Delivering an inclusive approach to implementing the Social Services and Well-being Act: Integrating through greater coherence

March 2015

Western Mail, March 2015

So what are we doing to get ready for implementing the Social Services and Well-being (Wales) Act next year?  ADSS Cymru is working with partners to focus on the following:

  • Identifying gaps in the readiness of health and social care economies to implement the new legislation.
  • Identifying what works in terms of coherence and partnership working.
  • Supporting arrangements that strengthen regional coherence /governance and  the  capacity to deliver a ’whole’ system response to improving health, social care and well-being In each local community.
  • Enhancing joint working between regions to reduce duplication of effort and advance learning across Wales  about which new service models work best.
  • Taking action to co-ordinate preparatory work at national, regional and local levels.

The implementation of the Act is challenging to all in the sector and no single local authority or agency can manage this change alone. Delivering better outcomes for our citizens requires us to provide integrated services across health, social care and more widely. I believe that a focus on coherence will help us to deliver the key changes and improvements that we have all agreed to in the Act. Coherence is the key to unlocking the door to transformation.

A wide range of statutory, non-statutory, local, regional and national agencies and organisations will be able to respond to various aspects of these complex challenges However, lack of coherence among diverse stakeholders may result in working at cross-purposes, competition for funding, duplication of effort and sub-optimal economies of scale.

Improving coherence does not always translate into a more meaningful, effective and sustainable impact as there  are many obstacles such as conflicting values, a lack of shared vision, divergent principles, and confused mandates and responsibilities. These cannot be simply resolved through improved organisational/structural measures, coordination bodies or weekly meetings. In addition, failure to acknowledge and deal with these issues will undoubtedly limit the success of coherence-building efforts. More importantly, it may also lead to unrealised expectations, avoidance and mistrust between partners.

Another limitation to achieving coherence is the fact that the values, principles and mandates of some stakeholders can sometimes be unclear. Each stakeholder belongs to a specific sector(health, , local government, , law enforcement, independent and third sector etc.) and each will approach, prioritise and act on issues in very different ways. Trust and recognition of each other’s different roles is essential.  Also, different perspectives provide an opportunity for constructive challenge and creative solutions, focussed on the citizen rather than the organisation.

Yet another obstacle to a coherent and inclusive approach is power imbalance. Externally driven solutions are generally unsustainable. Local ownership and meaningful partnership and communication between internal and external stakeholders are critical to success but also very difficult to achieve. If left unchecked, external agencies will dominate the internal/external stakeholder relationship. Local stakeholders, particularly front line staff,  must own and lead service improvement and should be held accountable towards the local population.

A better understanding of these limitations of coherence and the inherent contradictions in the system could encourage a more sober approach to coherence and to set more achievable targets in the policy debate.

Gio Isingrini
President ADSS Cymru