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Response by the Cabinet Member: Dear Councillor Iain We are sorry to hear of the difficulties faced by your constituent and would be happy to investigate these in more detail in order to understand why they received this response, and to ensure that their circumstances are being continually reviewed. To investigate your constituent’s case specifically, we need to be provided with their name and date of birth, and their consent. Should they wish us to share information about their case with you, we need their consent for that, too. If you’re able to provide these, we will be happy to proceed. We are able to answer your questions about the provision of social care in rural areas of Powys more generally. As you may know, local authority social services have a duty under the Social Services and Wellbeing Act Wales 2014 to assess people’s care and support needs and to provide services to meet those needs which, under the act, are eligible to be met by the local authority. However, we do acknowledge that parity of provision across rural and urban areas is challenged by several issues which affect our ability to meet that duty, and addressing these is a priority for us and which we are attempting continuously to mitigate and resolve. Some of those issues are unique to Powys and some are common across Wales. The rural nature of Powys as a county, its low population density and its age structure all have important implications for how we deliver services (ONS, 2020). Specific issues include: · Ageing population. - The number of people over 65 who need assistance with the activities of daily living is projected to increase by 34%, from 2020 to 2040 (Audit Wales (2021). - 83% of adults receiving domiciliary care arranged or provided by local authorities are aged 65 or over; a figure that has remained constant since 2017-18 (Homecare Association 2021) - 27% of Powys residents are aged 65 and over and represent a significantly higher percentage of the population in Powys compared to the national average. · The geography of Powys. - We have the most dispersed population of any county in Wales and England. This means that in the rural areas we do not have the critical mass of population to provide the workforce base sufficient to sustain the delivery of services. - Staff must travel longer distances to their place of work which reduces the numbers of staff wanting to work in rural localities. · Increasing demand. - Despite providing nearly 800 more domiciliary care hours during November 2023 as compared to November 2022 we still cannot meet the demand represented by the increasing number of people with eligible care and support needs in Powys. · Workforce. - Powys has a lower working age population than the Welsh and UK average, with 16- to 64-year-olds making up 57% of Powys overall population (Wales 61%, UK 62%). This results in significant issues around recruitment and destabilises the provider market. - We are experiencing increased numbers of Domiciliary Care providers ‘handing back’ care packages due to staff shortages. Unemployment rates are currently very low, resulting in high levels of competition and choice in the job market, alongside the cost-of-living increase which has made it increasingly difficult to survive on low pay. - In rural areas, the rapidly increasing number of older people, through natural demographic growth and inward migration, is not matched by the availability of younger people to work in domiciliary care. Powys is experiencing a loss of approximately 600 people of a working age annually, many unable to afford the higher cost of living in our rural setting. This is especially and acutely the case in respect of the average wage for a carer. We recognise absolutely that the availability of services and good quality support such as domiciliary care is essential if people with care and support needs are to live well at home, and should be available to those who need it. We are currently working at both a national and local level to find solutions to the challenges outlined above and to improve our offer across the county. Through our transformation programme, we have a range of approaches in place or which we are working on to expand the coverage of services. These include: · Domiciliary care. - Working with providers to understand the barriers they face to increase coverage. - We have variable rates, including a rural rate, to go some way to cover the increased costs associated with provision in this type of locality. - Developing a new model which includes call banding, locality block contracts and developing a franchise model which would provide stability and improve working conditions. - Continuing analysis of the information provided through our digital database of people awaiting care and support so that we understand where demand and deficit are at the locality level and ensure that this intelligence informs our support to providers in their planning of runs. This will increase stability and sustainability of provider provision in our remote rural areas. - Continuing our commitment to the Powys Pledge, now in place for several years, which supports improved terms and conditions, such as paid time for training and travel between calls, paid-for uniforms and driving lessons, an increase in mileage from 35 to 45p per mile, and the provision of electric vehicles. - We have developed an internal Bridging Team, which provides temporary domiciliary care to people waiting for permanent packages of care from providers, and we continue to increase our internal domiciliary offer to provide coverage in harder to reach areas and pick up packages which are handed back from external providers when they are unable to maintain their delivery. - Increasing the use of technology-enabled support where appropriate to do so to release capacity for in-person support. - Expanding the Home Support model, an early help and prevention service for citizens (50+) that provides practical assistance to support independence and the maintenance of health, fitness and wellbeing (reducing the volume and complexity of demand in future years). - Working at a national level, where substantial changes are planned within the domiciliary care landscape in Wales, including the work of the National Commissioning Board, the plans to establish a National Care Office, and the development of minimum standard for terms, conditions, and progression frameworks for care workers by the Social Care Fair Work Forum. We are currently reviewing our transformation programme with a view to better focus at a locality level, rural as well as urban, to ensure we understand local variations in need, and local networks of provision and resources, and where we need to support community development; and to focus our resources through ‘Whole System’ and Place-Based Planning approaches. This is a complex issue and it will take a whole-system approach to deliver improvements over time, but I hope the above goes some way to reassure you that we are committed to addressing the gaps in service delivery which you raised. Should your constituent wish for us to investigate and respond to the concerns you raised specifically about their case, do send us their personal details and their consent, as outlined above. Please don’t hesitate to contact me again if you have further questions or if you would like to discuss issues about the provision of care and support in Powys in more detail.
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