Primary care inquiry by the Health, Social
Care and Sport Committee -
Care Council for Wales response
Sarah McCarty
Director of Learning and Development
Care Council for Wales
South Gate House
Wood Street
Cardiff
CF10 1EW
Introduction
- The Care Council for Wales is responsible for
regulating, promoting and developing the social care
workforce. We are a Welsh government sponsored body. In
April 2017 our remit will expand to include research and
improvement and we will have a new name – Social Care
Wales.
- In line with our remit, our response mainly
deals with the second item on which you are seeking views, namely
the emerging multi-disciplinary team in primary care GP
clusters, in particular the role of the social work service and
domiciliary care.
- The Social Services and Well-Being (Wales)
Act, 2016 emphasises the need to deliver integrated services which
have been designed around the needs of the individual. We
will be supporting the social care workforce to adapt to this
change by providing training and support.
Care and support
at home draft strategy
- We have recently produced a draft strategy on
care and support at home for the care sector, written in
partnership with the sector. We have sent the strategy to the
Minister for Social Services and Public Health and we expect to
receive her endorsement in the coming weeks before the strategy is
formally launched.
- There are a number of key messages from the
draft strategy which we believe will support the committee’s
inquiry into multi-disciplinary teams in GP clusters. Once
the strategy is published we would be pleased to share a copy with
you.
- One of the
strategy’s key messages is that care and support workers do
not have parity of esteem, when working in multi-professional
teams, despite usually having most contact with individuals and a
good understanding of their needs and aspirations.
- The draft
strategy reflects the growing importance of providing care and
support at home, rather than in hospitals or residential care
home. In this context it will be important to establish
effective co-operation between GP clusters and domiciliary care
services. It will be important for the committee to consider
models of how this effective partnership can be
achieved.
- Similarly the
relationship between the social work service and GP clusters is a
matter of key importance. The social work service plays a
central role in providing care, support and protection for
vulnerable people in our communities. Therefore it is vital
they have a strong relationship with GP clusters. Again, it
will be important for the committee to consider this
area.
Evidence on the benefits of working in
multi-disciplinary teams
- In preparing our draft strategy for care and
support at home, we commissioned a literature review by Social Care
Institute for Excellence. The evidence suggests that joint
working can improve the standard of care, promote more holistic
service provision, and encourage collaborative learning.
- In particular there is evidence about the
benefits of co-operation between GPs, social care staff and others
to support people dying at home. The evidence suggests that
‘that encouraging practitioners to share past experiences and
foster common goals for palliative care are important elements of
team building in interprofessional palliative care. Also,
establishing a team leader who emphasises sharing power among team
members and addressing the need for mutual emotional support may
help to maximise interprofessional teamwork in palliative home
care’.
- Similarly, the Commission on Improving Urgent
Care for Older People (2015), setting out the principles for
redesigning services that better meet the needs of older people,
supports greater use of multidisciplinary and multi-agency teams,
both hospital and community based, suggesting that for frail
patients ‘there is evidence that comprehensive geriatric
assessment – underpinned by a multidisciplinary approach
– leads to better outcomes.’ For instance, examining
the impact of the Westminster Falls Service, which provides a
multidisciplinary falls risk assessment and targeted intervention
for people referred following a fall, or who are at risk of
falling, the Commission on Improving Urgent Care for Older People
reports that people followed up a year post-discharge reported 60
per cent reduction falls, 55 per cent fewer fractures, 92 per cent
fewer A&E admissions, and an 80 per cent reduction in GP
appointments compared to the year prior to intervention.
There are examples of similar integrated teams across Wales, e.g.
the Gwent Frailty service and you may find the evidence from
schemes funded via the Intermediate Care Fund useful to your
enquiry.
- The use of an integrated multidisciplinary
approach is supported by the literature, as a way to meet the
multifactorial needs of complex dementia-related conditions. The
evidence suggests that joint working can improve the standard of
care, promote more holistic service provision, and encourage
collaborative learning. Some papers however caution that
multidisciplinary services may require specific, appropriate
commissioning and that integrated may increase demand for services
but not necessarily clinical outcomes.
- Research suggests that the most successful
multi-disciplinary teams are those which are designed around the
needs of the individual using services. A King’s Fund
study about the most effective approaches to integration found that
“the central plank of success … in shaping service
around the individual receiving services.”
- This approach is supported by National
Voices, a coalition of individuals who use services. They
describe integrated care as 'person-centred coordinated care'. For
an individual using care and support, this means: "I can plan
my care with people who work together to understand me and my
carer(s), allow me control, and bring together services to achieve
the outcomes important to me.
- This emphasis on the individual’s needs
underpins the approach to integrated services in the Social
Services and Well-being (Wales) Act, 2014, which sets out the
strategic approach to the regional design and delivery of the
health and social care services.
- Whilst such strategic frameworks are
important, the evidence is clear that the most effective integrated
services are those which have developed from the bottom up.
In its report on integration, one of the King’s Fund’s
main points of learning was that those planning multi-disciplinary
teams should “start from the bottom up by bringing together
frontline teams and align these teams with general practices and
their registered populations”.