Integrating care across Wales - a nationally enabled, locally delivered solution

Background: Brief overview of the problem and context- 1-2 sentences

NHS Wales has launched a national programme to create, disseminate, and maintain a comprehensive suite of care pathways. With clinical collaboration across all of its seven Health Boards, pathways define consistent standards and interventions for 3.3 million citizens, supporting the vision that residents remain well in their homes and communities. The programme exploits a ‘Once for Wales’ approach to maximise value of investment through a shared national pathway development process, governance and outcome measures

 

Approach: Methods, activities or interventions implemented include stakeholder involvement and codesign

Using learning from an implementation in Cardiff and Vale, Welsh Government commissioned the first All Wales approach to the development of integrated pathways supporting care of patients in the community, delivering against the national policy direction of provision of care closer to home. Each pathway describes the interventions and standards for care delivery that all residents, regardless of geography can expect, however, the subsequent localisation ensures the content is contextualised to the local system.

 

 Essential programme components include leadership from a national programme management team, working alongside National Clinical Networks who include lived experience representatives and third sector organisations, as well as local leaders from within the individual Health Board ensuring cross system representation from primary, secondary and community services.

 

This programme is the first time all independent Health Boards have successfully collaborated with a focus on joint success. Agreeing to adopt ‘pathway sharing by default’ required significant levels of trust across the teams, and was done so on the basis that it would deliver the greatest impact for the collective rather than the individual success of any one Health Board

Health Board leaders have recognised this ability to get “independent organisations to work together for a shared purpose” as both innovative and successful. The first of its kind, the programme has demonstrated what can be achieved through collaborative working built on a shared purpose.

Results: Key findings, impact or outcomes :Since the ‘once for Wales’ national programme was launched in 2023, over 320 clinical pathways have been published, with more than 1,500 locally adapted versions. These have generated over 1.2 million page views across all platforms.

Health Boards and GP clusters have used the pathways to review outpatient waiting lists and support GPs in determining whether patients require consultant review or could be managed through integrated community services. In Cardiff, this led to a 10% reduction in consultant outpatient assessments. For example, lumbar spine MRIs decreased by 72% and shoulder ultrasounds by 92%, yielding a theoretical saving of £400,000.