In November 2016, The Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething AM, announced the setting up of an expert and independent panel to lead a Parliamentary Review into the future of health and social care in Wales. The panel, led by former Chief Medical Officer for Wales Dr Ruth Hussey was established in March 2017, and was tasked with submitting a final report and recommendations by the end of 2017. As a result, the publication of the final report is due at any time.
The panel was asked to assess and recommend how health and care systems might deliver improved health and well-being outcomes for people across Wales, reduce inequalities, and best enable the health and social care system to be sustainable over the next five to ten years.
However, the specific Terms of Reference for the review are also worth noting:
- Define the key issues facing health and social care;
- Identify where change is needed and the case for change;
- Set out a vision for the future, including moving health and social care forward together and developing primary care services out of hospitals;
- Advise on how change can be delivered, building on the positive aspects of the current system.
The Review specifically excluded any analysis of alternative methods of financing health and social care, or questioning of the overall range of services available to the population funded by the public sector.
The Review has cross-party support and has been welcomed by stakeholders, with broad agreement that the scale and pace of the challenges facing Wales means urgent and sustained action is needed. However, the tight timescale and scope of the Review is challenging.
At the same time, we will not be coming to the final report entirely cold. In July 2017 the Review panel published its Interim Report, which set out some of the key themes and findings which have emerged from its work thus far. Indeed, the Interim Report notes the significant and generous amount of evidence it heard and received via written submissions, interviews, workshops and web feedback. Significantly, it also notes the extensive information and advice the panel received from the social care sector, reflecting the growing inter-relationship and inter-dependence of the health and social care. For many, greater health and social care integration is absolutely essential to the long term future and sustainability of both sectors.
The Interim Report was explicit about its main message, stating that the “case for change is compelling” and stressing that health and social care in Wales needed to adapt much more quickly to the changing needs of the populations and the other major challenges;
“…the health and care system is not sustainable into the future in its current form; change which delivers major improvement to services is urgently required much faster than in the past”.
The Report continued to put the emphasis on delivery; stakeholders were after ‘prompt and tangible action’ and recommendations that built on what was best about existing services but also set out how change could be delivered.
The Report also called for a stronger national direction with a bold, unified and clear vision and strategy for health and social care, as well as a focus on prevention and quality improvement. The need for delivery of tangible actions also emerged in its call for a limited set of new care models to be developed, trialled, evaluated and tested against clear standards, scaled up rapidly and supported by a national learning programme.
However, it also recognised that there are critical building blocks to make this happen. New skills and career paths for the health and social care workforce were needed to support the changing shape of care. Similarly, essential developments are required in infrastructure; data and information, capital planning and structured support for innovation.
The Interim Report also called for a much more active programme of co-production, with wider involvement in developing these new models of care, drawing in people from throughout Wales, service users, carers and health and social care staff. Alongside this, it recognised the need for leadership and cultural change; local involvement and autonomy must work alongside a stronger national lead, robust performance management and accountability and better sharing of learning across Wales. Indeed, strong working within and across organisations and across the whole of Wales was essential if real change was to happen.
The response to the Interim Report was very positive but in some ways surprisingly limited. Dr Rebecca Payne, Chair of the The Royal College of General Practitioners in Wales welcomed the Report’s acknowledgement of the need for new models of care and service change, whilst stressing that general practice must be strengthened if more services are to be delivered in the community and closer to people’s homes.
Dr Phil Banfield, Chair of BMA Welsh Council also responded positively welcoming particularly the call for a quicker pace of change and that:
“..further consideration needs to be given to the ways professionals and clinicians are empowered to innovate and lead significant new models of care; and the recognition that the public need to engage in ongoing developments”.
The Welsh NHS Confederation also recognised the Interim Report’s ‘clear case for change’. However, their response also argued that the final report should consider and tackle ‘head on’ the long term model for funding health and social care, as they believed adequate funding was key to delivering both service change and sustainability.
The Interim Report was discussed in Plenary at the Senedd in September, with strong agreement on the need for change and the direction of travel. The Cabinet Secretary, Vaughan Gething AM indicated that the report “provides us with a renewed urgency for discussion and decision” and called for cross-party working to deliver the recommendations of the final report, once received. Indeed, the need for such consensus was echoed by a number of AMs. At the same time, others were more cautious about how intentions would be translated into action, stressing that the final report needed to spell out in more detail how the enormous cultural and practical changes would be driven. Angela Barnes AM summarised the position:
“We need a clear identification of the barriers to change and imaginative proposals to bridge the gap between idea and action”.
Indeed, the Review has continued its work since the publication of the Interim Report, engaging more widely with stakeholders and via a specially convened Stakeholder Panel with representation from service users, health and social care professionals, academia and the independent and third sector, tasked with developing both the new models of care and a process for implementing them.
There is considerable anticipation and high expectations about what the Review’s Final Report is able to deliver. All the evidence indicates consensus on the need for change. At the same time, the indications are that stakeholders will be looking for recommendations which are not only clear but can be acted on and delivered at pace. It’s a challenging agenda but one that can’t be avoided.
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