Transcript a charter for community development in health
Welcome to the APPG meeting on Health Inequalities and Community Development 16 October 2014 Lord Victor Adebowale CBE Co-Chair of the APPG on Complex Needs and Dual Diagnosis
Speakers:
Brian Fisher, Patient and Public Involvement Lead, NHS Alliance Elizabeth Bayliss, Chief Executive of ‘Social Action on Health’ a London based Community development Charity Dr Niall Macleod, A practising GP in the South West
Community development in practice
Elizabeth Bayliss
Social Action for Health
• A community development charity with a focus on health and wellbeing • Promoting self determination • Building the confidence of local people, cross culturally, to become more creative, critical and reflective in their contributions to social life • Enlivening public life, since public life makes fruitful ground for the development of wellbeing
SAfH Spiral of participation
A range of projects –
a year 20 projects
• Advice and information – • Health improvement – one to one sessions individuals’ health improves • Community participation – based on direct experience • Community leadership – become more useful in service improvement, learning new skills to • Mutual support networks – lifestyle, new ways of being in the world sustaining changes in • Independent community action – action for themselves on their own terms people taking
Advice & information
• Working with 10,000 people a year • across 40 GP surgeries • in Hackney and Tower Hamlets • Raising an extra £ 7 million a year for spending in local deprived communities • Supporting 3 networks of community organisations to collaborate; • 16 local organisations employ local people as qualified advisors who work in mother tongue (so no interpreting costs)
Evidence based direct health improvement
• Weight management for adults in group settings • Diabetes health and wellbeing exercise groups • Self management courses (including now, epilepsy)
Community participation in service improvement
• Maternity (Mothers Support Group) • Mental health (Peoples’ Network) • Chronic health conditions (Patient Network)
Mutual support networks
• • •
Peoples Network
- mental health user led, user-run self help network
Patients Networ
health conditions k for living with long term
Peer Support Network
for people with severe physical disabilities
Community leadership
• • • • • • •
Health Guides
: running groups, giving information on services, gathering narrative on experiences to feed into policy ( Tower Hamlets & Wimbledon)
Mothers support group
Services Liaison Committee : recent mothers come together to learn, mandating, supporting their chosen representatives on the Maternity (Tower Hamlets & Newham)
Peer mentors
: mentoring others with long term health conditions in self management (Westminster, Harrow)
Community educators
: running groups, promoting health and wellbeing in community settings, giving information, promoting sharing of experiences, teaching people how to communicate with professionals (Waltham Forest & Harrow)
Compassionate Neighbours:
supporting carers and families of people dying at home (Hackney)
Patient leaders
: representatives of patients, feeding into Healthwatch (Tower Hamlets)
Community researchers
: community asset auditing, evaluating service impact. (Hackney, Tower Hamlets & Harrow)
Independent community action
Health wisdom groups: – Encourage people to use their own health intelligence – Get changes made (parks opening hours) through collective action – Raise awareness in schools and community settings of health threats (poor eating, transfats, vitamin D deficiency, drugs and alcohol, risk from no exercise) – Teach people how to communicate best with GPs to make best use of services – Promote community engagement in research projects (East London Genes and health) that will benefit society in the longer term.
Complementing the NHS
SAfH brings people together, cross culturally, to take part in projects that improve their personal health, offers the opportunity to share their experiences and join networks for purposeful action in the public arena. We have found that many people want to help their community, and contribute however they can to the work of the NHS. (for many, many people, the NHS is the only public institution they can believe in)
A Charter for Community Development in Health
Dr Niall MacLeod GP partner The Heavitree Practice, Exeter
System flawed
• Created in 1948 • 93% treatment- 7% prevention • “Should be 50-50” Prof Robert Harris, Head of NHS strategy • System over medicalised • Need a new model 15
Community Self Care Healthy Lifestyle Prevention
Right to Left Shift
Primary Care Secondary Care • • All Stakeholders need to work together in an Integrated Coordinated strategy for this to work ie Health and Wellbeing Boards, CCGs, Councils, Voluntary Sector, Faith Groups, Schools, Industry, Local media, general public etc • We need a Community Development Charter for Health……!
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Future NHS
• Patient empowerment- involving them in own health management and prioritising local health needs • More emphasis on prevention and developing health and wellbeing in communities • Involve pre-existing community, voluntary and patient groups • All these groups working together • Utilise advances in IT to best effect 17
The Future
• Patient empowerment • Do things WITH patient not To the patient • People and communities can help themselves • Co-produced activity- from the ground up (Robert Varnam, Head of GP Innovation) NHS England 18
EVIDENCE
• “people with strong social networks live longer healthier lives compared to those poorly connected in social terms” • Prof Alex Haslam- Brisbane University 2012 19
Charter for Community Development in Health
• Help focus CCGs, councils, industry on task at hand • Benefit NHS by helping reduce demand • Help develop resilience at grassroots level 20
My Vision Integrated Coordinated Healthy Living Strategy from GP to Community • Facilitate shift of healthcare from GP surgery out into healthy living in healthy communities • 2.5 years researching locally and nationally • Networked and liaised • All groups keen to be involved • Bring together the key players to share the vision- and get on with it….!
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Current Model
• Doctor centred model • We “sort” everything advice prescribe patient GP refer admit 22
H E A L T H Y The Health “Ferries”- no coordination
…
Community Groups Friends Voluntary sector library Public Health Campaigns GP U N H E A L T H Y L F I E S T Y L E 23
H E A L T H Y
Working together- a Pontoon Bridge
Community Groups Community database Public Health Campaign Friends library Apps Healthy Living Advisor GP U N H E A L T H Y Voluntary sector Specially Commissioned Services For High Risk Groups L F I E S T Y L E 24
Suggested New Future Community Focused Model Community database Community Communit y Health Team Voluntary Sector patient Healthy living facilitator GP medicatio n Hospital referral 25
GP to Community Shift
• Pharmacies take on minor ailment role • Practice Health Champions • Each surgery has healthy living advisor/facilitator • Neighbourhood Community Health worker created in each neighbourhood • Database of community activities- enroled in scheme 26
GP to Community Shift
• Specially commissioned activities for at risk groups eg frail, dementia, obesity, alcohol, severe mental illness • GPs buy into change in working patterns • Develop IT self help – eg approved Apps, on line self help etc • Embrace and include all the great community and voluntary sector resources 27
The Project “A Integrated Coordinated Healthy Living Strategy from GP to Community” • All groups say it is a good idea FRUSTRATING +++ !
BLOCKS • Lack of funding- CCG in financial deficit • Fear of getting it wrong- lack of imaginitive thinking • Lack of body/organisation to coordinate • Population unaware of issues/crisis • Media and politicians partly to blame for avoiding real issues • Lack of direction from Government…..!
• Lack of a Charter…..!
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Good work
• Bromley By Bow • Green Dreams, Burnley • Altogether Better, Leeds • Age UK, Living Well scheme • Westbank Healthy Living Centre, Exminster Devon • Turning Point • C2 Connecting Communities 29
Benefits to us all
• Reduced consultation rate • Reduced prescribing • Reduced A and E attendances • Reduced admissions • Healthier and Happier population • Improved Wellbeing • Reduced crime/drug use • Patients connecting with their communities • Improved resilience- physically and mentally 30
Good Work
• Is happening • Disjointed • Little overall strategy- no coordination • Patchy across UK • Poor sharing of good practice 31
Balance
• Yes we do need high tech treatments • But with ageing population and increasing demands • Need to put more emphasis on prevention • Care in the community • Need a Charter for Community Development in Health 32
Charter for Community Development in Health
• Good for Primary care • Good for NHS • Good for the individual • Good for the population 33
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Get A Life
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A CHARTER FOR COMMUNITY DEVELOPMENT IN HEALTH DR BRIAN FISHER NHS ALLIANCE HEALTH EMPOWERMENT LEVERAGE PROJECT
THE STATE AUSTERITY
Threat to community life Increasing inequality A crisis in democratic accountability
PARTICIPATORY
ACCOUNTABILITY
DEMOCRATIC
UNDER PRESSURE
• • • • Hollowed out communities Threat to mental health Attenuation of social networks • Weakening of associational life Deterioration in health •
AUSTERITY + REDUCING THE WELFARE STATE KILLS PEOPLE.
ASSET-BASED COMMUNITY DEVELOPMENT •
Statutory services become more responsive
•
Promotes health protection and community resilience
•
Helps tackle health inequalities
•
Has an impact on behaviour change
•
Saves money
SOCIAL RETURN ON INVESTMENT
• A saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8
• For £233,655 invested across four authorities the social return was £3.5 million. • For every £1 a local authority invests, £15 of value is created.
“ No society has the money to buy, at market prices, what it takes to raise children, make a neighbourhood safe, care for the elderly, make democracy work or address systemic injustices... The only way the world is going to address social problems is by enlisting the very people who are now classified as ‘clients’ and ‘consumers’ and converting them into co-workers, partners and rebuilders of the core economy.” EDGAR KAHN
C D Stronger and deeper Social Networks RESILIENCE CONTROL
Health protection Resilience to economic adversity Better mental health Can negotiate with services More strength for self-care Health inequalities reduce
70 60 50 40 30 20 10 0
OUTCOMES – HEALTH
6-Month Survival after Heart Attack, by Level of Emotional Support
Sources of support 0 1 2 or more Men Women
SOCIAL NETWORKS REDUCE MORTALITY RISK
• 50 % increased likelihood of survival for people with stronger social relationships . • Comparable with risks such as smoking, alcohol, BMI and physical activity. • Consistent across age, sex, cause of death. • 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316
PRINCIPLES FOR SOCIAL ACTION ON HEALTH
• • • • •
Enable people to organise and collaborate to:
• identify their own needs • take action to exert influence on the decisions which affect their lives • improve the quality of their own lives, the communities in which they live, and societies of which they are a part.
Address imbalances in power and bring about change
founded on social justice, equality and inclusion.
Active communities make a marked difference to their own health
and life expectancy .
Co-production between communities and service providers
thrives if communities are enabled to become leading players in their own interests .
Look for the strong, not the wrong: a needs-and-assets based approach
WE CALL ON HEALTH AND OTHER AGENCIES TO:
• • • • Inspire residents to become key players in developing their own health and well-being.
Be prepared to listen, respond and work in new ways.
Harness the interventions that have the best evidence and are most reproducible. These include community development or community building or community transformation Develop, through community building, community led neighbourhood partnerships of residents and service providers.
POLICIES FOR SOCIAL ACTION ON HEALTH
• • • • • A community development strategy in every Health and Well-Being Board and CCG.
Joint Strategic Needs Assessments to become Joint Strategic Needs and Assets Assessments Support investment in community development and social value.
Devolve decision making about service commissioning to communities undistorted by competition rules and commercial confidentiality.
All CCGs to collect evidence of local
community development.
POLICIES FOR SOCIAL ACTION ON HEALTH 2
•
Workforce capacity and capability in community
development ensured by Health Education England and LETBs.
•
A community development work programme
developed by Public Health England.
•
Commissioning and delivering evidence based
community development should be supported by Public Health England and NHSE Regional Teams in local authorities and other public health bodies.
www.healthempowerment.co.uk
Questions and discussion
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