Health and Social Care Committee

Welcome back to the Health and Social Care Committee. I move to item 3, and this is in regard to our next item, the health and social care workforce, and an evidence session this morning with Health Education and Improvement Wales and Social Care Wales. We've got a series of witnesses before us this morning virtually, so if I can ask the witnesses to introduce themselves and their titles just for the public record, please.

Bore da. Good morning. My name is Alex Howells and I'm the chief executive of Health Education and Improvement Wales.

Bore da. My name is Julie Rogers. I'm the deputy chief exec and the director of workforce and organisational development at Health Education and Improvement Wales.

Bore da. Good morning. I'm Sue Evans. I'm the chief executive of Social Care Wales. Good to see you this morning.

Bore da. Good morning. I'm Sarah McCarty, director of improvement and development at Social Care Wales.

Thank you ever so much for being with us this morning, and it's nice to welcome you all here for the first time for this new committee in the sixth Senedd. Thanks for your time this morning, and your papers in advance as well. Can I just check—? There was just an issue with translation earlier on, so can I just ask the translator to say something, please, just so we know that you can all hear correctly? If you could all just put your thumbs up if you can hear the translator, please. There we are. I should have said put your thumbs up if you need to hear the translation; you might not all need the translation from Welsh to English. But thank you for confirming that. Lovely. Thank you.

Members have got a series of questions this morning. The workforce strategy was published last October. Do you think there is any need for any update or changes to the strategy as a result of the pandemic? I appreciate not all of you will answer every question, so who would like to indicate to jumping on that one? Okay. Do you all mind me calling you by your first names? Is that okay? There we are. Thank you very much. So, Alex first, and then Sue, I think. Alex.

Apologies, I think Sue would have gone first.

I'm very happy for Sue to come in first, then, and then you to follow, Alex. Sue.

Thank you very much, Chair, and first of all, thank you for the invitation to come. We are looking forward to the session today. It helps us keep refreshed and reminds us why we're here.

I thought it would be useful just to remind the committee of some of the context that we're working in before we get into the detailed questions, which will cover your point. I guess the first thing to say is it really was a privilege for us as the two organisations to be asked to develop this joint workforce strategy for Wales—the first one we've ever done as two fairly new organisations. It was in response to 'A Healthier Wales', as we've set out in our submission to you previously. We took extensive research across the UK; we spoke to more than 1,000 people involved in the consultation—you know, provider representatives, user representatives, professional bodies. We really tried to get that ownership and engagement that we needed to make sure that this strategy didn't just sit on a shelf, but it was actively owned by the sector. One of the things I think we want to get across today, and I think it will come through the responses to the questions, is that this will be a collective responsibility for delivery, but there will be elements that each of our organisations, working jointly and sometimes in parallel, will be directly accountable for. But it won't work and we won't be able to deliver it unless all of the sector comes on board.

It's right to ask if it's still relevant. We presented a written letter to the Minister last summer, as we were thinking about COVID, and when you think, we were developing this strategy before we'd even heard the word 'COVID' or whether there was going to be a global pandemic. So, we wanted to think about is it still relevant. We did a bit of a review to check whether the themes were still relevant, and I'm delighted to say that those themes are still relevant and I think that the evidence will come through the responses you hear today. But I think that that was a useful way for us just to take stock and checking, in the light of the pandemic, that what we said when it was published a year ago is still relevant. And it was probably written and drafted by the January of that year, so before we'd even heard of the pandemic. So, I think that's useful.

We do have annual implementation plans to set out the detail. As you can imagine, a 10-year strategy needs to be very much a high-level strategy to keep us all on track. And it isn't just for Social Care Wales and HEIW to deliver; we will provide that leadership at a national level, that oversight, but very much relying on health boards, local authorities, providers and regional partnership boards to play their part in terms of better alignment of health and social care and delivery of joint planning and joint services where it makes sense to do so.

Thank you, Sue, for setting out some context there. I appreciate that. Of course, we echo your thanks as well, as a committee, to the workforce, particularly over the past 18 months. I suppose that question was a relevant one in terms of the pandemic. As you said, when this was written, 'COVID' hadn't been a word that was used or invented at that point. So, I suppose that was the importance of that question, really, with regard to what needs to change in the strategy, or if there is a change that's needed in the strategy from that perspective. In the strategy, it says that implementation plans will be developed, so I'm just wondering if you could just update us on the development of those plans, and also who is taking ownership of those plans, as well.

Alex is going to pick that up.

Thank you. The strategy was launched a year ago, and our original plan had been to develop some implementation process and mechanism with some stakeholder engagement around the launch of the strategy, in order to make sure that we had continued the stakeholder engagement that had led to the development of the strategy in the first place. But, that was probably the bit that we had to then adjust in light of the pandemic and take cognisance of the fact that, particularly, front-line delivery organisations were focused on the emergency response.

We had to also divert our attention largely into that emergency response as well. So, as a result of that, we haven't been able to progress with the implementation as planned. However, we have nonetheless taken forward some of the key actions in the strategy, because actually they were incredibly relevant and topical to the emergency response. Some of the areas you'll see in the evidence paper are particularly around well-being and some of the leadership work which proved to be reinforced time and time again through the experience of the pandemic.

What we've done since then, because we had to revert into much more short-term plans at the time in line with the rest of NHS and social care, we've kept saying, at the end of the plan will be the time to re-engage and put in place that implementation structure, and as you know we're still in the pandemic. So, we did feel that setting up a big process or mechanism around the workforce strategy as a whole was probably not the thing to do in that pandemic, but that's certainly the intention for next year.

What that will involve is a targeted approach at the things that really need that stakeholder engagement. Because some of the things in the strategy are things that Social Care Wales and HEIW should be doing anyway in our statutory functions, through our normal engagement mechanisms, and that's what we've relied on really during the pandemic. But equally, some of them are novel, some of them are transformative and innovative, and we do therefore need that engagement mechanism around it.

So, as part of our planning now for next year, which we're currently doing, we are re-engaging with organisations and we will be setting up those implementation mechanisms for some of the areas that you can see from our evidence paper we haven't been able to make as much progress on yet because of the pressures on the whole system over the last year.

Just to confirm, who's taking ownership of the plans? Sorry if you did say this, I may have not picked it up.

So, we are very much, as the strategic workforce organisations in Wales, holding the ring on all of the workforce strategy and its progress. Some of those implementation plans do fall to us as individual organisations. So, for example, the leadership development theme is very much in our gift as organisations to deliver. Other areas do require more input from across the system, including, clearly, all of the NHS and social care organisations, but also our education providers, our professional bodies, our regulators and, obviously, Welsh Government colleagues, because there is an interface with policy objectives there. That's where we really need to make sure we establish the right implementation mechanisms going forward, and we're very keen to hold the ring on those implementation mechanisms and take responsibility for driving the whole system forward in its delivery against the strategy, even though the delivery on all aspects is not necessarily within our direct control.

Thank you, Alex. I'm just conscious that both Sue and yourself talked about the importance of engaging with the relevant bodies. We did a piece of work over the summer period in terms of asking our stakeholders for feedback on a number of areas, and there was an element of some of the professional bodies suggesting that there's a lack of transparency in terms of the implementation of the strategy and also suggesting that more engagement could happen with them as professional bodies in terms of the implementation. Is that a fair criticism, or any idea why some bodies would tell us that in their responses to us?

Absolutely. I think, as I said, we were conscious that what we had wanted to do with the launch of the strategy was very much to re-engage with all of the stakeholders who'd contributed to it. So, we had planned to do a range of presentations and roadshows to celebrate the launch of the strategy, but also to talk to people about next steps, and it just wasn't the right time or place to do that in the middle of the pandemic when the majority of the system was focused on the emergency response. So, I absolutely appreciate that, in ordinary times, in usual planning processes, we would have absolutely done that early stakeholder work to accompany the launch. However, I think that, on some key pieces of work that we have taken forward, we have still engaged with stakeholders where we have been making changes.

If I just refer perhaps to the mental health work that we've talked about in the evidence paper, we did a huge piece of engagement this time last year across the system, using virtual means for the very first time, to seek views from a range of stakeholders and partners, and service users, to contribute to the first foundation of the mental health workforce plan, and the plan will be, after Christmas, to consult fully on the strategic plan that we are now in the final stages of developing.

And, equally, with the primary care work, we had two virtual workshops, which were attended by about 200 people. We used Mentimeter so that everybody had a voice during those workshops. On areas of work we have progressed, we have continued the stakeholder engagement. What we haven't had is an overarching process, or mechanism, if you like, labelled 'workforce strategy' that we have done that engagement on, because that felt like—. A lot of the things that we're doing in the workforce strategy are medium and longer term, and it felt at the time that our efforts were best placed on supporting the emergency response and not asking people to contribute too much time to those longer term things during the initial stages of the pandemic.

Thank you. And I can see from the plan that there's a lot of focus on implementation of the plan being implemented at local level. Do you think there's enough, the correct structures are in place, and leadership is in place in terms of delivering those plans at a much more local level?

I think that, through the pandemic, those local planning structures have become even stronger, and I think particularly the partnership arrangements that are necessary to support local implementation. I think, for us, when we were developing the workforce strategy, we were really pleased to have a platform to raise the profile of workforce issues, and, in a sense, the pandemic has helped do that automatically. And, I think, workforce, we can see, and certainly the evidence that you gained from the committee has been really helpful in getting an insight into a whole range of organisations, local organisations, and how they are actually aligning with the workforce strategy and taking forward that implementation.

But, nevertheless, we have a key role. Part of our added value is those things that those individual organisations can't do on their own because either they need to be done once for Wales, or they need some more specialist expertise that we can bring to bear. And that's really how we all work together to have that collective effort going forward really.

I think we will take on board some of the comments made by some of our partners in the evidence to the committee, and we will definitely follow that up with them to make sure that they are clear on how we want to engage with them going forward, because this is only going to be as good as the collective effort that goes into it really.

Yes, thank you, Alex. Do you think there's sufficient funding available to deliver the strategy by 2030?

Well, I'll kick off, but I think Sue probably wants to come in on this issue. We've benefited, I think, from a health perspective, with substantial investment into education and training in particular over the last few years, and the trend for that increased investment seems set to continue. So, in terms of how we can create additional workforce, and increase the pipeline into some of the workforce deficit areas, we've got a lot of solid financial support behind us.

Our bigger issue in Wales is actually our capacity to train, and I can touch on that in a bit more detail. So, I think that, financially at the moment, we've had support for changing and extending, for example, GP training; for changing the way in which we train our pharmacists to work more in primary care settings; for increasing the pipeline across a range of health professional areas, and so that investment is in the system at the moment. Obviously, some of the implementation plans may identify further areas for investment, but, up until this point, we've been really well supported in terms of the need to invest in the workforce, and to not see that as a cost, but to actually see that as a way of actually improving quality and reducing some of the waste in the system as well. But I think Sue probably might want to come in, if that's okay, Chair.

Thank you, Alex. So, the question is, Sue: is there enough cash to deliver the strategy?

Thanks very much. I think all of us are aware that it's been a very difficult financial situation across the UK, not just in Wales. And as we all try to protect the NHS, which we all respect highly, it means that other parts of the public sector, including local government, have had relative real-term cuts over the last 10 years I would say. And that has a direct impact on all of the public services delivered by local government, but particularly for social care, as the demand increases with our ageing population.

So, I think that it is well-acknowledged now, across the UK, that the funding arrangements for local government and social care are not sustainable. And you'll be aware of UK decisions about national insurance, which hopefully will have an impact on Wales as they come through, and it will be challenging for Welsh Government budgets, going forward.

But I think we all recognise—and it was set out in the evidence to the parliamentary review that set up the healthier Wales programme—that the alignment of social care and health is fundamental for both systems to work properly. So, if you underfund one, it has a direct impact on the other. And you'll know from the difficulties in discharging patients from hospital, because we haven't got appropriate care workers in the system, so people can't develop adequate packages of care to enable people to stay at home, to stay well, to stay able, and, if they do need to go into hospital, to come out as quickly as possible and to be in a safe place and well-cared for, either at home or in a care home setting.

So, the Government has that on its agenda—commitments to put more sustainable funding in for social care, including the fair work forum, which is looking particularly at the terms and conditions of the front-line care workers. And it isn't just about pay—it is about parity; so it is about funding for learning and development, it is about holiday pay, travel times, and all those other elements that make a good employment situation for individuals. So, I'm optimistic that front-line care workers will start to see an improvement in their pay; that will, inevitably, make it easier to attract people and retain people in the system. But this is a 10-year strategy, and I'm anticipating we will have to develop and grow the budgets to make our ambitions real over the forthcoming years. So, as we stand today, we can probably say there isn't enough money in the system, but hopefully, I'm optimistic that that money will be developed in the future. Thank you, Chair.

Okay. Thank you, Sue. I was just about to ask, 'So what's the answer?', but you've come to it at the end, I think—you set out the context, and I think I'm right to say that you don't think there's enough money in the system at the moment, but you're optimistic for the future. Is that right? Is that a fair assessment?

That's right.

Thank you, Sue. Joyce Watson.

Good morning, everybody. I'm going to ask questions around recruitment and retention, which is probably where the real question lies at the moment, reading your papers anyway, and the evidence that you've outlined that you're using to identify priority groups. And you've identified those as nursing, domiciliary care, social work and medicine, yet when we've taken evidence, it seems that each area of practice, including primary care, have pressures as well. So, my question is, in terms of your priorities, and working through those that you've identified, are you also able then to ensure some recruitment and retention to the other areas, because they all work as one?

Alex, I think you want to come in on this. Alex.

If I can start, and I might bring Julie in, if that's okay. You're absolutely right—there are issues facing all professional groups almost in the health service, and many services as well. And those were really the drivers for us developing the workforce strategy in the first place. So, we are developing, if you like, more rounded, comprehensive workforce plans in certain areas at the moment, which bring into play all of the different dimensions that would lead to a sustainable workforce—so, for example, recruitment, retention, education and training, how we grow our own staff, apprenticeships, et cetera. So, we're doing that on some priority areas, as you've mentioned, but that absolutely doesn't mean to say that we're not also trying to develop the other areas through our different functions. So, for example, in our education and training plan, we are increasing the numbers coming through the pipeline, and continuing to build on those increases across a range of different professional areas.

In relation to primary care, we've got a very important piece of work going on at the moment around how we provide a more sustainable approach to education and training in primary care settings to support the multiprofessional teams that we know need to wrap around GPs in their practices and in their clusters, and a whole range of other areas where we're plugged into the national programmes that are working on things like planned care, urgent and emergency care, cancer, and that brings in all sorts of considerations around the workforce.

Just to give you a few examples, we are commissioning additional education and training for optometrists that enables them then to take the pressure off our planned care system in eye care. We are developing workforce plans around radiologists and radiographers to support imaging, which is critical to cancer. So, the list could go on. In short, I absolutely agree with you—we need to be spreading our efforts across the whole workforce and we are doing that, but we do have some key pieces of work where we're trying to translate to the whole of the workforce strategy through those areas. And things like nursing, domiciliary care and mental health services are where we're starting. We've got a rolling programme of those to do over the next couple of years as quickly as we can. Sorry, Chair, but Julie might want to add to that.

Julie.

Lovely, thank you. Thank you for the opportunity. So, yes, as Alex said, we are obviously targeting some of those specific professions, but we're also going at it through other aspects as well to make sure that we create the right culture—that staff want to stay working within our sectors and that they have a positive staff experience and that we look after their well-being. So, those factors are as equally important as pay and other aspects of life as a worker in health and social care.

But in terms of the careers and widening access agenda and our recruitment programmes, both of us have got really active and positively supported recruitment campaigns. So, for the health sector, we've got 'Train. Work. Live.', which is something that Government introduced five years ago, and was transferred to our organisation about a year ago, and that we've been using to target some of the shortage professions. So, it started in 2016 around GPs and it was accompanied by a set of incentives.

We've then actually run campaigns around nursing and around midwifery, and our latest one was around pharmacy. So, as to the campaign for 'Train. Work. Live.', it's a generic one, encouraging people who want to train and work in Wales. We are also tackling some of the hotspots through that campaign and using it more broadly. And the same in social care—we've got the We Care campaign, and you may have seen the television adverts and things on the back of buses. Those are really strong campaigns, backed up by the sorts of things that we'd want to see in employment, like, as I say, the right culture and staff experience.

The other thing I just wanted to share is something that we're really proud of that launched on 28 October, and that's Tregyrfa, which is Careersville, which are two virtual villages—there's one in Welsh and one in English. It's not a translation of the English; it is actually a truly simultaneous bilingual platform. And that virtual village is aimed at a range of young people and children and schools. We launched it last week with headteachers and children aged between 11 and 14. We launched simultaneously the English and Welsh, at the same time. And our statistics on access to that resource were absolutely phenomenal. In terms of the Welsh platform, we got 27 per cent of access through that platform on the day and in the week following, which is incredible. I'm told by people who know better than me that, for simultaneous launches of similar products, you could expect to get access of around 5 per cent through the Welsh platform and we got 27 per cent. So, it shows there's a real appetite for the work that we're doing and a genuine interest in bilingual careers offers.

We're working with the Department for Work and Pensions and we're working with Careers Network, and we've established a joint careers network across both sectors to pool our resources. So, I hope that that, in a way, gives a bit of a flavour of what we're trying to do. We're encapsulating the latest digital technology. The virtual village—if you get a chance to have a look at it—is incredible. You can jump in a lift and go up to the first floor and hear about social care careers. You can go to another building and watch a film about what it's like to be a podiatrist or a paediatrician. It is absolutely incredible. So, yes, we're trying to do modern technology, but we're also, as Alex said, targeting specific hotspots through these tools and mechanisms as well.

Well, thank you. I'll have to take—

Sorry, Joyce, Sue just wanted to come in as well on that point, I think. Sue.

Thanks very much, Chair. Just to add a bit to the We Care campaign, we deliberately designed it as a national brand. So, it wasn't a Social Care Wales brand; it was a national brand that any employer in the sector could use. And the difference, I guess—the major difference—in terms of service delivery between health services and social care is the number of employers in the system. There are over 2,000 registered employers delivering social care in Wales, so you can imagine trying to reach all of those with a consistent message is quite a challenge, but we’ve managed to get most of our providers on board.

Following that We Care campaign, which is still active, and, as Julie said, with 'Train. Work. Live.', we try and target particular professions within the social care field at particular times. So, nurses working in social care was one we did earlier in the year. We’ve done a lot with domiciliary care workers, then on social workers, and it’s also used for our early years and childcare sector as well. So, it’s great branding that lots of employers can use.

Just to share with you some stats I think are worth you having, in terms of social media, there have been more 30,000 engagements through We Care; 2.2 million views of the films—the media there; and the website has had over 300,000 visitors. We’ve got a separate briefing paper that we can share with the committee after the session today, which I think you may find helpful. Following the success of the We Care campaign, we introduced what we called an 'introduction to social care' programme to try and fast-track people into the system, and we’ve had some great feedback so far from there, in terms of people going through that cohort. I’ve just picked out one person who’s happy to share with the committee their experience. A lady called Liesel talked about the tv campaign: 'Without seeing the advert, I don’t think social care would have come to mind. It was amazing. The We Care.Wales site was so great. Really helpful. Good experience. I found my job on your website.' So, we’ve developed a jobs portal since developing the campaign. 'I did one day of the training. Two days later, I found a job and started. Everything has fallen into place.'

So, it’s the first time in Wales, for the social care sector, that we’ve had that national system. We currently have over 5,000 jobs advertised on the portal, with more employers signing up every month. And just doing a quick look at what was happening in October, 713 new jobs were added, with 37 just in the first few days of November. So, like a lot of these things, they take a while to get kick started so that the whole system knows about them and uses them. But I think the combination of the portal, the We Care campaign and the introduction to social care—we’re hoping—will see a step change in trying to really attract people into social care, into roles they may not have thought about before.

Thank you, Sue. Joyce.

Thank you. That it really good and, of course, you’ve identified the fact that there are more than 2,000 employers in the care sector, but we’re also hearing that people are leaving the care sector and then not re-entering the care sector at all, despite all the very good things that you’re doing. And I think, in many cases, COVID and their experience in dealing with COVID, and the stress and the anguish, have probably played a major part. So, with that in mind, do you think there’s a need for a specific, priority focus on rehabilitation on COVID and non-COVID-related aspects?

Are you thinking about it as a service, in particular?

As a service, but also about training, because we're talking about recruitment and retention here. We're hearing about people’s experience not necessarily being a good one, which, probably, I suspect, is playing its part in trying to recruit.

Definitely, and I would think we’re probably still learning, across the health and social care system, exactly what the impacts of long COVID will be. It’s still early days, and there is a specific group looking at long COVID and what that means in terms of service models and then, consequently, what that means in terms of skills, knowledge and different types of roles. So, I think we're still in that learning process at the moment. It's interesting that, for some people, COVID has almost been a prompt to think about joining the health and social care workforce, because they've seen the direct impact and the contribution that those roles make to society. So, while some people have seen it as a, 'Oh, dear, that looks a bit scary', others, I think, are actually stepping up to the challenge. But, you're right—I think retaining people that we have with all that expertise and knowledge across the system, in all different professions at all different levels, is absolutely fundamental. Alex and Julie have both mentioned leadership and culture; it's a fundamental part of making people feel valued, feel well rewarded and well respected.

And I think there is a question for us across wider society, not just within the system, about how well we regard our public servants. They do an incredible job, whether you're in the police force, the health service, social care, and sometimes, maybe, as society, we don't value them as well as we might. But I think you're absolutely right that this pandemic has really shown the dedication of the health and social care workforce, and if we don't protect them and wrap our arms around them, and really give them the value and recognition they deserve, it would be to our loss. We know that it's a growing need and it's not going to disappear, so anything we can do collectively do raise the profile and raise the ambition, I think, would be well received. Thank you.

Of course, there is an immediate crisis in social care—there's no denying that by any of us in this room. So, have you got specific action plans, beyond the ones that you've mentioned—which are great—to try and do something to help with that right now?

Three things I'll mention. One is the fair work forum—so, that's working with Government to try and find a way forward in terms of improving the terms and conditions of that direct care workforce, and that will be pay, but also other things like career pathways. We did a whole range of the redesign of qualifications for health and social care for those entry-level posts a couple of years ago now, so they're starting to be embedded. They've all been redesigned and re-evaluated. So, we have clear pathways now for people entering, and it's about us developing those pathways, going forward.

You'll see, from the evidence, that the Association of Directors of Social Services Cymru have asked us to take a leadership role in terms of developing a national framework for qualified social workers. So, we'll take that away and we'll have a little think about how we can help the system develop that. I was looking at some vacancy information yesterday, and if you look, for example, at qualified social workers—and this was at a point in time in September—there was a 10 per cent vacancy factor there. And we've got the data there from our local authority colleagues. As we have more than 2,000 providers for direct care delivery, it's much more difficult to get some of that information in a systematic way. But, just doing a recent straw poll, we estimate that the domiciliary care sector is about 30 per cent-plus vacancies. So, that's a massive gap in the current situation before we even think about future needs in terms of population, people getting older, people recovering from COVID and other elements where long-term care and support will be required from the social care system. So, we need to do an immediate action plan, and I know our local authority colleagues are actively out there, working with our We Care campaign and their own resources, to really try and stimulate the development of a growth in those roles that we so desperately need.

Sue and Joyce, I think Alex just wanted to come in. Just to remind you, Alex, and all the witnesses, you don't need to change the—

Sorry.

I know it's a habit, I appreciate, but—. No problem.

Apologies. Just to add a couple of things from an HEIW perspective, we have that conversation of what else can we do in the here and now at least on a weekly basis, because we do appreciate the pressures that are on the system, and to see how we can use our resources in a different way to support that. One of the areas where we've developed into as an organisation through the pandemic that we didn't have any involvement in before was actually in relation to care homes, to look at how we support people who are working in care homes with more training that helps them meet the health needs of the people that live in those settings. So, there are a number of training programmes now going on to do that. How do we make our resources available to care home staff so that they've got access to things like well-being resources, guidance on things like verification of death, delegation, infection prevention and control? We've also recently established three care home education facilitator posts to look at how we can increase the number of people that can have clinical placements in care homes as a way of attracting people into those jobs in the future, if they actually experience the sector while they're doing their education and training. So, we're also trying to add our bit into the efforts that Sue has described there. Thank you.

Did you have any final questions, Joyce, at all?

Sarah's got her hand up.

Oh, sorry. Apologies. And then I'll come back you, Joyce, if you have got any final questions. Sarah.

Diolch. I was just prompted by what Alex said, because, actually, I think co-production and looking at solutions in a collaborative way have been a feature, particularly of the We Care campaign, and some of the challenges that we're seeing in social care recruitment can't be solved by any one body or organisation. So, Sue has identified a range of things that are happening in terms of education and training and the introduction of social care pilots. We've seen an increase in investment from Government during the pandemic in ways to attract individuals into the sector.

I just wanted to flag that we've also got a We Care advisory group that has got colleagues from across all different parts of the sector, so from social care, but also from our partner organisations, like Jobcentre Plus and DWP. So, it means we've got a collective grouping that are coming together with colleagues from across all of the regions of Wales to share intelligence and learning, what's working, what isn't. We had a meeting just two weeks ago to really focus on the point that Alex just made: is there anything else where we can go further to support recruitment at this point in time, recognising the work that's already happening through the Fair Work Commission, but where might some of those other barriers be, where might some of those other solutions be evolving from and where can we be learning across Wales?

So, I think those real collaborative spaces where partners are coming together are really important, and I think that where we've had those structures that predated COVID, such as the We Care stakeholder group, we've been able to build upon those during the pandemic and continue to work in a virtual way to ensure that we're looking at those ongoing solutions. I think, from those conversations, that does help us working to a plan of the further steps that could be taken at this time.

Thank you, Sarah.

Final question, Chair, on equality. There have been under-represented groups identified, and do we have the data that supports the fact that there are gaps there? Also, in terms of equality, how have you looked at flexible working, flexible opportunities for training that help with staff retention? We're talking there, really, about work-life balance.

So, Julie, if you just want to briefly answer that, because we've got quite a bit to get through still. Julie.

Yes, I will do, thank you, Chair. Thank you for the question, Joyce. The strategy, as you will have seen, has inclusion right at its heart, so it was one of those decisions that we made following discussions with stakeholders that we would actually embed equality, diversity and inclusion right the way through all of our activities. So, there is a strong commitment throughout the plan. We've already talked about bilingualism and making sure language-wise that we are inclusive. Both organisations have got strategic equality plans that set out a range of actions and ambitions in line with the workforce strategy, and we're starting to work on those. We've obviously been heavily involved, as well, with the race equality action plan that came out of Government and are also looking at the LGBTQ plan. So, there are quite a few things in place that we've been supporting and looking at.

In terms of flexible working—. Oh, sorry, on the data, the data isn't great across both sectors. We know that about 7 per cent of the NHS workforce is from a black and minority ethnic background, about 3 per cent of the workforce are disabled, but what we do also know is that a lot of staff do not complete that data, so one of the key things for us is to push on completion of data so that we've got more accurate numbers. But that has improved in the last two years, the accuracy of the data.

In terms of flexibilities, there are a lot of flexibilities across education and training, particularly in relation to medical education and training, where we've got an increase in less-than-full-time posts. You may be aware that we re-let our contracts for health professional education in the last year, and one of the core elements of that is not only about increasing the diversity of students and applicants for places, but also increasing the number of opportunities for studying on a part-time basis. And then across both sectors we have a lot of opportunities around work-based learning and apprenticeships, which are different, flexible models. So, hopefully that's answered very speedily what you were looking for, Joyce.

That is a comprehensive answer. Thank you, Julie. Rhun ap Iorwerth.

Diolch yn fawr iawn, Cadeirydd. Dwi yn ymwybodol bod amser yn rhuthro. Dwi eisiau symud at faes addysg a hyfforddiant. Mae yna dipyn o overlap yn fan hyn ac mae yna gwpwl o gwestiynau sydd wedi cael eu gofyn yn barod. Yn gyntaf, o ran comisiynu llefydd addysg a hyfforddiant, mae pryderon wedi cael eu codi efo ni ynglŷn â, o bosib, ddiffyg tryloywder. Mae'r RCN, er enghraifft, yn poeni nad oes ganddyn nhw ddigon o fewnbwn pan ddaw at gomisiynu llefydd, ac ati. Allwch chi—ac am wn i at Alex Howells dwi'n troi yn bennaf yn fan hyn—egluro sut mae'r broses o bennu niferoedd y gweithlu rydych chi'n mynd i fod eu hangen mewn gwahanol feysydd yn digwydd, a sut mae'r prif rhanddeiliaid, y colegau brenhinol ac ati a chyrff proffesiynol eraill, yn gallu bwydo i mewn i'r prosesau hynny?

Thank you for your question. Yes, education and training is obviously one of our biggest priorities, and we spend most of our money on that function as well. The education and commissioning process at the moment is an annual process, and the inputs into that process come from the health boards' workforce plans, which they submit as part of their annual plans or their integrated medium-term plans, but also in terms of any horizon scanning that we are doing in relation to hot spots that perhaps don't come out of those local plans. And also we have to take into account how many people we can physically train in Wales through either our university partners or, particularly and increasingly, in terms of clinical placement capacity. Those considerations for each professional group go through a number of iterations usually, and we do usually have a lot of stakeholder engagement during that process. This year, it was shorter than we would have liked, and I know that the RCN were unhappy about that. They did share with us their evidence, and we did take that into account in the final plan. But, unfortunately, there is a limit on the aspirations of some professional groups in terms of how many we can physically train in Wales.

We are increasing three out of the four fields of nursing once again this year. Over the last four years, the number of places has increased year on year by quite significant numbers, and we do need to make sure that we don't just produce numbers, but that we produce practitioners and professionals who have got good-quality skills and who are going to provide good-quality care. And clinical placement capacity has been at a premium. We do have a particular problem this year, and probably next year, with the way we've had to re-jig clinical placements because of COVID and the restrictions that that's imposed. So, we are dealing with a little bit of a backlog at the moment as well, but also, really, the system has been at capacity, and so we've had to tread very carefully in some areas.

However, one of the things that we're now trying to do in order to make those opportunities bigger for the future is, as I've just mentioned, looking at other places for clinical placements, like care homes, looking at our other contractor professions, and particularly looking at the primary care model and how we can use primary care more for clinical placements, and also to look at the role of simulation-based education. So, rather than the traditional education or clinical placement reliance, a more blended model that enables students to gain their skills in different settings, using simulation.

So, it's not a science, exactly; there are lots of different considerations, but sometimes it boils down to the art of the possible how we develop the numbers. We don't want them to be developed in a dark room without stakeholder engagement. Everybody needs to understand those numbers, so, as I said, we have had a meeting, a number of discussions, with the RCN since the process this year and, going forward, we will make sure that that transparency is definitely in place because that's certainly not the intention.

I think, Rhun, Mike wanted to come in on a quick point. Or were you happy, Mike, to come in at the end?

Can I come in on this point? Because if you reduced the placement by one fifth, you could train 20 per cent more. We are not going to solve the problems without training more people. We can have this pretend discussion, as we often do in the Senedd, that we can employ 1,000 more doctors, or 2,000 more nurses, when we know they don't exist, but what is the feasibility of reducing the placement by a fifth, and thus increasing the number of people training by a fifth?

Absolutely. So, I think all of those considerations around clinical placements are on the table at the moment. We've actually got somebody leading on this area of work in HEIW at the moment, as I said, to look at how we can put placements in areas that we haven't done before. We would need to work closely with regulators and professional bodies to reduce clinical placements, because clearly there are requirements and standards and criteria that students have to meet. But I think, as you say, we have to be very flexible about this at the moment to make sure that we can train as many as we're going to be needing in the years to come, and as I said, also considering ways of substituting clinical placements by looking at digital-based and simulation-based approaches. So, I think your question is absolutely correct and relevant for the times that we're currently in, and certainly part of our plans going forward.

Rhun.

Diolch yn fawr iawn i chi am eich ymateb cynhwysfawr iawn i'r cwestiwn cyntaf a dwi'n meddwl bod cwestiwn atodol Mike yn ddefnyddiol iawn hefyd. Os caf i ofyn y cwestiwn hwnnw mewn ffordd ychydig bach yn wahanol, mae Mike wedi awgrymu efallai 20 y cant yn llai o waith ar leoliadau, ond beth fyddai eich nod chi? Rhowch syniad inni o'r math o uchelgais sydd gennych chi o ran cynyddu'r capasiti, un ai yn gorfforol neu drwy gyflwyno technolegau digidol newydd a rhoi profiad i bobl dan hyfforddiant mewn ffordd wahanol?

When you say 'our ambition', what exactly do you mean? I probably can't give you numbers, if that's what you're—

Hynny ydy, mi oedd Mike wedi awgrymu 20 y cant o gynnydd. Hynny ydy, faint ydych chi'n meddwl ydyn ni angen cynyddu? Ydy Mike yn agos ati o ran y math yna o gynnydd rydyn ni ei angen yn y nifer sy'n dod drwy'r system? Achos rhywsut rydyn ni angen hyfforddi mwy ac mae angen creu capasiti, neu mae angen dod â ffyrdd gwahanol o roi profiad i bobl, neu y ddau.

Sorry, I understand now. Yes, I think we will probably need even more than that eventually because, as we know, the expectations of our younger generations around work-life balance and flexible working are different, and what we are seeing is that for every person we train, we don't necessarily get a full-time person in the workplace at the end of it. So, I think that there are so many changing variables at the moment that I think we can't necessarily assume a one-for-one basis, so I think 20 per cent would be a reasonable start, but I don't think that will solve the problem that we've got around the need to increase the workforce in Wales with properly qualified and trained people coming through those professional pathways. So, it is, as you say, down to having a blended model and everybody agreeing to be more flexible in the requirements that are placed on higher education institutes and the NHS in terms of some of those training requirements going forward.

Dwi'n falch iawn o'ch clywed chi'n sôn am y busnes yma o fethu bod yn sicr eich bod chi'n mynd i gael un gweithiwr llawn amser am bob un rydych chi'n ei hyfforddi, ac rydyn ni'n gweld efo meddygon teulu, er enghraifft, faint ohonyn nhw sy'n dewis gweithio'n rhan-amser ar hyn o bryd, ac mae o'n gonsýrn gen i ein bod ni ddim cweit wedi efallai deall faint yn union yn rhagor rydyn ni'n mynd i orfod eu hyfforddi ar gyfer y dyfodol.

Mi wnaf i symud ymlaen. Mi wnaeth Joyce gyffwrdd yn ei chwestiynau hi ar y syniad yma o gydweithio rhwng recriwtio gofal cymdeithasol a iechyd. O ran hyfforddi, rydyn ni'n sôn yn aml am integreiddio gwasanaethau iechyd a gofal. Beth ydy'r cyfleon o ran integreiddio hyfforddiant iechyd a gofal, a beth ydy'r rhwystrau i alluogi hynny i ddigwydd mwy? A dwi'n siŵr y buasai Sue Evans, o bosib, eisiau dod i mewn ar hyn hefyd.

Thank you, Rhun. I think I'd like to invite Sarah. She's got a lot of in-depth knowledge on that and is working on it every day, so, Sarah, it would be great for you to update committee on that for us, please.

So, I'll just start with some of the things that we've already got in place in terms of developments, and as you state, really, this is a growing area and one that we're committed to developing over the life of the strategy. So, we've already got in place a joint induction framework for support workers, so when people are starting out on their careers in support roles, there is already a joint induction process in place, and we've actually piloted in one region of Wales how that could be delivered in practice. There's some really good learning that's come from that, both about what people gain from when they train and learn together about understanding different roles, whether they be in a community care setting, whether they be in a hospital, and how that's really increased the skills and knowledge of individuals.

We've also got already joint qualifications at level 2 and 3 in particular, so when people are coming in and qualifying in different roles we've got joint qualifications in place, and we've got a joint apprenticeship framework across health and social care for colleagues that are starting out with us on apprenticeships. We've got about 26 per cent of all apprenticeships in Wales on a health and social care programme, so some really good progress made in the apprenticeship settings.

We've also done joint training on particular areas, so during the pandemic there's been joint work that's been done on infection prevention and control and other areas, and we're doing some work on safeguarding at the moment to try and think about how we can offer that common training programme to individuals regardless of what sector they are working in. We've also done some joint work and a pilot programme around outcomes-focused practice, particularly in relation to hospital discharge. I think the other area, though, that we're trying to do when we look at those who are going through our higher education routes is to look at the opportunities for those individuals when they're learning to train together. So, where we've got universities that are delivering, say, nursing and social work and other programmes, to what extent can we encourage those higher education providers to support individuals to be able to train and learn together in those settings, too? Because certainly the expectations of the service, when they start working in practice, will be that they work in multidisciplinary ways, and so we want to ensure that the training is in place. So, an area of further growth, but one that I feel we've made a good start on in terms of some of those pillars of work we've already got in place.

Diolch yn fawr iawn am hynna. Mae yna beryg yn fan hyn o'ch tynnu chi mewn i faterion gwleidyddol; nid dyna fy mwriad i, ond nid rhywbeth one-off ydy addysg a hyfforddiant, wrth gwrs—mae'n digwydd drwy yrfa staff. A ydyn ni'n mynd i fethu sicrhau integreiddio hyfforddiant go iawn tan mae yna integreiddio gwirioneddol o ran cyflogau a terms and conditions gweithwyr iechyd a gofal, lle rydych chi wedyn yn gallu gweld staff yn symud o un ochr—o ofal i iechyd ac yn ôl i ofal—oherwydd eu bod nhw ar yr un telerau? Pwy sydd am fentro i ateb hwnna? Alex, roeddech chi'n nodio.

Apologies, I think Sue probably wanted to come in on that one, but yes, I think you'll see from the workforce strategy this was a key issue that we identified in there. We were quite clear the stakeholder engagement that we'd done obviously told us that was a hurdle that had to be overcome if we properly wanted integrated working. But Sue probably would like to contribute there, if that's okay, Chair.

Thanks, Alex. Just to build on what Alex has said, I think there is a recognition now that, if you're trying to better align or integrate services, it makes it quite a challenge when you have so many different employers. There are about 10, I think, in the NHS family, you've got 22 local authorities and you've got over 2,000—. That's just the registered providers, there are other non-registered providers. So, the actual means to try and get more onto a level playing field that would enable us to have a better, more aligned career pathway at the moment is challenging.

But I think both organisations are up for doing whatever we can to try and align some of those. Sarah and Alex have both outlined some of the things we're currently doing and we intend to push that further. So, the example I gave earlier about the Association of Directors of Social Services asking us to start doing some leadership around a national framework for qualified social workers, so, even staying within the social care family, we have differences across the 22 local authorities. So, if we can get some consistency there, that will help us. So, if we can have something similar to 'Agenda for Change', for example, that may be useful. It would probably be called something different, not to confuse people. But, you know, I've worked in many integrated teams and sometimes the barriers that we perceive, some of the front-line staff don't always perceive them, and they do recognise that they are employed by a different body. They may have slightly different terms and conditions, but you can still deliver seamless services to people. But, obviously, it would make it much easier if some of those terms and conditions did have more parity, and again, as I said before, it isn't just about the salary—it is about the infrastructure supporting, the well-being support, holidays, learning and development, training. And we recognise that, at the moment, there isn't that parity, but we're working with the Government to try and get closer to that parity, and in an ideal world, you would have a comprehensive career pathway in relevant teams across the system.

Alex mentioned earlier the mental health workforce plan that we're jointly developing. That will be a great way of testing out how can we improve that and make it look more seamless. Even if people stay with a separate employer, we should be able to do it. We're never going to merge every organisation to have one system, or not in the short term anyway, but that may happen in due course, who knows? That would be policy decisions. But we should be able to do some of that joint training, that joint alignment, develop joint service models where each professional understands their own particular role in it and who employs them, and which terms and conditions are they under. So, the better we can align those, obviously, it will make it easier to manage the system and plan for the future workforce.

Thank you, Sue. Do you have any further questions, Rhun?

If I can have just a quick answer, perhaps, from Alex Howells on primary care, in particular. I'm getting the feeling that your work on the development of multidisciplinary frameworks for training in primary care is still in development. Is there an update on how that is coming together, and when you feel we might be able to see the impact of that?

It'll just have to be a very quick answer, if that's all right, Alex.

Yes, I think that we've got a good plan now that we're implementing over the next six months. I'm hoping that in the education and training commissioning round that I just spoke about earlier, in the coming year we will now have more of those primary care-available programmes as part of that education commissioning round that we can make available to the whole of Wales, and that will be based on some of the innovative schemes we've seen locally, like in Betsi, with some of the physicians' associates or with some of the nursing things in Aneurin Bevan. So, we want to really roll those out across Wales through that process in the next planning round.

Okay, thank you. Diolch, Gadeirydd.

Thank you, Alex. We've got about half an hour left and we've got three Members that have got a series of questions, so it's about 10 minutes per Member's subject area. I hope that witnesses don't mind if Members just jump in if they're not quite getting to the point that they want in order to get through all the questions. Thank you, appreciate that. Gareth Davies.

Thank you very much, Chair, and good morning to all the witnesses and thank you for the evidence that you've given the committee so far this morning. I just want to expand a bit on some of the points that Rhun made about the parity, or lack of parity, between health and social care. A lot of my work as a Member so far has been questioning the Minister—it was only yesterday I was asking about getting this parity of esteem between health and social care in terms of pay, terms and conditions and what that looks like, because I worked in the NHS for 11 years and I saw first-hand that a lot of people choose careers in the NHS over social care, where not necessarily their qualifications would dictate that sort of career path, but it's just purely the fact that the pay, the terms and conditions are far better than what the social care sector can provide. I've seen so far as well from Betsi Cadwaladr in my constituency that they're trying to bridge this gap in terms of employing staff on their terms to work in the social care sector, because there's so much evidence of bedblocking because of patients that are unable to be discharged to social care settings, so it's just to try and bridge that gap and solve some of the problems in the short term. But in terms of what your view is on that, I'd be interested to know.

Who would like to take that? Sue.

Thank you, Gareth—a really helpful question. Obviously we don't get involved in individual organisations' decisions. We try to remain at that strategic level to give that leadership and oversight of the strategy, and we acknowledge that during the pandemic all organisations are looking at innovative ways of trying to come up with solutions. At the end of the day, all of us are trying to focus on the citizens of Wales, and doing what we need to do. Those pilots that are being established, we will watch what's happening there and observe and see if there are things that can be learnt for Wales. We shouldn't be afraid of different approaches being tested out and piloted during these very unique circumstances. So, we watch to see what happens, and flexibility, I think, is the order of the day. If we're talking about multiprofessional teams delivering seamless services, we have to be as flexible as we can, and I think we've already shared our desire to support the Government in making sure there is sustainable funding for social care, and we know that that is in their plans. The Fair Work Commission and the fair work forum is part of that, looking at career pathways, looking at a real living wage for individuals, but other elements of fair work, as we've already described, that wrap around: good well-being support, holidays, funding and time for learning and development. So, it is a complex area, and we acknowledge that different approaches are being piloted in Wales, and we are watching to see if there are lessons that can be learnt. Thank you.

Thanks for that answer, Sue, and I agree with the majority of what you said, because I think that sort of collaborative working and ending the culture of working in siloes—I think that's going to be really pertinent, going forward, to address some of the problems that we've got. The strategy itself sets out the integration being achieved or hopefully being achieved around the 2030 mark, which we're less than nine years away from—it's probably eight and a bit years now—and it's probably seen as a bit of a radical step in terms of how that—. Once you've got your delivery and the whole of the process goes through, it's quite a short space of time, even though, in real life, it is a long time, but it's not in terms of a roll-out across the whole country. What's your view on that and how do you measure that success and at what point do you get to when you think, 'Right, we've achieved what we set out to achieve'?

Thank you—really helpful question. I think, for me, one of the key roles here is the regional partnership boards. We know, from the Government's rebalancing care White Paper, there are elements in there that indicate a national framework for commissioning social care, a national office, which will bring some consistency across the area, and a strengthening of the roles of regional partnership boards. If you think why they were set up, they were set up in direct response—. They were there before 'A Healthier Wales', but they were almost strengthened, or the expectations were strengthened recently since the publication of 'A Healthier Wales'. And if you think about their role, their role is trying to do the population needs assessment, so: what does the population need in terms of health, care and support? From that population needs assessment, develop service models that would meet those needs. Many of those service models are already integrated. So, whether it's mental health, whether it's intermediate care, whether it's learning disabilities, and then from those service models, you would then develop your workforce plans. So, we should be smart enough, I think, in Wales, and I think we are smart enough in Wales, to even deliver that aspiration of integration or alignment, to deliver a seamless service. It's the end product that we deliver for the citizens that is the most important thing. Twenty years ago, we might've called it a 'seamless service', now, we use the word 'integration'; very often, people see integration as maybe a power thing, or a reorganisation of the organisations we have. If we start talking more about multiprofessional working and delivering seamless services, I think some of those potential barriers start to fall away and we focus more on what the citizens of Wales need to meet their health, care and support needs, and I think that's a better way of approaching it, from my point of view. It takes away some of those potential barriers that might get in the way of us all focusing in on what we're trying to do.

The other thing we haven't mentioned much about, which I think is pertinent here, is we've started to explore, haven't we, different technologies and different ways of delivering services through the pandemic. So, when we're talking about our workforce needs, no doubt some of those roles may be augmented or enhanced by different technologies that we may not even be aware of yet. When we're looking at global numbers, we may not need all of those numbers if we can do some things better or prevent some things from happening, because, again, I think our focus on improving health and well-being in the population and focusing on early intervention and prevention needs to be part of this strategy, as well as thinking about the direct care and support and treatment delivered right now, so that we futureproof it. Thank you.

Thanks again, Sue. I agree, again, with the majority of what you're saying, and it seems, through the things that I'm hearing from you and in other meetings that I have, that everybody's thinking along the same lines. I just hope that, in time to come, the Government obliges what the sector and everybody's saying and provides the correct policies and funding strategies to achieve what we all want to, in a way.

I just want to focus my last question on the role of unpaid carers, because while they've played a prevalent role in care over a long period of time, I think the focus on them has seemed to be more so after the pandemic. Certainly in the worst of the lockdown periods, and after, there's been more of a focus on that. I just want to get your view on how you see things going forwards with them and how they can play a role within the health and social care sector, and where they fit in, really, and whether there's any opportunity for them to perhaps link in with the sector. It might even be the case in an ideal world that they might see a career path as an entry point into the sector. The benefits of recognising unpaid carers far outweigh the negatives or any other views that might be had. So, I just want to see what your view is on that.

I'll have to ask Sue to be ever so brief on that, I'm afraid.

Okay. Unpaid carers are absolutely vital. It's estimated that, in Wales alone, the benefit is over £1 billion in terms of what the health and social care system would have to put in place if we didn't have family and friend carers. So, they're absolutely vital to our progress. We sit on the ministerial advisory group, we work with Carers Trust and Carers Wales, so we very much see part of the role of unpaid carers and volunteers as essential to us, supporting our citizens in their time of need. All of our resources for learning and development are all available online, so unpaid carers can tap into those, and we absolutely work with the Wales Council for Voluntary Action, Carers Trust and Carers Wales in terms of their particular roles and remit for supporting the third sector and unpaid carers. We recently co-designed a framework for volunteering in health and social care with the WCVA and the Bevan Commission, and again, it talks about that moving from volunteering into a career, moving from unpaid caring into a career. So, I think it is more recognised now, even before the pandemic but definitely since the pandemic, that supporting volunteers and unpaid carers is fundamental to our success. Thank you very much.

Thank you, Sue. Jack Sargeant.

Thank you, Chair. Just moving on to the well-being of our wonderful staff, it won't be a surprise that, in the written evidence we've gained as a committee, well-being was clearly a key priority. I don't think that'll be a surprise for anyone. So, it was pleasing that the two witnesses we have in today do state that the well-being of the workforce is at the heart of the strategy. Just very briefly, I wonder if you could just expand on exactly how will the impact of the strategy on staff well-being be measured.

Julie wants to come in there.

Thank you for that, and thank you for the question. I think that's a really good point, isn't it? I think one of the first things I would say is it is absolutely at the heart of the strategy. In response to COVID what we did was we accelerated this aspect of the strategy to make sure that we were able to provide national resources in a single place and actually make those available across health and care, which wasn't the case previously. We also got ourselves onto the national workforce group that was looking at how we could support our staff across both sectors during the time of COVID, and obviously we're really active now in working with Government and all of our partners to make sure that we're keeping an eye on well-being across the organisations. So, there is a huge amount of stuff that's available and we can share the link with the committee, if that's helpful, to the resources. You'll see as well from the evidence that, by the end of this current financial year, we should have in place workforce well-being frameworks, which will enable us to actually be clear about the expectations.

We've talked a little bit earlier about compassionate cultures and the work that we're doing on leadership to create the right conditions for staff. In terms of not measures of support but measure as in impact, one of the things that we've described is actually a need to look at how we measure well-being going forward, and obviously Government does set, for both sectors, the expectations around performance. So, from a health perspective, there are indicators of performance that organisations have to comply with that are around well-being, and one of the aspects of that is the national staff survey. There is a question in the annual staff survey that talks about the extent to which managers ask and are interested in staff well-being, and it's around about 66 per cent of staff who feel that their managers are interested. So, there's clearly more to go at, but those are the types of things that we'll be looking at across both sectors, whilst also not undermining the responsibility of individual organisations, employers and managers to pay attention and look after the duty of care to their staff. I hope that gives you enough, but I'm happy to come back if there's anything else.

I think that was great. I can't quite see who—

I think Alex wants to come in.

Just to add to what Julie has said as well, obviously, making sure we're measuring the impact on well-being of our students and trainees and learners in the system, because our aspiration is to, as you know, make Wales a great place to train and learn. Clearly, COVID has had a huge impact on their experiences as well, and we do have a number of sources of information like the national student survey and national trainee and trainer surveys that we do look at to make sure that people are well supported and that that doesn't impact adversely on the outcomes of the training.

Thank you, both, for that, and it's pleasing to hear the point about students there as well. I think the committee will be grateful to receive the link from you, Julie, at the appropriate time.

Just in terms of on-the-ground delivery, then, burnout was perhaps an issue before COVID, and now with what we've been through, I just want to try and understand exactly how will it be ensured that staff are able to take breaks, are able to manage workloads, are able to have time and that work-life balance, and perhaps have access to that well-being support. Because I know from a friend of mine, way before COVID, she was terrible—leaving late, going in early and not taking her breaks. So, I'm just interested to hear about the on-the-ground delivery there.

I think that's a really good point, and I think the point you made—this has got worse during COVID, but it was actually a feature prior to COVID. We're under no illusions on that. I think the other thing as well is that, obviously, as organisations, what we're trying to do is support and enable access to resources. We can't actually be in the local organisations understanding the experience of individuals. So, one of the things we are doing is working with trade union partners across the sector. Well-being is something that we do discuss through the partnership forums, and that's why we're really keen, as we're looking at the staff survey for next year, to see what else we can build in around the type of experience that staff are having. And it does come down to the quality of leaders and managers in those organisations, making sure that their staff are well looked after and cared for. So, obviously, as I say, working with Government going forward, what can we do in terms of the performance frameworks for organisations to make sure that well-being is front and centre of staff experience and that there is proper evaluation of the impact of some of the things that are being done? But it is a long-term ambition, not a short-term fix, and we really do need to make sure that we create those conditions more generally that people feel able to continue in work and are supported in their jobs.

Diolch for that, Julie. I appreciate that answer. Perhaps, as a committee, we could seek to get some evidence from trade unions on those points as well.

Just very briefly, moving on to technology and innovation, I'm still trying to figure out what innovation means to the health and care sector, but I won't indulge in that because I know we're pressed for time. But, certainly, I just want to pick up for the record the point we've had from a stakeholder that we're already starting from a low baseline and that ICT and technical infrastructure in the NHS and social care is patchy, unreliable and outdated. I would probably tend to agree with that from the evidence I've sought myself, and I don't think that's the place we need to be. We should be innovating further and allowing our wonderful staff and academics to innovate further.

In terms of the strategy itself, and one of the themes, building a digital-ready workforce, can you explain perhaps how will the staff across the health and care sector be supported with this digital-ready workforce, and if you have made an assessment on the type of investment? Because, again, a stakeholder has suggested that investment is needed in that. And, just finally, one final point: have you considered the risk that small care providers, for example, may be left behind, and what can you do to mitigate that? I appreciate it's quite long-winded, but a brief answer would be great.

Julie. Thank you.

Thank you for that question. Sue may want to come in afterwards about social care specifically. But, yes, you're absolutely right, there is a very mixed experience across health and social care of access to IT and digital technologies, and I think that's one of the things that's generally recognised. Obviously, COVID has accelerated the deployment of digital approaches, and we've got to be really sure that we don't leave people behind as we rush to grab the latest bit of kit or technology.

One of the things that we're doing is we're working really closely with other NHS partners in particular, and Digital Health and Care Wales, the new body that was established earlier this year, to actually make sure that the IT infrastructure is aligned with our own expectations and ambitions around the workforce. We've just started a pilot with allied health professional workers in the NHS to look at actually testing a digital skills and capabilities framework, a self-assessment tool that would allow them to assess where they are and what sort of training that they need. And, obviously, we're working with people to make sure they understand how to actually participate in that pilot.

There's other training being rolled out and delivered through our partner, DHCW, as well. Obviously, if that digital workforce tool works in terms of the pilot, then we'll be looking to work with partners across health and social care to make that available more broadly. So, there's quite a lot of activity. It's one of those areas where it isn't in the sole gift of both of our organisations. There are some infrastructure and other aspects, and it is one of those areas where there's probably going to need to be investment longer term, but we've just made a start in terms of that digital-ready workforce with the pilot.

Thanks for that. Perhaps the committee can write to the new digital body.

Yes. Thank you, Jack; that would be helpful. Because we're pushed for time, we'll perhaps take up some other areas that we were going to raise today via written correspondence. Mike Hedges.

Can I raise the Welsh language? Is there anywhere in Wales where somebody could train to be a nurse through the medium of Welsh? And is there anywhere in Wales where you can do an NVQ level 3 for carers through the medium of Welsh?

I'm looking for who could answer that. Sarah. Thank you.

I'll start, but I will hand over to colleagues on nursing because I'm less familiar; you might have expected that. The new qualification frameworks at level 2, 3 and up to 4 should all be available bilingually. That was part of the design and the regulations done by Qualifications Wales. Part of the design of those programmes was to support individuals to be able to access that training and learning in a bilingual manner. Now, the implementation of those new qualifications, in part, had coincided with COVID as well, and we're conscious that certain elements of that, so particularly assessments, where assessors would be going into care homes and other settings, haven't always been able to happen in the way envisaged, because of the challenges we've had. But we are working closely with the consortium of awarding organisations to address that, and any barriers to delivery. So, yes, the frameworks can be delivered bilingually; if that's not happening in all places in practice, then that's clearly an area that we need to build upon.232

Certainly, in social work, you can undertake your social work training completely bilingually—in Bangor, but there are also other settings where you can do elements of your learning bilingually. And what we've seen, I think, probably through working in partnership with Coleg Cymraeg Cenedlaethol, there's a real growth in that over the last few years, where there has been investment and support; we're really starting to see the benefits in the numbers of our social workers who are now coming through, and are either more confident or more able to be able to operate bilingually. So, there's a lot of emphasis of an area that we need to work perhaps where that hasn't been in place as much, and areas to grow and identify where any of the barriers are, and also make sure that, with our employers, when individuals are going on placement and being supported, they can also undertake their placements in a bilingual environment as well.233

So, I'll hand to Alex or Julie in relation to nursing specifically, because I'm not aware on that one.

Julie, do you want to take this one, or shall I take it?

So, what I would say is, obviously, our new contract that's been awarded for health professional education has opened more opportunities for individuals to study through the medium of Welsh. That also includes an expectation that every student will have at least an hour induction into the Welsh language as part of their course, and that any student who does say that they want to learn Welsh will be supported and have free access to lessons to do so. In relation to the specific question, I can't actually tell you where at the moment, but I'm happy to confirm that with the committee, in relation to nursing in specific.

Thank you for that. If you could write to us, and if it doesn't exist, what you're doing to make sure it exists. There are an awful lot of elderly constituents of mine—and I'm sure of other people—who are much happier speaking in Welsh to people when they're unwell or when they've got problems; certainly a number of people who suffer from dementia whose Welsh is far, far better than their English, who would be much happier. And I think that we do need to ensure that not only is it available, but it's actually carried out.

The last question I've got is, action 28 sets as a long-term goal to develop a centre of excellence for workforce intelligence. How long is a long-term goal?

Julie.

What a brilliant question. Thank you. So, it's not going to be built overnight, but we have started scoping what that might look like. It's in HEIW's annual plan for this year, and both organisations have been doing some work in relation to digital and data. But it's fair to say it is dependent on a number of things. We've actually got in the NHS access to an awful lot of data for the employed workforce, and I know that Social Care Wales has also undertaken a major reform of the approach to collecting workforce data across their sector. But there are complexities, because not all of the people who we'd want to include in the centre of intelligence would be people who are directly employed. So, we've started collecting, in the last few years, as a system, GP primary care workforce data that wasn't collected previously. We're now looking to collect from other private areas—private employer areas. One of the problems we've got is differential systems across not only the sectors but across the different types of employers. So, it's long term because this isn't going to be cracked overnight, but what I would say is that we are making real progress towards this, and we will be able to, within a fairly short time frame, publish and produce data in relation to it that's more comprehensive and more robust. But the nirvana is a single centre of excellence, with a single data system that captures all of the workforce intelligence across both sectors, and that probably, realistically, is towards 2030.

I can see Alex wants to come in as well.

Yes. Just to reinforce the fact that we're not waiting for the shiny centre of excellence to get on with some of this. The workforce planning work that we've done on mental health, we've obviously had to do a big workforce intelligence exercise as part of that across both sectors, and I think that's been really helpful in identifying where the gaps are and how to collect that data and what data is really needed to inform plans going forward. So, I think on a more micro scale, looking at those services has really helped us finesse what that ask for the centre of excellence will be in the future.

I'm going to make you happy, Russ, and say I'm happy.

Okay, thank you, Mike. So, no further questions from you, Mike. Great, thank you. Okay, that's kept us on schedule then. Thank you for that. There might have been some areas that we would have liked to have covered, but we'll take that up via written correspondence. And I should thank you all actually for your time on committee today and for your comprehensive papers in advance of the meeting as well, but, as a committee, we look forward to working constructively with you over the term of this next Senedd and our committee. So, thank you in that regard. And I should also thank our stakeholders who provided information—written evidence to us—to inform us today in terms of us putting across some of our questions today. So, thank you to our stakeholders as well.

We'll give a copy of the transcript of proceedings to you all, just to check that for accuracy as well. But thank you for your time this morning. Diolch yn fawr.

Thank you.

Diolch yn fawr.

Thank you, take care.

And so, our next public meeting is on 18 November. That's our next meeting for committee. But as I move to item 5, I propose that in accordance with Standing Order—. Sorry, the clerk is whispering in my ear, quite rightly, that I have forgotten item 4.

I've jumped ahead and we've got a number of papers to note today. I won't go through each one, but I will just highlight that we did have correspondence from Pancreatic Cancer UK, and Members will have received an invitation to a virtual session this morning, which we were all unable to make because we were in committee here, so I'd like to wish them well in that regard, as we think about Pancreatic Cancer Awareness Month. So, are Members content to note the papers under item 4? Diolch yn fawr.

Right, and in that case, now we move to item 5 and under Standing Order 17.42, I propose that the committee resolves to exclude the public from the remainder of the meeting. Are Members content? Diolch yn fawr. That brings our public session to an end today.