board paper 2.12.14 item 14/277 - nhs wales 14_277...board paper 2.12.14 item 14/277 to improve...

Board Paper 2.12.14 Item 14/277

To improve health and provide excellent care

Title :

‘Together for Mental Health’ - North Wales Mental Health Partnership, Annual Report 2013-14

Author:

Wyn Thomas-Assistant Director, Partnership Development

Responsible Director:

Geoff Lang-Director of Primary, Community and Mental Health Services

Summary of Key Issues:

Together for Mental Health’ the cross-Government Strategy for mental health and wellbeing was published in October 2012. It set out an ambitious plan for improving mental health services and covers all ages. It reinforces the need to promote better mental wellbeing among the whole population and addresses the needs of people with mental health problems or a mental illness, ensuring those vulnerable people in most need receive the appropriate priority. To deliver the Strategy, Welsh Government established a National Partnership Board and required all Health Boards to establish Mental Health Partnerships to plan, monitor and performance manage series with senior membership across health, social care, housing, other agencies, third sector and service users and carers. In North Wales a Mental Health Partnership was established in 2013. These partnerships are required to provide an annual report to the National Partnership Board on progress against the actions identified in the ‘Delivery Plan’ (WG 2012) to support implementation. Attached is the second annual report, that was submitted on 31st October 2013 to Welsh Government.

Action Requ ired By Board:

To: (please tick all that apply) Note √ Endorse Ratify Approve

(Please provide a short summary against all that apply) Corporate Objective

Provides an update on progress against WG Delivery Plan for the Together for Mental

Key Impacts:

Health Strategy

Finance

Quality Impact Assessment

Standards for Health Services in Wales

Standards for Health Services in Wales 2, 3, 5, 6 7, 8, 9 10, 11, 18, 21, 22 and 25. The Mental Health (Wales) Measure 2010

Equalitie s, Diversity & Human Rights

Risk & Assurance

Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board

Board Coversheet v5.0 October 2014

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Together for Mental Health

Betsi Cadwaladr University Health Board Local Partnership Board Annual Report 2013 – 14

Contents

Page

1.0 Introduction from the Local Partnership Board Chair 3 2.0 Mental Health and Wellbeing in Betsi Cadwaladr University Health Board 2.1 Mental Health Measure Statistics

Child and Adolescent Mental Health Services 4 Adult and Older People Mental Health Services 7 3.0 Delivering Together for Mental Health 3.1 Promoting Better Mental Wellbeing and Preventing Mental Health Problems 10 3.2 A New Partnership with the Public 17 3.3 A Well Designed, Fully Integrated Network of Care 22 3.4 One System to Improve Mental health 30 3.5 Delivering for Mental Health 35

4.0 Summary and Conclusions: Looking ahead to 2015 and beyond 38 Annex 1 LHB Report against Together for Mental Health Delivery Plan Actions 2012 – 2016 39

Annex 2 Membership of the Betsi Cadwaladr University Health Board Local Partnership Board 79

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1.0 Introduction from the Local Partnership Board Chair I am pleased to present the second annual report for the North Wales Mental Health Partnership on progress in implementing ‘Together for Mental Health’. The report demonstrates continued progress of the partners in taking forward the actions required in the face of significant operational, financial and demographic challenges, and

highlights a number of innovations we are particularly proud of. The report also identifies some of the real service challenges we face. Of significant note is the role of our service user and carer members in working within their local communities to undertake meaningful research for the partnership on local issues and priorities to address, which are noted in the report, as well as the broader service user and carer input into mental health services across the region. This is invaluable in enabling us to assess the lived experience people have of services as well as supporting us in training and recruitment. The Health Board has committed to provide continued support to service user and carer involvement through re-commissioning a third sector service for a further 3 years to support this from July 2015. As part of the development of the partnership we have formalised links with the 5 local planning groups across the region, so that they are able to monitor local progress and address local issues. To promote this, local planning groups have been encouraged to ensure their membership includes areas such as housing and education, which are key issues for local services. In addition the chairs of the local planning groups are now members of the partnership board so as to provide that direct feedback and sharing of issues and innovation that is an important role of the partnership Board. The first part of this report highlights a number of key areas identified by the National Partnership Board for focus and therefore does not capture all our actions or progress to date, but the updated action plan in annex 1 provides a response to all the actions the partnership is responsible for. Over the next 12 months we will continue to progress the actions required and recognise the challenges that we will face given the continued pressure on public sector budgets, some re-structuring in the Health Board and the potential impact of the Williams review on local authorities in North Wales.

Geoff Lang Chair-North Wales Mental Health Partnership

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2.0 Mental Health & Wellbeing in Betsi Cadwaladr University Health Board This section highlights some key activity and quality information from the CAMHS and Adult Mental Health Services provided across North Wales.

CHILD AND ADOLESCENT MENTAL HEALTH SERVICES (CAMHS) Mental Health Assessments The charts below show information on referrals and activity for the first six months of the current financial year.

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Waiting Times and Numbers Mental Health Assessment Overall waiters have decreased as at the end of September 2014 although the West figure remains the same. The numbers waiting over 28 days have decreased significantly in East and Central with West increasing slightly.

Part 2 Care and Treatment Planning As at the end of September 2014 there were 81 patients who were reciving secondary mental health services, all had a valid care and treatment plan in place.

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Tier 4 Activity The following graphs show admissions and discharges for the North Wales Adolescents Unit, Abergele Hospital in 2014/15.

Detailed below are the monthly occupancy levels at the Unit shown in conjunction with the monthly vacancy factor. Data for the vacancy rate is not available from April – July; the overall vacancy rate for August and September was 21%, with the Band 5 Nursing Vacancy Rate standing at 42%

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ADULT AND OLDER PEOPLE MENTAL HEALTH SERVICES Part 1, Local Primary Mental Health Support Services (LPMHSS): Below is information on the referrals and assessments undertaken from April to August of this year by the Local Primary Mental Health Support Services.

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Part 2 Care and Treatment Planning Below is information on the number and audit results regarding Part 2 of the Mental Health Measure, Care and Treatment Planning.

(Information as at 23rd October 2014.)

Part 2 Transitions, CPA to CTP: (Welsh Government Target 90%)

Service Care Plan Total Percentage

Adult Mental Health CTP 3817 91%

Pending 292 7%

Standard 81 2%

Adult Mental Health Open Caseload Total 4190

Elderly Mental Health CTP 1123 93%

Pending 55 5%

Standard 24 2%

Elderly Mental Health Open Caseload Total 1202

Learning Disabilities CTP 131 100%

Pending 0

Learning Disabilities Total 131

Specialist Services (CRT) CTP 104 99%

Pending 1 1%

Specialist Services (Ty Llywellyn) CTP 55 95%

Pending 3

5%

Specialist Services Total 163

MH&LDS CPG CTP 5230 92%

Pending 352 6%

Standard 105 2%

Open Caseload 5686

MH&LDS CPG CPA – CTP Transition 92%

The above shows overall performance of 92% of eligible patients having a care and treatment plan in place as at 23rd October 2014. Of the audits undertaken, 1434 (94%) have met the minimum standards set by the Health Board.

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Part 3, Requests for Re-assessment, January 2014 – 22nd October 2014 The table below shows the number of requests for re-assessment that have been received under part 3 of the Mental Health Measure.

Service County

31/01/20

14 28/02/

2014 31/03/2014

30/04/2014

31/05/2014

30/06/2014

31/07/2014

31/08/2014

30/09/2014

31/10/2014

Grand Total

Adult Mental Health Mon 3 3 3 4 1 2 1 2 1 1 21

Gwynedd 1 1

2 1 1

6

Conwy 3

2 1

1

7

Denbighshire 6 3 10 5 7 2 6 5 2

46

Flintshire 5 2 1 1 3 3 7 3 4 1 30

Wrexham 12 6 11 7 5 6 15 7 11

80

Powys 2 4 3

2

2 2

15

Adult Mental Health Total 31 19 29 17 20 14 31 20 22 2 205

Elderly Mental Health Flintshire 2 1 3

Powys 1 1

2

Elderly Mental Health Total 3 1 1 5

Grand Total 34 20 29 17 20 14 32 20 22 2 210

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3.0 DELIVERING TOGETHER FOR MENTAL HEALTH 3.1 Chapter 1 - Promoting Better Mental Wellbeing and Preventing Mental Health Problems Partnership Board Vision It is the priority of the Health Board and its partner organisations to ensure that people in North Wales live longer, in better health and independently for as long as possible. We are also working within local communities in North Wales to ensure that people have access to services which will promote good physical and mental wellbeing.

What are the key challenges facing us? North Wales has a larger proportion of the population aged 55 years and over compared to the rest of Wales and a smaller proportion in the younger age groups. Increases in health and social costs are strongly associated with increasing age and it is widely projected that the healthcare of the very elderly will account for an increasing proportion of health and social care budgets in the future. This presents considerable challenges to providers of health and social care in the area. There is clear evidence that broad social and economic inequalities have a profound impact on health inequalities (Building Resilient Communities MHF 2013). Communities in North Wales have identified areas of deprivation such as Rhyl, Colwyn Bay and some areas of Wrexham. However, within rural communities there may also be hidden areas of deprivation (Public Health Wales). Unemployment, low income, access to affordable housing and low educational outcomes, as experienced in some areas of North Wales, are key factors which may impact on both physical and mental well-being.

What have we achieved in the last 12 months? A population mental health and wellbeing improvement plan for North Wales is in development. This aims to describe actions that might be taken by the Health Board and other partners to promote mental wellbeing, and to allow for the sharing of ideas and learning from activities undertaken. The ‘Five Ways to Wellbeing’ is being adopted as a unifying approach across different agencies, service delivery areas and population groups, and a suite of resources (briefings, postcards / posters, presentations) is being developed by the North Wales Local Public Health Team to support this. This work is progressing much more slowly than hoped, and the absence of any dedicated staff or other resource to support its development is likely to continue to hamper efforts to join up current initiatives across the region. BCUHB in partnership with Public Health Wales, has developed and launched a Maternal Mental Health Guideline, the purpose of which is to provide a standardised approach to identifying, assessing and caring for women who have or who are at risk of developing mental health problems during the perinatal period (i.e. including all pre-conception care, the whole of pregnancy, and the first year postnatally). The promotion of mental wellbeing for women and their partners is fundamental to this process. Several health professional groups provide both universal and specialist services for women and their partners with mental illness. Community midwives and health visitors are key to co-ordinating this care, supported

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by obstetricians, general practitioners, primary mental health support services and specialist mental health services as appropriate. The guidance sets out how these services should operate to ensure a consistent, integrated approach to early recognition and assessment of perinatal mental illness and the provision of timely, evidence based interventions. Recognising that the earliest years of life are crucial for the development of future emotional health and wellbeing, BCUHB is working with Public Health Wales to develop a strategy to achieve a comprehensive and equitable provision of universal, targeted and specialist services for families with children aged under 7 years. This work complements and is dovetailed in with the Maternal Mental Health guidance that covers the period from pre-pregnancy through to approximately one year post-delivery. To date a needs assessment, comprising a comprehensive summary of the evidence base for effective service provision to support emotional health development, an overview of the 0-7 years population and their circumstances, and a detailed mapping of services provided by Health Visitors, School Nurses, Community Paediatricians and specialist CAMHS practitioners has been prepared. This will inform discussions by a multi-disciplinary group leading to the preparation of a strategic plan to achieve parity of service across all areas served by the Health Board. Public Health Wales North Wales Team developed a resource to support the ‘Mental and Emotional Health, Wellbeing and Relationships’ element of the Healthy and Sustainable Pre-Schools Scheme. Following very successful piloting in settings across North Wales, this resource is now available to all relevant settings in Wales. ‘Mental Health Matters’ is a website developed by the Health Board’s Child and Adolescent Mental Health Service that provides help and advice to children and young people, parents and carers and people who work with children, so that they know what to do if they are worried about problems which may affect their mental health. It provides information for children and young people on keeping mentally well, dealing with worries and links to resources about the symptoms, diagnosis and treatments of common mental health problems. There are currently discussions about whether the site could be developed across the whole of Wales; a partnership between BCUHB specialist CAMHS and Public Health Wales is currently scoping what additional material might be useful for it. The Mental Health Matters Project was shortlisted for the Cymru/Wales 2013 CIPR Pride Awards. In preparation of the launch of the second suicide strategy; Talk to Me 2, a regional suicide and self-harm prevention network has been set up across North Wales and includes representation from Child and Adolescent Mental Health Services and other children and family services and will develop an action plan / priorities around the new Strategy, including delivery of training. A modified version of the training is to be made available for younger people. The Bangor University Nightline, work of the Samaritans, the North Wales CALL helpline plus the delivery of ASIST and Safetalk training all continue to contribute to the work to prevent suicide and self-harm across the region. Integrated Family Support Services (IFSS) are now in place across North Wales, although there have been recruitment issues in some areas. In two of the areas which have not previously had an IFSS, the service has been built on current therapeutic provision to support the most complex families. Team Around the Family provision has been in place

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across North Wales for some time, and this service is increasingly working with families with complex needs but who do not receive a service from Social Services. 2199 families have been referred to Team around the Family since 2012. A North Wales’ third sector Mental Health Commissioning Strategy has been developed and approved by the Health Board. This will be taken forward this year with the aim of having commissioned revised Service User and Carer and Community Mental Health Advocacy services from July 2015. The next stage of the implementation is to re-commission services for carers and the development of the services that support the Recovery Education College from April 2016. Current evidence suggests that the best approach to preventing dementia includes advocating healthy lifestyles and suggests that maintaining or adopting lifestyle changes is especially important in mid-life (i.e. 40-64 years of age). By tackling the lifestyle risk factors in middle age, an individual’s risk of developing dementia could be reduced by approximately 20%. In line with these recommendations, there are several projects within North Wales which have been set up:

The Inspiring Action Dementia Project is a regional project led by North Wales Social Services Improvement Collaborative and takes a whole population approach and aims to develop evidence based practice around the different stages of dementia care, including pre-diagnosis, diagnosis and then the various stages of cognitive impairment as the dementia progresses.

The National Ageing Well Programme has well-being of older people very much at its heart and is being led by the office of the Commissioner for Older People. The programme is due to be launched on the 22nd October. In North Wales, a network is being developed to complement the national programme. There are 5 key themes to the Ageing Well Programme, namely Age Friendly Communities, Dementia Supportive Communities, Falls Prevention, Loneliness and Isolation and Economic Activity for Older People.

The North Wales Social Services Improvement Collaborative also held a series of six multi-agency events (one per Local Authority) in spring 2014, presenting models through which wellbeing could be conceptualised, and identifying key factors felt to influence older people’s wellbeing. Further work on recognising the impact of loneliness and isolation on older people’s health and wellbeing has taken place, and consideration is being given as to how this might be addressed.

The priority of physical health promotion and improvement activity for people with a mental illness is recognised in policy, strategy and action planning in North Wales. The Director of Public Health annual report focused this year on the need to take an assets as well as needs based approach to improving health and wellbeing. A Public Health Consultant is a core member of the Mental Health Clinical Programme Group (CPG) Board. The CPG submitted evidence for Standards for Health Services: Standard 3 Health promotion, Protection and Improvement to the Health Board Star Chamber. The BCUHB obesity pathway plan has been approved and a business case is in development. Those public health practitioners working in and leading the alcohol work stream liaise regularly with the Mental Health CPG alcohol leads, and Alcohol Awareness Week is promoted both within the CPG and Occupational Health. BCUHB has the Gold Standard for Corporate Health.

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Recognising the importance of lifestyle health risk behaviours to physical health and the development of non-communicable disease (CVD, Diabetes, Cancer etc.) and obesity, BCUHB Mental Health Clinical Programme Group (CPG) has been working with the North Wales Public Health team for several years to help improve prevention activity. Promotion and support to stop smoking is seen as a priority. A Mental Health CPG Tobacco Champion is an active member of the Health Board Tobacco Group and the CPG is implementing the BCUHB Smoke Free Tobacco Policy, and NICE Guidance for Mental Health and Smoking. All smoking rooms are closed, smoking status is recorded and those who smoke are offered brief advice, support to stop smoking while an inpatient, including NRT and continued support on discharge. The CPG Tobacco Champion took part in an annual Tobacco Workshop held in March this year, where it was decided to develop Smoke Free Groups in each of the 3 areas of North Wales – East, Central and West. A representative from the CPG will participate in each group helping to further embed the use of the Smoke Free Policy within this patient group. The CPG takes part in all annual mass media promotions for smoking cessation (Stoptober – Sept/Oct; No Smoking Day - March; and Resolutions – January). One of the challenges is to engage mental health CPG staff who smoke and support them to stop and remain smoke free, thus leading by example. The Health Board supports staff by providing paid time off to attend specialist stop smoking services either in the community or hospital base. Stop Smoking Wales staff in North Wales have all undertaken the training to be able to deliver specialist advice to those with a mental illness. Mental Health CPG staff also receive Brief Intervention Training. The Primary Care Tier 1 Tobacco Group is working with General Practice to improve referrals of patients with mental illness to specialist stop smoking services which is four times more likely to be successful in stopping smoking.

What are our service innovations? ‘Pregnant Together' is a service improvement pilot, based in Rhyl. It supports BCUHB’s implementation of ‘A Strategic Vision for Maternity Services’, which requires maternity services to focus its direction on improving health inequalities through the delivery of key public health messages and by keeping women and their families central to all decision making by service redesign. It has the potential to impact positively on outcomes for both mother and baby through building confidence and helping women develop supportive social networks. Current antenatal service delivery is based on one-to-one 15 minute midwifery led appointments between midwife and mother, and as parent education groups are held separately, some women do not attend. The project (supported by funding from North Denbighshire Communities First) will support BCUHB to pilot a new approach to delivering antenatal care and parent education to women. The project will determine whether a group based approach to routine antenatal care in North Denbighshire, provided in partnership between generic community midwifery services and Flying Start midwives, is appropriate as a service model to provide maternity care, and whether it facilitates the uptake of Flying Start services during pregnancy and in the postnatal period. The evaluation (which is being supported by Public Health Wales), will consider how well the new model supports participants to:

engage with self-monitoring and parent education activities

understand the importance of their own health, and the impact of some health behaviours on their baby

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take up their entitlements to services postnatally (e.g. baby massage, Incredible Years parenting programme, etc.).

The launch of the Family Bereavement Service will create a regional network of voluntary and statutory agencies, offering differing levels of intervention to children and families who have suffered bereavement / about to suffer bereavement. The Service will link in with the Welsh Government bereavement standards but also needs to incorporate the local voluntary sector and local authority services in this area.

The North Wales Public Health Team is in the process of developing a local version of MECC (Make Every Contact Count) in line with national guidelines. This training package will address key health risk behaviours, by providing brief or very brief advice in all areas of physical health risk (exercise/ inactivity; nutrition; alcohol consumption and smoking). Being sedentary has recently been identified as an independent risk factor for non-communicable disease and the promotion of increased activity and good nutrition can help in giving up smoking or changing drinking habits. Together with service developments to support behaviour change, MECC is seen as a central element of improving the health of people with long term mental health problems. There have been a number of community initiatives and training events taking place which have been organised by the third sector within Wrexham and Flintshire. Hafal have two community gardens in the Wrexham areas and have been working in the outdoor areas at the Heddfan Unit, Wrexham Maelor growing vegetables. Day services have been working with Chirk Hospital to develop their gardens, this has provided outdoor therapy, whilst giving people the opportunity to engage in the community, and enable and increase confidence. Some of those involved in the project have since gained employment. Feedback from parent and carers of those involved indicate that the progress made has exceeded their expectations. The Health Board’s ‘Arts in Health and Well-being’ initiatives are providing a range of arts therapy interventions across age groups and across the region, often working in partnership

with the third sector. In 2013-14 the following initiatives were supported:

CAMHS – Art Psychotherapy group and individual work

Older Persons Mental Health – Music Therapy Dementia Assessment

Singing for Breathing initiative – (community based mental wellbeing and prevention of mental ill health).

Music Therapy (prevention of mental ill health, 3 pilot/intro sessions)

Acute Art Therapy. (Hergest Unit and Community Group, and ‘Art Therapy Outdoors` Group)

YGC Artist in Residence - arts vehicle supporting mental wellbeing) Care Homes: Chirk Court forms part of the Clwyd Alyn Housing Association Group of Care Homes, established under the Pennaf Housing Group Umbrella company. The home has provided residential placements in excess of 23 years with a registration for 35 persons. As part of a continued joint work programme with Wrexham County Borough Council and the Health Board, a needs assessment is being completed of older persons within the Wrexham geographical areas and beyond, to respond to ageing populations and increased numbers of older people requiring support. The Home and Mental Health Dementia Group have developed plans to develop the home to accommodate 66 residential placements. As part of the redevelopment the home will operate 10 residential very dependent elderly places with the additional 56 places dedicated to elderly mental health dementia residents.

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The environment will be designed to enhance enriched dedicated dementia care with the redevelopment of the home. Additionally as part of the progressive reskilling of Care Practitioners the home has worked with Wrexham Local Authority, the Health Board and dedicated training providers to train staff to the highest standards of dementia care delivery, undertaking a brand new pilot scheme to develop care staff to Diploma level 5, advanced practice, diploma unit accreditation. This will be accompanied by a recruitment strategy in 2015 to develop new posts to support the development and enriched care delivery strategy within the home. The home’s redevelopment follows a structured 2 phase approach with phase one the addition of the first 28 dementia care dedicated beds, followed with phase 2 shortly thereafter; all the work will be completed by Mid-2015. Chirk Court has developed an excellent care service reputation locally within the Wrexham area and is investing over £4 million in the development of the home, maintaining high staff retention levels, gold standard Investing in Peoples Award and an impressive accolade of being within the Financial Times top 100 employers list. Dementia Care in Extra Care Housing Schemes: A number of Housing Associations in North Wales in partnership with the Health Board and various County Councils have or are considering developing state-of-the-art supported accommodation to help older people with care and support needs - including dementia - to live independently for as long as they possibly can. The most recently developed Extra Care Scheme is Llys Jasmine, which has been built for Wales & West Housing in partnership with Flintshire County Council. The 61 apartment complex includes 33 one bedroom, 28 two bedroom and 15 apartments specially designed for people with dementia, plus an additional two, two bedroom bungalows. Care staff will be available 24 hours a day to deliver care in emergencies or in response to individual care plans. Llys Jasmine features dedicated apartments for people with dementia alongside integrated extra care facilities. Other similar schemes are in the pipeline in other areas of North wales.

Our priorities and actions for the next 12 months The coming year will see further activity in the development and implementation of Make Every Contact Count (MECC) for people with mental health problems, and in promoting smoking cessation and smoke-free environments. Expansion of universal and targeted mental health and wellbeing promotion activity is recognised as a fundamental aspect of taking forward the Health Board three-year plan as well as the Together for Mental Health Strategy, and efforts to identify the resources needed to support this will continue. In Arts Therapy we will progress:

CREATE` Conwy Venue Cymru (Arts collaborative project with Conwy Looked After Children – Conwy partnership multi agency)

NWAS Arts in Health Residency Project 2014.15

YGC Dementia Friendly Environment (YGC Arts Strategy/Development Project)

BCUHB & Gwynedd Council Adult Art Therapy Community Group 2014.15 – re-design/enhance access to Art Therapy in community/primary care

All Wales Veterans Health & Wellbeing (North Wales) General `Creative Well `Programme interfacing and collaborating with arts & mental wellbeing partnerships (e.g. Arteffact, museum based workshops) and university research

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An intergenerational practice is being developed in one area with a view to expanding across North Wales over the next twelve months. This will involve older people’s services, Communities’ First, Flying Start, housing providers and Supporting People services. The aim of the service is to have an early intervention support provision within the community with generations supporting each other and sharing skills.

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3.2 Chapter 2 - A New Partnership with the Public Partnership Board Vision Ensuring that people of all ages are better informed about mental health and mental illness is a priority of the North Wales Mental Health Partnership Board. This includes sustainably reducing the stigma and discrimination faced by people with mental health problems.

What are the key challenges facing us? Due to the rurality of some areas of North Wales ensuring that Welsh speakers are able to access linguistically appropriate mental health treatment and care where they need it is a challenge. There is currently a gap in the amount of Welsh speakers within some teams and the absence of Welsh speaking psychiatrists is a significant gap in our current service provision. Ensuring that service users feel listened to and fully involved in decision making about their care is an ongoing challenge and there is commitment to ensure that services are planned and delivered based on safety, dignity and respect.

What have we achieved in the last 12 months? Tacking Stigma & Discrimination A Time to Change Wales coordinator is currently being hosted by Hafal in North Wales. The overall aim of the project is to reduce mental health related stigma and discrimination. The project trains and supports ‘eductators’, these are people who have lived experience of serious mental illness, to speak about the stigma and discrimination they have faced. The North Wales Coordinator has trained twelve people to become educators since starting in post in November 2013. Educator talks have been delivered to a wide variety of organisations; social services departments, working links employment service, Job Centre plus, Independent Living, Mensheds, DVCS, Core Assets and the Welsh Government. Hafal have been tasked with recruiting educators in the workplace to discuss stigma and discrimination on behalf of Time to Change Wales, there have been fifteen people recruited in the Wrexham area. They attended the MOTIV8 event which was held in Wrexham which aims to reduce stigma and discrimination and encourage participation amongst people with diverse needs. Social media is being used widely in the Wrexham area. An ABF project is in place in South Wrexham which was identified as an area where stigma was a particular issue. There has been success in engaging the community with events such as workshops and food banks. The Health Board and the six Local Authorities have not yet signed up to the Time to Change campaign, the partnership received a presentation on the campaign at its meeting in June and the organisations will now consider signing up on a collective basis.

Service User & Care Engagement To ascertain young people and their families views, and experiences, of the service, and with the subsequent aim of improving services, North Wales Adolescent Service currently:

Hold monthly young person’s liaison group meeting (in patient)

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Have young people on staff interview panels

Collate patient questionnaires (both in patient and KITE) and referrer / family upon discharge which are regularly audited

Supports regular independent advocacy services and Independent Mental Health Advocate (IMHA) visits

There are also plans to run fortnightly parent / carer groups for inpatients in the near future

Young People have regular therapeutic sessions, case manager meetings and meeting with

their IMHA, if they choose. When a young person is admitted to the North Wales Adolescent

Service an initial meeting is arranged with an IMHA for each young person so they can

choose if they would like regular meetings or not. NWAS also has a contract with an

independent advocacy who visits regularly to meet with the young people. A Young Persons

Liaison Group takes place once a month and issues are raised by the young people there.

The Health Board commissions Unllais to support a number of adult service user and carers across North Wales in undertaking a broad range of functions as demonstrated below;

Services users & carers involved in the development of the Acute Care Pathway

Service users and carers training staff, 3rd sector organisations and other service users and carers in the Mental Health Measure as co-facilitators.

Service User & Carers working alongside Bangor University school of nursing to recruit and train and assess nursing students.

Service users & carers involved in recruitment and selection panels almost on a daily basis. Involved in all level of interviews from administration staff to consultants.

Service users and carers involved in improvements in all inpatient units.

Service users and carers facilitating patients’ forums in all inpatient and rehabilitation units.

Service users & carers actively involved in the Flintshire training partnership including developing, delivering and assessing training.

Service user and carer involvement in specifying commissioned services and involvement in evaluating tenders and agreeing preferred providers.

There is a service user and carer representative from each local authority area in place as a member of the partnership board. The partnership team hold pre meetings with the service user and carer representatives and Unllais before each board meeting. During the meetings, the agenda for each board is discussed with the representatives and two priority topics are selected through a group discussion. The representatives then research the chosen topics within their own locality; housing and carers issues have been topics in the past year. Reports are then presented back to the partnership board and actions agreed to address issues. This approach has proved to be effective as the service user and carers representatives engaged with members of their local community who are currently experiencing the services being researched. The partnership board have found this information very informative and the issues identified will be addressed as part of the action plan. A second ‘Measuring Up’ conference of service users and carers was held on 2nd October 2014 to consider a range of issues affecting local services. Over 80 people attended and contributed to discussions around;

Primary Care

Welsh Language and Rurality

Care and Treatment Planning

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Moving on The conference highlighted a number of issues and concerns that need to be addressed by the partnership going forward including;

Not enough services available in the Welsh language

Importance of services for older people being available in Welsh

Lack of communication between services

The impact of benefits on patients mental wellbeing as well as an obstacle to involvement

Employment and housing

Variation in the quality of and the process of developing and agreeing care & treatment plans, including carer input

Level of general training and awareness around the measure and care and treatment planning

Access to GPs

Variation in GPs awareness of mental health issues and services

Attitudes in primary care The conference also considered the progress to date of the North Wales Mental Health Partnership, the role of the local service user and carer board representatives, received an update on the development of the annual report and had an opportunity through the table discussions to contribute to the identification of priorities for the partnership over the coming 12 months.

The adult mental health services, in conjunction with Unllais, have recently undertaken a Picker survey for all acute inpatient wards. The sample size was 1095 patients and there has been a 27.4% return rate which Picker report as excellent. The survey report will be used to benchmark services against other mental health services. A Care and Treatment Planning Programme promoting good practice guidance and training was introduced in 2014 and has been extended until the end of 2014. However demand exceeded availability for the courses and an additional four courses have been organised. Planning will begin shortly for the course programme in 2015. Following a review of current third sector commissioned services, the Health Board agreed to re-commission services to support service user and carer involvement and engagement and community mental health advocacy services for the area from April 2015.A number of engagement events were held in agreeing the commissioning priorities for the Health Board and service users have been involved in developing the service specification and will be involved in assessing tenders and making recommendations on letting.

Carers

A focussed piece of work for the partnership, by the service user and carer board representatives, on issues facing ‘carers identified the following main gaps in the services:

Respite services- small breaks for carers

Advocacy services inducing outreach advocacy services.

There is a lack of support groups/ forums where carers can go to talk to others in similar situations and get information on issues that affect them.

Lack of services in rural areas. Conwy Valley was mentioned but this would also be relevant to other rural areas across north Wales.

Support for carers when the going gets tough

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The above could be addressed;

By providing more information on what is available in the local areas and how it can be accessed without having to ask for it.

By having more information on illnesses and medication

By delivering more staff training on the importance of carers and their rights

Equality & Diversity

Progress has been made in relation to first language Welsh patients having access to Welsh speaking staff, reception staff have been trained and more Welsh speakers have been employed since the previous audit. Three Polish speakers have been employed in Wrexham. A ‘More than just words’ workshop regarding dementia issues was a success. The implementation of changes to Older People’s Mental Health services in North Wales was subject to Equality Impact Assessment screening. This work continues and previous equality impact assessments have been reviewed and updated as services are developed and changed.

What are our service innovations? The Mental Health Matters Website is being developed further across Wales to include a user friendly focus for Children and Young People. The North Wales Adolescent Service, based at Abergele, consists of a 12 bedded in-patient ward and a community intensive support team (KITE).Young people are admitted on average for a stay of 8-12 weeks, with shorter periods of care within the KITE team. There is a courtyard area with the unit which was previously unused. Young People have been involved in a project and helped to design somewhere to meet their needs whilst there. It now has a gazebo, water feature, lighting, plants and will be used as a therapeutic space as well as used for relaxing and socialising. Unllais’ website has been updated to include a printable version of the mental health directory and also has links to health and wellbeing information. Unllais are also offering other organisations the opportunity to be included within their directory.

A proposal to develop a Recovery College has been agreed and Unllais have been asked to support the North Wales Recovery Network to support its establishment The Recovery College will build on existing good practice in the local area, delivering education and awareness raising sessions for staff as well as service users and carers and shared learning across statutory and third sector services. Hafal have been running training across Wales entitled ‘How to get a great treatment plan’ for service users and carers. There has been a very high intake in the Wrexham area, with a

waiting list in place. Our priorities and actions for the next 12 months The North Wales Mental Health Partnership Board will progress the proposal of BCUHB and the six Local Authorities signing the Time to Change Wales pledge together, extending the invitation to other public sector organisations in North Wales.

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North Wales Adolescent Service will undertake a project in 2015 called Experience Based Co-Design (EBCD); EBCD is an approach that enables staff and patients (or other service users) to co-design services and / or care pathways, together in partnership. The approach is different to other service improvement techniques. EBCD involves gathering experiences from patients and staff through in-depth interviewing, observations and group discussions, identifying key ‘touch points’ and assigning positive or negative feelings. A short edited film is created from patients interviews. This is shown to staff and patients, conveying in an impactful way how patients experience the service. Staff and patients are then brought together to explore the findings and to work in small groups to identify and implement activities that will improve the service or care pathway. A bilingual pathway is being developed by BCUHB. There is a specific bilingual service development group within adult mental health services which has a wide representation from across the service. Work is ongoing to explore how the referral information can be improved to include the offer of a service bilingually. The Health Board and Local Authorities offer a range of Welsh language training courses. Work is ongoing to develop a Welsh language course specifically for mental health staff. We will continue to look at innovative ways to attract Welsh speaking medical staff. We will re-commission services to support service user and carer involvement and community mental health advocacy from the third sector for the next three years and progress work in relation to carers support. We will progress the establishment of the North Wales Recovery College and identify the priorities for third sector services to support the infrastructure of the College and the education and learning components. Following the feedback from the ‘Measuring Up’ workshop we will work with service user and carer board members to undertake more work around the areas of primary care, care and treatment planning and language issues to develop an action plan to address concerns and issues highlighted.

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3.3 Chapter 3 - A Well Designed, Fully Integrated Network of Care Partnership Board Vision Our vision is for service users to be able to access a range of safe integrated services as timely and local as possible.

What are the key challenges facing us? As North Wales hosts some very rural areas, delivery of veteran’s services is a challenge. Transport and the associated costs are an issue for many. Support for the families and carers of veterans is also important. Ensuring an effective transition between adult and CAMHS services is a priority for services. The Health Board has faced some issues around services at the Hergest Unit in Bangor and in Tawel Fan ward in the Ablett Unit. The Health Board commissioned a review by the Royal College of Psychiatrists in October 2013 of the Hergest Unit which was subsequently followed by a HIW inspection in December 2013. These reviews have identified a number of issues including;

Poor professional relationships

Low staff morale

Dignity of care issues

Estate issues

In response to these the Health Board has developed an action plan to address the issues identified and has strengthened the management by appointing an experienced, Interim, Director of Mental Health Services. Following concerns identified regarding the care provided to patients on Tawel Fan ward, a 17 bed ward providing assessment and treatment for patients with dementia, the Health Board in December 2013 agreed to close the ward on a temporary basis and transfer patients to Bryn Hesketh Unit in Colwyn Bay. As of October 2014 the ward remains closed. The Board launched a comprehensive investigation into the issues raised about patient care on Tawel Fan ward in December 2013 and have been working with partner organisations, including Local Authorities and the police in line with the procedure for the Protection of Vulnerable Adults (POVA).

What have we achieved in the last 12 months? Service Innovations to improve Quality and Safety All CAMHS Teams in BCUHB are members of the Quality Network for Community CAMHS - a Royal College of Psychiatry quality and audit programme, gaining accreditation to the RC for achievement of a set of standards - The Quality Network for Community CAMHS (QNCC) is a professionally-led network of child and adolescent mental health services (CAMHS) managed by the Royal College of Psychiatrists’ Centre for Quality Improvement. Its aim is to facilitate quality improvement and development through a supportive peer-review network. Participating teams annually complete a self-review and receive a one-day peer review, where other CAMH professionals visit the service. It enables teams to demonstrate progress against national standards.

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Following the review process, teams receive a detailed report which identifies performance against the QNCC standards. Where two or more teams in a service are participating, members also receive a service-wide report which aggregates team scores to show how the service is performing overall. The QNCC standards have been mapped to current policy including the National Service Frameworks, the Standards for Better Health, the Healthcare Standards for Wales, and standards developed by the Clinical Negligence Scheme for Trusts. This means that services can use local reports to demonstrate compliance with these national standards. The CAMHS Service Board (formerly CAMHS planning network) continues to ensure that robust governance arrangements are in place for CAMHS service development including requirements for training, workforce requirements, performance monitoring, achievement of targets and the implementation of outcome measures in CAMHs. A workforce group is looking at the future requirements of a workforce strategy that aligns to policy and core skills and competencies required to address the needs of Children and Young People who require CAMHS. The Mental Health and Learning Disability clinical programme group (MH& LD CPG) supported and instigated development of a range of training in relation to the Mental Heath Measure (Wales) 2010, inline with the Welsh Government Mental Health Measure (Wales) 2010 Training Resources. 91% of MH&LD CPG staff members and 353 members of staff outside of the clinical programme group have received Mental Health Measure Foundation training. 51% of eligible care co-ordinators have been trained in Quality Management in Care and Treatment Planning. A further five sessions are to be delivered in 2014 of Quality Management in Care and Treatment Planning, which will accommodate a further 100 eligible care co-ordinators. A further four half day sessions of Mental Health Measure Foundation Training are to be delivered during 2014 this will accommodate a further 100 staff members. The 2015 training programme will see the Mental Health Measure Foundation Training delivered at least four times per year to accommodate new staff members and the Quality Management in Care and Treatment Planning training will be run for sixteen sessions to accommodate the remaining or new eligible Care Coordinators of the MH & LD CPG.

Access to Psychological Therapies We have completed the capacity and demand report about access to psychological therapies and have improved the data reporting system, identified the areas of greatest variance and an action plan has been developed. In 2013 -14 BCUHB was allocated £45,000 by WG to improve training in Psychological Therapies from the WG. BCUHB consulted with staff to identify priorities for development, and trained 30 members of staff in Mindfulness, Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behaviour Therapy (DBT).The Health Board has invested in staff from all areas of mental health services, including nursing and psychology, across primary and secondary services, adults and CAMHS, who are now using these skills in the workplace.

Training to increase capacity has been developed in two phases. Staff from BCUHB have completed a course for cognitive behavioural therapy (CBT) in primary care and all staff passed to gain a postgraduate qualification from Bangor University. A cohort of staff has

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also become Mindfulness "trainers" to develop this service across the health board. We have expanded the volunteer counselling scheme and have plans in place to develop services for personality disorder In 2014-15 BCUHB has been allocated £116K to improve training in Psychological Therapies from WG. The priorities identified for the resource include: CBT, Mindfulness and Group therapies, including Schema therapy. All options are being investigated to ensure that the additional funding can be used effectively.

Ongoing Implementation of the Measure Within the North Wales Adolescent Service (NWAS), all young people have a Tier 3 Community Clinician allocated as their care coordinator. Whilst it is the Care Coordinator’s responsibility to ensure a care and treatment plan is completed and regularly reviewed, when a young person is admitted to NWAS they are also allocated an NWAS Case Manager, a Named Nurse, and an Associate Nurse. Due to the fact their care may change whilst they are an inpatient, the care and treatment plans are completed and reviewed in collaboration with the young person and these staff members. Young people also sign off their care and treatment plans. The young people also contribute to ward round discussions via a pre-ward round meeting with staff and written questions coming into the ward round. All CAMHS services in Wales are being audited by the Delivery Unit (DU) to ensure mechanisms are in place for the use of robust operational policies, risk assessment; risk management policy, assured use of a Welsh Government DNA protocol and that robust transitioning policies are implemented in all CAMHS services. Arrangements for those children and young people referred for assessment from general hospitals is also being audited across all CAMHS Teams in BCUHB. A review of the Tier 4 inpatient unit is being undertaken and a review of commissioner / provider arrangements by DU is being undertaken. All CAMHS Teams have undertaken 2 - 3 week snapshots surveys to ascertain views from service users, carers, families, general practitioners and other referrers on implementation of the Mental Health Measure Part 1 In response to the implementation of the Mental Health Measure and the Social Services Act, each County in North Wales has an integrated CMHT with a joint County Manager who works across Health and Social Care. This is supported by a joint North Wales Collaborative across Health and Social Care which oversees the delivery of adult community based

services in relation to the Mental Health Measure. Out of Hours / Crisis Services / Section 136 The CPG’s Improving Service User & Carer Experience (ISUE) group was set up to improve the experience of people using mental health, substance misuse and learning disabilities services, and their carers. The ISUE group received reports that the Out of Hours service for mental health was not as good as it could be. The ISUE group takes all concerns seriously and asked Unllais to investigate what the issues were and what service users and carers would like to see in the service across North Wales. Unllais held four focus groups with service users and carers across North Wales to gather their comments and views.

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The service users and carers consulted about Out of Hours services reported that:

People experience difficulties phoning their CMHT Out of Hours number

A lot of people reported they didn't know who to call in a crisis and a lot of people felt they wouldn't contact an Out of Hours service unless all other avenues had been explored.

There are lots of concerns around going to an A&E department when in crisis. The main advice given to people who are unwell out of hours is to go to A&E and there is often a very long wait in A&E to be seen

Carers reported that they felt as though they were not always listened to by Out of Hours staff.

People can't get in to see a GP when they are feeling unwell and end up in A&E. The Out Of Hours GPs are reluctant to see people who are mentally unwell.

In response to the above, service users and carers identified the following that they would like to see in place:

To be able to go to directly to the inpatient unit for assessment with mental health trained staff who understand rather than go to A&E or

To have a separate place in A&E where people can go if they are mentally unwell for a chat with a nurse.

To have 24/7 crisis house where you can access people who will listen and understand.

An advocate should be available in A&E to support patients there.

More support workers are needed to prevent crisis and to give the carers some respite.

Home Treatment Teams to cover weekends.

Training for general nursing staff on mental illness and dementia.

Ambulance service training in mental health.

Support for carers out of hours.

A Mental Health Triage Ward

The Mental Health and Learning Disabilities Clinical Programme Group (MH and LD CPG) is currently reviewing practice and thematic issues related to the use of s136 across North Wales alongside key stakeholder organisations. This work has been driven in part by the significant efforts made to shift the primary location of detentions to health based Places of Safety and in part by the evidence and regular anecdotal dialogue within services that North Wales has disproportionately high numbers of detention under s136. We have made real changes to the way in which detention is managed – only 11 individuals were detained in police custody between 01.09.13 and 01.09.14 and all of these were for reasons of violence and aggression following a joint risk assessment. A North Wales S136 Monitoring Group has been established which is accountable to the BCUHB MH and LD CPG, Local Authorities, North Wales Police and the Welsh Ambulance Service Trust. The group has the responsibility for reviewing, implementing and updating regional policies and protocols with regard to the use of Section 135 and 136 of the mental health act. The group will also assist in the development of services and care pathways, with both a regional and national focus, utilising its multi agency membership. The group will develop and agree operational protocols for the use of S135 / 136 and monitor adherence to those protocols, establish a structured reporting mechanism for practice development and related activity regarding S 135 / 136, provide consultation on national policy and best practice, including barriers to implementation, on a multi-agency basis and contribute to

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multi-agency training for health and criminal justice agencies on the use of S135 / 136 and related legislation. An initial meeting has taken place to engage with locality staff in the Wrexham area as the figures regarding detention to date and the configuration of police and health services lend themselves to a conducive service environment in which to trial a pilot scheme. It is envisaged that Substance Misuse Service (SMS) may have a role to play in supporting the implementation of a Street Triage scheme as they already have access to mobile environments which could lend themselves to becoming mobile assessment suites. Anecdotal evidence (data on SMS not currently collated in s136) would suggest that there are high levels of drug and / or alcohol use within the arena of s136 detentions and it would be remiss not to include a substance misuse specific element to any planning and implementation if this is indeed the case and borne out by future data collection. Work will be undertaken to engage fully with wider CPG colleagues as it envisaged that staffing for the pilot may well be sourced from locality services. Emerging evidence from Street Triage in other evidence is compelling in its impact upon the use of s136 and improved outcomes for service users. The Home Treatment Team service offers an alternative to hospital admission along side the opportunity to be discharged early from hospital and continue care and treatment at home. The primary source of referrals are care coordinators, consultant psychiatrists, Mental Health Liaison Teams and following multi disciplinary team ward reviews. The Home Treatment Team consists of a team manager, mental health practitioners including nurses and social workers, support workers and consultant psychiatrists. There is also access to Carer support via Hafal. The service is operational 365 days a year between the hours of 8.30am and 8.30pm. Service evaluation forms have been designed by service users and carers, with involvement from staff, for acute care and the Home Treatment Teams to use on discharge from services. These evaluations are returned using Unllais' free post system, collated by Unllais and returned to the units for information and action as appropriate. Unllais then prepare a 6 monthly report on the service. The Adult Mental Health Team operates a nurse led 7 day a week, 24 hour services for adults from the age of 18 to 65. The Team provides an assessment service to those attending the Emergency Department experiencing mental health problems. The Team also offers a service to those admitted to the Maelor Hospital who have self harmed and require medical treatment following an act of self harm. In addition the liaison nurses will also assess those referred by the Medical Teams who have not self harmed but are experiencing mental health problems. The liaison nurses are supported by a Consultant Liaison Psychiatrist who will joint assess with the nurses for complex cases if needed.

Action to Respond to the WAO / HIW Report on CAMHS and Transition CAMHS have introduced a new home treatment service and following this, there has been a reduction in the number of under 18 admissions to adult wards. There is an ongoing monthly forum to discuss transition issues between Adult Mental Health Services and CAMHS. All admissions are now jointly managed between the two services. A transition protocol between CAMHS and Adult Mental Health Services is currently being ratified. In response to the HIW report on Health and Safety issues regarding inappropriate admissions to adult wards for under 18s, a workgroup is currently looking into the allocation of three beds, one for each inpatient unit to be made available to ensure a safe and

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appropriate admission into an adult ward setting for under 18s and to minimize inappropriate admissions wherever possible. Children’s Services and Adult Services are working together to establish a joint framework. An established risk strategy training group has been formed. A team of identified trainers for WARRN are now established within the Mental Health and Learning Disability Programme Group. An action plan has been developed on all safety issues identified within the Health Inspectorate Wales/WAO report and assurance has been given with evidence to Welsh Government regarding key concerns such as admissions to adult mental health wards, data collection of numbers under 18 admitted to adult mental health units and safeguarding. BCUHB has reported to WG on all issues highlighted in the report with evidence of delivery

Early Diagnosis of Dementia / Dementia in General Hospitals In order to address the variability in dementia diagnosis rates and to improve timely access to assessment, all memory services in North Wales are now part of the National Accreditation programme offered by the Royal College of Psychiatrists. In aiming to achieve the required standards, all services have undergone a development programme and waiting times have fallen considerably. As an example, in the East (Wrexham and Flintshire) the waiting list has reduced over 12 months from 26 weeks to 6 weeks. The issue of variable diagnostic rates has been addressed as an All Wales challenge and discussed as part of the Wales Memory Services audit in which we fully participated. Data to make statements about diagnostic rates is drawn from the GP QOF register and these are not fully representative of the actual numbers of people diagnosed. We have embarked on work with primary care to improve this and look for real change over the next twelve month period. Older Persons Mental Health Services have had a challenging year and have been subject to intense scrutiny and review. From that a development plan has been produced and in-patient areas are involved with Public Health Wales in revising the dementia driver. In particular North East Wales Carers Information Service has been commissioned to carry out a carer led review of those areas. Dementia identification and support in the general hospital continues as a priority area. The support system has been set as comprising of, effective governance, increased training opportunities, regular champion meetings, relaunching the Butterfly Scheme and publishing a champion’s newsletter. The whole is subject to audit and the dementia audit group is now carer chaired and the annual dementia audit plan is co-produced (up to 50%) by people with dementia and their carers. Flintshire have been using a Living Well approach for a number of years to support people living with dementia. Living Well aims to keep people with dementia living in their own homes as safely and independently as possible for as long as is appropriate according to their individual situation. This Living Well approach is now the focus for supporting people living with dementia in Llys Jasmine. The support provided is centred on the person with dementia and their relationships within extra care. We seek to understand the person’s past life, their personality, their hopes and fears, their strengths and wishes for the future; with staff working with the person and their families to focus on what might work well for them, to develop person centred relationships and help to maintain their independence.

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The aims of the Living Well approach are to:

To provide relationship centred support to enable people with dementia to stay living in their own homes for longer.

To support improvement in the quality of life for both people with dementia and their carers.

Focus on people’s abilities and promote their independence by encouraging them to undertake tasks by themselves (with supervision and prompting).

Promote an improvement in the relationship between people with dementia and their carers.

Improve communication with GPs, community psychiatric nurses, occupational therapists and others, ensuring that non-essential hospital admission and long-term care is avoided.

Promote and maintain good communication between the person, their family and all professionals involved.

Ensure continuity of care is provided by specially trained support workers.

Progress towards a Co-Morbid Substance Misuse Pathway The existing policy for substance misuse co-occurring with mental health problems is currently being updated in line with the Welsh Government updating of the All Wales co-occurring treatment framework. An Area Planning Board (fort substance misuse) is now established for North Wales to ensure clear pathways for dual diagnosis. Substance misuse services are represented at the weekly Single Point of Access (SPOA) referral meetings within the community mental health teams. An Area Planning Board commissioning and planning manager has also recently been appointed to look at the current service provision and future needs across the area. The new community intensive support team was launched from the Tier 4 base in Abergele and provides a step up and step down model for Young People with complex issues and needs including that of substance misuse. Working with Welsh Government substance misuse services, recruitment has commenced for two new posts in substance misuse in Central area (Conwy & Denbighshire) as a needs assessment highlighted this gap – they will be managed by CAMHS. Better data collection of referrals of those with co-morbidity and substance misuse issues is being undertaken at the three district general hospitals.

What are our service innovations? North Wales Veterans Services which works across the region have been further developed to support the establishment of the North Wales Veterans Forum. Combat Stress has also been commissioned by BCUHB to fund outreach workers and support groups for veterans. ‘Step Change Wales’, a peer mentoring welfare and advice service delivered by veterans for veterans and their families has been established and is hosted by CAIS and AVOW in North Wales. CAIS also offer ‘Listen In’, a new service for families and carers of veterans. Step Change will eventually be delivered across Wales. Adult Practice Reviews are now following the same theme as Child Practice Reviews. Gwynedd County Council is piloting an adult practice review under the new methodology; the outcome will inform the guidance. The Learning Event within Practice reviews is a new principle with an emphasis on minimising delay, supporting and preparing staff and sharing knowledge and learning.

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Dignity champions have been identified within BCUHB. Home treatment service evaluation forms are sent directly to Unllais who prepare six monthly reports on the service.

Our priorities and actions for the next 12 months A paper will be completed for the CAMHS Service Board on how improvements can be made to the Adolescent Eating Disorder Care pathways; it will also look at how the treatment can remain effective and safe. North Wales received an additional £10m funding for intermediate care for older people in 2013/14. This will enhance the work of the recovery and re-ablement for older people across North Wales. The additional funding will be used to drive forward collaborative working between Social Services, the Third and Independent Sectors in order to support people in the facilitation of early discharge, the prevention of unnecessary hospital admission and prevent delayed discharge. This funding will not be continued in 2014/15 and therefore partners will need to identify resources to maintain projects that have proved particularly successful in supporting recovery and re-ablement. We will continue to implement our action plans to address the issues identified in the Hergest Unit and Tawel Fan Ward to improve service provision. Work remains ongoing regarding the redevelopment plans for both the Hergest Unit and the Abblett Unit, and it is proposed that formal plans will be agreed within this financial year. Further reviews of ligature risks are currently being undertaken with an agreement to action any issues that come forward. Capital resources have been agreed for some upgrade work for the Medium Secure Unit, the seclusion room within Hergest and some work has been undertaken within the Abblett Unit. We are aware of the need to develop services for people with young onset dementia and await publication of a UK wide report that will offer new prevalence data; this will inform our developments over the next twelve months.

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3.4 Chapter 4 - One System to Improve Mental Health Partnership Board Vision Our vision is to support the population achieve good mental health, and support people with mental health problems and mental illness in having a good quality of life and realising their potential, by mobilising other statutory and non statutory services such as housing, education, advocacy and advice to support service users and their families.

What are the key challenges facing us? Better links need to be developed between CAMHS and educational services in North Wales and consideration therefore needs to be given to having a representative from education on the partnership board to contribute to our work. The impact of welfare reform as it relates to housing benefit changes in particular is considered a risk area for registered social landlords, local authorities and night shelters. These changes promote challenges in ensuring vulnerable groups have equitable access to safer homes and homelessness is reduced. It is estimated that up to 70% of homeless people have mental health issues and the average age of death for homeless people in Wales is between 47-50 years old. It is important to aim to improve the longer term health and well being of homeless people and specific vulnerable groups within our communities. Identifying appropriate accommodation with the correct level of support for individuals leaving hospital or a rehabilitation unit remains both a challenge and a priority. Working with vulnerable clients with poor educational backgrounds and low self-confidence to take control over their lives and develop sustainable and valued lives in the community, training and housing are critical factors in this regard. Registered Social Landlord's continue to profile their stock, identifying the tenants potentially affected by the on-going changes of the Welfare Reforms, in particular the introduction of Universal Credit, in order to ensure that they are supported through offering them benefit advice by welfare rights support or specialised housing support by Floating Support Services funded by the ‘Supporting People Programme’. Adult mental health services across Gwynedd, Ynys Mon, Conwy and Denbighshire have been able to take advantage or the European Funded New Work Connections Programme

over the past four years, however this funding ended in April 2014. What have we achieved in the last 12 months? Housing A regional group led by BCUHB has been established to consider accommodation facilities and services that are available for people with mental health needs, e.g. supported housing, residential care and specialist provision and includes input from the North Wales Commissioning Hub. Supporting People are also represented on this group by a designated lead officer.

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A welfare reform project board has been formed by the North Wales Social Landlords in response to identified risks due to housing benefit changes. The board will look to identify; who has been affected, what are the future options, the risk area of rent arrears, and access to floating support for people in crisis. Pennaf Housing Group has introduced the “Agored Accredited Opening Doors Enhancing Lives” (ODEL) learning units to women with mental health needs as a result of domestic abuse, and the provision of formal Mental Health First Aid awareness training for staff. Registered Social Landlord’s have continued working closely with community mental health teams, North Wales Housing provide specialist accommodation based support services for people with, or recovering from long term mental health conditions. Registered Social Landlord’s have all introduced financial inclusions strategies. A key dimension being managing the impact of the Welfare Reforms. In terms of the increase in people having difficulty with disability benefits (personal independence payment and employment support allowance) and have offered greater support / advice to those having this difficulty. As a result they have visited projects for young homeless people where their benefit has not been allowed. To support their appeals and the Welfare Rights Officers employed by Pennaf are looking to re-start an initiative of holding monthly benefit surgeries at the supported people schemes for this purpose. The service user and carer members undertook some research on behalf of the partnership on housing issues faced by people with mental health problems. The members visited homeless shelters and were able to discuss the issues first hand with individuals. The key issues identified were that there seems to be very limited services for people in North Wales who are homeless. Homeless people living in rural areas of North Wales have less access to services than people who live in the urban areas. Some people reported that they re-offend to get sent to prison in order to get a bed, a roof and a job. Most services for the homeless seem to be provided by 3rd sector organisations. There is a lack of tolerance/understanding for the homeless by the general public. The main gaps in the services that have been identified are:

lack of practical support e.g. cleaning, reminding to pay bills, reminding to go to appointments etc

lack of drop in centres

lack of 1 bed roomed properties

lack of supported accommodation

lack of independent living space

lack of support workers

lack of access to CAB and financial services

lack of advocacy services for the homeless The recommendations to address the above include

providing more information/ advice on where people can go to get help.

providing more advocacy services for the homeless

providing more hostels/ night shelters, somewhere to get food and healthcare.

providing education for the public on homelessness.

providing more single person accommodation.

providing more supported accommodation.

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A Regional Group led by the Health Board has been established to consider accommodation facilities and services that are available for people with mental health needs, e.g. supported housing, residential care and specialist provision and includes input from the North Wales Commissioning Hub. Supporting People and Local Authorities are represented on this group by a designated lead officer.

Education There is training in place to provide a regional provision of trainers in the Friends programme. The programme is recognised by the World Health Organisation as an effective approach in childhood anxiety and emotional wellbeing that builds resilience in children and young people and assists families and carers Training continues as part of a regional strategy for CBT and DBT and family therapy

Employment / Meaningful Day for Older People Care of the elderly services at Glan Clwyd Hospital, supported by the Consultant Nurse for dementia, participated in a yearlong Royal College of Nursing developmental programme in 2013-14. As part of that programme a dementia activity area was created between wards 1 and 2. This created space outside of the clinical area for patients with dementia to have access to meaningful activity in an environment where their dementia was not an issue. The area was evaluated and showed high levels of well-being in comparison to the acute wards. The room continues to develop and is the template for further initiatives across the Health Board. Unllais are delivering C&T Measure training across the 6 counties between April 2014 and March 2015. This is available for third sector, service users and carers and others. Hafal are also delivering accredited CTP training in every county. Hafal also deliver Carer awareness training and their ‘See ‘how to get a great care and treatment plan’ literature is widely available.

What are our service innovations? A North Wales multi-agency task and finish group was established to consider developing a needs mapping form which would assist in identifying people with mental health and accommodation needs. A protocol and needs mapping form was developed which has since led to all Supporting People teams across North Wales adopting a Regional Needs Mapping process which includes identification of mental health and housing needs. Denbighshire County Council have taken the lead responsibility for the centrally located needs mapping database which has enabled all providers to complete Supporting People Needs mapping electronically since 1st April 2014. Authorities have or are developing Supporting People Gateways, holding complex case meetings where required, for people with mental health issues, in order to bring together all relevant professionals and plan the most appropriate accommodation and support pathways. One Registered Social Landlord in North Wales has provided Mindfulness Training for staff followed up by research published by Bangor University Centre for Mindfulness Research and Practice that demonstrated the benefits of Mindfulness in the workplace. All Registered Social Landlord's in North Wales and three of the Local Authorities (Flintshire, Denbighshire and Conwy) continue to work on the introduction of a single access route to

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housing known as SARTH. This removes the need to make multiple applications for housing as is currently the situation. Registered Social Landlord's have a process where a home visit is also made to any new tenants to extra care schemes to offer welfare benefit advice. One Registered Social Landlord has provided Welfare Rights training to other 3rd sector support providers who work with mental health clients. Pennaf, through its Welfare Rights service officers has given increased direct support to tenants who face the ‘bedroom tax ‘to support them with their Discretionary Housing Payment claims but have noted the continuing difficulty with some Local Authorities Housing Benefit Departments that do not disregard Disability Living Allowance, which therefore makes it more difficult for disabled people to be awarded this. North Wales Fire Service is working in partnership with Communities First, to date 28-30,000 homes across North Wales have had fire safety checks and it is their aim that every home should have a working smoke alarm. Following discussions between Betsi Cadwaladr University Health Board and North Wales Fire and Rescue Service, partnership managers with responsibility for the local authority areas across North Wales will attend community mental health team meetings to discuss specific concerns and issues and provide information on the availability of home fire safety checks which can be provided by North Wales Fire and Rescue Service to clients of the mental health teams. The partnership managers also receive referrals for home fire safety checks from mental health team members for their individual clients. In partnership, third sector and statutory services host a Well Being Day in Flintshire when every user of mental health and substance misuse services are invited to meet in a local sports centre and, in the comfort of a supported environment, sample a range of activities and sports. The aim of the day is to spark some interest in a physical activity which will be developed further with support. Double Click is a social services run work scheme based in Deeside Enterprise Centre, they provide a printing service and employ 5 staff in total and support approximately 23 service users a week who are in the recovery phase following an acute episode of acute mental health illness. They are to become a Community Interest Company (CIC) which is a special type of limited company which exists to benefit the community rather than private shareholders. The focus will be to promote training and employment for people with mental health problems using IT as a means to do so. Bibliotheraphy services are in place in all libraries and all counties are progressing towards a provision of self-help and educational books for children and young people, families and carers in relation to emotional health and well being

Our priorities and actions for the next 12 months We will develop better links with education to support the CAMHS service locally and regionally. It is our aim to further enhance partnership working between North Wales Fire Service and the community mental health teams to increase numbers of fire safety risk assessments for service users undertaken. North Wales Fire Service will also offer specialist interventions such as fire safety packs and specialist arson support. An arson reduction team will also look at risk in more detail.

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The Health Board will map the existing supported housing in North Wales, assess the supported housing needs of individuals with mental health and identify models that can meet future needs. Continuing to find imaginative ways to establish and provide accommodation via non-traditional social housing grant. For example the Pennaf Housing Group, via Offa one of its subsidiaries has developed a letting agency whose brief is to work with care and support staff and private landlords to provide 3-5 year affordable private leasing rental accommodation. Using this model, Registered Social Landlord's are also increasingly working in formal partnership with third sector mental health providers to operate and run specialised accommodation and mental health services. Further expansion of the range of learning/training and employment opportunities to women with mental health needs as a result of domestic abuse. Pennaf Housing Group will be establishing two social enterprise companies offering supported work experience and employment opportunities to include the mental health client group as they are they are often the groups excluded from main stream training and employment opportunities. Other Registered Social Landlord’s are also exploring enterprise

initiatives.

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3.5 Chapter 5 - Delivering for Mental Health Partnership Board Vision We aim to ensure that the delivery of the Together for Mental Health Strategy becomes both measurable and meaningful for not only the people who access our services, their carers and families but also the wider communities in North Wales. This will be achieved by ongoing collaborative work within the local planning groups, a consistent method reporting to the local partnership board and effective feedback and ongoing support for effective service user involvement and participation at all levels.

What are the key challenges facing us? Ensuring that an appropriate local infrastructure is in place to oversee the implementation of Together for Mental Health at a local level is a challenge. It is an ongoing challenge to secure appropriate engagement and commitment from all partners in taking forward the Strategy in a coordinated and effective manner.

What have we achieved in the last 12 months? Prudent Healthcare within Mental Health In line with prudent healthcare the former CAMHS Planning Network will merge with the other existing network, thus reducing overheads of management to release funding for frontline services. There has been the introduction of a third sector counselling service, ‘Parabl’, for General Practitioners (GP’s) which allows them to access counselling without the need for further assessment by specialist mental health services. Parabl is available across North Wales and provides short term therapeutic support for individuals facing common mental health problems or challenging life events. It is available in a variety of venues and includes self help, online work books and support, therapeutic groups, and provides Mindfulness and Counselling services. The Health Board and Local authorities have agreed a county model across North Wales linked to a single point of access for primary and secondary care mental health services and e-referrals for GP's. Performance against the measure is reviewed on a weekly basis. Part 3 of the Measure gives the right to re-assessment for service users. From January 2014, 208 people in N Wales have used this right for a re-assessment. Training has been delivered across BCUHB on prudent prescribing with invitations sent to all clinicians to attend. The formulary is currently being reviewed to include further guidelines. Within the Mental Health and Learning Disabilities Clinical Programme Group a savings and quality improvement plan has been developed. The Heads of Program have been asked to ensure that the plan is disseminated, leads assigned to help carry out the audit work and that performance against the targets set is reported back to the Mental Health Medicines Management Group. The mental health pharmacists also support local agendas by providing information and advice on request. They will also carry out their own quality improvement areas in the workplan as agreed by the CPG and within the available resources.

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Following a number of workshops with service users and carer facilitated by Unllais a North Wales Third Sector Mental Health Commissioning Strategy has been developed and will be taken forward this year with a plan for commissioning services to take effect from April 2015. We are asking our service user and carer partnership board members to undertake discrete pieces of research with their local service users to gain a real understanding of people’s lived experience around key issues such as housing and access to primary care.

Core Data Set BCUHB has been involved in agreeing the national data set. There is a need to ensure that the appropriate systems are in place to collect the information consistently across the services and that processes are in place to enable the information to be used locally as well as centrally.

The Work of the Mental Health Partnership Board The North Wales Mental Health Partnership Board has been established with active service user and carer participation. Local Planning Groups across North Wales have also been consulted and there has been clarification of their role in relation to monitoring the delivery of the strategy. The Chair of each Local Planning Group is now a member of the partnership board. It has also been agreed that the Local Planning Groups will contribute to the work by identifying local gaps and priorities in relation to Together for Mental Health; they will also share comments on the delivery of local services on a thematic basis. The Workforce Sub group of the CAMHS Service Board is now in implementation phase with revised terms of reference. The objectives are:

To develop a consistent model of staffing for all teams across North Wales.

To focus on an increase in the proportion of time that is spent on early intervention

and prevention.

Each county will have an integrated CAMHS team that includes all the functions of

referral based CAMHS, Early Intervention and Prevention and Child Health

Psychology.

Our assessment of staffing requirements will be based on a detailed analysis of

capacity and demand. It is likely that we move to steadily more integrated teams.

What are our service innovations? The Mental Health Clinical Programme Group within Betsi Cadwaladr University Health Board has begun training all staff on older person’s wards in compassion training. All training on older person’s wards across North Wales will be completed by mid October 2014. Tasking our service user and carer board members to undertake research and feed back to board meetings.

Our priorities and actions for the next 12 months To continue developing the partnership to ensure regional and national priorities and actions are progressed effectively.

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To look at innovative ways of more service user and carer involvement in the work of the partnership and the development and dissemination of the annual report to partners, staff and users of services.

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4.0 Summary and Conclusions: Looking ahead to 2015 and beyond Partners in North Wales continue to progress the implementation of the strategy individually and collectively, in the face of a number of challenges including finance, the impact of the overall economic downturn and the demography and geography of North Wales. The input of the service user and carer board members is developing, and it is especially pleasing that the annual report is able to show a significant number of examples of service user and carer involvement in the work of the partnership and in supporting mental health services across the region more generally. The report has also been able to highlight a number of service innovations and the principles of ‘Prudent Health Care’ that demonstrate evidence based practice, appropriate interventions and co-production. There is still work to do in further developing and exploiting the benefits of partnership working at local and regional level. The North Wales Mental Health Partnership Board will need to review it systems and processes going forward, to maximise the benefits of having a forum and shared agenda across partners to improve mental health and well-being and mental health services for the population of North Wales. The reduction in Local Authority budgets and the potential impact on the broad range of services provided and commissioned is of concern, as it may directly impact on our collective ability to progress and sustain performance against actions. The partnership will need to be sighted on these plans and have the opportunity to reflect and respond to the impact on mental health and well-being as well as mental health services.

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Annex 1 LHB Report against Together for Mental Health Delivery Plan Actions Chapter 1: Promoting Better Mental Wellbeing and Preventing Mental Health Problems ACTION SUB ACTION COMMENT FROM BCUHB ANNUAL

REPORT 2012-13 UPDATE 2013-14 R/A/G

Outcome 1: Population wide physical and mental wellbeing is improved; people live longer, in better health and as independently as possible for as long as possible

1.1 To ensure that mental wellbeing is given equal priority with physical wellbeing in the development and delivery of policy, programmes and services

d. Key partners to ensure that mental wellbeing is given equal priority with physical wellbeing in impact assessment. Ongoing from December 2012

North Wales Public Health Wales staff are piloting an adaptation of Mental Wellbeing Impact Assessment that examines proposals and policies for their impact on mental wellbeing, taking account of the particular issues that might impact on people in the 'protected characteristics' groups

From April 2014 the development of a work plan for Mental Health and Wellbeing and will be prioritised within PHNW

f. Key partners to ensure that, where appropriate, mental wellbeing is included whenever healthy lifestyle messages are being communicated to the public utilising the 5 ways to Wellbeing. Ongoing from October 2013.

Five ways to wellbeing are incorporated into the corporate induction process of staff within CCBC and an article on Five ways was placed in the Conwy bulletin which is delivered to each home in Conwy The draft BCUHB Perinatal Mental Health pathway has embedded a universal approach to promoting mental wellbeing for all women who are pregnant, as well as recognising and responding to the needs of those with continuing or emergent mental health problems.

The Maternal Mental Health Pathway was formally launched in September 2014 (see section 2.1(c), below). Training will be made available for Health Visitors and Midwives. This will improve the identification, assessment and care and follow up of women who have or who are at risk of developing mental illness in pregnancy and the postnatal period.

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Outcome 2: People and communities are more resilient and better able to deal with the stresses in everyday life and at times of crisis

2.1 To improve resilience of children and young people

a. Local Health Boards (LHBs) and partners to ensure use of All Wales Maternity Record to identify women at risk of postnatal depression or psychosis. Ongoing from October 2012.

The revised version of the All Wales Maternity Record has been implemented locally.

Action complete 2012-13

c. LHBs to develop and put in place protocols for referral for advice from GPs or specialist services in place for obstetric services in Wales.

A BCUHB multidisciplinary group has been established to develop a Mental Wellbeing Strategy which encompasses these requirements. The document is nearing completion. Implementation and the development of a clinical network for North Wales will require inter CPG and Executive support.

The Maternal Mental Health Pathway was formally launched in September 2014.This includes recommended actions for midwives, GPs, Health Visitors, Obstetricians and staff from Adult Mental Health Services to both promote mental wellbeing during pregnancy and the perinatal period, and to improve the identification, assessment, care and follow up of women who have or who are at risk of developing mental illness in pregnancy and the postnatal period. Training for Health Visitors and Midwives is being developed on how to incorporate the ‘5 ways to wellbeing’ into their routine care provision.

o. LHB, LAs and Third Sector to ensure that family focused interventions deliver improved public mental health and wellbeing, most notably

Team around the Family is in place across North Wales with some variations in delivery. There are strong links with schools and health visitors which account for many of the referrals to TAF.

IFSS is now in place across North Wales although there have been recruitment issues. In some areas although they have not had an IFSS they have built the service on current therapeutic provision to support the most complex families.

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Flying Start

Families First

Integrated Family Support Service.

Ongoing.

Commissioning of services under Families First has also taken place and multi agency consortia have come together to deliver services. Integrated Family Support Services are in various stages of development with only Wrexham and Flintshire having an IFSS up and running as a joint service. Expansion of Flying Start has also taken place with more areas able to access Flying Start services across North Wales. More Health visitors are being recruited to support mothers in the most deprived areas.

Families First in some areas are reviewing the commissioned services. Team Around the Family are working with more families with complex needs who do not receive a service from social services. The number of families referred to TAF across North Wales in 2012/14 was 2199 with the highest referrers being health visitors with 476 referrals. 1590 of the referrals were referred on to either the commissioned projects or to a TAF intervention. A significant number of families have been supported. Development of intergenerational practice is being undertaken and is in the early stages. This will involve older people’s services, communities’ first, flying start, housing and supporting people. The aim is to have an early intervention support provision within the community with generations supporting each other and sharing skills.

2.3 To improve resilience of communities.

a. All agencies to identify contribution of third sector on mental wellbeing and resilience and to consider how joint working can further complement statutory provision. Ongoing.

There is agreement to develop a North Wales Mental health Commissioning Strategy. Parabl commissioned to provide Talking Therapies since 1/04/13. 3 workshops held in June and July 2013 to map care pathways across sectors. Integrated Care Pathway in place and launched on 10 October 2013.

A North Wales Mental Health Commissioning strategy has been developed and is in first draft and will be taken forward this year with a plan for it to take effect from April 2015.

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2.4 To further reduce levels of suicide and serious self harm.

b. LHBs, LAs, Third Sector and Criminal Justice Agencies to continue working in context of the 2012 PHW review of Talk to Me Suicide and Self-harm Action Plan.

Training on suicide, has taken place across Clinical Programme Groups (CPG’s) for all age ranges with representation from CAMHS, looking at building emotional resilience for children and young people. Also included train the trainer rolled out to GP's and partner organisations. Signage with wording agreed by Samaritans has been placed at two stations in Flintshire. Mental Health First Aid courses are run on a regular basis and are being promoted amongst primary care staff through the Localities Leadership Team

The launch of the second suicide strategy; Talk to Me 2 will coincide with the commencement of a regional network across North Wales to progress work on the Strategy and will include CAMHS and other children and family services.

c. LHBs and LAs to embed and mainstream MHFA and ASIST rollout training.

Risk assessment training in place. There are local workforce development training plans in place

A Regional board will form across North Wales to begin to action plan the new strategy ‘Talk to Me 2’ in Summer 2014. The Board will oversee new training plans. A modified training programme has been developed to be delivered for young people. See the work of Bangor University Night Line, The Samaritans and Call Helpline; all will be involved in the action plan.

d. LAs, LHBs, Welsh Ambulance Service, NHS Trust, Third Sector, Police and Prison Services to develop

There is a Criminal Justice Liaison Group in North Wales. Multi agency representation which includes all relevant parties

Criminal Justice Liaison Group continues to meet.

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person centred responses to manage and reduce the number of episodes of serious self harm in Wales. Ongoing.

e. LHBs and LAs to embed and mainstream MHFA and ASIST rollout training.

See 2.4 C

f. LHBs to refer to NCISH national reports. Ongoing.

Reports are considered by the Health Board and learning is applied. All recommendations are considered and implemented as appropriate.


g. Public Health Wales to work with LHBs and LAs through the Mental Health Leaders’ Collaborative to develop integrated approach to managing serious untoward incidents including suicide and self harm by April 2013

Being progressed at a National level.


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Chapter 2: A New Partnership with the Public

ACTION SUB ACTION COMMENT FROM BCUHB ANNUAL

REPORT 2012-13 UPDATE 2013-14 R/A/G

Outcome 4: People with protected characteristics and vulnerable groups, experience equitable access and services are more responsive to the needs of a diverse Welsh population.

4.1 To reduce inequalities for vulnerable groups with mental health needs, ensuring equitable access and provision of mental health services.

a. LHBs and LAs to routinely meet their obligations under the Public Sector Specific Duties (Wales) addressing the diverse needs of their local populations in service redesign and commissioning. Ongoing.

During the past 12 months the Health Board has consulted on and commenced the implementation of its plans to redesign services for Older Person's with Mental Health Across North Wales. The implementation of the Social Services Bill is key as it will continue to address inequalities. One of the LA’s has a Vulnerable Adults Group which considers the diverse needs of people with mental health issues.

Detailed implementation plans are available in supporting this work. Further work has been carried out on access and travel for both service users and their families.

c. LHBs to carry out and publish Equality impact assessments on service delivery plans. Ongoing.

As part of the OPMH and changes to how Adult Mental Health Services were provided, EqIA screening was undertaken. As part of the ongoing changes within OPMH services, full EqIA will be completed by Dec 2013. EqIA screening for South Gwynedd will also be reviewed by the Service Development Board by Dec 2013. All stakeholders affected by the changes, including the Community Health Council (CHC) have been involved in service change.

Implementation of changes to OPMH services in North Wales was subject to EqIA screening. This work continues and previous equality impact assessments have been reviewed and updated as services are developed and changed.

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d. LHBs and LAs to provide culturally appropriate assessment, responding to communication and translation needs. Ongoing.

As part of service reviews and changes all communication / information for service users and carers has been made available bilingually. As part of the Health Care in North Wales is changing consultation documentation was available bilingually, large print and easy read versions. People attending were also given the opportunity to advise us of any other needs. E.g. disability / sign language. Questionnaires were circulated on age, ethnicity e.g. Polish leaflets


Outcome 5: Welsh speakers in Wales are able to access linguistically appropriate mental health treatment and care where they need to do so.

5.1 To ensure that Welsh speakers receive services through the medium of Welsh when needed and to increase language capacity in the workforce.

a. NHS and Social Services to ensure that principles of the Welsh Language Strategic Framework including the ‘active offer’ are mainstreamed into service delivery. Ongoing.

Piloting Welsh Language pathway / Welsh Language programmes (mental health terminology) One function of the bilingual service user pathway has been to capture the process historically used by teams that have successfully matched bilingual service users with bilingual mental health workers. A second and progressive function of the bilingual service user pathway is to enable teams to capture solid data via unmet needs forms when / if a bilingual worker is not available to work with a Welsh speaking mental health service user. Each LA has produced a response to

Work remains ongoing within the development of the bi-lingual pathway. There is a specific group within Mental Health Services which has wide representation from across the service. Work is ongoing to see how we can improve the referral information to include the offer of a service bi-

lingually.

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‘Mwy Na Geiriau’ and there is a lead officer in Local Authorities to reinforce the importance.

b. LAs and LHBs to deliver language awareness training for all staff coming into contact with people with mental health problems. April 2014 and Ongoing

The CPG Welsh Language Development Group have created an outline for a training course which would raise staff's awareness and skills in relation to using Welsh language and culture in their clinical work with mental health service users. This is an ongoing project. The LA’s are exploring the delivery of this to its workforce located within the integrated CMHT’s.

Both the Health Board and the Local Authorities offer a range of Welsh Language training courses. Work is ongoing to develop a Welsh Language course specifically for mental health staff.

Outcome 6: People in Wales have the information and support they need to sustain and improve their mental health and self manage mental health problems.

6.1 To ensure that people of all ages are better informed about mental health and mental illness, with age appropriate information being available.

c. LHBs and LAs, together with Third Sector Partners, to ensure that Mental Health Service User Development Officers (MHSUDOs) maintain up to date web based directories of local Mental Health Services and information available and to share these with appropriate organisations such as C.A.L.L. and NHS Direct Wales. Ongoing from October 2013.

Bilingual website in place to provide help and advice to Children and Young People, parents, carers and people who work with children to know what to do if they are worried about problems which may affect their Mental Health. http://www.mental-health-matters.org.uk/ Unllais mental health directory is available on the company’s website. This focuses on adult services and there are links to the CALL helpline and NHS Direct. Unllais' new website, currently under development, will have a 'print' option so that parts of the directory can be selected and

Unllais will also link to Health and Wellbeing information. A printable version of the directory is now available on the Unllais website. Unllais will update their database over the next 12 months and offer other organisations the opportunity to be included within the database.

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printed directly from the web. There is work to be done on linking information and websites to ensure all ages are covered.

Outcome 7: People with mental ill health experience less stigma and discrimination and feel that these problems are being tackled.

7.1 To ensure that there is a concerted effort to sustainably reduce the stigma and discrimination faced by people with mental health problems

b. NHS and LAs to act as exemplar employers providing mentally healthy workplaces in their support to staff and tackling stigma and discrimination in their service delivery. Ongoing

It is the clear intention of the Health Board to ensure that no employee receives less favourable treatment or suffers any detriment because due to their disability through clear and consistent guidance on the rights of the individual and the responsibilities of the organisation. The Health Board has adopted practices to improve employee health and well-being in the workplace and holds the Corporate Health Standard Gold award. The Health Board has a mandatory equality e learning module that is designed to improve general awareness and understanding around Equality and Human Rights. The Health Board has given its support to MENCAP’s ‘Getting it Right Campaign and Charter’ which has an aim of reducing discrimination against people with learning disabilities within the NHS. The Health Board is planning to sign up to ‘Mindful Employer’ which is an

Time to Change Wales aims to reduce mental health related stigma and discrimination. The co-ordinator attended the NW T4MH Partnership Board and there is an idea in principle for Health Board, 6 Local Authorities and possibly other public sector organisations in North Wales to sign the pledge together. Flintshire Local Planning Group has been involved with Motivate and Reactivate with individuals to reduce stigma on a person by person basis. An event was also held on stigma in the workplace to promote Mental Health Day and Unllais also held a stand.

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initiative aimed at increasing awareness of mental health at work.

c. LHBs and LAs to identify TTCW Champions to raise the profile of mental health across their organisations, drive out discrimination and address stigma amongst staff by December 2012

There are Champions for Mental Health within organisations. This is a development area for organisations in North Wales.

As above. There is an idea in place for the HB, LA’s and public sector organisations in North Wales to sign the pledge together following discussions with Antony Metcalfe, Programme Manager for TTCW.

Outcome 8: People feel in more control as partners in decision making about their treatment and how it is delivered.

8.1 To ensure that service users feel listened to and are fully involved in decisions about their own care.

a. LHBs and LAs to ensure active participation of service users and carers in the development, delivery and review of their Care and Treatment (in line with Part 2 of the Mental Health (Wales) Measure 2010. Ongoing from June 2012.

In over 90% of adults case notes audited the service users had signed off their CTPs. Service user questionnaires are in place. CAMHS - There is a Tier 4 Service User Group in place, a Young Person Strategy is being developed by the group to include T4 and the Third Sector. There are also INSPIRE consultation groups.

NWAS – All young people have a care coordinator, when admitted into the service they are also allocated an NWAS case manager, a named nurse and an associate nurse. As their care may change whilst they are an inpatient, the CTP’s are completed and reviewed in collaboration with the young person and these staff members. Young people also sign their CTP’s and contribute to ward rounds discussions.

b. LHBs to ensure training is provided on care and treatment planning using the prescribed materials produced by Lincoln University to all Care Co-ordinators by end 2013.

An active training plan has been implemented.


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c. LHBs to provide service users and their carers with opportunities to discuss and agree service and treatments options. Ongoing.

Practice development is required to empower service users to actively participate and understand alternatives and implications in relation to treatment in their care and treatment plans.


d. Voluntary sector working as part of Mental Health Action Wales to provide training for service users to enable them to play a full role in the development of their Care and Treatment. Ongoing

Half day workshops have been delivered across North Wales to provide the opportunity for SU&C to have information on CTP. These to be rolled out again in 2014.

Unllais will deliver C&T Measures training across the 6 counties between April 2014 and March 2015. This is available for third sector, SU&C’s and others. Hafal are delivering accredited CTP training in every county. Hafal also deliver Carer awareness training. See ‘how to get a great care and treatment plan’ literature which is widely available.

e. LHBs to implement good practice guidance and training for staff working with service users to help them understand treatment options available. (Standard 9 Doing Well, Doing Better). Ongoing.

Good practice guidance and training has been introduced through CPT and the MH Measure Training. The CTP Planning Programme runs until June 2014. A further training programme needs to be developed with the aim of ensuring it is integrated into every day practice. A pool of SU&C’s have been trained as trainers to co-facilitate the delivery of MHM training. The delay in receiving the supplementary training materials from WG has meant the development of local materials involving local SU & C which is currently being used in training.

The CTP training programme was extended until the end off 2014, with an additional four courses scheduled post June 2014. However demand for these courses exceeded availability and an additional four courses were organised. Planning will begin shortly on the course programme for 2015. There is an ongoing need for service users plans to be in there own words. It is felt that it would also be useful for feedback on how service user feedback has improved service delivery.

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Within the Health Board, each CPG is required to establish a group dedicated to Improving Service User Experience (ISUE) which reports to the Corporate ISUE Group. The MH CPG ISUE Group has agreed an action plan and is taking that forward in partnership with Unllais, service users and carers.

8.2 To ensure that relevant patients access Independent Mental Health Advocacy (IMHA). NOTE: ALSO CONTRIBUTES TO OBJECTIVES 11 & 13

a. LHBs and LAs together with IMHA services to implement Part 4 of the Mental Health (Wales) Measure 2010 for newly eligible patients. Ongoing.

Unllais have been commissioned to provide the IMHA service in North Wales. A training plan has been implemented for LHB's and LA's. Ongoing emphasis on training and awareness raising is specified in the IMHA contract following the implementation of Part 4 of the Measure.


b. Independent Mental Health Advocacy providers to ensure the availability of appropriately trained advocates to meet the new statutory duties on LHBs and LAs within the Mental Health (Wales) Measure 2010. Ongoing from 2013.

Part of the monitoring process for the IMHA contract is to ensure the availability of appropriately trained advocates


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Outcome 9: Families and carers of all ages are involved in assessments for support for their caring roles.

9.1 To ensure support for families and carers through implementation of the Carers (Wales) Measure 2011.

a. LHBs and Trusts in conjunction with partner LAs to draw up local Carers Information and Consultation Strategies by October 2012.

The LA’s and Health Board agreed the Carers Strategy in October 2012 and a training programme is being launched

An application for Carers Measure Funding has been approved for the Older Peoples Mental Health Service in conjunction with the North Wales Community Health Council in order to commission NEWSIC to project manage a carers review of Older Peoples Mental Health Services

Outcome 10: People of all ages and communities in Wales are effectively engaged in the planning delivery and evaluation of their local mental health services.

10.1 To ensure that service users of all ages and their families and carers are fully involved in service development. NOTE: ALSO CONTRIBUTES TO OUTCOME 17

a. HBs and LAs to agree and put in place robust arrangements for engaging service users and carers of all ages in the design, delivery and monitoring of local services by Sept 2013.

Joint county based groups have been established across North Wales and will include service users and carers in their membership and will formally link to overarching policies. There is a service user and carer involvement contract in place for adults and older people for MH, SMS and LD. Alternative to Admission for 12 - 18 year olds in North Wales, a Young People’s Participation Project: • Meetings with Young People on

“service” design • Support from Children & Young

people’s Assembly for Wales ‘Funky Dragon’

• Young people’s interview panels for

staff interviews • Young people’s competition for

team name

Joint planning groups have been established across North Wales with the agreement that they will take the strategy forward. There are activity nurses in post in Heddfan Unit, Wrexham Maelor Hospital, this is due to service user input.

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• Young People’s workshops on

content of “home folders” • Work with young people on leaflets

and NWAS Website work

b. MHSUDOs to develop mechanisms to ensure active engagement in local planning mechanisms of people of all ages by February 2013. (Standard 5 Doing Well Doing Better guidance e-governance manual).

There are county based joint working groups across North Wales for adults and older persons' mental health and have places for SU&C involvement/representation. Service User and Carer Liaison Officers are employed by Unllais and operational across the 6 Counties. Similar arrangements are in place in Powys, with PAVO to facilitate service user and carer engagement in local planning

The work of the county based joint working groups is ongoing Service users are heavily involved in the National Groups. Service users are always involved in evaluations of the third sector.

c. WG and LHBs to ensure active engagement of service users and carers on Mental Health Partnership Boards at national and local levels – Ongoing from March 2013.

5/6 SU and Carers from across North Wales have been recruited to sit on the Partnership Board and Unllais supported the process. The Board members are meeting with the Chair of the NW Board before the next meeting of the Board. These Board members have automatic membership of the All Wales 'peer' Forum and have the option of applying for one of the 4 places on the NPB. The process for the NPB is being managed by Mental Health Foundation and Welsh Government.

There is ongoing support for SU&C reps on the NWPB including pre board meetings and support to undertake indentified pieces of work in relation to the strategy. The SU&C reps are also supported by Unllais.

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Chapter 3: A Well Designed, Fully Integrated Network of Care ACTION SUB ACTION COMMENT FROM BCUHB ANNUAL

REPORT 2012-13 UPDATE – 2013-14 R/A/G

Outcome 11: Service users experience a more integrated approach from those delivering services. 11.1 To ensure that public services work together to provide an integrated approach.

a. LAs, LHBs and third sector to further develop integrated services provision and to review care pathways against the aspirations of Together for Mental Health by December 2013.

A memorandum of understanding and S33 agreements are in place in some counties with the intention to develop agreements across the six LA's. We have established 6 County Mental Health teams with an agreed Operating Framework and single line management structures for all.


f. LAs to work together with the NHS to enact new duties from implementation of the Social Services Act. Timescale to be confirmed under regulation.

Welsh Government ran stakeholder events. Health Board and LA's have a number of forums in place to work collaboratively and progress implementation.

Each County in North Wales has an Integrated CMHT with a joint County Manager who works across Health and Social Care. This is supported by a joint North Wales Collaborative across Health and Social Care which oversees the delivery of Community Based Services in relation to the Mental Health Measure.

11.2 To ensure effective transition between adult and CAMHS Services.

a. LHBs, working with LAs and Third Sector, to develop plans to manage transition for young people effectively by November 2013.

There is a transition protocol currently being ratified which will be available to all staff once agreed. In conjunction with Bangor University, Unllais have been successful in having a research student part time and will be looking at the transition between CAMHs and adult services

A transition protocol between CAMHS and adult mental health services is currently being ratified. In response to HIW report on H&S issues re. inappropriate admission to adult wards for under 18s – a workgroup is currently looking into; the allocation of 3 beds, 1 for each in patient unit to be made available to ensure a safe and appropriate admissions into an adult

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ward setting for under 18s and to minimise inappropriate admissions wherever possible

11.3 To ensure substance misuse co-occurring with mental health problems is managed effectively.

a. Each Substance Misuse Area Planning Board (SMAPB) and Local Mental Health Partnership Board (LMHPB) to have in place clear protocols and integrated pathways between mental health and substance misuse services, in line with the Service Framework Meeting the Needs of People with a Co-occurring Substance Misuse and Mental Health Problems by September 2013.

Protocols and pathways have been recently reviewed and this is currently being consulted upon.

There is an existing protocol in place which is being updated. A new training plan will also be implemented once the protocol is in place. The Welsh Government is in the process of updating the Co-Occurring Treatment Framework which will be an All Wales Document. It is a requirement of the North Wales APB to ensure clear pathways for dual diagnosis, BCUHB are working with the APB to deliver this.

b. LMHPBs/SMAPBs to ensure all relevant staff are trained to recognise and respond to people with co-morbid substance misuse and mental health problems, and have a clear understanding of protocols and integrated care pathways in place by September 2013.

Training has taken place across BCUHB led by Health. There is SMS involvement in SPOA on a weekly basis across North Wales. Training across BCUHB teams will need to be part of the refreshed dual diagnosis (DD) Policy Implementation Plan. Mental health colleagues deliver training to SMS teams on a regular basis as part of the SMS annual training plan.

There is a new post in place which will be responsible for training in the early planning stages.

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11.4 To improve access to CAMHS expertise in Youth Offending Teams.

a. LHBs to ensure that All Youth Offending Teams (YOTs) have designated time from an appropriate CAMHS professional and access to forensic CAMHS. Ongoing from March 2013.

CAMHS team have access to a MH Advisor who works into and with the Youth Justice Service and provides advice and consultation to staff within the Youth Justice teams across the region. Dedicated sessions are available with a Consultant Child & Adolescent Psychiatrist for advice and consultation.

In order to improve access to CAMHS expertise in Youth Offending Teams; Consultant Psychiatrists from CAMHS are now providing advice to the Youth Offending Teams.

11.5 To improve physical and mental health care for those with chronic conditions including mental health problems.

a. LHBs to ensure effective liaison services to assure needs for people with mental health problems in the DGH setting are met. Ongoing from April 2014.

There are existing liaison services in the DGH's, which are reviewed against the Rapid Assessment Independent Diagnosis (RAID) model to ensure good practice. Following a review it is intended that the liaison services will be extended linking it with the out of hour’s provision.

The Liaison Services have just increased operations on the three main hospital DGH sites to a 24/7 service, this will be further complimented by the introduction of specialist Psychiatrist and Psychology posts into the Liaison Service again on each hospital site.

b. LHBs to provide physical health liaison to assure physical healthcare needs in mental health settings are met. Ongoing

There are ongoing discussions to clarify the DGH input into the Mental Health Units. Currently there are transfer arrangements in place. A Physical Health Group has been established to improve detection and treatment of co morbidity and Mental Health. The group has prioritised improving Clozaril treatment arrangements and improving outcomes for co morbid diabetes


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Outcome 12: People of all ages benefit from evidence-based interventions delivered as early as possible and from improved access to psychological therapies

12.1 To ensure the expansion of primary care mental health services. NOTE: ALSO CONTRIBUTES TO OUTCOME 13.

a. LAs and LHBs to implement Primary Care Schemes in conjunction with third sector where appropriate and in line with the requirements of Part 1 of the Mental Health (Wales) Measure 2010. Ongoing from October 2012

Local Primary Mental Health Service for Children, Young People, Adults and Older People established 1st October 2012. Scheme underpinning service agreed by Health Board and six LA's. Parabl Talking Therapies commissioned by Third Sector


b. NLIAH to develop a curriculum for Primary Care Mental Health Workers PCMHWs by year end 2012-13.

The curriculum has been received from NLIAH and will be implemented.


c. Each LHB to ensure competent workforce trained to deliver the range of interventions under the measure with a formal supervision structure including those commissioned from other sectors

Primary care staff have commenced Cognitive Behaviour Therapy training level 6, from Bangor University. Their accreditation is due Oct 13. This will expand the capacity of LPMHSS (Local Primary Mental Health Support Service) staff to provide formalised CBT in Tier 1. Psychological Therapies Institute Group convened to develop and coordinate training and ensure link to the Mental Health and Learning Disability Workforce and Education planning process. There is an accredited course in

The first cohort of staff have completed CBT L6 at Bangor University, this equate to 2 staff per County. There has been 18 staff trained in the use of Serenity (online CBT). There has been 6 staff trained in EMDR. There has been 3/4 DBT staff trained in East and Central. There is a plan to look at commissioning training in Mindfulness / DBT / EMDR across North Wales.

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common mental heath issues and substance misuse. Also training has been rolled out in personality disorder. Professional standards are adhered to by those services commissioned from the third sector

There have been 12 new primary care mental health posts filled in response to the Measure. There is a review underway of the rolling function of the therapy services.

12.2 To ensure that patients are supported to access their rights for re-assessment with regard to the Mental Health (Wales) Measure 2010, when required. NOTE: ALSO CONTRIBUTES TO OBJECTIVES 11, 13 & 14

a. LHBs and LAs to establish systems in conjunction with Third Sector where appropriate to ensure that eligible patients are aware of their rights to reassessment in line with Part 3 of the Mental Health (Wales) Measure 2010 by October 2012

As part of the Measure Implementation GP's, Police, Ambulance Service and Third Sector organisations were made aware of patients rights under Part 3 as part of the communication and information strategy. Discharge letters to service users and GPs include information on their rights


12.3 To improve access to and provision of Psychological Therapies

b. LHBs and LAs to review cross sector staff competencies in delivering psychological therapies and undertake gap analysis by June 2013

A management board has been established to oversee access, treatment and provision of Psychological services in North Wales. The emphasis will be analysing waiting times with a view to seeking reductions. Local Improving Access to Psychological therapies group convened to undertake gap analysis and build on 2012 mapping and local county team training audit and

A capacity and demand report on access to psychological therapies has been completed. The data reporting system has also been improved along with an action plan following the identification of the areas with the greatest variance. Staff have completed a course for CBT in primary care and all staff passed to gain a postgraduate qualification from Bangor University. A cohort of staff have also become mindfulness

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National Audit in Psychological Therapies data set

‘trainers’ to develop this service across the health board. We have expanded the volunteer counselling scheme and have plans in place to develop services for personality disorder.

c. Each LHB to constitute a Psychological Therapy Management Committee (PTMC) to advise on local mechanisms to take forward and develop psychological therapy services in line with WG Policy guidance and to take into account the baseline review. Ongoing

The Psychological Therapy Management Committee (PTMC) has been constituted with executive leadership; the chair is Andrew Jones, Director of Public Health. The first stakeholder group is to be convened in November 2013.


d. Each LHB to ensure competent cross sector workforce trained to delivering the range of interventions within a formal supervision structure. Ongoing

There is an agreed supervision policy in place. There is both clinical and management supervision arrangements in place for all professionals. Joint Health and Social Care training in place.


12.4 To ensure effective access for children and young people to CAMHS Services.

a. LHBs and LAs to ensure that they have in place pathways to provide appropriate specialist inpatient and community CAMHS (e.g.

Intensive Community Support Team (ICST) in place from October 2013 in place of CIIT. Forensic Adolescent Consultation Treatment Services (FACTS) is an All Wales Model but N Wales element is based in Abergele.

CAMHS have introduced a new home treatment service and following this, there has been a reduction in the number of under 18 admissions to adult wards.

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CIIT FACTS) for children with mental health problems.

Tier 4 team in place which provides step up / down between 3 & 4.

b. LHBs to put in place clear pathways for children with mental health problems in crisis. Ongoing

Intensive Community Support Team (ICST) has strong links with Youth Justice Service.


c. LHBs to ensure that inappropriate admissions of those under 18 to adult wards reduced. LHB to designate a ward with appropriate staff training safeguarding checks in place for unavoidable admissions by December 2012.

There is a working group consisting of CAMHS, adult and safeguarding representatives working through achieving the AIMS accreditation for age appropriate standards. This is an ongoing process with no end date as yet. The Abblett Unit has achieved and the Heddfan and Hergest Units are working towards the standards.

The CAMHS Service has introduced a new Home Treatment Service and following this, there has been a reduction in the number of under 18 admissions to adult wards. There is an ongoing monthly forum to discuss transition issues between Adult Mental Health Services and CAMHS. All admissions are now jointly managed between the two services.

d. Staff on designated wards to have completed formal training on needs of young people. Ongoing from June 2013.

As above - the accreditation standards involve the training of staff on the needs of young people

There has been no progress with staff receiving training on the needs of young people. A working group has been set up and training for acute inpatient wards to be led by CAMHS. A member of staff within CAMHS has been identified to reconvene the group.

e. LHBs working with LAs to produce guidance as to the range of local services available from specialist CAMHS for all other children to be developed by March 2013.

The Eligibility and Access Criteria Group is developing clear guidelines on services Children and Young People can access. Consultation will be taking place with partner agencies


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12.5 To ensure veterans receive services appropriate for their mental health needs.

a. LHBs to continue to commission and/or provide specialist community Health and Well Being Services for veterans in each area. Ongoing.

North Wales have a Veterans Service in place and also commission Combat Stress for additional support. The Health Board also attends the All Wales Veterans Network whilst having a North Wales Veterans Network.

Introduction of the NW Veterans Forum. Combat Stress is commissioned by BCUHB to fund outreach workers and support groups for veterans. The introduction of ‘Step Change Wales’ – a peer mentoring welfare and advice service delivered by veterans for veterans and their families hosted by CAIS and AVOW in N Wales. CAIS also offer ‘Listen in’ – a new service for Families and Carers of Veterans. Steps Change will eventually be delivered across Wales.

b. Clinical networks to disseminate knowledge and share best practice by March 2013.

The All Wales Veterans Health and Wellbeing Service is fully operational across North Wales. The Service has developed a pioneering multi agency approach with Combat stress, CAIS and RBL which is ensuring that Veterans are treated and signposted appropriately and that their needs are being met by the correct agency either Health or third Sector.


c. LHBs to develop care pathways for veterans to access substance misuse services by March 2013.

All veterans have priority allocation within BCU Health Board SMS teams across the region. There is close working with BCUHB veteran’s service and other third sector support services for veterans.

The All Wales Veterans service is progressing well. There are 1.5 therapists across North Wales. There is a new service delivered by CAIS, Change Step, which started in North Wales and will be rolled out across Wales and is a peer support group for Veterans. ‘Listen in’ is a service for Veterans’ families and carers.

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Combat Stress and Royal British Legion are offering support services across North Wales.

d. LHBs work with substance misuse and mental health providers to ensure veterans with PTSD have timely access to substance misuse treatment.

All veterans have priority allocation within BCUHB SMS teams across the region. There is close working with BCUHB veteran’s service and other third sector support services for veterans.


e. LHBs to establish Armed Forces Forums and Mental Health Clinical Networks.

Dr Peter Higson chairing the North Wales Veterans Network which will be reviewing best practice and identifying gaps in service.


12.6 To ensure appropriate and timely interventions for people in custody

c. LHBs to commission and/or provide prison mental health / CAMHS services in accordance with the published guidance by October 2014.

The North Wales Criminal Justice Mental Health Group has already discussed the implications for healthcare following the announcement of the "super prison" to be built in the Wrexham area and this item will remain on the agenda for future planning. HMP Altcourse has particularly strong links with BCUHB MH/LD CPG and the relationship with HMP Styal is being actively fostered.


d. LHBs to develop a care pathway for those who need to receive care or secure provision, away from their local area by 2013.

BCUHB Criminal Justice Liaison Service is currently targeted at pre-sentence stage. The team assesses individuals referred by North Wales Police custody nurses prior to court appearances and proactively offers


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assessment to individuals within the court precincts and detained in court custody. The CJLS is now jointly managed with the North Wales community forensic mental health team and is better able to ensure a broader local awareness of the Welsh prisoner population who might require input from Mental Health Services

Outcome 13: Service user experience is improved, with safety, protection and dignity ensured and embedded in sustainable services

13.1 To ensure service users of all ages are safeguarded from harm while accessing mental health services

a. LHBs and LAs to work together with third sector to implement safeguarding legislation and policies. Ongoing.

Development and implementation of 'Supporting Children, Supporting Parents: A North Wales Multi Agency Protocol. Parents with severe mental health problems and/or substance misuse: A framework for safeguarding children'. Joint implementation between BCUHB and LA in Conwy, Denbighshire, Ynys Mon & Gwynedd. Date arranged for Flintshire / Wrexham in 2014. Policy being developed for those pregnant under 18's to ensure risk management of the unborn child is in place

Children’s Services/Adults – working to establish to Joint framework. An established risk strategy training group has formed. Identified trainers for WARRN within the CPG. Development of the Veterans Services across N. Wales. Criminal Justice Liaison/joint managed with CFMHT – has created a broader local awareness of the prisoner population.

b. Services to review arrangements as the Social Services Wales Bill becomes law. Timescale to be confirmed.

Discussions taking place between Health and LA's in preparation. Quarterly joint forum between BCU and LA’s Social Services held. NWSSIC (meeting between the six LA Social Service Directors) also takes

Each county in North Wales has an integrated Community mental health team with a joint county manager who works across Health & Social Care. This is supported by a joint North Wales collaborative across Health & social

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place care which oversees the delivery of community based services in relation to the Mental Health Measure.

c. LHBs and LAs to adopt & share learning from published child practice reviews, POVA cases and relevant reviews by WAQ, HIW, CSSIW, Estyn and NCISH. Ongoing

Serious case review summaries are shared across localities. Learning from these events is introduced into every day practice

Adult Practice Reviews are now following the same theme as Child Practice Reviews. Gwynedd is piloting an adult practice review under the new method at the moment. The outcome of that review will inform the Guidance. The Learning Event within Practice reviews is a new principle with an emphasis on; minimising delay, supporting and preparing staff and sharing knowledge and learning.

13.2 To ensure that services are planned and delivered based on safety, dignity and respect.

a. LHBs, LAs and Third Sector to provide services that strive to improve the experience of all service users in line with Doing Well, Doing Better. Ongoing.

Service evaluation forms have been designed by SU&C, with involvement from staff, for acute care and HTT to use on discharge from services. These evaluations are returned using Unllais' free post system, collated by Unllais and returned to the units for information and action as appropriate.

Dignity champions within BCUHB have been identified. Home treatment service evaluation forms are sent directly to Unllais who prepare a 6 monthly report on the service.

13.3 To improve in-patient environment in mental health services, ensuring care is appropriately balanced between inpatients and

a. LHBs to ensure plans in place to ensure inpatient facilities are provided in modern, fit for purpose environments.

Heddfan Unit redevelopment is complete. There is a task and finish group reviewing the Hergest Unit. It has been highlighted that the Abblett and the Hergest Units are not fit for purpose. Issues are being worked through as part of BCU Health Board

Work remains ongoing regarding the redevelopment plans for both the Hergest Unit and Abblett Unit and it is proposed that formal plans will be agreed within this financial year. Further reviews of ligature risks are currently being undertaken with an

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community services

Estates Strategy.

agreement to action any issues that come forward. Capital resources have been agreed for some upgrade work for the Medium Secure Unit, the seclusion room within Hergest and some work has been undertaken within the Abblett Unit.

b. LAs, LHBs and third sectors to develop joint local strategies to reduce delays in transfers of care, rates of admission to mental health beds - including repeat admissions - within 28 days by April 2014.

Strategies are being developed as currently rates of admission are high but repeat admissions are low.

A PICKER survey was undertaken on all adult acute inpatient wards between 29/07/13 – 25/09/13 Unllais are working actively with the CPG on a discharge questionnaire for the Acute inpatient units. There is a WG Experience Questionnaire ‘Your NHS Wales’ (July 2013) which will focus on a patient’s latest experience of Health Care. The CPG are working with the corporate development team to develop an implementation plan.

c. LAs, LHBs and third sector to undertake joint training on care and treatment planning to include Health, Social Care and Housing teams training together to implement effective admission and discharge processes within care pathways by April 2014

Third sector have carried out training for service users and carers. Care plans have been changed to include housing needs. Housing referral forms have been standardised to identify needs


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d. LHBs and LA to ensure Crisis Resolution Home Treatment / Community Intensive Intervention support available for people of all ages within and out of hours by December 2012

Service offered 9am-9pm weekdays and at weekends. CAMHS have out of hour’s rota service in place. Intensive Community Support Team (ICST) will be in place from October 2013 who will aim to achieve improved access

CAMHS have introduced a new home treatment service and following this, there has been a reduction in the number of under 18 admissions to adult wards.

13.4 To improve older people’s mental health services, ensuring they are based on clinical need rather than age, with transitions managed effectively. NOTE: ALSO CONTRIBUTES TO OUTCOMES 11, 12 & 14

a. LAs and LHBs to have in place integrated assessment and care management systems and processes based on clinical need, ensuring dignity care and respect.

Common assessment framework is in place. There is collaborative working in place and work is on-going to ensure full integration. The Older Peoples Integrated Assessment Framework will be implemented from 1st January 2014; there has been regional representation in this development

The Older Peoples Integrated Assessment Framework is being implemented. Staff have been trained in its use and standardised documentation for the region has been agreed and implemented.

b. LHBs and LAs have protocols in place to manage transitions between adult and older persons' mental health services. On-going

Work to be developed as a result of the Older Peoples Integrated Assessment Framework

A protocol is in place that concentrates on the needs of the individual rather than age specific services.

c. NHS, LA and Third Sector staff, including Primary Care Mental Health workers who come in contact with older people, to receive

Advice and consultation is offered. Training tailored to identified need. A Co-ordinated BCU Strategy will be developed.

44 participants took part in the Youth Mental Health First Aid between October 2013-September 2014 from BCUHB. There were 328 people from BCUHB

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training to ensure they recognise and respond to signs and symptoms of mental illness such as depression and other functional illness, dementia and co-morbid conditions in older people by April 2013

trained in Mental Health First Aid between October 2013-September 2014.

13.5 To improve dementia care, including for younger individuals, in all settings across Wales. NOTE: ALSO CONTRIBUTES TO OUTCOMES 11, 12, & 14.

a. LHBs and partners to implement the WG National Dementia Vision document, including young onset dementia services Ongoing.

The National Dementia Vision aims are reflected in the 1000 Lives dementia targets which form the greater part of the MHLD CPG Dementia plan. The Health Board has adopted 14 Localities, which focus on primary and community health and social services. Ten of the 14 localities have identified Dementia care and support as a priority. The North Denbighshire Locality has developed and is disseminating the Dementia Respect Empathy and Dignity (RED) project. The Health Board has also adopted the Butterfly scheme in the acute inpatient hospitals.

The acute care dementia pathway is in place alongside the ‘Butterfly’ scheme across N Wales within residential and in patient settings and has increased awareness of dementia and the need to support dementia patients more effectively.

b. All Part 1 PCMHS staff trained to assess for memory loss and common mental health conditions in the elderly by January 2013

A specific pathway for access to memory clinics has been developed. Memory clinics are currently working towards achieving the Royal College of Psychiatry accreditation. There is an older persons' lead established in each Primary Care Mental Health Team.


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c. LHBs to implement 1000 lives + dementia Intelligent Targets. Ongoing.

Dementia intelligent targets fully implemented. Progress was analysed in March 2013. Advice received from PHWIU that LHB's may start to adapt the targets to better meet local needs. Task and Finish group established to discuss this with PHWIU.

All memory clinics in N Wales are now part of the National accreditation programme offered by the Royal College of Psychiatrists. In aiming to achieve the required standards all services have undergone a development programme and waiting times have fallen considerably. Variable diagnostic rates has also been addressed as an All Wales challenge, and discussed as part of the All Wales National Memory Service audit in which we fully participated.

d. All newly diagnosed people provided with Alzheimer’s Society Dementia Information Packs. Ongoing.

Provision of information following diagnosis is a requirement of the Mental Health Measure. All patients of the memory service are offered this information. This is documented in case notes and also on a separate care plan for those referred to a dementia advisor.


f. LHBs and LAs to ensure access to specialist advice available to all care homes

The Health Board will provide advice on request


13.6 To review Eating Disorder Services for all ages.

a. LHBs to commission and complete review of the pattern and cost effectiveness of inpatient eating disorder treatment across all ages services

Tier 3 CAEDS audit and monitor Adult over 18s admissions - out of area SEDU and local medical and inpatient admissions. Patterns and gaps highlighted. Tier 4 Option Appraisal with WHSSC at mid point with

CAEDS continue to monitor and be the gatekeeper for out of area adult (18+) Tier 4 SEDU admissions. Key issues are being identified – waiting times for out of area SEDUs in high risk cases, travel times for patients and staff, and

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by end 2013.

consultations received. MARSIPAN improvement group in place. There are designated local beds for patients with 1:1 nursing needs

ongoing needs and costs. WHSSC consultation did not led to any changes in service, despite recommendations made by CAEDS for North Wales. Local MARSIPAN beds still remain an outstanding issue for BCHB, and there are no designated beds locally. However, plans to develop these are more advanced and it is hoped this will be established this year although there will be a cost implication to resolve.

c. LHBs to develop services in line with outcome of review and Eating Disorders: A Framework for Wales by end 2015.

In adult services: Training and consultation to primary care and secondary care treating staff. Pathways, protocols and BCUHB information intranet developed. Adequate access to evidence based quality psychological therapies at primary MH and secondary care level needs addressing, as well as monitoring of quality and urgency of initial assessment in primary care and secondary care for high risk patients

Tier 3 CAEDS continue to lead on supporting stepped care services for adults (18 +) who have eating disorders in BCUHB. This includes a roiling programme of training and supervision of primary and secondary care staff, as well as provision of written guidance and tools via the BCUHB intranet site and at consultation. This includes highlighting thorough assessment of risk, and subsequent appropriate treatment planning. Things have improved considerably over the last 4 years, in terms of awareness of risk and appropriate treatment pathways. However, in such a large organisation with many different local services this work is ongoing

Outcome 14: Providers are positively managing risk, supporting people to increase their levels of hope and aspiration and enabling them to realise their full potential through recovery and enablement approaches.

14.1 To ensure that services are based on a recovery and

a. LHBs and LAs to ensure that Care and Treatment Plans for

Audits are completed on the quality of plans and managers discuss their quality during supervisions


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re-ablement approach supporting to gain more control over their lives.

service users embed the principles of recovery and re-ablement, where appropriate, from October 2012.

b. All Care Co-ordinators are competent in using recovery and other relevant skills through Care and Treatment Planning training, using Lincoln University materials. Ongoing.

The majority of staff have attended the Lincoln University Training programme.


c. LHBs and LAs to ensure that individual service user views of what recovery means to them become a core part of Care and Treatment Planning. Ongoing from October 2013.

Care plan includes section on service users’ views. Service Users and Carers, supported by Unllais have developed additional training materials and also support delivery.

‘What Matters’ needs to be developed and will form part of the Older Peoples Integrated Assessment Framework.


e. LHBs and LAs to provide support for children in addressing issues of attachment and developmental problems. Ongoing.

Attachment training has been delivered to all CAMHS staff across the region. There were 3 levels of training provided for cohorts of 30 staff. An evaluation of training was carried out


f. For people with dementia, LHBs, third sector and LAs to provide services that support them to maintain independence for as long as possible, sustaining

Dementia care encompasses the underlying principles of recovery and promotes coping and aiming to live well with dementia. There are dementia advisors in each memory service working to support recovery. Memory services across BCUHB offer


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quality of life. Ongoing.

a number of interventions aimed at coping with dementia as a chronic and enduring health problem. The CPG is piloting a psychological intervention with a view to roll out across North Wales

14.2 To develop service culture for positive risk management.

c. LHBs, LAs and Third Sector to ensure evidence based risk assessment training is provided for appropriate staff to extend to cover all settings, service user groups and all ages. Ongoing

The Mental Health & Learning Disabilities CPG has established a risk strategy training group and a document setting out the present risk training has been produced. The CPG has established a group of trainers who can train staff working in the CPG on WARRN developed 'Asking Difficult Questions' training; This training is being focused on those staff undertaking care coordination duties for the Mental Health Measure. A data base is maintained on the numbers of staff trained in ADQ and the areas where staff work. CAMHS - WARRN training carried out, along with train the trainers so messages can be relayed across the region. Structured Assessment of Violence Risk in Youth (SAVRY) training for generic and specialist CAMHS staff, along with Training to Train to build capacity.


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Chapter 4: One System to Improve Mental Health ACTION SUB ACTION COMMENT FROM BCUHB ANNUAL

REPORT 2012-13 UPDATE – 2013-14 R/A/G

Outcome 15: People of all ages experience sustained improvement to their mental health and wellbeing as a result of cross-Government commitment to all sectors working together

15.1 To ensure that people with mental health problems have access to advice and support on financial matters

a. LHB and LA staff to establish links and contacts with debt advice services to assist people in managing their finances. Ongoing from April 2013

Projects are in place with Citizens Advice Bureaus who target relevant groups. There are SLAs in place where there is a focus on MH. There are welfare rights teams in all Counties. Community Advocacy services commissioned by BCUHB are supporting service users to access appropriate financial support & information. LAs have processes for sign posting on initial point of contact


15.2 To improve mental wellbeing by improving the condition of housing.

b. LAs and LHBs to develop plans for joint working and developments on housing and associated services incorporating mental health as a priority by June 2013.

An event has been held to bring together LA, LHB and housing association colleagues to develop joint working and coordinate planning to ensure successful independent living. Work streams are being developed.

A Regional Group led by BCUHB has been established to consider accommodation facilities and services that are available for People with Mental Health Needs, e.g. Supported Housing, residential care and specialist provision and includes input from the North Wales Commissioning Hub. Supporting People and Local Authorities are represented on this Group by a designated Lead Officer.

15.3 To reduce homelessness and help people with

c. LAs to implement Supporting People Programme Guidance

Supporting People Groups set up regionally with LA's and Health Board representation

A North Wales multi- agency task and finish group was established to consider developing a needs mapping

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mental health problems sustain tenancies.

ensuring that commissioning decisions take account of mental health needs. Ongoing.

form which would assist in identifying people with mental health and accommodation needs. A protocol and needs mapping form were developed which has since led to all Supporting People Teams across North Wales adopting a Regional Needs Mapping process which includes identification of Mental Health and housing needs. Denbighshire County Council have taken lead responsibility for the centrally located needs mapping database which has enabled all providers to complete Supporting People Needs mapping electronically since 1.4.14. Authorities have or are developing Supporting People Gateways, holding complex case meetings where required, for people with Mental Health issues, in order to bring together all relevant professionals and plan the most appropriate accommodation and support pathway.

d. LAs and LHBs to develop plans for joint working and developments on housing and associated services, incorporating mental health as a priority by June 2013.

Forms have been standardised. Housing needs are assessed when accessing MH Services. Strategic housing meetings take place with social housing across all localities. The North Wales Working Group – Homeless and Vulnerable Groups Health Action Plan (HaVGHAP) has been reconvened, with membership from Health, Local Authorities and third sector, in response to the Welsh

An extensive mapping exercise has been undertaken across North Wales for homeless people groups. A data collection has been carried out across North Wales to inform the profile and health needs of homeless people groups. A Gypsy Traveller Needs Assessment has been completed with Bangor University in 2013.

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Government Standards for Improving the Health and Well-being of Homeless People and Specific Vulnerable Groups April 2013

A working group led by the supporting people team in Denbighshire has begun to review the existing night shelter model and explore alternative models of support for homeless people in crisis. Additional funding will need to be identified in order to implement a future service.

e. LHBs to provide senior representation on Supporting People Programme Regional Collaboration Committees by December 2012

Assistant Director of Community partnership development is BCUHB representative.


f. Social landlords (local authorities that still own their own housing and registered social landlords) take into account the needs of people with mental health problems when discharging their landlord functions. Ongoing.

Key activities for Registered Social Landlord's (RSL’s) has been to ensure that the impact of the Welfare Reforms, as it relates to Housing Benefit changes in particular, have been considered in the context of ensuring that our Tenants have been supported to reduce the impact i.e. tenancies are sustained.

A welfare reform project board has formed by the North Wales social landlords in response to identified risks due to housing benefit changes. The board will look to identify; who has been affected, what are the future options, the risk area of rent arrears, any access to floating support for people in crisis.

15.4 To ensure vulnerable groups have equitable access to safer homes

a. Professionals, Fire and Rescue Services and LHBs to promote safe homes through fire safety and slips and trips initiatives. Ongoing.

Assessment documentation. Local authorities have memorandum of understanding in place for sharing of information

Aim to further enhance partnership working between NW Fire Service and CMHTs to increase numbers of fire safety risk assessments for service users undertaken. NW Fire Service will also offer specialist interventions: fire safety packs, specialist arson support/ Arson Reduction Team will look at risk in more detail

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b. Staff awareness to be raised of where there is heightened risk for home fire or falls for vulnerable individuals (such as those with dementia) and of the need to share information on those individuals with the Fire and Rescue Service and other relevant agencies. This will ensure appropriate action is taken to mitigate the risks where possible.

First Contact teams will offer Fire Service check

N W Fire Service working with Communities First. 28-30K households in North Wales have had fire safety checks. There is an aim for every home to have a working smoke alarm.

15.8 To ensure that the physical health needs of people with mental illness are recognised and better met NOTE: SEE ALSO ACTION 1L3 IN CHAPTER 1

b. LHBs and PHW to ensure that general health promoting initiatives are signposted for people in contact with mental health services. Ongoing from April 2013.

A Physical Health Group has been established to improve detection and treatment of co morbidity and Mental Health. The group has prioritised improving Clozaril treatment arrangements and improving outcomes for co morbid diabetes. Wellbeing Centres are in place across N Wales provided by third sector which encourages attendees to look at lifestyle behaviours, e.g. smoking cessation.

Wellbeing centres have been established but are not in place in all areas across North Wales, this needs further attention and review.

15.9 To promote employment opportunities for people with mental health problems.

a. WG, LAs and the NHS Wales to act as exemplar employers in developing workplaces that support mental wellbeing and both recruit and retain people with lived

The Health Board has adopted practices to improve employee health and well-being in the workplace and has been awarded the Corporate Health Standard Gold which is one of the Health Working Wales programmes and is the national

Adult mental health services across; Gwynedd, Mon, Conwy and Denbighshire have been able to take advantage of the European Funded New Work Connections Programme over the past four years, however this funding will end in April 2014. There

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experience of mental illness. Ongoing from March 2014.

standard. One of the specific health issues in the bronze and silver standards is mental health

has been an opportunity for service users to access education and training and support to find employment.

b. All agencies to formulate policies to promote mentally healthy workplaces including policies to make reasonable adjustments to assist people to gain and retain employment.

Two tick ‘positive about disabled people’ symbol .Employers that use the disability symbol make five commitments regarding recruitment, training, retention, consultation and disability awareness. The Health Board has guidelines in place on the fair treatment of disabled people at work. These guidelines are aimed at promoting good practice in the employment of disabled people by providing managers with guidance and information on all aspects of the employment cycle


15.10 To promote the health and well-being of the people of Wales by enabling people to access information from libraries to promote, manage and improve their health status throughout their lifetime. NOTE: SEE ALSO ACTIONS UNDER OUTCOME

a. LA library services and public libraries to work with PHW to promote BPW. Ongoing

All North Wales Library Services hold and promote the full range of Book Prescription Wales (BPW) items

Bibliotheraphy services are in place in all libraries. However, this could be advertised more widely in Primary Care Settings. The promotion of the use of bibliotherapy for CAMHS Service User’s is a target area.

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Chapter 5: Delivering for Mental Health

ACTION SUB ACTION COMMENT FROM BCUHB ANNUAL

REPORT 2012-13 R/A/G

Outcome 16: Staff across the wider workforce recognise and respond to signs and symptoms of mental illness and dementia

16.1 All staff across the public sector to promote a culture this is respectful and experienced as empowering.

a. LHBs, LAs and Third Sector to ensure all their services embed a culture of dignity and respect. Ongoing.

The equality e learning module is a new and innovative learning resource developed by BCU that is designed to improve general awareness and understanding around Equality and Human Rights. The programme is mandatory for all staff.


b. LHBs and LAs with their partners to ensure that all relevant staff in the wider workforce receive training in mental health awareness raising, addressing stigma and discrimination and know how to get specialist support when they need it. Ongoing.

The MHLD CPG is in the initial stages of piloting awareness on compassion for staff working on mental health wards and this is taking place in one of our hospital hubs. This has yet to be rolled out to other service areas

The compassion training has now started within the Mental Health & Learning Disabilities Clinical Programme Group. The training has began on the older persons wards with the intension that training on all older persons wards will be complete by mid October.

Outcome 17: Inspirational leadership and a well-trained, competent workforce in sufficient numbers ensure a culture which is safe, therapeutic, respectful and empowering

17.1 To ensure a sustainable skilled workforce that helps people improve health as well as treat sickness.

a. LHBs to develop sustainable and affordable workforce plans to support the delivery of Together for Mental Health. Ongoing.

The LHB and LA's have workforce plans in place. The MHLD CPG develops a workforce plan on an annual basis. Part of this plan is the development of training. CAMHS - Workforce Sub Group established to develop blue print of

The Workforce Sub group of the CAMHS Service Board is now in implementation phase with revised terms of reference.

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CAMHS workforce over next 5 years

b. Personal Development Plans (PDPs) to be in place for all staff with annual appraisal process. Ongoing

Mental Health & Learning Disability Clinical Programme Group is committed to ensuring staff are continually developing and are supported to be effective in their jobs thus maintaining high quality services for the public. This is formally addressed through the PADR process. To date CPG compliance is 35%.


c. LHBs, LAs and Third Sector to adopt evidence based team working with an emphasis on clinical networks and locality teams. Ongoing

The MHLD CPG has established a number of clinical networks, particularly access to deaf mental health, personality disorder, eating disorder, veterans.


d. All clinical staff to be engaged in 1000 Lives and trained in methodologies. Ongoing

The CPG has leads for 1000 Lives Mental Health Intelligent Targets for Dementia, Eating Disorders and Early Intervention. The CPG would need to progress the action of the leads being trained in methodologies

Over the next quarter the leads for the 1000 lives will be booked onto receive training in improvement methodologies. Leads are in place for the 3 areas of improvement

f. Mental Health Clinical Leaders Group to be expanded for all ages to participate in a clinical leadership programme pilot during 2013

A clinical leadership group is attended by Chief of Staff


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In addition, the following actions will provide assurance that the aims of Together for Mental Health are being delivered

19.1 To ensure that appropriate arrangements are in place to oversee the implementation of Together for Mental Health at national and local levels. NOTE: SEE ALSO ACTION 10.1 IN CHAPTER 2

b. LHBs to put in place local multi-agency partnership arrangements on LHB footprint by January 2013.

A Together for Mental Health Partnership Board has been established and meets three times a year as a board and will supplement with workshop sessions as required. A project team is in place to coordinate a regional approach, collecting evidence and reporting.

Links with Local Area Planning Groups have been strengthened and the role of the Service User and Carer Representatives has been enhanced.

19.2 To ensure that the appropriate infrastructure is in place to measure progress in delivering the key actions of Together for Mental Health

c. Local partnership boards to routinely consider unmet need in the planning and delivery of services. Ongoing from 2015.

As 19.1. The action plan is reviewed regularly and developments are highlighted

It is the role of the Chairs of the Local Area Planning Groups to provide reports to the Partnership Board on unmet need in the planning and delivery of services within their areas.

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Annex 2 - Membership of the North Wales Local Partnership Board

Group/Organisation Represented

Name Position and Organisation

BCUHB Geoff Lang Executive Director (Chair)

BCUHB Dr Giles Harborne Chief of Staff

BCUHB Simon Pyke Assistant Chief of Staff

BCUHB Dr Peter Gore-Rees Clinical Director CAMHS

BCUHB Irfon Williams CAMHS Service Manager

BCUHB Mike Sinnott Director of Mental Health & Learning Disabilities

BCUHB Dr Sara Hammond-Rowley

Early Intervention Programme Lead

BCUHB Wyn Thomas Assistant Director Community Partnership Development

BCUHB Sue Owen Partnership Improvement Manager

Public Health Wales Jackie James Principal Health Development Specialist

North Wales Heads of Adult Social Services

Clare Lister Head of Adult Services Conwy County Borough Council

North Wales Heads of Children’s Services

Leighton Rees Head of Children’s Services, Denbighshire County Council

North Wales Local Authorities - Heads of Housing

Sam Parry Conwy CBC

Housing Associations Kevin Hughes Director of Care and Support Services, Pennaf

Unllais (Link to Third Sector Adult Mental Health)

Joan Doyle Director

Children’s Third Sector Representative

Kate Newman H&SCWB Facilitator

CVC (Third Sector H&SC) TBC

Service User & Carer Representatives

Andrea Hughes Bronwen Pritchard Hannah Murphy Marc Spacey Monica Dyke

Flintshire County Council Gwynedd & Ynys Mon Wrexham County Borough Council Conwy County Council Denbighshire County Council

LMC Dr Huw Lloyd GP

BCUCHC (Observer with speaking rights)

Chris Jones

North Wales Directors of Social Services

Neil Ayling Director of Social Services, Flintshire County Council

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Group/Organisation Represented

Name Position and Organisation

North Wales Fire & Rescue Service

Terry Williams Head of Community Safety

Local Planning Groups Geoff Lees Jo Taylor Mark Couchman Sean Clarke Tesni Hadwin

Denbighshire Flintshire Gwynedd & Ynys Mon Wrexham Conwy

board paper 2.12.14 item 14/277 - nhs wales 14_277...board paper 2.12.14 item 14/277 to improve...

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