Latest news stories and opinions about the Dental, GP and Care Industries. For your ease of use, we have established categories under which you can source the relevant articles and news items.
MIND THE GAP! Developing New Practice in response to The Social Services and Well-being (Wales) Act 2014
The Social Services and Well-being Act (SSWA) represents a 'step-change' in the legislation surrounding the DELIVERY of Social Care in Wales. Therefore, the intent of the Act will only be realised if there are developments in service design, professional-practice, and personal care delivery, which enact and embody the changes envisaged in the Act. For the purpose of this paper, I will refer to the intended character of SSWA compatible practice, as 'new practice'.
SSWA 'Drivers' of Change
Before considering the nature of the 'new practice' we need to locate the conceptual and practical 'drivers' of change:
- The concept of 'well-being' as used in the Act requires a super-high level of participation by each client in specifying the service which they will receive. This constitutes a re-coining of the term 'well-being' to include an 'active' constituent dimension - in effect extending its use into that of a verb as well as an adjective. The point is illustrated by comparing the term to the one it replaces in the corresponding English Act, namely 'care,' which is both an adjective (to be 'caring' towards another) and a verb - 'to care' - i.e. the 'act' of caring. It is the premise of this paper that 'well-being,' in replacing 'care,' must be capable of fulfilling the same linguistic functions. This has implications for the nature of person-centred support, as it will necessarily need to facilitate the super-high level of service-user participation envisaged by The Act. Participation should then move the service-user towards their unique well-being goals.
- The concept of 'person-centredness' prescribes that services will be designed around personal needs, strengths and abilities, as a departure from fitting individuals into existing services. The extended well-being concept requires a clear and strong central focus upon individually identified goals, and serves to negate service provision based upon 'old' values ('doing-to' or 'doing for').
- Funding arrangements designed to facilitate direct funding will empower service-users, or their chosen representatives/advocates, to tailor bespoke services around client need. In effect the service-user under these arrangements will become the commissioner of services too. This is intended to raise quality and maximise relevance of provision according to identified goals.
The Organisational Implications
As a result of the implementation of the Act, these concepts will need to be operationalised and put into practice. Practice change of this order will require support at process and organisational levels, both within Local Authorities (LA's) and within care-provider organisations. It will also require fresh thinking.
For example, when considering completed assessments, what will be the mechanism for deciding 'fair access' to care; how will this work and who will be involved; what will the criteria be for resource allocation and deciding between diverse well-being goals; and what will be the means of appealing and contesting decisions?
These are complex 'whole-system' questions which require workable solutions to be operationalised with the implementation of the Act.
Professional Roles and Assessment
If social workers continue to lead LA's assessment and care management procedures, they will necessarily find themselves having to balance the assessment function against that of resource 'gate-keeping,' thereby placing a constraint upon their ability to be person-centred. I would suggest that this will require 'new practice' from social workers to accurately locate and represent subjective service user well-being goals. This will require training and supervision to foster 'new-practice'.
In addition, therefore, to a wholesale requirement for training to raise awareness of the scope and function of the SSWA, specific training for social workers involved in eligibility assessments, or nurses, residential and support worker staff involved in service-specific assessments, will be required around 'eliciting', 'listening', and 'recording' skills.
There will surely also need to be some further measures to ensure that LA's extend assessment practice into more SSWA compatible person-centred formats. This logically would see the availability of independent individuals who could undertake the person-centred assessments, as well as advocates to represent the interests of the service user.
Conceivably the 'practice-gap' surrounding the assessment function could be filled by such suitably qualified (person-centred, knowledge of SSWA) and experienced individuals. This would provide a check against a wholly LA view determining the entire scope of the SSWA assessment and eligibility process. It also appears compatible with the person-centred practice, and increased access to advocacy, aspects of the Act.
The manner in which assessment data is captured will also need developing. Data will need to incorporate verbatim, where possible, the service-user's own words and reflect strengths and aptitudes as well as 'needs'. Support plans, arising from assessments, will be predicated upon identifying the 5 W’s (who, what, where, when) which need to occur to realise the well-being goals.
Consequently, if followed through in a logical manner, the SSWA will result in an extensive developmental agenda for social workers, nursing, care and support worker staff, requiring training and practice supervision to embed 'new' assessment practice.
Key to the 'new' practice will be an awareness and understanding of the well-being and person-centred concepts. Without awareness and understanding they will not be operationalized, and practice will continue as present. But adoption of the concepts raises fundamental questions of both professionals and agencies. How person-centred can an assessment be if it is undertaken by an employee (social worker) of the funding agency (local authority)? Surely it will be difficult for social workers to be impartial and truly person-centred when surrounded by a culture which has to be budget conscious. This is not to be idealistic about what can be provided, but it is to make a distinction between the assessment process and decisions about funding
In future articles; I will further consider practice around person-centred assessments with individuals with communication difficulties and delivering complex but truly person-centred support plans.
Paul Rees – QCS Expert Welsh Care Contributor