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An Integrated and Democratic Health and Social Care Service

Penny Owen

Delivery of an integrated National Health and Social Care Service for Wales

Separating people’s needs into health and social care makes it more difficult for the different services providing care to work together. 

Instead, we should transition to deliver integrated care of patients by primary/secondary/tertiary NHS and social services through the ownership of common values, shared patient health gains, joint training of staff and integrated service planning. 

Using this approach and with a reduction in the turnover of senior manager personnel, further whole-scale reorganisation of NHS Wales and Social Services will  be unnecessary.

Work must continue to rebalance the care system, which remains biased towards acute hospital treatment, towards earlier preventive and diagnostic interventions.

NHS Wales National Executive 

Difference in performances between Health Boards (HB) in Wales and within HBs are unacceptable. A Wales National Executive should be created to monitor, guide and ensure uniform standards of care in all Health and Social Care Boards and Trusts.

Increase democracy in NHS Wales

Health services will make better decisions the more that the public and health care staff are involved. Patients and health workers can provide an early warning system of service failings.  To facilitate effective communication  –

• Every Health Board should have a Patient Representative with full voting rights, elected by the Community Health Council (CHC). 
• The Chair and Vice Chair of every HB and Trust would be democratically elected. 
• HB and Trust Executive Directors representing health care staff e.g Nurse Director, must be elected by those staff in the HB/Trust.
• Independent HB/Trust directors must be elected by the organisations they represent on the Board.
• The Chair and members of CHC/Citizen’s Voice Body to be democratically elected.

All recommendations made by CHCs following their visits to health care facilities, and these may be unannounced,  must be implemented in full by HBs and Trusts unless they provide publicly available evidence why they cannot do this. 

There will be co-ownership of health and social care patient records allowing people to access their records with easily accessible technology.

Increase continuity of care in Primary Care

Patients highly value continuity with a health care professional and are more likely to seek help in primary care if they can speak to and be seen by the same HCP.

For Primary Health Care (PHC) to provide continuity of care the average GP list size will need to be decreased to 1,400, prioritising areas with the worst health indicators.

PHC Teams will work together in neighbourhood networks to facilitate joint planning of neighbourhood services with public health, pharmacy, housing, police, leisure, education and social care services.

Dental health care teams

Dental services should be brought back as a service free at the point of delivery. Dental health care teams will deliver these services based on the same principles as PHC teams. Dental nurses and hygienists will be trained to provide some dental care currently provided by dentists. A dental nurse will be present at Foodbank Centres.

Rebalance power relationship between the NHS and pharmaceutical companies

The NHS pays too much for medicines because we have no significant leverage over pharmaceutical company prices.  Wales should collaborate with Scotland and Northern Ireland to create a publicly owned company to manufacture generic drugs.

Wales should continue to support NICE working with others across the international Pharma scene to constrain world Pharma’s unfair pricing of new drugs.

Mutual Investment Model 

The MIM has many of the problems which led to the PFI model being abandoned. Alternative methods of funding new capital projects will need to be found, for example  through the use of the cooperative model.

Pandemic preparedness 

We must learn from our experience with the Coronavirus pandemic to ensure that organisation, equipment and staff are prepared and resilient for any future pandemic. Particular attention must be paid to the mental health and well being of all staff. Planning for the care of patients with the long term effects of COVID 19 will continue.

Mental health service for young people

The rise in mental health problems in our young people has been exacerbated by the COVID pandemic. Additional funding for this area will be prioritised. 

Contract locally

Where possible  health services will place their contracts with local companies as in the Preston model.

Children’s services

We need to 

• create a comprehensive range of early intervention and parenting support services.
• Invest in midwifery services to identify mothers engaging in high risk behaviours and to intervene early where abuse and neglect is identified.
• Increase Health Visitor numbers to ensure manageable case loads for early support for all parents and carers.
• Increased preventive work with all families early in a child’s life will avoid later life social care needs. Health and social care for the elderly should not overshadow  children’s needs linked to neglect and drug/alcohol misuse as underfunding impacts on the numbers of looked after children etc.
• Free school meals for all children.
• Introduce a national wage for social workers to maintain an experienced workforce.
• Pay foster carers a professional wage to ensure a good pool of skilled carers. 

Rural health

Improve the recruitment and retention of health and social care workers in rural communities.

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A National Care Service For Wales

Mark Turner

The pandemic has placed a crumbling and inadequate care system under the spotlight. A crisis such as the Covid pandemic puts all organisations and systems under pressure, but where there are existing weaknesses, they are exposed and exacerbated.

For nearly twenty years, care in Wales has been privatised where previously it was mainly delivered directly by Local Government and the NHS. Now, 62% of care workers work for private sector employers, 16% work in the voluntary sector and only 22% are directly employed by public services. 

Welsh Government estimates that Wales will need a further 20,000 care workers by 2030 to meet predicted demand. It acknowledges that pay, conditions, job security, training, career opportunities and esteem are low and within private sector care in particular. Access to trades unions is rare under private sector employers within the care sector.  There is little trade union recognition and no collective worker voice afforded, exacerbating the endemic problems. The sector therefore has a problem of high turnover and is highly reliant on expensive agency staff.  A fragmented sector has proven very difficult to make universal policy interventions in by Government. Poor working conditions for care workers have been recognised as having a negative impact on the quality of care.

Welsh Labour, in Government, is to be applauded for recognising these concerns and that urgent and radical reform is necessary if we are to improve the quality and scope of care in Wales and make care work an employment sector of choice. The registration of care workers is a first step in improving the skills and knowledge of care workers. A Fair Work Forum, made up of employers, trades unions and Welsh Government, has been established to address immediate concerns about pay and conditions in private sector care. It is a welcome and pioneering initiative, which it is hoped will lead to sectoral collective bargaining. This is only happening because of Welsh Labour’s social partnership agenda, but there is much work to be done.

Whilst addressing these worker issues would be a huge step in the right direction, there are many other matters which will prove difficult to address without a massive injection of funds. Welsh Labour should be proud of its commitment to a publicly provided NHS, yet social care continues with a discredited and dysfunctional privatised model. Too often, we see private sector employers going bust or just stop providing contracted services. Exploitative and complex finance models take millions in public money for profit. Yet employers say they cannot afford decent pay and conditions unless they are given more public money.

Welsh Labour must now apply the same public service ethos that is applied to the NHS to our broken care network. Therefore, in the next Welsh Labour Manifesto, the party should commit to a radical review of funding of social care in Wales. It should use regulation and commissioning to ensure improvements in the living standards and collective voice of care workers as a first step.

And before the end of this term, Welsh Labour should pledge to create a National Care Service, free at the point of use and directly provided by the public sector, which offers a greater scope of support and care for our vulnerable people, of all ages and wherever they are. The erosion of publicly provided care services, including domiciliary care, day centres, must be reversed, to provide networks of support and facilitate lives worth living.

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