Monthly Archives: September 2015

A special Wales edition of the Journal of Integrated care – so what?!!!

How can we better integrate health and social care? Stewart Greenwell of ADSS (Association of Directors of Social Services) Cymru shares the lessons from the Wales edition of the Journal of Integrated care.

Stewart GreenwellI guess that writing about what you do is common practice in most professional arena, but normally it is for a very limited audience – the employer, sometimes even service users so that they can see what a professional worker is explaining what they saw, what they did and what they intend to do. Writing for an academic journal is a different piece of work – the audience is wider, the rules feel more complex and the writing comes under more scrutiny.

I have always experienced writing as a way of reflecting on what I have done and the special edition of the Journal of Integrated Care focusing specifically on Wales, hopefully will bring some of our efforts in Wales into a wider public arena, from which others, but particularly policy makers and practitioners in Wales, can benefit.

I have always experienced collaboration and/or integration as the natural way of building alliances to ensure that people are not ‘given the run-around’. Sadly my experience is that the public sector has provided that experience for ordinary people, leaving them with the energy-sapping task of finding their way around systems, places and people to try to find a response to a set of circumstances that is troubling them. So by simply reducing the number of doors to knock, telephone numbers to ring and people to talk to, the path becomes less hazardous, less tiring and more likely to lead to success for the ordinary person.

That becomes the rationale for collaboration and integration – to improve people’s lives and only that end makes it worthwhile.

The people who have contributed to the Wales edition had very little experience of writing for the purposes of publication. They had all written for their own agencies, arguing for a change in practice, arguing for an allocation of some additional resources and the many other reasons that we have to put pen to paper (or fingers to keyboard) for our employers.

It has been a struggle, everything took longer than anticipated and there was always another reference to call on. In many ways it reflects the struggle that is captured by many of the authors, to hold on to a belief that what they were pursuing was worth all the effort, to resist the feeling that ‘I don’t really have anything to say that people want to listen to’.

Their efforts, actually our efforts, since it started with us all talking about the idea in a room in a church centre in Shrewsbury – a good start since it reminded us that you sometimes have to break the rules to achieve something – (in this instance choosing to meet outside of Wales!!) were worth it.

The articles highlight the theme of the WAO events on 14th and 22nd October, that integration and collaboration are less about science and more about craft and graft, continually pushing at the boundaries of traditional thinking and reminding ourselves that there is never a reason not to ‘do the right thing’, but there are often many reasons to simply continue to ‘do things right’. The former is about people and the latter often about little more than adhering to process.

However the process was energising and in the end, successful. It shows the character and
strength of the best practice, the importance of leadership that is unrelentingly determined and the most critical of all, that a focus on what makes a difference to people’s lives pulls you through and beyond the doubters and the resistors!!

Rhifyn arbennig i Gymru o’r Journal of Integrated Care – beth yw’r ots?!!!

Sut allwn integreiddio iechyd a gofal cymdeithasol yn well? Isod mae Stewart Greenwell o ADSS (Cymdeithas Cyfarwyddwyr Gwasanaethau Cymdeithasol) Cymru yn rhannu’r gwersi o rifyn Cymru o’r Journal of Integrated Care.

Stewart GreenwellMae’n bur debyg bod ysgrifennu am beth rydych chi’n ei wneud yn rhywbeth cyffredin mewn sawl arena broffesiynol ond, fel rheol, mae ar gyfer cynulleidfa gyfyngedig iawn – y cyflogwr, defnyddwyr gwasanaeth weithiau hyd yn oed, fel eu bod yn gallu gweld gweithiwr proffesiynol yn esbonio beth mae wedi’i weld, beth mae wedi’i wneud a beth mae’n bwriadu ei wneud. Mae ysgrifennu ar gyfer cyfnodolyn academaidd yn ddarn gwahanol o waith – mae’r gynulleidfa’n ehangach, y rheolau’n teimlo’n fwy cymhleth ac mae mwy o graffu ar yr ysgrifennu.

Rydw i wastad wedi teimlo bod ysgrifennu’n gyfrwng i fyfyrio ar beth rydw i wedi’i wneud a’r gobaith yw y bydd y rhifyn arbennig o’r Journal of Integrated Care sy’n canolbwyntio’n benodol ar Gymru’n dod â rhai o’n hymdrechion yng Nghymru i arena gyhoeddus ehangach, er mwyn i eraill – llunwyr polisïau ac ymarferwyr yng Nghymru yn arbennig – elwa.

Rydw i wastad wedi teimlo bod cydweithredu a/neu integreiddio yn ffordd naturiol o greu cynghreiriau er mwyn sicrhau nad yw pobl yn cael eu gyrru o un lle i’r llall. Yn anffodus, o ’mhrofiad i, mae’r sector cyhoeddus wedi gwneud hynny i bobl gyffredin, gan eu gadael yn wynebu tasg heriol o feistroli systemau, llefydd a phobl er mwyn ceisio cael ymateb i gyfres o amgylchiadau sy’n eu poeni nhw. Felly drwy leihau nifer y drysau y mae’n rhaid cnocio arnyn nhw, nifer y rhifau ffôn i’w ffonio a’r bobl i siarad â nhw, mae’r llwybr yn llai peryglus ac yn llai blinedig wedyn, ac yn fwy tebygol o arwain at lwyddiant i bobl gyffredin.

Daw hynny’n rhesymeg ar gyfer cydweithredu ac integreiddio – er mwyn gwella bywydau pobl a dim ond y diwedd hwnnw sy’n rhoi boddhad.

Nid oedd y bobl sydd wedi cyfrannu at rifyn Cymru wedi cael llawer o brofiad o ysgrifennu at bwrpas cyhoeddi. Roeddent i gyd wedi ysgrifennu ar gyfer eu hasiantaethau eu hunain, gan ddadlau o blaid newid arferion, dros neilltuo rhywfaint o adnoddau ychwanegol a thros y rhesymau niferus eraill sy’n gwneud i ni roi pensel ar bapur (neu fysedd ar allweddell) i’n cyflogwyr.

Mae wedi bod yn frwydr; fe gymerodd bopeth fwy na’r disgwyl, ac roedd rhyw gyfeiriad arall i edrych arno bob amser. Mewn sawl ffordd, mae’n adlewyrchu’r frwydr y mae llawer o’r awduron yn cyfeirio ati, sef credu bod yr hyn roeddent yn mynd ar ei ôl yn werth yr ymdrech, ac ymatal rhag y teimlad o ‘Mewn gwirionedd, does gen i ddim byd i’w ddweud y bydd pobl eisiau ei glywed’.

Roedd eu hymdrechion, ein hymdrechion a dweud y gwir, ers i’r peth ddechrau wrth i ni i gyd siarad am y syniad mewn ystafell mewn canolfan eglwysig yn yr Amwythig – dechrau da, gan ei fod yn ein hatgoffa bod rhaid i chi dorri’r rheolau weithiau er mwyn cyflawni rhywbeth (yn yr achos hwn, dewis cyfarfod y tu allan i Gymru!!) – yn werth y cyfan.

Mae’r erthyglau’n tynnu sylw at themâu digwyddiadau SAC ar 14eg ac 22ain Hydref, sef bod integreiddio a chydweithredu’n ymwneud llai â gwyddoniaeth a mwy â chrefft a gweithio’n galed; gwthio ffiniau’r ffordd draddodiadol o feddwl yn gyson a’n hatgoffa ein hunain nad oes byth reswm dros beidio â ‘gwneud y peth iawn’, ond yn aml mae sawl rheswm dros ddal ati i ‘wneud pethau’n iawn’. Mae’r cyntaf yn ymwneud â phobl a’r olaf yn aml ag ychydig bach mwy na glynu wrth broses.

Er hynny, roedd y broses yn egnïol ac, yn y pen draw, yn llwyddiannus. Mae’n dyst i gymeriad a chryfder arferion da, pwysigrwydd arweiniad diwyro a phenderfynol a’r mwyaf allweddol o’r cwbl, bod ffocws ar beth sy’n gwneud gwahaniaeth i fywydau pobl yn eich tynnu chi drwodd a thu hwnt i bawb sy’n amheus ac yn ymwrthod!!