Social Services (Wales) Bill – Consultation Response Form Your Name: Organisation (If applicable): Email address: Telephone number: Your address: Nick Morris Sense Cymru and RNIB Cymru And on behalf of: Action on Hearing Loss Cymru Guide Dogs Cymru Wales Council for the Blind Cardiff, Vales and Valleys Vision Support Nick.morris@sense.org.uk 0845 127 0090 Sense Cymru Tŷ Penderyn 26 High Street Merthyr Tydfil CF47 8DP Responses to consultations may be made public – on the internet or in a report. If you would prefer your response to be kept confidential, please tick here: If you are responding on behalf of your organisation, please tick here: This consultation runs from 12 March until 1 June 2012. Please send your responses to us by the deadline of the 1 June 2012. You can send your completed response forms to us by e-mail, to socialservicesbill@wales.gsi.gov.uk, or by post, to Social Services Bill Team, Social Services Directorate, 4 Floor, Cathays Park, Cardiff, CF10 3NQ. Responses can come from individuals or groups. The form is set out in the order of the consultation document and the questions are grouped into sections. You do not have to answer all of the questions if you do not wish to; you are welcome to only answer the questions that are relevant to you, and to continue your answers on additional sheets if required. There is however, a final question, (number 98), where you can feed back any other views you have on the Social Services (Wales) Bill, that are not covered by the other questions asked in the consultation document. Organisations responding Sense is a national charity that supports and campaigns for children and adults who are deafblind. We provide tailored support, advice and information as well as specialist services to all deafblind people, their families, carers and the professionals who work with them. We also support people who have a single sensory impairment with additional needs. We believe that every deafblind person has the right to choose the support and lifestyle that is right for them; one that takes into account their long-term hopes and aspirations. Our specialist services enable deafblind people to live as independently as possible, offering a range of housing, educational and leisure opportunities. RNIB Cymru works on behalf of over 100,000 people in Wales with sight loss. We campaign to create a society more inclusive of people with sight loss and we promote eye health by running public health awareness campaigns. We also work in partnership with organisations across Wales to provide local services, providing practical solutions to everyday challenges. Sight loss is not confined to those who are registered blind and partially sighted. It includes people who are waiting for, or having, treatment such as laser or other surgery to improve their sight. And it includes people whose vision loss could be improved by wearing the right glasses. These people are living with significant sight loss, and some have vision which is equivalent to people who are partially sighted or blind. Action on Hearing Loss Cymru is the new name for RNID Cymru. We are the charity working for a Wales where hearing loss does not limit or label people, where tinnitus is silenced – and where people value and look after their hearing. We use the term 'people with hearing loss' to refer to people with all levels of hearing loss, including people who are profoundly deaf. Guide Dogs Cymru is part of the larger Guide Dogs charity which operates throughout the UK. Our purpose is to deliver a world class service as part of a range of mobility services and work to break down barriers to ensure blind and partially sighted people can get out and about on their own terms. Wales Council for the Blind is the umbrella agency representing the third sector within the visual impairment sector in Wales. WCB works to campaign, lobby and support the improvement of services to people with a visual impairment. Its work covers includes a wide range of roles, including: -• Actively supporting and developing the work of local societies across Wales. -• Campaigning to raise the standards of services available to people with sight loss. -• Working to progress the skills of the workforce across the sight loss sector. Operating across South Wales, Cardiff, Vales and Valleys (CVV) provides direct services and support for people with sight loss, in their own locality. Vision Support is a regional charity recognised as the leading provider of local support and services to people of all ages living with vision impairment in north Wales and Cheshire. Context: sensory loss in Wales Hearing loss -• 500,000 people in Wales, 1 in 6, are estimated to be affected by hearing loss. -• More than 300,000 of those with hearing loss would benefit from hearing aids – 10% of the population. -• 44,500 of those with hearing loss are severely or profoundly deaf. -• The majority of people with hearing loss are older. The prevalence increases with age. -• 41.7% of over 50 year olds have some kind of hearing loss. 71.1% of over 70 year olds have hearing loss. Figures are based on the most comprehensive study into hearing in the adult population [Adrian Davis, Hearing in Adults, 1995] with prevalence rates applied to population estimates for 2009. [Office for National Statistics (2010) National Population Projections 2009-based]. Increase in prevalence -• 14% increase every 10 years, correlating to an ageing population [Medical Research Council]. -• By 2030 adult onset hearing loss will be in the top 10 disease burdens in the UK, above diabetes [The World Health Organisation]. Local Authority Registers 12,500 people in Wales were registered with hearing loss as at March 2011, based on data provided by 21 Local Authorities. [Welsh Government, Local Authority Registers of People with Disabilities at 31 March 2011]. The Statistical Directorate of the Welsh Government recognises that because registration is voluntary these figures may therefore be an underestimate of the numbers of people with physical or sensory disabilities. Sight loss Prevalence -• 115,000 people in Wales are estimated to be living with sight loss that has a significant impact on their daily lives. -• A further 200,000 over the age of 65 have a visual impairment that could be alleviated simply by wearing glasses. The above figures are based on prevalence statistics and applied to population estimates, 2007. Key statistics -• Every day 5 people lose their sight in Wales. -• Over half of all sight loss is preventable and avoidable. -• Sight loss affects people of all ages. However, the prevalence increases with age. -• 1 in 9 people over the age of 60 are living with sight loss. -• 1 in 3 people over the age of 85 are living with sight loss. Increase in prevalence More than 11% increase anticipated in the next 10 years - correlating to an ageing population and a growing incidence in key underlying causes of sight loss such as obesity and diabetes. Local Authority Registers 16,300 people in Wales were registered with a visual impairment as at March 2011, based on data provided by 21 Local Authorities. The Statistical Directorate of the Welsh Government recognises that as registration is voluntary. Therefore, these figures may be an underestimate of the numbers of people with physical or sensory disabilities. Deafblindness Definition of deafblindness While there is no generally accepted definition of deafblindness there is a working description across the UK that is used in Welsh Government Statutory Deafblind Guidance (2001): “Persons are regarded as deafblind if their combined sight and hearing impairment cause difficulties with communication, access to information and mobility.” Deafblindness can be found in all age groups, including children, but incidence is greatest among older adults. A person with dual sensory loss is not just a deaf person who has visual impairment or a blind person who has hearing loss. The two impairments impact on each other and multiply the total effect. Children We also use the term multi-sensory impairment (MSI) for children or young people who are deafblind. Welsh Government guidance says MSI “is regarded as any degree of dual-sensory impairment that has a significant adverse effect on the child or young person’s ability to access education. The children will have very different needs arising from a congenital loss, acquired loss or degenerative condition”. [Welsh Government circular, Quality Standards in Educational Services, No 34/2005] Prevalence -• 500 people in every 100,000 population will have some level of co-occurring sight and hearing loss and 212 per 100,000 will have a loss of a severity to classify them as deafblind. -• 62% of the deafblind population is aged over 70. Increase in prevalence The number of people who are both deaf and blind is estimated to grow by 60% in 20 years (2030) largely driven by general demographic change. People over 70 will be most affected with an 87% increase by 2030. [Robertson J and Emerson E, Estimating the Number of People with Co-Occurring Vision and Hearing Impairments in the UK, 2010] Local Authority Registers A survey by Neath Port Talbot CBC found 178 deafblind people per 100,000. If projected across Wales this suggests 5,300 deafblind people [Welsh Government, Moving Forward: Services to Deafblind People, October 2008]. 1. Maintaining and enhancing the wellbeing of people in need 1.1 Wellbeing of people in need Question 1 – Do you agree with our proposals to base this legislation on the concept of maintaining and enhancing the wellbeing of people in need? Question 2 – Do you agree with our working definitions of “wellbeing” and “people in need”? Do you wish to suggest alternatives? Question 3 – What are your views on the proposed general duty on local authorities and their partners to maintain and enhance the wellbeing of people in need in their local areas? Question 4 – What are your views on the proposals to provide guidance on this area through the Code of Practice? Response: Question 1 We agree with the proposal to base the legislation on this concept. However, we suggest that the Welsh Government should also include the second part of the Law Commission’s recommendation in this area [Recommendation 5 in Adult Social Care, May 2011]. Maintaining and enhancing the wellbeing of people in need is only the first part of the Law Commission’s recommendation. The second part is also compatible with the Welsh Government’s intentions to place the citizen at the heart of the service. It says the statute should “state that in deciding how to give effect to this principle in relation to individuals, decision makers must” followed by these statements: -• “Assume that the person is the best judge of their own well-being, except in cases where they lack capacity to make the relevant decision; -• “Follow the individual’s views, wishes and feelings wherever practicable and appropriate; -• “Ensure that decisions are based upon the individual circumstances of the person and not merely on the person’s age or appearance, or a condition or aspect of their behaviour which might lead others to make unjustified assumptions; -• “Give individuals the opportunity to be involved, as far as is practicable in the circumstances, in assessments, planning, developing and reviewing their care and support; -• “Achieve a balance with the wellbeing of others, if this is relevant and practicable; -• “Safeguard adults wherever practicable from abuse and neglect; -• “Use the least restrictive solution where it is necessary to interfere with the individual’s rights and freedom of action wherever that is practicable.” Question 2 The definition of wellbeing is the same as that proposed by the Law Commission. However, we would suggest additions to the definitions. “Social and economic wellbeing” is included in the definition, but we believe employment access should also be in the list. Access to employment opportunities is important, and care and support should enable people to access the support they would need to have a job, if appropriate. Paragraph 1.1.9 of the consultation also includes references to “and in the case of a child, development”. Adult development is also important, particularly to those over the age of 16 years old who have a learning disability. It is also important to include reference to the multiplier effect of co-occurring conditions. A person with dual sensory loss is not just a deaf person who has visual impairment or a blind person who has hearing loss. The two impairments impact on each other and multiply the total effect. Question 3 The duty to enhance the wellbeing of people in their areas (in paragraph 1.1.11 of the consultation) includes identifying the extent to which there are people in need in the area. This should also cover projecting future needs, not just current ones. We know that the prevalence of sight, hearing and combined sight/hearing loss increases with age [Adrian Davies, Hearing in Adults (1995) applied to ONS population projections in 2009; Welsh Government, Local Authority Registers of People with Disabilities at 31 March 2011 (2011); and Robertson J and Emerson E, Estimating the Number of People with Co-Occurring Vision and Hearing Impairments in the UK, 2010]. The Robertson and Emerson study also found the number of deafblind people among the over 70s age group is set to increase by around 50% across the UK by 2020. And by 2030 the World Health Organisation predicts adult onset hearing loss will be in the top 10 disease burdens in the UK, above diabetes. An EpiVision study projects a sharp increase in sight loss across the UK due to the four main eye diseases by 2020, including [Wales Vision Strategy, p.7]: -• 31% increase in the number of people who are blind or partially sighted because of age-related macular degeneration -• 20% increase in the number of people with cataracts -• 25% increase in the number of people suffering with glaucoma sight loss -• 15% increase in the number of people who are blind or partially sighted because of diabetic retinopathy. People with a visual impairment do not often describe themselves as in need, leading to the sense that they select themselves out of care. Positive phrasing could include: ‘people with the need for support in their wellbeing.’ Question 4 Codes of Practice are essential and must be statutory. They would preferably be subject to affirmative resolution in the National Assembly. The statutory Deafblind Guidance issued by the then National Assembly in 2001 is crucial to deafblind people and families: ensuring that local authorities have a responsibility to maintain contact with deafblind people, provide ‘specifically trained’ assessments of need, one-to-one support and accessible information. The guidance was originally necessary because a National Assembly and Department of Health joint consultation in September 2000 “concluded that the needs of deafblind people are often not identified nor are those in need of community care always in receipt of appropriate services”. A Welsh Government survey in 2004 found the guidance was “an important stimulus to improvement of services” but that improvements were not uniform across Wales. [Welsh Government, Moving Forward: Services to Deafblind People, October 2008] There is also a need to maintain statutory local authority registers for blind and partially sighted people. Blind registration is often the only referral mechanism for bringing social care needs to local authority attention. The Law Commission supports this and said “it appears that where there is a strong local commitment to make the registers work they can be an effective tool for planning and other purposes” [Adult Social Care, paragraph 12.15]. Unfortunately the Department of Health in England is ambivalent about the registers [see RNIB and Action for Blind People paper, Caring for our future – Shared ambitions for care and support, December 2011. Link: http://www.rnib.org.uk/getinvolved/campaign/healthsocialcare/Documents/DH_Caring_for_our_Future.doc]. Robert Lake, Director for Social Care Information Delivery at the NHS Information Centre for Health and Social Care, conducted a review of sensory impairment registration in England for the previous UK Government. He recommended that “Local authorities, working with the Association of Directors of Adult Social Services and the LGA, will need to review and, where necessary, revitalise their registration processes whether these be directly provided or on contract. This should include considering how the registration process should trigger arrangements for assessment, and how well that assessment addresses needs resulting from sensory loss.” He also supported the identification and record-keeping duties in relation to deafblind people [A Review undertaken for the Minister of State for Care Services, 2010] We would recommend the Welsh Government accepts the Law Commission’s Recommendation 73, which said: “Local authorities should be required to establish and maintain a register of blind and partially sighted people. In all other cases, local authorities should be given a power to establish and maintain registers. The code of practice should maintain the existing requirements for local authorities to analyse data on a number of issues including which groups are referred for assessment and receive services; and identify, make contact with and keep a record of deafblind people in their catchment area.” 1.2 Defining social care services Question 5 – What are your views on the proposed broad power for local authorities in Wales to provide or make arrangements for the provision of social care services? Question 6 – What are your views on our proposed definition of “social care services”? Response: Question 5 Paragraph 1.2.7 of the consultation gives a definition of social care services including information, advice, counselling and advocacy. It is important that information, advice and advocacy do not become chargeable services. The Law Commission report [Recommendations 6 and 28] suggests a way to ensure they do not become chargeable services, by creating categories of ‘universal services’ and ‘services provided to individuals following an assessment’. Information provision and related duties are placed in the ‘universal services’ category. Question 6 We would like it be acknowledged that ‘social care’ for people with sensory loss is not restricted to personal care but a much wider definition of support. For deafblind people access to information, mobility and communication are the principal care and support needs. Many of these needs are ongoing throughout the service user’s life. For example, Sense provides a communicator-guide service to deafblind people. Communicator-guides enable people with dual sensory loss to have greater independence and a better quality of life by providing support with communication and accessing the community. They act as the eyes and ears of a deafblind person. Comments by service users include: -• “I get such a lot from the service, to have help with my communication means a lot. Without this service I wouldn’t have the confidence to go out alone” – Service user in north Wales. • “I felt very low a few months ago, this has given me the confidence to go out and join groups. Now I know that I’m not the only one” – Service user in north Wales. -• “My communicator guide gets me out of the house and out of myself - reducing boredom and isolation - and gives my wife a break from caring for me” - Service user in south Wales. -• “I don’t know what I would do without [my communicator guide]. I can’t get out on my own, I’ve got no family at all, and there are no shops or banks where I live” - Service user in south Wales. Blind and partially sighted people – and some deafblind people - can benefit from a rehabilitation and reablement process, which is separate from ongoing care and support. For example, they may receive mobility training, help to recover literacy (e.g. through learning braille) and practical living skills. Rehabilitation work with visually impaired people evolved as a social care function but has never been an explicit social care function in any community care legislation. A study by York University’s Social Policy Research Unit (Home Care Reablement, Prospective Longitudinal Study) confirmed that there are longer term cost savings as a result of initial reablement work. There is an issue around the implementation of the definition, and sometimes confusion between the Welsh NHS and social services about funding responsibilities. Parents of deafblind children with additional health needs have reported disagreements between services over which agency should fund the care and support. In a case in which Sense Cymru was involved a disagreement took place in front of the parent during a services meeting. 2. A stronger voice and real control 2.1 Information, advice and assistance Question 7 – Do you agree that we need to make a significant step forward in making information, advice and assistance accessible? Question 8 – Do you think that the legislation should specify any particular organisational form for this, such as an information hub? Question 9 – Do you think that the legislation should specify more clearly how local government and the NHS should work more closely together in the provision of information, advice and assistance? Response: Question 7 We agree, but acknowledge that the main challenge for people with sensory loss is a more specific type of accessibility than the type mentioned by the question. Communication is the principal challenge and the costs of communication barriers include low educational achievement, unemployment and long-term mental health issues. Lack of awareness by information providers, professionals and people with sensory loss themselves can hamper delivery, uptake and development of information, and development of appropriate services. For example, Action on Hearing Loss Cymru’s Freedom of Information requests in 2011 showed availability of social workers for D/deaf people in Wales (within Sensory Teams in local authorities) is currently variable. In areas where provision is limited, it is likely that the provision of information about available services will be reduced, as the presence of specialist expertise (therefore unavailable in those areas) tends to generate greater demand. Note that many people whose first or preferred language is British Sign Language consider themselves part of the Deaf (with a capital D) community. Also Action on Hearing Loss Cymru’s report Open to All (2010) found nearly a quarter (23%) of research participants said it was difficult to get information about services provided by local authorities. When discussing local authority services, forum participants raised the need to have specialist social workers for deaf people in every local authority. There is also a lack of lip reading classes across Wales. The lack of information about services impacts on all areas of people’s lives. Less than 7% of books in hard copy are available in accessible formats. 79% of participants in a Guide Dogs for the Blind survey reported difficulties identifying food and medicine labels [Lockyer et al, Availability of Accessible Publications, 2004]. An Action on Hearing Loss UK members’ survey showed that 79% of people, when fitted with hearing aids, did not receive any information about other services or potentially useful technology. Question 8 We do not favour any particular type or structure of information service. For it to be accessible to people with a dual or single sensory loss, both the information itself needs to be accessible (in a range of formats) and the staff need to be trained in sensory loss awareness. There are some applicable lessons from the NHS in the report Accessible Healthcare for People with Sensory Loss in Wales (October 2010), which suggested NHS services should have an accessible information policy. This would be our preference for information services. A policy would include, for example, a requirement that correspondence is always at font size 14 in an accessible font like Arial and a communication flag placed on records to ensure communication needs of service users are noted and used. Specific measures would be needed to reach people isolated by sensory loss. Question 9 We support the suggestion that local government and the NHS need to work more closely together in the provision of information, advice and assistance. Referral pathways between NHS and local government are inconsistent. The consultation uses the phrase ‘assistance’ rather than ‘advocacy’. We would like ‘advocacy’ to be used in the Bill. We welcome the mention in Sustainable Social Services [paragraph 3.46] that the Welsh Government is looking at the business case for introducing a comprehensive advocacy service for older people. However, we believe advocacy should also be a right if an individual is either involved in the safeguarding process or where their active participation during the assessment/re-assessment process will not be fully attainable without an advocate. This is why our response to Question 1 said the definition of principles to this effect would be useful. Visual impairment is an area where close working can be mandated between health and social care. The 1948 NHS Act defines the legal status of blind or partially sighted, which manifests itself as Certificates of Visual Impairment and Registration of Vision Impairment. Work underway in Moorfields Eye Hospital in London (funded by initially by Guide Dogs and more recently by the RNIB) has been looking at the quality of data collected through Certificates of Vision Impairment. It has included the development of a prototype Electronic Certificate of Vision Impairment to speed up the notification to social care providers of a patient’s significant and permanent sight loss causing social care needs. 2.2 Assessment of need Question 10 – Do you agree there should be a single right of assessment? Question 11 – Do you agree the new system will benefit service users and their carers, as well as professionals in understanding their duties of assessment? If not, why? Question 12 – Do you agree that law and policy should provide for proportionate assessments i.e. a formal prescribed assessment for people who have social care needs? Question 13 – Is it helpful to prescribe the assessment process and who should be involved? Question 14 – What information do you think should be included within the “common core” of a new integrated assessment? Question 15 – Will the new system be more efficient and provide local authorities with greater flexibility? Question 16 – Do you see a role for self assessment and if so, how would this work? Response: Question 10 We have concerns that the current language implies an assessment process done to people rather than with them. We refer to our concerns in Question 22 about care plans. Question 11 Yes, however we also think that local authorities should consider all needs during an assessment, irrespective of whether they can or are being met by a third party (see Question 12). This is important in cases where a service user might also be receiving care for a partner, parent or carer who dies. Question 12 A judgement by the UK Supreme Court, handed down on 31 May 2012, has clarified existing social care law in England and Wales on whether a council can take its finances into account when assessing the needs of people for social care. The Court confirmed it is not lawful for local authorities to have resources in mind when they assess needs [R (on the application of KM) (by his mother and litigation friend JM) (FC) (Appellant) v Cambridgeshire County Council (Respondent), 31 May 2012]. Lord Wilson, on behalf of the court, has set out a four-stage model for provision. The local authority should ask itself four questions (with commentary): -• “What are the apparent needs of the disabled person?” These should be assessed in full without regard to cost. -• “To meet the person’s needs, is it necessary for the local authority to make arrangements for the provision of services?” At this stage the authority is allowed to consider its own available resources, what the family can provide, what other agencies can offer, how much money the person has to pay for their own services etc. -• “If it is necessary, what is the nature and extent of the services to be arranged?” This will relate to the person’s ‘eligible’ needs, and will often be the cause of discussion and argument. -• “What is the reasonable cost of securing the provision of the services identified in the previous stage?” These costs should be set out in sufficient detail for the individual to understand what has been allocated to meet each need, so that he or she can challenge the sums offered if necessary. While we agree that the approach should be proportionate to the person’s needs, law and policy should make it clear that this four-stage model should be followed in all cases. Question 13 Yes, particularly the person who conducts an assessment. Welsh Deafblind Guidance currently requires a ‘specifically trained and equipped’ person to assess a person who is congenitally or acquired deafblind. A trained assessor is also important for those who have sight loss. One outstanding issue has been the lack of a fixed definition for ‘specifically trained and equipped’. The code of practice should set out a definition for ‘specifically trained’. Sense has produced a guide for this in Wales: http://www.sense.org.uk/help_and_advice/social_services/deafblind_guidance/suitably_qualified/suitably_qualified_wales Question 14 Paragraph 2.2.13 of the consultation refers to the common core of the assessment, which should include a specialist assessment of sensory loss. Question 15 Not answered Question 16 Those who would want to self-assess would be small in number. The key issue is the involvement of the person in the process and the statute should require this. Also, individuals may benefit from professional help. People who may have recently received a diagnosis of sight loss, for example, may present challenges to local services to recognise and offer support they may need. When asked, people do say that they are coping and sometimes do not recognise when they are not coping. For example, although NHS-based, Eye Clinic Liaison Officers (ECLOs) support patients and carers when sight loss is a concern. They also provide information on the impact of a condition, help registering as blind or visually impaired, advice on reducing falls, emotional support and referrals. A City University study (2011) found 90% of clinical staff who work with an ECLO agreed that they significantly improve the patient experience. 2.3 Portability of assessments Question 17 – Should the Bill impose a general duty on local authorities and their partners to provide social care services to a person in need who resides in their area? Question 18 – Do you agree that portability of assessment will bring greater consistency of care for services users? Do you agree that it will lead to savings? Question 19 – When someone moves into a new local authority area, what do you think is an acceptable period for which to require that the new authority must maintain the assessment of a service user before it reviews the case? Question 20 – Do you agree with our proposals for notification and transfer of information? Response: Question 17 We would support this duty. The power exists already to assess a person before a move between areas but it should be made a duty. The new assessment usually starts after the move to another area, which means that people cannot move if there can be no break in support. And there is always the risk at present that assessment in a new area can result in worse service provision, especially if the eligibility threshold is higher in the receiving local authority. Question 18 On proposal i – the duty on local authorities to accept an assessment from another local authority - we would want to see a duty to begin support planning when there is a firm intention to move (i.e. before the person has actually moved). Proposal i aims towards geographic consistency, which is an aim we support. The benefits of consistency would be savings in reducing duplication and the saved human cost of uncertainty and unsupported needs. Question 19 There is a need for flexibility. If there can be no break at all in the support received then any wait without support would be unreasonable. But for others there is a reasonable time for which they could wait for support. Also, moving home could mean higher or different needs depending on the area. For example, moving between urban and rural areas could mean that new support is needed to undertake daily tasks. Question 20 We broadly agree. There would need to be a duty to share and transfer information together with policy and protocols to ensure confidence in data handling, sharing and storage. 2.4 Management and review of care plans Question 21 – Do you agree that the statutory duty changes we have outlined above are the right ones to improve care and support plan and review systems? Question 22 – Do you agree that it will be important to prescribe, in the regulations and guidance, the different arrangements for the different needs? Response: Question 21 The missing element in this proposal is the statutory duty to meet eligible needs, from which a care plan will follow. In the consultation paragraph 2.4.13 the consultation implies that the care and support plan must be produced and reviewed for everyone who has an assessment. This appears to include those not entitled to state support. If this is correct then the statement in paragraph 2.4.15 that this will not result in increased burdens is not accurate. Question 22 At the moment the proposals look very much like support planning is something done to a person rather than a process done with people. This is why a statement in the statute as recommended in the response to Question 1 is important. At a minimum we would want regulations to prescribe consulting, involving and enabling the person to be involved in support planning together with a statutory right to advocacy in some cases – as outlined in Question 9. This would also cover parents, guardians or advocates, when appropriate. People with sensory loss have some basic support needs that could be prescribed as a minimum for a care plan. For example, interpreting support for D/deaf or deafblind people and support with mobility needs. 2.5 National eligibility framework Question 23 – Do you think that a new national eligibility framework will be beneficial? Question 24 – What do you see as the local authority’s role in setting criteria for eligibility and what do you see as the Welsh Government’s responsibilities? Question 25 – Do you believe that the current four-level definition of eligibility: “critical, substantial, moderate and low” is a helpful way of categorising eligible needs? Question 26 – Do you agree the new framework should extend to all categories of people in need – both children and adults? Question 27 – Do you envisage any particular barriers in operating a single eligibility threshold? How would you overcome these barriers? Question 28 – Should people be able to self assess for access to services? If so, how would you see this working? Response: Question 23 A national eligibility framework could be beneficial, if designed and implemented correctly. Having a framework is important because the alternative is a ‘postcode lottery’ with unfair local variations. On proposal k we support the national eligibility threshold but believe it should be set at moderate. We acknowledge that this would include more people in state funded support than there are at present but this would actually make more financial sense than setting the eligibility threshold higher. As a CSSIW paper said: “The potential savings from restricting eligibility criteria may not always necessarily be as significant as imagined. One local authority had costed raising the threshold and had concluded that this would not deliver significant efficiency savings. This authority was also concerned that raising the threshold to critical and substantial would limit existing preventative work.” [CSSIW, National Review of Access and Eligibility in Adults’ Social Care, September 2010, p. 5] Question 24 A key role for the Welsh Government is a continued emphasis on prevention and early intervention to prevent needs escalating. The response to Question 23 shows CSSIW evidence that raising the eligibility bar does not necessarily result in real savings. The Law Commission report [paragraph 4.34] said: “We agree that the provision of prevention and early intervention services is a key aspect of adult social care and should form a central element of the statute.” People with sensory loss often need a specialised response. For example, blind and partially sighted people need access to low vision aids, emotional support, mobility training and help with orientation. There are benefits to the service user and savings to resources when appropriate provision is identified by a specialist. For example, a client of visual impairment rehabilitation had for many years received a care package of domiciliary care. No other services had been offered to the client. The package was a high tariff involving 20 hours of worker time. During assessment the social needs of the client were raised. The client reported that they wished to meet more people. Rehabilitation was offered for the first time and the client began mobility training. After three months, the care package was reduced to 10 hours due to increased confidence and independence of the client. It is estimated that this saved the local authority £6,500 per annum. Question 25 If eligibility is being reviewed it is important that all the aspects of mobility, communication and access to information that are important to people with sensory or dual sensory loss. In our experience, the impact of sensory impairment is poorly understood by generic assessors, and knowledge is often limited, even among staff who work with specific groups where the prevalence of sensory loss is particularly high (such as among older people). So, we recommend that the eligibility framework should make explicit reference to the issues raised by sensory loss. In some respects the criteria are useful but they do not always recognise the value of prevention and early intervention. Some sight loss and blindness is categorised below the eligibility threshold. Often the main issue is that the local authority is not asking the right questions about the impact of a condition. For example, a client approached his local authority for an assessment. The client was a male in his 70s, living alone, registered severely visually impaired with rapid onset sight loss, leading to a slow acquisition of coping skills. No immediate support mechanism was in place, he had no relatives and significant need for medication due to advanced Type 2 diabetes. Initial referral was to a ‘one-stop’ call centre. The client was offered an initial screening telephone assessment that placed his need as low and as such the local authority refused to refer the client to the dedicated sensory impairment team within the authority. The client contacted the third sector who referred him directly to a visual impairment rehab worker. Assessment of the person by the rehab worker led to critical and substantial need identification, resulting in a comprehensive care package. Question 26 No, we would not welcome a single set of criteria for both adults and children. The needs of children with sensory or multi-sensory impairment (MSI) are unique and would not be well served by a single model that also deals with adults. According to Welsh Government guidance MSI “is regarded as any degree of dual-sensory impairment that has a significant adverse effect on the child or young person’s ability to access education. The children will have very different needs arising from a congenital loss, acquired loss or degenerative condition”. [Welsh Government circular, Quality Standards in Educational Services, No 34/2005, December 2005] One of the reasons that children and young people need more support (and therefore will incur higher costs) is that they have to be supported to develop social skills, life skills, independence, communication and mobility, all of which needs to be underpinned by extensive education and health support. The majority of people who are recipients of social care have acquired needs, and so have often learned communication, social and mobility skills during their lifetimes, so need more support with transition into disability and using existing skills and abilities differently. Children and young people with MSI in particular do not have the advantage of this learning, and therefore support needs to be intensive and is critical to their wellbeing and learning. Adult services are structured and focused differently, and make presumptions about abilities that do not apply to children with multi-sensory-impairment. They also deliver different kinds of services that would not be useful for a child or young person. For children with more moderate levels of disability, they will have different capacities and abilities to develop, to learn and to be independent, but meeting all of these needs would require a process of specialist assessments by suitably qualified multi-sensory-impairment professionals. Sense’s Reaching Out toolkit (http://www.sense.org.uk/Resources/Sense/Publications/Publications%20by%20topic/Publications%20for%20professionals/Reaching_Out.pdf, page 15) suggests some of the key areas that would need to be included as part of an assessment, and also outlines some of the interventions that may be required. The assessment areas differ from those in Sense’s suggested adult assessment, recognising the different needs of adults and children. Given that hearing and sight account for almost all the sensory input a person receives, for babies born deafblind (depending on the severity of their impairment) there is a real chance that they will be unlikely to develop formal speech or communication skills, and will instead develop their own methods of communication with parents and family. Question 27 Our response to Question 26 indicates the main barrier to operating a single eligibility system. Question 28 We do not think this would work. Eligibility criteria are used to screen people into and out of services, so a system of self-assessing for this would not work. 2.6 Rights of carers Question 29 – Do you agree that the proposed definition of a carer should be based on the one referred to in paragraph 2.6.8? Question 30 – Should we allow local authorities to include some carers who receive payments or have a contract for the care they provide within the definition of a carer, where the relationship is not a commercial or ordinary volunteering one? (In order that carers can receive an assessment and benefit from other support provided to unpaid carers.) Question 31 – Are there other groups of carers that are not covered but should be included? Question 32 – Should local authorities be allowed discretion to consider requests from Foster Carers or Adult Placement / Shared Lives Carers to be classified as a ‘carer’ and be entitled to request a carers’ needs assessment? Question 33 – Do you agree that there should be a duty placed on local authorities to publish information on carers’ rights and the services offered to carers in their local areas? Question 34 – Do you agree that local authorities should be required to offer a carer’s assessment to anyone who appears to the authority to be a carer with substantial caring responsibilities? Response: Question 29 Consultee responses to the Law Commission said the test was “unclear, confusing and complex” [paragraph 7.12] but the current Welsh Government proposals appear to propose continuing it. Question 30 There is a difference between, for example, someone giving direct payments to a family member (who may also be providing services on top of what is provided for by the direct payment) and a commercial support worker. Question 31 This is covered by the response in Question 34: anyone who appears to be in need of an assessment. Question 32 This is covered by the response in Question 34: anyone who appears to be in need of an assessment. Question 33 Yes, an open and transparent system would be desirable. Question 34 We think anyone who appears to be in need of an assessment should be offered one. This is supported by the Law Commission [Recommendation 21], which said: “The carers’ assessment duty should no longer require a carer to request the assessment in order to trigger the duty. Instead, the duty should be triggered where it appears to the local authority that the carer may have, or will have upon commencing the caring role, needs that could be met by the provision of carers’ services or services to the cared-for person.” And if needs assessments for service users are to be made portable this should also apply to their carers. 2.7 Direct Payments Question 35 – Do you agree with the proposal to use this Bill to bring together legislation regarding the provision of Direct Payments in Wales? Question 36 – Do you agree with the proposals to allow Welsh Ministers broad powers to extend the existing Direct Payments arrangements so that they can introduce an effective model of self-directed support and control that also encourages a greater uptake of Direct Payments arrangements in Wales? Question 37 – Do you have views on other ways in which Direct Payments could be extended beyond the current scheme? For example, should they be extended to allow the purchase of residential accommodation or to allow a local authority or independent organisation to be an agent or a broker for services and hold a budget on the service user’s behalf? Response: Question 35 Yes, we note a separate consultation on self-directed support is forthcoming. There is a need for clarity in this area as terms and definitions are sometimes used interchangeably and are not well understood. A Sense members’ survey across England and Wales (2008) found 31% of people surveyed did not even know what direct payments are although 39% of people surveyed used them at the time of surveying and 24% had decided not to use them. A judgment by the Supreme Court (KM v Cambridgeshire CC), handed down on 31 May 2012, said that if direct payments are offered so a person can purchase services, they must be both transparent and reasonable to meet the cost of the services. The Bill should incorporate this judgment to ensure that direct payment provision is both transparent and reasonable. We have observed in England the temptation in some local authorities to change the commissioning of core specialist services, such as rehabilitation for blind and partially sighted people, from block contracts to more of a spot purchasing approach. This appears to be paving the way for such services to be dependent on Personal Budgets, The danger is that such services may not survive if income streams become sporadic. We have found that people who are D/deaf, deafblind or have complex needs often underestimate their requirements for communication support when engaging with non-specialist providers. We would urge that the additional communication costs required to secure specialist providers or interpreters to access generic support are included in the calculation of direct payments. Question 36 Yes, it would be prudent to enable Ministers to have these powers even if they are not to be used straight away. However, choice and control should also be extended to people who do not want direct payments. If they wish to, people should be in control and fully direct their care and support planning and delivery, which would include the writing of a care plan. They should also be supported to lead reviews and change providers if services are not acceptable. Choosing and selecting who supports them is a key part of self-directed support. Question 37 The crucial thing for making direct payments more effective at giving choice and control is for people to have flexibility when deciding how to use them. Core care and support should be complemented rather than replaced by community support. 2.8 Complaints and the Public Services Ombudsman Question 38 – Do you agree with the proposal that people funding their own social care should have their complaints considered by the Public Services Ombudsman for Wales (PSOW)? Question 39 – Do you agree that the PSOW’s remit should be extended to care homes and domiciliary care agencies only, or that a wider extension to his remit should be considered? Question 40 – Do you agree that the PSOW’s remit should be extended to independent palliative care services? Question 41 – Do you agree with the proposal to allow the PSOW to consider complaints about matters arising, prior to the PSOW’s powers being extended? Question 42 – We are not proposing that “information sharing powers” between CSSIW and the PSOW be included in the proposal, and expect that a protocol between the two bodies will be established. Do you agree that this is sufficient, or should information sharing powers be considered? Question 43 – Do you agree that individuals who have complaints about independent palliative care services should also be able to access advocacy services? Response: Question 38 Yes, we believe this is a good idea. If a person’s complaint is not resolved to their satisfaction locally there is currently no further system of redress. Question 39 Any widening of the remit should be staged. We note these proposals are similar to the changes in England. In England, complaints about adult social care increased by nearly 50% in 2010/11 after the Local Government Ombudsmen’s (LGO) remit was widened to cover self-funded social care. [LGO, press release, July 2011]. The Annual report of the LGO 2010-11 also anticipates further increases: “We expect the rising trend in complaints numbers to continue over the next year. This is linked to potential growth in demand for our service as a result of public spending reductions and an increase in complaints about privately funded or arranged adult social care.” Question 41 Not answered Question 42 The most important consideration is clarity and transparency. The protocol needs to encourage information sharing. Question 43 We do not believe that the complaints process should be the priority for additional advocacy support and that priority areas should be in the safeguarding process and also where active participation during the assessment or re-assessment process would not be fully attainable without an advocate. 3. Strong national direction and local accountability for delivery 3.1 National Outcomes Framework and Standards for Social Services Question 44 – Do you agree that there should be a duty on Welsh Ministers to encourage improvement in social services and social care services (as defined in this Bill) in Wales? Question 45 – Do you agree that Welsh Ministers should have a duty to publish (from time to time) and review (periodically) a statement of national outcomes for social services and social care services? Question 46 – Should there be a power to specify performance standards to be met by local authorities and social care service providers to sit beneath the national outcomes framework? Question 47 – Should the standards be measured through performance indicators? Question 44 Yes, improvement should be a duty for Welsh Ministers. There should be broad targets to indicate whether improvement has been achieved. Question 45 Not answered Question 46 There is a need to avoid the situation where compliance with performance standards could become an administrative burden, which could detract from service delivery. Question 47 Yes, on proposal x when local authorities publish their outcomes they should have to break these down for different groups. The key issue will be those who are missed. For example, if there is a 98% success rate but the 2% who do not receive acceptable standards of care all have sensory loss this would need to be identified. 3.2 Code of Practice Question 48 – Should there be a duty on Welsh Ministers to prepare a Code of Practice to bring together statutory guidance on social services matters? Question 49 – Should Welsh Ministers be required to consult on the contents of the Code of Practice before it is introduced? Question 50 – Should Welsh Minister be required to consult in advance on any substantial amendments that they propose to make to the Code of Practice? Question 51 – Should the Bill specify that the Code of Practice must be followed by authorities acting under the legislation and can only be deviated from where there are good reasons to do so (although this proviso would not give the freedom to take a substantially different course)? Question 52 – In addition to the Code of Practice, should Welsh Ministers retain their existing power to issue directions on certain matters, such as policy or practice guidance? Response: Question 48 Yes, and it should remain a statutory document. Question 49 Yes. Question 50 Yes, but we would prefer an affirmative resolution procedure in the National Assembly to approve it. Question 51 Not answered Question 52 Not answered 3.3 Directors of Social Services Question 53 – Do you agree that we should place the requirement to appoint a Director of Social Services on the face of the Bill and have powers to specify the competencies that a Director of Social Services should have? Question 54 – Do you agree that the local authorities should be able to share a Director of Social Services? Response: Question 53 There needs to be clarity in the leadership and accountability of social services. Question 54 Not answered 3.4 Collaboration in integrated Social Services Question 55 – Do you agree with the proposal to introduce a single consistent set of powers relating to the creation of formal partnerships in Wales, for the purpose of delivering integrated services? Question 56 – Do you agree with our proposal to introduce powers to define in Regulations and guidance the parameters for developing formal partnerships and pooled budgets and to set out how and when these will be used? Response: Question 55 Not answered Question 56 Not answered 4. Safeguarding and protection 4.1 A National Independent Safeguarding Board Question 57 – Do you agree with the view of the Welsh Safeguarding Children Forum on the role and function of the National Independent Safeguarding Board? Question 58 – What type of organisation do you think the Board should be? How would the relationship and accountabilities with Welsh Ministers and Safeguarding and Protection Boards be constructed (see section 4.2 – Safeguarding and Protection Boards)? Question 59 – How should the Welsh Government achieve service user representation on the Board? Response: Question 57 Yes, and if the positive aspects of children’s safeguarding principles can be made statutory for adults we would welcome. Question 58 Not answered Question 59 Representation for sensory loss would be welcome. There is a need to consider how service user representation can be achieved for those with co-occurring dual sensory loss and learning disabilities and complex needs. There may need to be proxies nominated where literal service user representation at Board meetings would not be viable. 4.2 – Safeguarding and Protection Boards Question 60 – What do you think the functions of the Adult Protection Boards and Safeguarding Children Boards should be? Question 61 – Do you agree that a funding formula is needed? What approach should be taken to devising this formula? Question 62 – Do you think that the existing statutory membership of LSCBs is sufficient for Safeguarding Children Boards? What additional members should be included within the membership of Adult Protection Boards? Question 63 – Should there be a requirement that all Safeguarding and Protection Boards have independent Chairs? Please explain your rationale. Response: Question 60 They should also monitor England and Wales issues (cross border and non-devolved matters), such as Criminal Records Bureau checks and issues related to the Independent Safeguarding Authority. We have some concerns that their representative function may be difficult to implement with only six rather than 22 boards. Question 61 A funding formula can ensure a reasoned and justified allocation of resources. A ‘devolved’ settlement to the boards can ensure ownership and accountability. The formula should balance both population size and relative needs. Sparsely and densely populated areas have different populations and needs. Question 62 Not answered Question 63 There is a need for healthy challenge, so a chair should be independent. Appointment processes also need to be transparent. 4.3 Adult Protection – a new legal framework Question 64 – Is the scope of what would constitute an ‘adult at risk’ reasonable? Question 65 – Should the duties on agencies to protect adults at risk be based on someone being the victim, or potentially the victim of ‘harm’? Question 66 – Should the definition of an ‘adult at risk’ also take account of where, or in what circumstances, the abuse has taken place and whether someone is unable to safeguard themselves as a result of their health and social care needs (paragraph 4.3.9)? Question 67 – Is the range of agencies that the Bill will places duties on appropriate? Are there any other agencies that should be considered for inclusion in this framework, and if so why? Question 68 – Should a duty to report apply to all the agencies encompassed by other duties? If not, why not? Who should the duty apply to? Question 69 – Should the legislation include powers of intervention? If so, what should be the nature of these powers? Response: Question 64 Yes, but it also needs to take into account the isolation that comes with many conditions like a sensory loss or learning disability. Those who have small social circles or support networks may not be able to disclose abuse and might not even have contact with people other than the person presenting the risk. This is particularly an issue for those using direct payments. We also note that in paragraph 4.3.8 of the consultation there is no mention of institutional abuse. Question 65 The duties must include those potentially at risk of harm underpinned by a sound understanding of the risk factors facing individuals with sensory loss. Question 66 We would agree with the need for the suggestion in paragraph 4.3.9 of the consultation about the third category: a person being unable to safeguard themselves because of their condition. Otherwise cases that should be considered straightforward crimes would become safeguarding issues inappropriately. Question 67 Not answered Question 68 On the duty to co-operate in paragraph 4.3.12 of the consultation, it is not clear what the duty actually is. Question 69 This is a difficult issue facing not just the Welsh Government. Some kind of last resort powers are needed but human rights issues need to be at the forefront of consideration. This reinforces the need for the statement of principles as outlined in response to Q1. 5. Regulation and Inspection 5.1 Workforce registration Question 70 – Do you believe that the current definitions of social care workers in the Care Standards Act 2000 are broad enough to capture workers in new models of service delivery? Question 71 – Do you agree that the Care Council should have powers to regulate the training of all social care workers, not only social workers? Question 72 – Do you agree that Welsh Ministers should have powers to make regulations that reserve certain activities to staff with certain specified qualifications? Question 73 – Do you have views about what activities should be reserved to staff with certain specified qualifications? Response: Question 70 We are clear that any changes should tackle a demonstrable problem with a suitable solution to achieve a desirable outcome. More regulation does not necessarily make service users safer. However, we acknowledge that new models of service delivery suggest existing legislation should be updated. Question 71 There needs to be a stronger case made for the registering of absolutely all ‘social care workers’. People who provide certain functions by direct payments may not provide enough care to make this viable. Regulation of functions rather than roles might be more viable. However, there ought to flexibility as there are some areas like intimate personal care where people may feel strongly that they want family members to perform these tasks and others feel equally strongly that they do not want family members to be involved. Question 72 Yes, to promote consistency and quality of some specialist interventions. Question 73 Deafblind specialist assessments, as currently prescribed by Welsh Deafblind Guidance, should be undertaken by a ‘specifically trained’ person. A definition for Wales is suggested here: http://www.sense.org.uk/help_and_advice/social_services/deafblind_guidance/suitably_qualified/suitably_qualified_wales Rehabilitation officers for people who experience sight loss should have specified qualifications. For example, a fully qualified Rehabilitation Officer for the Visually Impaired (ROVI) is the only specifically trained professional in the visual impairment field who can: -• Complete a full social care and functional vision assessment. -• Draw up a resultant habilitation/rehabilitation plan. -• Provide the required habilitation/rehabilitation training (which is aimed at enabling the level of independence that the visually impaired client wishes for themselves as identified within the assessment). -• Measure/monitor the whole process whilst reviewing the effectiveness of the input. Other examples include teaching children with visual impairments, as in RNIB Cymru’s Visual Impairment Pathway, which lists the recommended qualifications for a Qualified Teacher of children with Visual Impairment. Workers with young people in transition should also have specified qualifications. 5.2 Service Regulation 5.2a Extending regulation to new service categories Question 74 – Do you agree that Welsh Ministers should be able to bring appropriate new service delivery models into the scope of the regulator? Question 75 – Do you agree that social work services should become a regulated service? Question 76 – Do you agree that the registered manager of the service must be registered in the social work register of the Care Council for Wales? Response: Question 74 Yes, it is necessary to be able to include new service models. Question 75 We think that adding new models of service should be in Welsh Ministers’ powers, subject to National Assembly resolution. Question 76 Not answered 5.2b Revising the registration model for social care services Question 77 – Do you agree that there should be powers to make registration time limited? If so, should this be introduced in a staged way? Question 78 – Should certain services, as a matter of principle, be exempt from this provision? If so, why? Question 79 – What sectors/services do you believe would be particularly suited to this model? Question 80 – What issues do you think this model would raise? Response: Question 77 We recognise that there is merit to the case for time limiting registration. Question 78 Not answered Question 79 Not answered Question 80 For organisations that bid for tenders the renewal of registration could be a problem. For example, if an organisation is bidding for a five year contract but their registration needs to be renewed in three years this may create uncertainty for the commissioner and harm the organisation’s bid. 5.2c The Register Question 81 – Do you agree that the register should contain specified information? Question 82 – Do you think that this approach will enable service users and their carers to make decisions about services they use or may wish to use? Question 83 – Do you agree that there should be information sharing powers afforded to the regulator? Question 84 – Do you agree that this approach will drive up improvement? Response: Question 81 We have no objection in principle to this policy. Question 82 This approach would enable service users and carers to access specified information for making decisions about services, which would be welcome. Question 83 Not answered Question 84 It would improve access to information, which is welcome. However, it would not in itself guarantee improvements. 5.2d Organisational governance and quality assurance mechanisms Question 85 – Do you agree that these reports should be publically available? Question 86 – Do you agree that we should specify matters for public reporting? Response: Question 85 We have no objection in principle. It would be also be helpful to include case studies in the reports also. However, it would need to be proportionate, particularly for smaller organisations. Given this, the duty to publish reports and make them publically available should not fall on the organisation but should be the responsibility of regulators. Question 86 In principle we think it should be specified but we would want to see more detail. There is a potential danger for perverse incentives, as in any public reporting mechanism. For example, if the number of referrals for Protection of Vulnerable Adults (POVA) is publicised, and this is perceived to be negative for an organisation, this could potentially mean an organisation would stop doing its duty to refer. 5.2e National Minimum Standards Question 87 – Do you agree that we should remove the word ‘minimum’ from sections 23 and 49 of the Care Standards Act 2000 Response: Question 87 On proposal ba the intention of removing the word minimum is to drive up standards but we are not sure what this would mean in practice. 6. Services 6.1 Adoption Question 88 – Do you agree the functions that a National Adoption Service will be responsible for, as set out in paragraph bb? Question 89 – Do you suggest any additional functions that should be included? Question 90 – Are there any other barriers to the current arrangements that should be considered in the development of the Social Services (Wales) Bill? Question 91 – Do you have any other comments that you wish to make about our proposals for a National Adoption Service? Response: This section is not answered. 6.2 Transitions for disabled children and young people Question 92 – Are there any key, identifiable entitlements that disabled children receive that would be of continued benefit beyond age 18 for those with the most complex needs? Please provide details and rationale. Question 93 – Do you have any suggestions for how we might define “complex needs”? Response: Question 92 Not answered Question 93 We would define ‘complex needs’ as having more than one disability (including multi-sensory loss), the interaction of which has an effect on the ability of the individual to learn and to function as an independent person. Sensory loss is a multiplying rather than an additional factor. Since so much of what people learn comes through sight and hearing those without either sight or hearing or without both face additional difficulties. In particular, children with multi-sensory impairment need particular specialist support with development and education. The RNIB briefing, ‘The reasons blind and partially sighted children and young people need specialist educational provision’ shows there is a high prevalence of blindness and visual impairment in children who also have with learning needs, severe learning needs and profound and multiple learning difficulties (PMLD) [http://www.rnib.org.uk/professionals/documents/evidence_base_briefing.doc]. At the moment children with visual impairment or single sensory impairment and no complex needs can experience serious difficulties over the transition period and will miss out if this is limited to the complex needs bracket. With the right support these young people will succeed or otherwise will drop out and fall into the NEET category. RNIB Cymru’s Visual Awareness Pathway sets out key entitlements at different levels and those with complex needs fit into the highest tier, number four. We note that the definition for children and young people for the Welsh Education department goes up to age 25 and we believe this should be matched with the Health and Social Services model. Sense recommends in Moving On [Sense Children’s Specialist Services, Moving On, 2012] that a 0–25 system would need to be aligned with education and health care agencies using a multi-agency approach supported and co-ordinated by a key-worker. It also recommends that eligibility criteria would need to be structured to ensure that a child with multi-sensory impairment, regardless of the degree of impairment, would be able to access social care and support such as an intervenor [http://www.sense.org.uk/about_us/our_services/intervenor_schemes]. 7. Implementation of proposed legislation 7. Implementation of proposed legislation Question 94 – Throughout this document we have identified the impacts of the proposals we would like to include in the Bill. Do you have any comments on the impacts that we have identified? Question 95 – Do you agree with our analysis of the impacts? If not, why? Question 96 – What do you think the potential cost implications are for the new proposals? Could the new duties be met through minor changes to current arrangements etc? Question 97 – Are there other areas of impacts we should be considering? Response: Question 94 In the consultation paragraph 2.4.13 the consultation implies that the care and support plan must be produced and reviewed for everyone who has an assessment. This appears to include those not entitled to state support. If this is correct then the statement in paragraph 2.4.15 that this will not result in increased burdens is not accurate. Question 95 Not answered Question 96 Not answered Question 97 Not answered Final Consultation Question Question 98 – We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please let us know. Response: Question 98 Children Sense’s Children’s Services survey in 2012 found Welsh authorities identifying 70 children and young people needing intervention whereas Sense estimates more than 200 aged 0 – 19 in Wales [Robertson J and Emerson E, Estimating the Number of People with Co-Occurring Vision and Hearing Impairments in the UK, 2010]. Transitions On transitions, there are multiple pieces of work going on that need to be connected with the Social Services Bill. For example, Ken Skates’ Private Member’s Bill in the National Assembly and other transitions work elsewhere in Welsh Government. Sense research in the Moving On report (2012) said there was a need for clear information and lead agency or key worker to co-ordinate across the agencies. There is a need to reduce the number of assessments and to assess what a young person’s needs will be after leaving education.