Health and Social Care Committee

I'm happy to start. Thank you, Chair. I agree. The evidence has been really harrowing, and I think the sad thing about it is it isn't surprising to us. The people that you have spoken to are not the exception; they are what we experience day to day across Wales. Evidence from network partners of Carers Trust has really demonstrated that there are too many carers who are reaching crisis point without any support.

I want to just talk a little bit about the context that carers find themselves in today, if that would be helpful. There's a real significant complexity of need that's presenting at front-line community carers services, levels that aren't being met by others, including statutory providers. As I've no doubt Rob will share, in terms of 'Track The Act 7', the majority of local authorities are directly supporting fewer than 500 carers. Given what the committee has already heard about the level of demand, that seems really, really small, and the pressures on the system are just growing. There are really, really high levels of unmet need within our communities.

In support of this, I can certainly share that providers within our network have described needing to provide vicarious trauma training to front-line staff, and needing to take really proactive steps to support their mental health and well-being because of the levels of distress that they are seeing amongst carers and those that they work with. I'd like to draw this committee's attention to the work of Dr Siobhan O'Dwyer of Birmingham University, who demonstrated an elevated suicide risk amongst unpaid carers. Her research shows that carers have a level of suicide risk akin to that of veterans who have seen active service. One in eight carers has made a plan to end their own life, one in 10 has made an attempt. And that's one in 10 at a time where, on average, local authorities have support plans for less than 0.5 per cent of the caring population. And although it's likely to be an underestimate because of the way that death data is collected, there's one homicide every month in the UK undertaken by a carer who has reached the edge.

If I turn to poverty, poverty in Wales is deepening and the poverty rate amongst unpaid carers is at 31 per cent, which is far higher than the 22 per cent poverty rate in the wider population. More than one in six carers caring for a person in their household is living in fuel poverty. And while I'm really pleased that programmes like the carers support fund are successfully and proactively reaching thousands of carers most in need of support, it's really concerning that almost half of them accessing this emergency support for food and heating are not connected to any other service at the point that they present for support through the carers support fund.

If I can speak very briefly about young carers, when using 20 hours of care as an indicator, the proportion of young carers and young adult carers in Wales providing significant levels of care increased from 15 per cent to 27 per cent between 2011 and 2021. For those providing 50 hours of care a week, this increased from 12 per cent to 15 percent. I think we can all agree that 50 hours of care is substantial for anyone, let alone a child juggling that with full-time education. The census also made clear that young carers are more likely to live in areas of high deprivation than their peers without a caring role.

In terms of education, young carers in Wales miss more than six full school weeks each year in comparison to young people without caring responsibilities, who miss about 13 days. It's no wonder, therefore, why young carers are achieving less at school and they are less likely to go on into further and higher education, and if they do make it to university, they're less likely than their peers to actually graduate.

It's really difficult to get an understanding of what local authorities and regional partnership boards are commissioning. Statutory partners may fund a really small part of a service, but the significant charitable income that's underpinning the delivery of that service all too often goes unrecognised, and the importance of capacity building and sustaining this vital sector is really undervalued.

Because of the significant demand and the financial pressures that we're seeing right across the system, many respite services are volunteer led or saved only for emergencies or for hospital care—and I know my colleague Greg has some really strong evidence to that effect. Availability of respite provision is patchy at best, with too many carers telling us they simply cannot get a break.

So, in short, Chair, I think the context to this really important inquiry is one where too many carers are simply unable to access the support that they deserve and that they have a legal right to.

Thanks, Kate, for capturing that. That chimes with what we've been hearing. Rob, would you like to add to that?

There's not a great deal more I can add to that, to be honest, because that's a pretty effective summary. Things are getting worse. Anecdotally, we see that through our services, but also, that's what the research tells us. In the last two years, our 'State of Caring' survey has shown a 53 per cent increase in the number of carers cutting back on things like food and heating. Fifty-three per cent in two years is a shocking statistic and shows a trajectory that is going in one direction; it's not a good way. Similarly, 33 per cent more carers since 2024 are using credit cards, loans or overdrafts to try and cope with the cost of caring as a direct result of their caring roles.

And it's not just about finance and money, though that is a really important part of the support that carers need and deserve, but there's been a 39 per cent increase in the number of carers reporting bad or very bad mental health since 2023 as well. So, these are some really stark statistics. All the evidence that we're collecting shows that this is going in one direction and that's the wrong direction wholeheartedly. So, it's a bleak context.

Thanks, Rob. Greg, would you like to add to that?

Yes, Chair. I would just like to echo what has been said. Every year, we have contact with around about 5,000 carers, but we know that in our county, there's another 14,000 people who have caring roles who we aren't able to reach, just because what we have as a resource to be able to meet that need is consistently oversubscribed.

I'd echo what Kate has said and I'd echo what Rob said: we are seeing more and more people coming through our service, and we are seeing more and more people coming through with a complex need. There's a real sense, I think, that services are overloaded. People are being referred to us just as a means for those organisations and services to say that they've been able to do something for somebody. I think that's a pretty desperate place to be, where people are signposted around the system without ever really seeing anything tangible as a service that they're offered.

Just to give you an example, we have a parent carer service that works with families. It works to support the parents of young carers, and those young carers have, very often, complex needs. They're on a transition between child and adult services. We saw and had contact with about 82 families in the past year. Out of those, we completed 33 carers' needs assessments for those families. But we know, from that group, only two people ever received any form of service. One family had an occupational therapist assessment, the other family had a series of direct payments that didn't necessarily deal with their underlying issues, and I think that's the problem.

I think, for us in the third sector, we're increasingly getting asked to plug gaps. We're increasingly getting asked to meet crisis need without really having the time or resource to be able to tackle some of those deeper underlying issues—poverty, deprivation, isolation. We see an awful lot of carers who come to us who have almost been trapped in the system. As I said, they're going around, being signposted from organisation to organisation, without actually ever having a service. Or there are people, as was said earlier on, who come to us and say, 'I've had to fight, I've had to beg for everything that I need, and I'm still not able to get a service.'

Thank you, Greg. Mabon.

I just want to ask you one very brief question, just to be clear about what we're discussing. Could you give us a brief description of what an unpaid carer is? How would you define an unpaid carer in your area?

We would define an unpaid carer as anybody that has caring responsibilities—from taking somebody to appointments, picking up shopping, things that might feel like they tread lightly on your life, right the way through to people that are providing 24/7 round-the-clock care and doing things that you would expect medical professionals to be doing—operating equipment, administering medication—people who are not able to do anything else other than provide care because the system doesn't support them to be able to do so. We would deal with anybody within that very broad range. The census reckons there are about 310,000 unpaid carers in Wales. We think that's significantly lower than the number. We conducted research via Carers Week that reckons there's probably closer to 500,000 carers in Wales. So, it's a significant constituent part of the nation.

Thanks, Rob. Everybody was agreeing on that, so it's a really clear definition. Just recognising all of the pressures that, certainly, Greg, you outlined, and we know the context of how challenging and the increased pressure, has the third sector got the capacity it needs to deal with all of this? Who would like to come in on that?

I can start. You might have some more to say as well.

I think everybody wants to have a go, so you're welcome.

I'm just speaking for Carers Wales. It's difficult to speak for the whole sector. I know the Wales Council for Voluntary Action have some good stats on this, so I would recommend having a conversation with them as well. But we've been flat funded on the services that we deliver on behalf of the Welsh Government since 2022. We've worked out that, if we were to receive inflationary uplifts year on year, we'd have an extra about £50,000 to work with, which would help us do a lot more. We consistently overdeliver on our responsibilities, every single year, against what we're scheduled to do, but we're getting real-terms cuts every single year, and I know that that's the situation for lots of other charities across Wales doing similar work. Obviously, there are organisations and charitable organisations that are commissioned, like ourselves and like, I'm sure, the trust and network partners, to deliver services on behalf of statutory services and on behalf of Government. But all the evidence shows that, whether it's statutory services, whether it's third-sector organisations, capacity and resource is just vastly outstripped by demand, and that's only going one way as well. We're only seeing more demand and more complex demand, so the short answer is, ‘Absolutely not, no.’

Greg.

Yes, I would echo that. Just to give you an example, in one of our core funded services, we've had the core funding for about the last 10 years. It's not changed, really, that much. We've had relatively small uplifts. We receive about £119,000 a year for that core service, and that is to meet the needs of adult carers. We calculated that, in real terms, as Rob has just said, really, that if that funding had kept pace with what it probably should have done, that funding should now equate to around about £180,000 for the service. So, we often talk in the organisation about having to look at resources and spread the jam ever more thinly. That really causes us concern, because we're really keen to reach out to as many people as we possibly can, but we don't want to compromise the quality of anybody's experience when they actually come to work with us. But it's a really tough decision that we have to make where, probably for the first time in some of our services, we're not quite saying 'no' to people, but we're having to say a qualified 'yes' about what we're able to offer.

And probably the irony for me, just around the question in some respects, is that we are massively overstretched, we are massively oversubscribed across all of the services that we deliver, but we do have the expertise to be able to deliver those services. We do have the reach into those local communities, we do have the connection with people at the local level. Some of the frustration for us is that, very often, commissioners may not come to us as a first point of contact. They may look to other providers. They may look for something new when we're almost crying out to say, 'You know us. We've been around since 2009 as an organisation. We provide quality, we provide reach', and yet there's sometimes still a bit of a hiccup in how people come to us, or services are commissioned without there seeming to be a clear vision about what that service commissioning is meant to address.

So, my answer would be twofold, really, I guess: we don't have the current capacity to be able, probably, to work with significantly more people. So, as I said, those other 14,000 people who we know in our county who need our services, we're going to struggle to meet their needs, but we do have the expertise and the reach to be able to do it. It's almost, 'Give us the tools and we can do the job.'

Yes. Thanks for that. Kate, do you want to add anything before I bring James in?

Yes, I'm happy to. So, in terms of capacity across the sector, we have network partners across Wales who consistently tell us that they're either receiving flatline funding, insufficient funding or funding that comes very late in the year. So, decisions to issue funding in the autumn with 'Please get this money out of the door by quarter four', which doesn't allow for effective long-term planning and it keeps it as very much a sticking plaster, which creates real instability in the sector. So, if we think about recruitment and retention within these vital services, it's really, really difficult when the funding streams are inconsistent and not to the level that we need them to be.

When we look to capacity, as Greg describes, these community-based services are reaching into their areas where there are high levels of need and potential distrust of the wider system and a need for a third sector interface, and they're doing amazing work, but they're having to do so where demand far outstrips supply, and that's a very hard thing to manage when we think about making sure that carers are aware of their rights and they're asking for support. That does surface the demand, and we're really seeing that, which is a very difficult thing for services to manage. As Greg described, the third sector is really efficient, creative in how we deliver differently, but we can only do so much with what we have. So, I think there's a real call to look at that across the long term: how are we seeing the third sector as a crucial part of delivering rights under the Act? We simply can't do it without them, so we need to put them on an equal footing to statutory partners.

Yes. Thanks, Kate. James.

Thanks, Cadeirydd. As you said, you've had cash-flat funding from the Welsh Government for years—since 2022, I think was what you said. I'm just interested in how much extra additional funding you would need to meet the demand that you've currently got. We all know that there's no extra money, really, in the system, but I'm just interested in whether you've done any work on where the potential money could come from to meet the additional demand that needs to go into this service.

That's a very challenging question, and I think that the number would be a scary number, because the demand is so high. But I think that we have to be very cautious about not letting a scary number put us off the small steps that would contribute to a more positive outcome in the here and now. So, even with the same amount of money, better commissioning over the longer term with that money would result in better outcomes. So, I think that that is a first step that could be taken: understanding need at a regional level, and making clear plans as to how we're going to address the need and the gaps in services would really help. Better integration between health and social care, so that there isn't waste in the system and spend when people reach crisis, would absolutely help free upfront for the more preventative work. And I think what the committee has heard through these sessions is that we're not getting to the preventative piece and that's where you can make the savings.

Yes. Greg, do you want to come in?

Yes, just a quick one really to echo what's been said, I suppose, in answer to the question. I think one of the things for us as a fundamental question—and it's probably, I think, something that'll be picked up a bit later on in the questioning—is probably the role of health in this. I think we're probably perceived purely as carrying out a social care function, but we're clearly not, because we would argue that we keep people out of more acute health services in terms of respite, in terms of the sitting service that we actually provide that keeps people out of hospital. At the other end of things, we work very closely with primary care on when people need to go back home, so working with them on a pathway.

And I know it's not always down to resources and the money—I'm not always a fan of just saying that's what it is—but I think, for us, the challenge, just to answer the question that was posed, is: where does health sit within this? We receive very little funding from health and that's just an observation. I'm not here to make any sort of further inference about that, but it does make us question health's role in tackling some of these issues, because it might be a social care need that we're addressing, but that clearly has a wider health impact. I think probably, from our point of view, we don't necessarily see the evidence, other than we are told that we're valued. But I'm not quite sure where the NHS properly sits in this whole piece of work, and we would argue: is that one of the routes that could open up some of the funding? We all know the challenges that the NHS is under, so, I just say that as a broad answer, I suppose.

Yes. James, do you want to come back?

Yes, just really quickly, there are two points you picked up on that I'm interested in: you talked about the regional funding and better commissioning, and that all links back to the regional partnership boards, doesn't it? I'm just interested in your views on this. Do you think they're actually fit for purpose for what you need them to do, or do you think that sometimes some of those people around the table have got vested interests in trying to keep some of the funding that they have centrally within their organisations, to help their own balance sheets, rather than sometimes pushing that funding out to the third sector organisations, the people who are actually delivering the really good work on the ground? I'm just interested in your thoughts on that.

There's certainly work to do. So, third sector providers will describe—

You could sit in my job with an answer like that.

Yes. [Laughter.] But there is work to do. And I think there has been progress made, but third sector providers consistently tell us that they don't feel that they have an equal seat at the table. The example I gave in terms of being given the opportunity to take on funding late in the financial year—it just makes it impossible. So, in terms of influence and engagement through that process, the third sector consistently tell us that they don't have an equal seat, and that isn't good enough when we look at the scale of what's being provided.

I think, just to quickly add to that as well, with regional partnership boards in particular, obviously they're meant to have carer representatives on the RPB, and I think what Kate's illustrating here is a cultural issue within the RPBs that charities aren't considered equally because carers aren't, and they're not able to engage equally. In RPBs, you've got a whole range of often very highly paid, very experienced professionals who have years and years of experience, and then an unpaid carer who has lots of lived experience, lots of experience in relation to their caring role, but it is impossible for that individual, or in some cases more than an individual—there are a couple of RPBs where they share it—to engage in the same way. They're not able to read the meeting papers in the same way, they don't have the spare time to be able to do that; it's not their job, they don't have the context.

So, I think, culturally, if we're to tackle the issue that Kate's describing here, there needs to be a better level of co-production within the regional partnership boards with regard to unpaid carers anyway. Carers need better training, they need more support, they need more time. And the practice across the seven varies so wildly: there are some that literally just will not recruit carer reps to the board, despite that being a legal obligation to do so. So, I think, until we address that sort of systemic cultural issue within regional partnership boards, it's going to be very difficult to adjust that imbalance in terms of resource and capacity.

Yes, thanks, Rob. Greg, you want to add something.

Yes, it's only a quick point, really. I think, from the RPB point of view, I would echo again what's been said. And I think, for us, one of the challenges that we would probably pose is: do we see a vision coming out of the RPBs about what an overarching carers service could look like and should look like? Are we, as the third sector, recognised for the expertise that we could probably provide, or that we could put into that whole arena? And very much, yes, it does feel a little bit at times that carers sitting on those RPBs or when they're asked to do things—I mean, 'tokenism' is probably too strong a word, but you do question the role that carers have. They are supported well from our experience within it, but I think, as I said earlier on, from that point of view with the RPB: are we seen for our expertise when opportunities come up? Do they understand who we are and what we do? I know that might sound a bit fundamental, but on Kate's point about the funding coming very late in the day, it is money that's sort of desperately thrown out through the door without, seemingly, 'Where's that come from? Where does it fit with any broader vision?'

So, in that context of what we just heard, how well, then, is unmet need currently being assessed and planned for? Have you got any views on that?

Yes, lots. So, 'not very well' is the short answer. The paucity of data with regard to unpaid carers and how it's collected across Wales is shocking. If you look at our 'Track The Act' reports, you'll see that we ask local authorities and health boards the same set of questions every year, and have done since 2016, aside from the pandemic. Still, nine years on from the Act being implemented, basic questions with regard to carers in their local area and then how that fits into a regional picture are not able to be answered. There are local authorities who cannot quantify how many carers' needs assessments they could, in theory, carry out over the course of a 12-month period. How on earth are you meant to collect data from unpaid carers and plan services if you can't even figure out how many you can assess? These are basic stumbling blocks at an early stage that just completely set a system up to fail.

I think far more needs to be done to strategically collect data in a more comparable and coherent way, so that we can figure out what the issues are, where they are, apply a level of regional flexibility, but until we have a better understanding of what the issues are on a regional or a local basis, how on earth can we begin to plan services to address them? It's just not at all robust.

Thanks, Rob. I'm going to move this on—. Greg, do you want to add a point on that, please?

Just very briefly, I would again echo that. We do an awful lot of project reporting. We have seven quarterly project reports for a series of projects funded through one principal funding stream. So, we have seven sets of reports. We do an awful lot of project reporting that goes to our partner organisations and service commissioners. We do wonder what is done with that information. We get very little pushback on it. We get very little questioning about it. We're not clear how that necessarily informs service development. We're not necessarily clear how that fulfils some of the vision and the aims that, actually, those partner organisations may want to engage. [Interruption.] Pardon me, sorry.

That's all right. Thanks, Greg. Get yourself a glass of water.

Thank you.

I'll move us on. Can I invite Lesley Griffiths in, please?

Thank you very much, Chair. Good morning, everyone. I want to talk about the identification of carers, and we've heard, certainly from listening to the carers who've given us evidence, that there are very many missed chances for them to be identified as carers. Some of them self-identified, but it took many, many years. People weren't identified, and it would have benefited them if they had been. So, I wonder what you think could be done, particularly in the field of health. So, I would say start with a GP, to be able to tell somebody that they're a carer and then, obviously, signpost them for support, because I don't think that is happening at the level that we would all want to see.

I can certainly reflect that we've done substantial work to try and support primary care colleagues to identify and signpost carers. Some of the projects and programmes that organisations like Greg's will run have been effective, but it's pockets of effectiveness. It's not systemic, and I think some of the barriers there include how information is shared and stored. So, how are we recording carer data on the system? How is that being communicated and how does that inform, not just how we signpost to third sector support or for a carer's needs assessment, but how you engage that carer as a partner in the provision of healthcare to the person that they care for? Carers are often real experts in the needs, in the healthcare needs of the person that they look after and will undertake, as Rob has already described, very complex roles in terms of managing medication and providing care and support in the home, so it's really important that GPs and all medical professionals really understand the role that the carer is taking beyond just being a family member.

And I wanted to reflect a little bit on local health boards and their role in supporting unpaid carers. As I'm sure many members of the committee will know, the obligations that are placed on local health boards changed quite significantly between the Measure and the Social Services and Well-being (Wales) Act 2014. Between all seven local health boards, they still receive just £1 million a year for their work with carers, and that's a ring-fenced part of the regional integration fund. So, that's £1 million; it hasn't changed in the last decade. In some areas, we see really strong third sector delivered and LHB commissioned programmes. So, an example of this would be Investors in Carers in west Wales and some of the work that we've delivered as Carers Trust Wales, supporting pre-registration training to make sure that the next generation of medical professionals understand what a carer is, how to engage them in the health space and how to signpost for support. However, carers still tell us consistently about missed opportunities to be signposted to support and gaps in understanding about their roles.

To give a little bit of a reflection on what medical professionals are telling us, they have concerns around consent. Consent does seem to be a challenge in terms of sharing information about the cared for, and that's something that we need to work around. As I've already said, digital records, that's been flagged as a real challenge for healthcare professionals, as well as a reluctance to signpost to the third sector, which is something I've found very interesting, and that reluctance sprang from the insecure funding. They didn't know, year on year, what services would be there and didn't want to hold responsibility for that person once they'd identified them. So, a real barrier to identification was knowing, in a busy clinical environment, what to do next and having trust that there was someone to hand that carer on to, to make sure they had the support that they deserved.

Thank you. Is there anybody else?

Greg.

We do an awful, awful lot of work in a range of primary care settings that address a range of health issues that may or may not directly touch on the lives of carers. And I think one of the things that we've observed from that is, certainly, the challenge of getting to sit regularly within GP surgeries—that can be a challenge. We do some hospital-based work as well. But I think it's a bit of a two-pronged fundamental thing for me that we see that health staff at the sharp end of things are really overrun. You know, do they have the time to be able to sit with patients about the wider social care and healthcare needs that they may have? So, what is the quality of the conversation that's going on in that healthcare setting?

Going back to what I said earlier on, I think probably there's a perception in health that we carry out a purely social care function. So, in some respects, why would they know about us? We do a lot of work, as I said, to advertise what we do, to encourage primary care staff to refer to us, to identify carers. But it almost feels—as I said, that two-pronged thing, they are really busy, so do they have the time? And we also see a kind of churn of staff as well; we will go back to various healthcare settings and teams have changed, or the exchange of information between different healthcare teams, for some of the reasons that I think Kate has flagged up, is always a challenge. So, information is not always exchanged, and that may be for a range of issues—it might be consent, it might be because somebody's moved on, it might be simply because somebody's really, really busy. So, we try to work with those healthcare professionals to see what we can do to help them create that time to have that quality conversation and to develop that trusted partnership where we say, 'Look, you can refer to us', notwithstanding some of the challenges that Kate has flagged up in terms of funding. But I think it is that fundamental thing, for me, about are we perceived as solely providing social care or are we sitting as a bridge, as I think we do, in both camps: health and also social care.

Greg, you mentioned before, in an earlier answer, how many carers you have and how many unpaid—sorry, how many unidentified—carers. I think you said 14,000.

That's right, yes. Absolutely.

Did I hear that right?

Yes, you did, yes.

Which is obviously a huge number. And those people are missing out on the support that they could have. So, I hear what you're saying about health and social care, but for me—and this was something we took from the carers—I do think that there is more that can be done in health to identify carers and then be able to provide support, even if it's just posters in the surgery. I've specifically looked in my own surgery to see if there was anything in there, and there isn't. So, I think there is a lot more that could be done.

I agree, yes.

Yes, you agree. Do you think—? There is a lot more that can be done, obviously, but do you think more responsibility should be put on health to provide that support and identify carers?

I think so, because, if they are the primary contacts, which they very often are—. We've been involved in a number of initiatives around ophthalmology, around dentistry, around foot care—some of the things where you think, 'What's the direct connection with the carer?' But carers, as we know, like the rest of us, will approach their GP or their primary care service for a range of other things. Probably health colleagues will curse me for this, because it's something extra for them to do, but I think we would probably see it as their wider conversations with people who are carers. We know that some of the people we deal with have long-standing and almost friendship-based relationships with their GPs, or staff within the GP surgery. It's still always a surprise for me that, when we work with some of those people, they say, 'I've never been referred to a carers service.'

So, I think what you say is right, but I think there is work for all of us to do about raising the profile of what a carer is and how those individuals can be cared for. There's equally the challenge as well, as you know, that people do feel uncomfortable sometimes identifying themselves as a carer. That's one of the things that we work very closely on with the people who come to our services, and we work very closely with partners about how they approach that conversation with somebody. It's not as blunt as asking, 'Are you a carer?', it might be a different way to steer that conversation. But it's that issue, isn't it, about how carers turn up in a range of other health settings, and how those health professionals can look to identify those individuals and create what I think should be appropriate pathways of referral into our services—and I don't just mean us, I mean, obviously, other organisations as well.

It seems to me, as I say, that some of the cultural blockers between, as I said, health and social care—in our experience, anyway—seem to be the challenge that we have to find a way around. We are a social care provider, but we do work within health. We can bring a health benefit to the people that those health organisations, professionals, GPs et cetera are seeing on a regular basis.

What has struck me—[Interruption.] Sorry, Peter. What struck me in this inquiry, particularly with the adult carers, was not only had they identified themselves as carers but they'd gone out and found that support. They'd found something within their area and then got peer support. That's really struck me as something—that people are doing it for themselves.

Yes.

Sorry, Peter.

It's all right. I think Rob and Kate might want to come in on your last question as well.

Yes, just very quickly. I think it's difficult to argue against a greater onus on health services identifying and supporting unpaid carers. We did some research last year for our 'Track The Act' survey, and asked carers over a 12-month period what services they'd engaged with or visited, and 53 per cent said primary care. Councils were down at 20 per cent, and carer charities were 18 per cent or 19 per cent, depending on the local or national charities.

So, it's clear—and obviously this is no surprise to, I'm sure, anyone in this committee, because the same is true of the general population—that carers are interfacing, whether it's for themselves or the people they provide care for, with primary care services first and foremost. So, it's a missed opportunity not to identify carers in that setting at an early opportunity, hopefully, if they've got a lighter caring role, so that they can access the help and support they need as their caring role changes and progresses over time.

I do think, though, there's something around—. We see that, obviously, there are responsibilities on statutory services currently under the Act, but it's one thing to put responsibilities on a set of services, it's another to see services actually delivered as a result of those. If we're going to—. And it's a live conversation as to whether healthcare should take a greater role in identifying and supporting carers, and if we're moving towards a more integrated service anyway then, surely, why wouldn't it? But this has to come with leadership and culture change. This requires somebody to take responsibility of this process, not to just lump some guidance onto healthcare professionals that will sit on a shelf and never be read because they're time poor. It requires leadership and somebody to take control of this and to drive that agenda within Wales more generally, but also locally and regionally within health services. Without that, we're just adding responsibilities that won't be fulfilled, and carers will have a terrible experience.

Anything you want to add, Kate?

I agree with everything thing Rob says, and I have two things I'd like to add. Reflecting on primary care, many years ago there used to be quality outcomes framework points for identifying carers, so an incentive and an expectation that GPs should identify unpaid carers. That doesn't exist anymore, so I think there is a reflection there as to the compulsion for GPs to identify unpaid carers.

It's also worth reflecting that unpaid carers themselves are likely to have higher health needs than the general population, so they're more likely to be presenting in these universal services. And I wanted to reflect personally a little bit not with director hat on, but with mum hat on: I'm a parent carer, and my child has accessed services over the last 16 years from ophthalmology to audiology. He's autistic, he's under the children's hospital for Wales. I have never once been signposted to anything that would suggest that I am an unpaid carer or that I can access support. I'm looking for it, I'm there looking for that poster, I'm looking for the question. I've never been asked, it hasn't been recorded and it is relevant. So, I just think that kind of lived experience is really important.

Yes. Thanks, Kate. Lesley, back to you.

Just my final question is on young carers and the roles that schools play, and the group of young carers who gave us evidence, it was really striking, the young man who had moved up a year in school—. So, whereas he'd had a very good form teacher who knew he was a young carer and I think he was with him for three years, then suddenly he's in a new class, a new year and he's not getting that support. One of the other young carers, her teacher didn't understand what a carer was. She just assumed that she went out of the class to take a phone call or that she didn't do a piece of work. There wasn't that understanding. What role do you think schools should play with our young carers to make sure that they get that support and that they understand the role that they are undertaking at home?

It's a really important question, and I think my reflection on that evidence session with those brilliant young carers was their expectations were really low, that actually what they were describing as good support was somebody listening or signposting them to a foodbank. It wasn't comprehensive support to make sure that they achieved academically to their potential and went on to further destinations that met their aspirations. That wasn't the level of support they were looking for. It was just someone to talk to.

So, I think, looking across the piece, too many young people tell us that they're not identified and supported at school. From issues such as the loss of education maintenance allowance—a number of young carers will tell us that they lose their EMA because they're missing school as a result of their caring role. Schools can use their discretion, but they don't. It's really, really inconsistent for those young people.

Young carers are also telling us that they can be asked to look after siblings at school, which I think is a really interesting challenge, being called out of their own classrooms to deal with that young person that has a care and support need and missing out on their own education as a result.

Despite a Health, Social Care and Sport Committee recommendation in 2019, young carers are still not included within pupil level annual school census data, so we can't track that cohort. It leaves us behind England and Scotland, where we have good data to understand the needs and experiences of young carers in education. I think there's a little bit of a reflection of not reinventing the wheel. So, whilst there is some really good practice through some young carers in schools programmes, Estyn's recommendations that flowed through a thematic review undertaken in 2018 are still the right recommendations; they just haven't been implemented. So, I think there's perhaps room for us now to look at school improvement plans and have a clear understanding of how schools themselves can support young carers as a specific group of vulnerable learners within their school improvement plans.

And I think, finally, so many young carers tell us that, fundamentally, their time at school and time learning outside of school is severely impacted by the number of hours that they spend caring. You heard from the young people in committee. They don't feel there's anybody else that can take on that work. And when they describe their access to respite and the things that they wanted to do, things like housework were the barriers. Now, that is something a support plan can provide for. That is something a carer’s needs assessment should direct them towards. So, it's really important that we don't just think about what goes on in school, we think about the pressures outside of school and how we can remove them.

Thank you, Kate. James wants to come in on that and then I'll move us on to the next section.

Yes, very quickly, you mentioned young carers, and that's the part I really care about. I'm just interested—. One of those young people we spoke to also said that they were considering not going on to university, even though they did really well at school, because they weren't quite sure who was going to do the caring responsibilities at home. That's damaging someone's life chances and actually makes them, in the future, potentially economically inactive as well, because they can't go on to the jobs and careers that they want to do. I'm just interested from the organisations that you represent, do you have any data around how many young carers that you come into contact with have had their life chances really changed from not going on to, say, college or university to get those higher education degrees because of their caring responsibilities back home, because other parts of the system haven't backfilled to enable them to do that?

Yes, absolutely. We can provide you with supplementary evidence that can clearly track that young carers are less likely to go into further education, less likely to go into higher education, and less likely to succeed if they do get there. They're more likely to be economically inactive.

That would be really welcome. If you could furnish us with that, that would be very helpful. Lesley, is there anything further you wanted to add? No. Okay. Thank you. Can I move us then on to Mabon, please?

Thank you. We've already touched on this in terms of carers' needs assessments, and the evidence that we've received—and that you've given as well—has shown that people don't receive these assessments, and when people do have these assessments, they don't always lead to support. Why is that the case?

We ask this of local authorities every year via 'Track The Act'. The No. 1 response to that question, from their perspective, is capacity. The local authorities that do submit responses, where they can broadly quantify how many assessments they're able to deliver over the course of a year, always fall significantly short of the carer population according to the census, which, as we know, is likely to be an underestimate. Whether that's internal budgeting or whether that's a lack of resource from Welsh Government, there is a lack of capacity within local authorities to be able to deliver assessments.

As you rightly point out, an assessment itself can, for some carers, be a useful experience in terms of identifying other support, but actually most carers who get an assessment are clearly at the heavier end of their caring role. There's clearly going to be a statutory need for them to have some sort of support from the local authority, but a pitifully low number of carers then go on to get any sort of support at all.

As has been mentioned by colleagues, we often refer carers to local authorities or services to get an assessment, and we see that carer again, months down the line, when they're referred back to us after an assessment to go and get some information and advice. There is not enough capacity to be able to meet the needs of the carers at a local level.

In terms of the reasons why, there's a wealth of research behind this. This committee will probably make recommendations that will have been made in our 'Track The Act' reports over the last nine years, in the ombudsman report last year, in the Welsh Government's own evaluation of the Act in 2023, and in the Health, Social Care and Sport Committee report in 2019. We don't need to do any more research on what the issues are behind the lack of carers' needs assessments. Honestly, if you ask a carer, they will be like, 'You know what the problem is—do something about it.'

What we need to see is a good, solid plan in place. There is an improvement plan via the ministerial advisory group, which we welcome. There are some good, positive steps in that with regard to looking at good practice and scaling and spreading that across Wales, but to be very, very clear with this committee, the spread and scale of good practice alone will not go far enough to address the issues that we face. This is a significant implementation gap and requires more capacity, more resource and greater leadership to resolve.

I agree with Rob entirely.

I agree, yes.

I think the implementation gap, as you describe, is the biggest challenge. I think it's really important to reflect—. A carer's needs assessment isn't worth anything unless it comes with a support plan, unless it changes something for someone. The obligations on local authorities are to assess when they anticipate an eligible need. The number that are having an assessment means somebody thinks there is a need. That drop-off rate between assessment and support plan—and, I should say, an already pitifully low assessment rate—is a concern. That's a measure that really matters: the number of carers' needs assessments relative to support plans.

Anecdotally, we certainly hear that social workers share they don't offer assessments when they know there's no support to forward people on to. If there isn't something that can meet the presenting need, they may not want to undertake that assessment. I think we heard really strongly from carers to this committee their frustration at the lack of outcomes from assessments. I'm sure Greg will want to come in and discuss that challenge of people being stuck in a signposting loop.

Just to close, really, if we look at the WLGA forecast—that £201 million gap they see in their budgets for 2026-27—they've indicated that they're going to have an inability to meet their statutory duties. So, to me, that's really concerning, because carers and carers services are already struggling. There isn't the support available as a result of a carer's needs assessment, so any further cuts could be really catastrophic.

Before Greg comes in then on that, in that case, earlier you mentioned that it isn't necessarily always about money, but in this case, it is directly related to funding: the lack of funding for local government so that they can maintain the provision and provide that provision. Am I correct on that?

Yes. I think, without additional capacity and resource, it's impossible to rectify the situation that we're in. But that also needs to come with good data, collection of data, and monitoring and evaluation of that. There are pockets of good practice that can be spread and scaled, but, fundamentally, without additional resource, there's no chance of meeting the legal obligations that local authorities have on them.

How much money are we talking about there, nationally? What sort of figure are we looking at, in terms of additional money, that needs to be put into the system?

It's really difficult to say, because the data that we have available to us with regard to the gap is so poor. So, until, again, we can get a grip of how bad it is, it's difficult to put a price on what it will take to be able to address it. So, it's a bit chicken-and-egg, unfortunately.

Okay. The Act that exists also says that carers must be willing and able to maintain the provision, to give that provision of care. But we know from the evidence that we've received that, truth be told, they don't have a choice. A number of carers have told us that they can't do something, but, going back to that point that you've already made, there is no signposting, there is no support available, there is no assessment being made of their needs. So, what measures do you think are needed in order to improve this situation, so that there is support available for those people who make it clear that they can't continue?

So, we know that about 64 per cent—. So, the carers report in 2024 showed that about 64 per cent of current and former carers in Wales told us that they had no choice but to provide care, because there were just no other options available. Without it, the person that had care needs would have been in a very difficult position, and an even more difficult position as well for the carer. It comes back to capacity and resource again. Clearly, there's not enough capacity and resource within the system to be able to meet the needs of people with care needs and their carers—there's just not enough. Carers are having to step up and plug the gaps, and are just often being left to get on with it, because there's not enough capacity and resource to be able to support them.

I think, in an ideal world, where a carer is either unwilling or unable to provide care to somebody, this is what an assessment should pick up, and, therefore, a greater prevalence of assessments is needed. But, if that is the case, and it becomes clear in an assessment that a carer is either unwilling or unable, or both, to provide care, then really statutory services should put in place a package of support that relieves that carer of their duties and their caring duties, and allows them to not provide care, whether they're unwilling or unable. But, as it is, that isn't happening, and carers are having to provide care because that support just doesn't exist.

So, a lot of carers, as you'll have heard from the evidence sessions, are simply left to get on with it. Anecdotally, we know lots of carers who are refusing assessment because they're in work and they have an income. We're driving people out of the workforce, because when they ring up for an assessment, to have any sort of support, they're told, 'Well, actually, there are carers that are financially worse off than you, and so we have to prioritise them', which is just absolute insanity. But then also, on top of that, there are people who are discharged from hospital in just the most horrendous, unsafe ways—people who are literally wheeled out of hospitals and put into cars of unpaid carers, or sent home in ambulances without any communication. So, yes, we're a long way from where the Act is telling us that we should be.

Can I bring James in briefly, and then I'll come to Greg?

On this point of willing and able, the elderly population especially are under severe pressure. A lot of them have worked their whole lives, have got savings, and all the rest of it, are just getting by with a bit of a pension as well, and don't want to lose their savings. Do you find sometimes, through those carers as well, that people are being, I wouldn't say forced into doing caring, because they're worried, if they have to put that loved one into full-time care, about losing their savings, potentially having to sell their homes to pay for that level of care, especially people who I represent in rural areas? I see that as probably more prevalent, especially in the farming community as well. Is that something that you pick up through the work that you do, that people are being forced to take it on, even though they're physically probably not able to do so, because they're worried about losing their savings, losing their home and the rest of it?

I think older carers are less likely to identify themselves as carers. They're less likely to accept that as a term and therefore to understand their rights. I think there's a real importance in making sure that older carers specifically understand their rights in terms of barriers to accessing support beyond identification. Caring itself isn't a bad thing. Caring without support is a bad thing. So, I think I would reflect, particularly in rural communities, the choice not just financially, but distance-wise, physical distance to the person that you love, is a real barrier. If that older carer wants to care for the person they care for at home, they should be given the support to do so in a way that is not detrimental to their own health and well-being. This committee has heard about people having to physically carry and care for people in a way that they're not able to. You've heard about people missing appointments and not being able to look after their own well-being, and that is never more true than for older carers.

Members, we've only got—. We're not making the progress that we need to, but it's really fascinating and it's really interesting. Greg, I'm going to bring you in, and I'll ask Members to be a little bit more succinct, so we can cover as much ground in the next 20 minutes as possible. So, Greg, would you like to come back in?

Yes, just a couple of quick points, really. Going back to carers' needs assessments, I think it is a capacity issue. We've had the local authority in our area effectively concede to us they're only ever able to pick up people who we refer who have really acute and severe need. They weren't able to define what that actually meant or what that actually constituted. I know it's only an anecdotal comment, but they are clearly feeling the pressure about being able to pick up all of those people that actually have those assessments, which does lead us, or has certainly led us as an organisation, to question, 'Well, there is an awful lot of work that goes into carers' needs assessments—we used to carry them out at one point—and very, very few people, as we've said, ever get any service from that.' So it's almost like a question of: what's the point of actually going through that process if there's no end product?

And particularly on the point that was raised there about older carers, we do have a developing cohort of older carers who are caring for ageing adult children. We see issues around deprivation, around poverty, around worry and concern about what's going to happen to that adult child that these people may have been caring for pretty much all of their lives. It's a real growing concern. We know, anecdotally, that, obviously, we are an ageing population, but we are seeing that growing cohort, really. That's really troubling because those people, very often, have had to battle and fight to get care for that child, and as that child has aged, the needs have changed. And, as I said, there's a real worry within that group of individuals about what will happen, who will actually pick up the support for that child.

Mabon.

Thank you. I'm afraid I am going to be in a loop here as well, because we're aware that one of the biggest needs of carers is the need for respite. If someone receives an assessment, then obviously they'll have a right to respite, if that's part of the assessment, but they do not get that respite and that provision isn't there. Should there be a legislative element saying that unpaid carers must have respite? Or how can we go about it to ensure that unpaid carers receive the respite that they need in order to continue to care?

I think technically, under the auspices of the Act, carers do have a right to respite in Wales. They have a right to well-being alongside their caring role, and respite is inherently a key factor of that well-being. I mean, I guess you could make the argument that an explicit legislative right to respite would be part of a culture setting agenda, but my scepticism here is that carers have a fairly strong set of legal rights as it is at the moment, and very few of them are having those rights realised. So, I think if we're going to add any more legislation with regard to unpaid carers, we need to be able to do that in the confidence that it's going to make a difference, and there needs to be capacity and resource to follow up and underpin that legislation to be able to make a difference. There's no shortage of carers that we work with in Wales who can tell you their rights and tell you that they should be entitled to respite, who can tell you that they've cared for years without breaks, but then, asking for their rights to be fulfilled at local authorities, often it's like, 'Well, we can't, sorry.'

We wouldn't be necessarily against a legal right to respite for carers, but I think there probably is enough provision in the Act already that we don't necessarily need one. I think, again, it's more capacity and resource. The work that the colleagues in the trust do with regard to the short-break scheme is fantastic. It massively over-delivers against what it set out to do, but it's a drop in the ocean. We know that local authorities aren't delivering enough respite to go alongside that. The short-break scheme was only ever meant to supplement and add capacity to that. But are local authorities moving capacity around inside their organisations now that there's an existing source of respite? We're not sure.

I think the one thing I'd just add to this is that the Carers Week report from 2025 shows that 66 per cent of carers in Wales face disadvantages in being able to take breaks, which is significantly higher than any other UK nation. It's 50 per cent in Scotland and 54 per cent in Northern Ireland—both numbers that are too high, but that's a huge difference. We're doing respite very poorly in Wales. We know that from evidence, we know that from anecdote. And I think anything we can do has to be met with capacity and resource to be able to deliver on it regardless of what bit of legislation we put it under.

And in terms of that legal right to respite, as Rob described, if you have a support plan that captures your needs, then you do have a legal right to it. We're just not getting to that stage.

And to reflect a little bit on the national short-break scheme, we had an independent evaluation of that scheme undertaken by Bangor University, and one of the interesting findings in that, despite the fact that carers—the 65 per cent of them that had a break through that scheme—were caring for 50 or plus hours a week or more, most of them hadn't had a carer's needs assessment, and if they had, they hadn't been asked about respite. And I think that's a really interesting figure—that even if you've gone through the process, you haven't had a proactive offer. So, I think, potentially, there is something that can be done, not denying the resource and capacity piece, in that active offer—how we have good conversations with carers, who often will limit what they're asking for because they know the demand and the pressures on the system.

To speak a little bit about the short-break scheme, another interesting figure from that is that 82 per cent hadn't received a break in the previous year—really high levels of people not accessing any other support through their local authority. And, as Rob described, the short-break scheme is there to complement, to be in addition to what local authorities should be providing to carers.

And I would say that there is some level of concern about the regional partnership board element of the national short-break scheme, the transparency around how that is spent and how data is recorded and reported, and the extent to which that may be being used to backfill local authority provision—it shouldn't; it should be in addition to what was already there—and I think it's very important that we have national visibility that that investment by the Welsh Government is providing additionality, not providing backfill.

Thank you. Mabon, if you don't mind, I'll move on to invite John Griffiths in, please.

Thank you very much, Chair. Good morning, Kate, Rob and Greg.

Thanks very much for coming in to give us evidence today. You've already said quite a lot about the impact on carers of their caring responsibilities, but I wonder if I could ask you about a few other matters so that you could perhaps add a little? First of all, we've often heard from carers about the struggle to prioritise their own health given their caring responsibilities, and often even attending health appointments is difficult. Could you indicate to the committee any specific changes you would suggest to us to deal with those issues?

I think there's probably a couple of ways you could go about this, aren't there? I mean, first and foremost, you have to be able to take a break from your caring role to be able to go and access appointments. You know, it's not always appropriate to take the person that you provide care for with you to an appointment. So, there's an issue here around breaks and respite, which directly feeds this problem and then creates situations where carers then present into the health services in cases of emergency, and we're inherently missing the preventative point of the Act as a result of this. So, breaks and respite is a key factor to being able to address this issue. The other one is making services more carer friendly and ensuring that carers are given more flexibility with regard to making their appointments and being able to attend treatment—given flexibility and priority even in some instances to secure appointments that are convenient for them and the people they provide care for. So, there are two ways there that you can address the situation. But, I think, until there's a point where carers are able to have the respite or break, that they can leave the person they provide care for to go and attend that appointment or receive treatment, it's never going to happen.

Replacement care is essential for unpaid carers to be able to access any kind of health appointment, and I think, reflecting on how carers cope when receiving treatment for their own ill health or recovering, they need to be able to access a carer's needs assessment quickly, not to sit on a waiting list for a carer's needs assessment whereby that time will have passed and the need will have changed. So, a more responsive system that can meet emergent or emerging need would really add value.

And I wanted to reflect a little bit on what young carers have told us specifically in terms of access to child and adolescent mental health services and therapeutic interventions. They very strongly described that they would like to see more access to mental health support for themselves and for those that they care for.

John.

I think Greg wanted to come in, Chair.

Sorry, Greg.

Yes, please, if I could. I think, on this point, it is, for me, about practical assistance for people around being able to meet some of those basic needs. Again, some of the carers that we see have their own health conditions. We see ageing carers as well who are really concerned about their physical well-being, about their mental health.

As a practical example, we actually have a sitting service that is led by volunteers. We have provided 207 sits so far this year for people that equate to around 3,000 hours of time, being able to sit with the cared for, which allows those carers to be able to attend health appointments, which allows those carers to have that very brief period of respite. And we're only talking about a two-hour break at a time, but some of that is really critical to maintain the health and well-being of the carer. So, I would say that a much wider spread of service of that type is real practical help that we know we have carers coming to us crying out for—'How can I find the time? I have urgent health appointments. I have a series of health appointments.'

And I think the other thing, linked to that for carers, as well, is wider availability just in terms of counselling. We also have a counselling service. We delivered 800 counselling appointments to 136 carers over the course of last year. Some of those counselling sessions are for, obviously, varied need, but we found that they've been a real significant practical help for people around being able to enable them to maintain their caring role. So, I think, from this, there are probably some quite simple and effective interventions that could be provided that would keep carers well, because we know that's a primary concern that they have. If we keep the carer well, the cared for is better cared for, and it avoids any breakdown in that caring relationship that may lead to people going into hospital, into more acute services, and those sorts of things.

Thanks very much for that. I think even the basic practical steps that are relatively easy and quick to achieve are really important for us as a committee, in terms of looking at the way forward.

So, Greg and Kate, you touched on some of the services available in terms of mental health and well-being, and we've heard from carers and young carers that that responsibility that they have to care does impose strain in terms of mental health and well-being. Is there anything else that you could point us towards in terms of mental health and well-being, other than what you've already mentioned, that we ought to consider?

I think it's important to reflect on the evidence that I described earlier from Siobhan O’Dwyer in terms of rates of suicide and thinking about the suicide action plan for Wales, and ensuring that carers are specifically considered there.

Greg, did you want to come back in?

Yes. I think, practically, there's probably more work for all of us to do, and, I would say, certainly in terms of our organisation, probably a better interface within our services and third sector agencies that provide that well-being support and the mental health support. We can do more work, I think, on that, on working on those relationships so we're not replicating service and duplicating service. There's a clear cross-over between our service and services that other third sector organisations actually provide. And that probably extends as well into, maybe, developing a better relationship or working partnership arrangements with mental health teams, both within social services and within the NHS as well. I think it's probably a bit of a compartmentalisation thing, where we do our caring bit and they have the expertise in terms of mental health. There probably needs to be a much better interface between those two.

Yes. John.

Just finally from me, in terms of financial hardship, again, is there anything in particular that you'd suggest to us in terms of steps that might be taken to deal with the financial hardship that carers and those who are cared for face?

Not to let the Welsh Government off the hook here, because I think that there are things that the Government can and should be doing better to better support carers in financial hardship, but, realistically, the levers to alleviate the levels of poverty and deep poverty that we see among unpaid carers probably sit at a UK level and are probably most efficiently administered in Wales via the benefits and welfare system. So, I think that we would like to see the Welsh Government take a more strident step with regard to its representations to the UK Government. There were conversations last year around the carers allowance overpayment scandal, for which the context then changed when there was a change of Government in Westminster. So, I think we would like to see some pretty practical steps with regard to making representations to the UK Government to demonstrate that the system is not working for carers in Wales.

That said, there are some things that the Welsh Government can and should be doing. If you look to Scotland, Scottish carers receive a supplement to the carers allowance, which is equivalent to an additional £587 per year and arrives in two lump sums. Now, obviously, the devolution framework is slightly different in Scotland to here, but this is certainly something that the Welsh Government can do and should be doing. There are about 60,000 carers in Wales who receive the carers allowance—so, not all of them, and the eligibility criteria is an absolute mess, and I know that we haven't got time to get into that. But there are things that the Welsh Government can and should be doing. Just linking in to something that Kate said earlier about overarching strategies, we know that carers are significantly more affected by poverty than the general population in Wales, where poverty is already a sticky issue. When we're planning policy interventions relating to poverty, we need to make sure that unpaid carers are a central part of that planning process and that it's co-produced with carers as well to make sure that it's rooted in reality and works for them, too.

Yes. Thank you, John. Can I bring James in? We'll try to focus on some solutions now.

I've got one question first, Cadeirydd.

Well, we're scheduled to finish in three minutes, but we'll just stretch it into the break time a little.

I have two questions, if that's okay. We saw yesterday the Welsh Government launch their dementia strategy, and we do know that there are a lot of older carers and carers who are looking after people with dementia. So, I'm just interested in how you think that that strategy links to the strategies that we've got around supporting unpaid carers across Wales and how they interface together to make sure that we're not going off on one tangent with one strategy and another tangent with another. How do you think they can interface better together?

They're not as connected as we'd like them to be. I think that we would say that for all strategies. They do tend to run in parallel. I would say that the ministerial advisory group has been looking at the draft strategy for unpaid carers, as Rob has already referenced, and there is a specific section within that draft looking at the interconnected policies. But that's very theoretical. We have to look at the practice, when services are commissioned or practice is delivered to deliver the obligations or what is set out within policies. That's where the connectivity needs to happen and be supported to happen. And I think that that comes back to Greg's point around vision—we need a stronger vision for unpaid carers, a stronger vision for our communities, and connecting it in in a more holistic way.

Lovely. My final question, to get us back on time, Cadeirydd, you'll be very pleased—

It's all right. I'm going to stretch us for five minutes, if it's okay with you.

Marvellous. There we go.

Let's not beat around the bush, we do a lot of talking, inquiries, there are a lot of warm words, we have strategies, there are warm words from civil servants, warm words from Ministers going back decades on how we need to improve things for unpaid carers and the role of caring across Wales. I've been here five years and I don't see any change from the moment I walked into this building to where I'm sitting now, hearing the same things over and over again and we're not getting anywhere. So, my question to you would be: if there are one or two things that could really make a difference quickly, what would they be?

Good question.

I'll try to keep it quick.

You can all have a go on this one.

Data collection, monitoring and evaluation are key. Until we have a better grasp of what the data is telling us with regard to unpaid carers, how on earth can we shape interventions to begin to address the problems they face? So, better collection of data in a more coherent and comparable way across Wales. That's going to require leadership and drive from Government to co-ordinate that. That should sit with Welsh Government, not with regional partnership boards or local authorities. Then, obviously, we've talked about capacity and resource, I won't reiterate that, but just to flag it.

Then, the other thing I would add is just a general awareness of carers. We've talked a bit about the stigma of caring roles. I know the carers who came and gave evidence have said that as well. If you compare where we are with unpaid carers now, compared to where we were with, for example, mental health 10, 20 years ago, the conversation and our societal understanding and acceptance of it has moved on significantly. They're not the same. I'm not seeking to compare apples with oranges. It's that wider understanding of unpaid caring done in a culturally competent way—because caring looks very different depending on what community in Wales you're talking to—and having that greater awareness that people can identify as unpaid carers at an earlier stage, so that they know that, when they need it, if they need it, support is and should be available to them, and they can go out and seek it. That will be key as well.

Yes. Kate.

Absolutely. I'll build on Rob's call in terms of data and having the evidence we need. We need better data. There are things we already know. If we just look back to the last committee inquiry into this very subject area, we know what good models look like. We know there are some services you will always need. Every local authority should have a young carers service, I think we can all agree to that, but they don't all have a commissioned young carers service. We know that there is a range of services that we can predict there will be a population need for. For me, I would reflect on the value of organisations like Greg's, like the Neath Port Talbot carers service. We know they do an amazing job. We have the evidence to demonstrate the impact that they have. The challenge is sustainable funding and that long-term, sustainable footing. With that, the third sector can generate more income. It's something we're very good at. We're thrifty in how we spend, and we generate income to go alongside, but we need that core to keep us going.

Yes, thank you. Greg, you can have the last word.

How long have I got? Seriously.

Two minutes.

Two minutes. There we go. All right. I think absolutely, for me, for us, it's those practical solutions. It's about, as I said earlier on, if you give us the tools in terms of resourcing, we can do the job, because we can evidence that we can. What we can't do is continue to spread the jam ever more thinly. I think there needs to be a bit of a paradigm shift between—. We are filling the gaps, we are meeting the crises, we are preventing things getting worse, but not to a preventative agenda, because we're picking stuff up pretty late in the day. So, there needs to be that paradigm shift towards generally more preventative-based services that allow us to be able to intervene and provide those helpful practical solutions, some of which have been identified, to carers, because those are the things that actually make a difference to people's lives. I think we are trapped a little bit in what feels like a bit of a doom cycle. I don't mean that, necessarily, but it is all about crises, it is all about plugging gaps. It is looking to plug gaps. Are we trampling on the toes of providing a statutory service? Because sometimes it kind of feels that way. It needs to be that shift.

Yes. Thank you, Greg. Can I thank you all? It's been an invaluable session. We've covered a lot of ground; sorry we've had to rush things on a little toward the end. There will be a transcript available for you to check over. If you find anything you're not comfortable with, please let us know. Thanks again for all you do, and for taking the time to come in and talk to us today. Thank you very much. I'm going to move us into a short break now for 10 minutes. Okay.