A revolution for health and social care in Wales?

by Ross Gregory, Head of External Relations, Royal Pharmaceutical Society in Wales

Ross Gregory, Head of External Relations, RPS Wales
Ross Gregory, Head of External Relations, RPS Wales

If you haven’t already heard of the Parliamentary Review of Health and Social Care in Wales, there is little doubt you soon will. Published early in the New Year and anticipated as one of the most important independent advisory reports for the NHS Wales in nearly two decades, the report makes a case for change for radically transforming the Welsh model of health and social care to make it fit and sustainable for the future.

I would recommend you take a look at the report. At less than 40 pages long, it’s far from an onerous or difficult read and you may find it provides a certain ‘feel good factor’. You may even find it provides a ray of hope that the challenges facing us in the delivery of health and social care services are being thoroughly addressed. Beyond the glow of enthusiasm and optimism however, a number of critical questions remain; Will the report have the potential to drive a revolution from within our system and significantly transform services? What will a new system look and feel like? What will this mean for pharmacy services and the future of pharmacy profession in Wales?

At this early stage, these are not easy questions to answer. The report makes a plethora of recommendations for consideration by the Welsh Government, which gives us some insight. The thrust of the report focuses on a locally delivered system, driven by national principles, where care and support is seamless, free of artificial organisational and sectoral barriers, and is inclusive of all key stakeholders including the public, the voluntary sector and independent sector. It calls for strong leadership at national, regional and local levels and better governance to drive transformation. Greater transparency is also called for through annual reviews of progress to accelerate the pace of change. Importantly, the report calls for greater empowerment of individuals and a system which listens and responds to the public as part of the ‘customer/user revolution’.


Echoes of the past?National Assembly Chamber


For those who have been working in and around the NHS in Wales for some time, like myself, you’d be forgiven for having a sense of déjà vu. The echoes of Sir Derek Wanless’ Review, published some 15 years ago, are clear. That report recommended a radical redesign of services, seamless service provision, and new delivery and planning mechanisms to get more from the huge resource allocated to the NHS. Sound familiar? Critically at that time, the squeeze on public funding was nowhere near the financial pressures felt in Wales today. New monies, commonly referred to as Wanless Monies, were provided by the Welsh Government to pump prime innovation and change across the health and social care system and yet the radical transformation that was envisaged then could not be progressed in Wales. The current Review recommends establishing a national transformational fund which will be critical. Even if the Welsh Government agrees to this and is able to make additional investment available, it is clear that there must be learning from the missed opportunities of the past.


An elephant in the room?


The current Parliamentary Review highlights the need for efficiency and getting best value from health and social care services but purposefully does not address it in detail. This is perhaps the elephant in the room which will need careful attention. It is interesting to note that the Welsh NHS Confederation has already highlighted this concern and called for the Welsh Government to consider the recommendations of the Review in conjunction with the Health Foundation’s 2016 Path to Sustainability report that analyses the demand and cost pressures facing Wales now and until 2031. I totally agree because if we are truly going to turn the NHS tanker around and create a system that sustainably addresses the challenges of today and the future, then the funding question is a critical one.


Care for People that care for the people

Where does pharmacy feature?


Pharmacists are referred to only once within the report. While disappointing, it is understandable given the review covered all professions working in the health and social care system and has arrived at a very strategic view of what needs to change. The review calls for a revision of national contracts for general practice and community pharmacy to “ensure effective seamless and prompt responses to health and care needs”.We are pleased that the review panel, headed by former Chief Medical Officer Dr Ruth Hussey, has made this recommendation and listened to the points we made about reducing tensions between national contracts to encourage greater cooperation between the contractor professions in the community.Coupled with the increasing shift from volume and cost to quality and patient safety, we can perhaps be optimistic about the appetite for strengthening the role of community pharmacy in Wales.

The report also has a focus on nurturing and empowering employees across the health and social care system which could have a positive impact on the pharmacy profession. The report calls for greater staff wellbeing, training, management and engagement and it is perhaps this element of the report that is of most interest. It certainly marks a departure from the reviews of the past and perhaps offers new hope for investment in the most important part of the Welsh health and social care system – its people.

At the RPS, we are delighted that the report of the Parliamentary Review incorporates staff wellbeing into one of its four core pillars for sustainable change, referred to as the Quadruple Aim for all. The Welsh Pharmacy Board has committed this year to address issues of workforce pressure and to lead a programme of support for our members, which aligns well with this part of Quadruple Aim. Those who attended our Medicines Safety Conference last year will recall the messages on resilience and wellbeing from the charismatic and inspiring Sally Gunnell OBE. As a former Olympic and world champion athlete, Sally drew parallels between the world of elite sport and the pressures experienced by health professionals and kicked off our campaign to address workplace pressures and the wellbeing of our members. The identification of wellbeing as a key tenet of transformation and sustainability is therefore very much welcomed.


Foundations for change


On reading this report, I was generally pleased to see that in its quest to strive for ‘one system of seamless health and care for Wales’, the report does not throw the baby out with the bathwater. The review calls for radical change but clearly recognises the excellent progress already made in transforming care in Wales. It is particularly pleasing to note that the report calls for Local Health Boards to build upon good practice through further development of locality initiatives and primary care clusters, and to learn from initiatives such as the Pacesetter programme.
We know that patients and NHS Wales are already benefiting considerably from the development and incorporation of primary care cluster pharmacist roles: improving access to a pharmacist, shifting capacity around the system, enhancing patient safety, and delivering financial efficiencies. We know that pharmacists are playing incredibly important roles in the 111 unscheduled care service and that the growing pharmacy specialisms in the secondary care setting are providing new benefits to patients and other healthcare professionals Our task now is to ensure those opportunities not only remain in place, but are expanded and built upon for the future. For instance, creating the infrastructure for community pharmacists to be more actively integrated into local models of care, is one particular area that will need attention.


Tight timescalesCompass pointing to Vision

Talking to the Welsh Government is our next key step in this process. Over the last twelve months we have contributed to the Parliamentary Review by meeting with Dr Hussey on several occasions to outline the challenges facing pharmacy, the obstacles to delivering better pharmaceutical care and to highlight the excellent pharmacy innovation that is already happening in all corners of the country. The Welsh Government will now consider the recommendations of the report to inform the development of a new long term strategy and action plan for NHS Wales. The proof of the pudding will arguably be contained in this important strategy.

Recently I had the opportunity to hear from the Welsh Government officials who will be taking this work forward and was advised that the strategy will be published in April this year. This is an incredibly tight timescale but with an opportunity to speak directly to the lead officials about the development of the strategy, it is imperative that RPS Wales takes prompt action and speaks on behalf of its membership.
I believe that there is a real urgency to paint a clear and aspirational picture of pharmacy services for the future. We did this previously in partnership with the Welsh Pharmaceutical Committee and published our recommendations for pharmacy in Your Care, Your Medicines as a result. Almost four years on, those recommendations are nearly all delivered in Wales and a new and inspirational vision is needed. Discussions are already underway between us and the Welsh Pharmaceutical Committee about this vision and this work will be instrumental in our future discussions with the Welsh Government and NHS Wales.


Add your voice


One of the biggest strengths of the Parliamentary Review, I believe, is bringing to the forefront the critical challenges for our health and social care system and providing a renewed stimulus for change. We need to speak out now and to be bold in our vision for the future role of pharmacy in Wales. There is small window of opportunity to influence the shape of things to come and right now, we need your views, comments and examples of innovative practice that we can take to the Welsh Government. Please get involved and don’t hesitate to contact me directly at ross.gregory@rpharms.com.

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