Towards integrated and seamless care services

As I have posted previously the care industry is a significant sector in Wales and, with the population changes we face, it will continue to grow. Across Wales adult social care makes a contribution of £1.2 billion to the Welsh economy and a £2.2 billion wider contribution.

So in the most recent part of my look at your local health and care services I met with representatives of Caerphilly CBC, including Cabinet Member for Social care and Wellbeing Cllr Carl Cuss, to discuss social care. I am meeting Merthyr Tydfil CBC in the near future for a similar conversation. We had a wide ranging and useful conversation about the changing laws and patterns of care, the increasing demands on services and therefore finance and some of the practical ongoing changes they hope to deliver in services for the Upper Rhymney valley.


As part of the conversation we also considered the pressure on CAMHS and the need to better understand what is driving the increase in demand that is causing delays in service. This is the local experience of issues recently considered in the “Mind over matter” report by the Assembly’s Children, Young People and Education Committee. It is not good for anyone if the response to a delay in accessing a service is an increase in medication at such young ages. I do wonder if a referral to CAMHS is being seen as a ‘silver bullet’ whereas the need is for more rounded support of emotional wellbeing rather than a CAMHS specific response. We must continue to understand this trend to make services sustainable and avoid inappropriate interventions and hopefully the new taskforce will help with this by encouraging a whole school approach.

Care and Wellbeing

At a more general level I was interested to hear about the “chatty café” initiative in which the council are encouraging local cafes to identify a table at which people can sit and signal they would welcome a conversation. It is another technique in helping to build conversations and break down social isolation and build more resilient communities.

It is the type of initiative that may help to reduce pressure on GPs and builds on the “Community Connect” ethos that Caerphilly Council has developed. The ‘Community Connect’ initiative is similar to GPSOs in Merthyr, and Social Prescribers in Cynon and all these services are exploring ways of diverting problems around social issues (housing, debt, isolation) away from GPs and being able to offer and signpost to other forms of support. Perhaps we need to move beyond the varying innovative labels and standardise the description of what these services provide.

These initiatives are part of a cultural shift that encourage us all to think of the support we need the seeing the doctor.

Integrated and Seamless Services

It was encouraging to hear that Caerphilly and partners have submitted a bid to progress the integration of health and care services, initially in the Upper Rhymney valley. For many years Rhymney has benefitted from the co-location of services in the centre in Rhymney, but there is more work to carry out to provide integrated hubs of services. From the councils viewpoint it will hopefully broaden the services they can offer through the pilot sites in Rhymney, the White Rose centre and in Bargoed. Let us hope the bid can be successful.

I recalled various integration models I had discussed in my days as a trade union official when looking at Torbay, Scotland and Manchester. I recently read the report of ADSS Cymru and the Welsh NHS Confederation on seamless services with interest. This recent guidance builds on the work of the National Commissioning Board on “Leading Integrated and Collaborative Commissioning

Service Demands and Funding

The Council referred to the increasing demands on domiciliary services in the light of the reductions in local government funding. It was stressed that domiciliary care can have a great impact in helping to manage demand on secondary (hospital services) and it cannot be allowed to decline further. The council stressed the role of the draft Welsh Budget settlement in this this.

Workforce and IT

The outcomes we desire require greater flexibility in roles and teams across health and social care. We discussed whether some domiciliary care workers can be trained up for low level medical tasks which would enrich their roles, and District Nurses could focus on more dependent medical needs. So workforce planning and design going forwards is important. Like the shift in to use of pharmacies as part of  the “Choose Well” campaign the integration journey takes time.

Progress is being made in the design and integration of IT, though it is not universal as yet.

Like many of these issues the real, practical changes and benefits take time to embed and for organisational cultures to change.

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