In the past, people were expected to fit in with the routines and practices that health and social services felt were most appropriate.
In order to be person-centred, services now need to change to be more flexible, working with people and their families to find the best way to provide their care.
In 2013, my Member Proposed Bill on Community Care (Direct Payments) (Wales) was designed to offer carers and service users choice, control and independence - allowing people to choose whether they want to be in control - and giving them the support to do this.
The Deputy Minister stated that she would like the principles in my Bill to be taken forward in the Social Services and Wellbeing Bill – and I therefore agreed to withdraw my motion and work with the Welsh Government on this.
The subsequent Social Services and Wellbeing Act Part 2 Code of Practice stated “This puts in place a system where people are full partners in the design and operation of care and support. It gives people clear and unambiguous rights and responsibilities.”
It said that “Local authorities must seek to empower people to produce innovative solutions through local networks and communities” and that this “means putting robust arrangements in place to secure involvement of people in the design and operation of services”.
It also stated that well-being includes key aspects of independent living, as expressed in the UN Convention on the Rights of Disabled People, and that:
“the approach to promoting people’s well-being, is one that recognises that care and support can contribute to the removal of barriers in line with the social model of disability - recognising the Welsh Government’s framework for Action on Independent Living, which “expresses the rights of disabled people to participate fully in all aspects of life”.
The well-being objectives in the Well-being of Future Generations (Wales) Act also include people contributing to their community, being informed, included and listened to.
However, despite legislation that's supposed to be about designing and delivering services with people, we still hear horror stories, like the wheelchair users who continue to be denied access to the coastal path in Flintshire - and the deaf community in Conwy having to go to the Ombudsman after Conwy Council decommissioned the British Sign Language services on which they relied.
They told me that there was no consultation, advance notice, information or transition planning.
False economies such as this result in multi-million pound cost pressures on Health and Social Services.
This is being added to by the adverse impact of Welsh Government funding decisions, which are putting at risk prevention and early intervention services which make a big difference in communities and families across Wales.
I speak of the removal of the ring fence from Supporting People and the Welsh Independent living Grant – and the impact of lost funding for organisations such as the Family Fund and Afasic Cymru.
Co-production should be about doing things differently, with service professionals, services users and their communities working side by side to provide solutions – about by moving from needs – based approaches to strength based development - helping people in communities identify the strengths they already have.
Five years ago I heard Western Australia’s inspirational Mental Health Commissioner speaking at a Co-production Wales Conference in Cardiff.
He had launched Local Area Co-ordination, making a real difference for both local people and professionals, who started to think and act differently.
- shifted focus from people as “passive recipients of social care” to people who have gifts, assets and contributions in inclusive communities.
The new model of care proposed by St Marks Dee View Surgery in Connah’s Quay, Flintshire, “Quay to Wellbeing”, puts the ‘lived experience’ at the forefront - returning the local NHS to its communities by encouraging community engagement and participative democracy.
In order to achieve their aims, a Social Enterprise model of governance, support and commitment from all stakeholders will be required.
With collaborative participation from Health Board, County Council and Bevan Commission, and through Co-production with partner organisations, “Quay to Wellbeing” aims to become a world leading centre of excellence for Social- Trauma focused, Prudent Healthcare and Wellbeing.
As Wales’ Chief Medical Officer states:
“Co-production with communities is a potentially powerful way in which public sector staff can respond to the social gradient of health need.
“Understanding community assets and co-productive working seems vital for GP practices, primary care resource centres and primary care clusters”.
“This can involve a variety of activities which are typically provided by voluntary and community sector organisations”.
However, reporting on the experiences of older people in Wales following the introduction of the Social Services and Wellbeing (Wales) Act, Age Alliance Wales Winter Newsletter warns that “- Third sector representatives on Regional Partnership Boards have reported feeling excluded, or at least not fully engaged. Whilst the rhetoric is good, this is not reflected in experience”.