New models of service delivery in Wales and lessons for local government Dr Andrew Goodall Chief Executive Aneurin Bevan Health Board

How does it feel? ABHB

How has the NHS responded? Built on the foundations we had in place Let our staff get on with it Safe care being at the core of the Health Board Acknowledge that we are facing a challenging environment Ensuring patients are seen in the right environment, when they need it, with the right professionals

How has the NHS responded? Promote that health (and wellbeing) is not just what the NHS does. Different skill sets (and workforce) for this new environment Used service redesign and modernisation Focused on developing a reputation for good care

Positively embracing change “If you do what you’ve always done, you get what you’ve always got”

New models: Areas of Focus Four tough service delivery issues: – promoting independence and wellbeing for the frail, vulnerable and elderly; – improving the life chance for families with complex and interrelated needs; – reducing the incidence of domestic abuse; and – one that is particularly relevant to those here today – increasing the proportion of young people in education, employment and training.

New models: Areas of Focus In a very practical sense, our work has involved: – understanding, from the perspective of those delivering services, the nature of the problem and what could contribute to alleviating it. – mapping current practice and, through systematic and timely research, identifying those approaches that hold the greatest potential. – working with service delivery organisations (all projects have been jointly led by Chief Executives of Delivery Organisations) and Welsh Government Departments to encourage the wider application of practices identified to be effective.

New models: Encouraging adoption Encouraging the wider take-up of practice has been advanced in a variety of ways: – helping leaders, managers, and frontline staff to quickly understand different models of service delivery – clearly demonstrating how commonly perceived challenges can be overcome; and – where possible, facilitating a coherent offer of improvement support to accelerate the pace at which a new approach to service delivery is designed and implemented.

New Models: Not in employment, education or training We embarked on a short sharp review to: – Quickly and sharply understand what our exemplar areas have done to make a difference; and – assess the costs and benefits of the approaches, both to society and public service delivery organisations.

New Models: Not in employment, education or training Results and performance: – Swansea had the highest proportion of year 11 leavers known to be out of education, employment or training in 2004 (12.2%) but had cut this by almost two thirds to 4.2% by 2010; – Wrexham had one of the highest proportions of Year 11 leavers known to be out or education, employment or training from (7.3% - 9.6%) but saw the rate drop to 4.2% in 2010.

New Models: Not in employment, education or training General Learning: – Public service leaders are recognising the problem and accepting responsibility for developing a joint response. – A targeted approach to ensure that support gets to those young people at greatest risk of disengaging. – Forming meaningful and effective partnerships. – Developing appropriate pre and post 16 provision. – Recognising that good people should be developed and supported alongside good systems.

Areas and learning to highlight More to be done to move from learning to adoption. We can implement more quickly with greater clarity around the service design characteristics that make up new approaches to service delivery. There needs to be a harder edge to measuring benefits Taking the whole system view beyond our own organisations There is an impatience at the operational level to make progress but also for support and facilitation. This is about public services – not public sector

In summary… “If you do what you’ve always done, you get what you’ve always got” Thank you Diolch yn Fawr