Supporting people to identify options for care

Dudley CVS’s Carer Coordinator worked with a carer who was experiencing considerable stress relating to her own physical and mental health needs, and also those of her mother for whom she is the main carer. The mother had recently had a couple of hospital admissions, and the carer was preparing for surgery herself and felt overwhelmed by her situation.

Our Carer Coordinator gave the carer an opportunity to complete a carers first contact assessment and talk to someone about her situation. They discussed a number of different issues relating to her forthcoming surgery and her concerns for having a plan in place.

The carer’s assessment identified that the carer needed further time to look after her own health and wellbeing and to plan for her surgery. Our carer coordinator contacted the carers network to organise a sitting service for her mother for 6 weeks to enable her to do this. The carer was also referred to Integrated Plus to find out more about social activities and further community contacts.

It was recommended that when her mother was discharged from hospital that they request a package of care to prepare her for being supported by other people so that her daughter didn’t have sole responsibility and that when she goes into respite (temporary) care, she would be less anxious.  

After working with the carer coordinator, the carer became much more prepared for her own surgery in the knowledge that her mum will have other contacts to support her.

“The Carer coordinator was very empathetic and provided clear, supportive and effective advice. In terms of Mom and I, we are better placed to consider, identify and access options for care. It would be difficult to imagine a better service. Sharon’s help has been immense and just what we needed as a family.”

Linking volunteers to the right opportunities

Our work with Dudley Canal and Tunnel Trust has helped them to reach more volunteers increasing from 2 or 3 to around 60 volunteers.

Ben’s volunteering journey has helped him to start building his CV, get out of the house and do something that is connected with his interests.




Supporting people to maintain their independance

Integrated Plus supports people aged 16 and over who frequently visit their GP and who are at high risk of hospital admission. The aim of the service is to look at the whole needs of a person, regardless of what those needs might be and jointly find solutions to problems faced and identify opportunities for people to become more involved and active in their community. We help ensure people are accessing services and activities appropriate to their needs. Integrated Plus is funded by Dudley CCG. During 2017/18, there were 12 staff, one manager, 5 Link Officers and 5 Link Support Workers.

Mary helped to access social networks and services to help her maintain her independence

A link officer met with Mary in June 2017. Mary had lost her husband in March and was finding it hard to adjust without him, they were very close. Her daughter lives in Hampshire and her son lives in Gloucester so she had no close family who lived local to look after her. Mary’s daughter had suggested she moves to Hampshire to be closer to her and Mary was considering this. In the meantime, Mary wanted to get more active in her community to keep her occupied and busy.

During the initial home visit, the Link Officer and Mary together explored some things that may be of benefit to Mary. Mary was introduced to the COPD group in Dudley called Airtime, which is a social peer network for people who suffer with chronic obstructive pulmonary disease and other respiratory conditions. Air Time brings people together to collaborate, make new friends, offer peer support, and help people to help each other to better self-manage their condition and generally have some fun. As Mary had some anxiety about going to Airtime, the Link Support Worker supported Mary to attend and helped to connect her with others there. Mary said “the group is very good, I have made friends and we have a great laugh – they are a cheerful lot”. As Mary had enjoyed the first visit so much, she has been back to Airtime via taxi and looks forward to going every Thursday.  

Mary was also connected to the Assisted Living Centre in Coseley as Mary identified that she was afraid of falling in the house, especially when getting in and out of the bath. The assisted living centre has a range of equipment to assist daily living. It is located in an adapted house which enables demonstrations and trial use of equipment within every day settings such as the kitchen, bedroom or bathroom. The link officer chaperoned Mary to this appointment and Mary was able to get an electronic bath seat for no additional cost. This was installed a week or so later and Mary says that “the bath seat helps me every day. I am not afraid of falling when getting out of the bath because the chair is great support”. Overall, the bath seat enables Mary to get in and out of the bath with ease and by a press of a button!

We had also noticed that Mary was not seeing very many people on a day to day basis and as a result was getting extremely lonely and confused when problems arose, such as issues with the telephone, television and heating. To help her in this situation, a referral was made to the Enabling Community Support Service, who provide a range of practical help, advice and support to older people, aged 60 plus, in their homes. It is intended for people who live at home but who need a little extra support on a short term basis, to live independently, happily and successfully.

Mary now gets a visit from a member of the team, Andy, every Wednesday and they chat about anything and everything!

Mary was also given information on a number of services that could help, such as the Driving Miss Daisy taxi service, Cruse Bereavement Care, a calendar of events from Dudley Stroke Association and the Townswomen’s guild in Sedgley, all of which Mary is considering accessing whilst she is still in Dudley.

Throughout the months we helped Mary, we built a rapport with Mary’s daughter which enabled her to rely on us. Mary’s daughter communicated with both the link officer and link support worker through phone calls, e-mail and texts when she was concerned about her mother and we were able to feedback to her daughter about these concerns by visiting or calling Mary to make sure she was okay. Ideas that her daughter had about the care that her mother needed were also taken into account and we were able to inform her about the groups and services available in the Dudley area, which she was impressed by.

Mary has now sold her house in order for her to move to Hampshire to be closer to her daughter. Although she is excited to move on in her life, Mary is extremely grateful for the work that ourselves at Integrated Plus, Enabling Community Support and friends/staff at Airtime have done for her:

“I feel happier now I have support from Andy at Enabling Community Support, he is a lovely man and he is very kind. As a matter of fact, I have found everyone very kind and most helpful. I would give Integrated Plus 11/10 if I could for sorting all of this out for me, I don’t feel so lonely now that I know I have all this support around me and a lovely group Air Time to go to every Thursday”.

Working together to provide a safe space where local people can get to know each other over a hot meal

A great partnership between East Coseley Big Local, Integrated Plus, Just Straight Talk, local residential homes, Marston’s Brewery and the staff at the Apple Tree Inn, enables 4 Lunch and Chat events to take place throughout the year for local people and families of all ages who often feel a little lonely and isolated in the community. These events provide a safe space where local people can get to know each other over a hot meal.

We worked with services that work directly with isolated people on a day-to-day basis including Integrated Plus, Just Straight Talk and residential home Jack Newell Court, to reach people who may be feeling lonely in the community that would benefit from social interaction and a place to go to meet new people. It’s through working in partnership with these services that we have been able to identify isolated people in the community.

At 2017’s Christmas lunch, we were joined by 55 members of the community, ages ranging from 22 all the way up to 101. Volunteers, support workers, people and families from the community all enjoyed and shared a three-course Christmas meal together, with entertainment and a small gift.

Jack Newell Court in Coseley is a council owned building for residents over 55, single or couples. “Residents at Jack Newell are surrounded by other people, but once the door closes they are on their own. We found that food and drink is one of the best ways to bring people together. Many people have now developed friendships and often meet for a coffee in between the meals.” East Coseley Big Local Changemaker

Karen Grigg, resident and East Coseley Big Local core group member said:

“My elderly next door neighbour was very isolated having recently lost her husband and having no family. I brought her along to the lunch at the Apple Tree arranged by East Coseley Big Local.  She had a wonderful time and got speaking to some ladies there and now attends coffee mornings with them, it has made such a difference to her life she is more outgoing and has the confidence to go along on her own to the meetings. She is no longer feeling isolated.”

Airtime: boosting health and relieving isolation

Last year, Dudley CVS and Healthwatch Dudley worked with Dudley CCG (Clinical Commissioning Group) to explore community support to people who are living with a wide range of respiratory conditions. In June we co-hosted an event to bring local people with breathing difficulties together and hosted weekly ‘Airtime’ sessions leading to the appointment of a new coordinator in September.

Airtime provides varied and interactive weekly activities including appropriate exercise, professional support from health experts and information and advice about keeping well. People who attend have fun too and also enjoy recreational activities including bingo, quizzes, music and craft activities which has proved invaluable for people with similar conditions to come together to support each other.

One gentleman, Charlie, has been a regular participant of Airtime since December 2016. When Charlie first arrived he was incredibly anxious. He had always worked hard for a living and had to forgo this passion when he received his diagnosis which also affected his mental health. He had lost his ‘sparkle’ and was on antidepressants. He was drinking and smoking heavily as a way to ‘blot it out’.

Our Airtime Coordinator ensured that she took the time to sit down with Charlie, listen to his story and to take a non-judgmental approach to his situation. She discussed with him the many benefits of the group, ensured he felt welcome when he first joined and promised to call him later in the week to check in. The Coordinator also encouraged other, more longstanding members of the group to support to make it easier for Charlie to return each week. We felt that he would become a valued and needed member of Airtime.

The outcome was that Charlie started attending Airtime regularly and continues to do so! Charlie has stopped smoking and really reduced his alcohol consumption. Charlie has also stopped his anxiety meds which he attributes solely to Airtime giving him renewed confidence.

Charlie has become a larger than life character in the group, is helpful, positive and very involved.

Recently Charlie has taken part in the People’s Network event where he championed the benefits of the group and also relayed his own personal experience. He also took a central role in our steering group with the CCG in order to help Airtime continue, which thanks to him and others, was a success.


“If it wasn’t for this group, I’d still be on antidepressants. I have a purpose and we have a laugh. It has changed my life.” Charlie, member of Airtime