The birthplace of the NHS, Wales, is celebrating the 70^th Anniversary with the publication of a new plan for Health and Social Care – A Healthier Wales. We hear the cry ‘not another plan’ but will the delivery of this one be different? The emphasis on continuous engagement in this short and highly strategic plan would seem to point to something different…

The Director General for Health and Social Services highlights that this plan is not about a new change of direction. Rather, he sets out to drive forward an acceleration of the integrated and social model of health and social care, that has been incrementally put in place since the final vestiges of the internal market in the NHS were removed in Wales in 2010. After an eight-year period of organisational stability in Wales, and little prospect of further change, perhaps the Welsh Government see the opportunity for accelerating away from England.

The vision outlined is the systematic description and roll-out of community models of care, so that in ten years’ time, community-based health and social care will be seen as the prime focus of the NHS in Wales. This requires a significant effort to shift care out of hospitals, which in our experience is always likely to provoke controversy. So much change on the horizon for NHS Wales. But do they plan to consult?

Interestingly the concept of ‘continuous engagement’ with the public is billed as being at the heart of the new plan to ‘build mutual understanding and trust…. with citizens….to develop a shared sense of ownership and responsibility’ – an aspiration that the Institute most definitely endorses. Interestingly the Plan also sets out its duty to meet its obligations to approach things differently under the Well-being of Future Generations Act, a piece of legislation unique to Wales: yet to be tested through the courts. The Welsh Government sets out three new approaches to fulfil this goal:

• An integrated approach to engagement across organisations, bringing together legal duties to consult and engage so that the process is more efficient, effective and easier for people to contribute.
• An on-going dialogue with a focus on digital means to enable this to happen.
• Engaging on a more holistic basis, so that conversations about changes to services are more clearly linked to how they will be delivered and to how they will be funded and paid for.

The Plan sets out three areas where this new approach will initially be taken forward at national level, in relation to the vision and design principles set out in the Plan, and also the future funding models for NHS Wales. An investment of £100M has been set aside to drive the implementation of the Plan with leadership at the highest national level. An additional £1.2M over five years is also likely to go to Wales as a result of the UK Government’s announcement of investment in the NHS, and if allocated to health is also likely to help drive change further.

The Institute welcomes the approach set out by the Welsh Government, that should help to redress the balance in ensuring that organisations are talking to communities on a range of health and social care issues that concern them at a formative stage, rather than single one-off events. As so much is set in statute in terms of formal requirements to consultation and also case law through the courts, we will observe closely how the Welsh Government plans to change the legislative and policy framework that will inevitably be necessary to remove some of the barriers to integrated consultation.

The Plan is silent, for example, on the future role of Community Health Councils in Wales, which was the subject of a consultation in 2017. We will observe with interest how some of the specific structures and guidance in Wales may change to accommodate the vision set out in this Plan, and will keep you updated through our weekly newsletter and training courses.

Article written by Institute Associate Bruce Whitear