Summary of issues

• Areas for improvement include further development of preventative and early intervention services, building on established programmes such as Family Information Services, Families First and Team Around the Family; refocusing managed care and support to promote independence and wellbeing; improving multi-agency working and improved collaboration across the region to bring services to a consistent level and standard
• Collaborative action should also be considered to address strategic challenges such as reducing budgets, workforce development and the establishment of user-led preventative services

 

	Relevant Objectives within the Delivery Plan
Developing appropriate access to a range of information, advice and assistance that directs families with children and young people to relevant care and support within communities	1.3; 1.4; 1.14
Enhancing assessment and care planning processes to ensure that citizens have a genuine voice when agreeing outcomes and the support needed to achieve them	1.15; 2.1; E7
Ensuring that children, young people and their families are able to access services through their language of choice and that the ‘active offer’ through the Welsh medium is available	For consideration by regional Welsh language forum
Developing community-based, user-led, co-produced services that support families with children and young people to become more resilient and develop a range of skills including life skills	1.14; 1.15; 1.17
Reconfiguring commissioning processes for high cost, low volume care and support packages for children with complex needs, to deliver consistent cost-effective services that ensure best outcomes for service users	3.5
Improving the support offered for family relationships, particularly for new parents or parents who are experiencing stress due to other factors such as imprisonment or disability	1.14
Enhancing accommodation and meeting accommodation support needs of young people leaving care or following custodial sentences	For further discussion with PSBs
Improving integration between children’s services, mental health and learning disability and access to mental health services at an early stage	1.18
Reducing the number of placement moves for LAC and reducing reliance on residential care	1.14
Improving joint planning between CAMHS and learning disability services, to ensure equitable service provision for children with neuro-developmental conditions via the ‘Together for Children’ programme	1.18
Developing links between Integrated Family Support Services (IFSS) and other council services such as adult care and housing as well as community-based services, to help families back to independence and enable them to function effectively within their communities	2.9
Improving access to child sexual health services	1.2; 1.4; 1.15
Adopting consistent methodology such as Signs of Safety to underpin care and support across the region	1.16
Developing a consistent, outcomes-based performance framework for children and young people’s services across the region	Address through regional outcomes framework

  A regional Children’s Service Group is in place with representatives from all partner agencies. Reporting to the RPB, this Group will oversee implementation of relevant objectives within the Delivery Plan, working where appropriate with other forums such as the Regional Adoption Committee and IFSS Lead Officers' Group.

• A range of ‘accelerating factors’ have been identified within people’s environments that might increase the likelihood of them developing an ongoing health condition, or aggravate the effects of existing conditions, and against which mitigating action should be taken. These include unemployment, low wages and poor housing conditions
• Neurological conditions are the most common cause of serious disability and have a major, but often unrecognised, impact on people’s lives and care and support services
• The contribution of care and support services must be complemented by a range of collaborative approaches to improve people’s social, economic, environmental and cultural wellbeing
• Public Health has an important role in providing the population with general information and advice on healthy life choices and support in areas such as diet and smoking cessation. This needs to start in the early years but should be sustained where possible across the range of age groups.

 

	Relevant Objectives within the Delivery Plan
Developing appropriate access to a range of information, advice and assistance including Dewis Cymru and Infoengine, and advocacy services relevant to health and social care needs at all key life stages	1.3; 1.4
Developing consistent, integrated regional services that are accessible and respond to population need	Whole plan
Improving the early identification, treatment and management of preventable and chronic conditions including diabetes, heart disease and respiratory illness, to improve long term wellbeing and reduce complications	1.1
Ensuring effective interventions and pathways for prevention, treatment and management of obesity and childhood obesity are routinely available and systematically implemented	1.1
Improving early identification and treatment of risk factors associated with health inequality	1.1
Strengthening transition arrangements between children and young people’s services and adult services	Whole Plan
Developing community-based, user-led, co-produced services that prevent isolation, promote independence and support people to become more resilient and manage their own conditions	1.2; 1.4; 2.3; 3.1; E5
Increasing use of assistive technology, such as telecare to transform domiciliary care and supported living services	1.5
Improving flexibility to deliver step up and down provision to respond to changing needs	2.2; 2.3

 

HDdUHB is committed to working with partners to improve health outcomes for those who live in, work in, or visit West Wales. A population health approach, which seeks to embed prevention and early intervention, underpins the Transforming Clinical Services programme. In the medium to longer term, a Public Health and Well-being Strategy will be developed, under the auspices of Health Board’s Health Strategy Committee, developing cross-cutting plans and processes to ensure effective delivery of strategic aims in this area.

The Strategy will need to ensure ‘fit’ across the wider system, and effective partnership working across sectors and agencies providing care and support, will be crucial in maximising impact and improving the health of the West Wales population.

• The way in which the needs of people with a Learning Disability are met has changed over the last twenty years. People who would historically have been placed in institutional care are increasingly being supported to live in their communities. Health and social care services along with the third sector collaborate to maximise the independence and potential of those who use our services.

 

	Relevant Objectives within the Delivery Plan
Improving the recognition, diagnosis and the treatment and management of people with neurodevelopmental disorders including ASD and ADHD	1.9; 2.8
Empowering people with a learning disability to decide who provides their support and what form that support takes	1.19; 1.20; 2.12
Strengthening pathways back to local communities following education, and developing local education, volunteering and work opportunities in communities, making the necessary adjustments for people with a learning disability	1.19; 2.12
Increasing access and availability of appropriate local housing and accommodation to enable people with a learning disability to live as independently as possible, in a place of their choice	2.12
Developing consistent, integrated commissioning and procurement processes that are based on co-production principles, which involve user-led community-based groups and fora in the design and delivery of services	1.19; 2.12; 3.8; E2; E3; E5
‘Right-sizing’ existing packages of care to ensure they meet current needs, facilitate personal development, increase independence and deliver cost-effective services that ensure best outcomes for service users	2.12
Developing a consistent, outcomes-based performance framework for service delivery across the region, utilising data to support future planning and commissioning	3.8

  A regional Learning Disability Programme Group is in place with representatives from all partner agencies. Reporting to the RPB, this group will oversee delivery of the relevant Objectives within the Delivery Plan. A regional Strategy Group is in place to oversee the implementation of the Integrated Autism Service (IAS) in West Wales.

• Significant number of people will require support with respect to our mental health throughout our lives whether this is low intensity support for difficulties such as low level anxiety /depression or longer term support
• Mental illness can develop from a number of factors including social traumas, illegal drug use and genetic predisposition. Mental health does not discriminate and can affect anyone often leading to debilitating conditions.
• Early intervention is crucial and this can take the form of providing information or referral to community or third sector services. Admissions to inpatient services may occur in extreme situations, where the individual cannot be treated in the community and presents a risk to themselves and/or others
• It has been estimated that the economic and social costs of mental health problems in Wales is estimated to be £7billion a year

 

	Relevant Objectives within the Delivery Plan
Improving prevention and early intervention services, alternatives to hospital services such as a safe haven, respite and transfer of care liaison services, and access to services, especially for those in crisis	1.21; 1.22; 2.14
Developing an outcome focused and ‘risk-enablement’ approach to service provision to support a flexible approach	1.21; 1.22; 2.14
Improving access to specific mental health welfare rights support and increased support for carers and carers need to be involved in Care and Treatment planning	1.21
Developing 24 hour direct access to alternative provision for those in crisis where hospital admission is not the best option	1.22; 2.15
Improving service user experience and conveyancing in relation to S136 of the Mental Health Act for those detained in police custody	Take forward through Transforming Mental Health Implementation Plan
Developing co-produced services and community networks to support people in building confidence and skills using peer support and/or mentoring	1.21
Developing a flexible and responsive workforce across health and social care to successfully deliver new models of mental health service	1.7; 2.4; 3.2; E1
Addressing the lack of transport links within very rural regions, which add to the difficulty of accessible service delivery and recruitment challenges	For further discussion with PSBs

  A regional Mental Health Programme Board is in place which has responsibility for taking forward the Together for Mental Health Programme and has a strong link to the Transforming Clinical Services programme. Links between the Board and the RPB are being established.

• Rates of dementia in older people are also set to rise, with particularly high projections in North Carmarthenshire and Pembrokeshire
• Rurality can be an accelerating factor in exacerbating the needs of older people, due to social isolation, higher levels of deprivation and poor access to services

 

	Relevant Objectives within the Delivery Plan
Developing appropriate access to a range of information, advice and assistance including Dewis and advocacy services relevant to health and social care needs at relevant stages for health and social care	1.3; 1.4
Improving anticipatory care across the health, social care and other sectors to avoid escalation of need	1.1; 2.2
Reducing the reliance on residential and nursing care in favour of lower level, preventative and well-being services	1.1; 1.2; 1.4; 1.5; 1.23; 2.2; 2.5; 2.6; 2.16; 3.12; E5
Developing community-based, user-led, co-produced services that prevent isolation; promote community connectivity, well-being and resilience and support people to remain independent for longer in their own communities	1.2; E5
Enhancing assessment and care planning processes to ensure older people and their carers are involved in decisions about them, including discharge planning	2.1; E8
Ensuring that older people and their families are able to access services through their language of choice and that the offer through the medium of Welsh is available	For consideration by regional Welsh language forum
Achieving a consistent, integrated approach to frailty across the region that aligns with regional frailty and dementia strategies and pathway	1.1; 1.2; 1.3; 1.4; 1.5; 1.8; 1.23; 2.1; 2.2; 2.3; 2.5; 2.7; 3.1; 3.12; E1; E2; E3; E5; E7
Developing consistent, integrated commissioning and procurement processes based on co-production principles, which involve older people, user-led community-based groups and fora in the design and delivery of services, to achieve market sustainability	E2; E3; E5
Improving and standardising levels of telehealth and telecare across the region	1.5
Addressing the lack of transport links within very rural regions, which add to the difficulty of accessible service delivery and recruitment challenges	For further discussions with PSBs
Growing an integrated approach to quality assurance and contract monitoring of care homes to identify and address emerging concerns and prevent placement breakdown	3.11

  A regional group will be established to oversee delivery of the range of objectives included in the Plan, including those relating to dementia and frailty.

 

	Relevant Objectives within the Delivery Plan
Raising the profile and public understanding of sensory impairment and the NHS Low Vision Service and embedding good practices around identification, information, consultation and integration of other related services	1.24
Developing appropriate access to a range of information, advice and assistance that addresses the needs and barriers to accessing services, which can prevent those with sensory impairment accessing vital healthcare	1.3; 1.4; 1.24
Developing specific consistent support and services such as interpretation, translation, lip reading, talking therapies, rehabilitation and clinics for ophthalmology and glaucoma to ensure they are available and accessible across the region	2.17; 1.24
Increasing use of direct payments to ensure people can exercise genuine choice and control over the care and support they receive	3.1
Developing community-based, user-led, co-produced services that prevent isolation; promote community connectivity, well-being and resilience and support people to remain independent for longer in their own communities	1.2; 1.24; E5
Addressing the lack of transport links within very rural regions, which add to the difficulty of accessible service delivery	For further discussions with PSBs

  A regional task and finish group will be established to consider the gaps and areas for improvement within the Population Assessment and to agree a regional plan of implementation for the actions identified.

  More recent data that has become available since completion of the Population Assessment shows trends which are of concern and require appropriate remedial action:
 

• During 2016–17, the HDdUHB area saw the largest increase in rates of alcohol related hospital admissions for an alcohol specific condition across Wales. Carmarthenshire had an admission rate of 375 individuals per 100,000 population, an increase in 25% since 2015-16 and an increase of 46% since 12-13. Ceredigion has seen an increase of 13% since 2015-16 and Pembrokeshire an increase of 3%
• Alcohol attributable hospital admissions in Carmarthenshire in 2016-17, have increased by 12% compared to 2015-16 and by 27% over the past 5 years. Ceredigion has increased by 8% in the past year and by 19% compared to admission rates five years ago. There has been no change in Pembrokeshire rates since 2015-16 but there has been an increase of 9% since 2012-13
• In 2016 /17 there were 1,197 referrals for alcohol treatment (compared to 1,137 in 2015-16) and 978 referrals for drug treatment

 

	Relevant Objectives within the Delivery Plan
Ensuring that children, young people and families are able to access services through their language of choice and that the offer through the medium of Welsh is available	1.25 Refer to Area Planning Board (APB) Prevention Plan. Currently under development.
Establishing a more co-ordinated and coherent approach to drug and alcohol misuse education and awareness raising for young people across schools and for those who are not in education, employment and training (NEET)	Refer to APB Prevention Plan. Currently under development.
Establishing clear and coherent treatment options for young people and their families with drug and alcohol problems to provide a more holistic approach to prevention and early intervention ensuring that there is a clear link to the Adverse Childhood Experiences (ACE) agenda	Refer to APB Prevention Plan. Currently under development.
Developing clear pathways between services for service users with co-occurring substance misuse and mental health problems	Refer to APB Treatment and Harm Reduction Plan. Currently under development.
Targeting prevention, early intervention and treatment interventions to reduce harm to older people (50 plus) with alcohol problems	Refer to APB Treatment and Harm Reduction Plan. Currently under development.
Development of housing options and reintegration opportunities within the community for recovering service users	Refer to APB Treatment and Harm Reduction Plan and Drug-Related Death Action Plan. Currently under development.
Establishing, developing, implementing and managing a robust process for the review of both fatal and non-fatal overdoses including the rollout of the distribution of Naloxone across hospital sites	Refer to APB Treatment and Harm Reduction Plan and Drug-Related Death Action Plan. Currently under development.
Developing consistent, integrated commissioning and procurement processes based on co-production principles, which involve service users, carers, young carers, parents or significant others, user-led community-based groups and fora in the design and delivery of services	E2 Refer to APB Treatment and Harm Reduction Plan. Currently under development.

  The Dyfed APB for Substance Misuse will take this work forward through a regional commissioning strategy, based on the following vision:

• People will be healthier and experience fewer risks as a result of alcohol and drug use
• Fewer adults and young people will use drugs or drink alcohol at levels that are damaging to themselves or others
• Individuals will be able to recover from problematic drug and alcohol use and improve their health, well-being and life chances
• Alcohol and drug prevention, treatment and support services will be accessible, high quality, evidence based, timely and continually improving
• The family members and children of people misusing alcohol and drugs will be safe, well supported and have improved life chances

Links are being established between the APB and the RPB to help facilitate a joined up approach in this area.

• In 2011 an estimated 137,000 girls and women were living with consequences of Female Genital Mutilation (FGM) in the UK and in 2011 an estimated 60,000 girls under the age of 15 were living in the UK who were born to mothers from FGM practising countries and therefore could be at risk of FGM. It is estimated there are 140 victims of FGM a year in Wales
• 80% of cases dealt with by the Forced Marriage Unit involved female victims; 20% involved male victims. It is estimated there are up to 100 victims of forced marriage a year in Wales.
• Domestic Abuse alone costs Wales £303.5m annually. This includes £202.6m in service costs and £100.9m to lost economic output. If the emotional and human cost is factored in there are added costs of £522.9m.

 

	Relevant Objectives within the Delivery Plan
Raising the profile and public understanding of violence against women, domestic abuse and sexual violence, including among vulnerable groups such as Black and Ethnic Minorities, disabled people, the LGBT community, older people, refugees and migrants	Refer to VAWDASV Strategy - Due mid 2018
Embedding good practices around identification, information, consultation and integration of other related services	2.18
Earlier identification of violence against women, domestic abuse and sexual violence	Refer to VAWDASV Strategy - Due mid 2018
Enhancing education about healthy relationships and gender equality	Refer to VAWDASV Strategy - Due mid 2018
Ensuring professionals are trained to provide consistent effective, timely and appropriate responses to victims and survivors	1.26
Provide victims with equal access to appropriately resourced, consistent high quality, needs led, strength based, gender responsive services	Refer to VAWDASV Strategy - Due mid 2018
Developing community-based, user-led, co-produced services that prevent isolation and promote well-being and resilience	Refer to VAWDASV Strategy - Due mid 2018
Increasing survivor engagement in the planning, delivery and monitoring of services	Refer to VAWDASV Strategy - Due mid 2018
Developing and implementing an integrated pathway for all forms of violence against women, domestic abuse and sexual violence	Refer to VAWDASV Strategy - Due mid 2018
Increased focus on perpetrators, holding them to account for their actions and providing opportunities, through intervention and support, to change their behaviour	Refer to VAWDASV Strategy - Due mid 2018

 

The enactment of the Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 requires the public sector in Wales to work together in a consistent and cohesive way to improve the outcomes for individuals and their families subjected to Violence against women, Domestic Abuse or Sexual Violence.

In 2018 Mid and West Wales will publish its first joint strategy to tackle Violence against Women, Domestic Abuse and Sexual Violence; outlining how the region will support victims and survivors, tackle perpetrators, ensure professionals have the tools and knowledge to act, increase awareness of the issues and help children and young people to understand inequality in relationships and that abusive behaviour is always wrong.

The strategy aims to provide a framework that will improve the planning, coordination and collaboration of responses and, furthermore, support the integration and transformation of service delivery; enabling a step change in action to achieve a sustainable reduction in violence and abuse, improve outcomes for all individuals and families affected and prevent such abuse from happening in the first place.

The strategic direction for VAWDASV sits with the Mid and West Wales Safeguarding Executive. A Violence against Women, Domestic Abuse and Sexual Violence Strategic Group, accountable to the regional Safeguarding Executive has been established to provide a governance structure to develop, approve and monitor the regional arrangements for Violence against Women, Domestic Abuse and Sexual Violence.

The RPB will work closely with the Mid and West Wales Safeguarding Boards to agree formal reporting arrangements for VAWDASV enabling us to strengthen effective partnership working and identify opportunities to align work plans around early intervention and preventative services.