1. Rhaglen Iechyd a Gofal Cymdeithasol
Well-being in Action
Llesiant ar Waith
Rhaglen Iechyd a Gofal Cymdeithasol
Bae’r Gorllewin
Western Bay Health
and Social Care
Programme

2. Alex Williams (Head of Adult Services, City and County of Swansea)
Overview
Alex Williams (Head of Adult Services, City and County of Swansea)
Local Area
Coordination (LAC)
Local Community
Coordination (LCC)
This innovative model recognises that people with care and/or support needs can be supported in place by accessing the strengths within themselves, their families and communities. The evidence base is well documented, and shows that this approach empowers people to achieve their personal well-being goals, therefore reducing the demand for health and social care services.
Neath Port Talbot County Borough Council and the City and County of Swansea subscribe to the ‘Inclusive Neighbourhoods’ model to Local Area Co-ordination.
Bridgend County Borough Council’s approach is being progressed as Local Community Co-ordination.
Locality based approach
Strengths based model
Delivering against the SS&Wb (Wales) Act 2014

3. Principles and Values
Gifts and Strengths – all that individuals, families and communities bring
Citizenship – with all its responsibilities and opportunities
Relationships – the importance of personal networks and families
Information – supporting decision making
Expertise – the knowledge held by people and their families
Leadership – the right to plan, choose and control your own life and support
Services – as a “back up to natural support”.

4. Local Area Coordination: People, Places, Possibilities
Jane Tonks (Local Area Coordination Manager, Swansea)
Sarah Waite (Local Area Coordination Manager, Neath Port Talbot)

5. Workshop objectives Local Area Coordination model
Implementation across Neath Port Talbot and Swansea
Key learning points
Local Area Coordination in practice

6. History and Context Part of national funding and disability reform
Cumbria
Derbyshire
Derby City
Suffolk
Walsall
Western Australia (started 1988)
Sites in Wales and England either doing or developing Local Area Coordination.
The two best practice sites are Thurrock and Derby – we have a working relationship with them.
A short summary evaluation paper is available.
Gloucestershire
Thurrock
Swansea,
Neath Port Talbot
Isle of Wight

7. Our solutions are often not fit for purpose
Over the years, the health and social care systems have created unintended consequences, including:
Complicated systems – multiple disconnected service silos
Service duplication
Difficult to navigate and control by local people
Often multiple service contacts
Wait for people to fall into crisis, assess deficits, test eligibility
Life can be put on hold, waiting for services
Many have to wait for problems to get worse before we listen or act
Assess deficits
Increasing service costs, increasing demand, decreasing money
Services are often an obstacle to inclusion.

8. Currently, we wait for people to fall into crisis and respond with services (if eligible), but with fewer services now available to help
Currently, we wait for crises to happen – when people fall over the edge, we try to fix with money or services.
Some people say that we now only have 1 or 2 ambulances, but more people at the top of the cliff.
There is an anticipated increase in older people and people with mental health issues in the next 5, 10, 15 years…

9. We often make it harder for people to get services through tightening eligibility - risking bigger and more expensive crises in the future
There has been talk about prevention – building a wall at the top of the cliff.
However, sometimes we use eligibility as a way of keeping people out of services – this stores up greater, more expensive problems for the future.

10. Prevention, resilience, interdependence
The choice……….
Do we:
Wait for people to fall into crisis and try to ‘fix’ them with (increasingly scarce) resources?
OR, try something different…
Help individuals, families and communities to stay stronger and more connected, and find practical, non-service solutions wherever possible?
Prevention, resilience, interdependence

11. Coordination is about…
Local Area
Coordination is about…
helping people, families and communities to build resilience further back from the cliff edge - staying strong.
Local Area Coordination is about:
Strengthening people and communities further back from the cliff edge
Supporting people in crisis (at the cliff edge) to find local, non service-based solutions wherever possible
Help people find services if needed, but also help people to reduce dependence on services where possible.

12. Wales and England Context
Pressure on finances – service and
funding reductions
Increasing demand, less ££,
complex service system
SSWb (Wales) Act 2014 – increasing
focus on resilience, local solutions,
prevention
Prevent – Reduce – Delay
Ultimately, the New Act:
Gives people a stronger voice and more control
Ensures people get the help they need to lead a ‘good life’
Ensures communities have the chance to offer their knowledge and experience
Makes Social Law easier to understand
Clarifies what Social Services should be like across Wales
Provides a performance framework.

13. What is Local Area Coordination?
Focus on prevention -- building individual, family and community capacity and resilience.
Seeks practical, no-cost, local solutions.
Works to make services more personal, flexible, accountable and efficient.
Acts as a catalyst for cultural change.
Prevention, resilience, interdependence
Turning the system upside down – rather than waiting for crises, assessing deficits, testing eligibility…..helping people stay strong, connected and finding/building local community solutions.
Services are pushed back as a “back up” to local solutions – Local Area Coordination is regarded as the “new front end” of the service system.

14. Local Area Coordination approach…
Instead of asking…
“What services and money do people need?”
We should be asking…
“what makes a good life for each person and what are the different ways we can get there?”
“Get a life, not a service”.
Local Area Coordinators “start from the start” by taking time to get to know people, families and communities well.
A good life for most people is characterised by:
Friends, family, personal relationships
Contribution
A home of my choosing
Challenge
Safety and security in the future – includes health and well-being
Services cannot provide most of these.
If you just ask the service/deficit question, you have a much smaller range of options e.g. respite, residential care, day services.
If you ask what is important to people and are highly connected to the community, the possibilities are endless.
Instead of asking questions that only drag people into services, we are asking questions that help people to stay strong and connected.

15. Getting a life, not a service

16. What do Local Area Coordinators do?
LAC places a strong emphasis on partnerships with statutory services, community services and local people – building on local resources and expertise.
Rather than asking what needs do you have or what services do you want, Local Area Coordination starts at a different place.
It asks, person by person – ‘what is your vision for a good life and what are the range of ways we can get there?’.
It focuses on gifts, skills, interests and local solutions first, but values services as a back up.
It specifically aims to help people stay strong instead of waiting for crises.
In the community, Local Area Coordinators are skilled individuals that support individuals across age groups and service labels as a single point of contact in the local community.
Rather than being parachuted in for a time limited intervention to fix people – they take time to get to know people and support local solutions and build resilience. Help people to stay strong in the future.
It combines a range of traditionally separate roles and delivers alongside local people, families within the community, including:
Identify gifts, strengths and needs
Information advice
Relationship building – circles of support
Self advocacy
Community building
Planning for the future
Community connecting
Find practical non service solutions
Access services
Navigate and control services – brokerage.

17. What do Local Area Coordinators do?
Build Mutually Supportive Communities
Map, understand & connect existing community resources
Assist in building inclusive, resourced local communities
Build partnerships – people, organisations, communities
Assist people to develop & use personal & local networks
Assist people to develop practical ways of meeting goals and needs – divert from services/reduce demand
Assist people to access support and services

18. How does it work? A single, local, accessible point of contact
Get to know people (children & adults), families/carers & local community well – help people stay strong
Access to accurate information – variety of sources
Provide support and assistance to identify their strengths, goals and needs – plan for the future
Promote self advocacy, advocate with people, access independent advocacy
LAC combines a range of traditionally separate roles and delivers them alongside local people in their community – including building supportive relationships, information, advocacy, community connecting, service navigating, planning for the future, brokerage/control, community building, etc.
Brokerage, community connecting, community building, etc are all small but important parts of LAC.
Some of these roles are done by lots of different people, which is more complicated, confusing and disempowering for local people.
LAC simplifies the system for people and services.

19. How is this different? Children and adults Across ‘service types’
Combines traditionally separate roles in one, single point of contact
Focusses on
building capacity, rather than on money/services
supporting people to find local, non service solutions to problems
Applies strengths based thinking to supporting people and improving systems and services
Rather than having 10 services in your life, you have 1 person you know, trust who can help you to be in control.
Local Area Coordination is a joined up way of helping key parts of the new Act happen.

20. Evidence and Outcomes Reduction in… Isolation
Visits to GP surgery and A&E
Referrals to Mental Health Team
Referrals to Adult Social Care and assessments
Safeguarding concerns
Evictions and costs to housing
Smoking and alcohol consumption
Dependence on day services
Out of area placements
Long term studies show that where designed effectively (according to core principles, values and approach) and driven by strong, connected, contributing leadership (including people with a lived experience). There are a range of consistent, positive outcomes.
Also, Derby saved/diverted £800+k across two small locations in first 10 months. Now expanding from 7 to 10 areas.
Start of systems and cultural change – single point of contact, building resilience to avoid service need or reducing dependency of people receiving services.
Impact on Social Work – Thurrock Council showed people leaving Safeguarding earlier through integrated working with Social Work. Social Workers more able to focus on core Social Work specialist role alongside individuals, families with significant need.
Starting to impact/contribute to cultural change… – focus on individual, whole family and community
- looking at non service alternatives to need/aspirations
- communities getting involved in recruitment of other professionals
- people with lived experience leading training/induction of staff.
Evidence of wider partnership working (alongside services and voluntary/3rd sector) leading to better outcomes
Increased choice and control over supports and services
Better resourced communities
More inclusive and supportive communities.
Out of area placements – long term studies show people not having to move from their local area and/or people able to return from high cost out of area placements.
Thurrock, cont’d…
Reduced calls to GPs and visits to A&E (Following LAC support, person requiring interventions 41 times over 7 month period reduced to 3 over 4 month period).
Derby City
Estimated cost avoidance / reduced demand equivalent to approx. £800k in first 12 months whilst operating at 40% capacity.

21. Road to Implementation
Funding from Western Bay has been secured within each area.
The ‘Inclusive Neighbourhoods’ Director is engaged to support the implementation process.
The Western Bay Leadership Group is informed and engaged.
Diverted managerial resources from other posts.
Intense period of design and mentoring to implement LAC correctly – link to the Local Area Coordination Network.
Areas selected based on differing demographics to trial the concept:
Publication /promotion of LAC
Recruitment (community co-produced) communication exercise
Evaluation - Swansea University.
Evaluation

22. David’s Story… How does it work in practice?
David (84), returned from home following a hospital stay where he received treatment for a leg fracture.
Circumstances:
Isolated
Difficulty looking after property
Wants to stay in local community and own home
Risk of homeless (house condemned – risk of harm due to garden and interior of house)
Neighbour disputes (due to garden).
What could happen?
Respite, leading to early entry to long term care.
What did happen?
Community action with David to clear garden
Steps to maintain garden together (garden share)
Rebuild neighbourly relationship
Reconnect with family
Negotiated with Environmental Health
Negotiated with healthy housing hub to install heating.

23. Potential savings/cost avoidance identified by support typically provided by LACs:
Supporting people with mental health problems:
£445 average cost per day adult mental health inpatients, hospital attendance, etc.
£956 average annual cost of service provision per adult suffering from depression and anxiety disorders (Kings Fund 2008, NHS Reference Costs )
£165 average cost per contact for mental health community provision (NHS Reference Costs )

24. Key Learning Leadership group/ senior management/ politician buy in.
Support from the LAC Network – invaluable
Co- production—don’t miss it!
Takes time – Not a quick fix
Reflected in evaluation.

25. Key Learning
Local, no-cost and non-service solutions wherever possible -sustainability
Strengths, not deficits - new conversations
Robust evaluation
Relationships - community, Professional, etc..
Flexibility and accessibility are key.
(All of these points are reflected in our and other evaluations).

26. Local Community Co-ordination (LCC)
Lesley Acton – Project Manager
Local Community Coordination (Bridgend)

27. CATALYST SUPPORT CONNECTOR
For individuals, families & carers
When gaps and opportunities exist
Connecting people to their community & to each other

28. LCC works at an individual level and at a community level
At an individual level Local Community Co-ordination is about supporting and connecting people differently and providing a proportionate response. For some it means simply signposting to people or organisations who can help (Level 1).
For others it will involve more intensive, skilled intervention and longer-term involvement, in order to develop coping strategies, build resilience and achieve personal wellbeing outcomes (Level 2).
LCCs use a combination of Solution-focussed and Task-centred practice, and our LCCs receive accredited training in Solution Focussed Therapy.
These approaches help re-frame issues and co-productively come up with solutions. They help individuals to recognise their strengths, think about their aspirations and plan a route towards achieving them.

29. At a community level it involves:
Working with partners to stimulate new community opportunities
and broker new organisational partnerships
Creativity for Wellbeing Project with the Health Board
Wellbeing project with REACH Rural Development Team & a local Housing Association
Fire Service Volunteer Scheme with SW Fire & Rescue and other partners
Encouraging and supporting the development of Social Enterprise
Strictly Cinema
Shed Quarters
Helping to shift the balance towards community-based support
Agreed referral pathway from GPs and South Wales Fire & Rescue Service
As a local authority, we’re joining up our early intervention services, and LCC is part of the review of our front door and our intermediate care planning.

30. Our approach is underpinned by clear principles, values and beliefs…
that the most important assets in any community are people
that people need meaningful relationships and self-belief
that individuals need purposeful lives, and to feel valued for the contribution they make
that people need to feel in control of their own lives, and able to make choices
that whilst some people may need services, everyone needs purpose, human contact, and some level of community engagement
that giving people services does not necessarily increase resilience or reduce loneliness and isolation.

31. Bridgend has three Local Community Co-ordinators (LCCs),
each working in a defined geographical area.
We also have one Community Connector who supports the team
with community development initiatives.
LCCs are easily accessible with regular drop in sessions across their communities.
Strong emphasis on strengths-based working and progression, not dependency.
Significant community development element.

32. Example from practice…
MINDFULNESS
WALKING
GROUP
LCC worked with five ladies with anxiety and depression, then brought them together using a Mindfulness group. A few of them have now started walking together in a small group which will provide a resource for others.

33. Facilitated by Valley & Vale Arts
‘Creativity for Well-being’
Pilot Project (in partnership with the Local Health Board)
Facilitated by Valley & Vale Arts
Co-produced Creative session
GP or LCC
Social Prescriber
Similar to the National Exercise Referral Scheme, with individuals referred for Therapeutic Creative Activity. The target group is people with anxiety and depression.
Outcomes measured

34. Examples from practice…
Strictly Cinema
Try it…Do it sessions
Shed Quarters

35. ABMU GPs CAP Public Health Wales Be Active Bridgend Halo BAVO ARC V2C
Developing working partnerships to make best use of available resources…
Natural Resources Wales
ABMU
Wallich
Communities 1st
GPs
Linc Cymru
CAP
Care Homes
Yellow Wales
Halo
Men’s Sheds
Faith Groups
Rural Development
STEER
Public Health Wales
Court House
Be Active Bridgend
BAVO
Mental Health Matters
WCADA
S Wales Police
Caerau Dev Trust
CAB
Mirus
Celtica Radio
Community Councils
ARC
Trinity
Caerau Primary
Film Hub Wales
TY ELIS
DRIVE
Gwalia
LCC is proud to work closely with a wide range of partners representing a variety of sectors. Here are some local, regional and national examples.
Awen Trust
Zoom Cymru
Working Links
Job Centre Plus
STARSCIC
NFI
Bridges into Work
Love2Walk
S Wales Fire & Rescue
Schools
V2C
Cartrefi Cymru
Digital Bridgend

36. LCC Bridgend is now part of the National Co-Production Learning in Action Collaborative
Support from the Programme Team to help develop some of our projects
Provides a forum to enable us to share the work we are doing with others across Wales, as well as giving us the opportunity to learn from others in the Collaborative
Fire Service Volunteer Project has been identified as a Flagship Project for this year.

37. YouTube Video

38. Thank You – Diolch yn Fawr
For more information on Local Area Coordination or Local Community Coordination, please contact the Western Bay Programme Office via at
or telephone
Thank You – Diolch yn Fawr