Following the 2016 National Assembly for Wales’ elections, the First Minister made a commitment to establish an expert panel who would undertake a Parliamentary Review of Health and Social Care in Wales. The expert panel, led by former Chief Medical Officer for Wales Dr Ruth Hussey was established in March 2017, tasked with submitting a final report and recommendations by the end of 2017. In July 2017 the Parliamentary Review published its interim report, which will be debated by Assembly Members in plenary on Wednesday 20 September 2017.
The Parliamentary Review of Health and Social Care in Wales
The Parliamentary Review of Health and Social Care in Wales has cross-party support. It has been widely welcomed by stakeholders, though many have been sceptical about what the Parliamentary Review can deliver. After all, the review is wide ranging and has less than a year to report. The Review is expected to set out a vision for the future of health and social care in Wales and come up with the seemingly impossible – a solution for meeting rising demand for health and social care and public expectations.
There is little doubt that health and social care services face enormous challenges over the coming years. For example, some Health Boards are still struggling to balance their books, there are no easy solutions to the “workforce crisis” and new investment in infrastructure is needed to support the NHS at a time of continuing financial austerity. The challenges facing health and social care services in Wales are well-documented.
What stakeholders didn’t want was a Parliamentary Review that restated the current evidence. What they do want is a vision for the future that helps to shape Welsh health and social care policy. A review that advises on how to deliver change whilst building on the best of the current system. The Interim Report puts it clearly:
‘…the people we interviewed were clear that they do not want another report that does not lead to prompt and tangible action’.
Macmillan Cymru, the Royal College of Physicians, and the Royal College of General Practitioners are just a handful of stakeholders who have responded enthusiastically to the interim report. They say the interim report makes the case for change, providing a positive vision for the future of the NHS and social care in Wales – one centred on putting patients at the centre of these changes. (Though that enthusiasm is tempered with a note of caution – as Gregg Pycroft from Macmillan Cymru puts it).
The Interim Report
The interim report describes the case for change as ‘compelling’ and calls for a ‘bold and unified vision for the whole health and social care system’. The interim report is clear that to achieve better health and well-being for the people of Wales, stronger national direction is needed to speed up how the health and social care system adapts to the changing needs of the population and major challenges.
The interim report places a strong focus on the need to increase the pace of change, the spread of good practice, and promote engagement with the public. It wants to see continuous quality improvement and prevention at the centre of the vision for health and social care going forward. Indeed, the interim report sets out that the scale of the challenges facing the system are such that they ‘cannot be resolved by incremental changes to the current models of care’.
The Review calls for a limited number of new models of care in the first instance to be trialled, evaluated and scaled up rapidly across Wales. It says that new models of care will need to be underpinned by action in a number of areas and makes further recommendations including the need for:
- The people of Wales, staff, services users and carers to have greater influence on new models of care with clearer, shared roles and responsibilities
- New skills and career paths for the health and social care workforce with a focus on continuous improvement
- Better use of technology and infrastructure to support quality and efficiency
- Streamlined governance, finance and accountability arrangements aligned for health and social care.
The interim report states that the Social Services and Well-being (Wales) Act 2014 and the prudent healthcare agenda offer powerful sets of principles – but these ideas need to be embedded across the system if they are to transform health and social care in Wales. It also states that an effectively integrated health and care system requires the levers and incentives for change to be aligned and to be acting in synergy across the whole health and social care system. The report also indicates that there are leadership and cultural issues that need to be resolved in order to achieve ‘rapid and effective progress’.
There are issues that the interim report did not cover, or not did report on in enough detail for some. For example, the interim report says very little about new models of care in terms of mental health; other than to say that “the roadmap for improvement across the whole mental health system is not clear”. Others feel that the interim report could have gone further in considering the wider set of ‘social determinants’ or root causes of ill health – in particular poverty, in the provision of health and social care.
In their response to the interim report, the Welsh NHS Confederation say that the report raises concerns around funding of health and social care in the future. But the Review panel are clear that their remit does not include an analysis of alternative methods of financing the health and social care system. Vanessa Young, Director of the Welsh NHS Confederation, said:
“The report sets out the case for change and highlights a number of challenges and opportunities for reform over the next five years. But, the absence of any consideration of the long term model for funding health and social care is the elephant in the room. We believe the final report needs to tackle this issue head on and provide sufficient direction. Without adequate funding for health and social care in the future, the changes outlined in the interim report will not be enough to ensure a sustainable health and care system”.
The final report
Following the publication of its interim report, the Review now moves onto turning this ambition into practical reality. The next step for the Review panel is to consider the options for new models of care for Wales. These will cover primary care, hospital care, and community health and social care provision, working with a stakeholder forum drawn from service users, the NHS, local government, professionals, the independent and third sector and academia.
Dr Ruth Hussey explains that the expert panel will turn their attention to develop a list of recommendations that “command widespread support, are implementable, and give Wales the best chance of delivering the changes needed to achieve quality driven, sustainable, whole health and social care system and services that the population rightfully expects”.
Stakeholders will be hoping that the Review’s final report will have clear recommendations that can be implemented relatively swiftly to ensure that the health and social care system in Wales is fit for the future. The interim report, and the response to it, demonstrates that the case for change – and the swifter delivery of that change – has so far been persuasive. But meaningful reform will depend on the cross-party support for change holding.
The Parliamentary Review will publish its final report in December 2017.
Article by Sarah Hatherley, National Assembly for Wales Research Service.
This post is also available as a print-friendly PDF: Parliamentary Review of Health and Social Care in Wales Interim Report (PDF, 186KB)