Prevention is better than cure

Ed Bridges says the Welsh Government’s latest policy on social services is dealing with the symptoms rather than providing a long term answer for our problems

Last Thursday saw the release of Sustainable Social Services for Wales: a Framework for Action, the Welsh Government’s White Paper setting out the future of social services in Wales. The headlines were grabbed by the news that Wales’ 22 local authorities would be encouraged to collaborate on social services but, scratch below the surface, and the bold vision was not matched by detailed action.

The trick which the Welsh Government missed in the White Paper – alongside a conspicuous lack of funding to back up its ambitions – is how social services users with the most intensive needs can be helped through early, low-level interventions. To have done so would have produced a more radical agenda as well as being more cost-efficient and harnessing the power of partner organisations that can help deliver those services effectively.

For example, the WRVS helps over 100,000 people in homes and communities across Britain through our befriending schemes, community transport and lunch clubs. In Wales, we have more than 4,000 volunteers in nearly 150 schemes right across the country. We operate those schemes because we know they work. Research has shown that these sorts of low-level, preventative measures can significantly help older people to remain independent in their own homes, rather than having to rely on more formal and costly social care or on hospital treatment.

Not investing in these sorts of preventative measures is a false economy. Wales cannot afford to pay more money further down the line to treat the symptoms of problems such as loneliness or poor nutrition, when investment at an earlier stage could save money and also produce better outcomes for the individual.

The argument here is not a crude request for more money. Indeed, against the backdrop of ever-tightening social services funding in Wales – for example, a possible £3.3m cut in social services in the Vale of Glamorgan or a mooted £260,000 cut to community transport and day services in Bridgend – the argument is more about maintaining existing services. Yet, there is an opportunity to shift Wales’ approach to social services radically by ensuring that investment happens at the lower end of the spectrum where it can make the greatest difference.

This should have been the starting point for last week’s White Paper. There were many fine words about preventative care and some very welcome pledges on re-ablement which will certainly help to ease the transition between hospital and home for those being discharged but there was also a conspicuous lack of funding to make these ambitions as achievable as they might have been.

The unspoken theme running through the White Paper is that the improvements to which it aspires can be met through efficiencies. Ironically, the paper says that “the scale of the challenge… requires more fundamental changes… [than] pooling back office functions and smarter procurement”. However, it is precisely through those back-office savings that much of the White Paper’s ambitions are to be met. There is, for example, no ring-fenced funding to local authorities to promote prevention or re-ablement. Such funding has been used effectively elsewhere, and yet Wales’ few re-ablement schemes will only remain in pockets across the country rather than being made a requirement everywhere.

There will also be no national eligibility criteria to ensure consistency between social service provision, helping people with similar needs receive similar services across Wales. The Paper acknowledges that eligibility criteria have generally been tightened across Wales, and that this is not sustainable. It says that the answer is

“…not a return to the ‘prevention role’ for social services, but recognition that the whole local authority has a responsibility for leading community services and promoting community wellbeing”.

This is a strong statement of intent, and helps to mainstream issues around preventative care. However, there is no mention of national eligibility criteria, or of local authorities being encouraged to lower eligibility criteria to prioritise that prevention agenda.

Finally, there is no directive for local authorities to merge social services, or to reorganise social services along the footprints of the Local Health Boards – a move which would have removed a big bureaucratic hurdle to more joined up health and social care. Local authority social services will be encouraged to work collaboratively, but they will not be compelled to do so. Wales’ social services will remain patchy, with significant regional differences, and with a lack of collaboration between health and social care.

Some of the announcements in the White Paper are not entirely dependent on resources and can be enacted relatively quickly and easily. These deserve to be welcomed wholeheartedly. The new National Social Services Partnership Forum will involve the independent sector in shaping key decisions about social services and this will happen alongside a commitment to develop citizen-run social enterprises. The fact that the Welsh Government is acknowledging that the independent and voluntary sectors can offer huge benefits to social services is evidence of a mature and inclusive attitude to social services provision and should be welcomed as an important step forward.

The announcement of a task group to look at the Welsh language in social services and the commitment to respond to the recommendations of that group are also hugely important. Many older people, particularly those suffering from dementia, find it harder (and in some cases impossible) to communicate in English. Exploring ways to ensure that their needs can be catered for through the Welsh language is a tangible step forward.

Ultimately, Thursday’s White Paper demonstrated what we already knew – Wales faces huge pressures in its social services. To its credit the Welsh Government has the ambition to develop social services to meet those challenges. But without the resources to invest in the low-level services that older people desperately need the Government is treating the symptoms rather than finding the long-term cure. Only by matching the fine words with money can we truly make Wales a great place to grow old.

Ed Bridges is the Public Affairs Manager with the WRVS in Wales [email protected]

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