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Community lessons from The Coronavirus Pandemic

Brian Fisher, Chair, Health Creation Alliance

Have you been participating in the online experiences that have mushroomed in response to the pandemic? Have you been clapping for carers? Have you been contacted by a local group, perhaps offering support to collect food and medicines?

The astonishing outpouring of community solidarity, compassion and practical support has brought people together, encouraged confidence, and helped people take more control over their lives and their areas. These initiatives are undoubtedly life-saving in some instances, keeping people in the community when there would otherwise have had to have been an institutional response.

The pandemic has demonstrated the power of community action in health creation.

This insight is not new, but it may not have been so evident before, certainly not so evident to planners and decision-makers in the NHS. The pandemic is also taking us beyond what we knew before. We have long known that bringing people together, strengthening ties within communities, supporting people to collectively identify the issues that matter to them and then supporting them in finding solutions, in collaboration with the statutory sector – all that has a huge benefit to health. In fact, that face to face community action is about as beneficial as stopping smoking. It promotes both physical and mental health at all ages.

What this pandemic has taught us is that this benefit probably extends to non-face-to-face contact as well. The evidence on this point has never been clear. Actually, there has been little research on that at all. We can now see that any kind of benign contact can be health-enhancing.

Health is not just an individual, but also a social process.

We have made so many things happen in the last few weeks, with government’s recognition of the importance of society and the investment needed into the state sector. We must commit to embedding these insights. A healthy society requires a healthy state.

The NHS must now work with Local Authorities to make sure that every layer of out of hospital NHS provision is geared to support building community capital, community solidarity . There are many ways of doing this, but a common route is some form of health creating community development. This approach has a long pedigree.

Community development is an essential part of creating health

Community development is a technique that, at it’s best, helps people, usually in a geographical area, to identify the issues that matter most to them. The approach then supports them, often with the statutory sector, in finding solutions that work locally. It is the building up of control that is the key to health creation.

There are examples of community development in many different sectors across the country over many years. Now we need to recognise this activity as an essential part of creating health to understand what works and why and recognise this activity as an essential part of creating health. We need investment into communities to enable development of a systematic approach that enables each community to make it their own, tailored to their area and their communities. We know that that approach builds relationships and builds trust and also has impacts on health inequalities.

When our physical distancing ends, let’s make sure that our social approach shrinks distancing and builds a more human, community approach to keeping us well.

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The twelve health creating days of Christmas

As the dust settles on the 2019 general election the focus shifts to a new government that has ensured the electorate is conscious of the need for investment into health and care. We all know that the issues are more than additional investment, so here’s twelve Christmas actions for a health creating New Year.

Peter Hay, Treasurer, Health Creation Alliance

@peter_hay

Action 1: think about how the 3 C’s help create value 

The election debate has been about traditional big levers of government, particularly taxation and spend. It’s seen little about ways in which citizens can engage as participants in health and care. The Health Creation Alliance commitment to health and care systems pivots on the capability to have confidence and control as well as being able to connect, supporting the big levers from the bottom up.

Action 2: let’s get people involved

Being invited into the process and finding ways in which people can participate takes time. But it does build a better approach which doesn’t sound so long term when contrasted with watching for money to show up in your locality.

Action 3: well, it’s Christmas, so we could commit to a journey

Participating and making our own health and well-being does not come ready made.

We could lead with a question about what it might take to meet the needs of people today in the best ways? (If you know all the answers already then proceed directly to a top down plan. If you know some of the shape but still need to find some answers then going on a question-led journey may work for you!) As we have never had today’s demographics be wary of the former!

Action 4: what would new hospitals look like?

40 new hospitals will be new capacity. Let’s try and avoid this meaning 40 more A&E’s that are full of older people for the want of something more imaginative or those in heightened mental distress as there is nowhere else. What do hospitals look like that are designed for the needs of people now rather than being more of what we have?

Action 5: can we find the younger adults (please?)

Social care is important to older people and is equally important to adults with needs arising from their mental health, learning disability, substance use or a whole range of needs which require support in day to day living. We need to ensure that the debate about social care is inclusive for all people whose needs require support.

Action 6:  think broadly about assets

A debate framed around not using your home to pay for the costs of care starts from the wrong perspective. Where we live and the houses we live in can change the way we age. We know from the research of Extra Care Charitable Trust and Aston University that extra care is life improving and creates better health. And we also know that 80% of older people want to stay living in their existing home. We need to think about using our housing choices and our community connections to change our life experiences. (If defending the financial asset is important, let’s not attack the best from of defence?)

Action 7: profitability does not guarantee quality

It’s uncomfortable but quality does not automatically follow money. There are profitable businesses that should not be allowed to hide behind the cloak of severe cuts of recent years.

Last year the Guardian reported how inadequate care homes were being run by very profitable companies. This is also an issue in children’s care: look at  action taken by Ofsted against a profitable company where children had to share a single toilet roll across six bathrooms and one child had a weekly ‘diet’ of approximately 122 chicken nuggets and 14 litres of fizzy drink.

We have to challenge the use of money as much as the allocation.

Action 8: well, it’s Christmas, so what about thinking about morality?

We need to find a language about ethics and morality that is entwined with the regard that we show people. The era of spin, fake news and a casual approach to evidence presents a challenge to how people trust, engage and think about organisations. How are the organisations in health and care different?

Action 9: bring in public health

There were some election commitments about broader thinking on wellbeing and how regulation and wider levers for change might be used. We need to think how we plan to make public heath the centre of population and place-based approaches.

Action 10: well, it’s Christmas, so let’s bring in the Tiny Tim’s (and Timina’s …)

Children are 25% of the use of the NHS – but you wouldn’t think it. There are serious issues to be faced from mental health to lifelong  approaches to disability and more. These issues need some considerable attention and children need more visibility.

Action 11: have a Christmas wish …

What one thing would make the biggest difference for you? For me, perhaps the end of the use of seclusion for people with learning disabilities and mental health?

Action 12: Enjoy! Have a Happy Christmas and a health creating New Year.

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Get to know your neighbours (or you face a lonely struggle)

Emerging Primary Care Networks will be expected to deliver ‘locally agreed action to tackle health inequalities’ by 2021. The good news is they don’t have to do it alone.

Merron Simpson, CEO of Health Creation Alliance explains the opportunity awaiting PCNs and General Practices that reach out to local and community partners in the task of addressing inequalities.

@merronsimpson

The advent of Primary Care Networks in the 2019 NHS Long Term Plan marked the moment when General Practice officially gained a ‘system’ around them.

Operating as small businesses contracted by the NHS, a mixture of financial, regulatory, clinical and administrative drivers has led practices to self-organise in recent years into federations, networks and super-practices. General practice ‘at scale’ has increased the capacity of practices to deal with the more strategic demands facing modern practices. This organic coming together of practices around patient populations of 30-50,000 have paved the way for Primary Care Networks (PCNs) and most practices are signing up.

Local partners operating outside the NHS are both relieved and frustrated by this new development: relieved at the potential to engage with primary care at a systems level and frustration that the PCNs have adopted a different administrative neighbourhood footprint that doesn’t reflect either the ‘real’ neighbourhoods, the way that communities experience them, nor local authority neighbourhood boundaries. This presents a conundrum for councils who are keen to connect with health and at the same time to maintain the flow of their own transformation programmes. Greater Manchester Combined Authority, has squared this circle by undertaking a wholesale reorganisation of their neighbourhood boundaries around these PCN populations in order to smooth the way for more integrated working. The fact that it hasn’t managed to do this across all ten of its localities is testament to the difficulty and disruption it has caused.

PCNs are focused on delivering 7 nationally set specifications. But they need to give equal focus to developing relationships with the raft of new partners on their doorstep, including communities themselves, if they are serious about the reducing health inequalities (the 7th service specification). Health Creation is all about relationship; it is about recognising, building on and connecting the strengths – people, networks, organisations – that already exist in a place and nurturing the energy and action that emerges. It’s about working with the grain of existing efforts and seeing communities as part of the system, not separate from it. This point was made loud and clear by delegates at a recent event hosted by Health Creation Alliance and Royal College of General Practitioners’ Health Inequalities Standing Group.

This is wholly different from how the NHS is used to working. And given the pressure on primary care it is a big ask. But a handful of places have made the shift and are paving the way for highly effective partnerships to emerge. This includes Dr Vikesh Sharma, a Stockwell based GP who has, over the last 4 years, devised new ways of working to improve the wellbeing of the Portuguese-speaking community. Speaking about this work, Vikesh says that his role has been largely as an enabler and advocate, explaining to his health colleagues what it is his community-based colleagues are doing and why it’s working. It also includes the Alvanley practice in Stockport which has developed Practice Health Champions who help to connect community members to each other and support them to take action that is both fun and that serves the needs of the community well. At the PCN level, it includes Modality that has employed a community development worker to help to broker connections between general practice-based staff and local communities.

Models for developing this community-based working as a vehicle for improving population health and reducing health inequalities are emerging. Health Creation Alliance is hosting a further series of events, with a wide range of partners and supported by NHS England and NHS Improvement, to shed more light on how Primary Care Networks can best work to succeed in reducing health inequalities. As well as unearthing new models, we hope to answer questions such as: What skills are required to bring practices, communities and local partners together? What needs to happen to prevent link workers from sinking under the strain of expectation? How can PCNs work effectively within wider public sector reforms taking place? What should the 7th service specification contain?

We are asking delegates to come with a ‘discovery mindset’ because unless we find some solutions to these questions then nothing much will change; primary care will continue to struggle and the huge contribution it could make to population health and a better functioning healthcare system overall will not be realised.

Link to July 19 event report: https://www.thehealthcreationalliance.org/wp-content/uploads/2019/10/PCNs-conference-report_3.0.pdf

Link to the July 19 event video: https://www.youtube.com/watch?v=md_bCY_vKB0&feature=youtu.be

To find out more about each event and reserve your ticket, please click on your preferred event and complete the details:

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Join Health Creation Alliance in joining the dots at its Annual Summit on 6 December!

Health Creation, Wealth Creation

The NHS can no longer afford to operate as an isolated service that sorts out people’s medical problems while largely ignoring the social factors that cause them to be ill. This ‘isolationist’ service model is now becoming overtaken by the sheer weight of dis-ease in our society (as oppose to disease) as increasing societal pressures, poverty and stress take their toll and health inequalities increase.
A modern, sustainable health service needs to re-envisage its role and relationships within a wider ‘health system’ that must include communities and focus on what it is that makes people well. Key to this is, how to ‘create health’.
Duncan Selbie, CEO of Public Health England, and a keynote speaker at the Health Creation Alliance 2017 Action Summit taking place on 6 December, often says that the biggest determinant in a person’s health is having a job. It’s no accident that we have chosen the theme of Health Creation: Wealth Creation – the power of people and communities for our annual Action Summit. And that we have a session on Creating Health through Work.
Health Creation Alliance is leading pioneering work in ‘what it is that makes people well’. It is forging ahead in defining how a health system – not just the medical service – that has wellness at its core might function.
Health Creation Alliance started earlier this year by explaining how health is created through the ground-breaking Manifesto for Health Creation. This includes perspectives from people and communities (who are also, of course, patients), codifying this in terms of the 3Cs of Health Creation (Control, Contact and Confidence) and demonstrating how the five features of health creating practices can be adopted by professionals to bring about real change: https://www.thehealthcreationalliance.org/wp-content/uploads/2016/07/A-Manifesto-For-Health-Creation.pdf
We are now exploring how ‘wellness’ might translate and be taken-up into different parts of health and care services. We are doing this by bringing together NHS and non-NHS professionals with communities, and joining the dots together – we are a movement after all.
The Health Creation Alliance 2017 Action Summit is a pivotal moment in advancing the Health Creation movement. We want delegates from across the health and care systems to be there and play their all-important part. The Summit is specially designed to help us to collectively join the dots between poverty and a sustainable economy, via people-powered health. For the sceptics, we will also be looking at the economics of Health Creation. The summit will consider:

  • Evidence of how poverty-related stress makes people ill
  • Evidence that the 3Cs of Health Creation helps to mitigate the negative impact of poverty on health
  • The links between the 3Cs, productivity and workforce wellness
  • The roles of medicines in creating health
  • Roles for health organisations in creating health and improving local economies

We will hear from British Red Cross about the hard lessons they learned from their work with the communities affected by the Grenfell tragedy; senior leads about how Health Creation can set a new standard in health and care; the perspective from the top, from Rt Hon Jeremy Hunt MP, Secretary of State for Health.
The Summit´s best-in-class programme is brought together by an organisation that wants you to help shape your future as a health and care professional or community health creator.
We are confident that delegates will go home full of optimism that the health service can successfully reinvent itself by working alongside communities. Not only to improve people´s health, but also to improve their lives!
This could be the most exciting and uplifting conference you attend all year! ….. This is what Charles Alessi, Senior Advisor Public Health England says about our 2017 Action Summit:
“This Summit is hugely important in the journey the health sector needs to take – from a service to a system, from treating illness to creating health, from the biomedical to the biopsychosocial … whether you are in public health, primary care, a community or acute trust, local authority, housing, if you want to be part of the solution you need to be there.” Charles Alessi, Senior Advisor Public Health England
Click here for more details, a full agenda and to purchase your tickets: https://www.eventbrite.co.uk/e/health-creation-wealth-creation-the-power-of-people-and-communities-tickets-37726543106?aff=eac2
Here’s what delegates said about last year’s Action Summit
“Great inclusive atmosphere. Highlighted direction of travel / cultural shift that is happening”
“I found the whole day excellent”
“The entire day was inspirational and it was so good to meet with like-minded people”
“Got to be honest I enjoyed all of it”
“It was all worthwhile and I have taken a lot away from it”
“Sensing the change in the zeitgeist”
Merron Simpson – Chief Executive, Health Creation Alliance
 
 

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What mattered to David

This blog is written by Kay Ellermeyer, Business Manager at Alvanley Family Practice, Woodley

There were lots of reasons for us starting a practice based walking scheme, but one of the drivers was David.  What mattered to him was that he wanted to reach the top of a hill he used to sit on as a young man, and knew with his poor health and severe COPD he was unlikely to manage it again.  He had asked his wife to scatter his ashes at the top so that he could see the view of the aeroplanes coming into Manchester Airport again.
David had told us this and we felt determined to help him become more mobile.  His biggest problem was fear.  Fear of becoming breathless and the fear of failure.  Our promise to him was that we wouldn’t make him do anything that made him feel uncomfortable and we would only walk at him pace.  The first week that David joined us there were 5 other female patients with us, we could see David was all ready for the charm offensive, and had quickly made friends with all the other walkers.  So much so that we were nearly half way round before he even realised he was exercising.

There is a hill on the walk, and in the first week David stopped half way up, but he did get to the top.  After that he managed it every week, a low wall at the top served for a good resting point and an occasional joke.
What mattered to David now was that he had made new friends, he was part of a team, and he was enjoying Wednesdays.  He had a focus and some social activity that was supported and safe.
We didn’t know but he was planning to head to his childhood stomping ground to have a look at the hill that he dreamt of climbing once again.  He and his wife decided to take a stroll up it.  Speed wasn’t important but he wanted to see how far he could get with his new found confidence.  He got half way!  On deciding to stop he looked up and looked down and decided to keep going.  He made it to the top and he watched the aeroplanes circling ready to land at the airport.
The following Wednesday David came early to the walk and spoke to us about his achievements.  With tears in his eyes he told us that he had managed to achieve the thing that mattered most to him; to regain some of his confidence, to exercise and to reach the top.  He smiled like he’d won the lottery and I guess he had!

David and his wife Julie now offer support to other patient in the practice and are great advocates for our practice ethos of doing things differently.  We have engaged with Altogether Better and now have 30 patients out of our population of just under 5000 that want to help us to develop solutions to the things that matter to our patients and the community.
They have helped us develop a Wellness Prescription that the clinical team can use to signpost patients to different types of Social Prescribing.  With this we are striving  to address those 30% of patients that make appointments to see their GP for non-medical matters.  Our Wellness Prescription now offers support with health eating, money matters, loneliness, singing and growing, cooking and eating together; all things that matter to our patients and our Practice Team.

What matters to us is that our patients are well looked after by each other and by us, they have alternative routes to health and wellbeing which are supported within the community reducing the pressure and reliance on the medical team.  It’s a long journey but we are starting to get there!

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Turbo-boosting STPs? It’s time we got serious about ‘partnership’

Jeremy Hunt and Simon Steven’s recent announcement to ‘turbo-boost’ Sustainability and Transformation Partnerships (note, they are Partnerships now, not just Plans) provides a welcome shot-in-the-arm for those across the system who are working hard to transform our health service into one that truly focuses on people’s health, and not just their illnesses.
In a united front, they announced capital funding (to the tune of £325m) and increased autonomy and flexibility is being offered to the 15 best-developing STPs in a bid to create a peloton of front-runners paving the way for others to develop. Primary care hubs will receive some new investment and a new forum for national and frontline leaders to ‘have more conversations’ will also be established.
But the lack of zeal for revolutionising ‘partnerships’ which are, after all, what a shift to place-based, population-based health system is all about, was laid bare.
When challenged by David Orr of the National Housing Federation about why it is that hospitals are making a case for funds to build homes – rather than working in partnership with housing associations which are much better equipped to do this – the question was side-stepped, or not understood. Jeremy Hunt instead focused on the need to join up organisations within the NHS before being able to integrate with those outside it adding “I’d love to see a time when the health budget will pay for sorting out the damp in someone’s home … in perhaps 5 years time” … Simon Steven’s immediately adding wryly, “ … with our growing health budget”.
This is old-thinking. In places like Liverpool and Derby, CCGs monies have been funding ‘healthy homes programmes’ for some time and the NICE guidance on ‘Excess winter deaths and illness, and the health risks associated with cold homes’ makes a clear evidence-based case for spending to make vulnerable people’s homes warm as a route to improving their health (and avoiding deaths). Housing organisations are building affordable key workers homes for the health workforce and repurposing sheltered housing for step-down to alleviate the DToCs crisis. They are being commissioned by CCGs to do all sorts of things to modernise our health system, to deliver outcomes for patients and to take the burden off primary and secondary care, public health and mental health.
This has been happening for some time. If we are serious about improving health outcomes, we must get serious about money following people, about drawing the expertise from wherever it exists and stop putting cross-sector spend into the ‘too difficult’ box because it challenges us conceptually.
The P in STPs also needs to extend to seeing people and communities as partners because an equal partnership between people and services is how health creation happens(see Health Creation Alliance Manifesto for Health Creation): https://www.thehealthcreationalliance.org/wp-content/uploads/2016/07/A-Manifesto-For-Health-Creation.pdf. This new National Forum for national/local conversations must include local residentswho know how to create health in their communities. If it is limited to professionals (whether national, managerial or frontline) then a huge opportunity to transform our health systems into ones that truly deliver for people will be missed.
It is time our leaders – at national, STP and local level – understood that bringing partners in from outside the NHS is not just ‘nice to have’ but is the route to successful transformation and actively support it. The NHS can’t heal itself, it’s tried enough times already. It’s time to let others have a go!
 
Merron Simpson, Chief Executive Health Creation Alliance