Developing Resilience and Wellbeing with Carers in Rural Communities

1. “A public health perspective on developing resilience and wellbeing with Carers in rural communities” Dr Dee Gray @grays100 Dr Sue Fish @DrSueFish

2. A Carer Workforce • There is a recognition that health and social care services need to develop towards the ‘third curve’ in service delivery (Feeley and Leitch, 2017), which means ceding power from traditional routes and mobilising social action. • An essential but often overlooked existing population in the ‘third curve’ are carers, who make up an essential third in the triangle of care (Worthington and Rooney, 2013) • The carer ‘workforce’ is known to be over six million strong in the UK, and has an international presence estimated to be that of billions. • The carer ‘workforce’ provide interventions which ensure that the cared-for remains well enough to live at home (RCGP, 2014).

3. Carer health – resilient communities • An overarching goal of public health is to promote the health of individuals (Talley and Crews, 2007). • This may be compromised for carers as they are known to sacrifice their own health and wellbeing in order to care for others. • This has a deleterious impact both on other public sector services and the broader public health of the communities in which they live.

4. Resilient communities • Between 2001 and 2011 the percentage change of carers in Ceredigion was 8.7% (ONS, 2011) • Providing more than 50 hours of unpaid care can increase the likelihood of self reported poor health (ONS, 2011) • The RCGP Supporting Carers programme 2015 recommended a number of initiatives that can be used by practices to identify and support carers health and wellbeing • Carers Strategies (Wales) Measure 2010 placed a requirement for the NHS and Local Authorities in Wales to work in partnership to prepare, publish and implement a joint strategy in relation to carers to include their identification and the provision of relevant information.

5. Salutogenic Resilience and Wellbeing programme • Pilot service, commissioned by the MWHC, which demonstrated how a salutogenic approach to resilience and wellbeing positively affected carers in terms of mental wellbeing and role endurance. • Core components include developing situational awareness of stress, utilising a resilience and wellbeing model/process at micro, meso and macro levels • Focus on independence • Designed to address specific stressors such as loneliness/isolation, identity and ‘self’ care

6. The Resilience and Wellbeing model • SoC • Comprehension • Management • Meaning BEST SELF CORE 1 2 PERIPHERY 3 4 5 6 7

7. Evaluation • Service development • Resilience and wellbeing descriptors – thematic analysis (modal) 7 spaces x 4 domains • SWEMWEBS (pre and post) – Mental wellbeing metric -  Anything over (> 0.5) would show a change,  the effect size was large as post programme r 0.780105 * • Pre and post qualitative questions regarding resilience, wellbeing and role endurance – interrogated for GRRs

8. Table 1. Analysis of descriptors of individual resilience and wellbeing Orientating towards ‘best self’ = wellbeing

9. Findings • By co-creating new worker identity, the carers were able to deal with elements of social exclusion from their local communities (Rand and Malley, 2013)and establish themselves as a third workforce collective within the community. • A return to ‘community’ was initiated through the carers themselves becoming a peer support work group, reminiscent of a well-functioning work team. • 2 years post intervention, the carer ‘work team’, known as ‘Caring Friends’ continue to meet and offer peer support through a range of transition episodes.

10. Let’s talk….any questions?

11. Dr Dee Gray grays100@gmail.com Dr Sue Fish Sue.Fish@wales.nhs.uk Thank You