“Working with people and partners to protect and promote people’s physical and mental health and emotional well-being” Quality Standard 2

Supporting Well-being

The concept of well-being comprises two main elements: feeling good and functioning well. These affect, and are affected by, many different factors: our age and gender, the quality of our relationships, where we live and work, our state of health and access to support and services. The Community Well-being Team in Conwy aim to help residents in Conwy to take up opportunities to improve their health and well-being by getting involved.

Our activities will meet the five criteria:

The aim for 2016/17 was to establish the Community Well-being team in all localities, aiming for the provision of at least 40 healthy lifestyle activities in the five health hub localities between April 2016 and March 2017– 200 in total. We achieved this and more, as well as:

• Just under 5000 attendances at Community Well-being Programme sessions between April 2016 and March 2017.
• Provision of over 200 different types of healthy lifestyle activities in the five health hub localities between April 2016 and March 2017.
• A working partnership with over 55 organisations and 30+ session providers, all of whom are helping to embed 5 ways to wellbeing and prevention activities locally.
• Co-production of a Well-being Ambassador Training Pilot Project with CVSC and running two training sessions with third sector organisations. This project encourages individuals to get involved with spreading the word about preventative health, the CWT programme and 5 ways to wellbeing.
• Co-development of the Villages Project with CVSC to help to fund well-being activities in nine communities outside of the hub areas. This has enabled villages to run their own well-being activity tasters.

From the feedback received, 16% reported improved Relaxation, 13% improved skills, 13% felt better about themselves and 12% felt less lonely.

Next year our focus will be to:

• Develop another 4 x 5 Community Activity Programmes to cover hub localities

We aim to devolve more funds to the local community and the Third Sector to encourage them run their own wellbeing activities then help to support them to ensure the sessions become sustainable

• Full engagement with statutory health and social care teams across Conwy

The focus will be to ensure that communication channels are effective, that staff are aware of the programme and clear about how the programme can be incorporated into the prevention and support remit

• Launch the Health Ambassador programme

We want to recognise the contribution that people are already making and capitalise on the work they already do.

• A more targeted system of evaluation

We have got better at understanding what is required for measurement of health and wellbeing and trialled changes in quarter 4. We are ready for full implementation from April.

• Development of the Conwy Learning Partnership

The network will offer recovery opportunities for residents who have presented with mental health issues.

• Development towards a pilot social prescribing programme

This creates a better network to access services that are not just focused on medical intervention – e.g. singing for people with COPD – validation of social approaches to medical problems.

 

In line with this work we hope to open our third Wellbeing Hub in Llanrwst in 2018.

Client feedback

“Just to say thank you for the help you gave me in class to overcome my big fear of my Tablet. By opening up the uses Google, shopping looking for train services and so on has given me the will to keep going, I know I still have a lot to learn so I will see you on the next course in May if I can get a place.”

Staff feedback

X was suffering from anxiety and depression and felt very isolated. She spoke freely at the last session to say how much she has enjoyed the course and how she is now going out a lot more. She felt more confident and comfortable around people, she also said it had made a difference to how she communicates with others she had made some life style changes in connection with food and mental health and said she was going to discuss this with her son who she cares for. She has thoroughly enjoyed the course and found it really useful and helpful.

Reablement

Conwy has a well-established reablement service that continue to demonstrate a high success rate. We have seen a slight dip in performance over during the year, due to adopting an intake model. (This is the reduced package increasing, but no ongoing care reducing).

Extra Care Flats

Conwy has four Extra Care flats (part funded via the Intermediate Care Fund and Continuing Health Care) which are being used in the main to expedite hospital discharge from acute and community hospitals. It also used as respite for carers. The flats are used as an alternative to residential and nursing care which prevents dependency on care and support. Outcomes for the users include returning to their home in their community as opposed to residential care, moving to suitable housing – such as the flats – where their independence can be maximised. Our aim for the year was to increase the occupancy rates for the flats through better engagement with our Health colleagues. Occupancy has increased from 57% to 68%. The success of these flats has led to us opening a further flat funded via ICF in March, which has been used every night since opening.

Recently, the flats have been used as alternative to residential care where either the previous accommodation is not suitable for the individual to return to, or the person was homeless. Again, the outcome is maintaining independence and avoiding unnecessary residential care which had the potential to become the permanent solution. Conwy are also moving towards using the flats for other user groups which is a trend nationally.

We will continue to monitor the use of the flats and engage with our Health colleagues.

Recovery Compass

‘Recovery Compass’ was established in April 2016 to assist service users with their own recovery pathways and to have a presence in the third sector that would bridge services between statutory services and the community. The aim is to offer a variety of interventions for individuals and to provide support to enable them to navigate their way to appropriate points on their personal recovery journey, with their own aspirations or destinations as their focus or outcome. This recovery model aims to reduce service users’ reliance on statutory services by increasing their resilience, giving them control over their lives and connecting them to their communities for a sustainable support network.

The first twelve months of the new model have been developmental and the service is still evolving. We have seen a steady number of referrals to the service, 37 of whom are receiving regular support and input from the Recovery Compass. Strong links are being made with the Community Well-being Service, which will mean that service users can still access social and support networks beyond Recovery Compass. It hasn’t been without challenges for both staff and service users as the concept moved away from traditionally provided services.

The service expects each individual to have a Wellness Recovery Action Plan (WRAP) and so far 9 service users have completed theirs, with 2 revisiting their plans to set themselves new goals. Two service users have gone on to deliver workshop presentations and report that their confidence and self-esteem has increased as a result.

We will continue to review and develop the service to enable us to be as bespoke as necessary to achieve goals for service users, be that greater social interactions, volunteer or work placement opportunities or education and training. Going forward in 2018 the establishment of the Learning Partnership will be a critical link to ensure that our service users have the opportunity to maximise their potential by attending courses, acquiring skills and growing their confidence and abilities.

Community Mental Health Services

It has continued to be a very challenging 12 months for Community Mental Health Teams (CMHT) for both Health and Social Care services, who wish to run an integrated service to effectively support our service users. Issues have been highlighted concerning staffing and the subsequent effect on caseload management and waiting times, governance, IT infrastructures and the clinical environment.

A comprehensive action plan to stabilise and re-design services was formulated in January 2017 and the senior management team have focused efforts in addressing the issues identified. In addition, regional multi-disciplinary pathways groups have been set up to respond to the requirement of the Mental Health strategy, ‘Together for Mental Health’ and Public Health Wales are undertaking a national review of all CMHTs.

A new innovative practice is being tested in Roslin CMHT with the introduction of the ‘safety huddles’, which has been adapted from the successful use in acute care. The huddles take place at a regular time each day for 10–15 minutes and provide the forum to look at any issues affecting the team that day, e.g. cover for sickness absence or any risks to be managed. This is a very effective and time-efficient method of the team working together to manage risks for themselves and service users.

There is an acknowledgement that service and cultural change will not be a quick win but having a stable staff group and a service fit for purpose and sustainable in the long-term will be a longer-term goal. This should reflect the principles of the Social Services and Well-being (Wales) Act 2014 and the Future Generations Act.

Moving forward in 2017/2018 the Social Care team plan to focus on prevention and early intervention in the Primary Care setting as a fundamental factor in providing efficient and sustainable services, e.g. working with clients with social care issues that negatively impact on their mental health and resilience to prevent further escalation to crisis point and secondary care. A recovery-focused model is important to ensure that service users do not remain unnecessarily in statutory services and are supported to regain and maintain their lives actively in the community.

Children

The Community Well-being Service has recently undertaken research with families who have received intervention through Families First services. Following the research report we have launched a project to explore multi-agency early intervention within Conwy through identified zones/areas. The zones will focus on early intervention and work together to identify and implement an effective model. Partners include Social Care, Health, Education, Youth Justice, Community Development, Team Around the Family and Rural Families First, along with appropriate third sector organisations.

Case Study – Disabilities

Miss Z previously lived with her long-term partner in a flat. Z had experienced significant personal loss which resulted in relationship problems often involving alcohol, solvents and violence. Following a break-up Miss Z became homeless and became very depressed. She stayed in temporary accommodation for some months and contacted the social worker several times a day extremely distressed and wishing she was dead. Working in partnership with Housing we were able to secure a permanent tenancy. In working closely with her in an attempt to build her confidence and embrace her sense of belonging within the community she has grown from strength to strength. She is now partaking in daily chores to meet her skill base needs, attending training courses in confidence-building, and plans to return to education. This has proved a valued piece of work and a true pleasure to see her transformation.

 

Mr. X has experienced three strokes in the last few years. This has resulted in weakened and reduced use of right hand side limbs. Mr. X becomes easily short of breath and fatigued; he is able to walk independently with some difficulty, but has a history of falls.

The issues that Mr X identified were that he was struggling to get dressed independently and that he also needed some help with medication and preparing a hot meal. As a result, re-ablement focused on maximising Mr X’s independence in these key areas. Whilst there are also other longer term outcomes to be worked towards, the ability to provide an early intervention in these specific areas enabled us to maximise independence in the short term without developing dependency. Mr X has fed back that one short visit per day has encouraged him to do more for himself and to get out more often. He says that this has improved his physical and mental health.

Supporting performance data for quality standard 2

Quantitative

The rate of delayed transfers of care for social care reasons per 1,000 of the population aged 75 or over is 00.0%

The percentage of adults who completed a period of re-ablement and:

• have a reduced package of care and support six months later is 8.23%
• no package of care six months later is 89.63%

The average age of adults entering residential care homes is 81.44 years

The percentage of children seen by a registered dentist within three months of becoming looked after is 89.19%

The percentage of looked after children registered with a GP is 72.5%