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Commission on Social Services in Wales Evidence submitted on behalf of the Health, Social Care and Wellbeing Network

Evidence submitted on behalf of the Health, Social Care and Wellbeing Network

26^th February 2010

The Health, Social Care and Wellbeing Network welcomes the opportunity to contribute to the independent review of social services and social care in Wales.

At a time when Wales is facing very significant challenges arising from a variety of economic and demographic factors it is timely that we consider how current and future developments in health and social care may be best utilised to provide the best possible outcomes for all of our citizens.

The Health, Social Care and Wellbeing Network is facilitated by WCVA but independently represents the views, and promotes the work, of a broad range of large and small third sector organisations engaged in the health and social care sector throughout Wales. Its recently adopted strategic aims include:

• Achieving meaningful citizen and community empowerment

• Achieving recognition of the need for adequately resourced social care

Summary

• Professional practice should support the principles of cross disciplinary collaboration and integration through the development of generic workers, including the development of common standards and competencies.

• There should be greater movement towards a holistic approach to the delivery of health, social care and wellbeing outcomes, recognising the interdependence of health, social care, housing and other functions.

• An approach built upon the principles of co-operation, community development and co-production, all characteristic of many third sector organisations, could lead to genuinely reciprocal partnerships in the design, commissioning and delivery of integrated public services.  These partnerships would include not only the third, statutory and independent sectors but also service users, their friends and families and the wider community.

• Citizen empowerment, co-production and collaborative approaches could deliver better outcomes for service users, and the communities within which they live, and contribute to a better and more effective use of available financial resources as well as generating additional resources through the mobilisation of community action and inputs.

The following paragraphs seek to directly address the specific questions posed in the Commission’s call for evidence document.

How can the Assembly Government:

Support the further development of professional practice?

1. Significant barriers to integrated working within current arrangements are both a lack of understanding between different disciplines and overprotection of ‘professional’ or sectoral boundaries. This is particularly significant in the case of health and social care but can apply across other areas as well, for example housing, and welfare.

1. This might be partly tackled through a broader approach to the training of social workers, health professionals and others to incorporate placements or familiarity training across a variety of roles within social care to include the third sector. There are currently examples within Wales where third sector service delivery organisations facilitate social worker placements.

1. The role of the social care/support worker, and the range of tasks expected of them, has widened considerably in recent years to include aspects of work traditionally associated with health, housing or other professionals.

Staff within the supported living sector may provide a model for this new ‘generic worker’ incorporating as they do tasks related to health, social care/support, assessment, housing and welfare benefits, amongst others.

1. Further development around the generic worker is required to incorporate the development of joint training programmes (especially between health and social care) as well as closer collaboration, even joint working, between professional, regulatory and improvement agencies. Eg. NLIAH and SSIA.

These joint programmes would be further supported by the development of a common set of standards and competencies to contribute towards the development of an integrated health and social care workforce.

1. Where ‘specialist’ competencies are required we can envisage a role for ‘specialist’ generic workers. For example, generic ‘Health and Social Care Worker (mental health)’. The ‘specialist’ generic worker might use their more detailed skills and knowledge to devise an integrated care/support plan in partnership with the service users, the generic H&SC worker to be responsible for implementation.

1. We would be concerned to ensure that the health and wellbeing related aspects of the generic workers role be seen as distinct from medical inputs requiring specific medical training and expertise. This would allow for the ongoing development of the role to be seen very clearly in social care and wellbeing terms rather than as an adjunct to medical interventions. We would suggest that the third sector, given its experience in managing generic roles as outlined above, is best placed to be the lead sector in further developing the generic worker concept.

Build Inclusive social services based on the contribution of all partners who work in social care?

1. Analyses of the social care workforce have repeatedly highlighted the fact that the majority of social care is delivered in home or community based settings by family and other informal, usually unpaid, carers. In considering the contribution of ‘all partners who work in social care’ it is therefore vital that these carers and the communities within which they live are not left out.

1. In its policy statement ‘Better Outcomes for Tougher Times...’ the Welsh Assembly Government restated it’s commitment to collaboration rather than competition in meeting the needs of its citizens. It goes on to say, “This means partnership; with all those working in public services, including the third, independent and private sectors and, above all, with citizens and communities”.

1. We would wholeheartedly commend this approach as being consistent with the traditions both of Wales as a country and the third sector as deliverers of services and supporters of communities. It needs to be based upon principles of co-operation, community development, co-production and citizen empowerment.

10) This would mean turning the rhetoric of service user and citizen empowerment and engagement (One Wales, Fulfilled Lives) into a reality through investment in supporting and extending the third sectors work on community development, community led services, service user directed services and volunteering.

11)Aspects of this approach would include Direct Payments, Individual Budgets and other forms of citizen directed services.

12)Whilst we would commend the further development of these and other approaches there should also be systems to ensure the safeguarding of staff and service users and the exercise of appropriate levels of responsibility. The Wrexham individual budget project might provide some valuable lessons in this regard.

13)There are currently a number of projects underway to develop systems of outcomes focussed commissioning, procurement and monitoring including joint work by the Supporting People Information Network / Cymorth Cymru outcomes group. This approach, if based firmly upon user generated outcomes, would further enhance citizen engagement and empowerment leading to a more integrated and inclusive service delivery model.

Effect a step change in collaboration between social services and with other key services.

14)There are a number of examples where Social Services work closely with other agencies in the delivery of services although this is patchy and reliant often on the efforts of enlightened individuals. In some areas Social Services and Supporting People (Housing) officers work together to commission and procure services, although this is not universal.

15)Protection of professional boundaries, budgets and a lack of understanding may place barriers in the way of collaboration. This is particularly the case at the interface between health and social care. The development of a generic worker and joint training etc as outlines earlier may go some way towards helping the situation. However a more robust and directive approach from the Assembly may be necessary to achieve real and significant change.

16)Work needs to be done to re-emphasise the social model of disability across all client groups and to stress the interdependence of health and social care outcomes. The mutually supportive nature of the relationship needs to be emphasised and explained, expressed through pooled budgets, joint assessments and provision.

17) An example is offered by the Aberystwyth mental health project which brings together social services, housing related support provider, a housing association, local health board and NHS trust to deliver intensive support to adults recovering from episodes of mental ill health. The support is based upon a ‘whole person approach’ led and owned by the service users themselves.

Ensure integrated social services capable of meeting the needs of children, young people and adults and older people in the most effective way.

18)Much of the comments made earlier in relation to co-operation, partnership and collaboration would contribute to the development of an integrated service model.

19)Current criteria for access and eligibility are often barriers to the delivery of integrated services although it is to be hoped that the current Law Commission proposals on the reform of adult social care law may go some way towards addressing this issue.

20)Experience would suggest that arbitrary, age related criteria for access to services are not always helpful in this respect and the needs and preferences of the individual service users should take priority instead.

21)Whilst we would support models that promote as high a level of independence as possible for individuals, and a move away from institutional care, there needs to be a recognition that these models are not appropriate for, or desired by everyone. We should strive to maintain a full ‘menu’ of options and choices for people which span the whole range of provision and models of support.

22)Flexibility is often the key to best meeting people’s needs and aspirations and care management approaches, service specifications and funding streams need to incorporate as much flexibility as possible.

23)Concentrating procurement, specification and monitoring activities on qualitative outcomes for service users, rather than crude quantitative measures of hours of service delivered or ‘episodes of care’ may go some way towards achieving the flexibility required as well as improving the quality of the service.

We would, of course, be happy to expand upon this response if we can be of any further assistance to the work of the Commission.

Adrian Roper, Vice-Chair Health and Social Care Network. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Alun S. Nutt, Development Manager, Cartrefi Cy

Submission to the Commission on Social Care by Ron Walton

Submission to the Welsh Assembly Government Commission on Social Care

1.Supporting the development of professional practice

For social workers it is essential that they should be able to enhance their skills through post qualifying training. The Post Qualifying Consortium for Wales has just ceased operating and a new structure of awards has been introduced by the Care Council for Wales with provision through HE institutions. If it is desirable to improve social work services it is critical that a high proportion of social workers continue to develop their skills and provide evidence-based services. The new patterns of awards should be monitored closely by the Care Council for Wales with a clear message to local authorities of the need to support staff in accessing the awards.

2. Social Care support staff

Support staff work in community settings, in day care services and in residential settings. Many of them are the key people working in service users’ own homes. At present, however well motivated, many of them have very limited training, are poorly paid and frequently work to such a rigid role and poor work conditions that service users, in many instances, receive a barely adequate service. There is an urgent need to address: their training needs and level of qualification; a more flexible role-responding to practical tasks with sensitivity and also to other needs; where the support staff are employed by independent providers, ensuring that commissioning processes include quality and flexibility of service as well as cost in their criteria; considering the possibility of creating a social care/health support worker able to provide a wider range of service and avoiding duplication of visiting to service users.

3. Inclusive social services

Issues of collaboration between personal social services, health, housing and voluntary and independent service providers have been identified in many official reports. But inclusivity also means the involvement of service users and informal carers. Involvement and engagement with these latter groups is patchy and often relates to limited areas of reactive opinion and consumer satisfaction. Involvement in the planning, design and operation of services fragmentary and uneven, yet is essential. Training and support is required to make this a reality.

Between agencies and departments, despite the various partnership and local service board structures, problems remain. Even at the level of front-line staff, unless cooperation is mandated by child protection procedures, collaboration is difficult with planning meetings for service users marked by the absence of key professionals, from health, education and police.

Even within adult social services and children’s services of the local authority the pattern of specialist teams makes it difficult to achieve inclusivity in the same department. In children’s services one child and family may be being dealt with by an adoption social worker, foster care social worker and support worker, long-term social worker and possibly disability team worker. This is before we examine the role of CAMS and education workers. The result is that service users and carers are commonly relating to a succession of workers with poor continuity of care.

The structure of services seems to be structured primarily by managerial efficiency criteria rather than the quality of service in meeting need. Eligibility criteria are drawn ever more tightly with the aim of rationing services. There are frequent issues in the transition of children to adult services and for the transition of younger adults to services for older people.

4. Effective collaboration with other key services.

There is an overlap of health and social care services. Both are coping with increasing numbers of children and adults with disabilities and also of children born with significant health problems. The frailty of older people and the needs of those with dementia derive from medical conditions but may not require substantial medical intervention until the later stages of life.  A major impediment to collaboration between health and social care is the charging policy for social care coupled with health service arrangements for continuing health care. Those with a high level of social care needs will try to access continuing health care because it is free. Thousands of hours of professional social work and health staff time are wasted on deciding whose responsibility it is to provide care rather than how best to meet people’s needs.

A celebrated case in the Vale of Glamorgan left a person in need of a special bed in limbo because the health trust, local authority and local health board could not agree who was responsible. Under the new NHS structure in Wales most LHBs have to deal with at least two local authorities with all the complexities this brings. Also the small size of many local authorities means that they are ill-equipped to deal with the complex needs of a small proportion of children and adults who are not infrequently left with a poor quality service or placement far away from home. A further issue is the slow assessment provided by educational psychologists and the CAMS services leading to delays in planning for children in need.

5. Integrated social services.

Integrating social services is a praiseworthy aim but integrated from whose perspective - the providers or service users and informal carers? It is in children’s services that most progress has been made in trying to engage children in partnership and make their voice count. But for adults and services for older people this process is only in an embryonic stage. Within health services it is mandatory for LHBs to consult with Community Health Councils about proposed major changes to services. There is no equivalent duty with local authorities. Policy and planning are undertaken behind closed doors only coming to public attention when the plans are aired in Scrutiny Committees and Cabinets. Thus the structure of social care services is largely determined by professionals and managers working to specified targets from the Assembly. From a service user perspective this, at times, may seem to have little relevance to the quality of service individuals and families receive.

6. Potential directions for change

There is much positive development within social care services but this is occurring within a situation of basic underfunding which severely hampers local authorities in providing adequate services and fully cooperating with other services. The following are suggestions for building on positive features of present services.

• There is a strong case for making social care services more responsive to service users and informal carers. A duty should be placed on local authorities to consult when making significant changes to social care services. Consideration should be given to establishing a Social Care Citizen’s Council in each local authority area, along similar lines to Community Health Councils. There are alternatives such as requiring local authorities to consult with relevant user groups. For example, the concept of Council of Elders could provide a model of consultation and engagement, which would link both social care and health. Existing Older People’s Strategy Forums could be a basis from which to develop this idea.

 

• Engaging with service users and informal carers in the planning provision and monitoring of social care services. There is considerable potential in voluntary and independent agencies in facilitating   engagement of service users and carers and also developing new models of service provision on the basis of co-operative values and principles. A mutual model of provision can be linked to community objectives and strengthen citizen participation. Linking community approaches to co-operative models would also create employment in deprived areas, moving away from regarding them only as a problem and seeing them as part of the solution. The third sector would be ideally placed support and facilitate such developments.

 

• Innovation. The personalisation agenda in England, now having influence in Wales, takes many forms-direct budgets, individual budgets and cooperative provision of service. Other types of innovation are tele-care, extra care housing, focussed rehabilitation services, crisis intervention teams and food access solutions such as Food Train. What is not clear, with the exception of the latter, is how effective these are as general solutions, which can be rolled out across Wales. There is still limited outcome research either of single services or comparing the effectiveness of two or more services.  Research into social care should incorporate evaluation of outcomes as a key criteria and focus. Without this there is a high risk that service models could be rolled out as fashionable without evidence that they make a difference to people’s lives.

 

• Charging for Care. Abolishing charges for social care would get rid of the inquiries arising from different charge rates across Wales. It would foster better cooperation between social care services and health where the focus would be on how best to meet needs rather than who is to foot the bill. There would be local authority savings in administration an assessing liability and collection. It could alter community attitudes to social care services, the removal of means testing inculcating the view that this is not state charity but a right to services

• Local authority corporate responsibility. Despite the existence of partnership and local service boards, local authority departments still operate within silos, and, even within children’s services, there is limited cooperation between specialist teams. Strengthening the concept of corporate identity and responsibility should foster greater internal cooperation and improve transitions from one service to another when needs change or services are organised on an age basis

 

• For service users with highly complex needs their situation could be improved if there were a reorganisation of local government to align local authorities and LHBs or there was an impetus to establish local authority consortia to plan and provide highly specialised services.

 

• Unified assessment. This assessment tool is still in a development phase. It is most useful in systematically reviewing a range of need, but the big drawback has been that the categorisation of need has been used to ration services to only those with critical or substantial needs. Its administrative function in determining eligibility has significantly reduced   provision of lower level preventive services. It is the antithesis of a service user focussed instrument. A way forward could be to maintain the Unified Assessment (in both comprehensive and short forms) but to remove the categorisations, which purely serve organisational interests and not those of service users and carers.

Resources

Some of the ways forward do not need extra money but others do. Much depends on the outcome of the Paying for Care consultation and political decisions. It is disturbing that much of the financial debate has referred to protecting health and education services with no indication that social care services will be protected.  It is well established that social care services prevent use of acute hospital services and that better health status is the result of social determinants rather than health services. There is a strong case for rebalancing expenditure on health and social care, with say, a quarter of one percent of health expenditure shifted to social care.  Ideally additional funds for social care should come from general taxation, used to enhance the workforce, meet increasing need and support innovation and service user and care engagement. Without some protection of funding (including that for the third sector) social care services will be forced to ration services further and to concentrate on protective services.  Such a scenario would seriously hamper the objective of providing services with dignity for those with disabilities and for older people.

Conclusion

From the service user and informal carer point of view the most important issue is access to and the quality of service and respect from social care staff at every level. Shifting the services towards engagement and partnership with service users and informal carers is the surest way of ensuring that social care in Wales becomes fit for purpose. Mutuality has an important part to play in realising this ambition – in line with the ‘One Wales’ Coalition agreement.

R. G. Walton

Penarth

 

22^nd February 2010

What are the strengths, weaknesses and future prospects for existing models of Care delivery?

 Mark Drakeford, the previous First Minister's senior special adviser, welcomes the opportunity of speaking on 'What are the strengths, weaknesses and future prospects for existing models of care delivery?' at our 24th March 2010 conference. (opens in a new window)

PhD studentship on Co-operatives in Health and Social Care - Closing date 15th March

ESRC CASE Studentship
'Co-operation in Health and Social Care'
Middlesex University - Middlesex University Business School in partnership with Co-operatives UK.
Closing date: 15th March 2010

Applications are invited for an ESRC CASE Studentship in 'Co-operation
in health and social care.' The fundamental aim of the research is to analyse the current situation
and future prospects for co-operation in health and social care in the
light of changing social, economic and political environment factors.

This studentship of £19,200 is offered via a partnership between the Centre for
Enterprises and Economic Development Research (CEEDR) at Middlesex
University and Co-operatives UK, the member owned and led trade
association for all types of co-operative enterprise throughout the UK.
Full details can be downloaded from:
http://www.mdx.ac.uk/research/areas/enterprise/ceedr/social_enterprises/CASE_PHD.aspx <http://www.mdx.ac.uk/research/areas/enterprise/ceedr/social_enterprises/CASE_PHD.aspx>   

Professor Fergus Lyon
Centre for Enterprise and Economic Development Research
Middlesex University Business School
The Burroughs
London NW4 4BT
02084116856
www.mdx.ac.uk/ceedr <http://www.mdx.ac.uk/ceedr> or www.mdx.ac.uk/socialenterprise <http://www.mdx.ac.uk/socialenterprise>

Message from the Older People’s Commissioner for Wales

Hello.  My name is Ruth Marks and I am the Older People’s Commissioner for Wales.
This message is about my First Review and an invitation to engage. My role is:

* To promote the interests of older people in Wales	* To review the law
* To challenge age discrimination in Wales	* To encourage best practice

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http://www.cooperatives-uk.coop/live/dynamic/News2ShowArticle.asp?article_id=2039D9E5-E95D-41B7-9AE8-2B0B8D9BE33F