Healthy Caring Powys Start Live and Age Well

Healthy Caring Powys Start, Live and Age Well ‘Delivering the Vision – Discharging Our Duties in Relation to the Joint Area Plan’ 1

Joint Planning Framework Phase 3 3

Planning Alignment and Coordination A prosperous Wales A Resilient Wales A Healthier Wales PCC Corporate Improvement plan Other Corporate Plans A More Equal Wales A Wales of Cohesive Communities Powys Area Plan A Wales of Vibrant Culture and Thriving Welsh Language A Globally Responsible Wales PTHB IMTP THE HEALTH AND CARE STRATEGY FOR POWYS Powys Wellbeing Plan Powys Wellbeing Assessment 4

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Based on Wellbeing & Population Assessment 8% 15% 59% 26% Projected overall decline in the Powys population by 2039. Powys population aged 15 and under. (UK 18 Powys population of working age. · (UK 64%) Powys population aged 65 or over · (UK 18%), 58% of adults are overweight or obese (Wales 59%) 17% of adults reported their general health as fair/poor in 2014/15 20% of adults in Powys smoke (Wales 20%) 24% of adults in Powys binge drink at least once a week (Wales 24%) The number of young people and those of working age is predicted to decrease while the number of older adults in Powys is predicted to increase. Health Inequalities - Life expectancy in Powys is above average for Wales and continues to improve. There is a growing inequality gap in healthy life expectancy between the least and most well off areas and the gap is expected to widen over next 10 years. Isolation - Powys is the sparsest and most rural county in Wales with just 26 persons per km 2. Child Obesity The majority of 4 -5 year olds are of a healthy weight, however this is not evenly distributed across Powys and levels of obesity are higher in more deprived areas. Vulnerable Children The number of looked after children is low in Powys compared to Wales, however there are more complex needs arising. Children being placed on the child protection register is increasing, with neglect being the most common reason. Poverty Mental Health 8% of Powys population report being treated for depression or anxiety, it is one of the top 3 leading causes of disability. Young people are increasingly using mental health services in Powys, partly attributed to improved access to information and counselling. Carers Powys has a total of 16, 154 unpaid carer’s, 65% of these are over 50 and 39% are retired; their health is typically below average. Just over 1 in 5 children are estimated to be living in poverty in Powys (after housing costs are taken into consideration. Transport - Powys is ranked in the bottom 10% of Housing - Powys is the 6 th most expensive local authority areas in Wales in terms of access to services, particularly in terms of access to services by foot or public transport. authority in Wales to buy a house, based on ratio of household earnings and Land Registry house prices. 7

Based on What the People of Powys Said 8

Six Principles That Guide Us 9

Six Principles That Guide Us 10

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Lifespan – Start Well 12

Lifespan – Live Well 13

Life Span – Age Well 14

Enabling Objectives 15

Emerging Intended Outcomes by 2027 Working with the people of Powys, we have identified ambitious outcomes that will guide the way we deliver health and care across the life course ‘start well’, ‘live well’ and ‘age well’. ·I am responsible for my own health and wellbeing. ·I am able to lead a fulfilled life. ·I am able and supported to make healthy lifestyle choices about my mental and physical health, and wellbeing, for myself and my family. ·I have life opportunities whoever I am and wherever I live in Powys. ·The environment/community I live in supports me to be connected and to maintain my health and wellbeing. ·As a carer I am able to live a fulfilled life and feel supported. ·I can easily access information, advice and assistance to inform myself and remain active and independent. ·As a child and young person I have the opportunity to experience the best start in life. ·I have easy access, advice and support to help me live well with my chronic condition. ·I have easy access to support, information and early diagnosis. ·I have early intervention and treatment. ·My treatment and support is high quality, evidence based and timely, as locally as possible. ·I have timely access to equitable services as locally as possible. ·I am treated as an individual with dignity and respect. ·My care and support are focused around what matters most to me. ·I receive continuity of care which is safe and meets my needs. ·I am safe and supported to live a fulfilled life. ·I receive end of life care that respects what is important to me. 16

The Four Enabling Themes THE EMERGING INTENDED OUTCOMES TO BE ACHIEVED BY 2027 ARE: · Those who I need to support me are able to make decisions and respond because they are well informed and qualified. If they can’t help me directly they know who can. · As a carer, I and those who I care for are part of ‘the team’. · I can access education, training and development opportunities in Powys that allow me to secure and develop my skills and opportunities. · I am enabled to provide services digitally where appropriate. · I am engaged and satisfied with my work. · I am part of a thriving community that has a range of opportunities for health and social care, social events, access to advice and guidance services to support my well-being. · I have access to regional rural centres providing one stop health and care services – diagnostic, advice and guidance, day treatments, etc. which reduces unnecessary out of county travel. · I am encouraged and supported to utilise the great outdoor environment to support my well-being and care. · I am able to have my home adapted to help me to live independently and make me feel safe. · I have care in a fit for purpose environment that enhances my experience. 17

The Four Enabling Themes THE EMERGING INTENDED OUTCOMES TO BE ACHIEVED BY 2027 ARE: · I am able to find and do what I need online, such as make or change appointments, pay my bills, self assess or reach a doctor or consultant without having to travel. · I am helped to use technology and gain access to resources to allow me to be digitally independent. · As a Powys resident I ‘tell my story’ once and I am confident that those looking after me are working together in my best interest considering welsh language and cultural diversity. · The services I receive are coordinated and seamless. · I am able to access buildings and resources which are shared for multiple purposes, by multiple organisations. · My community is able to do more to support health and wellbeing. 18

Emerging Blueprint Model of Care 19

Emerging Blueprint Model of Care Out of County Hospitals Regional Rural Centres Newtown Llandrindod Brecon Wellbeing Community hubs Community Offer/Assets 20

Emerging Priorities 1. Community Development 1. Tackling Adverse Childhood Experiences Working with our strongly connected local communities to develop and strengthen community assets that support people’s wellbeing 2. Supporting Unpaid Carers Ensuring the well-being of carers before, during and after caring through information, advice and assistance, supporting skills and training development, opportunities for employment, respite and community support. 3. Prevention & Health Improvement Enabling and supporting people to make decisions and take actions to improve their health and well-being and avoid or reduce ill health through, for example, stopping smoking or increasing physical activity. 1. Mental Health Across all tiers, from health promotion through to specialist services focus on further improving integrated working arrangements and on wellbeing, early help and support and to include autism, alcohol and substance misuse, children and midwifery, learning disability and carers. 2 Cancer, Respiratory and Circulatory Further develop services to focus on early screening, information, advice and guidance to ensure appropriate signposting to help and support. Focus on meeting people’s holistic needs through more integrated working and new workforce models. This work will mainly be delivered via the Health Boards Integrated Medium Term Plan. Working with families we will make the maximum positive impact within the first 1000 of a child’s life, focusing on preventing adverse childhood experiences. We will do this through developing a joint plan to implement good practice guidance. 2. Primary & Community Care • Working within the primary care clusters and Third sector we will develop a population based approach to planning and delivery of health and social care. Further integrating primary care to improve accessibility via Wellbeing Community Hubs. 3. Managing Long Term Conditions We will support people to identify if they are at risk of developing a disease, and help them to reduce the risk and its impact by taking a wider, whole system approach to risk reduction and chronic condition management. 1. Care Co-ordination Build on the success of the two Integrated Team pilot sites in South Powys and further develop across the county in line with the Regional Centres and Community Hubs. 2. Unscheduled Care Reducing more avoidable emergency admissions and re-admissions of people with chronic disease, plus the frail elderly. 3 & 4. New model of care for Llandrindod and Machynlleth Assessment of current service provision, as well as working with the community to further develop a potential of the Regional Rural Centre and Wellbeing Community Hub, which deliver integrated health and care for the population. 5. Planned Care Closer to Home Prevent people having to go out of county to receive health and care and bring people in need of specialist care and support out of county back closer to home. 21

Emerging Priorities 1. Regional Rural Centre in Newtown We will look at the options for developing a Regional Rural Centre in Newtown to address the issues around the ageing estate, support the future population needs and mitigate against the potential shift of services away from north Powys under the Future Fit programme. 1 Staffing Model 2. East Radnorshire Wellbeing Community Hub Maximising the role of the workforce across all sectors including carers through an integrated approach will be fundamental to delivering the new model of care. New innovative models will be based on multi-skilled roles ensuring a shift to prevention and early intervention. Review service provision in East Radnorshire against the integrated model of care and existing community hub assets. 2. Partner Engagement Develop suitable accommodation that enables people to access basic services, build good relationships with neighbours and others, and maintain their independence, Develop a joint approach to using the collective knowledge, skills and experience of our staff and key stakeholders to inform and develop the work that we do. 1. Information, Advice and Assistance (IAA) Continue to develop IAA including the Community Connectors to enable swift access to local community support. 2. Implement Welsh Community Information System Continue to implement the WCCIS system across Powys to support care coordination 3. Telecare and Telehealth We will promote and roll out telecare and telehealth to enable people to self care and remain independent in their own homes. 3. Development of Wellbeing Community Hubs East Radnorshire, Machynlleth and Ystradgynlais are identified as key areas. In 2018/19, agree other areas for further development. 4. Supported Housing 5. Innovation, Improvement, Research and Development We will develop our evidence base, improve our ability to measure impact and seek to identify, share and embed good / innovative practice. 1. Safeguarding Continue to work with private, voluntary and independent sectors to ensure that Safeguarding remains every bodies business 2 Third Sector Commissioning Develop pooled budgets and joint commissioning arrangements for Third sector provision to support our increased focus on wellbeing, early help and support and IAA. 3. Care Home Commissioning Develop pooled budgets and joint commissioning arrangements for Care Home Commissioning to ensure those in need of residential and nursing care receive a seamless service. 4. Access and Transport: Miles Matter Review of non emergency patient transport and voluntary transport schemes to ensure future provision of community transport. 5. Welsh Language 22 We will improve the welsh language offer across health and social care services to improve equity.

Parliamentary Review – Recommendations • • Recommendation 1: One seamless system for Wales Recommendation 2: The Quadruple Aim for all • improve population health and wellbeing through a focus on prevention; • improve the experience and quality of care for individuals and families; • enrich the wellbeing, capability and engagement of the health and social care workforce; and • increase the value achieved from funding of health and care through improvement, innovation, use of best practice, and eliminating waste • • Recommendation 3: Bold new models of seamless care – national principles, local delivery Recommendation 4: Put the people in control Recommendation 5: A great place to work Recommendation 6: A Health & Care System that’s always learning Recommendation 7: Harness innovation, and accelerate technology and infrastructure developments Recommendation 8: Align system design to achieve results Recommendation 9: Capacity to transform, dynamic leadership, unprecedented cooperation Recommendation 10: Accountability, progress & pace Review of Powys Health and Care Strategy against the Recommendations • Similarities: • Put people in control • Care closer to home • Outcome based measures • New models of seamless care • Enhance use of digital • Innovating and learning • Great place to work etc. 23

Any Questions – Stay Involved 24