Monthly Archives: April 2014

Prevention: What’s the Reality of Shifting your Resources?

Bromford's preventative approach

Bromford’s preventative approach

The term ‘prevention’ is used increasingly freely in public services at the moment. But what is the reality of shifting the focus of services away from reaction and towards prevention? We worked with the Welsh Government (the Public Service Leadership Group’s Effective Services for Vulnerable Groups programme) to bring together some practical examples of how organisations have approached this ‘prevention’ agenda in the form of a seminar. We also wanted get the people working to deliver public services into a room and ask them what their own experiences were.

I’d like to share some of the delegate’s positive experiences of striving towards prevention and also what they’re struggling with on a day-to-day basis.

Firstly, there are some good examples of public services looking beyond their own specific areas of expertise. The Fire and Rescue Services are a clear example, when they have taken a holistic view of people’s wellbeing within their homes. We also heard from Cardiff Alcohol Treatment Centre, where diverse sectors (such as the Students’ Union, the Council licensing department and health bodies) are all benefiting from one project. Public Health Wales also discussed their work in connecting General Practices to community assets for health and wellbeing, for instance by ensuring a community health worker is based in GP surgeries.

There are also some excellent opportunities within the role of voluntary sector. Delegates emphasised the role they can play in taking over some responsibility from public sector for prevention, and the additional resources they can provide for specialist preventative work. A WCVA representative discussed the early intervention work that the sector is already doing in communities. However, they felt that many people don’t know how much they can actually offer and that there is much more scope to involve the voluntary sector not as a ‘third’ sector but as an integral part of community preventative services.

Finally, there are examples of organisations willing to take well-managed risks and adapt new approaches as they go. Isle of Anglesey Council discussed their work on transforming children services, moving from safe certainty to safe uncertainty. As Bromford have done, Cartrefi Conwy discussed work on tenant profiling, to move away from one-size-fits-all approach and adapt to each client.  We heard examples of how very small shifts in resources such as these, combined with a willingness to launch imperfect services and adapt as necessary, can have big effect on developing preventative services.

However, we also discussed a range of challenges that delegates experiences in their day-to-day roles. The first and perhaps most expected of these was funding. In particular, how to strike a balance between funding statutory services and funding innovative prevention approaches. Moreover, if prevention activities are successful, there is often an expectation that expenditure will lessen over time. But these resources are still needed to maintain prevention work.

Secondly, how do you demonstrate the benefits of preventative work? How do you demonstrate something that you stopped from happening? This was a particular challenge for delegates when the financial or other outcomes of their prevention activities are by others.

You can see all the presentations on our website, as well as some more of the key ideas that were raised during the day.

Atal: Beth yw Gwirionedd Symud eich Adnoddau?

Bromford's preventative approach

Dull ataliol Bromford

Mae’r term ‘atal’ yn cael ei ddefnyddio’n fwyfwy rhydd mewn gwasanaethau cyhoeddus ar hyn o bryd. Ond beth yw gwirionedd symud y ffocws gwasanaethau i ffwrdd o ymateb a thuag at atal? Buom yn gweithio gyda Llywodraeth Cymru (Rhaglen Gwasanaethau Effeithiol ar gyfer Grwpiau Agored i Niwed Grŵp Arwain y Gwasanaethau Cyhoeddus) i gasglu rhai enghreifftiau ymarferol o sut y mae sefydliadau wedi mynd i’r afael â’r agenda ‘atal’ hwn mewn ffurf seminar. Rydym hefyd am gael y bobl sy’n gweithio i ddarparu gwasanaethau cyhoeddus i mewn i ystafell a gofyn iddynt beth oedd eu profiadau nhw.

Hoffwn i rannu rhai o brofiadau cadarnhaol y cynrychiolydd o ymdrechu tuag at atal a hefyd yr hyn y maent yn cael trafferth â nhw o ddydd-i-ddydd.

Yn gyntaf, ceir rhai enghreifftiau da o wasanaethau cyhoeddus yn edrych y tu hwnt i’w meysydd penodol o arbenigedd. Mae’r Gwasanaethau Tân ac Achub yn enghraifft glir, pan fyddant wedi cymryd golwg gyfannol ar les pobl o fewn eu cartrefi. Clywsom hefyd gan Ganolfan Trin Alcohol Caerdydd, lle mae sectorau amrywiol (megis Undeb y Myfyrwyr, yr adran drwyddedu Cyngor a chyrff iechyd) i gyd yn elwa o un prosiect. Hefyd roedd Iechyd Cyhoeddus Cymru yn trafod eu gwaith i gysylltu Meddygfeydd i asedau cymunedol ar gyfer iechyd a lles, er enghraifft trwy sicrhau bod gweithiwr iechyd cymunedol yn seiliedig mewn meddygfeydd teulu.

Mae yna hefyd rai cyfleoedd gwych o fewn rôl y sector gwirfoddol. Pwysleisiodd y cynrychiolwyr y rôl y gallant ei chwarae wrth gymryd rhywfaint o gyfrifoldeb oddi wrth y sector cyhoeddus ar gyfer atal, a’r adnoddau ychwanegol y maent yn eu darparu ar gyfer gwaith ataliol arbenigol. Trafododd cynrychiolydd Cyngor Gweithredu Cwirfoddol Cymru gwaith ymyrraeth gynnar bod y sector eisoes yn ei wneud mewn cymunedau. Fodd bynnag, roeddent yn teimlo nad oedd llawer o bobl yn gwybod faint y maent mewn gwirionedd yn cynnig a bod llawer mwy o le i gynnwys y sector gwirfoddol nid fel ‘trydydd’ sector ond fel rhan annatod o wasanaethau ataliol yn y gymuned.

Yn olaf, ceir enghreifftiau o fudiadau sy’n barod i gymryd risgiau a reolir yn dda ac addasu ymagweddau newydd fel y maent yn mynd. Trafod Cyngor Sir Ynys Môn eu gwaith ar drawsnewid gwasanaethau plant, gan symud o sicrwydd diogel i ansicrwydd diogel. Fel mae Bromford wedi’i wneud, trafododd Cartrefi Conwy gwaith ar broffilio tenantiaid, er mwyn symud i ffwrdd o’r dull un-maint-i-bawb ac addasu i bob cleient. Clywsom enghreifftiau o sut mae newidiadau bach iawn mewn adnoddau fel y rhain, ynghyd â pharodrwydd i lansio gwasanaethau amherffaith ac addasu yn ôl yr angen, yn gallu cael effaith fawr ar ddatblygu gwasanaethau ataliol.

Fodd bynnag, fe hefyd trafodom ni amrywiaeth o heriau y mae profiadau cynrychiolwyr yn eu rolau o ddydd i ddydd. Y cyntaf ac efallai’r un a ddisgwylir fwyaf o’r rhain oedd cyllid. Yn benodol, sut i daro cydbwysedd rhwng ariannu gwasanaethau statudol ac ariannu dulliau atal arloesol. Ar ben hynny, os mae gweithgareddau atal yn llwyddiannus, mae disgwyl y bydd gwariant yn lleihau dros amser yn aml. Ond yn dal angen adnoddau hyn i gynnal gwaith atal.

Yn ail, sut yr ydych yn dangos manteision gwaith ataliol? Sut ydych chi’n dangos rhywbeth yr ydych yn rhwystro rhag digwydd? Roedd hyn yn her arbennig i gynrychiolwyr pan mae’r canlyniadau ariannol neu eraill yn cael eu gweld gan eraill.

Gallwch weld yr holl gyflwyniadau ar ein gwefan, yn ogystal â mwy o’r syniadau allweddol a godwyd yn ystod y dydd.

Making integration “core business”

Guest blog post by Professor David Oliver.

David is Consultant Physician, Royal Berkshire NHS Foundation Trust; Visiting Professor of Medicine for Older People, City University, London; Visiting Fellow, the Kings Fund; President-elect, British Geriatrics Society; and Recently of the Department of Health National Clinical Director for Older Peoples Services (England).

Population ageing is surely a cause for celebration not catastrophising. It represents a victory for societal conditions, for preventative medicine and public health and for advances in medical treatment. And it gives all of us a higher chance to live well in to older age. Just after the Second World War, nearly half the UK population died before 65. It’s now only 14%, with the over 80s the fastest growing demographic. By 2030 a UK man of 65 will live on average to 88 and a woman till 91.

Although older people generally report high levels of wellbeing and happiness and many remain remarkably independent and connected, we can’t duck the fact that more older people has inevitable consequences: more people with multiple Long-Term Conditions, with frailty syndrome, with Dementia and with a degree of disability or dependence. These same individuals are often reliant on multiple services and practitioners and on informal care from family and friends.

Our current service model needs to shift far more towards prevention, towards co-ordinated care focussed around the needs of individuals rather than single disease and to recognise that the care of such older people is now “core business” for health and care systems. If we don’t get care right for older people with complex needs, we won’t get it right for any group. This has radical implications for workforce, education and training and for collaborative and integrated working between organisations. Wales already has some of the building blocks in place to help realise these goals and many current examples of good services for older people. But we need to spread and implement good practice at scale and pace to get “the rest as good as the best” and be prepared to look to other health systems for other examples of “what good looks like”.

We hope these events and the “community of good practice” which follow on from them will help facilitate the public conversation, improve collaboration and encourage the dissemination of good ideas. Ultimately, we hope it will result in services that go beyond “mission statements” and really are built around the needs of our ageing population.

Here is a snapshot of the key messages from a recent report by Professor Oliver and his colleagues, ‘Making our health and care systems fit for an ageing population’.

Gwneud integreiddio yn “fusnes craidd”

Erthygl blog gwadd gan Yr Athro David Oliver.

Mae David yn Fferyllydd Ymgynghorol yn Ymddiriedolaeth Sefydliad GIG Royal Berkshire; Athro Gwadd Meddygaeth i Bobl Hŷn, City University, Llundain; Cymrawd Gwadd, Cronfa’r Brenin; Darpar Lywydd, Cymdeithas Henoed Prydain; ac yn gweithio yn y Department of Health National Clinical Director for Older Peoples Services (Lloegr).

Does bosib fod y ffaith fod y boblogaeth yn heneiddio yn rheswm i ddathlu yn hytrach na’i weld fel bwgan mawr. Mae’n fuddugoliaeth i amodau cymdeithas, meddygaeth ataliol ac iechyd y cyhoedd, ynghyd â datblygiadau mewn triniaethau meddygol. Mae’n rhoi mwy o obaith i ni gyd y gallwn fyw’n hŷn. Ychydig ar ôl yr Ail Ryfel Byd, roedd bron i hanner poblogaeth y DU yn marw cyn eu bod yn cyrraedd eu 65 oed. Erbyn hyn, dim ond 14% sy’n marw cyn cyrraedd 65 oed, a phobl dros 80 oed yw’r demograffig sy’n tyfu gyflymaf. Erbyn 2030, bydd dyn 65 oed yn byw tan y bydd yn 88 oed ar gyfartaledd, a menyw 65 oed yn byw tan y bydd yn 91 oed ar gyfartaledd.

Er bod pobl hŷn yn nodi lefelau uchel o les a hapusrwydd ar y cyfan a bod llawer ohonynt yn dal i fyw’n annibynnol, nid oes modd anwybyddu’r ffaith y bydd mwy o bobl hŷn yn arwain at ganlyniadau anochel: mwy o bobl â Chyflyrau Hirdymor lluosog, syndrom eiddilwch, Dementia a rhyw fath o anabledd neu ddibyniaeth. Yn aml, mae’r unigolion hyn yn dibynnu ar wasanaethau ac ymarferwyr lluosog ac ar ofal anffurfiol gan deulu a ffrindiau.

Mae angen i’n model gwasanaeth presennol symud mwy tuag at ataliaeth a gofal cydgysylltiedig sy’n canolbwyntio ar anghenion unigolion yn hytrach na chlefydau unigol, a chydnabod bod gofal pobl hŷn o’r fath bellach yn “fusnes craidd” i systemau iechyd a gofal. Os na fyddwn yn llwyddo i ddarparu’r gofal priodol i bobl hŷn ag anghenion cymhleth, ni fyddwn yn llwyddo i wneud hynny ar gyfer unrhyw grŵp. Mae gan hyn oblygiadau radical i’r gweithlu, addysg a hyfforddiant a gwaith integredig a chydweithredol rhwng sefydliadau. Mae Cymru eisoes wedi gwneud trefniadau i helpu i gyflawni’r nodau hyn, ac mae ganddi lawer o enghreifftiau o wasanaethau da i bobl hŷn. Ond mae angen i ni rannu arferion da yn gyflym ac i’r fath raddau fel bod gweddill y gwasanaethau’n datblygu i fod cystal â’r gwasanaethau gorau, a bod yn barod i archwilio systemau iechyd eraill er mwyn gweld enghreifftiau o wasanaethau da.

Rydym yn gobeithio y bydd y digwyddiadau hyn a’r “gymuned arfer da” a fydd yn deillio ohonynt yn helpu i hwyluso sgwrs gyhoeddus, gwella cydweithredu ac annog rhannu syniadau da. Yn y pen draw, rydym yn gobeithio y bydd yn arwain at wasanaethau sy’n mynd y tu hwnt i “ddatganiadau cenhadaeth” ac at wasanaethau sy’n canolbwyntio ar anghenion y boblogaeth sy’n heneiddio.

Dyma cipolwg o rai o brif negeseuon adroddiad diweddar gan Yr Athro Oliver a’i gydweithwyr, ‘Making our health and care systems fit for an ageing population’.