Local government, housing and planning priorities for the Seventh Senedd

The Welsh NHS Confederation is the only membership body representing all the organisations making up the NHS in Wales: the seven local health boards, three NHS trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales and Health Education and Improvement Wales). We also host NHS Wales Employers and are part of the NHS Confederation.

As the largest recipient of public funding in Wales, it is vital that the NHS is held accountable, and Senedd inquiries play an important role in supporting that scrutiny. The Welsh NHS Confederation has built a strong relationship with the Clerking team from a range of Senedd Committees, including the previous Local Government and Housing Committee, during the Sixth Senedd. These relationships have been very beneficial for NHS organisations and also for previous Committee members to hear directly from NHS representatives. We hope this relationship continues during the Seventh Senedd term to ensure Committees hear from experts within the NHS, enabling Committee members to fully understand NHS’ policies, processes and recent developments.  

This response has been developed following information and feedback received from our members.

Priority 1: Sustainability of the social care sector

The Welsh NHS Confederation would like to see a review of the social care system in Wales so that a long-term sustainable service can be developed. A review should include all parties in the Senedd to ensure cross-party talks and agreement on the long-term future of social care in Wales.

We welcome that the Welsh Government are looking to re-commence the Strategic Advisory Group (SAG) meetings in the Autumn, which will include the development of an enhanced National Care Service plan. However, we would urge the Welsh Government to establish an independent review of the social care system as a matter of urgency. A review should include all parties in the Senedd to ensure cross-party talks and agreement on the long-term future of social care in Wales.

The adult social care system across the UK is in desperate need of reform. State-funded social care is only available to people with the highest needs and lowest means, while many face potentially catastrophic costs. Services are under extreme pressure, with high levels of unmet need, patchy quality of care and an unstable provider market. This places a heavy burden on families and friends to plug the gaps by providing informal care, often with limited support. The sector is facing a workforce crisis, with high vacancies and uncompetitive pay and conditions. The challenges in the sector mean that people are missing out on vital care and support, leaving them less independent, more vulnerable and more likely to rely on healthcare services. 

The challenges facing social care have an impact on the wider healthcare system. The NHS is reliant on a sustainable social care system as capacity and workforce issues in social care have implications on patient flow through hospital, impacting the NHS’s ability to discharge large numbers of patients from hospital. Across Welsh hospitals, typically there are 1,200 – 1,500 patients who are medically fit to be discharged from hospital but cannot do so because there is no available package of care.   This delay then affects the capacity available to provide treatment for other patients and on the patients in hospital.

Remaining in hospital longer than needed increases the risk of a patient catching a hospital-acquired infection, losing mobility and cognitive function. For every 10 days of bed rest in hospital, a person over the age of 80 will experience 10 years of muscle ageing.  These factors can make it harder for people to regain their independence after leaving hospital and lead to an increased need for further care and support.

Despite the pressing need for change, successive governments across the UK have failed to reform social care for decades. With the Casey Review beginning to shape the future of adult social care in England, now is the time to begin making real change in Wales. 

In scrutinising future Welsh Government policy work on Social Care the Committee should consider how the system needs sustainable funding, improved workforce pay and conditions, better integration and the collection and reporting of social care data.

Long-term funding reform is essential. The Welsh Local Government Association (WLGA) reports rising demand and complexity in both adult and children’s services, with social care accounting for 45% of additional in-year pressures on councils in 2024-25 (£106m). 

Workforce challenges remain significant, with workers experiecing a legacy of low status and low pay. The 2023 Social Care Wales workforce survey found that 26% were looking to leave the sector in the following twelve months and 44% in the following five years. Of these, 58% per cent planned to leave because of the pay and 30% because of poor employment or working conditions. For context, 11% are employed on zero hours contracts. 

However, funding alone will not deliver sustainability. Evidence shows that closer joint planning and commissioning between local authorities and the NHS improves outcomes, supports prevention and early intervention and makes better use of community-based services. To achieve this, we need incentives and performance measures that drive collaboration, not competition, across the whole system.

While NHS data are published consistently by the Welsh Government, such as monthly activity and performance figures and data on the NHS workforce, there are minimal and inconsistent social care data made publicly available. This is essential to understanding how current and future social care services can meet demand.

Case Study

Across Wales there are initiative that evidence that closer working between local authorities and the NHS help people to recover and keep well. These initiatives involve focusing on prevention and early intervention, making better use of primary care and community services and improving access to community support and advice, improving the self-management of conditions. 

Llesiant Delta Wellbeing’s blue army is supporting hospital discharge and patient flow in Carmarthenshire, helping to free up much-needed hospital beds. On average, patients have been able to be discharged from hospital five days earlier as a result. Working closely with Hywel Dda University Health Board, Carmarthenshire County Council and Welsh Ambulance Services University NHS Trust, a multi-disciplinary team of different health and care professionals has been set up. In Glangwili Hospital in Carmarthen social workers, occupational therapists, staff from Care & Repair and members from the Delta Wellbeing team are regularly part of the ward rounds to support patients. 

Priority 2: How Local Government planning decisions considers health and wellbeing of their population.

We recommend that the Committee undertakes an inquiry which considers how planning decisions and systems can positively (or negatively) impact on people’s health and wellbeing.

As highlighted in our recent explainer, developed with Public Health Wales, How does Wales’ planning system impact on the health and wellbeing of the population?, how we plan housing, transport, services, green spaces and food environments shapes our daily routines, influencing physical activity, obesity, mental health and wider conditions such as respiratory illness. 

The built and natural environment are key determinants of health and wellbeing. Healthy urban planning is about planning for people, considering the implications of planning decisions on health and wellbeing, and putting the needs of the local population at the heart of decisions. The way we plan a new development, how housing and travel routes are designed and configured and how accessible local services are, will all influence our life, our work and travel patterns, our access to healthy food and the opportunities we have to be active in our daily lives. These factors in turn link to our mental and physical health and wellbeing outcomes.

Case Study

Public Health Wales NHS Trust are leading on a Whole Systems Approach (WSA) to tackling obesity, looking at the big picture, demonstrating how different parts of the system are connected and interconnected in a way that can make it challenging for people to stay healthy. The WSA recognises the complexity of the systems that affect our health. It works with everyone in the system to create changes that meet stakeholders' needs. WSA brings together various players - such as health organisations, local councils, businesses, and schools, to work together to change the environment around us. This collaboration embraces the complexity of these systems, creating stronger and more effective healthy solutions with a better chance of making a real difference. 

This includes empowering local authorities to prioritise health and wellbeing when assessing planning applications for new takeaways. Betsi Cadwaladr University Health Board has been working with local authorities in North Wales on objecting to planning applications based on health and wellbeing grounds. The number of fast-food outlets in Wales has increased by 48% from 2010 to 2018, with 670 new establishments opening during this time. 

Priority 3: The strategic partnership arrangements in Wales 

We recommend that the Committee undertakes an inquiry which considers the statutory partnership arrangements in Wales and how they improve partnership working across public sector bodies. This inquiry would link with the work that the Welsh Government is currently undertaking around One Welsh Public Service.

There exists a multitude of agencies and partnership arrangements in the Welsh public sector. There are at least 164 formal partnership groups in areas relating to health and care (excluding subgroups and local arrangements), representing a partnership body for roughly 20,000 people in Wales. 

Working in partnership can lead to better decisions about changes in health and care services and managing overall resources, for example support pooled budgets. However, despite the positive intension of partnership working, several reviews have been commissioned which have considered the partnership landscape in Wales. The reviews carried out all acknowledged that the partnership landscape in Wales is cluttered, as well as:

• There is an urgent need for the simplification of governance and accountability arrangements for all bodies involved, particularly for Reginal Partnership Boards and Public Service Boards so that they can establish exactly what they will be accountable for, as well as who drives the overall long-term planning.  
• Funding arrangements also tend to be short-term, inconsistent and unclear, despite policy intentions, joint pooled funding is rare, and this can exacerbate siloed interests and lack of shared ownership. 
• Too many partnerships meetings take place often with overlapping agendas.  

The recommendations from NHS leaders to improve partnership working include the following: 

• Regions should consider adopting Joint Strategic Needs Assessments that can be used as a common unified evidence base for decision making.
• Specific population requirements placed on partnerships should be reviewed to enable greater response to local population need.
• Planning requirements placed on statutory organisations and partnership structures should be better aligned.
• Additional work should be undertaken to consider the principles around One Welsh Public Service to improve public services. 

The first principle in effective partnership is the need for clarity of purpose. Clear and simple national strategy is necessary to provide a rallying point for partnership. Effective partnership working hinges on shared goals, mutual trust, and clear communication. Best practice begins with establishing a common purpose with a clear and understood strategy and intended outcomes. Partners must invest time in building relationships, understanding each other's roles and legal duties, and aligning their values and priorities. Transparent governance structures, joint decision-making processes, and clearly defined responsibilities help prevent duplication and ensure accountability. Another key element is the coproduction of services with stakeholders, including service users and community groups. This ensures that solutions are grounded in lived experience and tailored to local needs of the population.   

Research on high performing systems identifies the following necessary characteristics:

• Leadership to provide the stability and vision
• Alignment between providers and payers
• Performance management
• Connectivity between primary care teams and secondary care
• Information – both for operational management and for improvement  

These characteristics could be used when undertaking a inquiry into the Welsh Partnership landscape.