Legislation and Strategies for Health, Well-being, and Resilience in Wales

Overview of Legislation, Strategies, and Principles in Wales

• Legislation is defined as the whole or part of a country’s written law. It represents the body of rules that govern a society. An example provided is the Social Services and Well-being (Wales) Act $2014$.

• Strategies are the key steps or action plans that relate to specific legislation. An example provided is A Healthier Wales: our Plan for Health and Social Care.

• Principles in health and social care describe the values, beliefs, and behaviors that should guide the delivery of legislation and strategy. An example provided is the prudent healthcare principles.

Social Services and Well-being (Wales) Act $2014$

• This Act focuses on the well-being of individuals who need care and support, as well as carers who require support.

• Contact with social services can occur at different points and for various reasons. For example, an individual might need support during discharge from a hospital after an operation.

• Reablement services provide appropriate care and support to help an individual develop or regain independence. This may be for a specific period of time until support is no longer required.

• Support may be long-term, such as a child living in a residential children's home or with foster carers until they reach adulthood, at which point contact may end or change based on circumstances.

• The Social Care Wales organization identified four fundamental principles of this Act:     - Voice and control     - Prevention and early intervention     - Co-production     - Well-being

Voice and Control Principle

• Individuals must be empowered to have a new relationship with health, social care, and childcare services, acting as equal partners with professionals.

• Equal partnership implies:     - Professionals must assume an adult knows what they want and need to improve their own well-being.     - Children have a right to identify what matters to them. Provided there is no threat to health or well-being, the family should be inherently involved in decisions.     - Advocacy must be available to help individuals be central to their care plan, expressing views, feelings, and wants.     - Information for children must be appropriate to their age and level of understanding.     - Individuals participate in developing personal outcomes—realistic, observable, and achievable milestones describing what they want to achieve.     - Barriers to personal outcomes (e.g., lack of confidence) should be identified so the care plan can include actions to remove them.

• Respect for dignity and diversity includes characteristic, culture, and religious/spiritual beliefs.

• Welsh speakers have a specific right to have their care and support delivered in the Welsh language.

• Promotion of rights and entitlements links to human rights and the right to express concerns and complaints.

• Individuals have a responsibility to contribute to their care, alongside contributions from family, friends, and communities.

Prevention and Early Intervention Principle

• Prevention means delaying or preventing the need for care and support and stopping needs from escalating.

• Local authorities must conduct population assessments to understand well-being needs and barriers (e.g., addressing causes of poverty if identified).

• Section $15$ of the Act requires local authorities to provide or arrange preventative services (information, advice, and assistance) to:     - Prevent or delay the development of the need for care.     - Reduce the need for care for those already having needs.     - Promote the upbringing of children by their families.     - Minimize the effect of disabilities (applying the social model over the medical model).     - Prevent abuse or neglect.

• Preventative services are categorized as:     - Universal: For people without current support needs (e.g., general advice).     - Targeted: For those at increased risk (e.g., people in poverty).     - Minimizing impact: Removing barriers for those with existing needs.

• Early intervention is critical for changing outcomes in circumstances like poverty. Programs such as Families First aim to build resilience before families reach a crisis point.

Co-production Principle

• Co-production involves individuals and professionals working together with shared power and responsibility to find innovative solutions.

• Principles of co-production identified by the Act:     - Assets: Seeing people based on what they can contribute.     - Capabilities: Building on what people can already do and their existing strengths.     - Mutuality and Reciprocity: Understanding each other’s situations and being willing to give and take in decision-making.     - Investing in Networks: Sharing information across communities in Wales to communicate what has worked and what should be done differently.     - Blurring Distinctions: Creating equal partnerships between providers and users with mutual respect. For example, involving individuals in designing tender specifications for services.     - Facilitating: Empowering communities to promote resilience through relationships rather than relying solely on paid services.

Well-being Principle

• Well-being outcomes and definitions are contained in the National Outcomes Framework.

• These definitions were developed through engagement with individuals needing care and their carers.

Well-being of Future Generations (Wales) Act $2015$

• This Act binds national government, local government, health boards, and other public bodies to work together to improve well-being.

• It requires organizations to promote "sustainable development," meaning improving economic, social, environmental, and cultural well-being without threatening the ability of future generations to meet their needs.

• There are seven well-being goals described in Section $4$ of the Act.

• Organizations must follow five ways of working:     1. Long-term: Thinking about the long-term impact of current actions.     2. Integration: Considering how one goal influences and is influenced by other goals.     3. Involvement: Involving diverse people in decisions that affect them.     4. Collaboration: Individuals, households, and organizations working together sustainably.     5. Prevention: Understanding and addressing the root causes of problems to prevent recurrence.

• The Act distinguishes between individual well-being (linked to the $2014$ Act) and the well-being of Wales (linked to sustainable development, economy, society, and environment).

• Example of application: Reducing childhood obesity now to prevent future health problems; or the sugar tax, which charges companies to fund health programs like youth sports.

• Public Service Boards in each local authority must carry out sustainable development and publish objectives demonstrating their practice.

Prudent Healthcare Principles

• The Bevan Commission defines prudent healthcare as healthcare developed, managed, and delivered in a thoughtful, cautious, and wise way.

• The Minister for Health and Social Care asked the Bevan Commission in $2013$ to identify how limited resources could best support high-quality care amidst challenges like an aging population and poverty.

• The Bevan Commission focus includes:     - Individual responsibility for promoting health.     - Prevention and early intervention to reduce healthcare needs.     - Increased efficiency through integrated services (e.g., social services and the NHS combining efforts).

• Prudent healthcare is not about cutting quality or provision, but about using resources effectively.

• The Four Prudent Principles:     1. Achieve health and well-being with the public, patients, and professionals as equal partners through co-production.     2. Care for those with the greatest health need first, making the most effective use of skills and resources (addressing health inequalities).     3. Do only what is needed—no more, no less—and do no harm. This involves stopping ineffective treatments to avoid waste and ensuring safety to prevent devastating errors and financial/reputational damage.     4. Reduce inappropriate variation using evidence-based practices consistently and transparently. This involves shared learning between professionals to understand what works best.

A Healthier Wales: Our Plan for Health and Social Care

• This strategy emphasizes a whole-system approach and the prevention of illness.

• The vision includes:     - A Whole System Approach: Health and social care services are joined-up and respect individual needs rather than forcing the person to fit the service.     - A Wellness System: Promoting health and early intervention to reduce health inequalities.     - Services Close to Home: Moving services into local communities and using technology to support independence, with hospital stays as a final, short-term response.

• NHS Wales Core Values: Putting quality and safety above all, integrating improvement, investing in staff, focusing on prevention/inequalities, and working in true partnership.

• Implementation steps include:     - Personal responsibility for lifestyles (diet, activity, smoking, alcohol).     - Immunization and public health programs (e.g., Healthy Schools Programme).     - Supporting people to live independently at home for as long as possible.     - New technologies for earlier detection and precise diagnosis.     - Utilizing social and community networks to reduce loneliness and isolation.     - Addressing the "social gradient" to close the gap in outcomes between prosperous and disadvantaged areas.

• Ten National Design Principles:     1. Prevention and Early Intervention: Addressing health risks throughout life.     2. Safety: Safeguarding those at risk of abuse/neglect.     3. Independence: Supporting people to be resilient and manage their own health.     4. Voice: Empowering people with info to make decisions based on what matters to them.     5. Personalised: Tailoring services to individual needs, including language choice.     6. Seamless: Ensuring joint working between professionals for less complicated delivery.     7. Higher Value: Better outcomes while making best use of resources.     8. Evidence Driven: Using research to understand what works.     9. Scalable: Ensuring good practice is accessible from local to national levels.     10. Transformative: Ensuring new ways of working are sustainable and fundable.

More Than Just Words (Welsh Language Strategic Framework)

• This framework addresses the rights of Welsh speakers to communicate in Welsh when accessing care.

• The Cymraeg $2050$ strategy aims for $1,000,000$ Welsh speakers by $2050$.

• The "Active Offer" means providing services in Welsh without the patient having to ask for them.

• Statistics provided:     - The sector has $200,000$ staff.     - Patients interact with the NHS $20,000,000$ times a year.     - In $2011$, $37\%$ of Welsh speakers lived in mid/southwest Wales and Gwynedd.     - In $2018$, $76.4\%$ of residents aged $3$ and over reported being able to speak Welsh according to Welsh Government ($2019$) data.

• Importance of Welsh language in care:     - Communication in a first language is a matter of dignity, respect, and human rights.     - It prevents the distress of having to translate feelings while in pain or fear.     - Four particularly disadvantaged groups without Welsh provision: children and young people, older people, people with learning disabilities, and people with mental illness.     - It reduces clinical risk and ensures professional standards are met.

• The Welsh Language (Wales) Measure $2011$ states Welsh should be treated no less favorably than English.

• Six Key Objectives for Organizations:     1. Complete approach to Welsh services integral to planning.     2. Provision based on the Active Offer.     3. Increasing Welsh language skills among workers in priority areas.     4. Creating leaders who promote the Welsh language.     5. Providing education and development reflecting the responsibility to provide Welsh services.     6. Mainstreaming Welsh language services in all national strategies and policies.

Questions & Discussion

• Activity 1: What does an advocate do?     - Based on a $3\text{-minute}$ video, how did advocates help Robert, Korto, and Ali? (Note: Video content not fully transcribed, but advocacy involvement is the Focus).

• Activity 2: Case Study – Nia and Owen     - Nia ($16$) is active and eats healthily. Her grandad Owen ($59$) had a heart attack and is obese with poor diet. Owen is now recovers at home, on long-term medication.     - Question $1$: State one way Owen’s choices influenced his health later in life. (Answer context: Diet and low activity leading to heart attack/obesity).     - Question $2$: State one way Nia’s choices impact her future health. (Answer context: Active lifestyle and fruit/veg consumption reducing risk).     - Question $3$: List two healthcare resources Owen used that could have been prevented. (Answer context: Ambulance crew, intensive care, heart operation, long-term prescription).     - Question $4$: How might Nia’s use of healthcare differ? (Answer context: Less reliance on emergency/acute care due to prevention).

• Activity 3: Case Study – Gwyn and Dr. Jones     - Gwyn ($50$) has hypertension and is overweight. He initially lied to Dr. Jones about going to the gym and eating healthily.     - Question $1$: Describe why Gwyn might have lied. (Answer context: Thinking it was what the doctor wanted to hear).     - Question $2$: Describe why honesty is important. (Answer context: Building a realistic plan that works; co-production).     - Question $3$: Describe why taking responsibility is important. (Answer context: Improving own well-being outcomes through lifestyle changes).

• Activity 4: More than Just Words Video     - Discusses the difference the Welsh language made for a daughter's hospital care and the impact on well-being.