the independentsector for the first time);

• domiciliary care in both the statutory and independent sectors;• small children’s homes (fewer than 4 children);• independent fostering agencies; and• maintained boarding schools (welfare inspections only).

• Private and voluntary sector health care.

The "Care Standards Inspectorate for Was" will be set up as a Division of theAssembly itself rather than as an independent statutory body as planned in England.It will work independently from SSIW but the 2 Inspectorates will come together atthe strategic management level. The Assembly will have under Section 8 of the Act,the general duties of encouraging improvements in the quality of care services andto make available information about these services to the public. These duties relateto recommendations by the Royal Commission on Long term Care for the Elderly.Under the revised arrangements in both Wales and England, regulation will becarried out to new national minimum standards. There will be full consultation with allinterests in the care sector about the standards and how and when they will beimplemented. The Act provides for a right of appeal against the decisions of the newregulatory authorities and Councils established under the Act and decisions of theSecretary of State for Health regarding the vulnerable adults protection list. Appealswill be considered by a new Care Tribunal which will cover both Wales and England.

Implementation

There is a significant and complex implementation agenda to address so that the Assembly’snew regulatory arrangements can be established from 1April 2002. This involves integrating16 Health and Local Authority Inspection Units and also LA Under 8s Inspectors into theAssembly - 180 staff from a total of 27 different authorities. There will need to be a majorrecruitment exercise to employ the new Inspectors and other staff that will be needed to coverthe significantly enhanced regulatory scope of the new regime. An Implementation Team –led by Project Director Sherry Rees – has been established to set up the Care StandardsInspectorate for Wales. Sherry will handle the personnel, accommodation and IT, theprogramme of secondary legislation needed as well as overall change management andproject control. with the wide range of inspection methodology and procedural issues thatwill need to be looked at if a single, cohesive regulation and inspection process is to beshaped from the different methodologies currently used across Wales. The transition from thecurrent arrangements to the new regime will need to be carefully planned and managedbetween the Assembly and authorities. The close involvement of regulatory staff affected hasalready commenced through 3 Conferences held across Wales in November. A newsletterand Website will start soon. An external Task Group with LA and HA, private and voluntarysector representation is also advising on the development of the inspection regime,particularly with regard to National Standards. Contact: by e-mailSherry.Rees@wales.gsi.gov.uk, by phone on 029 20898708, or by post at the Care StandardsImplementation Division, National Assembly for Wales, Cardiff Bay, CARDIFF

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2. THE CREATION OF THE CARECOUNCIL FOR WALES:The Waterhouse report recently reminded us that there have been examples ofserious misconduct, bad practice and abuse by a minority of staff in social care. TheAssembly is determined to protect the public, and to restore public confidence. The

Care Standards Act 2000 therefore establishes a new statutory body called the CareCouncil for Wales, or Cyngor Gofal Cymru, to raise standards in the social servicesworkforce. The Assembly has set up a Task group on Raising Standards in theWorkforce, which has a broad membership and has met 4 times during the last 12months. The Care Council will have two key tasks to regulate the social careworkforce in Wales and to drive up levels of training and qualifications. It will takeover the task of regulating social work training presently undertaken by the UK-wideCentral Council for Education and Training in Social Work (CCETSW). It will act asthe National Training Organisation (TOPSS) for social care in Wales. But it will notbe an "old-style" regulatory body dominated by the profession itself - all the keyinterests such as employers will have a voice, but service-users, carers and other laypeople will be in the majority. The Council will be established in shell form in April2001 and will assume its full role in October 2001. The Council will achieve its keytasks by developing:

i. Enforceable code of conduct and practice and ii. Registration ofindividual social care workers

THE CODES OF PRACTICE FOR EMPLOYEES AND EMPLOYERS:

The Council’s first job will be to set standards. These will include:a code of conduct for employees, and a code practice for employers

The code of conduct for employees will deal with such matters as:

• treating people as individuals• being reliable• keeping information confidential• working openly with service users• safeguarding service users from abuse

The code of practice for employers will require all employers to have thoroughrecruitment and selection policies. The aim here will be to make sure that onlysuitable people find employment in social care and the code will require allemployers to have effective complaints and disciplinary procedures. The aim herewill be to make sure that if people are found to be unsuitable they are removed - anddo not re-appear elsewhere in another home or in another part of the country.

THE REGISTRATION OF INDIVIDUAL WORKERS:

The Care Council for Wales will also be responsible for registering individual workers- this is widely seen as an important lever in improving quality and in raising publicconfidence. Different parts of the UK may well take different approaches to this. InWales we found overwhelming support for the idea that we should move as quicklyas practicable to the registration of all workers - the "employment-based" approachwe expect registration of the workforce to begin in 2002 - the Care Standards Act willenable the National Assembly to make the final decisions on the scope and speed ofregistration. There has been widespread concern to exclude all those, qualified orunqualified, who have shown themselves unsuitable to work with vulnerable childrenand adults. The CCW will have a duty to refuse entry to the register to those who are

unsuitable and it will have powers to suspend or remove from the register in cases ofmisconduct, bad practice, negligence or abuse. The Council will consult withemployers, user and carer groups, trade unions and other interests before bringingforward its proposals. Contact: by e-mail Margaret.Provis@wales.gsi.gov.uk, byphone on 029 2082 5566, or by post at the Social Services Inspectorate - Wales,National Assembly for Wales, Cathays Park, CARDIFF CF10 3NQ

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3. PERFORMANCE MANAGEMENTPROJECT IN FULL SWING:Chris Hawker joined the Social Services Inspectorate in May at the Assembly on atwo year secondment from Rhondda Cynon Taff Social Services to lead theAssembly’s work in supporting the development of the Performance ManagementFramework for Social Services in Wales. The ‘Building for the Future’ White Paperproposed a wide ranging programme of work be undertaken to measure and monitorperformance in Social Services through the creation of a Performance ManagementFramework for Wales. This would need to link work being carried out for Best Value,the development of a new Planning Framework, effective performance indicators anda programme of inspection, monitoring and review by the National Assembly. Threeimportant milestones have already been achieved with regard to this programme:

1. Extensive research into Department’s capacity and capability into the use anddevelopment of ‘management information’. This study identified the majorproblems we face in matching modern standards in these areas and identifiedclear focuses for our work in the future.

2. Preparation and publication of new guidance for planning in Social Services.3. Extensive consultation with authorities on the development of a new

Performance Management Framework.

Information on a wide range of existing indicators is being collected, however, it isrecognised that these need to be re-shaped for the future. They will focus on a coreset of such indicators supported by a wide range of local development andbenchmarking work by authorities themselves. A programme of new work based onthese three achievements is now in hand to help to deliver this based on:

• the development of a core information specification for both local authoritiesand the National Assembly;

• provision of a clear linkage between strategic and operational managementinformation needs;

• building capacity and competence in Social Services in collecting andmanaging information;

• producing accurate and useful information and addressing performance at theinterface with partner agencies.

Social Services Departments have a major challenge on their hands both to improve theirperformance management processes to meet modern management standards and address the

needs of the fast growing Best Value requirements. The Inspectorate and the Assembly needto know that Social Services continue to meet the needs of the people of Wales effectivelyand efficiently - both needs must be met from the same basic sources of managementinformation. Chris has established a quarterly forum in conjunction with the Association ofDirectors of Social Services in Wales to help shape our response to the challenges ofPerformance Management and Best Value in the future. All 22 authorities are activelyinvolved in this work. He can be contacted: by e-mail onchristopher.hawker@wales.gsi.gov.uk, by phone on 029 2082 5019, or by post at the SocialServices Inspectorate - Wales, National Assembly for Wales, Cathays Park, CARDIFF CF103NQ.

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4. INCREASED FLEXIBILITIESThe Health Act 1999 introduces three key flexiblities to reduce the barriers toeffective joint working between health and local authorities. The measures are:

i. pooled budgets ii. lead commissioning iii. integrated provision

Other structural changes in respect of introducing more flexibility to transfer moneybetween the authorities are also included . These reforms are expected to bringabout significant change in the scope for effective joint working and lead to betterdirected service to support vulnerable people. The Regulations to introduce theFlexibilities were approved by the Assembly on 7 November, were launched by JaneHutt, Minister for Health and Social Services on 29 November and come into forceon 1 December.

What are the aims of the Increased Flexibilities provisions?

The provisions will enable closer joint working between the NHS and localgovernment than was possible under previous legislation, and promote innovation inthe way services are provided to benefit the user and carer. This will encourage theNHS and Local Authorities in Wales to build on the good practices they are alreadydoing in client care, to make the best use of their resources and to develop jointworking structures that suit local circumstances. By introducing these provisions theaim is to improve services for users and carers through enhanced arrangements,including the delegation of functions (lead commissioning and integrated provision)and the pooling of resources. The legislation will improve services for carers andusers by enabling a more client centred approach to be taken jointly across NHS andlocal government services. These new opportunities for more flexible ways ofworking will mean that innovative patient and community orientated services can bedesigned and delivered to meet local needs and objectives.

Why have the regulations been widely drawn?

The functions which can be included in the use of the flexibilities are widely drawn.On the local authority side they go well beyond social services to embrace otherhealth and care-related services of local government.

What progress has already been made?

Already joint planning is in hand in each Health Authority area. Each Health Authorityis co-ordinating a Task Force with a wide ranging membership, includingrepresentatives from NHS organisations, social services and other local partners.The Assembly will maintain close contact with the groups throughout the winter andwill look to ensure that the Emergency Pressures guidance is being implemented.The new statutory provisions will lift limitations on collaboration and provide aframework for new and innovative approaches to support the continuingdevelopment of this working partnership.

What are the implications for charges currently in existence?

Charging has long been an area of discretion on the part of local authorities. Thereare good arguments for this discretion in setting charging policies for home care bothin terms of the level of charges set for a service and in terms of exemption fromcharges. There is a need to make sure that the system is fairer and more consistentacross the country. Statutory guidance which I intend to (consult on and) issue underpowers taken by the National Assembly in the Care Standards Act 2000 will providethe opportunity to provide benchmarks to local authorities and to ensure that they actreasonably in setting home care charges. As part of the process we will beconsulting local government and service users on drafting the new guidance later inthe year.

How will the use of the new flexibilities be promoted?

The draft Assembly budget proposes funding of £2m in 2001-2002; £5m in 2002-2003; and £10m in 2003-2004, which we would use to promote flexible care and jointworking. We plan to work with others to develop a central resource to provideguidance, spread good practice, develop good joint training models, promotemonitoring and evaluation to assist the NHS and local authorities to establishpartnership arrangements.

Why are the powers permissive?

The powers are permissive and it is for the statutory partners to determine whereand when they can be used to best effect. We are only just embarking on theflexibilities. There is real commitment from all of the key players. We should bedirecting our efforts to ensuring that the new flexibilities are widely used, notspeculating about what we will do if these opportunities are not taken up.

How will these partnerships to be governed / managed?

The guidance proposes that health and local authorities will need to establish a member levelforum – a Strategic Partnership Board – to provide strategic leadership for flexibleworking and other developments at the interface between them. At operational level - a

broad partnership is needed which is capable of developing operational plans, devisingdetailed plans and managing implementation– LHGs may be best placed to take this role,although it will be for statutory partners to consider the options and agree the localarrangements. Contact: by e-mail Lynne.Hamilton@wales.gsi.gov.uk, by phone on 029 20826429

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5. CHILDREN’S SERVICES

The most significant events this year in the field of children’s services have been thepublication of Lost in Care, the report of the North Wales Child Abuse Tribunal ofInquiry on 15 March and of the Assembly and Government responses on 29 June.Lost in Care was a devastating report, but we must focus now on action to be takento ensure that such events do not happen again in the system of public care inWales and that children looked after get a better deal. Changes must be made toimprove safeguards and standards. There is no room for complacency TheAssembly is responding to the Tribunal’s report through the Children Firstprogramme and under three broad headings of listening to children, safeguardingchildren and better services for children. The changes promised in the White Paperwill make a huge contribution in each of these areas.

Listening to children

One of the Assembly’s highest priorities has been the establishment of anindependent Children’s Commissioner to give all children in Wales a voice. The CareStandards Act gives an independent Commissioner the functions recommended bythe Tribunal for all services for children which are regulated by the Act (eg daycareand childminding, private and voluntary healthcare), not just those who are lookedafter by local authorities. It is hoped that an appointment can be announced beforeChristmas. The Assembly is seeking an early opportunity to extend theCommissioner’s statutory role, functions and powers.

Safeguarding children

Safeguards have been strengthened and will be strengthened further by themeasures in the Care Standards Act allied to the implementation of measures in theProtection of Children Act 1999. The new Care Standards Inspectorate and CareCouncil for Wales will address many of the recommendations in Lost in Care.Existing guidance on safeguards is being reviewed and will be strengthened ifnecessary. Consultation has is in hand about the commencement of sections 40 and41, relating to the regulation of small children’s homes, as interim measures pendingimplementation of Part II of the Act.

Better services

The Assembly’s programme, Children First will deal with the failings in the system of careand education identified in the Tribunal’s report and aims to strengthen and enhance thequality of management and practice in children’s services in line with White Paperobjectives. It sets clear objectives and specific targets to improve care and the education and

health of children looked after by local authorities. The Assembly has made it possible forlocal authorities to spend £48 million extra on social services this year and expects them tospend at least a third of that on children’s services. An extra £3 million of central resources isbeing made available to them in support of Children First. The Assembly’s draft budgetproposes resources of £12.2 million, £16.3 million and £18.6 million to support ChildrenFirst over the next three years. The bulk of this will be distributed to local authorities inaddition to Revenue Support Grant. This funding includes support for the improvedarrangements to be introduced following the enactment of the Children (Leaving Care) Act.Any queries on this article should be addressed to Keith Ingham, who can be contacted by e-mail on Keith.Ingham@wales.gsi.gov.uk, by phone on 029 2082 6746, or by post at Childrenand Families Division, National Assembly for Wales, Cathays Park, CARDIFF CF10 3NQ.