WCVA is working with volunteer organisations, public and private sectors, towards making that a reality.
A Healthier Wales is a policy developed by Welsh Government in June 2018. It is the Welsh Government’s response to a Parliamentary Review of the ‘Long-Term Future of Health and Social Care, A Revolution from Within: Transforming Health and Care in Wales’. The Review’s remit was to make recommendations on how health and care services might be realigned to manage current and future demands.
A Healthier Wales outlines a vision for a health and social care sector that works together to focus on well-being and prevent illness, echoing the philosophy of ‘prudent healthcare’, which leads to higher quality care and value, through less intensive clinical interventions and a reduction in variation, waste and harm.
It seeks to shift services out of hospital into communities and support people to live healthy, happy lives, ensuring they stay well at home. This requires all organisations, including voluntary, to come together, get better at measuring what really matters, and offer appropriate multi agency services.
It’s about enabling people to live independently for as long as they can, supported by new technologies and by integrated health and social care services that are delivered closer to home.
Welsh Government has repeatedly stated the importance of the voluntary sector to successfully implement its vision and has created a £100m transformation fund.
THE QUADRUPLE AIM AND TEN DESIGN PRINCIPLES
Welsh Government’s long-term future vision of a ‘whole system approach to health and social care’ is shaped around what is known as ‘the Quadruple Aim’. The Parliamentary Review recommended its use in order to encourage a shared understanding among all partners, including voluntary organisations, on how the health and social care system should develop and change.
In the context of Covid-19 the Quadruple Aim and the Ten Design Principles are all the more relevant and will continue to be key in achieving improved well-being outcomes for the population of Wales.
The Quadruple Aim comprises four interlocking aims, which have been successfully used in the development of several international health and social care systems.
The Quadruple Aim
- Improved population health and wellbeing
- Better quality and more accessible health and social care services
- Higher value health and social care
- A motivational and sustainable health and social care workforce
Its international profile should hopefully encourage shared learning and open engagement with other countries’ health and social care systems.
The Quadruple Aim also allows Welsh Government and partner organisations, including voluntary organisations, to:
- report on progress towards achieving the overall future vision of ‘A Healthier Wales’
- map out legislation, such as the Social Services and Wellbeing (Wales) Act, which already embeds a commitment to prevention and early intervention, co-production and shared voice and control
- map out how the health and social care system contributes to achieving the goals of the Well-being of Future Generations Act.
Complementing the Quadruple Aim are Ten National Design Principles, which are there to
help people, including those in the voluntary sector workforce, to understand how to deliver a ‘revolution from within’ and to check whether they are heading in the right direction, and at the right pace.
Welsh Government will work with all partners, including the voluntary sector, so these principles, based on delivery and feedback, may be periodically reviewed.
Ten National Design Principles
- Prevention and early intervention
Welsh Government suggests enabling and encouraging good health and wellbeing throughout life; anticipating and predicting poor health and well-being.
Example: The Education Programme for Patients helps people become an expert in living life to the full with their condition. Volunteers help to reduce the pressure on health services as more patients develop the knowledge and confidence to manage their own condition.
Welsh Government suggests enabling people to live safely within families and communities, safeguarding people from becoming at risk of abuse, neglect or other kinds of harm.
Example: Action for Children supports vulnerable children, young people and families in Wales through nearly 80 projects and services, working in partnership with local authorities, health boards and other third-sector organisations.
Welsh Government suggests supporting people to manage their own health and wellbeing, to be resilient and independent for longer, and to be in their own homes and localities.
Example: Age Connects Morgannwg Hospital to Home Service supports older people living in Rhondda Cynon Taf, Merthyr Tydfil and Bridgend to return home from hospital. Their discharge service provides 6-8 weeks support for people over the age of 50 who live alone or with an elderly carer and need help to re-adjust to living back home.
Welsh Government suggests empowering people to make decisions about care and treatment based on ‘what matters’ to them.
Example: Macmillan Cancer Support offers wellbeing coordinators in hospitals.
Welsh Government suggests health and care services that are tailored to individual needs and preferences including language of choice, precision medicine etc.
Example: Cruse Bereavement Care Wales offers somewhere to turn to when someone dies, with branches offering free and confidential services by trained volunteers.
Welsh Government suggests services and information that are less complex and better co-ordinated for the individual; close professional integration, joint working, and information sharing between services and providers.
Example: Dementia Matters in Powys take an intergenerational approach, hosting dementia meeting centres and supporting people living with dementia and their families. They use creativity to connect, share and support self-expression to break down barriers and improve social isolation so that people remain independent and have control over their lives.
- Higher value
Welsh Government suggests achieving better outcomes and a better experience for people at a reduced cost; care and treatment that is designed to achieve ‘what matters’ and delivered by the right person at the right time; with less variation and no harm.
Example: The Hear to Help service in Machynlleth is one of 15 services across Powys run by volunteers. The volunteers are trained by audiologists to help people find out how hearing aids work, how to look after them, and tips to try if one of them stops working.
- Evidence driven
Welsh Government suggests using research, knowledge and information to understand what works; learning from and working with others; using innovation and improvement to develop and evaluate better tools and ways of working.
Example: Nesta is a foundation that funds ‘Y Lab’, which works with public services in Wales to build innovation and research capacity, in order to develop and test solutions to major societal challenges in Wales.
Welsh Government suggests that good practice scales up from local to regional and national level, and out to other teams and organisations.
Example: Blood Bikes is a free of charge courier service run by volunteers to and for the NHS, delivering plasma, blood samples, breast milk and documents. They work with six of the seven Health Boards and had undertaken over 15,000 courier calls across Wales up to December 2019.
Welsh Government suggests developing new ways of working that are sustainable, changing and replacing existing approaches, rather than add an extra permanent service layer to what is done already.
Example: PIVOT (Pembrokeshire Intermediate Voluntary Organisations Team), led by the British Red Cross, supports people at risk of admission into hospital or who have been recently discharged where a non-medical intervention is needed to support their well-being needs.
Developing a shared sense of ownership and responsibility for the health and social care system is integral to ‘A Healthier Wales’, with Welsh Government echoing its commitment under the Well-being of Future Generations (Wales) Act, 2015 to listen to all voices, build understanding and trust.
This means all partners, including voluntary organisations, must use digital as well as regular communications to establish an ongoing conversation about the future of health and social care in Wales, through a co-productive approach with the public. This involves three distinct pieces of work:
- Different organisations complying with legal duties to collaborate and consult with the public or their workforce
- Consistent and dynamic interactive engagement so people can contribute their knowledge and preferences while also responding to new and emerging challenges and opportunities
- Have conversations about changes to services that will impact on how they will be funded and delivered in future.
THE HEALTH AND SOCIAL CARE WORKFORCE
The new vision will fail without redefining ‘the health and social care workforce’. ‘A Healthier Wales’ requires a rethink about who from the public, private or voluntary sectors is best placed to provide care for a specific individual, while also:
- ensuring greater parity of esteem between health and care professionals
- acknowledging the vital role of unpaid carers and volunteers, without whom there would be no overall system.
A Healthier Wales focuses on a broad multidisciplinary team approach where well-trained people work effectively together and all the up-to- date and relevant information about the individual’s circumstances and preferences is shared, in order to make the best possible use of everyone’s skills and experience.
Wales is a country of diverse and inspiring communities. Developing new models of care requires a clear and coherent approach to developing and planning the whole workforce in partnership with NHS and local government, the voluntary and private sectors as well as regulators, professional bodies, and education providers. This would also allow for providing care through the medium of Welsh and other languages.
For this to happen, the voluntary sector in Wales needs to be on the same footing as other sectors in the health and social care sector to effectively fulfil the role that Welsh Government has envisioned for it.
WCVA is calling for voluntary sector staff to be paid a fair, living wage, and be offered decent working conditions that would encourage new recruits to stay on. Volunteers and carers, who are vital unpaid members of the workforce, must also be provided with adequate supports, because it is a misnomer that the voluntary sector is providing services free at the point of delivery.
Read how Age Connects Morgannwg adapted their services to respond to flooding and support people that are shielding.
Read about the ways that the national charity, Kidney Wales, has moved quickly to respond to Covid-19 and has offered personalised services for people living with kidney disease.
Read about Community Connectors, who liaised with the British Red Cross, Age Cymru and even the local pub to help a couple, so the wife could be discharged from hospital and recuperate appropriately at home.
Read about a co-productive disability support project where people with a learning disability were treated the same as paid staff for Torfaen People First. Together, they worked with each other’s strengths to develop services to meet the needs of their community.
WCVA’S VIEWPOINT ON A HEALTHIER WALES
WCVA has long advocated and supported people to self-manage, with prevention at the heart of voluntary sector services. Importantly, the sector should be the first ‘port of call’ for many citizens, then referred onwards if needed.
Overall, voluntary organisations are telling WCVA that they’re not seeing robust evidence of continuous involvement and ongoing conversations with citizens and with the sector to develop new models and ways of working to support ‘A Healthier Wales’ and the transformation agenda.
A Healthier Wales calls for revolution, a radical approach which needs the involvement of the voluntary sector. Commissioners and strategic managers need to understand the role of the voluntary sector and its positive impact on delivering health, social care and well-being services.
WCVA is working with its partners, calling for:
- Longer-term funding cycles of a minimum of three years to allow sector organisations to deliver more sustainable services and retain staff with the right skills, knowledge and expertise. Short timescales mean voluntary organisations are less likely to be involved or be able to suggest new models of delivery from funding pots such as the Transformation Fund and the Integrated Care Fund.
- More co-production which means activity being properly resourced and inclusive. Too often, the term ‘co-production’ is misused or misquoted, with no citizen involvement or engagement, with public services dictating the tone, subject matter and pace.
- Investment in leadership within the sectors and in volunteer management capacity to develop strategic and sustainable volunteer programmes.
- Strengthening stakeholder relationships, especially with the voluntary sector as frontline providers.
- Support people to use Direct Payments more creatively.
- More research into the voluntary sector workforce, paid and unpaid (volunteers and carers), particularly as to how it can support the delivery of care and support services. For example, a voluntary sector worker, such as a social prescriber, link worker or community connector, may not benefit from the same opportunities (such as accredited training or clinical supervision) as public sector colleagues, especially in health.
- Ensure Social Value Forums have the mandate and resources to develop new models of delivery across health and social care. Section 16 of the Social Services and Wellbeing (Wales) Act, 2014 already sets out the need to look to new models delivered by, for example, third sector organisations, user-led groups, community interest companies and co-operatives. Voluntary sector representation brings unique, diverse, alternative and rich characteristics based upon their local knowledge of the communities they work with. Time is required to develop social value consortiums that could take forward issues and make the case for funding through those Forums. The County Voluntary Council / voluntary sector members of the Regional Partnership Boards have a role to play in identifying who would be best to deliver services in the best way.
- Identify standardised cross-sector evaluation tools to measure impact. Currently, evaluation methodology is varied, with voluntary sector organisations using different tools to measure, for example, social value. Each funder asks for different data and different templates to present the evidence.