Paper 2 - Early intervention and prevention approaches for Social Care Wales (SCW)

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1 Paper 2 - Early intervention and prevention approaches for Social Care Wales (SCW) Strategic Improvement Steering Group (SISG) Advice for the Minister for Health and Social Services Purpose This paper aims to raise some of the issues which Social Care Wales (SCW) would need to consider in encouraging and developing new thinking about early intervention and prevention as it relates to older people. It is based on discussions that members of the Strategic Improvement Steering Group (SISG) had last year about early intervention. Social Care Wales - Developing Early Intervention and Prevention for Older People Older People must be at the Centre of Policies, Strategies and Delivery One of the most important themes of the Social Services and Well-being (Wales) Act 2014 ( The Act ) is the centrality of citizens. SCW must model this principle in all it does. Firstly, SCW - with older people and relevant partners - needs to set out the broad quality-of-life outcomes that older people want for themselves. These are likely to include such outcomes as being healthy, safe, independent, having financial wellbeing, etc. It is important to define these outcomes - as well as what is meant by wellbeing in the Act - at the outset because all subsequent strategies should aim to improve at least one of these outcomes. It is equally important for SCW to establish a process which models what is arguably the most important theme in the Act. Action SCW should ensure that older people are at the centre of policy formulation and the development of early intervention (and all) strategies. In particular, older people should determine what they want for themselves, as they become vulnerable. National Social Services Citizens Panels and a project using older people to identify the ways in which their dependence on services might be avoided, commissioned by the Social Services Improvement Agency (SSIA), could both be used to identify these outcomes. Defining Early Intervention Early intervention strategies are likely to vary according to which particular aspect of older people s lives are being focused on. For example, the Keeping Safe Outcome which might include a strategy to reduce falls, will be different to strategies of early intervention to promote economic wellbeing or the relief of isolation and loneliness. By working with older people and partners to establish the outcomes they want for themselves, it will then be possible to start to define what effective early intervention might look like in relation to each outcome. Working out what 'good would look like' - in effect, a series of qualitative performance measures - will start to produce an outline of which areas 'early intervention' might focus on.

2 Local authorities need to think of early intervention as a 'whole system strategy' and regard it as a high priority. They, therefore, should understand that such services as libraries, community centres and housing departments all have an important role to play. However, the risk is that the savings targets are likely to include these services and therefore, the savings which could be expected for health and social in the longer term will be threatened by the reduction or removal of preventive services which are needed to deliver early intervention. In addition, there are organisations outside local authorities which have an important role to play in prevention such as Health Boards, Public Health, Transport etc. These organisations also need to give early intervention a priority and be monitored appropriately. There are also potentially important roles for Town and Community Councils and such initiatives as Community First. Action: SCW, with older people and partners, should produce Qualitative Performance Measures to ensure that developing strategies will have a real impact on, and make a difference to, the lives of older people. Citizens Panels and those involved in the SSIA project can also help define what early intervention and wellbeing mean from an older person s perspective. Research and Evaluation SCW will be able to promote or undertake comparative or other studies to enable it to make recommendations..." (Para 69 of the Regulation and Inspection of Social Care (Wales) Bill). Commissioning research or evaluation into what works, in Wales and elsewhere, in preventing falls or increasing independence, will be a necessary part of a systemic approach to early intervention. It will also ensure that, as far as possible, an evidence-based approach is adopted by SCW. Action: SCW should ensure that Research and Evaluation, which falls within the responsibilities of SCW, is driven by the priorities of SCW. Priorities Early intervention is specifically mentioned in the Act as being a priority of Government. This is an important commitment but needs definition, and clarity, as it potentially could relate to a vast number of areas on which to focus. In its early days, SCW will need to decide on a limited number of priorities on which to focus, not least to test its modus operandi,in relation to citizen involvement,, it's working with partners, it's limitations and its effectiveness in developing new thinking. A risk to choosing priorities is that, dominated by professionals, SCW may give priority to those areas which concern them most, rather than those issues which are of most concern to citizens. Action: Together with Government and older people, to identify the priorities which relate to early intervention.

3 Local, Regional and National Roles Although early intervention models can only be delivered at a local level, there will be roles for those working at regional and national levels, which will help support and consolidate the work done locally. These roles will include those involved in appropriate regulation, workforce development, high-level partnerships and resourcing. SCW needs to take the lead in ensuring there is clarity about roles and responsibilities, ensuring maximum emphasis on the devolution of responsibility to local levels and maximum support from the centre and elsewhere, to ensure that strategies are effectively implemented. Action: Welsh Government should ensure that SCW is in a position to influence the various roles and responsibilities relating to early intervention at local, regional and national levels. SCW should also be able to advise on funding opportunities, such as European funding, to increase resources available. Greater Control and Choice for Service Users. As stated in the report, the centrality of citizens as it relates to Social Care, is arguably the most important and challenging commitment of the Act. SCW should play an important role in developing models, and distribute examples of good practice where service users have more choice and control over the policies, strategies and services they receive. The implications of this objective are, however, far-reaching and complicated. Proper consultation and involvement takes time; greater control for service users means that decisions will be made in different ways; political processes will have to be reviewed; and authorities may have to work in different ways. In addition, there will be limitations to consider about the degree to which people will have control and choice. Action: SCW - in partnership with older people and partners - and by using existing examples of good practice, to identify what the centrality of citizens means in practice, as it relates to early intervention. The Citizens Panels and those older people engaged in the SSIA project, could make a significant contribution to this discussion. Demographics and Data SCW cannot develop models of early intervention in the absence of accurate information about a range of factors which will affect an ageing population. Access to local information for older people is a likely initiative of any early intervention strategy, but SCWs development" role will require data across Wales to identify the rural and urban challenges that need to be addressed. Producing models for obtaining relevant data for local authorities will part of that process. Action: SCW to ensure that appropriate data is available to help identify priority areas for early intervention and what kind of intervention might be most effective.

4 Models of Early Intervention The previous sections all highlight particular actions which SCW might take to create and build on a framework for early intervention in Wales. What it cannot do is deliver early intervention, as this can only be done locally. One model of early intervention is to accept that local authorities, under increasing financial pressures, will be unable to fund expensive early intervention strategies. To deliver new, innovative and effective preventative strategies will require a new mind-set and fresh thinking. Community-based partnerships with a range of partners focusing on one or two priorities, each making small contributions, coordinated properly and building a critical mass - may start to make a difference to the lives of older people. Developing a community-based model such as this should produce a range of small scale but implementable strategies appropriate to the particular estate, town or community. In some areas, a good neighbour scheme might reduce loneliness; In others, an information hub might give older people easy access to services which could help them maintain their independence; Pubs might deliver healthy meals, or towns might become dementia friendly to promote the safety of older people. The way that SCW could promote early intervention, is by encouraging local authorities to fulfil its leadership role by creating local community-based partnerships in areas of greatest need, and give them examples of what works and a framework by which to implement new strategies. A community-based approach is not the only model available and SCW will through its research and evaluation elaborate on is aligned to take anyway often role, identify other early intervention models which it can share with partners. Whatever model is developed by the local authority will require clarity of vision from its leaders which is properly communicated throughout the local authority and to its partners. A key responsibility of SCW will be to encourage, support and monitor the way a variety of early intervention strategies are being developed and implemented locally, and to provide new ideas and examples in Wales, and elsewhere, of effective strategies. Action: To develop, encourage and monitor new models of early intervention as they relate to older people. Regulation SCW will be responsible for many of the regulatory functions as they relate to Social Care. Early Intervention must become priority for Regulators in assessing the leadership role of local authorities in encouraging early invention strategies. However, early intervention requires the contribution of many partners and other regulatory bodies, and must also ensure that Health organisations and other bodies are giving early intervention the priority that they should. The Welsh Audit Office could play at important role by adding early intervention as a priority to its

5 Inspections. Action: SCW should ensure that early intervention is given a priority in the Inspection Framework of local authorities. Workforce Development Integrated Model of Prevention Section 67 of the Regulation and Inspection of Social Care (Wales) Bill states that SCW should promote and maintain high standards of training of social care workers. Early intervention and prevention will have an impact, not just on social care staff, but also on Health Visitors, District Nurses, GPs, Community Centre Staff, and many others. SCW should influence the training needs for all agencies in delivering an integrated early-intervention strategy, in coordinating the training implications for all partners if an integrated model of prevention is to be achieved. Action: Currently, with the difficulties of recruitment to the care sector, SCW should play a leadership role in advising on the recruitment of care workers, as well as succession planning, so that in Wales there exists a workforce fit for purpose. Leadership, Partnership and the Management of Change Much has been said of the need for a culture change in delivering new ways of working, creating different kinds of partnerships and engaging citizens in the development of their services. As stated above, clarity needs to be given, not only to what is meant by early intervention and prevention, but also what culture change looks like when it has been achieved, as well as how to get there. SCW should, as part of its development role, play a significant part in developing leaders across Wales who will drive and develop the kind of changes required to produce better outcomes for vulnerable people in Wales. In doing so, it would need to research and disseminate examples from the public, private and third sectors, from the UK and elsewhere, of how organisational change and new thinking can be encouraged and achieved. If fundamental changes are expected to the ways in which vulnerable people's lives can be improved, then maintaining the status quo is not an option. Leadership, an understanding of the management of change and new kinds of partnership will all be required if a culture change to the way things are done, is to be achieved. Relationships between SCW, Local Authorities and other Organisations SCW will have a range of specific responsibilities to manage, monitor and report on. It will also have an important developmental role in creating and supporting innovative thinking in relation to early intervention and prevention, as well as other priorities. During a period of austerity, new thinking is of particular importance as the lives of vulnerable people are placed at increasing risk. SISG believe that the credibility and success of SCW will depend on the quality of the relationships that it builds with its partners - both new and existing. These relationships will be based on a shared understanding that changes to people's lives occur in communities, and that the rest of the system should be designed to support those changes, not the other way round.

6 Summary This paper has sought to identify the range of issues that SCW needs to consider in developing an early intervention strategy locally and nationally. It includes suggestions about some specific actions it might take to create a momentum for change. It is clearly incomplete and suggestions would be welcomed on how it could be improved. A core proposal is that SCW has a development role which seeks to embed the key principles of the Act including: a commitment to the central role of citizens (of whatever age), a shared agenda between partners and therefore genuine partnership working with a range of agencies in the public, voluntary and private sectors, an acknowledgement that changes in culture which affect vulnerable people occur locally, performance needs to be measured against impact on the service user, Welsh Government and SCW need to operate in a way that is supportive to local initiatives and that initially limited objectives are likely to be more successfully implemented than a long list of ambitious aims.