Working-for-a-shared-common-purpose-11.5.18-Word

INTRODUCTION AND APPROACH

METHOD

In order to achieve this, there were two key phases which ran from January-May 2018: DESK RESEARCH

Prior to the case study visits, our desk research established a foundation for the subsequent research phase, consisting of two key components: a brief literature review, which is summarized in the 'Conclusions' chapter, and a desk research exercise aimed at identifying current examples of integration across Wales This research focused on locating projects, reports, and publications that showcase integrated working at local, national, and international levels, with a primary emphasis on existing projects within Wales To streamline the information, we excluded older projects from 2009 and earlier.

The senior project team conducted an online search and reviewed recently published documents to identify relevant project examples This process yielded a diverse collection of key projects, varying in scale and size, pertinent to the brief A total of 143 Welsh examples are compiled in Appendix I, though it is important to note that this list is not exhaustive due to the time constraints of the exercise.

Following the desk research phase, we conducted in-depth investigations into three integration projects, selected through a collaboration between UNISON's networks and our research team The chosen case studies are as follows:

1 Monmouthshire (Gwent) – examining the strategic context, workforce integration, and the operation of integrated teams in Monnow Vale;

2 Bridgend (Western Bay) – exploring a number of work streams that have been focused on continually improving integrated community services for older people; and

3 Ynys Môn (North Wales) – investigating the integrated provision of enhanced dementia EMI residential care.

The case studies focused on the team conducting interviews with a diverse group of individuals, including frontline workers, strategic leaders, and intermediary personnel, to explore the various approaches implemented in three selected localities.

− the implications the projects have had for the workforce;

− the mechanism for the trade unions to engage with the process of determining and developing the integrated service;

− how Welsh Government is perceived to have impacted on achieving integration in Wales;

− the role of structures, including governance arrangements involving the Regional Partnership Boards (RPBs) and Public Service Boards (PSBs) in assisting implementation;

− the role of local organisational leaders in this process;

− whether and how the ‘fragmentation’ of social care has impacted on the ability to achieve integration and vice versa;

− the impact of additional financing and resources in enabling or hindering the integration practice; and

− the factors, overall, which have assisted implementing integration at greater scale and pace;

The findings from the case studies were shared with the key informants to sense check the accuracy of the outcomes of the research.

REPORT STRUCTURE

The next section of the report offers crucial context regarding policy and legislation for the study, followed by an analysis of findings from three case studies The final chapter situates these findings within existing literature on integration and considers insights from the recent Parliamentary review of health and care services We aim for this report to enhance understanding of integration among UNISON activists and to guide policymakers on necessary steps to expedite its implementation.

CONTEXT

THE CONTEXT FOR THIS RESEARCH - UNDERSTANDING INTEGRATION, INTEGRATED CARE AND COLLABORATION

INTEGRATION, INTEGRATED CARE AND COLLABORATION

Establishing a strong foundation of understanding regarding integration and collaboration in health and social care is crucial for facilitating in-depth research and evaluating specific initiatives aimed at achieving an integrated approach This involves examining policy developments in integrated care, exploring the conceptual frameworks of integration and collaboration, and identifying various tools that can transform theoretical concepts into practical applications.

The term "integration" in care and support remains open to interpretation, despite various strategies and government statements Integrated care, rooted in the principle of collaboration, has a history of successful implementation in Wales, particularly through initiatives funded by the Integrated Care Fund Literature reviews indicate a growing recognition of the significance of integrated care practices in Wales The Social Services and Well-being (Wales) Act 2014 has further strengthened collaborative efforts by establishing statutory obligations for cooperation, shifting the evaluation of integration from short-term gains to a focus on long-term sustainability and embeddedness.

A mutual understanding of integration among partners, supported by both linear and cross-sector governing bodies like regional partnership boards, is crucial to prevent confusion in implementing the Act's requirements Existing Statements of Intent and strategic plans may already outline this understanding, but it is essential to prioritize integrated care as a fundamental aspect of planning and delivering health and social care services across all regions.

INTEGRATION IN WALES

The Parliamentary Review of Health and Social Care in Wales emphasizes the necessity for integration across various domains, including strategic approaches, information and support systems, public engagement, career pathways for the workforce, innovative health and social care models, organizational accountability, and resource management.

The term "integrate" is often used as an active function rather than merely referring to "integration." This distinction helps prevent definitional pitfalls, clarifies the relationship between means and ends, and emphasizes the necessity of integration as a constructive and rational endeavor.

The report emphasizes the necessity for close harmonization between the NHS and social care at a national level to effectively develop new models of integrated health and social care, particularly given the involvement of numerous non-public organizations in various settings It highlights the benefits of integration in achieving a seamless approach to meeting needs and delivering services Notably, the Review Team's documentation identifies the integrated strategies in Monmouthshire and Bridgend as closely aligning with the principles outlined in recommendation 3 of the review's final report.

“Bold New Models of Seamless Care – national principles, local delivery.” 2

Achieving successful collaboration and integration in care and support faces numerous challenges, as actions intended to promote integration often become confused with the ultimate goal of providing seamless experiences for individuals While strategies like pooled budgets, co-located teams, and joint appointments are recognized as facilitators of integration, they do not guarantee a truly seamless response to needs Additionally, some argue that significant organizational change is necessary for integration, yet this perspective views change as a means rather than an end To fully appreciate and understand the value of integration, it must be considered at both strategic and operational levels.

Despite criticisms regarding a focus on means over ends in challenging integration scenarios, it is essential to acknowledge the successful activation of mechanisms that facilitate practical support These mechanisms also help define the components of a fully integrated approach, as outlined in the toolkit.

The 2018 Parliamentary Review of Health and Social Care in Wales emphasizes the importance of seamless, community-focused health and social care for older individuals It outlines key principles and features aimed at enhancing well-being and accessibility for this demographic For more detailed insights, the full report can be accessed at the provided link.

The 2018 Parliamentary Review of Health and Social Care in Wales, titled "A Revolution from Within," emphasizes the need for transformative changes in the health and care sectors This report, prepared by the Social Services Improvement Agency, supports the development of population assessments mandated by the 2014 Act, highlighting the importance of addressing current challenges to improve service delivery and outcomes in Wales For more information, the full report is accessible at: https://beta.gov.wales/sites/default/files/publications/2018-01/Review-health-social-care-report-final.pdf.

- An approach to the planning, organisation and delivery of health and social care services:

- Where partners work together on a common cause and are prepared to share sovereignty;

- Where integration is commonly understood and leadership to deliver integrated solutions is shared;

- Where integrated care is built from the bottom up as well as the top down;

- Where professionals are tolerant of each other’s business pressures and the complexities of the challenges therein;

- Where resources are pooled, teams are co-located, and commissioning undertaken jointly;

- Where the workforce is used flexibly and effectively and is open to innovations in skills mix and staff substitution;

- Where information is shared widely and openly;

- Where there is shared governance and shared accountability;

- Where assessments of need and care pathways are developed jointly with the aim of maximising joint working for the benefit of the individual.

We will return to the extent to which these featured in our case studies as part of our conclusions.

Achieving integrated care presents numerous complexities, but clarifying its meaning is essential for effective implementation Understanding integration from the perspective of service recipients can be particularly insightful According to the Welsh Government’s Framework for Delivering Integrated Health and Care for Older People with Complex Needs, integration should empower individuals by ensuring that their care is collaboratively planned, taking into account their personal circumstances, family, and caregivers This approach emphasizes the importance of giving individuals control and coordinating services to meet their specific desired outcomes.

Receiving a cohesive and coordinated approach from agencies, rather than a disjointed series of interventions, is crucial for avoiding confusion and disruption, ultimately leading to better outcomes.

3 Social Services Improvement Agency (2016) Population Assessment Toolkit – accessible from: https://socialcare.wales/research-and-data/research-on-care-finder/population-assessment-toolkit?record-language- choice=en-cy

4 Welsh Government (2014) A Framework for Delivering Integrated Health and Social Care for Older People with Complex

Needs – accessible from: https://gov.wales/docs/dhss/publications/140319integrationen.pdf

The Integrated Care Fund 5 guidance enhances our understanding of integration by promoting collaborative efforts among key regional partners It emphasizes the importance of proposals that showcase effective local delivery arrangements developed through discussions with Local Authority Housing and Social Services Departments, Local Health Boards, Registered Social Landlords, and Third Sector organizations This guidance advocates for strengthening existing partnerships and fostering new collaborations to improve service delivery.

Integrated care is essential for individuals of all ages and encompasses a wide range of agencies beyond just social services and health Effective plans should incorporate contributions from the third and independent sectors, housing, and education As mandated by the 2014 Act, joint area plans must also emphasize collaborative efforts with carers and other stakeholders to ensure a comprehensive approach to care and support.

Integration can occur at local, regional, and sub-regional levels, highlighting that there is no one-size-fits-all method for achieving it The population assessment toolkit emphasizes the importance of recognizing partial integration as a valuable step, rather than aiming for complete integration This approach encourages the use of local and sub-regional initiatives to foster broader strategies that can be implemented throughout the entire region.

Integrated care is now a fundamental aspect of Welsh Government's health and social care policy, influenced by the Government's response to the Parliamentary Review For integrated working to be the standard in Wales, a universal understanding of its meaning and implications is essential, extending beyond specific stakeholders to include organizational leaders, service users, and carers Furthermore, the integration of health and social care must be contextualized within the broader framework of collaboration in Welsh public policy.

INTEGRATION AS PART OF A COLLABORATIVE APPROACH

Collaboration in public policy is a complex area that requires a thorough understanding for effective public service delivery in Wales Despite increasing experience with collaborative initiatives, these efforts are often susceptible to political changes, economic fluctuations, established norms, and ecological challenges As a result, they struggle to generate the necessary value for sustainability unless proactive measures are implemented Research indicates that a range of strategies is needed to enhance the effectiveness of collaboration in this context.

The Welsh Government's Intermediate Care Fund Guidance for 2016-17 outlines key characteristics to assess the effectiveness of collaboration as a credible public policy, providing a framework for evaluation beyond just outcome measurements For more information, refer to the full guidance available at: https://gov.wales/docs/dhss/publications/170518icf-guidanceen.pdf.

Collaborations are often inconsistently defined and can manifest in both formal and informal ways, taking various forms and structures They emerge from diverse motivations, including resource dependency theories and rational-altruistic perspectives The outcomes of these collaborations can vary significantly, leading to mutual learning or enhanced efficiency and effectiveness However, they may also encompass contradictory elements, such as competition and conflict, which can both challenge and shape the collaborative process.

Collaborations serve as a practical application of organizational, institutional, network, and agency theories, often viewed as a governance tool Various factors influence their success, which evolves through different phases of a partnership's life cycle As collaborations progress, the dynamics of relationships shift, necessitating ongoing revitalization and support For instance, the initial enthusiasm during the early stages may diminish as the realities of implementation become apparent.

Collaborative working can take place both vertically and horizontally across various sectors, influenced by hierarchical structures and market dynamics in the implementation of public policy This collaborative process is driven by significant social interactions, including power dynamics and trust, which are essential for achieving shared objectives Ultimately, successful collaborations rely on the active participation of individuals—networkers, leaders, and stakeholders—who bring diverse skills and competencies to the table.

Understanding collaborations and collaborative behavior involves recognizing their complex characteristics, which do not easily translate into a clear typology Mutually beneficial motives may mask underlying conflicts and competition, while the quest for an ideal organizational structure must consider various informal networking elements that are not always apparent Additionally, governance issues are often intertwined with collaborative initiatives, making it challenging to clearly define the shared objectives of a strategy.

AN ASSESSMENT OF COLLABORATION TO DATE

To enhance the likelihood of successful collaboration, it's essential to identify and focus on key characteristics that foster teamwork, even if a complete definition of collaboration remains elusive Recognizing these common features can significantly improve collaborative efforts.

From a national perspective, it is essential to celebrate the diversity of collaborative approaches in Wales, viewing it as a necessity shaped by the unique culture of Welsh public policy This liberal approach allows local initiatives to dictate the motivations and forms of collaboration, resulting in richer, more sustainable experiences that are less influenced by state control Historically, Wales has embraced this framework, promoting collaboration over competitive market strategies However, the decision to prioritize collaboration is not as straightforward as it seems, particularly with the introduction of legislative mandates for public agencies to cooperate, as outlined in the Social Services and Well-being (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act.

Since 2015, the government has indicated that the voluntary approach to partnerships has not achieved the necessary scale and pace New statutory guidance mandates national and regional strategies for critical functions, including adoption services and safeguarding Additionally, the requirement to pool funds across health and social care has introduced complexity and challenges However, there is positive evidence of progress in various collaborative efforts, with some agencies benefiting from the authority granted by recent Acts to support their ongoing initiatives.

Collaboration among local authorities has led to a debate over whether government policy has been compromised by the need to accommodate local discretion, reflecting the central/local partnership culture Since 2003, various government initiatives have aimed to balance local autonomy with shared sovereignty in public services Key developments include the establishment and dissolution of local health boards, the publication of the "Making the Connections" strategy, and significant reports such as Beecham (2006) and Williams (2014) on public services Other notable changes include the creation and abolition of local service boards, the introduction of public service boards, and the evolution of community strategies and integrated plans Additionally, measures like the Compact for Change, proposed collaboration legislation, and the Local Government Act (2015) have shaped the landscape of local government reorganization.

Amid ongoing policy development, the integration of health and social care has become essential, sparking debate over the clarity and consistency of government policies to foster greater collaboration.

The evidence indicates that the Welsh Government's policy agenda on collaboration is facing uncertainty According to the WIHSC's review of the initial annual reports from statutory Directors of Social Services, titled "Achievements & Challenges," there are significant concerns regarding the fulfillment of these collaborative goals.

6 Beecham, J (2006) Beyond Boundaries: Citizen Centred Local Services for Wales Welsh Assembly Government – accessible from: http://www.wales.nhs.uk/sitesplus/documents/829/WAG%20-%20Beyond%20Boundaries

7 Williams, P (2014) Commission on Public Service Governance and Delivery in Wales ISBN 978 1 4734 0837 1 – accessible from: https://gov.wales/topics/improvingservices/public-service-governance-and-delivery/report/?lang=en

The Social Services Improvement Agency's report from 2011 highlighted the achievements and challenges in social care provision across Wales for the year 2009/10, based on insights from the 22 Statutory Directors for Social Services It indicated progress in partnership arrangements among Welsh local authorities in various service areas; however, this progress lacked a cohesive strategic approach and varied significantly across regions The 2013 SSIA report further revealed that four authorities struggled to meet their goals of achieving integrated services across geographical boundaries Despite some success stories, there remains a notable gap between strategic intentions and effective implementation of central government policies, particularly regarding significant organizational collaboration.

The Williams Report highlights that a mandated, hierarchical approach, where the government dictates the paths to follow, is an unappealing alternative to voluntary collaboration, as it fails to acknowledge the inherent complexity of the situation.

In 2014, it became evident that collaboration needed improvement for greater consistency and effectiveness The introduction of grant funding and program adjustments in health and social care, alongside the establishment of local authority-based public service boards, has paradoxically reinforced a collaborative culture while complicating policy This has resulted in an uneven patchwork of local regional governance structures for various functions, potentially worsening the issue.

The Integrated Care Fund has provided significant additional funding to enhance care coordination in health and social care, leading to various initiatives aimed at integrating services New regional partnership boards have been established to foster collaborative working, showing promise in their early stages However, these boards currently lack essential tools such as adequate staff, resources, and direct decision-making authority, which limits their effectiveness Their ability to enforce collective decisions without unanimous agreement has yet to be tested, leaving their potential as key players in the collaboration landscape uncertain.

9 Social Services Improvement Agency (2013) Collaboration in Social Services - A User Guide to Help Local Authorities

Address Social Services Collaboration and Achieve Good Governance in a Collaborative Context Cardiff: Wales.

CASE STUDY - MONMOUTHSHIRE

DESCRIPTION OF THE INTEGRATED MODEL IN MONMOUTHSHIRE

The integrated health and social care model in Monmouthshire operates through three locality-based hubs, each managed under a single agreement to streamline service delivery An Integrated Services Manager oversees the coordination of health and social care services within each hub The multidisciplinary teams consist of occupational therapists, physiotherapists, community nurses, chronic condition nurses, social workers, direct care staff, and support personnel, employed by Aneurin Bevan Health Board or Monmouthshire County Council Additionally, the hubs engage volunteers sourced from the third sector to enhance service provision.

The delivery model varies in each hub depending on previous service developments, for example one hub has rehabilitation beds and one hub has an in-patient ward.

Before the model's development, services operated independently with separate management structures, leading to isolated referrals and performance management across different areas Each service had its own criteria for handling referrals, resulting in a fragmented approach In contrast, the new model streamlines the process by allowing referrals to come directly into the team, which then provides the necessary support or intervention without needing to pass referrals between team members.

The model serves the entire Monmouthshire region, which has a population of 92,336, specifically targeting individuals aged 18 and older It is important to note that older adult and mental health services are excluded from this model due to existing alternative arrangements Since 2017, direct care has been an integral part of this model.

The three hubs are at Chepstow, Mardy Park (Abergavenny) and Monnow Vale(Monmouth) The focus of this case study is the Monnow Vale hub.

MONNOW VALE

Monnow Vale offers a comprehensive range of health services to residents of Monmouth, Raglan, Usk, and surrounding areas, with accessibility for individuals from other regions as well Key facilities include an inpatient ward, day services, specialist clinics, a café, family accommodation, a reminiscence room for dementia support, an intermediate care team, and a long-term support team The dedicated team is led by an Integrated Services Manager, who oversees Occupational Therapy and reports to the Head of Service at Monmouthshire County Council This diverse team comprises Auxiliary and Reablement Nurses, District Nurses, Chronic Conditions Nurses, Physiotherapists, Occupational Therapists, home care workers, administrators, and facilities staff.

The hub offers essential services that were formerly available at Monmouth Hospital, Overmonnow Day Hospital, Dixton Road Clinic, and various Social Care and Community Nursing Teams This initiative was established through collaboration with Monmouthshire County Council, local voluntary organizations, Gwent Healthcare NHS Trust, and Monmouthshire Local Health Board Additionally, a mini hub is set to open in Usk by May/June 2018, further enhancing community healthcare access.

In Monnow Vale, a streamlined assessment process for individuals requiring care and support is utilized, allowing staff to collaborate effectively using a bespoke database designed to align closely with practical needs This co-location of resources facilitates rapid response to identified needs while minimizing unnecessary bureaucracy, enabling staff to focus on leveraging their skills to enhance well-being outcomes for those they support.

- Staff are freed up to focus on what matters to people who need care and support.

- Their skills and expertise are recognised, used and valued.

- They are “part of something bigger”

- The importance of sharing values.

ORGANISATIONAL LEADERSHIP OF THOSE DELIVERING THE INTEGRATED ACTIVITY

Effective integration at Monnow Vale and throughout Monmouthshire relies on strong leadership at all levels, fostering a supportive culture for the integration agenda A shared corporate culture is essential, with clear objectives and innovative thinking driving the approach Additionally, an open-door policy encourages participation in senior-level discussions, enhancing collaboration and transparency.

Recent changes in senior management and organizational structures have been recognized as contributing factors to enhancing health integration A locality-focused structure is seen as more conducive to this integrated approach Building relationships founded on trust and respect is crucial for success, and such connections are often more easily established in local environments.

Effective governance and operational frameworks are crucial for integrated services, ensuring a clear understanding of responsibilities Integrated Service Managers oversee budgets from multiple organizations while maintaining consistent accountability standards These managers collaborate across two organizational services, addressing aspects such as HR, finance, and policies and procedures.

RELATIONSHIPS BETWEEN “KEY” DECISION MAKERS

The integration agenda in Monmouthshire leading to the development of the hub approach and Monnow Vale has been developed over many years and has been described as an

The ongoing journey of integration relies on long-standing, positive relationships built on mutual respect and trust among all partners, including statutory bodies, trade unions, the Third Sector, and the independent sector A strong, honest relationship characterized by equality among partners, along with a shared willingness to challenge and collaborate, is essential for achieving successful integration.

Building relationships within a local structure, rather than a centralized one, offers significant advantages Engaging the right individuals who are willing to collaborate and make decisions is essential for successful integration.

3.5 ROLE OF THE PUBLIC SECTOR WORKFORCE

The Monnow Vale hub is built on a foundation of shared values and behaviors that enhance its integrated approach to care Staff members believe that this integration significantly contributes to the success of the initiative, with clear expectations outlined in job descriptions and recruitment processes Employees from various sectors, including statutory, third sector, and trade unions, recognize and support this unified approach Central to this model is the focus on what truly matters to individuals in need of care and support Frontline staff express that this commitment is a primary reason for their desire to work at Monnow Vale, feeling empowered to take action and collaborate effectively.

Individuals can be recruited by either the Health Board or the County Council, with the option to choose their employer on a case-by-case basis Many employees tend to remain with their current employers due to familiarity or pension considerations For instance, a Health Board employee successfully applied for a position advertised by the Council but opted to retain their status as a Health Board employee Although job descriptions are standardized, there remains a lack of alignment in terms and conditions between staff of the Health Board and the County Council.

Staff collaborate in a shared hub while also engaging with the broader community, with various professionals, such as Occupational Therapists (OTs) and Support Workers, performing similar roles across different organizations.

Staff at Monnow Vale emphasize that a key reason for their commitment to the organization is its strong focus on people-centered work They appreciate having the authority and autonomy to take action, guided by a core mantra that underscores this ethos.

Frontline staff's judgment is highly valued, as their integrated approach helps minimize bureaucracy and guarantees timely support for individuals in need.

Monmouthshire's integrated approach to staffing fosters a positive work environment, attracting and retaining social workers, occupational therapists, and physiotherapists However, challenges persist in recruiting managers, evidenced by a recent unsuccessful team manager appointment While there are many high-quality, experienced practitioners, not all are inclined to pursue management roles, partly due to insufficient financial incentives related to pay levels.

The "Raglan" project, which began in Raglan and now encompasses all of Monmouthshire, was initiated four years ago following discussions between care at home staff and management Staff expressed concerns regarding their roles and the effects on individuals requiring care and support This feedback led to the development of the "Raglan" project, which involves approximately 140 council-led Care at Home staff The key drivers for this transformative change were the staff members themselves.

10 http://www.monmouthshire.gov.uk/app/uploads/sites/11/2014/05/6a-Select-Committe-Report-The-Raglan-

Domiciliary-Care-Model.-Appendix-1-Evaluation-Short-Summary.pdf people who need care and support and carers themselves, alongside responsive leadership.

A pilot program, followed by a phased rollout, involved discussions with trade unions and shifted the focus from rigid care plans to supporting individuals in achieving their personal outcomes Home care staff play a crucial role as partners in providing support for people with dementia in their homes Significant changes have been made to the terms and conditions for care at home staff, transitioning from zero-hour contracts to stable 35-hour weekly salaries This change fosters stability, consistency, and flexibility, resulting in a more fulfilling role for home care workers.

Every six months, payroll reconciliation occurs, ensuring that staff who have worked fewer hours do not incur any deductions Managers are accountable for maintaining a balance in overall hours worked Additionally, employees have been trained in areas such as emotional intelligence and dementia care to adapt to changes in their work practices effectively.

Staff work in teams of five or six, ensuring that service users' needs and wishes are prioritized Individuals receiving care are empowered to make choices, such as attending appointments or shopping, with the support of home carers This approach necessitates specific competencies and has led to extensive training and ongoing development for staff While the majority of staff have responded positively to this shift towards relationship-based care, the challenges of adapting to new working methods are acknowledged The emphasis now lies on granting staff the autonomy to build meaningful relationships with those they support.

There have been no negative issues on this change flagged to UNISON.

ROLE OF ADDITIONAL FINANCE AND RESOURCES

The Integrated Care Fund (ICF) and Delivering Transformation Grant (DTG) are crucial for advancing the integration agenda However, the uncertainty surrounding the continuation of ICF funding poses significant challenges, as the time-limited nature of this funding raises concerns about long-term sustainability.

Ending a successful project that delivered positive experiences and outcomes due to a lack of funding can be seen as unethical In Monmouthshire, it is crucial to prioritize long-term sustainability to ensure continued benefits for the community.

ENGAGEMENT OF TRADE UNIONS

UNISON has a longstanding positive relationship with the council, health board, and third sector regarding integration, having been actively involved since the initial work began over seven years ago Despite some initial reservations, the integrated approach has proven beneficial for both individuals requiring care and support and the staff involved Although there is a noted "two-tier" system concerning differing pay and terms, UNISON members have not prioritized this issue The dialogue between UNISON and statutory partners remains honest and open.

ROLE OF WELSH GOVERNMENT

The SSWBA and its statutory guidance emphasize the importance of integrating care and support to enhance personal well-being outcomes for individuals This Act establishes new statutory partnerships between local authorities and health boards, promoting integration, innovation, and service transformation Furthermore, the initiative is supported by additional funding through the Delivering Transformation Grant and the Integrated Care Fund (ICF).

The Welsh Government's influence on the integration agenda in Monmouthshire, particularly regarding the Monnow Vale hub, has been significant While the integration journey began prior to the Act, its implementation has empowered local initiatives and reinforced the aspirations outlined within the legislation.

The demand for various plans across different sectors negatively affects integration, as organizations are burdened with producing multiple documents This fragmentation strains resources and complicates processes Implementing a unified plan and approach would significantly alleviate complexity and reduce waste, benefiting all parties involved.

The importance of engaging regionally with the RPB was raised in relation to grant funding such as DTG and ICF.

ROLE OF “STRUCTURES” – INCLUDING THE RPBS AND PSBS

Monmouthshire is part of the Gwent Regional Partnership Board, which operates under the Aneurin Bevan Health Board Established as a response to the Social Services and Well-being Act (SSWBA), the Gwent RPB has undergone significant development to enhance its operations Recent revisions to the partnership's terms of reference ensure clarity in reporting accountability and consistency across various boards, including the Greater Gwent Workforce Development Board and the Provider Forum and Citizen Panel To foster collaboration, partnerships now convene quarterly and are focused on creating a comprehensive work plan aligned with the regional Area Plan, enabling effective tracking of work streams and reporting to the RPB.

Monmouthshire has maintained an Integrated Services Partnership Board (ISPB) for several years, recognizing the importance of collaboration among partners However, a challenge arises from the differing levels of decision-making authority held by each Board member.

The role and significance of RPBs and PSBs from the Monnow Vale/Monmouthshire viewpoint remain unclear However, significant efforts are underway at the regional level to establish supportive and relevant structures.

Monmouthshire has a lower rate of outsourcing home care workers compared to the rest of the region, with 568 individuals (76%) receiving support from independent sector providers and 153 individuals (24%) benefiting from in-house home care services as of the end of 2017 The county utilizes ten different independent home care providers to meet these needs.

Health board and council staff operate under varying pay scales, terms, and conditions, leading to ongoing discussions about improving collaboration and resource allocation Funding processes for staff are intricate, involving charging and recharging through established Section 33 agreements, which incur associated costs However, these procedural challenges are managed effectively to ensure that neither patients nor staff are impacted or aware of these complexities.

In diverse workplaces with multiple employers, varying policies, and pay scales, team managers lead large groups from different organizations, each with unique terms and conditions Despite these differences, employees remain motivated by a shared purpose, collaborating seamlessly regardless of salary disparities This unity fosters a strong commitment to common operating principles, ensuring that individuals performing similar roles are aligned in their goals and efforts.

Valuing independent sector home care workers is crucial, especially in Monmouthshire, where several agencies operate An innovative initiative in Usk aims to foster collaboration between local authorities and private sector home carers through a new mini-hub, designed to provide information, advice, and support to care staff This hub encourages open communication about any issues that may arise, facilitating a seamless service that reflects the shared caseload between local authorities and the independent sector This initiative stems from the "Turning the World Upside Down" project, which emphasizes the development of care plans and patch-based, person-centered support, shifting the focus from transactional to relationship-based care Currently, five providers are collaborating on this Monmouthshire-wide project.

Collaboration with the Third sector is essential for recruiting and coordinating volunteers within community hubs and wards These volunteers play a vital role in multi-disciplinary teams, participating in weekly meetings to identify individuals and caregivers who could benefit from their support.

11 https://democracy.monmouthshire.gov.uk/documents/s13143/Turning%20the%20World%20Around.pdf

CASE STUDY - BRIDGEND

DESCRIPTION OF THE INTEGRATED MODEL IN BRIDGEND

Bridgend's integrated services for older and disabled individuals aim to enhance the planning and delivery of community services for frail and disabled people, excluding those with learning disabilities and mental health issues Initiated in 2013 through the Western Bay Health and Social Care Programme, this comprehensive approach addresses the challenges posed by an ageing population The Bridgend model stands out within the Western Bay region, as it not only integrates core services but also encompasses intermediate care, making it a more extensive solution to meet the needs of its community.

The programme aims to enhance community health and social care services, ensuring that citizens, represented by a fictional character named Mrs Jones, receive a coordinated and well-planned approach Its primary focus is on creating care pathways that foster independence and wellbeing while minimizing duplication of services, unnecessary admissions to nursing or residential care, and hospital stays Additionally, the programme supports early discharge and encourages independence within the community, with the ultimate goal of reducing dependency and mitigating risks to individual autonomy.

Integrated community services for frail and disabled people are now well established and this case study concentrates on two elements:

The Community Resource Team (CRT) offers a range of services, including acute clinical support, reablement, telecare, and mobile response, as part of a regional intermediate care strategy Operating under a Section 33 agreement with the Health Board, the CRT features a common access point designed to streamline services and prevent duplication of efforts.

- Three Integrated Community Network Teams comprising social work, district nursing and therapies.

The CRT in Bridgend integrates various intermediate care services into one cohesive unit, facilitating a streamlined referral process through the Common Access Point Staffed by skilled social work assistants and supported by a multi-disciplinary team, this approach ensures timely and appropriate interventions while minimizing referral duplication.

The Community Resource Team (CRT) operates under a person-centred, proactive care model, emphasizing the advantages of a multi-disciplinary approach within a collaborative framework Programs for enabling and re-enabling support are assessed and developed by qualified professionals, ensuring that care is both professionally evaluated and appropriately delivered Consequently, the CRT maximizes meaningful independence for individuals at home or within Bridgend’s Reablement Unit.

The CRT in Bridgend features integrated management positions that utilize a single line management structure, including senior roles such as a senior nurse, senior occupational therapist, and senior social worker Additionally, access to senior allied health professionals within core services enhances escalation pathways for all CRT roles, promoting effective governance and oversight.

Intermediate Tier services in Bridgend are supported by a Section 33 pooled fund agreement between the local authority and the health board, ensuring significant annual investment from both partners This funding is further augmented by the Intermediate Care Fund (UCF), which facilitates accelerated service redesign and the development of innovative working methods.

INTEGRATED COMMUNITY NETWORK CLUSTER TEAMS

The establishment of integrated networks aims to revolutionize traditional service delivery models by merging social services and community health care Previously, social services offered support for the elderly and physically disabled through separate teams, while district nursing was provided through various access points Now, integrated teams consisting of social workers, occupational therapists, and district nurses operate under a unified management structure, enhancing collaboration and efficiency within community network clusters.

Three integrated community network cluster teams have been established to provide managed care and support, featuring professionally led, fully integrated management These teams include social work, district nursing, and community occupational therapy Each team is overseen by one of three integrated community network managers, who hold professional leadership roles in community nursing or social work, addressing governance issues effectively.

The transformation of services aims to provide citizens with well-coordinated and strategically planned community health and social care Key features of these networks include enhanced collaboration, streamlined access to resources, and a focus on holistic well-being, ensuring that individuals receive comprehensive support tailored to their needs.

The model draws on insights from the Torbay Care Trust and the Scottish NHS to implement anticipatory care planning through a multidisciplinary GP practice approach It focuses on creating co-produced anticipatory and contingency plans with individuals, aiming to prevent personal and family crises while reducing unnecessary hospital admissions and long-term care placements This framework ensures that all professionals can access agreed-upon support plans, which are shared across primary care, community services, and out-of-hours services to enhance outcomes for individuals.

- The Community Independence and Wellbeing Team (CIWT)

The countywide integrated health and social care team provides multidisciplinary support for adults facing complex, long-term illnesses, chronic conditions, or sudden impairments due to trauma Their primary goal is to help individuals maintain and regain independence and well-being while equipping them with the skills to manage their disabilities or health challenges effectively.

The CIWT Team offers a multidisciplinary, person-centered service that addresses the fluctuating needs of individuals with complex long-term conditions By adhering to a social model of disability, the team emphasizes choice, control, dignity, equity, opportunity, and co-production, fostering active community participation.

Since the introduction of this service, reliance on traditional residential nursing respite has significantly decreased, as more flexible, person-centered approaches to support and short breaks have emerged This team has facilitated the rehabilitation of individuals recovering from disabilities due to trauma, allowing them to receive care at home and expediting their discharge from regional hospitals.

ORGANISATIONAL LEADERSHIP OF THOSE DELIVERING THE INTEGRATED ACTIVITY

Integrated care has advanced significantly due to strong, inclusive leadership and the dedication of senior managers, who recognize the importance of staff support By prioritizing the integration and delivery of services over organizational structure debates, leaders have collaborated with staff to create a shared vision that highlights the benefits of integrated services for individuals The case of a fictional service user, "Mrs Jones," illustrates the real-world impact of these efforts.

Integrated communication from senior management down to local and regional levels, along with Section 33 arrangements, ensures effective collaboration Memoranda of understanding outline service specifications and objectives, reinforcing a shared vision Jointly formulated strategies acknowledge the finite nature of resources, emphasizing the public duty of agencies to utilize them wisely and prudently.

A Leadership Group is essential for maintaining senior-level commitment, with a crucial success factor being the courage to adapt models based on practical effectiveness This process requires ongoing engagement and learning from frontline staff to ensure continuous improvement.

RELATIONSHIPS BETWEEN “KEY” DECISION MAKERS

Bridgend has a rich history of collaboration between health and social services, fostering mutual trust that has facilitated significant changes Current integration efforts have evolved from earlier, less successful attempts, which nonetheless helped identify and address key challenges Senior managers recognize the ongoing need for progress and are committed to continuous improvement Crucially, regional Chief Executives have endorsed this collaborative approach, encouraging broader participation and commitment to the initiative.

Trust is built through a shared vision and a people-centered approach that prioritizes citizen needs and aligns resources with effective decision-making A Joint Partnership Board of senior officials promotes an integrated strategy, while a monthly Change of Culture Board, led by the Council’s Head of Adult Services, fosters collaboration among all adult services managers This inclusive environment encourages feedback and peer learning, highlighting issues across various services in relation to older people’s services Additionally, a dedicated Transformation Team focuses on implementing practice changes.

Trust and mutual respect are more crucial than structural and technical issues in driving successful outcomes, rooted in shared values Significant time investment has been made to empower frontline staff, ensuring they lead the approach effectively Additionally, capturing patient and user stories has reinforced the benefits of the WCCIS shared information system, which not only showcases trust but also enhances it.

ROLE OF THE PUBLIC SECTOR WORKFORCE

Frontline staff and managers express strong enthusiasm for working in an integrated, person-centered approach Teams are co-located, with a dedicated integrated team manager overseeing both health and social care personnel and resources Additionally, integrated job descriptions are in place for the Integrated Community Services Managers of the Community Response Teams (CRT) and networks.

Efforts to harmonize service terms and conditions have not been pursued, which is viewed as a practical decision given the complexities involved Employees in the new teams have maintained their original employment conditions post-change Managerial positions were assessed and aligned with the Agenda for Change bandings, which overlap with local authority bands, resulting in some managers earning varying salaries This disparity has been accepted as a natural outcome of integration and has not posed significant issues Although there is some dissatisfaction among Occupational Therapists, who are employed by different organizations at different pay rates, this has not escalated into major grievances Staff representatives refer to the pay discrepancy as a minor concern, acknowledging that it has been a longstanding issue among OTs in health and social care prior to integration.

The recent organizational changes emphasize employee actions over compensation, with significant time invested in engaging staff to voice their concerns and comprehend the practical implications of the new vision Employees report a reduction in bureaucracy and feel empowered within established professional governance frameworks, ensuring timely support for individuals They address issues through open dialogue and have adopted discussion-enhancing tools like “fishbowl” meetings.

The comprehensive staff engagement process revealed that concerns were primarily related to working practices, particularly regarding documentation, rather than terms and conditions of service Each agency appointed a human resource officer to collaborate on HR aspects of the change, which facilitated knowledge sharing and the resolution of potential issues Innovative workforce structures have been incorporated into the integrated arrangements, including leadership of the three network teams by managers from both agencies, effectively alleviating fears of a "takeover" by either entity.

To enhance professional confidence and safety within governance structures, each discipline now has a designated senior professional for guidance and decision-making An integrated leadership program, commissioned from the University of South Wales, has trained managers on essential regulations, including leave of absence policies, ensuring they are well-informed about staff needs.

A pragmatic approach to appointments has ensured that individuals' employment status remains unchanged Initially, the process prioritized opportunities for those directly impacted by the changes, allowing professional staff to transition into new roles while facilitating open competition for managerial positions within this group A joint consultation document was created to clarify the process and prevent misunderstandings.

Achieving change outside a targeted savings agenda is crucial, although budget cuts complicate this process It is recognized that securing staff buy-in from two agencies is more manageable compared to broader multi-agency initiatives.

Some of the key lessons about the importance of front line staff which emerged are that:

- The hearts and minds of front-line staff must be signed up to the model – this takes time and patience;

- Staff must be empowered to deliver on the shared vision;

- Staff need to feel secure in their professional governance arrangements;

- There needs to be flexibility in approaches to human resources issues;

- You need clarity between management roles and responsibilities and professional leadership in matrix models;

- The commitment of middle managers is critical;

- It is important to develop integrated job descriptions and person specs where possible;

- Certain people are in prime positions to adopt change agent roles;

- Joint training helps develop the right skills;

- Fears about changes in culture and working practices are common in any change process It is not unique to integration; and

To maintain a clear and organized professional identity within integrated teams, it is essential to establish dedicated professional leads and appropriate leadership This approach prevents the potential for confusion and disorder among various disciplines.

ROLE OF ADDITIONAL FINANCE AND RESOURCES

The transformation of services for frail older and disabled individuals has been achieved through the realignment of budgets and successful funding from the Integrated Care Fund, aiming to implement an optimal intermediate care model across Western Bay The health board has spearheaded the rollout of anticipatory care, focusing on enhancing the primary care workforce with regional support Additionally, the CIWT service was established by decommissioning an underutilized traditional care model, followed by the development of a new service based on a thorough analysis of service gaps and consultations with disabled individuals.

The availability of ICF funding has led to the implementation of integrated services, including the Acute Clinical Team's multi-disciplinary rapid response service This funding supports projects like the Better@Home service, which provides social care in patients' homes while arranging short-term assessments, allowing for quicker hospital discharges Additionally, the Carers Centre has received funding to establish a Carers Support Worker position at the Princess of Wales Hospital, helping to address caregivers' concerns and facilitate earlier discharges.

Although the ICF has helped, its administration – short-term funding, late notifications etc – has not It was said that these issues make strategic developments more difficult to manage.

It was also felt that the ICF’s short-term nature stifled creativity.

ENGAGEMENT OF TRADE UNIONS

In Bridgend, positive relationships with trade unions have facilitated significant consultation regarding changes among staff and union representatives Employees expressed greater concern over cultural shifts in working practices rather than issues related to terms and conditions Due to early and extensive involvement, trade unions did not require substantial participation during the deployment of staff into teams It is crucial to highlight that the initial change process was not a TUPE exercise, necessitating respect for differences between the two employers to ensure progress.

The trade union remained relatively unconcerned about the project since it did not result in job losses Nonetheless, they recognized occasional staff discomfort stemming from varying pay rates and concerns about potential internal disputes, such as whether one employee's grievance could trigger disciplinary action against another, particularly in cases involving multiple employers.

The pay disparity emerged concerning identical positions, such as OTs employed by both organizations Integrating the distinct workplace cultures was considered equally challenging as addressing issues related to terms and conditions.

Local TU representatives emphasized that assigning at least one managerial position to each profession was crucial in preventing feelings of takeover or power struggles, which in turn fostered trust among team members.

The SSWBA emphasizes the importance of integrating care and support to enhance personal well-being outcomes It establishes new statutory partnerships between local authorities and health boards to promote integration, innovation, and service transformation Key funding sources, such as the Delivering Transformation Grant and the Integrated Care Fund (ICF), play a vital role in enabling these changes.

The aspirations of the Act were supported, indicating that progress towards integration had begun prior to its implementation, while the Act provided authority to local initiatives and reinforced existing achievements In Bridgend, the approach mirrors the three pillars of the Social Services and Wellbeing Act: enhanced access to information and universal services, timely early intervention, and coordinated care for those in need This service integration has ensured that the principles of prudent Healthcare are consistently applied across community services, utilizing an evidence-based, co-produced strategy with citizens to ensure that the appropriate professional with the necessary skills responds promptly.

The national policy direction and the Well-being of Future Generations Act are generally viewed favorably; however, the Welsh Government's focus on specific metrics, like delayed transfers of care, raises concerns It is suggested that progress and performance should be assessed within a broader context Additionally, the short-term nature of the Integrated Care Fund (ICF) and its administrative mechanisms are perceived to somewhat undermine its positive effects.

ROLE OF “STRUCTURES” – INCLUDING THE RPBS AND PSBS

In Bridgend, the primary focus was on prioritizing the needs of the citizens, exemplified by their approach of starting with individual cases, such as that of Mrs Jones, rather than immediately addressing structural issues like governance However, there was a clear recognition of the necessity for effective policies, procedures, and robust governance arrangements to support their initiatives.

Bridgend, part of the Western Bay Regional Partnership Board under the Abertawe Bro Morgannwg University Health Board, is committed to a whole systems approach to tackle the challenges posed by an ageing population The Regional Partnership Board (RPB) effectively governs the strategy, with a Well-being Community Services Board reporting to it Recognized as a key accountability entity, the RPB recently hosted a Ministerial visit, highlighting its significance beyond its individual members.

Governance arrangements are supported by a senior officer led Joint Partnership Board which has responsibility for managing the integrated service and accounting for expenditure.

Section 33 agreements support certain aspects of service and budget arrangements; however, the entire service is not classified as having a pooled budget due to the absence of shared over and under spends The flexible arrangements permit the transfer of funds between services, provided a strong decision-making process is adhered to, and this is well understood by all parties involved, preventing any issues The senior officer Joint Partnership Board supervises the performance of the budget holder.

While there was consensus on the importance of resource sharing, there was hesitance towards strictly defined pooled budgets due to concerns about increased bureaucracy and workload, especially for finance officers Many felt that the administrative challenges associated with pooled budgets could hinder integration efforts, suggesting that although the concept was sound, its implementation posed significant issues that overshadowed its potential benefits This raised questions about the overall value of pooled budgets in practice.

Bridgend conducted comprehensive financial modeling to assess the impact of failing to adapt to rising demand versus the benefits of innovative approaches The focus was on optimizing resource allocation to address increasing needs while eliminating duplication to create efficient, seamless services However, some viewed Bridgend's arrangements as more of a "paper exercise" rather than a true pooled budget, as there was no obligation to achieve savings like other budgets This perception did not indicate a lack of diligence in fulfilling financial responsibilities.

Bridgend's framework includes 15 independent domiciliary care providers, with 13 currently active, alongside 22 residential and nursing homes These independent providers collaborate effectively with the local authority, demonstrating a strong understanding of the adopted strategies Additionally, there is a diverse array of third sector providers actively engaged with the three network teams.

Health board and council staff operate under varying pay scales and conditions; however, there is a strong commitment to collaboration beyond these differences The workforce is united by a common purpose, and partners are increasingly utilizing shared information systems, notably the expanding use of the WCCIS.

The issue of service delivery fragmentation in Bridgend may not have been recognized due to the market's stability and the process of new referrals being funneled through the integrated short-term assessment service prior to care commissioning However, the inconsistency in care delivery approaches, characterized by differing values and principles, poses a significant challenge to the integrated care agenda.

CASE STUDY – YNYS MôN

DESCRIPTION OF THE NEED FOR THE INTEGRATED MODEL IN YNYS MÔN

A collaborative service model has been established between Betsi Cadwaladr University Health Board (BCUHB) and Isle of Anglesey County Council (IoACC) to offer specialized care and accommodation for individuals with dementia facing complex health and social care challenges This innovative approach will cater to the needs of 28 older adults.

Individuals aged 45 and older, regardless of gender, may be diagnosed with dementia following a comprehensive medical and multi-disciplinary evaluation These individuals often present with complex health and social care needs but do not require nursing care.

Eighteen months ago, a shortage of older people’s mental health (OPMH) nursing beds on the island led to out-of-county placements and delayed transfers of care (DToC) Although the situation has since improved, concerns remain about potential future shortages With the island's changing demographics, including a growing number of individuals living with dementia and an emphasis on supporting people to live at home longer, the demand for OPMH residential and elderly mentally infirm (EMI) nursing beds is expected to rise, while the need for general residential care decreases This shift is accompanied by the development of extra care facilities and increased investment in community-based services and preventative interventions, alongside enhanced collaboration with the health board.

Over the past 18 months, the IoACC has collaborated with BCUHB to create a specialized service model aimed at assisting individuals with dementia who face distress and complex care requirements This initiative has resulted in a residential facility that offers an enhanced dementia service, featuring trained staff and tailored resources designed to effectively support those with intricate needs and emotional challenges.

GARREGLWYD

Garreglwyd care home, located on the outskirts of Holyhead and owned by Anglesey County Council, has introduced a new service model to support individuals living with dementia who have complex care needs but do not require 24-hour nursing care Built in 1991, this purpose-built facility offers long-term accommodation divided into four units with single occupancy rooms Ultimately, Garreglwyd aims to accommodate 28 adults, aged 45 and above, who meet specific criteria following a medical and multi-disciplinary assessment, providing both long and short-term care for those diagnosed with dementia.

To enhance dementia care in the residential home, 20 staff members have undergone additional training and have gained experience by shadowing professionals in EMI homes across the island The team now possesses QCF Level 2 and 3 Diplomas, working collaboratively in an integrated environment Daily support is provided by community psychiatric nurses and a district nurse, funded by ICF resources, ensuring specialized health care through BCUHB The enhanced service operates from 8am to 8pm, with out-of-hours support available via telephone from Ysbyty Cefni and a GP out-of-hours service District nursing services will also be accessible, ensuring that a Registered Nurse or Health Care Assistant can respond to care home needs, either through phone assistance or an on-site presence as required.

Daily updates and reviews are essential components of an individual's service plan in care homes These updates involve thorough discussions among care home staff, Community Psychiatric Nurses (CPNs), and District Nurses (DNs) regarding each resident Any emerging issues are promptly addressed, leading to necessary amendments in the individual service plans These changes are then approved by the Allocation Panel and documented in the Multi-Disciplinary Team (MDT) service delivery plan.

Individuals can be referred for placement at Garreglwyd through the Adult Services Care Management team or directly from hospitals A thorough assessment of each individual's needs is conducted, and placement is only confirmed when the multi-disciplinary team (MDT) is confident that the care home can adequately address those needs The MDT convenes biweekly at Garreglwyd to ensure prompt decision-making involving all relevant professionals Upon acceptance of a placement, a person-centred care plan and a multi-disciplinary service delivery plan are created in collaboration with the individual and their relatives Both plans undergo regular reviews, with the care plan assessed as necessary and the service delivery plan reviewed monthly at the care home.

ORGANISATIONAL LEADERSHIP OF THOSE DELIVERING THE INTEGRATED ACTIVITY

The leadership within the two key delivery organizations has significantly influenced the evolution of the Garreglwyd service model By fostering a collaborative environment, leaders maintained a positive outlook on potential solutions and made decisions collectively Their candid discussions about challenges and possibilities cultivated a supportive partnership within the strategic group.

Partnership agreements under Section 33 were not mandatory but significantly enhanced governance and addressed initial uncertainties The operational responsibility was assigned to the IoACC, while clinical accountability rested with BCUHB Interestingly, many leaders involved in the partnership were unaware of the Section 33 agreement, highlighting that the strength of their relationships outweighed formal processes in advancing the new service model.

The community's cultural needs have long been recognized by local leaders, who prioritize their own neighborhoods and the relationships they've nurtured over time The ongoing special measures of the health board have prompted organizational leaders to adopt new collaborative approaches, fostering closer ties between organizations and enhancing their ability to address these cultural needs effectively.

The locality benefits from strong working relationships, fostering a sense of confidence as they build on their successes It is recommended that initiating projects on a small scale and gradually expanding is the most effective approach to ensure successful integration.

RELATIONSHIPS BETWEEN “KEY” DECISION MAKERS

Effective organisational leadership hinges on the dynamics of relationships among leaders, emphasizing the importance of a common purpose and the right team composition Although the process may not always be seamless, strong relationships drive progress Key decision-makers prioritized collective achievements over institutional obstacles, fostering a collaborative spirit focused on serving people rather than merely the organisation This shared commitment to overcoming challenges and celebrating successes united the team Ultimately, the presence of dedicated staff with aligned values is crucial for successful integration and change.

The relationships in this part of North Wales have evolved over many years, rooted in a culture of trust and collaboration that blurs professional boundaries While not deemed essential for developing integrated service models, the absence of these established relationships could significantly prolong the process of implementing changes Stakeholders acknowledged that fostering these connections would facilitate smoother transitions and enhance the effectiveness of service integration.

‘win-wins’ is crucial, and that this is difficult to do unless you have the underpinning trust.

ROLE OF THE PUBLIC SECTOR WORKFORCE

The new service model has transformed the way the frontline workforce at Garreglwyd, previously an older people’s residential home, operates With the threat of closure or sale looming for the past five years, the staff were excited about the change, recognizing it as an opportunity for a secure and sustainable employment model While adapting to this change has presented challenges, the dedicated team of 20 care workers has shown remarkable enthusiasm and willingness to embrace new ways of working.

In 2017, during Q2 and Q3, care workers received extensive training to prepare for an enhanced dementia service They visited EMI nursing and residential homes to learn from fellow care workers, gaining valuable insights into best practices Additionally, the IoACC introduced specialist care support to increase dementia awareness among staff.

The care home staff have successfully united as a team, benefiting greatly from the daily presence of the CPNs, which fosters a supportive environment for both care workers and CPNs Initially, some care workers felt apprehensive, believing the CPNs were there to judge their interactions with residents However, as the new model has developed, trust and respect have flourished, with care workers appreciating the CPNs' valuable insights and mentoring This collaborative relationship has empowered staff to enhance their caregiving practices, leading to a more effective and positive work atmosphere.

The stability of terms and conditions for the frontline workforce has significantly aided the transition process, allowing managers to avoid overwhelming changes and giving staff time to adapt to new working methods Currently operating at a low capacity with only six residents, the care home anticipates challenges as it prepares to accommodate up to 28 residents over the next year With three employed Community Psychiatric Nurses (CPNs) and one District Nurse (DN) supporting the care home staff, staffing levels will need to adjust appropriately, especially with the upcoming opening of an additional wing housing eight more residents Ensuring the right staffing ratios is crucial for maintaining an effective care model as the resident population grows.

Recruiting Community Psychiatric Nurses (CPNs) and District Nurses (DNs) in North Wales presents significant challenges, particularly as one moves further west, with recruitment difficulties for DNs emerging as a more recent concern In the next year, care home staff are expected to become more skilled and specialized, highlighting the need to consider career pathways for these workers It is essential to identify gaps in the care home market and explore innovative integrated care models Frontline care workers prioritize performing their roles effectively, ensuring dignity and respect for those they serve They adapt daily to the unique needs of individuals, recognizing that strategies that worked yesterday may not be effective today, which drives their continuous improvement.

ROLE OF ADDITIONAL FINANCE AND RESOURCES

The transition to an integrated service model in Garreglwyd was significantly influenced by the revenue and capital from the Welsh Government's Integrated Care Fund (ICF) Many stakeholders emphasized that the availability of ICF funding was essential, suggesting that this initiative may not have been possible without it.

In North West Wales, the ICF allocation resembles a pooled arrangement, fostering collaboration among projects across the sub-region This initiative has united various people and organizations, enabling the development of innovative service models Early meetings were facilitated by the prior resolution of financial responsibilities, alleviating concerns about funding, which created a mutually beneficial situation for all parties involved.

The staffing budget for Garreglwyd is lower than that of an EMI nursing model; however, key leaders emphasize the importance of sustainability for this service model and their commitment to the community beyond the ICF funding period Understanding the functionality and impact of this new model is crucial, particularly in assessing its effects on patient flow and reducing delayed transfers of care (DToC) and hospital admissions There is a strong desire to base future decisions on solid evidence to ensure that the model delivers value for money.

ENGAGEMENT OF TRADE UNIONS

The development of the Garreglwyd model notably lacked involvement from trade union representatives Acknowledging this gap, there is a clear commitment to enhance engagement with these representatives in future discussions regarding integration.

ROLE OF WELSH GOVERNMENT

The proposed enhanced dementia model was initially discussed with CSSIW, who provided encouraging feedback and outlined their expectations regarding the Statement of Purpose and required details CSSIW's subsequent involvement included site visits and assessments of staff training and governance arrangements before approving the new registration While the importance of ICF funding as a key enabler for this service model was acknowledged, there was minimal direct commentary on the Welsh Government's role Although the impact of new legislation was generally recognized, it was concluded that the changes at Garreglwyd had little direct connection to the Welsh Government's influence.

ROLE OF “STRUCTURES” – THE RPB AND PSB

The RPB has minimal impact on the Garreglwyd model's development but oversees all ICF-funded projects in North Wales Its large scale makes it difficult to effectively influence every project and build strong relationships across the region.

There is a noticeable strategic disconnect between the Regional Partnership Board (RPB) and the Public Services Board (PSB), as their agendas do not align, leading to differences in reporting methods and accountability at both local and national levels However, the sub-regional PSB demonstrates positive working relationships and effective collaboration.

The integration of health and social care in Gwynedd and Môn is best approached at a regional level, with Anglesey-specific structures identified as beneficial for this purpose This initiative highlights the importance of localized frameworks in enhancing service delivery and fostering connections within the community.

‘care closer to home’ strategy

This example of integrated working is in its early stages, highlighting the importance of identifying the lessons learned and assessing the impact of the evolving new model.

CONCLUSIONS

CONCLUSIONS FROM THE LITERATURE

The research highlights the intricate collaborative challenges associated with cross-sector initiatives, particularly in integrating health and social care To enhance collaboration and accelerate integration in Wales, it is essential to systematically utilize existing guidance on effective integrated working Four significant examples illustrate this approach.

1 The King’s Fund guidance (2013) 12 which contained a 16-point plan for increasing the scale and pace of integrated care whilst recognising that changes to national policy and to the regulatory and financial frameworks are needed for local leaders to fully realise a vision of integration.

2 The previously referred to SSIA guidance (2013) on collaboration in social services in Wales which produced a checklist of some 80 questions to support local authorities and their partners in their collaborative endeavours.

3 The Social Care Institute for Excellence Logic Model (2017) 13 which provides a framework for addressing integration that includes identification of the enablers and components of integrated care together with expected outcomes and impacts.

4 The integration self-assessment tool produced jointly by the Local Government

Association, NHS Confederation, Association of Directors of Adult Services and NHS

The King's Fund (2013) emphasizes the importance of scaling and accelerating integrated care to enhance healthcare delivery The report outlines strategies for effective integration, highlighting the need for collaborative practices among health and social care providers It advocates for patient-centered approaches that prioritize individual needs and improve overall outcomes By fostering partnerships and utilizing shared resources, the report suggests that integrated care can lead to more efficient services and better health management The findings underscore the critical role of leadership and organizational culture in driving successful integration initiatives.

13 SCIE (2017) Logic model for integrated care – accessible from: https://www.scie.org.uk/integrated-health-social- care/measuring-progress/logic-model

Clinical Commissioners (2016) 14 which focuses on the key elements and ingredients needed for successful integration.

This year, the Parliamentary Review team has produced documentation that emphasizes the importance of integration in delivering seamless, community-focused health, social care, and well-being services for older people in Wales.

To ensure effective integration and collaboration in public service governance and delivery in Wales, it is crucial to utilize available guidance and adopt a consistent approach rather than proceeding slowly and sporadically, as indicated in some evidence presented to the Commission in 2014.

Enhancing collaboration is essential for the integration of health and social care This integration aligns with the idea of "collaborative advantage," where organizations work together to achieve creative outcomes that they could not accomplish independently Through collaboration, each organization can meet its own goals more effectively while also contributing to broader societal objectives beyond their individual aims.

The emergence of interprofessional teams (IpTs) has highlighted the importance of effective leadership in coordinating diverse skill sets among team members Literature emphasizes the need for shared, collaborative, or collective leadership within these teams, while also identifying the role of a leader who can drive transformation, foster creativity, and support innovation as essential components of successful team dynamics.

Effective leadership in interprofessional team (IpT) settings is crucial due to the predominantly multi-professional nature of the health and social care workforce This unique leadership context requires leaders to navigate the challenges of guiding a diverse team, as they often lack expertise in other professions As a result, leaders must skillfully encourage team members to relinquish some professional autonomy, fostering integration and collaboration to enhance overall team performance.

14 LGA et al (2016): Stepping Up to the Place: Integration Self-assessment Tool – accessible from: https://www.local.gov.uk/sites/default/files/documents/stepping-place-integratio-a3d.pdf

15 Huxham C (1993) “Pursuing Collaborative Advantage” Journal of the Operational Research Society Vol 44, pp.599-611: https://www.tandfonline.com/doi/abs/10.1057/jors.1993.101

16 Smith T, Fowler-Davis S, Nancarrow S, Ariss SMB and Enderby P (2018) "Leadership in interprofessional health and social care teams: a literature review" Leadership in Health Services: https://doi.org/10.1108/LHS-06-2016-0026

Effective leadership and positive workforce engagement are crucial for successful integration in various contexts Workforce leaders should focus on three essential steps: clarifying the local integration agenda, tackling integrated workforce management challenges, and executing successful workforce changes It is vital to determine the most suitable form of integration from the beginning to address local needs, which can encompass care pathways, workforce teams, management and governance, as well as commissioning and planning.

The government's role in fostering integration, particularly through additional funding, is crucial yet complex While a combination of prescription and enablement may seem appropriate, the intricacies involved suggest a need for a new strategy The establishment of various regional partnerships for specific functions has introduced flexibility but has also led local authorities to challenge the rationale behind the government's methods.

Targeting grant funding through the ICF enhances strategic clarity for regional approaches, yet it may inadvertently undermine less formal governance models A recent review of the ICF in Wales highlighted that the funding was utilized flexibly, enabling agencies to collaborate more effectively The involvement of the third sector was pivotal in numerous projects, showcasing the ICF's role in fostering independence and preventing the escalation of needs.

Research in Scotland emphasizes that integration design must be tailored to the unique geographic, financial, policy, and professional contexts of each locality, as there is no universal solution Achieving a balance between local fragmentation and insufficient standardization is crucial for successful integration Key factors influencing integration include a clear vision, adequate time, effective leadership, integrated teams, and an understanding of local culture Notably, a strong connection exists between vision, outcomes, and leadership, with outcomes being a vital aspect of the vision and strong leadership essential for shifting the focus from inputs and outputs to meaningful results.

The Centre for Workforce Intelligence (2013) outlines a three-step approach to workforce integration, emphasizing the importance of cohesive strategies in workforce management This framework aims to enhance collaboration and efficiency within organizations For further details, the full report can be accessed at the provided link.

18 Welsh Government (2017) Review of ICF – projects and initiatives which demonstrate good practice

19 Petch A (2013) Delivering integrated care and support: IRISS – accessible from: https://www.iriss.org.uk/sites/default/files/2016-07/iriss-delivering-integrated-care-and-support-2013-12.pdf

Fully integrated care is likely to include an important contribution from the third sector and research 20 in this context suggests:

- Collaboration is resource intensive and requires time, money and senior involvement

CONCLUSIONS FROM THE CASE STUDIES

The case studies offer a significant glimpse into health and social care integration across various regions in Wales, focusing on the processes that facilitate successful integration rather than solely on the outcomes Despite this emphasis, the positive results achieved by each case should not be overlooked Our analysis highlights the key factors contributing to integration, derived from interviews, and presents them in a ranked summary below These findings align closely with the key messages found in existing literature, and we provide further details on each factor to enhance understanding.

THE ORGANISATIONAL LEADERSHIP OF THOSE DELIVERING THE INTEGRATED ACTIVITY

Our investigation focused on how leaders from various organizations collaborated and addressed evolving governance structures We found strong leadership at all levels, with a clear focus on the desired outcomes of integration Senior leaders demonstrated commitment to an integrated approach, providing support to their teams by clearly defining expectations Establishing a shared vision from the beginning proved essential for sustaining support during the complex implementation phases, fostering a unified understanding of goals and encouraging innovative solutions to challenges.

Effective leadership requires a clear and strong presence from those at the top of organizations, ensuring that followers understand their direction and purpose without confusion.

In "Managing to Collaborate: The Theory and Practice of Collaborative Advantage," Huxham and Vangen (2005) emphasize the importance of engaging staff at all levels to foster integration, highlighting a commitment to understanding what works best for the integrated frontline Leadership has been effectively demonstrated by frontline staff, particularly in the Raglan project, where open communication with management facilitated significant change This approach prioritizes individual care and the sentiments of frontline workers, suggesting a more bottom-up methodology Furthermore, effective leadership at various levels is crucial for managing integrated teams, as evidenced by the respect team members show for each other's disciplines, achieved through shared knowledge and collaboration.

Leadership is crucial at every level, as evidenced by the proactive engagement of frontline staff who openly communicated issues This collaborative approach with management fostered significant change, highlighting the importance of shared leadership in driving agendas forward.

KEY FACTORS IN ACHIEVING INTEGRATION – FINDINGS FROM THE CASE STUDIES

Key factor Description of key factor Rank

Most important factor in achieving integration

1 Organisational leadership of those delivering the integrated activity

This article explores how leaders from various sectors and organizational levels collaborate to deliver integrated activities effectively, ensuring the successful implementation of a sustained integrated approach.

2 Relationships between ‘key’ decision-makers

This focuses on the personal relationships between those people

‘around the table’ including the trade unions who initiated and have seen through the integration These relationships had been forged over time and had allowed trust to build

3 Role of the public sector workforce

The positive response of frontline workers and managers to changes in service delivery has greatly influenced the success of the three case studies In two of these cases, trade union leaders played a crucial role, while innovative Human Resource management strategies have facilitated effective collaboration within integrated teams.

4 Role of additional finance and resources

The importance of external and additional finance (primarily via the Integrated Care Fund [ICF]) cannot be overstated – it has enabled and catalysed the integration activity

5 Formal mechanisms for the trade unions to

In two out of three cases, trade union representatives have played a crucial role in shaping and supporting the new integrated services The upcoming challenge lies in how these unions can continue to contribute effectively to this evolving landscape.

Key factor Description of key factor Rank

Engaging with trade unions is a crucial aspect of achieving integration within leadership structures Their involvement significantly influences key factors in the integration process, underscoring the importance of collaboration between unions and leadership arrangements.

The Working Group (WG) has played a crucial role in facilitating integration through new legislation, policy, and financial support from the ICF However, to ensure long-term sustainability, funding regimes must be more adaptable and accessible.

7 Role of ‘structures’ including governance

Section 33 agreements are valuable, but resource pooling has not relied solely on clearly defined budgets The effectiveness and significance of the Regional Partnership Boards (RPBs) and the Primary Care Boards (PSBs) present a mixed scenario, further complicated by the existence of a sub-regional PSB in one case study, which is not aligned with the local authority boundaries.

Despite the fragmented composition of the frontline workforce, including independent and third sector workers, the integration examples analyzed show that this fragmentation has not significantly hindered progress However, the pursuit of seamless service delivery continues to be a key objective.

RELATIONSHIPS BETWEEN ‘KEY’ DECISION-MAKERS

The success of integration initiatives largely depends on the personal relationships among those involved, as these connections foster trust over time Our case studies reveal that strong, trusting relationships enhance structured approaches, such as effective program management Organizations are not merely mechanical entities; they are dynamic systems shaped by the people within them Ultimately, while structures and integration formats are important, prioritizing the human element is crucial for achieving successful outcomes.

Building trust takes time and is essential for fostering collaboration among staff from different agencies This investment in time allows for the development of mutual respect and understanding of each other's abilities and constraints, leading to a more sustainable integrated approach Staff emphasize that their people-centered work is supported by the authority to act independently, guided by the principle of trusting frontline staff's judgment While challenges to professional boundaries may arise, working together helps minimize bureaucracy, ensuring timely and appropriate support for individuals Ultimately, true integration is a gradual process that cannot be hurried.

Information sharing remains a critical area for development, as co-located team members can freely discuss individuals, but systems for routine information exchange between agencies are lacking Our case studies highlighted effective shared approaches, such as the implementation of the new WCCIS system and tailored locality-driven methods However, without a systematic strategy across Wales, achieving a fully integrated approach will continue to face significant challenges The progress observed in our case studies demonstrates that, with the right commitment and conditions, this long-standing issue can be effectively addressed.

CONCLUSIONS RELATING TO THE PARLIAMENTARY REVIEW

Many of the central messages of the Parliamentary Review are consistent with the findings and conclusions from this research project The review team’s report prioritised the need for

The article advocates for a unified health and care system in Wales that eliminates barriers between physical and mental health, as well as between primary and secondary care and health and social care It highlights the significance of a robust workforce and strong leadership as essential components for success Additionally, it stresses the need for appropriate funding structures to align system design with desired outcomes, ultimately linking the Welsh Government's role to the achievement of strategic health objectives.

The Parliamentary Review's extensive scope highlights the broader interpretation of seamless services beyond traditional integrated care This research study is contextualized within the Review’s recommendations, particularly in a supplementary document aimed at enhancing community-focused health, care, and wellbeing services for older people in Wales Numerous relevant references from this document, which were also featured in case studies, underscore the importance of these recommendations.

Co-locating health and social care staff enhances collaboration, enabling quicker mobilization of resources to effectively address crises and facilitate patient discharges from hospitals to their homes.

“Hospitals and care homes will work more closely with these seamless primary care services and work with them to identify and act to support particular patients or communities.”

The Social Services and Wellbeing Act enhances the integration of health and social care by mandating collaborative efforts This includes assessing local needs, evaluating how well these needs are currently addressed, and identifying the necessary services to fulfill them.

“A care culture orientated towards the outcomes the citizen wants and can achieve: ‘what matters to me’.”

“Staff should have fulfilled and productive working lives and work towards continuous quality improvement.”

The initiatives in Monmouthshire and Bridgend were highlighted in the review's final report as exemplary models that align with the principles of recommendation 3, emphasizing the importance of "Bold New Models of Seamless Care" for effective local delivery.

In summary, the insights gained from our case studies reinforce the strategic direction outlined by the Parliamentary Review and should serve as a valuable resource to achieve the Review's objectives.

SUMMARY

To promote a more integrated approach to health and social care in Wales, we believe it is essential to consolidate our findings into several key messages that will guide stakeholders in their efforts.

The guidance established in the King's Fund's "Scale and Pace" 16-point plan from March 2013 remains crucial as research on integration has evolved Key themes such as effective leadership, the importance of a shared vision, allocating time and resources, and innovative workforce utilization were prominently demonstrated in our case studies, highlighting their ongoing relevance.

– Demonstrate strong and clear leadership Organisational leaders must visibly commit to the integrated way of working and back this up with support for others to achieve the aim.

– Ensure the vision is clear and shared, and based on the needs of the person/patient Reinforce that vision especially when difficult situations have to be addressed.

Valuing the knowledge and expertise of frontline staff is crucial for achieving organizational goals Integration should not be rushed; allowing time for understanding ensures long-term sustainability It is important to create opportunities for staff to share their knowledge and experiences through conversations, meetings, and training sessions Building on existing relationships while establishing new ones fosters trust, which must be earned, and addresses any power imbalances Additionally, improving working conditions, such as providing salaries for home care workers, and establishing clear pathways for career development are essential for empowering frontline employees.

– View integration as an investment opportunity, not a cost saving venture

Notwithstanding its uncertainty, use Welsh Government funding to embed integrated methods and develop innovative models of care to achieve seamless services

Recognise that integration can achieve greater efficiency and effectiveness.

Achieving success requires a careful balance between structural elements and the human factor While formal agreements, collaborative governance, and effective organizational structures are crucial, it is essential to remember that people are the driving force behind progress Empower frontline staff to excel by fostering teamwork and collaboration, enabling them to deliver their best for the community.

– Accept that achieving an integrated way of working is mandatory not optional

Cooperation between organisations is a statutory requirement and the Parliamentary Review’s emphasis on seamless services points the way forward.

Leverage the expertise of traditionally referred support staff, such as Human Resources and Finance Officers, from all participating organizations to actively engage in achieving shared goals Empower these professionals to collaborate effectively in addressing challenges and implement practical solutions for complex staff and financial issues.

In conclusion, we highlight the significant roles of the Welsh Government and trade unions in promoting integration Both entities contribute positively to this effort, although there remains room for enhancement in their collaboration and effectiveness.

The Welsh Government has laid essential foundations for integration through statute, policy, and funding; however, the non-permanence of the Integrated Care Fund poses a significant barrier to advancing integration at the necessary scale and pace While officials have communicated positive messages regarding the funding's longevity and successful integrated practices, it is crucial to recognize and maintain the interdependence between funding and integration The Welsh Government must take a leadership role to ensure that non-collaboration and non-integration become exceptions rather than the norm, implementing appropriate levers, incentives, and sanctions Additionally, it should reassess its funding mechanisms to ensure quick access, proper routing, and a focus on delivering tangible improvements.

Trade unions are encouraged to adopt a proactive role as joint leaders in the integration agenda, emphasizing their unique position to support staff during periods of change A passive "no objection" stance is insufficient; instead, union representatives must recognize and communicate the benefits of integrated working, which enhances job satisfaction Achieving this requires a deeper understanding of the concept of integration and active involvement in the change process.

ã COMPENDIUM OF EXAMPLES OF INTEGRATION IN WALES

Source and date Summary Region

1 The Wallich Reflect to Perfect Group 2016 http://www.goodpractice.wales/

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The Wallich is a dedicated supported housing organization in Wales, focused on assisting homeless and vulnerable individuals By offering opportunities for skill development and encouraging client feedback, we enhance the support services provided to our clients.

Mawr 2016 http://www.goodpractice.wales/

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Cynefin is a Welsh Government initiative designed to enhance the well-being of underprivileged communities throughout Wales The program employs eleven 'Place Coordinators' who actively engage with residents, foster communication among stakeholders, and empower locals to elevate their quality of life.

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The Llyn Parc Mawr Community Woodland Group was formed under the Cynefin programme, which seeks innovative strategies to enhance the long-term well-being of communities throughout Wales.

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A consortium of Welsh local authorities who collaborate in relation to commissioning placements for looked-after children All Wales

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Cynefin is a Welsh Government initiative aimed at enhancing the well-being of underprivileged communities throughout Wales The program employs eleven ‘Place Coordinators’ who actively engage with residents, foster communication among stakeholders, and empower locals to elevate their quality of life.

Source and date Summary Region

Numerous examples of integrated working in health and social care

Report - The Parliamentary Review of Health and Social Care in Wales – A Revolution from within: Transforming health and care in Wales (2018)

Multiple integrated working examples All Wales

Centre Hub 2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

Development 2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

9 Pentyrch Surgery 2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

2017 http://www.nhsconfed.org/-/me dia/Employers/Publications/W NHSC-Briefing-Integration- Briefing.pdf

Case Study Cardiff and Vale

Source and date Summary Region

2010 http://www.wales.nhs.uk/sitespl us/documents/829/Joint

Joint working programme examples Cardiff and Vale

2015 https://www.ncbi.nlm.nih.gov/p mc/articles/PMC4494466/

An invest-to-save scheme, serving a population of about half a million.

Launched in September 2011, the initiative focuses on delivering comprehensive services for frail elderly individuals Key components include facilitated discharge, an alternative falls pathway for ambulances, in-reach support to care homes to prevent unnecessary admissions, enhanced case management for those with long-term conditions, and targeted step-up responses for vulnerable older adults.

Action in Caerau and Ely (ACE) Multi

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ACE is a community development organisation based in the Ely &

The Caerau district of Cardiff is collaborating with community members and various partners from statutory and third sectors to establish a sustainable, community-led regeneration charity aimed at addressing social, economic, and health inequalities.

14 Single point of access (SPoA) 2018

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The Single Point of Access serves as a telephone-based Customer Contact Centre, streamlining the integration of local social care and community health services It acts as the primary contact point for Health and Social Services in Cardiff and the Vale of Glamorgan, ensuring efficient access to essential support.

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The service integrates various existing and new offerings to create a cohesive approach, enhancing access to information, support, and advice for Cardiff residents This initiative aims to promote independence and decrease reliance on long-term care and support services.

Source and date Summary Region

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The Accommodation Solutions Team included Housing Re-settlement Officers and Occupational Therapists working with hospital staff to assess and plan for individual housing needs in preparation for their discharge

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The Rapid Response Adaptation Programme (RRAP) was provided by Care and Repair Cardiff and Vale as part of the Accommodation Solutions Project.

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The FOPAL service delivers senior clinical expertise in complex geriatric medicine right at the initial point of hospital contact, aiming to prevent unnecessary hospital admissions By collaborating with intermediate care services, the team effectively manages patients in the comfort of their own homes.

The benefits are well recognised and being embedded in many units in the UK

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

Partnership made up of the City of Cardiff Council, Vale of Glamorgan Council, Cardiff & Vale University Health Board, Welsh Ambulance Services NHS Trust, Third & Independent sectors and carer representatives.

Centre 2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

Source and date Summary Region

21 Dewi Sant Phase 2 development 2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

2017 http://gov.wales/newsroom/hea lth-and-social- services/2017/care-centres/? lang=en

Health Secretary Vaughan Gething announced plans to deliver nineteen new integrated health and care centres across Wales by

2010 http://www.wales.nhs.uk/sitespl us/documents/829/Joint

The Reablement Assessment Team is comprised of five Occupational Therapists—four from the Council and one from Cwm Taf Health Board—along with two Physiotherapists, both employed by Cwm Taf Health Board.

2010 http://www.wales.nhs.uk/sitespl us/documents/829/Joint

Joint working in health and social care Cwm Taf

2010 http://www.wales.nhs.uk/sitespl us/documents/829/Joint

In 2008, Rhondda Cynon Taf County Borough Council, in collaboration with Merthyr Tydfil County Borough Council and Cwm Taf Health Board, formalized a partnership under Section 33 of the National Health Service (Wales) Act This agreement enables local authorities and NHS organizations to engage in pooled funding, joint commissioning, and the integrated provision of community equipment services.

Source and date Summary Region

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The Glyncoch Community Regeneration charity, founded by local residents, serves as a catalyst for revitalization in Glyncoch and nearby regions This transformative organization runs the Communities First program, supports Oxfam’s Sustainable Livelihoods initiative, and enables individuals to express their opinions on services that impact their lives through Community Voice projects.

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

This pilot project in Porth aims to implement strengths-based community development strategies that leverage local assets By actively engaging with the community, the initiative seeks to recruit Community Connectors—individuals who possess a deep understanding of their neighborhoods and maintain connections with local residents.

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

The CHST aims to collaborate with the nursing home sector to identify residents with complex health needs at risk of acute hospital admissions This multidisciplinary team consists of professionals from medical, nursing, dietetic, and pharmacy backgrounds.

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)

Sharon Richards and Anne Morris, ICF leads for Cwm Taf, have played a crucial role in supporting Third Sector innovation Their contributions to the ICF Third Sector stream have been instrumental in fostering integration and implementing significant changes at both strategic and operational levels This support has led to the development of Project 5, known as 'ways to wellbeing.'

Report – Review of ICF (Intermediate Care Fund) – Projects and initiatives which demonstrate good practice (2018)