People, place, health: constructing a health and care ecosystem for Wales

People,Place,Health ConstructingaHealthandCareEcosystemforWales September2022 Contents 1Executivesummary IntroductionExperttestimony Ourresearchandfindings Amodelfitforthe21stCentury 10Wherewearenow? ThescaleofthehealthchallengeAchanceforchange 15-minutecitiesforhealthandcareCasestudies 20Thewayforward Fivekeyingredientsforahealthandcareecosystem •Movingtoapreventativemodel •Enablingacultureshift •Consideringpeopleandplace •Embracingtechnologytobringaboutchange •Changingmodels:frommedicaltosocial(andfromgeneralhospitalstocommunity-basedhealthandsocialcare) Bringingittogetherthroughapeople-and-place-basedapproach 36Makingithappen ImmediatenextstepsLookingfurtherforward 2 September20223 People,Place,Health:ConstructingaHealthandCareEcosystemforWales Executivesummary Wherearewenow? Thewayforward Makingithappen Introduction Experttestimony WhilethebasicprinciplesonwhichtheNHSwasfoundedremainthesame,oursocietyhasshifted,ourindividualneedshavechanged,andtechnologyhasadvanced.Atthesametime,theCOVID-19pandemichasstretchedour healthandcareservicestobreakingpoint.Responsetothepandemicandtotheongoingclimateemergencyisdrivingunprecedentedchangeinhowweliveandworkinourtowns,citiesandruralcommunities. Thecaseforurgentchange With80-90%ofgoodhealthcomingfromfactorsoutsideofourdesignatedhealthandcaresystems,thesesystemscannotberemotefromtherestofourdailylives.Wider impactsonhealthmustpermeateotherpublicplanninganddecision-makingprocesses–especiallyattimesofgreatchange. Allthismeansthatwemustactnowtoradicallyrethinkhowwecanalltakeresponsibilitytomaintainourhealthandwell-beinganduseourhealthandcareservicesmostprudently.Proactivelyinvestinginwhatkeepsusallwellanddisinvestinginwhatharmsusseemsanobviouschoicebutcanonlybeeffectivelyachievedwithcoordinatedandfocusedinputfromeveryone–thosewithin,andoutsideof,existinghealthandcaresystems,includingthepeopleinourcommunities. 4 Thisreportidentifiesandexploresfivestepsthatcapitaliseonthecurrentpaceofchangetocreateamoreeffectivehealthandcareecosystem:asystemwherehealthandcaresupports–andissupportedby–ourplaces,ourcommunities,oureconomy,andourenvironment. Workingtogether:apeopleandplacebasedapproachtohealth ThereporthasbeenpreparedbytheleadinghealthandcarethinktankinWales,theBevanCommission,andArup,aglobaladvisory,designandengineeringconsultancy. Theseperspectives-theBevanCommission’shealthandclinicalexperienceandArup’sbuiltenvironmentexpertise -havebeencombinedwithtestimonyfromadiversecohortofstakeholders.Together,theyprovideadifferentinsightforthepublic,clinicians,policymakers,ministers,public-sectorleadersandthethirdsector.ThereportdrawsonresearchinWales,yetit’sfindingsprovideablueprintfortransformationalchangeacrosstheUKandbeyond. Ourresearchincludesinterviewswithabroadspectrumofcityleaders,healthboardleadersandprivate-sectorstakeholdersfromacrossWales.Adiversecohortwas essentialtoinformtheintegratedapproachneededtomeetthechallenge. Wespoketoseniorrepresentativesfrom: •CwmTafMorgannwgHealthBoard •BetsiCadwaladerHealthBoard •CardiffandValeHealthBoard •TheFutureGenerationsCommission •CardiffCapitalRegion •CardiffCouncil •Locallyelectedmembers •PublicHealthWales •Legal&General Interviewscoveredtwomainsubjectareas: •Whatchallengesandopportunitiesarewefacing? •Whatcouldthefutureofhealthandcarelooklike? Aswellasinformingourstrategy,quotesfromintervieweescanbefoundthroughoutthereport. People’sviewofthehealthserviceneedstochangefrompoliticallyneutraltowardsomethingthatdirectly ‘‘ ‘‘ triestointervene. –Healthboardinterviewee 5 People,Place,Health:ConstructingaHealthandCareEcosystemforWales Executivesummary Wherearewenow? Thewayforward Makingithappen Ourresearchandfindings Thisreportisdividedintothreesections:Wherewearenow,ThewayforwardandMakingithappen. Wherewearenow Thereportconsidersthescaleofthecurrenthealthchallenge,includinglifestyle(obesity,physicalinactivity,poordiets)healthandcaresystemsandstaffwell-being,highlevelsoflong-termillnessandcareneeds,andsustainabilityissuessuchastransportneeds.We explorecurrentdriversofchangeaffectingpeople,places,communities,economy,andtheenvironment–includingtheclimateemergencyandtheCOVID-19pandemic.Weshareexistingbest-practicecasestudiesofplacesworkingforbetterhealthandcare. Thewayforward Informedbyinsightsfrompanelinterviews,alongwithconsiderationofwherewearenow,weexplorefivekeyingredientstotransformhealthandcareinWales: 11.Considerpeopleandplace 22.Investinapreventativemodel 33.Driveaculture-shift 4. 4Changemodels:frommedicaltosocial(andfromgeneralhospitalstocommunity-basedhealthandsocialcare) 55.Embracetechnologytobringaboutchange Weoutlineavisionofamoreprudentfuturehealthandcareecosystemandillustratehowthatcanbebroughttogetherusingapeople-and-place-basedapproachtohealthandcare. Makingithappen Thereportconcludesthatanewmodelofhealthandcareisurgentlyneededtomeettheprofoundchallengesourhealthsystemfaces.Atitsheart,thismodelneedstobebasedonpreventingpeoplefallingilland,wherepossible,enablingthemtomanagetheirownwell-being.Itneedstobebase