integrated community services feedback from public ......community vanguard proposals: proposals and...

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INTEGRATED COMMUNITY SERVICES

Feedback from Public Engagement Event

Poole 07.04.16

INTRODUCTION

In response to the need to co-design integrated community services with local people a series of 9 public engagement locality based events (supported by a virtual/online engagement opportunity) were held in March and early April 2016. This is an important stage in on-going engagement or participation work in Dorset – with a vital local community focus. OVERVIEW OF THE EVENTS

The initial focus of each event was to listen and learn from local people, with lived-experience and knowledge of each area, exploring what they felt we need to consider when developing health and care services in their particular area of Dorset. A presentation was then given explaining:

Why health and care services need to change

What has been done so far and

Introducing some emerging ideas for improving health and care in the community.

Attendees were then invited to review information on the vision for community services and emerging ideas in greater detail. This was done through an interactive ‘walk-through’ of information posters displayed on a series of boards. Staff were on hand to answer questions and local people were invited to capture their views on colour coded post-it notes on the posters - reflecting on a) what they felt is good/positive about the ideas/proposals and c) what they feel should be given consideration/any concerns or questions they might have. This methodology was developed in response to feedback from local people about having shorter presentations, more time to review and consider information presented and the opportunity for all attendees to provide feedback. The day after each event all of the posters were displayed online with an electronic survey to enable other people to provide their views. FEEDBACK FROM EVENT EIGHT

On Thursday 07 April 2016 the eighth ICS public engagement event was hosted at Parkstone

Grammar School in Poole.

42 members of the public attended this event.

This paper pulls together all of the feedback provided at this event. 239 pieces of feedback were

provided at this event.

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A synopsis of the feedback is provided within the main body of this report and all feedback (as

captured by attendees) is listed in the appendices.

Feedback is provided in two sections:

Section One: What we need to consider when developing community health and care services in

Poole.

Section Two: Feedback on ICS information displayed in the information ‘walk-through’.

SECTION ONE: WHAT WE NEED TO CONSIDER WHEN DEVELOPING COMMUNITY HEALTH AND

CARE SERVICES IN POOLE.

Attendees were asked to give consideration to the following question:

“Based on your local knowledge and experience please tell us what you feel we need to consider

when developing community health and care services in Poole and surrounding area?”

This was done individually in the first instance, with attendees capturing their thoughts on pre-

prepared feedback cards. Attendees then discussed their thoughts with others and feedback was

shared with everyone at the meeting, to provide a collective sharing of emerging priorities within

the local community.

All of the feedback collected has been collated and themed to ease interpretation. A number of the

themes are not mutually exclusive and there is a degree of overlap which should be considered

when interpreting and responding to the feedback. To provide consistency across the 9 event

reports themes are listed in a set order, rather than in order of strength.

As mentioned above, a synopsis of the feedback is provided below with all feedback (as captured by

attendees) listed in the appendices.

Synopsis of feedback

Prevention/Education

There was support for improving access to healthy lifestyle advice, exercise opportunities for all age

groups. Comments highlighted the importance of starting healthy lifestyle education and exercise

from birth. When diagnosed with a condition or given a care plan people would like to see more

focus on what you can do to improve your health yourself and where you can get support.

13 comments of this nature were received.

Integration of Health and Care services

There was strong support for services including GP and Primary Care, community services, acute

services and social services to work more closely together. Better co-operation, communication and

patient record sharing between organisations to improve the patient experience and to speed up

services. Comments also focused on the need to have joint funding between health and social care

to create a smoother service for the patient and reduce duplication.

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16 comments received.

GPs/ Primary Care services

Comments focused on the wish to receive prompt GP appointments lasting an appropriate time for

their needs – have both short and longer time slots. There were suggestions that GP practices

should offer a wider range of in-house services such as blood tests.


Community Services

Support for community services was strong particularly in relation to providing rehabilitation, re-

ablement packages and care in patients’ homes following stays in hospital. It was felt that providing

better care in the community would ease ‘bed blocking’, reduce hospital stays and assist recovery.

Comments reflected that responsive and supportive packages of care were needed so older people

can remain at home for longer. People also felt that Telecare could also be used more widely.


Care closer to home

Comments were in favour of having more services available local or at convenient locations, such as

close to home or work. There was particular emphasis on the need for services to be available

locally for older people.


Service availability/7 Day services

Attendees would like to see more services available 7 days a week, with appointments available

across a range of services at evenings and weekends.


Access to services/ referrals

There was a focus on the wish to be able to access services in a timely manner through one point,

with less complex referral processes.


Mental Health – Adult

Comments focused on the need for stronger links between mental and physical health. Concerns

were raised that there were not enough facilities to manage mental health problems in the

community.


Voluntary Services

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People would like to see the development of voluntary services in Poole to encourage healthy living

and support people. Suggestions included more peer to peer support to manage long term

conditions and volunteer befriending schemes.


Transport & Parking

There was a concern about the difficulty of accessing public transport from Poole to Bournemouth

hospital. The high cost of parking at Poole and Bournemouth hospital was also raised as an issue.


I.T/Technology

Computer systems that talk to each other would be beneficial, so patients did not have to repeat

themselves. One suggestion included making more use of technology by having access to health

professionals via Skype.


Communication and information

The need to have easier access to information such as a directory of services was highlighted.


Staff and staff training

Comments included concerns about recruiting enough GPs and community nurses. People would

like to see skilled staff providing a high quality service.


Geography, Demography & Diversity (Service planning/Demographics and Age related concerns)

Contributors were keen that any planning should take account of the growing age profile in the

county and the different health needs of the population.


General Comments and Quality of Service

Comments included tough decisions need to be made and we cannot keep going as we always have

done. There needs to be a focus on the long term not just short term solutions.


Some comments of note were also received in the following areas:-

Community Hospitals – more publicity needed for the MIU at Wimborne. 2 comments.

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Mental Health – Children and Young People – develop more ways of educating young

people to help prevent a mental health crisis. 2 comments.

Carers – carer’s and/or family need more support. 1 comment.

Funding Concerns – need Funding and support for medicines compliance aids supplied by

pharmacies to aid independence / delay admission. 2 comments.

A & E - emergency services need to be able to cope with population peaks e.g. university

terms and summer vacations. 1 comment.

Pharmacy services – triage and provide minor prescriptions via chemists instead of through

a GP or a hospital visit. 4 comments.

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SECTION TWO: FEEDBACK ON ICS INFORMATION DISPLAYED IN THE INTERACTIVE INFORMATION

‘WALK-THROUGH’

After receiving a presentation on integrated community services attendees were invited to review an interactive ‘walk-through’ of information posters displayed on a series of boards. Staff were on hand to answer questions and local people were invited to capture their views on post-it notes reflecting on a) what they felt is good/positive about the ideas/proposals and c) what they feel should be given consideration/any concerns or questions they might have. The series of posters displayed information in the following areas:

Our Vision: Our vision for community health and care services – as informed by local people

– including what this would mean for local people, workforce and systems and the

importance of prevention, joint working, better access and IT.

Local Views: Local people’s views on community health and care services captured in 2013-

14 and in 2015.

Emerging models: The fact that different people have different needs requiring different

models of care and some emerging models that might meet these needs.

New ways of working: Examples of new ways of working that are already happening,

integrating community health and care services

Community vanguard proposals: Proposals and emerging ideas from community vanguards

– groups of GPs and other service providers looking at how the emerging vision might be

met locally.

Service specific information: Service specific information in a number of areas including

mental health, maternity, paediatrics and blood services.

Local voices matter: Comments from local PPEG members about why local voices are so

important.

The feedback captured on the posters largely reflected the themes identified in section one.

Positive comments were generally in support of the vision for integrated community services, the

emerging models of care and other information displayed (as described above).

Concerns tended to reflect those captured in section one.

The amount of feedback on each poster doesn’t lend itself to ‘theming’ – for comments on the

individual posters collected at this event please see Appendix 2.

Feedback on the posters has also been considered across all 9 locality based events and a more

detailed analysis is provided in the overall report – available to read on

www.dorsetccg.nhs.uk/events.

http://www.dorsetccg.nhs.uk/events

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NEXT STEPS

The ICS Steering Group, together with NHS Dorset CCG’s Engagement and Communication Team, will

work with colleagues and partners to coordinate the following:

Individual reports for each event and a ‘master’ report to be shared with health, care and

voluntary sector partners, Clinical Working Groups, Clinical Delivery Groups and Community and

Acute Vanguard Programmes.

Local views provided within the reports to be used to inform emerging models of care.

Frequently asked questions will appear on NHS Dorset CCGs website.

Suggestions made within the reports to be shared with appropriate groups or organisations.

Feedback, on how people’s views are used and responded to, to be shared with attendees and

other local people through the CCG’s “Feedback” bulletin and website.

Local people to be informed of further opportunities for engagement prior to public

consultation.

For further information or if you have any questions please contact

[email protected]

mailto:[email protected]

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APPENDIX ONE

SECTION ONE: WHAT WE NEED TO CONSIDER WHEN DEVELOPING COMMUNITY HEALTH AND

CARE SERVICES IN POOLE.

Prevention/Education

Prevention/education – teaching people to look after themselves in terms of physical/

mental health. Start from age 0, helping schools to educate.

Helping school staff to educate.

On diagnosis a care plan is discussed. What can you do to improve health by yourself, what

could be done if the situation worsens (what support is about, will they need re-hab / temp

residential care). Get people thinking about the what if.

Information and advice to enable people to keep themselves healthy – not too much

reliance on services being provided.

Evolving the community in educational events regarding healthy lifestyles.

Prevention is the key – screening.

Educating communities re independent self-care so that health care can be better targeted.

Better / more educations about health and social care.

Incorporate/embrace the outdoor areas in preventative care – obesity/depression/diabetes

etc.

Putting prevention at the heart of thinking and more emphasis on non-clinical solutions.

Education, education, education! We need to make the public more responsible for their

own health and lifestyle.

How can we support people to take more action to manage their health and plan for their

futures.

I consider that more investment ought to be made in community / preventative solutions.

Not just funding but there has to be acceptance that there will be risk and value is long term

and sometime difficult to evaluate.

Integration of Health and Care services

Good quality liaison between hospital, GP and patients.

Shared database of information sharing in health and social care.

More joint funding to increase free services to the public. E.g. medication administration,

incontinence support, equipment to support staying at home.

Better links between health and social care.

There should be far more cooperation between departments and there’s no excuse now in

the age of computers.

A joined up approach including prevention.

Link up services / integrated services.

Working closely with social care providers / councils etc to make positive changes.

Information sharing between all services.

Have shared information between agencies / hospital / doctors.

A joined up healthcare service - one budget.

Joined up communication between different departments.

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Joined up thinking - social care should be taken over by NHS so you get the full package.

Local GP led care in multi-disciplinary teams.

Communications from acute care to pharmacy and GP re discharge slow and sometimes

doesn’t happen. Means medicine errors and potential readmission.

More consideration should be given to how to effectively operate integrated care, especially

for vulnerable and elderly.

GPs/ Primary Care services

Warfarin clinics

Faster access to GPs

Increase scope for prescribing nurses, pharmacists diagnosis, giving medicine.

Stress levels of GPS and staff are palpable and have a negative effect on patients.

Patient education – so that not everyone feels short changed when they don’t see GP e.g.

Medicine review. Practice nurse for BP, phlebotomists for blood. GP if they raise issues.

Blood tests in GP surgeries.

Have blood tests in GP surgeries.

Service of small jobs / minors by specialist nurses.

Community physiotherapy access via GP.

Being able to see someone at my local GP practice or any practice?

Longer appointments for complex problems, shorter appointments for quick activities.

Ability to access doctors’ appointments.

Community Hospitals

Keep Alderney hospital and care of elderly people.

More publicity / encouragement for use of MI at Wimborne.

Community Services

Assistance to maintain independence when older

Community focus rather than hospital.

Increase capacity in care agencies.

Telecare for housebound vulnerable people and Skype visit from GPs.

Packages of care for older people to remain at home for longer – responsive and supportive.

Care at home – increasing time spent, increasing the skills for HCAs.

Telemedicine programme – iPad etc., manage me.

Work on improving the discharge journey especially in elderly or polypharmacy. Discharge

meds list – pharmacy with meds review to increase compliance and understanding and

lower re admissions.

Ensure enough post hospital care available so that there are no bed blockers.

More support for elderly people at home.

Convalescent homes.

Care in your home, good back up when you need it.

As is necessary do address the care home situation and care workers.

Short term support packages when elderly patients might have a fairly minor illness to

prevent hospital admission (similar to discharge package).

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Care closer to home

Think outside of the box – take services to people – they won’t’ necessarily come to you.

Local services.

Local availability – convenient especially for the elderly.

Keep it local where possible.

Simple services like blood taking closes to home and doctors.

Minor surgery at the surgery. Haematology at the surgery.

Continuity of care, patient centred care, local care but seeing the right person at the right

time.

Service delivery has to be accessible – closer to where people live / work / shop.

How can we take services closer to the prospective users/ communities?

Service availability/7 Day services

Ease of appointments for working people.

Later opening times for small hospitals such as Wimborne – could provide simple care and

remove waiting lists.

More out of hours services for full time employees e.g. physio / therapy classes.

Easy access 7 days per week – out of hours – flexible appointments.

Excellent extended Saturday services targeted at urgent not planned care, extend use of

pharmacies and community hospitals.

Provide better out of hours care for the public.

Higher consistent standards and availability of care at weekends.

Saturday is good for me – optician, dentist, pharmacy.

Access to services/ referrals

One point of access.

Access to services in a timely manner – acute community care, GP, rehab.

Ease speed treatment for simple treatment/diagnosis.

Consider how people are to access service and remove any obstacles.

Service demand.

Timely access to services in terms of availability – travel time and parking.

For there to be enough service to go around.

Appropriate appointments and appropriate times.

When necessary swift access to a clinician who knows my medical history and complexities.

Ease of access, locations, times, booking.

Options, I don’t mind travelling if I can get a fixed time within reason.

Walk in service.

Look at which access to points are used for service delivery – consultant / GP / nurse / A&E

etc are able to done by the lower denominator.

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Mental Health – Adult

Better ways to manage adults/children with severe/acute mental health problems in

community and their carers – avoiding hospital admissions.

Not enough facilities to manage adults with challenging behaviours / dementia / mental

health problems in the community.

Rapid access to mental health / counselling services.

Drug and alcohol services.

Better integration of mental health and physical services.

Link between physical / mental health needs to be stronger – within GP setting – joint

education.

There is little or no provision for patients with mental health problems e.g. councillors,

psychotherapists etc. The doctors do not have time to deal with these issues and do not ask

questions pertinent to depression etc.

Mental Health – Children and Young People

Mental health - developing ways of educating young people/children to make more aware /

prevent crisis.

Children and Young people

Don’t just focus on elderly – understand needs of young people’s services.

The importance of educating young people on the importance of physical and mental health

and where to get support is important.

Voluntary Services

Make best use of the voluntary services that are here in Poole.

Can we develop peer to peer support in managing long term health conditions.

More investment in low level early intervention schemes such as volunteer befriending

schemes (coordinated by paid staff) reduces isolation and prevents small problems from

escalating and health deteriorating.

Younger older people want to volunteer support les fit or older people – enable them to do

so by investing in volunteering organisations, infrastructure organisations to harness that

good will. Volunteers benefit too – wellbeing, self-development, new skills wider social

networks.

Carers

Don’t just treat the patient, the carer and/or family need more support.

Transport & Parking

Improved transport.

Take into consideration public transport.

Better bus service to RBH.

Easy transport – getting to locations.

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Transport links, parking car easily – park without paying.

Community transport encourages older people to get out and keep mobile and stay

connected. People on low incomes need help to travel.

I.T/Technology

Using IT more effectively, making it joined up.

Access to records and results – clinical monitoring. Support self screening.

Improving systems to improve the patient journey.

IT systems that talk to each other.

IT systems that talk to each other.

One clinical system I only want to tell my story once.

Different ways to ‘ask an expert’ phone, tablet/online, face to face, email.

Communication and information

Signposting raised an as issue, but there are many signposting agencies, so there is a danger

of overload of information. Maybe raise awareness of agencies where info is available.

Signpost services easily available if concerned about a neighbour.

Big drive on patient education to support ‘who do I call..’ therefore making the

communication between patient and healthcare professional clear.

Easily accessible advice when NHS 111 doesn’t fit the bill or provide the answers to avoid ED

attendances.

Staff and staff training

How are we/the NHS going to recruit more GPs? Can the government help?

Promote NHS jobs.

Quality trained staff.

High quality of staff.

Staff skill sets.

Lack of staff.

Make sure there are enough GPs.

Well informed

Skilled people looking after me.

Enough admin staff to keep things flowing – it takes a lot of work to keep things flowing

smoothly. Usually underrated.

More community nurses – bring back state enrolled nurses.

More doctors and nurses plus back up staff to work in community.

How can we attract more staff to work in an expensive area where transport links are poor?

Geography, Demography & Diversity (Service planning/Demographics and Age related concerns)

Better cultural integration.

Ageing population (80+) and baby boom.

Pockets of deprivation in Poole with poor health outcomes.

Better, quicker response to elderly issues.

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Ageing population.

Supportive care for ageing.

Think of all ages.

Changing health needs – age, diabetes.

Limited resources, living longer, more treatments more expensive treatments.

We have an older population who need more care – more paid carers, increased demand on

services esp. social care.

Older people need help to understand and negotiate health and social care services e.g.

advocacy support.

Older people and carers need swift access to assessment which are speedily followed up by

services. Weeks not months. Social care will money for health.

Funding Concerns

Funding and support for medicines compliance aids supplied by pharmacies to aid

independence / delay admission.

Cost pressures.

A & E

Emergency services able to cope with population peaks e.g. uni terms and summer

vacations.

Effective management of demand – dealing with people in the right way, non A&E cases not

going to A&E.

Acute Hospitals

Keep Poole Hospital A&E.

Pharmacy services

Use triage and minor prescriptions via chemists instead of GP or hospital visit.

Make STDs pay at pharmacies.

Funded emergency supplies at pharmacies to stop the 111 –pharmacy – 111- or – GP. Go

without meds once they realise they have to pay.

Community pharmacy used as a tool to aid accessibility of service delivery – extended

weekends and late nights.

111 Service/SPOA

Better call centre knowledge.

Single point of access to a local team – a team who ‘prevents’ admission.

Ambulance response times

A swift ambulance service to respond to 999.

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Service/Condition Specific Concerns

Excellent services for dementia care.

Poole maternity is such a fantastic unit – you don’t want to travel far when in labour so to

have to travel out of Poole would be horrendous.

Good quality.

General Comments and Quality of Service

Make some hard commercial decisions.

Avoid ‘not in my term’ culture. Spend £10m now to save £100m in 10 years.

We need to public discussion on funding should we be paying more for our health service –

we must convince our MP.

Long term planning not short term again.

Suitability of people’s accommodation. More people need to be encouraged to think ahead

and move to the appropriate accommodation.

Concentration of services. Out of choice if you cancer would you want to see a GP to be

referred or see a specialist. Too much spreading of services can mean people do not

develop the expertise.

The most important thing is to not just do what we have always done the way we have

always done it. It is in our gift to shape the future and deliver health in a more cost effective

and accessible way.

How can we make use of existing resources and skills in the community to support people.

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APPENDIX TWO

SECTION TWO: FEEDBACK ON ICS INFORMATION DISPLAYED IN THE INTERACTIVE INFORMATION

‘WALK-THROUGH’

The feedback provided for each poster that was commented on is listed below. To view all of the

posters displayed at this event visit www.dorsetccg.nhs.uk/events

Our vision for community health and care services – health and care system

Positive Comments:

Positive. I agree.

Prevention – use the echo.

http://www.dorsetccg.nhs.uk/events

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Our vision for community health and care - workforce

Concerns, questions and suggestions:

Community pharmacy – needs to be a partner to all that you plan to do. Engagement is key.

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Our vision – better access to services

Positive comments:

A great reassurance for patient and hospital: blood collection on GPs.

Excellent thinking

Yes – x-rays, scans, physio, basic diagnostics.


Minor aliments scheme in pharmacy.

National community pharmacy minor aliments scheme.

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Our vision - prevention


Health checks available at a maximum number of providers to improve uptake – not just one

provider.

Re-educate at first diagnosis e.g. what is BP why important to lower. What can you do to get

help yourself.

Offer personal health assessments to encourage people to take responsibility and engage in

preventative measures.

Fund advocacy services what are not just about problems, complaints but ensuring people

can access, understand this information advice, support.

Capacity build grass roots community organisations to disseminate health messages in most

appropriate way e.g. by word of mouth to BME community.

People only normally responds to health needs in a reactive way when it affects their life or

lifestyle, there needs to be a deeper understanding to promote proactive lifestyle choices.

Education – how is it working now, what needs to be true.

Start education early to encourage looking after your health. Encourage better lifestyle

choices e.g. youth organisations, scouts etc.

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Our vision – Information Technology

Positive comments:

This is long overdue

One system, one record with easy access for the patient.

SCR will help this for community pharmacy.

Much needed but the right system for 1* & 2* care needs. Scanned paper records are a

nightmare to navigate.

Link patients / family to IT for better input.

Have access to my records also allow all healthcare staff to see them – dentist included.

Speed to decision. Healthcare staff time wasted over records missing.

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Our vision – blood services

Positive comments:

We do at last. It is great.

Yes please but still provide access to an anticoag. Specialist nurse. This is important after

e.g. hospital admission when medication has been changed.

I am from Blandford this already happens and works well.


Community pharmacy more than able to deliver this. Pharmacists can support patient

journey from initiation through to ongoing monitoring and support and prescribing.

Community pharmacy based INR testing. Easily accessible. Likely to be within walking

distance or a bus journey.

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Our vision for health and care – views collected-


Important points to improve out of hours GP appointments. Public transportation more

frequent.

Community pharmacy up to 7 days a week, longer hours, closer to home/work/shop.

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Specialist Care Support for people with high intensity needs

Positive comments:

At 4 ‘joint care planning’ do you mean ‘joint’ with the person/patient? Are people

empowered through advocacy support to express their needs?

7 mentions person’s goals GOOD but person’s goals should be the focus from the start –

what constitutes quality of life for the person – before perceived needs.


Where is community pharmacist in this journey

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Different patients have different levels of needs


What are the various access points for service provision.

Where is pharmacy?

Where does cost fit with this rising level of need.

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Rapid access to health and care teams


This is an excellent model but requires much better front line assessment than NHS 111

currently provides.

Requires a lot of staff and money

Where is community pharmacy in this.

Could better 111 type services triage A&E and better direct non urgent cases?

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Routine Care

Positive comments:

My experience of GP services has been very positive. Pharmacy is linked to GP surgery.


Where is pharmacy first education in this model.

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Urgent and Unplanned Care

Positive comments:

If only people would do this


Again, where is pharmacy first education in this model.

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Creating community hubs


Would this not risk raising cost and diluting expertise.

Peer support groups could be the answer.

Community pharmacy and pharmacists on the high street 7 days a week.

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Weymouth and Portland Integrated Care Hub


Where is community pharmacy in this model

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Weymouth and Portland Integrated Care Hub – results so far

Positive comments:

Results show this works.

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Voluntary Sector Support in Purbeck - example

Positive comments:

Volunteers great for social support as long as they don’t’; start being expected to provide

care.


Need to encourage more volunteers for face to face contact with isolated people. Telephone

contact is sometimes not enough.

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Our vision for health and care services in Dorset – views collected


Need to improve transport links. Set up temporary accommodation close to community

hospitals e.g. prefab type buildings in hospital grounds.

Where are we going to get the people/staff from to provide these services as we want to

work 9-5 mon-fri so do the people you want to provide the 24/7 as and when services.

Direct access to nutritionists required not just for weight problems but for better drug

efficiency i.e. Vitamin K – warfarin.

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Co-producing Mental Health Services


Where is thinking of community pharmacies, part to play in Dorset CAMHS.

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Labour Line

Positive comments:

Excellent

A very good idea

This is needed.


Women should have the choice of hospital delivery.

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Maternity Services Vision


Provide clarity service for all but not every single service.

Breast feeding support lactation consults removed in Dorset?

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Paediatric Services


A community based paediatric expertise would be beneficial for the slightly more complex or

deteriorating child to prevent A&E attendance.

This is difficult to as a lot depends on how much the parents understand.

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Virtual Wards – joint working

Positive comments:

Cost effective. Technology will make this better.

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Virtual Ward - example

Positive comments:

How wonderful that the lunch clubs and befriending services were available what a pity the

GP / surgery did not think of social isolation as a cause much earlier on.


Please fund community development workers to develop culturally appropriate schemes for

BME groups and other hard to reach groups.

Please fund paid co-ordinators of local befriending schemes to harness volunteer goodwill

do not rely on lead volunteers every GP surgery could have a befriending scheme.

Please fund voluntary sector infrastructure organisations to increase capacity and maximise

efficiency of small voluntary organisations.

Bring back the old style rehab hospital, we need them closer to better transport links or in

towns.

Rehab units needed

Please fund local voluntary organisations to run lunch clubs, community transport,

befriending schemes. They are experts.

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Including young people


Talks at colleges

Schools have pastoral care services for children to link to.

integrated community services feedback from public ......community vanguard proposals: proposals and...

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