Our primary source of signposting is our website. We also provide information via our professionals and partners, and our Conwy Single Point of Access (SPoA). SPoA is the first point of contact for a range of services including Older People’s services, Physical Disability and Impairment services, Occupational Therapy services, Learning Disability services and Carers’ services. This team currently receives an average of 1500 contacts per month, around 75% of which receive signposting information and low level advice which results in them being able to proactively manage their own situation without interventions from statutory services.
In addition, we actively promote Dewis, and engage with our Health colleagues and the third sector to promote this and the All Wales Health and Wellbeing website to public and professional teams alike. Currently Conwy has around 700 resources, ranging from low level support groups and activities to more established groups such as care support groups on the DEWIS site, pulled from independent, third sector, community and statutory groups/teams. This site is used by the SPoA and other teams across Health and Social Care, and others, to support members of the public to undertake activities of their choosing in their own community.
This year our focus was on promoting the use of Dewis and all of its resources to professional teams from across Health and Social care in all five locality bases, as well as the hospitals.
With ICF (Intermediate Care Fund) support we have developed the SPoA to include a falls pathway. This is because the impact of having a fall can then result in a greater need for both Social Care and Health support, as well as Well-being. We have enhanced our CAT (Conwy Access Team) provision to be able to deal with enquiries and increased demand more effectively.
We have been able to meet most of our objectives and strengthen our information base. This work is ongoing into 2017/18, where we will be reviewing the effectiveness of the impact of the changes and the best use of resources. Priorities for next year include making the process more effective and efficient in order to provide smarter access into services.
Customer feedback has been initiated and we will build on this to establish making consistent service user feedback a priority for next year.
We are promoting the Dewis website to ensure that families can access information directly. At the front door referral point we are working closely with Team Around the Family to ensure that people can access advice and assistance at the appropriate level without the need for statutory intervention.
We are piloting a new way of working using collaborative skills and techniques to promote self-determination and personal achievable outcomes. The approach is based on enhanced communication, with a focus on working in partnership with children and families to identify and build on strengths, promoting positive outcomes. Positive feedback has included families being more open to attending and actively participating in family group meetings which is, in turn, improving communication within families, between families and professionals, and assists in building a plan for withdrawing from a case. This pilot will be evaluated in 2017 to consider the next steps towards a roll-out within all teams.
We are mindful to ensure that our decision-making is inclusive of children and their families wherever it is safe for the children to do so. Legal Planning Meetings are designed to consider the UNCRC (United Nations Convention on the Right of the Child) when making decisions which will inevitably affect the rest of their lives.
Dignity and respect are promoted through the collaborative skills work and is shared through lunchtime seminars.
Children and families are included in planning processes wherever possible. This is facilitated in Care and Support planning, Core Groups and Public Law Outline processes.
Healthy lifestyles are promoted through care and support planning and some children are assisted with the allocation of sessional workers who can provide positive role models and promote healthy lifestyles, which includes facilitating activities.
We continue to work closely with CAMHS – Child and Adolescent Mental Health Services – to ensure that all children can have equal access to services as needed. We meet bi-monthly and have more recently introduced case discussions to the agenda.
Conwy is part of the regional collaboration which commissions advocacy services for children receiving social care. This is promoted through raising awareness at team meetings and ensuring that information leaflets are available, particularly for looked after children. In June the service provider will be implementing the ‘Active Offer’ to ensure all children within the child protection arena and looked after fully understand what the service can provide, including the offer to attend meetings and act as the child’s representative should they wish to take up the offer.
All agencies are invited to be involved in the care and support review meetings. Attendance is inconsistent and is being considered. Workshops are planned to engage other agency colleagues in the collaborative skills approach.
The North Wales Regional group has recently launched the new assessment tool to be built into the managing information systems. This has been designed to comply with the SSWBA and enhance assessment and eligibility.
Case Study – older people team
X was a gentleman in his early 70s, married for over 30 years to his wife, Y, also in her early 70s. They have grown up children who all live away.
Work to support this couple began 18 months ago following concerns by mental health services that Y had been diagnosed with a form of dementia following physical health complications, whilst X on the other hand had become obsessive in some of his beliefs and routines.
Initially both were supported by X as a carer who had now found himself in a very different role in life and he found it hard to undertake physical daily tasks that many of us just see as routine; this was down to the traditional roles he and his wife had adopted throughout their marriage.
It became apparent that X’s mood had become very low and his GP and our enablement teams tried to raise his mood and support with day to day tasks. However, X’s health declined further and he admitted himself to the local psychiatric unit where he remained for several months supported by his social worker, Community Psychiatric Nurse and the mental health and therapy team. His wife went to stay with one of their children.
X was clearly able to make decisions but would sometimes, due to a depressive episode, be unable to weigh up information as part of the decision-making process. Because of potential family conflict and the competing views of family members, at this stage we sought to appoint an independent advocate to support X to ensure his views were clearly respected and upheld at all times.
Whilst staying with family, Y was admitted to hospital as a result of both her physical health and the impact of the separation from her husband on her emotional well-being.
We worked with the health board where Y was staying and our local health board to have Y transferred back to North Wales for rehabilitation. This enabled the couple to see each other again on a near daily basis, and re-established the sense of belonging to an area. It also enabled the multi-disciplinary team to properly assess both and ensure that both had the optimum opportunity to be as independent as possible to reach their full potential and ensure that they are both seen as central to the whole process.
It took a few weeks for all the family to see the importance of the reunion. Separation of a couple has such a detrimental impact on people, and as a best interest assessor we always consider the impact such a loss could have, especially those with dementia.
Despite the attempts of all members of the MDT and our commitment to support people back into a community they have known and been an active part of such a long time, they, with support of all family members (after a series of family conferences and the voice of the advocate supporting X and Y) asked to be admitted into residential care close to one of their children.
X felt that being able to see family on a daily basis would support them more and would support him to support Y on her dementia journey.
We were able to work with the care home for both to remain together as husband and wife. Sadly however within 4 months of the placement commencing X’s health declined significantly and he was admitted to a general hospital in England.
Whilst all their children were now in support of the decision they felt excluded from what was going on in the general hospital. X’s health declined further and his capacity to the point where he too was diagnosed with a form of dementia.
We travelled down to his hospital in England to ensure that family were central to his whole process and to ensure his needs were met and he was central to the whole process.
He was so depressed he now was unable to communicate. By attending the hospital and having time with him at his bedside, we were able to get him to start communicating his wishes and aspirations again and although limited, it was clear he wished to be with his wife.
After over two months of complicated negotiations with the health board in England we were able to ensure that he was moved to an appropriate nursing home near to family, and once settled he and his wife could be together again.
In today’s world we often assume that we should be supporting people to remain in their own home however it was clear that X and Y felt that they would not manage in the community, it was a decision which has largely safeguarded both as there would have been risks if X’s mood had dropped further.
It is also worth noting that, to have safeguarded them in the community, we would have been looking at 24 hour care in the home and this may not have been the least restrictive option as it would have been hugely intrusive.
Case Study – Looked After Children Team
Two siblings live with a family member due to issues of neglect, concerns of physical abuse, domestic violence and substance misuse. The eldest had presented with escalating issues with behaviour, including attacking others on a regular basis and being destructive within the family home. He has had a CAMHS assessment and has been diagnosed with a number of disorders.
There was real concern that there would be an imminent placement breakdown if specific timely support did not commence.
Regular therapeutic support from a Clinical Psychologist has been put in place and has increased in frequency in recent weeks now that the child is becoming more comfortable with the therapeutic approach. Sessional Support is provided during school holidays to engage and provide activities and support around behaviour. This also allows the younger sibling and carer to get some one-to-one time.
The aim of the support provided to the carer has been to help them both to think about the elder child’s difficult and challenging behaviours and the aggressive, controlling and rejecting manner. The therapist provides therapy, experience insight and theory.
It has been challenging for the care giver to accept the support from the therapist, with a number of appointments cancelled. The challenge of gaining the trust of a care giver takes time. Out-sourcing our sessional support has led to some difficulties.
This has been one of the first ICF support packages that we have commissioned and it is currently working well and providing good outcomes. We will review in due course and develop the project further.
Supporting performance data for this quality standard
People reporting that they have received the right information and advice when they needed it
79% of adults who responded told us that this was the case. Most additional comments were also positive, with only three respondents suggesting that advice is not forthcoming, or can be conflicting at times.
73% of adults with a learning disability agreed with this statement, although some expressed concern that they don’t receive adequate advice to give them the full picture and can feel confused.
Similarly, 78% of carers agree with the statement, feeling satisfied with the information and advice that they have received. Most additional comments were from those who responded ‘sometimes’, expressing frustration with the complexities of the system and incorrect information about respite opportunities. The financial implications of incorrect advice seemed to be a concern.
85% of children who responded were happy with the information and advice they receive. Additional comments suggest that they rely heavily on their parent(s) and Social Workers for that advice, but one respondent has taken the initiative to do their own research.
People reporting that they were treated with dignity and respect
94% of adults stated that they were treated with dignity and respect whilst receiving a care and support plan. The remainder responded ‘sometimes’. Additional comments were mixed, with some citizens praising carers who are “well trained and very courteous” whilst others expressed concern that discussions take place with their family rather than themselves, or they have felt ‘told off’.
92% of adults with a learning disability feel respected, with very few additional comments to help build a further picture.
93% of carers agreed with the statement, with several positive comments about polite, helpful and respectful staff within the Authority. No-one disagreed with the statement from this cohort.
89% of children feel that they are treated with dignity and respect; some responses have included their own parents’ behaviour towards them as well as that of Social Care staff.
People with a care and support plan reporting that they have been given written information of their named worker in social services
82% of adults know who to contact about their care and support plan. This question generated lots of additional comments to clarify who the named officer is and who tends to make contact with the service (even from those who answered ‘no’).
88% of adults with a learning disability are aware of who to contact within the team, with many naming the relevant professional in the additional comments. There seems to be a confidence that someone will be there to help.
82% of carers know who to contact and many offer additional comments in support of the valuable support provided to them in their caring roles. There were, however, several negative comments around financial struggles and being able to contact the relevant professionals when needed.
93% of children know who to speak to about their care and support. The additional comments name some of these individuals and highlight the additional support networks at school and home.
People reporting that they felt involved in any decisions made about their care and support
78% of adults have felt involved in decisions, however many of the additional comments highlight a certain lack of control due to conditions such as Alzheimer’s or dementia. In many cases, family members make decisions on the care and support package on their relatives’ behalf.
Adults with a learning disability felt that they had a higher level of decision-making ability, with 83% of respondents agreeing that their views have been listened to. The additional comments do suggest that improvements could be made to levels of contact from Social Care professionals.
84% of carers felt actively involved in decisions regarding the service provided to the cared for person, although comments suggest that more regular contact with the service would be welcomed.
85% of children who responded felt that their views were listened to.
People who are satisfied with the care and support they received
86% of adults are satisfied with the care and support they receive from us. Some comments refer to a need for consistency in the times that care is delivered and that communication around changes to visiting times and support staff is essential.
85% of adults with a learning disability are happy with the care and support received, but again, changes to staff, agencies or accommodation are often unwelcome.
78% of carers are happy with the support they have received. The additional comments demonstrate the conflicting priorities and burdens on this group of people, many of whom are managing their own health problems, looking for support in obtaining respite from their caring duties and struggling with financial burdens.
88% of children feel happy with the care and support they have had, whether that be with their own parents or as a looked after child.
- The percentage of adults who have received support from the information, advice and assistance service (IAA) and have not contacted the service for 6 months is 76.64%
- The percentage of assessments completed for children within statutory timescales is 95.34%
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