A new direction for care in Wales

Featured article - 13 April 2018
By Professor Keith Moultrie, Director of the Institute of Public Care at Oxford Brookes University

Head-shot of the author, Professor Keith Moultrie, Director of the Institute of Public Care at Oxford Brookes University

Professor Moultrie writes in a personal capacity. IPC works across the UK on research, evaluation, consultancy and development for health, social care and wellbeing organisations.

Partners across the sector are now working hard to help the Welsh Government develop a long-term plan for health and social care for Wales.

Professor Keith Moultrie

A New Welsh Care Agenda

Last year I was asked by the Cabinet Secretary for Health and Social Services in the Welsh Government to join the panel of a Parliamentary Review of Health and Social Care. Extensive work by the panel throughout the year, ably led by Dr Ruth Hussey, led to a set of recommendations in a report in January 2018 which we called ‘A Revolution From Within'.

I think this review is the next major step in a progression to making Wales have that distinctive landscape, and one which the rest of the UK would do well to keep an eye on. It builds on the ground-breaking legal and policy commitments in The Wellbeing of Future Generations (Wales) Act 2015, the Social Services and Wellbeing (Wales) Act 2014, and the NHS Prudent Healthcare Framework for Wales and emphasises:

  • Seamless local care organised around what matters to the individual citizen
  • Prevention and early help to secure timely and effective care and support in the community wherever possible
  • Sharing risks and responsibilities between citizens and professionals with the aim of achieving personal outcomes
  • Making sure the formal and informal ‘careforce’ is able provide the best possible sustainable care and support.

Of course, the Review Panel looked carefully at the previous analyses of challenges facing the health and care sectors across UK (published in the interim report from the Panel in June 2017), and we drew on these to inform our discussions with many hundreds of contributors on what to do about it. The final report contains plenty of detailed recommendations, but I have picked out two particular areas which I think show clearly the future direction of travel in Wales.

Better outcomes through seamless local care and support

The review proposes that a fundamental building block should be community-based localities with seamless health, care and wellbeing provision. These must be designed locally, with equal engagement from citizens and partners across health, social care and wellbeing. There are lots of examples of great locality practice from Wales and elsewhere, but the speed of change needs to be accelerated. The panel was convinced that spreading great seamless practice across Wales holds the key to more effective prevention and a better early help offer to citizens, and we made a number of recommendations about how to do this. Our choice of the word ‘seamless’ was very deliberate - we were not convinced that major structural changes are needed – it is much more important to devolve care decisions and responsibilities as close as possible to the individual professional and citizen.

Integrated regional and national arrangements

However, the panel was also clear that this change is not just about leaving it to localities to sort out on their own. The supporting architecture has to be there to make sure it is delivered. Wales has been working hard since the Social Services and Wellbeing (Wales) Act in 2014 to build integrated arrangements across health and care in 7 different regions, and the panel recommended further development of these arrangements so that Regional Partnership Boards are responsible for driving, supporting and resourcing localities in their region. At the same time national agencies have to play their part, which means:

  • Developing common principles of good practice in localities at a national level
  • Developing shared outcomes-based indicators of performance across health, care and wellbeing services
  • Focusing the attention of inspection and improvement agencies on the effectiveness of localities
  • Investing in a national transformation fund to help regional partners deliver on the aspirations of the report.

Keep an eye on Wales

A national transformation fund has already been announced. The focus will be on programmes that can have the greatest impact in developing and delivering new models of transformed services. Partners across the sector are now working hard to help the Welsh Government develop a long-term plan for health and social care for Wales in response to the review. Do keep an eye on this plan. As we approach the 70th anniversary of the NHS, which of course was born in Wales based on a model developed by the Tredegar Workmen’s Medical Aid Society, it may be time for another Welsh model to inspire a new future for health and care across the UK.

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