Category Archives: Uncategorised

Behaviour Change Insiders Podcast: Episode 3

More details are available at the Wales Audit Office, Good Practice Exchange Podcast Page

In Episode Three:

Rachel Lilley from Aberystwyth University talking about changing how people think about energy use at home with Ymlaen Ceredigion. (1.43 – 9.20 minutes)

Matt Stowe from Cartrefi Conwy explaining the environmental improvements at Parc Peulwys Housing Estate and how they changed behaviours and help gain a Keep Wales Tidy Green Flag award. (10.30 – 25.30 minutes) 

Links to resources mentioned in the Podcast:

National Energy Action Cymru details of working with Ymlaen Ceredigion in partnership with Ceredigion County Council and Aberystwyth University including a link to a report from Rachel Lilley.

Parc Peuwlys Management Plan 2015-2020, produced by Cartrefi Conwy.  Report from BBC Wales on Parc Peulwys acheving the Keep Wales Tidy Green Flag award.

Behaviour Change Insiders Podcast: Episode 1

More details about the podcasts are available on our Behaviour Change Insiders Podcast Page on the Good Practice Exchange Blog.

square_bciIn episode one:

Rupert Moon – on working with rugby players at Rugby Gogledd Cymru to develop behaviours that went beyond the playing field (1.30 – 15.20 minutes)

Professor Judy Hutchings – on the KiVa anti bullying programme in schools. Learning from Finland on how taking a whole school approach can change behaviours and reduce bullying (15.25 – 27.10 minutes)

Links to resources mentioned:

Wales Audit Office, Good Practice Exchange Podcast Page.

Bangor University KiVa Programme

Rupert Moon on sport and improving well being

The role of scrutiny in relation to Future Generations – Environment

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We recently held a Good Practice Seminar on ‘The role of scrutiny in relation to Future Generations’ at Cardiff and Llanrwst. This was very different seminar to our usual Good Practice events. As the Well-being of Future Generations Act is very much in its infancy, case studies reflecting the five ways of working are yet to emerge. So that meant we had to design a seminar to fit the need. We opted for a ‘learning through doing’ approach, which meant that the delegates worked jolly hard on the day.

We were also aware that how we were going to share the messages from the day, needed to be shared in a manageable way, so we are trialling sharing these through blogging. This is the first of a series of three blogs based on the characteristics of good scrutiny – Environment, Practice and Impact.

We’ve recognised, as a good practice team, that people like information in different ways. We’ve included the raw outputs from the day if you would like more detailed information.

On the day we asked delegates to feedback on the one thing that they were going to do differently as a result of the three workshops they attended. In this first blog we wanted to share with you some of the points that delegates shared after Workshop 1 – Environment. If you didn’t attend the event this blog will give you an insight into points to consider and reflect on if you are currently using these factors.

We thought it may be helpful if we put the outputs from the day into the following headings.

Public Engagement

I’ve used the words ‘Public Engagement’ to summarise one area of the statements delegates shared at the end of workshop 1 on the theme of Environment. It is clear to me that delegates understand the need to engage, listen, and consult more with their public to ensure that ‘real people’ have a chance to input their views. A two-way communication is key when making decisions, it was very pleasing to hear that this has been recognised and many delegates identified that making it more accessible and inclusive for questions to be asked and voices to be heard.

One delegate stated ‘‘People before process’ – consider emotional as well as financial support’.

Involvement

This is another area that was mentioned a number of times in the feedback. I love that delegates are really seeing the importance of improving the way that they involve the local people and communities in shaping their futures – whether that be direct or early involvement, or involving partners like the 3rd sector as well as other public sector bodies.

‘Less focus on budget and more on decision making that matters’ – one delegate has written down.

Feedback

A few delegates felt that feedback was important. Giving more feedback on the reasons behind the decision, and being clear on the purpose of what is trying to be achieved.

Support

This feedback says to me that quite a few delegates feel that they need support to help them improve the understanding and work of scrutiny in relation to the well-being of future generations. Some mentioned that working in partnership between organisations to address the seven well-being goals of the WFG Act would be a big help to them. It would help them to ‘forward plan’ and to not think about annual budgets.

How can you improve the understanding of using the 5 ways of working in your organisation? Should they be used to shape and inform the decision making process at the earliest stage? These were a few questions that came out of this section of feedback.

One delegate wrote – ‘Scrutiny should not be linked to annual budgets. You can’t make progress for future generations when you are working in 12 month restrictive stretches.’

Culture

Lastly, a few points were made about needing a change in culture at all levels in order to think more long-term about effective scrutiny. Scrutiny should not just be about outcomes and budgets it should be about forward thinking to make a lasting, positive change. I am very happy to see that delegates are aware that this needs addressing and hopefully our seminar helped to reinforce the message of how important their role is shaping the future of our future generations.

‘Scrutineers to be aware of the importance of their role and the power scrutiny has to influence.’

Whilst preparing and shaping this seminar, we recognised that this is a step change for public services. Our colleague Tim Buckle wrote a great blog ahead of the seminar ‘Scrutiny for the well-being of future generations – more questions than answers?’ We encourage you to have a read when you have a few spare minutes.

Stay Well @ Home

by Emma Ralph from Stay Well @ Home

We are pleased to announce that the Stay Well@ Home Team will be presenting at this year’s ‘I’m a patient, get me out of here’ event. We thought it would be useful to give you a flavour of our exciting new service model before the event. But to truly hear about the fabulous work that the team are undertaking, please join us at one of the workshops that we will be hosting in both South and North Wales.

SW@H is a new and innovative way of working, where partners across Cwm Taf University Health Board, Rhondda Cynon Taf and Merthyr Tydfil Country Borough Councils have joined forces to create a truly integrated way of working together to support those being discharged from hospital.

How do we do this? We are an integrated, multidisciplinary hospital based team made up of Assistant Therapy Practitioners, Occupational Therapists, Physiotherapists and Social Workers, whose primary focus is to either prevent individuals being admitted to hospital unnecessarily by providing early assessments in our A&E departments, but we also work to reduce an individuals overall length of stay by completing timely and robust ‘person focussed’ assessments and through using community based services to support someone in their own home rather than a hospital bed.

What’s new about this? Well, we work across 7 days, 12 hour shifts patterns but more importantly, we have enhanced our community based services across health and social care, such as the RCTCBC Support@Home and CTUHB @Home nursing service who also provide a 4 hour response and work across 7 days in order to provide robust support to individuals upon their discharge home. In a nutshell, we can deliver the following:

  • Through the development of the ‘Trusted Assessor role’ we can set up packages of support within a 4 hour time frame, 7 days per week
  • Rapid community response services to support the hospital based team (both health and social care)
  • Restart or increased packages of care to facilitate discharge to home, 7 days per week
  • We utilise a variety of problem solving options at A & E (including third sector services)
  • Everyone discharged home via us will have a individualised review of their needs within a 14 day period

Come and join us at our workshops where we will be talking through some real life cases and discussing how this model of practice has improved the quality of the services provided. #noplacelikehome #rightcareattherighttimeintherigthplace #personattheheart

Three questions…

If you read our previous blog, you will know that our upcoming seminar, I’m a patient get me out of here, is about hospital discharge planning and the services around that process.  Looking at this from another angle, I started thinking about how I would feel if I was a patient.  How would I want my hospital discharge planned?

 

I’m an *overly* organised and efficient person in work.  I know that if I went in to hospital, I would start trying to meticulously plan my escape as soon as possible (no offence to hospitals of course, just would rather be at home!).  I would want to know what was happening to me, why it was happening and when it was happening.  And I would certainly want to know how soon I could go home and what I need to do to help that happen.  This led me to the three questions below, which I think should help any patient ensure that they can help in their own discharge planning.

What’s going to happen to me while I’m here?

I want to know why I’m in hospital and if it is the best place for me, the type of care I might receive and what I can do to help myself.  What care/treatment do I need to have to get me well and when will those things happen during my stay?  Will other health and care professionals be involved in my care (e.g. social workers, therapists or community workers), and will I meet them while I’m in hospital or after I get home?

I want to start planning for my discharge straight away, not once I’m told I can go home.  That leads us to the next question…

When am I going home?

I want to know as soon as arrive (within 24-48 hours) when I’m likely to get home.  I have a job, a four year old and a life to get back to and I have to make plans (again with the planning) for what is happening at home whilst I’m in hospital.  I understand that this date may change as my treatment progresses, but I want this reviewed regularly and to be kept updated.

What do I need to do to get home?

This question is much more than just being ‘medically fit’ to leave hospital, I can be medically fit without being discharge ready.  This means that staff should ask me how I currently manage at home and about the types of support, formal or informal, that I already receive.  But there are other questions that need answering as well.  For me these questions would involve what I can do to help myself, but also whether everything I am going to need is prepared for my move back home and my recovery.  I’m lucky, my answers would be fairly straightforward – I know where I’m going is safe and that there are people at home to care for me.  For others, this might be much more complex.  I’m thinking about things like:

  • Is my home suitable for me to live in at the moment? Is it warm, dry, safe and/or accessible?
  • Do I have clothes to wear home?
  • Who is going to take me home?
  • Do I have food at home?
  • Does anyone know I’m going home (family/other services/support/carers)?
  • Will you tell my GP that I was hospitalised and why?
  • Will you give me information about what to do if I become unwell after I get home?
  • Should I expect a home visit or will I receive an appointment for further support or follow up?
  • Will my medication be ready for when I leave?
  • Are there any other factors which may affect my discharge?

If you find yourself in hospital as a patient, or if you’re caring for someone and they end up in hospital (knock on wood), keep these questions in mind.  This dialogue between patients and staff can reduce delays by highlighting potential issues early during your hospital stay.  This will help to ensure that you, or your loved ones, are discharged in a safe and timely way.

I’m a patient, get me out of here

Our seminars on hospital discharge planning are coming up on March 14th and 22nd.  The Good Practice Exchange has worked together on this one with the Health team at the Wales Audit Office.  Sara sat down with Anne to talk about why this seminar is happening now.

If you only had 1,000 days left to live,

how many of them would you choose to spend in hospital? (#last1000days)

Discharge planning is an ongoing process for identifying the services and support a person may need when leaving hospital (or moving between hospitals).  The Wales Audit Office has recently completed reviews of the discharge planning arrangements across all the health boards.  The reviews showed that whilst health boards have the frameworks in place to support discharge planning, there were a number of reasons that were preventing discharge from being as effective as it could be.

The majority of hospital discharges are relatively straightforward, but for approximately 20% of patients, discharge is much more complex for a variety of different reasons.  The number of delayed transfers of care has been steadily increasing during 2017 and the number of patients delayed 13 weeks or more is rising.  These delays in discharge lead to poorer outcomes for people through the loss of independence and mobility.

For every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and reconditioning takes twice as long as this de-conditioning. One week of bedrest equates to 10% loss in strength, and for an older person who is at threshold strength for climbing the stairs at home, getting out of bed or even standing up from the toilet, a 10% loss of strength may make the difference between dependence and independence. [Professor Brian Dolan, more info can be found at this website.]

One of the common themes coming out of the reviews was that there was opportunity to have greater integrated working throughout the discharge process, including stronger links to services in the community, to make sure the patients are receiving the right care, in the right place, at the right time.

We felt that this theme, in line with the Well-being for Future Generations (Wales) Act 2015 and the Social Services and Well-being (Wales) Act 2014, was tackling a key part of discharge planning – putting the patient at the centre.  Patients are not concerned with who is providing which service, they just want to be assisted to achieve the best possible individual outcomes.

In essence, patient time as the key metric of performance and quality is best measured from the perspective of the person and is a journey not an event. [#last1000 days]

So at this seminar, you will find projects that are working across the sectors, navigating links to services in the community, showcasing truly integrated partnerships and joint working throughout the discharge planning processes and, most importantly, keeping the individual at the centre of the service.  They are finding solutions to the variety of reasons which cause the delays in complex discharges, whether they are related to transfers of care, safety, homelessness, mental health, housing, assessments, or all of the above.

These projects are looking to provide you with food for thought, ideas you may be able to adapt to your own environment, or to spark new ideas.  See what you can take back to your organisation or working environment which will help your patients to have better outcomes.

 

We would like to note that our background research also highlighted all the work that is going on to prevent admissions in the first place.  In fact, there were so many that we decided that this area deserved a seminar all to itself, so that one will be coming up in February 2019.

Scrutiny for the well-being of future generations – more questions than answers?

In January, we are holding a seminar which is going to challenge how public services in wales need to rethink how they hold members and officers to account in relation to future generations. We recognise that this is a step change for public services and we caught up with our colleague Tim Buckle who has a foot in both camps – working on a Wales Audit Office review of local authority scrutiny arrangements during 2017-18, and helping shape this seminar.

There have been numerous conversations about the term ‘scrutiny’, we thought it would be helpful to clarify how this fits with the seminar in January.

The Well-being of Future Generations (Wales) Act (WFG Act) challenges public services in Wales to work differently. So what does this mean for scrutiny? That’s what we’ll be discussing and working through in the seminar in January 2018. But before we start talking about that, in this blog I wanted to talk about another question, what do we mean by ‘scrutiny’?

My initial reaction to this question is….well more questions! It depends who you ask? It depends who’s doing the scrutinising? It depends who’s being scrutinised? Do we mean local government overview and scrutiny because that has specific roles set out in legislation? Do we mean the process or function or scrutiny more broadly across the 44 public bodies covered by the WFG Act? But then in trying to work differently I’ll ask another question – does it really matter that we don’t have a succinct definition? Maybe not, as long as we are all talking about broadly the same type of activity then we can still discuss what might work, what doesn’t work and what might need to change including possibly the behaviours of the scrutineers and the scrutinised. Maybe one of the things we all need to come to terms with is that in a complex, fast moving world where change is constant we have to accept that not everything can be neatly defined and compartmentalised?

The term scrutiny is commonly used in local government because Councils in Wales have at least one ‘overview and scrutiny committee’. But the process of ‘scrutiny’ also takes place in councils in many different forums and processes – officers ‘scrutinise’ performance information, as do Cabinet Members. In any public body there will be some ‘scrutiny’ of performance, budgets and policies. To keep things simple what we are really talking about is holding decision-makers to account, challenging performance, policies and ways of working, reviewing outcomes and so on and so on…. There are probably quite a few other words that we could use to describe what we mean by the process of ‘scrutiny.’

If we follow this logic this also means that simple designations of the ‘scrutineers’ and the ‘scrutinised’ are also too simplistic. There are some obvious groups who will probably see themselves as part of the ‘scrutiny community’ – scrutiny committee members and scrutiny officers in local government, non-executive board members and so on, but cabinet members and executive board members may also find themselves scrutinising the way in which their own organisations have acted in accordance with the sustainable development principle. Crucially they may also be holding partner organisations collectively to account on Public Service Boards – accountability isn’t always vertical it can be horizontal too….

So what does this mean for delegates attending the event in January 2018? It means we want them to bring their knowledge and experiences of scrutiny – whether as a ‘scrutineer’, as the ‘scrutinised’, or as someone who’s observed scrutiny in action – and to share this with people from other organisations and sectors. It means we hope that delegates learn from each other and can work through solutions to common (or not so common) barriers to effective scrutiny to help improve the wellbeing of future generations and to find solutions that will work in their organisations. To help do this, at the event, delegates will be challenged to think differently about scrutiny, about what effective scrutiny means and about why they think it’s important for the wellbeing of future generations?

The WFG Act requires public bodies to challenge themselves to reconsider what they do and how they do it. This challenge is not limited to a single policy area, team or function and it is recognised that the change won’t happen overnight. Scrutiny, in all its forms, could potentially play a key role in driving that change by ensuring the right questions are asked, at the right time.

Wales Co-Operative

Casey Edwards @casey_walescoop from the Wales Co-Operative Centre @WalesCoOpCentre has blogged for us about how housing co-operatives are helping to build resilient communities.  The North Wales leg of our #WAOADM event is next week.

No two housing co-operatives are the same; it’s not a one size fits all approach. Co-operative housing is about communities having democratic control over decision-making about their homes, neighbourhoods and communities. It is a flexible and innovative approach to ways in which we meet the housing needs and the aspirations of local neighbourhoods. Co-operatives can be developed in either new or existing housing and can cover a range of tenancies.

The Co-Operative Housing Project was established in 2011 and is managed by the Wales Co-Operative Centre, and supported by the Confederation of Co-Operative Housing. The project has helped to deliver over 130 homes across Wales and is supporting the delivery of many more by developing expertise in different co-operative models and providing advice to developers and co-operative groups.

I joined the Wales Co-Operative Centre in May 2017 as the project advisor and have realised it takes a lot of hard work from a lot of people to get these schemes ‘shovel ready’. All of the housing schemes have developed in contrasting ways and adopted different models, from the different ways in which schemes were instigated and funded; how individuals came to be involved; to the size, nature and tenure of the housing co-operative. So does all of this hard work actually pay off?

Being part of a housing co-op is about more than just having an affordable roof over your head. It is about being part of a support system, helping yourself but also taking the responsibility to help others in the wider community. Read about how Luana, at Loftus Village Association, is helping to bring the community together through organising events and social activities.

Examples like this also show how living in a housing co-op can also help to tackle isolation and loneliness, especially amongst the vulnerable and the elderly. Co-operative communities form close bonds and look after one another; that feeling of being part of a community which is hard to come by in the 21st century. Haydn from Old Oak Co-Operative shows how being involved in the co-op has helped him grow in confidence and take on responsibility within the community.

Living in a diverse, supportive community also gives people the chance to share knowledge and skills with each other, that maybe they wouldn’t have had the opportunity to learn living in more traditional environments. As part of the development of the co-op, tenants are involved in a rigorous training programme which includes topics such as co-operative principles, governance and housing management. They learn new transferrable skills which can help them improve their employment status or give them the confidence to change career. Our scheme Ty Cyfle is empowering young people to manage their housing independently, learning new skills along the way.

This self-help and self-responsibility approach to addressing housing need is having a much bigger impact than just providing affordable homes, it is creating self-sufficient, resilient and healthy communities, which can reduce the demand on wider support services.

Living in a community-led housing scheme can offer the kind of support that public services are increasingly finding it difficult to provide, often in a more personal and cost-efficient way. The Well-being of Future Generations (Wales) Act has now placed a duty on public bodies to think more about the long-term; to work better with people, communities and each other; to prevent problems and to take a more joined up approach. Co-operative housing is doing so already.

The seven wellbeing goals compliment the seven co-operative principles developed by the International Co-Operative Alliance, which all co-operatives should adhere to. They both emphasize the importance of developing attractive, viable, healthy and sustainable communities, that maintain, even enhance the natural environment. A democratic and fair society with an economy that generates wealth, without discrimination. A society that enables people to fulfil their potential no matter their background or circumstances. A society that provides employment opportunities and education and training for a skilled workforce. A co-operative society that highlights the importance of social and cultural wellbeing.

Co-operative and community-led housing can be a part of the solution to the housing crisis in the UK. But more than just a quick fix, it can be a part of a long term sustainable option to providing affordable homes and creating resilient communities.

The Wales Co-Operative centre offers support and advice to any new or existing organisation wishing to develop co-operative housing. We can provide access to experts’ advice about co-operative housing and we can provide skills and development training for members of a co-operative. We have recently developed a Co-operative Housing Pilot Toolkit, developed to help community groups, housing associations, co-ops, local authorities and others in the initial stages of considering how to develop new co-operative & community-led homes. Take a look.

More information on co-operative housing and what support is available can be obtained from the Wales Co-operative Centre on 0300 111 5050 or at co-op.housing@wales.coop.

Faster closing – it’s good to talk

Following on from our recent event on ‘Early closure of local government accounts’, Matthew Coe, Financial Audit Manager at the Wales Audit Office, talks about his experience of the day and the important discussions he encountered with delegates…

On 10 October 2017 I attended the latest Good Practice Exchange shared learning seminar in Cardiff on the Early closure of local government accounts. Alongside many representatives from local authorities, there were a large number of staff from the Wales Audit Office, all keen to understand lessons from those already piloting faster closing timetables.

In the first plenary session there was a lot of audience participation with table groups considering a number of mini scenarios on how not to manage the accounts closure and audit processes. Even with some of the Wales Audit Office “actors” hamming it up for all they were worth, it was clear that everyone in the room recognised we need teamwork and regular communication to make a success of this transition.

As is usual at Good Practice Exchange events, we then broke into smaller workshop groups covering three particular aspects:

  • Making Assets Early Closure Friendly – ensuring the streamlining of asset valuations and capital accounting;
  • Knowing why we want what we want! – what is needed in terms of working paper requirements; and
  • The importance of Internal Quality Assurance on your Financial Statements – highlighting why internal quality assurance checks are critical to a successful audit.

These workshops looked at practical actions that we could take. It was particularly useful having a trained – tamed? – valuer present in the asset valuation workshop to explain his work and give his perspective on how to give valuations sooner.

The big learning points for me from these workshops were:

  1. Everyone agreed but more importantly accepted that there will be more estimates in the accounts.
  2. In addition it is likely there will be more uncorrected misstatements noted in the auditor’s reports (ISA260 reports) – BUT this is not necessarily a bad thing: a key message to relay to those charged with governance.
  3. You can actually do things earlier on non-current assets – it is not solely a year-end exercise after all – and together we just need to think creatively about it.
  4. Finally, auditors need to be clearer on working papers they need – not want, but actually need – and in what format with finance staff. On the flip side, finance staff also need to change the way they prepare and provide the working papers.

In the final plenary session I was struck most with just how long I had spent discussing the detailed arrangements with the finance staff from Cardiff Council. While we do cover this in our work as an audit team, as a Client Manager, I personally seldom get a chance to discuss the detailed approach to working papers with the finance team preparing them. For me, to have nearly four hours to go through the practicalities and challenges of changing both Council and Wales Audit Office approaches and ways of doing things, was incredibly valuable.

There and then we were able to agree a number of key principles such as early engagement on changes, quick resolutions to queries by both sides, and further meetings to improve supporting documentation for the 2017-18 accounts (meetings we have already starting arranging).

Also not only did I find that we agreed on the need to change both our approaches (and were positive about doing something about it for 2017-18) but I could communicate the collegiate way of working that sets the tone of our audit work first hand.

Finally I would say that communication really is the key – preferably by just talking to the right people face to face – so that you can talk around the implications of potential problems early on makes a big difference to how smooth an accounts/audit process can be. Early engagement on changes in accounting policies, methodologies and potential issues, as well as carrying out earlier testing, will certainly smooth the way to a faster closing Nirvana!

10 Steps School Project

Georgina James, Melin Homes

As I’m writing this, I’m sat at my desk working towards developing our offer for Melin’s schools program over the next 5 years, a schools program that didn’t exist 4 years ago.

Flashback to our energy efficiency project, Powering Up Communities and we’re just entering schools doing a little energy program training Junior Green Energy Champions. Our street naming competitions with schools were a success and we were offering our Melin minibus to schools for educational trips. Overtime, the work we were doing in schools developed, with the eco program helping schools to achieve their ECO flags with Keep Wales Tidy and the groups were creating energy saving songs to well known tunes and performing them at our events. I’d say our first step in our recognition of the importance of working with schools, was deciding to do an end of project celebration event with the children we had worked with. We worked with partners such as ICE, Keep Wales Tidy, Constructing Excellence in Wales and Techniquest to deliver a carousel of workshops with over 100 children and teachers attending. The event was a massive success and it was there that we thought “WOW! These young people we are working with are our future residents, staff members, and local councillors or supporters” We need to make sure that our work encompasses the young people of our communities and what better way to do it than through schools. Now our journey on schools wasn’t an over night success, it took months if not years, of developing projects and relationships with schools and partners.

One of our partnerships was with Career Wales, who we had done ad hoc ambassador work for previously.  They approached us to see if we would like a business partnership with 2 secondary schools that were situated within our area. We have now signed up to a 3 year business partnership with the two schools and are focusing on a three-pronged approach between the pupils, staff and parents, to ensure we make an impact and difference to the people we work with.

And the best part, Melin have committed to a delivery of a schools program for the next 5 years. Had Melin not had the idea to do the little bits in schools then we wouldn’t have progressed to the stage we’re at now. New projects focusing on the health and wellbeing of pupils and teachers. Which leads us to the 10 Steps project… If you want to know about where we are now and what we’ve got coming up then come along to Wales’ Audit Offices seminar on Using Alternative Delivery Models to deliver public services.