More Than Just Words - GOV.WALES

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Follow-on Strategic Framework forWelsh Language Services in Health,Social Services and Social Care2016 – 2019Regulation and InspectionPromotion andEngagementProfessionalEducationMorejustMapping, Auditing,Data Collectionand ResearchthanNational andLocal Leadership,and National Policywords .Service Planning,Commissioning and Contracting,and workforce planningWelsh in the workplace

Contact details:Welsh Language Policy UnitHealth and Social ServicesWelsh GovernmentCathays ParkCardiffCF10 029 2082 3135Mae’r ddogfen yma hefyd ar gael yn Gymraeg.This document is also available in Welsh. Crown copyright 2016 WG27825Digital ISBN 978-1-4734-6223-6 Print ISBN 978-1-4734-6211-3

ContentsPAGE3Contents4Ministerial Foreword6IntroductionCHAPTERS8Chapter 1: Policy Context for Delivering Welsh Language Servicesin Health and Social Care16Chapter 2: Building on More than just words .18Chapter 3: Responsibility and AccountabilityOBJECTIVES31Objective 1: National and Local Leadership, and National Policy33Objective 2: Mapping, Auditing, Data Collection and Research35Objective 3: Service Planning, Commissioning, Contractingand Workforce Planning37Objective 4: Promotion and Engagement39Objective 5: Professional Education41Objective 6: Welsh in the workplace43Objective 7: Regulation and InspectionANNEXES4448Annex 1: Examples of Good Practice in Health, Social Servicesand Social CareAnnex 2: Index of AcronymsFollow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care3

MINISTERIAL FOREWORDEnsuring the safety, dignity and respect of Welsh speakers is at the heart ofproviding health and social services in Welsh. It is not just about complyingwith legal requirements and maintaining professional standards; it is alsoabout improving the quality of care and meeting the language need ofpeople and providing good public services that focus on the individual.More than just words ., the Welsh Government’s original strategic frameworkfor Welsh language services in health, social services and social care, launched in2012, has led to a number of improvements which helped ensure Welsh speakersreceive health, social services and social care services in their first language. Thishas been achieved by making the best use of the existing skills and resourcesacross our NHS and social services.The aim of this follow-on strategic framework is to maintain momentum but alsosupport a greater level of recognition among service providers that the use ofthe Welsh language is not just a matter of choice but also a matter of need. Itis especially important for many vulnerable people and their families who needto access services in their first language, such as older people suffering fromdementia or stroke who may lose their second language or very young childrenwho may only speak Welsh.When More than just words . was launched in 2012 it was clear thatstrengthening Welsh language provision in health and social services wouldbe a journey. As various initiatives celebrated at the annual Welsh Languagein Health, Social Services and Social Care Awards have shown there is a lot ofcommitment to realise the vision of More than just words . but more can bedone to ensure more consistency in implementation across Wales.The focus of this follow-on framework is providing care that meets the needsof the individual, not just procedures. We have also taken the opportunityto ensure that the framework reflects changes in the political and legislativelandscape since the publication of the original More than just words . As4Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care

such, implementing this follow-on framework will provide a good foundationfor organisations to provide services in compliance with the forthcoming WelshLanguage Standards.The objectives outlined in this follow-on framework will not be achievedovernight but I know that there is a clear commitment to delivering change. Ifwe remember to ask service users not just what is the matter with them but whatmatters to them we will be well on our way to turning vision into reality.Mark Drakeford AMMinister for Health and Social ServicesFollow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care5

INTRODUCTIONAt the core of all arguments for strengthening Welsh language provisionin health, social services and social care is patient safety, dignity andrespect. Care and language go hand in hand and the quality of care canbe compromised by the failure to communicate with people in their firstlanguage.Many people can only communicate and participate in their care as equalpartners effectively through the medium of Welsh. Service providers thereforehave a responsibility to meet these care needs. Language may seem a marginalissue to some but it can be key to service users.People choose to receive health and social care services in Welsh because that istheir preference and right. For others, however, it is more than just a matter ofchoice – it is a matter of need. This is especially true for the elderly, people withdementia or a stroke, or young children who may only speak Welsh. It is alsoimportant to recognise that the individual is not always in a position to expresstheir choice. People are often vulnerable, and not confident to ask for services inWelsh. Language must therefore be an integral part of the care provided.Throughout my career, I’ve seen many situations where therehas been a lack of availability of Welsh-medium staff whichhas led to a misinterpretation of patients’ needs or even amisdiagnosis because patients are confused, in pain or havelost the ability to understand and speak English.– Service providerWith a high proportion of services in the NHS, social services and social carebeing contracted to third parties, it is essential that the importance of languagesensitivity is also clear and explicit in all commissioning.There is an acceptance that public services are operating within very tightand challenging financial constraints but realising the vision in this follow-onstrategic framework is unlikely to require additional resources. It will, however,require organisations to operate differently. Organisations need to mainstream6Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care

Welsh language services as an integral part of their service delivery and workforceplanning. The original More than just words . strategic framework brought aboutthe development of a number of initiatives which showed how it was possibleto ensure that Welsh speakers can receive health and social services in their firstlanguage by making the best use of existing skills and resources.The focus of this follow-on strategic framework is on care not simply proceduresand so everyone working in health, social services and social care needs to ask theirservice users not just what is the matter with them, but what matters to them.Good practiceAn intensive care nurse was caring for a patient who had not fully regainedconsciousness two weeks after sedation had been stopped and this wascausing concern. Although there wasn’t any language preference noted onthe patient’s records, the nurse started speaking in Welsh and the patientimmediately understood her. It transpired the patient had lost the ability tounderstand or speak English.Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care7

CHAPTER 1Policy context for delivering Welsh language services in healthand social care(i) Overview1.1The Welsh Government is committed to delivering high-quality health,social services and social care services that are centred on peoples’ needsand outcomes. Organisations across the public sector have a responsibilityto comply with the Welsh Language (Wales) Measure 2011 which allows thecreation of new Standards to ensure Welsh speakers can receive services inWelsh. Therefore, Local Health Boards and Local Authority Social ServicesDepartments have a statutory responsibility to ensure that peoples’ wellbeing outcomes are supported, and that their care and support needs,including their language need, are accurately assessed and met. Manypeople can only communicate and participate in their care and supportas equal partners effectively through the medium of Welsh and serviceproviders therefore have a responsibility to meet these care needs.In Welsh I can talk about experiences and personal things.The flow isn’t the same in English. You have to translate,especially when you are talking about something that is soimportant.– User experience1.28Since 2007 the Welsh Language in Health and Social Services Task Group hasmet regularly to discuss concern about the availability of Welsh languageservices. It became clear to the Task Group that there was a commitmentby staff working in both health and social services to provide services inWelsh. There was also some good practice, but this was more often thannot the result of the commitment of individuals, rather than being aplanned element of service provision. In 2012, a report published by theCare Council for Wales expressed concern about the lack of Welsh languageservices available for patients and families through the medium of Welshand this report contributed towards informing the Welsh Governmentpolicy on the use of Welsh in health, social services and social care.Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care

(ii) Strategic Framework for Welsh Language Services in Health, SocialServices and Social Care, More than just words .1.3The Welsh Government published More than just words . its strategicframework for health, social services and social care in November 2012to address these issues in a planned and co-ordinated way. The strategicframework confirmed the Welsh Government’s commitment to strengthenWelsh language services in these areas. Two three-year action plans, onefor NHS Wales and the other for social services, were also published tocomplement the strategic framework and outline the practical actionsrequired to realise the vision. The strategic framework was intended tocover the period April 2013 to April 2016 with annual reports published todemonstrate progress.1.4Being able to access Welsh language services is a clear desire for some,and having the option to use services through the medium of Welsh isnot always a matter of choice: it can also be a matter of need and vitalin securing positive well-being outcomes. Expressing and communicatingneeds in Welsh can be more comfortable and effective for those whothink and live their lives through the medium of Welsh. A lack of servicesavailable in Welsh can therefore be seen as a failure to provide basicrequirements. Many Welsh speakers feel more comfortable expressingthemselves and communicating their needs in Welsh, as they think and livetheir lives through the medium of Welsh. It can therefore be argued thatwhen services are not available in Welsh; this is a failure to meet a basicrequirement.She (mother) used to go to hospital but it was difficult for herto express herself in English. So, she used to feel that thingsweren’t moving as quickly as they should. She used to feelthat they were talking above her and that they couldn’t havea dialogue with her.– User experienceFollow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care9

1.5There are good reasons why health and social care and support servicesshould be available in Welsh: Improving the quality of care and clinical necessity – it is important torecognise the concept of language need. Although the Welsh languageis an integral element in the care and support of many Welsh speakers,some groups have greater need to receive their services in Welsh. Forthese groups, the Welsh language should be viewed as an even morefundamental element of service provision. These groups are:o Children and young peopleo Older peopleo People with learning disabilitieso Mental health service userso Dementia serviceso Stroke serviceso Speech and language therapy services Maintaining professional standards – numerous professional standards inhealth and social care list effective communication as a key requirementand highlight the need to ensure people are treated with respect anddignity. Meeting the language need of people – organisations have aresponsibility to recognise and to respond to language need as anintegral element of care. In other words to provide an Active Offer. Comply with legal and statutory requirements – organisations in thepublic sector have a responsibility to comply with the new WelshLanguage (Wales) Measure 2011. This will create standards regardingWelsh, which will result in rights being established that will ensure Welshspeakers can receive services in Welsh.10Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care

(iii) The Active OfferThere were two people who spoke Welsh on the ward andwhen one of these happened to be on duty, he’d be quieter.He used to sit down, whereas otherwise he used to paradearound. It makes the condition a lot worse if you can’tcommunicate in your first language.– User experience1.6One of the key principles of More than just words . is the Active offer. AnActive Offer simply means providing a service in Welsh without someonehaving to ask for it. It means creating a change of culture that takes theresponsibility away from the individual and places the responsibility onservice providers and not making the assumption that all Welsh speakersspeak English anyway.I think it is hard to ask for a Welsh language service. Youdon’t want to upset the people who are treating you.– User experience1.7In the context of health and social services, many service users are veryvulnerable or anxious and therefore expecting them to ask to receive theirhealth or social care services in Welsh is unfair. It is the responsibility ofNHS Wales and social services to deliver appropriate services, which includemeeting people’s linguistic needs. Only by doing this can they provide aservice that is safe and effective.1.8Over the last 3 years there has been a growing understanding about theimportance of the Active Offer which remains a key element of the Morethan just words . strategic framework. A recently published informationand training pack aimed at supporting all staff across NHS Wales andsocial services in making an Active Offer has helped raise the profileand understanding of the principle. As part of this follow-on strategicframework, the Welsh Government will be creating and updating an onlineinformation resource for all health, social services and social care staff tohelp with a more consistent delivery of the Active Offer.If the child is monolingual, then you should be offered theservice in Welsh without having to ask.– User experienceFollow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care11

(iv) Welsh Language Standards1.9Since the publication of More than just words . the Welsh Language (Wales)Measure 2011 has become law. The Measure provides for new Standards whichare being placed on a range of organisations across the public and privatesector and gives the Welsh language official status in Wales which means thatit should be treated no less favourably than the English language.1.10 Welsh Language Schemes have been successful in raising the profile of servicesthat should be available in Welsh as well as ensuring that many of the servicesare now provided bilingually. The Standards replace and build on the WelshLanguage Schemes and will make it easier for people to use Welsh in theireveryday lives whilst ensuring that services are provided according to languagechoice, as well as need.1.11 The introduction of the Standards should not be seen as an addition to theimplementation of More than just words . or vice versa. The Standards shouldinstead be viewed as a strengthening of the commitments made in this followon strategic framework. By delivering actions from this strategic framework,public bodies will be simultaneously meeting some of the Standards.1.12 Unlike the current Welsh Language Schemes, the Welsh Language Standardshave greater enforcement provisions to ensure compliance. Upon discoveringthat a body has not acted in accordance with a Standard (through spot checksor complaints received), the Welsh Language Commissioner has powers toinvestigate a potential non-compliance. If the Welsh Language Commissionerfinds that a body has not complied with a Standard, the Commissioner mayimpose a civil financial penalty upon the infringing body and publicise the noncompliance to compel the body to comply.1.13 Welsh Language Standards for local authorities (and therefore social services)will come into force on 30 March 2016 and the Regulations creating theStandards for NHS Wales are likely to be passed by the National Assemblyfor Wales in late 2016/early 2017. From that point, the Welsh LanguageCommissioner will have the right to serve a Compliance Notice to organisationswithin NHS Wales. Organisations will have at least 6 months from the date onwhich the Compliance Notice is served to comply with the Standards the WelshLanguage Commissioner chooses to subject them to.1.14 As this follow-on strategic framework is built upon the foundations laid bythe Welsh Language Standards, if people are unable to receive services in theirlanguage of choice, they would have access to the Welsh Language Standards’complaints procedure. This typically involves contacting the organisation whichhas failed to provide services in Welsh directly and awaiting a response. If theperson concerned does not feel that the response is adequate, the individualmay choose to report the matter to the Welsh Language Commissioner whomay investigate the alleged infringement.12Follow-on Strategic Framework for Welsh Language Services in Health,Social Services and Social Care

(v) European Charter for Regional or Minority Languages1.15 European legislation and compliance with the European Charter forRegional or Minority Languages establishes the principle that: the rightto use a regional or minority language in private and public life is aninalienable right.1.16 Article 13 of the Charter is concerned with ‘Economic and Social Life’ and isbinding upon the UK Government (and therefore the Welsh Government):‘to ensure that social care facilities such as hospitals, retirement homes andhostels offer the possibility of receiving and treating in their own languagepersons using a regional or minority language which are in need of care ongrounds of ill-health, old age or for other reasons’ (article 13).1.17 However, the most recent monitoring report from COMEX1 (Council ofEurope’s Committee of Experts) in 2010 showed that there is still much tobe achieved. They made the following recommendation:‘ that the authorities of the United Kingdom take concrete steps tofurther increase the use of Welsh in health and social care’.(vi) My Language, My Health: The Welsh Language Commissioner’sInquiry into the Welsh Language in Primary Care1.18 My Language, My Health was published by the Welsh LanguageCommissioner on 10 June 2014. The inquiry was undertaken on the primarycare sector as this is the first point of contact for many members of thepublic with the healthcare system. Therefore, it is important that there areadequate Welsh language services available in this sector. Health boardswill need to ensure when commissioning services that adequate provision isavailable and at the same time publicise the location of these services.Good PracticeTo provide services in Welsh, a GP’s surgery encouraged staff to learnor improve their Welsh and it developed a new computer system thatrecorded a

(ii) Strategic Framework for Welsh Language Services in Health, Social Services and Social Care, More than just words . 1.3 The Welsh Government published More than just words . its strategic framework for health, social services and social care in November 2012 to address these issues in a planned and co-ordinated way. The strategic

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