Tara Hughes is a Local Area Coordinator in Wales, she is also in the final stages of completing a part time Masters within Social Justice and Inclusion at the University of Wales Trinity St Davids. In a crossover of her work and studies Tara has written this blog piece about Local Area Coordination in Wales in relation to the Social Services and Wellbeing (Wales) Act (2014).
As Local Area Coordinators in Wales we are extremely fortunate that our roles have been implemented alongside the roll out of a new piece of the legislature, The Social Services and Wellbeing (Wales) Act (2014) commonly referred to as the Act. I would like to highlight how the principles within Local Area Coordination are aligned to the principles set out within the Act. And explore how working within these principles alongside a strong voice from the Local Area Coordination Network and the leadership groups within the authorities in Wales which have implemented Local Area Coordination, can support transformational system changes which are needed within Wales and throughout the UK.
The Act Came into effect in April 2016, it places a legal duty on both Health Boards and Local Authority Social Care Services and various functions across Wales to deliver changes to services which will: Enable individuals, families, carers and communities to feel better supported and cared for; and over time contribute towards improved wellbeing outcomes and more sustainable Health and Social Care Services (Verity, Andrews, Blackmore, Calder, Richards, and Llewellyn, 2019). As suggested by many authors the Act is an ambitious piece of legislature, with the potential to enable transformative changes within Health and Social Care Policy, Practice and Systems (Clements, 2017; Rees, 2015; Verity, Andrews, Blackmore, Calder, Richards, and Llewellyn, 2019). In comparison Local Area Coordination is a powerful strength focussed, asset based approach adopted by a growing Network of local authorities and health partners throughout the UK. On an individual level Local Area Coordination helps people and their carers to think about their version of a good life and take steps to make it happen. On a local level Local Area Coordination enables communities be more inclusive and ambitious with and for their citizens which supports individual and community resilience, health and wellbeing (Local Area Coordination Network, 2019).
The Act expects organisations to move from a service led and needs based approach to focus on working together with the individual, their family and networks to understand their circumstances, their strengths and identify outcomes which matter to them and develop a shared plan of action as to how these outcomes can be achieved (Social Care Wales, 2018). This mirrors the principles within Local Area Coordination which are embodied throughout all elements of the model and are crucial to its success (Local Area Coordination Network, 2019).
The Act proposes a framework which recognises issues of power and control and the re-distribution of inequalities within society. Which is specifically necessary within the current political climate, critics have argued that the transformation as outlined within the Act will be difficult to implement during a time of imposed austerity with limited funding available to local authorities (Clements, 2017; Hatherley, 2017; Rees, 2015). Local Area Coordinators work within communities and build capacity in order to reduce the burden on Health and Social Care Services, people who are supported by Local Area Coordinators are encouraged to use natural authority and make connections in the community, using service provision when appropriate.
The Act promotes sustainability within Health and Social Care systems as well as complimenting other key pieces of Welsh legislation such as the Future Generations Act (Wales) 2015. Local Area Coordination is an evidenced based approach with 14 independent evaluations over 8 years demonstrating a number of key benefits for public sector bodies including; Health and social care integration, co-production, co-commissioning and community capacity building. Reforming the front door to services and wider system reform and investing to reduce costs (Local Area Coordination Network, 2019).
The Independent Commission on Social Services in Wales, (2010) adds that Health and Social services in Wales are at a Retrench or Reform tipping point in relation to public spending. There is the chance to make sustainable, preventative and collaborative changes and therefore reform social services rather than retreat into providing only core services. This will involve increasing preventative, early intervention and re-ablement services which engage service users, their carers and the public (Independent Commission on Social Services in Wales, 2010). Local Area Coordination can work with statutory services and with the public to achieve these changes and contribute to this system reform. Although this requires time and a strong, connected, and collaborative senior leadership and network. This is apparent within the evaluations of Local Area Coordination, there are consistent positive outcomes for individuals, families, communities and the service system (Local Area Coordination Network, 2019).
Despite the Act emphasising for more early intervention and preventative services, the current system offers a specialist, expensive, case management and late intervention service (Green and Antibi, 2017). This means that people are sent away until they reach crisis point, requiring more expensive interventions later on, often with poorer social and clinical outcomes. Local Area Coordinators have no eligibility criteria, apart from the location which they work. Each Local Area Coordinator works within a community with a population size of 8,000-12,000. They approach, or are introduced to people, who may be isolated, causing concern or are at risk of needing formal services. Coordinators support people to build their own their vision for a good life, finding pragmatic solutions to any problems, and drawing on family and community resources, before considering commissioned or statutory services (Local Area Coordination Network, 2019).
Contemporary research surrounding implementation of the Act suggests there needs to be a strong voice from the Welsh government to Local Health boards on how to behave and roll out the principles of the Act in action (Clements, 2017). Focusing specifically on promoting local and sustainable services, minimising the turbulence of organisational change and reducing bureaucratic burden. Greenwell and Antibi (2017) suggest that this will involve entirely different conversations at all levels including a shift in power and relationships, the changes required reflect the strong social justice element within the Act. Greenwell and Antibi (2017) suggests the adoption of new non-institutional power bases and relationships where professionals and managers do not hold onto managerial and professional power, but instead talk with people and other agencies as equal partners, recognising their strengths through a conversation about what is important to them in their neighbourhoods. Implementing Local Area Coordination alongside the Act could remedy these issues and support these suggestions, as evidence shows that Local Area Coordination helps to simplify the system, drives integration, strengthens cross-system collaboration and creates shared system outcomes (Local Area Coordination, 2019).
Although it is the personal reflections and stories that people share about how they have led positive change in their lives which are the most powerful. In Local Area Coordination we celebrate our stories, the stories are consistent across our network and positive outcomes in England and Wales are now influencing the development of Local Area Coordination internationally. For more information on Local Area Coordination I encourage you to access the Local Area Coordination Network website and connect with a team near you.
Further video resources demonstrating the different levels of working in Local Area Coordination in Swansea
- Broad, R. (2012) Local Area Coordination; From Service Users to Citizens. The Centre for Welfare Reform [online] Available at: https://www.centreforwelfarereform.org/uploads/attachment/340/local-area-coordination.pdf
- Clements, L (2017) Social Services and Wellbeing (Wales) Act 2014: a critical overview [online] Available at: http://www.lukeclements.co.uk/wp-content/uploads/2017/06/2017-03-BASSW-Keynote.pdf
- Greenwell, S. and Antebi, D. (2017) A new health and social care context in Wales. Journal of Integrated Care Vol. 25 (4) [online] Available at: https://search-proquest-com.ezproxy.uwtsd.ac.uk/docview/1948412566?accountid=130472&rfr_id=info%3Axri%2Fsid%3Aprimo
- Hatherley, S. (2017) Parliamentary Review of Health and Social Care in Wales Interim Report. National Assembly for Wales. [online] Available at: https://seneddresearch.blog/wp-content/uploads/2017/09/parliamentary-review-of-healthe.pdf
- Independent Commission on Social Services in Wales (2010) From Vision to Action: The Report of the Independent Commission on Social Services in Wales [online] Available at: https://gov.wales/sites/default/files/publications/2019-06/from-vision-to-action-the-report-of-the-independent-commission-on-social-services-in-wales.pdf
- Local Area Coordination Network (2019) Its Time for Local Area Coordination Report [online] Available at: https://lacnetwork.org/wp-content/uploads/2019/07/Its-Time-for-Local-Area-Coordination.pdf
- Local Area Coordination Network (2019) Evidence Base: How do we know it works? [Online] Available at: https://lacnetwork.org/evidence-base/
- Social Care Wales (2019) Social Services and Wellbeing (Wales) Act (2014) [online] Available at: https://socialcare.wales/hub/sswbact
- Verity, F., Andrews, N., Blackmore, H., Calder, G., Richards, J., Llewellyn, M. (2019) Evaluation of the Social Services and Wellbeing (Wales) Act 2014: Framework for Change Report. Cardiff. Welsh Government, GSR report number 38/2019 Available at: https://gov.wales/evaluation-social-services-and-well-being-walesact-2014-framework-change