social services and well-being (wales) act 2014 …€¦ · an overview of the workstreams, key...

SOCIAL SERVICES

1. Introduction The purpose of this regional plan is to provide animplementation of the Social Services and Well-enabling a national perspective of what is takingBeing (Wales) Act 2014. 2. Current status The Mid and West Wales region has an establishedInitiatives such as the Mid and West Wales Procurement

SERVICES AND WELL-BEING (WALES) ACT 2014REGIONAL IMPLEMENTATION PLAN

MID AND WEST WALES

an overview of the workstreams, key decisions and milestones-being (Wales) Act 2014 in Mid and West Wales. The plan

taking place to lay the foundations for the successful implementation

established tradition of collaborative working to improve and integrateProcurement Hub and West Wales Adult Placement Service have

S&PC PAPER 10 – APPENDIX 2

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Regional Implementation Plan Mid and West Wales

2014

milestones that are planned for the plan uses a nationally-adopted template

implementation of Social Services and Well-

integrate health and social care. have been in place for a number of


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years and were conceived from a commitment by Directors of Social Services to work collaboratively to address shared challenges, maximise efficiency, achieve consistency and deliver better outcomes for users and carers. During 2011-12 the regional boundaries were revised to reflect the Welsh Government’s Public Services Footprint and former partners in Bridgend County Borough Council, Neath-Port Talbot County Borough Council and the City and County of Swansea were transferred into the new Western Bay region. At the same time the Mid and West Wales Health and Social Care Collaborative (MWWHSCC) was extended to include Hywel Dda University Health Board and Powys teaching Health Board. In the intervening period the expanded MWWHSCC Board has overseen the development of a comprehensive programme of activity aimed at ‘maximising resources available, reducing duplication, achieving consistency and bringing about service improvement and transformational change on how [partners] jointly commission and procure high quality services at a better price, improving outcomes for citizens in the region’. This programme has been designed to deliver strategic commitments contained within Statements of Intent for older people and people with learning disabilities, respond to the specific strategic priorities such as integrated and proportionate assessment and to put in place regional arrangements for adoption and safeguarding. Funding has been provided mainly through the Welsh Government’s Regional Collaboration Fund (RCF), Delivering Transformation Grant (DTG) and Intermediate Care Fund (ICF). Self assessments undertaken regionally and locally in early 2015 indicate that the existing programme has delivered firm foundations for the further integration of services and delivery of statutory requirements under the Social Services and Wellbeing (Wales) Act. These include regional arrangements for adult and children’s safeguarding and adoption and integrated approaches to developing key services, for example intermediate care as a key part of a wider service model focused on prevention and independence The self assessments also identified critical areas that need to be taken forward as a region to ensure that in the coming period we sustain the pace of transformation that is (1) required by the Act, (2) necessitated by increasing demand and reduced resources and (3) rightly expected by our citizens. This plan sets high level objectives for the region stating where we are and where we need to be to achieve this overall strategic aim. The high level objectives are common across the region but we are clear that the means of delivering the objectives will vary across different areas. Crucially, we are unique among the health and social care footprints in Wales in having 2 health boards within our region which share certain challenges but which face distinct issues in relation to the future configuration of public services and specific areas such as the health/ social care interface. The plan provides flexibility for different approaches within shared strategic aims and the opportunity for the 2 health board areas to come together to share learning and consider those issues that make sense to tackle together.


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3. Who has been involved in developing the regional plan? The plan has been developed through discussion with all partner agencies that constitute the MWWHSCC: Carmarthenshire County Council, Ceredigion County Council, Hywel Dda University Health Board, Pembrokeshire County Council, Powys County Council, Powys teaching Health Board, Pembrokeshire Association of Voluntary Services (also representing the other voluntary services councils in the Hywel Dda area) and Powys Association of Voluntary Organisations. The plan and priorities within it have been directly informed by the regional and local self assessments, which identified priorities for action to ensure compliance with the Act across Mid and West Wales. The plan was approved by the MWWHSCC Board on 19 March 2015. 4. Governance arrangements for the plan The MWWHSCC Board has approved revised governance arrangements to support delivery of the plan, which will come into effect on 1 April 2015. The new governance framework will: • Be fit for purpose in driving, monitoring and evaluating a programme of transformation across health and social care in Mid and West

Wales, via the regional implementation plan.

• Provide robust leadership of the programme at all levels through appropriate representation and engagement across from health and social care partners across the statutory, independent and third sectors.

• Build on established structures and consolidate existing foundations for partnership working.

• Include clear reporting and accountability arrangements between the various tiers of governance.

• Address the need to accommodate linked but separate agendas in the Powys and Hywel Dda Health Board areas and provide flexibility to facilitate further adaptation of the arrangements in the light of new local government structures following the expected announcement by the Minister of Public Services in the summer.

• Streamline structures, identifying opportunities for rationalisation and merging of currently separate arrangements.

• Clarify terms of reference and membership of regional fora.


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• Facilitate and strengthen relationships with the wider public service infrastructure, including Local Services Boards (LSBs), county-level health and social care partnerships and WLGA-led regional arrangements.

The Mid and West Wales Governance Structure is set out below:

Joint programme boards will be mandated by the Partnership Forum and Leadership Board to develop and deliver specific programmes of activity to achieve the high level objectives within the plan. These will build where appropriate on existing activity, include new areas particularly in relation to children’s services, receive funding from Welsh Government grants and local budgets and be monitored using robust performance frameworks. Progress will be reported to the Partnership Forum and Leadership Boards on a regular basis.

Detailed and costed programme plans for 2015-16, accompanied by outcomes-based performance measures, will be completed in support of the regional implementation plan by 30 June 2015 for approval by the MWWHSCC. A cost benefit analysis of the programme will be completed over this period. We will ensure that these reflect and take forward local and regional commitments within existing plans such as LA improvement plans and the HB Integrated Medium Term Plans.

MWW Partnership

Forum

Hywel Dda Area

Leadership Board

Powys Health

and Adult Social Care Integrated

Board

Powys Children

and Young People’s Partnership

MWW Leadership Board

MWW Workforce

Programme Board

MWW Children’s

Services Programme

Board

Powys Area Programme

Boards

Hywel Dda Area

Commissioning Programme

Board

Hywel Dda Area Integrated

Services Programme

Board


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Ongoing self assessment of our readiness for the Act and the impact of the agreed programmes will be undertaken as part of the programme planning phase and regularly over the coming 12 month period. This will enable us to review the plan and refocus activity as necessary. This will inform a second iteration of the regional implementation plan revising objectives and setting out supporting activity for 2016-17 and beyond. The timeline for the development and implementation of these activities is illustrated in the following diagram:

Ensuring workforce development programmes support delivery of the plan is a key priority. The MWW Workforce Programme Board will ensure that the regional Social Care Workforce Development Programme (SCDWP) aligns with the high level objectives of the plan and supports the detailed workstreams beneath it. We will also continue to work towards a strategically linked workforce development programme with health colleagues to further support integrated working. 5. Strategic Intentions The following section presents our current position in relation to strategic intentions which underpin the Act, our future position, early decisions required to continue our progress in each area and key milestones in the short to medium term. More detail on outputs and milestones, including a robust performance and outcomes framework, will be contained within the detailed programme plans which will be completed between April and June 2015.

Submit high level RIP to WG

31 March 2015

Develop detailed supporting

programme plans

April - June 2015

Submit detailed costed RIP to WG

30 June 2015

Deliver RIP

July 2015 - March 2016

Review RIP

Early 2016


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5.1 Access to information, advice and assistance

Current position The self assessments evidenced a range of approaches and facilities in place across the region, including: • Contact centre and Single Point of Access arrangements • Third sector brokers providing signposting to community-

based services and facilitating the development of web-based information on available services

• Establishment of the first accredited contact centre for children and families in Wales

• Range of advocacy services available

Future position • Consistent, high quality provision across the region of

information, advice and assistance in relation to how the care system operates, types of care and support available, how to access available care and support and how to raise concerns about people who appear to have a need for care and support

• Shared ownership of and responsibility for information, advice and assistance provision across sectors

• Performance and outcomes frameworks across the region which align with the national outcomes framework for social services

Decisions and Milestones 1. This area will be considered further by the Hywel Dda Area Integrated Services Programme Board and Commissioning

Programme Board, the MWW Children’s Services Programme Board and relevant Powys Programme Boards. 2. Immediate activity will include detailed mapping of current arrangements across the region, capturing effective practice, setting

consistent standards, ensuring access to information, advice and assistance is available to the standards required by the Act (Part 2) across the region by April 2016 and identifying opportunities for collaborative working regionally and with national partners

3. Similarly, we will review and develop advocacy services in place across the region in the light of the requirements of the Act 4. Detailed plans will be finalised by 30 June 2015 which will ensure delivery of relevant requirements of Part 2 of the Act by April

2016


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5.2 Proportionate assessment to maximise independence and well-being

Current position Partners are actively progressing transition to proportionate and outcomes-based assessment. Achievements to date include: • Development of a regional delivery plan for integrating

assessment, care planning and review for older people in alignment with Welsh Government guidance

• Development of joint family assessment framework under the Families First programme

• Initiated joint ICT solutions to facilitate joined up assessment • Introduction of integrated assessments for children and

families based on an agreed pathway • Open referral systems that provide assessment even where

the user or carer is not eligible for core services

Future position • Fully integrated, simplified and outcomes-based assessment

frameworks for individuals applied consistently across health board footprints

• Appropriate signposting to preventative and wellbeing services through initial assessment process

• Outcomes-based approach to care management and review for recipients of formalized, long term care

• Application regionally of national eligibility framework • Performance and outcomes frameworks across the region

which align with the national outcomes framework for social services

Decisions and Milestones 1. This area will be considered further by the Hywel Dda Area Integrated Services Programme Board and relevant Powys

Programme Boards. 2. We will implement the regional delivery plan for integrated assessment, care management and review, revisiting specific

elements to ensure compliance with the Act and focusing on systems and skills development 3. We will develop delivery plans for integrated assessment for other client groups, drawing on the experience of the older people’s

work and ensuring compliance with the Act 4. Detailed plans will be finalised by 30 June 2015 ensuring delivery of relevant requirements under Parts 3 and 4 of the Act by April

2016


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5.3 Meaningful engagement with the local population

Current position • Partners are committed corporately to effective engagement

with citizens, for example in relation to the development of Single Integrated Plans.

• Examples of user and carer involvement in service development and improvement include incorporating user-focused feedback within contract monitoring

• Increasing use of digital stories providing users and carers with opportunities for sharing their experience of services and the outcomes that have been achieved

• Development of citizen engagement frameworks at local authority level and engagement strategies by the NHS

• Promotion of and support for social enterprises in delivering wellbeing services

Future position • Effective mechanisms for user and carer engagement in place

across the region and shared standards identified • Genuine user and carer engagement in service development,

delivery and review

Decisions and Milestones 1. This area will be overseen directly by the Leadership Board 2. We will undertake a comprehensive mapping exercise identifying current arrangements for citizen engagement across health and

social care in Mid and West Wales, drawing on reviews already completed at local level and seeking to build on initiatives such as the current ‘Let’s Talk Health’ programme run by Hywel Dda UHB

3. We will present recommendations on a model for ensuring effective citizen engagement to the MWW Leadership Board by 30 June 2015

4. In addition individual programmes will be expected to meet identified standards in relation to citizen engagement. Mechanisms will be implemented by 30 September 2015 and evaluated by 31 March 2016


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5.4 Providing care and support for the most vulnerable people

Current position • Across the region partner agencies are committed to

developing new service models which combine proportionate community support to those with less acute needs, helping to maximise their independence, with outcomes-focused and responsive services for those needing formalised care and support

• Examples include delivery of a range of intermediate care services for older people using the ICF, development of a shared model for Learning Disability Services, community-based mental health services based on progression principles and identification of opportunities for a regional approach to services for children with complex needs, transition and vulnerable people leaving care

• The establishment of regional safeguarding arrangements has provided an opportunity to share effective practice and establish shared accountability frameworks to ensure that children at risk of harm are assured of appropriate protection

Future position • Appropriate, high quality, outcome-focused services available

to those needing preventative and wellbeing support and for recipients of formalised care

• Integrated approach across sectors to ensure appropriate care is available and provided in a timely fashion

• Support provided reflects the individual needs of the recipient and the communities in which they live whilst meeting agreed regional standards

• Effective safeguarding arrangements in place at regional and local levels


Decisions and Milestones The Hywel Dda Integrated Services Programme Board, relevant programme boards within Powys, the MWW Children’s Services Programme Board and the regional safeguarding boards will all have a role in building on current achievements and ensuring appropriate levels of care and support to the most vulnerable people in our communities. Current activity will be reviewed and detailed future programmes will be finalised by 30 June 2015. These will ensure delivery of relevant requirements under Part 7 of the Act relating to adult protection by April 2016 Regional arrangements for adult safeguarding will be in place in the spring of 2015. The regional LSB (CYSUR) will be evaluated by December 2015


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5. 5 Integration to achieve better outcomes for people

Current position • Integration of services within and across the region remains

a key priority. • Regional Statements of Intent for Older People and Learning

Disability services endorse this position and set objectives for taking integration forward. The Statements of Intent reflect current achievements in relation to integration, including the establishment of multi-disciplinary community resource teams

• The Mid and West Wales Adoption Service and Integrated Family Support Service (IFSS) are examples of successful integration of children and family services across the region

• Programmes such as the Mid and West Wales ICF have provided an opportunity to fund innovative new approaches across the statutory, third and independent sectors, evaluate their impact and identify how these can be mainstreamed in the future.

Future position • Opportunities for service integration are identified and

addressed through appropriate programmes, and impact monitored via the MWW Leadership Board

• Appropriate levels of integration are in place to deliver improved services and outcomes

• The MWW Leadership Board provides an effective framework to work across sectors to remove barriers to integrated working


• Alignment of data systems

Decisions and Milestones 1. The strengthening of strategic governance and establishment of the Hywel Dda Area Integrated Services Programme Board with

parallel forums in Powys will enable a sustained focus on identifying and responding to opportunities for service integration at regional, sub-regional and local level

2. Detailed programmes, taking forward the commitments within the Statements of Intent, building on existing activity and drawing on evidenced effective practice will be finalised by 30 June 2015

3. Funding to support these programmes will be identified from the RCF, DTG and funding announced by the Minister for Health and Social Services to support further development of Intermediate Care and integration of primary, community and social care across Wales


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5.6 Primacy of well-being and its connection with prevention, assessment, eligibility and information/

5.7 Early intervention to maintain people's independence

Current position • The MWWHSCC and individual partner agencies recognise

the importance of prevention and wellbeing services as part of wider service models that deliver positive outcomes for people in need of care and support and their carers.

• A range of preventative services are in place throughout the region and across services to support people to maintain their independence, including a variety of reablement services, schemes to reduce unnecessary hospital admissions and accelerate discharge, housing adaptations enabling older people to return home from hospital or intermediate care as soon as possible, return to home schemes for people with learning disabilities, mental health wellbeing schemes and family-based approaches such as Integrated Family Support Services (IFST)

Future position • Consistent provision of appropriate wellbeing services for

people in need of care and support across the region, commissioned collaboratively and delivered in partnership across sectors

• Performance and outcome frameworks across the region which align with the national outcomes framework for social services

Decisions and Milestones 1. The new governance structure in place from 1 April 2015 will deliver strengthened links between Local Service Boards/ Public

Service Boards and provide alignment between Single Integrated Plans and the regional implementation plan. This will help ensure that wider preventative and wellbeing services are developed and targeted at those in need of care and support but not qualifying for ongoing formalised care

2. Outcomes and performance frameworks in place at regional level to monitor wellbeing 3. The Hywel Dda Area Integrated Services Programme Board and relevant boards in Powys will consider opportunities for further

improvements in this area, informed by current arrangements and linking in with the planned review of information, advice and advocacy outlined in 5.1

4. The contribution of social enterprises and user led services to the delivery of wellbeing services will be critically assessed, opportunities identified for future development across the region and appropriate programmes put in place to take this forward

5. Detailed programmes will be finalised by 30 June 2015


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5.8 New models of delivering care and support

Current position • As evidenced in other sections of the plan, partners within

the MWWHSCC are committed to the radical transformation of health and social care across the region and are committed to building on existing achievements to ensure that the care provided in our region meets the requirements of the Act and delivers the optimum outcomes for those using our services and their carers.

Future position • New models in place across service areas that deliver improved

outcomes for service users and carers, meet the underlying objectives of the Act, are sustainable and are regularly monitored for impact

• Joint commissioning across health and social care and effective engagement with providers in shaping future services and securing market sustainability


Decisions and Milestones 1. The Hywel Dda Area Integrated Services Programme Board and Hywel Dda Area Commissioning Programme Board, and relevant

boards within Powys and the MWW Children’s Services Board will lead on the further development and delivery of new service models, working with service providers to ensure future markets are sustainable and provide the right care in the right places. Our population needs assessment and supporting Market Position Statements will be enablers in this and will be completed by April 2017

2. Financial and charging requirements will be reviewed and enhanced to ensure they support new models of delivery 3. Detailed programmes to support this aim will be finalised by 30 June 2015 4. Ongoing engagement with users and carers will ensure that, alongside meeting specific requirements of the Act, they are

genuinely responsive to individual and community need 5. The MWW Workforce Programme Board will work to ensure that the SCWDP and other training and development programmes

align with the wider transformation programme and help ensure that staff are equipped and enabled to deliver the major change that is required


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5.9 Giving people more control over their lives

Current position The transformation activities outlined in this plan are predicated on the principle of giving people more control over their lives. This involves engaging users, carers and providers in service design, planning and review, ensuring people can directly influence the type and level of care they require to achieve their desired outcomes and that from assessment onwards all care provided supports and promotes independence and choice. The MWWHSCC is committed to ensuring these principles underpin current and future activity and is reflected in our approaches to integrated assessment, direct payments and complaints

Future position • Consistent approach to Direct Payments which maintains the

ability of local authorities to meet the care and support needs of service users and carers and increases self determination of care

• Social enterprise, cooperatives, third sector and user-led services promoted as part of a vibrant health and social care market

• Genuine user and carer engagement in service development, delivery and review


Decisions and Milestones 1. Each of our programme boards will have a stake in ensuring our aspirations and commitments are met through regional and local

activity. 2. All programmes within the plan will be tested against the above principles. 3. We will further develop and promote social enterprises, cooperatives, third sector and user-led services, responding to the

findings of a comprehensive regional mapping exercise 4. Opportunities will be taken to review Direct Payment arrangements across the region and identify improvements within existing

contracts to meet new statutory requirements and ensure that they are used as a means of giving more control to users whenever appropriate

5. We will work across the region to implement new complaints arrangement, achieving best use of resources to provide a consistent and responsive approach and ensuring that complaints directly inform service improvement


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6. Key determinants for successful implementation This plan outlines how partners intend to implement the requirements of the Social Services and Well-being (Wales) Act 2014 within Mid and West Wales. The plan has been pitched at a strategic level; detailed programmes to support the delivery of the Plan will be developed between April and June 2015. The key determinants for successful implementation include: 1. Successful implementation and integration of new regional governance arrangements from April 2015 to facilitate (1) a consistent

understanding of the requirements of the Social Services and Wellbeing (Wales) Act and its implications and (2) genuine buy-in from

partners

2. High level objectives within the Plan used as a basis for further development of supporting programmes between April and June 2015

3. Strategic leads identified from the MWW Leadership Board to chair joint programme boards and facilitate development of supporting

programmes

4. Clarity over funding levels and parameters and priorities for investment at regional level

7. Key risks and mitigation

Risk Mitigating action/s

Inadequate resourcing to support transformation

• We will work collaboratively to maximise grant and core funding to deliver identified objectives

Delayed confirmation of grant funding and parameters

• We will liaise with Welsh Government to obtain confirmation as soon as practicable

Annual funding

• We will plan strategically to ensure delivery of identified objectives within financial year

• Continue to negotiate for funding flexibility with Welsh Government

Depleted funding from 2016-17 onwards putting sustainability of programmes at risk

• We will evidence impact of funded schemes and seek core funding


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Risk Mitigating action/s

Insufficient capacity to deliver identified programmes due to problems with recruitment

• We will seek secondment from/ diversification of existing roles within partner agencies

• We will consider extension of fixed term posts beyond grant funding using core budgets

Inability to deliver plan because of competing demands at local/ regional level

• We will maintain a clear strategic focus on delivery and achievement of outcomes identified in this plan and supporting programme plans

• The allocation of lead Directors to each Programme Board will support this

Complexity of Mid and West Wales region covering two health boards • We will ensure governance arrangements are flexible to accommodate varying challenges and priorities whilst facilitating combined approaches for tackling shared issues

Impact of Local Government Reorganisation • We will ensure collaborative and partnership arrangements are robust to transfer into likely new structures

Non-sustainability of provider market and/ or inability to deliver new service models

• We will work closely with providers to gain consensus and understanding in relation to new service models and to provide appropriate support and capacity to respond to changing need

• We will ensure clarity and consistency in relation to strategic commissioning intentions

Community resistance to service transformation • We will use the improved governance arrangements and citizen panel to develop a consistent and evidenced narrative around the need for and benefits of change, thereby increasing understanding and ownership of new service models and delivery patterns

social services and well-being (wales) act 2014 …€¦ · an overview of the workstreams, key...

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