SHA Cymru Wales meeting in Abergele
For the first time in many years, SHA Cymru Wales met in North Wales responding to growing local interest in health matters and the work of the Association. The topic was Welsh Government plans to bring health and social care together in Wales.
Ably organised by Dr Kathrin Thomas and kindly hosted by Unison in their premises in Abergele, speakers were Welsh Minister Huw Irranca Davies, Unison’s Donna Hutton, and local G.P. and “cluster lead” Dr Matthew Davies.
Huw outlined the scale of the challenges from austerity facing the health and care system in Wales which need a “Welsh” solution bringing health and social services together as one increasingly seamless service. He cited areas of good practice in Cwm Taff as ones that needed up scaling and sharing and stressed the need for increased attention to preventing preventable ill health or dependency. The “Parliamentary Review” had urged ways of fusing together both parts of the system and also urged that this be done “at pace” through strong all Wales leadership. Regional machinery and footprints, pooled budgets, needs forecasting, working with the third sector, and making wise use of the Integrated Care Fund to spread good practice, were all part of the new approach as was a £100m transformation fund. Personalised budgets and patient voice had a role to play as too did digital technology. The pressures brought by austerity could only be countered by radical thinking.
Donna noted that the public wanted an integrated service, and thought Wales was well placed to do this given its legislative capacity and its collaborative approach to the NHS – unlike England where the NHS had effectively ceased. She saw the public sector leading change but it had to address pressures on both the directly employed and private sector work force in both health and social care. Trade Unions needed to be the voice of staff. She was also wary of different approaches by regional boards in terms of their links with trade unions and their degree of openness to the public.
Matthew stressed the centrality of primary care and the role of GP clusters in making the new approach work. Clusters involved social care and the third sector and must become another voice of front line workers. Clusters needed to aid both vertical and horizontal integration. He noted that general practice was only now beginning to shake off the damage done by the divisive nature of GP fund holding. He felt current plans were still light on detail, but thought this might be useful as local solutions could thrive in an unconstrained environment. He was also concerned that equal weighting was given to areas and that the new system needed to recognise the forecast demands arising from co-morbidities and the frail elderly. Increased public health support to clusters was necessary. He also pointed out the need for key staff, such as advanced nurse practitioners , to be addressed and for GP clusters to have a clear role in influencing Health Boards which had to be more open and accountable.
Discussion and questions from the floor raised issues in relation to:
- care of the elderly being a dominant issue
- putting patient experience and worries closer to decision makers
- the need for a defined place for national leadership to achieve a healthier Wales
- looking at the idea of a “social care levy” to fund costs
- having localism and co-production central to local initiatives
- concerns about the way the Welsh Independent Living Grant had been managed
- worries about the different approaches taken by regional boards and their complex accountability arrangements that seemed to shut out the general public.