For Bevan Foundation members Winter 2017

For Bevan Foundation subscribers Wellbeing in Wales

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Welsh Government No proofs required 3 CertifiedPDF®for digital print ISO-15930 PDF/X-1a:2001 30794_Advert_92x125mm.indd1 1 18/01/2017 14:33 Dawn Bowden AM/AC Assembly Member for & Rhymney

As the Assembly Member for Merthyr Tydfil & Rhymney, I am here to support my constituents and ensure that you have a strong voice in the National Assembly for Wales.

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www.cih.org/cymru | 029 2076 5760 | @CIHCymru | facebook.com/cihcymru contents: winter 2017 For Bevan Foundation subscribers

Sarah Hatherley Tara Lewis Ceri Dunstan 2 Parliamentary Review of 4 Communicating for 6 The beginning of the end health and social care in Wales better health for HIV transmission?

2 Sarah Hatherley 14 Stuart Elliott & Carol Wardman Parliamentary Review of health Treading lightly on holy ground and social care in Wales 16 Victoria Winckler 4 Tara Lewis Close the well-being gap Communicating for better health 18 Bevan Foundation News 6 Ceri Dunstan Keeping you up-to-date with The beginning of the end for what’s going on HIV transmission? 19 Subscribers’ News 8 Carmen Bezzina All the latest from our subscribers Leading the way on mental health in the workplace 20 Subscriber Spotlight: Lesley Smith, DOVE Workshop 10 Natasha Davies Subscriber Decent work for women’s 20 Spotlight: well-being Lesley Smith, 12 Ed Evans DOVE Workshop Improving social value through investment in infrastructure

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Winter 2017 | Bevan Foundation Exchange | 1 Health and Social Care: Sarah Hatherley Parliamentary Review of Health and Social Care in Wales

Sarah Hatherley, Research Team Leader for Health and Social Care at the National Assembly for Wales, considers the Parliamentary Review of Health and Social Care in Wales Interim Report.

ollowing the 2016 National Assembly for Wales’ elections, the First Minister Fmade a commitment to establish an expert panel to undertake a Parliamentary Review of Health and Social Care in Wales. The expert panel, led by former Chief Medical Officer for Wales Dr Ruth Hussey published its interim report in July 2017. The Review has cross-party support. It has been widely welcomed by stakeholders, though many have been sceptical about what it can deliver as the Review is wide ranging and has less than a year to report. The Review is expected to set out a vision for the future of health and social care in Wales and come up with the seemingly impossible – a solution for meeting rising demand for health and social care and public expectations. vision for the future that helps to have responded enthusiastically to There is little doubt that health and shape Welsh health and social care the interim report. They say it makes social care services face enormous policy – a Review that advises how the case for change, providing a challenges over the coming years. to deliver change whilst building on positive vision for the future of the For example, some Health Boards the best of the current system. The NHS and social care in Wales – one are still struggling to balance their interim report puts it clearly: centred on putting patients at the books, there are no easy solutions “…the people we interviewed were centre of these changes. to the “workforce crisis” and new clear that they do not want another The interim report says the case investment in infrastructure is report that does not lead to prompt for change is ‘compelling’ and calls needed to support the NHS at a time and tangible action”. for a ‘bold and unified vision for of continuing financial austerity. Macmillan Cymru, the Royal the whole health and social care What stakeholders don’t want is College of Physicians, and the Royal system’. It is clear that to achieve a Review that restates the current College of General Practitioners are better health and well-being for the evidence. What they do want is a just a handful of stakeholders who people of Wales, stronger national

2 | Bevan Foundation Exchange | Winter 2017 The interim report states that the health and social care is the Social Services and Well-being elephant in the room. We believe The interim report is (Wales) Act 2014 and the prudent the final report needs to tackle this clear that to achieve healthcare agenda offer powerful issue head on and provide sufficient sets of principles – but these ideas direction. Without adequate funding better health and need to be embedded across the for health and social care in the well-being for the system if they are to transform future, the changes outlined in the health and social care in Wales. interim report will not be enough people of Wales, It also states that an effectively to ensure a sustainable health and integrated health and care system care system”. stronger national requires the levers and incentives Following the publication of its direction is needed… for change to be aligned and to be interim report, the Review now acting in synergy across the whole moves onto turning this ambition health and social care system. The into practical reality. The next step direction is needed to speed up how report also indicates that there are is to consider the options for new the health and social care system leadership and cultural issues that models of care for Wales. These adapts to the changing needs of the need to be resolved in order to will cover primary care, hospital population and major challenges. achieve ‘rapid and effective progress’. care, and community health and The interim report places a strong There are issues that the interim social care provision, working focus on the need to increase report did not cover, or not did with a stakeholder forum drawn the pace of change, the spread report on in enough detail for some. from service users, the NHS, local of good practice, and to promote For example, it says very little about government, professionals, the engagement with the public. It new models of care in terms of independent and third sector wants to see continuous quality mental health; other than to say and academia. improvement and prevention at the that “the roadmap for improvement Dr Ruth Hussey explains centre of the vision for health and across the whole mental health that the expert panel will turn social care going forward. Indeed, system is not clear”. Others feel that their attention to develop a the interim report sets out that the the interim report could have gone list of recommendations that scale of the challenges facing the further in considering the wider “command widespread support, system are such that they ‘cannot be set of ‘social determinants’ or root are implementable, and give Wales resolved by incremental changes to causes of ill health – particularly the best chance of delivering the the current models of care’. poverty – in the provision of health changes needed to achieve quality The Review calls for a limited and social care. driven, sustainable, whole health and number of new models of care In their response to the social care system and services that in the first instance to be trialled, interim report, the Welsh NHS the population rightfully expects”. evaluated and scaled up rapidly Confederation say that it raises Stakeholders will be hoping that across Wales. It says that new concerns around funding of health the Review’s final report will have models of care will need to and social care in the future. But clear recommendations that can be underpinned by action in a the Review panel are clear that their be implemented relatively swiftly number of areas and makes further remit does not include an analysis to ensure that the health and social recommendations including the of alternative methods of financing care system in Wales is fit for the need for: the health and social care system. future. The interim report and the • the people of Wales, staff, services Vanessa Young, Director of the response to it demonstrate that the users and carers to have greater Welsh NHS Confederation, said: case for change – and the swifter influence on new models of care “The report sets out the case for delivery of that change - has so far with clearer, shared roles and change and highlights a number of been persuasive. But meaningful responsibilities; challenges and opportunities for reform will depend on cross-party • new skills and career paths for the reform over the next five years. But, support for change to hold. The health and social care workforce the absence of any consideration Parliamentary Review will publish its with a focus on continuous of the long-term model for funding final report in December 2017. improvement; • better use of technology and infrastructure to support quality …effectively integrated health and care and efficiency; system requires the levers and incentives • streamlined governance, finance and accountability arrangements for change to be aligned. aligned for health and social care.

Winter 2017 | Bevan Foundation Exchange | 3 Health Equality: Tara Lewis Communicating for better health

Tara Lewis, from the NHS Centre for Equality & Human Rights, discusses the importance of improving access to healthcare for people with sensory loss.

services. In 2014, a survey carried out by Action on Hearing Loss Cymru, RNIB Cymru and Sense Cymru reported that only one in five people surveyed had been asked by NHS staff about their information and communication needs. Over threequarters of people had not received information in a format they could understand and half had met at least one member of staff who wasn’t able to communicate well with them. Not identifying and meeting the information and communication needs of patients creates serious safety risks. Communication and information barriers can result in: • missed appointments when people cannot read their appointment letter or do not hear their name being called; • medical advice not being sought when needed because of inaccessible appointment systems and provision being made for ore than 600,000 people over the age of 85 living communication support; people in Wales have with sight loss. People with sensory hearing or sight loss loss are more likely than others to • compromising confidentiality when or dual sensory loss experience major health conditions another person is required to relay M personal health information; (a combination of hearing and sight as well as higher levels of mental loss). This means that in any hospital ill-health. People with sensory • the risk of consent being given or GP surgery waiting room, one in loss therefore need to be able without being properly understood; four patients is likely to have some to access all areas of healthcare • people not understanding their form of sensory impairment. and not just ophthalmology and diagnosis or how they should take Sensory loss affects people of audiology services. their medication; all ages. It is particularly common Research shows that the • late diagnosis and less effective in older adults with 70 percent of information and communication treatment; the population aged 70 and over needs of patients with sensory loss having hearing loss and one in three are often not met by healthcare • poorer health outcomes. 4 | Bevan Foundation Exchange | Winter 2017 IMS poster_Layout 1 01/12/2015 13:32 Page 1

In any hospital or GP waiting room, one in four patients is likely It Makes Sense to have some form of SENSORY LOSS AWARENESS MONTH sensory loss. G More than 600,000 people in Wale s have sight In recognition of the barriers faced ‘My Health Online’ enables patients medical record. or hearing loss. by patients with sensory loss, the to book appointments and repeat In addition, it is expected that NHS Wales Standards for Accessible prescriptionsThe A withcces stheirible GP He surgeryalthcar e Stathend systemards ar wille a bsoonout khaveeep theing Communication and Information for and greaterpatie usents wis ibeingth sig madeht or ofhe aring functionalityloss safe an tod wensureell ca thatred fwhenor. People with Sensory Loss (All Wales texts to remind patients about their a GP surgery makes a referral Standards) were launched by the appointments. Other initiatives offer to hospital services, a patient’s in December deaf patients the option toA cemailcess to cinformationonsider ste pands t hcommunicationat people 2013. The All Wales Standards are or use text to change a hospitalserv ices wneedsith se willnso bery lautomaticallyoss might ne sented with about keeping people with sensory appointment and a few pilot projects the referral, therefore increasing the loss safe and well cared for. They are exploring the provision of likelihood of these needs being met. provide guidance to NHS staff on online British Sign Language (BSL) The success of the Sensory Loss how to ensure patients’ information interpreter support. F a ir services thInformationat deliver Standardequality willof largely rely and communication needs are met. A new project board has been aoncc eGPss , practicestreatme ntakingt and responsibility Representatives from health established to oversee the otout collectcomes this for information,all and boards and NHS trusts, Welsh introduction of a Sensory Loss the willingness of patients to share Government and the third sector Information Standard. The ‘Standard’ their communication needs with have been meeting since the will require GP surgeries toE capture,ffective ktheireep ssurgeries. patients To sa helpfe an withd this, publication of the All Wales record, flag and sharecom themu nication ethenab Centreles th eform Equalityto have and a g oHumanod Standards to work together to create communication needs of patients eRightsxperie willnc ebe o fengaging our care with general the changes required to improve with sensory loss. At present, very little practices, healthcare professionals access. In 2015, the group agreed information of this kind is gathered and members of the sensory loss three priorities for action – these are: and kept in GP surgeries and Chospitalheck dcommunityo you and inyo Wales.ur pa t ient departments. This means it can be Together the All Wales Standards • developing staff awareness and  understand each other? difficult for information about a and ‘It Makes Sense’ campaign, the workforce engagement; patient’s communication needs to Information Standard and the many • accessible appointment be safely and effectively shared projects taking place across NHS systems that enable patients to within and between wGPw surgeries,w.equal ityhuWalesman rhaveight thes.w potentialales.nh sto.u bringk/ communicate in a variety of ways hospital departments and other about significant improvements for including using texts and emails; healthcare services. patients with sensory loss. We hope • capturing, recording, flagging and NHS England has very recently to see a large increase in the number sharing patients’ communication introduced their own ‘Accessible of people being asked about their and information needs across Information Standard’ and a data communication and information primary and secondary healthcare. coding system that describes the needs, and a significant increase in different communication and the number of people having those As well as training NHS staff to be information needs of people with needs met. sensory-loss aware, in 2015 the sensory loss. The data coding Most importantly, we hope to ‘It Makes Sense - Sensory Loss system developed by NHS England see better health outcomes, an Awareness Month’ campaign was has been applied to Wales. All GP improved patient experience, and launched and each November surgeries in Wales are required an increased sense of wellbeing for activities take place across the NHS to establish the information and people with sensory loss. in Wales to raise awareness of the communication needs of their All Wales Standards for staff and patients with sensory loss and to For further information or if patients. The campaign has also record their requirements using the you have an event you would been supported by an online training coding system. The system also like us to attend to promote module for staff, a newsletter, and a provides tools for GP surgery staff the Sensory Loss Information film which can be accessed online. on how to meet a patient’s needs Standard please contact Tara New technology is helping to once identified, such as how to Lewis at [email protected]. offer patients different ways of generate letters in large print and uk or ring 029 2010 4234. contacting healthcare providers. how to add prompts to a patient’s

Winter 2017 | Bevan Foundation Exchange | 5 Sexual Health: Ceri Dunstan The beginning of the end for HIV transmission?

Ceri Dunstan, Policy and Campaigns Officer at the Terrence Higgins Trust, says that new medication could end the transmission of HIV in Wales

n April this year, Wales took a huge step forward in the fight against HIV when the IMinister for Health, Well-being and Sport announced a three year trial to provide Pre Exposure Prophylaxis (PrEP) on the NHS to anyone in Wales for whom it is clinically appropriate. The move was especially welcome as just days earlier the All Wales Medicines Strategy Group (AWMSG) had advised the Welsh Government not to make PrEP available on the NHS at this time on grounds of cost- effectiveness. While acknowledging the AWMSG’s points, the Health Minister’s statement reflected the advice of the World Health Organisation and the arguments of campaigners, including the Terrence Higgins Trust and Stonewall, that, taken correctly and in conjunction with wider preventative sexual health services, PrEP is effective in reducing rates of HIV transmission and infection. So what is PrEP and why is its introduction in Wales so significant? Put simply, PrEP is the most effective way for people who are more likely to be exposed to HIV, where relationship with an HIV positive dosing). Like HIV treatment, HIV condoms are not always or easily partner who is not on effective prevention has evolved over time. used, to protect themselves from treatment. Condoms are effective at preventing the virus. These might include gay PrEP involves taking anti-HIV HIV but consistent condom use is and bisexual men, trans women drugs either daily or at specific times not always a reality and people more and men, heterosexuals assessed before and after sex as needed likely to be exposed to HIV need to be at higher risk and those in a (often referred to as event-based a range of options and choices to

6 | Bevan Foundation Exchange | Winter 2017 best meet their individual needs and circumstances. There has been There is a clear need for action. Public Health Wales figures show a steady increase that there has been a steady in the number of increase in the number of people living with HIV in Wales. This reflects people living with both an increase in survival and new HIV in Wales. diagnoses. On average, over the last six reporting years (2010-2015), there have been 153 new cases of 86 per cent. France used both diagnosed annually. PROUD and Ipergay as evidence Alongside other prevention to approve the provision of PrEP methods such as regular HIV on its health insurance system in testing, condom use, sex education December 2015. PrEP has been and encouraging and supporting for other sexually-transmitted available in the USA, following the behaviour change, PrEP is a crucial infections and to discuss other approval of the Food and Drug new addition to the range of prevention methods. Administration since 2012 and is interventions available to sexual The challenge in Wales now is also available in France, Norway, health services. It is no exaggeration to ensure that people who could Kenya, Israel and Canada, and will be to say that PrEP is a game-changer benefit from PrEP are able to access available soon in Belgium and Brazil. in HIV prevention. Studies have treatment in areas where regular Previously in Wales, PrEP was only shown that when used correctly its sexual health services are few and available online at a cost that would effectiveness is 100 per cent. far between. There is a real risk that be out of many people’s reach. The results of the UK-based some people could miss out. There There was also no way for sexual PROUD study evaluated the are still too many places outside of health professionals to track who effectiveness of PrEP in a high-risk the major towns and cities where was using it, how they were using group of men who have sex with people have to travel long distances it and whether they were having men which reflected ‘real life’ use of to access sexual health services. the regular check-ups needed the anti-HIV drug. In total 545 men Effective public information is vital, to monitor their health. While were randomly allocated either to as is close monitoring and analysis extremely effective at preventing take the PrEP drug Truvada straight of take-up to identify and address HIV, PrEP does not protect against away or to defer starting PrEP for a gaps in provision. other sexually transmitted infections year. Both groups had regular three- and, as with any medication, it is It is hoped that the evidence from monthly clinic check-ups. important to check for side effects, this trial will convince the Welsh The results clearly showed as well as making sure that those Government to commit to making that PrEP was highly effective at taking it require it. PrEP routinely available in Wales for preventing HIV infection. Daily Making PrEP available through anyone likely to be exposed to HIV, PrEP reduced the number of HIV NHS sexual health services will not as is the case in Scotland. We now infections by 86 per cent in this only make a life-changing difference know that people on effective HIV group; only three men became HIV to people who might be exposed positive during the trial and these to HIV by protecting them from a individuals either didn’t take PrEP as lifelong and stigmatising condition, PrEP is a game prescribed or were HIV positive at but it will also save the NHS an the start of the trial but had not yet changer in HIV estimated £360,000 in lifetime been diagnosed. treatment costs for every person prevention - when In addition, the PROUD study who would have become HIV showed virtually no difference in positive without PrEP. used correctly its reports of condom use between The cost of a year’s HIV treatment effectiveness is 100%. the two groups and no difference in is about £11,000 whereas PrEP costs rates of other sexually transmitted £5,000 per year. While people need infections (STIs), disproving to take HIV treatment for the rest concerns that access to PrEP would of their lives, PrEP will generally be treatment can’t pass the virus on – encourage an increase in risky needed for a much shorter period. with the addition of PrEP for people sexual behaviour. It also engages people with sexual at risk we could finally be seeing In France, the Ipergay study looked health services, encouraging them the beginning of the end for HIV at an intermittent on-demand model to get tested, and if needed treated, transmission in Wales. of PrEP, which also had an efficacy

Winter 2017 | Bevan Foundation Exchange | 7 Health at Work: Carmen Bezzina Leading the way on mental health in the workplace

Carmen Bezzina, UNISON lead organiser for mental health outlines what UNISON is doing to improve well-being and good mental health in the workplace.

oming to a workplace near If you are asking why a trades right therefore that UNISON takes a you: dedicated, support union is making such a fuss about stand and has a visible presence in for members of staff with mental health, it’s because mental workplaces to support those with Cmental health problems. health problems are much more mental health problems. If this sounds like exciting, ground- widespread than you realise and Unfortunately, mental health is still breaking stuff, it’s because it is. many of those affected are in the surrounded by prejudice, ignorance UNISON Cymru Wales has been workplace. One in four people will and fear. The stigma can lead to making waves since 2014 with our experience them at some stage in isolation and exclusion, making it pioneering campaign to train mental their life, so it is extremely likely that more difficult to recover. This is no health champions across public a family member or close colleague way to deal with something that is services. No public body or trades of yours has been affected. so common. The truth is that mental union outside of Wales is engaging UNISON is dedicated to supporting well-being is not taken as seriously with mental health in this way, going the welfare of our members and as physical well-being. into offices, school staff rooms and mental health-related problems Despite the very real demand, hospitals, talking to people, seeking are frequently caused by difficult mental health services are in crisis to tackle the stigma and provide situations in the workplace. It is now and there are long waiting help to those affected.

8 | Bevan Foundation Exchange | Winter 2017 the knowledge gleaned on a Mental well-being is not taken as seriously daily basis. as physical well-being…We are working with “I sit on the Time to Change Wales action group within my local employers to raise the profile of mental health. authority where we have made considerable progress in helping to challenge attitudes toward mental health through organising awareness events, training and policy changes. We’ve managed to secure training on mental health delivered by Mind as part of the compulsory management programme as well as being one of the first councils in Wales to draft a mental health policy. “My objective is to afford members with mental health issues the right to stay in employment without fear that their condition will cost them their times to access counselling. These to the best available help livelihood.” services must be more widespread and support. and accessible. Once individuals The feedback has been fantastic, Further UNISON training courses pluck up the courage to seek help, with participants praising the are planned and our first forum for acting quickly to support them is excellence of our training and our mental health champions to share critical. In Wales there are extensive champions are very enthusiastic to ideas, experiences and support geographical problems involved put their new skills into practice. took place in September. We are in some communities accessing The experience of Emma Garson, a passionate about ensuring people counselling services. UNISON mental health champion at know how to access the best mental UNISON Cymru Wales took a Cardiff County Branch, is typical. health services for themselves and decision to step into this void I am proud that UNISON Cymru/ and fight for change. All our Wales is taking a lead here. We are campaigning work is focused on We have called upon working with employers to raise winning an end to austerity and Welsh Government the profile of mental health. It’s in sustained investment in public everyone’s interests that there is services and public service workers. to appoint a mental good well-being at work. We want We have called upon Welsh health minister to a cultural change to encourage Government to appoint a mental employers to be more open about health minister to ensure mental ensure mental health mental health and for them to health is afforded equal status with is afforded equal ensure those experiencing other health and community services problems are provided with decent and to better co-ordinate services. status. care and support, as well as taking Working with Mind Cymru effective action on the causes of and Time to Change Wales, we workplace stress. “Since working in the role of launched a mental health awareness branch secretary, I’ve noticed an programme. We have been busy ever-increasing call for mental training mental health champions UNISON Cymru/Wales health awareness. Whether its and sending them into workplaces held its first mental health members needing support with throughout the land. Our first conference on World Mental contact visits for stress-related champions graduated in April. They Health Day, 10 October at absence, or members who face completed a two-day awareness the Pierhead Building, Cardiff sanctions as severe as dismissal course followed by two-days’ Bay. The event was sponsored due to having suffered poor mental training which we designed and by Dawn Bowden AM and health, there is a real need for ran with the assistance of a mental UNISON General Secretary champion representation within health practitioner. This course gave Dave Prentis and Vaughan trade unions. members the confidence and skills Gething, Cabinet Secretary for needed to undertake their new role, “The mental health champions Health, Well-being and Sport as they help colleagues with mental training I received with UNISON has attended. health problems by directing them been invaluable in my role and I use

Winter 2017 | Bevan Foundation Exchange | 9 WORK: NATASHA DAVIES Decent work for women’s well-being

Natasha Davies, Policy and Research Lead at Chwarae Teg, calls for an economic strategy based on quality employment for all.

t’s widely accepted that work trends. They are more likely to be poverty, particularly in-work poverty. is important for an individual’s working in low-paid, part-time roles Research has shown that while well-being. Work provides an and in sectors that are characterised men are more likely to experience Iincome, fulfilment, support by poor quality employment, in-work poverty as a result of their and social networks. At least it such as social care and retail. family situation, women are more does in theory. The prevalence of women in likely to experience in-work poverty Over the past few years several these kinds of jobs contributes to due to their employment situation. trends have undermined the ability the continued economic inequality Securing better quality employment of work to contribute to well- they face and the gender pay gap, for women could therefore help being. We’ve seen an increase in which stands at around 16 percent to reduce poverty levels, further in-work poverty, a real-terms pay for all workers in Wales, rising to as improving the well-being of people squeeze, the rise of insecure work, much as 30 percent for full-time in Wales. zero-hours contracts and the so- workers in sectors such as ICT and The impact of poor quality called ‘gig economy’. Women are life sciences. These kinds of jobs work and the inequality it helps particularly vulnerable to these also increases women’s risk of to perpetuate goes beyond just

10 | Bevan Foundation Exchange | Winter 2017 individuals. It’s increasingly accepted that inequality stifles economic Women are more likely to be working in growth and limits the impact of economic development. It’s been poor quality employment. estimated that £150bn could be added onto the UK’s GDP by 2025 if action is taken to bridge conduct research into decent work approaches in Wales and around the gender gaps. for women in Wales on behalf of world have focused purely on GDP To secure the well-being of Oxfam Cymru over recent months. or GVA as a measure of success; women in Wales, and the social and Exploring decent work and barriers they have favoured high profile economic well-being of Wales as to progression in domiciliary care sectors like ICT, manufacturing a nation, we must therefore look and the food and drink sector, and engineering, all of which are to deal with the problem of poor we have confirmed that many of dominated by men; and they have quality work and the inequality to the factors highlighted by Oxfam paid little attention to issues such as which it contributes. Scotland ring true for women in well-being, poverty and inequality. Recently there has been increased these sectors. Pay and conditions As a result, women have often discussion of decent or fair work. have unsurprisingly been flagged benefitted to a lesser extent from The Welsh Government has created as priorities but there has also been economic development and in a Fair Work Commission to explore a strong steer on the importance some instances companies have the issue and the UK Government’s of feeling valued, particularly from been incentivised to come to review of ‘Good Work’ by Matthew those working in the care sector. Wales but have not necessarily Taylor had the ambition of ensuring Traditionally, work carried out by provided quality, well-paid and that ‘all work in the UK economy women has been under-valued by secure employment. should be fair and decent with society, by women themselves and There is now an opportunity to realistic scope for development and by government policies. ‘Feminine’ take a different approach in Wales: fulfilment’. But what do we mean by sectors generally have lower wages, one that fulfils the duties placed decent work? poorer terms and conditions, are on the Welsh Government by the Decent work can mean very viewed as low-skilled, and have Well-being of Future Generations different things to different people, gained little from economic policy Act and that recognises that pursuit but it is possible to identify some and investment. of economic growth cannot common factors. It’s inescapable The Welsh Government is in the be completely divorced from that pay is a central element of process of developing a number of considerations of decent work, decent work, but we have to look policies and strategies that could poverty and inequality. It’s our hope beyond pay to understand decent significantly improve the provision that the new strategy will ensure that work fully. Internationally, indicators of decent work in Wales. The Fair prosperity delivered by economic of decent work include access to Work Commission says that the growth is felt by all, recognise that training, security, work-life balance, government is concerned about tackling gender inequality and employment relationships and the quality of work as much as increasing growth are mutually motivation. Similar factors were the quantity. There have been supportive goals and seek to identified by Oxfam Scotland who steps to bring business with them deliver an economy that is built set out 26 characteristics of decent on this agenda, with the Code of on a foundation of quality work including a hourly pay rate, job Conduct on Ethical Employment employment for all. security, paid leave, opportunities in Supply Chains seeking to secure We know what decent work for progression, flexible hours and some elements of decent work looks like. Now is the time additional benefits such as help with in the public sector supply chain, to make sure that it’s widely childcare. Interestingly, women are namely the Living Wage, fewer available and accessible to all. more likely than men to rank highly abuses of zero hours contracts and Securing decent work has to be factors such as a supportive line fewer instances of bogus self- a central consideration for Welsh manager, support to return to work employment. Government, and there’s some good after absence, flexibility in hours and The eagerly awaited economic work underway. But it needs to fit a job that is easier to get to. strategy remains a significant piece with a new economic strategy. Chwarae Teg has been pleased to of the puzzle. Traditional economic To mindlessly pursue growth at any cost would undermine efforts to increase the provision of decent work and would be a missed We know what decent work looks like. opportunity to get serious about Now is the time to make it widely available. the well-being of current and future generations.

Winter 2017 | Bevan Foundation Exchange | 11 PROCUREMENT POLICY: ED EVANS

Improving social value through investment in infrastructure

Ed Evans, Director of Civil Engineering Contractors Association Wales (CECA Wales) sets out a new way of delivering social value through investment in infrastructure.

elivering social value as to engagement with local schools offer is often a ‘mixed bag’ which is part of any infrastructure and colleges. Yet, despite this rarely enforced and rarely produces project is nothing new to emphasis, have real community tangible and long-term benefits. Dthe construction industry benefits been delivered? In the contractual case, targets are in Wales. Ensuring ‘community The current approach is largely not well thought out and suppliers, benefits’ has been a key component based on public sector bodies particularly smaller ones, struggle of the narrative around the Welsh seeking community benefits via to deliver meaningful results. Government’s procurement individual projects either voluntarily, Both approaches are difficult to policy for a number of years. The where a supplier provides an ‘offer’ apply, manage and measure and, emphasis is on projects that create of social value, or contractually, as a result the impacts are highly opportunities in the communities where the social value is proposed variable. There is rarely a penalty for where they operate, from targeted via contractual conditions. In the non-delivery of ‘contractual’ benefits recruitment, training and upskilling case of voluntary benefits, the and there is no formal obligation to

12 | Bevan Foundation Exchange | Winter 2017 social value at a programme or from suppliers involves direct the laudable aim of regional level rather than a local or interventions in communities, on a contract-specific level. The model voluntary basis, to support specific community benefits should focus on the strategic community needs and initiatives is stagnating in its delivery of four key elements such as refurbishing community Firstly, targeted training. The facilities. Whilst these are well- current form. establishment of support structures meaning and can have a positive to deliver training and upskilling legacy, their identification can be ad opportunities is crucial, be they hoc and efforts are not necessarily deliver the “voluntary” benefits. shared apprenticeship opportunities directed at those most in need. In addition, measurement of or the creation of skills academies. To maximise the impact of these success is poorly understood, Having such clear structures in place interventions a more strategic with the Welsh Government’s will provide consistency of support approach by public sector bodies Community Benefits Measurement for both suppliers and those seeking such as local authorities, who are Tool not used consistently across training opportunities such as the very often best placed to engage all projects and a clear lack of long-term unemployed, NEETs etc. with communities and identify performance data available. This also provides clear opportunity community needs, would ensure For many, the laudable aim of to engage further education or that supplier resources are better community benefits is stagnating in higher education institutions in the targeted at those with the greatest its current form – those involved in support process. Secondly, and need and community benefits its implementation are experiencing similarly, the delivery of targeted are maximised. (and sometimes exhibiting) recruitment where clear support increased cynicism. structures are put in place from Infrastructure projects in Wales which suppliers will source people Infrastructure projects have the capacity to deliver real to deliver contracts. benefits for our communities but Thirdly, a strategic approach to in Wales have the for a social value programme to be schools and college engagement. capacity to deliver successful a consistent, strategic Whilst many suppliers are already approach led by the Welsh public interfacing with schools and real benefits for sector is absolutely vital. colleges as part of their community benefits programme, much our communities. How can delivery be improved? of this occurs on an individual Well, there is some room for and sometimes ad hoc basis optimism. The Wellbeing of Future and therefore often lacks the Inevitably there will be some Generations Act offers a golden impact and longevity that a more who say this can’t be done, it’s too opportunity to rethink the processes strategic approach could offer. difficult or who will pay for it in for procuring infrastructure and The Construction Industry Training these times of austerity. Well it can construction works. The current Board and CECA Wales are already be done if the will is there and it’s drive towards regional collaboration supporting projects in this area, only difficult for those who struggle across the Welsh public sector focusing on contextualising the with the concept of collaboration. also has a greater impetus given curriculum and better schools And when it comes to the cost and the desire of the Cabinet Secretary engagement. These projects will who pays, well the public sector for Finance, AM, provide a consistent set of resources are already paying for it, via the for this to happen, with or without to support engagement which tender process. They’re just not legislation. In addition, we have means that schools and colleges can getting great value from it, which Local Service Boards and the receive a consistent ‘product’ from is why other funding options for creation of City Deals covering the industry to support their delivery a more strategic delivery model southeast and southwest Wales of the curriculum regardless of need to be considered. These could plus a Growth Deal in the north to which supplier is involved in delivery. include allocating a percentage of drive economic development and This strategic approach would the cost of projects or programmes greater prosperity. address the problems in the current specifically for social benefits. Or it The private sector has a crucial approach and better support long- could include a lump sum “offer” role to play but success will only term academic achievement. by the contractor team or a be achieved through a more Fourthly, a strategic approach provisional sum allocated by the collaborative approach. A new is needed to identify specific public sector body. model to increase social value from community needs. Part of the Either way it’s doable, affordable construction investment will require current community benefits ‘offer’ and a better use of public money. a strategic approach, delivering

Winter 2017 | Bevan Foundation Exchange | 13 ENVIRONMENTAL ACTION: STUART ELLIOTT & CAROL WARDMAN Treading lightly on holy ground

Revd Stuart Elliott and Canon Carol Wardman tell us about a new environmental initiative by the Church in Wales. Photo credit: Revd Elliott Photo credit:

e don’t often fall in love with an idea. It’s Do the little things in life - Gwnewch y hard to love graphs, Wfacts and figures that pethau bychain mewn bywyd. suggest bad news; and yet this is all too often the way in which the problem of climate change, and our pre-industrial levels. We see storms, droughts and failed harvests in human role in it, is portrayed. exacerbated by sea-levels that have sub-Saharan Africa, to floods in We are told that in order to avert already risen, due to global warming. Bangladesh, and island homes ecological catastrophe, we must We recognise that the worst effects disappearing under the waves of the ensure that global temperatures of climate change are borne by the Pacific. We find it difficult to engage climb no more than 20C above world’s poorest people – from with issues that are so vast, and are

14 | Bevan Foundation Exchange | Winter 2017 without simple, practical solutions which we can adopt without There is an interdependence of all life. changing our whole lifestyle. The change required is too great We cannot do without each other, nor all at once; and so, naturally, we without the rest of the earth. either deny it or turn away. A Rocha UK is a Christian charity working for the protection and restoration of the natural world. In 2016 it introduced a new Eco- We ought not be put off that only A Rocha’s Eco Church and Church accreditation scheme which small things are possible. Eco Diocese project: offers Bronze, Silver and Gold There is an interdependence of all awards when particular benchmarks life. We cannot do without each https://ecochurch.arocha.org.uk/ of positive action are reached. At the other, nor without the rest of the Creation Time resources in Welsh meeting of its national governing earth. Green is not a luxury; it is part and English: body in September 2017, the Church of what we are. Living closely in in Wales resolved to work towards community, we need to be ready to http://www.cytun.org.uk/ Eco-Diocese status across all six of take care of what is around us, and BookletCreationTime2017-web.pdf its component dioceses be ready to do more than what we Eco-Church is a tool to begin a think is our own share, if that is what More about Creation Time: conversation about climate change, is necessary; and to call gently into http://seasonofcreation.org/ about the environment, and about line those around us who we see how we might respond as church abusing what we have. https://ctbi.org.uk/creation- communities and as individuals. It is The myth that there is a special time-2017/ not a panacea, though it might be a place called ‘Away’ where we can place to begin. It aims to engage throw things when we are done is peoples’ hearts for the environment false. Wherever we put what we – for this is where change happens. cannot deal with is a place that still If we had but a glimpse of For the most part, Eco-Church stays exists; it is just out of sight. We need the world away from the facts and figures of to think more of ourselves as as a resting place would we climate change and human participating with the natural be caught environmental damage. environment, involved in the whole A natural complaint about process, and being reminded by our in the sacred story? schemes like this is that they amount friends when we get it wrong. Honoured as the to little more than tinkering at the Whether it’s managing edges. Or perhaps we fear that as a churchyards to encourage wildlife, whole of life becomes a church, engaged in local managing buildings to optimise day of preparation. communities, we should be loudly energy efficiency, investing church We might just then become prophetic: a thorn in the side of the funds ethically, linking up with local co-creators establishment, calling for divestment environmental groups, or from fossil fuels, challenging encouraging church members to of the dawn for a divine financial corporations, taking bold apply ecological principles to their re-imagining actions, making positive own lifestyles, Eco-Church’s gentle environmental decisions. Essentially, questionnaire suggests a range of of the lost arts and beauty we worry that ‘doing the little things’ things churches can do. A guide to of a creation. are not enough. getting started, produced by Revd Life laid fallow, for a time, It is certainly true that doing Stuart Elliott of the Church in Wales, is not in vain. nothing but ‘little things’ is not is called Treading Lightly on Holy enough. But unless we are reminded Ground – because, for the most To let go, to allow a daily to “do the little things in life” - part, we first have to acknowledge natural restfulness “Gwnewch y pethau bychain mewn that we have not been treading bywyd”, as St David tells us – particularly lightly. to rise up with gentle ease, however insignificant we might feel Eco-Church will help the church to to participate; they are, how are we ever to take reclaim a narrative of care for the earthed once again. the large, significant decisions? environment. The task is to re-awaken Small action – even down to the a sense of connection with the Revd Stuart Elliott. paper we put in our printers – can earth. To re-engage our hearts, and be the catalyst for greater actions. to find that this task might be joyful.

Winter 2017 | Bevan Foundation Exchange | 15 Enabling services: Victoria Winckler Close the Well-being Gap

Victoria Winckler, Director of the Bevan Foundation, argues that decent services are essential to closing the gap in well-being between the best and least well-off.

Personal well-being and material well-being are inextricably linked.

decent quality of life in terms of personal freedom and relationships. The definition in the Social Services and Well-being Act for example includes freedom from abuse, good family and personal relationships, and having control over day-to-day life as well as housing, participation in work and education. Personal well-being and material well-being are not separate – they are inextricably linked, with personal freedoms and fulfilment very much reflecting people’s resources. To put it very simply, the more money you have the more likely you are to enjoy high levels of personal well-being. The relationship between material and non-material wellbeing is very clear if we look at the findings in the ell-being is one of the people’s lives that matter as much as latest National Survey for Wales. new buzz words in the material. The popular press Looking at the fundamental question Wales. It has two might have us believe that the route of whether people feel that they can WWelsh Acts of its very to well-being involves a spa, some do the things that matter to them, own – the Social Services and chia seeds and a step-tracker on the gulf between the haves and the Well-being Act and the Well-being your wrist. But the perspective in have-nots is stark. Nearly one in four of Future Generations Act – as well Wales is much deeper and rightly people who live in ‘material as featuring in countless strategies, so in my view. Here, the idea of deprivation’ do not feel that they policies and statements. well-being brings together both can do the things that matter to The new emphasis on well-being decent material circumstances them. That compares with one is important because it covers many – such as having a warm home and in eight people who aren’t of the non-material aspects of a secure job – along with having a materially deprived. 16 | Bevan Foundation Exchange | Winter 2017 That well-being gap is one that is rarely talked about. One in four people who live in ‘material The only characteristic that makes more difference to someone’s sense deprivation’ cannot do the things that matter that they can do what matters to to them. them is people’s health, with between a third and a half of those whose health is bad or very bad saying they can’t do what matters them and do not have adequate control over your everyday life. to them. information about services. This isn’t Without it, people can’t claim many There are now a great many plans a question of costs or austerity – social security benefits, keep up with and strategies designed to improve it is about the operation and ethos friends on social media, look for and well-being. I suspect many are the of social care. So getting social care apply for jobs, or compare prices on same old plans as we had before services right – not just in terms of everything from white goods to dressed up in new clothes. Certainly the number of hours of care or the energy prices. With more and more we are yet to see much shift in qualifications of care workers – but services being digital only, being emphasis on the ground – for by working with and respecting the able to go online is widely regarded example in economic development, people who receive care – is an as being as important as utilities both nationally and locally, the important step towards improving such as electricity or water. Yet priority continues to be given to people’s well-being. people living in Wales’ most deprived inward investment and growing Being able to get out and about is areas are twice as likely not to have jobs and GVA at any cost. An also important to people’s well- access to the internet as people in economy for future generations is being – it’s a rare person indeed the least deprived with more than a long way off. who can do the things that matter to one in five not being online. There are, however, practical them within their own four walls. It’s a similar story with access to things that can be done to improve Owning a car is the now norm in affordable financial products. people’s ability to do the things that Wales, with three-quarters of With so many new ways of paying, matter to them. In particular. decent households having at least one whether it’s a contactless debit card services can help those on low vehicle. But for people on low or payment apps on a mobile phone, incomes to enjoy at least some of incomes, it is the norm not to have a it’s hard to realise that around one in the freedoms that the better-off take car – for example more than half of twenty people don’t have a for granted. These services are what tenants in social housing live in functional bank account. These are the Joseph Rowntree Foundation car-less households, as do high people who use the services of has described as ‘enabling services’ proportions of lone parents and companies like Cash Generator, who – such as social care, public people from certain Black and were advertising in my local high transport, access to the internet and Minority Ethnic groups. street that they would cash school the right financial products – which Those without their own cars have uniform grant cheques. allow people to access employment, to rely on a mix of buses, trains and It is hard to argue against the new leisure and health and education taxis, or else walk or cycle in order emphasis on well-being and indeed services. They’re the means rather to get anywhere. With the mileage why would you want to? But unless than the ends, but no less important covered by Wales’ bus services in the link between well-being and because of that. freefall, few services outside peak material conditions is recognised, A basic requirement for living the times and taxis being eye-wateringly efforts to boost well-being will be kind of life you want is being able to expensive for anything but short doomed to benefit the better-off. get out of bed, get washed, dressed journeys, lack of public transport is There needs to be an explicit and eat. Yet in Wales last year nearly a real barrier to having control over recognition that the well-being gap 60,000 adults needed support in your everyday life. In large areas of exists and must be addressed. their own homes to do these tasks. Wales, there’s no going to concerts, The task might seem huge, but there Although receiving social care ought no participating in adult education are critical, practical steps that could to enable people to have at least classes, no gym membership and be taken to enable people to have some control over their everyday no visiting Mamgu in hospital of an more control over their everyday lives, nearly a quarter of those evening if you can’t drive. So if we’re lives. Politicians can’t cut the ribbon receiving social care feel unable to serious in Wales about improving on good social care, reliable bus do the things that matter to them. ‘well-being’, improving public services, affordable broadband or This isn’t simply a reflection of transport – and especially bus a basic bank account, but they people’s needs - a substantial services – is a very important nevertheless matter. Some careful minority of people who receive step too. investment could improve social care feel that they aren’t And third, being able to access everybody’s lives. involved in decisions that affect the internet is important to having Winter 2017 | Bevan Foundation Exchange | 17 news Keeping you up-to-date with what’s going on Bevan Foundation News

What we’re up to Our future

Better opportunities for The future of ‘doing good’ Our strategy young people ur work with Big Lottery ur strategy for the next three e’ve crunched the numbers on ‘doing good’ in Wales years will be unveiled at our and found that there are Ois nearly complete. We’ve OAnnual General Meeting on Wvery few options for young outlined our findings to the 8th November 2017. people who don’t get five ‘good’ Assembly, Community Foundations It will identify: GCSEs. We’re now listening to the UK conference and more – the final experiences of 16-24 year olds in report is out soon. • our priority areas of work, Port Talbot, and will be working • how we will achieve change on on proposals for change in the the ground and coming months. • the resources we need. With thanks to the Garfield Weston Foundation, Community Union and The Bevan Foundation faces those who kindly donated to our appeal. significant challenges – in the last financial year our income was just £127,000. We’re working with Brexit funding and marketing experts on a way forward, and hope that you, our supporters and subscribers, will ith just 18 months until the help us too. UK leaves the EU, we’re Wlooking at what We hope to see you at the AGM to organisations should do to prepare find out more. for life after Brexit. Our report with WLGA on ‘regional economic policy after Brexit’ was published on 2nd New taxes to transform Wales October, with more to come on housing and construction, public hree of the Cabinet Secretary Housing options for services, higher education and for Finance’s low-income households development finance. Tfour possible new Welsh taxes in the valleys announced in the draft Welsh budget for 2018/19 were advocated Changes to housing benefit are set by the Bevan Foundation last year to cut even further the amount of – a tourist tax, a tax on disposal help low income households can plastic containers and a tax on get towards their housing costs, land values. making social housing unaffordable for some people. Not only did we get the potential of new taxes into the public domain, We’re working with the Joseph we’re thrilled that there’s a real Rowntree Foundation, tenants and prospect of them being introduced. social landlords to find some With thanks to the Joseph Rowntree practical solutions. Charitable Trust for their support.

18 | Bevan Foundation Exchange | Winter 2017 news All the latest from our subscribers Subscribers’ News

Projects Shelter Cymru is being funded by Events Our future Swansea City Council, City and Academi Wales are challenging County of Cardiff Council and Welsh Women’s Aid will run a public service leaders to think about Wrexham Borough Council to carry Supporting Women who Experience how they ‘Lead By Choice’, and out a study of the reasons behind the Multiple Disadvantage Seminar, on become deliberately disciplined sharp increase in rough sleeping in 30 November, in Wrexham. For more leaders, for more information go to the three authority areas. The findings information, email AliceMoore@ www.gov.wales/academiwales. of the study are expected to be welshwomensaid.org.uk. published in the summer of 2018. The Coalfields Regeneration Trust ICAEW is hosting a series of half day are seeking new partners for their conferences in Cardiff, Swansea and new Forum called ‘Tredegar For Wrexham this November, aimed at Change’ to promote Tredegar Town accountancy professionals based in Centre regeneration. If interested industry. Each conference is free for contact: Alun Taylor email: alun. ICAEW members; £30pp for non- [email protected] Tel members. Email emma.friedl@icaew. 01443 4044455 com for details.

Public Health Wales with Cardiff University and the Wales Institute of Publications Social and Economic Research, Data and Methods (WISERD) is holding CIH Cymru has launched the Good the Julian Tudor Hart Annual Public Practice Compendium 2017. The Lecture on 16th November at Cardiff publication compiles every shortlisted University. For more info and to book application, in full, from the Welsh go to www.wiserd.ac.uk. Housing Awards. To download for free, go to www.cih.org/cymru/ Other news welshhousingawards. AM has written a Estyn is sharing innovative practice pamphlet called “Developing our identified during inspections as one economy. How the economy of way of raising standards of education the Swansea City region can be and training. Over 100 other case studies developed”. Available online at from schools and post-16 sectors can Bron Afon Community Housing Mikehedges.org.uk or from mike. be discovered at estyn.gov.wales. is giving extra help to under 35s to hedges assembly.wales. @ The Royal College of Nursing in Wales make sure they are ready for changes is committed to the national campaign the government is making to the WCVA has published the Plan for to #scrapthecap – supporting its amount of housing benefit they can Change 2017-22, which looks at what members by canvassing the public and claim. For more information call they hope to achieve with the third sector, over the next five years. Read MPs, attending rallies and holding and 01633 620 111 or email enquiries@ publicising awareness events. bronafon.org.uk it at www.wcva.org.uk. Indycube Community are opening Oxfam Cymru has commissioned their doors by offering freelancers new research on the position of low and the self-employed membership paid women in the to the organisation absolutely free for market. The findings will aid policy 6 months. Sign up free at indycube. and practice in Wales and is due for community/join-us. publication in Autumn 2017. Winter 2017 | Bevan Foundation Exchange | 19 Spotlight On Lesley Smith Dove Workshop

In 140 characters describe If Dove Workshop were a If you could invite the Dove Workshop: biscuit, what would it be? anyone, dead or alive, to a dinner party who would DOVE Workshop, a Charity and A wafer, complex with many layers. you invite? Social Enterprise, is a Community Anchor Organisation that provides I would invite Alice Walker, author a plethora of services and What are the biggest of ‘The Color Purple’. I’m sure the opportunities for the communities conversation around the table of the Dulais Valley and surrounding challenges facing Dove would be very interesting, about area. We have a Day Nursery and Workshop? life in Georgia in the 1950s and Café/Catering Company on site. Continual development of the her involvement in the civil rights Organisation to meet the different movement. What is your role at Dove needs with the communities. Workshop? Being innovative in our approach to learning with a particular focus Why does the Dove on new technology. Retention of Workshop subscribe to the I am a Joint Co-ordinator, sharing experienced qualified staff when the responsibilities of managing the Bevan Foundation? funding is scarce. Organisation with my colleague Julie. The role entails: employing It is important that we (Wales) have staff, ensuring good governance, an independent Think Tank that can developing programmes, respond to and influence policy. negotiating learning opportunities with Local Education Providers and ensuring a high-quality experience I am a Joint Co-ordinator, sharing the for the people using our services. responsibilities of managing the Organisation with my colleague Julie. The role entails: What do you enjoy most employing staff, ensuring good governance, about working at Dove Workshop? developing programmes, negotiating learning opportunities with Local Education Providers I benefitted from the services available in DOVE when I returned to and ensuring a high-quality experience for the the Dulais Valley with my family. I very quickly realised that the organisation people using our services. is about equality of opportunity and providing people with the chance to improve their lives. I am now fortunate to be in a position that allows me to continue this work, supporting people to reach their potential and providing services and support that is accessible.

20 | Bevan Foundation Exchange | Winter 2017 @EstynAEM @EstynHMI

Mae arolygiadau Inspections have wedi newid changed

Rydym wedi lansio’n We’ve launched our trefniadau newydd ar new arrangements for gyfer arolygu ysgolion a inspecting schools and dysgu yn y gwaith. work-based learning. Mae ein fframwaith Our new inspection arolygu newydd yn framework focuses canolbwyntio fwy fyth even more on the most ar y meysydd pwysicaf important areas that sy’n helpu dysgwyr i help learners achieve. gyflawni. To find out more about I ddysgu rhagor am yr what’s changed, visit: hyn sydd wedi newid, www.estyn.gov.wales/ ewch i: InspectionChanges www.estyn.llyw.cymru/ NewidArolygu

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