Evolution or revolution? the future of health and social care in Wales

Peter Martin argues cultural change is as important as any structural reform of health and social care in Wales.

The final report of the Parliamentary Review of Health and Social Care in Wales published in January 2018 is subtitled, ‘A Revolution from Within: Transforming Health and Care in Wales’.

It makes recommendations about what health and social care should look like in the future. It recommends new models of care with services organised around the individual and their family, as close to home as possible. It also emphasises that services need to be “preventative, easy to access and of high quality”. In response the Welsh Government will very shortly be publishing a new ‘long term plan’ for the future of health and social care in Wales which will take account of the report’s recommendations.  

Who would argue with the report’s four mutually supportive and interdependent goals for Wales? The ‘Quadruple Aim’ is:

  • Improving population health and wellbeing through a focus on prevention
  • Improving the experience and quality of care for individuals and families
  • Enriching the wellbeing, capability and engagement of the health and social care workforce
  • Increasing the value achieved from funding of health and care though improvement, innovation, use of best practice, and eliminating waste

These goals are not particularly new or revolutionary. It was back in 2003 that Derek Wanless said in his own report into the future of health and social care in Wales that there should be a, ‘strategic adjustment of services to focus on prevention and early intervention’.  e needed, ‘to be resolute in breaking down the barriers between health and social care’. Wanless also said something that seems increasingly relevant today; ‘a step change in individuals’ and communities’ acceptance of responsibility for their health is needed’.

That was 15 years ago, and we are still saying the same things. Is this evolution or revolution?

Inevitably health and social care services will respond by drawing up their own local and regional plans, repeating the rhetoric, and setting out in detail how they intend to achieve the requirements of the Welsh Government’s ‘long term plan’. We now have an excellent opportunity to begin shifting attitudes and changing mindsets.  Without cultural change the only real tangible difference is likely to be a rearranging of the deckchairs.

There are already some positive signs that attitudes and mindsets are beginning to shift. Superficially at least there is an increasing awareness and recognition of the value of involving and engaging with people in all aspects of their own care, as well as in the design and delivery of services more generally.

The health and social care community in Wales is looking at ways of designing and planning services on the basis of people achieving outcomes that they value and that make a real difference to their lives. Additionally, health and social care practitioners, along with third sector organisations, are seeking to expand and make more widely available a range of local non-clinical services (social prescribing) such as volunteering, sports activities, gardening, befriending, cookery, arts activities, etc. Put simply, things that make us feel good.

Alongside social prescribing, having access to good quality education, training and employment is important to maintain or improve health and wellbeing. Building on people’s strengths, focusing on wellness and on what people can do rather than what they can’t do must surely be the way to move forward?

But we should also bear in mind that according to the National Survey for Wales 2016/17 a staggering 47% of adults reported they had a physical or mental health condition or illness which was expected to last for 12 months or more. 33% stated they had a condition or illness which limited their ability to carry out day to day tasks. So the challenge is huge, and we need to be wary that resources are not diverted away from services that support people most in need.

People receiving health and social care and support do not necessarily distinguish between social care workers and health care workers. They want services that are flexible and more tailored to meeting their needs.  There are positive signs that health and social care agencies recognise and understand this. Within Health Boards’ and local authorities’ plans there are commitments to further integrate health and social care, and to design and deliver services around identified needs, rather than trying to fit people into very narrow and specific service models.

Of course all is not perfect, there are inconsistencies across Wales, and the challenge is to make the good intentions work effectively in practice. There is still a need to transform the quality of care and treatment that people receive, and it’s important we don’t ignore the needs of people who have severe and/or long term health conditions and who are in greatest need.

We have an opportunity to seize the day and to rise to the challenges set out in the Hussey report. As well as redesigning some of our service models, we also have an opportunity to foster a culture that is focused on values and compassion, which puts people’s hopes and aspirations at its heart.      

Ultimately, all revolutions come from within. The alternative is becoming weak and open to invasion – and we don’t want that!


Photo by Marcelo Leal on Unsplash

All articles published on Click on Wales are subject to IWA’s disclaimer.

Peter Martin works in the mental health third sector

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