New ways of living well & keeping healthy in rural Mid Wales Anna L. Prytherch Project Manager, Rural Health and Care Wales

Rural Health and Care Wales Recommendation from the Mid Wales Healthcare Study (Marcus Longley, 2014): “The three Health Boards that cover Mid Wales, working with local universities and others, should develop and support a centre of excellence in rural healthcare, with a particular focus on research, development and dissemination of evidence in health service research which addresses the particular challenges of Mid Wales. This has great potential to carry out work of relevance internationally.” Launched by Prof. Mark Drakeford AM, Minister for Health and Social Services, on 24th March 2016 (now First Minister of Wales) Funded and supported by Hywel Dda and Betsi Cadwaladr University Health Boards, Powys Teaching Health Board and Welsh Ambulance Service NHS Trust RHCW Management Group includes representatives from Ceredigion, Powys and Gwynedd Local Authorities, and the Universities of Cardiff, Swansea, Bangor, Aberystwyth, UWTSD and Coleg Cymraeg Cenedlaethol

Rural Health and Care Wales Vision to become a world-leading organisation in rural health and social care research, training, recruitment and best practice Aims   Rural Health and Care Wales’ prime aims are to: provide a focal point for the development and collation of high quality research pertinent to rural health and wellbeing improve the training, recruitment and retention of a professional workforce within rural communities be recognised as an exemplar in rural health and wellbeing on the international stage

Rural Health and Wellbeing - the Positives UK Government Statistics on Rural Health (31 August 2017): Average life expectancy is higher in rural areas than urban areas Men 80.6yrs vs 79.4yrs Women 84yrs vs 83.1yrs Infant mortality is lower in Rural areas than Urban areas (3.1 deaths per 1,000 births versus 4 deaths per 1,000 births) Small but consistent improvements in wellbeing also measured in people living in rural areas vs urban areas: Life satisfaction 7.82 (urban 7.61) Life is worthwhile 7.98 (7.81) Happiness 7.65 (7.45) Anxiousness 2.73 (2.98)

Rural Health and Wellbeing - the Challenges Health and Social Care challenges facing people in Rural areas: Access to health care: Access to GPs / hospitals/ consultants Transport links Broadband infrastructure Logistical issues relating to care in the community (distance / time) Demographics - elderly population Recruitment and retention of health and social care professionals Access to “local” education / training and Continuous Professional Development opportunities Lack of recognition of skills required by rural healthcare practitioners

Rural Health and Care - Opportunities Health and Social Care opportunities in Rural areas: Maximise health and wellbeing benefits from living in Rural areas: Green / blue / social prescribing Build on strong communities (e.g. Solva Care) Attract professionals looking for work / life balance Better integration of health and social care provision Share rural experience and best practice – international collaboration

Rural Health and Care - Opportunities Health and Social Care opportunities in Rural areas: New roles – Physician Associates / Nurse Practitioners / Link Workers Recognition of “rural” specialism within healthcare Broadband connectivity – improvements needed - telemedicine Develop “local” education / training opportunities Cardiff University School of Medicine CARER (Sept. 2018) Swansea University Primary Care Academy (Sept. 2020?) Return of Nurse training to Mid Wales

Rural Health and Care - Work Examples Addressing the challenge of Recruitment and Retention: Funding PhD student to research the recruitment and retention challenges to rural nurses in Mid Wales Recruitment brochure for Health and Care professionals in Mid Wales https://ruralhealthandcare.wales/rural-mid-wales/working-mid-wales/ Recruitment video for nurses across Mid Wales https://www.youtube.com/watch?v=J2IzGBPx8zE&feature=youtu.be

Rural Health and Care - Work Examples Sharing Best Practice and Innovation - Annual Rural Health and Care Conference: Annual event held in November at RWAS, Builth Wells Linking health, care and voluntary sectors, encouraging public attendance and involvement https://ruralhealthandcare.wales/public-staff-engagements/events/rhcw-conference-2018/ This year extended to 2-day event

Rural Health and Care - Work Examples Sharing Best Practice and Innovation - Annual Rural Health and Care Conference:

Rural Health and Care - Work Examples Research and Publications Comparison of the Population Assessments undertaken across Mid Wales Review of the Well-being Plans across Mid Wales Recruitment and Retention of Health and Social Care Professionals in Rural Mid Wales Nurse Recruitment and Retention in Rural areas Education and Training for Health and Social Care Professionals in Rural Mid Wales

New ways of living well and keeping health in rural Mid Wales Welsh Government – “A Healthier Wales: our Plan for Health and Social Care” Closer collaboration between health and social care services More care at home or closer to home – increasing role of communities / voluntary sector Support for people to stay well by looking after themselves – moving from a dependent health culture to taking more responsibility for own health and well-being https://gov.wales/topics/health/publications/healthier-wales/?lang=en Increasing focus on “well-being” and using the green / natural environment and community resources to support well-being and happiness – see https://ruralhealthandcare.wales/green-health-practice/

New ways of living well and keeping health in rural Mid Wales Examples of RHCW projects that align with new direction for health and care: Social Prescribing research project grant application submitted (PHW, AU, BU, RHCW) Community Resilience project in development stage, working with Solva Care https://solvacare.co.uk/ Supporting CARER medical student with loneliness project Social Prescribing Pilot project (2018) On your Bike / Ar dy Feic

Social Prescribing pilot project Social Prescribing Research Project in Rural Mid Wales: What is Social Prescribing? https://youtu.be/Etza2LE5Gh4. Collaborative project between Public Health Wales, Aberystwyth University (WARU) and RHCW Undertaken in 2018 in North Ceredigion “Link Worker” employed Funded by PHW through an internal “pump priming” fund 6 month project, extended Working with Cambrian Primary Care GP Federation Research currently being written up Grant application submitted for up-scaled project

Social Prescribing pilot project

On your Bike - Background Child obesity is on the increase, with Wales figures higher than England 23.2% of 4-5 year old children in Ceredigion are overweight or obese (Ceredigion Local Well-being Plan, Feb. 2018) Research shows that overweight children grow up to be overweight adults, with associated health impacts Public Health Wales predict that 2/3rds of adult population in Wales will be overweight by 2025 Important to instil health lifestyle in young people, encouraging exercise and healthy eating Strategic support to improve health and well-being: Wellbeing of Future Generations Act (Wales) 2015 Ceredigion Local Well-being Plan (2018)

On your Bike - Intent PRIME AIM: to increase and mainstream physical activity in young people by innovative incentivisation “On your Bike” will provide a sustainable means of generating energy that will charge mobile devices By charging mobile devices in this way, young people will engage in outdoor physical activity The physical activity will/should improve health and well-being Not aimed at traditional gym-users

On your Bike – Additional Benefits Will raise the profile and create a dialogue around sustainable energy generation Will highlight the benefits of regular exercise, particular outdoor activity Will open discussion on obesity, health and well-being Will show that exercise can be fun! Will encourage community co-hesion and co-production

On your Bike / Ar dy Feic 2 part project – consultation and implementation Initial consultation phase with young people aged 14 – 25 – currently live Implementation and installation April 2019 Active research after installation of equipment to: Monitor usage Monitor any health and well-being benefits Undertake focus group and questionnaire analyses Receive feedback from participants Report and recommendations Constant theme – Awareness Raising of Health and Well-being benefits from outdoor activity https://www.youtube.com/watch?v=D-78pxfmWGw

Current Stage - Consultation Target: 14 – 25 year olds in Ceredigion involved in consultation: All secondary schools in Ceredigion Ceredigion Youth Service (Youth Clubs) Hyfforddiant Ceredigion Training Coleg Ceredigion Ceredigion Actif

New ways of living well and keeping health in rural Mid Wales SUMMARY Rural areas ideally placed to lead on new ways of working in health and care due to: Strong communities Innovative approaches already being used and cited as best practice The green / natural environment Recognition of role of Bronglais DGH to Mid Wales Increasing prioritisation of community hospitals, “local” centres of care and telemedicine New roles being developed in health and care and greater integration between both Initiatives to recruit and retain rural health and care workforce Challenges – broadband / digital health agenda; Brexit? Areas to develop – digital skills; Welsh language; flexible career pathways

Any Questions? Unrhyw Cwestiynau? Anna L. Prytherch Project Manager, Rural Health and Care Wales www.ruralhealthandcare.wales Email: anna.prytherch@wales.nhs.uk Phone: 01970-635918