The Wales way forward

by Huw Thomas

25 September 2018


Wales has the framework in place to deliver integrated services and to focus on the delivery of value over the long-term, but it is time to turn intent into action.

Integrating health services more closely with services provided by local authorities and the voluntary and housing sectors is essential if we are to focus on keeping people well rather than just treating them when they are ill.

Wales is well placed to make this happen through its existing policy and legal framework, our size and structure. Being a small nation, we can focus on a ‘once for Wales’ approach and our drive for collaborative working. We already have integrated health boards and a planning-based system to address the challenges; and legislation, such as the Social Services and Well-being (Wales) Act 2014 and the Wellbeing of Future Generations (Wales) Act 2015, provides the clear encouragement to think about issues over the long term and to focus on value.

Echoing this years’ independent Parliamentary review into health and social care – A revolution from within: transforming health and care in Wales – and the Welsh government response – A healthier Wales: our plan for health and social care the framework is in place and it is now time to operationalise plans quickly. In doing so we need to be aware of what we are spending, how we are spending and the impact and outcome of spending.  Our plan must think about who will be at the door of the NHS in six months’ time, six years’ time and beyond and how our plans can have the best impact.

We already have much progress to be proud of in Wales – such as our initial work on value-based healthcare, working closely with the International Consortium for Health Outcomes Measurement. The HFMA briefing, published this week, 70 years of the NHS in Wales: the changing role of the NHS finance function shares some of the positive examples from the finance community and the critical role finance professionals have in supporting the NHS transformation agenda.

However, the scale of the challenge is not to be underestimated. The demography and geography of Wales, and access across rural areas, create an inherent difficulty. And across Wales performance standards clearly show both an increasing number of unscheduled care cases and a continued number of patients waiting longer than the target time for services. Although there is a clear commitment in Wales to collect both costing and outcomes data to underpin improved value, this approach remains at a relatively early stage with scaling up of pockets of good progress required.

It is time now to address these challenges head on, turning intent into action.  Building on the good progress in recent years, it is imperative that we shift the way we work to focus on delivering value with our partners both in the short and longer term.  A focus on outcomes is core, along with trust, in developing a common vision and approach to co-plan and co-deliver – with local authorities and others – an integrated health and social care system. Work has already begun with regional partnership boards to develop area plans and pooled budget arrangements.

For me there is something really powerful about the way we work as a community of professionals to address issues, which I am sure will be underlined again at this week’s HFMA Wales Branch conference Leading the way: made in Wales. As well as looking forward to hearing speakers and learning from the floor, what makes the conference – and what I always look forward to – is those that attend it and their desire to share stories and support each other as we push forward in delivering our NHS plan.

This blog was written ahead of the Wales branch conference.  After the event, presentations from the conference (held 27-28 September 2018) are available here