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Written statement in response to the Health and Social Services Committee’s report of the review of the Interface between health and Social Care

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Brian Gibbons, Minister for Health and Social Services
Purpose: To present the Welsh Assembly Government’s response to the Health and Social Services Committee’s report of the review of the Interface between health and Social Care

Responses to the report’s recommendations are set out below. The recommendations follow the report’s headings and numbering.

The mechanisms for joint planning and provision of services in health and social care and the quality of the evidence base

The Committee recommends that:

1. The two information and communication technology (ICT) strategies should be integrated as soon as possible to facilitate the provision of more effectively integrated health and social care and the development of the electronic patient record.


Accept – We support the Committee’s view that the two ICT systems need to work well at the interface between health and social care. We need to address issues of equipment, applications, security access arrangements, staff/user/patient identification and governance.

One priority will be further exploration of the social services systems which will support the social care information (and other selected items) with an interconnectivity hub that allows the exchange of information between systems.

The Informing Healthcare-led all-Wales project on Unified Assessment will increase the level of collaboration and tease out some of the complexities surrounding the health social care interface.

Financial Implications – There are no additional financial implications.

The Committee recommends that:

2. See Recommendation 17



The Committee recommends that:
3. The Welsh Assembly Government should review guidance to local health boards (LHBs), trusts and local authorities (LAs) to secure the engagement of the independent and private sectors in joint strategic and service planning and commissioning

Accept  – We whole-heartedly share the Committee’s view of the need to engage the independent sector and are aware of the variability of this engagement across Wales currently.

LHBs and LAs, when developing and reviewing their local health, social care and well-being strategies, already have a statutory duty to co-operate with any private, business, voluntary or other organisation which is concerned with or has an interest in the provision of health and well-being services for the local population.  The statutory provision also requires LHBs and LAs to prepare a procedure of co-operation with the responsible bodies involved before developing the strategy.  This is amplified in the related policy guidance. Levels of engagement will be considered in discussions when evaluating local experience in preparing the strategies.

Current planning and commissioning guidance is already under review with a view to developing more robust joint guidance for both health and social care.  The importance of engaging the independent sector in joint strategic service planning and commissioning will be emphasised in the new guidance. This will also address the current variability of engagement.

Financial Implications - None


The Committee recommends that:

4. Proposals for all short term funding schemes should include:

• a statement of the aims and objectives and a plan for evaluating the scheme’s success in meeting them;

• an assessment of the impact of the scheme on core services; and

• proposals for mainstreaming the project where evaluation demonstrates there would be benefit in so doing.

Accept - We accept the importance of these points.  As part of the follow-up to the Wanless report, there will be a close examination during 2005/06 of how best to improve evaluation and accelerate take up of best practice, which will consider these issues.

Financial Implications -There are no additional financial implications.


The Committee recommends that:

5. In giving guidance to the statutory agencies on strategic planning, the Welsh Assembly Government should emphasise the importance of effective research and intelligence gathering so that health and social services can meet the dynamic needs of the population they serve. This should include encouraging links with research and developments in higher education.

Accept – We share the Committee’s view of the importance of research and intelligence to improve health and social services planning and provision for the future. We will emphasise this in statutory guidance (for example on strategic commissioning) and appropriate policy and framework documents.

Research and evaluation will be an integral part of this process, to ensure that both policy and practice are evidence based.

Financial Implication – There are no additional financial implications












The Accountability arrangements for joint planning and service provision

The Committee recommends that

6. The following key indicators should be assessed within performance management arrangements for LHBs, NHS trusts and LAs to demonstrate progress towards effective joint working:

• early identification of care needs and early intervention;
• implementation of unified assessment;
• effective hospital discharge planning;
• integrated teams of health and social care providers;
• support for carers;
• involvement of voluntary and independent sectors.


Accept  - Although the above principles are not specifically measured as indicators through the performance management arrangements, information is collected on all these activities through a range of mechanisms,  for example the performance agreements, Service and Financial Framework, Balanced Scorecard and inspection regimes. Current guidance reinforces the importance of these as will the National Service Framework for Older People on which we plan to consult in the Summer.
Financial Implications - None


The Committee recommends that:

7. The Welsh Assembly Government should make evidence of comprehensive joint working a clear and central performance indicator in the Service and Financial Framework and similarly it should be included as a performance indicator under the Wales Programme for Improvement. Although the Committee does not believe that sanctions to promote joint working are appropriate, rewards are a clear way to mainstream good practice



Accept in part - We accept the spirit of this recommendation and fully agree that effective joint working between the NHS and local authorities is essential, across a range of issues and services.  We have put in place a number of measures to capture and implement effective practice.

It would be difficult to include in the Service and Financial Framework (SaFF) an indicator on comprehensive joint working in the way suggested, as the SaFF does not cover non-NHS organisations, and as the targets included focus more on service delivery outcomes and less on the mechanisms that support delivery.

However, the Balanced Scorecard introduced for NHS Wales specifically requires organisations to evidence joint working arrangements with all stakeholders and partner organisations.  It also requires organisations to evidence that they work with, learn from and share knowledge with partners.

The extent to which local authorities and others work in collaboration, and the effectiveness with which they do so, will continue to be assessed under the Wales Programme for Improvement for local government.  Any weakness in this area would be identified as a risk by a local authority’s regulators, which would then need to be addressed

The Assembly voted unanimously on 8 March to support a new performance measurement framework for local government which focuses on outcomes (such as a reduction in delayed transfers of care) rather than processes (such as the extent of collaboration to that end).

We are looking at what incentives might be appropriate and what are considered to be successful outcomes.

Financial Implications – None


The Effects (both positive and negative) that decisions in one service can have on another

The Committee recommends that:

8. The Welsh Assembly Government should review the guidance on
• Health, Social Care and Well Being Strategies,
• Community Plans and
• Health Impact Assessments
to ensure that there is adequate consultation and recognition of the impact of local authority services on health and well being.                  



Accept - We support the Committee’s view of the importance of adequate consultation and recognise the powerful impact local authority services can have on health and well being.
On Health, Social Care and Well Being strategies, the legal requirements (The Health and Well Being Regulations 2003) and current guidance already provide for adequate consultation and recognition of the impact of local authority services on health and well being. Any future guidance will look to reinforce the continued inclusion of local authority services in the development of joint strategies.
Future guidance on community strategies will be informed by evaluation of those prepared in the first round. We intend to adopt a two-stage approach. The first stage, which is largely complete, is an in-house assessment of the individual Community Strategies.
The second stage is an evaluation of the process of preparing the strategies which will be undertaken by external consultants who are expected to report by early Autumn. The consultants intend to approach a number of councils / partnerships to examine aspects of their community strategy processes. The evaluations will contribute to the development of our policy towards Community Planning and the revision of existing guidance on the preparation and implementation of the strategies. We will consult on proposals towards the end of this year.

The 2004 Practical Guide to Health Impact Assessment reflects the experience of working with the NHS, the WLGA and Communities First partnerships. The guidance is highly relevant in helping to clarify the health contribution of local authorities and its application is assisted by a nationally funded support unit.

Financial Implications – There are no additional financial implications


The Committee recommends that:

9. LAs and their partners should collaborate in identifying which social services are currently provided around the clock, seven days a week, and whether additional services should be available at all times.


Accept – We share the committee’s view on the need for collaboration. Several initiatives are underway to improve emergency services (Developing Emergency Care Services, Welsh Emergency Care Collaborative). Social services have been engaged and this engagement will develop further. Work now beginning  will pick up the issues of extended access and more integrated working of emergency services and will address the priority areas that could make the greatest contribution to improvement.

Financial Implications - None














Key areas that impact on the quality and provision of a seamless service

The Committee recommends that:

10. NHS trusts and LAs should take steps to ensure that:

• discharge staff of different disciplines co-operate and receive training to   facilitate better understanding of the roles of the different professionals in the discharge team;
• discharge teams should have access to joint finances or joint resources to enable them to put services in place more quickly;
• the procedures for discharge planning should be established as soon as a patient is admitted to hospital;

Accept – We fully support the Committee’s view and have developed hospital discharge planning guidance for issue in May 2005 as a joint Welsh Health Circular/National Assembly for Wales Circular. The guidance sets out the key requirements for effective multi-agency discharge planning arrangements and includes detailed guidance on all the areas identified within this recommendation.

Financial Implications - None


The Committee recommends that:

11. The Welsh Assembly Government should explore the scope for innovative provision of intermediate care, including outside the hospital setting.

Accept – We agree with the Committee on the need to consider the range of provision of intermediate care. The development of intermediate care will be the focus of one of the standards of the draft National Service  Framework for Older People.   This will identify the need for schemes in a range of settings.  Such schemes have already been a feature of both the Wanless Local Action Plans and the more recent Health, Social Care and Well-being Strategies.  

A scoping study has been commissioned for an audit of intermediate care services in place or planned in Wales.

Financial implications – There are no additional financial implications










The Committee recommends that

12. Health, Social Care and Well Being Strategies should address the issue of long term planning for social care needs for people with mental and / or physical care needs.

Accept– Guidance on Health, Social Care and Well-being strategies requires local bodies to plan services for all major client groups on the basis of the local needs assessment.  The initial Strategies cover a 3-year period, and local bodies are now starting to act on those, but subsequent planning rounds will cover  a 5-year period. In the course of this year we expect  further policy development and guidance will emphasise the need for long term planning as identified in this recommendation.

Financial Implications – None

The Committee recommends that

13. Commissioning agencies should have greater regard to the independent and private sector and involve them fully in the planning of services at all levels.

Accept – We fully support the Committee’s view of the need to engage the independent and private sectors in planning services at all levels and the response to recommendation 3 sets out the actions in hand.

Financial Implications – None


The Committee recommends that

14. Service users should be informed about, and closely involved in, the planning of services.

Accept – As services develop we are committed to an approach that more openly engages the public at all levels, in accordance with Making the Connections.

We share the Committee’s view that service users should be consulted in the planning of services. This is already reflected in current guidance, for example Shaping Health Services Locally, which was issued in January 2005.  This builds on Signposts – a practical guide to public and patient involvement in Wales, published in October 2001 to provide guidance to NHS organisations on how to undertake Public and Patient involvement (PPI) activities in a range of different circumstances. It also placed a duty on Welsh NHS organisations to carry out a baseline assessment of PPI activities and to develop and publish annual PPI plans which, for the first time, set out priorities for public and patient involvement.

Signposts Two – putting public and patient involvement into practice was published in September 2003. This provided further guidance to help NHS bodies develop joint working with other stakeholders on PPI, how to engage staff to improve PPI capacity, and how to monitor and evaluate PPI to gauge the impact it had made.  Work is currently being undertaken to develop the networks for Trusts and LHBs to work together more and share good practices, and at training packages for PPI leads to educate all NHS staff.

The review of the planning and commissioning guidance encompasses the involvement of service users at each stage of the planning and commissioning cycle. Closer engagement with service users was also an element within the Wanless implementation programme.

Financial Implications – None

The Committee recommends that

15. See recommendation 3.



The Committee recommends that

16. Care plans should take account of the level of care being provided by carers. Agencies should work together to ensure that they understand the role and needs of carers and that they support them as members of the care team.

Accept  - We support the Committee’s view. SSIW has recently issued guidance to clarify how carers’ assessments should integrate with the unified assessment process for adults and link with the children’s assessment framework. Welsh Assembly Government hospital discharge guidance (to be issued shortly) will reinforce the need to involve and support carers.

In April 2005, the Carers (Equal Opportunities) Act 2004 powers were commenced in Wales. This legislation places new duties and responsibilities on authorities, including a duty on local authorities to inform carers of their right to an assessment of their community care needs. When undertaking assessments, the local authority must also consider whether a carer wishes to pursue work, education, training or leisure activities.

Financial Implications – There are no additional financial implications










The Committee recommends that

17. The Welsh Assembly Government should consider the need for centralised accreditation and dissemination of good practice (from Wales and elsewhere) and investigate the scope for an award scheme for rewarding exceptional examples of innovation and good practice in joint working.

We fully agree with the Committee’s view on the importance of good practice and have set up the National Leadership and Innovation Agency for Health care (NLIAH) in order to foster innovation and improvement within service delivery.

NLIAH will promote Health improvement and achieve excellence by providing a range of services that

- build leadership and management capacity and capability
- increase organisational effectiveness
- promote and support the redesign of the workforce
- engender and embed innovation.

In support of this agenda the organisation aims to hold an annual conference at which awards are given for innovation and good practice which has lead to real meaningful improvements. A category for good practice in joint working might well be included. Importantly, awards are given on the understanding that any organisation that receives such an award is contracted to share their learning.

We understand that "Excellence Wales" take a formal approach to best practice for local government and there is therefore scope to bring our ideas together in a considered way. We will pursue this further.

Financial Implications – There are no additional financial implications


The Committee recommends that

18. The Welsh Assembly Government should develop guidance for health and social care managers on providing training and development opportunities with the aim of breaking down barriers between different professionals / practitioners. These should include co-location of staff; reducing duplication of work, work shadowing and pre-and post-registration training.

Accept – We share the Committee’s view and recognises the importance and benefits of joint training and this commitment to breaking down barriers is a central element in Making the Connections.

Current guidance emphasises the importance of joint training and all healthcare education providers are encouraged to ensure that they encompass interdisciplinary and multi-organisation issues within their training programmes.  

Local Health Boards are already drawing together a range of organisations and agencies involved in delivering health and social care with the intention of  ensuring an integrated service for clients/patients. This includes the development of appropriate training.

Financial Implications - None


The Committee recommends that

19. The initial unified assessment should be carried out early in the episode of health / social care, so that a care package can be developed quickly and where possible prevent the need for acute care. It should include housing needs.

Accept  - We agree that unified assessments should be carried out early in the patient care pathway. The current guidance on unified assessment states the need for all levels of assessment and consequent care planning to be undertaken in a timely manner and to take account of a range of needs, including housing.

Financial Implications - None


The Committee recommends that

20. The Welsh Assembly Government should review the guidance on the unified assessment process to:

• address the concerns about its implementation;
• ensure that housing needs are taken into account;
• highlight the involvement of the voluntary sector in planning and      delivering care where appropriate; and
• identify and disseminate good practice.

Accept – We are carefully monitoring and evaluating the implementation of the unified assessment process. An advisory group has been established to advise the Welsh Assembly Government on the need for future developments.

The successful implementation of unified assessment will be hugely important to individual service users and to ensuring that services are effective and professional skills are used well.  

Financial Implications – There are no additional financial implications





The role of health and social services in promoting the independence of patients and the prevention of unnecessary admission or re-admission to hospital

The Committee recommends that

21. Health and social care providers should be alert to the benefits of assessing care needs early in a care pathway in discussion with the patient or client and the carer(s), with a view to preventing deterioration and possible hospitalisation.

Accept – We agree with the Committee’s view and the response to recommendation 19 sets out the actions in hand.

Financial implication - None

The Committee recommends that

22. Evaluation of the Blaenau Gwent Assist Project should be disseminated to the rest of Wales, and consideration given to how assisted technology can be used effectively to help vulnerable people live safely in their own home.

Accept - We welcome the Committee’s view on the importance of assistive technology and the need to learn quickly from good practice.  Work has been commissioned on guidance to help local authorities/ Local Health Boards and their partners to develop a strategic approach towards the implementation of tele-care and assistive technology.

This guidance will be shared with local authorities and Local Health Boards through a conference or regional workshops. The opportunity will also be taken to share good practice that is developing across Wales, including the Blaenau Gwent project.  

Financial Implications – There are no additional financial implications