Tuesday, 11 May 2021

Dying Matters - Being in a Good Place to Die

Dying Matters week this year is the week beginning the 10th May. The focus of the week this year is ‘being in a good place to die,’ Many of us focus on the quality of our lives but how we die and end our lives is equally important. Sarah Wheeler tells us more about the steps we’re taking in Powys to ensure that people living in our communities are in a good place to die.    

Sarah Wheeler - Macmillan Lead Nurse End of Life Care Planning

What brought you to work in the field of palliative care?
I have been a nurse for 34 years and enjoyed my career latterly in Birmingham working as a Colorectal Specialist Nurse in a hospital and community setting. Within this role I was often privileged to support patients and families at the end of their lives, developing a passion for end of life care. In 2005, my family and I decided to move to beautiful Powys and I joined PTHB team as a Macmillan Palliative Care Clinical Nurse Specialist and have enjoyed being part of a supportive rural community in Powys.

Tell us more about your role as Macmillan Lead Nurse for End of Life Care Planning with the PTHB?

My role is to work within national and local end of life guidance, to ensure best care and support in end of life care for all adults along with partners within Health, Social Care and Voluntary sector organisations. I also enable and empower health and social care staff to deliver best practice in end of life care, educating and training staff improve co-ordination of end of life care.

An important part of my role is to ensure that every adult in Powys has the opportunity to talk and share their future care wishes voluntarily with family, friends, and health & social care professionals.  We know it is important to help you and those people close to you to understand what you feel is important for your future care. This is known as Advance Care Planning (ACP) and ensures that your voice and opinions continue to be heard, even if you are unable to speak for yourself. ACP can help you live your life to the full with peace of mind that your future care wishes have been talked about and shared.

ACP Lauch 2019
Tell us more about Advance Care Planning and how it started ?
In 2019, as part of the Powys Specialist Palliative Care Team we launched the PTHB "My Life, My Wishes" Advance Care Plan documentation following extensive key stakeholder and public engagement.

“ACP is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future care”.

In Powys, this ensures honest conversations, informed choices, with the aim of involving family and carers to allow for seamless care provision at end of life or if you were unable to speak for yourself: What is ACP?

Are there particular issues which arise with end of life care in rural areas like Powys?

ACP in rural communities such as Powys face additional challenges, as our local residences are often far from hospitals and loved ones, making planning ahead especially important to ensure quality palliative and end of life care or clear decision making within a crisis conversation. Although these are often seen as difficult conversations, evidence suggests that ACP is more accessible and less threatening in rural areas when these conversations are held with local people who are a trusted and part of the community in Powys. Evidence also suggests that when loves ones are able to make wishes and preferences happen it can be very comforting and helps in loss and grief.

Bevan Commission exemplar
Do you work closely with any  other organisations or statutory services to provide support to people?
With these challenges in mind, I have now become a Bevan Commission Exemplar following completion of a project educating key partners in PTHB, Powys County Council and Powys Association of Voluntary Organisations (PAVO); whose members are now Powys ACP Champions, and have the knowledge, skills and confidence to support and advise on informal and formal ACP within their community of Powys. ACP opportunities arise through their roles, their established local community networks and their personal networks.

Through collaboration with health, social care and local voluntary organisations ACP champions empower and enable ACP in their communities in rural Powys, encouraging open conversation and using the PTHB My Life, My Wishes ACP document and Information guidance. www.pthb.nhs.wales/about-us/programmes/my-life-my-wishes

What are the benefits of My Life My Wishes?

To date we have educated 220 ACP Champions in a variety of health and social care and voluntary settings, and My Life, My Wishes ACP document continues to support open conversations, to write and share wishes in advance. We continue to support Powys health and social care professionals to respect future preferences, values and wishes that matter to the person in the community we care for.

What are your hopes for the future of palliative care in Powys?

Through my role, my hope is to continue to nurture and grow an ACP movement in Powys with a rolling programme of public awareness of ACP, utilising the support of the local Powys ACP champions and acknowledging them as a huge community asset. Awareness campaigns such as CompassionateCymru/Dying Matters Awareness week, Death Caf├ęs and Departure Lounge will support breaking the taboo of talking about death and dying within local communities in Powys. When the Covid-19 crisis hit us in 2020 it changed the whole landscape of the death and dying conversation and brought serious illness conversations and ACP to the forefront of our community’s thoughts. 

What does being in a good place to die look like in Powys?
Dying Matters Awareness week 10th – 16th May 2021 focuses on the importance of being in a good place to die – we want people of all ages to be in good place physically, emotionally and with the right support in place – getting there means having important conversations, taking careful decisions, thinking, talking and planning for it.

Let’s grasp the opportunity to promote and support future care planning with community networks that make a difference at the heart of the community in Powys!

In a good place to die.

If you could change one thing about the way we approach death and dying what would it be?

If I could change one thing about the way we approach death and dying is that it would be normal for us all to have a future care and death plan in place, just as it is now the normal to have a birth plan in place.

ACP remains more effective when introduced to our whole community in Powys, even before a person becomes unwell, or unable to speak for themselves or if experiences an acute crisis. “I didn’t want that..”

I hope through open conversations about death & dying we can to unleash the concept of compassion, care and support within the local rural community for those with the greatest needs.

If you had one top tip, or piece of advice about being in a good place to die what would it be?

My tip is Advance/future Care Planning is for everyone and “it is never too late to talk about your future care wishes.”


“it is never too late to talk about your future care wishes.”

Our thanks to Sarah for taking the time to let us know about the steps in place to support death and dying in Powys. If you'd like to find out more please contact Sarah Wheeler at the health board Sarah.J.Wheeler@wales.nhs.uk

To read more about bereavement support in Powys please see our PAVO Mental Health Blog Bereavement Support in Powys








Monday, 26 April 2021

Young and Adult Carers – the backbone of our care system!

Wales has the highest proportion – at 12% – of carers in the UK and every day 6000 people become carers, but who supports the carers? We met recently with Kevin and Eve from Credu who tell us more about the great work they do to support unpaid carers in Powys. 

Who Cares? 

A carer is someone who cares or intends to care for a family member or friend with a life limiting illness, disability, mental health condition or who suffers with substance misuse. An adult carer is a person who is aged 18 years old or over and a young carer is under 18 years old.

1 out of 3 of us will be/have been a Carer in our lifetime.

·        The role can involve a wide variety of support roles offering practical and emotional support.

·        A Carer may provide around-the-clock support or for a few hours a week, in their own home or for someone at the other end of a motorway…

·        The care and support they give is unpaid.

More formally, a Carer is anyone of any age who supports someone with a health condition or disability without being paid. There are over 16,000 unpaid Carers in Powys.

16,000 unpaid carers in Powys

Carers in Wales

Those who look after a family member or loved one with a health condition and/or disability are the backbone of our care system. At least 370,000 carers in Wales (estimated at 683 000 Carers identified during COVID via Carers Wales report).

Unpaid carers save the state the equivalent of £8.1 billion in Wales each year (this figure is also likely to have increased during the pandemic)

Wales has the highest proportion – at 12% – of carers in the UK

Carers across Wales provide 96% of care and as our loved ones are living longer with illness or disability, more and more of us will be looking after them. Unpaid carers save the state the equivalent of £8.1 billion in Wales each year. Wales has the highest proportion – at 12% – of carers in the UK. Unpaid carers in Wales have saved £33 million every day of the pandemic.

Every day 6,000 people become carers. Looking after someone can be challenging for some and for others it can be rewarding.

Young and Adult Carers have an abundance of strengths and often have to juggle life and work alongside their caring role! It is vital that Carers feel acknowledged and supported for the selfless sacrifices they make in supporting the most vulnerable members of our society.

 Carers have rights!

Carers have rights.

In Wales, Young and Adult Carers have rights that are protected in law. The Social Services and Wellbeing Act ensures that Carers be entitled to receive social care support. This includes the right to a Carers Assessment.  In Powys, there is a guide to detail more about advice and support, which may prove useful – visit: www.carers.cymru/post/a-guide-for-unpaid-carers to access this guide. 

Getting Support in Powys

Credu - believing in carers

Credu (which is pronounced ‘cre-dee’) means believe in Welsh. We believe in Young and Adult Carers. We are based in Powys and have been supporting carers since 2003.

·        We believe in people: their skills, abilities and talents, and the resilience they display in everyday life.

·        We believe in the invaluable contributions carers make to their loved ones and their communities.

·        We believe carers of all ages deserve to thrive and be able to get the most out of life.

·        We believe no-one needs to do this on their own.

·        We believe in supporting carers by connecting them with whatever they need to live to their full potential.

Make sure you get support & help

We think carers of all ages are amazing. We love to listen to you and support you with what is important to you in a way that works for you, whether you just need some basic information or if you want to work through some complicated challenges.

Credu’s support depends on what would work for you and how, but can include:

·        Practical support such as services for the person you look after / respite / financial support

·        Emotional support / counselling

·        Listening to enable you to work through challenges and find ways forward that work for you

·        Young and Adult Carers Groups and Events

·        Volunteering and getting involved as a Carers Champion

·        Courses (e.g. first aid / manual handling / stress less / sleep easy)

Credu also works alongside partners and professionals to raise awareness of caring and provide information and advice about identifying and supporting Carers.

Getting in touch

Here to help

Website: www.credu.cymru

Make a referral or self-referral: www.carers.cymru/credureferral

Facebook: Credu Connecting Carers - https://www.facebook.com/creducarers

Twitter: @CreduCarers - https://twitter.com/CreduCarers

Instagram: @creduconnectingcarers_ - https://www.instagram.com/creduconnectingcarers_/

YouTube: On Being A Carer – short clips of Carer’s stories told by Young and Adult Carers:


Visit www.carers.cymru/creduevents to see and register for our upcoming events in Powys.

If you like to receive news & updates from Credu by email, please feel free to sign up: https://tinyurl.com/yyg3kfsl - we send out a weekly email with events happening for Carers. Please check spam folders when signing up.

If you have any questions or enquiries, please call 01597 823800 / email: carers@credu.cymru


Monday, 12 April 2021

County Lines & Cuckooing - Understanding the risk to our Communities.

County Lines is a growing national concern. A review of violent crimes was carried out in 2018 leading to a greater understanding in 2021 and a recognition that County Lines is a serious current problem.

What are County Lines?

‘County Lines' is a term used to describe gangs and organised criminal networks involved in exporting illegal drugs into one or more importing areas (within the UK), using dedicated mobile phone lines or other form of ‘deal line’. These lines are likely to exploit children and vulnerable adults to move (and store) the drugs and money and they will often use coercion, intimidation, violence (including sexual violence) and weapons. The top 3 exporting areas in the UK are London, Merseyside and the West Midlands. The major cities have become saturated with drugs and have recognised that there is money to be made in selling the drugs in smaller localities. Whilst the export of drugs from larger cities to smaller local areas has always been a problem, the increased concern with County Lines is the use of weapons and exploitation of vulnerable individuals, with the increased threat risk of harm.

Areas with an impact on Powys.

How has Powys been affected by County Lines?

No county lines activity had been recorded in DPP for a number of months until the summer of 2020. County lines have since been recorded operating in towns including Brecon, Newtown, Llandrindod and Llanelli. The biggest threat to the Powys with regards to County Line offenders is from groups originating from Birmingham and the North West of England. Towns impacted by County Line groups originating from multiple areas are at greatest risk of violence.

How does it work? 

We're asked to consider it in the same was as a business model, whereby criminal networks supply drugs. Members or individuals from the group will visit the location they are targeting and get to know local drug users supplying them with crack cocaine and /or heroin. They will build up a client list by offering cheap or good quality drugs using a ‘branded drugs line’ (E.g., Scouse Steve/Oscar/Goldie) and send out bulk texts offering drug deals and incentives to buy from them. The drug line is commonly held in the exporting area and young gang members or locals deal the drugs in the importing area. Those selling the drugs may ‘cuckoo,’ addresses or use B&Bs, Air BNBs changing address frequently, this is commonly known as ‘cuckooing,’

Image thanks to Pixabay.
Criminal networks supply drugs

What is ‘Cuckooing’ ? 

Cuckooing is a new type of crime which involves a drug dealer befriending a weak, old or otherwise vulnerable individual who lives on their own. Like a cuckoo, the dealer moves in, takes over the property, and turns it into a drugs' den. Gangs begin by taking over premises in the target town, sometimes by coercion, by using property belonging to local addicts who are paid in drugs, or by beginning a relationship with a vulnerable individual. Once in place they use common marketing tactics to get established, including ‘introductory’ offers. They then expand the workforce, recruiting local runners to deliver drugs and money. The groups often use children, because they work for little pay, are easy to control, and are less likely to be detected. Children can then be groomed with gifts and money to control them via a ‘debt’ Where girls are used they can sometimes also became the victims of sexual violence.

How can we tell if someone has become a victim of Cuckooing? 

There are a number of signs that can alert us to the fact that someone might be a victim of cuckooing.

  • Missing appointments / avoiding contact with people in a position of authority / or not allowing access to the premises (E.g., Police, housing association staff).

  • Reports of anti-social behaviour at the address. 

  • Intelligence reporting / Increased number of visitors to the address / unusually high key fob activity to social housing properties.

  • Loss of bank card / indication that someone else is using their account.

  • Not staying at their home address (possibly because someone else has taken over it!).

  • Nervousness and or injuries.

  • Sudden appearance of new friends or friends from out of town with no clearly established links or common background.

  • A number of new or  unfamiliar people in the property.

  • Resident appears uncomfortable.

  • A relapse into drug use. 

Who is involved? 

Cuckooing and County Lines involves the national movement and transportation of exploited, vulnerable children and individuals. Once established in town the drug dealer will return to the larger cities. Young gang members or other vulnerable people in the local area are then used to convey the proceeds back to the organisers in the cities and replenish the drugs. Frequently the drugs will be transported internally. There is likely to be evidence or intelligence of exploitation, violence or the use of weapons.

Children as young as 11 years old can be targeted for a County Lines operation. Males and females aged between 18-25 years are the current most common age group recruited, with around 20% of those involved in County Lines being under the age of 18. More often than not it's young males who are targeted and exploited. In legal terms people under the age of 18 are recognised as children and cannot consent to being exploited.

There are certain common characteristics of people targeted for County Lines operations.

  • People with mental health issues or physical/learning difficulties

  • Those having prior experience of neglect, physical/sexual abuse

  • Those without a stable home and children in care

  • Social isolation and those without a support network can make someone more vulnerable.

  • Connections with other people involved in gangs

  • Individuals who are excluded from mainstream education

  • Students and foreign exchange students known as 'Money Mules,' There are examples of people enrolling for courses then not attending, simply to provide a way in to recruit students to County Lines gangs.

  • Even children who have had no previous contact with services who are known as ‘clean skins’.

  • Class A drug users.

Image thanks to Dyfed Powys police.
Look past the stereotypes

Why are children and vulnerable adults used?

Whilst children and adults are mostly commonly used – anyone can become a victim.

  • They can have different roles within the organised crime gang or network. 

  • They are easy to manipulate / groom / exploit.

  • Children don’t always see themselves as victims and can therefore be easily exploited.

  • The criminal isn’t caught with drugs and therefore there is less likelihood of conviction. 

  • Children are less likely to be stopped and searched.

  • Children and the vulnerable are seen as expendable.

  • Older vulnerable people may have addresses that can be used by drug dealers to run their business from, allowing them to accommodate drug runners and stash the drugs. 

  • The train and public transport network is used because of the ease of use, links to other areas and because children don’t drive. 

The Childrens’ Society #LookCloser campaign asks us to look past some of the stereotypes, to look at what might be taking place under the surface. It asks us to consider the situation and what we can do to help to protect vulnerable young people. It's a collective responsibility that we have to ensure the safety of young people.

What attracts young people to the County Lines movement ?

There are a number of factors known as ‘Push / Pull factors,’ that can coerce young and vulnerable people to get involved with county lines. Factors that can make a young person more susceptible to being recruited are 

  • Children who have been victims of abuse.

  • Children from households where domestic violence has been a feature.

  • Children whose parents are vulnerable.

  • Households with a history of family breakdown.

  • Children with disabilities/ EBD Children who are bullied.

  • Children with an absence of primary attachment figure. 

A recent investigation by Yorkshire and Humberside police found that very often victims are sold a dream, or a way of life through social media and made to feel part of something, giving them a sense of belonging and attention not received elsewhere. This can be achieved through

  • Being made to feel special, trusted, liked or fancied. 

  • Receiving alcohol, drugs, money, food or gifts. 

  • Getting a buzz and the excitement of risk taking behaviour.

  • Being offered somewhere to stay where there are no rules or boundaries.

  • Being given lifts, taken to new places, having adventures with ‘friends’.

Young & vulnerable people are often targeted. 

How can we tell if a young or vulnerable person has been recruited into a County Line? 

The warning signs below on their own are not in themselves always cause for concern but a number of combined factors, that raises professional curiosity is worth asking the question, what might be happening here? We need to look at and be aware of what is going on around us.

  • Are they in possession of more than one mobile phone?

  • Are they paying with large sums of cash? (E.g., paying train fares or fines in cash).

  • Do they have any obvious signs of wealth (E.g., new trainers, new clothing / jewellery / phone – could be an indication of grooming).

  • Do they appear nervous / unfamiliar with the area?

  • Are they travelling at unusual times or travelling out of their home area? Another clue is the possession of train or bus tickets. It's not just people coming in to the area, it's also people going missing from the local area.

  • Are they making / receiving excessive calls or texts?

  • Are they avoiding staff or police?

  • Has their behaviour changed – becoming secretive or withdrawn or isolating from peers.

  • Are they going missing with unexplained absences from school, college, training, work or appointments?

  • Have they talked about being in debt?

  • Are they missing their bank card, or is there any unusual activity on their account? 

  • Have they been found with large quantities of drugs or weapons?

  • Are they more confident than usual with expressions around invincibility, or not caring what happens – ‘others have their back’. 

  • Possession of hotel keys or cards or keys to an unknown premises.

  • Entering or leaving vehicles with unknown adults.

  • Unexplained new friendships, often with the use of nicknames.

What can we do to stop the growth of County Lines in Powys? 

Adopting a multi-agency response is the most effective way forward, it's not a problem that we can simply arrest our way out of. We need to be the eyes and ears of our communities, to keep vulnerable individuals within our communities safe. To do this we can ensure that our workforces and colleagues are aware of the issue and how to spot the signs. We need to encourage our workforces and colleagues to be confident that ‘If they feel something is wrong, say something about it’. Information on these concerns may be the missing part of the jigsaw

If you have any information about people involved in organised crime or those who may 

be exploited then please contact Dyfed Powys Police

• Call - 101 or 999

• Email - contactcentre@dyfed-powys.pnn.police.uk

• Speak to your local PCSO’s

The message from our Police force is simple, “Whatever your role we need you to act on your professional curiosity – don’t leave it to others.”

Image thanks to Pixabay.
Working together to support our communities. 

Further Useful Resources

Government advice - County lines: criminal exploitation of children and vulnerable adults. Brings together documents and promotional material related to the government’s work to end criminal exploitation https://www.gov.uk/government/collections/county-lines-criminal-exploitation-of-children-and-vulnerable-adults

What is County Lines? https://www.youtube.com/watch?time_continue=50&v=3ILaguFXHr4&feature=emb_title

Gwent police – County Lines; Spot the Signs - https://www.gwent.pcc.police.uk/en/news-room/county-lines-spot-the-signs/

‘Are You Listening?’ – New film to tackle Child Criminal Exploitation - https://www.youtube.com/watch?v=UbY7zCJCi3w&feature=youtu.be

SchoolBeat.Cymru have developed a lesson for delivery in schools to educate young people about one of the most significant issues that affect our communities- Criminal Exploitation of Children and County Lines - https://vimeo.com/436784100/96042b5590

Crimestoppers #Fearless - https://www.fearless.org/en/campaigns/county-lines

The ruthlessness of a County Lines perpetrator -  https://tinyurl.com/yya3x43c

Thanks to Richard Weber from Tarian Regional Organised Crime Unit for his recent presentation and information provided.