The Social Services and Well-being (Wales) Act 2014 has been described as “ground-breaking” (see our previous article for further information on the Act). The Welsh Government commissioned an independent evaluation of the Act, which concluded at the end of 2022. A number of initial reports were published over the course of the evaluation. As we await the final evaluation report, our two part series looks at what we know so far about whether the legislation is having the desired impact.
Our first article looked at the social care workforce and services. Here we look at what service users and carers have said.
What’s been the experience of service users and carers?
The evaluation’s ‘expectations and experiences’ report (2022) found “ample evidence” that the experience of service users and carers was “sub-optimal”.
While there were positive encounters with social services, and stories of improvements, the report notes that this was “not the dominant story”.
For the majority of respondents, their experience was one of frustration, with one saying “the fight is just draining”. Service users and carers identified barriers around a relatively “tokenistic’” approach to listening; power imbalances between themselves and professionals; the need to chase social services for support and recognition; and cultural insensitivity.
Service gaps were also identified, in areas such as “support for individuals with children in leaving abusive relationships, specialist services for children, and support for Black, Asian, and Ethnic Minority people”.
Lack of avenues for challenge and redress
The expectations and experiences report says there is a considerable concern that, despite the promise of greater rights in the Act, the process by which these rights can be achieved is not working for service users and carers. The report concludes it’s not clear how people can realise their entitlements in the Act or challenge decisions that are made.
A recent Equality and Human Rights Commission (EHRC) inquiry looked at Welsh and English social care legislation. It found that adults receiving social care in both countries are being failed if they try to challenge decisions made by local authorities, for example regarding eligibility for statutory services. The EHRC concludes that local authority processes are confusing and slow, with risks that people do not get the care they need. It says some people are deterred from seeking help by a complicated system, which should be upholding their rights to challenge decisions about their care.
Unpaid carers urgently need more support
The evaluation report found that carers “too often feel that they are unable to have their voice heard, listened to and acted upon”. It identifies that more needs to be done to support unpaid carers as a priority. One carer commented, “As we are not in crisis, we are ignored.”
The ‘Measuring the Mountain’ project, commissioned by the Welsh Government to evaluate experiences of social care in 2020, reached similar conclusions. It gathered stories of people’s experiences, and found three key themes:
- People’s need to fight for services;
- Individuals feeling judged; and
- An expectation that people will accept, and fit in with, whatever support they are given.
Measuring the Mountain highlighted an urgent need to provide better support for carers. The final report says the stories showed that carers’ assessments and respite services were often not providing the required support. According to the report, three in four carers experiences were negative, and their stories demonstrated more than any others, the impact of not treating people as partners, and of not recognising their views, expertise or needs.
In 2019, the then Health, Social Care and Sport Committee held an inquiry on the impact of the Act on carers. The Committee found that the legal improvement in rights had not been accompanied by a better experience for carers. Its report states “for so many that we heard from, the Act has failed to have any meaningful impact on their lives”. It goes on to say, “five years on from the passing of legislation that was meant to be transformative for the lives of carers, the results are, at best, underwhelming”. Almost a year later, Audit Wales reached a similar conclusion.
People from ethnic minority backgrounds feel let down
The evaluation includes a specific report on the experiences of Black, Asian and Minority Ethnic service users and carers.
This report found an overall sense that people had been let down by social services, and these feelings were especially acute given that people had often tried to avoid needing to use social services. Service users and carers reported “a massive lack of responsiveness to simple requests”, that they are “not seen as equal partners” and that when support was needed, “after years of coping without it”, it wasn’t there for them.
There were many concerns raised over the fact people feel they have no ‘voice’ in the system, and they are not listened to in a meaningful way. The report says, participants reflected on troubling experiences and, “There were real concerns that on too many occasions, the colour of their skin had been a consideration in their interactions with the system”.
Service users and carers acknowledged that the social services system is under significant pressure and there are challenges everywhere when it comes to having enough staff. However, they felt it was difficult to reconcile the lack of compassion and empathy they experienced, from a system designed to support and care for people.
Conclusions by the National Care Service Expert Group
The National Care Service Expert Group highlights the importance of the values, principles, and vision set out in the Act, such as giving individuals greater voice and control. However the Expert Group’s report November 2022) states that “the consistent translation of the Act into practice has fallen short of its ambition”.
The Expert Group says despite the aspirations of the Act, the imbalance of power remains between people accessing care and the professionals and systemic processes. It states there can be a disconnect between the available service offer and the ambitions to deliver personalised care based on individual outcomes. According to the Expert Group, people are often expected to fit into whatever support they are given, rather than exploring and receiving services to suit ‘what matters’ to them. It says this “is a systemic failure, not a criticism of our dedicated social care workforce”.
The evaluation’s expectations and experiences report says the evidence suggests “that the ‘journey’ towards the full implementation of the Act is not yet complete”. The final evaluation report is due to be published imminently, and there will be many stakeholders waiting with interest to see the conclusions and recommendations.
Article by Amy Clifton, Senedd Research, Welsh Parliament
