This section reports against each of the four areas in the Performance Improvement Framework: People, Prevention, Partnership and Integration, and Well-being. Each section will include commentary set out to answer four self-assessment questions.
The self-assessment is evaluative, drawing upon a range of evidence sources such as performance data, research and surveys.
People
- All people are equal partners who have voice, choice and control over their lives and are able to achieve what matters to them
- Effective leadership is evident at all levels with a highly skilled, well qualified and supported workforce working towards a shared vision
Increasing our autism and neurodivergence offer
In last year’s report we told you
that we were recruiting a Conwy and Denbighshire Autism Lead Officer. Jeni Andrews is now in post and has been focused on:
- Developing and coordinating the Autistic Spectrum Condition (ASC) Code of Practice implementation plans, which have been independently valued; Conwy is shown to be making good progress.
- Improving publicly-available information around autism by creating a dedicated web page in collaboration with autistic people in line with the Code of Practice duties. In addition, there is a local directory of autism-related activities and projects.
- Re-establishing regular meetings of the multi-disciplinary ASC stakeholder group, which is chaired by a parent carer.
- Developing services to support neuro-divergent (ND) people through a successful bid for Welsh Government funding for ND-specific research, posts and training.
- Developing autism-specific projects and activities in the local area, including re-establishing a process for funding.
We also told you that the National Autism Team had launched two training modules: Understanding Autism and Understanding Effective Communication and Autism. The modules are available on the Local Authority’s e-learning platform and, although they aren’t yet mandatory, have been promoted via various channels to encourage internal staff and external providers to log in and increase their knowledge and understanding. So far 94 Conwy staff have accessed the modules, and we’ll continue to promote and embed them within our teams.
An autism-specific workforce development task and finish group has been established across Conwy and Denbighshire to help drive forward its duties in the autism Code of Practice. It has identified the range of autism training offered to date and the number of staff trained; the group will focus on an autism training needs analysis.
We have commissioned sensory processing training, including the Autism Reality Experience, and sensory integration training, which is aimed at Occupational Therapists. Over 150 people have benefited from the Autism Reality Experience during this reporting period, including staff from CCBC teams and Conwy MIND, and parents with links to the five Family Centres. Additional Welsh Government funding is being used to procure a range of enhanced ND training for staff and families; this is being coordinated in partnership with a local third sector organisation.
How we can improve
We will continue to drive forward improvements and developments to raise awareness and understanding of autism and neurodivergence in Conwy. We will consider making the training modules mandatory, as they are in other Local Authorities, and address the gaps in skills and knowledge as a result of increasing complexities around neurodivergent individuals.
We know that delays in diagnostic assessments are causing frustration for autistic people and their families; often they are unsure where or how to access pre-diagnosis support. We hope that our suite of planned activities will start to reduce the barriers to autistic and neurodivergent people receiving appropriate support including:
- Further promotion of e-learning for internal and external staff
- Autism training needs analysis to inform priorities
- Autism awareness sessions at forthcoming employment hub events, plus a possible ND-specific employment event
- Improved information, advice and assistance around diagnosis, and better links with diagnostic services
- Autism-specific projects that support people pre-diagnosis
Restructuring our Youth Justice Service
Last year we told you that we’d be reviewing the staffing structure within the Conwy and Denbighshire Youth Justice Service in order to deliver an improved service and ensure compliance with statutory guidance and best practice principles. We have commenced a review and restructure of staffing roles and responsibilities that will result in adequate resource for professional oversight, advice, support and guidance.
How we can improve
Temporary staffing arrangements have been in place for nearly two years and have become unsustainable. In line with feedback from a recent Youth Justice Service HMIP joint inspection process, whilst also taking into account colleague well-being, recruitment and retention, there was an urgent need for a permanent management structure to increase capacity. As well as supporting an improved service, implementing the new structure will increase our capacity to deliver on key organisational and partnership priorities, against the improvements highlighted by the inspection.
We need to be supported by a robust future-focused management structure via the creation of lead specialist practice roles to deliver our action plan and the work required to improve a partnership approach within the service.
A future focus for our management team is providing excellent management support and oversight to the staff within the service and wider partnership, as well as providing up to the minute data and analysis of performance and need. We’ll be looking to create systems that generate data at the right time for the right people, and looking at how the digital agenda can influence information sharing, helping to support the service, management board and the wider partnership.
Our action plan
By implementing a new, improved management structure and introducing an Information Management role to the service, we will create more understanding and awareness, supporting the management board and staff with the development of more effective, simple processes. As part of our two-phase restructure programme we will:
- Support management oversight by enabling the progression of focused Operational Manager roles, leading on prevention, statutory court-ordered intervention, and wider partnership work, as well as the benefits of the Information Management role, to support our organisational priorities.
- We will align practice with the creation of specialist practice roles, leading on themes such as parenting, harmful sexual behaviour, and sexual and criminal exploitation, closely linked to areas of practice around early intervention, prevention, out of court and statutory intervention.
Phase one of the restructure has commenced. The Youth Justice Board agreed the management restructure proposals at a board meeting in April 2024 and we’re progressing this through our human resources process. Once phase one has concluded, and managers are in post, phase two will involve aligning and reviewing the roles of current staff to facilitate the creation of lead roles to address a variety of themes.
Capturing the voice of the child
Conwy and Denbighshire Youth Justice Service gathers feedback from children in a variety of different ways, including:
- Self-assessment questionnaires which are completed by the child, and separately by their parent, carer or guardian at the start, review and end of orders, are used to gather data to help inform assessment and develop an intervention plan that is co-created with the child.
- Mind of My Own surveys to gather general feedback from the child on the quality of service they received from us, including timeliness, location of delivery and whether it made a difference.
- Involving children in co-producing bilingual information and leaflets for children and young people using the service, using child-friendly language.
- Working with the Children’s Commissioner for Wales to ensure that we are fully compliant with legislation and best practice principles; we’ll be identifying a children’s rights champion within the service to mentor staff and lead on developing and improving participation.
- Involving children and young people in the recruitment and selection of Youth Justice Service staff and volunteers.
How we can improve
We recognise that we need to improve the consistency and use of feedback from children to improve service delivery and inform both staff and the Strategic Management Board on a regular basis. To progress matters we are eager to develop and establish an improved and responsive feedback processes in order to facilitate and understand, from a young person’s perspective, what could be done to improve their experience. We are eager to review the compliments and complaints processes for children and young people to ensure that all issues raised are responded to by a Youth Justice Service Manager to facilitate and develop learning and promote continuous development. Our aim is to ensure that we aggregate feedback and report to the YJS Local Management Board on an annual basis.
Our action plan
We have created a small working group to improve the service feedback structures and processes and are making steady progress. A new Participation and Engagement Strategy has been agreed and presented to the Management Board and we are currently embedding the principles of the Strategy in all aspects of YJS engagement with children and young people. Our aim to identify a Children’s Rights Champion has been delayed as a result of interim management arrangements, and the subsequent lack of staffing capacity within the service.
However, despite this, we have this year sought to engage children and young people in the development of the Youth Justice Plan. Following discussion with those open to the YJS, a list of areas of focus were agreed and a survey was conducted among children and young people to obtain their views on the top priorities. Their views have been used to shape the Youth Justice Plan and the priorities for the team for the coming year.
We also have further examples of feedback being provided to the YJS that has led to a change or development. Through various engagement methods young people shared that they wanted additional support with positive activities as often they didn’t feel comfortable attending open access provision. In response the YJS established a holiday and summer activity programme to engage and support children to take part in leisure activities; this also includes some weekday provision. A clear need has been identified for this support, and we are currently in the process of negotiating with the Youth Service for a YJS-specific Youth Worker to lead and support young people to access positive activities.
Use of the Mind of My Own app
Mind of My Own is a web/app-based system that provides an additional way for children and young people to engage with the workers in their lives and share things that are important to them. Strategically, our focus has been to promote the use of Mind of My Own (MOMO) to enhance the review process for children who live with a foster carer, although it is also being used in positive ways across children’s services.
Flexibility is the key to ensuring effective engagement with the widest range of young people, according to their own preferences. We also want to offer up to date methods of communication, and MOMO is one of them.
Feedback from young people who attended a consultation group in 2023 suggested that most do not want to attend their reviews in person, therefore a platform like MOMO is an ideal way for them to contribute their views.
‘Preparation for a meeting/review’ is the most common use of the app, followed by foster care reviews, general problem-solving (where a young person can share any issues with their worker to ask for help), as well as ‘this is me’ and ‘my well-being’ statements which provide useful snapshots and insights into the young person’s life. These are useful for informing ongoing assessment and reviewing processes.
The app has steadily gained traction, with 95 young people and 163 of our workers having created an account for themselves.
Opportunities to support children and young people and their parents/carers have occurred at the regular Loud Voices sessions, which have included an extended invitation to families with children with disabilities. Foster carers are also supported to increase their familiarity with the app, through regular foster carer coffee mornings. There is a Mind of My Own intranet page, and an article on the Small Steps Big Future care leavers’ website which promotes the app. Monthly operational meetings with representatives from key teams (including a foster carer representative) are held to share developments, feedback to and from teams, and initiatives for promoting the app across the service. A monthly infographic is produced and shared via team meetings to highlight usage and those workers who have used it most. All teams have Mind of My Own as a standing agenda item at their team meetings.
Progress against last year’s priorities
- Training sessions have been held for staff
- The Fostering Team will be developing their welcome boxes for children coming into care upon the appointment of a new Recruitment Officer
- Links have been made with the foster carer group
- The Family centres have developed a consultation strategy which now includes Mind of My Own as a tool for helping gather insights into the children’s perspectives
How we can improve
Despite the positive use of Mind of My Own, there is a feeling that a greater number of staff could be making more use of it with the children and young people they work with. We must acknowledge however, that Mind of My Own is but one tool in the toolkit, and practitioners are engaging with young people on their terms, according to their preferences.
Our action plan
A staff feedback survey about Mind of My Own will provide further insights to help maximise the potential benefits of the app. The Local Integrated Family Team works across both Conwy and Denbighshire, and helps families with managing children and young people’s challenging behaviour at home, up to the age of 18. They will start to benefit from using Mind of My Own soon.
Ensuring that people with learning disabilities have a voice
The North Wales Learning Disability Strategy focuses on the needs of people with learning disabilities in the area, and was developed jointly by the six councils and Betsi Cadwaladr University Health Board. Based on what people said was important to them, a vision was set out:
Voice and control puts the individual and their needs at the centre of their care and gives them a voice in and control over reaching outcomes that help them achieve well-being. In Conwy we want all services for people with learning disabilities to help make that happen, and as part of that aim, we, along with our partners, commissioned support for the North Wales Flyers (the North Wales Participation Group) from Conwy Connect for Learning Disabilities, North Wales Advice and Advocacy, and All Wales People First.
The Regional Self-advocacy Advisor post-holder promotes understanding of self-advocacy across the region, encouraging individuals with learning disabilities to become part of the North Wales self-advocacy network. They support the contract with the organisations listed above for the delivery of The Flyers, who are commissioned to ensure meaningful participation for people with learning disabilities in matters that affect them. The role also provides much-needed support to individuals who are interested in starting, participating in and growing self-advocacy groups in Conwy. The Flyers’ contract outlines what they want the contract to achieve, and what it will enable the group to do:
- To give people with a learning disability in North Wales a bigger voice and make sure they are heard and what they say is acted upon.
- To have a place to talk about important local issues and support each other.
- To make sure people with learning disabilities know their rights and are treated with respect and as equals.
- To tell the councils, Health Board and other organisations what we want and drive change.
- To work in partnership with other organisations and people across North Wales.
- To talk about issues like transport, parenting, independent living, benefits changes and feeling safe, and campaign to make them better by connecting with the right people.
- To develop the group so it is financially secure and well run.
The role has helped to address the regional under-representation of people with learning disabilities by helping citizens, and the people who support them, to understand the importance of self-advocacy, empowering them to have their voices heard, assisting them to articulate and express those concerns, and providing a clear pathway through to those who are able to support in addressing those concerns. Feedback from the Chair makes the following observations:
- More people are now coming to the group, and those who do attend feel more able to talk.
- There is a benefit to holding groups both on Zoom and in person.
- The Flyers are supported further by representation in the county areas.
- Having one overall coordinator helps to maintain consistency and continuity.
- During meetings people have a choice about whether to speak up.
- Meetings have been well organised, and reps have been able to talk about their topics of choice directly with Local Authority managers.
- The Flyers group is now more structured in terms of its purpose, and that is cascading down to the self-advocacy groups in the localities.
- The Flyers have been able to input into how North Wales Together funding is allocated.
How we can improve
There have been challenges during this contract period, including getting all North Wales counties on board to the same degree, preparing group members for the meetings, arranging transport to meeting venues, managing the budget, and marketing the group so that staff teams and citizens alike know that it is available, and what it can help to achieve. The Flyers would love to develop a website but will need more money and support to make it happen.
Our action plan
To mitigate some of these challenges we hope to secure:
- Ongoing funding to ensure that the project has longevity and can begin to publicise more widely.
- A link person in each county to ensure clear routes for dissemination of information; this would need to be someone enthusiastic who understands the purpose of self-advocacy and the role of The Flyers.
- A development plan to set out the direction of The Flyers.
- The continuation and development of the Regional Self-advocacy Advisor post as a totally equal partner in the coordination of the service.
Meeting the accommodation needs of vulnerable people
The Vulnerable People Service has set out its accommodation strategy to meet the needs of their service users:
In order to achieve this vision we need to repurpose the project houses that are already available, which are shared properties that no longer meet the requirements of the service.
We have therefore worked with the North Wales Housing Association and our Housing Department to hand back one empty property so that it can be more appropriately used for a family with general housing needs. Focused work has been undertaken with the residents to move on; one is in residential care due to his physical health needs and one is in their own flat with on-site support.
How we can improve
We need to increase collaborative working with local registered social landlords (RSLs), and possibly care home providers, to develop a new model of move-on accommodation. We would need it to provide the safe, secure and affordable environments that service users require in order to build independent lives.
Our action plan
- Complete the handover of one further housing project and move the two residents to more appropriate accommodation
- Continue with the Housing Support Grant review process
- Develop and share our commissioning intention with RSLs to find collaborative and innovative solutions to the issue
Developing a mental wellness pathway with the Health Board
The Mental Wellness Team formed during the Covid-19 pandemic in 2020. Since then, we have been working to establish a strong team with robust processes to meet the needs of our service users and manage the rising demand and increased complexity of mental health. Noticeably, there is an escalation of hoarding and self-neglect cases, which appears to be as a direct result of the pandemic.
There are 225 people open to the team for direct support, plus 310 who receive statutory review and/or support due to an ever-increasing number of people who are detained under the Mental Health Act. This means they have entitlement to Section 117 aftercare, which is ongoing review and financial support.
To build a strong partnership approach, the team are co-working cases with other Local Authority teams, such as the Older People Service, Housing, and external agencies, such as substance misuse services, Probation, Community Mental Health Teams and the third sector.
How we can improve
We want to develop robust pathways between Social Care and colleagues in the Community Mental Health Team (CMHT) within BCUHB, to ensure that the right service can be accessed at the right time for the individual, i.e. a medical or a Social Care response. A joint approach to reviewing Section 117 cases is required as best practice, as well as developing a process for discharging people from Section 117 status as appropriate.
We want to develop a clear vision, entitled The Triple Aim, for the Vulnerable People Service, encompassing the Mental Wellness Team. This in turn will result in an effective and sensible measurement process getting underway to demonstrate our improvements and good practice.
We want to develop increased links with the community and third sector so that service users can be ‘stepped down’ or diverted from statutory services.
We also want to see continued improvement to operational processes, such as the duty system, and management of Section 117 and jointly-funded Continuing Health Care (CHC) cases.
Our action plan
- We’re setting up a working group with BCUHB colleagues to ensure that local pathways are developed as a continuum of care, recognising professional specialisms and providing a smooth transition between organisations.
- We’ll develop closer working relationships via a weekly consultation meeting with children’s services, again to ensure a smooth transition from children’s to adults’ services.
- We’ll continue to provide and evolve drop-ins for Conwy Mind staff to be proactive with the referral process, and to step individuals down to third sector provision.
We’ll continue to develop and refine the team action plan to meet The Triple Aim, for example by repeating the service user satisfaction survey, sending out a staff satisfaction survey, increasing the collection and use of case studies, and ensuring that performance data influences change.
Reverting to Deprivation of Liberty Safeguards
In April 2023, it was announced nationally that the long-anticipated Liberty Protection Safeguards (LPS) would be postponed indefinitely (“beyond the life of this parliament”). Although they remain written into the Mental Capacity (Amendment) Act 2019, there is now no date as to when they will be actually be triggered. Like other local authorities, Conwy had been working towards implementing this new model and so we have had to re-group, review and re-adapt to working under the existing model of the Deprivation of Liberty Safeguards (DoLS).
The principles of the LPS and the wider Mental Capacity Act continue to remain relevant. The previously anticipated roll-out of the LPS required training and an embedding of the philosophy and principles of the Act both within the DoLS/LPS team and across Social Care. This has been achieved, therefore time spent on the LPS has not been time wasted.
The introduction of the LPS would have brought all those requiring a Deprivation of Liberty (DoL) authorisation under one umbrella process for authorisation “in-house”. Instead, we now have to revert back to the previous dual process. On the one hand we have the in-house DoLS authorisation process for those in care homes. On the other, we have the court application process for those in any other setting (Community DoL process). There are waiting lists for both.
How we can improve
Reducing the waiting list
The DoLS team continues to prioritise the waiting list. Each month, a combination of the most urgent and longest-waiting referrals are allocated. The waiting list is a rolling one, as authorisations can only last for a maximum of twelve months and then have to be re-done completely. It should also be noted that every month, consistently the DoLS team has more referrals coming in than it can close. In December 2022, the waiting list was 245. In December 2023, the waiting list was 185.
Whilst there is a waiting list, there is a clearly defined service model and process for these cases. The process for community DoL cases is less clearly defined and the expectation was that the LPS would resolve this and become the model for authorisation. Now that the LPS are no longer being introduced, a decision needs to be made as to how best to address outstanding Community DoL cases.
A piece of work is currently being completed across all services to scope out the number of Community DoL cases and identify workable solutions. One of the possible solutions for consideration is to introduce a model similar to that of the LPS, whereby frontline staff complete the main assessments, with an independent Best Interests Assessor providing a layer of impartial scrutiny on the work before it is sent to the Court of Protection. So although LPS are not being introduced, we continue to use the knowledge gained to apply best practice.
In order to help address the backlog of DoLS cases and help to look at the Community DoL cases, a business case has been submitted for four additional Best Interests Assessors and funding to provide the extra doctors’ assessments, advocacy and administrative support this would require. It is hoped the outcome of this will be known in early 2024.
Training and development
In mid-2023 a training schedule was set up for care homes. The DoLS team now provides training in pairs to two care homes per month. So far, training sessions have been provided to ten care homes, with positive feedback. The aim is to build knowledge, quality of care, safeguard people’s rights and develop positive relationships.
Three lunch-time sessions have been provided to managers and senior practitioners across Adult Social Care. A talk has also been given to Occupational Therapists (OTs) on the Mental Capacity Act and OT-related DoL / restraint issues.
Regular support is provided to staff from other teams who are undertaking complex capacity assessments. For instance, support in three complex cases has been provided in the past week.
The DoLS team continues to build its own skills and knowledge base. Annual legal refresher training is legally required in order to maintain the Best Interests Assessor qualification. Since April 2023, all staff members have attended at least two full-day sessions as well as a number of free webinars and shorter sessions. In order to try to meet the challenge of community DoL cases, the team is attending training specific to this in January 2024.
Information leaflets have been developed to support the work of the DoLS team and promote awareness of rights. They relate to the Deprivation of Liberty Safeguards, Community Deprivation of Liberty and also the right to a Relevant Person’s Representative (advocate). These have been produced bilingually and also in an easy-read version.
The DoLS team has commissioned some work from the Quality Standards (Monitoring Team) to undertake visits to care homes to audit DoLS cases, care home compliance and also to identify any training or operational issues which may arise in relation to the DoLS.
All the Best Interests Assessors on the DoLS team have undertaken recent and regular training to ensure practice is up-to-date and knowledge is current. More training is planned for 2024.
Staffing
After a period of change where a number of long-standing members of the team retired or moved on, the team is now fully-staffed. There are three full-time assessors (one of whom is grant-funded on secondment) and one who works four days per week. This team is managed by a full-time co-ordinator.
We currently have one assessor who speaks Welsh as their first language. We continue to work closely with doctors who also have to contribute to each assessment. We have one Welsh-speaking doctor who we are able to refer to consistently. We have a very positive relationship with our main advocacy provider (Conwy and Denbighshire Mental Health Advocacy Service) and they also have a pool of Welsh-speaking advocates. This means we are able to fulfil our commitment to the Active Offer.
How to find out more
If you’d like to know more about Deprivation of Liberty Safeguards throughout Wales, Healthcare Inspectorate Wales (HIW) and Care Inspectorate Wales (CIW) have jointly published their annual monitoring report on the use of DoLS in Wales during 2022-23. You can read their report here.
Rolling out Positive Behaviour Support training
In last year’s report we told you about funding that became available for some of the in-house Disability Resource staff to undertake a Swansea Bay Accredited BTEC qualification in Positive Behaviour Support (PBS). It was agreed to pilot key staff from each section of the service to either undertake an Advanced Certificate (Level 3), Advanced Diploma (Level 4) or Advanced Professional Diploma (Level 5) qualification, then apply learning to their service area.
At the end of the pilot it was evidenced as successful across the service areas, as behaviours that challenge had reduced, and the individuals had gained new skills to communicate their needs. Individuals who previously participated in limited activities progressed to shopping, cooking, and operating household appliances, as well as taking part in regular leisure and cultural activities. Feedback received from family members confirmed the positive impact of the PBS approach:
Staff are fantastic! We are very happy with the service. I cannot fault the communication, planning or adaptations made.
The learning from the pilot has allowed us to start rolling out PBS to the wider service. At Bron y Nant, key staff members were able to input into the design of the building that would allow individuals with complex behavioural support needs to access services in an environment that meets their needs, particularly around sensory processing. Individuals accessing services have now successfully transitioned into the inclusive day service on site.
With regard to recruitment, we have moved to values-based job adverts to attract applicants with the right values and transferable skills to work with people with behaviours that challenge, rather than those with direct experience. We have seen an increase in applications and successful recruitment, which in turn has allowed the service to offer more services to people with complex needs.
Other developments:
- One staff member has completed their Level 5 qualification, and as a result, have undertaken a full functional assessment and PBS plan for one person with complex behavioural needs, delivering it to the staff team working with that individual as a training session. This has relieved pressure from Health services.
- Through increased knowledge, staff feel more confident in supporting people with complex behaviours, offering them more activities and opportunities in the community.
- All external domiciliary care providers are invited to attend a monthly Supported Living Domiciliary Care Providers Forum, which the PBS lead has been able to attend as a guest speaker.
- Following Welsh Government’s introduction of the Reducing Restrictive Practice Framework, in-house training has been delivered to all Disability Resource staff, and due to its success, has been rolled out to wider services.
- PBS training requirements are currently being mapped out across the Disability Service to increase understanding, reduce potential crisis situations and take pressure off Health services.
- Discussions have taken place with the North Wales Together Disability Transformation Team to discuss funding sources for staff to undertake qualifications and the option of Conwy setting up a Community of Practice.
- We are looking at how PBS can form part of the tendering process when commissioning new or replacement support providers where appropriate, allowing us to select the right provider for our 24-hour supported living projects.
- Qualified staff have enrolled with Swansea Bay Health Board as official mentors for colleagues in Conwy who undertake the PBS qualification.
- The PBS lead is attending an Innovation Coaching Service, delivered by Social Care Wales, with the aim of developing ideas to embed and change cultural views of PBS across all internal and external disability services.
Progress against last year’s priorities
In terms of delivering on the priorities identified last year, we have rolled out the PBS qualification to staff and have raised awareness about the PBS plan amongst family members. We are working hard to reduce out of county placements and bring people back to Conwy by developing accommodation that suits the need of the person. You’ll read more about our accommodation strategy in this report.
How we can improve
In terms of improvements we need to provide bespoke PBS training packages to families, rather than taking a one size fits all approach to training content. We also need to work with external providers to get them on board with PBS and reducing restrictive practices; despite our engagement activity, responses have been limited. We also have limited capacity to mentor colleagues undertaking their PBS qualification due to time pressures.
Our action plan
Our action plan for the next reporting period involves:
- Meeting with Health services to understand how PBS can become a joint venture
- Setting up a Conwy Community of Practice with key stakeholders from internal teams and external providers and organisations
- Increase the number of staff with PBS qualifications so that they can go on to mentor others and reduce pressure on existing mentors
- Key staff undertaking Coaching training to instil culture change
- Development of in-house expertise in working with behaviours that challenge via Person-Centred Planning, Active Support.
- Co-producing training packages with families
Sensory Processing training
We have seen an increasing number of requests for intervention for children and young people with sensory processing challenges. These would previously have been dealt with by an Occupational Therapist based at the Local Health Board’s paediatric unit, and they would have provided advice on care planning and environmental design and equipment. When their role became vacant and was not filled, a knowledge and service gap was left.
How we can improve
Due to the extra demand and impact this has had on our own Disability Occupational Therapy team, we were concerned that our staff team didn’t have the expertise, experience or training to bridge the gap since the Health post became vacant. It was therefore agreed that Sensory Processing training would be commissioned, and five of the Occupational Therapists would attend a one-day session to cover:
- Understanding the sensory systems and what they do
- Understanding what happens when sensory processing isn’t working as it should, and how this presents itself
- Exploring how we can support children and young people with sensory processing difficulties (SPD)
- Exploring links between SPD, trauma and ADHD
Feedback from the attendees suggested that the training provided a general overview on relevant topics, however it was at a basic level. Whilst it was beneficial, it fell significantly short of developing the types of skills and knowledge required to complete specialist assessments and interventions for those presenting with complex scenarios caused by sensory processing difficulties, and which were previously provided by a specialist role within BCUHB.
Our action plan
The team’s Section Manager remains aware of the service gap and has asked for expressions of interest from practitioners should they wish to further develop their skillset in this area. Discussions on what kind of training and development would be required, and how this would be facilitated and commissioned is at an early stage. We may find it beneficial to work with OT colleagues in the Vulnerable People Service who are also likely to receive referrals for people with autism and sensory processing difficulties.
Co-production with our care leavers
A key principle within our Personal Advisors’ Team is to co-produce wherever possible with the young people we work with, to enable them to influence the service they receive. We recently created a website specifically designed to provide information relevant to Care Leavers in Conwy, called Small Steps Big Future. In order to gain some feedback on the website we sent out a survey.
The results showed that 62% of the respondents use the website less frequently than once a month, and the majority use it to submit requests for the St David’s Day grant, which provides funding for Care Leavers. We also asked for comments on the content and format of the website, and ideas for improvement. Of those who chose to respond, feedback was mostly positive:
These categories are useful to me, the site is great the way it is.
I find them very useful to help find what I need and they’re organised perfectly so others can find what they need also.
In answer to what else they would like the website to provide they suggested:
Advice for life
This site could be helpful to other young people if there could be information on how to live in a home, e.g. using a boiler, water and energy rates, and how to pay, how to save on energy bills.
A forum for care leavers to ask for help so other care leavers can help? Like an online friend who knows what they are going through.
Important contact numbers, Shelter Cymru, North Wales Housing, Step-Change debt charity, national suicide line, etc.
The team also used the survey to find out what the young people would like to be planned for Care Leavers Week. The consensus was for trips out and activities that they often cannot afford or experience, and an opportunity to informally get together. In response, we have ring-fenced grant funding to offer those opportunities and we are providing trips to the cinema, Colwyn Bay Zoo and Zip World, as well as providing meals out to Hickory’s and takeaway treats via Just Eat. The team also set up a few informal get-togethers where young people could chat and catch up over pizza, providing them with a safe space to connect.
How we can improve
The content of the website is constantly reviewed and updated, and we have incorporated the suggestions made in the survey responses, especially since the cost of living crisis, to provide advice and information about where to seek support for household costs. The important contact information was already provided; there are over fifty links to a variety of support agencies, which would suggest that the layout requires improvement to be more intuitive.
Increasing the number of users and the frequency of visits to Small Steps Big Future would also be an improvement aim, as would giving greater autonomy to the young people to develop it themselves, for example by writing blogs, sourcing relevant information and keeping the layout fresh and interesting.
Our action plan
- Create a peer-led forum so that the website content is co-produced by the young people
- Co-produce the Care Leaver Week event so that it is meaningful and responsive to our Care Leavers
Engaging with Care Leavers
Last year we talked about introducing a new practice model for engaging with care-experienced young people, and nominating individuals to take part in the research. Since the research started we have involved 20 young people from across North Wales, and eight are from Conwy. We have held focus and steering group meetings for both young people and the professionals who work with them. In Conwy we have so far recorded two podcasts which are available on Spotify; the first featured Care Leavers discussing the experiences of engagement, and any barriers they have encountered, and the second focused on feedback on the research up to now.
How we can improve
All young people involved in the research project have been given opportunities to discuss what they feel they need, their journey through services, and the things that have or haven’t worked well for them. This information will be used to help Local Authorities develop services that are meaningful for the young people we work with, and provides a legacy in the resources and approach to enhance the way Care Leavers are engaged in the services they receive.
Our action plan
This is a two-year project, so it is too early to identify improvements at this point. However, we can be sure that young people are being given a voice and are being heard.
Here are some care leaver figures:
These performance indicators aim to measure how well we are supporting our children looked after as they transition into leaving care services.
The Carers Team
Here are some carers figures:
These Welsh Government metrics have been designed to capture data on carers who present to social services in relation to contacts and assessments. This information is an important mechanism by which we monitor the volume, flow and demand into the service.
In Conwy we are fortunate to have a dedicated Carers Team comprising of three full-time Carers Officers. They support individuals from 18 years of age who have caring responsibilities. Our duty system ensures that carers have access to an officer, in the absence of their nominated worker, for immediate advice and guidance. Partners and other stakeholders have shared positive feedback regarding the service provided by the team and the integral part it plays in the well-being and support of the citizens of our community.
We promote and share information for carers with our partner agencies to promote the right for carers to request an independent assessment and related appropriate support. An example of this was during Carers Week and Carers Rights Day when our Carers Officers and Direct Payments Officers were available to offer advice and information as part of the wider drive to acknowledge the vital role of carers in Conwy.
How we can improve
No formal surveys have been completed since before the Covid-19 pandemic. However, practitioner feedback from their direct work with Carers helps us to evaluate service delivery and highlight areas for improvement, and has demonstrated the need to expand the service to reflect the significant of role of the unpaid Carer and their need for recognition and support.
Our action plan
A comprehensive survey will be conducted during 2024 which will identify further improvements and development opportunities.
People: Some feedback on our performance
Staff feedback
Twice a year we ask staff from our older people and disability domiciliary and residential care services for feedback about their experiences in the workforce, the support they receive to undertake their roles, and how effective they feel they are in delivering care and support to older and disabled people in Conwy. Here is a flavour of the feedback we received in August and September 2023.
Staff feel supported through regular one to one supervision sessions and ongoing training to carry out their roles confidently. All staff across the teams feel that, as a team, they listen to the individuals they support and ensure that they are able to make choices about their lives. As individuals, domiciliary care staff clearly understand the importance of placing the person at the centre of care planning, supporting their health and well-being, and respecting their views and wishes.
…being person-centred, listening to what they want and doing our best to carry out their wishes.
I listen to any client concerns, raise them with management or families if necessary, and encourage them to have a say in how they would like their care conducted.est to carry out their wishes.
…listening to and acting on what individuals say to us. We support them with Health appointments, encourage healthy lifestyles and promote independence so they have control over their lives.
Similarly, with regard to safeguarding, 100% of staff who responded agreed that they support individuals to stay safe and protect them from abuse and neglect. Additional comments suggest the staff are attuned to the individuals they support, quickly noticing any changes in demeanour or behaviour, and building trust to talk about any problems they may be experiencing. Robust safeguarding training contributes to this, as do clear policies and procedures for staff to follow.
…looking out for any signs of abuse, being aware of any changes in behaviour. Gaining their trust to make them feel that we are approachable and can help.
We follow the risk assessments that are in place, report any health and safety or other concerns to our managers. We attend and keep up to date with safeguarding training and report any concerns in the appropriate manner. We get to know the individuals we support, notice any changes and listen to them.
As well as being asked to identify what their service does well, staff are also asked to identify any improvements that can be made. In general, a recurring theme is the need to recruit more permanent staff and increase capacity. As discussed elsewhere in this report, recruitment is an ongoing challenge for many roles in Social Care, and frontline care and support is no exception. We are often reliant on agency staff to fill posts that struggle to attract applicants.
Despite feeling short-staffed at times, frontline workers enjoy their roles and the satisfaction they derive from providing an effective service. Asked what the best part of their role is, people said:
Knowing I am making a difference and the children interacting with me is the best feeling of accomplishment.
Everything, I wake every day with a smile on my face and look forward to coming to work.
Being proud to be part of a successful team and supporting vulnerable individuals with complex needs, knowing that I’ve made a difference.
Stakeholder feedback
Stakeholders are also asked for their views on our in-house domiciliary services and our residential home, Llys Elian, twice a year. These are colleagues who assess and refer individuals to our front-line services and who work in social work teams, housing associations, the voluntary sector, and Health settings. We ask about the quality of service, our timeliness in dealing with queries, and for examples of effective partnership working.
With regard to all of the frontline services, 100% of respondents agreed that staff listen to the individuals they support, enabling them to make choices about the care and support they receive, and the opportunities available to them. Additional comments acknowledge limits to the teams’ resources, given the demand, but also the flexibility and responsiveness demonstrated to accommodate the wishes of people they support.
Very supportive team and we always hear positive feedback from patients.
The team are always open to conversation about the needs of individuals and try to flex the service in order to facilitate individual needs.
Again, staffing restrictions are noted throughout as a barrier to being able to deliver more services, or being able to put care packages together quickly. However, there is clear evidence of effective cross-organisation working, whether that be via cluster meetings, over the phone or via e-mail.
Service user feedback
Here are some service figures
These measures aim to capture and monitor services provided to adults as identified within their care and support plan. These measures as well as other reporting mechanisms help us to monitor the demand and volume of services provided.
The total number of services for adults started during the year where that service is:
| Adult Care Home | 351 |
| Domiciliary Care | 683 |
| Respite Care | 196 |
As a residential home for people with dementia, the setting, levels of comfort and the on-site welcome are all important elements of the Llys Elian experience for residents and visitors alike. Stakeholders overwhelmingly report excellent standards here, with 100% agreeing that individuals have opportunities to take part in meaningful activities, are safe and protected from abuse and neglect, have their privacy, dignity and confidentiality maintained, and live in a comfortable, personalised environment. All respondents report being made to feel welcome during their visit, and that staff are able to provide correct and timely information about the residents they support.
Everyone is so good and helpful, great team, make people feel at ease and relaxed, which is a major factor when having dementia.
It’s a lovely care home and other care homes could use Llys Elian as an example of how to create a caring, kind and effective working environment that is respected as the home of the people they care for, with residents shown genuine kindness, high standards of care and quality of life/enjoyment in later years as the focus.
I have visited [Llys Elian] on a number of occasions and it is evident that there is a great emphasis on providing a positive environment to promote positive outcomes for all. It has been a privilege to be invited to take part in activity days held by Llys Elian for the users of the service, we appreciate this collaborative approach.
