Written Statement - Integration of Health and Social Services  for Older People with Complex Needs

It is excellent news that people in Wales are living longer and healthier lives than ever before. As a result, we know that there is increased demand for both acute and community care services for older people, particularly those aged 85 and more. Frailty, dementia and the effects of multiple chronic conditions are more prevalent in this population group now and this will be so in the future, at a time when resources are tighter than ever. With these challenges to our care system and the need to strive for continuous improvement of quality, it is vital that we move with greater pace and scale to create fully integrated health and social services. We are therefore launching for consultation a new Framework for Integration of Health and Social Services for Older People that will give fresh direction and impetus to address these pressures at the same time as striving for improvement in the quality of services.

It is important that we have a clear definition of what we mean by integration. We must also recognise what it is not. It does not have to mean structural reform where for example social services are merged into the NHS. The Social Services and Well-being Bill makes clear that social services are a core activity of local government. The term ‘integration’ has many definitions which reflect the spectrum of levels at which integration can take place. Integration is the opposite of fragmentation. For people needing care and support it should mean:

‘My care is planned by me with people working together to understand me, my family and carer(s), giving me control, and bringing together services to achieve the outcomes important to me.‘

We must also be clear about the benefits that we expect integration to create. It will increasingly over time improve consistency in health and social care outcomes and shift the focus of care to the home and away from the hospital. It will ensure that good multi-disciplinary assessment becomes the standard. Inappropriate hospital admissions and unnecessary care home transfers wil be reduced. The role of the GP will be more central. Early intervention, reablement and intermediate care will be encompassed in a single system. Dignity and privacy will be protected.

There are a number of key essential requirements that we believe are necessary ingredients for successful integration that must be deployed to meet local circumstances across Wales. These include:

• A set of outcomes measures across health and social services – starting with older people with complex needs – that we can all recognise as being appropriate, ambitious and achievable.
• Services based on the principle and practice of giving voice and control in the provision of care to the patient/service user and their carer in a meaningful way; Strong shared collective leadership from the highest level in Councils and Local Health Boards and key partners with effective governance and accountability arrangements. 
• Systems that allow information to be both protected and shared across organisational and geographic boundaries so that information sharing is no longer seen as an inhibitor to integration
• Much greater use of formal partnership arrangements and pooled budgets.  Building on the initial investment we are making, transition funding will need to be identified by councils and Local Health Boards Following consultation we will want to see a year on year increase in use of shared resources. We will expect each Local Health Board and related Council to set a specific locally agreed target for the proportion of older people resources that are committed to a pooled budget.
• Renewed emphasis on establishing joint teams at regional and locality levels around services with a joint senior level manager driving change. The perceived barriers presented by different terms and conditions of employment must be overcome.
• Improved integrated care through care co-ordination managers is needed, utilising integrated care planning and through a team with a range of skills and roles. The notion of clinical and service champions should be further developed.
• Finally a clear sense of purpose and direction is needed across each region and local area. This is not a quick fix but we must move forward with early momentum. Agreed Statements of Intent for integration of services for older people with complex needs signed by each Council and partner Local Health Board will be required by the end of January 2014.

This new impetus for integration does not start from scratch. Building on significant investment in the Welsh Government Joint Working Grant for Social Services and Health and on continuing care development funding, further work is already underway across Wales. This is primarily related to frailty, for example the Gwent Frailty Programme, Hywel Dda’s ‘Virtual Ward’, and the Wyn Campaign being progressed in Cardiff and the Vale of Glamorgan, all with Invest to Save funding from Welsh Government as well as the Bhowmick Innovation Model (BIM) in Anglesey and the Frailty Project in Wrexham. Regional Collaborative Funding is also being made available.

The development and implementation process must build upon the experience and learning from these early pioneer sites and from the good practice, for example from mental health and learning disabilities and in putting integrated support for families with complex needs on a statutory footing. We must build on the principles that were fundamental to getting that approach off the ground and the lessons learned.  The next stage will need to take this to the next level, and to ensure that new, specially designed service models become part of the normal pattern of services for older people with complex needs right across Wales.

This framework does not stand alone but complements a range of other work already in hand.  Welsh Government has had a very effective co-productive partnership with Local Government, the NHS and Third and independent Sector in developing an Integrated Services Framework for older people with complex needs. This framework which we are today publishing sets out our expectations on the scale, scope and pace of change to achieve integrated services across Wales.

We must direct resources increasingly to the community and to capacity building within it and to enable people to stay at home as independently as possible.  The role of Primary Care and especially the GP in achieving effective integration is central to that aim. We have developed a related Delivering Local Health Care Plan to ensure effective integration across acute and primary care and with local government which we launched on 25 June.

The Social Service and Well-being (Wales) Bill will strengthen partnership arrangements for local authorities and the NHS to be working together.  There are specific provisions in the Bill (Section 147) that would enable Welsh Ministers to make Regulations which direct the type and form of the service led partnership as well as a range of supporting operational and management arrangements. These are substantial powers that would enable greater consistency to be mandated if that is not achieved in the next few years through collaboration.

We will report to the National Assembly on progress in implementing this important programme of change on a regular basis.