Powys Patients' Council responds to Smoke-free Premises consultation

John Lilley (PPC volunteer), Owen Griffkin (Participation Officer) & Rhydian Parry (PPC volunteer)

Ever since learning of the Welsh Government's proposal to introduce a ban on smoking in all hospital grounds, Powys Patients' Council has been working hard with current and former patients of the mental health inpatient unit in Powys - Felindre Ward at Bronllys Hospital - to gather feedback. The Council was determined to prepare a formal response to the recent government consultation on the topic. 

Up until now mental health wards have been exempt from the regulations, and designated indoor smoking rooms have been allowed. The new regulations, if agreed, would give hospitals 18 months to close down their indoor provision, and, if appropriate, set up outdoor smoking areas instead. However, as the Council discovered, it is not necessarily straightforward to set up outdoor provision. In the case of Felindre Ward, patients smoking outdoors would require staff supervision due to the nature of the outdoor space. Obviously if already busy nurses have to watch people smoking then they're not able to do much else at the time!

In his Ministerial Forward to the consultation document, Cabinet Social Secretary for Health & Social Services, Vaughan Gething, noted:

"The consultation considers the removal of an exemption that allows designation of a room in which patients and residents of mental health units may smoke and replacing it with a time limited one that would expire 18 months after the new regulations come into force. Smoking prevalence among people with mental illness is substantially higher than the general population and is of great concern. Removing the exemption will bring the law in line with general hospital service users and will aim to address health inequalities for persons with mental heath conditions."

My colleague Owen Griffkin introduced the topic to readers last month when he wrote Powys Patients' Council: Kindles, smoking ban and more. 

Since then he joined PPC volunteers John Lilley and Rhydian Parry to circulate the relevant questions from the consultation to put to current and former patients, along with staff working on the ward. These included:

1. Do you agree with the proposal to remove the exemption that permits the designation of smoking rooms in mental health units? (Regulation 8) (Please note that the removal of the exemption would not prevent the person in charge of the premises from designating outdoor areas as places where patients can smoke).
2. Do you agree that the proposed transition period of 18 months after the 2018 Regulations come into force is sufficient time to allow mental health units to implement indoor smoke-free conditions in a safe and secure way? (Regulation 8(6).

Much feedback was gathered, and the Council pulled together a formal response which was submitted by the deadline earlier this month. Owen has now summarised this response for our readers:

Powys Patients’ Council's response to
The Smoke-free Premises & Vehicles (Wales) Regulations 2018 Public Consultation

A consultation was launched in May regarding changes to the Smoke Free premises and Vehicles' Regulations that will affect mental health wards, including the Felindre Ward in Bronllys Hospital. Rhydian and John from the Patients’ Council attended a meeting on the ward with Ward Manager Lisa Hale and Penny Price, Service Manager for Adult Mental Health Services in South Powys, to ensure that they had a voice in the hospital’s response to the consultations. The Council also responded themselves by completing the consultation form and we have summed up the main points here.

At the moment, the only option for people on the ward is to smoke indoors in a designated smoking area. These new regulations would end this practice and would force people into refraining from smoking for long periods. Some of the people with lived experience on the ward who smoke also used facilities in England where indoor smoking was banned and they said it was a very difficult time that made recovery more complicated. During a time of great distress it could cause extra stress to have an enforced period of nicotine withdrawal. It’s always possible for other hospital patients to leave their beds and ‘sneak out’ for a cigarette but due to the secure nature of mental health wards this will not be possible for Felindre patients. The Council was also concerned on the effect on staff time, with the staff having to accompany smokers to an unsecured outdoor smoking area.

One of the main barriers to giving up smoking in a mental health unit is that patients do not have enough activities to help keep them occupied. Patients have said that they have wanted to smoke more because of the boredom as it gives them something to do. We urged that there be increased funding specifically for activities on mental health wards.

We also want there to be access to a full range of cessation tools on the ward, including vaping/e-cigs, and for staff to be well trained in cessation techniques so that patients can be fully supported.

The consultation closed on 17 August 2018 so we will keep you informed as to the outcomes and findings.

Powys Patients' Council is facilitated by the Health & Wellbeing team at Powys Association of Voluntary Organisations and aims to give a voice to people staying on inpatient wards in Powys. For more information, please contact Participation Officer Owen Griffkin by emailing owen.griffkin@pavo.org.uk or ringing 01597 822191.

Compassionate Communities

Dr Julian Abel and Dr Helen Kingston

Last month I attended a seminar with colleagues from Powys Teaching Health Board, PAVO’s Community Connectors and our Health & Wellbeing team at Bronllys Hospital in South Powys. It was to learn about a new model of Primary Care working to provide health services. Compassionate Communities is its name and it has been operating in Frome in Somerset successfully for the past 3 years.

Dr Helen Kingston, a Senior Partner at Frome Medical Practice, and Dr Julian Abel, Director of Compassionate Communities UK, were travelling throughout Wales to spread the word. 

In brief, the three key messages, which I took away from the session

1. People – you, and me, our families and friends (the actual or potential patients or users of the health service), benefit hugely from this way of working. 
2. People – the ones working to provide the health service, from GPs, nurses and pharmacists – right the way through primary care services – are enthused, reinvigorated and actually enjoying jobs where their actions make much bigger differences to people’s lives. 
3. Money – is saved. Emergency hospital admissions drop drastically. 

The Compassionate Communities' approach is about joined up or “integrated” working. The focus is on people. The community in Frome appears to have been transformed. It looks like a genuinely supportive network. We all hope (but don’t necessarily expect) that people would rally round if we were struggling to deal with not just our health, the unexpected curve ball life had thrown, or even the mundane challenges of day-to-day life. In Frome it appears to actually happen. People help each other within this system. And, as a result, their health and wellbeing improves. 

Maggie Sims (Regional Partnership Board public representative) and
Andrew Evans (Assistant Director of Primary Care, Powys Teaching Health Board) listening to Julian

The original motivation – Julian tells us more

“We asked - how can we do what’s best for people? It’s common sense that if they are lonely they need support. Friendship. Love. Companionship. That’s what’s needed. Not a tablet.”

Julian described the essentials that are required for this kind of approach – specialist care, generalist care, compassionate communities and civic actions – and how these can affect health and wellbeing in local populations. It was all these components, working together, that led to the dramatic impact in Frome.

It is a whole population intervention – equally as valid to a teenager as a frail elderly person. The teenager might be bullied at school, cyberbullied at home, become depressed and have poor educational outcomes. Drug and alcohol misuse could establish leading to life-long problems. The solution in the context of Compassionate Communities is at school – the civic community, and at home – the community.

It is the union of the new model of primary care and the Compassionate Communities approach which brings about change. But, how you implement change is as important as the change itself. We are used to the permissions effect of top down change. This approach requires the people who do the work to implement change in a systematic way, determined by ground up change.

It is also about looking at people rather than the medical conditions they may have. “If someone is suicidal because of loneliness then their chronic lung disease might not matter to them,” said Julian.

It is about not having treatment rather than having treatment. It is about networks of support. Fifty years ago people would rally round to give extra support – but this response has been lost to some extent in local communities. Yet the resources at our fingertips are enormous, and our natural networks can extend up to five hundred people. So much is going on in communities that may be untapped. It makes sense to use that, to have a profound impact on people’s health and wellbeing, and because this is the focus, almost the unintended consequence is that emergency admissions drop. 

Dr Mary Hughes and Dr Sean O'Reilly from Haygarth Doctors' Practice

The Compassionate Communities approach in a little more detail – Helen tells us more

There are three main components to the model:

1. Clinical team and GPs. 
2. Community workers. 
3. Integration across the Health & Social Care sector. 

Previously staff in Frome worked in separate silos depending on the disease they were treating. They wanted to get back to basing care around what the individual needed – to improve care, and also their working lives. Helen described the anguish staff experience sometimes. A human being in need sits in front of them but they can only focus on just one small part of the story and have to ignore the rest. It is about recognising firstly that life is complicated – separating self-esteem from physical issues is not possible; and secondly that human relationships are powerful and in many instances, the most beneficial in maintaining and achieving health and wellbeing.

First on left: Freda Lacey, Senior Officer Health & Wellbeing Team at PAVO

Setting up a hub in Frome

The hub is the single point of access in the community. Staff - the primary care team (GPs and nurses), work alongside the new Health Connectors (akin to our Community Connectors). Volunteer Community Connectors (akin to Community Champions) are out in the community, they can be post people, the hairdresser, local shop keeper, milk person, taxi drivers, sixth form students, but have a route into liaising with primary care staff at the hub, if this is needed.

So, when people call, it’s not just about discussing medical matters, but also other things that are important to them. “We have turned life’s difficulties into a disease and medicalised everything and then use the medical model to manage it,” explained Helen.

There may be a window of opportunity in a crisis situation. It is about empowering staff to take a different approach. But, also, about meeting people where they are. “There’s no point telling someone about community groups if they have to work up courage to go and buy milk”.

Mentors work with staff to help them change their approach. Stories at team meetings can turn hearts and minds and people begin changing their way of working. Helen suggested finding key people in practices who are enthusiastic to work with initially, so the energy goes with the flow.

Mistakes will be made, but we can learn from them. It is about being creative in our approach.

Suzanne Iuppa, PAVO Community Connector, contributing to the discussion

The voluntary sector

In Frome, the paid Health Connectors (now mainstream, funded for three years) work very closely with an “amazing voluntary sector”. Health Connectors offer one-to-one appointments and do care planning (“they are the glue, but not necessarily the experts”). They recognise that 95% of the support that people need is around them in the community, and link them in. Some people may not be ready to accept help immediately, but Helen’s advice is “have courage and be persistent. They will come back when the time is right for them.” Many of people’s problems are solved outside the medical practice in this model.

Over 400 groups and services are listed in Frome’s electronic healthcare recording system so social prescribing is at their fingertips. When patients are signposted this is coded on to the system. The nature of the conversation changes with this website directory immediately to hand. (In Powys we have the online service directory infoengine, and although it is not currently linked in to the GP electronic system here, we are in discussions about this with a provider of this type of technical service).

Then there are over 600 trained volunteer Community Connectors (Community Champions). These are interested members of the public, whose role is not 1:1 work but to raise awareness of the service. In an ideal world, everyone would be a Community Connector or Champion! Each person signposts on average twenty times a year.

Building community resilience

Other options for people:

• Talking Cafés – drop-in sessions run by the Health Connectors. Anyone welcome. Signposting to other resources and places to make friends. 
• Health Connectors’ groups – peer support groups following 1:1 work. 
• Self-sustaining groups – leg ulcer, diabetes, macular degeneration, stroke support… and many more. 

Helen finished the session with a couple of detailed case studies which brought the Compassionate Community approach to life.

“Most small acts of kindness happen with individuals. It’s building that capacity. It’s about face-to-face relationships, and people caring for each other. About having that conversation that might not have happened.”

What do you think about the Compassionate Communities approach? Here in Powys we already have a lot of the elements of this model in place – we have our Community Connectors’ team, an equally amazing voluntary sector, and the online service directory infoengine. And work is well underway to further integrate systems and teams to do what’s best for people here too.

Once we know how this work progresses we’ll update you in another blog post. Watch this space!

Start the conversation, it's good to talk / Dechreuwch y sgwrs, mae’n werth ei chael

Farming Connect campaign helps farm businesses 

navigate their way through succession planning

by guest author Elin Jones

In an ideal world, the older generation would discuss their plans for the future of the farm business openly with other members of the family. They would “start the conversation” long before the time when such a discussion becomes essential.

Unfortunately, that is often not the case which has very serious implications for both families and farms in Wales, according to Einir Davies, mentoring and development manager with Menter a Busnes, which delivers Farming Connect on behalf of the Welsh Government.

“The greatest threat to many farm businesses in Wales is lack of a robust succession plan, which is why Farming Connect launched a new succession campaign at the recent Women in Agriculture forum in Bangor on Dee and are committed to making it the topic of conversation around farm kitchen tables this year,” said Einir.

The new campaign, “Start the conversation, it’s good to talk,” comprises a suite of Farming Connect succession planning support services and guidance tools which will help families navigate their way through what are often challenging and unwelcome discussions.

“Businesses which do not plan ahead risk serious consequences for both family and farm, ranging from the falling out of family members and the loss of homes and livelihoods, to adverse financial consequences and the impact to all if the family farm has to be sold, carved up or divided.

“Succession planning will address when and how best to pass on the assets to the next generation which includes preparing them for what lies ahead and passing on responsibility too,” said Einir.

The starting point for those wanting to know when and from whom they should seek advice is to obtain a copy of Farming Connect’s succession planning booklet. This straightforward A4 booklet sets out what support and guidance is available to help families prepare for those all-important discussions which need to take place. It also contains a ‘succession planning toolkit’, providing templates which enable families to discuss and record the facts, opinions and goals of each family member, saving them valuable time ahead of instructing their own professional experts. Collect a copy from your local development officer or from any agricultural show where Farming Connect has a presence.

The new campaign will signpost farming families towards a team of newly appointed ‘succession’ mentors who have joined Farming Connect’s successful fully-funded mentoring programme. Eligible farmers can now apply for up to 22.5 hours of one-to-one confidential and impartial guidance on ‘succession planning’ from a mentor who has relevant experience or knowledge. Browse the online mentor directory, which also includes mentors on a wide range of business and technical topics, including ‘niche’ diversification enterprises and farm safety experts. A filter system will help you identify the mentor with the skills and knowledge you require before applying for the service.

Farming Connect also arranges succession surgeries when eligible farmers can book a fully-funded one-to-one meeting with a specialist rural solicitor. For information on the next round of dates and locations and to book a place, contact your local Farming Connect development officer.

“You will receive a synopsis of your meeting which you can then discuss with your own professional adviser,” said Einir who added that if any families need further assistance with strategic business planning, they can access 80% funding through Farming Connect’s Advisory Service.

Farming Connect is funded by the Welsh Government and the European Agricultural Fund for Rural Development.

Ymgyrch Cyswllt Ffermio yn helpu busnesau
drwy’r broses o gynllunio olyniaeth

Mewn byd delfrydol, byddai’r genhedlaeth hŷn yn trafod eu cynlluniau ar gyfer dyfodol y busnes fferm yn agored gydag aelodau eraill y teulu. Byddent yn “dechrau’r sgwrs” ymhell cyn i drafodaeth o’r fath fod yn angenrheidiol.

Yn anffodus, nid yw hyn yn digwydd bob amser, ac mae hynny’n arwain at oblygiadau difrifol i deuluoedd a ffermydd yng Nghymru, yn ôl Einir Davies, rheolwr mentora a datblygu gyda Menter a Busnes, sy’n darparu Cyswllt Ffermio ar ran Llywodraeth Cymru.

“Y bygythiad mwyaf i nifer o fusnesau fferm yng Nghymru yw diffyg cynllun olyniaeth gadarn, a dyna pam mae Cyswllt Ffermio wedi lansio ymgyrch olyniaeth newydd yn ystod fforwm Merched mewn Amaeth yn ddiweddar ym Mangor Is-Coed ac wedi ymrwymo i sicrhau ei fod yn bwnc trafod o amgylch bwrdd y gegin eleni,” meddai Einir.

Mae’r ymgyrch newydd, “Dechreuwch y Sgwrs, mae’n werth ei chael” yn cynnwys cyfres o wasanaethau cefnogi a chanllawiau ar gyfer cynllunio olyniaeth a fydd yn cynorthwyo teuluoedd i ganfod ffordd o gynnal trafodaethau sy’n aml yn heriol ac yn anodd.

“Mae busnesau nad ydynt yn cynllunio ymlaen llaw mewn perygl o wynebu goblygiadau difrifol iawn ar gyfer y teulu a’r fferm gan amrywio o anghydfod teuluol a cholli cartrefi a bywoliaeth i sefyllfeydd ariannol anffafriol a’r effaith ar bawb pe byddai angen gwerthu, chwalu neu rannu’r fferm deuluol.

“Bydd cynllunio olyniaeth yn mynd i’r afael â sut a phryd y dylid trosglwyddo asedau i’r genhedlaeth nesaf, gan gynnwys eu paratoi ar gyfer y dyfodol a throsglwyddo cyfrifoldeb hefyd,” meddai Einir.

Cam cyntaf ar gyfer y rhai sydd eisiau gwybod pryd y dylent ofyn am gyngor a chan bwy yw derbyn copi o lyfryn cynllunio olyniaeth Cyswllt Ffermio. Mae’r llyfryn A4 hwn yn hawdd i’w ddefnyddio, ac mae’n amlinellu’r gefnogaeth a’r arweiniad sydd ar gael i helpu teuluoedd baratoi ar gyfer y trafodaethau pwysig sydd angen eu cynnal. Mae hefyd yn cynnwys ‘pecyn adnoddau cynllunio olyniaeth’ sy’n darparu templedi sy’n galluogi ffermwyr i drafod a chofnodi’r ffeithiau, barn a nodau pob aelod o’r teulu, gan arbed amser gwerthfawr cyn cysylltu â’u harbenigwyr proffesiynol eu hunain. Gallwch gael copi gan eich swyddog datblygu lleol neu o unrhyw sioe amaethyddol ble bydd Cyswllt Ffermio yn bresennol.

Bydd yr ymgyrch newydd yn cyfeirio teuluoedd fferm at dîm o fentoriaid ‘olyniaeth’ sydd newydd eu penodi i ymuno â rhaglen fentora lwyddiannus Cyswllt Ffermio sydd wedi’i hariannu’n llawn. Gall ffermwyr cymwys ymgeisio am hyd at 22.5 awr o gyngor annibynnol, diduedd a chyfrinachol wedi’i ariannu’n llawn gan fentor sydd â phrofiad perthnasol neu ddealltwriaeth o gynllunio olyniaeth. Ewch i www.llyw.cymru/cyswlltffermio i edrych ar y cyfeirlyfr mentora ar lein, sydd hefyd yn cynnwys mentoriaid gyda phrofiad mewn nifer o feysydd busnes a thechnegol, gan gynnwys mentrau arallgyfeirio arbenigol, ynghyd ag arbenigwyr diogelwch fferm. Bydd system hidlo yn eich cynorthwyo i ganfod y mentro gyda’r sgiliau a’r wybodaeth sydd arnoch ei angen cyn ymgeisio ar gyfer y gwasanaeth.

Mae Cyswllt Ffermio hefyd yn trefnu cymorthfeydd olyniaeth ble gall ffermwyr cymwys drefnu cyfarfod un i un wedi’i ariannu’n llawn gyda chyfreithiwr amaethyddol arbenigol. Am fanylion y rownd nesaf o ddyddiadau a lleoliadau ac i archebu lle, cysylltwch â’ch swyddog datblygu Cyswllt Ffermio lleol.

Byddwch yn derbyn crynodeb o’ch cyfarfod, ac yna gallwch drafod gyda’ch cynghorydd proffesiynol eich hun,” meddai Einir, ac ychwanegodd y gall unrhyw deuluoedd sydd angen cefnogaeth bellach gyda chynllunio busnes strategol, gallant dderbyn cyllid o hyd at 80% trwy Wasanaeth Cynghori Cyswllt Ffermio.

Ariennir Cyswllt Ffermio gan Lywodraeth Cymru a Chronfa Amaethyddol Ewrop ar gyfer Datblygu Gwledig.