Local Authority and Health Board Partnerships Annual ... · Annual Update 2012-13 Page 0. Local Authority and Health Board Partnerships Annual Update 2012-13 Page 1 Intentionally

Local Authority and Health Board PartnershipsAnnual Update 2012-13

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Contents Page

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1. National Level Working1.1 National Policies 51.2 Association of Director of Social Services (ADSS) 7

Commissioning Board

2. Regional Working2.1 Mid and West Wales Collaboration Board 92.2 Mid and West Wales Integrated Family

Support Services (IFSS) Consortium2.3 Three Counties Carers Programme Board2.4 Three Counties Transport Development 102.5 Hywel Dda Health, Social Care and Wellbeing Team2.6 Wellbeing Activity Grants2.7 Dementia Care and Support 112.8 Obesity Pathway Implementation in Hywel Dda 132.9 Tobacco Control2.10 Falls Prevention 142.11 Substance Misuse 16

3. County Level Working3.1 Local Authority Facilitators 193.2 Local Service Boards 203.3 European Social Fund Project–Third Sector

Brokers Project 243.4 Integrated Health and Social Care Services 253.5 Section 33 Agreements 313.6 Elected Member Engagement for Clinical

Services Strategy 33

4. Joint Working outside of Health and Social Care4.1 Emergency Planning 354.2 Joint Estate and Asset Planning 364.3 Transport 374.4 Central Wales Infrastructure Collaboration4.5 Central Wales Waste Collaboration 384.6 Learning and Development 39

5. The Year Ahead–the challenges and opportunities5.1 Locality Based Resource Planning 415.2 Developing Community Resource Teams5.3 Funding 42


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2.1 Mid and West Wales Collaboration Board




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Sustainable Social Services Bill

This Bill places a duty on both local authorities and health boards to deliver thefollowing and sits alongside Together for Health in terms of requiring improvedservices. Hywel Dda Health Board is involved with this work in the following ways:

Trevor Purt is the NHS Chief Executive representing health on the LocalGovernment Implementation Board and is there to ensure full health boardrepresentation on all the sub groups. Currently it has been difficult to engageother health boards and there is concern that this Bill becomes too focused onlocal authority implementation and misses the opportunity for a sharedapproach to delivering both this Bill and Together for Health.

Sarah Jennings is the NHS Lead alongside the NHS Confederation ondeveloping a shared outcomes framework which fits underneath the above Billand Together for Health. This is essential if social care and health are to workin an aligned manner moving forward. Currently we have different targets andtherefore are set to focus on different priorities which often cause problems onthe ground.

Sustainable Development Bill. We have received the attached discussionpaper from Welsh Government last week ‘Sustainable Development Duty &Collaborative Working’. It is proposing to use the Sustainable Development Billto put Local Service Boards on a statutory footing. It may be useful to refer tothis as the proposals could have an impact for the Health Board. They are nowalso starting to refer to the Single Integrated Plan–our Integrated CommunityStrategy as ‘The Well-being Plan.

Sustainable Development Bill

This Bill is promoted as an overarching Bill where it is difficult to see what thelegislative duties will be. As a Health Board we are involved in shaping this in thefollowing ways:

Sarah Jennings (Veck) is the NHS representative for Health in on the NationalReference Group which advises the Commissioner for SustainableDevelopment on how the Bill should develop its outcomes.

The Local Service Board queried how organisations such as the Police, whoare not subject to the duty, would not be involved in the implementation of thisBill but through Local Service Boards they would still have a key part to play. Itwas also stated that there are aspects of what the Bill is proposing already inplace at organisations which makes it vital that the Welsh Government clarify

1.1 National Policies


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what they want to achieve with this Bill, but to avoid excessive bureaucracywhich will inhibit innovation and flexibility.

Further clarity is required regarding how this Bill would link with the other 22proposed Bills, in particular the Public Health Bill and the Sustainable SocialServices Bill. The co-ordination of these is critical and the outcomes fromeach need to align.

Public Health Bill

Views have recently been gathered across Wales about whether the WelshGovernment should introduce a Bill to improve the health of the people of Wales. AGreen Paper was published for consultation to consider whether legislation couldhelp Welsh Government and Public Health Wales to further improve overall healthand wellbeing in Wales. The paper in essence, started a debate about whether newlegislation would provide an effective way of making further progress in key areas.(The consultation period closed in February 2013)

Hywel Dda Health Board has responded positively to the consultation document, andnote that a new Public Health Bill provides an opportunity to improve the health of thepeople living in Carmarthenshire, Ceredigion and Pembrokeshire. Much of the effortto improve health has and still is focused on ‘lifestyle choice’ and ‘behaviour change’. While these approaches have proved successful and improved the health of somepopulation groups, the impact on others has been negligible, with the net effect thathealth inequalities have widened. Thus a Bill could support the health and wellbeingagenda by:

providing an opportunity to address the environmental factors which createinequalities in poor health between people from different socio-economicgroups living in different localities.

making an important contribution to addressing the social conditions whichinfluence behaviour and lead to inequalities in health, and,

Mandating changes that have a real impact on health and avoid thestigmatization found in many behaviour-orientated health improvementprogrammes.

Welfare Reform Bill

This Bill is a UK Bill and will have significant impact on the most vulnerable in ourcommunities–particularly those with a disability and young families and there isgrave concern amongst all public sector partners about the wider impact of thesewelfare changes.

Each Local Service Board has not directly met to discuss the Welfare Reform but keyfrontline partners have offered to participate in local Task and Finish Groups.


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The Health Board has nominated Rhys Sinnett from our Public Health team to be thekey link for each county and we have identified “experts” throughout our health system who may see the impact of this Bill on people as they present at our front lineservices (eg GP, A&E, children’s services, substance misuse, domestic abuse,health visitors and others). In addition, elements of how the effects of WelfareReform will be addressed locally will be included in the final version of the SingleIntegrated Plan. The Local Service Board is at the initial stages of forming outcomebased Action Plans to carry out the aims of the Single Integrated Plan. Some ofthese are likely to tackle some of the effects of impact of the Welfare reform that areincluded in the Single Integrated Plan.

The Carmarthenshire Local Service Board is linking in to a task and finish projectbeing taken forward by two Carmarthenshire County Council scrutiny committees onpreparing for the impact of the Welfare reform programme. Dyfed Powys Police andHywel Dda Health Board are key partners in this work and link officers have beenidentified within both organisations to feed into the project. The final report andrecommendations will be developed by May 2013.

This is an all Wales Group that looks at regional and national commissioningframeworks between health and social care. It explores opportunities to driveefficiencies by commissioning collaboratively and was started by social care. KarenHowell has joined the group as the all Wales NHS representative to ensure thathealth are also included in the framework and any approaches so that health canalso derive the financial and quality benefits of collaborative commissioning.

1.2 Association of Director of Social Services (ADSS)Commissioning Board


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The newly formed collaboration provides a strategic framework for co-ordinating anddelivering a range of health and social care programmes across the Mid and WestWales region. The objective of the Programme is to further develop and transformcollaborative working between Hywel Dda and Powys Health Boards and our fourco-terminus local authorities, supporting existing areas of joint working andidentifying new areas, maximising the resources available and bringing about serviceimprovement and transformational change in how we jointly provide services toachieve efficiencies and improved outcomes for citizens.

Hywel Dda Health Board together with Powys Teaching Health Board andCarmarthenshire, Ceredigion, Pembrokeshire and Powys County Councilsestablished a regional Consortium to jointly implement and oversee the delivery ofIntegrated Family Support Services across the four counties. Over the course of2012/13 the Consortium has co-ordinated the delivery of 15 training programmes forthe wider workforce attended by 324 staff from a wide range of professionalbackgrounds; health, social care, education, voluntary sector, youth service, youthoffending, substance misuse.

The Consortium has also developed Section 58 agreements to support theimplementation of IFSS across the region and to meet the statutory requirements setout in the Children and Families (Wales) Measure 2010.

In readiness for the development of the Information and Consultation Strategy forCarers the Hywel Dda Carers Measure Programme Board was established. ThisBoard oversees the development of the Strategy and the resulting ImplementationPlan and is chaired by Chris Martin as Carers Champion for the Health Board. This isthe senior overarching group to raise the profile of unpaid carers and its membershipincludes Directors of Social Services and Carers Champions from each localauthority.

2.2 Mid and West Wales Integrated Family SupportServices (IFSS) Consortium

2.1 Mid and West Wales Collaboration Board

2.3 Three Counties Carers Programme Board


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Following on from the Improving Customer Access to Rural Health Service (ICARHS)pilot the multi agency approach adopted for Non Emergency Patient Transport(NEPT) has now been mainstreamed from April 2014. This has been reflected in theNEPT Strategy for 2013/14 which will see the further development of an integratedmixed provision of patient transport including Welsh Ambulance Service NHS Trust,social care, third sector and independent sectors with specific reference to improvingthe patient experience whilst also achieving value for money.

Each month we have a meeting of all those who the Health Board either fully fund orpartially fund in other partner organisations in local authorities and the third sector toundertake partnership working. This group of people who are skilled catalysts andhave the skills to influence and shape agendas across organisations comes togetherto share what is going on across sectors and across counties with the aim of aligningour work, working to the same objectives and delivering tangible outcomescollaboratively.

It is one of those meetings that is well attended and that seems to add value and helpeveryone achieve their own aims by working together. This meeting will in futurereport to the Strategy and Planning Committee to ensure there is a governancestructure and also so that key developments are part of the wider strategic planning.

Carmarthenshire

In Carmarthenshire the Health Challenge Wales Well-being Activity grant of £23,250has supported a total of 13 projects ranging from positive ageing projects and familycentre cooking projects to challenging pain in the community sessions.

In Carmarthenshire the Support for Life fund is currently going through its first roundof allocations for delivery in 2013/14.

2.4 Three Counties Transport Development

2.6 Wellbeing Activity Grants

2.5 Hywel Dda HSCWB (Health Social Care andWellbeing) Team


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Ceredigion

Fourteen project applications were granted support through the Wellbeing ActivityGrant with a total allocation of £23,250. Projects covering mental health andwellbeing, nutrition and physical activity as well as addressing harms from excessalcohol consumption and reducing the impact of chronic conditions have beensupported. Project interventions in some cases also addressed accidents, injuriesand falls as well in some cases assisting carers, family and support teams.

Pembrokeshire

The aim of the Well-Being Activity Grant scheme, is to promote and support thedelivery of wellbeing activities in Pembrokeshire’s Health, Social Care and WellBeingStrategy, particularly the local Public Health Strategic Framework priority areas. Overthe years this grant scheme has enabled the Partnership to support a number ofactivities and projects including:

Health promotion activities delivered by the county’s Youth Offending and Prevention Service;

walking projects, specifically targeting carers and the disabled; Sports/activity clubs particularly allowing clubs to broaden their user base by

looking to reduce inequities between service users. Funding to support specific counselling sessions Funding to establish sustainable staff training sessions such as through the

Train the Trainer framework; specific first aid training sessions to individualswith learning disabilities

Funding to purchase specifically adapted riding equipment for a projectworking with disabled people

Carmarthenshire

Dementia in Carmarthenshire has been recognised as one of the key priorities of theHealth & Social Care Board and also adopted as one of the four CommunityResource Team work streams. Currently, the GPs in the Amman/Gwendraeth localityare developing a pathfinder approach to dementia. A key target is to increase therates of dementia that are low compared with other areas of the UK. However, wealso need to ensure that the memory clinics operating within the locality have thecapacity to meet additional demand. A Carmarthenshire Dementia Action Board hasbeen established to provide a strategic vision for dementia services and direct thedevelopment of support for people affected by dementia. The inaugural meeting washeld on the 21 February. Carmarthenshire County Council is one of threedemonstrator sites for the Social Services Improvement Agency project

2.7 Dementia Care and Support


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‘Transforming Services for Older People’. Carmarthenshire is focussing on support for people who have dementia.

Ceredigion

A review of services that relate to dementia care and support has been undertaken toinclude the commissioning of Elderly Mental Illness (EMI) residential accommodationprovision in the county. This has included the reconfiguration of in-house provisionand the designation of an EMI facility in Llandysul, with a focus on dementia. TheHealth Board’s Dementia Coordinator is co-located on a part time basis in this facilityand works across both health and social care sectors.

The overarching Older Peoples Strategy is to be put in place for 2013/14, and willhave a focus on dementia services.

A GP protected time learning session specifically on dementia has been provided byCeredigion’s Dementia Co-ordinator with the presence of the Alzheimer Societyrepresentative offering further information. This has been seen as a positiveprovision with referrals being made as a direct result of this provision.

The memory clinic packs suitable for distribution by GPs for newly diagnoseddementia patients as produced by Welsh Government are being endorsed by theHealth Board for the three counties.

Pembrokeshire

The Health Board Project Co-ordinator based with the local authority; works acrossboth health and social care sectors; currently undertaking a research project onresidential and nursing homes; positive developments to support vulnerableindividuals using health and social care services.

Good progress has been made in implementing the Dementia Action Plan which ishelping improve services to those customers with forms of dementia. The DementiaEducation and Organisational Development Workstream, led by Health, includerepresentatives from Social Care Workforce Development Programme inPembrokeshire, Carmarthenshire and Ceredigion authorities. Partners are workingtogether to establish specific skills for particular job roles as well as developingtraining programmes that reflect long term plans for working with dementias.Specialist training was purchased from the Alzheimer’s Society and has been delivered successfully to local authority and health board staff and external providerorganisations.


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In Carmarthenshire, as in the rest of Wales, the proportion of adults and children notmaintaining a healthy body weight is increasing. Data from the Welsh Health Surveyshows the percentage of adults in Carmarthenshire who are overweight or obese hasincreased from 54% to 61% within the last decade. In response to the launch of theAll Wales Obesity Pathway (2010) the Hywel Dda Local Public Health Team inpartnership with the Local Authority and Health Board have established an ObesityPathway Implementation Group to ensure a co-ordinated approach to obesityprevention and reduction across Hywel Dda. The main outcomes for this group areto:

Increase in the proportion of adults and children at a healthy body weight Increase in the proportion of adults and children meeting national guidelines

for healthy eating (fruit and vegetable consumption) Increase in the proportion of adults and children meeting national guidelines

for physical activity Increase the number of settings (workplaces, schools, hospitals, communities

etc) in which access to healthier choices/options are available Develop a motivated and well-trained workforce providing services across all

delivery tiers to support weight management Develop effective services and interventions which are monitored and

evaluated.

Tobacco Control forms a key action in all three county Health, Social Care andWellbeing Strategies and in the newly emerging Integrated Strategies. A specificTobacco Control Action Plan, supported by a task group has existed in each countyfor a number of years and during 2012/13 work has started to rewrite these to fit thenew Integrated Plan model.

Each partner leads on specific aspects of tobacco control. Public Health Walesoperates smoking cessation services in conjunction with community pharmacy,primary and secondary care. The Health Board integrates advice and support forsmoking cessation into patient care pathways and prioritises the issue through schoolnursing and child health, midwifery and health visiting. County Councils operateschools, leisure facilities, housing and environmental health services which all play arole in addressing smoking. Encouraging children to stay smoke free is addressedthrough the Healthy Schools’ Scheme and Trading Standards departments prosecuteshops that sell to minors and fine individuals found smoking contrary to theregulations.

2.8 Obesity Pathway Implementation in Hywel Dda

2.9 Tobacco Control


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Third sector organisations, both locally and nationally, play a key role. These includethe British Heart Foundation which promotes No Smoking Day each March andMIND who are concerned with support for smokers also affected by mental distressnot just prosecute underage sales but educate and advice businesses to assist themin the process of preventing underage sales and take appropriate action wherenecessary.

Carmarthenshire

The effective management of frailty requires a whole system, multi-disciplinaryapproach to care and service provision for all individuals: the independent, those whoare frail or at risk of functional decline and those who are most frail. The developmentof an integrated falls pathway has therefore adopted a frailty approach to theprevention and management of falls across these different levels of need and whichis embedded in the evidence base. It is important to recognise that falling is not aninevitable part of the ageing process and that many falls can be prevented.

Independent individuals are encouraged to keep active and healthy. Fallsprevention interventions at this level are highlighted within theCarmarthenshire Healthy Ageing Action Plan and include physical activity andnutrition as well as efficient management of chronic conditions.

The frail or those at risk of frailty: Falls prevention at this level involvesearly identification of those at risk, multi disciplinary assessment, interventionand review. As well as health and social care professionals from theCommunity Resource Teams, this level of service is supported by GPs andcolleagues in the leisure department of the Local Authority who facilitatecommunity based Postural Stability Instruction programmes. Postural StabilityInstruction is proven to improve strength and balance in frail older people andprevents falls as part of a multi factorial falls risk reduction plan. With ninecommunity based Postural Stability Instruction programmes, Carmarthenshireis viewed as exemplar in delivering a variety of exercise opportunities across acontinuum of need.

Most Frail: At this level, assessment and intervention is supported by districtnurse leads in falls and frailty based in each locality who have referral accessto a consultant geriatrician led clinic. This rapid access clinic is based inPrince Phillip Hospital and provides individuals who continue to fall despiteprimary care and community intervention with comprehensive geriatricassessment, diagnostic tests, assessment from physiotherapist andpharmacist as well as rapid access to reablement service where appropriate.

2.10 Falls Prevention


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Ceredigion

Through a strategic partnership between the Health Board, Aberystwyth University,and representatives from the voluntary sector, the Ceredigion Strategic Falls Grouphas been promoting and developing falls prevention in the region, with an evidencedriven focus on proactive, community-based, and multidisciplinary interventions.Some of the work conducted is summarised through the patient and stakeholderfacing website (www.aber.ac.uk/falls), designed to inform people of simple behaviourmodifications and interventions that could make a substantial difference in preventingthem from falling.

The group hosted a conference and networking event during falls awareness week2012 which attracted approximately 100 delegates, and 19 organisations. A speednetworking event and interactive play raised awareness and helped relevantstakeholders make links. Further work has been undertaken to link telecare alarmservices into the pathway and consideration given to people with dementia. It isanticipated that the National Exercise Referral Scheme will be able to offer a posturalstability programme for potential fallers across the county later this year and GPs inCeredigion are working with the Ceredigion Strategic Falls Group as falls and frailtyis a priority area for them at present.

Existing and ongoing research projects have included a collaborative project inpartnership with Age Cymru and Hywel Dda NHS Trust, evaluating an established 6week hospital and 12 week community based postural stability instructioncourse (2009 to date, funded by the Hywel Dda Charitable Funds Committee and aEuropean Social Fund Knowledge Economy Skills Scholarship) involving monitoringof changes in muscle mass, balance, strength and psychological quality of life inolder people, and a service evaluation of a 32 week postural stability instructioncourse in Tywyn, in partnership with Betsi Cadwaladr University Health Board, theNational Exercise Referral Scheme, and Gwynedd County Council (2010 - 2011).

Key findings have included offering evidence that in as little as six weeks, it ispossible to see improvements in mental health and physiological well-being. Theresearch has driven changes in best practice with Hywel Dda integrating novelscreening techniques and programmes into available care pathways. The capacity ofthis group has recently been extended by the appointment at Aberystwyth Universityof Professor C Bridle, lead of the Pre-FIT: Prevention of Fall Injury Trial (£2.5 millionEU funded project).


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The Dyfed Substance Misuse (Drug and Alcohol) Area Planning Board mainobjective is the improvement and strengthening of arrangements for the planning,commissioning and performance management of substance misuse services in thethree counties of Carmarthenshire, Ceredigion and Pembrokeshire.

From April 2013 the Area Planning Board will be responsible for the WelshGovernment Substance Misuse Action Fund (SMAF) and the NHS Ring FencedSubstance Misuse Allocation. The role of the Area Planning Board Executive will fitacross four broad areas of 1) Governance, Accountability and Scrutiny 2) StrategicDirection, Progress and Delivery 3) Finance and 4) Performance.

The Area Planning Board is made up of three groups, the Area Planning BoardExecutive, the Area Planning Board Strategy Delivery Group and the Area PlanningBoard Finance and Performance Group. The Area Planning Board Executivemembership is made up of those organisations previously represented at localityCommunity Safety Partnership level, who are the responsible authorities forSubstance Misuse as defined in the Crime and Disorder Act. The ResponsibleAuthorities have the legal responsibility for ensuring there is a plan to addresssubstance misuse, in line with the Welsh Strategy for Substance Misuse, in theirlocality and for monitoring its implementation.

Responsible authority members are the Health Board, the Local Authority, the Police,Probation and Fire Service. The current Chair of the Area Planning Board is theHywel Dda Health Board, Assistant Director of Quality, Safety and Assurance. AnArea Planning Board Strategy Delivery Group sits beneath the Area Planning BoardExecutive and is a multi agency partnership made up of a range of stakeholdersincluding all drug and alcohol agencies, the voluntary sector, local authority, housing,probation, licensing, supporting people, health, police, probation, education and otherrelevant organisations required to implement the Strategy. Welsh Governmentguidance suggests that the Area Planning Boards should report into the LocalService Board structure at a locality level.

A range of other multi agency Substance Misuse Task and Finish Groups report intothe Area Planning Board Structure including: Drug Related Death Panel, SupervisedConsumption and Needle Exchange Review Group, Harm Reduction Group,Prevention group, Provider Partnership Forum, Carers Group, Children and YoungPeople Group.

2.11 Substance Misuse


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We are just about to embark on our third and final year of part funding the work ofthese skilled partnership workers. The work has matured significantly and theprogress made is significant to date. Largely due to their tenacity and ability to workbetween organisations and across boundaries the agenda has moved onsubstantially and we are now expecting the year ahead to gather pace in integrationand implementing our jointly agreed plans for our community led services.

The objectives we have agreed for them for the year ahead are:

1. To support the development of the County Needs Analysis and SingleIntegrated Plan to ensure close alignment with other counties and HealthBoard Plans.

2. To produce an Annual Report for March 2014 which encompasses the rangeof partnership working with the Local Authority to give Hywel Dda HealthBoard assurance of progress made.

3. To support the development of performance management frameworks whichalign to the emerging All Wales Health and Social Care Outcomes, PublicHealth population indicators and which link to Foundations 4 Change and towork with other county facilitators to align these as much as possible.

4. To support the development of the overarching Section 33 Agreement andService PIPS which fit underneath ensuring the pace of development quicklytakes us to a position of pooled budget for at least two service areas.

5. To enable the Third Sector Health and Social Care Brokers to deliverintegrated working.

6. To ensure that Locality Based Planning is developed alongside CountyIntegrated Structures and involves all partners from the outset.

3.1 Local Authority Facilitators


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Carmarthenshire Single Integrated Plan and NeedsAssessment

In July 2010 Carmarthenshire Local Service Board decided to bring together anumber of previously separate strategies and plans and bring them together into asingle community strategy. As a result the Integrated Community Strategy forCarmarthenshire 2011-16 was published in July 2011 and brings together into onedocument the requirements of the following policies and strategies:

Community Strategy Children & Young Peoples Plan; Health, Social Care & Well-being Strategy; Community Safety Strategy Carmarthenshire Connexions (Regeneration Strategy); and Environment Action Plan.

The overall vision for Carmarthenshire outlined in the Integrated Community Strategyis as follows:“Enablingpeople to live healthy and fulfilled lives by working together tobuild strong, bilingual and sustainable communities.” In order to achieve this vision five key outcomes have been confirmed which each of the strategic partnershipswork towards delivering:

People in Carmarthenshire are healthier People in Carmarthenshire fulfil their learning potential People who live, work and visit Carmarthenshire are safe and feel safer. Carmarthenshire’s communities and environment are sustainable. Carmarthenshire has a stronger and more prosperous economy.

In June 2012 the Welsh Government issued guidance (Shared Purpose–SharedDelivery) to confirm the expectation that all Local Service Boards across Waleswould prepare and publish an integrated plan by April 2013.

The Integrated Community Strategy fulfils the requirement for an integrated plan andas we are into our second year of the strategy we will fit with the three year cycleoutlined by Welsh Government. Therefore Carmarthenshire will not be publishinganother plan.

3.2 Local Service Boards


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However, there is a need for us to ensure we fully comply with the requirements setout in Shared Purpose–Shared Delivery which does require us to complete thefollowing pieces of work all termed as enabling strategies by Welsh Government:

Information Strategy, Engagement Strategy; and Strategic Needs Assessment.

Ceredigion Single Integrated Plan and Needs Assessment

‘Ceredigion for All’ the Local Service Board’s Single Integrated Plan for Ceredigion was published for consultation on 15th January. The Local Service Board agreed onthe following guiding principles that any activity would be based on:

Working Together Tackling Inequalities Access to Services Early Interventions Bilingualism Resilience to Risk

The three priority areas selected by the Local Service Board in the Single IntegratedPlan were:

Supporting Familieso To protect vulnerable children and families; to reduce the effects of

poverty and other aspects of deprivation; to enable children and youngpeople to reach their full potential

Economy and Placeo To improve the skills of the workforce, particularly young people; to

improve people's prospects for employment and to foster enterpriseo To strengthen and maintain viable local communities and enhance our

natural environment to support wellbeing, increase resilience andprovide economic opportunities

o To ensure that Ceredigion has increasingly resilient and diverseecosystems that deliver environmental, economic and social benefits

o Environment

Independent Livingo To ensure services meet the needs of our changing population,

especially the needs of older peopleo To improve the supply of housing and the quality of the housing stock

to enable people to live comfortably and independently in their homesthroughout their lives

o To enable Ceredigion citizens of all ages to live safely and free fromharm, crime and disorder.


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Next steps

The draft Single Integrated Plan will be out for consultation/engagement until 31stMarch 2013. The Local Service Board will consider the findings of the consultationand agree on the changes need to be made to the draft Single Integrated Plan.

The final version of the Single Integrated Plan will go to Council for approval beforebeing published in April 2013.

During the consultation period and shortly thereafter, an RBA approach will be takento developing the shared priorities.

Needs Assessment

The Single Integrated Plan was prepared after reviewing and analysing data from awide range of sources, as well as information from the four statutory plans, to createa ‘Single Needs Assessment’.

At the initial stage this meant gathering together a wide range of statistical data andother information to give a picture of Ceredigion and its people. This process startedin January 2012 and was done on a collaborative basis with Carmarthenshire andPembrokeshire. This was done as many of the Local Service Board partners work ona regional basis as well as ensuring consistency, providing comparative data andbeing able to identify gaps and use the skills and capacity of each area.

This information was gathered into a report by September 2012 and used to highlightthe main issues for Ceredigion and to identify priorities for the Local Service Board totackle over the coming years.

The Single Integrated Plan in its current form focuses upon identifying the strategicpopulation issues to be addressed by the Single Integrated Plan and how they mightfit with a set of high level population outcomes. It does not identify a set of measuresfor population outcomes; these will require further study and analysis to decide onmeasures which are suited to the outcome and which provide an effective means ofmonitoring the progress of the Single Integrated Plan.

The analysis of service outcomes and issues will be developed later. This servicebased study will refer to the population issues and outcomes following furtherexploration of the links between service outcomes and population outcomes.

The Single Needs Assessment, therefore, should be seen as an iterative processthat, in general, moves from an initial outline of issues affecting the population ofCeredigion towards a more detailed examination of those issues, and then developsthese analyses to inform the process of investigating services issues and identifyingservice outcomes which contribute most effectively to the population outcomes.


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Needs Assessment

In Carmarthenshire a small group of officers have formed a Joint Strategic NeedsAssessment Steering Group to look at building the analytical capacity between LocalService Board partners in Carmarthenshire and to formulate the CarmarthenshireNeeds Assessment. The officers on this group are from the Local Authority, PublicHealth Wales, Dyfed Powys Police and the Public Health Observatory.

To date the work undertaken has involved setting a baseline of the published dataagainst key identified themes but this will now develop to an analysis function toshare the intelligence held by different organisations in Carmarthenshire. A finalreport and set of recommendations going forward is in the process of being writtenand will be presented to the Carmarthenshire Local Service Board at their March2013 meeting.

Pembrokeshire Single Integrated Plan and NeedsAssessment

A draft Single Integrated Plan for Pembrokeshire has been developed and wascirculated for a period of public consultation from 28 November 2012 to 15 February2013. Following consideration of a wide range of comments received during theconsultation period, the Plan was reviewed and amended by partnership sub-groups.The final version of the Plan was due to be agreed by the Pembrokeshire LocalService Board on 21 March 2013 and then circulated to partner organisations forapproval and adoption.

The Single Integrated Plan is the document that will frame public, private andvoluntary sector activity in Pembrokeshire over the period 2013-2018. It describesthe issues that are important to Pembrokeshire and identifies the approach that arange of organisations will adopt in attempting to tackle them.

In preparing this document, a wide range of partners have analysed data from a widevariety of sources and brought that information together in a Single NeedsAssessment.

The Plan builds on, and brings together in one document the Community Planpublished in May 2010, and the Community Safety, Children and Young People's andthe Health Social Care and Well-being Partnerships’ plans published in 2011.

The Single Integrated Plan focuses on six main outcomes:

Children, young people and families have the opportunity to fulfil their learningpotential and to live healthy and happy lives

Pembrokeshire has a thriving and prosperous economy People in Pembrokeshire enjoy an attractive, sustainable and diverse

environment


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People in Pembrokeshire are healthier Children and adults are safeguarded Communities in Pembrokeshire feel safe

Following agreement of the final Plan, the Pembrokeshire Health, Social Care andWell-being Partnership Board will agree a series of detailed actions to deliver thehealth and well-being focused outcome: People in Pembrokeshire are healthier.

The work will be organised under the following priorities:

Help and support people to take responsibility to improve their health and well-being throughout their lives.

Reduce inequities through cross-sectoral working Provide the people of Pembrokeshire with appropriate and sustainable health

and social care services.

Carmarthenshire

Carmarthenshire Local Service Board has been successful in gaining EuropeanSocial Fund grant funding to support the delivery of 5 projects within the county. Theprojects cover a wide range of topics and include a Development Officer toco-ordinate the work of the board and also take a lead on ensuring that all the projectcomply with EU rules and regulations. Other projects supported include employing aco-ordinator to develop the Environment Partnership, a co-ordinator to pull togetherall of the Advice & Support agencies working within the County specificallyconcentrating on the Anti-Poverty agenda.

The final two projects have been more recently approved, Carmarthenshire Success,which looks at developing and co-ordinating an apprenticeship scheme across theLocal Service Board organisations and finally the Third Sector Broker Project whichis a joint project between Ceredigion and Carmarthenshire, led by Carmarthenshire.

The Third Sector Brokers will be based within the Community Resource Teamsacross the two counties. Their role will be to work as equal partners in identifyingpotential gaps in services within the community and develop innovative ways ofworking to address the wider issues of healthcare to include social care determinantssuch as social inclusion and creating robust communities to meet the needs of thepopulation.

3.3 European Social Fund Project–Third Sector BrokersProject


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Ceredigion

Ceredigion Local Service Board currently has the following European Social Fundprojects running. Third sector broker posts (three in Carmarthenshire and two inCeredigion) have been established to sit within the health and social care integratedCommunity Resource Teams across the three counties (including Pembrokeshire):thus filling the remaining gap in these fully integrated teams. This is a jointCeredigion, Carmarthenshire project in order to strengthen the application and movetowards consistency across the Hywel Dda Health Board area (Pembrokeshirealready have a Broker Project running). This approach will also ensure thatinformation on third sector provision of health and social care services is readilyaccessible to other team members and relevant professionals. This will include theproduction of a comprehensive directory of health and social care services. The newposts–which began on 14 January will broker service provision through the thirdsector in response to identified needs/service gaps. This will provided added value tocore statutory service provision as well as support clients who are not eligible for coreservices.

Carmarthenshire

Older People’s Services The Social Care division within the Local Authority has commissioned theVanguard Consultancy to work alongside the Community Resource Teams (bothhealth and social care) in order to review working practices and to deliver leansystems and processes which are made up of value work. Working as anexperimental multidisciplinary team the project has returned professionals to theircore values and interventions in order to empower people to make informeddecisions and to support and enable them to do what matters to them.

The project has over the last 2 months worked with over 50 individuals and isdeveloping a new system rid of bureaucracy which aims to limit failure demand.The project encourage local area co-ordination in order to enable people toaccess their community rather than becoming dependent on long term health andsocial care services.

It is intended to roll in the system to the county Community Resource Teams overthe coming spring and summer months.

3.4 Integrated Health and Social Care services


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As part of the development of Reablement service, funding has been agreed bythe Local Authority for three additional occupational therapists to support thisservice. Early evidence suggests that around 70% of people coming through thereablement pathway leave the service without needed ongoing care at home.This will enable community services to support more individuals at home ascapacity is released from long term service provision. The posts are fundedinitially for two years and are currently in the process of being recruited.

Children’s ServicesFollowing the announcement from Welsh Government last year that will be furtherinvestment put into the Flying Start Service, expansion of the programme inCarmarthenshire will take place over the next three years where indicative grantfunding allocated, will see an increase from £2.1 million per annum. Revenue to£3.5 million by 2014/15. Capital investment has verbally been offered to the sumof £1.8 million to be utilised by 2014/15.

This will see the number of children in Carmarthenshire benefitting from theintensive services rise from 902 (in 2012/13) to 1654 by 2014/15, an 83%increase in target children.

A detailed piece of work has been undertaken to map the most deprivedcommunities in Carmarthenshire based on the criteria of the highest percentageof households with children 0-3 years, in receipt of Income Benefits as wasrequired by Welsh Government. This has resulted in a number of new areasbeing added to the programme and an expansion of some of the exiting areas.

Mental HealthThe county mental health management and supervision structure has beenrestructured and this was signed off in January 2013. This has seen an addition ofa senior practitioner which will increase capacity towards developing localitymanagement/professional supervision/locality integration with CommunityResource Teams. A new post has been created in the new structure with a Riskand Quality Assurance lead, Richard Griffiths. Richard’s role will ensure increased capacity towards management and support with county complaints, seriousincidents, and CTP issues. Finally, we have also seen an additional CountyMental Health Team team leader created with the new structure which will allowthe functional integration of the Assertive outreach team into the County MentalHealth Team’s.

Community Mental Health Team ‘Link Working’ –work has been progressing overthe past few months in developing and establishing further the Link WorkerSystem as a standard and equitable approach to all GP Practices across theCounty. The secondary care mental health link worker role is primarily focused onproviding the communications and liaison between the Community Mental HealthTeams and respective GP practices on the progress/risks of those registeredpractice individuals with severe and enduring mental illness who are known to theCommunity Mental Health Teams.


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This enhances the care and treatment planning process through the sharing ofinformation with GPs and also enables the recovery pathway from secondary careback into primary care to be supported and sustained. Essentially, and alongsidethe current establishment of the Local Primary Mental Health Support Service(LPMHSS), this provides all GPs with a ‘dual’ mental health resource presence in the Practices and thereby promoting and enhancing joint working for new referralswhilst also promoting the recovery pathway.

Learning DisabilitiesWork is continuing on the development of a Four Counties (Mid & West Wales)Learning Disabilities Strategic Board which will establish integrated learningdisabilities services across the region. There are issues in terms of there notbeing any integrated or joint policies and procedures (eg joint risk management,commissioning, record keeping, training and other policies) that mandate orenable staff to make more efficient use of resources through creative and moreperson centred approaches. Development of the Service Specific Schedule forlearning disabilities to accompany the overarching Section 33 Agreement willresolve some of these issues and work is about to commence on developing thisschedule.

Communication and IT Integration Steering GroupA Communication and IT Integration Steering Group has been established inCarmarthenshire to explore the vision for Integrated IT systems across health andsocial care so as to enable integrated working by supporting the development ofthe joint operational systems for the Community Resource Team members. Theoverarching aim of the group is to create an interface between the Local AuthorityCareFirst system and the Health Myrddin system so that staff working betweenthe two organisations do not have to enter two separate systems to retrievepatient data. It has been decided to us the NHS number as the common patientidentifier and progress is being made to link CareFirst with the Enterprise MasterPatient Index which is a project led by NWIS (NHS Wales Informatics Service)who have developed a system to ensure patients are identified. The EnterpriseMaster Patient Index will only store basic personal information and not hold anysensitive medical/health related information.

Work is progressing to establish a link between the health and local authoritysystems to create the interface between the two. We are also exploring theoptions to create an Electronic Discharge Summary which will enable doctor’s working within the acute sector to discharge patients electronically rather thanthrough the usual paper format. This will allow the discharge information to betransferred to the Community Resource Teams. It is likely that Carmarthenshirewill become part of a national pilot looking at developing the Electronic DischargeSummary and this will take place towards the end of the summer period.


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Ceredigion

Ceredigion Social Services has presented a report to Cabinet to outline the nextsteps in implementing an ambitious transformational agenda which includedre-configuring social care services in order to better align with the health structuresand work towards integrated services.

This will enable the delivery of the right care, in the right place, at the right time. Thenew teams as proposed will provide support for the population of Ceredigion whichwill enable them to be cared for and treated in the community and to maintain activeand independent lives. These teams will also enable discharge from hospital to careat home for those for whom a lengthy hospital stay would previously have been thenorm. Once the service is fully embedded further work will be undertaken to developpooled budgets for the service which will support future sustainability anddevelopment of the integrated service, whilst maintaining cost and efficiency savings.

Next steps include, sharing and discussing the changes within health and developingan implementation phase which will move to greater alignment of the teams, with thefuture aim of integration once accountability, governance and funding have beenexplored and agreed and a Section 33 Agreement process and formal agreement isin place. This is hoped for by September 2013.

Family and children already work in an integrated way, supporting the Children andYoung People’s Framework Partnership plan and objectives. The areas forincreased collaboration across families and children community services include:

Transitional arrangements Emotional Well Being Substance Misuse Advocacy Targeted early intervention programme

To support this, pioneer funding has been secured for early intervention viaintegrated service delivery mechanisms and IFST for higher level intervention.

An intensive multi-agency Integrated Family Support Service (IFSS) for families withcomplex needs to effect change and reduce compromised parenting was launchedearlier this year with recruitment of four multi-disciplined teams to work togetheracross the Carmarthenshire, Ceredigion, Pembrokeshire and Powys regions toimplement effective service to families in such a large geographical area.


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Pembrokeshire

Community Care Closer to Home (CCC2H) –Pembrokeshire is one of fivedemonstrator sites across the UK selected by the Kings Fund to participate in theresearch–Care Co-ordination of people with complex needs. The CCC2Hstakeholder group is a partnership of primary care, community, local authority,voluntary and acute services working collaboratively to deliver the vision of care asclose to home for the people of Pembrokeshire and developing the concept of a‘virtual ward’ whichwill provide a proactive approach for frail, vulnerable people whoare predicted to need care in the near future.

Patient and Family Centred Care–The Health Board and Local Authority areworking with the Kings Fund as one of 11 sites across the UK. This project will focuson the exacerbation of COPD and is based on the findings of the pathways andprocesses workstream in relation to respiratory care. Patient experience will be usedto support the development of services that will support patients to remain in a steadystate for longer. Patients have been involved through ‘shadowing’ their experience of care, and by attending the Breathe Easy Group within Pembrokeshire to listen totheir experiences and issues. The team is made up of a multi-disciplinary group ofstaff covering primary, secondary and community healthcare together with socialcare. It is led at the executive level by the Director of Therapies and Health Scienceand senior medical engagement is via a Respiratory Consultant and a local GP. Theworking group meets on a weekly basis and reports on progress to the county seniormanagement team.

Predictive/case finding tool–There are five GP practices across Pembrokeshirethat are piloting a software package which will support the primary care team inidentifying patients on their practice caseload who may need additional support fromthe Community Resource Team. Case finding methodologies have been scoped andevaluated and will be implemented by the end of the year across the Health Boardcommunity.

Community resource team–A joint operational policy has been developedbetween health and social care. Development and training with the CommunityResource Teams will be undertaken as an integrated service.

Results-Based Accountability–Following a workshop in December 2012 of health,social care, voluntary, public health representatives a report card has beendeveloped to capture the headline indicators and measurement of success forCommunity Care Closer to Home. This is a collaborative approach of demonstratinghealth and social care performance.

Frequent attendees - Reports are being developed that will highlight patients withchronic conditions who have had 5+ A&E attendances and/or 3+ in-patient episodes.The appointment of the Primary Care Locality Development Managers will enable thesustainability of this reporting mechanism with the GP practices and CommunityResource Teamss.


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Self Management Plans - Patients who have a long term chronic condition oftenhave a Self Management Plan of their care drawn up in conjunction with one of thechronic condition nurse practitioners, clinical nurse specialist or doctor. A trial istaking place of a copy of these plans being available to GP Out of Hours to providecontinuity of care for people who need support out of hours.

SHAPES - joint equipment store; operating under the terms of a Section 33Agreement.

South Pembs Health and Social Care Resource CentreIntegration of health and social care services delivering timely and seamlessservices. By delivering a co-located joint rehabilitation, reablement focussed inpatientand day service we reduce duplication, streamline services, enhances rehabilitationand recovery and integrate closely with home health and social care provision. Byworking together the citizen is places at the centre as the driver for improvement.

Management of patient flow - joint working to deal with discharge and admissionprevention; regular joint meetings being held; multi-disciplinary teams, includingoccupational therapists and Physiotherapists; the use of Multi-disciplinaryAssessment Team (MAST)–which help deal with the multi-faceted health and socialcare needs continues to support patients and families by preventing unnecessaryadmission but more importantly ensure patients get these inputs at home or in theirlocal community. This team is based in A&E at Withybush Hospital, staffed bycommunity health and social care staff who liaise with the Community ResourceTeams to facilitate transfers of care. This team is currently trialling new ways ofworking by co-ordinating transfer/discharge plans for those people who need to beadmitted for a short period of time.

Learning Disabilities - joint teams; Three Counties Management Board.

Mental Health- collaborative teams including CMHT & OMHT; co-location; jointworking

Healthy Food Options. This project is being delivered in partnership between theHealth Boards Dietetic Unit and the Food Safety Team.

Transport–The use of local authority vehicles to support discharge from hospitalscontinues to be a valued, successful development in an integrated approach tomanaging the needs of patients and their families in the support of a discharge plan.This service supports the flow of patient’s home, contributing to the availability ofbeds within the hospital.

Training–partners sharing training resources and courses (eg occupationaltherapist training undertaken jointly)


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Section 33 Agreements are one of the legal instruments available to health boardsand local authorities to enable us to integrate in a way that presents low risk to eachorganisation. The overarching Section 33 Agreements in themselves do not commitus to any pooled budgets but rather outline the shared vision and aims, outcomes,structures and most importantly the governance structures both organisational (andfinancial) and clinical. The process of developing this legal framework is so that allthe possible issues are discussed and solutions for resolving them agreed inadvance which mitigates any risk and allows a safe integration.

Without a Section 33 Agreement in place any integration, roles and joint work canunravel extremely quickly if say those who originally worked on the approach leaveand are replaced by others without the corporate knowledge or inclination to worktogether–this would be high risk to both organisations and I would counsel againstmaking financial or structural changes without a formal agreement. The alternative isbetter collaboration and co-location which carries no risk but also none of thefinancial pooled budget benefits.

The real work however is in the detailed schedules that sit below the overarchingagreement and this is where the really detailed schedules are jointly developedincluding finance, resources, staffing, operating procedures, quality and safety andmuch else which the rigour of the process forces you to address. Many of thesechallenges have been resolved by our teams on the ground–Information SharingProtocols, terms and conditions alignment, complaints handling and disciplinarymatters and recently we realised that from a governance point of view we needed aMemorandum of Understanding on Internal Audit Sharing Information. This is all nowavailable to support the county teams and local authority colleagues in developingtheir integration at a fast pace and with little need to pay lawyers as much of the legaldesign is done and we have fit for purpose templates.

Carmarthenshire

In Carmarthenshire the Overarching Section 33 Agreement has been signedand work is underway on the development of the service specific schedulesfor the following services:

o Primary, Community & Social Care Serviceo Learning Disabilities Serviceo Mental Health Serviceo Children’s Services.

3.5 Section 33 Agreements


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Work has already been undertaken within the Learning Disabilities service toprovide support for integrated managers on implementing HR andmanagement policies and protocols appropriately. This work is now beingused as a guide within other integrated services (specifically the CommunityResource Teams).

The Local Authority and Health Board have signed up to an InformationSharing Protocol to support the work of the Community Resource Teams. Thisis enabling information sharing within the community teams.

Ceredigion

The agreement on governance issues for multi-disciplinary teams is part of ongoingdiscussions led by the Ceredigion Health and Social Care Leadership group. Atpresent the transformation of older people programme in social services is moving inthe direction of alignment of services with a view to these services becomingintegrated in the medium to longer term.

As services are currently not aligned and integrated, the accountability andgovernance issues are being defined within a Memorandum of Understanding andservice specifications will follow the content of the PIPS template. Memorandum ofUnderstandings are currently nearing completion for both mental health and learningdisabilities services; and the older people’s services will follow.

The Quality Assurance, Performance, Policies and Procedures (QuAPPP) group hasbeen put in place to ensure a common governance framework is developed withinthe new integrated teams. This will include working through the relevant informationsharing protocols and IT solutions, to facilitate greater alignment and joint working.

Pembrokeshire

Pembrokeshire has moved significantly towards a final draft of an OverarchingSection 33 Agreement and to develop detailed service schedules (PIPS) forenablement and adult services.

With changes in key leadership roles in both the Health Board county team and theLocal Authority social care senior roles this work has paused temporarily but thereare plans to accelerate over the next few months to bring all the new team membersup to date on the journey so far and recommit to the vision and shared outcomes thatwere always envisaged.

Pembrokeshire already have a signed Section 33 Agreement for the Joint EquipmentStore and will consider the South Pembrokeshire agreement alongside the newOverarching agreement with a view to making it one of the first PIPS.


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This year there has been a significant level of engagement with County CouncilElected Members in each of the three local authorities. We visited full council ateach at the key stages of the engagement and listening exercise and again once informal consultation.

Whatever their views we spent over three hours at each session answering all theirquestions and had the opportunity to present fully our proposed options. We listenedand made changes in light of some of the suggestions.

We also met with the Town and Community Councils during this process and valuedtheir comments and made changes.

Our Chairman, Chris Martin also regularly meets with the Leader of each Council anddiscussed the key emerging issues and has developed positive relationships with allthree new Leaders over the last 12 months.

3.6 Elected Member Engagement forClinical Services Strategy


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As defined by the Civil Contingencies Act 2004, a Local Resilience Forum is basedon a Police Force Area. The Dyfed Powys Local Resilience Forum is a multi-agencypartnership made up of representatives from the three blue light emergency services,local authorities, two Health Boards, Environment Agency, Health Protection Agencyand HM Coastguard. These agencies are known as Category 1 Responders. TheLocal Resilience Forum is also supported by organisations known as Category 2responders, such as the Highways Agency, public utility companies, train operators,HSE and telephone operators who have a responsibility to co-operate with Category1 organisations and to share relevant information with the Local Resilience Forum.The Dyfed Powys Local Resilience Forum Strategic Leads Group meets three times

a year, as do the Co-ordination and Training Group. The Co-ordination and TrainingGroup is made up of fifteen Local Resilience Forum Sub Group Chairs, who addressthe risks and training requirements attributed to their group. The Dyfed Powys LocalResilience Forum also work in conjunction with, wider partners such as the Military,the Voluntary Sector and commercial COMAH sites who provide a valuablecontribution to Local Resilience Forum work in emergency preparedness. Hywel Ddaplays a key role in this partnership as Category 1 responder, and alsorepresentatives chair both the Health Group and the Co-ordination and TrainingGroup.

Ceredigion example of joint response to the Floods

Overnight of the 8th and 9th June 2012, a one in 100 year flood event affectedseveral villages and Aberystwyth in North Ceredigion. Residents were forced toabandon their homes and caravans, and businesses were also affected including theGP surgery in Aberystwyth providing a service to 9,000 of its registered patients.An emergency civil contingencies response was declared to deal with the

emergency involving all blue light agencies; the Coastguard and RNLI floodemergency response services. A rest centre was set up manned by local authoritysocial services and homelessness staff, as well as volunteers and school staff. Asthe flood waters subsided, the Dyfed Powys Local Resilience Forum Recovery Planwas instigated: Officers from the public health protection services andhighways/waste services visited the flood affected areas in the immediate aftermathof the floods to relay public health and safety advise, to determine whether anyimmediate rehousing or other needs were required as well as assist householders inclearing away the flood damaged goods.

In accordance with the Recovery Plan, a multi-agency Recovery Co-ordinating Groupwas set up with a number of subgroups including Health and Welfare, Infrastructureand Finance. These groups were multi-agency including representation of the HealthBoard, voluntary sector and local authority on the Health & Welfare Group.

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Ongoing support was provided by the homelessness service through the provision ofemergency accommodation for residents who were unable to return to their homes,and continuing support has been provided from the county councils’ Public HealthProtection service to advise and support those who have had to have considerableremediation works on their homes in order to make them fit to live in once again.Several drop in surgeries were arranged over the weeks and months after the floods,which were attended by all agencies involved with supporting the communitiesaffected. Even nine months after the floods, the communities are still recovering fromthe floods, with a handful of people still waiting to return to their homes, and the GPsurgery is still in temporary accommodation until works are complete.

This flooding event was unfortunate and tragic for those directly affected, yetdemonstrated the existence of the community resilience and cohesion that exists fordealing with such events. It also demonstrated the strong work relations andcollaboration that exists in such circumstances between the public and third sectororganisations involved in dealing with both the immediate and recovery responses tothe event.

Following this event a pan-Wales working group has been set up, the purpose ofwhich is to look at what can be learnt by public protection services from suchincidents. Working with the Scottish Flood Forum, it is intended that a good practicedocument that highlights the role of public health protection services (housingstandards, homelessness, trading standards, food safety, environmental protection)has in assisting with the recovery from such extreme weather events.

This area is developing rapidly now. We are now close to making formalarrangements with a number of local authorities around litter collections, gritting inpoor weather conditions and also reviewing with each of the Directors of TechnicalServices, the sort of day-to-day work requirements our respective estates teamsundertake. This scoping will allow us to understand whether any opportunities existin many areas including grounds and gardens and basic maintenance duties. Fromour initial discussions, there is scope in this area which we are now developing amore formal understanding.

4.2 Joint Estate and Asset Planning


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RobElliott’steam have developed this following Chief Executive and team meetingsbetween Hywel Dda and two of the local authorities where ideas for joint workingwere explored. The team are liaising with the Local Authority to look at innovativeways at developing pool car arrangements within the Health Board and potentiallyhire car fleet to minimise high costs of basic transport. Whilst this is in the earlyphase of feasibility, we have requested our HR team to take a lead on this as itclearly has implications on contracts of employment, etc. The Local Authority havesome experience in this area and we are working closely with them to scope out thiswork.

Bunkered fuel is more advanced and we should, in the next few months, be able totap into this arrangement.

The Central Wales Infrastructure Collaboration is an initiative between Ceredigionand Powys County Councils which is looking at sharing the delivery of services in thefour work areas of Property Services, Engineering Strategy, Engineering Operations(includes engineering consultancy services), and Transport and Road Safety.The objectives of the collaboration are:

Maintain high value jobs within the area Maintain highly responsive services that suit local needs Improvements and consistency in service delivery across the region Leaner working to achieve efficiencies Create growth in services to aid economic development Increase and improve opportunities for staff Reduction in the overall cost of service delivery.

The Collaboration is governed by a made up of two Local Councillors from eachCouncil. The Central Wales Infrastructure Collaboration Board are committed toimproving services and reducing costs by challenging the way the local authoritiescurrently provide infrastructure services.

4.3 Transport

4.4 Central Wales Infrastructure Collaboration


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The Central Wales Waste Collaboration is an initiative between Ceredigion andPowys County Councils which include the following projects.

Exploring Opportunities for Collaboration project: To deliver more efficient androbust waste management services through closer collaboration; to reviewand where possible pursue joint management arrangements; to explore thepotential benefits of establishing a regional waste authority

Residual Waste Treatment Project: To procure sustainable and affordablewaste solutions in relation to residual waste treatment

Food Waste Treatment Project: Preparation for the commencement of the newAgrivert services on 1 November

Collaborative Change Programme: To Implement the Collaborative ChangeProgramme (CCP) for waste services; to improve performance and quality ofthe waste management services; to deliver the Simpson Compactcommitments

A programme manager has been in post since June 2012 and the collaboration isgoverned by a Board made up of two local councillors from each Council. CentralWales Waste Collaboration is committed to recycling, composting or treating asmuch of the region’s waste as possible and are working together to find new and sustainable ways of dealing with waste and reduce the amount of waste sent tolandfill.

The Central Wales Waste Collaboration has been concentrating on dealing with thefood waste produced in the region and has recently awarded a contract to AgrivertLtd to provide these treatment services.

For both of these projects it would be hoped that the Health Board can get involvedand benefit from the efficiencies that are realisable through more powerful jointprocurement and reduction in duplication on all fronts. This could also be a model forall three counties going forward however in terms of capital opportunities, from ourdiscussions with each of the Directors of Technical Services, there are limitedopportunities in this area, particularly due to our framework arrangements in NHSWales.

4.5 Central Wales Waste Collaboration


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Coaching

Coaching is helping to build self-reliance, self-responsibility and confidence for manystaff within Hywel Dda. Performance coaching is an intervention that is supportingthe development of a sustainable approach to addressing the challenges of workingin a fast changing environment and achieving optimum performance for staff. TheHealth Board is developing both an internal network of coaches and, is part of theMulti Agency Local Service Board Carmarthenshire Coaching Network as well as theAll Wales Network through PSMW. Accredited coaching courses are available forstaff to access through Learning and Development and those members of staffwishing to receive coaching are also linked to a coach through Learning andDevelopment.

Joint Training

Hywel Dda Health Board is an active partner in SCWDP partnerships and contributesto the shared agenda of joint training particularly within the social care workforce andwhere there are joint teams developing.

Modern Apprentices

Hywel Dda Health Board is committed to ensuring it has the right workforce, with theright skills at the right time. Building skill capacity for the future is essential indelivering care that meets the ever changing need of Hywel Dda. The introduction ofcarefully selected apprenticeships offer the opportunity to take a new approach todeveloping individuals to meet the demands of the service and providing theappropriate opportunities to maximise their potential for the future. At the core of theapprenticeship is a vocational qualification. The apprentice is employed while theylearn, and can also use the apprenticeship as a stepping stone to higherqualifications. The work is developing and strong links to local colleges to work inpartnership with us to move forward with this work are being made.

Other initiatives with Local Authorities

Hywel Dda Health Board works with local authorities across the three counties toensure that training within the Carers Measure will be available to all staff whorequire it.

4.6 Learning and Development


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Hywel Dda Health Board has submitted an Invest to Save bid to Welsh Governmentto enable the rapid implementation of Locality Resource Planning. This will enablemulti-professional groups based within geographical localities to work acrossorganisational boundaries to develop robust, sustainable and qualitative services forlocal communities. It will be essential to ensure that these groups include the voiceof local services and the third sector.

We have asked our local authority Health and Wellbeing Facilitators to get involved insupporting this work and that of the Community Resource Team development as partof their objectives and this should help ensure the Planning is whole system not justhealth. Elaine Lawton has already made contact with them and they are working onhow best to work together.

Our community services are now aligned to seven geographical localities and arebeing developed to provide a locality partnership network of health, social and thirdsector services that deliver an out of hospital service that meets the needs of thelocal population. The work completed so far lays the foundations for larger scaleservice transformation towards an integrated care system that will meet our objectiveof ensuring financial and service sustainability for the future.

Structures and Services:

Locality Leadership Teams have been developed and are now embedded,with seven GP Leads, one for each locality appointed together with social careand nursing co-ordinators.

Community Resource Teams established in each locality providing integratedhealth, social care and third sector working (includes therapists, nurses andsupport workers).

Specialist nurses and therapists aligned to the Community Resource Teamsenabling a much more joined up approach between generalist and specialistservices.

5.1 Locality Based Resource Planning

5.2 Developing Community Resource Teams


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Workforce Modernisation:

New roles for health and social care generic support workers will be developed toensure that duplication between current domiciliary care workers and healthcaresupport workers and community nurses is prevented and time and skill competenciescan be used in the right place at the right time.

There is an opportunity to work in more local neighbourhoods when these posts existto reduce travel time and cost and provide a much more population focused role.This should increase the capacity of all teams as travel less and train other staff onsome key competencies which the Community Resource Team can oversee from aclinical governance point of view.

The constant reducing envelope for all public sector organisations provides thebackdrop to all the items included in this report. On the one hand this createsenormous pressure on individual budgets if we try to continue to deliver in the sameway we always have and on the other it creates a burning platform for change.With our local authority colleagues they are expecting 12-18% reduction in theirsettlement over the next three years and that equates to our flat cash but increasingcost net reduction in available budget.

This challenge will be enormous on our organisations to work together to pool ourresources, reduce duplication, deliver differently and be prepared to give up someday to day management of services as well as taking on others. Human nature willtrigger protectionist tendencies in some and a lack of understanding that this is awhole system problem which can lead to a blame culture.

Our leaders in both organisations will need to hold their nerve to support staff to worktogether for joint solutions not retrench into old behaviours–that way lies failure forus all. If we go through this together we stand a fighting chance of changing thesystem so that it can continue to serve people with high quality services despitespiralling demand.

I

5.3 Funding


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