As I flagged up earlier the Second National Think Tank – Active Communities for Health was held last week on the 6th of June.
The programme aims to develop a “stronger national dialogue on how we can work together to activate the full potential of our communities to improve health and well being. It builds on the February 2011 event organised by the sadly missed Health Inequalities National Support Team – which DH appears to be walking away from.
The February session had allow us to share experiences and practice with the intention of building a common understanding of challenges and opportunities. At this second session jointly hosted by Altogether Better and Leeds Beckett University’s People in Public Health Programme we aimed to identify common goals and actions to promote this agenda.
The session was chaired by Jane South from Leeds Metropolitan University – with inputs from Cllr Jan Smithies – who has led on community engagement for the DH Health Inequalities National Support Team and Trevor Hopkins who works with LGID and has led on the development of work on Asset Mapping – informed by John McKnights ABCD work in the states – Alinksy again.
The event had strong cross England attendance from a range of interesting organisations and individuals with a track record and commitment to this work. They included people like:
- Chris Drinkwater – who Chairs the Newcastle Healthy Living Network Healthworks
- Pam Essler a non executive director from Bradford Primary Care Trust
- Martin Wilson from Lincolnshire County Council – who are doing really interesting work getting strong community engagement in their JSNA;
- Mina Jessa from NHS Luton – who have implemented a community engagement strategy that has a powerful focus on the Equality responsibilities
- Thara Raj from NHS East London and the City
- Olivia Butterworth – DH Big Society and Voluntary Sector Lead
There were plenty of others – the point is that we have the beginning of a strong and inclusive network. Some themes emerged:
First, we know that there are plenty of examples of excellent practice at a local level although much of it is not whole system – but some is!
Second, there is an almost complete absence of this agenda at a mainstream national policy level in DH.
Third, there are quite of lot of opportunities – such as:
- Relationships with other players – such as Locality
- Emerging Government and DH policy to influence – the “Command Paper (whatever that is) – which will precede the final bill”
- Direct Enhanced Services funding that is going to GPs
- Engaging with NICE on the refresh of community engagement public health guidance
Fourth we were clear that the urgent job was to identify which strategically important practical tasks we could get on with that would deliver 3 immediate objectives.
- Attract a wider membership
- Raise our profile
- Deliver some practically useful short term actions
There was a reasonable consensus that we should not spend too much time grinding out complex terms of reference and organisational structures – we need something that is light on its feet.
While the final notes are still to be written up some of the things that emerged for me included:
- A virtual environment to support and connect champions who are trying to drive this agenda forward at a community level.
- Offering thought leadership through a series of articles that raise the profile of this work at a national level
- Giving some thought to a communications strategy which uses virtual media such as facebook, blogging and webinars.
- The need to develop our links with key national organisations such as Locality (Altogether Better meet with them soon) and Community Matters.
So – I think a really good start – some great connections made and our journey gathers pace.
National Think Tank – Active Communities for Health
As we await the Government’s response to the “Pause” and its response to its various consultations I was reflecting again on its draft public health strategy – “Healthy Lives, Healthy People” and the associated Public Health Outcomes Framework.
In part this was prompted by a recent posting by David Buck on his Kings Fund blog – but also by the fact that tomorrow I am helping to run a National Think Tank – Active Communities for Health which is organised by the People in Public Health Team at Leeds Metropolitan University. It will be considering how we can develop a stronger more organised way of seeking to influence the Department of Health in particular in order to advocate more powerfully for public health solutions that are based on greater partnership with citizens and communities.
There is considerable experience on the ground in developing small but influential services that are based on strong relationships with people – particularly those from disadvantaged communities. I have written earlier about Darnall Well Being – but they are not alone. Altogether Better has now trained over 12,500 community health champions in Yorkshire and Humber and in the Northwest there are excellent organisations like Unlimited Potential working in Salford.
Yet when we look at Department of Health Policy like the public health strategy – but also other work like the recent Mental Health Strategy or the Tobacco Control Strategy – the importance of relationships with citizens in co-design and co-delivery barely merits a mention. When it is there it is usual in a “case studies box” – a clear sign that it is still seen as being in the “interesting and innovative category” rather than the mainstream one.
This is particularly frustrating because I think that we are on the cusp of being able to offer practical, evidence based ideas that would lead to significant system redesign that could create the conditions for more empowered citizens who are more knowledgable about their own health and well being and more able to take control of how to improve it.
But we need commitment and interest at a national level to maintain the momentum – hence the event tomorrow.
Darnall Well Being
Last week – I facilitated an awayday of the Darnall Well Being Project. This fantastic organisation based on the principles of the Peckham Settlement has been going for over 10 years.
Darnall is part of Sheffield and has a population of about 12,000. It is one of the more deprived parts of the city – but also has many strengths – a diverse population, great community organisations and of course Colin Starsmore one of the last proper tailors in Sheffield – who retired in 2014.
There were approximately 30 people at the away day of whom over half were local people who are involved as volunteers – as Community Health Champions – or users of the project or as staff – such as Health Trainers.
A couple of things struck me.
First – much of the funding for organisations like Darnall Well Being comes from the NHS – usually public health budgets in the PCT. This can mean that they are rely on champions in the NHS who understand what they are trying to achieve, and in particular value and understand the relationship building work that they do between statutory services and communities.
The problem arises when budgets are cut or requests for funding turned down. The NHS has little tradition of local democratic accountability and little expertise here. This means that funding decisions are usually made in internal meetings between professionals (in this case public health) and bureaucrats who are responsible for commissioning. The greatest degree of local accountability is when a decision goes to the PCT board for discussion – and most of us do not know when this meets, who is on it and how to influence it.
Of course most of us have little experience of lobbying PCTs and their boards and tend to rely on the advocacy of professionals employed by the PCTs. This is in complete contrast to our relationship with local authorities.
I am not claiming that local authorities are perfect here. But many more people understand how to bring pressure to bear on local authorities, how to lobby them, how to make the case for their communities. Whether this is through putting pressure on local councillors, attending council meetings or area meetings, petitioning the town hall, demonstrating outside it or even writing to the local press.
Because we do not understand local NHS processes, have little tradition of lobbying here and are seduced into thinking that somehow the discussion is more evidence based than that which occurs in local government we are disempowered and do not lobby and get in the face of commissioners.
We let NHS commissioners off the hook.
Second thought. On a more positive note I was interested to hear from a nurse at one of the practices in Darnall that one of the challenges they face – in an area with a very high prevalence of diabetes – is that they struggle to get people to go for check up visits and screening.
This led to an interesting discussion about the potential offer that Darnall Wellbeing could make. It is the health and well being organisation that has sustained and coherent links with people in the community. It is in the best position – using its networks – the expertise of its volunteers and service users – to promote screening and to support people attend screening. The away day agreed to follow this up and talk to GP practices about piloting this intervention. More on this as this develops
Mental Health and Welfare Rights Symposium
Improving Mental Health and Wellbeing – The role of advice and advocacy
National Symposium – 20th of May 2011
This is a summary of the key note address I gave – in my role as Chair of Sheffield Mental Health CAB
Sheffield Mental Health CAB had organised this symposium in partnership with Sheffield Health and Social Care Trust and Citizens Advice.
There is a strong evidence base that shows the strong correlation between debt and mental illness. Which makes it all the more unacceptable that Government Policy does not create a positive and supportive environment to ensure that as a minimum all people with acute mental health problems have access to specialist welfare rights provision as a matter of course.
The evidence appears in official Department of Health documents such as “Improving Efficiency and Quality in Mental Health” which is a supporting document to the Cross Government Strategy “No Health without Mental Health” which was launched in 2011.
This publication uses much of the work done by people like Martin Knapp at the London School of Economics. So we see in the document information about who is likely to be in problematic debt:
“8% of the general population are in problematic debt, this figure rises to 24% for those people with moderate mental ill health such as depression and 33% for those with a Psychosis.”
There is also detail about how debt support services can help people recover from mental ill health and of the resulting savings to the NHS and gains to personal well being and productivity which outweigh the costs of providing the debt support service. The detailed calculations behind these costings are in the “Impact Statement “ (February 2011) produced as part of the Mental Health Strategy.
However, this evidence does not go far enough. The impact statement fails to show the relationship between interventions and how by doing a number together there will be greater efficiency gains.
This is one of the reasons why “No Health without Mental Health” hardly mentions the importance of welfare rights services and instead focusses on provision of Cognitive Behavioural Therapies – which taken in isolation appear to have a bigger impact than debt support.
I think that this completely misses the point. Universal access to good welfare rights services would be likely to make other clinical interventions such as CBT more effective, by helping to relieve people of one of the main factors that is causing them anxiety – personal debt.
Of course those of us who work in the welfare rights sector know that Debt Support is just one element of a good welfare rights service. There are a range of other services which are not recognised in the governments mental health strategy. These include Housing Advice, Support and Advocacy to address issues of personal harassment or discrimination and advocacy work with clinicians and others for people who are clients of the mental health service. All have a role to play. Not least because the experience of many people with an acute mental health problem is of heightened vulnerability, prejudice, difficulties with communication and so on.
At the moment it is the exceptional care trust and PCT (I suspect that Sheffield Health and Social Care Trust and PCT are one of the few) who support a coherent in house welfare rights service that works directly with people while they are on the wards and in day centres. Helping them address their financial liabilities, secure their housing and address other concerns – that will mean that when they return to the community they are more likely to have a secure home and a degree of financial security.
The same situation applies to community provision – there are shining examples such as the almost 100% coverage of GP surgeries in places like Derbyshire and the Wirral. Experience shows that many of the people who use these services have diagnosed mental health problems. Even here these services are vulnerable – they are often funded from public health budgets. It should be a ‘no brainer’ this is a primary care service – helping people to live successfully in the community and should be funded by GPs directly. Despite these examples it is the case that most PCT areas do not have such provision.
So what can be done?
Some starters for 10 – at a national level we need
- A clear narrative that sets out what good provision for people with mental health problems should look like. A cornerstone to this provision should be good access to welfare rights and advocacy provision in the communities AND on the wards and in the day centres of acute care NHS provision.
- Further development of the evidence base to empower local commissioners to invest in welfare rights provision for people with a mental health problem.
- A programme of development funding to support further innovation and capture and disseminate existing good practice from within the welfare rights sector
What do you think?
Local Democracy and Health 