RPP 17 2 Mark Drayford Issues and debates: health and social care services and the National Assembly of Wales

Research Policy and Planning: The journal of the Social Services Research Group – Vol 17 (2) 1999

Issues and debates: health and social care services and the National Assembly of Wales

Dr Mark Drayford, Senior Lecturer in Social Work and Social Policy, School of Social Sciences, Cardiff University

Editorial comment: ‘Issues and Debates’ is the RPP section designed to bring readers informed comment and opinion on a wide range of topics from those who have their finger on the ‘policy pulse’. In this issue we focus on the new National Assembly of Wales and its approach to policy development in health and social care services.

Introduction

Less than six months after its inception, any attempt to describe and assess the approach of the National Assembly of Wales to its social services and allied responsibilities must, necessarily, be tentative and preliminary. In addition to the inherent complexities and difficulties of the field itself, social service policy-making at the Assembly is evolving and responding to the developing experience of its new members, institutional pressures and the activities of other significant actors in the social welfare field.

Against this background, my aim in this brief paper is five-fold:

  • to trace, in a broad-brush way, the most relevant facets of the Assembly in relation to its powers and responsibilities;
  • to indicate, from the first working weeks of the Assembly, the emerging terms of its working practices, and to suggest some elements of particular significance to the social services;
  • to make some preliminary mapping of the major social services issues which are likely to pre-occupy the Assembly in its first year;
  • to set out some of the more important elements within the operating environment of social services, especially in relation to health and housing;
  • and to consider some ways in which those involved in the design and delivery of social services in Wales may wish to provide an input and produce an impact upon these developments.

The Assembly

The National Assembly of Wales is part of the wider pattern of constitutional change and devolution of power which has been amongst the earliest and most radical policies pursued by the New Labour government of May 1997. In the messy business of translating Manifesto proposals into legislative actions, the Government was able to draw, in Scotland, upon the work of a long standing all-Party Constitutional Convention which had already produced a practical blueprint for devolution. The Welsh settlement, by contrast, displays a set of distinctive characteristics, emerging through the sometimes fraught and usually tortuous policy-making of the Labour Party in Wales. The result is a strange amalgam of hesitation and radicalism. On the hesitant side, the Assembly has neither tax-varying nor law-making powers of its own. On the radical side, it is elected by a form of proportional representation and operates within statutory obligations to develop formal partnerships with key players, such as local government and the voluntary sector, in Wales. Additionally, and uniquely amongst the devolved tiers of government throughout Europe, it includes an obligation to test all its policy actions against the principle of sustainability. Due to the actions of the political parties, rather than the institution itself, the National Assembly also has an elected membership which displays a greater degree of gender balance than any other similar body in the European Union. The results of the Assembly elections on the 6th May 1999 produced 28 Labour members, a majority of whom are women, 17 Plaid Cymru members, 9 Tories and 6 members of the Liberal Democrats. These members will continue in office at the Assembly for a period of four years until elections take place once again.

A number of these factors have a particular relevance to the development of social services. The emphasis upon the voluntary sector will be especially important in a sector where so many services are delivered directly by voluntary organisations or rely upon voluntary effort more generally. The number of female Assembly members is also bound to be of significance for an area of activity where the social welfare workforce – and service users in a number of sectors – are mostly made up of women.

In financial terms, the Assembly has inherited the budget and the areas of responsibility of the Welsh Office. It has some eight billion pounds to discharge its obligations in health, education, housing, agriculture, economic development, transport, tourism and an equally long list of other policy areas. Social services, in terms of budget share, number of employees and the range of services delivered stands well in the top half of the list but, inevitably, finds itself in competition with others for a share of a budget cake which is fixed and which the Assembly itself cannot enlarge.

In practice

By the time the Assembly moved to its first summer recess, at the end of July 1999, it had spent most of its first three months putting in place the structures which will provide the bedrock of its first-term working practices. Crucially, the election results set out above produced a political outcome in which no single Party commanded a majority of seats over all others. The Assembly has begun life as a minority Labour administration, with a First Secretary and all eight Cabinet Secretaries drawn from Labour’s ranks. In these early days, at least, the administration has been able to rely less on positive alliances with others, than upon the intrinsic improbability of all three opposition parties uniting to defeat it. This may prove, however, to be an unstable longer-term strategy.

Amongst the division of Cabinet responsibilities, the first First Secretary, Alun Michael, has decided to combine health and social services in the one portfolio, appointing the Assembly member for the Vale of Glamorgan, Jane Hutt, to that position. The combination of these two large policy areas was, undoubtedly, a product of the Labour Party’s Assembly manifesto commitment to breaking down the barriers between hospital and community-based services. The danger for the social services in all this, however, was clearly apparent in Labour’s Manifesto promise to appoint a health supremo to bring about the desired change. Within the Assembly’s budget, health is by far the greatest spender, taking some third of the total funds at its disposal. The anxiety has to be that in a health and social services portfolio the relationship may be skewed in favour of the former. An analysis of first meetings of the Assembly’s Health and Social Services Committee provides a preliminary indication that this may be the case. Of 12 substantive agenda items seven were directly or primarily health-related while only three were social services directed, with a further two items spanning both areas. A discussion of possible future areas for Committee consideration produced three social services items and eight related to its health remit.

Framing these events more positively, it could be said that the social services are mainstream players in one of the most powerful portfolios in the Assembly. Quite certainly, in Jane Hutt, the social services could have done no better. A person of formidable energy, intelligence, creativity and determination, Secretary Hutt has spent her working life in different branches of social welfare. She brings an experience and a capacity to the portfolio which is unrivalled amongst other Assembly members and represents a rather stark contrast to the relationship between certain other Cabinet members and their portfolios.

Within the new Assembly structure, the work of Cabinet secretaries is scrutinised by a series of parallel committees. The membership of committees reflects the political balance of the Assembly as a whole. The Liberal Democrats, in the person of Kirsty Williams, member for Brecon and Radnor, hold the chair of the Health and Social Services Committee. The intended remit for Assembly committees is that they should both scrutinise the work of the Cabinet and develop a policy-generating capacity of their own. Very early indications suggest that the power of balance between Cabinet and committee is weighted rather firmly in favour of the former. The developing relationship between the two most important institutional arms of the new body will, however, be amongst the most important areas to keep under review during the months ahead.

The social services

There is no scope here to discuss, or even list, all the social services questions which are likely to require the Assembly’s attention during the coming 12 months. Some will be influenced by broader functions than the social services themselves, particularly the decisions made in relation to local government budget-setting and the Assembly’s attempt to translate the essentially Anglo-centric ideas of Best Value into the Welsh context. Others will involve the social services in relation to separate policy areas, especially health, as suggested earlier. Within the sector itself, a number of issues which have been working their way up the agenda will continue to command attention, including the re-orientation of child welfare services towards prevention, rather than protection and the realignment of community care strategy and funding around primary-care led services. Other issues have a short-term urgency which is bound to bring them to the attention of the Assembly, sooner rather than later. The long-delayed publication of the North Wales Child Abuse Inquiry will provide both political and policy challenges in its wake. Scandal and risk-management are more endemic features of the social services than the apparently non-partisan notion of ‘welfare’ might suggest. The practical implementation of the Labour Party Manifesto commitment to establish a post of Children’s Commissioner in Wales has already been set in motion but dealing with the aftermath of the Waterhouse Report, particularly in the light of on-going investigations in South Wales, will demand skill and sensitivity. Less contentiously, but of considerable future importance, the Assembly will have to deal with the demise of CCETSW in Wales, the establishment of a joint TOPPS and Care Council for Wales and the on-going review of social work training. Here, relatively detailed and technical questions about training investment and priorities will demand more than an expansive political response.

The sharpest arts in politics lie in fashioning a response to the unexpected as well as the predictable. No doubt the months ahead will bring to light social services matters which are presently difficult to predict. Given the list of known issues set out above, however, the social services agenda is bound to form a regular and significant part of the Assembly’s business.

Boundary issues

The effective delivery of social services does not, of course, depend only upon those factors which operate directly within their own ambit. In the key area of community care, for example, the interface with housing providers, on the one hand, and health on the other, will be crucial to the capacity of social services departments to deliver their own policy programmes. The 1998 Welsh Office White Paper, Putting Patients First, anticipated considerable realignment of local government, health authority and regional government boundaries in order to deliver services that promote a more community-based preventative, rehabilitative and maintenance role for care providers. A long-term commitment from the Assembly to a process of organisational and cultural change is implied in the White Paper, a process which will meet its first challenge in the formation of Local Health Groups, at primary care level. The capacity of such Groups to provide the collaborative and creative solutions to organisational bottle-necks and resource mis-allocations is as yet untested. It is, naturally, always easier to move systems towards greater alignment and co-operative patterns of working when money can be found to oil the wheels of change in this direction. The auguries in this regard for Wales are mixed. The Assembly will benefit from its share in the additional money which the New Labour administration intends to devote to health. Within Wales, however, larger debates concerning the match – or lack of it – between historic patterns of health spending and health needs, together with disputes over the pattern of specialist and general hospital provision seem likely to draw attention away from the advantages which might be obtained from the injection of relatively small amounts of money into easing the path of reform at community level.

Reforming the boundaries between health and social services will be eased by their co-location within one Assembly Secretariat. Housing and social services, while both local government functions, have been separated, at Assembly level, between two different Cabinet members. The housing stock in Wales is old, with 37% built before 1919. It is also plagued by problems of unfitness and disrepair. Fully 13% of the total housing stock of Wales was judged to be unfit in the Housing Conditions Survey of 1993. The bulk of these difficulties is concentrated in the privately owned sector. Historically, Wales has had a higher proportion of owner-occupation than other parts of the United Kingdom, with 71% recorded in that form of tenure in the 1997 Welsh Housing Statistics. At the same time, Welsh local authorities generally resisted the pressures towards divestiture of council housing stock during the 1980s and 90s. These pressures have continued, however, under the 1997 New Labour administration. Recent moves toward the large scale voluntary transfer of council housing stock to Housing Association ownership, in the city of Cardiff, for example, may be a sign of wider changes to come. From the perspective of social services providers, the upshot is a further layer of uncertainty and instability in the operating environment. In the most acute cases, these two arms of single authorities seem set to find themselves in conflict. The 1998 Crime and Disorder Act, for example, could result in housing officers attempting to evict families under its ‘anti-social behaviour’ components, while social workers attempt to keep the same families together and in their accommodation. Even where the interests of the two services are not so directly in opposition, the preoccupations of either side with its own agenda may leave little space in which to develop new or more fruitful ways of working together.

Making an impact

The political mood-music which accompanied the establishment of the National Assembly of Wales suggested a break with previous ways of conducting government. The new body was to be open, accountable, transparent and, above all, inclusive. It would belong to the people of Wales through the active rather than passive promotion of participative democracy. Even if the early weeks of the Assembly proved disappointing in this regard – committee meetings held in secret, papers denied to press and public, debates dedicated to point-scoring rather than dialogue – it seems most sensible, at this stage, to attribute all this to teething-trouble, rather than a more cynical reversion to political type. Rather, the commitments to openness and participation need to be seized by those without as well as those within, the Assembly. The constituency which has an interest in social services in Wales is an enormous one. It ranges through service users and providers and encompasses the interested but isolated individual as well as the formidably organised interest group. If the National Assembly is to be the success it needs to be – for on that success rests the practical quality of life which can be obtained by some of the most vulnerable members of our society – then all those who work within the social services sector in Wales need to contribute their voice to shaping such a future. The ultimate test for the Assembly will be how it encourages such voices and acts upon them inclusively in response.