The growing interest in the prevention agenda has led many health and care systems to start to create services which aim to improve access to voluntary and community organisations, but few commissioners have considered whether it is necessary to take a strategic, whole system approach to engaging with this sector. Instead we usually see the commissioning of gateway services like social prescribing.
This goes against all other commissioning. For example, no one would consider increasing access to primary or urgent care without taking into account current capacity and capability.
Lets look at some of the options that exist…..
Social Prescribing
A lot of local health and care systems have leapt on the social prescribing bandwagon – seeing this as a practical way to unlock access to community assets. I talked a bit about this here. I know that there are a variety of models but in essence it is:
- available across a whole system
- reliant on the prescriber – often GPs
- primarily concerned with matching individuals to specific services (statutory or none statutory) that already exist
- not about building long-term relationships with the social prescriber
Some social prescribing services do include funding to support existing services respond to increased demand or help new services develop. One of the best examples is Rotherham.
Local Area Co-ordination
Leeds Beckett is currently working with Waltham Forrest on their Local Area Co-ordination programme which presently covers 4 wards. Local Area Co-ordination started in Australia. LAC are reluctant to use terms like “client”, ‘referral” and “service user”. They talk about walking alongside people to help them make their own steps towards what that person might see as a “good life”. While the language might feel a bit clunky it’s a useful challenge to deficit led models and assumptions about the primacy of service led support.
I like the LAC model for three reasons:
- neighbourhood focussed – LAC co-ordinators tend to operate at ward level.
- relationship – they are focus on building relationships with people – not just with people who a Local Area Coordinator may “walk alongside” but also with those in a community who have strengths and assets.
- targeted – they aim to be responsive to people who have slipped through the net – precisely the sort of people who may not be picked up by social prescribing or whose needs are too complex to enable them to use some services effectively without help.
Community Health Champions and Community Health Educators
For the last 15 years I have had more or less continuous involvement in a range of initiatives to support people become more active in their communities as “Community Health Champions” sometimes these have been with the direct support of their local authority
I have gone on about these before. I remain convinced that this model which is basically about building a structural relationship with a community which includes physical assets such as buildings as well as people is tried and tested and is particularly relevant in neighbourhoods that have a long history of economic and social exclusion. The model has been around for over a hundred years and has various iterations – such as Settlements, Social Action Centres and Healthy Living Centres. The photograph below is of the Time and Talents Settlement in Bermondsey that is still in existence over 100 years later. I love the name – it shows that asset based approaches ain’t new! Also see this 1899 paper by Jane Addams on the Hull Settlement in Chicago – A Function of the Social Settlement (thanks to Heather Campbell).
Cast aside?
There are other models such as Health Trainers. Some health trainers cover similar ground to social prescribing, Local Area Co-ordination and Health Champions combined. Indeed, there are a number who are based at a neighbourhood level in Community Anchors. Nonetheless the Health Trainers model is under threat. I think this is largely because institutional memory is short and as public health teams have diminished some of the champions for this approach have disappeared.
What next?
While I think that we need to move from considering how the voluntary and community sector can help statutory services to considering what types of services need to be in place to respond to a variety of needs. I see little of that – however, there are a number of places that are beginning to try to understand the scale and contribution of the VCS – that is a start; for example:
- Calderdale CCG has invested £3m over three years in supporting Voluntary Action Calderdale improve the capacity of the sector
- Community Foundation for Calderdale are just about to undertake a mapping of the the sector with the aim of raising its profile and understanding its challenges and contribution.
- Waltham Forrest have set out plans that seek to take a balanced approach between some of the interventions I set out above.
- East Sussex have a major programme to build VCS capability and assets.
What do you think?