Dividends of devolution

A legacy of chronic under-funding combined with some of the
highest rates of poverty, ill health and deprivation in Europe has
made Wales a challenging place to deliver high quality social
care.

For decades practitioners have struggled against the odds to
provide vital services, but there are now signs that as a result of
the partnership approach between the Welsh assembly, local
authorities and the voluntary sector, the delivery of more
effective services is at last on its way.

Since the arrival of devolution and the assembly just over four
years ago, the beginnings of a distinctive and certainly less
adversarial approach to delivering those services has begun to take
shape.

In Wales, there are, for example, no “league tables” for social
services departments, despite some poor inspection reports, and
there is a commitment not to introduce fines for local authorities
for delayed hospital discharge.

Wales also has its own distinct strategies in place for service
user groups and there are plans to appoint a commissioner for older
people with a similar type of brief to that of the children’s
commissioner.

Major reforms to the health service in Wales, which took place in
April this year, will have important implications for social care
and the principality was the first UK region to appoint a
commissioner for children.

The publication of the new review of both health and social care in
Wales carried out by Derek Wanless, and under discussion by the
assembly this week, will provide an important step forward in
understanding the key pressure points for delivery of
services.

A key factor is that the review examines social care in the
principality as well as health, a joined-up approach that social
services chiefs have long been calling for in England.

Lynda Bransbury, head of social care at the Welsh Local Government
Association, describes the approach being taken in Wales as a
sensible one.

She argues that collaborative working to find solutions to capacity
problems is much more likely to result in successful outcomes for
vulnerable people who need to use services. And she says that the
principality is forging its own very distinctive path when it comes
to social care.

“There are very different policies on health and social care in
Wales than there are in England. England is going very much to the
model of transferring social services into the health service so
adult services are being transferred into primary care trusts and
there is a proposal for independent children’s trusts. We have been
given to understand that neither of those two policy changes are on
the table in Wales,” she says.

“We have a partnership approach to improvement based on the Wales
programme for improvement which is the Welsh approach to Best
Value, based on self-assessment, with external scrutiny from the
inspectorate,” she added.

That partnership theme, combined with solutions that are tailored
to Welsh needs, is echoed by the approach taken by the Care Council
for Wales, the body responsible for the social care
workforce.

Through several initiatives, the council has set about tackling
some of the workforce’s recruitment and retention problems. The
induction framework, for instance, is a strategy unique to Wales
and which has been developed through partnership working with
employers in Wales.

The framework offers common induction guidelines together with
assistance on preparing staff that is aimed at developing
consistent standards across the whole of the care sector in
Wales.

“The Care Council has made an impressive start in engaging the
whole sector in addressing the key workforce issues facing Wales.
It has helped establish four regional social care partnerships, and
has provided the glue to help these partnerships form,” says Colin
Berg, corporate director at Monmouthshire Council.

Significantly, sharing information across Wales both in terms of
good practice and in identifying local needs is now high on the
agenda.

Software has been introduced that allows every local authority to
assess what it is doing and, importantly, share that information. A
10-year development programme has been set up that will
systematically examine data to look at user needs.

There is also the innovative All Wales Unit that works across the
principality to support local authority social services in policy
development, implementation and review.

Case study: Mental health

Wales has its own mental health strategies for adults and
children. Both 10-year strategies are aimed at providing a holistic
approach to the treatment of patients with therapies matched to the
individual’s needs and those of their carers, rather than users
having to fit in with whatever services are available. 

But while the philosophy behind the assembly’s attempt to tackle
the stigma and Cinderella status of mental health services has been
largely welcomed, many mental health service users, voluntary
groups and assembly members feel that government proposals in the
form of the draft mental health bill are in direct contravention of
devolved Welsh policy. 

“There is a strong feeling that the tenor and direction of the
proposed legislation is very much opposed to the philosophy and
direction that the Welsh assembly government is taking in terms of
mental health services,” says Claire Williams, policy information
officer for Mind Cymru  

“And unfortunately we will have to go along with the legislation
when it is passed even if it is conflict with homemade strategies.
For the first time last summer the assembly health and social
services committee were called out of recess to discuss the
implications of the proposed legislation and they have expressed
very grave reservations,” she added.

Local Health Boards   

Local health boards (LHBs) are the cornerstone of the health
reforms introduced in April this year. The decision to abolish the
five existing health authorities in Wales and replace them with 22
LHBs is aimed at removing an unnecessary tier of bureaucracy and,
crucially, taking local people into the decision-making
process.  

There is now a joint statutory duty that the local authority and
the LHB work together. Each of the 22 local authorities has four
places on the LHB and decisions on health are now a local
government responsibility with joint strategies on both heath and
social care.  “The new LHBs have a huge potential for improving the
lives of people in Wales.

The reason is that there is a great deal of local involvement
and the boards have greater powers to shape services. There is the
potential for a much better network that can tap into the needs of
the community. There are around 22 members brought together from a
wide variety of backgrounds, health social care and the voluntary
sector,” said Marjorie Dykins, secretary of the Wrexham refugee and
asylum seeker support group. 

“The LHBs reflect the intention of the Welsh assembly that
health and social care matters should be rooted in public and
community involvement,” she added.

Children’s Commissioner   

Peter Clarke, the UK’s first children’s commissioner, has been
in post now for more than two years. With his appointment came a
clear statement that post-devolution Wales was prepared to take
radical steps to improve the lives of children. 

His work has not only been influential in promoting children’s
rights in the principality but has fuelled demands for other
independent children’s champions.  During the recent response to
the Victoria Climbi‚ Report, the parliamentary health
committee noted that the Welsh experience pointed to the value of
appointing a similar advocate who would work outside the machinery
of government. 

“Wales’s experience points to the value in pursuing the role of
a children ‘s rights commissioner and we do not believe that this
role could be fulfilled by the chief executive of a new national
agency,” the committee stated. 

During the past two years Clarke has shown that he is prepared
to tackle difficult issues. In his first annual report he drew
attention to what he described as the national disgrace of child
poverty in Wales, and in Telling Concerns a major report into
social services departments in Wales, Clarke highlighted worrying
inadequacies in safeguarding vulnerable children.