HEALTH, SOCIAL CARE AND WELLBEING STRATEGY FOR RHONDDA CYNON TAFF

2011-14

CONTENTS

INTRODUCTION ...... 1 WHAT IS THE HEALTH, SOCIAL CARE AND WELLBEING STRATEGY? .... 2 THE CONSULTATION PROCESS ...... 3 OUR VISION ...... 4 OUR VALUES ...... 5 OUR APPROACH ...... 5 OUR ACHIEVEMENTS SO FAR ...... 9 OUR THEMES FOR 2011-14 ...... 12 THEME 1 ...... 13 PROMOTING HEALTHY LIFESTYLES AND PREVENTING ILL HEALTH ... 13 i REDUCING HEALTH INEQUITIES - FAIRER OUTCOMES FOR ALL ...... 15 ii. HEALTHY LIFESTYLES ...... 16 iii. ALCOHOL AND DRUGS ...... 19 iv EMOTIONAL WELLBEING ...... 20 v WORK AND HEALTH ...... 21 THEME 2 ...... 22 PROMOTING INDEPENDENCE AND PROTECTING THE VULNERABLE .. 22 PEOPLE WITH A LEARNING DISABILITY ...... 27 PEOPLE WITH MENTAL HEALTH PROBLEMS ...... 28 PEOPLE WITH CHRONIC CONDITIONS ...... 30 OLDER FRAIL PEOPLE ...... 31 PEOPLE AFFECTED BY THE MISUSE OF DRUGS AND ALCOHOL ...... 32 PEOPLE WITH A PHYSICAL DISABILITY AND/OR A SENSORY IMPAIRMENT ...... 33 CARERS ...... 35 THEME 3...... 36 IMPROVING SERVICES AND JOINT WORKING ...... 36 IMPLEMENTATION ...... 41

INTRODUCTION

Welcome to the third Health, Social Care and Wellbeing (HSCWB) Strategy for Rhondda Cynon Taff (RCT), covering the period 2011-2014.

It is a statutory requirement that Rhondda Cynon Taff County Borough Council and Cwm Taf Health Board produce this Strategy to show how we will drive forward improvements in the health and wellbeing of our local population.

Enjoying good health and avoiding harm is a priority for us all as individuals, families and communities. However, many factors which influence our health are outside the control of the Local Authority and Health Board on their own. There are a range of other partners who also have an important part to play, including other statutory and voluntary organisations, the independent sector, service users, carers, community groups and of course our staff. We therefore set up the RCT Health Social Care and Wellbeing Partnership in 2004 to oversee the development and delivery of the Health, Social Care and Wellbeing Strategy. The Partnership has added value to the work of individual agencies and although we are proud of what we have achieved together, there are always further improvements that can be made.

The approach of the HSCWB Partnership has been to address a broad range of factors that influence health and wellbeing, including employment, housing and transport, as well as considering the specific needs of groups such as older people and people with mental health problems. Many of our communities suffer from high levels of deprivation and lifestyles which do not support good health. The HSCWB Strategy has motivated and engaged partners in addressing these issues together. However, health improvement is a long term process and there is still much to do. The economic challenges facing the country will impact on individuals and communities in RCT as well as putting severe pressure on all public sector budgets. It is therefore more important than ever that we focus on the outcomes we want to achieve.

In addition to the work undertaken by the HSCWB Partnership, individuals, too, have a responsibility to look after and take more control over their own health. We need to encourage and support people and communities to be able to do this, getting rid of the barriers that stop people leading a healthy life.

If we are to promote healthy lifestyles and provide high quality, sustainable services in the future that promote independence, whilst also protecting and supporting those in the greatest need, we must change the way we work and use our resources. The HSCWB Strategy sets out how we intend to do this and our priority areas for improvement and action.

In developing and finalising this Strategy, we have taken account of all the comments made as part of the consultation exercise. Thank you for taking the

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time to tell us what you agreed with and the issues which are important to you, your families and communities. We have reflected on your views and have made reference to these throughout the document. We will continue to keep you informed of progress in implementing the new plan which will only be a success, as many of you pointed out, if we all work together.

Together we can make a positive difference to the lives of everyone in Rhondda Cynon Taff.

Dr C D V Jones C.B.E Councillor R Roberts Chairman Leader Cwm Taf Health Board Rhondda Cynon Taf County Borough Council

WHAT IS THE HEALTH, SOCIAL CARE AND WELLBEING STRATEGY?

The Health, Social Care and Wellbeing Strategy is a three year plan which is about everybody. It is not just about treating and caring for people who are ill, although that is of course an important element, but it is also about keeping everyone fit and independent, helping people to participate fully in life.

This means that the Strategy must not only consider the physical and mental health problems people may have but also the range of factors that can influence their health and wellbeing. These include living, working and environmental conditions as well as social, cultural and leisure opportunities. All of these elements contribute to people’s health and wellbeing and also help make our communities strong and sustainable.

The HSCWB Strategy is a statutory plan which identifies our aspirations and commitments in relation to health and wellbeing in Rhondda Cynon Taff. In producing this plan however, we are mindful of the Welsh Assembly Government requirement that the HSCWB Strategy should concentrate on two significant elements –

• reducing inequities in health that are unfair and avoidable • improving the provision, quality, integration and sustainability of services provided by both the NHS, Local Authority and other partners

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THE CONSULTATION PROCESS

Guidance from Welsh Assembly Government states that a diverse and wide range of partners must be consulted and involved in the development and monitoring of the HSCWB Strategy. In October 2010, the Partnership Board therefore approved an Engagement Plan which outlined the approach to be taken to ensure that public engagement and community involvement was as inclusive and meaningful as possible.

A formal 12 week consultation period was required to consult on the draft strategy. However, it was also expected that there would be ongoing engagement with the public, staff and stakeholder organisations throughout the whole process and in a range of ways. In RCT, engagement to help inform the drafting of the consultation document was undertaken in the Big Bite event in Pontypridd in the summer of 2010, at the 50+ Life is What you make it event in Llantrisant in the Autumn, with LHB staff at an event in the Royal Glamorgan Hospital, with the LHB Stakeholder Reference Group and with a range of partnership groups including those established as part of the Third Sector’s HSCWB Forum.

The formal consultation process took place between 30th December 2010 and 25th March 2011. The draft Strategy consultation document was made available electronically in both English and Welsh, together with a questionnaire to collect responses. The document was distributed widely using the databases of partner organisations and other stakeholders to reach as many groups and individuals as possible, including some whose needs are sometimes neglected or not fully met by mainstream services. Copies were made available in Braille and as audio discs in response to requests from service users through RNIB.

In addition to presentations at meetings and specific events with opportunities for workshop discussions, a variety of methods were used to communicate as widely as possible, including the use of partner organisation newsletters, websites and the local media. An edition of the HSCWB magazine LIVING was used to provide a summary of the consultation document and a copy of the questionnaire to be returned via Freepost. Information was also provided in locations accessible to the public including Local Authority libraries, One 4 All centres, and leisure centres. Other methods included the use of Interlink’s Facebook account, Community 1st networks and the Local Authority’s Citizens Panel. Consultation with children and young people was undertaken with the ROOTS group for disabled young people and with pupils at Hawthorn High School.

Where appropriate, events were held jointly across RCT and Merthyr Tydfil for example, an event with Community First Partnerships and a workshop for the Third Sector.

All responses received were considered by the HSCWB Partnership Board and a number of common themes and key messages were taken into account when finalising the Strategy. Throughout this document, we have included

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many of the views expressed whilst other more specific comments have been referred to the relevant operational groups responsible for developing and implementing the Action Plans that will deliver the Strategy. We are grateful to all those individuals and groups who responded.

“I welcome a chance to be part of the debate. Talking to patients, carers, families is the only way to actually find out what the problems in the system are.”

The final Strategy was agreed by the HSCWB Partnership Board at the end of March 2011 and then formally approved by RCT Local Authority and Cwm Taf Local Health Board.

OUR VISION

The HSCWB Strategy sets the direction for all other health, social care and wellbeing plans and policies. As such, we have developed an overarching Vision which reflects our ambitions for the future. We revisited the Vision from the 2008-11 Strategy and made clearer the outcomes we want to achieve.

WHAT YOU TOLD US:

There was broad support for the general direction of the strategy and the Vision itself. Some respondents however had concerns that the Vision statements were too aspirational and would be challenging to achieve, particularly given the difficult financial circumstances.

“As always, it’s how visions are achieved that matters.” “To succeed will involve changing culture which is difficult and cannot be achieved overnight.”

There were a number of comments highlighting the unfair and avoidable differences in health that exist between different parts of RCT. The need to tackle this inequity across the Borough is a key element of the new Strategy and the Vision has been strengthened in this respect. Many comments stressed the importance of partnership working if the Vision was to be made a reality and we have therefore reflected this important aspect by prefacing the Vision with an additional statement :

BY WORKING TOGETHER, RHONDDA CYNON TAFF WILL BECOME A PLACE WHERE

• Everyone lives a longer, healthier and happier life with fairer outcomes for all

• Everyone lives life to the full and is enabled to achieve and maintain their independence for as long as possible

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• Everyone who becomes ill, frail or vulnerable receives the care and support they need at the right time in the right place

• All individuals and communities recognise the need to take more responsibility for their own health and wellbeing and are supported to do this

OUR VALUES

Building on the developments of the first two HSCWB Strategies, our plans will be underpinned by the following key values:

• Equity: tackling the unfair and avoidable differences in health between people in different areas and social groups. We need to improve people’s social and economic prospects, helping them to avoid action which can damage their health and reducing inequalities in access to services.

• Engagement: involving all stakeholders, including service users, carers, the wider public and staff in both the development of service plans but also in decisions about care which affect their daily lives.

• Empowerment: supporting individuals and communities to take increasing control over their own lives and health.

• Effectiveness: making health and social care as safe, sustainable and careful of resources as possible, avoiding harm, waste and variation which means the best is not provided everywhere

• Empathy: treating service users with dignity, respect and integrity.

OUR APPROACH

In developing the Strategy, we have placed great emphasis on the following:

1. Needs based planning

The HSCWB Strategy is based on an assessment of health needs which has helped us to understand the key challenges we face. The needs assessment analyses a range of statistical data and evidence but also takes account of other “softer” information based on what people have told us is important to them, their families and their communities.

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As part of a project to provide a common needs assessment which will cover all the planning partnerships in both RCT and Merthyr Tydfil, the full needs assessment will be available in 2011 as an online resource which can be accessed by any professional or member of the public.

The main findings are listed below, with other specific issues highlighted in the relevant sections of this document.

• The level of deprivation in RCT is greater than in the rest of Wales which results in poorer health for our residents and lower life expectancy.

• Compared with the rest of Wales, people in RCT have a shorter healthy life expectancy which is the estimate of how long people can be expected to live in “good” or “fairly good” health.

• We have a growing elderly population which is likely to cause a rise in chronic conditions and in dementia. There is also likely to be an increase in economic dependent and care dependent people.

• The population in RCT has higher death rates from cancer, circulatory disease (including heart disease and stroke) and respiratory disease than the Welsh average.

2. Relationship with other Partners.

In the same way that health and wellbeing cannot be improved by the NHS and Local Authority alone and is a shared goal for a wide range of stakeholders, so too the HSCWB Strategy must not be developed and delivered in isolation from the other key plans that affect our population.

WHAT YOU TOLD US: There were many comments stressing the importance of more effective partnership working, in particular - to consider the needs of children and young people in the context of family life and adult services that will impact upon them - to make a greater impact on the most challenging problems such as alcohol misuse - to better understand and value the contribution Third Sector services can make - to share the positive examples of many community groups delivering successful projects at a grass roots level

In particular, we need to work together with the following Partnerships and groups to achieve the greatest benefits for our residents.

• Rhondda Cynon Taff Local Service Board The Local Service Board is a statutory partnership involving the Local Health Board, the Local Authority, Police and the voluntary sector. It aims to make partnership working more effective across the board, identifying key priority issues that need to be tackled jointly, enabling more effective use of resources and improving outcomes for citizens. The Local Service Board oversees all

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the strategic partnerships in RCT, including HSCWB, and will hold us to account for our work and the progress we are making towards delivery of common priorities.

The Local Service Board has developed the Rhondda Cynon Taf Community Strategy for 2010-2020 which provides the overarching context for all plans in Rhondda Cynon Taff. The plan’s focus is on “Promoting Achievement and Tackling Disadvantage” and enabling RCT to become a “County Borough of Opportunity.” The HSCWB Strategy will be critical to this as health plays such an important role in enabling people to participate fully in life and achieve their potential.

In particular it will deliver the ambitions identified for Healthier Adults and Communities:

o Reduce health inequalities o Develop world class health services o Increase the independence of older and vulnerable people o Improve access to health and social care services

• RCT Children and Young People’s Partnership (Fframwaith) The Children and Young People’s plan outlines the strategic planning intentions and priorities for all children and young people’s (CYP) services in RCT. It is essential that this plan is closely aligned with the HSCWB Strategy as

o good health in the early years and adolescence makes a vital contribution to maintaining good health through life o the health and wellbeing of children is intimately connected with that of their families o children use other services besides those specifically designed for them o children will go on to use services designed for adults and we must have good transitional arrangements in place

The Children and Young People’s Partnership in RCT (Fframwaith) has recently produced its new plan for 2011-14. Although the HSCWB Strategy is focused primarily on adults, there are specific areas of overlap with the CYP plan.

In particular we need to work together with Fframwaith to promote healthy lifestyles, tackle child poverty and meet the complex needs of our most vulnerable families. We also want to learn from the multi agency Canopi framework which has been developed by the CYP Partnership. This enables agencies to plan and work together to deliver services to children, young people and their families in the communities where they live. We need to explore how this framework will relate to arrangements for delivering locality based services to adults.

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• RCT Community Safety Partnership Many of the issues being addressed by the Community Safety Partnership (CSP) to ensure Safer Communities will also have an impact on health and wellbeing. In particular we have common interests in seeking to reduce the impact of alcohol and drug misuse and also in the prevention of domestic abuse. Our two Strategies must work together to tackle these problems. Both Partnerships also recognise the importance of strong community networks which will be developed as part of the RCT Community Cohesion Strategy.

• RCT Local Safeguarding Children’s Board The Local Safeguarding Children’s Board focuses on the protection of children from abuse and neglect. As such it needs to work very closely with Fframwaith, the HSCWB Partnership and Community Safety Partnership in order to safeguard and promote the welfare of children. The LSCB has a specific role in monitoring the work of the HSCWB Partnership in respect of our safeguarding responsibilities and related issues, for example our work with adult carers has an impact on the safety of children and young people. We also need to learn from the work of the LSCB. For example, serious case reviews conducted by the LSCB have identified issues in the way that adults who are parents have received services which have had a detrimental impact on their children.

• Communities First Partnerships There are 24 Communities First areas in RCT, recognising the significant levels of deprivation experienced in many parts of the County. Vibrant, sustainable communities where people want to live, work, play and flourish, are essential to achieving our Vision. It is therefore important that the local plans and actions developed by Communities First Partnerships take account of the HSCWB Strategy but also influence it’s priorities and contribute to it’s delivery. We have an active Community Health Development Network in RCT which brings partners together to identify common issues, share best practice and develop projects to tackle local priorities which will improve health and wellbeing.

• Third Sector partners The Third sector includes the range of organisations operating between the state and the private sector, such as small local community and voluntary groups, registered charities both large and small and a growing number of social enterprises. The third sector plays an important part in the prevention of ill health, the provision of health, social care and wellbeing services and support for carers and local communities across RCT. Interlink, the County Voluntary Council for RCT, represents the Third Sector at the HSCWB Partnership Board and as such, together with its members, is a key strategic partner in the development and delivery of the HSCWB Strategy. Interlink also coordinates the work of the voluntary sector HSCWB Forum which influences the development of health and wellbeing activities and services in RCT.

• Other RCT Planning Groups In addition to the key relationships highlighted above, there are a range of other strategic and operational partnerships in RCT with which there are

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already close links. We must continue to align our plans and priorities as well as look for more opportunities for joint working on specific programmes. Examples include

Local Housing Partnership Economic Regeneration Partnership Social Care Workforce Development Partnership Lifelong Learning Partnership Environmental Improvement Forum Supporting People Operational Group Area Planning Board for Substance Misuse for RCT and Merthyr Tydfil

• Merthyr Tydfil HSCWB Partnership Like us, the HSCWB Partnership in Merthyr Tydfil has produced its new HSCWB Strategy and there are a number of common issues faced by the populations in both RCT and Merthyr Tydfil. We have already worked together across the two Boroughs on a range of health and social care initiatives and will continue to do so where appropriate in order to improve outcomes for our residents, share best practice and make the best use of resources. Although there are two separate HSCWB Strategies reflecting the local needs of each area, we have used common needs assessment, strategy development and consultation processes.

3. Engagement with stakeholders The development of the HSCWB Strategy must be an open and inclusive process. It has involved a wide range of partners including statutory, voluntary and independent sector organisations, service users, carers, members of the public and staff. This approach will continue through out the implementation of the Strategy and there will be regular feedback on progress and ongoing engagement with all our stakeholders. This will be undertaken in a variety of ways including through public meetings, Third Sector and community groups, the use of partner newsletters and websites and through specific events.

“ I would like to know what happens, when it happens and positive outcomes should be given a good press so that people can see the differences for themselves, hopefully getting them to become more involved.”

OUR ACHIEVEMENTS SO FAR

We developed the first two HSCWB Strategies from 2005-8 and 2008-11 based on our needs assessment and on what you told us was important to you and your families. We concentrated on 7 key themes which focused on the priorities you identified –

Healthy Environments Community Collaboration and Prevention Mental Health and Emotional Wellbeing

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Children and Young People Maintaining Independence Work and Health Transport and Access

Working through these themes, we have made good progress in tackling some of the underlying causes of ill health which exist in many areas of Rhondda Cynon Taff. Examples of our successes include:

• Supporting people into or back to employment. Since 2003, more than 4000 residents have been helped back to work through programmes like Pathways to Work. In particular, the award winning Condition Management Programme has helped people to manage their health conditions more effectively so they feel more in control of their own health and able to cope with being in work.

• Supporting self management and self development programmes Programmes like the award winning Routes to Recovery, for people with mental health problems, Mental Health First Aid courses and the Expert Patient Programme, for a range of chronic conditions, have helped service users and carers learn more about their conditions, cope better with their difficulties, identify and work towards their own individual goals

• Increasing opportunities for physical activity Over the past three years we have attracted over £900,000 of funding from the Big Lottery and Sports Council to encourage people to be more active, for example, the Mentro Allan project works with older people, those on low incomes and with mental health problems. The Active Communities hub project brings leisure services and local community organisations together to develop new activity opportunities, promote partnership working and ensure the best use of local resources. The project was successfully piloted in Rhydyfelin, Ystrad and Abercynon.

Active travel opportunities have been encouraged through a range of schemes as part of Safe Routes in Communities. These include improved footways and cycle paths, pedestrian crossings, cycle storage, 20mph zones and traffic calming, especially near schools. School “walking buses” have also been established. The Church Village Bypass Community Route opened in 2010 has already proved very popular, providing a high quality route for cyclists, pedestrians and wheel chair users. As well as being functional and providing links between residential areas, the route has a strong recreational element.

• Increased use of technology and equipment The use of telecare equipment in people’s homes through projects like Safe At Home helps them live independently and minimises the impact of falls, accidents, flood, fires and gas leaks.

Technology can also be used to help people manage their health conditions more effectively. For example, in partnership with the MET Office, the Chronic

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Obstructive Pulmonary Disease (COPD) Health Forecasting Service provides COPD patients with information on how to proactively manage their condition and identifies individuals most at risk of becoming ill or of their condition deteriorating due to changes in environmental conditions. Reaching these patients early can help to prevent their symptoms becoming worse and may reduce the need for patients to go into hospital. 20 GP Practices across Rhondda Cynon Taff participate in this programme.

The Integrated Community Equipment Service (ICES) has brought together the LHB and Local Authorities across RCT and MT to pool their resources to support the management and delivery of a joint equipment service. This has enabled the development of modern, state of the art facilities for the storage, decontamination, demonstration and management of Community Equipment, a more responsive service for users and more effective use of resources.

• Development of Community Mental Health projects In partnership with the LHB, Local Authority, Maerdy Communities First, their local peer support group MASH (Maerdy Association for Self Help) and Journeys, an innovative and award winning scheme was set up to help people with experience of mild to moderate depression. This community mental health model has been rolled out to other areas of RCT including Tonyrefail, Glyncoch and Darranlas.

• Raising awareness of health and wellbeing activities and services Approximately 20,000 people attend the annual 3 day Big Bite event in Pontypridd. The HSCWB Partnership hosts the Wellbeing Zone, a dedicated marquee with a range of stands and activities provided by both the statutory and voluntary sector. Feedback from both standholders and the public is that the event provides an ideal opportunity to share information and raise awareness of health and wellbeing issues. Views have been sought from large numbers of the public on priorities and the development of services.

The Health Challenge RCT website provides people with health information and advice on how to make small changes in their lifestyle which can make a big difference to their health and wellbeing. The website signposts people to activities and services in their area by using a postcode search facility. It also enables local community groups to publicise their events.

• Investment in facilities to improve access and quality of care For example, significant investment in three Local Authority residential Homes for Older People to enable them to provide better services to older people with a mental health problem; the refurbishment of 6 Doctors’ surgeries and the recruitment of 39 GPs to meet the demand for primary care; the opening of Ysbyty Cwm Rhondda in 2010 and the development of the new neighbourhood healthcare facility in the Cynon Valley opening in 2011; a purpose built Macmillan Cancer Unit in Prince Charles Hospital to enable patients to receive treatment closer to home in a comfortable and relaxing environment; Wales’ first Dental Training Unit in Porth to improve access to dentists, particularly for disabled patients

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• Improving service user and carer involvement The award winning mental health Carers and Service Users in Training Project (CSUIT) has helped to raise awareness about mental health issues from the perspective of users and carers who have been involved in the training and recruitment of staff. The project also works with schools to give pupils a better understanding of working in social care and mental health issues in general.

• Schemes to tackle fuel poverty The Council’s very successful Homeowners Insulation Grant programme has targeted a gap in national grant assistance. Our local scheme provides financial assistance to all private households regardless of income and sets eligibility criteria based on local needs and local average household income. Over a period of 12 months, nearly 2000 lofts and over 1000 cavities have been insulated and from the Council’s original investment of around £50,000, a further £800,000 of investment has been made in the Borough by private householders and utility providers. Both energy bills and carbon emissions have been reduced. Other organisations have also made a significant contribution to this agenda for example, RCT Homes has already invested £5m in improving the energy performance of its stock.

• Improving access to healthcare facilities A range of new bus routes have been introduced to improve access to hospitals, for example, the demand responsive evening service between the Cynon Valley and Merthyr hospitals, including Prince Charles Hospital (PCH) - the service operates on a door to door basis using accessible vehicles; more frequent services between Pontypridd and Royal Glamorgan Hospital (RGH); new Sunday service between Cynon Valley and PCH; new daytime bus link between the Cross Inn area and RGH; additional bus stops to serve new facilities like Ysbyty Cwm Rhondda.

• Health checks for people with learning disability People with learning disability have higher than average incidences of chronic health problems like diabetes, weight problems and high blood pressure. Specialist health checks for adults with learning disability were established in 2006 to help people identify and manage their conditions better. However, the uptake of checks in RCT was poor. Following discussions with service users and carers, a campaign to raise awareness was launched including a DVD, patient leaflet, poster and webpage. This successfully raised awareness and dispelled fears around the checks, increasing the uptake.

OUR THEMES FOR 2011-14

Although we have made good progress, we need to do more. The increasing elderly and often frail population, higher than average levels of disability and long term illness as well as high levels of deprivation are creating unaffordable and unsustainable demands upon health and social care. It is clear that we can no longer continue as we are. We must change the way we work and deliver services and we must do so in partnership with service users, carers,

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staff and the public, who need to take a more active role in their own health and wellbeing.

In working to achieve our Vision, we will group our priorities for action during the next three years around three key Themes rather than the seven included in the previous HSCWB Strategies. This will help us focus our efforts more successfully and increase the pace of change. Our themes are

1. Promoting healthy lifestyles and preventing ill health 2. Promoting independence and protecting the vulnerable 3. Improving services and joint working

WHAT YOU TOLD US: All three themes were supported by respondents. Comments have been linked to each theme and the areas for action on which we want to focus.

THEME 1 PROMOTING HEALTHY LIFESTYLES AND PREVENTING ILL HEALTH

Actions to promote healthy lifestyles and prevent ill health must be delivered through all stages of life. Success will mean that children and young people are given a good start in life laying down the foundations of good health, adults can lead healthy and fulfilling working lives and older people have the knowledge and support needed for “active ageing”, enabling them to live healthy, independent and full lives for as long as possible.

In addition to health and social care, a range of other partners across the statutory and voluntary sectors have a role in developing communities which support people to maintain their health, participate in social networks and promote financial stability. All these things will have an impact on achieving this Theme.

This Theme will address the issues identified in “Our Healthy Future” (the Welsh Assembly Government’s strategic framework for Public Health). Our Healthy Future has two overarching aims - to improve quality and length of life and create fairer outcomes for all. It has identified ten priorities which are the biggest causes of preventable ill health. By tackling these we will also be able to help those experiencing the greatest disadvantage.

The ten areas for attention identified in Our Healthy Future are :

Smoking Health in the workplace Physical activity Sexual Health Unhealthy eating Accidents and injuries Alcohol and drugs Immunisation Teenage pregnancy Health inequities

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In RCT, work will be taken forward across all these headings by a range of organisations and Partnerships. For example, the lead on immunisation will come from Cwm Taf Health Board; the priorities to support young people to look after their sexual health and to reduce teenage pregnancy will be driven through the work of Fframwaith, the partnership for Children and Young People; action to develop a coordinated approach to the prevention and treatment of falls in older people will be led by the Cwm Taf multi agency Falls Collaborative established as part of the 1000 Lives Campaign.

An overview of where we are in relation to Our Healthy Future areas can be found in the annual report of Cwm Taf Health Board’s Director of Public Health. All these areas will have an impact on the health and wellbeing of our residents but, as the HSCWB Partnership, we will be concentrating our joint efforts around the following priorities which will benefit most from the support of the Partnership in order to try and achieve the greatest impact.

WHAT YOU TOLD US:

Whilst this Theme was supported, the point was made that taking more responsibility for their own health and wellbeing would be difficult for some individuals and groups. Whilst the Vision Statement acknowledges that people need to be supported to be able to do this, the Action Plans for this Theme in particular will need to address ways of providing appropriate help and advice.

The Local Authority has recently adopted its Local Development Plan which shares common themes with the HSCWB Strategy, particularly in relation to this Theme. One of the objectives of the LDP is to encourage a healthy and safe lifestyle through improved access to open and green space as well as the protection of recreational areas.

Many respondents stressed

• there is a need to support informed choices rather than dictate what the choice should be. • the importance of working with children and young people as well as with families in a coordinated way • there is scope to work more effectively across Partnerships to tackle lifestyle issues, for example in relation to obesity and alcohol. • the costs of eating healthily and accessing leisure opportunities can be a barrier for people on low incomes • the contribution that voluntary and community partners can make to delivering this Theme must be given more recognition. • the importance of the natural environment as a source of leisure activities and emotional wellbeing

“Role of education will be key in beginning to change behaviour of children and young people but will also need to work with parents to develop their knowledge and skills and change family behaviour.”

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“Community projects like Maerdy MASH and Fat Club are excellent – how can we share best practice and roll out to other areas”

“Through education, the mind needs to be active as well as the body, learning new skills in later life, staying active, taking up a new sport or a new hobby.” “Engagement with and participation in arts and culture supports the delivery of all the priority areas in this Theme.”

Work and health was considered to be of particular significance although there was concern that in the current economic climate it would be difficult to generate sufficient jobs. It was pointed out that whilst joblessness needs to be tackled, we must not overlook the importance of the health of people already in the workplace.

“it would be wise to invest in course/programmes that develop the skills and confidence of the unemployed while increasing their chances of employment.”

“Emotional wellbeing cannot be attained in poverty. This must be linked to employment.”

The link to other issues like child poverty and financial inclusion mean that it will be very important for all partners to work together on this challenging agenda. We need to develop coordinated action plans and review the roles of the various delivery groups across agencies and partnerships to see how they can be brought together to work more effectively.

Specific comments made on the following priority areas will be referred to the relevant delivery groups to take into account in developing their Action Plans.

i REDUCING HEALTH INEQUITIES - FAIRER OUTCOMES FOR ALL

Our ambition is to : Increase healthy life expectancy

Where are we now?

People in Wales can expect to live for about 68 years in good health. However in RCT, the healthy life expectancy figure is only 64 years and there will be further differences depending on where people live within the County so that for some RCT residents, their healthy life expectancy will be less than 64 years.

Current projections see a rise in the older population (75 years and over) from 22,000 (8% of the total population) in 2006 to 39,000 (13% of the total population) in 2031. RCT has higher numbers of older people reporting limiting long term illness than in some other parts of Wales and more people living alone. RCT had the fourth highest proportion of people aged over 65 admitted to hospital on an emergency basis.

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Why does this matter?

Poor health can impact on someone’s ability to live their life to the full and maintain their independence. Our population has a shorter healthy life expectancy than the rest of Wales. This puts pressure on local health and social services as well as on carers and communities, as greater numbers of people suffer with chronic disease and disability. The increase in the number of older people is likely to cause a rise in chronic conditions such as circulatory and respiratory diseases, cancers and dementia. We need to prevent the onset of such conditions where we can and work with individuals to help them manage such illnesses better.

What will we do about this? Targeting areas of high social exclusion and deprivation and addressing issues such as education, transport and housing are not just the responsibility of the HSCWB Partnership. We need to work together with other Partnerships in RCT to recognise and address the underlying causes of poor health such as worklessness and poor educational achievement. Our focus will be to

• Identify areas for joint working including - maximising income through the Child Poverty Action Plan and Financial Inclusion Strategy - addressing fuel poverty through the Affordable Warmth Strategy - tackling poor housing through the local Housing Strategy - improving access to services through improved transport services.

• Ensure wellbeing is included in all strategies and action plans

• Facilitate a community development approach to improving health and wellbeing For example, working with the Communities First Community Health Network.

• Target support for individuals and communities who experience the greatest disadvantage and find it hard to access services. For example, encouraging and supporting people with Learning Disabilities to access annual GP Health Checks. ii. HEALTHY LIFESTYLES

Our ambition is to: • Encourage more people to adopt healthier lifestyles

- We want people to be more active, more often, throughout life - We want to reduce unhealthy eating - We want to reduce the level of smoking Where are we now?

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ƒ In 2008-09 27% of adults in Rhondda Cynon Taf met the physical activity guidelines of 30 minutes exercise five times a week. This is below the Wales average of 29%. ƒ Only 17% of women in RCT are physically active compared to 41% of men. There is a significant drop off in participation rates for both male and females during the transition between school and college/work ƒ In 2008-09 60% of adults in Rhondda Cynon Taf described themselves as overweight or obese, compared to a Wales average of 57%. ƒ In 2008-09, 28% of adults in Rhondda Cynon Taf said they ate at least five portions of fruit or vegetables a day, compared to the Wales average of 36%. ƒ The risk and prevalence of malnutrition increases with age. One in 10 older people in the UK are at risk from malnutrition. 1 in 4 people are malnourished on admission to hospital. ƒ 25% of adults in Rhondda Cynon Taf smoke; this is just above the Welsh average of 24%.

Why does this matter? ƒ Regular physical activity has many benefits to health including mental health and wellbeing. People who are physically active will live longer and have up to a 50% reduced risk of developing major diseases such as coronary heart disease (CHD), stroke, diabetes and some cancers. ƒ Low levels of physical activity along with an unhealthy diet are leading to an increase in obesity. ƒ Being overweight or obese increases the risk of developing diseases such as diabetes, cancers and CHD. ƒ A balanced diet helps promote good health and prevent disease. Diets high in fat and salt and low in fruit and vegetables and whole grain cereals are linked to an increased risk of heart disease and cancers. ƒ Smoking is the biggest avoidable cause of ill health and early death in Wales and the most important single factor in producing health inequities

ƒ Smoking is a key risk factor in the development of lung disease, cancer and CHD

What will we do about this? The work of three multi agency Partnerships established as part of the RCT Health and Wellbeing Alliance will help people to change their behaviour and create an environment that supports them to become healthier. Taking exercise, eating a healthy balanced diet, not smoking and drinking below the recommended limits can add a potential 14 years to life.

1. Physical activity Our priorities will be to:

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ƒ Increase the participation in sport and physical activity of 16-25 year olds ƒ Encourage women and girls to become more active ƒ Develop natural and built environments that encourage and support people to be more active

The Active Living Partnership will develop a Creating an Active RCT Plan to take this work forward.

2. Healthy Eating Our priorities will be to:

• Decrease the number of children, young people and adults who are overweight or obese, for example by implementing the All Wales Obesity Pathway. The first step is to undertake an obesity mapping process to highlight food and fitness activity in Rhondda Cynon Taf and identify any gaps. The results of the mapping exercise will then be used to determine what needs to be done locally. • Increase the number of people eating five fruit and vegetables a day, for example by improving access and availability to healthy food through initiatives such as Food Coops and the Healthy Options Award Scheme. • Ensure people in health and social care settings receive and are able to eat nutritious meals that are appropriate to their individual needs

The Food and Nutrition Partnership will develop an action plan to take this work forward.

3. Smoking Our priorities will be to: • Help and support smokers who wish to quit, for example increasing referrals to smoking cessation services (Stop Smoking Wales and Community Pharmacy Services). We will build on the successful initiatives to increase referrals for patients undergoing elective surgery, pregnant women and stroke patients. • Prevent young people from starting smoking - we will work with our Healthy Schools and School Nursing teams to support and develop initiatives aimed at preventing children and young people from starting smoking. • Protect non smokers from the effects of environmental tobacco smoke

The RCT Tobacco Control Partnership consisting of a range of partners from the Local Health Board, Local Authority and Public Health Wales will develop an action plan to take this work forward.

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iii. ALCOHOL AND DRUGS

Our ambition is to: ƒ Prevent the harm caused by alcohol and drugs

Where are we now? ƒ In 2007-2008, Rhondda Cynon Taf had the highest rate of referrals for drug problems in Wales. ƒ In 2007-2008, Rhondda Cynon Taf had the second highest number of hospital drug and alcohol admissions in Wales. ƒ Particularly worrying is the 63% increase in the number of deaths from alcoholic liver disease in Cwm Taf and the 60% increase in alcohol related diseases between 2001 and 2008. Why does this matter? ƒ People who misuse drugs or alcohol can cause considerable harm to themselves, their families and their community as well as affecting their life expectancy. ƒ Misusing drugs or alcohol is likely to be a factor in domestic violence and school absenteeism.

What will we do about this? Our priorities will be to:

ƒ prevent harm through a co-ordinated approach to education with consistent messages to support the prevention or resistance of misusing drugs and/or alcohol ƒ provide support for those misusing drugs and alcohol to reduce associated harm and minimise the risk to individuals, for example through the Peer Mentor scheme which supports drug and alcohol users to make positive, sustainable lifestyle changes and enter employment ƒ support and protect families and communities, for example through the work of the Integrated Family Support team ƒ tackle availability of drugs and alcohol ƒ tackle domestic violence

We will work with the RCT Community Safety Partnership which has the responsibility to commission a wide range of services to address drug and alcohol problems. A multi agency action plan has been developed to reduce the harms associated with the misuse of drugs and alcohol.

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iv EMOTIONAL WELLBEING

Our ambition is to: ƒ Improve the emotional health and wellbeing of people living in Rhondda Cynon Taff

Where are we now? ƒ People in Rhondda Cynon Taff have poorer emotional health and well being than the rest of Wales. ƒ Unemployed people and those on low incomes are more likely to have poor mental health. It is likely that mental health in Rhondda Cynon Taff will get worse as a result of the current economic climate.

Why does this matter? ƒ Emotional wellbeing is essential to good health. It helps people to cope with daily challenges, reach their full potential and support others. ƒ Poor emotional health and mental ill health is a major cause of death and disability. It reduces people’s quality of life and can harm their families and the wider community. ƒ Mental health problems can occur at any time in a person’s life and are often caused by a combination of factors.

What will we do about this? Our priorities will be to: ƒ Make sure that organisations, communities and partnerships make the most of the opportunities they have to improve emotional health, improving people’s knowledge of emotional health and helping them to develop the skills they need to stay healthy

ƒ Support the delivery of mental health awareness raising projects, Mental health First aid courses and utilising other opportunities to reduce stigma such as World Mental Health Day Celebrations

ƒ Engage older people to raise awareness and de stigmatise depression and dementia by providing education on prevention and providing community based social activities for those affected, their carers and families

ƒ Focus on the people most at risk of having poor emotional and mental health. ƒ Promote engagement in the arts which are an essential ingredient of our emotional health and well-being and a valuable means of self- expression, boosting self esteem and encouraging socialising with others. This includes the design of the public spaces around us, opportunities to enjoy music, dance, comedy and drama in our theatres and to participate in high quality arts activities as part of community life. The arts also have a valuable role to play within the health and social care support environment.

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ƒ Work with young people through the Healthy Schools Programme to provide mental health awareness raising activities and intergenerational projects which will promote understanding and resilience

The Cwm Taf Emotional Health and Wellbeing working group will be responsible for developing and implementing an Emotional Health & Well- being Action Plan. v WORK AND HEALTH

Our ambition is to: Support people to achieve a healthy and fulfilling working life by • reducing the impact ill health has on their ability to find and maintain employment • developing skills for work • promoting and protecting the wellbeing of those in work.

Where are we now? Unemployed residents have a range of barriers that may prevent them from actively seeking or gaining employment including health problems, lack of skills and confidence and lack of employment opportunities. 31% of the working age population in RCT are economically inactive which is higher than the rate of 27% for Wales as a whole. Average weekly earnings in 2009 were £496 which was just below the Welsh average.

Mental health, musculoskeletal and cardio respiratory problems are the three major causes of sickness absence and health related worklessness. Almost four out of ten adults of working age with a mental health problem are unemployed.

A range of services, such as the Engagement Gateway, Bridges into Work, Future Jobs Fund, Workinglinks and Jobmatch, support residents to acquire and improve work related skills, with the aim of gaining employment. Other services such as Mentro Allan, Remploy and the Condition Management Programme have provided specialist health support to individuals.

Why does this matter? There are very positive links between being in work and enjoying good health, not least in terms of increasing income levels and lessening financial disadvantage but also in terms of social inclusion and self worth.

Being out of work can also affect the next generation. Children in workless households suffer higher rates of mental health and behavioural problems. They are also more likely to experience worklessness themselves in adult life.

Changes to the welfare system will impact on our local population, many of whom currently receive a range of benefits including incapacity benefit. It is

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likely that the economic challenges facing our communities will lead to more people needing support in the future.

What will we do about this? The RCT Work and Health group will produce an Action Plan, taking account of the national Health, Work and Wellbeing Action Plan for Wales. This seeks to join up activity to improve the health of the working age population as well as providing a basis for partnership working and identifying gaps for future action. In particular we want to

ƒ Research the impact of the welfare reforms on the hardest to reach families and identify the most effective intervention and support measures to help them ƒ Work with providers, for example through the Engagement Gateway projects, to provide training opportunities which will develop the coping and confidence skills people need to enter the workplace. ƒ Support people with mental health problems that are affecting their ability to work

ƒ Promote health and wellbeing in the workplace, for example through initiatives such as the Corporate Health Standard and Wellbeing Through Work.

ƒ Link our work with that of Fframwaith on the Child Poverty Action Plan and the work of the Integrated Family Support Service

ƒ Work with the RCT Lifelong Learning Partnership to develop adult community based learning.

ƒ Recognise and support the role of volunteering as a valuable activity which can promote self confidence and self worth and also provide opportunities for social inclusion or a stepping stone into paid employment

THEME 2 PROMOTING INDEPENDENCE AND PROTECTING THE VULNERABLE

Our Vision recognises the importance of people being able to participate fully in life and remain as independent as possible for as long as possible. However, it also requires that if people do become ill or vulnerable, their needs are met effectively.

In the past, health and social care services may have inadvertently developed a culture of dependency and overreliance on services. Too often, services have been about responding to crisis rather than preventing the crisis in the

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first place. We should be focusing on what people can do, giving them more control over their lives by promoting and supporting their independence.

Whilst rebalancing services and focusing on preventing deterioration will be vital, it is course equally important that services can respond effectively when people have more complex needs, whether they be physical, emotional, social or a combination. Services also need to be rebalanced less towards hospital based care and more towards locally based services.

WHAT YOU TOLD US: All but one respondent agreed with this theme and for many people, this was considered to be the most important. In discussion groups there was support for the context we provided above in the introduction to this Theme, that we may have inadvertently promoted a dependency culture, doing things to and for people, rather than enabling them to do things for themselves. There was support for the need to be more proactive and avoid crisis. There also needs to be a higher profile for services available for young adults at transition from children’s services.

“There is a culture of dependency in RCT and an expectation that there is a sticky plaster for all ills.”

“We need early intervention and faster responses to meet need.”

“Empowerment is key to move individuals through services more quickly.”

“Allow people to be active consumers of services rather than passive receivers of services.”

“Independence is vital regardless of age”

“ Often the young and the elderly are the focus. Those of middle age are often overlooked.”

“Existing patterns of delivery are focused at the older age range even in mental health and are not suitable for young adults.”

This Theme affects all groups in our population and spans the whole lifecourse. However, it will be of particular relevance to the following client groups:

• People with a learning disability • People with a mental health problem • People with long term chronic conditions • Older frail people • People affected by the misuse of drugs and alcohol • People with a physical disability and/or sensory impairment • Carers

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The areas of work we want to focus on as part of this Theme will benefit all of these groups. However, in addition, some of the specific issues that are important to these client groups have also been highlighted in separate sections, together with any key messages made in the consultation responses.

Our ambition is to

• Empower people to maintain their independence and manage their own conditions as far as possible, only going into care or hospital placements when they have a need to do so.

• Ensure that when people become ill or vulnerable, the treatment and care they need takes place in the most appropriate setting and supports them to regain their health and wellbeing wherever possible.

Where are we now? We have some of the highest levels of chronic disease in Wales and higher than average hospital admission rates for some chronic conditions. Respiratory conditions like COPD are the most common causes of admission to hospital locally.

We have an increasingly elderly and frail population which will increase demands on health and social care services unless we focus on the complete needs of individuals, supporting healthy ageing and services which promote independence.

Our residents face increasing challenges to maintaining good mental health and have a higher burden of mental illness.

Why does this matter? A number of national policy documents have stressed the importance of promoting independence and rebalancing services including

• “Fulfilled Lives Supportive Communities”, the 10 year strategy for social care in Wales, which aims to provide more accessible, personalised care, support people earlier and help them retain their independence for longer. • “Improving Health and Wellbeing in Wales – A Framework for Supported Self Care” which highlights the role of self care in preventing or delaying the onset of chronic conditions as well as helping people manage their conditions better and remain independent for longer. • “Setting the Direction”, the Strategic Delivery Programme for Primary and Community Services in Wales, which requires a move away from services provided in isolation by different agencies towards an integrated model of health and social care built around the needs of our citizens. • “Sustainable Social Services for Wales: A Framework for Action” which looks for much greater integration of services and prioritises families with complex needs, transition to adulthood for disabled children and frail older people.

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What will we do about this? What is needed is a renewed focus on individuals and communities being empowered to help themselves but also the development of local services that meet their needs. Community initiatives can often provide an informal, front line response that can appropriately support many people rather than avoidable escalation into statutory services, be they in health or social care.

Once people need more help, services should work in ways that help them to make full use of their potential, protect them from harm and offer a choice about how they are supported. We must identify complex needs as early as possible and avoid unnecessary and potentially life changing emergency responses such as unplanned admission to hospital.

ISSUES AFFECTING ALL CLIENT GROUPS

What you told us: There was support for all six areas we identified below as our focus for action.

a) Encouraging and supporting self care We need to develop the knowledge, skills and confidence people require if they are to understand and manage their long term conditions more effectively. Self care networks for service users and carers are also essential to provide peer support, build confidence and improve social inclusion.

An enhanced range of primary care, community and day services within localities are necessary to promote early intervention and to support recovery, ensuring that people are better supported to live independently and free from crisis.

b) Innovative use of technology and equipment We need to make better use of technology to support independent living for older and disabled people or those with particular chronic conditions. This can also help to reduce the need for personal care, help to prevent hospital admission and facilitate return home after a hospital stay.

We will also continue to develop the highly successful Integrated Community Equipment Service

c) Developing Reablement services Intermediate care and Reablement are time-limited services, designed to help people reach their full potential when recovering from illness, injury or an exacerbation of a chronic condition. The primary focus is to assist people get back their confidence or learn new skills and techniques, which will help them retain their independence in their own homes. For older people or people with a physical disability, this can be an important means of regaining daily living skills and avoiding escalation into an acute health care setting or a long term social care service. This emphasis on short term interventions at a critical point in an episode of health deterioration is

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a less traditional approach to care provision, but reliance on long term services is often very disabling in itself.

In order to meet the challenges of increasing our capacity and also expanding our criteria to accommodate a wider range of needs, we must continue to develop this service in partnership. d) Opportunities for Social Inclusion Support for people to participate as active citizens both economically and socially is important as a means of empowering them to take more control over their lives and avoid loneliness and isolation. This is particularly important for learning disability, physical disability and mental health services to promote equality and enable people to contribute to community life. We will develop a range of community based day services, purposeful activity, training and employment support to achieve this. Opportunities for social inclusion can also be provided through arts and cultural provision.

e) Supporting and safeguarding vulnerable adults and families We need to make sure that the most vulnerable in our communities are identified and supported in a more effective and coordinated way.

What you told us: We need to be clearer about who is defined as “vulnerable” and provide support in a positive rather than negative environment. We must prioritise parents who have additional needs such as those with mental health problems, learning disability or substance misuse problems, which may impact on their ability to parent.

Examples of work with particular groups will include

- The Integrated Family Support Service which has been set up to work with children and families who are affected by parents or carers drug and alcohol misuse. The multi agency team will work directly with the most vulnerable families and also be able to mobilise other services to support families further. The service will cover RCT and Merthyr Tydfil as one of the pioneer areas selected by Welsh Assembly Government in relation to the delivery of its Family First initiative.

- Continuing to work within a co-ordinated multi-agency framework to help meet the needs of children and adults who are on the Autistic Spectrum Disorder (ASD) continuum, including Aspergers Syndrome. This will include raising awareness, supporting parents and carers and assisting people with ASD to live as independently as possible and to become active members of their local communities. This multi-agency approach will be crucial in ensuring the successful implementation of the ASD Action Plan for RCT.

- Protecting vulnerable adults who may be in need of services by reason of disability, age or illness and who are unable to take care of themselves, or unable to protect themselves against significant harm or serious

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exploitation. The RCT Area Adult Protection Committee oversees this work. We need to raise public awareness of the issues surrounding vulnerable adults and the abuse they may be suffering, undertake staff training and development in relation to the process of identifying and managing cases and implement the revised Welsh Assembly guidance “In Safe Hands” and the All Wales Policy and Procedure due to be published in 2011.

f) Meeting complex needs and long term care The predicted growth in the number of older people and the increasing numbers of people with complex needs for long term care following serious illness or injury is placing additional demand on services to meet their needs. We want to promote independence, ensure people retain control of the services they receive, support community based responses to need whenever possible and reduce inappropriate reliance on high levels of care.

Continuing Healthcare (CHC) is currently mostly planned on an individual patient basis. However the number and cost of CHC packages is increasing rapidly. The LHB and Local Authority will need to work closely together, and with our partners in the Independent Sector, to develop high quality and affordable, local service solutions for CHC and long-term care, with consistent standards across all CHC providers.

PEOPLE WITH A LEARNING DISABILITY

People with learning disabilities have poorer general health than those in the general population and have an increased risk of early death. However, with the advancements made in science and technology, there are a growing number of young people surviving into adulthood with complex health and social care needs. Although many people with learning disabilities are living longer, other health related problems can arise as they grow older.

There are currently just over 800 people who are on the Learning Disability Register for RCT. This means they are known to the Local Authority, meet the eligibility criteria for services, receive a service and are annually reviewed by a care manager. Over half live at home with their parents and family whilst nearly 10% of people on the register are over 65 years old. However, it must be remembered that for various reasons, the register does not include all people in RCT who have a learning disability.

What do we need to do? • Provide accessible information for people with a learning disability about health promotion and promote the uptake of annual health checks • Seek opportunities to establish an integrated health and social care model in day services to pilot the joint management of individuals with complex needs.

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• Provide opportunities for people to live independently with care and support in accommodation within their local communities. We need to modernise existing models of care to ensure we can sustain services in the future. • Support families and carers, including reviewing the way residential respite care is provided in order to better and more equitably meet needs as well as the increasing demands for the service. • Provide comprehensive information about services, ensuring that service users and carers are able to inform service planning • Continue to develop the Older Carers Support Scheme in partnership with the voluntary sector • Improve the level and quality of advocacy services • Continue to strengthen transition arrangements • Continue to develop a range of day time opportunities including employment and training options. • Review and remodel the Skills for Independence Day Services in order to ensure that we are able to better meet service demand and changing needs, particularly in relation to the increasing number of individuals with complex needs. • Following the independent review of community based health care services for adults with Learning Disabilities in RCT, the LHB and the Local Authority will need to work closely together to ensure that the key improvements outlined in the Review Report are implemented and that services are better able to meet the needs of people with a Learning Disability. • We will continue to work closely with Abertawe Bro Morgannwg University LHB who provide specialist learning disability services to people within RCT.

The RCT Learning Disability Local Partnership is the main strategic coordinating group for services for adults with a learning disability. The Partnership oversees and supports the local planning arrangements for these services. It will produce an annual Learning Disability Change Action Plan.

PEOPLE WITH MENTAL HEALTH PROBLEMS

In Theme 1, we identified improving emotional wellbeing as a priority to help prevent mental ill health, but we also need to ensure that we have effective mental health services for those people that need them.

In Cwm Taf, 13% of the adult population reported being treated for a mental illness. This is the highest in Wales and compares to the average for Wales of 10%. Over recent years, through close working with a range of partners including service users and carers, there have been a number of significant improvements in mental health services provided to adults of working age. These include new inpatient facilities at the Royal Glamorgan Hospital, new mental health resource centres at Trealaw and Pontypridd, enhanced community health services and primary care support in the Cynon valley and the development of self help groups within local communities.

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However, there are a number of areas for improvement when compared with else where. • We need to do more to raise awareness and understanding about mental illness and coordinate activities that will promote positive mental health • More resources in Cwm Taf are currently dedicated to in-patient hospital beds rather than community services • Primary care services elsewhere have better access to services and interventions which can support people earlier on and prevent the development of serious mental health problems • We have a large number of people placed in high-cost private sector placements outside RCT • We have very high rates of prescribing for anti-depressant medications • There is insufficient supported accommodation locally which means that hospital beds are often the only option for people who need more support than can be achieved within their usual home environment • An expected increase in our older population over the coming years is likely to mean increased demands on Elderly Mentally Ill (EMI) services

What you told us: There were a number of comments made in relation to mental health with many people advocating alternatives to the medical model and the overuse of medication. Tackling stigma is still considered to be a challenge and there was a view that mental health problems are likely to increase in the current climate. The need to consider both mental and physical health problems together was stressed.

What do we need to do? A comprehensive approach to the population’s mental health from promotion and prevention through to early intervention, treatment and rehabilitation across all ages is required. The Mental Health (Wales) Measure 2010 also provides legislation which will support our aims to ensure that people are better supported to live independently, crises are prevented and recovery promoted.

Our aim is to redesign and improve services for adults of working age, older people and children and adolescents with mental health problems, as well as their families/carers. This will include: • Early interventions: supporting people at the outset of experiencing mental health problems and preventing ill-health • Day care: a range of services within localities where people can drop-in, have someone to talk to or gain practical skills and support in achieving their goals (e.g. in relation to leisure activities, volunteering or employment) • Emergency care and specialist response services: being responsive to acute mental health need within a variety of settings • Liaison services: many people experience mental illness alongside physical health problems and to ensure they are able to make a positive recovery they must have both of these needs addressed.

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• Rehabilitation services: preparing people for independent living including new developments in step-up and step-down rehabilitation facilities between hospital and home (similar to a ‘half-way house’ between community and hospital settings). If more services are provided within localities, this should impact upon the number and type of mental health hospital beds required in the future. There will also be a need for supported accommodation provided via Supporting People and other projects • A greater range of services within RCT to prevent the placement of patients in expensive out of county placements away from their families and social networks • Reducing suicide and self harm: this is an all Wales target, as the incidence is generally higher in areas of deprivation and at times of economic decline.

PEOPLE WITH CHRONIC CONDITIONS

Chronic Conditions which cannot be cured, only controlled by medication and /or therapy, include a range of conditions such as respiratory diseases, diabetes, coronary heart disease, people living with some cancers and musculoskeletal conditions. They can be very life-limiting, severely impacting on the person’s mobility, independence, self esteem and employment prospects. The prevalence of chronic conditions is a significant issue in Rhondda Cynon Taff and it is predicted that this trend will continue. Chronic conditions are most prevalent in older age, which also brings the risk of increasing frailty.

Evidence from across the UK suggests that 80% of consultations in primary care and 60% of secondary care admissions relate to chronic conditions. Locally, COPD and other respiratory related conditions are the most common causes of admission to hospital, with higher than average admission rates compared to the rest of Wales.

In 2008 a joint Chronic Conditions Strategy was developed for RCT and Merthyr Tydfil which has resulted in a range of improvements in the way we manage people with a chronic condition. These include education programmes including Expert Patient Programme, the use of technology and additional services provided by primary care and community pharmacies.

What do we need to do? Our focus needs to shift to the promotion of healthier lifestyles which will help to prevent chronic conditions, and to the effective management of these conditions and increasing frailty in order to promote independence and prevent acute episodes requiring hospital admission. This will include:

• Health promotion and ill health prevention activities, such as smoking cessation • Patient/carer education, information and self help opportunities, encouraging people to share responsibility and control for managing their condition, for example, the Expert Patient Programme

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• Integrated locality based services within the community. We will increase the provision of services in the community and facilitate closer working between primary, community and secondary care professionals • Effective use of available technologies such as telecare and telehealth to support independence and reduce avoidable hospital admissions • Early identification and proactive management of risk within primary and community care so that people with a chronic condition and increasing frailty will be less likely to suffer an acute episode requiring hospital admission.

OLDER FRAIL PEOPLE

Whatever their age, older people are a very mixed group. Some are fit and healthy, leading very active and independent lives. Some have very good support from family, friends and neighbours whilst others have problems that need additional help from health or social care agencies.

Older people living alone may place greater demand on services and in RCT 43.9% of people over the age of 75 live alone. Older people are also more often admitted to hospital on an emergency basis. Our elderly population is growing and population estimates for RCT suggest that by 2033, the number of people over the age of 85 will have risen from 5100 in 2008 to 11,600. As people grow older, frailty can pose a significant risk to health, wellbeing and independence. The demographic changes are likely to increase the need for health and social care among older people, particularly those over the age of 85. For example, conditions such as stroke, sensory and mobility impairments, falls, depression and dementia can reduce older people’s abilities to lead independent lives.

What you told us:

Given the large numbers of comments received from people over the age of 65, it is not surprising that many respondents expressed concern about getting older and facing possible discrimination and poor quality of services. There have been several high profile national reports in the media recently about the care of the elderly which have probably contributed to these views.

“Most health carers are indifferent to anyone over the age of 60.”

“I am 73 years old and fit and healthy but I dread getting sick after seeing the care that other older people have received.”

What do we need to do? We need to promote older people’s health, wellbeing and independence but also provide support when needed due to illness or increasing frailty. People need to have control over their lives and choices about how they are supported so that we do not create or perpetuate inappropriate dependency on health or social care services. Service users and carers need to be confident in the quality of care they will receive and that they will be treated with dignity and respect.

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Actions will include • Health promotion and prevention of ill health activities, including seasonal flu vaccinations, encouraging older people to participate in Smoking Cessation programmes, physical activity and healthy eating, implementation of the Falls & Fractures Prevention Strategy. Sheltered housing complexes could be used as community hubs for older people living in the local area as well as people living in the supported housing. • Locality based services targeted at those most at risk of hospital or care admission and providing proactive assessment and management of their risk factors • Evaluation and roll out of the local Enhanced Service being provided to Care Home residents by Nurse Practitioners • Roll out of the Homecare Medication Administration Scheme to support people who would not be able to remain living at home without help to take their medication. • Integrated Day services for assessment and care • Prompt response to increasing frailty, minimising risk whilst maximising independence. Rapid response services will support people in the community in times of crisis where hospital admission is not required. • Intermediate Care services that provide an alternative to hospital or care home admission when crises arise, and enable more timely transfer of care out of hospital with a focus on rehabilitation, reablement and promotion of independence • Better co-ordination of care both within the community and during any transition into and out of hospital avoiding duplication of assessments and interventions by different agencies. This will include a single point of access to services and effective hospital discharge planning

PEOPLE AFFECTED BY THE MISUSE OF DRUGS AND ALCOHOL

The misuse of drugs and alcohol can have a devastating impact on individuals, their families and the wider community. Inappropriate use of drugs and alcohol can increase the risk of harm to both physical and mental health, as well as leading to increased levels of crime, disorder and anti-social behaviour. The findings of the Health Needs Assessment for the HSCWB Strategy were particularly worrying in relation to the increase in alcohol related diseases and deaths.

To tackle the problems in RCT, the Community Safety Partnership has established a multiagency action plan to target services, activities and responses so that we minimise the damaging impact of drugs and alcohol. Extensive progress has already been made in its implementation, with a wide range of effective services in place, e.g. Alcohol Brief Interventions Scheme; social marketing campaigns; Drop in Centre; Structure Counselling Service, licensed premises inspections, to name but a few. Whilst there have been notable successes, there is still more to be done to improve outcomes for those who access the services available. As such, the CSP regularly reviews the services in place to ensure compliance with set targets and to ensure they

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continue to meet the needs of its population. The HSCWB Partnership needs to work closely with the CSP on this very challenging agenda.

What do we need to do? • Increase awareness of the risks and consequences of drug and alcohol misuse • Implement a co-ordinated and consistent approach to drug and alcohol education for children and young people up to age 25 • Increase the access, engagement and retention of people who misuse drugs and alcohol in appropriate treatment services • Offer harm reduction services to children, young people and adults with recognised drug and alcohol issues • Reduce the number of people who enter and re-enter the criminal justice system as a result of drug and alcohol misuse • Reduce the level of drug and alcohol misuse amongst offenders • Implement a co-ordinated approach to meet the needs of people with a co- occurring drug/alcohol and mental health problem • Increase the level of service user involvement in the development and delivery of services • Improve the lives of children and young people living with parents/carers who misuse drugs and alcohol • Provide support for families and carers of people who misuse drugs and alcohol • Implement a co-ordinated approach to meet the needs of people affected by domestic abuse and drug and alcohol problems • Provide communities with the opportunity to engage with those who misuse drugs and alcohol • Enforce the Licensing Act objectives to reduce harms to individuals and communities • Increase enforcement activity to reduce drug and alcohol related crime and disorder • Reduce alcohol related anti-social behaviour and vandalism

PEOPLE WITH A PHYSICAL DISABILITY AND/OR A SENSORY IMPAIRMENT

It is currently estimated that in RCT there are just under 11,500 people aged between 18-64 with a moderate physical disability and just under 3500 people aged between 18-64 with a serious physical disability. These numbers are predicted to fall slightly by 2014. In Cwm Taf, the Annual Population Survey for 2009 showed that there were 25% of people of working age with disabilities compared with the Wales average of 22%.

What you told us: Some very detailed responses were made, providing views on all aspects of the HSCWB Strategy from the perspective of those with vision impairment or sight loss. Whilst it is not possible to include all the detail in this document, all the comments will be shared with the RCT Sensory Services Network and will

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be very helpful both in shaping the work of this group in responding to the Wales Vision Strategy Plan but also in informing other HSCWB Action Plans.

“People with sight loss experience disadvantage on many levels from lack of accessible information to poor employment prospects and social isolation. Accessing the services available to others is difficult.”

What do we need to do? • Vision loss

Of particular concern is the numbers experiencing Vision loss. The UK Vision Strategy is an initiative to develop an action plan relating to vision across the 4 countries of the UK. It was launched in 2008 in response to the World Health Organisation VISION 2020 resolution, to reduce avoidable blindness by the year 2020 and improve support and services for blind and partially sighted people. Half of all sight loss is avoidable. Sight loss costs an estimated £215 million every year in direct and indirect costs for Wales

There are approximately 1450 people registered in RCT as severely sight impaired/blind or sight impaired/partially sighted. This is an under representation of the numbers who could be registered but it does provide a baseline. The split is approximately 50% in each category.

In RCT, we have a Sensory Services Network of health, independent contractors, social care and 3rd sector representatives which is adopting the Wales Vision Strategy Plan as it's plan for taking forward developments across the Borough. These will include

• Improving the eye health of people in RCT • Delivering excellent support to people with sight loss • Inclusion, participation and independence for people with sight loss • Improvements to housing, for example using RNIB Visible Better scheme.

In addition to vision loss, other areas for attention will be

• Social inclusion We need to develop daytime, employment and accommodation opportunities for younger people with a disability.

• Supporting young people in transition from Children’s services to adult services and providing better information for service users and carers about access, services and support.

• Developing links with the newly formed Third Sector Cwm Taf Disability Focus Group facilitated by Interlink for example, to share information about services, promote good practice and explore opportunities for joint working

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CARERS

Carers look after family, partners or friends in need of help because they are ill, frail or have a disability. In RCT there are just under 30,000 carers – 12.5% or one in 8 of the whole population, which is higher than for Wales as a whole. However, it is likely that this figure is an underestimate. Nearly 8000 carers provide 50 or more hours of care a week. Unpaid carers currently provide around 70% of care in the community. Many carers are themselves elderly.

Caring for someone can be both physically tiring and emotionally stressful. Carers often feel isolated, unsupported and alone. Many carers may themselves suffer from poorer health brought on by caring with inadequate support and they often lack financial security because of the cost of caring and the difficulties of balancing employment with their caring responsibilities. Through their caring role, carers often have less opportunity to access social and leisure activities.

Changing demographics, including an ageing population, smaller families and different family structures, mean that 3 in 5 people will care for someone at some point in their lives

What you told us: The guidance from WAG for developing the HSCWB Strategy did not prescribe carers as a group to which we must make specific reference. However, in RCT, carers are considered a very important group whose needs must be taken into account in their own right. This view has been borne out by the large number of comments received about caring issues. All the comments received will be shared with the multi agency Carers Strategy Steering Group and used to inform the development of the action plans that implement the joint Carers Strategy.

“Carers are key to this theme and their needs must be catered for.”

“Vital to ensure the carer is supported to maintain their caring role.”

“Is the support for carers a postcode lottery?”

“Better and more support for carers and more respite care, reassure people help is there when needed.”

What do we need to do? We need to empower carers so that they and the person they care for receive the information, services, support and recognition needed to remain living as full a life as possible within the community

We will implement the joint Carers Strategy for RCT which was developed in partnership with carers, statutory and voluntary sector agencies. It has the following aims

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• Identify carers • Recognise carer contribution • Provide information to carers • Promote carers assessments • Deliver quality services for carers • Ensure carers have a voice

The Carers Strategy has an Action Plan, the implementation of which is monitored quarterly by the Carers’ Strategy Steering Group. Actions include the further development of the Carers’ Champion project in GP practices to help primary care staff identify and support carers; including carer awareness in staff induction and training programmes; providing and updating a multi agency Carers Pack of information about services and how to access them; supporting carers who wish to return to work.

A separate Young Carers Strategy is in place and we will work with Fframwaith to support the needs of young carers.

THEME 3. IMPROVING SERVICES AND JOINT WORKING

Some people receive services provided by or on behalf of both the Local Authority and the NHS. The effectiveness of the services provided by one agency often depends on what others do. Because of the complexity of organising services and because services are currently structured according to health, social care, educational and voluntary provision, there may be gaps or duplication in what is provided.

All partners want to provide the best possible care to our local communities. We want to make the very best use of the skills and knowledge of all our staff, across the statutory and voluntary sector, and we want to make sure that citizens get the best quality and range of care across all age ranges and what ever their condition. We also need to ensure that we meet our responsibilities in relation to equality and diversity.

We need to take a fresh look at the management and organisation of health and social care across children’s and adult services and explore new ways in which it can be both more efficient and effective.

Our ambition is to Develop an integrated model of health and social care in communities built around the needs of our citizens. Provide the right services at the right time, in the right place and by the right staff

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Where are we now? The current system can be difficult and confusing for service users to find the support they need. Often patients are being seen by several different staff or agencies for different aspects of their illness, condition or broader needs. Some of the major challenges facing existing services are: • There are gaps in community services which mean that people are often admitted to hospital because there are limited alternative services in place, particularly in the evening and weekends. • Health services have traditionally focused on buildings rather than on providing a range of services in community settings • Services are often reactive (treating people at the point when there is a crisis), rather than proactive, preventing an escalation • Health and social services often operate separately, rather than in a joined up way • Unnecessary bureaucracy and organisational barriers get in the way of delivering support and coordinating care more effectively.

Why does this matter? Changing public expectations mean that people do not want to be perceived as patients, service users or customers of single statutory services. Instead they want their needs to be considered in a holistic and coordinated way.

The significant challenges we face, including the levels of deprivation and ill health experienced locally, the growing elderly population, the economic climate and the problem of sustaining high quality services, mean we cannot continue as we are. We must find new ways of working that better meet the needs of our residents and also make better use of our resources.

What you told us: The overwhelming majority of respondents agreed with the priority areas identified as important in this theme. A key message running through responses across all sections of the document, although of particular relevance to this Theme, was that effective joint working will be essential if we are to deliver the Strategy. The value and contribution of voluntary sector services needs to be better understood and valued by statutory partners. There needs to be more joint working across adult and children’s services in communities.

“ Ensure that the various agencies and voluntary organisations are aware of the part each plays and that there is dialogue between them”

“ Shared resources and shared practice could ensure an improved and holistic provision to benefit people’s health and wellbeing, including their social care needs.”

What do we need to do: We will structure services to enable more comprehensive care to be provided that reflects the journey that patients typically follow across community, social care and health services. This will mean a rebalancing of services towards more locally based services, capturing the opportunities that integrating services across health and social care can give us. The quality and cost

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effectiveness of services can be significantly improved when organisations work well together.

We will focus on the following areas which were supported by respondents. Where there were a significant number of common responses, this has been reflected in the relevant sections. a) Rebalancing services towards more locally based services

What you told us: In relation to some of the areas for action associated with Setting the Direction, there were a number of specific comments which will be referred to the appropriate implementation groups to consider and take action as needed, for example • The need to review the links between Canopi arrangements for children and young people and the locality arrangements to be established for adult services • The opportunity to link Housing partners into locality models and community based services • Professionals need to be based in local services and identify gaps • The need to tackle service redesign in an integrated way rather than as separate organisations eg in relation to day services • The challenges of meeting complex needs in a locality setting eg integrated day services for those people with a learning disability who have complex needs

Coordinated health and social care services will be organised within geographical localities: Rhondda; Cynon Valley; and Taff Ely which will: • focus primarily on the patient or service user rather than on professionals or the organisation; • have a population size which enables effective and efficient delivery of community services; • be led by multi-agency locality leadership teams which will include clinical leads and social services members, who will ensure local services are delivered in response to local needs • build up a network of health, social care and voluntary sector services • increase the level of support within communities, reducing dependency upon hospital beds b) High quality information and effective communication

What you told us: One of the specific issues most commented upon was around the improvement of information sharing and communication. Points raised included

• Raise awareness of services available and how to access them • Improve the sharing of knowledge and information between agencies, both statutory and voluntary

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• One point of contact for services would be helpful • The difficulties in trying to find the information people needed

“We need to know about services available to be able to signpost”

“Need to maximise opportunities for exchange of information.”

“Families need holistic support at one point of entry, avoiding confusion and multiple assessments”

“There needs to be better engagement and improved working with GPs.”

“One point of contact is a good idea especially for the elderly, providing there are a number of phone lines and at a lower priced call rate”.

“There should be a well publicised site or telephone number where a real person can give you the contact information you need”

“ reliable transfer and sharing of information and patient records, to avoid unnecessary duplication and repetition.”

We need to share up to date (and regularly updated) information more effectively with service users and between agencies. We must also make better use of our shared knowledge in order to target services more effectively. We will develop Information Sharing Protocols in line with the Wales Accord on the Sharing of Personal Information.

Work has already commenced to develop a Communications Hub as a single number contact centre to improve communications and provide a single point of access for health and social care which can support effective decision-making. It will be available to service users, carers and health and social care professionals, acting as a gateway which can provide information about services as well as organising appropriate care and support. c) Enhanced multi disciplinary community services The aim is to create integrated, citizen focused teams of workers from adult social care and community based health staff. They will play an active role in supporting people but also identifying people in vulnerable groups who would benefit from the enhanced services available from the Community Resource Team. This team will work across the geographical localities to create a strong, multidisciplinary approach focused on supporting patients with complex needs in the community. This proactive approach will lead to: • the maintenance of independence and wellbeing; • the avoidance of unnecessary hospital admissions; • timely hospital discharge; • improved management of patients with chronic conditions; • active rehabilitation and reablement.

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d) Integrated transport to health and social care facilities There is a need to improve access for the public in RCT and also for staff working in the area. We want to transform the current transport service through more effective collaborative working by co-ordinating the effective use of transport services, i.e. commercial, statutory and voluntary sector services, in relation to journeys to health and social care facilities. e) Joint Commissioning In addition to integrating the delivery of services, another important way in which health and social care can work better together is to join up our planning and commissioning arrangements. Commissioning is about making decisions about what services are required to respond to health and social care need.

Good commissioning, driven by sound analysis of needs and based on evidence and best practice, will be a key driver in shaping services in the future. Commissioning plans will translate the commitments made in strategic plans like this HSCWB Strategy into the delivery of high quality seamless services to meet the needs of local citizens

We must exploit the opportunities for joining up with other organisations, involving genuine partnership with service users, independent and voluntary providers, and get the right balance between mainstream and specialist services. In RCT, a Commissioning Framework for public and third sector organisations has been developed which, although focussing on commissioning third sector services, will improve our commissioning and service planning processes. It will help us to design and deliver services that are citizen centred, needs based and outcome led. It will also provide a basis for increased joint commissioning and procurement. f) Workforce development

What you told us: Many respondents commented on Workforce Development as a key issue and highlighted in particular the opportunity for more joint training both with the voluntary sector and also involving service users and carers. It was pointed out that flexibility to change services and work more effectively together can sometimes be hampered by staff having different terms and conditions.

The overall aim is to have the right staff in the right place at the right time, providing the right service. Workforce strategies need to recognise the need to modernise and rebalance the health and social care workforce to support the change from hospital to community based care. We need to identify the education and training requirements needed to support the shift to community settings and more integrated working.

The workforce must be competent to meet the challenges of the present and future health and social care needs of people living in RCT. Staff must have the required skills, experience, knowledge, values and personal qualities for the work that they do, as well as the flexibility to adapt to changes in working

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practices. It is important to create an empowered workforce that is engaged and involved in developing as well as delivering new models of care.

New roles and new ways of working will need to be created across traditional professional and organisational boundaries. There are benefits if staff from different professions and organisations train and learn together, particularly given the move towards multi skilled staff working within multi disciplinary and integrated teams. It is also invaluable to include service users and carers in training opportunities.

In order for services to be more flexible to support the needs of patients and clients, the Health Board and Local Authority are exploring opportunities to develop a generic or flexible workforce which will reduce duplication and make best use of the skills and knowledge we have across the health and social care workforce.

The work of the RCT Social Care Workforce Development Partnership and the Training and Development Network set up by Fframwaith will be important in helping to ensure staff in both the statutory and voluntary sector are developed and supported so they can deliver the priorities in the HSCWB Strategy.

IMPLEMENTATION

Implementation of the Health, Social Care and Wellbeing Strategy 2011-14 will require joint action by both statutory and voluntary sector partners, together with strong community engagement. The HSCWB Partnership is responsible for overseeing the delivery of the Strategy and monitoring performance.

What you told us: A number of comments were around implementation issues, for example • the need to be able to measure success • the importance of sharing good practice and rolling out successful projects across RCT • the importance of using all our resources effectively and targeting them in the areas of greatest need, particularly at a time of great financial pressure

“How do we know if we are making a difference and travelling in the right direction – changing the course of a large tanker takes time”

“We need to promote success and share best practice to encourage others to follow.”

“More effective commissioning is needed together with using resources differently to achieve our objectives.”

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“We need to be realistic about the capacity of services and the resources available and make better use of both staff and facilities.”

What do we need to do: The following will be important aspects in delivering the Strategy and ensuring we achieve our Vision. a) Annual Action Plans The HSCWB Strategy is not a fixed and final plan but a framework which sets out what will be taken forward over the next three years. It will form the starting point for a series of annual Action Plans for each Theme which will provide the detailed actions, lead responsibilities, timescales, resource implications and performance measures which will focus on the outcomes we want to achieve. The outcome measures will also align with the requirements of the RCT Community Strategy.

b) Monitoring and review It is very important that we can measure clearly what progress is being made during the life of the Strategy and what difference it is making. The Partnership Board has agreed the need to focus on a small number of high level outcomes in those areas where it is felt agencies need to work together to maximise the impact on population health and wellbeing. These will then become shared outcome measures, supported by individual agency or programme performance indicators.

Progress on the Action Plans will be monitored quarterly by the HSCWB Partnership Board and feedback will also be given regularly to a range of planning and partnership groups, including the wider public. An Annual Report will be produced which will enable us to reflect on progress and allow us to refocus activities if necessary, informing the development of action plans for the new year. c) Accountability The individual organisations which make up the HSCWB Partnership remain accountable for the delivery of services for which they are responsible and are always responsible to their own governing authority. In addition, however, as the HSCWB Partnership, they are accountable to one another and as a Partnership to develop and deliver the HSCWB Strategy. The Partnership has a Procedure for Cooperation which governs its working. d) Use of resources It is impossible to consider the future without reference to the challenging financial circumstances in which we are operating. Working more efficiently and with less resources but with increasing demand will be a feature for public services during the life of this Strategy.

Sustainable development is a key objective for the public sector .We will need to ensure services are as safe, effective and careful of resources as possible..

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To do this will involve a range of service reviews and service redesign, workforce modernisation and performance improvement. e) RCT and Merthyr Tydfil Partnership Reviews The Partnership Reviews already underway in both RCT and Merthyr Tydfil for the Local Service Boards will result in a clearer focus on common priorities across Partnerships and across geographical boundaries where appropriate. This will facilitate a streamlining of delivery groups, the work of which will become more focussed and coordinated. There will also be a consistent approach to performance management and this will assist us as we develop the detailed Action plans to implement the new HSCWB Strategy, including the appropriate outcome measures against which to monitor progress.

COPIES OF THE HSCWB STRATEGY 2011-14

The HSCWB Strategy 2011-14 is available in both English and Welsh electronically on partner websites including www.cwmtaflhb.wales.nhs.uk www.rctcbc.gov.uk www.interlinkrct.org.uk

It will also be available in large print or other formats on request. A summary version will be produced for wider distribution.

If you would like a hard copy of this document, please contact the Health and Wellbeing Team at Cwm Taf Health Board on 01443 744800 or by writing to us at Cwm Taf Health Board Ynysmeurig House, Navigation Park Abercynon CF45 4SN

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