Effective partnerships are in place to commission and deliver fully integrated, high quality, sustainable outcomes for people.
This year we have embarked on an exciting new collaborative project with our partners at Betsi Cadwaladr University Health Board (BCUHB) and Grŵp Llandrillo Menai (GLLM). The plan is to establish a new Extra Care Housing scheme alongside health and wellbeing provision on the site of the former Welsh Government offices in Rhos on Sea. Located at the heart of the community, close to bus routes, shops and local services, the site has great potential for development, providing sufficient scope for:
- Extra Care Housing apartments
- A reablement unit
- Student accommodation and teaching/education centre
- Multi-agency office and clinic space
The anticipated benefits following completion are numerous and wide-ranging. In terms of individuals who receive care and support from us, they would benefit from access to modern and accessible facilities, homes and reablement accommodation. We would expect a reduction in long-term residential, domiciliary care, and hospital admittances due to vulnerable individuals feeling supported to live safely and independently for longer.
Staff will benefit from improved working conditions and a modern environment which is fit for purpose and facilitates partnership working. We will focus on working together as one team to enable the individuals we support to enjoy a more independent life, doing what matters to them. The quality of care we provide will improve, our staff will be highly skilled, and as a result of our close working relationship with Grŵp Llandrillo Menai, we’ll benefit from increased retention of fully trained and qualified staff for the future.
This project is therefore an investment in our vulnerable individuals, staff, learners and wider community, and we look forward to updating you on progress in next year’s report.
Independent living scheme for adults with complex needs
In order to prevent adults with very complex needs either going into out of county specialist placements or getting them to move closer to home, we are working with BCUHB to develop a four-person independent living scheme in Conwy County. First Choice Housing Association in Cardiff has been identified as the Registered Social Landlord as they specialise in disability schemes. At present, land is being sought to locate the project.
Families of the identified individuals are an integral part of the multi-disciplinary team and are able to provide input on their behalf. This has taken the form of pen pictures, personal profiles, positive behaviour support plans, and identifying what matters to each individual. We have studied lessons learnt from previous developments, analysed the suitability of potential sites, met with potential support providers and worked on funding streams with BCUHB.
What were the challenges?
The main challenges so far have been around partnership working, and in particular agreeing complex support schemes with BCUHB. Finding land that is suitable within the county for the needs of the project and identified individuals has been challenging, as has finding a support provider who has a qualified and skilled workforce who are able to deliver support in line with Positive Behaviour Support Network guidance.
What’s next?
- Purchase of land and build of development where a collective agreement on architect plans is found
- Continue with monthly stakeholder meetings, ensuring that identified individuals remain at the centre of all decision-making
- Start the tender process for a support provider
- Agree formal partnership process between CCBC and BCUHB which has full governance and delivers outcomes for individuals where all decisions are person-centred
- Agree outcomes between CCBC and BCUHB where joint working is more economically viable for all parties on a long-term basis, creating future joint-working agreements for new developments in line with the Act
- Agree and sign off business case
- Identify a transition plan where the views of the individuals can be sought when the time is right, based on their disability, and ensuring their compatibility to share the building
Children’s Transformation Project
The Central Area Children Integrated Service Board (a partnership between CCBC, DCC and BCUHB) have developed two main projects utilising the Transformation funding.
Bwthyn y Ddol Multi-Disciplinary Team
Objective: to reduce the incidences of children and young people becoming looked after and for those who are, reduce the time they spend in a care placement.
The team will work with families where children and young people are at the edge of care and at risk of becoming looked after as their parent/carer, for a variety of reasons, is unable to manage a healthy family dynamic. The work of the team is initially focused upon completing a holistic formulation of strengths and difficulties, risks and needs in order to recommend a program of work and any additional suitable resources necessary to resolve the issues, in conjunction with delivery of their own intervention. All of the team have now been recruited into position and are accepting referrals.
Complex Behavioural Needs Team
Objective: to support families experiencing difficulties with managing challenging and unusual behaviour.
This project is focusing on the early help aspect of the Transformation bid. This team of professionals will work with families where children and young people have complex behavioural needs that are not being met by the current services offered, with the aim to intervene at the early stage of the presenting behaviour.
The team of navigators will offer signposting and practical guidance to assist parents and carers but will also be supported by the occupational health and psychology professionals within the team, where more complex cases present themselves.
This service will provide support to children and young people that do not have an official diagnosis, have a diagnosis but with limited or no support available or are waiting a formal neurodevelopmental assessment by CAMHS so that the family awareness and understanding of issues improves and they can remain resilient.
What’s next?
A separate project is underway to develop a purpose-built children’s assessment and residential centre with a six-bed property and 2 further emergency beds available, funded through the Integrated Care Fund. It is intended that this premises will be completed by mid-2022.
Whilst this development is underway the transformation programme is looking to develop an interim solution to provide families with this intensive level of support. We will seek to use an existing residential property with the intention of providing both assessment accommodation and a team base until the new facility is up and running.
Working together to make our services accessible
You will read throughout this report that, in our Covid-19 response in particular, we have relied heavily upon collaboration with other services, both internal to Conwy County Borough Council and external. Teams such as Audit, Human Resources and Corporate Finance have enabled us to coordinate support quickly to the most vulnerable people in our communities. We have borrowed staff from Leisure Services and Venue Cymru to get PPE out to direct care settings and provide practical administrative support.
These relationships, now forged, will enable us to react quickly to any future crises, and the learning curve we have experienced in Social Care and beyond has been invaluable.
Telephone support to care homes in Conwy during Covid-19 pandemic
A new service has been established to support the 72 Care Homes, 28 domiciliary care providers and 43 supported living projects that operate in Conwy County. The team work closely alongside colleagues in Environmental Health, BCU Community Health Care Nursing and the Corporate Health and Safety Team in a new collaborative way. Contact is maintained each week with all the providers and care settings to make sure they are up to date with the latest guidance and advice, that CCBC has up to date intelligence on where the sector is at in terms of Covid-19 infections, staffing levels, infection control measures and risk assessments. We ensure that settings are supported when they have positive Covid-19 cases with timely advice, guidance and often additional staff and financial support through the Covid-19 Hardship Fund. The team also hold regular multi-disciplinary meetings, including CCBC and our partners, to review the impact of Covid-19 on individual settings, the impact this is having on the wellbeing of the residents and clients, and what measures can be put in place to support them.
Weekly support and monitoring calls have also been made to commissioned children’s independent residential and foster care settings across the UK throughout the pandemic.
What were the challenges?
This Covid-19 response service has taken resources away from other areas of work for almost twelve months. There are significant challenges managing the Covid-19 response alongside normal activities.
What’s next?
The future of this service is unknown at the present time. Positive Covid-19 cases in the care sector in Conwy are still high at the time of writing, but it is hoped that because many have now received their first dose of the vaccine, these numbers will start to fall. There are however many positive aspects of the service that have developed over the past 12 months that will continue, in particular the close partnership working with BCUHB and the private sector care providers.
Social Value Strategy to raise profile of social values across Conwy and help embed social value into the work all partners undertake.
The future of this service is unknown at the present time. Positive Covid-19 cases in the care sector in Conwy are still high at the time of writing, but it is hoped that because many have now received their first dose of the vaccine, these numbers will start to fall. There are however many positive aspects of the service that have developed over the past 12 months that will continue, in particular the close partnership working with BCUHB and the private sector care providers.
It has not been possible to produce a Social Value Strategy following staff redeployments in response to the Covid-19pandemic. We have continued to support the Social Value Sector in 2020-21 though the commissioned services provided at our Family Centres, our funding to the Conwy Voluntary Services Council and our support to the Community Navigator project in the Conwy West GP cluster.
What were the challenges?
The impact on Social Care of the Covid-19 pandemic has been significant requiring staff redeployment and the creation of entirely new services in response.
What’s next?
CCBC recognise the importance of Social Value and it will be included as a key priority when producing a new commissioning strategy in 2021-22. Incorporating Social Value into the Council’s commissioning will raise the importance among providers for Co-production, Prevention and Collaboration, all of which are essential to deliver our duties under the Social Services and Wellbeing Act.
Digital inclusion within Care Homes
Early within the first lockdown (April 2020), Conwy provided 95 iPad devices to care homes, through a combination of regional transformation funding and Welsh Government ICF funding. Every care home in Conwy received at least one iPad, with the larger homes receiving more iPads to ensure there were enough to meet the needs of residents. All of the iPads had a 4G data allowance and could link to the homes’ own WI-FI. The project has been very well supported by Digital Communities Wales, who have worked with care home staff to help them to maximise the benefits of the iPads.
Feedback from care homes shows that the iPads were very well received and have been well used for maintaining contact with loved ones via “virtual visiting” with family members using Zoom or Skype (or similar), and also to support links with primary care, for example, consultations with GPs as well as links with other professionals such as the Deprivation of Liberty Safeguards Team.
Many of the larger homes had reported issues with WI-FI coverage, in that their signal did not reach certain parts of the building. Additional ICF funding has been used to install WI-FI extender kits in over thirty care homes in Conwy, which has further enhanced digital connectivity, particularly for those isolating.
To further support people living with dementia in care homes, ICF dementia funding has been used to fund the purchase of ten smart desks comprising Android tablets within a mobile stand, with concealed eight-hour battery packs. Ten homes received a smart desk in March 2021, which can be used to enable and promote engagement, leisure activities, creativity and word games, sensory experiences, virtual visiting with families, and consultations with health and other professionals. The large 32” screens will be particularly beneficial for those who may struggle to focus on the smaller iPad screens.
We have been able to take advantage of grant funding to also purchase ‘Rempod’ devices for five residential homes. These create the feel of authentic settings, such as a train carriage, with an LCD screen showing footage of scenic countryside, or a visit to the pub for a drink and meal. Whilst day trips are restricted due to Covid-19, the Rempods have provided an opportunity for residents to enjoy a change of scenery and choose how they want to spend their time. They have been able to enjoy a cup of tea and watch the world go by through the ‘window’, or perform everyday tasks that they used to carry out regularly. Resident feedback has been positive, and it has allowed care home staff to spark up a conversation, or perform reminiscence therapy.
Here is Mr David Boot enjoying a session with the new device installed at Llys Elian residential home in Colwyn Bay.
Case Study
We conducted a consultation exercise with a small group of residents from a local residential home. Covid-19 was present in the home and the residents were unable to go out for their daily exercise as they were used to. This was very upsetting for them, as the home is for younger adults of working age who are used to having some independence.
We discussed the current Covid-19 restrictions and the fact that there would be an end date, when outdoor exercise would once again be allowed. We talked about other activities inside the home which might help with occupying time. The home had recently opened the basement as an additional space, employing an extra member of staff for social activities. One of the residents was enjoying snooker, so we suggested that he organise a snooker tournament for the residents.
One resident commented that he had enjoyed the conversation and felt better having discussed it all. We made sure the residents understood that if they wanted to speak with us again, they could ask the home management, who could arrange another call.
Community Services Transformation Programme
The Community Services Transformation Programme builds on the strengths and achievements of the former Community Resource Team (CRT) Programme which established CRTs in a gradual bottom-up teams-led approach. This programme maximised the Integrated Care Fund (ICF) grant to create capacity and collocating previously dispersed teams, which formed the basis of integrated working and shared values.
A review of this programme identified the collaborative approach was bringing about change but there were numerous organisational and systemic barriers constraining further integration. There was a need for a more targeted approach to remove these barriers in order to achieve transformational change as set out in Heathier Wales. The revised programme of work, through a number of interconnected work streams will result in a plan for the long-term development and sustainability of CRTs across the area by:
- Facilitating a shift away from acute to community-led support
- Ensuring the seamless integration of services and service delivery
- Making best use of digital technology to improve efficiency and enable agile and virtual working
What we plan to do:
There are six thematic research work streams which are in progress and scheduled to be completed in the first quarter of 2021-22. The key objectives of the programme are:
- To understand the whole of the health and social care systems to get a complete and intelligent picture of demand, capacity, flow and cost
- To develop a competency-based workforce strategy that is designed to meet the ambition for seamless models of care
- To develop and deliver a programme of engagement which allows citizens, carers and communities to share their experiences and take an active part in shaping future services
- Through consultation and case audit analyse the effectiveness of our current ways of working, identifying good practice and the elements of redesign needed to support new seamless models of care
- Establish an integrated health and social care management entity that will create the conditions in which the community resources of health, social care, third sector partners and the local community can work together to meet the care and support needs and improve health & wellbeing
- Agree a service model and framework for integrated care delivery that is focused on the person, considers important aspects of their lives, their goals and what matters to them
What have been the main achievements in implementing the programme?
- The strengths of the established CRTs and approach to integrated working during the Covid-19 response has been independently evaluated
- An analysis of the working culture within and across services and organisations
- Data provided by the health board, primary care managed practices and social care has been matched at an individual client level to provide analysis across the whole breadth of the health and social care system and enable evaluation of existing provision to determine the extent to which current and future demand is and can be met
- Analysis of the flow of individuals through the whole system, including building on the work undertaken using the ‘Right-Sizing’ model
- Analysis of costs across the whole system, including a thorough mapping of services and assets
- An accountability framework and role template for Care Co-ordinator, Generic Worker – Integrated Health Social Care Workers and Administrators
- A leadership development programme for senior leaders focused on leading change, collaborative and relational practice skills.
- Three Integrated Health and Social Care Localities have been formed with members from health, including primary care, social care and third sector. These locality bodies will plan for local leadership, governance, commissioning and the deployment of resources
- The programme team are trialling working on Office 365 and how it can support integrated team working.
- The programme team has completed training on Results Based Accountability (RBA) methodology and John Bolton’s Single Integrated Pathways for People and will pilot its application in an agreed pathway to test the emerging insights of the Whole Systems Analysis (WSA)
CRTs have continued to develop working practices and build relationships that will support integration:
- Eight out of nine CRTs are now co-located; work on the base for the ninth in Prestatyn is underway and scheduled to be completed by 31 March 2021.
- The in-reach project has embedded across all CRTs
- A strengths/asset-based approach is embedded in Denbighshire throughout the citizen journey and scaled up across the area through a development approach facilitated by the National Development Team for Inclusion
- The relationship with primary care has strengthened and enabled a cohesive and response approach to service pressures as they have arisen, as well as sharing of information
- Weekly multi-disciplinary team meetings for case discussion and CRT development are being held in most localities
- An integrated approach to triage and complex case reviews are established in a number of CRTs
- A rotation of Occupational Therapists from the Health Board is to be introduced to support continuous professional development.
- Covid-19 emphasised already challenging hospital discharge pathways and practice. BCU have invited social care to join their acute and community services to agree new pathways and improve citizen experience. A pilot of Pathway Zero: SPOA Discharge Pathway in now being piloted in both Conwy and Denbighshire
What were the challenges?
- During the pandemic, the programme was formally paused and programme capacity/resources were redirected to support our front-line response. This has impacted on the recruitment of programme capacity and the commencement of commissioned work. Subsequent waves of Covid-19 have resulted in a slowing down and constraining of some programme activities.
- Getting information governance agreements into place delayed the start of some elements of cross-matching client data.
- Ability of corporate support teams such as HR or IT in responding to the unique requirements of multi-agency work teams.
- Multiple video conferencing platforms and variable access to ICT within different staff groups and across the public sector, third and voluntary sector and citizens have often frustrated effective virtual working.
What’s next?
The work streams will conclude their findings and inform a partnership plan for the long-term development and sustainability of CRTs across the area.
