Andrew Goodall, chief executive of NHS Wales, sets out his agenda for health, housing and social care
It has been 18 months since the landmark Wellbeing of Future Generations (Wales) Act was given Royal Assent, and it is clear that health, housing and social care are critical partners in achieving the ambitions set out within its pages. We are well placed in Wales as there is already a strong relationship between those sectors, but we need to be going much further, much faster.
A lot of the priorities for health services in Wales over the past few years under Together for Health – for example, reducing the pressures on Accident and Emergency departments, improving the quality of life for people with chronic conditions, strengthening local health care – have been more effective when addressed through effective and productive working arrangements and partnerships across public service organisations, including housing and domiciliary care and support providers.
In many ways, health priorities are shared priorities. Housing organisations provide much more than housing, including extra care, nursing care, respite, and specialist mental health care.
The key challenge is how we strengthen our partnership working arrangements and jointly secure the improved outcomes that we all want in an ongoing age of austerity. We need to use these demands as an opportunity to accelerate the work we are doing to find shared solutions to joint challenges like demography, the disease burden and multi-morbidities.
Collective public service leadership
These remain challenging times for all of us working in the public service – in the NHS and social care we are balancing our values for quality, improvement and good patient experience, with an environment of resource constraint, and a pace of change for practice and technology; all of this is set in a context of growing demand, not least from an older population living longer and with more years of healthy life and higher public expectations to deliver and make progress across a broad range of settings.
I know these challenges resonate with housing colleagues. This is behind the recent launch of the enhanced adaptions system ‘Enable – Support for Independent Living’ to generate even closer working between local authority housing departments and organisations such as Care & Repair to improve the way in which people who need adaptations to their homes receive them. The system is good but will be even better.
It is the role of managers and leaders to adopt a ‘can do’ attitude to pressures and change in services – to respond and make things happen.
One example of this kind of approach is the work that has been implemented in Gwent through the In One Place Programme. The key to its success has been effective collaboration and breaking down barriers to provide person centred accommodation and support for individuals.
The latest In One Place development gives the opportunity for five people with complex needs to live independently while providing 24-hour support on site. The scheme has been brought about by close collaboration between Monmouthshire Housing Association, Monmouthshire County Council and Aneurin Bevan University Health Board. As a result, service users who were previously long-term inpatients have been given the chance to live in their own homes whilst hospital admission rates have greatly reduced for this group of people.
It is paramount that we collectively build upon these types of examples at scale and pace to design service with our citizens for our future generations.
The future
Going forward, I believe we have a responsibility to respond to the issues that are driving demand in our services. Part of our health legacy is that we have a higher proportion of older people here in Wales. This means coordinating service models for an ageing population associated with cancer survival, living with illness, disabilities, dementia and frailty. We should work actively on how, despite frailty, independence can be positively supported so that as far as possible, care can be provided closer to the community and home environment.
We will need to continue to review and deliver our health and care approach through a ‘prudent healthcare’ lens. These principles apply more broadly across public services and will resonate across health, housing and social care sectors as we strive collectively to provide sustainable services for future generations. We want Wales to clearly demonstrate it is delivering better value, quality and outcomes for our citizens by applying prudent principles in all we do. Specifically we need to change our question to our service users from ‘What can I do for you?’ to ‘What matters to you?’
Our future plans need to continue to demonstrate primary (and community) services acting as the focus of the vast majority of patient contacts in wales. The NHS should not need to default to a traditional hospital environment for its health offer to patients.
From an NHS perspective we need to ensure that the Social Services and Wellbeing Act promotes closer working and alignment with social care. In the context of our care system rather than just the NHS, we also need to work much more closely with the care home sector as a key part of our system capacity.
It is to our advantage that our public services are close. We know each other and that creates the trust and relationships that are key to our success in Wales. It is a privilege for all of us to have positions that support public service in and the ability in our different roles to positively influence the health and wellbeing of our citizens and in a way unique to Wales.