Sue Denman explores how communities can play a full role in delivering care and wellbeing.
There is widespread support for the groundbreaking health and social care policies of the Welsh Government. Successful implementation will require organisations to work very differently in the care and wellbeing of older people. People and their needs will have to be placed at the centre of strategies, power shared, and an agreement reached on what is done, why and how. The emergent model must combine the social with the medical and strategies will need to shift towards prevention and the promotion of wellbeing.
The Third Sector, especially local community groups, are well placed to play a crucial role in the complex field of care and support . Their strength lies in knowledge of the health and care needs of their populations. They can draw on a local volunteer workforce and respond quickly to meet the support needs of individuals who may be isolated, lonely and living with multiple morbidities. Home based support, often coordinated with local public services (and in some cases private providers) can prevent people from being unnecessarily admitted into hospital or enable them to be discharged in a timely way. Communities can also provide respite for carers and extend local activities into wider prevention, integrated in a way which is meaningful to people’s lives. There is growing evidence of the considerable impact that such activities can have on individual wellbeing, and on community resilience and sustainability when part of a broader approach to development.
The Social Services and Well-being (Wales) Act of 2014 highlights the Third Sector as a crucial partner in its implementation and the procedures needed to design and deliver care and support. But how realistic is this expectation, at a time of extreme pressure on resources, and what could be done to make it a reality?
The first imperative is to ensure that Third Sector organisations operating at locality level are fully involved, at the outset, in the formulation of strategies that could optimise their role and the impact on their populations. This requires the public sector to view the Third Sector as equal partners in strategy and delivery. Yet all too often they are invited to crucial meetings as an afterthought, if at all. It also requires the building of mutual trust and an acceptance that the Third Sector adds to provision and is not there to replace the work of statutory services to save money.
Getting everyone around the table at an early stage in the process will build an understanding of the culture of organisations and the ways that communities work. Given time, an exploration of the respective language used around care and wellbeing, together with a sharing of organisational aims and objectives, scope, limitations and priorities will help to pave the way to an agreed way forward which is owned by all. This in turn should help to avoid unrealistic expectations and imposition of ways of working that could divert communities from their people focused priorities to bureaucratic tasks which needlessly absorb precious time and resources.
The second imperative is to explore and arrive at a viable solution for funding the Third Sector. Given the potential scale of impacts, these sums are often comparatively small when weighed against public sector budgets. Volunteers need, however, to be DBS checked, trained and coordinated; premises have to be booked for preventive activities and heating paid for. In a climate of diminishing resources, forcing already over stretched community groups to repeatedly compete for grant funding , which is itself flatlining, makes their future precarious, and all too often unsustainable. Equally, placing requirements on them to be ‘innovative’ (in the parlance of some funders meaning ‘new’) causes them to abandon their core mission and values and risks diluting their impact.
Still on funding, evaluation is quite rightly a core requirement of grant applications. Despite the importance of building an evidence base funders seldom allow sufficient resources to be allocated for this purpose. Furthermore, dedicated research and development grants cannot be applied for by communities in a leading role – yet another indication of their lesser status.
One solution to funding could be for local authorities to adjust their eligibility criteria and commissioning processes to enable communities to apply for funding, as deliverers of a service (grants through regional groups being, at best, a short term solution). Another is to explore the way in which groups of recipients of direct payments could cooperate to collectively buy preventive services. Policy makers must also ensure that they create a pull for evaluation and the provision of dedicated resources for this purpose.
The third imperative is for the public sector to organise support. This sounds daunting given the potential numbers of community based initiatives but is worth considering if they can be grouped and federated. Community groups, often operating with just a handful of people have to behave as quasi organisations and deal on an individual basis with time consuming matters related to governance, finance, human resources, communications and reporting. The provision of support in some back office functions could help community groups grow in numbers and flourish. Networking will also help them to share ideas and resources.
The fourth and final imperative here concerns leadership – which organisation is leading on this agenda and is accountable? There are currently a myriad of fact finding reviews being undertaken at national, regional and local levels in Wales. Whilst these no doubt have an important effect on organisations getting their own thinking straight, the duplication of effort and lack of coordination are striking to observe. As yet there is no clarity on where the leadership lies in the overarching delivery of the Act and what the relationship is between the various levels and types of public sector organisations: national, regional and local.
Some progress has been made but the solutions for change remain elusive and implementation is slow. Grass roots community groups are largely isolated and on the periphery of processes. Bold and radical actions are urgently needed to ensure that this is no longer the case.
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