All people are equal partners who have voice, choice and control over their lives and are able to achieve what matters to them
Deprivation of Liberty Safeguards/Liberty Protection Safeguards
The Deprivation of Liberty Safeguards (DoLS) process continues whilst the national transition to the Liberty Protection Safeguards is still anticipated in future. No start date has yet been confirmed.
The DoLS team is now almost back up to full strength following a period of change, with additional agency staff taken on to help manage the waiting list. Now the worst of the Covid-19 pandemic has passed, practitioners have been able to return to more nuanced face-to-face visits rather than remote assessments. The team continues to build positive working relationships with advocacy services and other partner agencies. Feedback suggests the Conwy DoLS team has a good reputation in terms of advocacy.
Through group training and consultation on individual cases, the DoLS practitioners (Best Interests Assessors) continue to actively support front-line staff (both social work teams and care homes) in improving robust, person-centred application of the Mental Capacity Act and the Deprivation of Liberty Safeguards. They have also fed into the national consultation process regarding the new Mental Capacity Act Code of Practice (incorporating the forthcoming Liberty Protection Safeguards).
What difference has it made for people?
Implementation of the DoLS process means an increasing number of individuals have their rights safeguarded, have an extra layer of scrutiny over their care arrangements, access to advocacy, and are able to bring a challenge to court should they wish to do so. The DoLS help ensure care planning is lawful and completed in accordance with the Mental Capacity Act’s principles of being in the person’s best interests and of being the less restrictive option. This includes more robust planning, consultation and documentation around issues such as advocacy, tailoring placements, access to the community, the use of covert and anti-psychotic medication and meaningful daily activities.
What are the challenges?
There is a long waiting list for referrals. The high concentration of older people and care homes in the area result in an above-average number of people deprived of their liberty. In addition, DoLS authorisations have to be renewed at least every twelve months and the assessments are legally complex and lengthy. These factors perpetuate the waiting list. As a result, there is a risk people may be unlawfully deprived of their liberty, may not have full access to their rights, and may be in a placement which is not in their best interests, or which is overly restrictive.
We are awaiting the start date for the introduction of the Liberty Protection Safeguards, but we know that some responsibilities under the LPS will transfer from the DoLS team to front-line social work practitioners. This will require significant preparation and adequate training for those teams. Not knowing the date, final shape or form of the LPS makes it difficult to plan and develop a service delivery model.
The DoLS team will continue to actively manage and prioritise the waiting list. On-going high quality legal and refresher training will be provided to new and existing staff, both in terms of the DoLS and LPS, in preparation for the changes in practice. Existing Best Interests Assessors (DoLS practitioners) will prepare to convert to the role of Approved Mental Capacity Professional (AMCP) under the LPS. However, this cannot happen until the accredited training organisations and conversion requirements for this post have been published.
Loud Voices is a group for children and young people cared for by the Local Authority and facilitated by Independent Reviewing and Safeguarding Officers. The aim of Loud Voices is to listen to children and young people about their experiences and views to ensure that they have a voice. This enables professionals to learn about what is going well and what we as professionals can do differently.
Following exit from the Covid pandemic, we have reactivated this group. The sessions are always planned to ensure there is a balance so that children can have some fun time, as well as participating in consultation with the adults present.
Developing our dementia services
To support the development and delivery of dementia services locally we have established the Conwy Dementia Services Forum. This is an operational group which aims to foster open and collaborative discussion for those involved in the development, implementation and reporting of dementia care across Conwy. The group will also drive and oversee the innovative implementation and delivery of the Dementia Strategy across the County. We have representatives from the Council, Betsi Cadwaladr University Health Board, and the Third Sector on the forum.
Officers from Adult Social Care have established a working group with representatives from a range of different departments across the Council to support us with achieving the status of being recognised by the Alzheimer’s Society as a Dementia-Friendly organisation. We are now working on an action plan to support the retention of that status. This is now acknowledged and recognised in Conwy’s Corporate Plan.
We are actively engaging in a range of newly-established task and finish groups managed by the Regional Collaboration Team in relation to supporting the implementation of the ‘All Wales Dementia Care Pathway of Standards’. These have been scoped over the past two years, with over 1800 people, ranging from those living with dementia to voluntary sector organisations and practitioners across Wales and the UK. This work has been led by Improvement Cymru as part of the Dementia Care Programme, and directed by the requirements of the Dementia Action Plan for Wales, overseen by the Welsh Government Dementia Oversight Implementation and Impact Group (DOIIG).
There are 20 standards (narrowed down from over 100 potential standards), and they drill down to the detail of what people believe will make a positive difference to dementia care in Wales.
Within the Social Care Department we have utilised Regional Integration Fund money to appoint a Dementia Support Worker (DSW) within each of our five locality teams. They support Health and Social Care staff working at the CRT, enhancing our multi-disciplinary approach to supporting people to live well with dementia whilst staying in their own homes. This in turn supports the development of the team around the individual approach referenced in the Dementia Action Plan and provides more person-centred and coordinated care, as well as support and treatment as required. The DSWs provide a key point of contact for families to help them navigate the complex Health and Social Care system, and also deliver:
- Flexible, personalised outreach support, using a ‘team around the individual’ approach from first diagnosis.
- Community navigation (signposting to other services) and advocacy support for people with dementia and their loved ones.
- Support which responds to need, rather than dictated by rotas.
- Support to access overnight and day respite services at Llys Elian residential home as needs escalate.
- Extra support for those where traditional domiciliary care is failing, and more support is needed to maintain independence.
- Support and training for families and unpaid carers, including the promotion of the use of digital technology.
- Links with district nursing around end of life care, and the wider Community Resource Team.
Through the Dementia Support Team (again funded through the RIF) we have been able to test the concept of a more flexible approach to delivering care and support in the community for people living with dementia, and their unpaid carers.
The team has enabled people living with dementia to maintain their independence and remain at home, avoiding unnecessary admissions to hospital or residential care, and delaying the need for such services. They have also reduced delays when someone is due to be discharged from hospital. Within the local context, this means a reduction in incidences of Delayed Transfer of Care from the psychiatric hospital, with reduced use of out-of-area placements, thus reducing disruption and distress for families and with associated savings in placement costs. It is anticipated that this more effective support for carers of people with dementia will impact positively on carer resilience and reduce crises. Unfortunately, recruiting to the team has continued to prove extremely challenging, and we have never been able to appoint into every position.
Due to service pressures, our plans to trial a more flexible service at our Elderly Mentally Ill residential home (Llys Elian) and link it with the work of this team have still not been able to progress. We had hoped the team could access overnight and day respite at Llys Elian as needs escalate, but due to Covid restrictions and capacity issues across the care home sector, we have not been able to progress this at all. Regardless of this, the team itself has had a positive impact on some individuals’ lives.
The following case study demonstrates how the Dementia Team work closely with individuals and their loved ones to create the best possible outcomes.
Prior to our involvement, M lived independently at home with the support of his caring step-daughter. Following his dementia diagnosis, our Reablement Team supported him for an initial assessment period, and were then replaced by the Dementia Team for four calls a day for personal care, meals and medication. M is a pleasant gentleman who is mostly receptive to care, however on occasions he will decline assistance to dress for bed. This was an initial challenge, as his step-daughter was concerned that he wasn’t getting to bed at night, and the bed didn’t appear to have been slept in. We had concerns that, in time, he may develop pressure sores, so we worked with M to establish an evening routine, which has had a varied success rate.
In good weather M likes to walk over to the local grocery shop, and is sometimes absent at the lunch call. We work with M, and go back to him at a later time.
We also work closely with M’s step-daughter, who escorts him to all his health appointments and feeds back any relevant information to the team. We are currently working together to fortify M’s diet due to weight loss and low blood platelet counts, and completing food and fluid charts. His weight is being monitored at the clinic.
M continues to live well with dementia in the community with four calls a day.
What were the challenges?
Ensuring the involvement of a person living with dementia and their loved ones on the Dementia Services Forum has been challenging, so a different approach is being trialled to engage and consult with individuals who access the Dementia Centre, managed by Carers Outreach. By discussing service issues and hot topics on a regular basis, this avenue will allow us to inform service development and delivery.
The DSW was a new role for us, and at its inception we weren’t really sure what the form and function of the role would entail. However, it is true to say that the role has evolved over time and the post-holders are now seen as integral to, and very valued members of, the CRT.
We would like to increase the number of Dementia Support Worker posts as the role has become key in enabling the wider CRT’s support of individuals living with dementia in their area. Should any further funding be made available to us it is certainly a resource we’d like to build on due to the positive difference they make.
Over the next twelve months we hope to progress with our plans to foster links between the dementia team and the resources available at Llys Elian residential home.
Engaging with Care Leavers research programme
Conwy County Borough Council, in collaboration with Bangor University, have won a bid of £234,000 from Health and Social Care Research Wales to undertake a two-year piece of research that looks specifically at the engagement of care-experienced young people. Currently the ethics application has been submitted and the literature review is underway.
What were the challenges?
A large factor was seeking funding during the Covid-19 pandemic. This piece of research was the only successful bid in North Wales and, in order to strengthen the application, we have partnered with other agencies across Wales to ensure there is a national approach to the research and its dissemination.
The research itself focuses on the poor engagement of care-experienced young people with services, and this may present a leading challenge going forward.
The research aim is to:
- Develop a new practice model for engagement with care-experienced young people.
- The project management board has been established and nominations have been put forward for young people across Wales to take part in the research.
- Dissemination of the research will include creation of a podcast, TikTok and training packages for all Local Authorities.
Autism Reality Experience Bus
Conwy commissioned the Autism Reality Experience Bus in the autumn and winter of 2022-23. The Autism Reality Experience is an innovative, immersive and hands on training session which has been developed to give non-autistic people a virtual experience of living with autism. It provides a very practical hands-on experience that gives participants a greater insight into autism and helps them to begin to see the world from the perspective of a person with autism.
The bus focuses on raising awareness of the sensory processing difficulties faced by people on the autism spectrum. As this is an important area of awareness-raising across the Local Authority, the experience has been made available to all public-facing services across Conwy, including Housing, Leisure Services, Libraries and of course Social Care and Education. We included an invitation to local architects working with the Local Authority, whose feedback was positive in terms of their understanding of how the environment can positively or negatively impact a person with sensory processing difficulties.
This is what participants took away from the experience:
It has made me think more about how a person with autism thinks and sees things around them, and their interaction within their environment.Participant
Being more aware in terms of communication and be aware of the environment and any background noise before asking questions or giving instructions. I had been aware of this before, but the Autism Bus brought this more alive and made it more visceral.Participant
Being more aware of how overwhelming sensory input can be when asking an individual to complete a task or follow a daily routine.Participant
You can read books and attend other training but this gave so much more insight and really hit home how much of an affect autism has on the individuals we support’s everyday life and what they may have to deal with on a daily basis. I really didn’t appreciate how hard it is.Participant
What were the challenges?
Raising awareness that this has cross-cutting relevance for all departments has been a challenge. We are also aware of competing priorities in terms of what training should be mandatory, especially given people’s capacity to complete everything that is asked of them.
We will continue to commission the Autism Experience Bus, based on the positive feedback received from participants. The feedback suggested that this would also be beneficial to parents of children with sensory processing difficulties.
The National Autism Team have launched 2 new modules:
- Module 1: Understanding Autism (we would like this to be mandatory across the Local Authority)
- Module 2: Understanding effective communication and Autism
We have commissioned specialist Sensory Processing Training for the Disability Service Occupational Therapists, Occupational Therapy Assistants, and in-house support staff.
Children and young people have their say via Mind of My Own app
Mind of My Own is a web-based system for children and young people to communicate with the professionals in their lives. Strategically, the aims are to encourage greater levels of participation within Children Looked After (CLA) reviews and Child Protection Conferences, so that the views and preferences of the child are more clearly present. Monthly training sessions have been provided and all Children’s Services teams have started to use the apps with children and young people.
The apps also allow young people to share good news with their workers, and create one-page profiles using the “This is me” feature within the app, amongst many other options. There are two versions of the app, one of which is designed for younger children and those with additional learning needs. A monthly infographic is shared with teams, to stimulate sharing of good practice examples, and to promote more staff to use this valuable new system as part of their overall toolkit.
An audit was carried out in late summer 2022 to establish the quality of “the voice of the child” within Children Looked After reviews. The audit revealed a very positive picture. Out of 20 cases audited, 16 were deemed ‘Good’, 3 ‘Excellent’ and 1 ‘Adequate’. This is good evidence that as a department, we are engaging with children and young people very well, and Mind of My Own is contributing to that success.
Feedback from the “Loud Voices” group suggests that most young people do not wish to attend their CLA reviews in person, and so Mind of My Own offers a great way for them to let people know what’s important to them, in their own words, in their own time.
What were the challenges?
Implementing a new system like Mind of My Own takes time, and has been a challenge following the pandemic, and through a period where staff caseloads were high due to staffing issues.
Staff have existing methods and preferences for modes of communication with children and young people, and some (older) groups of young people may have seen the apps as being more suitable for younger children.
Many foster carers have embraced the new system and say that the children in their care have enjoyed using it. Some have struggled with the technology aspects, and additional sessions and demonstrations have been provided. Sessions have also been provided for Independent Foster Agencies.
The challenge going forward will be to promote continued use of the app alongside other meaningful ways to engage and consult with children and young people who access our services.
Mind of My Own has been funded for the next three years, which provides a fantastic opportunity to continue to maximise the benefits of the system. We are continuing to provide monthly training sessions for staff, and supporting foster carers via attendance at their bi-monthly coffee mornings. The fostering team are adapting their ‘welcome boxes’ to include materials to support the use of Mind of My Own, particularly when children come into care for the first time. The Family Centres are also beginning to use it. At Conwy we’ll continue to use Mind of My Own in order to encourage children and young people to share their voice, so that we can keep them safe, check on their wellbeing, and constantly enhance our services for them.
Conwy and Denbighshire Autism Lead Officer
The Conwy and Denbighshire ASD Stakeholder Group agreed in 2020-21 to support a proposal to employ an Autism Lead to work across both Local Authorities. The new officer started in March 2023 and they will lead on driving the implementation of the Welsh Government’s Autistic Spectrum Code of Practice across Conwy and Denbighshire. They will also work closely with the Conwy and Denbighshire Autism Stakeholder Group to develop a joint local action plan which will build on the Local Authority Code of Practice Implementation Plans and be co-produced with people who have lived experience. They will work alongside the Regional Collaboration officer with responsibility for regional co-ordination of delivery of the Code.
What were the challenges?
Autism currently affects 1-2% of the UK population; that is 1 per 100 children and 2 per 100 adults. Based on the current population of 118,184 and 16.7% being aged 0-15 we would estimate that there are 198 children with Autism in Conwy and 2,359 adults (Conwy population profile research document Oct 21). Denbighshire population is 98,800, with 16.5% under 16, so around 163 children with Autism and 1,973 people with Autism. Across both Local Authorities this is a considerable potential population (4,963) to provide support to in terms of the intent of the Code of Practice for the delivery of Autism Services. Many will not require the support of Social Care, but will require the Local Authority to consider their needs as local citizens in receipt of a broad range of services from the Council.
The Autism Lead will need to consider how the Local Authorities’ policies and procedures need to be adapted or amended to ensure that they take into account the diverse needs of people with Autism and neurodevelopmental conditions, making recommendations as appropriate. Where needed, the Autism Lead may need to work with officers to create new policies and procedures which are specific to the needs of people with Autism. For example the Safeguarding Board have recently drafted a ‘Safeguarding Practice with Autistic People’ policy which will need to be implemented in Conwy and Denbighshire and may impact on existing Local Authority policies and procedures. This could also include corporate policies, for example in relation to reception and advice around effective communication with customers who are Autistic or who have Neurodevelopmental Conditions. We’d also need to consider how our forms and information systems need to be adapted to meet the diverse needs of Conwy citizens.
The Lead Officer will need to take responsibility for implementing Conwy and Denbighshire separate internal Autism local implementation plans. Conwy and Denbighshire internal structures are organised quite differently, and the Lead will need to familiarise themselves with both in order to effectively implement the plans. These will focus on
- Raising awareness of Autistic Spectrum Conditions (ASC) amongst staff
- Ensuring that there is a seamless referral pathway between Conwy and Denbighshire
- Identifying gaps in provision and commissioning appropriately to address them
- Creating a Conwy and Denbighshire ASC Action Plan in partnership with a range of services and partners
- Contributing to the development of services to support people with a range of neurodevelopmental conditions
Youth Justice Service
In the Youth Justice Service, we have safeguards and processes in place to support children and young people to learn how to make choices. We see this as a vital part of their development. We continuously seek to provide them with the freedom to make decisions about venues, who is involved in meetings and intervention plans to build their confidence. We understand and acknowledge that young people with a history of trauma may find choice challenging. We work with young people to discover their preferences, to ensure that they have an experience of being treated with dignity.
Our programmed intervention also supports and encourages the involvement of families and carers in all aspects of our work, when safe and appropriate to do so. Through our programmed intervention and feedback systems we support families to develop an understanding of what’s important to each other, and work in partnership with other services and professionals to deliver positive change. We are currently advocating the creation of a Parenting Officer within the service to develop this aspect of work further.
Child-first and trauma-informed approach
As a service we have adopted and implemented a child-first and trauma-informed approach to service delivery which focuses on creating positive relationships with children and young people, their families and carers by providing safety, trust, choice, collaboration and empowerment.
Through the trauma-informed approach, we have supported practitioners to adopt this practice to all work with children and young people open to the Youth Justice Service.
What difference has it made?
Through the delivery of this approach we have been able to:
- Introduce new safeguards and processes to support children and young people to learn to make choices which, in turn, builds their independence. We acknowledge that young people with a history of trauma may find choice challenging.
- Seek the view and preferences of the young people we work with, ensuring that they have an experience of being treated with dignity. We feel that this supports them to develop self- respect, and confidence.
- Ensure that we work in collaboration. Collaboration runs through every interaction we have as a service, with children, young people, their parents, carers, partner agencies and colleagues.
- Embed processes that ensure that we regularly meet and review intervention plans and support, and involve children and young people in decision-making around their intervention plans and contact.
- Encourage and allow practitioners the opportunity to get to know young people, and show that as a service we care by encouraging an ethos that we are working with them not on them.
- Promote the use of positive language with young people and advocate on their behalf. This work is supported and developed by the feedback from young people and families gained from our embedded feedback processes.
- Target the involvement of parents and carers. We’ve programmed intervention to support and encourage the involvement of families and carers in all aspects of our work, when it’s safe and appropriate to do so.
What were the challenges?
There have been a number of challenges in the implementation of the child-first and trauma-informed approach. Since the Covid-19 pandemic we have needed to re-establish contact arrangements and relationships with children, young people and their families.