National review of prevention and promotion of independence for older adults

Our work for this report took place during 2019 across all 22 local authorities in Wales.

This is a companion report to our national review of care for people living with dementia.

What we did

We looked at the experiences of people aged over 65 who had received support from social care and health services

We worked with Healthcare Inspectorate Wales (HIW) to find out how social care and health services work together, and contribute to the experience and outcomes for people who need support.

We looked at these key themes:

• People – are their voices heard and do they have control?
• Partnerships, integration and co-production – who is working together and who is designing support together?
• Prevention – how are services stopping people from reaching crisis or from needing care and support
• Well-being - what matters to people?

For each theme, we considered:

• What outcomes do people achieve?
• How well do services respond to people day-to-day?
• How well do organisations work together at the senior level, and how well are budgets and resources meeting the local need?

Our findings

• People – voice and control - Almost all of the time, people were treated with dignity and respect by care staff who made a positive difference in their lives. Care staff were looking for opportunities to ensure people had their voices heard more often and were able to make choices about things that matter to them. More work is needed to make sure that carers have their voices heard. Leaders and managers must work towards bringing information, advice and assistance (IAA) together, and apply the Mental Capacity Act 2005 in all their work.
• Well-being – We found the importance of helping older people to maintain their well-being was increasingly recognised as a positive way to promote independence, and an aspect of work many care staff found rewarding. The right for carers to have an assessment hasn’t yet helped carers with some of the challenges they face. The law says that carers must have their well-being prioritised, but there isn’t much explanation, which means that carers’ expectations and available resources are not the same.
• Partnerships and integration – We found many people benefitted from positive relationships they developed with care staff who treated them as equals and helped people to achieve what matters to them. More focus is needed by leaders and senior managers across local authorities and health boards on their responsibility to recognise and develop a culture of sustainability, through working together and designing services together.  To date, people in our communities have not seen many benefits from this.
• Prevention - we established that the duty to support people before they reach crisis is not consistently carried out across Wales. Sometimes managers misunderstand their duty and believe that if a person is not eligible for care and support plans then they are not eligible for other help. Welsh Government will want to give more clarity in this area and around the role of personal finance in assessments for care and support. 

Next steps

We are committed to following up the recommendations contained in this report and will work with others to improve outcomes in relation to the prevention and promotion of independence for older adults.