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. The service can also help support people when they return to home from hospital by helping other Third Sector services, such as Red Cross, identify additional local services that may be needed.
To meet this need PAVO has been providing an independent Third Sector Broker Service for Powys operating out of Powys People Direct; Powys County Council's (PCC) single point of access contact service for individuals needing support from social services.
PAVO has now changed the service to become the Community Health and Well-Being Coordination Service and it is now also being provided at a community level in many areas of Powys by locally based Community Connectors, as well as through the central point of contact in Powys People Direct.
- Handles referrals or requests from organisations or individuals seeking to obtain support from local community and voluntary organisations for people who may be in need of services such as befriending, shopping, advocacy, home adaptation, community transport, or support with specific health related concerns such as Dementia.
- Works with the individuals referred to it to identify their requirements and then supports them to access the community services or activities that they feel are right for them and seeks to provide this information on first contact with the individual using a "right first time" approach.
- Participates in local GP surgeries; brokering access to Third Sector support for frail/elderly patients across the whole of Powys as part of the Powys Teaching Health Board's (PtHB) 'Virtual Wards' service model.
- Currently works within the multi-disciplinary teams in community hospital settings, providing support and guidance for local teams on what services are available locally which may assist people in getting out of hospital more quickly, through promoting local third sector services.
- Helps identify areas of unmet need or gaps in service provision; evidence which is then used to help inform the planning of public sector services, through liaising with commissioners and additionally, liaising with other PAVO colleagues to help provide support in developing Third Sector services with local providers.
- Is beginning to operate within health and social care integrated teams, firstly in Ystradgynlais and subsequently in Brecon. Integrated teams are being rolled out across the county. The Community Connector will bring their knowledge of third sector services, both at local and pan-Powys levels, helping to broker in local Third Sector services for people accessing the integrated teams.
- Participates in the "Falls Forum" by helping identify people at risk of falls and helping support
- Adult son is on Virtual Ward. He has a terminal illness and doesn't want any additional support. His mother cares for him and he is happy with this. However, the mother is struggling with her caring role and his condition. She would like him to accept help but understands the need to respect his decision.
The Community Connector asked if the mother would consider getting support for herself instead, to enable her to manage the difficult situation. After discussion, the mother agreed to be referred to Credu for carers' support.
- A father rang Powys People Direct looking for support for his son, who is in the process of moving into Powys. The son has a neurological condition which has become worse with the stress of moving house. He usually manages independently but currently, he is not able to do some tasks and being new to area, isn't aware of what services exist locally to support him. The father lives 200 miles away.
Powys People Direct passed the call to the Community Connector on duty. The son is managing his personal care and would like practical support that he can make use of, as and when he needs it. Floating Support was suggested as an option and the father thought this was just what his son was looking for. The demand-led nature of Floating Support would appeal to the son who is able to refer himself.
- Mr X was referred to the service by Powys People Direct. He had contacted PPD to ask for help in finding services in his local area. The Community Connector had a conversation with Mr X about what mattered to him and his family. He said he was looking for support in his hometown, his wife had a stroke 9 years ago and he was the main carer but had his own health concerns. Mr X said he hated to see his wife struggling and found it really upsetting. Even using the bathroom was problematic for his wife as her wheelchair did not fit through the door. The equipment Mrs X had at home to assist her was old. Since her stroke her family had taught her to speak again. The Community Connector spoke to Mrs X and agreed to make a referral to Powys People Direct for a full assessment of her needs. The Community Connector also agreed to ask the NeuroVoice Powys officer to contact them so they could tell their story and get their voice heard. Mr and Mrs X both said they were pleased that they were going to get some help that would hope improve their daily lives.
Further case studies can be found here
It is not the role of the Service to set up or deliver new services. However, in situations where there are no opportunities or services to meet the needs of individuals referred to the Service, the Community Connectors will then work with others locally (particularly voluntary and community organisations) to help them access the support they might need to extend or develop the individual support arrangements or services needed.
The Community Health and Well-Being Coordination Service will also help strengthen the work of Powys’ many community groups and voluntary organisations by:
- Identifying and sharing evidence of service demands, unmet needs and service gaps to help Third Sector organisations strengthen and develop their services and activities, as well as to help inform public sector funding and service commissioning decisions;
- Helping public sector organisations to work better with local Third Sector organisations and services to meet the needs of community and individual citizens;
- Continuing to grow the public sector’s understanding of the work and value of the Third Sector and their confidence in it, and;
- Helping local organisations and groups access the information, contacts and support they need to develop or strengthen their service.
- Producing a quarterly report, with case studies, statistics/data and shows particular service gaps.
PtHB and PCC Social Services are currently moving more towards community based services, by developing integrated health and social care teams based in local community areas, along with multi-disciplinary teams based in community hospitals or other settings.
Because of this change the Community Health and Well-Being Coordination Service now has Community Connectors based in many of Powys’ community areas to work as part of the new integrated or multi-disciplinary teams.
The Community Health and Well-Being Coordination Service covers the whole of Powys. However, not all areas of Powys currently have a Community Connector based in them. Referrals or enquiries for people in those community areas without a local Community Connector are handled by Community Connectors operating via Powys People Direct.
The community areas currently being covered by locally based Community Connectors are:
Brecon, Neuadd Brycheiniog
TBC (Machynlleth Hospital/local community)
East Radnor (Knighton/Presteigne)
TBC East Radnor Day Service
Llandrindod Wells and Rhayader
TBC (Llanidloes Hospital)
Ystradgynlais Community Hospital
PAVO is currently recruiting two further Community Connectors who will be based in the Llanfyllin and Welshpool areas and who will be undertaking a pilot of social prescribing activity for Powys teaching Health Board. We are also currently exploring the possibility of a Community Connector role in the Crickhowell, Hay and Talgarth area.
You can make a referral to the Community Health and Well-Being Coordination Service through any of the following contacts:
- Powys People Direct on 01597 827666
- Community Health and Well-Being Coordination Service 01597 828649 or firstname.lastname@example.org
- Your locally based Community Connector
If you have any queries about the Community Health and Well-Being Coordination Service please feel free to contact PAVO; Clair Powell on 01597 822191 or email@example.com, Freda Lacey on 01597 822191 or freda.Lacey@pavo.org.uk
For more information about Powys People Direct click here.
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