The integration journey in Wales – moving below the waterline. Fitting with the conference theme of ‘Change management implementation' this presentation will explore the journey so far in Wales in creating structural, legislative and system change. 

Abstract

In 2014 the ground-breaking Social Services and Wellbeing Wales Act set out a new vision for social care which was built on the principles of prevention, service user voice and control, co-production and integration.  This was further supported by the vision set out in a Healthier Wales; our 10 year plan for Health and Social Care.
 This legislation placed a legal duty on Local Authorities and Local Health Boards to ‘co-operate’ in meeting the care and support needs of their population.  It saw the creation of seven Regional Partnership Boards (RPBs) which brought together Health, Social Care, Housing and Third Sector partners with service providers, service users and unpaid carers to strategically plan care and support in their area. 
 Six years on RPBs have made some notable progress including integrated needs analysis and planning arrangements and the development of integrated service delivery models.  However more work is needed to embed integration into our heath and social care system. 
 RPBs are increasingly being viewed as an iceberg, with partnership working so far being progressed ‘above the waterline’ with the small group of people and organisations committed to the integration journey.  This presentation will set the ambition in Wales for moving ’below the waterline’ and engaging with wider stakeholders and partner organisations to mainstream integration.
 RPBs are made up of a wide range of stakeholders including service users and unpaid carers.  They have all contributed to the integration journey so far and in 2022 these stakeholders have been working closely with Welsh Government officials to review and strengthen current structural arrangements.
 Recent work has included the co-production of an engagement charter to support the effective engagement of services users, carers and third sector organisations in the work of Regional Partnership Boards as true partners.
  
 Work has also been completed to fully align the strategic work of RPBs with Local Primary Care Cluster arrangements in order to ensure strategy and locality based delivery inform and complement each other. 
  Evidence to understand and shape the journey so far has also been provided by Audit Wales, a KPMG review of pooled budget arrangements across Wales and evaluations of the Integrated Care Fund and the Transformation Fund. These two evaluations provided the learning to shape the five year Regional Integration Fund (RIF) launched by Welsh Government in April 2022. The £144.6m a year RIF will seek to create sustainable system change through the integration of health and social care services so that by the end of the five year programme, we will have established and mainstreamed six new national models of integrated care. 
 This presentation will highlight the progress made in Wales in relation to creating structural, legislative and system change but will also raise the question of how to secure the necessary behavioural change to mainstream the integration of health and social care. It will focus on the importance of having the right balance and alignment between systems, structures and people, resources to lever change and the need for a new style of leadership.