Health and Social Care Bill faces key Senedd vote this week
The Welsh Government’s Health and Social Care (Wales) Bill, which proposes major changes to the delivery of care services for children and adults, is set to face its first hurdle in the Senedd on 22 October.
The Bill, introduced by the Minister for Children and Social Care, Dawn Bowden MS, aims to prevent profit-making in services for children in care and enable Direct Payments for NHS Continuing Healthcare.
Bowden emphasised the urgency of the legislation, stating, “doing nothing in this area is really not an option for us,” highlighting that the rising costs of children’s care are unsustainable for local authorities.
“In 2016-17, the cost to local authorities of looked-after children was around £65 million.
Less than 10 years later, it has nearly tripled to £200 million, with up to 25% of that being extracted as private profit,” she added.
Without intervention, she warned, these costs could hit £1 billion within a decade.
Changes to Children’s Care
If passed, the Bill would require providers of children’s services registered with Care Inspectorate Wales to be “not-for-profit” entities.
The transition to this model would begin in April 2026 for new providers, with existing “for-profit” providers facing restrictions from 2027.
Local authorities would need special approval to place children with for-profit providers after transitional arrangements end, potentially leaving England as the only option for such placements.
However, concerns have been raised about the potential disruption this shift could cause.
The Welsh Local Government Association (WLGA) warned of a “sudden and critical shortage of placements” if for-profit providers withdraw or scale down services. These concerns come at a time when demand for placements already exceeds supply.
As of June 2023, nearly 2,000 children were placed by Welsh authorities in independent or private settings.
Challenges of Supply and Workforce
The Bill’s Explanatory Memorandum acknowledges that local authorities face significant challenges in meeting the needs of looked-after children, especially those with complex needs.
The number of children in care has risen sharply, increasing by 26% since 2014, and the sector is also grappling with workforce shortages. In 2021-22, there were 639 vacancies among Wales’ 4,774 children’s social work positions, with nearly one in five social workers employed through agencies.
Organisations such as the Chartered Institute of Public Finance and Accountancy have cautioned that eliminating profit from care provision could exacerbate these issues, driving workers out of the sector and leading to a loss of essential skills.
Voices from Care-Experienced Young People
Care-experienced young people have voiced strong support for the Bill’s goals, calling for a system where they are not treated as “commodities.”
One young person, Rowan Gray, told the Senedd committee, “Children in care want to be looked after by people who treat them as if they were their own. We don’t want to be advertised with a price tag.”
While supportive of the Bill, Gray expressed concerns about potential unintended consequences, saying, “My biggest worry is that if profit-making companies leave the market, it could cause major disruptions for the children they currently care for.”
Next Steps and Concerns
The Health and Social Care Committee has largely backed the Bill’s principles but issued 26 recommendations for improvement, 16 of which relate to children’s social care.
Committee Chair Russell George MS warned that while the ambition is clear, the Welsh Government’s plan for implementation remains uncertain. “More than one in every hundred children in Wales is now in care. Their needs must be central to any reform which passes through the Senedd,” George said.
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