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Summary

A paper to update Cabinet on progress and future direction of A Healthier Wales, our long term plan for transforming health and social services in Wales. 

  1. A year ago, I provided an update on A Healthier Wales, our long term plan for transforming health and social care in Wales, and the Welsh Government’s response to the recommendations of the Parliamentary Review.
  1. This year our health and social care systems have faced the biggest challenge of our lifetimes through the global Covid-19 pandemic. Health and social care services are at the forefront of both responding to the current crisis and preparing us to move into the recovery phase. Covid-19 has accelerated change in how health and social care services are delivered. We have been able to build on the foundations of A Healthier Wales and our response to Covid-19 has brought forward the implementation of our long term plan in some areas.  For example, technology has transformed the way we access many services, and going to hospital is now something we should do only when necessary. 
  1. The workforce is engaged in these changes and strongly motivated to drive further improvements in response to Covid-19, and to take the opportunity to make rapid progress against wider ambitions in A Healthier Wales. There is a recognition that both the world we live in has changed as a result of the pandemic, and that the long term vision in A Healthier Wales is still relevant.  The health and social care system must not go back to how it was, it needs to push ahead with new ways of working. We have an opportunity to accelerate and embed the transformation we set out to achieve.
  1. We have realised some of our early ambitions for A Healthier Wales and so it is right to now pause and reflect and ensure our plan is relevant for the Wales of today.

Objective of the Paper

  1. This paper is to update Cabinet on progress made against our long term plan, to reflect on the ways A Healthier Wales has contributed to our Covid-19 response and to secure Cabinet’s agreement to the areas we will focus on going forward.
  1. In the past 12 months significant progress has been made on the priority actions set out in A Healthier Wales. This is despite the pressures put on the health and care systems by the Covid-19 pandemic. Details on key areas are provided at Annex A.  Our strategy for transforming health and social care in Wales is now more important than ever. We have had to revisit our priorities, some of which have changed as a result of Covid-19, and we will need to remain flexible going forward in order to learn from our experiences and embrace the new ways of working introduced. In this paper I am outlining key approaches for the crucial time ahead, as we look forward to stabilisation and recovery, and I am seeking your support for our ongoing commitment to A Healthier Wales.

Impact

A Healthier Wales response to Covid-19

  1. Whilst some areas of work have had to be paused or revisited during the Covid-19 pandemic, we have also seen accelerated service transformation.
  1. The foundations of A Healthier Wales have led to impressive levels of partnership and collaboration across both organisational and geographical boundaries, which is testament to the collective commitment of our public services to respond to community needs. As a result several new ways of working and innovative practices have been introduced which we must now build on whilst ensuring that we still reach the digitally excluded or otherwise disadvantaged members of society.

Looking ahead – stabilisation and reconstruction

Significant and accelerated investment has enabled us to quickly transform our services in response to Covid-19. As we move into the stabilisation and reconstruction phase we will focus on the following areas:

  1. Sustaining our Health and Care System: We have worked closely with our partners in Local Authorities, Health Boards and the third and independent sectors, and through the first Supplementary Budget for 2020-21 provided an additional £573 million to the Health & Social Services MEG to support the Covid-19 response. This included £492 million to help Health Boards and Trusts meet the initial costs of responding to the pandemic with funding for personal protective equipment, field hospitals, additional staffing, testing and additional medical equipment and consumables. An £800m stabilisation package for the Welsh NHS was announced in August 2020 to support the development and implementation of a Winter Protection Plan to prepare for a potential Covid-19 second wave alongside usual winter pressures, whilst continuing to increase access to essential services. This latest package takes the total of Welsh Government Covid-19 support to the HSS Main Expenditure Group (MEG) to more than £1.3 billion.
  1. Social Care and Housing: Since April 2020, we have made £62.7m available to help adult social care providers meet additional costs associated with the pandemic.  We also continued our commitment to tackling homelessness, rehousing those provided with emergency shelter during the pandemic, building on the £10 million announced in March 2020 with an additional £40 million in August for Local Authorities.
  1. As well as continuing this support, going forward we will be considering a fundamental shift in how we support our social care sector. We will continue to work with stakeholders to rebalance social care and address the barriers which have made it difficult for the public sector and not-for-profit organisations to be major providers of care. The financial viability of social care remains a prominent issue and the Inter-Ministerial Group will continue to consider future options. We will also establish a Social Care Forum to examine how to deliver fair work in the medium and longer term across the sector.
  1. Children and Young People: We will focus on ensuring we protect vulnerable children and young people. In a joint project with the Children’s Commissioner for Wales, Children in Wales and the Youth Parliament, we launched an online survey in which over 23,700 children and young people told us their opinions on Covid-19 and the impact of lockdown. We know the pandemic has brought increasing challenges concerning safeguarding and so established a cross-government workstream focusing on vulnerable children and young people to ensure they were safe, seen and heard during the crisis. Following the return to schools we have introduced robust referral and prioritisation processes so that appropriate support is offered as quickly as possible. Recognising the impact of Covid-19 on the emotional and mental health of children and young people, we will work with our partners to ensure a ‘no wrong door’ approach to provide an integrated and multi-disciplinary model enabling access to the right help and support when needed and as close to home as possible.
  1. Mental Health Support: Officials continue to work closely with Health Boards to ensure services are in place to meet changing mental health needs of the wider population post pandemic. Welsh Government is considering what additional national actions will now be needed and, as a result, reflected in our current three year Mental Health Delivery Plan.
  1. Care Closer to Home: A Healthier Wales emphasises the importance of care being delivered closer to home. During the pandemic local services have made rapid advances in implementing key aspects of the Primary Care Model for Wales. We have seen increased cluster level collaboration and service models being adapted to support the separation of Covid-19 and non Covid-19 patient flows. Optometry and dental services have worked on a cluster basis to establish emergency treatment centres. The rapid implementation of telephone triage has taken place across Wales with a ‘phone first’ culture becoming quickly embedded.
  1. A Healthier Wales describes a system in which patients have a choice over how they access services. Through accelerated investment during the Covid-19 response we have put in place the infrastructure and systems required to enable video consultations with clinicians and have provided devices to facilitate this. Feedback on these new ways of working has been very positive, highlighting the time and travel expenses saved when compared to traditional models of accessing treatment. Going forward this will mean that patients are able to access care in the most efficient and appropriate way. Working with Digital Communities Wales we are ensuring the vulnerable and digitally excluded are also able to access services.
  1. Accelerated decision making and investment along with industry and commercial partnering has enabled the implementation of digital advances at pace. We must maintain our focus on infrastructure and retain these new ways of working. Work is underway to establish a new Special Health Authority (SHA); Digital Health and Care Wales by April 2021. This will establish our national digital services organisation as a dedicated organisation which reflects the importance of digital technology as a key enabler of change, as set out in A Healthier Wales.
  1. Rehabilitation: We anticipate an increasing demand for rehabilitation from people affected by the pandemic. This includes people recovering from Covid-19, people whose planned care was paused, people who delayed seeking help and people impacted by lockdown. Health Boards are working with partners to assess population need and develop rehabilitation services to meet that need.  We provided £10m to RPBs in support of the surge response to fund new and enhanced home care packages to enable patients to leave hospital for their ongoing assessment and recovery.
  1. Workforce: The wellbeing of our workforce is of paramount importance in helping us to provide high quality care. During the pandemic our health and care staff have gone over and above what could ever be expected of them and, in some cases, have experienced hugely traumatic events. We have worked with employers, HEIW, SCW and Trade Unions to provide a range of resources and practical support for all staff. A wellbeing focused sub-group of the Welsh Partnership Forum has also been established to respond at pace to the needs of our workforce.
  1. Obesity: In January 2020 we set out our ten year Healthy Weight: Healthy Wales strategy. There are strong links between excess weight and poorer outcomes for Covid-19 patients which have brought into sharp focus the reason why supporting people to be a healthy weight remains an absolute priority for A Healthier Wales. An updated delivery plan has been produced focussing on a healthier food environment, active travel, increasing physical activity, reducing obesity and effective communications.
  1. Community Resilience: During the pandemic over 130,000 people were shielded within their communities – an unprecedented action to provide care via food boxes, medicines, and social contact and wellbeing support. Instrumental to this activity has been the partnership with Local Authorities and County Voluntary Councils. In March 2020 we provided an initial fund of £24 million to support Wales’ voluntary sector in response to Covid-19. We have now established the Voluntary Services Recovery Fund which will focus on reducing the inequalities in society highlighted during the pandemic.
  1. Reducing Inequality: Covid-19 has compounded existing health inequalities in Wales. In the short term our A Healthier Wales focus will be on reducing inequalities in Covid-19 outcomes, including direct and indirect harms. Longer term we will prioritise action in response to the wider socio-economic impact of the pandemic, as well as reducing risk factors across the population with a focus on deprived areas. Recognising the particular adverse impacts of Covid-19 on Black, Asian and Minority Ethnic (BAME) communities, we have also established a socio-economic sub-group, chaired by Professor Emmanuel Ogbonna, to provide recommendations which address inequalities, close the attainment and pay gaps, tackle racism and promote community cohesion.
  1. Much progress has been made since the launch of A Healthier Wales, and it has been encouraging to see that in spite of the Covid-19 emergency work has continued and in many cases accelerated. Going forward we must not just retain but expand and build on the gains made during these difficult times, and ensure that successful models of care are fully implemented in our health and social care system. This requires careful consideration about viability and affordability, future investment and discontinuing outdated approaches. We have seen the pace of change that can be achieved through accelerated investment and the progress this has enabled against the aims of A Healthier Wales and we now have to decide whether to maintain this.
  1. Covid-19 has been a true test of our health and care system and it is evident that through the foundations laid by A Healthier Wales we have created an environment in which our partners and workforce have actively embraced and delivered transformation at pace, often in very difficult circumstances. As demonstrated by the updates in Annex A we have continued to make progress against our original plan. Covid-19 has created a unique context for rapid transformation and made delivering high quality integrated health and care services more important than ever before. Our proposed areas of focus will ensure we learn from the pandemic response whilst maintaining the innovative practices and new ways of working introduced.  I am clear that the original vision for our plan has been validated and remains relevant for the Wales of today and ask Cabinet to endorse this to ensure we achieve our long term aims of A Healthier Wales.

Communications and publication

This paper should be published six weeks after the respective meeting.

Recommendation: Cabinet is asked to note the content of this paper and to endorse the future direction of A Healthier Wales. 

Vaughan Gething
Minister for Health and Social Services
September 2020

Drafted by: Transformation Programme Team
Approved by Albert Heaney on behalf of Andrew Goodall

Annex A: Progress against the 40 actions in A Healthier Wales

  1. Digital and technology: The accelerated roll-out of digital technology has enabled continuous delivery of essential health and social care. Digital services have supported social distancing, and virtual consultations and remote diagnostics have allowed patients and healthcare professionals to choose the most appropriate channels of care. Handheld devices have enabled social care professionals to provide advice, and have helped vulnerable people to access support.
  1. New Models of Care: The £100 million Transformation Fund is supporting the scaling of seamless models of health and social care delivered through Regional Partnership Boards (RPBs). Prior to the Covid-19 emergency, £89 million had been allocated across all seven RPBs to support 14 proposals, many of which have played a fundamental role in our Covid-19 response. The remaining £11 million was moved into the Covid-19 response reserve. In August 2020 I announced an extension of the Integrated Care Fund and Transformation Fund until April 2022. This additional funding will provide stability for RPBs and support ongoing work to transform services.
  1. A national mid-point evaluation of the fund has been published and offers valuable learning for the ongoing implementation of new models of care. Communities of Practice (CoPs) have been established to share experiences and best practice across RPBs focussing on the themes identified in the evaluation report - hospital to home services; place based care; emotional and mental health; and technology enabled care.
  1. We have provided funding to all RPBs and NHS Trusts to establish Research, Innovation and Improvement Co-ordination Hubs, building a national network of stakeholders to bring together research, innovation and improvement activity.
  1. The £89m invested through the Integrated Care Fund (ICF) has enabled us to test and deliver new ways of integrated working to provide seamless care for a number of key population groups at or close to home, enabling people to live independently as part of a community. 
  1. System governance and incentivising the system: A Healthier Wales emphasises the role of good governance and good practice to drive effective, meaningful change. We are reviewing NHS Delivery Framework measures and have consulted on a Code of Practice and Technical Guidance for measuring social services’ performance. With RPBs we have developed a self-assessment tool to evaluate joint working which will be piloted in two regions post-Covid.
  1. A Healthier Wales highlighted the need for a new whole system approach, moving away from a medical model of health and separate system of social care. Experiences from the last six months demonstrate the vital role social care has played in the protection of the most vulnerable people in our communities. We established a care home action plan to focus on immediate pressures concerning infection prevention and control, personal protective equipment, clinical support for care homes, staff and residents’ wellbeing, and financial stability.
  2. We have undertaken a mapping of partnership structures, delivery mechanisms and funding streams, and have published the final report on the Review of Strategic Partnerships. All RPBs now have pooled fund arrangements in place for care homes for older people and we have completed a review in order to strengthen arrangements further. We have made changes to RPB structures to ensure local authority housing, registered social landlords and education sectors are appropriately represented and engaged in regional plans. We have also strengthened the focus on children’s rights and participation within regional partnership working. Earlier this year we issued new guidance for the ICF and responded to the WAO report on the ICF offering lessons to include in current and future funding arrangements. We published our first annual report providing an overview of how funds had been invested in Wales.
  1. The establishment of the NHS Executive was paused due to Covid-19. Many of the Covid-19 response arrangements have provided stronger central co-ordination and direction, as proposed for the NHS Executive.  Going forward officials will review lessons learned from the crisis response and consider how the NHS Executive takes a strategic role in NHS Wales.
  1. High quality of care contributes to improved outcomes, and six sites have been confirmed as early adopters of the first Quality and Delivery Frameworks focused on Emergency Departments. A policy framework for urgent and emergency care has been developed describing policy expectations of health and social care communities and how they will be supported to deliver them.
  1. System Planning: I have approved balanced and achievable three year plans from seven organisations for the period 2019-2022 as part of the Integrated Medium Term Planning (IMTP) annual cycle, and it is encouraging to see a strengthened and streamlined IMTP approach. We issued the first National IMTP in September 2019 along with the new NHS Planning Framework. The IMTP process has paused during the Covid-19 pandemic to allow organisations to focus on operational planning and management of the response. Work on the National Clinical Plan has also been placed on hold. We will review timescales and the relevance of specific activities in light of progress already made.
  1. Workforce: A Healthier Wales emphasises the role of the workforce in providing quality, value-based health and social care. HEIW and SCW has developed the first 10 year health and social care workforce strategy. This is now being re-assessed to account for the emergence of new priorities due to Covid-19.  To support our response to future health and social care challenges, we have established a Postgraduate Diploma in Healthcare Planning and agreed the development of a similar academic approach for social care.  
  2. Engagement: From September 2019 to January 2020, Welsh Government and RPBs jointly delivered 14 workforce events with attendees from Health Boards, Local Authorities, and the third sector. We have produced a range of communication tools and established an engagement network encouraging collaboration and sharing of best practice between regions.

Annex B: Statutory, finance, legal and governance matters

Statutory requirements

None. This Cabinet Paper provides an update to Cabinet.

Finance requirements and governance implications

There are no financial implications directly arising from this paper as it is an update on progress to date.

Strategic Budgeting have cleared this paper – SB1239/5

Research or statistics

None included.

Joined up working

List all ministers and departments that have contributed to the contents of the paper. It is also essential that the paper is cleared by each minister on that list.

Health and Social Services