The Welsh Context: Wellbeing, Language and Equality

Reaching everyone without being asked

This part of the course is about what makes health and social care in Wales its own thing. The specification brings together three areas that look separate. The first is how health and wellbeing are promoted and measured across the whole population, which includes the Well-being of Future Generations (Wales) Act 2015, a law that sets seven well-being goals, and the Public Health (Wales) Act 2017. The second is the Welsh language in care, and in particular the Active Offer. The third is the experience of Black, Asian and minority ethnic people in care in Wales: the racial inequalities in who gets access to services and in the workforce that provides them, and what the Welsh Government is doing about it, including the Anti-Racist Wales Action Plan 2024. One idea runs underneath all three, and it is worth holding on to because it turns a list of names into something you can use in an answer. A service that waits to be asked only reaches the people who ask. Measuring wellbeing is how you find out who is being missed. Acting early is how you reach somebody before a problem is serious. The Active Offer is a Welsh-language service that does not wait to be asked. And tackling racial inequality in access starts by looking at what a service does, rather than at the people it is failing to reach. This module teaches that idea. The different types of service and who regulates them, who does what in a care team, and the full list of protected characteristics each have a module of their own.

Five ideas for the Welsh context

These five come up across all three areas of this topic. Two of them are easy to blur together, and an answer that keeps them apart shows that you know what each one is for. Read the definitions carefully, because the steps that follow ask you to apply them to situations rather than to recite them.

Match each wellbeing measure to its kind

Spotting early intervention

A school in Wales wants to improve pupil wellbeing. Which of these is EARLY INTERVENTION, rather than prevention, treatment or measurement?

• A teacher notices that one pupil has stopped joining in, and arranges a conversation with a support worker that same week
• Every pupil has lessons on managing stress, before anybody has shown any difficulty
• A pupil who has been unable to attend for a whole term is referred to a specialist service
• Every pupil fills in a questionnaire about how they feel, and the answers are compared with last year

Waiting to be asked, or making the offer

The Active Offer is about the Welsh language, and the specification describes it in two parts: Welsh should be as visible as English, and a service should be available in Welsh without the person having to ask for it. The difference between that and a service that is simply available in Welsh on request sounds small. It is not, because it moves the job of raising the question away from the person receiving care and onto the service. Two other names belong here. The Welsh Language Commissioner promotes the Welsh language and checks that organisations meet their duties towards it. The Welsh Language Strategic Framework is the plan for strengthening Welsh-language services in care.

From the numbers to a change

A health board wants to know whether its services are reaching everybody. Put these five stages into the order that turns measurement into action.

• Collect wellbeing indicators across the whole population
• Break the figures down to compare different groups and areas
• Find out from the group doing worse what is getting in the way
• Change what the service does, such as acting earlier or offering it differently
• Measure again to see whether the gap has narrowed

Where to look for the gap

In one area, fewer people from Black, Asian and minority ethnic communities are using a local health service than the population figures would lead you to expect. Which THREE are sensible things for the service to check?

• Whether its information and appointments are offered in the languages people in that area use
• Whether it records who uses it by ethnic group, so that the gap can be seen and tracked at all
• Whether it has asked people in those communities what gets in the way
• Whether people in those communities care less about their health
• Whether those people should be sent to a separate service of their own

Look at the service, not the people

When a figure shows that one group is doing worse, or using a service less, there are two ways to read it. One reads it as a fact about the people: they do not want help, or they do not bother. The other reads it as a fact about the service: something in how it is run reaches some people and not others. Only the second is useful, because it points at something the service can change, and it is the reading the specification asks for when it names racial inequalities in ACCESS. No figure can tell you how a whole community feels, and an answer that claims to know is making a claim that no evidence could support. The specification also names inequalities in the WORKFORCE, which is a reminder that the people who provide care in Wales, and not only the people who receive it, can meet unequal treatment. The Human Rights Act 1998 and the Equality Act 2010 are part of the law that applies in Wales. The Anti-Racist Wales Action Plan 2024 is a Welsh Government plan, and its name says what it is for: not only avoiding racism, but acting to remove it. In an exam answer, the strongest move is to name something a service could change, and then to say how you would know whether the change had worked.

Find the line that blames the people

Five lines from an imaginary review of a community clinic. Tap the ONE line that explains a gap by blaming the people rather than looking at the service.

• Attendance from one neighbourhood is well below the rest of the area, so the clinic will ask residents there what gets in the way.
• Appointment letters are sent in English only, and the review recommends offering them in the languages patients use.
• People from that neighbourhood clearly do not value the service, so no change is needed.
• Reception staff will greet everybody in Welsh and English and ask which they would prefer.
• The clinic will record attendance by ethnic group and check the figures again next year.

The bus that nobody knew about

A village had a bus route that almost nobody used. The company decided that the villagers simply preferred their cars, and it was about to cut the route. Before it did, a new manager looked at how the route actually ran. The timetable was pinned up inside the depot, three miles outside the village, and nowhere else. Nobody standing at a stop could see when a bus was due, so only the handful of people who had already found out ever caught one. She put the times up at every stop and in the window of the village shop, and she started counting who got on at each stop, week by week. Within a season the buses were full. Nothing about the villagers had changed. What changed was that the company stopped waiting for people to come and find the bus, and started counting who it was missing. Hold on to that picture for the next step.

Complete the Welsh context ideas

Making a service available in Welsh from the start, so that nobody has to ask for it, is _____. Stopping a problem from starting at all is _____, while acting as soon as its first signs appear is _____. A measure that shows how a whole population is doing over time is _____.

Build the exam sentence

An answer about a gap in who uses a service is strongest when it points at something the service could change. Choose the option in each gap.

Law, plan, service or office

Five quick questions on what each named thing in the Welsh context actually is. Three lives.

Running the clinic

You manage a community health clinic in Wales, and this year your figures have just arrived. Work through three decisions.

• The figures show that people from one neighbourhood, where many Black, Asian and minority ethnic families live, are coming to the clinic far less than the rest of the area. A colleague says it is obviously because they are healthier. What do you do first?
• A Welsh-speaking woman in her eighties comes in for an appointment. The reception desk greets everybody in English, and a small sign says Welsh is available on request. She does not ask. What should change?
• At a team meeting a colleague says the clinic cannot be unfair to anybody, because it treats everybody exactly the same. How do you answer?

Explain how a service can reach everyone

A health and social care service in Wales wants to be sure it is reaching everybody in its area, including Welsh speakers and Black, Asian and minority ethnic communities. Explain how it could find out whether it is, and what it should do if it is not.

• Name two kinds of wellbeing indicator and what each would show
• Tell prevention apart from early intervention, with an example of each
• Explain the Active Offer and why Welsh on request falls short
• Say where to look first if one group uses the service less
• Say how the service would know its changes had worked