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Ceredigion County Council & Hywel Dda Health Board

Bywyd Da

Draft Health, Social Care and Well Being

Strategy for Ceredigion 2011- 2014

Consultation Document

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Draft Health Social Care and Well Being Strategy for Ceredigion 2011-14

Consultation Document

Content Foreword 4 Have Your Say 6 Who We Are 7 What We Do 8 Achievements over the last 3 years 9 Where We Are Now 13 Key Challenges over the coming years 14 Where We Want To Be 15 The Outcomes we aspire to achieve 18 Implementation, Monitoring and Review 38

Appendices

1. Summary of Health Needs Assessment 2010 39 2. Tell Us What You Think Feedback Form 48

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Foreword Improving the health and wellbeing of the population is not, and cannot, be the sole responsibility of one or two organisations and therefore the development of this HSCWB Strategy for 2011-14 reflects a multi-agency and community based approach that will be needed to further the health and wellbeing of the population of Ceredigion. The 2011-14 Strategy is the third of its kind. It builds upon the successes of the previous two strategies, to ensure that health, social care and wellbeing issues are planned, delivered and resourced in a coordinated way, integrating resources and expertise across the public and voluntary sector boundaries. It is also being developed at a time when there are significant challenges for us all, and never has it been more important to find suitable, affordable and sustainable solutions to meet the needs of our county. The HSCWB Strategy is being developed at a time when the new Hywel Dda Health Board is developing its 5 year Rural Health Implementation Plan ‘Right Care, Right Place, Right Time’. Our local HSCWB Strategy complements this document, bringing a local perspective on the local health needs of Ceredigion’s population as well as highlighting the impact that wider issues, such as housing and poverty have on our health and wellbeing. Reflecting on past strategies provides an opportunity to see the journey we have taken since 2005, and will continue to take over the next 3 years: The first HSCWB Strategy 2005-08 saw the development of firm partnership relationships and shared priorities. It was an important period in consolidating and determining the roadmap for the journey we continue to take today. The second strategy 2008-11 set four strategic objectives that included:

1. To tackle the underlying factors that influences our health in order to reduce inequalities in health outcomes.

2. To make better connections as organisations, partnerships, communities and

individuals to ensure effective and meaningful participation, consultation and feedback on health, social care and well being in Ceredigion.

3. To ensure the maximisation of opportunities to promote early intervention and

health improvement in order to prevent future ill health as well as early diagnosis of illness.

4. To improve the quality and integration of services so as to ensure that the

services that we deliver are commissioned and delivered effectively and efficiently according to local need, within our local communities where practicable.

The 2011-2014 Strategy will not only reflect the significant agenda of change both organisationally and financially within the county, but also look to the future in terms of the predicted potential health needs of our population. These future needs and demands on our health and social care services serves to reiterate the importance of safeguarding our ‘wellbeing’ services. This strategy will therefore retain the strategic objectives previously

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set; seek to consolidate the strategic direction that has been pursued over the past years and endeavour to accelerate the pace of change to ensure that:

• The aspirations of ‘Our Healthy Future’ are achieved.

• Early identification of our most vulnerable and elderly population could bring benefits from comparatively inexpensive interventions and long term savings, reducing acute hospital admissions.

• Strengthening the links between housing need and health so as to address health inequities1

• Alignment and integration with the priorities of the Community Plan and Local Service Board, through the realisation of the Cylch Caron project.

• Make best possible use of the public resources available to us within a period of financial challenge

• The health and social care systems are rebalanced to ensure more people are supported at home or in the community they live (i.e. the Rural Health Strategy model)

• Enhanced access to services through the development of models of health and social care so services are integrated and seamless.

• Developments that have been underway for many years are completed. In order for this strategy to make the generational changes that are needed, and for it to make any sustainable difference to health and wellbeing, its implementation needs to stimulate, encourage and support every individual in the county to take control and responsibility for their own their families and their communities health and wellbeing. This means that EVERYONE needs to take action to make the difference that we all need. Cll Keith Evans Chris Martin Leader Chair Ceredigion County Council Hywel Dda Local Health Board

1 Inequity versus Inequality - The concept of inequity has been considered synonymous with the

concept of inequality; however, it is fundamental to differentiate between the two. While inequality

implies differences between individuals or population groups, inequity refers to differences which are

unnecessary and avoidable but, in addition, are also considered unfair and unjust. Not all inequalities are

unjust, but all inequities are the product of unjust inequalities. The definitions of just and unjust are

subject to various interpretations. In the context of health, one of the more accepted definitions of "just"

refers to equal opportunities for individuals and social groups, in terms of granting access to and using the

health services, in accordance with the needs of the various groups of a population, regardless of their ability to pay (WHO http://www.paho.org/english/sha/be991ineq.htm accessed October2010)

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Have Your Say Your views are requested to help inform the Health, Social Care and Wellbeing Partnership in developing the third HSCWB Strategy that will run from 2011-14 Your thoughts on the Outcomes and Priority Work Areas that has been proposed by the Partnership are requested. It is important that as many views as possible are captured in order to ensure that we have a balance between national requirements and local need. To assist you in providing your comments please complete the questionnaire included in Appendix 2 telling us:

• What you think about the outcomes we have set

• What you think about the priority areas for work we have set

• If you think there are priority areas for work missing. You may also feedback online, and a copy of the form is available on www.ceredigion.gov.uk or www.hyweldda.wales.nhs.uk. How your views and the information you give us will be used Any response you send us will be seen in full by the HSCWB partnership. It may also be seen by other staff to help them plan services and future consultations. The HSCWB partnership intends to publish intends to publish a summary of responses to this document together with some responses in full. Normally, the name and address (or part of the address) of the person/organisation who sent the responses are published with the response. This helps to show that the consultation was carried out properly. If you do not want your name or address published, please tell us this when you send your response. We will then blank them out. Responding to the Consultation You are invited to respond as an individual or organisation. To share your thoughts please complete the online questionnaire which can be found at www.ceredigion.gov.uk or www.hyweldda.wales.nhs.uk, or complete the questionnaire starting in Appendix 2 and return it by post or email to: Gaynor Toft Health and Wellbeing Strategy Manager Ceredigion County Council Penmorfa Aberaeron CEREDIGION SA46 OPA Email: [email protected]

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Who we are The HSCWb partnership provides an overarching strategic lead and direction for the development of the Health, Social Care and Wellbeing agenda in Ceredigion. The Partnership is made up of senior representatives and elected members from Hywel Dda Health Board, Ceredigion County Council, Ceredigion Association of Voluntary Organisations, Public Health Wales and Ceredigion Community Health Council. HSCWB is one of five statutory plans developed for the county as shown in the diagram below, and also forms a key contributor to the delivery of the aspirations of the Ceredigion 2020 Community Strategy and Local Service Board.

The delivery of the HSCWB agenda cannot and should not happen in isolation and therefore the partnership has established strong links with the Children and Young People’s Partnership, Community Safety partnership and Local Development Plan with joint priorities being agreed across the partnerships e.g. on alcohol harm reduction, and accidental injuries. Update reports are also received from the Ceredigion Older People’s Partnership and Carers Alliance. In view of the current financial climate, it has also been agreed to move towards the eventual integration of plans and/or partnerships.

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What we do Health, Social Care and Wellbeing is multi-faceted. It is about improving and protecting the physical, mental and social wellbeing of local people through direct and indirect interventions that also enables us to acquire the knowledge and skills to look after our own lives; ensuring the right treatment and help is available when needed, at the right time and place; improving access to existing services and developing new models of delivery that have better outcomes for those receiving them. Increasingly this means working far more closely together across agencies to share expertise and resources both financially and through a highly skilled and motivated workforce. At the HSCWB partnership level, a Procedure of Cooperation has been signed by the statutory partners which lays down the ‘ground rules’ for the partnership. This Procedure has been in place for all previous strategies, and has been reviewed in readiness for this third strategy. The HSCWB partnership pays particular attention to emerging needs, develops solutions to address difficult problems within the health and social care systems and links across the various partnerships. It also considers the wider influences on health and wellbeing such as housing and poverty. The partnership considers the impact of emerging national policies and strategies from WAG and determines their impact and delivery locally. The Local Authority and Local Health Board also have a statutory duty under section 40 of the National Health Service Wales Act 2006 to produce a Health, Social Care and Wellbeing Strategy and to cooperate across the range of functions to improve health and wellbeing.

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Achievements over the last 3 years This section shows some of the key achievements that have been made over the past few years under the umbrella of health, social care and wellbeing in Ceredigion. Theme 1 To tackle the underlying factors that influences our health in order to reduce inequalities in health outcomes.

• With the aim of tackling fuel poverty, a multi-agency bid was successfully submitted led by Age Concern Ceredigion under the Feel the Heat funding programme run by National Energy Action. The project developed a ‘Keep Warm in Ceredigion’ user-friendly resource pack that brought together information from existing energy efficiency schemes, including top tips for keeping warm and availability of benefit advice. Training was provided to community councils and Age Concern Community Champions to take this information back into their communities.

• A Maximising Income Group regularly meets and consists of key partners within the county whose aim is to ensure that vulnerable people access to financial support that they are entitled to through take up of welfare benfits.

• Under the Supporting People (SP) Programme, there has been the development of a 4 unit supported housing service for young people in Cardigan

• Development of a 14 unit floating support service and 2 unit refuge move on service for women affected by domestic abuse through the SP programme

• Pilot of a countywide floating support service for people affected by HIV in partnership with Pembrokeshire SP during 2010/11

• Development of an 8 unit SP support service for families in temporary homelessness accommodation in the North.

• The remodelling and expansion of SP support to temporary homelessness accommodation projects in line with leased accommodation changes

• Expansion of the existing social lettings agency provided by the Ceredigion Care Society to include a specific provision that facilitates move on from SP support

• Development of an 8 unit SP supported accommodation service for persistent, prolific offenders and those with complex needs in Borth.

• Development of a specialist SP floating support project to support tenants of accommodation allocated for the prevention and treatment of substance misuse and expansion of existing SP floating support services countywide.

• Development of a Mental health Accommodation and Support Strategy to guide the development of supported housing services in Ceredigion. Remodelling and retendering of Mental Health SP support services in line with the strategy.

• Development of SP community based support for people with Autistic Spectrum Disorder and expansion of the ASD support capacity in existing services to include 2 units of temporary homeless accommodation.

• Declaration of the Tregaron Area Housing Renewal Programme in 2010 which aims to improve the energy efficiency, sustainability and condition of housing in the declared area, as well as improving take-up of available assistance to householders.

• New initiatives developed around dealing with issues arising from the Night Time Economy of main towns. The process has involved a multi agency approach with community engagement that has included young and older people. This has led to the

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identification and implementation of real solutions to concerns around anti social behaviour, noise and littering such as the Sshh campaign that encourages late night revellers to be considerate to residents late at night and the Community Pride initiative. The latter employs a community warden and project officer to work with local community groups and residents in reducing the environmental impact of rubbish and providing funding to improve the local environment and quality of life.

• £2.7 million of the County Council’s capital programme was committed to improving the housing stock in the County, including £1.2m on adaptations to properties that enabled elderly and vulnerable individuals to maintain their independence.

• £900k was spent in the Cardigan Housing Renewal Area on environmental works, sustainable regeneration measures, group repair schemes and the renovation of individual properties.

• At the end of the year, 387 houses in multiple occupation had been licensed as part of the County Council’s licensing regime and over 200 licence applications were being processed. Interim management orders were issued in response to the poor standards identified in 3 multi occupied properties.

Theme 2 To make better connections as organisations, partnerships, communities and individuals to ensure effective and meaningful participation, consultation and feedback on health, social care and well being in Ceredigion.

• Community Engagement Framework, Action Plan and Directory: approved by the Local Service Board, Ceredigion Cabinet and full Council, it was launched by Gwenda Thomas, Deputy Minister.

• A Citizen’s Panel has been recruited and 2 questionnaires has been issued and returned from them. A third is currently being developed. A copy of the newsletters that contain the results from the surveys is available on http://www.dyfed-powys.police.uk/en/ceredigion/citizenspanel/

• Eight touch screen information points have been purchased – to be put in places such as Integrated Children’s Centres and the Digi Lab. Of the eight screens, two are portable points – one for parents and one for parent and child.

• Ceredigion 50+ Forum: There are approx 50 members from local forums and social/ special interest groups but building representation is an ongoing process.

• Local 50+ Forums: Two forums are administered by the Local Authority’s 50+ Engagement Officer in the North and South. Help the Aged have also set up two independent forums in the rural upland areas of Tregaron. Whilst attendance numbers vary they are running well and are contributing to development processes and policies in a meaningful way

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Theme 3 To ensure the maximisation of opportunities to promote early intervention and health improvement in order to prevent future ill health as well as early diagnosis of illness.

• Health Challenge Ceredigion - As part of the Well Being Activity Grant conditions, a local Health Challenge Ceredigion website has been developed which features sections on alcohol awareness, physical activity, nutrition, sexual health and general health and well being matters.

• Obesity Prevention - The Big Lottery Fund has awarded 3 years of funding to tackle obesity prevention for young children in Ceredigion. The grant will enable healthy eating and physical activities to be developed for children up to the age of 12 and their families in Penparcau, Llandysul, Llangybi, New Quay and Llanarth. The new programme entitled ‘Iachus Gyda’n Gilydd / Healthy Together’, was developed by a partnership group of voluntary and statutory organisations under Ceredigion’s Health and Well being Partnership.

• A Community Public Health Dietitian is now in post. This post is funded by WAG and provides nutritional training for people in the community working with ages 0 - 25 yr olds. The dietitian is a key deliverer of two Community Food and Nutrition Skills courses both of which are accredited by Agored Cymru.

• Alcohol related crime in the County has a significant impact on local public sector resources, including police, local authority and health services. For this reason the Community Safety partnership and Substance Misuse Action Team (SMAT) have provided funding towards a Health Awareness Officer (Alcohol Harm Reduction). This work includes running awareness raising sessions with children and young people, issuing proof of age cards, running accredited courses on alcohol harm reduction.

• Tobacco Control – A Tobacco Control Action Plan has been developed in partnership and is being highlighted as an example of good practice across Hywel Dda.

• Emotional and Mental Health Promotion - An Emotional Health Promotion Action Plan was launched in 2010, and includes actions for all agencies aimed at improving emotional health and wellbeing.

• The Local Health Board confirmed funding for the continuation of the Mind your Heart programme that aims to improve the physical health of those with enduring mental ill health.

• Curiad Calon Healthy Options Award - A total of 27 premises secured the Curiad Calon Healthy Options award which aims to make healthier food choices available to customers. This award is offered by Ceredigion County Council and supported by Health Challenge Ceredigion as part of a national scheme to reward businesses that make it easier to eat healthily when dining out.

• Ceredigion has been successful as a pilot area under the WAG Appetite for Life programme, that aims to improve the uptake of and nutritional quality of school meals. The pilot funding which is for 2 years, looks at addressing some of the barriers as to why school children do not eat school meals.

• Physical Activity for Older People group continues to meet and monitors initiatives such as Extend, Moving More Often, GP Referral etc. and develops new ideas such as Wii Fit pilot.

• The GP Exercise Referral programme which is funded by WAG as part of a national research programme has seen considerable success, with the targets set by WAG for referrals onto the programme being exceeded.

• Progress on the Corporate Health Standard has been achieved within the LHB and NHS Trust, with both these organisations achieving the Gold Standard in 2008-09. The County Council are aiming to achieve the standard in 2010.

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Theme 4 To improve the quality and integration of services so as to ensure that the services that we deliver are commissioned and delivered effectively and efficiently according to local need, within our local communities where practicable.

• Agreement of a programme for service integration of Health and Social Care has been agreed and commenced.

• Ongoing Ceredigion Joint Care Beds service provided in partnership between Social Services and Hywel Dda Health Board in the provision of beds within the Local Authority’s seven residential homes to prevent hospital admission or provide care upon discharge from hospital. Care is provided for a period of up to 4 weeks and users of the JCBs receive assessment and input from the Re-ablement Team.

• Assistive Technology – CATH scheme: has been rolled out throughout the county with an increase in clients to 153. Home Care provide responders during the day and an On call night time service. The service is managed on a multi agency basis – the Local Authority in conjunction with the Welsh Ambulance Trust and Fire Service. The 48 Extra Care units at Maes Mwldan, Cardigan will also be covered by the responders at night time when it becomes operational in January 2011. The CATH scheme is currently undergoing evaluation. Tele Health is operational in two North Ceredigion surgeries.

• Reablement Service is fully operational and available throughout the whole of Ceredigion and has recently moved from being a five-day service to a seven-day service.

• New Integrated Equipment Store has been officially opened by the Deputy Minister and is operational. The Store is an open resource for the public to get impartial and informative advice and provides a safe environment for service users to try equipment. Training courses have been held for staff and carers. A partnership with the voluntary sector is being planned.

• The building of the first Ceredigion Extra Care facility in the South of the county nearing completion. Older people have influenced design eg balconies.

The HSCWB partnership is proud of the achievements that have been made over the past 6 years. These achievements would not have been possible without the commitment and support of staff and volunteers from agencies across the county. The partnership will strive to continue to build on this platform of cross agency working to ensure that health, social care and wellbeing issues are planned, delivered and resources in a coordinated way, and ensure that resources and expertise are integrated across the public and voluntary sector in order to deliver the best possible outcomes for residents of Ceredigion.

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Where are we now? Before developing any Strategy it is important to have a clear understanding of the issues that we face. We need to understand a problem before we think about a solution. The HSCWB Needs Assessment 2010 was developed using an approach that gathered both quantitative and qualitative information together in one place in order to provide detailed information on local health needs for the whole population, building on what we know already, but also looking forward into the future to indentify new and emerging challenges. (The full document may be seen on www.ceredigion2020.org.uk). The HSCWB Needs Assessment was also complemented by the needs assessment carried out for Children and Young People in the county. The intention is to allow CCC and HDHB and our partners to strategically position resources and services to meet changing population needs and, if necessary, redesign services to address these future challenges. The 2010 Ceredigion HSCWB Needs Assessment highlighted a number of areas that calls for focused action from all partners: (The key findings are listed in Appendix 1).

• Tackling deprivation

• Promoting healthy lifestyles

• Meeting the future health, social care and wellbeing needs of an ageing population

• Safeguarding the vulnerable in our communities

• Driving forward the health and social care modernisation agenda. In addition, the guidance issued by the Welsh Assembly Government stated that they wish to see the local HSCWB Strategies more narrowly focus on:

• improving health and well-being and reducing inequities, that is inequalities in health that are unfair and avoidable;

• improving the provision, quality, integration, and sustainability of ‘overlapping services’, that is services provided by the NHS, local government and their partners to certain specified groups, including older frail people, people with long-term conditions, people with mental health problems, people with learning disabilities, people with physical disabilities, people with substance misuse problems.

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Key challenges over the coming years All sectors will face major challenges over the next few years as the allocation of monies from central funds reduces. These spending cuts are occurring in a period when demand for statutory and third sector services continues to increase. The worry in such a climate is that those services that seek to reduce health inequalities, contribute to ‘wellbeing’ and early intervention/health improvement will be further squeezed and threatened. Some of the challenges that are faced include:

• Delivering equitable and accessible services in community settings where transport and ICT links are poor; and funding is limited.

• Meeting to the needs of an ageing population: There is a projected increase of 7500 persons (+47%) aged 65 and over by 2026. The most pronounced growth will be amongst the oldest old, with the 85+ age group increasing by 1500 persons (+67%).The elderly are more concentrated in the rural areas of the county, particularly around Cardigan.

• The associated increase in illnesses associated with an ageing population such as dementia, stroke, falls, excess winter deaths, diabetes etc.

• The impact of public sector cuts on the economy as a whole, and the associated knock-on effect on people’s health and wellbeing e.g. poor mental health, increased alcohol/tobacco consumption as a coping mechanism.

• Meeting the challenges of unhealthy lifestyles, and associated impacts on health and social care services. Excess alcohol consumption already impacts significantly on people’s lives and subsequently the demands on support services.

• Many of our community health facilities are not fit for purpose given the current advances in patient care and technological developments.

• Accelerating the pace of change needed to modernise health and social care when organisational and professional barriers exist.

• Ensuring that our workforce is flexible and competent to adapt to meet the future challenges.

• The need to align and eventually integrate our governance and partnership arrangements.

• Continuing to acknowledge the importance of ‘wellbeing’ services in times of shifting resources and priorities.

• The challenges of providing safe and appropriate accommodation for individuals in the right settings in a time when there are drastic cuts in capital allocation.

• 80% of contact with health services is outside the hospital but community services are often only available 5 days a week, 9am-5pm. These accessible hours need to be extended to achieve a minimum of emergency/crisis services that are available 7 days a week between the hours of 8am-9pm (7, 8, 9).

• Identifying those within our communities who are vulnerable so as to enable early interventions where needed.

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Where we want to be This will be the third Health, Social Care and Wellbeing Strategy for Ceredigion. The intention of the strategy is to act as the Framework from which all other Health, Social Care and Wellbeing delivery plans and policies will derive and dove tails into other strategic documents for the county. As would be expected with a long term and high level strategy, the vision will remain the same as for previous years. The vision is that

‘We want the people of Ceredigion to be as healthy and independent as possible.’

In order to achieve this vision, the underpinning values to enable its delivery are:

• We want to work together to improve services,

• We want to help people improve their own health and wellbeing.

• This will be done in a way which raises awareness, is equitable, and accessible,

• Makes best use of resources, and

• Based on involvement, engagement and collaborative working.

In order to achieve the vision the following strategic themes that have been in place since 2008 will continue to offer the framework for action, with some minor amendments. These are:

1. To tackle the underlying factors that influences our health in order to reduce inequities in health outcomes. (The term health inequities will be used rather than inequalities as in previous years, in line with Our Healthy Future). This theme will concentrate on those wider issues such as housing, neighbourhoods, community cohesion and poverty, all of which have an impact on our health and wellbeing.

2. To make better connections as organisations, partnerships, communities and

individuals to ensure effective and meaningful participation, consultation and feedback on health, social care and well being in Ceredigion. The focus under this theme will be on service user and community engagement through the Older People’s Forums, Citizens Panel, Third sector involvement. We also need to put more robust arrangements in place to enable identification of vulnerable people and for the sharing of information/knowledge on health needs and service demands.

3. To ensure the maximisation of opportunities and support for people to

improve their health and wellbeing. In particular there will be a focus on how we can support individuals, groups and communities to look after their own health.

4. To improve the quality and integration of services so as to ensure that the

services that we deliver are commissioned and delivered effectively and efficiently according to local need, within our local communities where

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practicable. The focus of this theme will be the successful implementation of the Modernisation Plan for the Integration of Health and Social Care.

The main refocus of our work from previous years is to ensure that the strategic themes are outcome focussed with clearly defined measurable and realistic priorities arising from them. The strategic themes also align with the three key themes of the national Rural Health Plan which are:

• Access to services - Improving access to services across the spectrum from emergency to routine services.

• The need and opportunities for closer service integration - Integrated service models, workforce planning and systems are necessary to improve service provision and ensure effective use of resources and skills within communities.

• Community cohesion and engagement - This is an important resource and is of immense potential to rural and urban settings. Community cohesion, engagement and ownership needs to be a key element of service planning.

We are also mindful that other key statutory strategies exist for the county, and work is ongoing to ensure that our plans are aligned and contain shared priorities where appropriate. Ultimately we may move to a point where the statutory plans are integrated. The Community Strategy is currently being reviewed, and a number of cross cutting descriptors have been agreed to which all partnerships will sign up to. The overall ‘vision’ that has initially been proposed for Ceredigion under the Community strategy is that ‘People in Ceredigion belong to a community that is safe, confident and connected. This vision may be further refined as laid out below:

People in Ceredigion are:

Examples of activity

Accident prevention Crime reduction Protection of vulnerable groups Flooding / Coast protection Home Safety Health – e.g. falls services and prevention. Public protection

Economy / jobs / benefits / poverty Housing Education / skills All services Wellbeing Bilingualism Maintaining independence

Safe

Confident

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ICT Transport links / accessibility Information ‘Economically connected’

Participation Inclusion Neighbourhood / community networks

The HSCWB partnership and this Strategy has strong links with the Children and Young People’s partnership and Plan, which has been identified by the Welsh Assembly Government as the strategic lead for all children and young people’s services. The synergy that exists between both the CYP and HSCWB agendas is considered carefully within our existing planning arrangements, with shared priorities and cross membership having been in place for a number of years. For example: Good health in the early years and adolescence is a vital contribution to maintaining good health through life. To this end a number of excellent programmes exist in the county that aim to achieve this goal. These include the Healthy School Programme and Healthy Together (Big Lottery) programme. Family health and wellbeing – the health and wellbeing of children is intimately connected with that of their families. Transition arrangements – children will use other services besides those specifically designed for them; and children will go on to use services designed for adults, so good transitional arrangements are vital. Alignment between the HSCWB Strategy and the CYP Plan will be crucial within these areas in order to ensure that the HSCWB services that our children and young people may require now, or in the future are fit for purpose.

Connected

Belonging

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The Outcomes we aspire to achieve We have set a number of long term Outcomes that we will work towards achieving. The Outcomes we have set are challenging and long term, and may not be achieved by 2014. The Outcomes priority work areas are also deliberately high level since it is acknowledged that this is a strategic document, and the intention is to provide a framework for development and delivery of health, social care and wellbeing services. It is intended that specific implementation plans are developed to cover the four strategic themes within this Strategy and each will have an outcome. The Outcomes have been described in the tables included in the following pages, and below is an explanation of the headings included in each of the Outcome tables:

Outcome

This is a statement that defines the ‘end-result’ from what we will be working to achieve. The narrative set the context to the outcome.

Population

This covers the population or subpopulation that the outcome will target.

Priority Area

This is a subset of the overall outcome, and highlights the specific actions that will be developed and delivered.

What are we going to do?

Provides a high level summary of the actions that the HSCWB partnership will lead on or support in achieving the overall outcome.

How will we measure success? (Headline Indicators)

These are the measures or ‘headline indicators’ that we will use to determine whether ‘what are we going to do’ actually makes a difference.

Other data development needs identified

This refers to data that we may not currently gather or have access to but is needed to inform us on progress.

Links to the Community Plan

The HSCWB partnership is committed to assisting in the delivery of the Community Strategy outcomes, and many of the actions within the HSCWB Strategy contribute to this.

Story behind the baselines i.e. how we are doing?

This details the baseline data/intelligence that we already have access to that has been used to inform the Priority Areas arising from the Health Needs Assessment.

Partners with a role to play This lists the partners who will be responsible for

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delivery of actions to achieve the overall outcome.

Outcome 1 Reducing Inequities The health and wellbeing of individuals experiencing disadvantage will improve to the levels found amongst the advantaged Health is much more than not being ill. Health is the state of physical, mental and social well-being and not just the absence of illness. There are considerable variations in the health status of different social groups and communities across Wales and Ceredigion. Many social factors combine together to affect the health and well-being of individuals in the communities. The underlying reasons for these unfair health inequalities are a complicated mix of different social, economic, employment and cultural factors, and the effects of the man made environment such as the work place, housing conditions, layout of lands and villages and the way we travel. Health inequality and deprivation are intrinsically linked. Within the Ceredigion, our various measures for fuel poverty, housing conditions, excess winter deaths and income poverty tell us that individuals and communities within the county suffer disadvantage. Such disadvantage affects the lives of these individuals and their families, by reducing opportunities to full engage and participate.

Population: Those suffering inequalities

Priority Area What are we going to do?

How will we measure success?

(Headline Indicator)

Ensuring that our residential accommodation is fit for purpose. This priority area includes a consideration of ensuring that the range and condition of our housing stock is adequate to meet our populations’ needs, as well as ensuring that we offer support services for those threatened with or who are homeless.

Within the review of the Housing Strategy, ensure that the health impact of housing is considered.

Develop and deliver an Accommodation Strategy for Older People. This specifically in the short term includes delivery on the Maes Mwldan Extra Care housing

Strengthen and promote the health and wellbeing impact of housing improvement and regeneration through supporting an impact assessment of the proposed Aberystwyth Housing

Future national surveys e.g. next WAG Housing Condition Survey.

Update to 2007 Ceredigion House Condition Survey, and more specifically:

• Proportion of all dwellings in Ceredigion categorized as Risk Hazard on the Excess cold, falls risk and/or fire risk (these are the ‘hazards’ most directly relevant to health)

• And/or Reduce the proportion of dwellings at risk due to these hazards in specific

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Renewal Area. Provide support for those threatened with or who are homeless. Ensure that Houses in Multiple Occupation in the county are identified, assessed and licensed. Support the Local Service Board in the delivery of its priorities especially through the delivery of the Cylch Caron project.

geographical areas as identified in the various measures`

• the proportion of buildings at risk in areas of Llandysul and Tregaron

• housing condition in old town area of Aberystwyth

• Number of HMOs identified and licensed.

Number of affordable and single/small unit properties Number/proportion of affordable houses provided (i.e. existing policy)

Ensure that health and wellbeing impact is highlighted and promoted within strategic regeneration programmes and policy development.

Support the regeneration of Aberystwyth through ensuring that health needs and impact are considered in the planning and delivery of the work programme.

Numbers of impact assessments carried out.

Reducing Excess winter deaths High rates of excess winter deaths occur in the county and variations exist between areas of Ceredigion.

Work with agencies to raise awareness of excess winter deaths and ensure targeted interventions are delivered within areas of the county where EWD rates are highest.

Rates of Excess Winter Deaths in Ceredigion

Supporting activities aimed at reducing poverty Income levels in Ceredigion are amongst the lowest in Wales. When linked with indices of multiple deprivation (WIMD and Townsend), areas within the county such as Cardigan and Aberystwyth are worse off.

Support the CYP Partnership in the delivery of the Child Poverty Strategy. Continue to support the Maximising Income group for Older People to ensure that older people receive the benefits that they are entitled to.

Child Poverty measures, e.g.: % entitled to free school meals Educational achievement % children dependent on worklessness benefits Proportion of population on employment related benefits Numbers helped into employment or reduce

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High rates of fuel poverty exist in the county particularly in the rural areas of the county and Aberystwyth.

Target programmes towards those areas with high fuel poverty rates e.g. Tregaron Housing Renewal Area (HRA), proposed Aberystwyth HRA

benefit dependency Fuel poverty measures

Supporting People programme There is need to further develop services to address disadvantage and complex issues.

The Supporting People programme will continue to deliver and develop a range of supported accommodation and housing related support services in line with the complex range of issues identified. The programme will also seek to increase the availability of sustainable and affordable accommodation for vulnerable groups in partnership with statutory and voluntary sector partners. This will aim to ensure that individuals can move on to independent living and free up supported accommodation resources for those who need it. Specific priorities areas for the programme include the review and development of services for young people, learning disabilities and older people.

Outcomes of Support as measured by the Supporting People Programme: - Feeling Safe - Contributing to the safety

and well-being of themselves and of others

- Managing accommodation

- Managing relationships - Feeling part of the

community - Managing money - Engaging in

education/learning - Engaging in

employment/voluntary work

- Physically healthy - Mentally healthy - Leading a healthy and

active lifestyle

Support the health and wellbeing needs of carers

Implement requirements of the Carers Strategies (Wales) Measure 2010

Carers Measure indicators: Agreement of Carers Strategy

What other data do we need?

• Determine the rates of benefit uptake and identify where these may be improved.

• Recent Excess Winter Death data Furthermore, developing the following could yield some measurable headline indicators over which we have some control:

• Reduction of the proportion of population on employment related benefits

• Numbers helped into employment or reduce benefit dependency

• Number/proportion of affordable houses provided (i.e. existing policy)

22

Does it contribute to the Community Strategy outcomes? (0 = no contribution, 5 = full contribution) People in Ceredigion will feel: Safe Confident Connected Belonging

0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

Story behind the baseline Housing – suitability and condition

• Ceredigion ranked 4th highest proportion of unfit dwellings of LA in Wales in 1998 Welsh Housing Condition Survey (11.1% all dwgs); absolute improvement noted by 2007 Ceredigion House Condition Survey (8.1% unfit) relative position in Wales unknown

• 2007 Ceredigion Survey showed high proportion (19%) of housing classed as Category 1 hazard: main reason noted was excess cold (17%), and also included risk of falls on steps/stairs (3.1%), and risk of fire (1%). Rates of Category 1 failure were significantly above average in Llandysul (29.3%), Tregaron/Hinterland (26.8%) and Rural Remainder (23.6%).

• 9 out of 47 LSO Areas in Ceredigion were in worst 10% in Wales in the 2008 WIMD Housing Domain (most of the main town areas); further 8 areas were in worst 20%. Abersytwyth Canol was ranked the worst area in Wales on this housing measure of overcrowding and lack of heating

• There is a shortage of suitable housing accommodation in the county for small/single households. By 2013 there will be a reduction from an average household size in Ceredigion of 2.27 persons to 2.06 persons per household (all Wales figures: 2.30 in 2006 declining to 2.03 by 2031). Therefore there will be a demand for additional dwellings driven in part by an increase in single person households, which are projected to be most common household type by 2031, and in part by population growth from net in-migration.

• Sheltered housing services in the county are highly traditional, resulting in limited opportunities to improve the quality of the housing and services for the benefit of residents. As part of the modernisation of accommodation for older people, it is envisaged that the Council’s broad strategic requirements to shift from institutional care to independent living in the community will require the development of ‘extra care’ sheltered housing together with the possibility of re-modelling some of the present sheltered housing schemes into a more appropriate format.

Income and Poverty

• The Wales Index of Multiple Deprivation (WIMD) shows that Aberteifi/Cardigan – Teifi is in the most deprived 10% on the Child Index, and Aberystywth Penparcau 2 falls into the 20% most deprived.

• The 2009 mean employee earnings in Ceredigion was £19,134 (2nd lowest in Wales) and the median £17,584 (4th lowest in Wales), household incomes however were relatively higher in the all-Wales ranking

• For Wales as a whole mean house prices in 2007 were 4.5 times full-time pay. In. Ceredigion this ratio was 6.6 times full time pay (the highest in Wales).

23

• Within the county, Aberystwyth town have the worst fuel poverty rates with 23% of households in the Aberystwyth Bronglais, Central and Rheidol LSOAs suffering fuel poverty. 21% of the people in Cardigan in the south of the county (Cardigan Rhyd-y-Fuwch and Teifi) are affected and approximately 19% of households in the rural east of the county

Supporting People

• Financial hardship is a significant need for those accessing the Supporting People Programme.

• Homelessness, Mental health, substance misuse and offending issues are often compounded for those accessing SP services.

• The availability of appropriate sustainable move on accommodation is an issue for those accessing supported accommodation who are ready to move on to independent living.

• A greater choice of accommodation options with a range of support services is required to meet the needs and aspirations of an ageing population.

Excess Winter Deaths

• The index of excess winter deaths shows that winter deaths are higher in Ceredigion

compared with Wales and England in the over 65 age category.

• Two areas in the county stand out as having higher rates of winter deaths compared with the county average – these are located in Aberystwyth (south part of the town) and to the east of the county which covers Tregaron and the hinterlands.

Carers The Carers UK and University of Leeds Report Valuing Carers – calculating the value of unpaid care 2007 estimates the costs to Ceredigion as:

Carers Census (2001 Census) Numbers

2002 value (based on £57 billion) (£ millions)

New value (based on £87 billion) (£ millions)

Change £ millions

Change %

Ceredigion 7,749 89.2 125.6 36.4 41

In a challenging economic climate the burden on carers is often deemed to significantly increase as availability of services is affected. In a “self identification” survey through Secondary Schools by the Carers Service with British Red Cross in 2009 the figure was considerably higher at 1 in 7 - 422 potential Young Carers. The estimated scale of informal caring in Ceredigion according to the 2001 Census was that:

• There were 7,749 carers in Ceredigion – 10.4% of the population

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• 1,981 of those carers were providing more than 50 hours of care per week – 2.6% of the population.

• 13% of all carers reported that they were in poor health and over 20% of all carers providing over 50 hours care per week reported that they were in poor health.

• Just over half of adult carers (50.5%) were juggling work and caring.

Partners with a role to play Ceredigion County Council

– Housing – Finance/ Housing benefits – Social services

Private Sector Landlords

Registered Social Landlords Utility companies Hywel Dda Health Board Department of Work and Pensions

25

Outcome 2 Making Better Connections Organisations, partnerships, communities and individuals are better engaged to ensure effective and meaningful participation, consultation and feedback on health, social care and well being in Ceredigion. 1. Engaging people within development and policy making processes to: o Help to ensure that services are better designed o Enable services to respond to feedback from users, regularly making adjustments and

improvements based on those users experiences 2. As more of our population becomes elderly there is an increasing need to ensure that networks are in place through projects such as Good Neighbourhood Schemes that promote independence whilst enabling individuals to participate and engage in local activities. 3. Ensuring that we have ongoing robust data and information sharing arrangements between agencies to allow better use of the information that we each collect so as to inform health need, service design and delivery.

Population: Whole population




Work with voluntary sector, carers and service users to contribute towards service development and delivery where their skills and expertise can complement services provided by other health and social care professionals.

• Develop and implement a consistent approach to service user/patient engagement through the implementation of the Community Engagement Framework and Directory.

• Continue with the support for existing communication and engagement networks offered by the Older People’s Forums, Citizen Panel, Carers Alliance, H&SC Third sector county Forum.

Support and continuation for OP Forums. Number of people participating in Citizens Panel Self reported experience of patients and service users. Service user satisfaction surveys

Improving access to services

• Improve health knowledge and skills (health literacy) to increase people’s capacity to

Number of patients ‘registering’ as expert patients

26

manage their own health and better access health services

• Ensure that service users are offered use of services in their language of choice.

Number of staff welsh speakers

Improving data and intelligence sharing in order to inform health needs and service development/delivery.

• Support LSB Research Intelligence and Information Sharing Group as main forum for furthering data exchange between strategy partners, and implement the Research and Information Strategy to improve data quality and utility.

• Liaise with primary care to identify potential vulnerable people within our communities, malnutrition assessment arrangements.

• Develop and train our workforce to enable appropriate engagement with individuals at a community level

Data sharing arrangements set in place Training events carried out

What other data do we need? Number of health professionals able to speak welsh Service user satisfaction surveys


0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

Story behind the baseline

• We do not know the location of the most vulnerable population, particularly those who live alone and in rural locations.

• With our ageing population, it may be concluded that malnutrition in older people could

27

increase in the future, and further research is needed into the incidence and monitoring arrangements already in place in Ceredigion.

• Cervical screening uptake rates in Ceredigion are low. Further analysis is needed of these statistics in order to obtain a better understanding of the rates in order to answer the following questions:

1. Do high student levels skew the results with female students waiting until they return home before attending screening services?

2. Are there barriers to accessing screening services, e.g. geographical, societal/cultural, opening hours?

• Food poisoning rates in Ceredigion are higher than the rest of Hywel Dda and further investigation is needed to ascertain why.

• Further research is needed locally into the rate and impact of falls in our elderly.

• Through the development of the Health Needs Assessment it was identified that a wealth of information and data is gathered yet not always shared effectively.

• Results from the Citizens Panel survey carried out in summer 2010 indicated that 53% of respondents considered access to information about services in Ceredigion was fair, poor or very poor.

Partners with a role to play

• CAVO

• Third sector

• CCC

• Community Health Council

• HDHB

• Police

• GPs

• Statutory partnerships

28

Outcome 3 Health Improvement

Maximise opportunities and support for people to improve their health and wellbeing. The way that we live our lives directly influences our health. The World Health Organisation states that ‘The major causes of disease are known (diet, tobacco use, physical inactivity, obesity). If these risk factors were eliminated at least 80% of all heart disease, stroke and type 2 diabetes would be prevented and over 40% of cancers would be prevented’

Population: Whole population




Assisting people to look after their own health and that of their families.

Continue to support people to look after their own lives and those of their families through raising awareness of the opportunities available to them to improve health and wellbeing – e.g. continued use of information networks through Older People’s Forums, Health Challenge Ceredigion website,

Feedback from Citizens Panel Number of ‘hits’ on Health Challenge Ceredigion web pages.

Maximise opportunities for improving health through the delivery of the priories of ‘Our Healthy Future’: Improving health at work

Achievement of Corporate Health Standard and Small Workplace Health Awards. Follow-up investigations to reported workplace incidences/accidents.

Achievement of Workplace Health Award / Corporate Health Standard. Notified workplace health and safety incidences/accidents

Increasing participation rates of physical activity

Review of Physical Activity Strategy for Ceredigion in line with the recommendation contained within Creating an Active Wales Physical Activity Action Plan for Wales - http://new.wales.gov.uk/topics/health/improvement/index/active/?lang=en

Participation rates in physical activity (5x30 minutes)

Prevent and reduce the harm from alcohol misuse

Stopping the growth in harm from alcohol – through ensuring information is available on safe drinking levels, controlling availability of

Referral rates to treatment for alcohol misuse Deaths from chronic liver

29

alcohol through enforcement of licensing regulations and underage sales.

Disease Number of Proof of age cards issued

Improving nutrition

Supporting the role and work of the Community Dietician Working with Appetite for Life and Healthy Schools Programme. Promoting Healthy Options with local food businesses. Development of a programme for assessing nutritional levels of the elderly.

% eating 5 fruit and veg per day

Reducing accident and injury rates

• in children (shared priority with CYPP)

• older people

Development and delivery of a multi-agency accident prevention plan. Development of a multi-agency falls prevention pathway for older people and service across the county.

Childhood accident rates. Hospital admission due to falls

Reducing smoking prevalence

Promoting uptake to the Stop Smoking Service in the county and to implement locally the requirements of the national Tobacco Control Action Plan (awaiting publication).

Numbers accessing the Stop Smoking Service. % adults who are smokers. Participation in Smokebugs

Increasing vaccination and immunisation rates to target levels

Promote and support through promotional campaigns the uptake of flu vaccinations and cervical screening.

Immunisation/Screening Rates – flu, cervical, childhood. Proportion of women aged 20-64 who have received cervical screening

Reduction and management of strokes

Implement the requirements of the Stroke Reduction Action Plan - http://new.wales.gov.uk/topics/health/improvement/index/actionplan/?lang=en

Stroke mortality and morbidity data

Reduction and prevention of obesity

Implement the All Wales Obesity Pathway http://wales.gov.uk/docs/phhs/publications/100824obesityen.doc

% adults who are obese

What other data do we need? Rates of Childhood obesity Profile of physical activity across the county Physical activity participation rates across the ages. Obtain data for all causes of admissions to A&E.

Does it contribute to the Community Strategy outcomes?

30

(0 = no contribution, 5 = full contribution) People in Ceredigion will feel: Safe Confident Connected Belonging

0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

Story behind the baseline

• In Ceredigion the Welsh Health Survey indicates that an average of 22% of adults who smoke. Although this rate is lower than in Wales as a whole, the effects of smoking present continuing challenges to service providers in the area.

• Stop Smoking Wales service has reported a 20% increase in people contacting the service although the uptake in Ceredigion remains low.

• Falls accounts for 17% of the response incidents for the Ambulance Trust and is the primary reason for verified incidents needing a response.

• There is no integrated community falls service in Ceredigion.

• Further research is needed locally into the rate and impact of falls in our elderly.

• Although rates of chronic illness in the county are below national average, with the age profile of the county there is a need to maintain good health and wellbeing.

• There are better than average levels of physical activity and fruit/vegetable intake in Ceredigion. Nevertheless, over half of Ceredigion residents are either overweight or obese. Poor lifestyle leads to poor health and an increased risk of developing chronic illnesses such as diabetes, heart disease, stroke,

• With our ageing population, it may be concluded that malnutrition in older people could increase in the future, and further research is needed into the incidence and monitoring arrangements already in place in Ceredigion.

• From Substance Misuse Action Team data, alcohol makes up 58% of all referrals The estimated number of individuals referred for alcohol treatment for Ceredigion was higher in 2008-09 than the Wales average.

• In a national survey of young people those most likely to have tried alcohol were: – White – 15-16 year olds from rural communities, where there are fewer teenage activities – Living with two working parents – In non-deprived regions

• There are no mental health/wellbeing indicators within Ceredigion or indeed Wales. The Warwick-Edinburgh Mental Well Being Survey (WEMWBS) is available for use in the UK and consequently is advised that such indicator is used in Ceredigion.

• Ceredigion does not reach the Welsh Assembly Government target of 95% uptake for any of the childhood immunisations.

• Uptake rates of the flu vaccine are low in all surgeries and do not meet WAG targets of 75%. Similarly, cervical screening uptake rates in Ceredigion are low.

31

Trends for lifestyle indicators from the Welsh Health Survey, census and immunisation reporting:

% Consumption of alcohol above

guidelines

0

10

20

30

40

50

2003/5 2004/6 2005/7 2007/8 2008/9

Ceredigion Wales

% overweight/obese

45

50

55

60

2003/5 2004/6 2005/7 2007/8 2008/9

Ceredigion Wales

% Limiting Long Term Illness

22

23

24

25

26

27

28

29

2003/5 2004/6 2005/7 2007/8 2008/9

Ceredigion Wales

Deaths from accidents for all ages 2001-2009

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005 2006 2007 2008 2009

Ra

te p

er

10

0,0

00

inh

ab

itan

ts

Wales Ceredigion

% achieving physical activity guidelines

0

5

10

15

20

25

30

35

40

2003/5 2004/6 2005/7 2007/8 2008/9

Ceredigion Wales

% consuming 5 fruit and veg/ day

0

10

20

30

40

50

60

2003/5 2004/6 2005/7 2007/8 2008/9

Ceredigion Wales

32


• Public Health Wales

• Ceredigion County Council – Education and Leisure Services – Environmental Services and housing – Social Services

• HD Health Board

• Third sector

• Local GPs

• Food industry

• Catering businesses

• Local businesses

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Outcome 4 Improving Quality and Integration of Services Health and social care services are integrated, commissioned and delivered effectively and efficiently according to local need. This thematic area specifically addresses how partners will work together to improve the provision, quality, integration, and sustainability of ‘overlapping services’ to ensure that people live independently for as long as possible. The outcome also covers those elements of targeted early intervention of the vulnerable which will Particular attention will be paid to services which supports: older frail people, people with long-term conditions, people with mental health problems, people with learning disabilities, people with physical disabilities, people with substance misuse problems, carers and children and young people.

Population: Those using health and social care services and in particular:

• older frail people,

• people with long-term conditions,

• people with mental health problems,

• people with learning disabilities,

• people with physical disabilities,

• people with substance misuse problems (led by the Community Safety partnership)

• children and young people (led by Children and Young People’s Partnership)

• carers (see Outcome 1)



(Headline Indicator) (will be further refined)

Development of Locality Networks for Health and Social care

In developing a more integrated and diverse role for community services, we will re-configure and integrate services into North and South Localities for delivery of Community Care

1. The rate of delayed transfers of care for social care reasons per 1,000 population aged 75 or over

2. Delayed transfers of care (non mental health) per 100,000 population

3. The rate of: a) older people (aged 65 or

over) supported in the community per 1,000 population aged 65 or over at 31 March;

b) older people (aged 65 or over) whom the authority supports in care homes per 1,000 population

Development of an integrated health and social care independence service

Developing an integrated health and social care independence service, building upon the existing partnership arrangements in place for the Integrated Living Centre, encompassing:

• Re-ablement

• Therapies

• Assistive technology/tele health

• Equipment

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• Early intervention aged 65 or over at 31 March

4. The percentage of clients, in the following age groups, who are supported in the community during the year: a) Aged 18-64 b) Aged 65+

5. Responding to carer needs i. The percentage of

carers of adults who were offered an assessment or review of their needs in their own right during the year

ii. The percentage of carers of adults who had an assessment or review of their needs in their own right during the year

iii. The percentage of carers of adults who were assessed or re-assessed in their own right during the year who were provided with a services.

6. Number of section 33 agreements signed off / being developed

7. Proportion of spend on Residential and Nursing Care

8. Unplanned Hospital Admissions/Re-admissions Falls

9. Numbers of equipment and home adaptations

Review of existing accommodation for Older People

Develop proposals for future flexible accommodation options and support

• Res Homes

• Independent Sector

• Community Hospitals

• Accommodation, including the completion of Maes Mwldan and the further progression of the Cylch Caron and Aberaeron resource centres

Mental Health and Learning Disabilities

There is a need to review the current high cost low volume packages of care and placements and look to repatriate eligible individuals. Community Mental Health and Learning Disabilities Services are currently the most integrated area of service delivery with co-located teams and joint team managers. However, it is recognised that the arrangements require formalising in order to clarify relevant governance and accountability. This will be taken forward through the development of S33 arrangements that will be developed for Ceredigion initially, but link into proposals being taken forward on a Hywel Dda basis. Work has already commenced to review Elderly Mental Illness (EMI) accommodation provision in the county, and the need to extend provision of EMI within the county has been identified as a priority.

Children and Family Services

Community Services for Family and Children already work in an integrated way, supporting the Children and Young Peoples Framework Partnership plan and objectives. The areas for increased collaboration across Families and Children Community services include:

• Transitional arrangements

• Emotional Well Being

• Substance Misuse

Transition to independence The percentage of: a) young people formerly

looked after with whom the authority is in contact at the age of 19;

b) young people formerly looked after with whom the authority is in contact, who are known to be in suitable, non-emergency accommodation at the age

35

• Advocacy

• Targeted early intervention programmes

of 19; c) young people formerly

looked after with whom the authority is in contact, who are known to be engaged in education, training or employment at the age of 19.

The percentage of children looked after at 31 March who have experienced one or more changes of school, during a period or periods of being looked after, which were not due to transitional arrangements, in the 12 months to 31 March.

Coastal (Creating Opportunities and Skills Teams Alliance)

The COASTAL project is a joint project with five other local authorities (Pembrokeshire, Neath Port Talbot, Swansea, Carmarthenshire, and Bridgend). The project is funded by European Social Fund money, as part of the 2007/13 Convergence Programme. COASTAL presents a significant opportunity to access an additional £1m resource to facilitate the modernisation of existing services and develop more efficient person centred provision.

Participants in the project will be individuals who are currently economically inactive as a result of

� illness

� disability, (Mental Illness, Learning Disability, Physical Disability, Sensory Impairment),

Coastal strategic aims:

� Develop a sustainable centralised referral model for pan disability groups and create a comprehensive ‘career pathway’ to employment for the target participants based on a Person Centred Planning approach.

� Review the activities provided within the whole service delivery model and the wider agenda for change with a view to developing a range of services that are purposeful and valued.

� Develop wider service delivery to include the range of disability groups and reconfigure/restructure existing services in line with the social services modernisation agenda to create a framework for commissioned services that optimise independence for service users while demonstrating value for money and sustainability.

� Develop specific sustainable social enterprises that are financially viable in the long term and provide a range of

Numbers of project participants that are assisted into employment.

36

� substance misuse problems and/or

� the serious social disadvantage associated with the transition from long-term foster care into adulthood (Care Leavers).

employment opportunities to people from pan disability groups.

� Develop a supported employment project and deliver work opportunities for people with disabilities within the authority and the private or voluntary sector.

Reduction and management of limiting long term illness

Implementation of the chronic conditions management programme in the county.

% adults with limiting long term illness

What other data do we need?

• No of people who solve their care problems/needs without intervention, for example number of self funders for Residential Care, people who buy their own equipment.(we only measure reactive interventions)

• Ambulance data around frequent responses

• Telecare outcomes

• Analysis of the carers providing care without support

• Sharing information around those individuals requiring high levels of care


0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

Story behind the baseline Drivers for change in the need to integrate and modernise health and social care services includes:

• the demographic pressures we face in the future, with increasing numbers of frail older people, many of whom will require increasing social care support and health care, which will need to adapt to meet changing expectations.

• The developing role of Health and Social Care partnerships to effectively plan a future “whole system” service for Ceredigion. This approach will further develop the integration of Social Care and Health care, to provide a ‘seamless’ service and break down traditional boundaries and barriers between social care and health.

• Efficiency requirements - This is in the context of increasing constraints on public finances and ever-increasing public expectations. One of the greatest challenges form both organisations has been identifying capacity to drive this modernisation and change agenda, therefore these proposals focus upon creating initial capacity to drive specific areas.

37

• Unsustainable reliance on Residential and Nursing care

• Shift of emphasis to caring for people at home, maximising their independence

• Shift in culture to help ‘push’ people away from dependency on services and pull from institutional/hospital care to the community.

Outcomes We recognise that individuals want to:

• Live independently in their own homes or in a homely environment in their chosen community for as long as possible.

• Receive services that help them to help themselves.

• Continue to make a contribution to society and be viewed as assets to society.

• Have access to a wide range of services to help them maintain their independence and safety in the community and promote good health.

• Access good quality information to enable them to make informed decisions about services they may need.

• Retain control of decisions concerning their life and lifestyle.

• Know that services are person centred in that they are flexible and responsive to need.

• Receive services that are provided as soon as the need has been identified.

• Receive services that support informal care networks in terms of family, friends, and community.

• Be protected from harm, abuse, neglect and isolation.

• Have: o the best quality treatment as close to home as possible o a smooth transition of care between community services and hospital and between

hospital and community services. o to return home as soon as possible with appropriate support when required o access to rehabilitation services to maximise their level of independence

• Admission to institutional care will be made on the basis of positive and informed choice.


• HDHB

• CCC – Housing – Finance/ Housing benefits – Social services

• Third sector

• Independent Sector

• Ambulance Trust

38

Implementation, Monitoring and Review Progress in relation to this Strategy will be monitored at strategic level by the HSCWB Partnership. The successful implementation of this Strategy depends upon good communication and flow of information together with robust monitoring and evaluation arrangements to measure how we are progressing with the Strategic priorities. There is an intention to agree the use of a joint performance monitoring system, Ffynnon, which is currently being used by the County council. Ffynnon enables the sharing of information between partners in a timely manner. It makes linking service plans and partnership priorities and actions much easier and avoids duplication in reporting. The tables above have been generated for the Strategy priority outcomes, have been developed using a Results Based Accountability principle, that relies on the development of measurable outcomes for both population based and project/service based priorities. Results Based Accountability relies on the use of, and when needed the development of, baseline health data that enables the measurement of progress, outcomes and impact over time. Within the tables, examples of baseline health data has been inputted where possible but it is acknowledged that further work is needed to develop and refine some of the indicator data that will be used.

39

Appendix 1

Health Needs Assessment 2010 - Key Findings In general, statistics for the county indicate that the health status of the population is good. Nevertheless, it is apparent that due to social, economic and environmental reasons, some people in the county face greater challenges which influence their ability to maintain good health and access services. Furthermore, a significant number of individuals (at least a quarter of the population) face challenges with day to day living, whilst managing a long term illness. The following table summarises some of the key findings and conclusions drawn from the Needs Assessment. Key Finding (in no order of priority) Implications of no intervention Population projections indicate that the years 2008 to 2026 will see an overall increase in the resident population of around 8600 persons (+11.0%). There is a projected increase of 7500 persons (+47%) aged 65 and over. The most pronounced growth will be amongst the oldest old, with the 85+ age group increasing by 1500 persons (+67%).The elderly are more concentrated in the rural areas of the county, particularly around Cardigan.

�2 chronic illnesses.

� Demands on health, social care and voluntary services.

Income levels in Ceredigion are amongst the lowest in Wales. When linked with indices of multiple deprivation (WIMD and Townsend), areas within the county such as Cardigan and Aberystwyth are worse off.

�Inequalities in income and health continue (and possibly widen) in these areas.

Access to services is poor due to the rurality of the county (WIMD).

� social and physical isolation, � mental ill-health � mortality (due to late presentation of illness)

Excess alcohol consumption impacts significantly on people’s lives and subsequently the demands on support services e.g. Supporting People.

� alcohol-related illnesses � demand on support services (primary, secondary, social, police, LA, voluntary)

High rates of fuel poverty exist in the county particularly in the rural areas of the county and Aberystwyth.

� poverty � social isolation � cold-related illnesses

High rates of excess winter deaths occur in the county and variations exist between areas Ceredigion. Rates of Excess Winter Deaths in Ceredigion are 29 compared with 16 in Wales and 19 across Hywel Dda.

� EWD continues as proportion of elderly rises. � cold-related illnesses

Housing conditions in the county are worse that the national average with variations found within the county. The main cause of poor housing is due to excess cold (i.e. poor thermal standards).

� respiratory, circulatory and mental illnesses due to poor living conditions leading to � demands on support services (primary,

2 �denotes an increase

40

Key Finding (in no order of priority) Implications of no intervention secondary, social, voluntary)

Lack of suitable housing for the elderly and other single person/small households including young people.

� people living in housing not suited to their needs leading to, � mental ill health, falls/accidents in the home leading to, � demands on support services

24% of people in Ceredigion have a diagnosed chronic illness (limiting long term illness). Variations exist between areas in the county.

� in chronic conditions with increasing inequalities within the county � demands on services (primary, secondary, social, voluntary)

Demands on public sector services are increasing in a time when resource allocations are shrinking, which in turn will have implications on our capacity to address the needs identified in this HNA.

�3 service efficiency and effectiveness

� waiting lists

Many of our community health facilities are not fit for purpose given the current advances in patient care.

� service efficiency and effectiveness � waiting lists

Of Adults in Ceredigion: 22% adults smoke, 54% adults are overweight/obese, 43% consume alcohol above recommended 23% binge drink, 59% do not eat 5 fruit/veg a day, 66% do not exercise 30 mins, 5 days/week These figures are better than the Wales average.

� lifestyle related illnesses: diabetes, heart disease, obesity, cancers � demands on primary care services � admissions to hospital

Rates of flu immunisations do not meet targets in Ceredigion for people aged 65+ and those in clinical risk groups (Target = 75%)

� seasonal flu � respiratory illnesses � demands on primary care services � admissions to hospital � mortality

Falls in the elderly is known to have a significant personal, societal and organisational cost in Ceredigion.

� falls � costs on health and social services

The estimated economic cost of workplace-related health and safety incidents (accidents and ill health) in Ceredigion is between £9.1 million and £14.1 million (in 2008/09).

� Personal and business cost due to ill health and accidents.

It is estimated that rates of dementia will increase due to the ageing population by 44% in 2021.

� costs on support services (health social and voluntary)

There are estimated to be 7749 carers in Ceredigion which is known to be a large underestimation. With an ageing population it is estimated that the figure will increase significantly.

� in number of carers as population ages. � demands in services if support services are not provided for carers.

3 � denotes a decrease

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Summary of Main Findings

_________________________________________________________ The following is a list of statements from information provided/gathered to inform the Health Needs Assessment. The evidence to substantiate the findings is included within the Technical document. Chapter 3 - Ceredigion Demography and Socio-economic profile Main findings

• If Higher education students are excluded, Ceredigion’s population structure becomes markedly older than the population of Wales as a whole.

• The high proportion of HE students has a marked effect on the Total Fertility Rate4 (TFR) for the county, making it one of the lowest in Wales: In 2009 Ceredigion had the lowest TFR in Wales at 1.59 children per female.

• Ceredigion has the highest life expectancy at birth for both men and women in Wales (80.7 and 84.2 years respectively).

• Population projections indicate that the years 2008 to 2026 will see an overall increase in the resident population of around 8600 persons (+11.0%). With most other age groups remaining fairly stable as a proportion of the population, there is a projected increase of 7500 persons (+47%) aged 65 and over. The most pronounced growth will be amongst the oldest old, with the 85+ age group increasing by 1500 persons (+67%).The elderly are more concentrated in the rural areas of the county, particularly around Cardigan.

• The latest data from the Labour Force Survey/Annual Population Survey for the year to December 2009 show 15.2% of the population aged 16-64 excluding students to be economically inactive (Powys 20.6, Mid Wales 35.9) and including students, Ceredigion 30.1 (Powys 25.8 , Mid Wales 27.5).5

• A reduction from an average household size in Ceredigion of 2.27 persons to 2.06 persons per household by 2031 (all Wales figures: 2.30 in 2006 declining to 2.03 by 2031). Demand for additional dwellings will be driven in part by an increase in single person households, which are projected to be most common household type by 2031, and in part by population growth from net in-migration.

• The average house price paid in Ceredigion in July 2010 was £181,408, which is 338% of the average house price in January 1995,

• For Wales as a whole house prices in 2007 were 6.6 time full-time pay. In. Ceredigion this ratio was 9.4 times full time pay (the second highest in Wales after Monmouthshire).

• According to the 2001 census an average 51% of the population spoke welsh, ranging from 69% in Llandysul town to 23% in Llanbadarn (Sulien). A higher proportion of the elderly and children speak welsh, therefore emphasising the importance of providing services in the service users language of choice.

4 The Total Fertility Rate (TFR) is the average number of live children that a group of women would have if

they experienced the age-specific fertility rates of the calendar year in question throughout their child-bearing lifespan. 5 Statistical Bulletin SB73/2010 available at http://wales.gov.uk/docs/statistics/2010/100831sb732010en.pdf

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Chapter 4 - Determinants of Health and Wellbeing Main findings

• The Wales Index of Multiple Deprivation (WIMD) shows that Aberteifi/Cardigan – Teifi is in the most deprived 10% on the Child Index, and Aberystywth Penparcau 2 falls into the 20% most deprived.

• The WIMD also shows that three LSOAs appear in the most deprived 10% - Aberteifi/Cardigan – Teifi, Aberystwyth Rheidol 1 and Aberystwyth Canol/Central, with a further two in the top 20% and two more in the top 30%.

• The WIMD shows Aberystwyth Central is ranked 1 in Wales for housing deprivation, measured on lack of central heating and overcrowding (excluding student households). Rural areas are typically ranked higher for access to services.

• Annual income for employee jobs in Ceredigion was fourth lowest in Wales at £17,584 in 2009 (Wales £19,214) and the mean was second lowest in Wales at £19,134 (Wales £22,442).

• There is a lower proportion of people in full-time employment than the Wales and GB averages.

• The index of excess winter deaths shows that winter deaths are higher in Ceredigion compared with the rest of Hywel Dda, Wales and England in the over 65 age category.

• Within the county, Aberystwyth town have the worst fuel poverty rates with 23% of

households in the Aberystwyth Bronglais, Central and Rheidol LSOAs suffering fuel poverty. 21% of the people in Cardigan in the south of the county (Cardigan Rhyd-y-Fuwch and Teifi) ar

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