1999–2003

Improving Health in Wales - a Plan for the NHS with its Partners 2001    

Set expectations that local authorities and NHS bodies would work closely together through strategic partnerships to coordinate and plan service delivery. Committed to developing new performance management frameworks for both health and social services to help organisations understand their contribution to joint working and partnership building. Promoted extended care teams and unified assessment processes for patients with complex conditions. Set expectation for local health, social care and wellbeing strategies to facilitate joint working and planning to meet population needs.

 Wellbeing in Wales 2002

Set out proposals for Welsh Assembly to reduce health inequalities and calls on NHS, public health and social care services to work together and develop integrated approach to policymaking to tackle the causes of poor health, disability and poor quality of life.

Health, Social Care and Wellbeing Strategies (Wales) Regulations 2003

Set requirement that Local Health Boards and local authorities would work together to meet the needs of local population and develop a health, social care and well-being strategy for their local area.

Strategy for Older People in Wales (2003-2008)

Set vision and action people to address priority issues for an ageing population. Set commitment to develop joined up services that are tailored and integrated through more coordinated planning and establishment of a National Service Framework for older people. Included investments in social care services and unified assessment procedures. Committed to establishing guidance to promote intermediate care and improve discharge processes, and to create a grant scheme to reduce delayed transfer of care. [Subsequent phases of the strategy have been refreshed between 2008-2013, and 2013- 2023 that build off the original strategy to support more older people to live independently and support more age-friendly communities]

  

2004 – 2009

Designed for Life: Creating world class health and social care for Wales in the 21st century 2005

Built from Improving Health in Wales, to renew a long-term vision for health and social care services, that emphasised integrated service delivery, particularly for older people and patients with complex needs. Reinforced integrated commissioning strategy, committing to review information need and skill development and clarify accountability and governance issues to help local health boards and local councils work together. Called for strengthened action to address health inequalities jointly. Committed target that joint health and social care assessments would be used for all adults, resulting in integrated personal care plans where appropriate. Set requirement that all areas would develop an intermediate and rehabilitative care offering.

One Wales Strategy 2009

Merged provider and commissioner functions into seven unified Local Health Boards to oversee primary, community, secondary and tertiary care services. LHBs are required to work with local authorities and other public services through integrated forums and coordinate action in priority areas to deliver integrated plans for each local authority area. (These forums provided basis for Regional Partnership Boards established in 2014).

Invest to Save Fund 2009

Provides interest-free government loans to public services aimed to encourage innovation and new ways of working to support efficiency. Small scale funding has gone to LHBs to support integrated models of care delivery, for example expanding community response teams to support older people to live independently and avoid hospital admissions.

  

2010–2014

Sustainable Social Services: A framework for action 2010

Set out priorities for social services, and accelerated integrated care delivery in three priority areas: families with complex needs, transition to adulthood for children with disabilities, and frail older people. Committed to expanding reablement services to help more people live independently in the home.

Setting the Direction: Primary and Community Services Strategic Delivery Programme 2010

Established locality networks that had responsibility for assessing the needs of local populations and planning, facilitating all parts of the NHS to work better with social care services and communities, and commission services based on those needs. The strategy emphasised coordination between the LHBs and local authorities, and signalled a shift towards joint management structures and resource management. It also established community response teams, made up of health and care professionals to provide coordinated care management in the home, supported by shared electronic health records.

Together for Health: Five year vision for the NHS 2011

Built off Setting the Direction strategy document, and reiterated the expectation for LHBs to improve links across the NHS and with social care, particularly to help the most vulnerable to live independently. Accompanied by workforce and organisational development framework to support appropriate staffing models to deliver the vision. These frameworks emphasised cross-boundary working and joint roles between health and social care to facilitate rapid responses, rehabilitation, and accelerated discharge.

Delivering Local Health Care 2013

Builds on Setting the Direction to accelerate progress on integration. Set expectations that LHBs would establish new models of care for patients with complex needs, pool budgets, and establish single management structures and joint accountability arrangements. Advanced the development of locality networks by requiring LHBs to establish accountability agreements with local government and other partners. Committed to strengthening incentives for collaboration by transferring budgets and resources into local services and developing shared savings models. Set expectations that LHBs and local authorities would develop shared local frailty models for their area.

The Social Services and Wellbeing Act (Wales) 2014

Set out legislative requirements needed to implement Delivering Local Health Care. Introduced a legal duty on local authorities, health boards, and Welsh ministers to promote well-being and integration of health and social care services. It brought together local authorities, housing, health boards and other local partners into new statutory partnerships called Regional Partnership Boards, that would develop population plans based on local assessments of needs. Set requirement that integration of services for people with learning disabilities, older people, people with long-term care needs, children with complex needs, and carers would be prioritised. RPBs expected to share information and pool budgets for care home and family support functions, and other services boards wished to cover. Gave local authorities the ability to delegate a number of their social care functions to LHBs, and vice versa.

Integrated Care Fund (originally Intermediate Care Fund) 2014

Provides revenue and capital investment to enable integrated working between health, social care, housing, and other sectors. The fund originally focused on supporting older people and helping to avoid unnecessary hospital admissions, delayed discharges / transfers, or inappropriate admission to residential care. The scope expanded gradually to include children and adults with complex needs and / or learning disabilities. Since the inception of the fund, the Welsh Government has made a total of £270 million available up to March 2019. The fund can support new initiatives (or projects), as well as the extension of existing initiatives to a broader area. The Welsh Government’s intention is that successful initiatives are sustained but mainstreamed into organisations’ core business and supported by other funding streams.

  

2015–2020

The Wellbeing of Future Generations Act 2015

Established seven wellbeing goals for all public bodies, designed to support longer-term planning and cross-government strategy on poverty, health inequalities, and climate change. Integrated working of public services seen as a core aim, and stated that public bodies must consider how their own health and wellbeing goals impact objectives of other public bodies. Required all local authority areas to establish a Public Service Board, that includes representatives from health and social care, to produce local well-being plans, including pooling of budgets.

A Healthier Wales: Plan for health and social care and Transformation Fund 2019

 Set out vision for a whole system approach to health and social care, delivering on recommendation from the Parliamentary review of health and social care services in 2018. Created new national Transformation funding programme to develop and scale new models for integrated health and social care that will be ‘seamless’ and build on primary and community care network clusters. RPBs will oversee and coordinate these pilots, with each locality designing at least two models of care. Designated Transformation Fund to support implementation. Complemented by a workforce strategy that identified skills and training needed in workforce to deliver new models of care.

Rebalancing care and support white paper 2021

Proposals to improve social care service delivery simplifying joint planning and delivery for services, and reorienting commissioning practices towards value. A national framework for commissioning care and support for children and adults would be established to develop standardised commissioning processes across local authorities and local health boards for these services. Regional Partnership Boards would be established as corporate legal entities, with the ability to directly employ staff and hold budgets.