To integrate, or not to integrate…? by Viv Sugar

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

It’s discussed endlessly, but we seem no nearer a consensus: should health and social care be formally integrated? This is the subject of Viv Sugar’s blog this week in our ‘20 blogs for 20 years series’, to mark the Institute’s 20th anniversary. Viv has a wealth of experience at the most senior levels in local government and across the public sector more generally, in Wales and throughout the UK. Different approaches to integration proliferate, and there’s much to learn from them all… but which is best?

To integrate, or not to integrate…?

In 1974 I was working in Teesside County Borough Council’s Health Department when our service was transferred into the NHS. With a highly regarded, innovative and creative service pioneered by the Medical officer of Health, Dr Paddy Donaldson and a progressive Minister of Health in Barbara Castle, I was optimistic about the future. But 6 months in, I had no definitive budget to work to, orders of sterile supplies were not arriving in time for our clinics and with complaints falling on deaf ears, I realized that the total focus of the new Senior Management was on the hospitals and not the community.

Why am I remembering that now? Because two recent experiences have shown me that forty years on, acute, community and social care services are still not as seamless as they need to be to ensure the best outcomes for patients and carers. Of course individual personal experience does not necessarily make a solid foundation for the development of public policy but recent experience of frail elderly relatives who live alone and a visit to Scotland have made me realize how much more we need to do. Liaison between hospital, GP, District Nurses and Social Services required some family intervention to make it work. Individually most of the staff, the doctors, nurses and carers were professional, compassionate and trying to do their best under great pressure and with limited resources. But there was a lack of clarity about who was “championing” the patient and finding a path through the maze of agencies, voluntary bodies and the complexity of the DWP and Council forms that had to be completed. At the most basic level who could be found to boil an egg when appetite was not up to coping with a Meal at Home offering?

A few weeks ago I visited one of the Scottish Councils who have formed a Health and Social Care Partnership with their local NHS Region. The Partnership Director reports to both the Council and the NHS Chief Executives and sits on their Management teams. In that area, clinical health professionals, social work services, housing services, care home and home care providers, voluntary and community services and representatives of people who use health and social care services are all working together as partners for change. The Partnership brings together local government services for children, families, adults and older people with Community Hospitals, District Nursing, Community Mental health services, Learning Disability services, allied health professionals etc. Their vision is of enabling everyone to live longer, healthier lives at home or in a homely setting. The focus is on prevention, anticipation and supported self- management. For older people they aim to deliver more care at home by increasing the number of integrated community teams in local communities around G.P. practices. Sharing information and increasing access through a single point of contact and sustaining independent living.

I was impressed but they stressed that they are only 6months in. And then they asked me what they could learn from Wales…..

Viv Sugar


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‘No more throw-away people – the co-production imperative’ by Ruth Dineen

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

Ever wondered what ‘co-production’ really is, but been too embarrassed to ask?  Well, save your blushes, and read on…  This week’s blog in our ’20 blogs for 20 years’ series is by Ruth Dineen, who knows more about co-production – and has done more to promote it – probably than anyone else in Wales.  Ruth is joint head of Co-production Wales

‘No more throw-away people – the co-production imperative’*

Last year, a number of those involved in developing the Social Services & Well-being Act and received a letter from Edgar Cahn – an American civil rights lawyer and founding father of the international co-production movement.

‘I just learned of your breakthrough achievement: embedding the co-production imperative into the health care system in Wales. This is an act of profound importance in an age that seems only to value budget cuts as a form of efficiency.

You did it. You worked from the inside to make this remarkable achievement possible. And I was thrilled to hear of how your efforts joined with others’ … [to culminate] in an affirmation of what we need to hold most precious: the strengths and capacities of community members to care for each other and to live vibrantly and well through mutual support, trust, and strengths.

Yours is a first.’

This was a high point.

Co-production – an asset-based approach to public services based on equal and reciprocal relationships between state and citizens – appeared to have entered the mainstream. Wales was in the vanguard of an international movement for social justice.

So what happened next? Is co-production here to stay? And if not, why not?

On the plus side are growing numbers of supporters and practitioners: professionals and citizens, researchers, government officials and politicians. There’s a compelling evidence base and a wealth of real people’s stories. Co-production inspires and engages. It transforms lives and services. In other words, it works.

But not everyone is a fan. Some assume that co-pro is just a re-branding exercise with nothing new to offer; some argue that it is a neo-liberal con-trick – an attempt to get volunteers to do what the state should be doing. And some confuse co-production with engagement, consultation and collaboration.

Such challenges are not insurmountable. Misapprehensions can be refuted and people persuaded.

A more significant barrier to progress is an apparent gap between the stated desire of government to act as an enabler of co-produced services and their subsequent willingness to invest in that change. Our shared ambitions will only be achieved if state and citizens have a sense of common purpose based on relationships of trust and reciprocity. That requires time, real commitment and explicit, funded support.

There’s a long way to go.

 Ruth Dineen, Joint Head, Co-production Wales

* Cahn, Edgar (2004) No more throw-away people. The co-production imperative, Time Banks USA, Washington.

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Riding the wave of success

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week we are delighted to welcome Dr Ruth Hall as our guest blogger, in the 20 blogs for 20 years series celebrating WIHSC 20th birthday.  In addition to various senior public appointments, Ruth is the joint Chair of the Mid Wales Healthcare Collaborative – her co-chair was last week’s blogger.  As a former Chief Medical Officer for Wales, Ruth has a wealth of experience in health policy, as well as a lifelong commitment to making Wales a healthy country for its citizens.   


Riding the wave of success

Many congratulations to WIHSC, this year celebrating their 20th anniversary, an excellent reason for those directly involved to rejoice and for the rest of us, caught on the wave of WIHSC’s achievement, also to celebrate.

We should be celebrating successes much more regularly, not just the significant landmarks but the everyday milestones. As well as giving credit where it’s due, it enables a wider audience to enjoy the warmth and satisfaction of reflected glory. This particularly applies to the NHS where there’s much missed opportunity to contribute to wellbeing in this way. We hear big research developments reported nationally but only sporadic echoes of the many outstanding day to day clinical achievements. Clinicians and practitioners naturally get a personal kick out of things that go well and from achieving aspirations, but this effect is magnified when shared.

The importance of wellbeing in everyday life and as a positive promoter of health is not in doubt. People in mid Wales, asked what upsets their wellbeing, often refer to loneliness and isolation. Granted this is a rural area, but evidence points to the same issue undermining urban communities. Not just engaging, but involving people in planning and development of health and social care, gives them chance to share directly in achievements and this itself has to be good for health; we need to be proactive in making sure everyone knows about the successes as well as the problems.

A welcome development, fully acknowledged in the Wellbeing of Future Generations Act, is acceptance that outdoor activity and recreation can bring significant capital in wellbeing and health. It is also bringing increasing economic capital to Wales with the development of new recreation opportunities – adding zip-wiring across quarries, zorbing, mountain boarding, kite surfing and cliff-hanging camping to our longstanding traditions of mountain walking, rock climbing and caving.

It’s interesting that adrenaline-fuelled highs are now sought widely as ‘recreation’ which, in less generally sedentary eras, used to be a term more often equated with rest and recuperation. One of the traditional images of Wales from earlier times is of tranquil, green space where one might reflect and switch off. We lose this at our peril; not everything valuable in life is a commodity and it’s important that some profits also remain personal.

In Wales we have lots to be thankful for; and we can justifiably ride the wave of success and celebrate as WIHSC moves on to its next 20 years.

Well done WIHSC!

Dr Ruth Hall

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Accountability in the NHS – The pursuit of a false God? by Jack Evershed

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

What’s the most interesting job in NHS Wales?  One of the contenders for the title must be a job thats so big it takes two people to fill it!  This week’s blog in our ’20 blogs for 20 years’ series is by Jack Evershed, the joint Chair of the Mid Wales Healthcare Collaborative.  Jack – along with his co-Chair, Dr Ruth Hall, who will be writing next week’s blog – leads a unique collaboration of three Health Boards and the Ambulance Trust.  Recommended in the WIHSC review of healthcare in Mid Wales,  it is forging a new pattern of services, and a new way of working, for the people who live in a band across the middle of Wales from Ceredigion and south Gwynedd to the English border.  

Jack’s background confirms the uniqueness of this new force in healthcare.  Like Britain’s political elite, he read PPE at Oxford, but then ran the family farm, while finding time to lead the Community Health Councils in Wales, and campaigning on local health issues.  His blog reflects on how NHS Wales should make difficult decisions, which has particular resonance in the context of the Welsh Government’s current Green Paper on NHS governance.

Accountability in the NHS- The pursuit of a false God?

Ballot Box? Courts? Governance structures?

During the lifetime of WIHSC the pursuit of accountability within the NHS has led to an almost bewildering array of structural changes. Often the judicial process has been the last resort provider of accountability (eg Francis report, judicial reviews, compensation cases). This is a negative accountability, not the positive accountability that everyone is seeking – an NHS that takes account of and acts on the hopes, fears and aspirations of its population.

Welsh Health Ministers have tried various governance arrangements to provide a Health Service that is responsive to the local population. Small local boards, commissioner provider splits, larger regional boards, patient bodies, all have been tried but have not consistently provided the answers. Often these organisations have been unable to meet the aspirations of their populations or meet their statutory requirements or targets. Perhaps it is the pursuit of accountability that has led to this unsatisfactory situation. In the same way that allowing farmers with their diverse needs to dictate the weather would lead to climate chaos, trying to formulate an NHS governance structure that promises local accountability may be intrinsically flawed.

The Westminster Government has retained accountability for the Economy but has delegated the operation of the main levers of the Economy to an independent apolitical committee, the Monetary Policy Committee (MPC). The Government sets the framework (growth, inflation etc) and leaves the decisions on the operation of monetary policy to the MPC. This averts short term political necessities interfering with what needs to be long term strategic management.

Perhaps this provides a model for the Welsh NHS. The democratic process can lead to a set of principles within which a Health Services Committee should operate*. These would be high level principles about equality of access, quality of outcomes, promotion of health and well being. The long term strategic decisions would be taken by this body, rather than the various local bodies with their diverse pressures. The local bodies can then concentrate on the delivery of services. This way the positive accountability (responsiveness to people’s needs and aspirations) remains with the Welsh Government, and the negative accountability (duty of care) is shared with the local bodies delivering the service.

There are many grey areas in this model about some of the commissioning decisions. In the same way that the MPC sets the base rate and the banks, building societies and other financial institution deliver a variety of loan packages and deposit accounts, so the local bodies could deliver services in various ways. Perhaps this model could deliver high quality services that are fair, sustainable, and adapted to local need.

Jack Evershed, the joint Chair of the Mid Wales Healthcare Collaborative

*Similar arrangement to the All Wales Medicines Strategy Group.


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Regulation for success

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog in our ’20 blogs for 20 years’ series completes a trilogy of blogs on regulation by the heads of the three main regulatory bodies for health and social care in Wales [Listening and Speaking Out by Dr Kate Chamberlain  and Basing Regulation on human rights in health and social care by Imelda Richardson].  Rhian Huws Williams is  the Chief Executive of the Care Council for Wales, which is shortly to be transmogrified into Social Care Wales.  But as Rhian points out, this is much more than a re-branding exercise.  The new body will still police professional staff and their training, but it will also be charged with ‘regulation for success’.   What does that mean? Can the two be combined successfully?  And what does it mean in an increasingly integrated world?


Regulation for Success

“Regulation for success,” that is how the Minister for Health and Social Services has described his vision for the new regulatory and inspection arrangements for social services and social care in Wales through legislation which will come into force in 2016. He intends that the Regulation and Inspection Bill will forge a regulation system geared to support success, not simply to identify or describe failure. The approach will be to regulate for improvement and for success. This is music to my ears!

The importance of synergy between regulation and development has been a founding principle for Care Council for Wales (the regulatory body for social work and social care practitioners and training) since its establishment in 2011. This is also the model for the sister regulatory bodies in Scotland and Northern Ireland. But it goes against the grain of the health professionals regulatory models which are non-devolved.

Effective regulation needs to be about:

  • Protection for those who use the services
  • Strengthening and supporting professionalism
  • Raising standards of practice (and education)
  • Contributing to the wider whole systems improvement

That requires partnership working. The Welsh Government was ambitious when it established the Care Council as a body where all interested parties would have a voice. A collaborative model and at the time a blueprint for citizen-led regulation.

It has not been tokenistic. But more can be done.

The Regulation and Inspection Bill will reconstitute the Care Council for Wales as Social Care Wales. This will involve a step change for the social care sector and, for the first time, it will combine responsibility for workforce regulation, workforce development, research and service improvement all within the one leadership body with a prime purpose of securing the best outcomes for people in need of and receiving care and support.

The Minister is looking to Social Care Wales to build on the successful foundations laid down by the Care Council. The key difference will be its new strategic focus and authority for setting and supporting the delivery of the improvement agenda for services. The workforce and supporting partners will play an important part in delivering that improvement across the social care sector.

What and how we learn from regulatory work is vital. What does the information tell us about areas of concern and how do we use that information to target and support learning and improvement? That is the ultimate added value.

With our eyes firmly on improving outcomes and strengthening safeguards for children and adults in Wales and more integration what appetite might there be in Wales to discuss some of the ideas offered by the Professional Standards Authority on how professional regulation can complement, support and facilitate the cultural and practice changes which are now required in Wales?

Over the years the team at the Welsh Institute for Health and Social Care have been prepared to generate and facilitate discussions on similar hot topics in health and social care. They have hosted some tricky round table conversations that exposed assumptions and long established positions, but also generated thoughtful reflections and were catalysts for change.

For change to happen we must secure opportunities to think the unthinkable, to avoid assumptions, to take risks, to accept that there will be failures but also to learn from failure in order to inform development. We need evidence for what really works and makes a difference.  For reform to become a reality, we need distinctively Welsh solutions, drawing on the strength of our local communities and our workforce and building on our Welsh values.  Ambition is critical, in both senses of the phrase.

Rhian Huws Williams, Chief Executive, Care Council for Wales

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Basing Regulation on human rights in health and social care by Imelda Richardson

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog in our ’20 blogs for 20 years’ series is by Imelda Richardson, Chief Inspector, Care and Social Services Inspectorate, Wales.  It takes a fresh look at the fundamental basis of service regulation in Wales, and nicely complements Kate Chamberlain’s contribution last week.  Imelda argues for a completely different approach, based on individuals and their human rights, rather than one based on the services they happen to receive, or the setting in which care is provided.  In the context of the current Green paper on service governance, the implications for an integrated approach to regulation are certainly thought-provoking.


Basing Regulation on human rights in health and social care

Rethinking regulation[1] argues for a radical overhaul of regulation to meet the aims of health and care services. My proposal is to move from place/service based regulation to person centred regulation based on human rights[2]. This would enable constant enduring rights across health and care, specific to your required wellbeing outcomes and, passported to wherever you are.

This approach empowers people to know and claim their rights; improving the effectiveness and accountability of regulators, commissioners and providers of services who are responsible for protecting and promoting those rights. Human rights based regulation would meet the fundamental values; dignity, autonomy, equality, fairness and respect. Regulation based upon citizen’s human rights enables them to have personal responsibility for their wellbeing.

Each care provider at any point would evidence human rights based legal duties for their service, taking us beyond service definition of regulations to a person centred and more flexible rationale for established, new and emerging health, housing or social care services. This could determine what regulation people require for integrated services such as Extra Care Sheltered Housing, where accommodation is registered by the local authority, domiciliary care by the social care regulator but both services may be provided by the same provider.

The Equality and Human Rights Commission[3] inquiry found serious systemic threats to the human rights of older people who needed or used home care. They highlighted the role commissioners of services can play in the promotion and protection of human rights through their procurement and monitoring of home care. The Commission found a lack of awareness among public authorities with responsibility for home care services about what compliance with the Human Rights Act means in practice. They established a framework to assess the risks to human rights in home care services, which focus on the areas of dignity and security; autonomy and choice; privacy, social and civic participation.

What would a well being and human rights based approach to regulation look like? 

The statutory framework would establish and clarify the roles and responsibilities of relevant parties by reference to a citizen rights based model.

Article 21 of the Convention on the Rights of Persons with Disabilities is concerned with freedom of expression, opinion, and access to information. The example shows how a well being and human rights approach to regulatory activity, taking account of the provisions of article 21, could work in practice:

Citizen: I have the right to information, in Welsh, language of choice or other means (eg Braille, British Sign Language, Makaton), about any changes to my care service.

Provider: I have a legal duty to consult with people in the language of their choice, or using other means of communication, about changes in their care service and report on the consultation to the regulator/inspectorate.

Commissioner: I have a legal duty to keep the people informed, in the language of their choice, or using other means of communication, about changes in the contract for their care and care funding.

Regulator: We have a legal duty to ensure there are no barriers to access to information to people using services and that the provider and commissioner are compliant in respect to their respective duties.

Regulation has developed from a risk, principles and rules base[4] to right touch[5], all of which contribute to the development and improvement of regulators work, however human rights based regulations are objective, taking into account the effect on all who are involved and empowering people to exercise their rights for themselves.

Imelda Richardson, Chief Inspector, Care and Social Services Inspectorate, Wales


[1]Harry Caplan, Professional Standards Authority, Rethinking Regulation, August 2015

[2] Imelda Richardson, Four Nations Seminar, 12/11/13

[3] Equality & Human Rights Commission (EHRC), 2011.Close to Home and EHRC,2013 Close to Home Recommendations Review.

[4] Better Regulation Executive, 2000, Five Principles of Regulation

[5] Council for Health Care Regulatory Excellence, 2010, Right Touch Regulation

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Listening and Speaking Out by Dr Kate Chamberlain

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week we reach the 10th in our ’20 blogs for 20 years’ series, celebrating the Institute’s foundation back in 1995. This week, the Chief Executive of Healthcare Inspectorate Wales, Dr Kate Chamberlain, reflects on the dual responsibilities of Listening and Speaking Out, and how these might apply, not only to NHS staff, but to the population of Wales as a whole.

Listening and Speaking Out by Dr Kate Chamberlain

LISTEN (ˈlɪsən )

verb (intransitive)
1. to concentrate on hearing something
2. to take heed; pay attention ⇒ I told you many times but you wouldn’t listen

All of us connected in any way with health services have a responsibility to ensure that we are creating an environment where ongoing and real-time feedback is encouraged and that we capture and respond appropriately: either to address concerns, or to spread the word when things are working well.

The health service collectively continues to work hard at developing care providers as “listening” organisations:

• 1000+ lives published their improvement white paper ‘The Listening Organisation’ [1] in 2013;
• also in 2013 the Welsh Government published their ‘Framework for Assuring Service User Experience’ [2];
• the revised Health and Care Standards published in 2015 reflect this ongoing importance by including a new standard on ‘Listening and Learning from Feedback’ to support the delivery of individual care [3];
• Also in 2015 a follow-up paper was published by 1000+ lives titled Listening and learning to improve the experience of care [4]

This is essential work. When things go wrong the subsequent inquiries and investigations such as those in Mid-Staffordshire [5], Abertawe Bro Morgannwg University Health Board [6], and Tawel Fan [7] frequently report that patients, relatives, carers, and staff were trying to raise concerns long before matters came to a head, but encountered difficulties in doing so.

But developing listening organisations is only part of the equation…

For listening to be really effective there needs to be a body of people: staff, patients, relatives, carers, friends, who feel willing, able, empowered and enthusiastic to provide honest and timely feedback on their experience of care and constructive, positive suggestions on how services could be improved.

As highlighted above, too often people are reluctant to do so for a whole variety of reasons:

– It won’t make any difference – Its difficult, complicated and time-consuming – Afraid that negative feedback may have consequences for themselves or relatives – Not sure whether they are expecting too much

Prudent healthcare includes a principle around “achieving health and wellbeing with the public, patients and professionals as equal partners through co-production”. In practice the public, patients and professionals are not discrete groups. The Welsh Health Survey [8] showed the extent to which the public are also patients or users of health services:

• almost 1 respondent in 5 had attended a GP in the previous 2 weeks,

and in the previous year almost

• 1 in 5 had been to A&E;
• 1 in 10 had been an inpatient;
• 1 in 3 had been to outpatients;
• 2 in 3 had used a pharmacist or dentist.

Taking into account relatives and friends the overlap is even more pronounced.

And of course all professionals are also members of the public, users of services, related to a user, or a friend of a user; or so on. And interestingly roughly 1 in 25 (75,500) [9] of working age people work in the health service.

Of course we need to ensure that organisations are listening, but we also need to pay as much attention to enabling and encouraging people to speak. And those ‘people’ are all of us, in whatever capacity we find ourselves: public, patient or professional.

Wales is a relatively small country and that gives us the opportunity to harness the commitment and support for local services which is evident in the unease frequently expressed by local communities when service change is proposed, and to use this energy to drive and influence positive change.

Maybe the real power lies, not in developing the listening skills of the 75,000, but in developing, encouraging and harnessing the combined power of the 3 million to speak out and actively contribute to the development of consistent high quality care?

SPEAK OUT (spēk aʊt′)

verb (intransitive, adverb)
1. to state one’s beliefs, objections, etc, bravely and firmly
2. to speak more loudly and clearly

Dr Kate Chamerberlain, Chief Executive of Healthcare Inspectorate Wales



[1] ‘The Listening Organisation – ensuring care is patient centred in NHS Wales’, 1000+ lives, 2013’
[2] ‘Framework for Assuring Service User Experience’, Welsh Government, 2013,
[3] ‘Health and Care Standards’, Welsh Government, 2015
[4] ‘Listening and learning to improve the experience of care’, 1000+ lives 2013,
[5] ‘Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry’, 2013
[6] ‘Trusted to Care’, Andrews and Butler, 2014
[7] ‘External Investigation into Concerns Raised regarding the Care and Treatment of Patients; Tawel Fan Ward, Ablett Acute Medical Mental Health Unit, Glan Clwyd Hospital’, Ockenden, 2014
[8] Welsh Health Survey:
[9] StatsWales:

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20 Years of Learning by Stewart Greenwell

Introduction by Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog in our ’20 blogs for 20 years’ series is by Stewart Greenwell, whose entire career has been devoted to helping people improve the quality of their life, most recently as Director of Social Services, Housing and more in Torfaen and then Newport.  He reflects on what health and social services should really be about, and how improving people’s quality of life starts with understanding the worlds of both clients and staff.


20 Years of Learning

20 years of WIHSC has made me reflect on my own journey over the last 20 years, albeit now retired, but still working – a conundrum that is becoming clearer by the day!!

In 1995, I was regional manager in South West England for CCETSW, the social work training council, that followed 10 years, between 1982 and 1992 as an academic.

I wanted to get back into local authority social services, to the amazement of friends, my family and colleagues. Eventually I returned in 1997, as Area Director in Gloucester, finding, unsurprisingly, that it was still about working alongside people who were, amongst other things, experiencing poverty and finding it tricky to lead successful lives and to provide for those around them.

I had always been interested in community development, making as many links with key local people and agencies as possible, to understand the neighbourhoods in which I worked. So on my return to local government in 1997, I sought out opportunities to again build links with other agencies in the city and the establishment of Primary Care Groups, the predecessors of PCTs, was one that I seized upon.

It was a large group, probably 20 in all, with about 10 GPs, giving us all the chance to find out more about what other people and agencies could contribute to the health of the population. I was the sole representative from social services and gave a lot of time to listening to GPs to understand their world view. There was very little consistency between them, but my understanding developed, such that I became a local expert on phlebotomy services (probably because I admitted to not knowing what phlebotomy meant) with GPs regularly suggesting that I should do presentations on the importance of the service, as I seemed to have ‘got the message’.

That has continued, ie getting the message. I moved to Wales in 2000, as Assistant Director, Performance and Partnerships for Torfaen CBC and was mainly responsible for the relationship between the council and the NHS. Eventually I was appointed Chief Officer, Social Care and Housing in Torfaen, meaning that I had to develop understanding of the ‘housing’ world, as well as the NHS.

I challenged the barriers between these different and at times competing worlds, winning small battles, but struggling to find and suggest a different way of responding to demand.

In 2009, I moved to Newport, holding the responsibilities of director of social services, as well as being responsible for ‘customer care’, something that I cherished but had found little real evidence of it, as a dominant cultural and organisational characteristic.

A new railway station was built in the city to coincide with the Ryder Cup in 2010. Most of the old railway station has lain unused for the previous 30 years, only the ground floor operating as a booking office and entrance to the station. The five floors above were empty and deteriorating. The city council wanted to develop one Face to Face centre in the city, to save money on the many offices offering public-facing services in the city: a council tax office, a social services office, a housing/homelessness office, an adult learning office and many more.

On appointment I set out to experience what it must feel like to try to access services in the city. It was not good, most reception areas were unwelcoming, with poor displays of information and generally a feeling that if you had the misfortune to need to go into social services, the local general hospital or the CAB, you were probably desperate and left with a sense that desperate people are difficult to help. We eventually stumbled across the idea of refurbishing the railway station and, working with Network Rail, secured a deal that led to the opening in January 2011 of ‘The Information Station’. Staff were trained in customer care skills, the environment was planned to be welcoming and all the city council’s front-of-house services were located there, with the majority of other front-line staff based on the other floors. The experience of seeking out public sector services in the city had been transformed, or, at the very least, significantly improved.

So what has all this got to do with the 20th anniversary of WIHSC?

Everything!! An Institute for Health and Social Care could set its stall as only being concerned with the world of NHS and social services. Or it can get its hands dirty.

I believe that WIHSC, by getting out there, has also discovered and added academic weight to many of the simple things that make a difference to people’s lives.

I discovered early on how it made a difference to homeless people having a freshly painted wall when they moved into a temporary home, or the rubbish moved from outside, which previous tenants had left.

I discovered how important it was to understand the paradigm that GPs used in their daily contact with people and with other professionals. I had to do that, if I was to expect them to understand the world view of a social services manager.

I experienced the nonsense of ‘process over people’ and the intensification of that nonsense when two or more public sector agencies are involved. I had trouble making sense of it and I assumed, quite rightly, that people outside of the professional world would find it even more daunting.

I spotted the importance of housing to us all, it is the difference between feeling ok and feeling unwell, depressed, unwanted and worthless and all of which can easily become the business of health and social care.

I also saw what a difference it makes to the relationship between local people and professionals when we created an environment that gives a message that says: ‘you are worth the effort of creating a setting that welcomes you, makes you feel as if you are important and treats you with dignity and respect’.

All these are critical characteristics of decent health and social care and to its credit, WIHSC has spotted them too!!

Stewart Greenwell

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Don’t Worry be Appy!! by Professor Alka Ahuja

Introduction by Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog in our ’20 blogs for 20 years’ series is by Professor Alka Ahuja, Visiting Professor at WIHSC and Consultant Child and Adolescent Psychiatrist at Aneurin Bevan Health Board.  Alka’s work is at the forefront of the application of Prudent Healthcare principles to clinical practice.  In this blog she describes a brilliant simple and effective App her team has developed, that provides the technical ‘glue’ by which children and young people with autism, their families, and all the services on whom they depend can work in partnership. It is developments like these which transform people’s lives.


Don’t Worry be Appy!!

Smartphone applications (or apps) are becoming increasingly popular. In 2011, 5820 health-care apps were available in the market and this number is increasing rapidly ( A national survey (, 2012) showed that > 160 million apps are downloaded in a month and 70% of British people search for health info online. Yet there is a lack of regulation or guidance for these health-care apps and even lesser control over their content. Despite an increasing number of health related apps in the market there is low level of health care professionals’ involvement in their development and contents. There is growing evidence that mobile apps would benefit not only from health care input but also from having user involvement in their development (McCurdie et al 2012)

Keeping this in mind “ABOUT ME” the autism mobile app was co-produced by the CARIAD team (Centre for Autism Research Intervention and Diagnostic team), Aneurin Bevan University Health Board (ABUHB). The app was developed along with children and young people with autism and their carers in collaboration with colleagues in education, social services, voluntary sector and technology providers. Young people were key in the development of the layout of the app, content, colours, and text.

The app enables parents and children to access, “hold” and share information with services especially at times of emergency eg visit to A&E. It provides a low cost solution to well-known information sharing issue. Having accurate information will mean that more suitable provision could be more easily identified and provided, which in turn will reduce anxiety and stress for the child and family and the number of high cost crisis situations experienced.

This professional and partnership initiative will hopefully prove to be a catalyst for further development as this framework could be used to work with children and adults with other lifelong conditions such as epilepsy, schizophrenia, or physical conditions such as diabetes and at times of transitions or crisis.

Alka Ahuja, Consultant Child and Adolescent Psychiatrist and Visiting Professor, WIHSC


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Dear Diary by Morton Warner, Emeritus Professor

Introduction by Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog, the seventh in our ‘20 blogs for 20 years’ is by the man who started the whole thing off 20 years ago – Professor Morton Warner.  Morton was WIHSC’s first Director, and he and I moved across from the NHS in 1995 to set up the Institute at the invitation of Adrian Webb, then Vice Chancellor of the University of Glamorgan.  In this blog, Morton draws on classical sculpture and Victorian engineering to describe the future of health and social care in Wales…


Dear Diary

Saturday, July 2015, 11am: To the British Museum for `Defining Beauty: the Body in Ancient Greece`.  Not my top choice, I must admit, but how wrong! Had read The Times Review – “These bodies have an odd ability to act like some sort of mythical mirror that reflects back a culture`s own inner self”.  Typical vacuous nonsense.  And the curatorial blurb was no better – “They invented the idea of the human body as a vehicle of intelligent mind and object of beauty”.  By midday I was hooked: all those superbly crafted figures just did it – chunks of marble and alabaster chiselled such that  beauty  was intrinsic, embodied.  Objects able to represent the predominant thinking of the time.

Saturday, 4th July 2015, 3pm: To the London Museum of Water and Steam at Kew.  No idea what to expect, but it filled in the time until dinner.  Reflection – I`ve become a culture vulture!  By 3.10 I was in awe: cavernous chambers fit for an emperor`s tomb; water pumps even bigger than Anish Kapoor sculptures, certainly more understandable;  and brickwork patterning inside and out equal to the V&A.  But more – building on the legacy of John Snow and his Broad Street Pump, the Victorian engineers set out to care for the nation (and its main economic resource, the workforce, which would not have passed them by).  Embodied beauty, Victorian style.

Note to self: the many private sector companies originally involved were not up to the task of developing a coordinated population approach across London.  Water and sewage treatment provision had to be nationalised to get that!

Wednesday, 29th July 2015: Breakfasted early today listening to the Today Programme.  It provided a relief from my disturbed slumbers as I wrestled with whether the NHS of the 21st century could be an outstanding example of national embodied beauty with the dominant ideological forces at play since the mid-nineties.  Repeated assurances of `free at the point of access` are no longer enough when planned conflict (oops, competition!) seems to rule the day.  The 20th century embodiment choice had been easier: combine the 1911 Health Insurance Act and the inception of the NHS in 1948 and there you have it.

Then, through the fog of a Jim Naughty interview with a NICE doctor on why the palliative care Liverpool Pathway is to be relegated to the tick box of history, there was a gem gleaming, albeit one that still remained to be further polished.  Science in medical practice makes us live longer, he said. The Art of practice is to help us live more comfortably.  To this, it seems to me, we need to add pro tem `Support` of the type that cocoons the sick or disabled person and those who look after them. This is where the social services and voluntary sector come in. There we have it in a nutshell!

Thursday, 30th July 2015: Woke early. Still have the nutshell, but there is no kernel.  16.20 hrs, as I write this, it comes to me.  I`m slowing up! It is the notion of `Care` that wraps around SAS, and which must be integral within each element.  The intent to care mutually for one another will bring rewards for all, both to those giving and those receiving help.  My 20/20 vision: An NHS where Care is the guiding moral imperative.  Looking back from 2050 I hope an observer would then be able to describe a Caring NHS as an embodied beauty.

Morton Warner, Emeritus Professor, 71 and a quarter (and ever hopeful) 

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