08/02/2017 The Wales Report

We talk about the state of social care in Wales -

faced with rising demand and increasing costs.

The Brexit journey for Wales, and its effect on Labour.

We'll be talking to the former leadership contender Owen Smith.

And, the rising rate of suicide among men.

We'll be talking about tackling isolation and stigma.

Good evening, and welcome to The Wales Report.

First tonight, the cost of social care in Wales is set to double,

more or less, over the next 15 years as the population grows older.

The question is, how will that growing demand be met?

Remember, you can join in the discussion tonight ?

As we approach local government elections in May,

one of the questions is how care services provided at home,

as well as in residential care homes, are funded.

The Welsh Local Government Association says this is the biggest

problem faced not just by them but by all decision-makers

In a moment, Bethan Rhys Roberts will be asking the Minister

for Social Services, Rebecca Evans AM, how she intends

to deal with the increasing pressure on the system.

Deciding you need support from social services isn't easy for

anyone. Margaret Morgan and her husband, Malcolm, always thought

they'd be able to stay in their own home, but Malcolm has dementia and

he now needs round-the-clock care in a residential home. It hasn't turned

out as it was planned. We'd spoken about this quite often and we bought

we might be able to live at home and stay at home, but the condition that

Malcolm has now, I couldn't look after him at home. I did for as long

as I could, and it would have been impossible. Nursing in care homes

like this are a vital part of the social care system. They provide

around 23,000 beds across Wales, doubled the amount available in the

Welsh NHS, so it's clear that homes like this do help to ease the

pressure on hospitals. There are concerns that, despite fewer cuts to

social care here than in England over the last few years, the care

market in Wales is fragile, and that makes the system unsustainable. For

Margaret, Malcolm and many others, it's an uncomfortable truth. I worry

what I'm going to do and what is going to happen. I don't know what's

going to happen. If they haven't got any money now and there are going to

be many more older people, it's not a problem that's going to diminish.

It's to get worse. It's a great problem. The county of Conwy offers

a glimpse of the future. Across Wales, one in five people are over

65 but, dear, it's oh -- it's one in four. The proportion in the rest of

Wales is opposed to reach that by 2032. Cared -- care providers say

that while demand is growing the number of community beds available

is shrinking, which in turn is putting more pressure on the health

service. Recently we have had seven care homes closing in the county

with the loss of 133 beds, 8.4% of local provision, and that's been on

top of the homes that have closed in recent years. We've lost around 20%

of our provision. We can't meet the current demand, so we are seeing

problems in the local hospitals, where there is delayed transfer of

care. The deputy manager of the home says the care needs of residents are

becoming more and more complex. The needs of clients coming in are

increasing. We seem to be getting a lot more residents with quite

chronic conditions, sometimes quite acute illnesses that we are looking

after their in the homes, rather than, I would imagine in the past,

they would have been hospitalised. They are becoming more dependent. In

contrast to England, most Welsh care homes are run by small, independent

providers meaning that, when costs go up, they are more vulnerable. The

pressure is so great now that are having to provide more hours of care

than they are being paid for. We are currently funded to provide 23 care

hours per resident per week, but we are actually delivering 25, so the

two hours per resident per week shortfall we are having to make

ourselves from our own funding. These are the most vulnerable people

in society we are looking -- we are looking after and we have to make

sure we deliver care that they need, and those needs are increasing. They

have increased significantly. Funding hasn't kept up. Local

government in Wales has called for the funding crisis in social care,

including residential care and care at home, to be addressed urgently,

but it's the long-term pressures that cause real concern. The health

foundation recently published a report which shows the current cost

of social care in Wales is 2.3 billion. By 2030, it nearly doubles.

The question is, if local authority budgets have gone back in recent

years to levels that we had in 2004, 2005, no growth in those benefits,

how are we going to meet at anticipated growth in social care?

It is clear that social care and health care depend on each other, so

local health boards, local authorities and care providers need

to work more closely together to deliver a joined up service. I think

that's starting to occur in many places. We are starting to see the

integrated care fund, ?50 million, where local authorities work closely

with authorities, great schemes like extra care schemes, a range of

strategies around learning disabilities, but we need to up our

game and make sure that those are not isolated examples of good

practice, but that good practice travels across Wales. Others believe

that poor planning and a lack of political leadership are to blame

for the situation. I think we are seeing, in a relatively mild winter,

huge pressures and not just in Wales but across the UK, and this is no

surprise. This should be no surprise to anybody. The fact that we still

don't have an integrated independent care sector of ring step-down

respite beds, that is able to care for people with dementia in crisis

situations, there is not any cohesive structure to do that, and

we should have that by now. The reality is that we are 1 million

miles away from where we need to be, where we could have been, and we

need a wake-up call. Is that, as Wales's population continues to grow

older, demand on both health and social services services will

continue to rise. So the difficult question politicians need to address

now is, just how will that demand be met?

Bethan Rhys Roberts talking to Social Services

and Public Health Minister Rebecca Evans.

How do you see it? Are we facing a crisis in social care? The Welsh

government is under no illusions that there are real pressures in the

social care sector, which is why we have prioritised it as a sector of

strategic importance, and whilst in England they are cutting the funding

for social care, in Wales we are investing in it. An extra ?25

million in the budget for social care this year and an extra ?10

million to recognise the extra pressures the national living wage

will put on the sector. We take these discussions having discussed

them with care in Wales. But there is still a shortfall of 92 million.

This year, that is despite you putting extra money in. You heard

from Margaret Morgan, who is worried about the future. The demand is only

going to increase. What is the long-term answer? The social

services and well-being act, which came into force last April, was

predicated on the understanding that demand for social care will grow and

public finances will become tighter, so we are taking a preventative

approach, seeking to support people more at home and in the community.

Many people don't realise that the number of people having residential

care at the moment is declining because of the success of being able

to support people at home. But you heard there that we are 1 million

miles away from where we should be when it comes to respite care,

step-down beds and the sort of help for carers as well. Surely you must

be concerned and you could do more. We are not where we want to be yet,

but we are investing in integration of social care throughout our

immediate care fund that fund is worth ?60 million this year and we

pledge to keep that going throughout this Assembly, because we know how

important a whole system approaches. Health and social care working

together to meet the needs of people. So is the example to

integrate it completely? There are two ministers in charge, one of the

NHS and you for social care. Should it be fully integrated? The health

minister and I work very closely on integration, which we are keen to

drive forward. The intermediate care fund is already showing good results

in terms of demonstrating numbers saved to the NHS, preventing

unnecessary hospital admissions. What about the idea that is

happening in England of raising council tax, giving councils the

right to raise council tax? Is that a possibility long-term? We are not

taking that approach in Wales because the Welsh government is

directly investing in social care by providing extra money to local

councils. Raising council tax isn't necessarily fair. Some parts of

Wales have a much larger proportion of older people than others and

obviously, if we were to put the burden on local authorities to raise

council tax to pay for that, it would disproportionately affect some

areas of Wales. No rise in council tax, you are putting the money in

but there is already a shortfall. Are you just going to live year by

year with a shortfall and just crisis management? We would like to

take a longer, more sustainable look at social care but we need the UK

Government to help us. They had an enquiry which produced a report and

recommendations on the future of social care funding but

unfortunately they have said there will be no change until at least

2020 in response to that, so that means we can't plan on

consequentials and we don't know what long-term funding will be.

These are issues beyond our control but, within our control, we are

doing everything can to make social care good quality and fair across

Wales. Do you stay at wake -- do you stay awake at night worried about

social care and the future and the growing challenge? I am under no

illusion how fragile the sector is in Wales and the fact that the Welsh

government needs to support it, but we are working hand in hand with the

Welsh Local Government Association and the third sector to give us a

sustainable approach for the future. Everything we can do in order to try

and make the system sustainable and good quality, we are doing.

Bethan Rhys Roberts talking to Social Services

and Public Health Minister Rebecca Evans.

Britain's journey towards Brexit has progressed a little further this

week, with the Bill which triggers the Brexit process moving

to the House of Lords from the House of Commons.

Despite Jeremy Corbyn's instruction that Labour MPs should approve

the Article 50 process, not all of his Labour

47 Labour MPs rejected party orders last week,

and they opposed the Government's Bill.

One Labour MP who voted against the Bill, and who stood

against Mr Corbyn for the party's leadership last year, is the Member

I asked him if he was simply out of touch with public opinion. My view

is that I was not elected to parliament for my hometown, my

community in order to vote for things that will make my community

poorer, and I am absolutely convinced that Brexit, if it goes

ahead on the rock-hard terms the Tories are now proposing, for

ideological reasons within their own party, in Pontypridd and working

class communities like mine across Britain, we will get poorer. We said

before the referendum that Brexit on these terms will make Britain... I

didn't come into politics to do that to the people I grew up with and

represent. Have you discussed your position with Jeremy Corbyn and that

you are persisting with your line? I haven't spoken to Jeremy Corbyn

since September 30 four. Do you feel a sense of obligation to the leader

in the sense that he is trying to maintain a party line? Jeremy Corbyn

was always a Eurosceptic and didn't fight for us to stay in the EU, and

he is now in my view weaving through a Brexit on the worst possible terms

for the people we in the Labour Party are meant to fight for and

speak for. I am not prepared to do that, so I'm going to continue

making my case and continue to speak up for what I believe to be the best

interests of the constituents I represent and the country. The first

duty of an MP is to speak without fear or favour in the national

interest, and then in the interest of his or her constituents, and I

feel absolutely confident and comfortable that I am doing that,

and I am also confident that as a democrat those people I represent

will have an opportunity at the next election to make their judgment as

to whether that will be in their interests or not.

What do you say to somebody who comes up to you on the streets of

Pontypridd and say, we voted to leave, you are not represented as

probably? I have had thousands and thousands of e-mails and letters,

many from my constituency. They have been overwhelmingly in favour of the

position I have taken. I went to the rugby on Saturday to watch

Pontypridd versus Carmarthen, and not a single person came up to me to

tell me they thought I was making the wrong decision, but a lot of

people came to me saying that I proved what I was doing, the stand I

was taking, and even if they didn't agree, they want a politician who

has the courage of his convictions. When colleagues talk about party

discipline and the fact that it appears disunited, what do you say

to them? Do you say that has to take second-place? The party clearly is

disunited. Some MPs from the whips' offers are doing the telling and

voted against the bill just a few days ago, the party is completely

divided on this issue. In that respect, it does reflect the

country. The country remains divided. But I'm very clear that

Brexit on these terms for sure is going to be bad for people in this

country, bad for my constituents, and I'm going to keep saying that.

Carwyn Jones was very clear, saying that freedom of movement is

politically and issue that has to be dealt with, and that people do have

legitimate concerns about levels of immigration. Is that a line that you

feel comfortable with yourself? Well, I agree with Carwyn that

freedom of movement is something that needs to be addressed across

the whole of Europe. I said that during the summer, during the

election campaign, and took some criticism for it. But I'm confident

that other countries in Europe, France and Germany, also want to

address it. It is a common problem across Europe. What I'm equally

certain of is that if we were to simply pull up the drawbridge in

respect of immigration in this country we would actually be doing

ourselves damage in terms of our economic future. And crucially,

immigration isn't going to stop once we exit Brexit, once we exit the EU,

you know, the reality is that people who are discomfited by immigration,

I think it is a mixture of immigration from within the EU and

without, there will be no change to immigration from outside the EU. And

in reality I suspect that people will be ultimately disappointed,

disappointed that they were lied to about the extra money that was meant

to come into the NHS, for example the famous ?350 million per week

that we're never going to see. And disappointed too there will not be

visible, substantive change in terms of immigration. When the First

Minister and others within Welsh Labour talk about full and

unfettered access to the Single Market, that has been described as

completely unrealistic by others, do you think that is a prospect that

they should be holding up? I wonder if you think that is deliverable in

these circumstances? I absolutely think we should still be aiming to

be a member of the Single Market. My view is that, my view is very clear

that we will still be better off if we'll within the EU, and we need to

hold open that possibility. In case the Government fail to get a thing

like a good deal for us on Brexit, rather than falling out of the EU on

to a terrible trade organisation terms, we need to retain the

possibility of staying in, at least throughout the transitional period.

But the crucial thing is of course we now know that the Government or

intending to not enter into any further realistic, substantive

engagement with the Single Market. Theresa May says we are leaving the

Single Market, she says we are also probably leaving the customs union.

That is a definition of a rock hard Brexit, the worst kind of Brexit but

only the real Eurosceptic head-bangers on the Tory side of the

aisle have ever wanted. That's why they are so happy. There is clearly

a difference of emphasis between what you are saying and the tactics

taken by your colleagues in Cardiff Bay. You asked all basically

fighting the campaign to try to the, that is the opposition. Carwyn

Jones's view is that there is no question of staying in, it is how we

come out, it is not whether we come out, it is how we come up. That

difference is therefore alter sees a POI suppose it is. The reality is

that the decision will be taken in Westminster, Britain is a member of

the EU, not Wales. Of course, colleagues in Cardiff Bay will

rightly make their opinions known. I'm disappointed that the Supreme

Court didn't rule that there should be more formal consultation with the

national assembly, because there ought to be. There will be changes

that will have dramatic impacts for Wales. Carwyn Jones ought to have a

seat at the table in shaping whatever the future of the country

looks like. My contention is that we still don't know where this is going

to end. There are many, many unknowns in this long process. This

may take two years, like the Tories are telling us, but I suspect it

will take a lot longer. During that period, our economy will change, the

global security situation may change, the volatile world we live

with, Putin at one end and Trump at the other, may change public

opinion. It is perfectly conceivable that all of these things may flux

and shift over the next few years, and we need to retain the

possibility of having continued access to the Single Market, and

having continued membership of the European Union. Mr Smith, good of

you to come in, thank you very much. The latest facts on male suicide

in Wales, according to experts, In Wales, men are nearly

four times as likely Male suicide is a particular problem

in rural communities, with the latest figures showing that

six farmers took their Emma Picton-Jones runs a charity

to raise awareness of mental health She set the charity up

after her husband Daniel, a farm worker, took his own life

in June last year. Daniel and I met just over five

years ago. And, you know, we were kind of your average young couple in

our 20s. I knew that Daniel had problems with mental health, that

was quite apparent from the beginning. He wasn't ever hiding it

from me. He was very good at hiding it from other people. Daniel worked

on farms. And I think that specific kind of sector is quite an isolated

sector. You can be doing 12, 13, 14 hour days on a tractor by yourself

at times. I think he found that hard. You are around people who are

very masculine. There is a real, like, sense of what you should

behave like and how you should be. That night, he said, I think I'm

going to go and talk to my Nan. That was really the last time that I saw

him. He told us he loved us and gave us a kiss and he went. Looking back

now, he was outside. To have ten or 15 minutes before he left. And in

hindsight, I mean, I couldn't be too sure but I think he was probably

putting things in the car. In order to... I think you probably knew what

he was going to do. -- I think he probably knew. The thought never

crossed my mind. I thought that the children and myself... I had a phone

call at two o'clock. He rang and he said, you know, I love you, he said

he was going to go and speak to his mum. I was half asleep and I

remember thinking, gosh, it's 2am, why are you going to speak to your

mum? Just come home, you know. He said, no, I'm going to go and speak

to mum. I love you. That was it, kind of thing. Yeah, so that... He

didn't go down to his mum's. Gijon himself. -- Gijon himself. He

hung himself on the tree outside his family home. And we actually lived

on a caravan there for two years. And the tree was right outside the

caravan. I just remember falling to the floor and just screaming. My

first thought was, the poor children, that was my first thought.

Like, my children, they haven't got a dad any more. And I was just

devastated for them. It's just pure devastation. Like nothing I've ever

felt before. Sorry... Reading that letter, there was, sort

of the part I suppose that resonated the most with me was the part that

really drove me forward in supporting other people with mental

health problems, where he said that we weren't able to help him, but we

could support other people. I wouldn't want anyone to have to read

that letter from the person that they love, or read that letter

directed to their children. I'm dreading that day that my children

are asked to read that letter. I really, you know, I feel like if I

could stop somebody else from having to read that letter and having to

get their children to read or have their children read that letter,

then that would mean, you know, it would mean everything to me. Our

thanks to Emma for sharing that very painful experience.

I'm joined now by actor and writer Boyd Clack, who has spoken

about his own personal experiences of mental health issues.

And Richard Bundy, from Welsh mental health charity GOFAL.

Good of you both to come in. Richard, for you, what are the main

issues that arise from Emma's storage? The huge issues that came

up for me with the issue of isolation. I think the peer pressure

that men face in the terms of the way they are perceived and expected

to deal with problems. I think, inevitably, it draws thinking around

stigma and the way people may feel judged, that may present a barrier

for people seeking help. I think that talking about mental health

problems has become much easier for people. Of course, it's still there.

The problem is of course, the thing is, when you are suffering from

mental health problems, you have a great feeling of isolation and fear.

Isolation, fear, and profound unhappiness. Now, these things are

the things that stop people communicating. What kind of

framework of help is there at the moment in Welsh terms? And have you

seen a noticeable increase in the kind of take-up of people asking for

help? Yes, well certainly with the introduction of the Welsh mental

health measure in 2010, our primary objective there was to improve

people's access to mental health services. And certainly the

introduction of primary mental health care teams, working alongside

GPs, has opened up a huge level of demand that wasn't being satisfied

before. In terms of policy and strategy, I suppose Wales has been

ahead of the game in some respects. I gather from the mental health

strategy, the measure introduced in 2010, and I think within the context

of suicide, there is a suicide and self harm prevention strategy which

was introduced in 2015. That is due to be reviewed by Public Health

Wales at the midpoint. Are we in a better position, then, to be able to

explain why the numbers are rising, and in Welsh terms, because the

problem seems to be more acute, what are the factors in that rise which

we can identify with some confidence? I think one of the

factors with male suicide is that we have a deep-rooted tradition in

Wales of masculinity. A sort of active masculinity. It comes from

the mining days, where the miners were tough men who work together.

They had friendships, they earned money, good money. It was a horrible

job but they aren't good money. They could look after their families, go

and have a point, go to church. They had an enormous sense of community

and friendship. I think with the post-industrial times in Wales, this

infrastructure has broken down. And now what we have is sort of a

desolation. The churches, abandoned churches at the valleys, the pubs

are boarded up. They had tombstones that had a very strong... Affect on

the Welsh psyche. And that being taken away, a lot of people feel

lost. And you combine that with the largest think contributing towards

mental illness and suicide in the valleys, alcohol. We Welsh I think

are part of our national characteristics as a people have a

sort of morbid introspection. I think that has remained with us. As

the landscape has changed, the landscape has come to reflect that

mental state more. Alcohol has been mentioned. A morbid introspection

has been mentioned, which is acutely may to some areas, those valid

reasons -- which is peculiar may be to some Welsh areas. I think alcohol

use is a significant factor in suicide. That is a well acknowledged

point. Social cohesion is a real issue. And I think the statistics

are borne out in terms of, you know, there are higher incidence of

suicide and mental ill health in Wales's most deprived areas, in the

same weight that there are higher incidences of suicide in their home

was communities. There are real things. Thank you both for coming

in. If you'd like to get in touch

with us about what's been discussed tonight,

or anything else, email us Or follow us on social media,

where the discussion continues. All of them? All of them.

Drafted by all of them. He went on to play for the

Buffalo Bills in the Super Bowl and the Cleveland Indians in

the World Series.