To consider the proposed Model of Care for the North Powys Project.
Minutes:
Documents:
· Report of the Corporate Director (Children and Adults)
· North Powys Wellbeing Programme – Model of Care
· Impact Assessment
Discussion:
· A high level, extensive consultation with the public, staff and wider stakeholders had been carried out
· The next steps of the programme would see a more detailed design of the Model of Care developed
· The Model would be the delivery vehicle for the joint Health and Care Strategy approved in 2017.
· A key focus of the programme is around delivering care closer to residents’ homes and aims to keep residents as independent as possible for as long as possible
· There had been concern via engagement feedback that dementia did not have a section of its own, but it was considered under the wider issue of mental health
· Similar issues had been raised regarding younger disabled adults – the view is that the Model covers Start Well, Live Well and Age Well and single groups should not be singled out at this stage
· There had been criticism that the Model was too medicalised – the language had been adjusted but it was not possible to remove all medical terms
· The Citizens’ Pledge had been revised to soften the language regarding expectations of citizens
· The Project Manager was asked whether a desk top exercise had been carried out, the validity of the exercise and how many residents had been engaged in the process – engagement reports have been completed and were available to any Member
· The programme was ambitious and the level of risk was also questioned, for example whether it would be possible to recruit an adequate workforce etc – a risk register was in place behind the programme with workforce being one of the greatest risks. Workforce issues would become more apparent as a more detailed case is prepared and would be supported by a Workforce Strategy and plan. The right resources need to be in place to deliver better outcomes. Demand may also change if the prevention and wellbeing programme is effective.
· The programme intends to develop a campus approach incorporating education, housing etc
· The medicalisation of the Model was also a cause of concern. Within the document people are viewed as ‘patients’ which was not thought to be appropriate in a high-level document.
· The components of the Model are not described on an equal basis
· The Health and Care Strategy underpins the programme and the proposal must not be seen as provision of new medical facilities in Newtown
· Some elements were not mentioned at all
· It would be necessary to engage with all residents and ensure that there was awareness that the project was not exclusively for Newtown
· A bid for capital funding for site development would be made to the Welsh Government
· There is the potential for savings to be made and for the project to be delivered within the existing revenue budget. In time, the programme will influence demand as early intervention and wellbeing increases. There could also be a change to the type of services commissioned, for example less residential care or more technology enabled care to drive independent living.
· More emphasis should be given to other partners – it currently appeared as though the project was a joint arrangement between the Authority and PtHB but the 3rd sector was crucial. Communities need to be aware of all bodies involved.
· The Corporate Director indicated that the Model of Care was only part of the issue. Detailed design work would be the next stage. A broader update of the project should be provided to Members.
· The Engagement, Communications Specialist briefed Members on the level of engagement that had taken place. This began in June in Llanidloes and Newtown. Schools were also involved at an early stage. Communities were asked what helped them to keep safe and well in their own homes. Every library, apart from Montgomery, held an engagement session. Three hundred people attended these sessions and 1600 comments were received. Qualitative comments were received around transport, affordable housing, access to services out of county and mental health services. In the Autumn an engagement report was produced and published and was available at powys.wellbeing.wales. The second phase took place during December and January when comments received were shared. A survey was conducted on social media. The next stage is to produce a plan on a page.
· It was noted that there were proposed new builds at Cedewain and Brynllywarch Schools and it was asked if these schools had been consulted with. PAVO had undertaken consultation with Brynllywarch before Christmas. All town and community councils had been emailed with details of sessions. The same email had been sent to all Councillors in the north. Shaw Healthcare, day centres and residential homes had also been included. Further work could be undertaken with private businesses and with Care and Repair and domiciliary care providers.
· Transformation funding had been provided to support the project
· There seemed to be some contradictions – for example the Model indicates that children will be supported to achieve their full potential at school but at the same time, some schools were looking at redundancies. How can the ambition of the project be communicated to communities? A culture change was needed. The aim was to campaign as much as possible now to build a narrative around what is already happening.
· It was suggested that reasons were needed to enhance the recommendation given in the report. The Model will eventually be used across Powys but there is a significant reliance on citizens response. Austerity remains an issue and services are heavily reliant on goodwill and voluntary activity. Is it realistic to expect the project to be delivered?
· Further integration was needed, and a multi-agency approach would be beneficial for outcomes
· Identifying the demographic of participants was challenging. Surveys asked for resident’s age etc but very few, for example, complete the earnings question.
· Members were supportive of the programme but asked that the recommendation be strengthened.
Outcomes:
· The Health and Care Scrutiny Committee retain concerns regarding the medicalised model and primacy given to medical services included. The Committee would like to see a more positive attitude to in reach communities in the region. The Scrutiny Committee approves the model of care for more detailed design to focus on prevention, education and future support across Powys.
· The reason for this recommendation is to allow further discussion to take place between principal partners and encourage a change in culture in order to deliver the project
· Town and Community Councils to be reminded of the consultation process
Supporting documents: