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.
The Six Regional Boards: Reducing Parochialism?
Since the disestablishment of our 13 counties in the mid 70s, Local Authority Boundaries have shifted within Wales several times. Our current 22 Local Authorities have been comparatively stable and successful when viewed in the context of their previous incarnations, however, and Social Services departments will continue to function within these boundaries under the terms of the forthcoming enactment of the Social Services and Wellbeing Act.
At the same time, however, it has been recognised that problems exist in the application of national policies.
Firstly, we sometimes have a tendency to create unnecessary bureaucracy. The great Gareth Edwards once quipped that our love of rugby stems from our preference for committees to discuss and organise anything – and he suggested that a scrum can be viewed as the ultimate committee meeting! This propensity for in-house discussion has led to Local Authorities doing their own thing, and disparities therefore occurring, within systems that were designed to provide rigid national guidance. A major example of this can be seen in the application of Safeguarding legislation, with clear differences in reporting requirements between adjoining authorities. I recently spoke with a regional manager for a large Learning Disability service, who told me the following:
- One authority rigidly adheres to the submission of the standard VA-1 form for every safeguarding concern, filled in by the service provider.
- Another authority seeks the same form, but from the alleged victim’s care coordinator.
- That a third adjoining authority does not seek the VA-1 form, but asks for summary emails instead.
None of these ways of working are inherently wrong, of course. The first approach sticks rigidly to stated policy, the second involves and informs a key individual, and the third may well speed up unwieldy processes. It undoubtedly creates confusion, however, particularly for service providers who straddle Local Authority boundaries.
If we continue the rugby analogy, then our success over the past ten years has been built on our defence or, more specifically, our ability to protect our territory. This highlights another national characteristic. We can be notoriously parochial, and nowhere can this be better illustrated than in the jealous demarcation of our own roles. While there is nothing wrong with preserving and applying our own area of expertise, we have probably all experienced times when service-users have complained about unnecessary duplication because of failures to communicate. And how many of us have sorted out a miscommunication and said to our colleagues “I wish people would talk to each other.”
Perhaps the greatest illustration of this territoriality is the reluctance of services to allow another specialism to get involved with a service-user when there is an obvious need i.e. “We don’t need them, we can manage.” Conversely, a specialism may also not wish to get involved if and when they are asked to do so i.e. “They’re already receiving a service so they are ok.” Classic examples of this would be Learning Disability services being unable to fully address a service-user’s Mental Health difficulties because they do not wish to involve the Mental Health service, and/or the Mental Health service being too busy to get involved with someone who is already receiving a service.
While these twin totems of bureaucracy and territoriality have not explicitly been identified within the new legislation, they are clearly addressed. The planned cure can be seen in the formation of six regional entities which will oversee the areas of Safeguarding and Partnership Working.
Within Safeguarding, it is to be fervently hoped that the six Regional Safeguarding Boards will reduce the disparities in the application of the legislation highlighted earlier in this article. The very fact that there are 6 agencies who have to comply with national policy, rather than the current 22, will hopefully drive greater uniformity.
At the same time, this will hopefully not mean that we throw the baby out with the proverbial bathwater. For example, it is not clear at this stage if this will mean a reduction in the number of Adult Safeguarding Officers, designated specialist police officers etc. Current austerity measures may mean that this will unfortunately be the case. Many of us will have built relationships with local safeguarding officers over long periods, which are based on transparency and mutual respect for each other’s judgement. Could the introduction of these larger bodies, while driving uniform application of a vital law, also mean a reduction in these interagency relationships – and unintentionally cause a return to the “bad old days” of the early noughties, when every concern had to go through protracted processes and caused the de facto gridlock of the safeguarding system? Will we still be able to deal with the same Safeguarding professionals in our own locality that we know and trust, or will referrals be dealt with through a kind of clearing system – the equivalent of telephoning a helpline and waiting for “the next available operator.”
These 6 new geographical areas will also see the formation of Regional Partnership Boards, whose remit will be to ensure that service-users receive input from all necessary specialisms, at the stages of both Assessment and Meeting Need. Under the terms of the new legislation, Assessment will need to include specialist input from all professionals that are indicated by the person’s presenting needs (with the exception of emergency admission to a service, such as a safeguarding requirement). Specialist input will also need to continue if a person’s ongoing needs indicate the necessity for it. For example, it will be mandatory for an EMI community service to offer support to an elderly person who originally accessed a service for their physical health needs, who is now developing dementia.
What remains to be seen is whether the Regional Partnership Boards will have powers of enforcement. Earlier in this article we cited the example of a care manager posing the rhetorical question “Why don’t people talk to each other?” It is to be hoped that The Regional Partnership Boards will mean that this question can now be directly asked, and that professionals can be forced to interact and share information, in the interests of the people they serve.
The six regional entities are therefore to be cautiously welcomed, in the hope that uniformity and lines of communication can be achieved, without the loss of trusting professional relationships at local level.
*All information is correct at the time of publishing