Contact:	Nesta Lloyd-Jones, Assistant Director, Welsh NHS Confederation.
Date:	31 August 2021

Introduction

1. The Welsh NHS Confederation welcomes the opportunity to respond to the Local Government and Housing Committee consultation into its priorities for the Sixth Senedd.

2. The Welsh NHS Confederation represents the seven Local Health Boards, three NHS Trusts, Digital Health and Care Wales and Health Education and Improvement Wales (HEIW). We also host NHS Wales Employers.

3. We are calling for an inquiry across all Senedd Committees on tackling health inequalities in Wales. Meaningful progress will require coherent efforts across all sectors to close the gap and an inquiry undertaken by all Senedd Committees will enable Committees to consider what action each Welsh Government department is doing to tackle the root cause of health inequalities and put forward recommendations around where improvements are needed.

4. We also recommend that the Local Government and Housing Committee consider the following key areas during the next 12 months:

· Undertake an inquiry to consider where integration of health and care services is working well and the barriers for further integration.

· Undertake an inquiry into the importance of good housing on supporting people’s health and wellbeing.

· Consider how the Welsh Government and public bodies can better engage with the public.

Health inequalities

5. We are calling for an inquiry across all Senedd Committees on tackling wider health inequalities in Wales. Health inequality is the result of many and varied factors. While COVID-19 has revealed and exacerbated pre-existing health inequalities, there have been many detailed and well-evidenced reports on health inequalities in recent years. In just the past year, many reports have called for system-wide action on health inequalities, including the Welsh Health Equity Status Report initiative, Placing health equity at the heart of the COVID-19 sustainable response and recovery (Public Health Wales and Welsh Government), The Marmot Review 10 Years On (Institute of Health Equity and the Health Foundation) and the most recent Unequal pandemic, fairer recovery (the Health Foundation). Every one of these reaffirms the need for coherent, coordinated activity across all delivery partners and in COVID-19 recovery, there is an opportunity to create a healthier, more resilient society, by addressing the root causes of poor health and invest in people and their communities – their jobs, housing, education and communities.

6. Health inequalities are the result of many factors and arise as a result of the social and economic inequalities that shape the conditions in which people are born, grow, live, learn, work and age. For too long, we have looked to the health service to address these challenges in isolation, but the NHS alone simply doesn’t have the levers to make the changes we know are vital to creating the conditions necessary for good health and wellbeing. Meaningful progress will require coherent, strategic efforts across all sectors – using their available resources, expertise and relationships – to close the gap. It will also be important that we are able to understand and measure our collective progress to ensure that we achieve the outcomes that matter most.

7. In April 2021, the Welsh NHS Confederation’s Health and Wellbeing Alliance published a short paper, Making the difference: Tackling health inequalities in Wales. In this paper, we suggest initial steps that the new Welsh Government should take in their first year to respond urgently to health inequalities and make the greatest possible impact by coordinating renewed commitment from all partners.

8. Through having a cross-Committee Senedd inquiry, it will enable all Committees to consider what action each Welsh Government department is doing to tackle the root causes of health inequalities.

Integration between the NHS and Local Government

9. The response to COVID-19 could not have happened without the excellent partnership working across Wales between the NHS, local government, the voluntary sector and the private sector. However, more can be done to support the integration of health and care services and whole system collaboration. We would recommend that the Committee undertake an inquiry to consider where integration of services is working well and the barriers for further integration.

10. The Welsh NHS Confederation believes that Wales, given its size, structure and strong working relationships, has a golden opportunity to achieve so much when it comes to designing and delivering integrated citizen-centred services. For example, the legislative framework, particularly the Social Services and Well-being (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act 2015, means Wales is well-placed to put people’s needs at the heart of decision-making, support people to maintain their own physical and emotional wellbeing, promote the use of preventative approaches and work collaboratively across all sectors to achieve the outcomes that matter most to them.

11. We must empower the whole public sector to enable them to work seamlessly across organisational boundaries. In September 2020, the Welsh NHS Confederation published it’s Senedd election briefing, Valuing, Engaging and Delivering: A health and care system for future generations, which sets out a number of key calls for the Welsh Government, including supporting the further integration between NHS, Local Government, and wider partners through:

· Introducing performance measures that focus on quality-based outcomes, prevention, community services and whole-system collaboration.

· Introducing joint inspection, regulatory regimes and governance arrangements to support regional and national decision-making to drive cross sector change.

· Publishing priorities to improve public sector working at all levels, with a focus on compassion, quality improvement, shared values and trust across the system.

12. To improve population health and wellbeing further, it is vital that meaningful person-centred performance measures and frameworks are developed across the NHS and local government, and wider public sector, which focus on patient experience, clinical outcomes, prevention, whole-system collaboration and applying value-based healthcare (which is delivering outcomes that matter most to patients for the same or lower cost).

Health and housing

11 We would recommend that the Committee undertake an inquiry into the importance good housing has on supporting people’s health and wellbeing. Through the Committee undertaking an inquiry into health and housing, it will consider the evidence that is currently available around the current partnerships between health and housing and the barriers to further implementation across Wales.

12 Our briefings, Why housing matters to health and care (November 2018) and How does housing influence our health? (January 2020), highlight how health and wellbeing outcomes and quality housing are connected. There is increasing evidence to suggest good quality housing helps us stay healthy and can improve our wellbeing, while poor housing can increase demand on health, other public services and the economy. As highlighted within the Public Health Wales NHS Trust report, Making a Difference in Health and Housing: A Case for Investment Report (June 2019), it is estimated the cost of poor housing to Welsh society is over £1bn a year, with 18 percent of homes in Wales considered to be of a standard that is detrimental to a person’s health. Poor housing not only costs the NHS, but also leads to more reliance on other public services such as social care, Local Authority referrals to food banks, more accidents at home and higher risk of fuel poverty. Quality housing also plays an essential role in supporting those with mental health conditions.

13 Housing and health are impacted by a wide array of public and private services. Therefore, an integrated approach on partnership working across health, social care, local government, housing associations, education, utility companies and other stakeholders is needed to reduce demand on NHS services and address the core relationship between health and housing.

Public Engagement

14 We recommend that the Committee considers how the Welsh Government and public bodies can better engage with the public.

15 In our Senedd election briefing, we called on the Welsh Government to “Implement a Government-wide national programme and engagement strategy to support the public to live healthier lives, take more responsibility for their health and wellbeing, manage their conditions and use services responsibly”.

16 There is an urgent need for a meaningful dialogue with the public about the future expectations of public services and the different role they need to play. Public support is critical to delivering and securing policy and service change. The programmes most successful in galvanising public support are those which place the public at the heart of the decision-making process, particularly when combined, if appropriate, with enabling legislation.

17 There is a need for an open and honest conversation with the public about what the NHS can provide in the future. While the NHS is free at the point of contact, it is not free of obligation, and the public will need to be supported in taking more responsibility for their own health and wellbeing. Patients need to become partners in managing and improving their health, rather than passive recipients of healthcare.

18 Communication and co-production with patients, the public, third and independent sectors will be required with more support in influencing the public message regarding co-production and self-management. Without support across all sectors for these messages, it will not succeed. The Committee has a role to consider where we are in Wales at the moment around public engagement and co-production of public services.

19 The COVID-19 pandemic means we have an opportunity to develop more effective communication and engagement with the public and patients by developing holistic messaging across the public sector and wider partners in the third and private sector around population health and the need for service change.