From Vision to Action The Report of the Independent Commission on Social Services in Wales

November 2010

INDEPENDENT COMMISSION ON SOCIAL SERVICES IN WALES

Report of the Independent Commission on Social Services in Wales

INDEX

Introduction 4

Executive Summary 6

Chapter 1: The Independent Commission on Social Services 10

Chapter 2: Building from Strength 12

Chapter 3: The New Realities 14

Chapter 4: Responding to the Realities 21

Annex 1: Membership of the Commission 43

Annex 2: Written and Oral Evidence Contributions 44

Annex 3: Meetings and Visits Undertaken by the Chair 48 and Members of the Commission

Annex 4: References 51

Annex 5: Glossary of Terms 53

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Introduction by the Chair of the Commission

The work of the Independent Commission Over the years I have therefore become into Social Services in Wales has been increasingly distant from the day-to-day undertaken in little more than ten months business of social work and the planning and by a team of four commissioners, with a management of social services organisations. secretariat and support staff. Our findings are In this respect, the skills and experience of my based on, and grounded in, what we have colleagues on the commission - Julie Jones, heard and learned from the real experiences Rhian Huws Williams and Phillip Robson - of people in Wales. We have received written have been an immense contribution, not only evidence from almost one hundred individuals to the work of the Commission but also to and organisations, and have organised oral me personally. It would be immodest to say evidence sessions in Llandudno, Builth Wells, that they brought me ‘up to speed’, but they Cardiff and Carmarthen with a variety of certainly ensured that I didn’t slow the journey service providers, managers, service users and down too much or too often. carers. The work of the Commission would also not In addition to these formal hearings of have been possible without our secretariat the Commission I and other members of – at first David Rich, then Paul Webb, and the Commission have had many individual for the bulk of the time Sarah Austin - who meetings with civil servants, politicians, have smoothed the way for us and helped tie researchers, and representatives of various things together. We have also had the help of organisations and lobbying groups – in a an admirable support team, at different times range that goes from Ministers of the Welsh Matthew Gray, Leigh Davies and Rebecca Assembly Government to a six year old service Perez. Finally, we have received invaluable user. I have also taken the opportunity to visit support from Mike Shanahan in helping to various parts of Wales to meet with frontline draft this report. workers and service users. In Denbighshire, It has been a challenging but rewarding Newport, Cardiff, Merthyr Tydfil, Swansea, experience working with the commission. It is Ceredigion and Caerphilly, I have been struck to be hoped that our report points some ways by the commitment and energy of those that will be of benefit to the citizens of Wales. people whom I have met, together with the warmth and hospitality with which I have Social services unlike the NHS are not, and been received. These people have given me never have been universal services. They numerous insights into the practicalities of evolved essentially from the post war welfare state reforms of the National Assistance modern social services in Wales. Act of 1948 and its provisions for ‘Part III I began my own working life as a social accommodation’ for older people and from worker with Sheffield City Council, working the Children Act, which themselves derived with the families of children and adults with from the Poor Law institutions, orphanages disabilities, and later I trained and worked as and workhouses of an earlier age. It is to be a psychiatric social worker. But the bulk of my hoped that the current UK Government’s working life has been spent in universities and commitment to a ‘Big Society’ does not polytechnics primarily in social work education involve a return to Samuel Smiles and Self and training, and also in the training of Help and the Dickensian Bleak House. Even probation officers, youth and community so, the severity of the financial climate means workers, health visitors, and in the policy that different ways of working will have to be fields of criminology and drug misuse. found in all public services.

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Wales has already set in motion its own public service transformation agenda, work that started after this Commission was established but we hope that the work of the Commission alongside other work in Education, Health and Local Government will contribute to that wider programme of change as well as set the specific agenda for social services and social care services. Our proposals involve a more efficient means of collaboration, intelligent commissioning and an emphasis on preventive services built around the service user, their families and carers. Our report was drafted before the full extent of the austerity measures was known. But whatever difficulties might have to be faced in the future, my positive experiences of meeting with managers of social services and frontline workers across Wales, should give all of us every confidence that they will make the very best of what might prove to be an extremely difficult job.

Geoffrey Pearson

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Executive Summary

The Commission’s Work Experience of Service Users and Carers The Commission started its work 10 months We identify issues to be addressed for ago. We were asked to consider the provision specific client groups including looked after of social services over the coming decade children and children in need, people with and to look particularly at: the development learning disabilities, adults and children with of professional practice; building inclusive mental health problems, older people, people social services; effecting a step change in with physical disabilities and carers. We collaboration and ensuring services are highlight the problems of consistency and in integrated and capable of meeting the needs transfers and transitions. of all client groups. This, with other work We touch upon other issues which, while commissioned separately is to inform a White important, were less prominent in the Paper to be produced by the Welsh Assembly evidence we received including substance Government in early 2011. We had written abuse, the diversity of the population and evidence from over 90 organisations and language needs. held over 150 meetings. All of these issues reinforce the crucial role of Building from Strength social services’ in responding to inter-related In recent years social services have enjoyed areas of social difficulty and the importance a higher profile within national and local of its place within local government government and have seen notable alongside, housing, education and other improvements in leadership, the range local government services. of services, innovation, user satisfaction,

collaboration, workforce qualifications and Responding to the Realities other improvements flowing from workforce The Role and Position of Social Services regulation. These are real strengths to build We endorse the role of social services upon going forward. as defined in the StrategyFulfilled Live, Supportive Communities as one The New Realities of: promoting social inclusion and Outlook for Public Spending independence, supporting people through The outlook for public spending is bleak. difficulty and vulnerability, protecting the Investment decisions need to be about ”whole vulnerable and championing within local systems”. We note that social services are a government the vulnerable and those at risk. key part of the work being taken forward by The analysis in the strategy remains valid. the Efficiency and Innovation Board. The task now is to translate the Strategy’s vision into action at greater pace. Retrench or Reform We emphasise the integrated nature of Retreating into core services and away from social services functions, in supporting prevention and collaborative improvement and enabling people over life’s course. would undo gains made in recent years and This underlines the importance of strong would quickly become unsustainable. Social links to other local government services services need instead to seize opportunities including: housing, education, youth and for efficiency and transformational change leisure services, transport and community and assess the longer term impacts of development. It is vital to keep adults investment decisions. and children under the same professional

6 INDEPENDENT COMMISSION ON SOCIAL SERVICES IN WALES leadership if the needs of children within Voice and Control families are to be properly addressed. More personalised services promote better We are not persuaded that some social outcomes, greater user satisfaction and can services should transfer to the NHS. This often be more resource efficient. People would undermine the integrated support, require voice and control. We define the protection and inclusion for the vulnerable principles of good personalisation. We provided by the local government family. highlight the importance of responding to There are faster and less disruptive ways the Welsh language needs of service users to address the issues encountered at the and carers. We recommend that the Welsh interface between health and social care. Assembly Government should champion We recommend that social services and social self directed support, work with partners to care for adults and children should remain a ensure people have good information and local government responsibility. advocacy to inform their choices and that the Welsh Language toolkit developed by Targeted Change the Care and Social Services Inspectorate for We heard concerns about the plethora of Wales (CSSIW) should be adopted in planning, improvement initiatives and propose in this commissioning and delivering services. report a small number of priorities where Improved Assessment Systems – most urgent action is needed and which are the Burden of Assessment likely to have the greatest impact. Current assessment systems for adults National Regional and Local and children are overly-bureaucratic, too We recommend a national/regional/local concerned with process, poorly served by model for the planning, commissioning and IT and do not assist professional judgment delivery of services to facilitate collaborative about risk. We recommend that they are working between local authorities and urgently reviewed taking into account between different public services. Most ongoing work in this area. We also delivery would still be managed locally but recommend that there should be a review more integrated thinking at higher levels of data collection and analysis to support would promote better joined up services evidence-based practice. locally. We suggest a number of areas Entitlement and Portability suitable for attention at national level which will promote equity (e.g. entitlements for We note the Law Commission’s proposals looked after children and care leavers) and/ for the reform of adult social care law and or efficiency (e.g. national specifications for the concerns about equity we heard in our commissioned care services). evidence. We recommend that the Welsh Assembly Government and Welsh Local The greatest gains from collaboration are Government Association (WLGA) should lead likely to be at regional level. We suggest on developing a national portable assessment where a regional approach should be scheme supported later by national eligibility pursued. Having examined different models criteria. We also recommend that all-Wales for the geographical coverage of the regional entitlements should be established for level we recommend that the Local Health Looked After Children. Board (LHB) footprint should be adopted. To address concerns about the inefficiency of Transitions and Transfers the multiplicity of local strategic partnerships To respond to the many concerns we heard in which social services are engaged we around the transition from children’s to adult recommend aggregating these partnerships services, for care leavers and at other key up to the LHB footprint area thereby points in people’s lives, we recommend that reducing their number by two thirds. the Association of Directors of Social Services

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(ADSS) Cymru with the Care Council for We refer to the problems of data sharing Wales and the Social Services Improvement as an obstacle to collaboration between Agency (SSIA) should lead a review of public services and the burden of collecting transitions and transfers as a practice issue to data which is not properly used. We refer improve the experience of users and carers. back to our recommendation to review data collection and analysis (see the section The Mixed Economy of Care entitled Improved Assessment Systems – Private providers are likely to remain the Burden of Assessment above). predominant in a growing mixed market of care. We can also expect more “micro- Leadership providers” if more personalised models The Welsh Assembly Government needs to of support are adopted. Opportunities to be more focussed in its expectations of social shape the market to innovate and achieve services. Local politicians should promote efficiencies are being missed. We recommend understanding of social services and joining that private and voluntary sector providers up across council departments to assist social should be more constructively engaged in services in supporting and protecting the the planning, design and commissioning of vulnerable. services. We also recommend that micro- We recommend that the Assembly providers and user-led organisations should Government should concentrate on a small be encouraged to contribute to self directed number of priorities for social services in a support arrangements. 5 year plan and that the social services and social care leadership across Wales should Using ICT to Modernise Social Care work together to enhance the reputation Social services should be firmly in the and public confidence in social services. digital age and fully engaged in the Welsh Digital Inclusion Strategy. Digital technology Professional Development offers flexible and relatively cheap ways of in the Workforce supporting service users, enabling self help Workforce matters comprise a separate work in local communities, transforming systems strand informing the White Paper. We have and processes and helping people to stay in shared the evidence we received on this with control of their lives. Telecare, telehealth and the Assembly Government. assistive technology should be more rapidly developed with the NHS as a more integrated We note the beneficial effects of workforce service supporting independence, prevention regulation and the considerable strides and early intervention. that professional development has made. Negative media coverage of social work has, We recommend that under Welsh Assembly however, promoted a risk averse culture and Government leadership, local authorities and an over reliance on process. The need is to providers should effect a step change in the rebalance towards professional judgment and development, promotion and application of reflective practice, to assist, safe confident, digital technology. evidence based-practice. Putting up to date information into the We suggest several areas that will contribute hands of parents, young people, people and recommend that the Assembly seeking support and their families is critical to Government working with employers, the empowerment. Information needs to be high leaders of the profession and others should quality, accessible and sensitive to language lead a change programme whereby career needs. The third sector can play an enhanced pathways and continuous professional role in supporting IT-based self help in the development are valued and encouraged. community. We also recommend that ADSS Cymru, working with employers, should develop

8 INDEPENDENT COMMISSION ON SOCIAL SERVICES IN WALES a more effective leadership programme with Committees. Earlier in our report (in the an emphasis on succession planning. section under National, Regional and Local) we recommend that these should be among Commissioning the partnerships that are scaled up to the We welcome recent developments to LHB footprint level. support improved strategic commissioning noting that social care represents the Regulation, Inspection and Improvement second largest area of public procurement We note current developments in inspection, after construction. We recommend that workforce regulation and Directors of Social the Welsh Assembly Government should Services’ annual reports as contributions to continue to provide central support for better improvement. We suggest that inspection commissioning including joint commissioning needs to move more quickly towards practice and capability taking into account concentrating on outcomes and that the commissioning by individuals through self- next set of annual reports need to be sharper directed support. about where improvement is needed. We welcome the contributions of the Prevention, Early Intervention Care Council for Wales, the SSIA and the and Re-ablement Social Care Institute for Excellence (SCIE) to We note the initiatives in train and that the informing and fostering improvement. evidence of better outcomes and longer term cost avoidance is improving. We highlight We identify the need for better arrangements children in need and carers as particular for analysing data and sharing evidence. areas where more timely, flexible responses We recommend that the Welsh Assembly are needed. We recommend that schemes Government works with the leaders of the of prevention and early intervention should profession to establish a work programme to continue to be supported and that there support sector priorities. We also recommend should be a renewed focus on re-ablement setting up an Advanced Centre for so that people are well supported to recover Learning and Research managed as a virtual their independence. We recommend a collaborative between Higher Education public-sector wide review of services to Institutes and closely linked to the National children in need and that carers’ needs Institute for Social Care and Health Research should be addressed. (NISCHR), SSIA and SCIE.

Protection and Safeguarding We note that the work in these areas is in train in the Adult Protection Advisory Board and the Welsh Safeguarding Children Forum. Safeguarding is a shared responsibility across several agencies. We heard of difficulties in getting some bodies to discharge their obligations, poor attendance and lack of resources. Part of the difficulty is that Adult Protection Committees and Local Safeguarding Children’s Boards are not accountable in their own right, but only through their component organisations. We recommend a review of the accountabilities of Local Safeguarding Children’s Boards and Adult Protection

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Chapter 1 The Independent Commission on Social Services in Wales

1. Our Remit has given us insights way beyond these 1.1  The Deputy Minister for Social Services issues and we have attempted where announced in July this year that the appropriate to reflect and include this Welsh Assembly Government intends to in the report. publish a White Paper on Social Services 1.4 In considering the four specific issues early in 2011. The White Paper will set we were asked to have regard to the out a clear direction of travel for social impact of changing public expectations, services and social care drawing upon demographic changes and a range a number of work streams including; of resource scenarios that ensure a • the work of this Independent sustainable service. We were also asked Commission on Social Services to have regard to the wider policy (see our Terms of Reference below); context including: • the Social Work and Social Care • The principles set out in Fulfilled Lives, Workforce Task Group; Supportive Communities • the Reports of the Adult Protection • the Assembly Government Green Advisory Board and the Welsh Paper on Paying for Care and the Safeguarding Children Forum and outcome of the consultation on the • a Review of Regulation and Green Paper Improvement. • Ministerial commitments to review the future funding of social care and Our Terms of Reference social services 1.2 The Deputy Minister asked us to • The Task Group on the future of the consider the provision of social services social work and social care workforce and social care over the next decade and in particular how the Assembly • The Assembly Government led public Government can: service reform programme, including the evolving arrangements for local • support the further development of government and health services professional practice; • The Primary and Community Health • build inclusive social services based on Strategic Delivery Programme. the contribution of all partners who work in social care; 1.5 The Welsh Assembly Government’s • effect a step change in collaboration further consideration of how to reform between social services and with other the current system of paying for care key services and has been deferred following the establishment by the UK Government • ensure integrated social services in July 2010 of an Independent capable of meeting the needs of Commission to consider the various children, young people, adults and options for reform. Any major reform older people in the most effective way. of how care is paid for will need to 1.3 While we had to concentrate in this be led by the UK Government as report on addressing these questions, key areas such as taxation, National the wealth of evidence we received Insurance and welfare benefits are

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non-devolved. The Commission has need to ensure that good schemes are been asked to report by summer 2011 more widely shared and that successful and to consider the implications for the projects are scaled up to programmes. devolved administrations in drawing up its recommendations. The review of We and those we have spoken to funding of social care and social services have found it hard to keep pace with is linked to this and to the implications the “blizzard of initiatives” which is a for Wales of the Comprehensive feature of modern day social services. Spending Review announced in We hope that our work will help to give October 2010. direction and pace.

Membership of the Commission 1.6 Biographical details of the members of the Commission are at Annex 1.

Acknowledgments 1.7 We received written evidence from over 90 organisations. In individual Chair’s or full Commission meetings we met over 150 individuals and representatives of various organisations from the public, private and third sectors including organisations representing service users and carers and service users and carers themselves. We also met senior managers, front line workers, professional bodies, trade unions and senior civil servants.

1.8 We wish to record our gratitude to all those who contributed written and oral evidence to our review and gave so freely of their time.

1.9 A full list of those who gave written or oral evidence appears at Annex 2. At Annex 3 we list meetings and visits undertaken by the Chair and members of the Commission. Written submissions to the Commission are published on the Commission’s website at www.icssw.org

1.10 We refer to a number of good practice examples during the course of this report. There will no doubt be many others but we can only use and quote from examples that have been provided to us. Some of those we refer to we came across only by accident. Elsewhere in this report we comment on the

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Chapter 2

This chapter outlines the progress that social report the considerable gains there have services have made in recent years as a basis been in recent years. for moving forward. Sustained Progress 2. Building from Strength 2.4 The report on the lessons from joint 2.1 Social services and social care are reviews Reviewing Social Services in a major industry in Wales, with a Wales 1998-2008 – Learning from total public investment currently of the Journey (Care and Social Services around £1,418 billion per annum Inspectorate for Wales (CSSIW) and the (Welsh Assembly Government (WAG) Wales Audit Office (WAO) 2008) noted: forecast outturn for 2010-11). There on leadership: are about 70,000 people employed “… there are welcome signs of within the sector, of whom the majority improvement in the leadership of social are working in care agencies for care within councils since joint reviews private and voluntary services. About began 10 years ago. Social care has 27,000 are directly employed by local been given a much higher profile within authorities. These include about 4,500 councils and there has been significant registered social workers, together new investment. A strong emphasis with other specialist staff such as on workforce development has yielded occupational therapists and mobility positive results with most councils and rehabilitation workers. showing consistent improvement in this 2.2 In addition there is a huge army of area”. informal carers - estimated at nearly on the range of services available the half a million people - who, although report said: not part of the paid workforce, make “There has been an overall an immense contribution to the care improvement in the range of services of older people, children and families available with more systematic and those with a range of disabilities. matching of resources to needs and It has been estimated that families and priorities. Better partnerships with communities provide 70% - 95% of the voluntary sector are also helping care provision in Wales. Without this services to be delivered more effectively. input of unpaid ‘informal care’ there Progress has been made in developing would be even more fundamental more focused approaches to promoting challenges to the formal system of independence and rehabilitation with local government and health service some good project based services now provision. available.” 2.3 The unremitting pressures facing On innovation and service user social services and the media attention satisfaction the CSSIW Annual Report given to serious failures can lead for 2008-9 (CSSIW, 2009) said to a perception of permanent crisis “… There are many examples of and irreversible decline. The reality is innovative and excellent practice different. We therefore feel it important throughout Wales, and people continue to acknowledge at the start of our to report good levels of satisfaction

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with services. Social care services need Higher Profile to build on and further develop these 2.8 The establishment of a Deputy Minister opportunities in order to continue post with responsibility for social and increase the pace of change services and a Director level post within which is needed. With public services the Assembly Government civil service facing a challenging future, improved have also helped to raise the profile of partnership working at all levels across the specific contribution made by and services is needed to deliver effective challenges facing social services and citizen centred services”. to signal the increasing importance accorded to social services by the Welsh 2.5 During our review we saw and received Assembly Government. evidence of number of innovative schemes working across organisational 2.9 Local government, for its part, has boundaries designed to sustain people signalled its commitment to social in their communities and to encourage services as an integral part of the independence and improvements in the local government family and part of quality of life experienced in good care the wider improvement and reform homes. agenda. The WLGA has demonstrated its commitment over the last decade (9 2.6 On collaboration with other agencies Social Services Commitments, WLGA, social services are probably doing more 2004) and restated its continued than most other public service areas support in its evidence to us. The in responding to the citizen-centred establishment of a separate Association agenda of public service reform set out of Directors of Social Services (ADSS) in Making the Connections - Delivering Cymru has provided increasingly Beyond Boundaries (WAG, 2006). We confident leadership and a strong note, for example, that nearly 60% representative body for the collective of current priority projects overseen concerns of social services professionals. by Local Service Boards there is active We are also aware that the Welsh social services involvement. There Assembly Government Director of are clearly a range of staff including Social Services Wales has established a managers and frontline workers who grouping of social services and social have developed skills which that enable care leaders in Wales including ADSS them to work across organisational Cymru, the Care Council for Wales, the boundaries. WLGA, the Wales Council for Voluntary Action (WCVA), Care Forum Wales and 2.7 The social services and social care Welsh Assembly Government social workforce is increasingly better services civil servants. qualified and employers report 2.10 Finally social services and social care increasing satisfaction with the quality have seen considerable new investment of training available. Social work is a over the last decade although regulated profession, Wales has also despite rising demand spending as a seen the value of regulating residential proportion of local authority budgets child care managers and workers, appears to have flattened off in recent managers for residential care for adults years. and for domiciliary care. Workforce regulation has been embraced in Wales 2.11 While there are undoubtedly major by all stakeholders as part of the drive challenges ahead, we believe that to improve standards and support social services are building from a base professional development. of considerable strength.

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Chapter 3 The New Realities

This chapter sets out the context within 3.4 We believe that local government which social services and social care will need social services need to hold their nerve to change and develop over the next decade. in the face of public expenditure cut- backs. They need to seize opportunities 3. The Outlook for for efficiencies and transformational Public Spending change, ensure that the available 3.1 At the time we were writing this report, money is well spent, draw upon the full implications for public services in evidence to assess the longer term risks Wales of the Comprehensive Spending in investment decisions and maintain an Review announcement in October 2010 appropriate balance between children had yet to be determined. It is widely and young people’s and adults’ services. expected that social services and allied The social return on investment should services within local government will guide the way we think about the face progressive, substantial, real terms commissioning and de-commissioning reductions over the Review period. It of services. will be very important that those taking budget decisions in this difficult climate “Only by constantly looking forward think “whole systems”. They will need and learning from the present to recognise that reductions in one and the past can we ensure that part of the public spending system can vulnerable people in Wales can look have a knock on effect, at higher cost, forward to consistently high-quality elsewhere. services in the face of increased demand and fewer resources.” Retrench or Transform Gwenda Thomas AM, 3.2 An understandable social services’ Deputy Minister for Social Services. response to this bleak public spending outlook would be to retrench - to Efficiency, Productivity retreat into “core services”, further raise eligibility criteria and abandon and Investing to Save preventive strategies and collaborative 3.5 We have been kept briefed on the improvement until the funding outlook work of the Efficiency and Innovation begins to improve. Some of the Board (EIB). This is designed to provide evidence we took from and on behalf of leadership across Welsh public services local government asked whether such to meet the challenges of rising an approach was now unavoidable. costs, pressures on services, rising public expectations and year on year 3.3 We believe that this would be short reductions in budgets in the aftermath sighted and would quickly become of the recession. It embraces efficiencies unsustainable in the face of the that can come from improving the demographic and societal changes day to day running of organisations which we refer to later in this chapter. (for example better procurement and Retrenchment would involve turning tackling duplication and complexity) back after several years of investment and identifying opportunities for in preventive services and encouraging transformative change in the most independent living. challenging areas of public services.

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It is a distinctly Welsh approach taking • around 27,000 referrals for alcohol full advantage the compactness of and substance misuse over the last 3 Wales, short lines of communication years. Around half of these referrals and shared values across public services. are new referrals. (WAG, 2010).

3.6 We welcome the fact that two of the Challenges from Changing Needs priority work streams being taken and Expectations forward by the (EIB) programme 3.8 The general view we heard from service (families with complex needs and the users and carers was that services were frail elderly) have a central role for social generally good once people had gained services. We see this as due recognition access to them. Getting information of the role social services has to play in and access were cited as significant the transformation of public services. barriers. We also heard concerns about Challenges from Demography, the lack of continuity in relationships with social workers and social care Social Change and Health Status workers due to high turnover of staff 3.7 The essential context within which and that services are struggling to meet social services will need to operate over demand. Poor transitional and transfer the next decade can be summarised as: arrangements such as from children’s to • a growing but clearly ageing adult services and at other critical points population with the overall population in a person’s life were also a recurring rising by 5% to 3.14m and those theme. over 84 increasing by 31% to 95,000 The number of children is set to fall “We think in boundaries. Children by 1% up to 2013 but to start rising and vulnerable people don’t.” gradually thereafter. (WAG, 2010) The Police • a projected a rise in the numbers of people with limiting life long 3.9 From what we heard it is clear that conditions: for example from 2006 service users and carers want to see a to 2031 the numbers of people fairer system in Wales with common with heart disease will increase from eligibility criteria. They want to see around 230,000 to 330,000, with openness and transparency in decision arthritis from around 310,000 to making. They also want joined up 420,000, with respiratory illness from services, avoiding the need to repeat 330,000 to 410,000. (National Public their story for assessment purposes. Health Service, 2009) 3.10 Despite the progress that there has • a rise in the number of people over 65 been made in recent times, there with dementia from just over 39,000 remain striking variations in what to nearly 50,000 by 2020 (Daffodil, service users can expect in different 2010) parts of the country. We note that the • an increase in the population of Care and Social Services Inspectorate Looked After Children (from 4635 in (CSSIW) Annual Report for 2008-09 said 2008 to 5160 in 2010) and children in “Authorities need to work together need (from 23581 in 2008 to 25045 to tackle the wide variation in in 2010) and children on the Child services. This has been highlighted Protection Register has increased by in the annual report for the last four 10% from 2320 in 2008 to 2728 in years. Set against a background 2010. (WAG, 2010) of continued improvement in

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services, the degree of variability 3.16 This disproportionate concentration between services and authorities of Looked After Children coming from remains largely unchanged. Tackling the poorest neighbourhoods suggests variability requires a joint approach that social services departments are between local authorities and well positioned to make a significant improvement agencies. Authorities contribution to the Welsh Assembly need to agree to target some key Government‘s Child Poverty Strategy – areas of variability, and to take consultation document (WAG, 2010). concerted action to improve them”. But as the Strategy pointed out, a single agency response will not meet the 3.11 What we heard reflected the views and challenge. expectations of those already in the care system. Over time we can expect a new 3.17 The rate of children in care in Wales is generation of service users who will be substantially higher than England (75 articulate, well informed, have a greater per 10,000 compared to 55 in England) sense of being “consumers” and who and the rate varies considerably will demand high quality services. between local authorities. The rate of children on the Child Protection 3.12 Some particular examples of current Register also varies between local and emerging challenges identified authorities from 60 to 9 per 10,000 during our work are discussed below: (CSSIW and WAO, 2008).

Looked After Children 3.18 While outcomes in terms of life and Children in Need chances are poorer for Looked After 3.13 Between 2009 and 2010 there was a Children than the general population, 12% increase in the referrals of children the outcomes for children in need to local authority social services. The are a greater cause for concern. The rate of Looked After Children in Wales approach to children in need has come has been rising on average by 3% a year to be seen as the sole responsibility in contrast to just under 1% in England. of social services. A combined multi- agency response across health, 3.14 Looked After Children services should education (particularly schools) social be at the core of all local authorities services, housing, youth services and and supported across the range of leisure services is essential to achieving Council’s responsibilities. Despite good outcomes. increased expenditure outcomes for Looked After Children, although 3.19 There is emerging international improving, are still relatively poor. evidence such as that from C4EO that Those local authorities with a higher good investment in prevention and proportion of Looked After Children early intervention can achieve better also have a higher proportion of outcomes for children and families and children and young people receiving avoid high end social costs later (C4EO, free school meals (which is a proxy for 2010). low family income). 3.20 Innovative projects are being developed 3.15 Our own analysis, drawing on data in Wales to identify small numbers of from the Welsh Index of Multiple the most vulnerable families. Between Deprivation, calculated that 51% of 30 and 300 families, according to the Looked After Children in Wales live in locality, are at high risk of becoming the 17% of neighbourhoods identified a concern for statutory services. In as the most deprived. some areas a Whole Area approach is

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being adopted similar to the English examples of good joint working in Total Place approach. In England, multidisciplinary teams and between schemes (for example, the LIFE project agencies at a strategic level and also in Swindon and the Family Recovery exemplar models of user and carer project in Westminster) target families involvement in service planning and with children who are ‘on the edge of delivery. There is also some good third care’. These are not so different from sector work related to mental health, the multi-disciplinary Integrated Family work and well being. For example Support Teams (IFSTs) being developed Hafal, a national third sector mental in Wales. health organisation, has adopted the international model of recovery based Child and Adolescent Mental Health on a whole-person approach including Service (CAMHS) personal care and wellbeing, money, 3.21 CSSIW, Health Inspectorate Wales, Estyn accommodation, caring relationships, and the Wales Audit Office completed treatment, work, education and social a review of CAMHS last year which and cultural needs. identified significant shortcomings 3.24 Difficult issues arise for children Services for Children and Young People and families when a parent has a with Emotional and Mental Health mental health problem. The Social Needs (2009). This is clearly a service Care Institute for Excellence (SCIE) led by the NHS but as the report publication Think Child, Think Parent stressed it is everybody’s business. Think Family (SCIE, 2009) points to The commissioning of CAMHS services research that adult mental health and would lend itself to service models children’s social care services need based on regional approaches. to work together to meet better the needs of families. It encourages services Learning Disabilities which: 3.22 The model adopted in Wales which • are joined up at every point of entry has moved people out of institutional • look at the whole family when co- care to be supported in the community ordinating care and build on family has been an unrivalled achievement. strengths; However now that people with learning disabilities are living longer some with • and provide support tailored to these more complex needs including early needs. onset dementia, there is a need for a 3.25 We welcome the establishment of the review recognising concerns about the new All Wales Adult Mental Health experience at the transition from child Programme Board jointly chaired by a to adult services and the fact that per Director of Social Services and a Local capita costs are among the highest to Health Board Chief Executive. They will be found. The model now needs to be have a key role in providing leadership re-visited and future-proofed to ensure and direction to achieve high quality and sustainability. best value for money services delivered Mental Health to promote and protect the mental health and well-being of the people 3.23 Supporting people with mental health of Wales. This joint approach properly problems to live normalised lives in recognises the interdependency of social the community is much less developed services and health and the role of the than services for people with learning third sector, service users and carers in disabilities. It continues to be a largely delivering whole person mental health health led model. However there are services.

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Older People the reality that increasing numbers of 3.26 The fact that people are living older people will be purchasing their longer and generally adding healthy own care. years to their lifespan is something 3.29 Currently, work is being undertaken to celebrate. The Welsh Assembly with local authorities by John Bolton, Government Strategy for Older supported by the Institute for Public People 2003-2008 (WAG, 2003) was Care (IPC, Oxford Brookes University) a landmark document in Wales and and sponsored by the SSIA. Among has received international recognition other things, it has identified that for its vision and scope. It recognised earlier interventions and a re-ablement the considerable challenge posed by approach to supporting people with demographic change, especially in dementia, incontinence, podiatry, Wales where we have a high proportion dental needs, strokes and falls can of older people. Whilst many will result in maintaining independence at remain fit, active and independent into home and delay the need for high end their 70s and beyond, there is also an residential care. increase in the numbers of frail older people which means a bigger and 3.30 This work will contribute to building different challenge for social care and a model of best practice in Wales for health. The success for older people for services for older people using maintaining their independence relies resources more effectively. The Gwent on a range of interconnected services Frailty Project is one of the key service including housing, leisure, transport and transformation projects supported lifelong learning all of which are at the by the Public Service Efficiency and heart of the Strategy for Older People. Innovation Board (EIB) and the Invest to Save programme. It provides an 3.27 Significant progress has been made opportunity to focus on the service and in developing new models of service workforce re-modelling implications for which will benefit older people in social services and for health. Wales. Setting the Direction (WAG, 2010), Improving Health and the Carers Management of Chronic Conditions in Wales (WAG, 2007) and the developing 3.31 Estimates of the proportion of all Framework of Services for Older People. care that is provided by friends and family range between 70% and 95%. 3.28 As ever, the challenge remains for According to Census data 100,000 organisations to work together to people in Wales regularly provide over build services around the citizen. 50 hours of care every week. The evidence submitted to us focused on third sector initiatives to support 3.32 During the course of our review we independence and the social care and heard about the particular needs of the NHS interface which becomes crucial carer spouses of frail elderly people and when responding to the needs of the of young carers. We know that carers most frail. There is a growing volume of tend to have proportionately more long international evidence which supports term conditions and mental health the economic and social case for new problems than the general population. flexible models of service which allow It is likely therefore that we will see a older people to keep control and dignity continuing trend of carers with a long to carry on living the life they choose. term condition caring for a significantly There is a need to better acknowledge older population.

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3.33 A recurrent theme was the need for Transitions (all groups) responsive support available 24 hours a day 7 days a week to deal with crises “Changing for children’s to adults’ such as when the carer becomes ill services was a nightmare. For or goes into hospital unexpectedly. years they said they would make a Supporting carers to maintain their plan, but they did nothing, and I caring role to work when they are able pestered them and they did nothing. and choose to and to take a break Eventually I had to make my son when they choose to has to be a key homeless to get them to make a plan ……I had to throw my son out part of service planning. on the street” 3.34 The Carers Strategies (Wales) Measure Mother of a young man with complex requires Local Health Boards (LHBs) disabilities and local authorities to work together to produce information strategies for carers. The Measure recognises that “At 21 years it’s a drop off point. After that you get nothing.  what carers need is good quality and There should be more support  accessible information. for 21 year olds.” Care leaver “The business case is the carer who says ‘look after me and I can care for 10 years. Don’t and I can only “The transition for children’s services manage 5’” to adult services is hopeless. First Third sector Manager you’ve got to learn one system and then start all over again. Why can’t they be joined up?” Physical Disabilities Mother of a young woman with a physical 3.35 We heard concerns from organisations disability representing those with physical disabilities concerns about the variability “It’s mad. If you’re at college or of support around Wales including in school, and you get to a certain age, the assessment process and the lack foster care ends in the middle of an of flexibility, choice and support to academic year … it’s just crazy.” regain independence. There was a particular lack of coordinated focus on Care leaver the needs of adults of working age with disabilities and people living in the areas 3.36 We heard much about problems in of small local authorities which have the transition from children’s to adult difficulty commissioning services for low social services (particularly for those numbers of people with complex needs. with learning disabilities), from care leavers and at major events in people’s lives such as moving into institutional care. Much more attention at national and local level needs to be directed to information, planning and assisting orderly transitions.

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Other Issues government alongside housing, 3.37 The foregoing discussion has covered education, social regeneration and other aspects of local delivery. those issues that were most prominent The overriding challenge for local in the evidence that we gathered. Other government is to provide leadership issues that were less prominent are and energy to ensure new service nevertheless important. For example, models are developed at regional and we received very little evidence on local levels which build services around substance misuse although we know individuals and families that are not it is a matter of concern in Wales constrained by geographical and what little evidence we received or organisational boundaries. was scattered. We heard little from commissioners or service providers, 3.41 We note that the Welsh Assembly practitioners or service users themselves Government has published a Rural about the diverse nature of Wales Health Strategy but that there is no particularly in relation to Welsh equivalent strategy for social services Language needs and Black and Minority and social care. One of the key Ethnic group needs. challenges is how to ensure that people in these communities do not become 3.38 We received evidence from the Welsh further isolated. Language Board and are aware that the Deputy Minister for Social Services chairs a Task Group on the Welsh Language in Health and Social Services to ensure that language needs are mainstreamed into service and workforce planning and delivery. One important development is the toolkit recently developed by CSSIW to address language need as part of quality care. It is a toolkit which should be adopted by those commissioning and delivering services as a way of mainstreaming language need into statutory responsibilities.

3.39 The diverse nature of Wales and the implications of language needs, religion, culture, ethnicity, age, disability, gender and sexual orientation have to be addressed in the planning and commissioning of services which are person centred and which maximise the community resources available.

3.40 These issues further reinforce the crucial role of social services in responding to the needs of some of the most vulnerable members of our communities and the importance of its continuing place within local

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Chapter 4 Responding to the Realities

This chapter describes the key areas where • Enabling – assisting individuals and priority action is needed to meet the families to obtain the help they need challenges set out in the previous chapter when they need it.” and includes our specific recommendations. 4.4 Our Terms of Reference require us to 4. The Role of Social Services “have regard to the principles set out in Fulfilled Lives, Supportive Communities” 4.1 Fulfilled Lives, Supportive Communities and we revisited the strategy as part of (WAG, 2007) described the role of our review. social services as: • promoting social inclusion and 4.5 We believe that this description of independence; Social Services’ role and much of the underlying analysis in that strategy • supporting people through, difficulty hold good. The case for social services and vulnerability; as a core service within the local • protecting children and vulnerable government family remains valid. adults from abuse or neglect and Social services’ roles in the protection • acting as corporate champions and support for vulnerable people are within local government for the most integral to local government’s wider vulnerable and at risk. responsibilities to promote well being, social inclusion and community safety. 4.2 All four elements are fully Social services’ work in influencing interdependent. Fulfilled Lives, and developing requires close working Supportive Communities identified with other parts of local government the balance between care, control including housing, education, youth and empowerment as the defining and leisure services, economic feature of social work “social workers development, transport and community confront difficult behaviour and regeneration. manage danger and uncertainty. They … protect individuals or communities. 4.6 Some who put evidence to us They help to manage risk and the … argued that the NHS should become consequences of things going wrong responsible for some or all of adult in people’s lives.” social care as a solution to longstanding problems between social services 4.3 It also identified social services’ and the NHS. We gave this serious championing role as needing to operate consideration. While it could be argued at three levels: there is merit in this suggestion, we came to the conclusion that a merger • Influencing – informing national, of health with adult social care would regional and local policy and planning not be the answer. There needs to be so as to support security and clear understanding of social services’ independence full range of functions (as outlined • Developing – promoting community above), the interdependence of those support and services to enable people functions and their crucial relationship to achieve their potential with other key responsibilities of local government.

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4.7 We acknowledge that there can be Targeted Improvement not Wholesale fragmentation and poor co-ordination Change across health and social services and 4.10 We were told several times in the that this needs to be addressed with course of our review that Wales greater pace and more systematically suffers from too many improvement building upon the many examples of initiatives which are not then linked or good schemes and good practice that coordinated at any level. Many spring we encountered during our review. from Welsh Assembly Government Later in this chapter we recommend strategies with implementation being a regional model and a rationalisation left to local determination. of partnerships which, among other things, will simplify relationships with 4.11 As a result, improvement tends to the NHS and facilitate joint planning, be patchy with pockets of good commissioning and delivery, where practice which are often not rolled appropriate, without disruptive out or replicated. The EIB work seeks structural change. to achieve better co-ordination and greater pace and ambition in the 4.8 Social services enable people to live transfer of best practice across public fulfilled lives at any point in their lives services. Social services need to be in not just in isolated care episodes. Such the vanguard of these reforms. a structural change would tend to define individuals only by their health 4.12 In this chapter we therefore propose status rather than to embrace their a small number of priorities for action wider well being. It could seriously that go deep and should be led undermine the integrated nature of nationally. support, social inclusion and protection. It would still leave a difficult interface Collaboration and Partnership between care and these wider functions within local government. For these “Paralysed by partnership” reasons we are not persuaded that the Children’s Sector case for such a structural change has been made at this time. 4.13 Much of the current debate about 4.9 We also believe it is vital that adults and collaboration and partnership children’s social services should remain concentrates on the interface between under the professional leadership of health and social care and between the statutory Director of Social Services. local authorities. As we note in chapter Many of the problems children face 2, considerable effort is going into joint arise from the problems of the adults approaches although we heard from who are responsible for their care (for service users and carers that they often example: physical and mental ill health, do not experience a joined up service in disability, poverty and substance abuse). practice. Social services and the wider local government family must be positioned 4.14 There have been a number of fairly to maximise the support given to recent innovations such as joint NHS/ children within families. social services appointments, joint teams and integrated services. None 1 We recommend that social services of this is easy to achieve. These various and social care for adults and initiatives will need to be evaluated for children should remain a local their impact and the learning shared government responsibility to across Wales. While we do not support deliver the vision set out in Fulfilled radical structural change we do support Lives, Supportive Communities.

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identifying what works and building local government re-organisation. The upon it. We wish to acknowledge that announcement in September 2010 by partnership approaches are positive the Minister for Social Justice and Local developments but that there are too Government indicated that the Welsh many of them. Assembly Government is looking for a step change in collaborative working “Health and social services don’t work between local authorities across the together. Parents have to repeat full range of their responsibilities. How their story, over and over again. this greater collaboration is achieved is And they always stress the negatives a question we have considered a great and not the positives. What you can’t deal. We agreed an approach that do, not what you can do” determined what needed to be done at national, regional and local levels. Carers’ group National “The problem with partnerships as 4.17 At the national level there is a need they are is that you have to repeat to set clear priorities, determine the the same process 3, 5, 6 times resources available, demonstrate joined whatever, each time with a slight up policies around people (rather difference” than policies within silos), with clear Senior NHS Manager outcomes and expectations across services. The key responsibilities “When you go to meetings, you have for government and for national to check the post-code first, to see organisations are about direction, policy what the agenda  frameworks, national standards for is going to be.” services and practice to ensure equity of access and outcomes as well as public Health official with responsibility confidence in a mixed economy of care. for liaison with social services 4.18 Reducing funding for social services also requires all of us to look for 4.15 We have also considered how best to opportunities for reducing staff time improve collaboration between local and effort by adopting Wales – wide authorities. It was not part of our approaches wherever practicable. brief to consider local government There is also an appetite within local reorganisation. However we found a government for some low volume, very large measure of agreement that the specialist care services to be provided present arrangements for the planning, on an all-Wales basis – that is planned commissioning and delivery of services and commissioned nationally and across the 22 local authorities are delivered regionally or locally. not sustainable. These arrangements are too heavy a drain on funding, 4.19 At the national level we believe that, managerial and change capacity. for example, there is both need and opportunity for: 4.16 Local Public Services in Wales – Developing a Whole Area Approach • national quality standards for Wales (SOLACE Wales, 2010) indicates based on evidence of good practice a desire to move to a different (not minimum requirements); distribution between national, regional • the establishment of national or sub regional and local without eligibility criteria linked to portable the upheaval that would accompany assessments;

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• a national minimum data set to • better alignment of needs over support workforce planning – a whole a larger population; Wales system available locally; • improved leverage in commissioning • setting the expectations of providers in and service planning; the mixed economy of care (through Wales-wide, clear consistent service • greater opportunities for pooled specifications, model contracts etc); funding across a wider area maximising public funding and • setting Wales-wide entitlements for community resources; looked after children and care leavers; • greater consistency in performance • providing the infrastructure for and digitally-enabled services such as a national portal for information • improved resilience especially for low and advice linked to more local volume, high cost services. information and 4.22 Working over a wider geographical • the establishment of centres of area than a single unitary authority excellence for research and post will clearly require high levels of qualifying training for social workers trust, strong political leadership and and national commissioning of some close attention to governance and training. accountability. Several models have Regional been used including lead director, lead 4.20 What is best commissioned, planned chief executive, joint boards and lead or delivered on a regional basis should cabinet members. The starting point flow from careful consideration of, for must always be a clear vision of what is example: to be achieved and clear commitment • the potential offered for improved by all the parties. capacity, leadership and the use of 4.23 There is certainly scope for the further scarce resources; development of the regional model • the potential to improve outcomes for highly specialist services e.g. for for service users and to raise public some learning disability services, some confidence (including the reduction services for older people and services of risk); provided to relatively small numbers of • efficiency gains which allow service users. This also applies where reinvestment in services; there is a shortage of local expertise, • the strategic impact from whole- local capacity and the high cost of the systems approaches and the interventions indicate that this model achievement of greater consistency in is substantially more cost effective and performance. produces better outcomes. 4.21 Regional approaches could offer, for 4.24 At regional level there is also scope for, example: for example: • the advantages of scale particularly • joint commissioning of community for specialised services; health and social care of services • pooling of capacity and leadership for people with limiting life long to manage change; conditions; • opportunities for better alignment • commissioning and delivering some with other public bodies, especially learning provision; NHS organisations;

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• co-ordinating and supporting social • A different model is provided by work practice learning assessment the four Welsh Local Government and social care learning assessment; Association Regional Partnership Boards, set up in 2006 in response • commissioning and providing to Making the Connections. The adoption services; Regional Collaboration Compendium • the management of high cost (WLGA, 2010) lists around 150 specialist placements; collaborative schemes for a wide • out of hours services; variety of different public services, not all of which arise directly from the • the joint commissioning and delivery work of the WLGA Regional Boards. with the NHS of CAMHS; However, a close examination shows • the commissioning and delivery that many of these collaborations of support arrangements for care stray beyond strictly regional leavers; boundaries, different schemes • shared services - back office functions overlapping different boundaries, such as Human Resources and payroll; producing their own version of ‘variable geometry’ - so that the • healthy schools initiatives and collaborative geography of Wales • low volume high complexity work looks like a jigsaw in which every (for example, children ‘on the edge piece belongs to a different set. of care’). • The establishment 7 LHBs covering These could lead to more efficient several local authority areas creates services and greater public confidence a different set of opportunities for and satisfaction. collaboration over a wider area than the 22 local authority areas. 4.25 It is at a regional level that collaboration needs to be most forcibly addressed. At the moment there is a messy series of multiple interfaces between the We have considered three main models: health service and local government • Ad hoc collaboration between services, which are costly in terms of different parts of the 22 local time and effort. Adopting the LHB authorities to suit different purposes. ‘footprint’ for collaborative effort This is sometimes called ‘variable would provide a single interface geometry’. This has some attractions, between health and social care and since it offers greater flexibility to the range of local government services address local circumstances. However, that contribute to the possibility of it is at best a haphazard approach, independent living in the community can be confusing for partners and such as housing, leisure services service users and typically depends and transport together with the much on personalities. While independent sector. Although not personalities can be important in specifically part of our brief it could effective collaboration, this form be argued that other services such as of collaboration can become education could easily fit this footprint. collaboration in and for itself, with no clear outcome for the service user. While social services should form Moreover, when personnel change, themselves into consortia based on the collaboration is endangered. the footprint of the LHB, for planning and commissioning of services and the delivery of some services, this will

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present local and regional challenges. the citizen so that citizens do not feel We recognise, for example, that in the join between organisations when North Wales the six local authorities in they use services. The principle of local the area covered by Betsi Cadwaladr delivery will therefore need to be built LHB comprise a particularly large on multi agency and multi disciplinary geographical area that might present team working. For example IFST, co- difficulties of connection and location, joint re-ablement teams, may integration. stimulate innovative delivery models such as social enterprise organisations. Local 4.26 National and regional approaches Rationalising the Partnerships will not work without a good 4.29 In the course of our work we heard a understanding of local needs and local great deal about the positive value of capacity. Around eighty per cent of partnership working but we also heard all social services and social care are concern about the cost, complexity and delivered locally. While planning and sustainability of maintaining the 154 or commissioning can be undertaken by so strategic partnerships working at the combining effort in the larger areas of local authority level across Wales that in the LHB footprint, the management some way involve social services e.g.: of most services needs to remain at • Adult Protection Committees; local authority level. They might be commissioned regionally but delivered • Children and Young People’s locally (such as the South East Wales Partnerships; Improvement Collaborative (SEWIC) for • Health, Social Care and Wellbeing child placements) and might include, Partnerships; for example, a range of services for older people, domiciliary care, multi- • Local Safeguarding Children Boards; disciplinary dementia care, supporting • Local Service Boards; children in need, child protection • Social Care Workforce Development services and models of self-directed Partnerships and sometimes support. • Community Safety Partnerships. 4.27 Some developing models of service are predicated on local delivery based 4.30 The LHB footprint model which on local neighbourhoods, drawing on we recommend in this chapter as knowledge of the local population and the regional level for planning and community resources including third commissioning creates a new set of sector organisations. Examples are relationships and itself requires a fresh emerging in the current work on the look at the number and geographical Framework of Services for Older People, coverage of such partnerships. the Setting the Direction model and the IFSTs. Some services could be wrapped 4.31 If such partnerships were scaled around the areas of GP practices adding up to cover the LHB footprint, the strength and depth to models of Local Service Board could become a primary care. Regional Service Board, making for more efficient collaboration between 4.28 Integrated thinking nationally and local government, health, the police, regional commissioning will assist local the private and third sectors and delivery that demonstrates the benefits so on. Regional levels are currently of collaboration and is built around often thought to add an extra layer

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of cumbersome bureaucracy, but the “It’s frightening not knowing who is model we are suggesting will replace, coming through your door” not add to existing arrangements. In the context of the complex political Domiciliary care service user concerned geography of Wales, they would offer a about frequent changes of staff distinctively Welsh brand of streamlined efficiency in the form of a single 4.32 Important steps have been taken in interface between the various services recent years to amplify the voice of the and sectors. citizen in the way that social services are provided, but there is little evidence 2 We recommend that: anywhere that that alone leads to transformational change. Children and a. to avoid the disruption and high adults using services and their families cost of reorganisation, the LHB need not only to have a stronger say ‘footprint’ should be adopted but greater control over how their own across Wales as the basis for support and care is arranged, how improved collaboration between services are designed, developed and local authorities and between local delivered and how resources are used. government and the NHS for the planning, commissioning 4.33 This requires a clear recognition that and delivery of services. people have valued expertise and ideas to offer, and working with them as full b. the Welsh Assembly Government partners can produce much improved should address the plethora of solutions and interventions. It can local strategic partnerships by enable them, for example, to make streamlining them on the basis better use of local support networks, of the LHB footprint. family and carers to supplement funded c. the distinctive Welsh model for provision. the future design, commissioning and delivery of social services 4.34 Implementing personalised care and should be built around the three support through voice and control is made easier through direct payments tiers of national, regional and and personal budgets but that is not local to improve both quality and essential. Control can be exercised in productivity. other ways. It does, however, require Voice and Control substantial rethinking and change on the part of commissioners, service “People are experts in their  providers, social workers/care managers own lives” and people seeking and using support and care. It requires commitment at A service user political and senior management level to significant culture change. “People want a life not a service” 4.35 In the course of our work we found Third sector umbrella organisation that expressions of commitment to principles of personalisation, and “I run the library and organise the claims to be applying them, are not book collection here. ……It keeps me always accompanied by real changes very busy, but it’s been the saving in practice. This often reflects limited of me, that’s what my dad says” understanding and vision of what a personalised service looks and feels like. A service user

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4.36 In our view the core principles of good suggest improvements and better use personalisation are: of resources. The practice of including • tailoring support to people’s individual service users as part of management needs boards is to be commended, but they need to have proper involvement not • ensuring that people have access to mere tokenism. information, advocacy and advice to make informed decisions about their ‘Personalisation means thinking about care and support public services and social care in an • finding new collaborative ways of entirely different way – starting working (sometimes known as co- with the person rather than the production) that support people to service. Although this shift will take engage actively in the design, delivery time, it will ultimately mean change and evaluation of services at every level throughout the whole • developing local partnerships to co- local authority system to ensure that produce a range of services for people universal services such as transport, to choose from and opportunities housing and education are accessible for social inclusion and community to all citizens. This means that development commissioning must change to be more strategic and open, with a focus on • developing the right leadership and the local community, its resources organisational systems to enable staff and the people who use the services. to work in creative, person-centred Approaches to early intervention and ways prevention need to develop further so • embedding early intervention, that people are encouraged to stay re-ablement and prevention so that healthy and independent.’ people are supported early on and Extract from A Rough Guide to in a way that is right for them Personalisation: SCIE 2010 • recognising and supporting carers in their role, while enabling them to 4.39 Although personalisation models and maintain a life beyond their caring approaches have progressed further responsibilities in adult community care services, they • ensuring citizens have access to have much to offer the development universal community services and of children’s and families’ services, resources. particularly in supporting partnership working between parents and 4.37 There is good evidence that increased professionals. involvement in the design of support arrangements improves user and carer “I’ve lived here for seven years. I used satisfaction with outcomes and often to have 24 hours support—cooking, makes better and more creative use cleaning, shopping—now I need only of available resources – the resources 7 hours. Mike and Robin my support go further because people are able to workers put me in touch with a mobilise their own support. church. I became a Christian … it’s 4.38 Given a choice, many service users do given me a lot of self confidence. Now I do volunteer work at an old people’s not choose traditional forms of service, home, washing up and serving teas” but options offering greater flexibility and independence. Even within existing A service user services, people using services can often

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4.40 Helping to make service users co- c. the Welsh Language toolkit producers in their own solutions developed by CSSIW should wherever possible is also much more be adopted in the planning, likely to help people to retain or regain commissioning and delivery of whatever degree of independence services. is achievable rather than allow them to slip into avoidable dependency. Improved Assessment Systems – Avoidable dependency is a poor the Burden of Assessment outcome for individuals as well as a continuing drain on resources. “I spend so much of my time sitting A “recovery model” looks at what a looking at a computer in-putting person might be enabled to do for data, that if I get a whole day just themselves, making use of their own visiting families, at the end of the support networks. It aims to reduce, day I don’t feel as if I’ve done any or at least hold a person at the current work.” level of need and plans for the orderly Social worker withdrawal, or the scaling down, of formal services to the fullest extent “In the future we need to enhance possible. autonomy, professional judgment and 4.41 One particular consideration which discretion. We’re too focussed on needs to be addressed is the matter procedures and form filling … We’ve gone too far down the road of of service users exercising voice managerialism” and control in relation to the Welsh language. Language needs must be Social work teacher embodied in service and workforce planning, commissioning and delivery. “Too much social work time is spent CSSIW has developed a Welsh on clumsy assessment systems and Language toolkit (CSSIW, 2010) that requirements” offers guidance in these matters Director of Social Services and provides a useful framework for commissioning and delivering language-sensitive services. “70 per cent of time is not  value time” 3 We recommend that: Director of Social Services a. the Welsh Assembly Government should give a stronger commitment 4.42 We heard much from social workers to seeing the principles of and other frontline staff and service self-directed support adopted users about the bureaucratic burden throughout Wales. This aligns with in their work and the extent to which its stated commitment to promoting process and time spent at the computer independence, prevention and early was getting in the way of productive intervention time with and for clients. The Integrated b. the Welsh Assembly Government, Children’s System (ICS) was given as local government and independent an example of an inefficient system partners should work together to that does not easily assist professional ensure that people have access to judgement about risk. better information, advocacy and 4.43 This mirrors concerns in England. support to make informed choices The first report of the Review of Child about their own care and support Protection being undertaken for the

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Department of Education in England and processes to outputs and by Professor Eileen Munro says of ICS: outcomes. “the assessment framework is Entitlement and Portability inefficient and does not easily facilitate 4.45 In evidence we heard that service users professional judgment about risk and wish to see common eligibility criteria safe next steps …” for social services across Wales. The and on ICT systems: Law Commission’s proposals for reform of adult social care law in England and “social workers are required to Wales recommend that assessment of spend too much time completing needs should be carried out against documentation ….” criteria determined at the national level and that there should be scope for 4.44 Proper assessment and proper records self-assessment to be an integral part of are important but it is about finding the process – another important aspect the right balance in professionals’ of voice and control - but not a free- workloads, particularly at a time of standing alternative to professionally- rising demand and shrinking resources. led assessment. In our view there are important opportunities for streamlining the 4.46 Under the proposals, meeting the processes, what information is collected national eligibility criteria would carry and for improving the ICT support to entitlement to support from local liberate staff time. The work being authority funds. Clearly the services undertaken by Professor Munro, by offered may need to vary according John Bolton on assessment for older to local circumstances (e.g. rurality). people and work in Neath Port Talbot The proposals also consider the County Borough Council in reviewing relationship between individual needs systems for children’s services will all assessment and carers’ assessments, help to inform how such a streamlining including whether both should be part are best achieved. There is however of a single integrated procedure. a risk that if these initiatives remain uncoordinated they may result in 4.47 Additionally, in Scotland there is a fragmentation. The Welsh Assembly Charter for Looked After Children and Government needs to take a strong in Wales the Children’s Commissioner leadership role to ensure consistency. has work under way to clarify entitlements for Looked After Children - 4 We recommend that: which we would support. a. the Welsh Assembly Government should urgently review assessment 4.48 Setting and implementing a national systems for both adults and children assessment framework and eligibility as a significant contribution to criteria for adult services will assist the improved efficiency and the better portability of assessments between local use of professional time and skills, authorities. We understand that the taking into account work already in WLGA is scoping a portable assessment progress in this area. approach across Wales and we would b. the Welsh Assembly Government, wish to support this. the WLGA and ADSS Cymru should review the data currently collected with a view to ensuring a shift away from an emphasis on inputs

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5 We recommend that: Voluntary providers account for only a. the Welsh Assembly Government a relatively small proportion of that total. Further, the pattern has changed and the Welsh Local Government to there being a smaller number of Association should lead the larger providers for residential care and development of a national, portable larger numbers of smaller providers for assessment scheme in Wales domiciliary care. ultimately supported by Wales-wide eligibility criteria 4.51 The preponderance of private providers b. standard all-Wales entitlements is likely to remain the pattern over the should be established for Looked next decade. Despite the cutbacks in After Children. public funding, the care market is likely to grow substantially over the next Transitions and Transfers decade in response to demographic 4.49 We noted in chapter 3 what we heard change and an increasing number about the difficulties that individuals, of self funders. If more personalised families and carers encounter around models of support develop, we can also the transition between adults’ and expect to see increasing numbers of children’s services, as care leavers, “micro-providers”. There will also be when leaving hospital as an elderly opportunities for innovative providers person and at other key points in led by the third sector and there is people’s lives. Poor handover and increasing interest in, for example, ineffective planning can lead to poor social enterprise models. outcomes and costly interventions later. In our view the Directors of Social 4.52 From what we have seen, the market Services have a pivotal role. It is not is currently not being managed sufficient, for example to keep adults sufficiently or appropriately. and children’s social services under the Opportunities to shape the market, same professional leadership. Those to innovate and to achieve efficiencies services must, in practice, work in a across local government and the NHS properly integrated way. Transitions and are being missed. transfers are a practice issue that ADSS 4.53 In part this seems to be due to Cymru are well placed to lead on. ambivalence towards the private sector provision of care. We heard 6 We recommend that ADSS Cymru from private providers that although with the Care Council for Wales they welcome initiatives such as the and the SSIA should lead an urgent Memorandum of Understanding (ADSS review of transitions and transfers, Cymru, Care Forum Wales, Registered policy and practice to improve user Nursing Home Association and the and carer experience which remains UK Home Care Association, 2009), unsatisfactory. their involvement in service planning The Mixed Economy of Care is sometimes peripheral at best. This is in nobody’s interest. A continuing 4.50 Over many years, social services have dialogue with providers could, for moved from being the main provider of example, identify areas of avoidable services to a position where currently cost in service specifications. The around 61% of domiciliary care hours, reality of the current make up of the 85% of residential care for adults in market needs to be acknowledged and Wales and 75% of residential care for both the private and voluntary sectors children funded by local authorities are more fully involved in the planning, provided by the independent sector.

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commissioning and design of services “digital inclusion of citizens is central to at national, regional and local levels. individually and collectively embracing the opportunities and imperatives of 4.54 The Welsh Assembly Government this rapidly evolving world. Significant Commissioning Framework Guidance savings and efficiencies can be made and Good Practice (WAG, 2010) notes through increased use of public that: services online.”

“the commissioning decisions of local 4.57 Social services and social care services authorities also influence the range of in Wales need to place themselves services available to those who fund firmly in the digital age. New their own social care. It is not enough technology can assist in the design and therefore for local authorities simply delivery of services and can improve to be concerned with planning the the engagement of service users and services that they fund. They have a workers. It opens up the possibilities responsibility to ensure that social care of high quality, innovative services that services provided by a wide range of are also resource efficient. different agencies available to their area are well planned, designed and 4.58 There are some areas where the delivered”. potential has already been grasped. For example in Anglesey there is a 4.55 We note that this document is to domestic violence telecare project and, be followed up with a development in Powys, an online counselling service programme to support the development for adolescents has been established. and sharing of good practice. Another exciting development is an online befriending service called Face 7 We recommend that: 2 Face, run by Scope Cymru for the a. to meet the stated commitment parents of disabled children. This can to inclusion, the private and be accessed online, particularly useful third sectors need to be more for rural communities. An online constructively involved by the spin-off is a social networking site Welsh Assembly Government, that enables parents to offer mutual local authorities and the NHS in support, information sharing, and to the planning, commissioning and combat the isolation often experienced design of services at all levels by the parents of children with high b. at the local level, micro-providers care needs. Initiatives such as this, and user led organisations should generated as much by the parents be encouraged to contribute to self- themselves, offer radically news ways directed support arrangements. of service delivery and can be applied to a range of provision. Using ICT to Modernise Social Care 4.59 We argue for a transformation in 4.56 There is increasing use of online the use and application of digital technologies in everyday aspects of our technology as a direct means of lives. The Welsh Assembly Government supporting service users and in document Delivering Digital Inclusion: transforming systems and processes. A Strategic Framework for Wales – Specific areas where expanding the consultation document (WAG, 2010) use of digital technology would be acknowledges that a key component include:

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• service user and carer information; their families is a critical element in • service access including self securing their empowerment and assessment; independence. Information needs to be readily available from a variety of • redesign of assessment processes sources, easily accessed, designed and to reduce the time spent by social produced in customer-friendly formats services staff at the computer screen; and responsive to language needs. • the development of hand held Additionally, for many individuals and equipment for the care management groups, advocacy may be necessary process, improving the access of front to help them make the best use of line staff to information and reducing information to help them to achieve the burden of report writing and the outcomes they want. • telecare, telehealth and assistive Existing and innovative third sector technology. services, including user-led and carer organisations, could play a lead role in 4.60 The use of telecare remains relatively developing cutting-edge information, underdeveloped in Wales compared to advice and advocacy services, making Scotland and some areas of England. full use of IT, information systems and It could however form a major part widespread home access to web-based of a new service, designed to support resources. independence, prevention and early intervention working closely with health 4.63 We have heard consistently about the and housing services and encompassing difficulties of information transfer both telehealth and wider assistive within and between organisations. technologies. These difficulties require urgent attention if they are not to remain “From aids to daily living to computer obstacles to collaboration between chips that monitor activity a range public sector services. We have also of equipment now exists that can heard consistently about the quantity of either enhance people’s quality of data collected without analysis or clarity life in their own home or will make about its end use. life safer for them. It will reduce 8 We recommend that under Welsh the amount of direct personal care someone needs and enable them to Assembly Government leadership, remain in their own homes” action should be taken by local authorities and providers to effect John Bolton, 2010 a step change in the development, promotion and application of digital The Use of Information and Information technology. Exchange Leadership 4.61 To promote their wellbeing and prevent problems developing, children, adults Political Leadership and families need advice, signposting 4.64 The Welsh Assembly Government and advocacy to help them make the and the Welsh Local Government best use of social care and services from Association have demonstrated other agencies. significant leadership in terms of the improvement in social services over the 4.62 Putting up-to-date information last decade. into the hands of parents, young people, people seeking support and

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4.65 As mentioned earlier, the creation “WAG is a ‘strategy factory’. Fulfilled of a post of Deputy Minister with Lives is an important strategy, but responsibility for social services and it is still just a strategy. They are Director level post in the Welsh lost on most people. Members do not Assembly Government civil service have read these things”. helped to raise the profile of social services in Wales with some significant Local government sector achievements over the past few years. However, we did receive evidence “There are lots of good things going that argued that, in view of its size, on. There are building blocks which importance and reach, social services the Commission needs to identify, should have a full Ministerial post and build upon and not explode. There a Director General lead in line with are good connections: policy and Education and Health within the Welsh infrastructure BUT we sometimes Assembly Government. fail to bring these together to tackle an agreed 3 or 4 things so as to 4.66 The evidence also wanted to see incrementally build up and progress.” the Welsh Assembly Government Director of Social Services do more to promote the importance and greater general understanding by the public, leaders and opinion 4.68 A particular concern is the apparent formers about the role, importance, lack of joining up across Welsh Assembly Government portfolios and challenges and the successes of social divisions. This tension will become more services and in this way lead for the problematic as new models of services most vulnerable who struggle to be are developed that involve service heard. There is a particular concern integration. that high profile interventions on the back of inspection and regulation are 4.69 It is also important that the impact eclipsing key messages about success across sectors and services needs to and achievements. As mentioned in have been properly worked though chapter 2 there is good evidence of with a clear vision of both what is to improvement made in recent years. be achieved and the means to achieve it. We heard that it is often left to local 4.67 We heard from many sources that, in partners to do the joining up locally and their enthusiasm to improve services, to seek resolve any mixed messages. the Welsh Assembly Government had caused a ‘bombardment’ of initiatives 4.70 Democratic accountability at the local and projects which are not then level includes a role for local politicians, scaled up to programmes. The Welsh and especially cabinet members, in: Assembly Government needs to be • promoting a thorough understanding more focussed in its demands and of the nature and importance of social expectations of social services. services across their local authorities and “It’s like watching ants running • ensuring that social services, across a page” housing, education, community Commission member confronted by yet planning and so on are effectively another unexpected jack-in-the-box joined up to contribute effectively Welsh Assembly Government initiative. to social services’ roles in supporting and protecting the vulnerable and promoting social inclusion.

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Professional and Service Leadership Professional Development 4.71 Effective strategic planning and and the Workforce commissioning requires the role of 4.73 Social work and social care will only ever the Director of Social Services to shift be as good as the people who work more decisively from service leadership in them. The workforce is the service. with its main focus on managing They are difficult and demanding jobs, designated social services resources and involving emotionally challenging staff performance, to more strategic decisions about other people’s lives and leadership with a requirement for maintaining the sometimes difficult significant investment in leadership, balance between care and control. management and professional development, commissioning and skills 4.74 Social services and social care workforce in collaborative working. We consider issues, including workforce regulation, that more concerted effort is needed are part of a separate work stream to support the development of future which will inform the forthcoming White leaders of the profession and the Paper. We were specifically asked in our services in Wales. terms of reference to consider how the further development of professional 4.72 This will place rising expectations practice can be better supported. of senior and middle managers and planners in social services 4.75 We received a great deal of evidence departments. It is likely to require on the workforce which set out significant investment in leadership and considerable achievements to date management development, and skills in including positive developments in change management and negotiation workforce planning and the retention at all levels. It will need improved of staff. We heard about the positive IT back-up and analytical capability, benefits of regulation of social workers, but, over time, the associated costs social care workers and managers as a could be offset by resulting efficiency mechanism for sharpening the focus improvements. on practice standards and service improvement. The evidence also 9 We recommend that: pointed up some of the key challenges which will need to be addressed going a. the Welsh Assembly Government forward. With the Deputy Minister’s should confirm that the national agreement, we have shared the leadership for social services with evidence received with those leading the its specific focus on the most work force work stream so that they can vulnerable is maintained and draw out the key priorities for action. strengthened during these years of economic difficulty 4.76 In Wales there is an agreed, well- b. the Welsh Assembly Government established framework of practice should focus on a small number standards and qualifications for most of high level strategic priorities, of the current job roles across the captured in a 5-year rolling plan whole of the sector. Over recent years there has been considerable investment c. the social services and social care in the workforce and in the education leadership community (referred and training of social workers. There is to in paragraph 2.9) in Wales a long history of working in partnership should take more responsibility for to create better synergy between the working together to enhance the qualifications and learning needs of the reputation of, and public confidence sector and the learning provided by the in, social services and social care. colleges and training providers

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4.77 Social work is a regulated profession. 4.81 In our view, there is now a need The number of qualified social workers to move beyond the minimum has increased by 10% in the past five qualifications to a culture where years, guidance has been produced for ongoing professional development is social workers and their managers for encouraged, valued and supported by the first year in practice and there has employers, commissioners of services been a reduction in the churn, more and practitioners themselves. confidence in the training and better information to inform forward planning 4.82 This will require a re-balancing of for training. assessment and reflective practice, with more emphasis towards reliance 4.78 The percentage of social care staff on professional judgement rather than holding required or recommended ticking the right boxes. There needs qualifications has risen in the same to be a shift to a culture of practice period by 20% in residential care governance. For social workers this will and 80% in home care. Residential be helped by the development of a child care managers and workers are clear career pathway and, in particular, regulated, managers of adult residential the consultant social worker role that care will be regulated by 2011 and will enable experienced practitioners to managers of domiciliary care by mid advance their careers while remaining in 2012. There is an appetite across the the frontline. The establishment of post- social care sector for new knowledge qualifying training for team managers and skills to improve practice. and the creation of consultant social work roles will, together, provide 4.79 Against these positive developments, important ways to improve professional the negative impression of social work practice further. Both are crucial in in the media and among the public allowing staff to focus their energies has encouraged a risk-averse culture and receive proper guidance and in social work. This has hindered supervision. professional development and been aggravated by cumbersome assessment 4.83 The development of the new procedures and by the emphasis on qualifications and credit framework, evaluation of process rather than the clearer career pathways and outcomes for service users. programmes to support continued professional development are equally 4.80 The key question is what action important for social care workers needs to be taken to strengthen the to support them in their roles as profession so that social workers and accountable, regulated practitioners social care staff further develop as working in different models of service. accountable practitioners and are able Safe, up to date confident and to practise effectively and confidently, evidence-based practice would also be making well-informed judgments, enhanced by: based on up-to-date evidence and in the best interests of people they work • attention to the right infrastructure with. The context for social workers and to support continued professional social care workers will be one where development including learning they will be working closely with other materials, professional guidance, professions. community of practice for practitioners to support excellence in practice (including the importance of the Welsh language);

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• the establishment of national d. the arrangements for delivering programmes of specific training the workforce strand in the White such as child care at post qualifying Paper should include following level and more specialised training up the suggestions in this section in, for example, positive behavioural of our report as an ongoing work management, dementia care, people programme. with hearing challenges; Commissioning • more shared learning opportunities with allied disciplines in health e.g. 4.84 Good strategic planning looks occupational therapy, physiotherapy ahead 5-10 years and starts with and nursing; a vision of where we want to be • involvement in National Institute immediately and in 10 years time for Social Care and Health Research The strategic assessment of needs (NISCHR) Research in Practice and the should be undertaken jointly across Social Care Institute for Excellence local authorities, the NHS, housing (SCIE); organisations, education, employment and training and benefits systems. • strong arrangements to advocate for Assessment should take account of the profession and for individuals – needs and capabilities of the whole both social workers and social care population - children, adults and families workers and - now and over the strategic period. • more emphasis on the responsibilities and accountabilities set out in the 4.85 Since the launch of the Care Council for Wales Code of Commissioning Framework and Practice for Social Care Workers and Good Practice Guidance (WAG, the Code of Practice for the Employers 2010) a commissioning development of Social Care Workers (2009). programme has been established to maintain the constructive engagement 10 We recommend that: with the statutory, private and third a. Wales continues with a programme sectors as the guidance is implemented. of workforce regulation as a mechanism for achieving 4.86 The commissioning framework should improvement across the sector. respond to the strategic plan and needs/resources assessments for b. the Welsh Assembly Government, children, adults and families. It should working with employers and identify the interventions, resources the leaders of the profession and services required to deliver the should lead a programme of vision, priorities, support networks and change focussing on securing safeguards set out in the plan. career pathways, commitment and investment in continued 4.87 Strategic commissioning moves professional development and the primary focus of the Director research within a new culture of of Social Services and the social practice governance services department away from c. the Care Council for Wales and the the management of social services SSIA should work with employers resources to being much more one of across the sector to develop a planner/ enabler/ deliverer of outcomes, leadership programme to support with social services’ resources a part, existing leaders and improve but by no means all, of the picture. succession planning The Director of Social Services has a

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crucial role to play within the wider wider value for money considerations – local authority and allied agencies in seeking to achieve value added to those advocating, promoting cooperation, receiving the services not simply cost creating alliances and negotiating joint savings for commissioners. local priorities and solutions. Value Wales, a division with the 4.88 Ensuring a sustainable managed mixed Welsh Assembly Government, market of care requires local authorities has supported commissioning and to consider not only the services that procurement through the production they will directly purchase but the of the Social Care and Housing wider service needs of the community. Related Support Procurement Route The commissioning framework Planner. This is a web based tool therefore needs to be broad enough to which contains over 500 pages accommodate not only local authority of practical information and has commissioning but also individual received over 80,000 page hits  commissioning using direct payments or since its launch last year. budgets and self-funders. It is important that Welsh Assembly Government 11 We recommend that the Welsh continues to provide central support to Assembly Government should identify, promote and support improved continue to provide central support commissioning practice and capability to identify and promote improved and thereby prepare both commissioners commissioning, including better and providers for the challenges ahead. joint commissioning, practice and In our view the commissioning model capability taking into account contained within the Commissioning commissioning by individuals Framework and Good Practice within the model of self-directed Guidance will be a fundamental tool in support. transformational change.

4.89 Local authorities will need to examine Prevention, Early Intervention all options to improve services and have and Re-ablement a clear rationale for understanding cost 4.92 We encountered a number of schemes and taking decisions which will face around Wales that are in some public scrutiny when some services are way aimed at prevention and early contracted out or are replaced. intervention including, for example, the established Wrexham Frailty model, the 4.90 The strategic commissioning process developing Gwent Frailty model, various should also identify the scope for schemes aimed at falls prevention, low skilled decommissioning of outdated, level Care and Repair interventions, underused or non cost effective telecare, work in schools around services, better use of existing substance misuse, work with vulnerable resources, gaps in provision and the families and many more. identification of potential providers and change management resources to 4.93 The developments that the EIB is secure future provision. monitoring on the frail elderly and families with complex needs will provide 4.91 Social care represents the second further evidence about what it takes to largest area of public procurement avoid people entering the care system. after construction. Work currently In chapter 3 we have underlined the being undertaken by Value Wales on importance of supporting carers to social care procurement is looking at maintain their caring role, to avoid

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their own health becoming impaired 4.94 The quality of evidence that prevention and the need for round the clock and early intervention pay off in back up to cover for crises. Also in avoiding costs downstream and provide that chapter we have referenced poor better outcomes for people is improving outcomes for children in need. There all the time. There is, however, often are strong arguments that support early a time lag between the investment intervention for this group particularly and financial pay back. Moreover it is when services are provided on a multi- important to think “whole systems” as agency basis. the cash savings often do not accrue to the budget of the organisation making the investment. Pooled budgets and “…expenditure on children should be resource transfers should become a regarded as if it were an investment more routine part of the design of these portfolio, and be subjected to a arrangements. continuous iterative process of evaluation, reallocation and further 4.95 In chapter 3 we caution against evaluation to ensure child well-being responding to budget reductions is actually improved … Learning from by moving away from strategies of international experience in particular prevention and early intervention. can be invaluable in helping us to All too often investment in preventive move forward, though, ultimately, services is pulled back at just the tough decisions need to be taken at wrong time without any proper sense a national and local level in the best of the risks for longer term costs and interests of children, families and, outcomes that such a course involves. indeed, the long-term prosperity of the country.” 12 We recommend that: C4EO, 2010 a. the Welsh Assembly Government should restate its determination to The Wrexham Frailty Project support and encourage prevention and early intervention to improve This project is a joint venture outcomes and reduce long term between the NHS, Wrexham Social costs Services, the Association of Voluntary Organisations in Wrexham and the b. there should be a renewed focus CHC in Wrexham. It aims to ensure by commissioners and providers on the appropriate early discharge from re-ablement to ensure that people hospital of frail elderly patients by are well supported to recover their ensuring they receive rapid clinical independence. This will reduce the interventions to minimise their lengths need for high cost alternatives of stay in hospital and appropriate c. the Welsh Assembly Government support and re-ablement to allow should continue its commitment them to return to their normal place to children in need and the public of residence. A dedicated ‘navigator’ sector in Wales should collectively role was created to coordinate the review the effectiveness of all various elements of care and ensure services provided for children in they are provided at the appropriate need stage of the patient journey and without delay and both voluntary and d. the immense contribution of statutory services will be working carers should be respected and together to support patients and their placed more systematically at the carers following discharge. heart of service development and commissioning.

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4.98 The model for safeguarding children The proposed system of care will in Wales with its clear legislative deliver an easily recognisable, framework and requirement for highly organised model of integrated inter-agency working is sound but we community services that will act as a bridge between primary care and are not persuaded that this approach the acute hospital. Services will be can or should be transferable to adults. focused on the holistic needs of the Managing risk and minimising harm citizen and delivered by the NHS, to adults, who have the right to local authorities and other partner make choices about their own lives, agencies working together. poses different challenges. The Welsh Assembly Government needs to The approach will change from work very closely with those who are reactive crisis management to responsible for shifting the balance of a proactive, co-ordinated and care so that more people are able to preventive agenda, with a particular continue to live in their communities. focus on high risk patient groups and Future adult protection policies and those with increasing frailty. Such responsibilities need to help identify services will enable an increasing "adults at risk", to provide support number of people to be managed to them when they need it, and to effectively in their communities and provide the means to protect them localities, avoiding unnecessary and from harm. Within residential care, often debilitating hospital admissions. more needs to be done to raise the This system would replace the current “push” hospital-discharge profile of the Code of Practice for model with one that actively pulls Social Care Workers and the Code of patients towards high quality Practice for Employers of Social Care organised services closer to home. Workers. Extract from Setting the Direction - 4.99 Learning from mistakes and from Primary and Community Services Strategic good practice remains a priority but Delivery Programme: WAG 2010 the current approach to Serious Case Reviews is no longer adequate. We Protection and Safeguarding suggest exploring other emerging models including Learning Together to 4.96 The Welsh Assembly Government Safeguard Children (SCIE, 2008). We is undertaking work via the Adult are also aware of the recent review Protection Advisory Board and the of Serious Case Reviews undertaken Welsh Safeguarding Children Forum by CSSIW and the Welsh Assembly with a remit to report on this area and Government. so we have not undertaken in-depth analysis of the issues. 4.100 Safeguarding is not just a social services responsibility, although it is 4.97 The reputation of children’s social often assumed to be. It is intended to services in Wales has been diminished be a shared responsibility across the by recent examples of systems failures police, health and local government. where children have not been adequately However, we have heard of difficulties protected from harm. We have heard getting some bodies to discharge their examples of good safeguarding practice obligations and in getting everyone but this remains uneven. around the table. We have heard about the difficulties in terms of finance, coordination, representation

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and information exchange at Local and driving improvement. Leadership, Safeguarding Children Boards (LSCBs). public service accountability, Part of the difficulty appears to be professional development and that these boards are not accountable effective commissioning all have in their own right. Accountabilities important parts to play. are discharged through individual members of boards representing 4.104 In recent years inspection regimes and reporting back to their parent have been adapting to focus more organisations. We believe it on the experience of the service users would be beneficial for the Welsh and on outcomes. The evidence we Assembly Government to examine received suggests that there is a need the accountabilities of LSCBs and to move more quickly in that direction. Adult Protection Committees and, as For example, the move towards previously mentioned, that both of more self-directed support which we these bodies be streamlined to fit the advocate in this report will require LHB footprint. inspection increasingly to adapt to concentrate on the achievement of 13 We recommend that the Welsh the intended outcomes as set out in Assembly Government reviews the individuals’ care plans. accountabilities of LSCBs and Adult Protection Committees. 4.105 The requirement for Directors of Social Services to produce an annual report Regulation, Inspection as set out in the statutory Guidance and Improvement on the Role and Accountabilities of the Director of Social Services (WAG, 4.101 Creating a sustainable regulatory and 2008) provides a potentially useful improvement framework that provides addition to the tools for improvement. protection and supports excellence is In future years, the process needs part of a separate strand of work that to move up a gear, however we will inform the Social Services White acknowledge that the new annual Paper. We comment on them only reporting regime is in its infancy. The briefly here. reports need to be much more open Inspection about where improvement is needed and subject to sharper peer and other 4.102 We heard a lot, particularly from local external expert review. authorities, about the burdens that inspection is said to place on them Regulation and Improvement and about other aspects of inspection. 4.106 We acknowledge that the Welsh We recognise that there is currently Assembly Government has used work being undertaken by CSSIW in regulation of the workforce as developing a new model of inspection a significant improvement lever. and improvement linked to work that Workforce regulation has introduced the SSIA is doing. a new and different focus on 4.103 Regulation and inspection are professional standards and professional important in maintaining public accountability led by the Care Council confidence, protecting the vulnerable, for Wales. It has also begun to identify identifying where improvement is where further guidance or learning needed, supporting that improvement and development are required. This and providing opportunities for the approach in Wales is commended by transfer of best practice. They do not the sector as one which should be stand alone in maintaining standards retained and further developed.

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4.107 Compared to health and education, 4.111 Such a centre would work closely social services has only very modest with NISCHR whose development dedicated resource to support on the social care side of its work improvement, innovation and service should now be accelerated by the change. The creation of the SSIA has Welsh Assembly Government. There been an important development in would also need to be closer working providing a locus for social services between NISCHR and the SSIA, the improvement. We particularly Care Council for Wales and SCIE commend the Agency’s work to to maximise knowledge transfer to support frontline managers. support improved services and well informed and confident practitioners. 4.108 The improvement agenda is also supported by SCIE, an independent 14 We recommend: organisation funded by the a. the Welsh Assembly Government Department of Health in England and should ensure that NISCHR moves the devolved administrations in Wales quickly to working with the and Northern Ireland. It captures and leaders of the profession to agree co-produces material about good and deliver a work programme to practice, extant research, evidence and support the sector priorities innovation. It provides many on-line resources to support practitioners. b. the setting up of an Advanced Centre of Learning and Research Social Care Research for social services and social 4.109 Redesigning services to meet the new care to be managed as a virtual realities and supporting confident collaborative initiative between evidence–based practice requires good HEIs in Wales. systems for capturing, evaluating and sharing knowledge about what works from within Wales, elsewhere in the UK and more widely.

4.110 We found that there is a large volume of data, but very little information, in the sense that the data remains un-analysed. We believe that to promote a smarter, evidence-based culture change for social services now requires an Advanced Centre of Learning and Research managed as a virtual, collaborative initiative between various Higher Education Institutes (HEIs) in Wales. The HEIs would be chosen through competitive bids to be centres for excellence in areas such as children and young people, older people, disability, substance misuse and mental health.

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Annex 1 Membership of the Commission

Professor Geoffrey Pearson, Emeritus Rhian Huws Williams has worked in the Professor of Criminology, Goldsmiths social work sector since 1981,firstly as a College, University of London, is Chair the social worker and then within social services Commission. Professor Pearson is a qualified training before taking up a national policy psychiatric social worker with a forty year development and advisor appointment career teaching social work and sociology with the Central Council for Education in universities and polytechnics including a and Training in Social Workers (CCETSW) post in Cardiff. His research and teaching becoming the head of the National Office for interests include criminology, drug misuse, CCETSW Cymru in 1994. She has worked at and working with children and young UK level contributing to the development of people. He has also served on a number of a range of policies and guidance for social UK Government working groups and bodies. work and social care training and practice. She has been Chief Executive of the Care Julie Jones CBE was educated in Wales Council for Wales since its establishment in and has some thirty five years experience in 2001. social services latterly as a Director of Social Services and Deputy Chief Executive of Phil Robson has worked in social services Westminster City Council, including a year as since 1984, starting out as a social worker President of the Association of Directors of then holding a number of practitioner and Social Services, before taking up her current managerial roles in Gwent and Powys before role as Chief Executive of the Social Care being appointed to the Director of Social Institute for Excellence (SCIE) in 2007. She Services role for Powys in 2001. He was then was awarded an OBE in 2003 and a CBE in appointed Executive Director for People and 2009. Wellbeing in 2005, a post that encompassed the role of Director of Social Services and Chief Education Officer. He retired from Powys County Council in December 2009.

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Annex 2 Written and Oral Evidence Contributions

List of Respondents to the Call for Written Evidence • Action for Children • Compass Community Care Ltd • Age Concern Cymru • Conwy CBC • All Wales Heads of Adult Services (AWASH) • County Voluntary Councils of • All Wales Heads of Children’s Services Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen (AWHOCS) • Crossroads Care in the Vale • Anglesey County Council (CC) • Cruse Bereavement Care • Association for Spina Bifida Hydrocephalus (ASBAH) Cymru • Cymorth Cymru • Association of the Directors of Social • Disability Can Do Services (ADSS) Cymru • Disability Wales • Betsi Cadwaladr Local Health Board (LHB) • First Choice Housing Association • Bridgend County Borough Council (CBC) • Glamorgan Partnership Social Work • British Association of Social Workers Degree Programme (BASW) • Gofal Cymru • British Lung Foundation Wales • Gwynedd CC • Caerphilly CBC • Hay and District Community Support • Cardiff Community Health Council • Health Social Care and Wellbeing Network • Cardiff School of Health Sciences, UWIC • Hilary Searing • Cardiff University Social Work Teaching • Hilda Smith and Research Team • Home Start Wales • Care Council for Wales • Learning Disability Wales • Care Forum Wales • Macmillan Cancer Support • Carers Wales • Mencap Cymru • Carmarthenshire CC and the Community Physiotherapy Team at Hywel Dda Local • Mind Cymru Health Board • Monmouthshire CC • Ceredigion CC • Multiple Sclerosis Society Cymru • Chartered Society of Physiotherapy • National Deaf Children’s Society Cymru in Wales • National Society for the Prevention of • Children’s Commissioner for Wales Cruelty to Children (NSPCC) Cymru • City and County of Swansea • National Youth Advocacy Service • College of Occupational Therapists • Neil Thompson • Commissioner for Older People • New Pathways • Community Pharmacy Wales • Parkinson’s Disease Society

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• Paul Hinge • Welsh Women’s Aid • Pembrokeshire Association of Voluntary • Wrexham CBC Services (PAVS) • Women’s Royal Voluntary Service (WRVS) • Powys County Council Adult Services • Youth Justice Board for England and Wales • Powys County Council Children’s Services • Professor Andy Pithouse, Deputy Director Oral Evidence Sessions and Meetings School of Social Sciences Cardiff University; • Constance Adams, Senior Policy Officer, Professor Judith Phillips, Head of Human WCVA Sciences, Swansea University and Professor • Kelly Ahern, Team Leader, Barnardo’s Odette Parry, Director, Social Inclusion Swansea Children Matter Project Research Unit, Glyndwr University. • Yvonne Apsitis, Vice President, United • RG Walton Kingdom Home Care Association • Rhondda Cynon Taff CBC • Paul Ashton, Chair, ARC Cymru • Rhondda Cynon Taff People First • Sir Mansel Aylward, Chair, NHS • Royal College of Nursing Safeguarding Children Review • Royal National Institute for Deaf People • Victoria Bancroft, South Wales (RNID) Development Manager, Funky Dragon • Royal Pharmaceutical Society • Lynne Berry, Chief Executive, Women’s of Great Britain Royal Voluntary Service • Sense Cymru • Neelam Bhardwaja, Director of Social • Social Care in Partnership South East Wales Services, Cardiff CC and Immediate Past President of ADSS Cymru • South Wales Fire and Rescue Service • Tricia Bochenski • The Princess Royal Trust for Carers and Crossroads Care • Lisa Bowen-Jones • The Survivors Trust • Ceri Breeze, Director of Housing, WAG • The Wales Neurological Alliance • Trish Buchan, Health and Social Care Facilitator, Powys Association of Voluntary • The Welsh Food Alliance Organisations • Torfaen CBC • Mary Burrows, Chief Executive, Betsi • Tros Gynnal Cadwaladr LHB • United Kingdom Homecare Association • Tony Clements, Director of Social Services, (UKHCA) Neath Port Talbot CBC • Voices from Care • Ruth Coombs, Manager for Influence and Change, Mind Cymru • Wales Alliance for Citizen Directed Support • Andrew Cottom, Chief Executive, Powys • Wales Council for Deaf People LHB • Welsh Council for Voluntary Action • Peter Crews, Unison (WCVA) • Jim Crowe, Director, Learning Disability • Welsh Language Board Wales • Welsh Local Government Association • Dr Dolores Davey, Head of Social Work (WLGA) Training, Cardiff University

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• Parry Davies, Director of Social Services, • Lindsay Haveland, Ceredigion CC Senior Health and Social Care Facilitator, • Rhian Davies, Chief Executive, Disability Denbighshire Voluntary Services Council Wales • Gareth Haven, Deputy Head of Finance: • Simon Dean, NHS Director of Strategy Community Care, WAG and Planning, WAG • David Hawker, (then) Director General, • Councillor John Dixon, Deputy Department for Children, Education, Spokesperson for the WLGA Social Services Lifelong Learning and Skills, WAG Portfolio • Robert Hay, • Monica Dyke Local Government Finance Division, WAG • Dorothy Edwards, Interim Locality Director, • Albert Heaney, Abertawe Bro Morgannwg LHB Director of Social Services, Caerphilly CBC • Leila Evans, Project Manager of Home • Pam Hill Cleaning Services, Age Concern Ceredigion • Phil Hodgson, Director of Social Services, • Phil Evans, Director of Social Services, Vale Blaenau Gwent CBC of Glamorgan CBC • Keith Ingham, (then) Head of Children’s • Karen Fawcett Health and Social Services, WAG • Carol Floris, Advice and Support Manager, • Dr Chris Jones, Chair of Cwm Taf LHB Voices From Care Cymru • Iwan Trefor Jones, • Beverlea Frowen, Director for Social Lead Director for Children and Young Services and Health Improvement, WLGA People Services, Gwynedd CC • Barry Gallagher, Chair, Cymorth Cymru • Richard Parry Jones, Lead Director for Children and Young • Laura Gallagher, Mental Health People Services, Anglesey CC Development Officer, Powys Agency for Mental Health • DCI Pam Kelly, Child Protection Representative, Association of Chief Police • Jenny Gilmore Officers • Ashley Gould, NHS Safeguarding Children • Evan Kinsey, Practice Learning and Review Development Officer, People and • Councillor Meryl Gravell OBE, Wellbeing, Powys CC, representing the Lead Spokesperson for the WLGA Mid Wales Regional Social Care Partnership Social Services Portfolio • Mario Kreft, • Stewart Greenwell, Chief Executive, Care Forum Wales Director of Social Services, Newport CC • Andrew Lewis, Director of Innovation and • Joanna Griffiths, Improvement, Cardiff and Vale University Director of Social Services, Conwy CBC LHB • Hefin Gwilym, Acting Director of • Bruce McClernon, Director of Social Social Work, Bangor University Services, Carmarthenshire CC and President of ADSS Cymru • Jean Harrington, Taff Ely Drug Support Service • John Mills • Councillor Rosemarie Harris, Cabinet • Dame Gill Morgan, Member for Adult Social Services, Powys CC Permanent Secretary, WAG • Janet Morgan, Chair of Social Care in Partnership (SCiP) North Wales

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• Julie Mountford, Partnership Manager, • Sue Ross, Professional Head of the SSIA Conwy and Denbighshire Adult Mental • Carol Shillabeer, Director of Nursing, Powys Health and Social Care Partnership LHB • Maureen Mullaney, Head of Social Services • Professor Mike Sullivan, (then) Special for Adults, Flintshire CC Adviser to the Deputy Minister for Social • David Murray, Chief Executive, Services Age Concern Gwent • Jane Taylor, Area Manager, Cartrefi Cymru • Liz Neil, Director, Mencap Cymru • Richard Tebboth (then), • Mary O’Grady, Head of Performance and Governance Youth Offending Team Manager, Powys CC Division, WAG • Emyr Owen, (then) Manager in Wales, • Gwenda Thomas AM, BASW Deputy Minister for Social Services • Nisha Patel • Dr Gwyn Thomas, Informing Health Care, • Vanessa Phillips, Director of Resources WAG WLGA • Steve Thomas CBE, Chief Executive, WLGA • Martyn Pengilley, Policy and Welsh • Keith Towler, Assembly Officer, Crossroads Care, Wales Children’s Commissioner for Wales • David Penny • Bill Walden-Jones, Chief Executive, Hafal • Sylvia Penny • Darren Whitby • Melanie Perry, Director, PRISM • David Wildman, Lead Cabinet Member for (Alcohol Advice Centre) Adult Services and Care, Pembrokeshire CC • Rob Pickford, Director of Social Services • Moyna Wilkinson, Director of Social Wales, WAG Services, Monmouthshire CC • Professor Andy Pithouse, Cardiff University • Catriona Williams, Chief Executive, • Bernardine Rees, Director of Primary, Children in Wales Community and Mental Health Services, • Ellis Williams, Director of Social Services, Hywel Dda LHB Rhondda Cynon Taff CBC • Margaret Reid, Health and Social Care • Graham Williams, (then) Programme Facilitator, Vale of Glamorgan Manager for Service Frameworks, • Jonathan Richards, Vice Chair, Office of the Director of Social Services, All Wales People’s First. WAG Supported by Yvonne Boxall, Advisor. • Paul Williams, Director General Health and • Imelda Richardson, Chief Inspector, CSSIW Social Services, WAG • Dr. Chris Riley, Health Strategy Policy • Donna Wilson, Director of Social Services, Adviser, WAG Powys CC • Bridgette Robb, British Association of Social • Rick Wilson, Chief Executive, Workers (BASW) Community Lives Consortium • Emyr Roberts, (then) Director General, • Helen Wright Public Services and Local Government Delivery, WAG • Karen Roscoe, Senior Lecturer in Social Care, Glyndwr University

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Annex 3 - Meetings and Visits undertaken by the Chair and Members of the Commission

Meetings • Neil Abraham, • Chris Maggs, Director of Social Services, College of Occupational Therapists Swansea CC • Neelam Bhardwaja, (then) President ADSS • Ruth Marks, Commissioner for Older Cymru People in Wales • Peter Black AM, Liberal Democrat • David Melding AM, Shadow Minister for Spokesperson on Health and Social Services Economic Development and the Welsh • Ruth Crowder, Conservatives' Director of Policy College of Occupational Therapists • Steve Milsom, Acting Head of Older People • Andrew RT Davies AM, Conservative and Long Term Care Policy, WAG Spokesperson on Health and Social Services • Professor Rod Morgan, University of Bristol • Sue Denman, Wales Office for Research • Mike Nicholson, Head of Children and and Development Family Services, Newport CC • Mark Drakeford, Cardiff University • Rob Pickford, Director of Social Services • Maizie Elfin, Scope Cymru Face 2 Face Wales, WAG Project • Professor Andy Pithouse, Cardiff University • Rhoda Emlyn-Jones, • Margaret Provis, (then) Assistant Chief Team Manager, Option 2 Programme Inspector, CSSIW • Carys Evans, Head of Division for Local • Jill Riley, College of Occupational Therapists Service Boards and Wales Spatial Plan, • Emyr Roberts, (then) Director General, WAG Public Services and Local Government • Beverlea Frowen, Director for Social Delivery, WAG Services and Health Improvement, WLGA • Mike Shanahan, Programme Manager for • Councillor Meryl Gravell, WLGA Lead Long Term Care, WAG Spokesperson for Social Services • Nicola Southall, Value Wales • Stewart Greenwell, Director of Social • Alison Standfast, Deputy Chief Executive, Services, Newport CBC Value Wales • Dame Deirdre Hine, Review of Dignity in • Professor Mike Sullivan, (then) Special Hospitals, Office of the Commissioner for Adviser to the Deputy Minister for Social Older People Services • Peter Hosking, Children’s Rights Officer, • Gwenda Thomas AM, Office of the Children’s Commissioner for Deputy Minister for Social Services Wales • Chris Tweedale, Director Children, • Helen-Mary Jones AM, Plaid Cymru Young People and School Effectiveness Spokesperson on Health and Social Services Group, WAG • Robin Jones, Health Statistics • Steve Vaughan, Head of Partnerships, Older and Analysis Unit, WAG People and Long Term Care Policy Division, • Huw Lewis AM, WAG Deputy Minister for Children

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• Graham Williams, (then) Programme Merthyr Tydfil CBC Manager, Service Frameworks, WAG • Jill Bow, Service Improvement Manager, • Paul Williams, Director General, Extracare Housing for Older People Health and Social Services, WAG • Sarah Davies, • Sue Williams, Youth Justice Board for Early Years and Child Care Coordinator England and Wales • Paula Houston, Family Support Coordinator • John Wrangham, Youth Justice Board for • Sue Hughes, Social Regeneration England and Wales Development Manager Visits • Mandy Perry, Manager of the Integrated Children's Centre Caerphilly CBC • Leighton Rees, Lead Manager for Children • Stephen Berry, Children’s Rights Officer IFST Implementation Team • Andrew Jarrett, Head of Children’s Services (Merthyr Tydfil CBC and • Janine Edwards, Rhondda Cynon Taff CBC): Team leader, Care Leavers Team • Ann Batley, Head of Assessment Care Cardiff CC Planning Children's Services, • Hannah Murray, Community Engagement • Niall Casserly, Substance Misuse Officer, Neighbourhood Management Team Development Manager • Sara Nichols, Ceredigion CC Head of Adult Mental Health Services • Eryl Bray, • Michael Waite, IFST Team Manager Disabled Children’s Team Manager • Parry Davies, Director of Social Services Denbighshire CC • Melanie Evans, • Julie Fisher, Social Worker Intake and Joint Commissioning Manager Safeguarding team • Jane Hughes, Cylch Caron – Tregaron Project: Senior Practitioner Older People’s Team • Ian Bellingham, County Director for • Alan James, Ceredigion, Hywel Dda LHB Hafod Community Mental Health Team Ceredigion Independent Living Centre, • Karen Waring, Senior Practitioner Intake Felinfach, Aberaeron: and Safeguarding Team

• Myfanwy DeFriend, Project Manager Swansea CC for Integrated Community Equipment, Ceredigion CC and Hywel Dda LHB • Peter Collins, Employment Services Manager and his team, Create Solutions Family drop-in centre, Penparcau Estate, and Cwmbwrla mental health day centre Aberystwyth, Ceredigion Social Services: • Jane Thomas, Officer in Charge and her • Sian Williams, Family Centre Project team, Ty Waunarlwydd residential home for Manager, Ceredigion CC older people with dementia • Jackie Whiteman, Day Service Manager and her team, Swansea Vale Resource Centre

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• Julie Thomas, Principal Officer Case Management and her team, Child and Family Services • James Thomas, Staff Development and Service Provision Officer for Mental Health

Care Forum Wales Regional Meetings – Cardiff and Carmarthen

Neath Port Talbot CBC – Children’s Social Services Systems Review

All Wales Heads of Children’s Services Biannual Meeting

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Annex 4 References

A Rough Guide to Personalisation: Social Household, Poverty and Social Care Statistics: Care Institute for Excellence, April 2010. Statistical Directorate, Welsh Assembly Government, October 2010 A Strategy for Social Services Over The Next Decade – Fulfilled Lives, Supportive Improving Health and the Management of Communities: Welsh Assembly Government, Chronic Conditions in Wales - An Integrated February 2007 Model and Framework for Action: Welsh Assembly Government, March 2007 Beyond Boundaries – Citizen-Centred Local Services for Wales: Welsh Assembly Fulfilled Lives, Supportive Communities Government, July 2006 Commissioning Framework Guidance and Good Practice: Welsh Assembly Government, Care at Home: Care Council for Wales and August 2010 the Welsh Institute for Health and Social Care, 2010 Learning Together to Safeguard Children - Developing a Multi-Agency Systems Care and Social Services Inspectorate for Approach for Care Reviews: Social Care Wales Annual Report 2007-2008: CSSIW, Institute for Excellence, October 2008 2009 and the Care and Social Services Inspectorate for Wales Annual Report 2008- Local Public Services in Wales – 2009: CSSIW, 2010 Developing a Whole Area Approach: SOLACE Wales, August 2010 Child Poverty Strategy for Wales and Delivery Plan (consultation document): Welsh Making the Connections – Assembly Government, May 2010 Delivering Beyond Boundaries, Welsh Assembly Government, November 2006 Code of Practice for Social Care Workers: Care Council for Wales, 2009 and the Code Memorandum of Understanding: of Practice for Employers: Care Council for ADSS Cymru, Care Forum Wales, Wales, 2009 Registered Nursing Home Association and the UK Home Care Association, Daffodil Care Needs Projection System: February 2009 Welsh Assembly Government and the Institute for Public Care, 2010 The Munro Review of Child Protection. Part One: A Systems Analysis – Delivering Digital Inclusion – Professor Eileen Munro: September 2010 A Strategic Framework for Wales (consultation document): Nine Social Services Commitments: Welsh Assembly Government, 2010 Welsh Local Government Association, December 2004 Grasping the Nettle - Early Intervention for Children, Families and Communities: C4EO, Projections for Population Trends and the National Children’s Bureau and Social Care Impact of the Chronic Disease Burden Institute for Excellence, October 2010 in Wales up to 2031: Welsh Assembly Government and the National Public Health Service, August 2009

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Regional Collaboration Compendium: WLGA August 2010

Reviewing Social Services in Wales 1998- 2008 - Learning from the Journey: CSSIW and the Wales Audit Office, November 2008

Rural Health Plan – Improving Integrated Service Delivery Across Wales: Welsh Assembly Government, December 2009

Services for Children and Young People with Emotional and Mental Health Needs: CSSIW, Estyn, HIW and WAO, November 2009

Setting the Direction - The Primary and Community Strategic Delivery Programme: Welsh Assembly Government, February 2010

Social Care Statistics Wales 2007-2008: Welsh Assembly Government, 2008

Statutory Guidance on the Role and Accountabilities of the Director of Social Services: Welsh Assembly Government, November 2008

Strategy for Older People: Welsh Assembly Government, November 2003

Team Manager Development Programme: Social Services Improvement Agency, 2009

Think Child, Think Parent, Think Family: Social Care Institute for Excellence, July 2009

Welsh Index of Multiple Deprivation: Welsh Assembly Government, 2008

Welsh Language Toolkit: CSSIW, 2010

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Annex 5 Glossary of Terms

Advocacy learning and building consensus. Where a person acts on behalf of and in the Most collaboration requires leadership. interests of a service user who feels unable Teams that work collaboratively can obtain to represent themselves when dealing with greater resources. professionals. Co-production Carer is an approach to public service reform which Carers are individuals who provide or intend encourages citizens to actively contribute to to provide a substantial amount of care on building community based mutual support a regular basis for: a child with a physical or networks. Co-production recognises that mental impairment, or an individual aged people are not passive recipients of services 18 or over. They are not individuals who but have assets, skills, experience and provide or intend to provide care: by virtue of expertise which can contribute to improving a contract of employment or other contract services if they are given opportunities for with any person, or as a volunteer for a body meaningful involvement in collaborative (whether or not incorporated). partnerships. In Wales co-production has been defined as the co-design and co- Children in Need delivery of public services. The Children Act 1989 describes a child in need as follows: Direct Payments • he/she is unlikely to achieve or maintain, are payments made by local authorities or to have the opportunity of achieving directly to some individuals including carers or maintaining, a reasonable standard who have assessed community care needs of health or development without the to enable them to purchase their own care provision for him of services by a local services. authority under this part Independent Sector • his/her health or development is likely is the umbrella term for all non-statutory to be significantly impaired or further organisations delivering public care including impaired without the provision for him a wide range of private companies. of such services; • he/she is disabled.' Local Service Boards are cross agency partnerships of key leaders Commissioning from the statutory, private and third sectors is the process of meeting needs at the with the aim of improving joint working and strategic level for whole groups of service facilitating whole system delivery of citizen users and/or whole populations and of centred services in a particular locality. developing policy directions, service models and the market to meet those needs in the Looked After Children most appropriate and cost effective way. is the term used in the Children Act 1989 to describe all children who are the subject Collaboration of a care order, or who are provided with is a process where two or more people or accommodation on a voluntary basis for organisations work together to achieve more than 24 hours. A care order may only a common goal by sharing knowledge, be made by a court.

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Micro-provider Total Place Services that are: looks at how a ‘whole area’ approach to • Providing support or care to people in public services can lead to better services their community at less cost. It seeks to identify and avoid overlap and duplication between • Delivered by 5 or fewer workers – paid organisations – delivering a step change in or unpaid both service improvement and efficiency at • Independent of any larger organisation. the local level.

Outcomes are the impact, result or effect of services on the community or of a service intervention on an individual.

Self – directed support is an approach to assessing need and managing social care provision which places individuals at the heart of the planning process, recognising that they are best placed to understand their own needs. Self Directed Support enables people to make decisions, manage risks, and arrange their own support (or have it arranged for them) in order to achieve their desired outcomes. In Wales Self Directed Support is now commonly termed Citizen Directed Support.

Service User is someone who uses or has used health and/ or social care services.

Social Enterprise are businesses with primarily social or environmental objectives. Their surpluses are reinvested in the business or in the community. Social enterprises include cooperatives, development trusts, community enterprises, housing associations and social firms.

Third sector includes the full range of non-public and non-private organisations which are non- governmental and value driven, that is motivated by the desire to further social, environmental or cultural objectives rather than to make a profit.

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