As Wales begins a new Senedd term, there is an important question for those responsible for scrutinising health and social care: what should success actually look like?
The Senedd’s Health and Social Care Committee asked organisations and individuals across Wales what it should prioritise during the Seventh Senedd. The consultation provides an opportunity to influence not just which issues receive political attention, but how progress is understood and measured over the years ahead. The Committee’s role includes scrutinising Welsh Government policy, expenditure and administration across health and social care.
At Adferiad, we believe the starting point should be simple; health and social care reform must ultimately be judged by the difference it makes to people’s lives.
There is much to welcome in the direction of travel. Prevention, community-based support, integration and workforce sustainability are all important priorities. But these ambitions will mean little if people continue to experience services as fragmented, difficult to navigate and unavailable until they reach crisis point.
This is particularly true for people with complex or co-occurring needs. Someone experiencing mental ill health may also be dealing with substance use, insecure housing, financial difficulties or caring responsibilities. These issues do not exist in separate boxes simply because services and funding structures do. Yet individuals can still find themselves moving between different systems, repeating their circumstances and being told that their needs fall somewhere else.
Thus, integration needs to mean more than organisations working together in principle. It needs to mean that people experience a more joined-up system in practice.
The same applies to prevention. Wales has rightly placed greater emphasis on moving away from a model that relies too heavily on hospital and crisis-based intervention. But prevention cannot simply mean reducing demand on acute services. It must mean making appropriate support available early enough to prevent people reaching crisis in the first place.
For people experiencing mental health or substance use issues, accessibility matters enormously. Services need to be understandable, responsive and proportionate to people’s circumstances. Where appropriate, people should be able to seek support without having to navigate complicated referral processes or demonstrate that they have already reached a particular level of need.
There is also a need to look more closely at the relationship between mental health and substance use. Individuals with co-occurring needs should not have to navigate separate systems that were designed around organisational boundaries rather than the realities of their lives. Mental health and substance use should be treated as public health priorities, with services designed to respond to the whole person.
The workforce is another area where ambition and reality need to meet. Sustainable services depend on having enough skilled and experienced people to deliver them. Recruitment and retention pressures, pay and working conditions, and short-term funding arrangements can all undermine the ability of organisations to provide consistent support. Workforce sustainability, therefore, cannot be treated as separate from service reform.
The Committee also has a crucial role in asking whether people are genuinely being heard.
Individuals with lived experience and unpaid carers should not simply be consulted when policies are being developed and then disappear from the process. Their experiences should help shape services and should form part of how their success is measured. For unpaid carers in particular, meaningful involvement in care and treatment planning and recognition of their own support needs are essential.
This raises a broader issue about how we measure progress. Waiting times, activity levels and service numbers are important, but they do not tell the whole story. A service can meet a target while a person still feels that they have not been listened to, cannot access the right support or has been passed between different parts of the system.
We need to ask different questions: Did the person get the right support? Did they get it early enough? Did services work together? Did they understand what was happening? Did they have a say in their care? Did their circumstances improve?
These are harder questions to answer, but they are ultimately much closer to what people actually experience.
The Seventh Senedd provides an opportunity to look beyond individual targets and consider whether the health and social care system is becoming easier to access, more preventative, more integrated and more responsive to people’s needs. The Committee has a key role in holding Welsh Government to account for turning its ambitions into consistent improvements across Wales.
Therefore, our message to the Committee is not simply to ask whether the right policies are in place. More importantly, it is to keep asking whether those policies are making a meaningful difference to the people they are intended to support.
That means scrutinising integration, prevention, accessibility, workforce sustainability, long-term funding and health inequalities. It means understanding the experiences of people with complex needs, unpaid carers and those who reply on community and third sector services. And it means measuring success not only through activity and performance data, but through outcomes and lived experience.
Fundamentally, health and social care policy exists for people. The scrutiny that shapes the next four years should keep that principle at its centre.
Read Adferiad’s full response to the health and Social Care Committee consultation here.
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