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