Social care in Wales

We look at the structure of social care in Wales, who it's for, how it's funded, issues, pressures on the workforce and the BMA's view.
Location: Wales
Audience: All doctors
Updated: Friday 3 April 2020
NHS Structure Article Illustration

The Social Services and Wellbeing (Wales) Act 2014 provides the legal framework for improving the well-being of people who need care and support, carers who need support, and for transforming social services in Wales.

 

Who receives social care?

  • Older people are more likely to need these services.
  • During 2014, about 1.5% of the population aged between 18 and 64 years received local authority social care services.
  • For those aged over 65 years this is around 14% of the population.
  • The number of adults receiving social care is likely to be higher as some fund their care independently. 

 

How social care is structured

  • The Welsh Government sets national policy through the Department for Health and Social Services.
  • Local authorities in Wales have a statutory responsibility for planning and commissioning social care in Wales, as well as a duty to safe-guard individuals.
  • Each of the 22 local authorities plan and deliver this statutory responsibility differently; for example some provide care directly whist some commission services from the private or voluntary sector.
  • As a result of local level decisions, adult social care services vary across Wales.

 

Paying for social care

  • Local authorities have a degree of flexibility about what domiciliary care services are charged for and to what level.
  • There are also a few domiciliary care services that local authorities are required to be provided for free, such as transport to and from a day centre.
  • For residential care, a person who has capital of their own above £50,000 is expected to meet the full costs of their care until their capital falls below the threshold.
  • Those with less are eligible for public support and none of their assets will be taken into account in their financial assessment.
  • Instead they will be asked to contribute to the cost of care through their weekly income.
  • Local authorities also set an annual maximum contribution that they will pay to independent care and the fees for local authority care homes.
  • For those who do not have sufficient income and other assets apart from their home, local authorities can offer to move home owners into residential accommodation with the help of a deferred payment scheme.

 

Pressures on social care

Social care, like healthcare, is facing unprecedented pressures. These pressures are coming from increasing demand, alongside funding and workforce constraints.

Increasing demand

  • The population is projected to increase by 6.1% to 3.28 million by 2039.
  • The number of people aged 65 and over is projected to increase by 44% between 2014 and 2039.
  • Wales has a higher proportion of older people with lower levels of financial means compared to the rest of the UK.
  • The population aged 65 and over needing help with self-care activities will grow from just under 200,000 in 2013 to almost 285,000 in 2030, an increase of 43%.
  • A greater number of people are living with multiple long-term conditions. As a result a greater combination of different social care services are needed.

Funding constraints

Whist social care funding in Wales has been broadly protected, there are still significant financial constraints.

Between 2013 and 2037 there is an expected 177% increase in net expenditure for community care services for older people.

The Health Foundation found that social care funding for adults would need to rise by 4% in real terms to meet demand.

Workforce challenges

There are huge challenges with recruiting and retaining social care professionals.

In addition migrant workers make up a large proportion of the adult social care workforce. As a result of the UK leaving the EU there are now uncertainties in the future of EU care workers’ status in the UK.

 

The BMA's view

Social care is an increasing area of concern for the BMA.

The BMA believes that the significant pressures in social care are a direct result of inadequate resourcing. To look after patients well, doctors need social care to be well-funded and adequately staffed. 

In addition, improved integration between health and social care services is needed to ensure patients move between the two services more easily. This is why an important priority for BMA Cymru Wales has been to strengthen engagement and collaboration between health and social care professionals.