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The National Review of Commissioning for Social Care in Wales, 2013-14

Our review found that local authorities and health boards need to make major changes to the way they plan and commission services for people with dementia.

The review took place between July 2013 and January 2014, looked at how well local authorities were implementing the statutory guidance on commissioning published by the Welsh Government in 2010.

As part of the review the inspectorate also visited five local authorities to look at how well services for people with dementia and their carers were being commissioned.

Chief Inspector of Care and Social Services Inspectorate Wales, Imelda Richardson, said:

Local authorities are transforming their services in order to support people to remain living in their own home and community. However, more needs to be done to ensure people understand why these changes need to be made.

By 2021, the number of people with dementia across Wales is projected to increase by 31% and by as much as 44% in some rural areas. Local Authorities and health boards must increase the pace at which they are transforming services to deliver integrated models of care that will effectively support people with dementia and their carers. The vision articulated in the Social Services and Well-being (Wales) Bill (2014) is of a complete change of approach built on citizen centred services; focus on delivery and greater collaboration and integration of services.

The report identifies that the current arrangements for commissioning services are not sustainable in the face of projected future demands and financial pressures.

The report also notes that the move towards integrating health and social care services, while evident, is slow. On the whole, services to carers are varied and underdeveloped in some areas despite the existence of carers’ strategies.

The report also found:

  • There are significant gaps in the planning and provision of prevention and early intervention services for people with dementia.
  • While voluntary agencies are active in developing preventative services, for example Alzheimer’s Society Memory clinics, the commissioning of preventative services from the third sector is ad hoc.
  • There needs to be a greater focus by local authorities and health boards on the quality of care and people’s quality of life when monitoring service contracts.

Review recommendations

Local authorities and health boards should:

  1. Develop current visions into firm plans for service transformation.
  2. Engage the public effectively in the debate about service transformation for adult social care.
  3. Effectively integrate health and social care provision, and develop joint, coherent, and financially robust plans for the commissioning of services for people with dementia and their carers.
  4. Include prevention and early intervention services within commissioning strategies for adult social care.
  5. Develop outcomes based commissioning strategies, with contract monitoring and review, focusing on the quality of care and outcomes achieved for service users.
  6. Ensure that joint commissioning plans have appropriate governance arrangements and frameworks that professionals can operate within, including effective control and mitigation of risks to service users.
  7. Implement effective strategies that provide a wide variety of services that support carers.
  8. Evaluate the effectiveness and financial viability of new and alternative models of care for people with dementia.

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