WLGA/ADSS Cymru

 

Briefing Note for Health & Social Services Committee Members

 

State of the Nation: Transforming Social Services in Wales

 

 

This briefing provides an overview of current work to transform social services within local government, demonstrating the strong political and professional leadership in evidence across local government.  Members are asked to consider how far the Social Services and Wellbeing (Wales) Bill will contribute to the key task of delivering new models of services, which are more responsive to need and more sustainable in the face of increasing demand.

 

1.    Changing demographics and the increasingly complex nature of individual needs has led to a debate about the future of social services in Wales. Service models are being transformed across Wales to deliver more innovative and responsive models of care, which respond to the individual needs of a user and provide a seamless pathway? The Bill needs to provide added value to this, unblocking barriers and providing a modernised legal framework.

 

2.    Improving services for citizens is our collective political and professional commitment, but we recognise social services cannot do this alone. The Bill therefore has a critical role in embedding new service models within a statutory framework which defines eligibility, and clarifies the role of public services in delivering improved wellbeing. The Bill must empower authorities to manage demand for care and support whilst empowering citizens to live more independently, and provide them with better choices and more control.

 

3.    Against a backdrop of growing demand and reduced resources, there isn’t a magic bullet. Social services are facing real and unsustainable increases in demand. The number of looked after children and those on the child protection register is growing. The number of people with a learning disability is increasing, along with greater numbers of older people, often with complex care needs, whose support needs are extensive.

 

4.     Service transformation and the specific requirements of the Bill will not be cost neutral. Political Leaders from across local government have called for  a debate, around how we can deliver change within the financial context. There is a strong consensus in Wales, around the principles for change, and we welcome the fact that the Bill endeavours to reflect those principles. Local government has long argued for action around these core principles and we believe they must be the cornerstone of reform, these include:

 

·         Simplifying legislation

·         Streamlining bureaucracy

·         Clarifying the functions of social services

·         Achieving a balance between national consistency and local autonomy

·         Requiring greater partnership working with key partner such as health

·         Providing social services with a core leadership role around wellbeing

·         Recognising the contribution of the wider public services, and third sector partners in developing and delivering preventative service

 

5.    The report of the Independent Commission on Social Services, the precursor to the White Paper and Bill, stated that we are ‘building from a position of strength’. Clearly, we accept that the Bill will require Local Government to make significant further improvements, especially in reducing inconsistency. We are confident that there is strong professional and political leadership at a local level to lead that change, which must be supported by a proportionate and flexible approach.

 

6.    Through our collective commitment to the ten-year strategy, the transformation agenda is already well established in Wales, with collaboration and co-production at its heart. Whilst the Bill will enable greater change, we are not standing still. Ambitious programmes of service redesign and reform have been established and are being driven through, with support from WLGA, ADSS Cymru, and SSIA. Already we have achieved a range of successes, but we must be clear that change is never easy and a number of barriers remain which we are looking to the Bill to unblock.

 

7.     The Welsh Government funded SSIA has supported a range of groundbreaking work, in tandem with a range of UK wide experts, to push the boundaries of change and develop new models of service. Through the WLGA social services policy group for Cabinet Members, there has been strong political leadership, resulting in the establishment of four regional social services improvement collaboratives managed by Directors of Social Services. Annex 1 describes some of that work.

 

8.    Building on the vision set out in ‘Sustainable Social Services: A Framework for Action’, local government has developed an ambitious implementation plan that the Deputy Minister describes as ‘ A landmark document which demonstrates the absolute commitment of local government to transforming social services in Wales’. The plan combines the delivery of regional programmes alongside national endeavours. The WLGA have established a Local Government Implementation Board to oversee delivery.

 

9.    To help ensure our vision becomes a reality, we are looking to the Bill to provide local government with necessary enabling powers. These powers must be focused on the principles outlined above and support delivery of new models of service, with our partners, minimising the extensive and expensive bureaucracy currently overshadowing social services, and  empowering social services, to play a leadership role across the public services in improving wellbeing.

 

10. This will be achieved only if the Bill is developed in genuine partnership with the sector and grounded in the current reality of increasing demand and extensive pressure on budgets. Provisions in the Bill must be proportionate, to enable flexibility around local service design, but they must also be prescriptive and bold where obstacles remain, such as in integrating services and requiring other public sector bodies to play a significant role in improving the wellbeing of citizens.

 

 

Annexe 1:

 

Regional collaboration across Wales

 

There are four social services regional improvement collaboratives across Wales - South East Wales (ten local authorities), Western Bay (three local authorities), North Wales (seven local authorities) and Mid & West Wales (four local authorities). 

 

The collaboratives have the political support of Cabinet Members, and leadership and oversight is provided via the WLGA’s regional Social Services Policy Group, in addition to local mechanisms. They are Director led, and each have significant programme of work in place.  Two representative examples are set out below.

 

1.       The Western Bay Health and Social Care Programme (Bridgend, Neath Port Talbot and Swansea)

 

Key Example - The Older People’s Project

 

·                     Currently analysing need and demand for existing and future services using a Whole Systems Model to produce a business case with costed options for change.

·                     Developing an overarching joint Health and Social Care Western Bay Older Persons Strategy, reflecting the Bill’s principles of early intervention and prevention via enhanced integrated health and social care community services. 

·                     Governance arrangements for the Western Bay Programme and the Abertawe Bro Morgannwg University Health Board ‘Changing for the Better’ Programme are being monitored and reviewed to achieve integration, collaboration, eliminate duplication and ensure interdependencies between the two programmes is managed effectively.  For example closure of acute beds and reinvestment in community based services.

·                     The delivery / implementation plans will incorporate the principles of the Social Services and Wellbeing (Wales) Bill, and detailed guidance as it becomes available on issues such as eligibility, assessment, wellbeing, safeguarding, and take a citizen centred community based approach delivered via integrated locality based teams.

·                     Whole Systems Modelling of dementia care pathways will commence in March 2013 and this will inform this crucial area of work.

 

Other Western Bay collaborative programmes include the Mental Health Project, the Learning Disability Project, the Commissioning Project, the Integrated Family Support Service, establishing Regional Safeguarding Boards, creating a regional Adoption Service, and regional services for children and young people with complex needs, the Youth Offending Service and Supporting People.

 

2.           The South East Wales Improvement Collaborative (SEWIC) (Vale of Glamorgan, Bridgend, Cardiff, RCT, Merthyr Tydfil, Blaenau Gwent, Caerphilly, Torfaen, Newport and Monmouthshire)

 

          Key example - Fostering & Adoption Services Project 

 

Exploring the potential for collaboration, between local authorities in the recruitment, assessment and training of foster carers.

 

 

·         A regional approach to marketing which would ensure consistent brand imagery for fostering across the whole of the regional.

·         Economies of scale and effort through pooling all existing marketing resource and expertise currently spread across the region.

·         A customer friendly efficient recruitment process which would ensure less applicants “dropping out” during the assessment process and assessments being undertaken in a shorter timescale.

·         More effective collaboration between local authorities in the recruitment of carers. 

 

Other SEWIC collaborative programmes include Extra Care Housing, Assistive Technology, High Cost Adult Regional Brokerage & Procurement Hub and Review of High Cost Adult Placements, the 4Cs Children’s Placements Commissioning Unit, regional adoption services, regional safeguarding boards, the Cardiff and Vale Integrated Health and Social Care Services Programme (the Wyn Campaign for Older People, integrated mental health services; integrated learning disability services, integrated services for children with complex needs because of disability) the Gwent Frailty programme, Integrated Family Support Services, integration of services across Caerphilly and Blaenau Gwent.

 

3.       Mid & West Wales Health & Social Care Collaborative (Pembrokeshire, Ceredigion, Carmarthenshire and Powys)

 

The Collaborative is engaged in a range of transformation projects spanning service areas, working across Councils and with Health to ensure that new service models deliver positive outcomes and achieve optimum efficiency. A particular example relates to Learning Disability, in respect of which all organisations involved are working to:

 

·         Drive through transformational change for developing sustainable Learning Disability Services in the Region

·         Develop an incremental approach towards full integration of services through consistent planning, commissioning and procurement

·         Movement towards integrated delivery of health and social services for people with a Learning Disability across the Region

 

4.       North Wales Health and Social Care Improvement Collaborative (Ynys Mon, Gwynedd, Conwy, Denbighshire, Flintshire, Wrexham)

 

The North Wales Collaborative is well established with a range of transformational activities. The Collaborative recently launched the North Wales Commissioning Hub, and is aligned with the North Wales Health and Social Services Programme Board established as part of the work led by Chief Executives in the region.

 

Key Example- North Wales Commissioning Strategy

 

·         North Wales Commissioning Hub formally launched

·         Improve capacity and quality of placements across the region

·         Facilitate more effective commissioning and Procurement of places

·         Project initiated to map demand, spend and usage across the 6 local authorities, to provide an options appraisal for the commissioning of IFA’s

·         Development of a NW strategy for in house fostering underway, looking specifically at recruitment, retention, and support to foster carers

·         Development of a regional domically care monitoring framework

·         Mental Health and Learning Disability commissioning workshops to support development of regional strategy

 

 

National initiatives

 

Since its inception in 2006 the Social Services Improvement Agency (SSIA) – funded through a grant from Welsh Government and a partnership venture between Welsh Government, WLGA and ADSS Cymru – has led a number of important national initiatives, working with Councils and partners, to support service redesign, achieve step change in operational practice and further build leadership capacity at all levels to effect the culture change needed for delivery of Sustainable Social Services. It is currently leading the development of a national specification for a Citizen Portal in partnership with Councils and other agencies, and recently facilitated a number of workshops across Wales discussion from which has informed a key report on Access to Social Services and Wellbeing Services. Setting out proposed models for achieving the core ambition of the Bill for improved access for wellbeing services for people in need and citizen-led, outcomes focused assessment, the findings of the report will support wider debate across the sector in the coming period on how current processes and practice are overhauled to achieve a new way of working with users and carers.

 

 

Examples of the programmes of SSIA include:

 

1. Transforming Services for Older People

 

Service transformation for older people remains a key priority for the SSIA. The current and predicted rise in demand for services, increased expectations from users and carers and unprecedented financial constraints make ever more urgent the need to radically rethink how services are delivered to older people across our communities. During 2011 the SSIA with the support of John Bolton carried out an analysis of older people’s services across Wales.  This work developed a suggested future model where the principles of prevention, independence and reablement are central. The ‘John Bolton’ model has gained currency as the recognised way forward for older people’s services, delivering greater efficiency and improved outcomes for service users and carers, and is referred to within the White Paper on Sustainable Social Services.

 

Progress on delivering the model is advanced in many parts of Wales. All Councils have reablement services in place, and analysis to be published shortly by the SSIA will provide further information on positive outcomes, often delivered in partnership with Health and other sectors.

 

In addition the SSIA is taking forward key aspects of this work with a goal to share nationally the learning.  The three demonstrators are:

 

·         Carmarthenshire County Council who are focussing on dementia services across the county

·         Denbighshire County Council are developing a single point of contact, information and assessment

·         Ceredigion County Council in partnership with Powys who are further developing  reablement services as part of a wider service remodelling initiative

 

SSIA continues to work with the three councils as they build on their early initial developments and successes.

 

2. Learning Disability Services in Wales – Opportunity Assessment

The SSIA has supported 5 Councils and their partners in reviewing their current service models and identifying priorities for improvement and service development through a methodology known as 'Opportunity Assessment'.  The approach has been used extensively in England to support service transformation in this area and based on a detailed assessment of commissioning and service strategies, performance data and individual case files.  Six Demonstrator Sites across Wales have taken this forward (Bridgend, Caerphilly, Gwynedd, Pembrokeshire, Neath Port Talbot and Vale of Glamorgan). Emerging from the work is a ‘progression’ service model which focuses on promoting and regaining independence, and looks to improve the outcomes both of those currently in care and those who have a potential future need.

 

Thoughts on this model are being discussed with the Deputy Minister’s Learning Disability Advisory Group to inform the debate on how the take forward the transformation of Learning Disability services in Wales. Wider learning from the Demonstrators are being shared at regional learning events across Wales and a further national event is planned in the summer.

 

3. Developing a Social Care and Wellbeing Information Site for the Welsh Citizen

SSIA’s work in this area involves a range of partners, users and carers and is focused on developing a specification for Social Care and Wellbeing Portals which will be provide information and advice to people ‘in need’ – i.e. who need a level of support to maintain their independence and ultimate wellbeing; this might be as a current or potential user of services, someone who cares for or is a friend or colleague of another person. The aim is to help people by providing effective information, with which they can make choices about what that may be available to them. Information on services available at national, regional and local levels will be provided in a dynamic, clear, succinct and interactive way and all in one place. This will form a key point of access to wellbeing services as set out in the Bill and an important example of how services will be adapted to give greater voice and control to citizens.

 

More information about any of the SSIA programmes can be found at www.ssiacymru.org.uk

 

 

 

Martyn Palfreman, Head of Social Services Directorate, Welsh Local Government Association

 

Phil Evan, President of ADSS Cymru – pjevans@valeofglamorgan.gov.uk

 

Andrew Bell, SSIA Knowledge Manager – andrew.bell@wlga.gov.uk

 

Emily Warren, WLGA Policy Lead – emily.warren@wlga.gov.uk