Powys Substance Use Harm Reduction Plan launch

Linda Hutchings, Brecon peer support worker

“Developing a partnership response to Harm Reduction across Powys 

to meet the needs of people with drug and alcohol concerns.”

The first thing I picked up at this Harm Reduction Plan launch recently was a flyer about nitazenes (synthetic opioids known for their potent nature) and the changing face of heroin. I hadn’t even pinned on my attendee badge. The bizarre names of drugs like naloxone (a potentially life-saving medication) and nitazene (an extremely harmful drug) were scattered throughout the day and I realised I had a lot to learn.

Fortunately this highly informative day at the Metropole Hotel in Llandrindod brought together a multitude of statutory and voluntary sector agencies with a wealth of knowledge and experience around substance misuse. But perhaps even more importantly it called upon those with the lived experience of the harm that can be caused by substance misuse - be that alcohol or drugs - and the often catastrophic effects resulting in damaged mental and physical health, relationships, living arrangements (homelessness and debt being extreme but not unusual outcomes) and an increased likelihood of coming into contact with the criminal justice system.

Jan Roberts (Suicide Prevention, Harm Reduction & Postvention Quality Improvement Lead), Joy Garfitt (Interim Executive Director of Operations, Mental Health Services) & Carol Daly (Harm Prevention & Reduction Lead - Substance Misuse)
Powys Teaching Health Board

Joy Garfitt, Interim Executive Director of Operations - Mental Health Services in Powys, and chair of the Area Planning Board, welcomed everyone. She explained that the APB brought together agencies across the county with the shared ambition of reducing harm from substance use. (There is a longer definition in the Welsh Government document Working together to reduce harm). The APB plans, commissions and delivers services and also brings networks together. As Joy explained, Powys is actually as long as the distance between the Severn Bridge and the Marble Arch, so this is quite challenging!

What is harm reduction and how can it benefit Powys - Rick Lines, Public Health Wales, Head of Programmes, Substance Use

Rick described how he was first introduced to harm reduction 30 years ago in his hometown of Toronto in Canada. He worked supporting prisoners who, he explained, were inevitably using drugs. His experience supporting people who had been traumatised by early life events, and went on to use drugs, led him to ask in court: “Have you heard this woman’s story? Why is the state looking at it through the context of drugs?” Rick highlighted that putting this particular woman in prison repeated the trauma she had experienced from authority figures when she was a child.

Rick saw the same scenario play out when he later worked in Eastern Europe. He said 90% of drug use is not problematic (how many people do we know who use alcohol on a regular basis socially…?) and asked what we can do to reduce deaths, to show that we care whether people live or die, and to help reduce the risk of using drugs in a risky fashion. We should be respecting the dignity of people who use drugs by providing services, and reducing feelings of vulnerability and stigma.

Recent concerns are around changes in the drug market whereby synthetic and highly dangerous drugs (like nitazenes) are increasingly coming onto the market. Rick championed the ongoing work in the 3rd sector and community pharmacies to provide harm reduction services - “it is the people on the ground who are making the difference”.

Welsh Government policy is committed to harm reduction, and is unique in the United Kingdom, and rare in the world. This policy influences how the police, prisons and partners regard substance use and filters down to the statutory and community organisations.

Current position in Powys and the focus of Harm Reduction - Carol Daly, Harm Prevention and Reduction Lead (Substance Misuse)

Carol’s aim is to set up a multi-agency Powys Harm Reduction sub-group (one of seven across Wales) to drive action across the county. This would draw on the knowledge of local organisations to deliver the key priorities, including:

Supporting the work of the Health Board in working to the World Health Organisation's global aim of eliminating Blood Borne Viruses by 2030. Powys is rolling out treatment and testing for people at risk of Blood Borne Viruses such as HIV, Hepatitis B and C.

• Training up peer supporters and carers.
• Developing pharmacy services to increase the uptake of Needle and Syringe Provision and Blood Borne Virus Testing.
• Raising awareness of the real risks of synthetic drugs coming onto the market.
• Increasing availability of Naloxone across partner agencies.
• Addressing the stigma (it was again pointed out that most people use some sort of substance, for example, alcohol).
• Prevention - the APB has commissioned services to educate children and young people about drugs, and Carol is working with Child & Adolescent Mental Health Services (CAMHS) to increase knowledge of new synthetic opiates.

This important agenda would save lives - and has saved thousands of lives already with the information and tools to help people who take drugs do so in a safer manner.

During discussion Barry Eveleigh from Kaleidoscope (the local substance misuse service provider) highlighted the financial element - if you can keep someone out of A&E you can save £2000. A liver transplant is £150,000. It costs £1000 a week to keep someone in prison. In comparison to these figures the costs of providing safe drug alternatives are minor.

There were also questions about decriminalising drugs as has happened in other countries such as Portugal, where the person using drugs is regarded as a patient rather than a criminal. Michael Curties from the Welsh Government explained that the criminal justice system is not devolved to Wales so this is not an option open to the Welsh Government.

What’s already being done and what are our priorities? - Neville Brookes, Area Planning Board Manager

Neville asked: “how can co-production work with this agenda?” We need to learn from people with lived experience, and spend time with individuals in the treatment system. “Who better to talk to when waiting for a service than another peer?”

Peers design relapse prevention programmes - they know what works. If people become part of a peer mentor programme they often give back to services and there is an onward pathway to work within the field if they choose.

He also said:

• Harm reduction should be on all our agendas - not just thought of as a clinical intervention.
• Out of hours community support is needed (this was identified by focus groups).
• We need to simplify the service so that individuals have a single pathway.

The overall outcome would be to enhance and improve systems and processes for everyone involved.

How we use peers, with lived experience, to enhance service provision - Elwyn Thomas, Co-production Lead, Kaleidoscope

Elwyn has been in post for 18 months now. He started as a peer on a script in a prison cell. He worked on a Welsh Government peer to peer support project providing the heroin substitute naloxone - over an 8 week period 237 kits were delivered! Amazingly eighty people did not even know that it existed.

There are now seven teams across Wales delivering this important service. Everyone was trained in just a year, and other initiatives have also been put into place including creating pathways to treatment and needle exchange schemes. Elwyn spoke of how people’s esteem and self-worth was raised after having access to the training, with peer uniforms (branded “ask me about Naloxone”) and lanyards breaking barriers.

In 2 years the delivery of harm reduction has changed massively in Wales, from prescribed scripts from nurses to working alongside peers.

Linda Hutchings, a Brecon peer, has lived experience for many years using drugs but is now drug free. She agreed that people can be the best they can be with training and involvement. She is now accepted in her community, not as a drug addict, but as someone with lived experience. “I built up belief in myself as I didn’t have any.” Linda started work with peer mentoring service Cyfle Cymru on 8 February.

Round table discussions & feedback

In round table discussions we looked closely at Powys challenges and priorities. The top three challenges on our table were: rurality, silos and stigma. We were very keen to promote the idea of a support bus which could travel the whole length of the county, the distance from the Severn Bridge to Marble Arch - and back again!

Our priorities were - prevention, communication and collaboration. We agreed that it was important to reach out into the community (it’s that bus again!) rather than expect people to come to us.

Overall it felt that there was a great enthusiasm in the room for genuine collaboration and partnership working to make real change so that people using drugs and alcohol, for whatever reason, could live well in the county.

Closing remarks - Michael Curties, Substance Misuse Policy Team, Welsh Government

Michael raised many relevant and important topics in his summing up in relation to the APB, data sharing, working more closely with GPs and prevention, etc. To finish off I’ll highlight just a couple of his comments that particularly resonated with me:

The Harm Reduction challenge is the same as it is for all other services - we solve it by working together. “How do we get to the point where there is no wrong door? Where people walk in and get a service wherever they are?”

“Coproduction is about learning - what do we say that gets in your way? We need to hear if there are those barriers. Ask - can we do it differently?”

I look forward to finding out more about developing drug and alcohol services in Powys as Carol continues her vital work on the Harm Reduction plan.

You find out more about Alcohol and Substance Misuse resources

on this Powys Teaching Health Board website page.

The future of the Wales Mental Health & Wellbeing Forum

John Lilley (Individual Representative, Mental Health) and Josh Beynon (Practice Solutions)

Improving mental health and wellbeing by respecting and 

empowering people to influence decision making

The Wales Mental Health and Wellbeing Forum is made up of people with lived experience of mental health issues and their friends and families. The members come from a range of different backgrounds and reflect the diversity of the people of Wales. Here in Powys John Lilley - more from him below - joins Rhydian and Sally to bring the voice of Powys service users and carers to the table.

Forum members work collaboratively with other key stakeholders to influence Welsh Government policy by using the skills, knowledge and experience they have gained within the field of mental health. They play a very important role in helping shape future mental health services within Wales.

We recently heard that Practice Solutions Ltd, the organisation which has provided support to the Forum over recent years, has been awarded the tender to support the Wales Mental Health and Wellbeing Forum for the next 3 years.

Since the Forum started working on the contract with Practice Solutions it has gone from strength to strength and a huge part of this has come from the fact that Practice Solutions staff have instilled in members that it is their Forum and they should lead the direction of the work and how this looks in the future. The members are then able to use the knowledge and experience of Practice Solutions’ staff to inform and guide them in the best way forward when developing projects.

Since the Forum started working with Practice Solutions there have been lots of exciting developments. The Forum changed its name from the National Mental Health Forum to the Wales Mental Health and Wellbeing Forum. It was felt that this better represented the Forum’s work focus - what happens within services in Wales.

John Lilley chairing a Wales Mental Health & Wellbeing forum meeting

The Forum also designed their own logo and branding which is now used on their promotional material and on their social media platforms and this enables the Forum to create a professional image when speaking to organisations.

With guidance from Practice Solutions' staff the Forum also established separate working groups alongside the quarterly meetings and these included Communications & Marketing, Future Planning & Recruitment, and Reward & Engagement. These groups enable some of the members to focus on particular aspects of the Forum such as designing a logo or their website, promoting the Forum and attending events. Proposals and ideas are taken to the main quarterly meeting for agreement and voting by all members.

Another huge part of the Forum’s growth has involved the development of the website which allows members to inform people about their work, share good news stories, promote events and publish some of the papers that the Forum has produced. The Forum has also been privileged to have members share their mental health journey through the production of digital stories. These can be extremely powerful in highlighting the issues that people with mental health face.

The Forum is looking forward to continuing its work with Practice Solutions and seeing where the future journey takes them. Onwards and upwards…!

Josh Beynon, who is an Associate at Practice Solutions, and provides support to the Forum as part of his role, says: “It’s great to be supporting and working with the forum again to improve services and put the voice of service users and carers at the heart of decision making”.

John Lilley, Individual Rep Mental Health,
 at a Shared Power training session last year

John Lilley is the expert on the Forum locally here in Powys as he has been a member for several years now. He says: “I became a Mental Health Service User Representative as I felt my experience as a service user, and as someone with lived experience of mental health issues, could help to give a voice and attempt to improve access and care within the mental health services.

“I was diagnosed with bi-polar in 2013 and before that with clinical depression as a result of life changing neurosurgery in 2000. After a three month stay as a patient in Bronllys, and attending Patients’ Council meetings whilst there, I decided that following recovery I would join Powys Patients’ Council as a volunteer. I believe this helped in my recovery and boosted my self-esteem and confidence.

“After being a volunteer for over 5 years I became a Mental Health Service User Representative in Powys in 2021. During my time as a rep I have also joined the Wales Mental Health and Wellbeing Forum to represent Powys. This national forum meets regularly and reports to the Welsh Government on issues affecting service users and carers locally. I have also been a member of the Powys Crisis Care forum which oversees the delivery of the Mental Health Crisis Care Concordat in Powys. This measures the effectiveness of how Powys deals with people in Mental Health Crisis.”

Find out more about the work of the Wales Mental Health & Wellbeing Forum.

Find out more about becoming a Mental Health Rep in Powys.

Shared Power - the training

How to use your lived experience to help in the planning and delivery of 

health and wellbeing services in Powys

Late last year the Health & Wellbeing team at PAVO launched Shared Power - An Introduction, an animated video, as a training tool for individuals who want to use their experiences of health services to help shape future services. The film delves into the different types of power, and how they interact with each other, when service user and carer representatives attend partnership board meetings in Powys.

The film is also aimed at those working in services so that they can avoid some of the barriers to co-production. Co-production means service users and carers work together with health professionals to design future services that work better for everyone. We received some excellent feedback about the film at the time.

Then, just a few weeks ago, came the perfect opportunity to show the film again - at the latest Shared Power face to face training session at our Ddole Road offices in Llandrindod Wells. Delivered by Owen Griffkin (Mental Health Participation Officer) with support from Sue Newham (Health & Wellbeing Engagement Officer), the training aimed to build the confidence, knowledge and skills of participants. Some of those attending were already volunteering as citizen or individual reps, and the training aimed to help them participate effectively in the planning and reviewing of services with public bodies.

Citizen reps volunteer their time, energy and passion to make a difference for others and to the services we receive, and are helping influence change at local, regional and national levels. Some of the participants are citizen reps on the Powys Mental Health Planning & Development Board and the Talk to Me 2 (Suicide & Self-Harm Prevention Forum), whilst others regularly sit on the Powys Regional Partnership Board.

Learning opportunities on the day included:

• How to influence positive changes in health and wellbeing services in Powys.
• Understanding the theories underpinning service user and carer involvement in planning services.
• Gaining practical experience of how partnership boards work with service users and carers in meetings.
• Recognising barriers to participation and how to overcome them.
• Finding out about current opportunities and how to apply for them.
• The opportunity to learn from current service user and carer representatives who sit on Health and Wellbeing Boards about their experiences.
• Learning assertiveness techniques and how to prepare for meetings.
• How to share personal experiences and avoid ‘trigger points’.
  
  

Here are some highlights from the day’s training.

Co-production demystified 

As a citizen rep, you are an equal partner with other professionals in the room. You are an expert by experience. But how do you gain the experience of other people and take their stories to a partnership board?

Owen updated the group about the work of the current mental health representatives, who regularly go out into the community at Meet the Rep events to listen to people’s voices about mental health services.

One of our experienced reps, John, spoke about how important it is to find out what is happening in the rest of Wales and about being aware of current mental health legislation. “Preparation is key! Ask yourself what are some of the key messages you want people to hear.”

John also described some of the resources available to people who want to engage in a co-productive way. The Co-production Network for Wales is a good starting point for finding out more.

And volunteering as a rep is a two-way street! We regularly hear that taking on the role “does improve confidence and help with personal recovery.”

Meetings - with remarkable people

Even introducing yourself at a meeting can be hard when in a room full of strangers, especially when most of them are there in a professional capacity. “A few years ago asking who I am would have been a really distressing question as I thought I was a nobody!”

Participants were introduced to Imposter Syndrome - it might feel daunting to be at a partnership board meeting, but as a rep you probably deserve to be there more than anyone else. “You are the most valuable person here,” someone was told at one meeting.

Everyone in the room is equal. Those working as heads of service for the NHS, or other statutory bodies, may be constrained in their work roles as to exactly what changes they can bring about and when - but they are people too. They may have a mother with dementia, a nephew who needs care, a friend struggling to access services…

As someone pointed out, “Town councils, health boards and councils are slow moving, which can be discouraging, but once they get going in the right direction they are hard to stop!”

Assertiveness is key - and learning the difference between being passive, aggressive and assertive an important skill. As a rep you need to think about being:

• Proactive about what you want to say.
• Confident and engaged.
• Self aware and aware of others.
• Sure your needs are met and that you are heard.
  
  

Hotspots, triggers & flashpoints

Participants spoke about their own triggers. These included being talked over, being told that there was not enough money, “mansplaining" and not being listened to.

One said, “I used to get in a tizz when people didn’t listen and I would storm out crying, but nothing good came from that!”

“You need a strong assertive Chair so that the meeting does not go off track and any problems can be shut down.”

“There will always be quiet people - it’s about managing a meeting to let all voices be heard.”

Dealing with difficult conversations

There was some very interesting group debate amongst the participants about what to do around some specific tricky scenarios which Owen had set up.

“Health staff are there for you. It’s about having the confidence and assertiveness to say, ‘I respect your views but I don’t agree with them.’”

“Ground rules are important to set the tone for the meeting.”

If there is a lack of respect someone suggested saying: “I have respect for your professionalism, so please have respect for my lived experience.”

The mock meeting

To round off the training session, Sue chaired a mock meeting designed to put into practice all the learning from earlier in the day. It turned out to be an extremely interesting and valuable exercise.

All those attending agreed that they had benefitted hugely from Shared Power training, both from the learning and also the opportunity to network with others with a similar role.

And finally…

Would you be interested in joining these citizen reps to take grass-root views and opinions to local board meetings where service providers can find out what is working and what needs to change? For further information about becoming a citizen rep, in the field of mental health or health and social care, just get in touch with us by emailing owen.griffkin@pavo.org.uk or ringing 01597 822191.

The next Shared Power training session will take place on 13 September 2023. 

Do get in touch with Owen if you would like to sign up.

Shared Power training - your chance to make a difference!

Sarah Dale, John Lilley & Rhydian Parry - Mental Health Individual Reps

Do you use health wellbeing services in Powys? Do you ever think about using your lived experience to make a positive difference to the way these services are designed and delivered?

If the answer is yes, but you’re not sure about how to get involved, you could well be interested in a full day of free training around this important area. Our Shared Power training will run on Wednesday 8 February at our Llandrindod Wells office.

We spoke to PAVO’s Participation Officer Owen Griffkin about why Shared Power training is important and the opportunities it may bring to people who attend.

Who is the Shared Power training for?

It’s for anyone who uses health and well being services in Powys and feels like they could use their lived experience to help plan and deliver these services.

What will people who attend get out of the training?

We will be looking at how health and wellbeing services are planned in the county, and the importance of the voice of the people who use these services in helping to make sure the services are run in the best possible way.

People might not know that their experience can be massively important in helping to make health provision better and there have been some big changes over the last few years that have been made because of what issues people have raised.

It can be quite daunting for people to share their stories, which can sometimes be traumatic, so we will look at how to share their experiences. There will be lots of practical exercises, and also we will talk to some of the current service user and carer representatives who sit on the partnership boards responsible for making decisions around health and wellbeing.

What can people do with the knowledge they learn?

A lot of the subjects covered will help with people’s everyday lives. We will have some assertiveness training, and look at how to prepare for meetings and confidence building. We will also look at discussing difficult subjects that can be quite personal to someone.

There will also be a chance to see what current opportunities there are in Powys for people to get involved and make a difference straight away. We try to have as much fun as we can whilst learning, and we will make sure there are lots of practical activities to try out what we are teaching.

Why is this training important?

The Well-being of Future Generations Act in 2015 made it a requirement for Welsh public bodies to involve the people who use, or who care for those who use, health and well-being services. The more people who feel confident in getting involved in this decision making, the better the services will be for anyone who has to use them.

People who have attended previous training sessions have gone on to help make really positive changes in Powys and Nationally as members of health and well-being partnership boards , volunteers for Powys Patients’ Council and leading awareness sessions for social care staff on issues important to them.

There are many more opportunities now to get involved than there were before COVID, and health services are always looking for people with lived experience in lots of different roles.

The people we work with in participation at the moment all say how much it has improved their own well-being because of their increased confidence and self-worth so I can really recommend getting involved and this training will be a great place to start!

If you want to find out more about the Shared Power training you can email owen.griffkin@pavo.org.uk

Or, you can book your place online HERE.

You can read more, and watch a video, about the concept of Shared Power, 

on our recent blog post Shared Power - an Introduction.

Shared Power - an introduction

The Health and Wellbeing Team at Powys Association of Voluntary Organisations is pleased to announce the launch of a new animation film called "Shared Power - An Introduction".

PAVO’s Mental Health Participation Officer, Owen Griffkin, who worked on pulling together the different elements of the film, explains why this was an important subject to make a film about.

For some time now PAVO has delivered training to the service user and carer representatives who sit on the local health and wellbeing partnership boards. These people have a seat on the boards to provide a voice for anyone who uses these services and their input is vital to ensuring a health service that is fit for purpose and effective. We called this training ‘Shared Power’ training and it was designed to give people confidence and knowledge when taking part in high level planning meetings.

When we delivered this training we would often look at the nature of power, and how different types of power interact with each other. One of the theories we discussed was called the POWERCUBE, which expanded on previous theories around the different forms of power. We found that this theory often provoked some interesting discussions, although it could sometimes seem quite daunting when presented in a training session. Therefore, when the opportunity arose to apply for a training grant from the Powys Area Planning Board, we thought that making a short film looking at this theory might be useful in future training courses. 

We also wanted to aim the film at professionals who sit on these boards, so that they could avoid some of the barriers presented by power imbalances that might exclude service users and carers from engaging with co-production opportunities.

We were successful with the funding so we began working with current representatives from the main health and wellbeing partnership boards to get their input on how the film should progress. (These boards include the Mental Health Planning and Development Partnership, the Regional Partnership Board and the Area Planning Board).

We thought an animation might be a good way to highlight the important points, using the opinions and voices of current and past reps, and we hoped to involve the reps in all creative aspects of the film-making process. We worked with Jim Elliott, a Powys-based animator and musician, and I held interviews where possible with the reps so we could use their voices (and likenesses). Unfortunately we were now in the midst of the COVID-19 lockdown so some of the original ideas were hard to do, and the reps weren’t able to be as ‘hands-on’ with the animation as we wanted to, but they still had input into the look and feel of the film.

We had discussed some of the old 1970s Open University graphics as a starting point for the aesthetic of the animation, and decided on a ‘stop-motion’ process to animate the talking head pieces. We also ensured there was a full Welsh version and worked with a local actor from Mid Powys Youth Theatre to provide the Welsh narration.

The initial reaction has been really good, and we plan to use the film in future training sessions as a way to break up the day and provide a break to whoever is leading the training. We hope that other organisations in Wales might want to use the film as well. To help with this we also produced some training materials that can be downloaded from the Powys Mental Health website - Shared Power additional materials.

If you would like to know more about the shared power training please contact mentalhealth@pavo.org.uk

You can view the films in English:

And Welsh:

The Wales Mental Health & Wellbeing Forum – an update

by guest author Sarah Dale 

Sarah Dale is a citizen rep – an unpaid volunteer who sits on regional and national partnership boards, including the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum) – “the voice of lived experience”.

“I became a rep because I don't want others to have to fight for years just to be diagnosed to get the treatment they need. I strongly believe we all have the responsibility to do what we can to change and improve the mental health services that we all use.” 

In the summer of 2020 Sarah attended the latest meetings of the Forum, which took place online over the course of two days (28 July and 12 August). It was Powys’ turn to host and Sarah chaired one of the sessions. Sarah recently reported back to the Engage to Change partnership board (sub-group of the Powys Mental Health Planning & Development Board) about what took place over the course of the two days.

We had a general update and I did a long Powys update because we have done so much. There was a lot of feedback from the other reps that they were surprised how much work we actually do in Powys as reps. Someone said “now that is real co-production!” A lot of the other health boards haven’t actually done a lot during Covid, for example, having meetings or involving reps.

Then we had a quick session on the logo, looking at the new name and design. That was all approved. This was followed by a session on the Terms of Reference which were also approved, including the Easy Read version which I had gone through and amended. I don’t like the term Easy Read, I call it “Sarah readable!”

We looked at the new member roles which were also approved. Some people who have exceeded their term of office are now able to stay on in the Forum. We have other working groups – so there’s a Diversity and Equality Working Group – and we are looking at people we want to include in these groups, so we send out “About Us” emails to organisations.

A representative from Welsh Government updated us. They have asked us to become involved in reviewing some of the Public Health documents. Ministers have invested £5 million towards ending homelessness and are supporting local authorities to provide longer term housing solutions. The three regional Suicide Prevention Coordinators have been appointed and an announcement about suicide prevention grant funding will be made soon. Welsh Government is working with the voluntary sector to develop a framework for better engagement in recognition that there is not enough work in partnership with smaller mental health charities in particular.

The Welsh Government is reviewing the Together for Mental Health and Talk to Me 2 delivery plans to strengthen areas which have been particularly impacted by Covid and to review timescales for delivery on one year actions. The revised plans will be presented at the National Partnership Board and the National Advisory Group in September for feedback. Equalities is one area where there will really be a focus, along with housing and homelessness, wellbeing and public health, and financial impacts. A number of Tier 0 interventions such as online self-help resources have been established. There have been some rapid reviews to changes made during lockdown which are being coordinated by the NHS – on what works based on user surveys and staff feedback.

One thing which Ainsley Blaydon (Mental Health Strategy Lead for Welsh Government) would like is feedback about what it has been like as a “service user” under Covid so I mentioned to her that we had done a survey of people under services in Powys.

Sarah on an interview panel for mental health services at the health board

Previously I have not been able to access the Forum working groups as they have been in South Wales and I don’t like to travel because of my anxiety. Covid has meant that a lot of these meetings are on Zoom so I have been able to join a couple which is really exciting. From each health board you have two service user and two carer reps and they are automatically invited to the Forum. Because of the number of health boards in the South there feels more of a South Wales representation – sometimes it feels like we are forgotten in the North. If I was in the working groups I felt I would have more of a sense of belonging so I joined the Equality and Diversity Group because that is my strong suit and also because there is inequality in representation.

In the group they have identified people they want to join – these are people from travelling communities, those experiencing homelessness, LGBTQIA, digitally excluded and Welsh language speakers. So I asked – do you even know who in the Forum fits into these categories? I’m here, I fit into the homelessness one because I’ve been made homeless. So I made them look inwards at the start – and now I’m doing some of that work. I was assigned the LGBTQIA list, so I did a lot of Google searching on all the different groups – most of them are Facebook groups and very hard to find, which is something we need to tackle, but I have compiled a list.

When I joined the Forum I just turned up, there was no Equality & Diversity form, so I’m creating a form I’ve dubbed the “Diversity Form”. It’s optional whether people fill out the details about their gender, sexuality, race – the usual equal opportunities but extended so that we can identify specific groups like people who use Personality Disorder Services or Eating Disorder Services or have been homeless. At the end of the document we explain that we are looking for people from these specific groups to talk about their experiences if they are comfortable with that.

I then joined the Future Planning group – one of the questions they have posed is – “Why are we losing so many members? Why can’t we get people to join?” So I explained that there are a lot of people from South Wales and if you’re not from there you feel left out, plus some of the topics don’t really apply to us in Powys. 

At the last Forum meeting the special topic was “Alternative to inpatient care,” which is good but as I said it would be nice to have the basics in Powys. We do not have a 24-hour crisis team – all the other areas do. When I was an outpatient at the Child & Adolescent Unit in Bridgend I missed out on the therapies, treatments and groups that are available to people who live locally. As a Powys resident I saw two different people who came up to Powys for two days a week for half a day by comparison. So one of the suggestions I made was to make it more welcoming to people so there isn’t that divide.

Locally I’ve been invited to join interview panels which I’ve really enjoyed – I did the Suicide & Self Harm Coordinator’s role, a Harm Reduction role and a Crisis Team Practitioner. My thoughts were totally taken into consideration and it was a really good experience. 

Many thanks to Sarah for telling us about the Forum meetings. If you would like to find out more about volunteering as a mental health “citizen rep” in Powys then get in touch with us by emailing mentalhealth@pavo.org.uk or call 01597 822191 and ask to speak to Owen Griffkin.

Introducing our new Head of Health & Wellbeing - Clair Swales

Clair Swales recently took on a new role at Powys Association of Voluntary Organisations as Head of Health & Wellbeing after previously working as Senior Officer Community Connectors & Info Engine Wales. She originally started work at PAVO in 2016 as a Third Sector Broker & Info Engine Officer and has since overseen the development of the hugely successful Community Connectors’ team within the organisation as well as further developing the online services directory infoengine. We met up with Clair recently to find out more about her new role.

Tell us more about your new role as Head of Health & Wellbeing at PAVO

My role is to facilitate positive relationships between Powys’ Third Sector and the Public Sector in the field of health and wellbeing, enabling third sector involvement in the development of policy and partnerships, championing a joined-up approach to commissioning of services and developing and maintaining effective service user and citizen engagement.

The role incorporates supporting the Health and Wellbeing team, overseeing the work of the Community Connectors and Powys Befriending Service and contributing to the management of PAVO. I also share responsibility with the CEO for the development and delivery of infoengine.

How is the new job going so far?

I began my new post in December 2019 and the first couple of months have been very busy indeed. In January I was delighted to welcome Sharon Healey as the new Senior Officer for the Community Connectors and Powys Befriending Services. It's been fantastic to get to work more closely with a larger team of PAVO colleagues and to continue working with the sector, health and social care colleagues albeit in a new remit.

Clair (2nd from R) & PAVO colleagues saying #HelloYellow on World Mental Health Day 2019

Can you - briefly - sum up the work of the three different PAVO teams you head up - Health & Wellbeing, Community Connectors & Powys Befrienders

Health & Wellbeing - the team supports Third Sector organisations working in the health and social care fields to work closely with the Health Board, County Council and others to develop better services for Powys’ people. It provides an important mental health information service, supports the delivery of health and well-being information via various mediums, and recruits and supports citizen reps for a variety of boards, as well as facilitating networks such as the Powys Advocacy Network.

Community Connectors - The service helps people in Powys (aged 18+) and their families or carers, to access community-level services and activities that will help them maintain independent lives and which help prevent their circumstances deteriorating to a point where they might need higher level health or social care services.

Powys Befrienders Service - Powys Befriending Service helps improve the independence of people over 50 by helping maintain social networks and remain in their own homes for as long as they are able.

Clair with some of the Community Connectors

Why do you think the Community Connectors have, in such a short time, become such key players in supporting some of our most vulnerable Powys residents?

For anyone who may be vulnerable or facing a challenging time, access to the right information at the right time is essential. Often it can be a challenge to keep on top of the latest information about the support that is available. The Community Connectors have become a key link between statutory services, the client and the sector. This has been driven by the Social Services and Wellbeing Act and A Healthier Wales; and the work with the Regional Partnership Board in delivering the Health and Care Strategy for Powys.

What are the main challenges of your new role?

Juggling time and commitments! With a large team and an even larger number of meetings to attend where I represent the sector, it is always a matter of judging the best way I can support the team and the sector in the best way possible. I like the challenge though and always try to ensure that I make time for my own health and wellbeing and ensuring a good work/home life balance.

Why do you think it is crucial that there is a healthy and robust Health & Wellbeing Third Sector in Powys?

There is a huge focus on health and wellbeing at the moment and in particular early help and intervention. Statutory services have changed immensely over the years and the model for delivery, and financial capability of delivering front line services has also changed. The third sector has a crucial part to play in our communities in supporting health and wellbeing but the sector itself needs to be healthy and robust, able to adapt to change and given the freedom to deliver what truly matters to people. Funding is always a challenge but I like to challenge funding bodies such as the local authority and Welsh Government to focus on early help and prevention and how this can be funded in the third sector. Volunteers play a huge role in supporting health and wellbeing in Powys so we must do what we can to look after Powys’ volunteers.

Clair with Andrew Davies, PAVO Health & Wellbeing Participation Officer

If you could change one thing in the Third Sector Health and Wellbeing world here, what would it be?

Ooh wave my magic wand……Other than overcoming funding difficulties within the sector, I would like to see more third sector involvement in the engagement and support of children and young people. Powys’ third sector has lost a lot of capacity in the remit of delivering support for children and young people and I think it is vital we play an active part in this area of health and wellbeing, to help support children and families and play a key role in reducing and preventing issues in the future.

Charities and voluntary groups (including PAVO) increasingly work more closely with statutory providers of health services - how do you think this will affect the sector from the tiniest local groups to the national big charity players?

I think the biggest challenge here is meeting demand. The SSWB Act has a focus on support close to home but we need to ensure that support for these organisations and groups filters right down to the smallest provider. The close work with statutory partners is certainly a positive step forward but I think there needs to be greater understanding of the role of the sector, in particular the smaller groups, that the sector cannot survive on thin air and it shouldn’t be the place to cut funding.

The Social Value Forum is really starting to see small groups and charities benefit from a small amount of funding that can make a big difference in the community. Sustainability of third sector services is always an issue. Powys is heavily reliant on the outstanding work of volunteers but there is only so much volunteers can do and only so much time to give for volunteering as we all work longer. 

Sharon Healey (L)  new Senior Officer for the Community Connectors &
Powys Befriending Services with Clair

How do you see co-production* working successfully in Powys to provide quality health services for all and what is PAVO’s role in this?

We have had some really positive discussions with third sector agencies such as Credu about co-production in Powys. I feel it's really important to include the service user or community’s views to shape services and this needs to be in a constructive and positive manner. To truly enable co-production we have to break down bureaucratic barriers and this can be a big challenge when working with statutory partners as they have their statutory duties to fulfill. Remove the barriers and let the sector work together with communities to shape future services.

PAVO can play an active role in bringing people together, ensuring the citizen and sector’s voices are heard at statutory level, and influence decision making on behalf of the community and third sector. PAVO’s mission is to be a CATALYST of voluntary Action, a legitimate VOICE for the voluntary sector and a HUB of essential information. We are looking at new ways of using the Community Connectors’ community workers’ meetings to co-produce services at community based level as we know in Powys one size does not fit all. It has to come from the community.

Lots of big issues are crowding out the H & W agenda, the Big 4 of Powys’s Health & Care strategy (Cancer, Mental Health, Heart and Respiratory disease), the Loneliness and isolation strategy of the Together for Mental Health new delivery plan. What skills can your PAVO teams bring to the table?

The team has excellent communication skills and the ability to decipher vast amounts of important health and wellbeing information. Using their creative communication skills they make information regarding health policies and wellbeing initiatives easily accessible to the public, and indeed statutory and third sector colleagues. The teams do this through a variety of platforms such as the ebulletins, social media, health lift films, infoengine.wales and by working with people directly; thus meaning there is something for everyone. The team uses a variety of skills to ensure the voice of the citizen and the sector is heard at all levels of the decision making processes. We also benefit from working closely with our colleagues in the development team to support the sector to meet the challenges of an ever demanding, ever changing wellbeing environment.

Clair (2nd from L) at a patient discharge home meeting with colleagues from Third Sector,
Powys Teaching Health Board and Powys County Council

If people identify gaps in mainstream and Third Sector health and wellbeing services - where should they take that information so that the gaps can be addressed?

The Community Connectors’ case management system allows the team to record gaps and unmet need when working with clients. This has proved very useful with our work with the Social Value Forum to identify needs in communities. However this is just one way of recording information, there is a huge amount of information out there and if you speak to residents or people working in Powys communities they know where there are gaps. The challenge is recording it. The team has used the Community workers’ meetings to also record data around gaps and unmet need and if you don’t already attend one of these meetings I would encourage you to do so.

There are a couple of social prescribing pilot projects in Powys. There seems to be a greater appetite for exploring new and innovative ways to tackling some health & wellbeing issues. What are your thoughts?

Firstly I am not sure I like the terminology ‘social prescribing’. We shouldn’t have to be ‘prescribed’ community based third sector services. However people do need to know what’s available to them to support good health and wellbeing. We should encourage and support people to access community based activities where medical intervention is not required. This type of service is designed to support physical activity and promote good mental health.

Have you taken inspiration from others in the fields of health and wellbeing and / or the Third Sector, and if so, who?

I have actually taken my inspiration from my late father. He was very community minded and spent years as a Town and County Councillor always striving to make people’s lives better. Seeing him work so passionately in the community helped shape me and gave me the firm foundations to strive to deliver the very best for people in the work I do today and every day.

Tell us about some of the most rewarding work you have done at PAVO

Supporting the growth if the connector service has been very rewarding and being shortlisted for an NHS Wales award in autumn 2018 was definitely a highlight. But listening to the difference we can make to people’s lives and to the communities of Powys is always heart warming. I am very clear that without the third sector in Powys the county would be less vibrant.

When you’re not working how do you enjoy spending your time?

My spare time is undoubtedly dedicated to my family. I live with my husband (pictured above on my wedding day) and I have three children and two step children. I am normally running around with various items of sporting kit from rugby to football to horse riding gear. I am very proud of the children and enjoy being on the sidelines cheering them on. I also love cooking with my husband. That's my daily de-stress hour when I get home. I enjoy going to concerts (Bruce Springsteen has to be one of my all time favourites along with The Rolling Stones but I would love to see Sir Tom Jones in concert too). I love walking the dog and getting out into the mountains. Getting fresh air into my lungs helps me to feel grounded and reinvigorated.

BIG thanks to Clair for telling us more about her new role. If you'd like to contact Clair then you can ring 01597 822191 or email clair.swales@pavo.org.uk

*Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co‐produced in this way, both services and neighbourhoods become far more effective agents of change.

Definition developed by the New Economics Foundation (NEF) and Nesta, in partnership with the Co-production Practitioners’ Network