Prevention

• The need for care and support is minimised and the escalation of need is prevented whilst ensuring that the best outcomes for people are achieved
• Resilience within our communities is promoted and people are supported to fulfil their potential by actively encouraging and supporting people who need care and support, including carers, to learn, develop and participate in society

Developing our Connected Persons Team

A Connected Person is a relative, friend or other person who is connected with a child, who may be assessed and approved as their foster carer if the child cannot live with their parents. It is usually in the child’s interests to remain with family or friends, than be looked after in a residential home or by foster carers who aren’t known to them. In Conwy we are actively developing our Connected Persons Team to ensure that we maximise opportunities to keep families together wherever possible. We have seen an ongoing rise in the number of Connected Persons assessments, and between the three assessors in post, we have 16 underway as of January 2024.

2023 saw the re-launch of the Public Law Outline (PLO) process, meaning that Connected Persons are expected to be approached and assessed at an earlier stage. We have seen shorter timescales from the courts when childcare teams are seeking Interim Care Orders, and this proved difficult in terms of completing in-depth assessments and ensuring that statutory checks are returned on time. The training programme devised last year now needs to be updated to reflect the changes in these processes, and the plans for 2024 are to develop and roll this out further.

We have been proactive in working with Y Bont, who run Family Group Conferences, to encourage our team’s presence at the meetings to have early discussions about Connected Persons, foster care and Special Guardianship options. This ensures that families benefit from our in-house expertise, have an understanding of the Connected Persons role from an early stage, and are able to discuss the assessment process and what becoming an alternative Carer or offering support to families will entail.

An additional Connected Persons Coordinator has allowed greater opportunity to explore Special Guardianship Order (SGO) conversions, moving children from Care Order arrangements into the full care of their Connected Person. We have achieved two conversions this year, meaning that two children are no longer classed as ‘looked after’. There are five SGO assessments currently underway for six Children Looked After looking to ‘discharge’ before spring 2024. The additional post has allowed us to be more creative when thinking of SGO support plans in terms of practical assistance for managing communications around family time. The post has also helped with managing the statutory checks and expectations of shorter timescales from the courts for assessments. It has allowed them to take the lead in ensuring documentation is sent off in a timely manner and avoiding unnecessary delays when filing with the courts.

The team have worked together to develop support groups for foster carers and there have been some successful events this year, including training around substance misuse, a pizza and pottery event to create some supportive discussions for kinship carers, and a coffee morning event raising money for the Loud Voices group in memory of a kinship carer who died this year.  Support groups promote resilience in foster care, developing their insight and skills, which in turn, support the stability of the home for the children and further the opportunity to move to a Private Order in time.

How we can improve

Due to the Public Law Outline changes, sickness within the team, and new assessors requiring more support to develop their skills, we have not rolled out the Connected Persons training for teams and professionals. It will be on the agenda for 2024 to ensure that Connected Persons processes are being prioritised, and that family members are identified early to promote family placements and permanency for children. Ultimately, doing this will increase the chances of care proceedings concluding with Private Orders, or family members being supported to access a Private Order, which will then reduce the numbers of children in care.

Due to the absence of a Recruitment Officer in post for the general team, our current Connected Worker is also aiding this role until the posts are filled; this has reduced her capacity to some degree, but this should resolve once successful applicants are in post in 2024. This has prevented us from dividing the SGO workload across two team members by the end of 2023.

Our action plan

• Connected Persons training will commence, utilising the information and experiences from the PLO re-launch, with the aims of promoting family membership for children, increasing stability for children in local familiar caring environments, and reducing the Children Looked After population.
• We want to benefit from the full capacity of a second Connected Persons Worker, splitting the caseload, and have more opportunity to create activity for SGO plans, allowing families more choice around their lifestyles, the ability to live free of statutory checks, and increase the number of conversions for us to assess.
• We want Connected Persons Workers to continue to link up with Family Centres, increasing awareness of Connected Persons for families receiving early intervention and support. We have seen the benefit this year with traditional SGOs, which in turn has likely stopped children coming into care or the child protection arena, as family members have been able to take control of their own situations with appropriate support to seek Private Orders when required.
• We want children to have more access to support services away from the Child in Need or Child Protection routes, and instead be supported by assessments, Special Guardianship Orders and universal services.

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Opening our new disability respite facility

Bron y Nant opened to service users on 4 September 2023, offering respite to people with disabilities and their families. Take a closer look via our You Tube video. The staff team have now settled into their new roles and have familiarised themselves with the site. Meanwhile, the service users who have accessed the service seem happy and settled throughout their stay, many choosing to take part in group meal preparation and socialising in the communal area.

How we can improve

During these early months, we are noting areas for improvement at the facility:

• The popularity of the communal kitchen was unexpected, and given that it is the smallest on site, we’ll take this into consideration for future projects.
• Service users have fed back to us that they’d like transport to take them to activities, so we now have access to a hire car and a minibus.
• Visitors have raised issues with the intercom, when trying to enter the building, so we have installed a doorbell until the problem can be fixed.
• There are ongoing issues with the phone signal at Bron y Nant, raised by both staff and visitors; we’re working with our IT department to look at alternatives.
• As some service users require more support, for example through the night, we are currently using agency staff.

Our action plan

The team have worked with service users to create a guide to Bron y Nant, covering topics such as our values, where Bron y Nant is located, the type of accommodation available (see images below), an introduction to the team, and how we deliver services. Residents are also informed about activities and places of interest in the area, with a view to supporting individuals to visit them during their stay.

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Diverting children from offending

Over the past twelve months the Youth Justice Service has successfully introduced and implemented the Ministry of Justice Turnaround Project, aimed at early preventative intervention to divert children and young people away from offending. A dedicated Case Manager and an Administration and Information Officer have been appointed, and both lead on the delivery of services and reporting to the Management Board and Ministry of Justice.

Across Conwy and Denbighshire there were 119 referrals for offences such as violence against another person, vehicle theft, handling stolen goods and sexual offences. 31 young people initially agreed to engage with the Turnaround Programme, and of those 25 did so.

Our action plan

Over the next twelve months the focus will be to further embed and develop the early intervention provision to ensure that the service continues to offer voluntary, needs-driven, whole-family-focused support to children and young people to de-escalate their behaviour and ensure that we get their lives back on track.

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Our Family Support and Intervention Service

During this reporting year we have continued to face challenges within the service, particularly with regard to recruitment of qualified social workers. Two of our teams have been carrying at least one vacancy for the whole of the past year, and this has resulted in an unprecedented use of agency staff. A Memorandum of Understanding has however meant that we’ve been able to regulate agency pay rates across the region. That said, we have been able to allocate cases, and social workers are working extremely hard with some very difficult and complex work. Increasingly, we are seeing those cases being managed in the Child Protection, Public Law Outline (PLO) or Child Looked After arena. It should be noted that many of the families we are working with have previously been unknown to us, and in some cases have escalated, needing both Child Protection and Child Looked After interventions relatively quickly into the process.

The service underwent a PLO inspection at the very start of the reporting period, with a number of positives reported by Care Inspectorate Wales. For those areas which required some improvement, an action plan was put in place and most of those actions have now been achieved. The PLO inspection identified good practice within this area of work, finding that “records clearly identify concerns, and the safety and well-being of children and young people is prioritised”. Also during this period the use of PLO was re-launched by the judiciary, focusing on work to be ‘front-loaded’ or prioritised, and for the PLO process to be more closely managed and monitored. Whilst there are still some areas to be worked on, all staff have worked hard to achieve better outcomes through the use of the PLO process.

The service has regular meetings with CAFCASS, CWLWM, and meetings with Health and Education in a bid to get them more involved with our Multi-Agency Safeguarding Hub (MASH). Managers within the Assessment and Support Team also hold monthly Contextualised Child Exploitation forums, attended by partner agencies to discuss cases and themes. These have proved popular and feedback from our partners is very positive. Work has been ongoing in this area of practice, and the Child Sexual Abuse Action Plan has now been completed, and is due to be reviewed by the Head of Service pending its closure.

We have now embedded the accommodation pathway for children at risk of coming into care and those in care who are at risk of disruption. Cases have the oversight of the accommodation panel and benefit from ‘edge of care’ prevention and intervention support. This is now working well, and all staff are aware of this process. However, we are pending a review of the process imminently to consider if it can be streamlined, and whether all of the steps are needed, moving forward.

Our MASH is now well established and operating under business as usual conditions. The hub has strengthened multi-agency working, particularly with North Wales Police in safeguarding vulnerable children and adults in Conwy. Work is ongoing with Health and Education colleagues to get their buy-in to the process and daily discussions.

One of the Family Support and Intervention (FS&I) managers gives talks to the Designated Safeguarding Managers on safeguarding, exploitation, Child Sexual Abuse and Harmful Sexual Behaviours on a regular basis. They also chair the management committee of the Pupil Referral Units and sits on the Elective Home Education panel. All work closely with the Education Social Work service and Health colleagues to ensure any concerns are dealt with in a timely manner. Education and the Police attend the Child Exploitation forum. We offer Multi-Agency Child Sexual Abuse Forum (MACSAF) consultations, mainly to schools, but also to other teams and social workers where there is a need or request.

Another of our managers has recently started to chair the newly-established pre-birth monitoring meeting with Health colleagues in which cases are brought for discussion to ensure that any concerns about the health of a mother or baby during pregnancy, or concern about the family post-birth can be shared and discussed, pending further actions or assessment.

We have seen an increase in the use of the Family Group Conferencing Service via Y Bont. This means that families are offered the opportunity to meet together to consider how they can contribute to and support children to remain within the family unit. A questionnaire will be conducted soon to obtain feedback from referring social workers to ensure the service continues to meet needs.

Conwy, along with the other Local Authorities within the region are piloting the use of parental advocacy. This has just started and will need to be reviewed later this year, however, early signs are that this is proving to be very useful to families within the Child Protection process who have reported that they have an increased understanding of the process and what is required of them and the Local Authority.

How we can improve

A review of both the accommodation pathway and PLO action plan are required to ensure that they remain fit for purpose. If required, we will update them so that we can operate to the best of our ability in both areas of practice. Further work is required across the social work teams within the FS&I service to ensure smooth transition of casework, and that the frontloading of cases is happening, as required by the PLO re-launch. We may need to consider the composition and roles of the teams within the FS&I service as a result.

We need to consider whether we continue to recruit unqualified staff to support the social work teams, and whether we can ensure that all statutory requirements can be met by doing this. Recruitment of social workers has been extremely difficult, but the statutory responsibilities of the department have increased due to the greater complexity seen within case work, and the needs of families seen by the service.

Our partnership with the MASH in terms of buy-in from Health and Education colleagues needs to be improved to ensure that they are involved in the decision-making process at the early stages of working with families, and that involvement doesn’t escalate inappropriately.

A strategy to manage the escalation of serious cases is required to ensure oversight of the most high-risk cases within the department at all levels of management. We also need to ensure that we are reviewing cases where families have had significant involvement with the department, where the changes that normally allow us to cease involvement have not been adequate.

Our action plan

• Review the accommodation pathway
• Review the PLO action plan
• PLO re-launch, review of cases and analysis of pre- and post-PLO activity
• Consider the role of teams within the FS&I service, their composition, and how best we meet our statutory obligations
• Create a survey to obtain feedback on Family Group Conferencing from staff and users of the service
• Undertake a review of parental advocacy with the provider, Tros Gynal Plant

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Digital inclusion for people with disabilities

In last year’s report we told you about a suite of training courses for people with disabilities and their families, with the aim to improve their access to, and confidence with, technology. In November 2023 Conwy Connect commenced Digital Drop-In sessions, scheduled for one Thursday per month at their office in Canolfan Marl, and discussions are underway about taking these ‘on the road’ to different sites across Conwy. The sessions will demonstrate equipment and support people with technology, digital inclusion, and getting online, evolving as they go.

Our action plan

Cartrefi Conwy, and particularly their Creating Enterprise element, have started a Digital Conwy group. They have monthly meetings and a weekly drop-in at a venue in Llandudno with input from the team at Digital Communities Wales.

Conwy Connect hope to commission training around Online Harms, aimed at support networks of people with a learning disability, around keeping safe when online and using social media. The aim is to deliver sessions in Conwy in 2024 by linking in with our in-house training team.

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Re-launching the Progression Service

We told you in last year’s report that we would be re-launching the Progression Service for people with disabilities. The service was originally launched in 2017, funded by the Integrated Care Fund (ICF), however was disbanded during the Covid-19 pandemic. The location previously used for assessing was required for other purposes, and there were also challenges with the previous incarnation that we wanted to improve on.

The service is aimed at individuals who have a disability that substantially impacts on their ability to live independently and carry out day to day activities, and who want to engage in an assessment and care plan that develops their independence in performing specific tasks. The service reflects a shift away from dependence on long-term support, and instead focuses on short-term interventions, adhering to a detailed plan to support individuals to maximise their strengths and develop new skills to achieve their pre-agreed outcomes. An Occupational Therapist (OT) post has been introduced to assist with the assessments and to facilitate some of the post-assessment monitoring of progress.

A setting has been identified where functional assessments of activities related to daily living can be completed in a suitable environment, and where specialist aids and equipment are available to be utilised as part of the assessment and care planning process. Improvements have been made to the on-site disability-friendly kitchen, and additional electric sockets have been installed to meet the aim of doubling the setting up as a ‘smart’ property. The work was completed in November 2023 with the aid of Housing with Care funding, and we are currently planning the furnishing and set-up of assistive technology for demonstration and assessment purposes.

With so many people in modern society using voice assistive technology such as Alexa and Siri, we want to create a space that enables individuals with a disability to see how technology available on the general market could make their lives easier and safer, without the need for Local Authority spend on specialist equipment and subscriptions. Features such as calendar prompts, video door bells and automated blinds, all available via an Amazon device, could prove useful. Bespoke pieces of equipment would be considered on a case by case basis, according to assessed need.

Demonstrating the use of modern equipment and technology will help inform citizens and professionals alike about innovative ways of meeting outcomes, overcoming barriers, and managing risks in a way that maximises individuals’ strengths, reducing their reliance on informal and paid support. Where long-term support is needed, the assessment will help to promote the right level of support.

Despite the assessment hub being unavailable to us, the service has continued, with the Occupational Therapy Assistant assessing and supporting people in the community, with really positive outcomes. Since the re-launch in April 2023, ten citizens have received or are currently receiving an assessment and support from the Progression Service. One lady in her late sixties was supported to use a smartphone for the first time, which allowed her to access the community more independently due to the risk management the device provides, including a one button emergency call. She is now able to make video calls to friends and family independently, and arrange her daily activities. All of this has resulted in an improvement to her well-being and confidence, without an increase to her care package. It is predicted that the skills she has learnt will allow her to remain more independent for longer, and has already reduced the strain on her Carer.

Progress on last year’s priorities

We successfully integrated an OT post, funded by the Regional Integration Fund, into the project. Towards the end of the financial year we also utilised some unused hours to employ one of our Co-ordinators within the Community Support Service to further bolster the number of people we can support under the Progression Service.

How we can improve

The work to date shows that whilst we encourage individuals to take positive risks and develop their skills, sometimes they aren’t always able to achieve what they set out to do at the beginning, becoming overwhelmed. Where this has occurred, we have dealt with the incidents, and analysed what happened in order to inform our final recommendations. Despite setbacks, the individuals are usually more independent and have better well-being outcomes than they did prior to the support being provided. Sometimes, as in the example mentioned above, people pick up skills and knowledge that they didn’t set out to achieve at the start, and benefit from new skills and life fulfilment that they previously didn’t have. As such whilst we try to have clear outcomes to work to from the outset, we understand the importance of being open minded and flexible, depending on observations made and conversations held during the sessions.

Whilst our main focus has been to support individuals to develop independent living skills, we recognise that other practitioners and senior managers would benefit from a service able to complete OT assessments of individuals’ functioning; these take into account the environment and support that has previously been in place, to support social workers and others to identify individuals’ potential and recommend the right level of care and support. We have utilised some capacity within the OT team to assist with this under the Progression Service remit where needed.

Our action plan

The main development for the project this year will be installing assistive technology into the assessment hub and smart house so that it can be used to assess and demonstrate its benefits to both citizens and professionals. It is hoped that they will embrace accessible and affordable technology as part of their assessments, enhancing well-being and managing risks at home and in the community. As well as promoting independence, assistive technology reduces the reliance on paid support at a time when pressures on availability and resources encourage us to reduce reliance on commissioned services, where it is safe and possible to do so.

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Mental Health Recovery College

People who were managing low-level mental health issues, such as anxiety and depression, in the community prior to the Covid-19 pandemic, experienced an exacerbation in their symptoms due to the lockdown and resultant isolation. This resulted in a higher demand for support services, such as the Mental Wellness Team, to help people with hoarding, self-neglect, and parent/carer strain, particularly for those living with adult children with neuro-diverse complexities.

To combat this situation, the team have focused on prevention measures, such as the introduction of a Recovery College, which we have mentioned in previous reports. The purpose of a Recovery College is to support people’s self-management of mental health difficulties through learning and education, as well as increasing people’s social networks, connection to their community, and offering opportunities to grow resilience and achieve a meaningful life. Our vision is:

The completion in December 2022 of the UK Community Renewal Fund (UKCRF) project to look at co-production gave us a blueprint to develop the course and activities that service users felt would benefit their mental health the most.

We are focusing on three areas of development:

• Venue: through working collaboratively with the Culture and Information Service we have been able to develop the first floor of Colwyn Bay library to provide an initial venue for the Recovery College. This is a safe, therapeutic and non-stigmatising environment from where we can deliver activities and courses that are fundamental to the Recovery College model.
• Activity: arts and craft activity is one of the more popular activities that people find supportive and therapeutic. We have therefore commissioned Creative Journaling sessions which offer relaxation, mindfulness, self-expression, processing and self-discovery opportunities. We aim to increase the number of similar activities we can refer to by building further relationships with community groups and third sector organisations. We have also offered walking groups and a specific anxiety management programme.
• Courses: we have worked closely with Conwy Mind throughout the UKCRF project and they are now in a position to offer a rolling five-week programme of courses to support people with their mental health.

How we can improve

Based on feedback we have received about the Recovery College, we need to ensure that our ongoing offer is a complete, seamless and vibrant provision, rather than the piecemeal arrangements we currently have in place. This will entail building effective relationships with a range of partners, specifically Health, the third sector and community groups, so that there is an equitable opportunity across the county, robust processes and a clear commissioning intention.

Our action plan

• Instigate the initial programme of courses with Conwy Mind
• Set up a planning forum to identify opportunities for growth and devise an action plan to achieve them, including future sustainable funding
• Continue to collaborate with the culture and Information Service on specific projects, namely Taith and Below the Waves

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Occupational Therapy Intake Team and Telecare

In previous years’ reports we have stated our intention to integrate our Occupational Therapy Intake and Telecare teams. The arrival of Covid-19, associated practice changes, subsequent staff changes and recruitment delays have all led to the integration of the teams being delayed.

An informal integration of Occupational Therapy Assistant (OTA) roles across the OT Intake and Telecare teams began in 2020 and was progressed more formally in 2023.  The aim is for all three staff to be able to provide environmental assessments, give advice, signpost and make recommendations for both community equipment and Telecare devices. This will widen the OTAs’ knowledge base, improving resilience within the team; crucial for periods of planned and unplanned absences.

Despite staffing issues for most of the year, successful recruitment of people with key skills for the role has meant the new starter induction and training process has been quicker than anticipated.

The team has continued to perform to a high level, for example, in the last six months they accepted 68% of OT referrals screened by the team, and passed just 16% on to longer-term teams within the Authority.

Some of our service users said:

You give us hope to maintain our independence at home and stay safe

Thanks to you all for your kind help you were brilliant

X was very friendly, courteous & professional at all times

How we can improve

Improvements needed, based on feedback received include:

• Increased staff knowledge of both community equipment, minor adaptations and Telecare equipment.
• Increased staff knowledge of and ability to provide guidance regarding digital devices in the home.
• Clear communication with Telecare customers who are not yet ready for the digital switch over in 2025.
• Lack of electronic process for Telecare admin to collect routine feedback to ensure that citizens, providers and other stakeholders are able to inform continuous improvement.

Our action plan

Developments for the coming year:

• All staff are fully trained in community equipment and minor adaptations.
• All staff will receive further training in specialist Telecare equipment and providing advice and guidance regarding digital devices in the home.
• A review of the specialist Telecare equipment on offer, for example, epilepsy devices (including input from Health professionals).
• Focus on assessing for specialist Telecare equipment and providing advice and guidance regarding digital devices in the home (including some joint work with Disability Service colleagues at the assessment flat).
• Continue to roll out digital devices, ensuring all customers are ready for 2025.
• Development of routine feedback processes to ensure that citizens, providers and other stakeholders are able to inform continuous improvement; preferably with an automated survey rather than relying on actively making phone calls or sending by post.

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Conwy Single Point of Access and Welfare Rights

Both teams have been managed by the Information, Advice and Assistance manager for the last year.  This time has given us the opportunity to observe how the two teams work and how they will be best supported in the future.

A mini restructure that will improve resilience and enhance service delivery for both teams is currently going through an approval process.  The proposal is to have a team leader in both teams with one overarching manager.  This will bring the following benefits:

• An over-arching manager dedicated to improvements regarding service delivery and people management.
• Dedicated supervisory functions for each team for the day to day running of the teams.
• Stronger support system for both teams.
• Improved resilience during times of planned and unplanned leave.

Here are some Single Point of Access figures:

These metrics demonstrate the volume and demand for information, advice and assistance.  This allows local authorities a simple mechanism to monitor the number of people who use the service.

How we can improve

Improvements needed, based on feedback received include:

• Unclear management structure with escalation from frontline to senior staff without intermediate role; Section manager has been managing both teams for over 12 months which has placed other tasks on hold.
• Staff benefiting from a review of processes, data collection and collation methods to ensure they are as efficient as they can be.
• Lack of process to collect routine feedback processes to ensure that citizens, providers and other stakeholders are able to inform continuous improvement.

Our action plan

Developments in the coming year will be:

• An improved management structure with dedicated management support for these teams.
• Review of processes, data collection and collation methods to ensure they are as efficient as they can be.
• Development of routine feedback processes to ensure that citizens, providers and other stakeholders are able to inform continuous improvement; preferably with an automated survey at the end of a call, rather than relying on actively making phone calls or sending by post.

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The development and provision of high quality accommodation for children and young people by transforming local residential and in-house placements.

The Transformation of Children’s Residential Services Programme has been instigated to respond to Conwy’s placement strategy 2022-2027 and the significant pressure on the Independent Placements budget and the Welsh Government’s Eliminate Profit agenda to remove profit from children looked after services by 2027.

Here are some Children Looked After figures

These Children Looked After measures allow us to keep track of the number of children and young people who are formally looked after by the local authority.  We are also able to monitor the numbers who are placed within and outside the county.

Last year we reported that this programme had been approved by our Social Care and Health Overview and Scrutiny Committee and Cabinet.

Care homes and placements for children and young people ensure that their needs are met when they cannot live with their own family. They are a place for children and young people to be supported to develop and grow. We aim to increase the number of local placements to enable children and young people who are currently out of county to return to the area, or closer to home, enabling them to retain their local roots, schools, culture, friends and known support networks.

This year a dedicated Transformation Programme Lead has been recruited and they have led the transformation delivery group in developing a ten-year outline plan to secure 18 units/beds for children looked after. The plan was based on information gathered from consulting with internal and external partners such as Social Care and Education, Housing, the five North Wales Local Authorities, 4Cs, other Local Authorities and care-experienced young people and children looked after.

The delivery group has prioritised a home for one young person living alone with support and created a specification for the home that meets Care Inspectorate Wales’ (CIW) criteria for children’s homes. A registered social landlord (RSL) has been identified to work in partnership with us and discussions will begin in January 2024 to plan and cost the project.

There are also three other homes in development: Bwythyn y Ddôl, Glan yr Afon and Sylva Gardens.

Bwthyn y Ddôl Children’s Assessment Centre

Bwthyn y Ddôl (BYD) is a collaboration between Conwy County Borough Council, Denbighshire Council and Betsi Cadwaladr University Health Board (BCUHB).  The assessment centre will provide temporary accommodation for four young people with the primary aim of them being reunified with their families.  If that is not possible, the alternative options are moving to a longer-term placement in foster care or residential care.  The centre will also provide two units for emergency placements.

The construction was awarded to Wynne Construction and the build started in May 2023, with an expected build time of 70 weeks.  All three buildings which form the BYD Phase 2 scheme have now been erected with internal works starting.  Work is progressing rapidly with the contractors confident of being able to hand over the site to the programme.

All residential staff and administrative staff are in post and fully operational.  The Multi-Disciplinary Team are also in post.  All staff are currently working out of BYD Phase 1, Ingleside, a building being leased until BYD Phase 2 is ready. The model of care being delivered is a family systemic model based on the Integrated Family Support Service (IFSS), which involves working intensively with all family members and in some circumstances, extended family.  The model ensures that the team works collaboratively with the family and other professionals in their lives to bring about long-term change.

Redevelopment of Glan yr Afon (GYA) Residential Children’s Home

Glan yr Afon Children’s Home will provide long-term accommodation for up to four children looked after by the Local Authority.  Funding has been secured and contractors, MPH Construction, are programmed to start on site in January 2024.  A 52 week construction time is estimated.  Work will soon begin to finalise the staffing structure and plan recruitment activities so that the home is successfully registered with Care Inspectorate Wales.  We will be ready to receive young people to the home in early 2025.

Sylva Gardens Development

Sylva Gardens is a residential development that will provide three two-bedroom apartments for three children with learning disabilities.  All three young people are also looked after by the Local Authority and currently reside in independent out of county placements, at a distance from their families and communities. 

Our partner and Registered Social Landlord, First Choice Housing Association (FCHA), has secured funding for the property based on pre-tendered estimates gathered in 2022.  Owing to rising costs in materials, services and refinements to specifications FCHA will be submitting a variation to the initial request to the Welsh Government Housing with Care Fund in early 2024.  A contractor started work on site in October 2023 and the development is expected to be completed in the summer 2024.  The project team is starting recruitment activities so that the home can obtain CIW registration and be fully staffed before young people move in from September 2024.

Our action plan

The next steps of the programme are to:

• Consult with independent providers to discuss their business models and support them with any plans they may have to transition to ‘not for profit.
• Work closely with FCHA to identify, acquire and develop accommodation for one young person looked after by the authority and currently living out of county. We will involve the young person with creating their new home and hope to support them to settle in before the end of the year. We will deliver the care and support for the young person and help them to achieve their full potential and live independently.
• Develop a recruitment, on-boarding and training plan to ensure the prompt and effective recruitment of Registered Managers and support workers for each development. 

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An accommodation strategy for disabled adults

This year our Disability Service has recruited a Service Development Officer who has been tasked with creating an up to date accommodation strategy. Currently, access to accommodation is well managed and ensures that each individual is provided with the most appropriate place to live, according to their need. Our approach is person-centred and honest about the options available.

Our action plan

The accommodation strategy will set out and support a strong focus to provide appropriate accommodation according to individuals’ needs, whilst ensuring that their well-being is considered throughout.

We intend to implement a strategy that is robust and achievable, that covers all available accommodation and the reasons behind the need. We will consult with affected groups, Conwy staff, carers, third sector organisations, and ask for public feedback on the document which will cover the period 2024-2029.

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Ensuring safe and timely hospital discharge for older people

The Discharge to Recover then Assess (D2RA) model has been developed by Welsh Government and the Welsh NHS to suit the needs of the Welsh Health and Social Care landscape. It offers a variety of pathways to achieve the best outcomes for people in receipt of our services when they are discharged from hospital, in conjunction with us listening and responding to what matters to them.

D2RA is an active recovery model with the ‘Home First’ ethos, at the same time making the most efficient and effective use of scarce resources:

• It focuses on ‘what matters’ to the individual, maximising their recovery and prompting independence.
• It minimises exposure to hospital infection risks and avoids deconditioning
• It provides a seamless transfer to longer-term support in the community if required, using a strengths-based approach and reducing over-prescription of statutory services.

Accepting the need for a process to support hospital discharges, we collectively developed and implemented a plan to facilitate the safe and timely transfer of people from hospital to the next stage of care with minimum delays. The next stage of care may be:

• In their own home
• Another hospital for further rehabilitation
• Reablement
• A new or existing care home placement

In line with the principle of ‘Home First’ our primary aim when planning a discharge from hospital must always be to enable the person to return to their home whenever it is safe to do so (their own home may refer to a care home if that is where they were living).

Pathways home from hospital have been introduced, along with responsibilities for the different partners involved in the hospital discharge process. Actions for Conwy as a Local Authority partner include:

• Agreeing a single point of contact for Health Board staff to approach when coordinating the discharge of patients that require Social Care support.
• Flexibly deploying Social Care staff from various disciplines across hospital and community settings to support patients on their D2RA pathways.
• Working as an active member of the multi-disciplinary team, providing appropriate social work support, arranging services, attending and assisting at meetings led by the nursing team, and completing actions identified at the meetings.

Each Health Board reports to Welsh Government on a monthly basis with delayed transfer of care activity data. Figures gathered with Local Authority partners enable the monitoring of delays, their length and reasons, assisting NHS organisations and partners to prioritise actions to alleviate delayed transfers of care.

The figures shown below for September 2023, December 2023 and March 2024 are for people living in Conwy who were ‘clinically optimised’, which is the point at which care and assessment can be continued safely in a non-acute setting. They include two acute hospitals, five community hospitals, and the two in-patient mental health units.

	Total delays	Awaiting Health assessment	Awaiting therapy assessment or equipment	Awaiting residential or care home assessment
Sept 2023	70	13	10	12
Dec 2023	42	11	1	4
Mar 2024	46	1	7	1

Traditionally, Social Care has been cited as responsible for the delays in people transferring from hospital to home, however the figures below, show that this isn’t the case.

	Total delays	Awaiting Social Worker allocation	Awaiting reablement service at home	Awaiting new domiciliary care package
Sept 2023	70	1	1	3
Dec 2023	42	2	0	6
Mar 2024	46	0	0	1

How we can improve

On the September census day, the delay in the completion of a joint assessment, usually a multi-disciplinary team meeting, was identified as an area for improvement. In Conwy nine people were waiting for a joint assessment to enable them to be discharged. Working together with our Health colleagues, we have been able to reduce that figure to four people on the December census day. It is difficult to reduce the figure to zero as the timeliness of the meeting also depends on the availability of family, next of kin and advocates. This was seen by an increase in this figure to seven people in March 2024.

The roll-out of the outcome-based working project in Older People’s Services has been beneficial in stabilising the domiciliary care market, and as a result of this, people are now transferring from the Reablement Service to long-term care and support in a timely manner. This is demonstrated by the December and March census day data, where anyone ready for discharge and requiring a period of reablement was able to go home without delay.

The December figure for people awaiting a domiciliary care package had increased to six, however the information behind the data showed that three of those had planned discharge dates within a few days of the census.  The remaining three people were awaiting either Health funding, or Health assessments. By March, with the further strengthening of the domiciliary care market, only one individual in Conwy was delayed while awaiting the start of a domiciliary care package.

It has been identified that despite the data being validated with our Health colleagues the final reporting to Welsh Government does not always reflect the figures agreed.  This will be improved in the next quarter by having sight of the final spreadsheet before it is submitted to Welsh Government.  This issue is not exclusive to Conwy.

Our action plan

For people living in Conwy we will collect further data to evidence the difference made by D2RA and ‘Home First’ by determining if we have listened to what mattered to them.  We intend to collect the following information from January 2024

1. The number of older people who go direct to a residential or nursing home from hospital as a permanent place to live.
2. The number of people who are offered domiciliary care reablement services, needing no further help or a reduced level of help after three months.

We will continue working with our Health partners to ensure safe and timely discharges home for the people of Conwy in the areas we are able to facilitate improvements.

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Our Reablement Team

The Reablement Team supports individuals to be discharged from hospital, prevents re-admission, and supports people in their own homes to regain their skills following illness, a fall, or decline in their well-being.

Here are some reablement figures:

These measures help us to monitor the number of packages of reablement which are completed during the year and what the outcomes are for those individuals who are supported by the reablement service.

Our teams work as part of the five Community Resource Teams located across the county, which we have mentioned in previous reports, and comprise of Occupational Therapists, Physiotherapists, Pharmacists, Social Workers, District Nurses, GPs, Psychiatric Nurses and other professionals. This multi-disciplinary approach ensures a seamless service, where concerns are communicated in a timely manner via weekly meetings, and support is coordinated in a holistic way.

The Reablement Team includes skilled workers and Reablement Officers. Some staff are qualified to provide small aids and equipment to help people in their homes, such as tipping kettles, gadgets and digital aids, or prompts to remind people about medication or appointments. The team will signpost to other agencies as required, or contact Health professionals as needed; all support is geared towards enabling people to live at home as independently as possible and reduce the likelihood of hospital re-admission.

During the reablement period, staff take the time to get to know individuals well, viewing their well-being holistically, and agreeing new outcomes or goals with them at any time during the intervention period. Depending on need, our team will agree what kind of support and frequency of visits is required to support the individual to reach their optimum, and will then agree future plans to support them to live as independently as possible at home.

Having skilled staff in the team who can support with low-level Health tasks under the supervision of District Nurses reduces the number of professionals who need to visit the person being supported, and also increases the skills of the staff and wider team.

The figures speak for themselves:

• This year, 61% of people who received reablement support no longer required ongoing support, or they received support at a reduced level.
• At the end of each intervention, individuals complete a survey to support us in improving the service; 98% said that their expectations of the service were met.
• At the end of the intervention period, 93% agreed that their outcomes or goals has been met.

Every team member that arrived here each day had a very positive and friendly attitude. They gave confidence, reassurance and good advice to both patient and wife, plus practical help and care.

Relief to have the support after being in hospital

I am much more mobile and confident now

Case study

Following a hospital admission due to a stroke, Mrs J stayed with her son whilst alterations were made to her own home, and received two calls a day from the Reablement Team. Once Mrs J returned home, the support was increased to four calls a day to settle her back in. However, within days of returning home, Mrs J became withdrawn and quiet, and on some days didn’t want to get washed and dressed. She became less chatty and didn’t want to get up each morning to feed her dog before we arrived. As we were in the process of transferring Mrs J to long-term support one of the team scheduled a longer visit in the afternoon to have a cup of tea and a chat. During this visit Mrs J opened up to the support worker and explained that, whilst she was at her son’s home, she had a reason to be up and dressed each day, but since she had returned home she hadn’t seen anybody except the support workers. Her friends hadn’t called round and her son was working long hours and was unable to visit.

The support worker suggested a later call the next day in order to go out for a walk; Mrs J was up, washed and dressed, and waiting for us to arrive. Whilst out for the walk Mrs J spoke to neighbours and friends that she hadn’t seen since before she had the stroke; they had a chat and arranged to meet up in her garden to catch up properly. From the initial prompting to go out for a walk, Mrs J was able to regain her previous confidence levels and re-connect with her friends again. She didn’t require any ongoing support from us.

Specialist equipment to deal with falls

Each of the community teams have purchased lifting equipment for use in ‘no injury’ falls. The Raizor Chair is used alongside an NHS app called iStumble for the safety of the person who has fallen. Using the chair allows us to assist the individual without the need to call an ambulance, preventing unnecessary hospital admissions and further injuries which can result from being on the floor for lengthy periods of time. The chair has been successfully used 37 times in 2023, saving the £367 cost of an ambulance and A&E visit each time. The saving in 2023 alone was at least £10,000.

Other support available

To prevent hospital admission and to facilitate hospital discharge, the team can support people to regain their health, confidence and well-being in one of the five Extra Care Housing flats across the county.

Dementia Support Workers are also available to support the individual and their families and carers. They work with partners to ensure that the person can live as well as possible with dementia, and are able to access services that are local to them, such as support groups, meetings, coffee mornings etc. Dementia Support Workers provide invaluable practical information, and we are fortunate to have access to the Dementia Centre in Mochdre, which is a source of information, support, and a place where friendships develop.

How we can improve

• Recruitment to the teams has been a challenge, and over the past year we have tried various ways to attract applicants, such as attending recruitment fairs, promoting our vacancies at local shops, and working with the Conwy Marketing Team to produce a film.
• We have received feedback via the service user survey regarding not having the choice of time for support. Unlike long-term support, reablement is not delivered in time slots, unless medication needs to be administered at a specific time.
• Overall we have received an excellent response from individuals, their families, and the staff involved. Clearly people feel that they have voice, choice and control over their service delivery wherever possible.

Our action plan

We know that we need to explore different recruitment methods to attract applicants for our vacant posts. We need to maintain service delivery and ensure that current staff undertake the necessary training and refresher courses to retain their registration; this can be a challenge, but staff value the training opportunities that are available to them.

Conwy and BCUHB are providing interesting and valuable training opportunities for staff, however, accessing online training has been a challenge for those who don’t have access to laptops. Desktop computers are installed in the office, iPads are provided, and our in-house Workforce Development and Learning Team are supportive, thereby ensuring that different options of support are available.

Progress against last year’s priorities

We have attended recruitment fairs to promote community support services as a career option.

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Spotlight on grant-funded and third sector services

Here we’ll focus on some of the partnerships that help us to deliver essential services in our communities.

The Families First and Flying Start programmes are designed to improve outcomes for children, young people and families. It places an emphasis on early intervention, prevention, and providing support for whole families, rather than individuals. We have a range of programmes and projects commissioned to deliver support for our families in Conwy. These commissioned services are carefully planned, using public consultation and engagement, and using our local needs assessments.

Family Support at the Conwy Family Centres

We have five local Family Support Teams in Conwy, funded mainly through the Families First grant. Some of these are based in Family Centres, providing support through:

• Access to information and advice
• Groups that are open for anyone to attend
• Targeted groups and courses, e.g. parenting courses
• One to one support from a Family Worker
• Access to other specialist support

Our Family Centres continue to be a busy and vital hub for Conwy families, and this year they have received 972 referrals for support.

Domestic Abuse Safety Unit (DASU)

We commission DASU to work with families who are at risk of, or who have experienced domestic abuse. They receive referrals from our Family Centre staff when they have been confided in by a victim (with their consent), and also provide drop-in sessions at the centres to provide a safe space for individuals to speak to staff and get information and support.

DASU’s Family Support Worker (FSW) has continued to work closely with the Family Centres over the last year, and a good relationship has been built, with both services working very well together. Family Centre staff continue to liaise with the FSW for advice and guidance on cases relating to domestic abuse and they continue to work jointly on cases.

The FSW has continued to run a weekly drop-in at the Llanrwst and Colwyn Bay Family Centres and integrates into the baby club and parent and child play group held at the respective centres. This gives the FSWs an opportunity to get to know the parents and children in an informal way, allowing them to pick up on any signs of domestic abuse. The parents feel much more comfortable approaching the FSWs about domestic abuse issues, and less stigmatised. The FSW is regularly joined by a Domestic Violence Officer from the police, and high-risk clients can access the support they need at the Family Centre. At the Dinorben Family Centre in Abergele, the FSW attends the ‘Paned a Scwrs’ (Cuppa and Chat) group in the morning. To reach the areas in the west and rural areas of Conwy there is a rotation of drop-ins at various locations.

DASU worked with 258 clients in 2022-23, which shows the importance of this work. It included 202 sessions at our Family Centres.

TAPE

We help fund an animation club run by TAPE, a charity based in Old Colwyn. The club is a Tuesday after-school arts and media youth club for young people aged 8 to 18 years, with an emphasis on inclusivity and a disability focus. It encourages attendees to join in and work together, thus increasing personal resilience, social skills, speech and language skills, and family relationships. The animation club is running very well, and has increased from 15 to 20 participants. Many who have been attending the club are focusing on their own projects and are looking at creative courses in college and university. There has been a lot of interest in the club, and even though the numbers have increased, the club continues to be a calm environment for the young people attending. They can choose to work on their own projects or collaboratively with other members. It is a social environment, and the regular group is very welcoming and supportive of any new members.

Lucy Faithfull

The Lucy Faithfull Foundation (LFF) provides parents with education and awareness-raising seminars regarding child sexual abuse prevention, targeted specifically towards the needs of parents of children with disabilities. A transition back to face to face sessions following the Covid-19 pandemic has been difficult, but the LFF have strived to provide more sessions through the Family Centres.

Feedback has been excellent, with parents stating that they had no prior concept of some of the issues presented at the sessions. Attendees also reported greater family resilience following the sessions.

Lucy Faithfull supported 106 service users via 23 sessions in 2023.

Cruse Bereavement Services

This project provides bereavement support for all, including families and children. The strategic priority of the organisation is to reach even more bereaved people, and to support them to help themselves.

Cruse deliver support throughout our Family Centres by developing facilitated group sessions around parenting and supporting children and young people, alongside the extension of current one to one services for adults with family responsibilities. They have also built links with Family Centre teams and established connections with other organisations working within the centres.

Families have reported an improvement in their emotional and mental well-being, with increased family resilience. Cruse supported 205 families through this contract in 2023.

Relate Cymru

Our contract with Relate ensures free provision of adult relationship and family counselling for families in Conwy who are in receipt of benefits or who are not in employment. Expert counsellors help people to explore their own relationships, either individually, as a couple, or as a family.

The project delivers counselling sessions with the objective of having a Relate Cymru practitioner in a community setting for 3-4 hours per week, for 26 weeks of the year.

Families are referred into the service from our Family Centres or other professionals within the Local Authority. This year saw a large increase in referrals to the service following on from issues caused by the pandemic.

Relate supported 78 service users via 360 sessions in 2023.

Carers Trust

We commission Carers Trust to support children and young people with disabilities and their families by offering activities and groups, both to the family as a whole, and in separate environments, to meet the individual needs of family members. The demand for this service has been increasing steadily throughout the year, with more and more families enquiring about support.

The trust delivers a service to support children and young people with disabilities, their parents and siblings through an activity group for children aged 4 to 12 years and individual one to one sessions. This service is delivered through weekly and ad-hoc sessions.

The organisation is registered with Care Inspectorate Wales to provide personal care to children and young people, and therefore is able to offer the service to children with acute health needs; they can administer medication and attend to any personal care that may be required. Many of the children who have attended have displayed quite challenging behaviour and have not been able to access other services. Feedback from families has been positive.

The project aims to:

• Support the family unit as a whole
• Prevent family breakdown
• Support children with high-level needs
• Integrate children with disabilities
• Focus on preventative or early intervention and offer advice and signposting as required
• Equality of service at no cost to families
• Signpost to other agencies, such as Social Services and Team Around the Family, and accept referrals
• Deliver a minimum of 60 family support groups (pro-rate for the service level agreement period of 7 months)
• Deliver a minimum of 800 hours of short-term one to one support through a minimum of 260 sessions (again pro-rata) to complement and encourage engagement in the group activities

Carers Trust supported 330 service users in 80 group sessions and 46 one to one sessions.

Portage

We use Flying Start funding to commission the CCBC Portage Home Service to work with Flying Start families. Portage is a model of support for children and families which can be adapted and used effectively, both in the home, and in early years settings to help them develop a quality of life and experience for themselves in which they can learn together, play together, participate and be included in their community in their own right. The Specialist Portage Worker, which this grant funds, is skilled in promoting developmental milestones in young children with additional learning needs, alongside empowering parents to continue teaching basic skills, independent of professional involvement, through play-based activities.

The Portage team supported 22 Flying Start families with additional support in 2022-23.

Home-Start

Through Flying Start we provide funding to Home-Start Conwy to employ a Family Support Organiser (FSO). Home-Start is a local community network of trained volunteers and expert support, helping families with young children through challenging times. This role allows Home-Start to offer parenting support to families under Flying Start and Families First. The FSO facilitates and manages the offer of support sessions to a family within their home, with the objective of improving the health, social and environmental needs of the family, in conjunction with the Flying Start ethos by encouraging families, who are reluctant to engage with the Flying Start service, to participate. It also enhances the ability to provide an ongoing response to a Flying Start family on referral.

The FSO (along with the Home-Start Manager) co-ordinates support to the referred family based on their individual/appropriate needs, and with the specific purpose of encouraging participation in the activities offered by the Flying Start project. Volunteers who may be allocated to the families if necessary will receive training and support in preparation for all aspects of their role within the family.

The FSO is also instrumental in ‘recruiting’ the volunteers to deliver this support to Flying Start families. They assist the Scheme Manager in training volunteers to prepare them for their role within the family. The volunteers are monitored, supervised and supported by the FSO. The volunteers are all from the local community and are required to complete a training/preparation course before being placed with a family or helping in a group setting. Volunteers are subject to an Enhanced DBS disclosure and must supply two references. The volunteer course comprises ten sessions which include modules on safeguarding, confidentiality, disability, equal opportunities, etc.  Volunteers offer support to the family in conjunction with the needs-led initial assessment and taking account of the information provided on the Flying Start referral.

Parents and children benefit from one to one volunteer support and are encouraged to attend group activities where they will meet socially with other parents and children in a friendly and safe environment.

Home-Start provided 142 Flying Start children with additional support in 2022-23. They recruited and trained an additional 18 volunteers who made 162 home visits to families.

Conwy Pre-School Support Team (CPSS)

This contract enables us to provide support to pre-school children with additional needs, and their families as appropriate, to enable them to integrate with their peers where possible, giving them the choice of inclusive pre-school play opportunities. 

A Co-ordinator liaises and works with childcare providers, professionals from multiple agencies, and the parents/carers of children aged 2-3 years with additional needs, to provide those children with the necessary support to integrate effectively with their peers in pre-school settings. Using other funding, they then facilitate the provision of an additional support worker in pre-school settings, when necessary, by providing funding to the setting towards the employment of the worker.

The Co-ordinator works closely with the Conwy Family Centres, the Flying Start Childcare Team and the Early Years Team. They also ensure that all families are aware of the wider support available from Family Centres. They target families living in poverty and/or children with disabilities.

CPSS works closely with other services to raise awareness of our work with children with additional needs. These services include childcare support agencies such as Early Years Wales, Mudiad Meithrin, individual childcare settings, the Conwy Child Development Centre (CDC), Education Services (Early Years), Flying Start, Health professionals and the Quality Standards and Commissioning Team. Most referrals come from either the CDC or individual childcare providers.

Feedback from parents shows the impact that receiving support has on both the child and their families and all are grateful for the support. Feedback from professionals shows how the service is valued as part of a multi-agency approach to providing early intervention and support to these young children and their families.

CPSS provided 48 Flying Start children with additional support in 2022-23.

Progress against last year’s priorities

We have a much more robust monitoring and reviewing process since the creation of the Social Care Grants Team. This has already identified many improvements within the service and provided much better oversight and assurance for senior management teams. 

How we can improve

We continually monitor all our commissioned services in Social Care to ensure they meet local need and fit with the objectives of the various grants that fund them. Any required changes are informed by feedback received from service users, staff, partners and stakeholders. Our Family Centre Section Managers regularly assess the quality of the provision to ensure it fits with local need, and ensure any development work is completed with the support of the Grants and Commissioning Teams.

Our action plan

All commissioned services are reviewed on a regular basis. This year we recommissioned contracts that were over three years old to ensure we were getting value for money, and that services were providing for the changing needs of the Conwy population.

Moving forward, we intend to review all contracts to ensure that they align with the outcomes for both Conwy and the grants that fund them.