How things have changed, and stayed the same, as Welsh Institute for Health and Social Care reaches its 25th anniversary

Professor Mark Llewellyn, Director of Welsh Institute for Health and Social Care

As the Welsh Institute for Health and Social Care reaches its 25th anniversary, Institute Director Professor Mark Llewellyn looks at what it how things have changed for the sectors over the past  quarter century. 


Late in 1995 the world was a very different place. Wales had yet to vote for devolution, Tony Blair had yet to make his way to Downing Street, and the Millennium Bug had yet to make its first appearance in the collective psyche. 

It was into this world that the Welsh Institute for Health and Social Care, affectionately known as WIHSC, made its first appearance. A research centre, based at the University of South Wales, WIHSC was created to look at health and social care policies and how they are implemented in practice.  

It was developed to analyse the workings of systems that impacted upon almost everyone in Wales, and advise on how they could be improved, with specialists carrying out evidence-based research using the best principles of academia – those of objectivity, evidence, and impartiality.   

Despite the many differences now faced by the world – not least the unimaginable challenges presented by the Covid-19 pandemic - the problems posed in managing health and social care are very much the same as they were then, and the questions being asked about how to improve support systems continue to be relevant. 

Despite these similarities, much has, however, changed dramatically. Not least among these is the wider involvement of people – whether citizens, service users, patients or carers – in guiding both personal and policy decisions on the care they and others receive.  

A concept reflecting personal choice that has, in particular, become more prevalent in the past decade is that of ‘co-production’, an approach that at its best, equalises the power between people and professionals, giving them voice and control over vital decisions made about their care, rather than it being something that is ‘done’ to them. 

This was enshrined in law under the Social Services and Well-being (Wales) Act 2014, and means that public bodies have a legally-enforceable responsibility to work with and involve individuals, their family, friends, and carers, in ensuring that their care and support is the best it can be. Citizens are able to hold bodies to account for decisions made about them.  

Although ‘co-production’ was officially recognised by the 2014 Act, the idea of individuals having a say, albeit in a smaller way, had already been used in Wales before the Millennium thanks to an idea brought here by WIHSC, that of Citizens’ Juries. 

Following the examples set by their use in England, America, and Germany, the Juries gave citizens the chance to debate complex matters after providing them with evidence on both sides of a subject. It then allowed them enough time and opportunity to come up with an answer to the question posed.  

The initial juries looked at a variety of subjects, including the impact that genome research was likely to have on the health service, what a group of teenagers thought about the ethical and medical impacts of designer babies, and whether older people should take a daily dose of aspirin. 

Earlier this year, an online jury was undertaken by Measuring the Mountain project, which is focused on the impact that the impact of the Social Services and Well-being Act is having on service users and carers. This is a companion project to the national evaluation of the Act which is being led by WIHSC in partnership with three other Welsh universities. 

Giving citizens the chance to debate and influence practices and policies affecting their care, and that of their loved ones, meant we were able to understand the issues raised, and include that in the research we carried out.  

As Director of WIHSC, I am immensely proud that the Institute helped, through juries and a range of other projects, to ensure that individuals are able to get involved in such important matters, and to amplify their voices and experiences. 

While celebrating the successes of the past 25 years, it would be remiss of me to not consider the massive challenges that have been posed in 2020 by the arrival of Covid-19. 

The pandemic has turned the whole world upside-down, and caused unparalleled strain to the health service, care services, and voluntary sector, in ways that the staff and users could never have imagined. We’re yet to see what further challenges these vital support services may yet face as we head into winter and a new year. 

There is, however, at least one glimmer of hope for the future. In no small part, the NHS and social services were established because of the shock to society caused by the Second World War. The impact they have had on society has been immeasurable. 

One hope is that, if anything good comes out of the Covid-19 pandemic, it might be that we as a society will take a long and serious look at sustainability of social care alongside health care in its broadest terms. We have a duty to come up with a sustainable solution to the massive challenges that providing care, both health and social, puts on all of us. 


This essay was published in the Western Mail on November 16, 2020.