Rural Health Plan Policy In Wales

Introduction

All societies across the world are faced with human needs such as education, security, wellbeing, and health. These needs are met through social policies. The social policies provide guidelines and procedures of how societies and states combat the worldly changes associated with changes in demography, economy, and society as well as changes in globalization, migration, and poverty. In Wales, 20 areas of social policy underwent devolution following the legislation of the 1998 Government of Wales Acts (The Open University, 2018). Among the devolved areas was the health, wellbeing and social care for which the Welsh Assembly Government (WAG) is responsible. This report intends to analyze the Rural Health Plan policy which is under the area of health, wellbeing and social care in Wales - evaluate its effectiveness and make recommendations for improvements.

Different scholars in social work have developed different ways of defining social policy (McClelland, n.d). Social policy analyzes the civil societies, families, markets, national governments, and international organizations and their roles in the provision of support and services in the course of life from infancy to late adulthood (Patt, n.d). According to McClelland, social policy intends to raise the wellbeing of people, and it focuses on the welfare of people who have been through some type of social problems. It targets to find and identify the ways of minimizing the disparities existing between social groups in accessing support and services. Social policy consists of the outcome and product-particular policies and the processes of contest, action and critical reflection between people (McClelland, n.d). It concerns itself with the social values, purpose, and goals (McClelland, n.d). The social groups are differentiated according to race, socio-economic status, ethnicity, sexual orientation, migration status, age, disability and nationality (Patt, n.d).

Social policy is part of the legislation and values which act as the standard for the provision and funding of the services and support of social workers. The social support and services given to social groups include neighborhood renewal and housing, family and child support, unemployment training and support, social and health care, poverty reduction, and income maintenance and education and schooling. Social policy is affected by the change of government or government policies, and this necessitates political scrutiny which puts into debate the extent to which social work services should receive public funds (The Open University, 2018). The debate is usually done by both the media and politicians.

Health, Wellbeing and Social Care

This policy field in Wales is characterized by a focus on integrating social care and health, as well as the delivery of social support and services by partnering with local institutions. This area of social policy in Wales is impacted by three levels of governance structures. These levels include the international and European level, the All-Wales level and the local and regional level (Wales Institute of Social & Economic Research, Data & Methods, n.d). The governance structure at the international level is the World Health Organization (WHO). The authority of the WHO in Wales, in some cases, stretches down to the local level. At the European level, Welsh policy is influenced by the WHO Regional Office for Europe.

At the All-Wales level, the health social care policy functions are incorporated in the Government of Wales Acts of 1998 and 2006, and they are subtly defined in the 2006 National Health Service Act of Wales. The WAG sets the strategies and policies for health and social care in Wales. At the local and regional level, there are seven Local Health Boards (LHB) which are integrated to cater to every healthcare services. Integration of health and social care at the local level came about due to the need to reform from the local and regional tier structures adopted by the NHS Wales in 2003. The structure in 2003 was deemed as over-bureaucratic and complex, and through integration, it would be easier to channel resources to front-line support and services (Wales Institute of Social & Economic Research, Data & Methods, n.d).

Comparably, in the UK, the policy field of health and social care is delegated to the National Assembly. Interest groups and organizations play a significant role in the dynamics of this policy field in the UK. For instance, the Faculty for Public Health, which works with NHS Wales, sets standards for health and social care work. The Health and Safety Executive (HSE) which also liaises with the WAG, promotes and regulates health, welfare, and safety in workplaces. The Social Care Institute for Excellence (SCIE) identifies and creates a knowledge base for ethics in social care aspects in the UK (Wales Institute of Social & Economic Research, Data & Methods, n.d).

Wales is aiming at transforming the way its health, wellbeing and social care policies are implemented. This is in pursuance to the plans initiated after a Parliamentary Review that was commissioned by the Welsh Government. Some of the priority areas which the Parliamentary review identifies are rural areas, children and young people and people that are dependent on carers (Welsh Government, 2018).

The Rural Health Plan

The trend towards achieving integrated social support and delivery of services across Wales necessitates the Rural Health Plan. Rurality concerns the whole nation of Wales, and it is a key element that impacts the processes of planning and service delivery by the LHBs. The Rural Health Plan exhibits the Welsh Government’s delivery of one of the key One Wales commitment – which is to ensure full utilization of staff skills and resources, along with new technology like telecare in providing people in rural Wales with better care (Morgan & Jones, 2007) .

Analysis of the Rural Health Plan

The Welsh government recognizes that the communities in rural areas are advantageous to the nation. Rural regions have open spaces with beautiful sceneries, occupied with fresh air that allows easy, natural access, community trust, and neighborliness and safety and freedom for children. Apart from the government, these properties of rural areas occupy a high place in the hearts of those who visit and relish in rural amenities. Notable, however, is the isolated state of rural places which presents challenges to rural communities. People who grew up in rural communities may have adapted to the inevitable challenges, but the Welsh government finds the need to conduct checks to ensure that local needs are well supported. In order to ensure that people in rural communities can live more fulfilled lives and experience more independence, the WAG focuses on improving their health, healthcare and social service requirements (Welsh Assembly Government, 2009).

Through the Rural Health Plan, WAG exhibits sound knowledge that health is inextricably interconnected other aspects of life not only in rural regions but also in urban regions. These aspects of life include transport, housing, leisure, and work.

The central aim of the policy is to lay focus on the people’s health in rural communities – their healthcare, wellbeing, social and health care needs so as to help them live happier and independent lives. The Rural Health Plan also aims at acquiring a more accurate understanding of life in rural regions and the factors which affect their well-being and health by taking feedback and views from the local people with regards to what their pressing concerns and needs are. The policy targets to use better planning and an integrated provision of health and social care, together with a good infrastructure of transport to enhance mechanisms of supporting rural communities. For instance, the plan would help solve the need for rural residents to go long distances before reaching the nearest healthcare service. Using evidence from the local people, this policy aims to establish more stable foundations for making plans for social and health care in Welsh rural communities (Welsh Assembly Government, 2009).

Another aim of the Rural Health plan is to establish a clear definition of rurality in Wales. This owes to the absence of a precise definition of rurality, and the existence of different classifications make it more difficult to make comparisons or rurality in the national and international context. Therefore, in a bid to define rural Wales, the policy considers “rural land,” “rural activities,” and “rural people.” The Organization for Economic Cooperation and Development (OECD) in 1994 defined rurality using a population bracket of fewer than 150 persons per square kilometer. Thus, using this definition, the policy helps in showing that approximately 50% of Wales consists of unitary authorities (Welsh Assembly Government, 2009).

The primary objectives of the social policy focus on community cohesion, integration, and access. Under the community cohesion and engagement objective, the policy shows that social understanding and integration significantly affects both the community and individual wellbeing and health. The policy illustrates that there is a direct relationship between community cohesion and community and individual lifestyles. Particularly, with better community cohesion, community and individual lifestyle factors such as diet and nutrition will increase. This outcome will be made possible by increasing the access to health and social care which improves the physical and mental wellbeing of people allowing them to share knowledge about different choices and cultures of food (Welsh Assembly Government, 2009).

The integration objective of the policy will ensure that support and services provided to people in rural regions is done using either third sector, private or statutory agencies. This objective will ensure the provision of rural health services will promote the best use of every essential resource. This best use of resources will originate from the existence of a crystal understanding and ease of identifying where and how services can be integrated and provided to people in rural communities. The policy emphasizes that solving single specific problems in isolation will not result in better services. Instead, dealing with integrated systems, integrated workforce, and having integrated services, service delivery, and planning models is more flexible and creates more economies of scale (Welsh Assembly Government, 2009).

The access objective ensures that services are brought closer to service, either by bringing the services to the people or bringing the people more close to the services. The WAG recognizes that health and social care services are limited and not every community receives an equal range of these services. To increase access, the policy suggests the development of strong transport networks, e-health, telecare, telemedicine, domiciliary visits and developing mobile services to close the gap between people in rural communities and the points of delivery of health and social support and services (Welsh Assembly Government, 2009).

Evaluation of the Rural Health Plan

Evidence of the implementation of the Rural Health Plan can be approached from three different perspectives. They include the public perspective, professional perspective and literature point of view. They are discussed as follows.

As aforementioned, critical to the implementation of the social policy was the acquisition of feedback from people living in rural areas to understand their real needs. Information to supplement this policy was sought through research by the Opinion Research Service of Swansea University. The results of the research contribute to the public perspective of the need of the social policy. One response from the public is that there is a need to improve access to every service in terms of transport, times of appointment and waiting lists. This is because it is identified that traveling costs in rural areas is higher than in urban regions. This high cost is due to the unavailability of transport and the long time needed to reach the closest health and social care service. The public showed understanding that it is potentially difficult to provide technical services completely locally, but they expressed the significance of those services being availed in their locality (Welsh Assembly Government, 2009).

The public also showed the need for improved communication and collaboration across every service. By coordination, statutory bodies and communities will no longer have to duplicate their efforts. Also, many respondents observed that inequalities in care provision by Unitary Authorities were as a result of a poor funding formula. Rather than basing on ‘per capita,’ there was a need for the funding formula to have a more realistic consideration of the range of rurality (Welsh Assembly Government, 2009).

The different kinds of evidence and experiences derived from healthcare providers and professionals working in rural regions contribute to the professional perspective of the Rural Health Plan. One opinion that necessitates the Rural Health Plan is that it was hard to achieve economies of scale in rural regions because the use of unit costs to measure efficiency was inappropriate and inequitable for the provision of rural services. Also, when services are widely dispersed in a geographical area, it becomes more costly to deliver them to those in need. Some professionals thought that with poor transport services, more challenges associated with access and medical expenses for both patients and staff were bound to be faced. The long distances required for patients to travel limited the time spent on direct patient contact. To increase efficiency, the professionals found it necessary for the development and training of rural healthcare practitioners and that significant traveling should not influence modes of delivery of services (Welsh Assembly Government, 2009).

The challenges pointed out by professionals unlocked a number of opportunities for the Rural Health Plan to intercede. Some of the opportunities included the integration of unscheduled care services connectedly across the primary, ambulance and secondary services which execute a fast and adequate response to patient needs in rural regions. Also, the misuse of ambulances can be diverted to supplement alternative services, like providing general transport in non-emergency situations (Welsh Assembly Government, 2009).

In order to support the objectives of the Rural Health Plan, a literature review was undertaken by the Institute of Rural Health. The literature review revealed that there exist constraints such as the increasing aging population, mental health issues, and long-term limiting illnesses. A comprehensive look into these needs shows that, despite having a better quality of life in rural regions, older people are acquiring less social support from informal structures. Therefore, service delivery in rural communities should not disregard the aging process as a terminal aspect, but as part of the experience of a complete and fulfilling cycle of life. In addition, with emergency care being another risk factor, people in rural communities were at higher risk of not acquiring defibrillation and thrombolysis within the standard time limits. It was also identified that the highest rate of long-term limiting illness in the UK is in Wales (Welsh Assembly Government, 2009). The evidence suggested that palliative care in rural areas is affected by the absence of symptom control, transport assistance, bereavement support, and nursing help.

Therefore, capitalizing on the information acquired from the public and professional perspectives and the literature point of view, the Rural Health Plan informs the future procedures and guidelines which will result in improved health and social care service.

Recommendations

In order to make improvements in the delivery of health and social care in rural areas, everyone needs to be responsible for the implementation of the Rural Health Plan both during the long term and short term. The actions to be taken include having a strong national expectation and purpose, as well as having clear delivery accountability. Some of the expectations include the development of infrastructure to facilitate service delivery, like training and developing staff. Social policies need to be reinforced with an integrated delivery of services. This is because, through integration, the expertise of different services and professionals can be brought together to increase sustainability (Welsh Assembly Government, 2011).

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Bibliography

• McClelland, A., n.d. What is Social Policy?. In: Part 1: Introduction to Social Policy. s.l.:Oxford University Press.
• Morgan, R. & Jones, L. W., 2007. One Wales: A progressive agenda for the government of Wales. [Online] Available at:
• Patt, L., n.d. What is social policy? International, interdisciplinary and applied. [Online] Available at: [Accessed 12 January 2019].
• The Open University, 2018. An introduction to social work in Wales. [Online] Available at: [Accessed 12 January 2019].
• The Open University, 2018. Legislation, policy and values: the social work remi. [Online] Available at: [Accessed 12 January 2019].
• Wales Institute of Social & Economic Research, Data & Methods, n.d. Health, Wellbeing and Social Care - Policy Briefing. [Online] Available at: [Accessed 12 January 2019].
Welsh Assembly Government, 2009. Rural Health Plan: Improving integrated service delivery across Wales. [Online] Available at: