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The Health and Social Services Scrutiny Committee met on 15 October 2026. It received reports on the 2025/26 revenue outturn, budget monitoring for 2026/27, the first point of contact for social care, hospital flow and the Council's draft Annual Report. It approved two reports for Cabinet: the West Wales Learning Disability Strategic Action Plan 2026 to 2031 and the Social Care Accommodation Strategy. It also noted why the Adult Social Services Sustainability Plan was late.
There were no apologies for absence.
Councillor Minute No (s) Nature of Interest M. Palfreman 4 - Revenue Budget Outturn Report 2025/26 5 - Revenue & Capital Budget Monitoring Report 2026/27 - For Information 6 - West Wales Learning Disability Strategic Action Plan 2026 - 2031 (Including Shared Actions for Neurodivergent People) 7 - Social Care Accommodation Strategy 8 - First Point of Contact for Social Care Services in Carmarthenshire 9 - Progress Update on Hospital Flow Improvement and Regional Partnership Board Activity 10 – The Council’s Annual Report He runs a Health and Social Care Consultancy. Has been granted a dispensation to speak but not vote at meetings of Carmarthenshire County Council in relation to the provision of social care services in Carmarthenshire and across the South West Wales Region. There were no declarations of prohibited party whips.
The Chair advised that no public questions had been received.
Decision as recorded
RESOLVED that the report be received.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered the Revenue Budget Outturn Report 2025/26, which provided the year-end financial position for services within its remit. Members noted that Health and Social Services reported an overspend of £5.711m at year end and received information on the main budget variances and savings monitoring position. The report included information relating to the following:- • Summary position for the services with the Social Care and Health Scrutiny Committee remit; • Report on Main Variances on agreed budgets; • Detailed variances; • Details of the Savings Monitoring position for the end of the year. The Committee asked why the report did not include the year-end capital position. The Cabinet Member for Resources confirmed that the report related solely to the revenue position and that the information regarding capital was addressed in the Budget Monitoring Reports which the Committee had considered prior to the meeting. UNANAMOUSLY RESOLVED that the report be received.
The Committee had considered and discussed the Revenue and Capital Budget Monitoring Report 2026/27 prior to the meeting. Key points noted included: • a forecast revenue overspend of £7.611m for Health and Social Services; • the capital programme showed a £7.282m variance against the approved budget; • £4.585m of operational savings were forecast to be delivered against a target of £5.148m, with £345k of the £965k savings brought forward from 2025/26 having been delivered; • new capital funding included £1.557m from the Integrated and Rebalancing Capital Fund for a new children’s home in Llanelli and £433k of Childcare and Early Years grant funding for works at the former Gorslas Primary School building.
Part of an issue followed across 3 meetings
Decision as recorded
RESOLVED that the report be approved for submission to Cabinet.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered the report on the West Wales Learning Disability Strategic Action Plan 2026–2031 (Including Shared Actions for Neurodivergent People). The report outlined the regional engagement and consultation undertaken across Carmarthenshire, Ceredigion and Pembrokeshire, which had informed the proposed priorities for improving services for people with learning disabilities and neurodivergent people. The consultation had highlighted the need for more accessible services and communication, practical support, improved transport and connectivity, and greater opportunities for independence, employment, suitable housing and community participation. It had also emphasised that lived experience and co-production should remain central to the implementation and monitoring of the Plan. The Committee noted that the Plan would provide an overarching regional framework, while reflecting differing local service needs. Carmarthenshire would develop a local delivery and implementation plan, aligned with the regional Plan and informed by local feedback and priorities, by March 2027. A number of questions were raised, the main matters were as follows: • The Committee asked how the regional action plan differed from the existing individual local authority strategies. Officers explained that the plan placed greater emphasis on transforming services, supporting people within their local communities and using assistive technology. It also enabled the three local authorities and health partners to share expertise, good practice and resources, while retaining detailed local action plans. The plan had been shaped by extensive engagement with people with lived experience and placed additional emphasis on relationships, transport, aspirations and community-based opportunities. • It was asked who would be responsible for delivering the actions and how progress would be monitored. The Head of Strategic Joint Commissioning advised that a local learning disability and neurodivergence partnership board would be established, involving people with lived experience and key strategic partners. Local groups would report to the regional Improving Lives Partnership Board, providing a clear route for accountability. Individual partners would also be held accountable for delivering relevant actions and targets. • The Committee asked whether the action plan would operate across all Council departments rather than being limited to health and social care. The Head of Strategic Joint Commissioning confirmed that the work would be led within the relevant directorate but would involve partners from across the Council and health sector. Task and finish groups or subgroups would be established where necessary, including representatives from areas such as housing, transport and accommodation. • It was asked how the action plan would be financed and whether delivery would be dependent on grant funding. It was stated that future regional funding and the Welsh Government’s learning disability transformation programme would support pilot projects and service transformation. However, existing budgets and services would also be reviewed to identify better value, redirect resources and develop more effective ways of working. • The Committee sought assurance that neurodiversity and disability-awareness training would be implemented across the local authorities and would result in practical changes to services. Officers acknowledged the importance of giving staff the time, knowledge and awareness required to support people appropriately. Workforce training and development formed a priority within the action plan. Existing neuro-inclusion training delivered in Pembrokeshire could be extended regionally, including through a train-the-trainer approach, while existing health board training would also be reviewed and developed. Officers acknowledged that implementation would be a continuing transformation process. • It was asked whether people with lived experience would be actively involved in developing and monitoring the actions rather than solely attending partnership board meetings. The Employability Manager confirmed that the action plan would be co-produced through the Learning Disability Partnership Board, which would include and be chaired by people with lived experience. Citizens’ champions, unpaid carers and representative organisations would also contribute. The plan would be reviewed annually, enabling the board to monitor delivery, challenge delays and revise actions where necessary. • In response to a question on how the wider public, private and third sectors, particularly employers, would be encouraged to provide genuinely accessible and inclusive services and employment opportunities, officers referred to supported employment programmes, job coaching, mentoring, working interviews and the development of roles suited to individuals’ abilities. An inclusive employer scheme was being developed in Pembrokeshire and could potentially be replicated across the region. Existing work in Carmarthenshire, including Connect to Work and skills hubs, could also support this objective. • It was asked whether British Sign Language would be included among the plan’s accessible communication arrangements. The Employability Manager confirmed that accessibility would include British Sign Language, easy-read information and auditory, digital and visual communication methods. Members suggested linking with the existing engagement network and its work with the deaf community. • It was asked whether links should be established between the partnership board and the Corporate Joint Committee, particularly in relation to housing, transport, connectivity and regional strategic planning. The Director of Social Care & Housing noted that no formal link currently existed between the Regional Partnership Board and the Corporate Joint Committee. An undertaking was given to explore whether a closer connection would be appropriate. • The Committee noted the issues relating to incompatible ICT systems, shared recording and data integration and how this would be reflected in the strategy. The Head of Strategic Joint Commissioning advised that strategic commissioning with health partners would need to address information sharing. Regional data-protection work, a regional commissioning portal and appropriate data-sharing agreements were being developed. UNANAMOUSLY RESOLVED that the report be approved for submission to Cabinet.
Decision as recorded
RESOLVED that the report be approved for submission to Cabinet.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered a report providing an update on the development and implementation of the Social Care Accommodation Strategy. It was noted that the Strategy supports the Council’s Adult Social Care Sustainability Plan and responds to increasing demographic pressures, particularly the projected growth in the population aged 85 and over, alongside challenges relating to market sustainability, workforce capacity, and accommodation provision. The Committee noted ongoing developments to increase accommodation options for older people, working age adults with disabilities, and children requiring care, with a focus on supporting independence, ensuring sufficient provision, and developing a balanced and sustainable care market. The report also highlighted the financial, workforce, asset, and risk management considerations associated with delivering the Strategy and noted that individual projects would be subject to separate appraisal and governance processes. A number of questions were raised, the main matters were as follows: • It was asked how had the projected increase in demand, including the estimated annual increase in working-age adults with profound and multiple learning disabilities, been calculated? The Head of Capital Projects advised that projections drew upon the West Wales Regional Partnership Board’s population needs assessment, the market stability report and the Housing LIN assessment. This work was being refreshed using updated demographic and market information to identify future demand and gaps in provision. It was acknowledged that provision could fluctuate as services opened or closed and that the assessment also needed to take account of potential market failure. • In response to whether the strategy addressed potential demand across all geographical areas of the county, the Head of Capital Projects confirmed that the strategy remained an evolving document and would be refreshed alongside the Adult Social Care Sustainability Plan to include children’s services and updated demand information. The geographical distribution of provision was an important consideration, with developments intended to serve different areas of the county and a future aspiration to develop provision in the Carmarthen area. However, this had to be balanced against affordability, construction costs and the availability of capital funding. Welsh Government funding provided 100% support for eligible children’s schemes, while schemes for older people and working-age adults required a 30% Council contribution. • It was asked how would the strategy address the needs of rural communities. The Head of Capital Projects explained that larger facilities were generally more sustainable in urban locations with wider catchment areas. Locations needed to maximise the ability to meet demand while allowing individuals receiving care to remain as close as possible to their communities. • When asked if there was a strategy and timescale for recruiting the staff required for the new facilities, and had the likely staffing requirement been identified, the Head of Capital Projects advised that indicative staffing structures were required as part of the Welsh Government funding submission and associated revenue business case. As an example, in the case of Plas Y Bryn, a workforce development group had been established and had begun developing a workforce and recruitment pipeline. The planning would also consider apprenticeships, career pathways through the Care Academi and Welsh-language apprenticeship opportunities. • It was asked whether other Welsh local authorities operated nursing home. The Head of Capital Projects confirmed that the Council would be the first Welsh local authority to do so. Regulatory changes introduced in 2018 had enabled local authorities to operate nursing homes. Officers had been engaging with English local authorities already operating such facilities to learn from their experience, and the Council’s approach was attracting interest from other Welsh local authorities. • In response to a question regarding who would employ the nursing and health staff, and what would the Health Board’s role be, the Head of Capital Projects advised that the agreed model was for the Council to register and operate the home and employ all staff. The Health Board would formally delegate the nursing functions to the Council, as it did with independent-sector care homes. Discussions were continuing with the Health Board regarding clinical and professional support for nurses employed at the home. • It was asked how secure was the capital funding for the identified schemes, and was continued Welsh Government funding expected for future developments? The Head of Capital Projects advised that the Welsh Government had indicated that the Housing with Care Fund and the Integration and Rebalancing Capital Fund programmes would continue for a further five years. However, the eligibility criteria and the level of funding available had not yet been confirmed. Carmarthenshire had previously been successful in securing significant funding and had demonstrated its ability to deliver funded schemes, although future efforts to achieve a more equitable geographical distribution of funding across Wales could place the authority at a disadvantage. • It was asked if increasing in-house adult social care provision ultimately reduce costs? The Head of Capital Projects explained that local authority provision was not necessarily cheaper on a unit-cost basis because of improved employment terms and conditions. However, the cost difference with the independent sector had reduced. The principal financial benefit would be greater control over the commissioning budget and the ability to support individuals with more complex needs in-house, thereby avoiding expensive external placements. In-house provision would also strengthen market resilience and enable the authority to respond to provider failure. • In response to a query regarding how dependent was the Council’s financial position on delivery of the Accommodation Strategy, given the time required to fund, construct, staff and bring developments into operation, the Committee was advised that work would continue during the transition period to manage demand through preventative community services, maximise people’s independence and make appropriate use of assistive technology. Regional funding had been allocated to test different approaches and share learning across local authorities. The strategic approach would remain focused on providing the right service, at the right time, for the right people, while making the best use of available resources. • In response to a concern regarding the potential risks that could arise if suitable provision was not developed quickly enough in rural areas, the Head of Capital Projects confirmed that the strategy was intended to serve the whole county and that rural communities had not been overlooked. However, developments needed to be located strategically to ensure a sufficient catchment area, maintain occupancy and remain financially sustainable. A balance would therefore be required between countywide accessibility and the viability of individual developments. UNANAMOUSLY RESOLVED that the report be approved for submission to Cabinet.
Decision as recorded
RESOLVED that the report received.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered a report on the arrangements in place for accessing social care services in Carmarthenshire. The Committee received assurance that a single point of access model was in operation, providing timely information, advice, assistance, assessment and support through integrated partnership working. The report outlined the role of the Information, Advice and Assistance (IAA) Service, referral pathways, eligibility criteria, financial assessment arrangements, governance structures and the financial context within which services were delivered. Members noted the significant improvements made to the IAA service, including reduced waiting times, strengthened preventative interventions and improved referral processes, whilst recognising the continued growth in demand and complexity across social care services A number of questions were raised, the main matters were as follows: • It was asked if there was evidence that people living in rural areas experienced longer response times or barriers to accessing services, including poor mobile or internet connectivity? The Social Work Team Manager advised that some barriers were inevitable, but no specific comparative data was available. Referrals could be made at any time through the 24-hour monitoring service or online, and professionals could submit referrals on a person’s behalf with consent. • It was aske who had undertaken the service review, and how did it relate to the independent review of Delta Wellbeing? The Head of Integrated Services advised that the review had been undertaken by the local authority’s transformation and change team, independently of operational staff, with support from the county transformation lead. The findings had been submitted for consideration as part of the wider independent review of Delta Wellbeing. • In response to a query regarding how had waiting times for referrals awaiting triage been reduced from over eight weeks to one or two days, it was explained that unnecessary and duplicate referrals had been removed, referral and safeguarding processes had been streamlined, and the IT system had been improved to identify urgent and safeguarding cases. Staff had also adopted a more preventative, strengths-based approach, which had reduced referrals into statutory teams. • In response to a query regarding why had no cashable savings been attributed to the service, the Head of Integrated Services advised that the principal benefit was improved demand management rather than direct cash savings. The service aimed to manage increasing demand, avoid further recruitment where possible and make information more accessible, including through digital and artificial intelligence approaches. • It was asked much funding did the Health Board contribute towards Delta Wellbeing. The Head of Integrated Services clarified that the referenced £1.2 million was funded through the Regional Integration Fund and was therefore regarded as joint funding. The Health Board also contributed towards the hospital bridging service, including responders and vehicle capacity, although the precise figure was not available at the meeting and would be shared subsequently. No other direct Health Board funding was currently provided to Delta Wellbeing. • It was asked should the Health Board make a greater financial contribution given the benefits to health services, including reduced hospital admissions and ambulance conveyances. It was noted that a return-on-investment evidence would support strategic discussions regarding future investment. It was acknowledged that sustainable funding was essential to continue the services. • When asked when the Delta independent review was expected to be completed, the Director of Social Services & Housing advised that the draft report was expected imminently. UNANAMOUSLY RESOLVED that the report received.
Decision as recorded
RESOLVED that the report be noted.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered a report on progress against the Welsh Audit Office action plan for improving hospital flow across West Wales. It was noted that the majority of recommendations had been completed or were substantially underway, with improvements made to governance, discharge planning, collaborative working and community-based support. The Committee acknowledged that hospital flow remained a significant pressure across the health and social care system. It was also noted examples of good practice delivered through the Regional Partnership Board, including the Home First Programme, Strength Based Collaborative Communication Programme and Regional Dementia Wellbeing Programme. The Committee further noted that challenges remained in relation to integrated data sharing, digital interoperability and digital patient information systems, with a number of outstanding actions dependent on national solutions. A number of questions were raised, the main matters were as follows: • It was asked whether a further internal or external review would be undertaken to assess whether the completed recommendations were operating as intended and delivering the required outcomes. The Head of Integration Services advised that no further Audit Wales review was known to be planned. However, progress and impact would be monitored through regional governance arrangements, including the Regional Partnership Board, the Regional Flow and Discharge Group and the Health Board’s three-pillar structure. • In response to a question whether the hospital flow arrangements included system-wide seven-day working, it was confirmed that seven-day services were being developed, with clinical streaming expected to become operational by the end of November. Most recruitment had been completed, although further enhanced care practitioners were required in Carmarthenshire. • Following clarification regarding the new three-pillar model, the Head of Integrated Services confirmed that the three-pillar model had been established by the Welsh Government as a reconfiguration of the Six Goals programme. The revised model was intended to improve coordination across the whole system. • In response to concerns raised regarding increasing year-round pressures, including summer heat, climate change and associated health risks, the Head of Integrated Services acknowledged that pressures were no longer confined to winter. The service had experienced significant summer pressures, including increased falls and hospital admissions associated with heat and dehydration. National discussions were taking place on adapting winter planning to address pressures throughout the year. The Committee was informed that the Welsh Government was establishing a Social Care Adaptation Accelerator Programme to examine the effects of climate change on social care and to improve preparedness. • Clarification was sought on whether the Pathways of Care Delay Grant was recurring funding and whether the additional capacity supported by it was sustainable. The Head of Integrated services advised that the Pathways of Care Delay Grant was recurring and was expected to transfer into the Revenue Support Grant. Recruitment had proceeded on the basis that the funding would continue, with £1.8 million expected to be protected. • It was asked how progress against the action plan was scrutinised and monitored within the Health Board. It was confirmed that the action plan was considered through both the Regional Partnership Board and the Health Board’s committee structure. Similar six-monthly reporting arrangements were also being introduced across the other regional local authorities. UNANAMOUSLY RESOLVED that the report be noted.
Decision as recorded
RESOLVED that the draft Annual Report for 2025/26 be received.
(NOTE: Councillor M. Palfreman having earlier declared an interest in this item remained in the meeting and took part in the discussion but did not vote). The Committee considered the Council’s draft Annual Report for 2025/26, which incorporated the corporate self-assessment and reported progress against the Council’s four Well-being Objectives. Some key point noted: • Early-help and prevention services had been strengthened. The Early Help Hub had supported over 1,000 families, and Families Connected had worked with 110 young people and their families to help prevent family breakdown and statutory intervention. • The Council had maintained one of the lowest rates of children looked after in Wales, although safeguarding demand had increased and fostering capacity remained under pressure. • Early-years provision had been expanded through Flying Start, Welsh-medium childcare and revised Rising 4s arrangements. However, childhood obesity, childcare sufficiency and access in some areas remained concerns. • Integrated health and social-care services had supported residents to avoid unnecessary hospital admission, leave hospital sooner and remain independent at home. Reablement waiting times had reduced from 10 days to four days. In response to a question regarding the purpose and intended audience of the Annual Report, it was confirmed that the report was primarily aimed at residents and Members and provided a retrospective overview of how resources had been used and services delivered. Previous performance was considered when developing future business plans, although the Annual Report itself did not directly inform those plans. The Committee also commented positively on the concise and accessible format of the Performance Management Report considered at its previous meeting and suggested that the Annual Report could benefit from a similarly clear presentation. UNANIMOUSLY RESOLVED that the draft Annual Report for 2025/26 be received.
Decision as recorded
RESOLVED that the explanation for the non-submission be noted.
The Committee received an explanation for the non-submission of the following scrutiny reports. • Adult Social Services Sustainability Plan. RESOLVED that the explanation for the non-submission be noted.
Decision as recorded
RESOLVED that the list of forthcoming items to be considered at the next scheduled meeting on the 25th November 2026 be noted.
RESOLVED that the list of forthcoming items to be considered at the next scheduled meeting on the 25th November 2026 be noted.
UNANAMOUSLY RESOLVED that the minutes of the meeting of the Committee held on the 2nd September 2026 be signed as a correct record.
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