PRIORITIES

Health and Social Care Committee

Date: 13 July 2011

Venue: Committee Room 1, Senedd, National Assembly for Wales

Title: Health and Social Services and Update

Purpose

1. This paper provides background information to inform the Health and Social Care Committee’s discussion with the Minister for Health and Social Services and the Deputy Minister for Children and Social Services at its meeting on13 July 2011.

2. As requested, this paper provides details of the Minister and the Deputy Minister’s priorities for this Assembly, including legislation and other manifesto commitments.

3. It also provides an update on a number issues which were the subject of the previous Health, Well-being and Local Government Committee reports.

INTRODUCTION

4. Many of the priorities for the Health, Social Services and Children’s agenda for this Assembly were set out in Standing up for Wales.

5. In relation to the NHS, our manifesto commitments have a clear focus on preventing poor health, improving health outcomes, and reducing health inequalities. We intend to take action to improve access to GPs, give children a healthy start in life, introduce health checks for the over 50s, and continue the improvements already made in cancer, cardiac and stroke services in Wales. Work to improve ambulance response times and to reduce unnecessary attendance at emergency departments will also be a priority.

6. More widely we want to ensure patients receive the care they need as close to their homes as possible in an integrated, safe and sustainable health system. We do not want a health system that is distracted by competition and complicated commissioning processes. Further details on our key health-related priorities, including legislation are set out in Annex 1.

7. In accordance with our manifesto, our priorities in relation to social services focus on delivering the vision in Sustainable Social Services for Wales: A Framework for Action. At the heart of these are values of fairness and well being for all and a belief in public services. We need to make sure that the right kind of care is there when it is needed and it is not about what help people can afford. Further details of our priorities for implementing Sustainable Social Services and the related legislation are set out in Annex 2.

8. Annex 3 provides an update on the key matters raised in the former Committee’s Legacy Report.

9. Our priorities in relation to the Children’s Agenda will be discussed at the Children and Young People Committee.

ANNEX 1: HEALTH-RELATED PRIORITIES

The Welsh Labour Manifesto sets out the programme for Government over the next five years and includes a range of commitments in relation to the health agenda which build on, enhance and embed work already underway Early priorities for action will include the following:

(i) Improving access to GPs surgeries in the evenings and on a Saturday

Introducing more accessible GP services to allow people to access local GP services at a time most convenient to them. The Welsh Government already has an agreement with BMA Cymru, which is delivering extended opening in around 10% of Welsh practices. The new patients’ website My Health Online will make it easier for working people to book appointments at their GP surgery.

(ii) Expanding Flying Start

We want to ensure that children have the best start in life and as part of this we will be:

· Doubling the number of children benefitting from improved health visiting, free nursery places and better support to families through our Flying Start programme; and

· Extending the reach of the programme and doubling the number of those gaining from Flying Start to 36,000, so that almost a quarter of all children in Wales aged 0-3 will be able to benefit.

(iii) Introducing Health Checks for the over 50s

We are intending to continue to develop a more preventative approach to health care, by introducing a programme of annual health checks for people over the age of 50. These checks will help to ensure structured assessment and advice are easily accessible.

(iv) Improving the diagnosis and treatment for Cancer

Implementing Designed to Tackle Cancer in Wales to deliver incidence, mortality and survival rates in Wales that are among the best in Europe by 2015 continues to be a priority To direct and guide activity at both a national and local level to achieve our aims, we are developing an all Wales Cancer Delivery Plan, which is being informed by the policy document produced by Macmillan Cancer Support in March, to help ensure a focus on person centred care. We are working with Macmillan to take forward the draft care plan template it has prepared, which, together with the Key Worker role introduced from 1 April 2011, will help ensure a more holistic approach to assessing a patient’s individual needs. To help understand what we need to do better, such as earlier diagnosis of cancer, Wales is participating in the International Cancer Benchmarking Partnership.

(v) Improving Stroke Care

Preventing stroke and treating it as a medical emergency remains a top priority for the Welsh Government. Local Health Boards (LHBs) have action plans in place for achieving national standards and guidelines by 2015. LHBs are now performing better on the acute phase of care, but have been asked to commit to a formal timescale as to when they will fully comply in all hospitals admitting stroke patients. We have invested in telemedicine equipment to support the roll out across Wales of a 24/7 thrombolysis service to help optimise outcomes. Monitoring tools for the intelligent targets for diagnosing and responding to mini strokes and for early rehabilitation are being developed, and these will act as a powerful tool for driving up the quality of care.

(vi) Tackling Cardiac Disease

Cardiac disease is still a major killer in Wales but our aim is to achieve incidence and mortality rates that are comparable with the best in Europe by 2015. The National Service Framework (NSF) for Cardiac Disease sets out a range of standards to ensure high quality care and each LHB has a Delivery Plan in place for the NSF. To direct and guide activity at a national and local level and to underpin the LHBs’ Delivery Plans, we are developing an All Wales Delivery Plan for Cardiac Disease.

(vii) Implementing Our Healthy Future

Continuing to rebalance the planning and resources of the health service towards prevention and early intervention is crucial It is one of the NHS’ key aims over the next five years to do more to protect and improve health for all. This is reflected in the 2011/12 Annual Quality Framework (AQF) and the requirement for LHBs to produce Local Public Health Strategic Frameworks. As part of this, Implementing the Strategic Action Plan Fairer Health Outcomes for All: Reducing Inequities in Health which was published last year is a key priority. The action plan sets out a vision for improved health and wellbeing for all, with the pace of improvement increasing in proportion to the level of disadvantage. It sets a new target to improve healthy life expectancy for everyone and to close the gap between each quintile of deprivation by an average of 2.5% - by 2020.

The current major public health campaign is Change4Life, a cross-Government funded (£90k each from DHSSC, Heritage and BETS) campaign to encourage people to eat more healthily and increase physical activity. In line with the manifesto commitment, proposals are currently being scoped to expand Change4life to include alcohol, and campaign options on smoking cessation are also being considered.

Evaluations of smoking cessation-focused mass media campaigns have indicated that these campaigns can build knowledge, change key beliefs and attitudes, increase calls to quit lines, and contribute, along with other tobacco control programme elements, to overall decreases in tobacco consumption and increase in smoking cessation. The draft Tobacco Control Action Plan for Wales recognises that careful consideration needs to be given to any future awareness campaigns, and we are considering what action we can take to prohibit smoking in vehicles. We are considering the responses to the consultation on the draft Action Plan and will launch the revised Plan in the autumn, including actions on smoking cessation campaigns.

(viii) Responding to the Dignity in Care Report

We have already taken action to respond to the report from the Older People’s Commissioner and I set out the detail of this in the Plenary Debate on 15 June 2011. The Welsh Government is working with NHS staff to enable them to spend more time with older patients, giving them the respect and help they deserve. To ensure compliance with recently revised standards, I have asked Healthcare Inspectorate Wales to carry out unannounced spot-checks on standards of dignity in care for older people in our hospitals. My officials will also be working closely with the LHBs, monitoring the implementation of their Action Plans prepared in response to the Older Commissioner's report.

(ix) Improving Mental Health Services

Improving Child and Adolescent Mental Health Services (CAMHS) in Wales remains a high priority, with the need to develop consistent services which are accessible to all young people. Within the last year, a national action plan to improve children’s mental health services has been launched. We will continue to strengthening the range of CAMHS, including access to specialist services for both older adolescents and young people. .

In relation to adult mental health services, we are already working to implement the Mental Health Measure and the Dementia Vision document. We are also examining closely the findings of the Wales Audit Office Report published last week and will be using the information it contains to prepare a new strategic framework for Mental Health services in Wales.

(x) Maintaining and Improving NHS Performance

The majority of patients continue to be seen and treated within our referral to treatment (RTT) waiting times targets and we want to maintain and build on this performance.

The latest figures for the end of March 2011 show that, if the orthopaedic specialty is excluded, the all-Wales waiting time performance remains above the 95% 26-week target, and has done so since October 2009. Improving the performance for orthopaedic patients will be a priority for the current year.

We will be continuing the work under the AQF to focus on patient outcomes. The Delivery Framework to support the implementation of the AQF will be issued to the NHS this month.

(xi) NHS Wales Informatics Service

Making better use of ICT is proving to be an effective way to deliver the efficiencies we need as well as reducing harm, waste and variation.

The NHS Wales Informatics Service is in the process of introducing new digital services that will deliver an integrated electronic patient record, giving clinicians access to vital information, where and when it is needed. Health staff can use online services to identify correctly the patient they are treating, record information and see the patient’s medical history, or order tests and see the results online – no more chasing up paper reports. Patients and citizens can increasingly and conveniently access information services from well-being to booking appointments and seeing test results. We are also considering the more strategic use of digital technologies and services such as telehealth, telemedicine and telecare, to deliver care closer to home, enabling people to live independently for longer, empowering care workers and helping address some of the challenges of our increasing elderly population.

(xii) Developing a Welsh Language Strategy

Strengthening frontline Welsh Language provision in Health and Social Services is a key priority. Work on a Strategic document is already in preparation and we will be consulting on the proposals later this year.

Legislative Programme

Our health-related legislative programme for this Assembly is still under discussion but our priorities include:

(i) Increasing Organ Donation

The First Minister announced in his statement on legislative priorities that an Organ Donation Bill would be brought forward to provide for an opt-out system of organ donation, backed up by a comprehensive education programme. The Bill will be underpinned by detailed policy work on a range of complex issues relating to the operational, technical, legal and financial implications of introducing a soft opt out system in Wales.

(ii) Parental Consent for Cosmetic Piercing

We have committed to consult on whether legislation should be introduced which would require the involvement and consent of parents for cosmetic piercing procedures on a young person below a certain age. Currently, there is no statutory age of consent for cosmetic piercing and such piercing of a minor is lawful, provided that a valid consent is given - which can be given by the minor himself or herself if he or she is capable of understanding the nature of the act to be done. It is the intention that a consultation document, seeking views on the introduction of the policy, will be issued. Once the outcome of the consultation is known I will decide on how to proceed.

(iii) Implementation of the Mental Health Measure Regulations

The Mental Health (Wales) Measure 2010 was passed by the National Assembly in November 2010, and received Royal Approval on 15 December 2010. Its key policy objectives are:

· The expansion of local primary mental health support services;

· Improved care co-ordination and planning for secondary mental health services;

· Enhancing access to secondary mental health services for previous service users; and

· Expansion of Independent Mental Health Advocacy (under the Mental Health Act 1983) for short-term sections, which do not currently attract this safeguard, and informal patients.

The Measure and its associated subordinate legislation, and statutory and non-statutory guidance, will support the delivery of modern, user-focused care, and will also ensure that every patient within secondary mental health services has an individual care and treatment plan which is overseen by a care co-ordinator. The care co-ordinator will work with the patient, and carers where applicable, to draw up the plan and to keep it under review.

(iv) Food Hygiene Rating Scheme

We are also considering legislation to enable the Welsh Government to make mandatory arrangements for a simple but effective public health measure to provide consumers with easily understandable, at-a-glance information on the hygiene standards of a food business, so they can make better informed choices about where they eat out or shop for food. The E. coli outbreak in South Wales in 2005 showed how important food safety is. This scheme will make mandatory the present voluntary but incomplete arrangements for display of Food Hygiene ratings and thereby help improve food safety and protect public health and the interests of consumers. Similar schemes in Denmark produced a rise from 70% to 86% in businesses with good food hygiene and in California resulted in a 13% drop in hospitalisations due to food-borne disease.

(v) Public Health Legislation

The policy document Fairer Health Outcomes For All: Reducing Inequities in Health Strategic Action Plan promised action to strengthen the focus on closing the health inequities gap and introducing a target for closing the gap.

The manifesto contained commitments on reducing health inequities. We are now giving consideration to the need to provide a legislative basis for delivering improved healthy life expectancy and wellbeing and reducing health inequities in Wales.

ANNEX 2: SOCIAL SERVICES IN WALES

Priorities and Commitments

The Welsh Government is committed to and ambitious for social services in Wales. Our vision and ambitions for social services and social care are set out in Sustainable Social Services for Wales: A Framework for Action and in the manifesto. At the heart of these are values of fairness and well being for all and a belief in public services. Social services and social care in Wales is embedded in a view that when people need social care services they need to know they can get the help they need not just the help they can afford.

We are committed to integrated social services within local government, achieving sustainability, and reinforcing our ethos of social services being built around a strong voice for citizens, rather than on a consumer model of choice and standalone self-responsibility for individuals.

Our programme is about government working together with its partners and with communities and families to ensure that we have good services where they are needed. Engaging people in services at every level is a priority. This is our society; our communities; our families; and our children and young people. We all play a part together – and in Wales that includes government.

Overall, we want to build a model of social services that is based on the importance of early intervention. We want to support people when their difficulties first begin, not wait until the problem is ongoing.

We are building on strengths. We have protected social services in the budget settlement. We have built a consensus about social services across stakeholders and partners. We have strengthened the voice of carers. We have set financial limits on the cost of support through our First Steps Measure and we have rolled out Integrated Family Support Teams . We have strengthened the workforce.

But we know we need to do more if we are to face the challenges .The changing nature of Welsh society, clearer expectations on behalf of those who use services, demographic change – coupled with the present difficult financial climate – are all set to make demands upon social services that will affect the ways those services are delivered in the decades ahead.

Sustainability in social services must be about all stakeholders and partners working together with service users and carers central to that partnership and collaboration.

Key priorities include:

(i) Leadership and Direction

We are strengthening the leadership arrangements for social services by setting up a national partnership forum, which the Deputy Minister will chair. Through these arrangements we will set a strong national purpose, a clear national direction and firm expectations.

(ii) National Outcomes

A new framework of national outcomes will be published to support the national direction and these will be underpinned by a set of indicators that will allow users and providers to understand and have their say on the nature and quality of services in their area. We are revising our approach to improvement to ensure that it is aligned with our national direction and outcomes framework.

(iii) Reducing Complexity and developing greater collaboration and integration

We will prioritise work to reduce complexity and overlap through greater collaboration at national, regional and local level and we will push forward better integration of services across organisations. We must build services around people, not organisations. We have asked local government to consider how they will respond to our priorities and they will report to us by the end of the year.

We will expect and, if necessary, require some services to be provided nationally for Wales (such as adoption services). We will expect to see some other services provided regionally (such as commissioning and specialist services).

We are committed to offering re-ablement right across Wales. A number of studies suggest that if re-ablement is given, the need for homecare can be reduced by as much as 60%, with significant cost savings for councils and better outcomes for individuals

(iv) Safeguarding

We are committed to streamlining and strengthening our safeguarding arrangements for children and adults. We will set up a national safeguarding board for children and adults to provide national leadership and promote high standards and introduce a more robust statutory framework for adult protection in Wales.

(v) Developing the workforce and reducing and streamlining regulation and inspection

We need to continue to focus on the workforce and particularly to build up front line staff’s contribution as professionals, for instance through a career grade for social workers. We want to ensure that it is the provider of services and the commissioner who are accountable for quality and for improvement of safety. If we do these things, we can strengthen and streamline regulation and reduce the burden of inspection.

Legislative Programme

Our social care legislative programme for this Assembly is still under discussion but our priorities include the commitments set out in Sustainable Social Services and in our manifesto. These will form the basis of a Social Services Bill, which the First Minister has indicated will form a prominent place in the legislative programme.

The Bill will provide, for the first time, a coherent Welsh legal framework for social services based on the principles we have set out in Sustainable Social Services. It will ensure a strong voice and real control for people, of whatever age, who need services, based on their rights as citizens, ensuring that they will be able to maximise their wellbeing. It will recognise that when we face difficulties, we all look to our family, friends and communities to support us. It will ensure that public services play an active role in supporting people. It will set the legal framework and infrastructure that will transform services enabling them to meet changing social expectations, changing demography and resource environment we now face.

In particular, we would like the Bill to clarify and simplify duties on local government and other key partners to:

· empower and strengthen people’s voice and control over the care and support they receive;

· jointly plan and deliver services to facilitate joint working and the development of new integrated models of service delivery;

· have a stronger role in safeguarding and promoting the wellbeing of people across their lives (this will include consideration of the role of Local Safeguarding Children Boards);

· introduce portable assessments and national eligibility criteria to ensure equity in access to support;

· apply common standards in the care and support provided;

· work within rigorous performance and governance arrangements that are transparent, enable challenge and promote the confidence of the people of Wales.

ANNEX 3: UPDATE ON LEGACY ISSUES FROM THE FORMER HEALTH, WELL-BEING & LOCAL GOVERNMENT COMMITTEE REPORTS

The Committee will be interested in the recent progress on the following matters, which are referred to in the former Committee’s Legacy Statement:

(i) Maternity Services

Following consultation, we are planning to publish the final version of A

Strategic Vision for Maternity Services in Wales in September. It sets out a

programme of action at both a national and local level to deliver

our vision, which is that pregnancy and birth should be a safe and positive

experience that enables the mother, her partner and family to begin

parenting feeling confident, capable and supported in giving their child a

secure start in life. An All-Wales Implementation Group will lead and oversee

this process.

(ii) Workforce Planning

As the previous Committee identified, meeting the future health and social care needs of the people of Wales, requires workforce modernisation, which will only be delivered through new working practices and changes to professional and support staff roles. NHS Wales employs 83,478 staff, which is equivalent to 72,023 full time equivalent (FTE) staff. The number of contracted staff in post decreased by 518 FTE between May 2010 and April 2011.

Workforce Planning arrangements in Wales have been strengthened by the formation of the new Strategic Education Delivery Group (SEDG). This group covers the whole workforce and advises on current and future learning and development needs to meet service and workforce modernisation developments. SEDG is a multi disciplinary/multi-agency forum comprising all professions, representation from Higher Education institutions; third sector, trade unions and other relevant stakeholders. The group is responsible for aligning education, training and workforce planning.

The social care industry is expected to grow significantly over the next ten years with a consequent demand for staff with a wide range of skill levels. Workforce planning in social care involves a partnership approach between the Welsh Government, the Care Council for Wales, Social Services Departments and organisations in the independent sector. A model to predict demand and plan the supply of social workers is well developed. Further work on gathering intelligence on the workforce through the regulatory system is set out in Sustainable Social Services for Wales.

(iii) Wheelchair Services Investment

Following the Wheelchair Review, an additional £2.2m per annum is being invested to reduce waiting times for wheelchair services particularly for children and young people. The funding has now been allocated and is primarily being used to double the number of clinical staff across Wales. This will ensure that individuals’ needs are assessed more quickly and enable them to have the most appropriate wheelchair to suit their need. The funding is also supporting more training for health professionals, patients and their carers. We are also working with the British Red Cross to ensure a better service to those needing to borrow a wheelchair for short periods.

Service improvement work led by the National Leadership and Innovation Agency in Healthcare (NLIAH) has already introduced changes, in particular to waiting times management, improving referral processes, thereby reducing the waiting times. Clarity on referral criteria, together with improved communication, ensures clients and carers are kept better informed of the delivery time of their wheelchair.

(iv) Orthodontics

The former Health, Wellbeing and Local Government Committee’s report, and a separate review carried out by an expert panel, contained recommendations for consideration by the Welsh Government, LHBs and the dental profession. Recommendations included the development of Managed Clinical Networks (MCNs) to help improve efficiency and effectiveness including the management of those patients waiting for treatment. Other recommendations include work around service development, changes to legislation, along with better referral and monitoring. Interim guidance has already issued to LHBs and the profession based on recommendations from the review, and an implementation process has been established to consider over the coming months further recommendations included in the expert group and the Committee reports.

(v) Neonatal Care in Wales

Following the Welsh Government’s response to the previous Committee’s Inquiry into Neonatal Care in Wales, LHBs, through the Welsh Health Specialised Services Committee and the Neonatal Clinical Network, have put in place an All-Wales Action Plan to implement all the service improvements identified. Individual LHBs are currently developing Action Plans to drive local activity. A recent development includes a dedicated Ambulance equipped to transfer sick and premature babies is now operating in South Wales.

(vi) CAFCASS Cymru

We are making progress with the review of child contact services currently available across Wales. This will be completed by December 2011. CAFCASS Cymru is also working closely with policy colleagues to consider how consistent, appropriate support can be provided to improve services to families experiencing difficulties with contact with their children following separation.

The Chief Executive of CAFCASS Cymru met with the All Wales Advocacy Providers Group in May. A task and finish group has been established to jointly agree an engagement framework between advocacy providers and CAFCASS Cymru to improve and develop more effective working relationships in relation to advocacy for children and young people.