Tuesday 7 December 2010


When the title of a government or government-commissioned report strongly emphasises how it focuses on “action not words” there is a suspicion that the authors are being defensive because they are wondering whether much will actually come of their work.

So, when we read that the title of the report just published by the Independent Commission on Social Services in Wales is "From Vision to Action”, we are at once on the alert to see whether it says anything interesting or will make any difference.

They certainly talked to a lot of people, including me. I recollect many months ago surreptitiously scavenging the remains of the Commission’s lunch in the waiting area before appearing before them at the Ivy Bush Hotel in Carmarthen (okayish canapés - but perhaps it’s harsh to judge when they’d being sitting around a while and the Commissioners may have discerningly consumed the best ones already).

The Report says a lot of commonsense things about making the existing arrangements for delivering social services in Wales live up to widely-agreed principles. So there is a lot of reasonable stuff about listening to consumers, intelligent commissioning, engagement with private and third sectors, coordination with health services, etc. There is also a useful suggestion about collaboration between local authorities and the interface with health which is worth quoting:-

The establishment of 7 Local Health Boards covering several local authority areas creates a different set of opportunities for collaboration over a wider area than the 22 local authority areas.

At the moment there is a messy series of multiple interfaces between the health service and local government services, which are costly in terms of time and effort. Adopting the LHB ‘footprint’ for collaborative effort would provide a single interface between health and social care and the range of local government services that contribute to the possibility of independent living in the community such as housing, leisure services and transport together with the independent sector. Although not specifically part of our brief it could be argued that other services such as education could easily fit this footprint.

There is a short section on mental health including just one example of good practice:-

Hafal, a national third sector mental health organisation, has adopted the international model of recovery based on a whole-person approach including personal care and well-being, money, accommodation, caring relationships, treatment, work, education and social and cultural needs.

Actually the model adopted by Hafal was created by our 1,200 members, not taken from an external source, though obviously we looked at and learned from other approaches around the world. You can see the model here.

The Report also says:-

We welcome the establishment of the new All Wales Adult Mental Health Programme Board jointly chaired by a Director of Social Services and a Local Health Board Chief Executive. They will have a key role in providing leadership and direction to achieve high quality and best value for money services delivered to promote and protect the mental health and well-being of the people of Wales. This joint approach properly recognises the interdependency of social services and health and the role of the third sector, service users and carers in delivering whole person mental health services.

We have now seen the Board operate for a few months and the jury is still out on whether it can make any difference.

The problem with all this is that the Report does not recognise the revolution that is surely coming to both health and social care services – that is real personalisation, not meaning just listening to consumers but giving them control over the money and their choice of care and care-providers (nor does it mean the current grudging and bureaucratic Direct Payments system which is not fit for purpose and needs to be simplified and go much further).

Consumers know that they will never get a first-class service by waiting for top-down solutions from Programme Boards and similar dominated by producer interest, however well-intentioned and however much they try to listen to the consumer voice. That’s the old way of doing things and it looks increasingly out-of-date compared with much of Europe and, more and more, England. By all means let us find Welsh solutions but that does not mean dragging our heels on personalisation, individual health budgets and so on. The Report also ducks the crying need to join up health and social services rather than continue to wring our hands about how they might better work together - another important, if secondary, part of the revolution which would reflect consumers' massive indifference to the distinction between the two.

That revolution is at an early stage in Wales and this Report does not really support it in spite of a genuine concern to focus services on consumers’ needs.

So why did the Report not look for more progressive and consumer-focused solutions?

All four members of the Commission – eminent and good people whom I respect - were social workers. In what other area of public life today would government set up an “Independent Commission” solely comprising people from the provider profession? Where was the independent professional voice – somebody from the private or voluntary sectors perhaps? And, most of all, where were the consumers?

Extraordinary! The choice of members of the Commission tells us depressingly and starkly far more about what needs to be done than the whole 56 pages of the Report.