This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at http://www.guardian.co.uk/society/2013/jan/29/wales-found-winning-formula-healthcare
The article has changed 2 times. There is an RSS feed of changes available.
Previous version
1
Next version
| Version 0 | Version 1 |
|---|---|
| Has Wales found the winning formula for healthcare? | Has Wales found the winning formula for healthcare? |
| (about 1 hour later) | |
| The search for the holy grail of care services integration takes well-worn paths to places like Torbay, Herefordshire and north Lincolnshire that have pioneered joint working. But those seeking the recipe for success are looking with growing interest across the Severn bridges to Wales. | The search for the holy grail of care services integration takes well-worn paths to places like Torbay, Herefordshire and north Lincolnshire that have pioneered joint working. But those seeking the recipe for success are looking with growing interest across the Severn bridges to Wales. |
| Publication on Tuesday of the Welsh social services and wellbeing bill underscores an increasingly clear picture of the country's devolved administration driving integration of health and social care. Measures in the bill would require NHS and social services agencies to collaborate, including the use of pooled budgets. | |
| Wales is struggling with cuts in common with the rest of the UK. But the Labour-led Welsh government has not protected the country's £6bn annual NHS budget as the coalition has protected the NHS budget in England, and consequently the pain is spread more evenly across health and social care. Over the past three years, according to the Institute for Fiscal Studies, councils' spending on services (excluding education) fell only 9.3% in Wales compared with 15.6% in England. Next year, the Welsh government says, councils will receive a 1.5% increase in central funding. | Wales is struggling with cuts in common with the rest of the UK. But the Labour-led Welsh government has not protected the country's £6bn annual NHS budget as the coalition has protected the NHS budget in England, and consequently the pain is spread more evenly across health and social care. Over the past three years, according to the Institute for Fiscal Studies, councils' spending on services (excluding education) fell only 9.3% in Wales compared with 15.6% in England. Next year, the Welsh government says, councils will receive a 1.5% increase in central funding. |
| Right direction | Right direction |
| Some key indicators for the Welsh NHS are already moving strikingly in the right direction as a result of improved joint working across primary, community and acute healthcare and social services. Emergency hospital admissions of people with chronic conditions fell sharply in 2011-12, down by almost 15% for diabetes and 17% for lung diseases such as bronchitis, while readmissions dropped even more steeply, by almost 30% and 25%, respectively. | Some key indicators for the Welsh NHS are already moving strikingly in the right direction as a result of improved joint working across primary, community and acute healthcare and social services. Emergency hospital admissions of people with chronic conditions fell sharply in 2011-12, down by almost 15% for diabetes and 17% for lung diseases such as bronchitis, while readmissions dropped even more steeply, by almost 30% and 25%, respectively. |
| "We're not saying we have got it all right," says David Sissling , chief executive of NHS Wales and, significantly, also director general of health and social services. "I'm sure there are things we can learn [from England] on a reciprocal basis, but I do think that what we are doing seems to be delivering quite promising results in terms of improving patients' clinical experience and making sure we use resources wisely." | "We're not saying we have got it all right," says David Sissling , chief executive of NHS Wales and, significantly, also director general of health and social services. "I'm sure there are things we can learn [from England] on a reciprocal basis, but I do think that what we are doing seems to be delivering quite promising results in terms of improving patients' clinical experience and making sure we use resources wisely." |
| Wales is different, of course. Since 2009, NHS services have been organised through seven local health boards and three all-Wales trusts for ambulance services, cancer care and public health. There is no purchaser/provider split at local level – the boards run their own services – and the controversial shakeup taking effect in England in April, when the bulk of NHS cash will pass to clinical commissioning groups, will stop at Offa's Dyke. | Wales is different, of course. Since 2009, NHS services have been organised through seven local health boards and three all-Wales trusts for ambulance services, cancer care and public health. There is no purchaser/provider split at local level – the boards run their own services – and the controversial shakeup taking effect in England in April, when the bulk of NHS cash will pass to clinical commissioning groups, will stop at Offa's Dyke. |
| Social services in Wales, covering adults and children, are still, however, run by 22 unitary local councils created in 1996. Many observers think 22 councils are too many, but political resistance to rationalisation is strong. | Social services in Wales, covering adults and children, are still, however, run by 22 unitary local councils created in 1996. Many observers think 22 councils are too many, but political resistance to rationalisation is strong. |
| Sissling, who has held senior posts in the NHS in England and in Northern Ireland's unified health and social care system, believes that the health-board model makes it far easier to deliver integrated services. "They don't have any allegiance to hospital-bed care," he says. "And you can think about designing a care pathway without having to think about it in terms of transactions that bring two or three different organisations into the equation." | Sissling, who has held senior posts in the NHS in England and in Northern Ireland's unified health and social care system, believes that the health-board model makes it far easier to deliver integrated services. "They don't have any allegiance to hospital-bed care," he says. "And you can think about designing a care pathway without having to think about it in terms of transactions that bring two or three different organisations into the equation." |
| There is, he insists, no template for integration. "We are not saying there is a single, prescribed, formulaic approach, but we are saying there need to be some ingredients that deal with problems that are evident in all parts of Wales – ingredients such as unified processes of assessment, and of service planning, and common outcomes." | There is, he insists, no template for integration. "We are not saying there is a single, prescribed, formulaic approach, but we are saying there need to be some ingredients that deal with problems that are evident in all parts of Wales – ingredients such as unified processes of assessment, and of service planning, and common outcomes." |
| Sissling thinks integration has particular benefits for people with mental health issues, children with care needs and adults living with long-term conditions. His department is developing a framework to support integration of health and social services for older people. One integrated programme for older people that is already running, and evidencing progress, is the Gwent Frailty Project, a partnership between the Aneurin Bevan health board and five councils in south-east Wales: Torfaen, Blaenau Gwent, Caerphilly, Monmouthshire and Newport. Under the project, part-funded by £9m from the Welsh government's Invest to Save budget, mixed teams of health and social care workers take responsibility for the care and rehabilitation of older people in, or closer to, their own homes. | Sissling thinks integration has particular benefits for people with mental health issues, children with care needs and adults living with long-term conditions. His department is developing a framework to support integration of health and social services for older people. One integrated programme for older people that is already running, and evidencing progress, is the Gwent Frailty Project, a partnership between the Aneurin Bevan health board and five councils in south-east Wales: Torfaen, Blaenau Gwent, Caerphilly, Monmouthshire and Newport. Under the project, part-funded by £9m from the Welsh government's Invest to Save budget, mixed teams of health and social care workers take responsibility for the care and rehabilitation of older people in, or closer to, their own homes. |
| In 2011-12, the project's first year, the teams received more than 13,000 referrals. In Newport alone, the Royal Gwent hospital has, as a result, been dealing with an average 120 fewer patients each month. Two in three older people have been declared successfully "reabled" after a period of support by the teams. | In 2011-12, the project's first year, the teams received more than 13,000 referrals. In Newport alone, the Royal Gwent hospital has, as a result, been dealing with an average 120 fewer patients each month. Two in three older people have been declared successfully "reabled" after a period of support by the teams. |
| Satisfaction | Satisfaction |
| Sian Thomas, who manages the Newport team from the NHS side, says health and social care staff have moulded very successfully. "We're taking services out of secondary care into the community with what is a very holistic approach. It's giving the team great job satisfaction and you can see the end results with our clients." | Sian Thomas, who manages the Newport team from the NHS side, says health and social care staff have moulded very successfully. "We're taking services out of secondary care into the community with what is a very holistic approach. It's giving the team great job satisfaction and you can see the end results with our clients." |
| Graeme Francis, head of policy for older people's charity Age Cymru, says the project has the potential to deliver the kind of joint working that his organisation has long been calling for. "Many older people live with multiple health conditions and the reality for many is that services spanning both health and social care are vital to daily living. However, barriers between services frequently make it extremely difficult to deliver whole-person care." | Graeme Francis, head of policy for older people's charity Age Cymru, says the project has the potential to deliver the kind of joint working that his organisation has long been calling for. "Many older people live with multiple health conditions and the reality for many is that services spanning both health and social care are vital to daily living. However, barriers between services frequently make it extremely difficult to deliver whole-person care." |
| Although the pace of change generally has been frustratingly slow, Francis says, the Gwent project does offer a glimpse of what may be possible across Wales. Other integrated care schemes are under development in west Wales, Cardiff, Bridgend, Anglesey, Wrexham and Rhondda Cynon Taf. Joint management appointments between health and social services have been made in places including Carmarthen and Newport, Cardiff and Bridgend, with the Welsh government aiming for it to be the norm. But a problem remains regarding the continuation of 22 social services authorities, seven of which have populations below 100,000. | Although the pace of change generally has been frustratingly slow, Francis says, the Gwent project does offer a glimpse of what may be possible across Wales. Other integrated care schemes are under development in west Wales, Cardiff, Bridgend, Anglesey, Wrexham and Rhondda Cynon Taf. Joint management appointments between health and social services have been made in places including Carmarthen and Newport, Cardiff and Bridgend, with the Welsh government aiming for it to be the norm. But a problem remains regarding the continuation of 22 social services authorities, seven of which have populations below 100,000. |
| A possible solution to this is emerging north of Cardiff, where neighbouring Caerphilly council (population about 180,000) and Blaenau Gwent (70,000) are planning to integrate their social services departments by April 2014. Gwenda Thomas, deputy minister for children and social services in the Welsh government, has described the plan as "exactly what we want to see". | A possible solution to this is emerging north of Cardiff, where neighbouring Caerphilly council (population about 180,000) and Blaenau Gwent (70,000) are planning to integrate their social services departments by April 2014. Gwenda Thomas, deputy minister for children and social services in the Welsh government, has described the plan as "exactly what we want to see". |
| Under the merger, great care is being taken to ensure that services are seen to remain locally accountable. Albert Heaney, Caerphilly's social services director, who is leaving imminently to become the Welsh government's director of social services, children and families, says: "Unless you restructure local government, it's impossible to do this at a quicker pace. We have to make sure we have the right business case and the right governance arrangements for the new model." | Under the merger, great care is being taken to ensure that services are seen to remain locally accountable. Albert Heaney, Caerphilly's social services director, who is leaving imminently to become the Welsh government's director of social services, children and families, says: "Unless you restructure local government, it's impossible to do this at a quicker pace. We have to make sure we have the right business case and the right governance arrangements for the new model." |
| If this first merger goes smoothly, others may follow and may indeed move more quickly. In central Wales, Powys and Ceredigion councils are working up a business case for "closer collaboration" in social services and share an interim joint director, Parry Davies. | If this first merger goes smoothly, others may follow and may indeed move more quickly. In central Wales, Powys and Ceredigion councils are working up a business case for "closer collaboration" in social services and share an interim joint director, Parry Davies. |
| Ultimately, though, the combined pressures of an ageing population of 3 million people (including a steady stream of retirees from England), harsh financial realities and a devolved government are likely to keep the integration bandwagon rolling in Wales. According to the Welsh Local Government Association, 2013 looks like the year when "something will have to give" in public services in the country. That something may include any remaining resistance to thinking and working across teams, across agencies, or across boundaries. | Ultimately, though, the combined pressures of an ageing population of 3 million people (including a steady stream of retirees from England), harsh financial realities and a devolved government are likely to keep the integration bandwagon rolling in Wales. According to the Welsh Local Government Association, 2013 looks like the year when "something will have to give" in public services in the country. That something may include any remaining resistance to thinking and working across teams, across agencies, or across boundaries. |
Previous version
1
Next version