To scrutinise the assessment of the care and support needs of the population carried out jointly by the Local Authority and Local Health Board as required by The Social Services and Well-being (Wales) Act 2014 ahead of approval by the Gwent Public Service Board.

Phil Diamond delivered the presentation and answered the members’ questions, with additional comments from Councillor Penny Jones and Richard Jones.

Challenge:

Regarding Disabled Facilities Grants and their take-up, can you further explain the diagrams on p49?

We have been guided by elected members to look at the regional impact of the DFGs, which are available to any resident to adapt their home to enable people to live in their own home longer. But the cost of building materials has increased, while their availability has decreased. We’ve also seen the effect of fewer Occupational Therapists, who normally visit people in their own home to assess what modifications are needed. Again, this is an impact on the workforce; with fewer OTs available, we have seen increased waiting times for those assessments.

Recent Welsh Government guidance has introduced a financial assessment. Unfortunately, this is putting some people off – they feel that the assessment might affect them in other ways. But it is just meant to ensure that the right people have access to the DFGs. All of this compounds the issue and leads to a fear that fewer people will apply for the grants. It will be harder for those who don’t apply to live in their own homes, possibly leading to increased falls and hospital admissions. Across the region we are linking in with the 5 commissioning leads within social services and looking at the Welsh Government funding available to us to help with the larger homes’ adaptations i.e. those in excess of £36k. Because the pandemic is a backdrop to this work, other issues and challenges are likely to come to the fore over the next 12-18 months. Once mapping and impact analysis has been conducted across the 5 authorities, that could come back to this committee for a wider discussion.

One of the emerging priorities in Item 6, under Mental Health, includes “an increased understanding and awareness of mental health among the public to reduce stigma and help to seek support earlier.” How do you propose to achieve this?

Following publication of the PNA, we will be required to produce an action plan response, so all of the emerging needs will be highlighted and through an area plan we will set the actions to address them. The first place to start is children and young people – educating and informing at an early age about mental health. So, there is a huge amount of work going on in schools, particularly in Monmouthshire through the healthy schools agenda. In general, it is a case of public awareness. We have developed a website with the health board, called Melo, with information for the public about services and steps that they can take. Increasingly, people are more comfortable admitting that they are struggling with their mental health – a charity working with the Welsh Dragons is an example of a positive shift. We are working with schools and the third sector to get out as much information as possible and convey the message that help needed for mental health should be seen the same as help needed for physical health.

For continuity, Monmouthshire is purple on the graphs in the reports, but not consistently.

That’s a very helpful observation, thank you.

There is increasing pressure on carers, and demand for them, which seems to be unsustainable. How can Gwent cope in the future? Is funding similar in the 5 councils?

Yes, it does seem unsustainable. There is a focus through Welsh Government, specifically, a £1m carers grant that is distributed across Wales each year that enables us to look at regional solutions. We have a regional carers board, chaired by a director of social services, on which sit representatives from health, community sector, and carers themselves. The key point is that in order to support carers, we need to listen to them. We know that respite for carers is critical, which will require investment. People want more adaptable and flexible solutions. For example, a carer might only need to step away for two hours. So, the voice of the carer is paramount, and respite is the number one issue that keeps coming up. Access to information is also important. A single individual providing care for over 50 hours a week is unsustainable, so it’s a question of how we can support that. Welsh Government and the carers national strategy is very much focussed on this problem, as are regional boards, but it is not a problem that is likely to be solved in the immediate future.

Is there a possibility to look for respite volunteers amongst the family and community of those with dementia, particularly for small amounts of time?

Definitely. ‘Befriending’ is the term widely used for solutions of this sort and is something that the Alzheimer’s Society has taken on, for example. Some communities do this automatically. Some who retire want to give back to the community, so we have an opportunity with our ageing population to increase volunteering. Peer-to-peer support with carers is also important: dementia-friendly cafes, for example, have previously provided this sort of wider support.

Has the evidence been fed into the Gwent Well-being Assessment? How will it be used by the PSB to determine future priorities?

We have worked very closely for a number of years to ensure that there is alignment and synergy between the assessments. For example, the needs of carers will come up through the well-being assessment engagement exercises, but there’s no need for the WBAs to include information on carers because there is a statutory duty in the PNA to look at their well-being. But there will be signposts in the documents for where the information can be found, rather than duplicating it. The collaborative approach should lead to a collaborative response, so that overlap and duplication of efforts are minimised. In the PNA, there are highlighted boxes to signpost relevant areas in the well-being assessment. The colour schemes and font etc. are also consistent between the two so they are almost two parts of the same document. Comments from today will be fed into the final PNA when it goes to Council for sign-off. How we respond to the issues identified will present opportunities to work between what is now the Gwent Public Services Board and Gwent Regional Partnerships Board.

Chair’s Summary:

Thank you for the comprehensive presentation on an important piece of work. Education in schools to remove stigma from mental health issues is key. There has already been a great improvement compared to previous decades. Councillor Penny Jones reiterated the importance of this work and called attention to the Carers Strategy group that works across all agencies and supports carers. Welsh Government is now much more aware of their role. More respite facilities are clearly required. The increase in the age groups of the over 65s and over 85s is surprising and will engender much more support being delivered. The care issue is ongoing, bringing a huge strain on providers. Career structure and pay are key drivers for whether people choose to enter that profession.