Written Statement - Social Services and Well-being (Wales) Bill: Prevention and Early Intervention

In my letter to the Chair of Health and Social Care Committee dated 20 May and during my appearance before the Committee on 6 June I gave a commitment to bring forward more details concerning provision of preventative and early intervention services.

As I said in introducing the Stage 1 debate on the Social Services and Well-being (Wales) Bill, prevention is at the heart of our programme to transform social services.  That is why the Bill places duties on local authorities to deliver preventative services and contains a range of other measures to enable and require local authorities to lead the preventative agenda.  In doing so, my expectation is that they will work with partners including local health boards.

If we are to improve outcomes for people, involve them in contributing directly to their own wellbeing and reduce or delay the need for intervention then we must create a system that builds around this approach and places citizens firmly at the centre. We have developed our thinking over recent years, building on the recommendations made in From Vision to Action, the report of the Independent Commission on Social Services in Wales, and in our strategy set out in Sustainable Social Services for Wales: A Framework for Action.

We must strengthen the prevention that is already made available across programmes and services, building and extending the activity base in order to make sure that services are available when people need them.

In its joint report published in September, ‘Transitional and longer-term implications of the Social Services and Well-being (Wales) Bill 2013,’ the WLGA and NHS Confederation recognised that   prevention and early intervention programmes will play a pivotal role in delivering better outcomes and in  reducing demand for unnecessary  acute and substitute care.

I know we are all agreed that we must focus on prevention and early intervention in order to make social services sustainable into the future. I appreciate the positive response and recognition there has been from the Health and Social Care Committee and others for the role that preventative services will play in contributing to the well-being of people with care and support needs.

The Social Services and Well-being (Wales) Bill provides the legal framework to secure this system change and re-balance the way we seek to meet need both at an individual level and across the population. I want to be absolutely clear that prevention is not a discretionary matter. It is a statutory requirement.

The following key elements will underpin the preventative approach: 

1. new duties on local authorities and local health boards to jointly assess population needs of people of all ages including carers and to assess the range and level of services required to meet those needs;  

2. new duties on local authorities and LHBs to assess the range and level of services needed to prevent, delay or reduce people’s need for care and support;
    
3. new duties on local authorities to provide a range of preventative services for people; and
    
4. through my amendments, duties on local authorities to assess whether preventative services can meet identified need.
    

The elements I have highlighted together provide the cornerstone of the prevention agenda  The duties set out in section 5 of the Bill. include matters currently provided for in extant legislation including the Children Act 2004.

That legislation has underpinned the provision of preventative services for children over a number of years and much progress has been made in this area. Our flagship programmes ‘Flying Start’ and Families First’ are examples of what can be achieved. We know that prevention and early intervention is critical to successful outcomes in supporting families particularly those with complex needs. Co-operation across the school, community organisations, the police and social workers makes a real difference.

We are now establishing our expectations in legislation for adults and for carers and in doing so this is one of those areas that most visibly represents the shift away from the established way of doing things.

The assessment of need and service provision will be undertaken in accordance with regulations to be made by the Welsh Ministers. These population assessment duties are powerful and detailed, and require a full analysis of need in the population. It is this assessment – conducted jointly by the local authority and local health board - that will inform the overall approach to prevention within the local community and specifically the new duties on local authorities to secure a full range of preventative services. This builds on the overall duty of the local authority to promote community well being, mobilising the commitment of its partners, communities and citizens in doing so.

It will therefore require that the whole local authority and its partners across health and other statutory partners and the third and independent sectors plan and work together to deal with the need for preventative support in their local population. They will need to consider together how their contributions can combine to support citizens. It is this co-operative approach that holds the key to successful delivery.

To do this successfully, local authorities, health services and their partners must be able to communicate directly with their local population. We can expect this planning process to drive a strengthened approach to cooperation and co production of services as a result by engaging citizens in defining what services should be available, and in shaping the kind of services that will be meaningful to them in preventing their needs from developing or escalating.

People usually know what will help them. I have spoken often about making sure that that ‘little bit of help’ is available and can be accessed. To ensure that this happens we must draw on the knowledge and experience of people who use services now and their families as well as understand the expectations of those who may require services in the future.

We have all agreed that it is unnecessary to provide a detailed definition of preventative services on the face of the Bill and that caution is needed to avoid the limiting of local flexibility and innovation that this could create.

I recognise there have been some concerns expressed that bringing legislation together into a people model might undercut aspects of existing provision for children. However, as I have made clear in my evidence, the Bill reproduces key elements of extant legislation including the Children Act 1989. As regards preventative services, the model we have developed draws heavily on the children in need and well-being elements of the 1989 and 2004 Children Acts. There has been no diminution in the rights and entitlements of children here. I am satisfied that the critical areas of prevention are reproduced, and that the list of purposes set out on the face of the Bill, taken together with the wider environment in which partners will be under duties to co-operate, including working to the well-being definitions and under an outcomes-based approach, will provide for the full range of needs as previously defined to be included. I will say more on this aspect in my Written Statement on Children’s Social Care, to be published shortly.

I have also recognised the need to ensure that people can get access to information about preventative services, as part of the new duties in relation to information, advice and assistance.  In addition, the amendments I have brought forward in relation to assessment  provide a further strengthening of this approach by ensuring that the role of preventative services is considered at that stage and in advance of any consideration of eligibility. In this way I expect that many more people will access preventative services.

ocal authorities are already on the pathway to providing the range of services in the community which provide early intervention to stop needs escalating or are preventative. For example, community re-ablement services and support to improve parenting skills through the Families First programme.

The contributions of third sector organisations illustrates this well, and include the evidence of activities and services in which older people engage that encourage social interaction, engagement and physical exercise. All these can be seen as preventative interventions. I am grateful for such contributions, the evidence they provide of preventative activity in operation and the benefits they achieve.

We must now drive this work forward to the next level.  This will require a purposeful reorientation of current thinking, a focus on the preventive elements of existing public service delivery and identification of what is already available. The role of the Director of Social Services is central to this and is one of leadership and enabling collaboration, across local authority, health and public services, driven by the needs assessment and joint planning.

I will use the Code(s) and Regulations to be made under the Bill to provide guidance and structure for this work and to set out the detail as to what constitutes preventative services. My officials are drawing together the arrangements for this next stage of the process and that includes how we engage stakeholders, including people who use services, in that detailed work.

Services built on common purpose and outcome focus will help to achieve our ambition, but it will require new thinking and new perspectives on the part of providers and engagement with the populations they serve, together with effective leadership across services.

It is in this way that we will ensure that people remain in control of their lives and are enabled to live their lives as independently as possible. It is in this way that we will ensure that social services are sustainable in to the future.