In this section we will provide progress updates on the key areas of work we planned to achieve during 2019-20.
A Healthier Wales
In our 2018-2019 we referred to ‘A Healthier Wales’ and how this plan sets out a clear vision of how Health and Social Care services will be delivered in Wales over the coming years. Within Social Care in Conwy, we have made great strides in achieving the vision as outlined within the ‘A Healthier Wales’ plan, so much so that it now encompasses everything we do as a service and has become ‘business as usual’. For example, we provide services which are outcome-focused and person-centred, we co-produce in relation to services and we are moving towards a more generic workforce.
Development of Community Support Teams
Last year we talked about the development of Community Resource Teams (CRTs) for Adult Services. This has been a programme of work, utilising ICF funding, to enable the integration of services between community Health and Social Care. The Integrated Care Fund (ICF) is allocated by the Welsh Government across Wales. The aim of the fund is to drive and enable integrated working between Social Services, Health, Housing, the Third Sector and independent providers to develop sustainable services. The fund can support new initiatives (or projects) as well as the extension of existing services. Development of the CRTs will now continue under a wider programme of Community Transformation & Integration utilising a Welsh Government transformation grant made available through the ‘A Healthier Wales’ plan.
The focus remains on developing a community team identity and ways of working that enable a ‘single team’ response to local communities.
Work undertaken so far
- There has been a review of boundaries to ensure that individual team catchments are aligned.
- There has been a pilot and subsequent roll-out to all CRTs which enables access to live in-patient data.
- An ‘in-reach’ project has been initiated with the recruitment of ‘progress chasers’. Their role is to improve communication between hospital and community services in regard to care support in place for individuals prior to their admission to hospital, and to support discharge planning.
- Recruitment of Health and Social Care Support Workers has continued. This role pilots the integration of care functions traditionally carried out by either Health workers or Social Care workers.
- There is a need for integrated teams to have a shared ethos for care and support. This is being progressed through ‘asset/strength based’ training for both service managers and Community Resource Teams
- Improvements to the working environment continues to be progressed. There will be refurbishment of the Abergele clinic, which is to be completed before the end of March 2020.
- Morning triage involving multi-disciplinary team meetings have been organised in some CRTs to provide smoother referrals into the teams from the Single Point of Access team, and to ensure the right professional is engaged from the start of the citizen’s journey.
At a team level, recruitment to Single Point of Access and Liaison posts has been successful after initial difficulties, and there are local development teams that are in place to drive local CRT priorities though engagement with teams outside of the core CRT, community groups and local activities.
For example:
- Abergele clinic have met with the Stroke Association and have a focus on falls prevention to tackle waiting lists with the Falls Prevention Service.
- Colwyn Bay have engaged with Telecare Services & Aberconwy Mind. District Nurses have been preparing for the pilot of a new scheduling system.
- Llanrwst have continued to meet regularly and have a focus on team development activities and tackling issues of storage for therapy colleagues.
- Coastal have reviewed office accommodation and how this is creating barriers to working in a more integrated way. A plan to make changes has been agreed with the landlords of the building.
- Llandudno have utilised the Dementia Bus experience, which was well received. The development group continue to engage with other teams and services such as Community Navigators and Age Connect.
What were the challenges?
Challenges still remain with some of the locality buildings such as Plas Menai in the Coastal CRT. Teams are segregated but there are plans to reconfigure teams to be located within the same area under the new scheme of work.
What’s next?
The focus for continued development will be on:
- Models of care and integrated care pathways to ensure seamless care provision.
- Defining the service delivery model and roles within CRT to support the delivery of integrated care, which includes business support services.
- Technical integration and modernisation that enable joint ways of working.
Strength-based practice
The Community Resource Team Programme Board has approved a comprehensive package of training for all professionals associated with integrated care. The joint training will enable staff to adopt ‘strength-based practice’, an approach proven to improve individual outcomes whilst reducing cost to Health and Social Care.
The training will be delivered by the National Development Team for Inclusion (NDTI), an organisation with a solid track record of supporting Health and Social Care providers to embed strengths-based approaches and improving collaboration across different organisations.
Improving efficiency and effectiveness requires organisations to think and act differently; this programme is designed to enable us to adopt innovative and responsive practice solutions that put people at the centre of the support and treatment they receive.
Feedback from Community Resource Team staff
There is far greater verbal communication being conducted now that we are all based together, which will certainly lead to better outcomes for the people we provide support to.
Excellent with regard to communication and efficiency when putting patient care at the heart of what we do as a team.
71% of respondents felt that working within the CRT has helped their learning and knowledge of other professions/services and some appreciate the roles of other colleagues much more since working alongside them.
68% of respondents believe that the CRTs improve the service for citizens, due to a greater coordination of services, less duplication of tasks, and the ability to network between teams to increase efficiency. 74% feel positive about working in the CRT environment going forward.
There are good team dynamics and lots of communication, which results in all the teams feeling confident in each other’s abilities and ensuring that we are all working to the [identified] wellbeing outcomes.
Self-Neglect Risk Assessment Guidance Sheet
In our previous report, we said that our social care safeguarding leads will be working in conjunction with our Health and Safety Team to develop a risk assessment guidance sheet to ensure individuals who self-neglect or hoard have a robust risk assessment. More information on this update can be found within the report under Quality Standard 3.
Focus on Sensory Impairment
Last year we reported on our focus to improve communication for everyone, specifically for our citizens who have a sensory impairment, to ensure that they have equal access to Council services. Here are some of our developments:
- The digital British Sign Language (BSL) interpretation service was launched. The twelve-month pilot has been completed and is now offered as a matter of course.
- The Conwy Deaf Translation Support Service is now located at Coed Pella Council Offices in Colwyn Bay and meets fortnightly.
- A bilingual e-learning module for deaf awareness and basic British Sign Language was launched during Deaf Awareness week in May 2019. Several face-to-face sessions have also taken place.
- Meetings have been held with visual impairment forums to review the accessibility of the Council’s website.
Learning for Recovery and Wellbeing
The Learning for Recovery and Wellbeing programme was a brochure that brought together in quarterly editions all the opportunities for people with mental health issues to learn how to manage their symptoms, develop new life skills and make social connections to build their resilience and support networks. During 2019-20 we were looking to embed the programme into regular practice and continue to produce a quarterly brochure to promote courses available within the programme. Unfortunately capacity to maintain and produce the programme was lost and the printing of the brochure stopped after quarter four.
However, the key element of the programme was the delivery of ‘Self-Advocacy for Empowerment’ (SAFE) courses and we were able to maintain these training sessions that support people in learning tools and techniques for self-care and management.
Our long-term aim was to work with service users to design and develop the types of courses we put in the programme. Although the printed brochure did not continue, we were able to commit to a piece of work with service users and partners to help us identify and shape effective mental health services in the community. We held a launch event in September 2019 exploring with people what ‘good’ looks like, and what support people would need to maintain and sustain their long-term well-being. This work then continued over the winter months with more in-depth stakeholder sessions across a range of groups who support people with mental ill-health. The information and ideas that were generated by these sessions was very rich, and will help inform how services operate and what we can do as an Authority to work collaboratively and creatively with partners to ensure people are empowered and able to have meaningful lives, despite a mental health diagnosis. The report and feedback will be presented at a summit event in the spring.
Preventing Child Sexual Exploitation
We said that we would pilot Wellbeing Ambassadors in two Conwy secondary schools and build on the good collaboration work with multi-agencies, professionals and the voluntary sector. One school has successfully embarked on this journey, with the Well-being Ambassador setting up a peer drop-in, making presentations and promoting awareness days throughout the year. We have now piloted a similar scheme at the Family Centres for parents which we hope, with sufficient promotion and take-up, will be a valuable model for the future.
Our Exploitation Forum continues on a rolling six-week basis, facilitated by social workers from the Assessment and Support Team but also with a colleague from the Youth Justice Service. The forum is encouraged to be multi-agency and in a setting where information can be exchanged around exploitation concerns in Conwy.
Strengthening Families Team
In last year’s report we talked about the Strengthening Families Team’s work with families at risk of breakdown. During 2019-20 the team have developed further, recruiting to full capacity and ensuring that the team offers a comprehensive and specialist service to the families who need them. Team members have received targeted training which relates to the specific needs of people who access the service, such as the impact of substance misuse within families, adverse childhood experiences, and how to undertake collaborative conversations.
Referrals are received via the Edge of Care panel and appropriate collaborative interventions are agreed to support the family. This includes the Children and Adolescent Mental Health Service (CAMHS) who ensure that interventions are carried out in a timely way.
Members of the team work in partnership with families, using strengths-based motivational interviewing techniques, and their approach has been extremely successful. Analysis has shown that of 58 referrals to the service affecting 106 children, 103 remained living at home or in the same placement.
The success of the Edge of Care forum has resulted in more regular attendance and commitment from other agencies. In terms of delivering services, more work is being shared with the Family Centres, particularly around managing more complex cases, and the Family Profile is being adopted as a tool for finding out what matters to families. The Strengthening Families Team have recently designated therapeutic workers to link with each Family Centre to provide advice and guidance about therapeutic interventions.
The shared Looked After Children model of care has been implemented between the Strengthening Families Team and CAMHS which involves a Strengths and Difficulties Questionnaire to measure the mental wellbeing of children in care. Other teams are being encouraged to make use of it, and training has been provided by CAMHS around interpreting the data.
We will:
- Continue to work with the Duty and Assessment team to deliver interventions at an earlier stage to prevent the need for ongoing managed care and support services
- Develop our working relationship with the new Reunification Team
- Strengthen links with the Special Guardianship Orders team
- Continue to develop relationships and provide clinic sessions within the Family Centres
Developing our accommodation services
Last year we reported on a range of developments regarding our projects for accommodation. Phase 1 of the Canolfan Marl Disabilities Accommodation Development project has been completed and was handed over in 2018. Phase 2 of this project, which includes the former Ysgol Maelgwyn site in Llandudno Junction, is underway with construction expected to be completed later in the year. Work has started within the Disabilities Service to identify prospective tenants and we are working with those individuals involved. We are also pleased to report that the following provisions have been offered to families and individuals as a direct result of our accommodation projects:
- Large family on Disability Register who have been waiting for suitable accommodation are ready to take up tenancy of one of the fully adapted large family houses
- Individual on Disability Register currently living in temporary accommodation (one of the Canolfan Marl units) is waiting to take up tenancy in the specialist bungalow
- Children and Vulnerable People teams will be actively taking on one pair of the semi-detached two-bedroomed houses in partnership with Cartrefi Conwy
- Vulnerable People Service has individuals earmarked for all of the 6 one-bedroomed units within the scheme
- The remaining properties on the site will be allocated via the SARTH register with reference to the Local Lettings Policy which has been put in place for this site
Tackling anti-social behaviour through sport
Last year we talked about developing a pilot football programme targeted at difficult-to-reach and disengaged young people who are known to, or associating with, young people already open to the Youth Justice Service (YJS). Often these young people are not engaging with mainstream services and provisions such as youth/sports clubs, as their behaviour creates a barrier to them accessing services, education and training opportunities. These sessions provided an opportunity to engage with positive, sports-based activities which in turn enabled the Youth Justice Service to build up trust and explore further work with the individuals around their behaviours and the impact of offending. The long-term aim was to re-engage them into mainstream services.
What were the challenges?
Obtaining funding to secure this provision was a challenge, due to the YJS falling outside of the eligibility criteria. Internally, a lack of resources, staff time and buy-in from other service areas to provide staffing support has proven challenging. Logistically, transporting younger children to the facility has also been an issue.
What was the result?
There has been a reduction in incidents of anti-social behaviour and offending in the area, thought to result from specific targeting of young people in partnership with North Wales Police. Their figures and local policing plans reflect and evidence this reduction, so the approach is working well.
Benefits for young people
Feedback received from the young people reveal the additional, ongoing benefits of the programme, including the following:
- Getting gym passes, which they would never have accessed without YJS support
- Reduction in substance use as attendees focus more on improving and maintaining their health and fitness
- Getting fitter, allowing some to consider a career in the military
- Two young people are currently undertaking military training
- Two young people have joined military college and put this down to a ‘kick start’ in their confidence levels
- Having something constructive and enjoyable to do
- Engaging in the community and developing links
As the programme has been so successful, in both Conwy and Denbighshire, we will be starting it up again in Llandudno and Colwyn Bay during the summer of 2020. These are the areas where the majority of targeted young people attend. Initially this will be a four-week project to establish engagement through delivering face to face sessions on anti-social behaviour and potential offending. We’ll also run the football sessions to ignite their interest in sports and divert them from offending.
Building resilience among care leavers
In last year’s report we talked about replicating a programme set up by Tottenham Hotspurs football club to build resilience and coping mechanisms. Research carried out by the Personal Advisor management team identified the following needs for an independent living course:
- Emotional resilience
- Budgeting
- DIY skills
- Cooking
- How to be a good neighbour
- How to manage a tenancy
The research was based on the views of young people gathered by the Personal Advisors team and research work carried out by other counties.
What were the challenges?
A lot of time has been spent identifying funding streams for this course and a way to make it sustainable. The result was a collaboration between the Personal Advisor service and the Youth Service.
What’s next?
After the Easter holidays the Youth Service will deliver Independent Living Skills training to small groups of care leavers, based on the modules listed above. The trainer is qualified to deliver accredited training, which means that all care leavers completing the course will gain two GCSEs. There will be two levels available to ensure that care leavers of all abilities are able to benefit from the scheme.
This will be a pilot and any feedback from this course will be used to tailor the approach in delivering future courses. As this is being run in conjunction with the Youth Service no additional funding has been required which means that this is a sustainable course for the future.