Closing remarks

Peter Llewellyn.
Job: Joint commissioning projects manager, Pembrokeshire Council.
Qualifications: Postgraduate diploma in health service management, Certificate in Management, NVQ assessor.
Last job: Community services manager.
First job: Clerical assistant, Department of Employment.

It was Frank Dobson who as health secretary in October 1997 first called for the demolition of the “Berlin Wall” that divided health and social services. Although it has certainly been breached since then, some parts still stubbornly remain erect among the rubble. Despite agreement over the need for joint working, there are often different understandings of what that means in practice.

However, one positive development that has generally brought together health and social care successfully is rehabilitation care for older people. This is where people, usually first admitted to hospital, can spend up to six weeks in a special unit receiving rehabilitative care aimed at returning them to their own homes. It certainly benefits the older people. And it suits both health and social care services: hospital beds are not taken up and care home placements are not rushed through.

The move to rehabilitation care has also been the catalyst in a groundbreaking scheme in South Wales. “In 2000 we secured sizeable funding from the Welsh assembly for the integration of a local authority residential care home and a day centre into a new purpose-built health and social care resource centre sited at South Pembrokeshire Hospital,” says joint commissioning projects manager, Peter Llewellyn. “The centre, which will open in December and concentrate on rehabilitation and intermediate care services for older people, is probably the first of its kind in Wales.”

Llewellyn, who was seconded from the NHS trust, had to consider the sustainability of the home while managing the closure. He says: “There are 14 available beds and we are happy to say that thanks to partnership working with the local NHS Trust and voluntary organisations, the home continues to be a vibrant community.”

Although it no longer accepts permanent residents, the home is being run as a mini-resource centre, providing rehabilitation and community care beds, day care and meals on wheels. The co-operation of the staff and the support of the home’s manager, Gaynor O’Connor, have been critical in achieving this transition. Llewellyn says: “From the outset staff have reacted positively and innovatively in changing their roles and making sure that we will be ready to move into the integrated service. The two-year lead-in time has given us an excellent opportunity to change the way people work and how they work together.”

O’Connor adds: “I was among the many staff who dreaded the thought of having to decommission the home, particularly over the relocating permanent residents to suitable alternative settings. Thankfully this piece of work has been completed sensitively andÊthey are extremely happy in their new abodes.” This included the successful placement in one unit of three female residents who wanted to stay together.

Regular meetings with staff – as a group and individually – and trade unions and staff-side representatives has helped make sure that any concerns or unease about change have been tackled. “Recent meetings have shown that staff confidence has grown,” says Llewellyn. “Having been in residential care where they are used to working hands-on, doing full care for residents, now there is more of an emphasis of prompting clients to do things for themselves in terms of re-ablement and daily living tasks.”

For O’Connor, the introduction of the rehabilitation service has been critical. “Not only has the scheme been of great benefit to clients but there has been a positive shift in the way we perceive clients’ needs,” she says. “Clients have seen the focus shift to enabling them to maintain their independence and dignity, while staff have developed skills in re-ablement and rehabilitation supported by physiotherapists and occupational therapists.”

All of which has led to proper partnership working. “People could see from the outset that the gap has closed between social care and health in terms of people’s needs and that the social element is a key part of health and vice-versa,” says Llewellyn.

“We managed to persuade people from early on that this initiative was for the benefit of patients and clients and would provide an opportunity for staff to develop in a multi-disciplinary way.”


  • Keep all staff informed all the time.
  • Drop prejudices and work in partnership.
  • Start joint training early.


  • Ignore unfounded rumours – they’ll just go away.
  • If you want joint training just put people together and let them get on with it.
  • Risk and liability issues can be sorted out later.


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