The purpose of this report is to meet the request of the Health and Social Care Scrutiny Committee for information about the partnership networks through which health and social care services are delivered.
Local authority social services departments have a statutory responsibility to commission services that meet the social care needs of their local population. It is well established that this duty can be carried out only in partnership with other agencies. The reasons for this include ensuring that there is a co-ordinated network of health and social care services, making best use of the range of statutory and independent sector bodies that contribute to the provision of services, making the best use of resources and enabling services to be responsive to the needs and views of users.
The duty of partnership is enshrined in legislation from the Community Care Act 1990, which set the planning, commissioning and regulatory framework for present-day services; through the Health Act 1999, intended to strengthen joint working through the "new flexibilities" of pooled budgets, lead commissioning and integrated service provision and supported by the joint working special grant; the Promoting Partnership in Care guidance requiring commissioners and providers to secure the mutual benefits of working together in the social care industry; to the Health, Social Care and Well-being Strategies (Wales) Regulations 2003, which required local authorities and local health boards to formulate and implement a local Health, Social Care and Well-being Strategy.
More recently the Welsh Assembly Government's strategy document, Making the Connections: Delivering Better Services for Wales, set out a vision for excellent public services. It defined the mechanisms for achieving these and for maximising efficiency gains as co-operation and co-ordination between agencies and collaboration between the producers and users of services.
Working in partnership incorporates a complex network of relationships with a range of bodies which feed into the process of commissioning and delivering services at every stage. It applies to the following processes:
· Joint commissioning and integrated service delivery
· Staff development and training
· Monitoring, review and regulation
· Learning and lobbying
· Working with users and carers.
The Health, Social Care and Well-being planning framework forms the Feeling Fine pillar of community planning and is the structure through which health and social care priorities, strategies and outcomes are set and driven. The planning framework has recently been restructured to address more effectively the agenda for change facing it. It consists of a Partnership Forum designed to act as an overarching stakeholder forum and to ensure top level ownership and understanding of the priorities and plans for modernising services. Membership consists of Carmarthenshire County Council, Carmarthenshire Local Health Board, the NHS Trusts of Carmarthenshire, Pembrokeshire and Derwen, and Swansea, Carmarthenshire Association of Voluntary Services, Carmarthenshire Community Health Council and the National Public Health Service. The Forum is supported by a Modernisation Board consisting of senior officers from members of the partnership charged with commissioning the work required to deliver the strategic direction and to act as a project board for the range of initiatives underpinning the changes. Reporting to the Modernisation Board is a range of implementation groups e.g. the Health, Social Care and Well-being Strategy Implementation Group, service specific planning groups and task and finish groups. The membership of these groups varies according to their purpose but generally consists of representatives from partner statutory and voluntary sector agencies, providers in the statutory and independent sectors and groups acting on behalf of users and carers. A chart of the planning structure is attached as Appendix 1.
Joint Commissioning and Integrated Service Delivery
The need for a service having been established, partnerships are increasingly used to commission and/or deliver the service jointly. Examples include:
· the joint commissioning team managed with Carmarthenshire Local Health Board;
· the community intermediate care teams provided with Carmarthenshire NHS Trust;
· the joint equipment store commissioned jointly with Carmarthenshire Local Health Board, Carmarthenshire NHS Trust and the Red Cross;
· the Workstep supported employment scheme delivered on behalf of Job Centre Plus;
· integrated mental health and learning disability teams with Pembrokeshire and Derwen NHS Trust;
· the development of integrated occupational therapy services with Carmarthenshire NHS Trust;
· the direct payments scheme with Ceredigion, Pembrokeshire and the Rowan Organisation;
· the implementation of the Unified Assessment Process with LHB and Trust partners;
· a consortium with Cardiff, Pembrokeshire and OLM (the supplier of our Care First computer system) to develop the capacity and efficiency of the system.
The authority commissions in the region of £22 million worth of care for adults from independent sector providers. These providers include around 140 care homes (70 in Carmarthenshire and 70 out of county) and ten domiciliary care agencies as well as a number of voluntary organisations ranging from major national bodies to small community groups. The services for adults purchased from the voluntary sector are listed in Appendix 2.
Supported housing projects to combat homelessness and enable vulnerable people to maintain accommodation are secured from housing associations and voluntary sector bodies through the Supporting People programme. Examples are the supported living projects for people leaving Maeslliedi Hostel and Coleshill Home for People with Physical Disability, as well as a planned scheme to accommodate seriously mentally ill people.
Good working relationships with the private and voluntary sectors are promoted through the planning structures and, more specifically, through the provider fora. There are four provider for a, meeting quarterly, in the service areas of older people, learning disabilities, mental health, and physical disabilities and sensory impairment. An inclusive forum for the providers of Supporting People services meets annually.
The development of the social care workforce is another area where partnerships are crucial in addressing the recruitment, retention and training of staff across the sectors. Departmental staff participate in the Carmarthenshire Training Partnership Strategy Group which includes representatives of training providers, Careers Wales, Carmarthenshire Association of Voluntary Services and external agencies such as Barnardo's and the Rowan Organisation. The Workforce Development manager is a member of the Regional Social Care Partnership and chairs the Carmarthenshire/Pembrokeshire Partnership.
Monitoring, Review and Regulation
The review of services, for instance a Wales Programme for Improvement review, would be undertaken with the input of relevant partners and representatives of users.
Social services are regulated by the Social Services Inspectorate, Wales, and the Wales Audit Office who carry out inspections and audits; the Care Council for Wales which registers and regulates the social care workforce; the Care Standards Inspectorate, Wales, which inspects registered facilities (residential and domiciliary care) and the Health and Safety Executive. The regulatory bodies are important partners in securing compliance with standards and promoting good practice.
It is generally recognised that the substantial challenges facing social services can best be met through collaboration and shared learning. Professional bodies, such as the Association of Directors of Social Services, provide such an opportunity. The Welsh Local Government Association in December 2004 agreed a set of commitments to speed up the pace of improvement and share good practice. A Social Services Improvement Agency is being set up within the WLGA to provide active support to local authorities to improve their performance.
The WLGA and ADSS also act on behalf of local government and social services in responding to, advising and lobbying central government.
The use of research - learning from research findings and the occasional commissioning of research - is an important way in which practice is informed and kept up to date. The department draws on the expertise of the Mid and West Wales Research and Development Support Unit and staff have participated in their training.
Working with Users and Carers
Finally, and most importantly, the service is particularly concerned to enable the active participation and contribution of service users and carers in the development and delivery of services. For this reason it works with a number of bodies whose purpose is to encourage and enable the involvement of users. Examples include the Carers' Alliance and the Disability Coalition for Action, both of which undertake a consultative, supportive and lobbying role.
A Voluntary Sector Health and Well-being Forum forms part of the planning structure and acts as a means of consultation with a wide range of voluntary sector organisations.
Use is made of the authority's Community Networks e.g. for consultation on the Health, Social Care and Well-being Strategy.
Advocacy services are funded through Mencap for people with learning disabilities and through Eiriol for people with mental illness.
This report has outlined the part that partnerships play in the provision of social services. It has demonstrated that an enormous range of organisations - statutory, private and voluntary - have varied but significant roles to play at every stage - planning, commissioning, delivery and review - to ensure that social services meet the needs of users and carers.