beyond healthcare - exploring new approaches to local health

Beyond healthcare – exploring new approaches to local health

Tuesday 9 February 2016

Follow the conversation on Twitter at #beyondhealthcare

What we’re learning about approaching health beyond healthcare

— In 2014 Guy’s and St Thomas’ Charity commissioned an agency to get out and about and talk to local people on the street about what health meant to them, how they looked after their own health and what they saw as important.

— We learned that:

– people are largely aware of how to stay healthy but do not prioritise their health;

– key life events can lead some people to focus on their health, whilst others no longer prioritise their health;

– mental health is seen as a core part of being healthy; and

– people see health as more than just the ‘avoidance of illness’, and that there is a strong interaction between health and self-betterment



— In 2015 we decided to build on that insight and commissioned a piece of research into community-defined approaches to health. We wanted to review the evidence available to answer one question:

Whether increasing individual and community agency – to define and achieve health on their terms – leads to improved health outcomes



— Work is in progress but initial insights suggest that:

– The word “health” is rather slippery. It can have a broad meaning, but because it can also mean absence of illness, it is easy for discussions and programmes to fall into that narrower focus.

– That agency is a tricky idea as well. Whilst this is a complex area, the research suggests that the vital ingredient is that people believe that they are able to change the things in their life that are important to them.

– It is not enough to recognise that there is more to life than avoiding illness, and that housing, education, jobs or the quality of your street are important. How we go about supporting change really matters – citizens and residents need to feel ownership of the change, not subjects of it.



Parents and Communities Together (PACT)Imogen Moore, Citizens UK


Parents and Communities Together (PACT)Strengthening Babies’ Futures Through Community Organising

COLLECTIVE AND SELF-EFFICACY FOR HEALTH

A HOLISTIC PREVENTATIVEAPPROACH

SUPPORTING PARENTS- Reducing social isolation- Peer to peer support- Parents sharing expertise- Understanding how to access health services and articulate needs

A SUPPORTIVE COMMUNITY- Community organisations sharing information and best practice

A COMMUNITY TAKING ACTION - Informing the design and delivery of health services- Housing; repairs, exploitativelandlords, affordable housing

Parents developing as leaders

Parent Champions- Signposting to

relevant support (housing, immigration etc.)

Community leadersready to respond

proactively to issues affecting parents

• MUMSPACE & DADSPACE - parent led supportive communities where the focus is on parental wellbeing and peer to peer support.

• PARENT UNIVERSITY – a parent and health professional co-designed course for pregnancy and the first year of life, supporting parents to be better informed about healthy behaviours, access to services, and how to articulate their health needs.

• THE PARENT CHAMPION NETWORK - members of civic institutions are trained to support and signpost pregnant parents and parents of babies to services.

• PARENT LEADERSHIP – parents are encouraged and supported to take action to improve their communities and health services and to find solutions to tackle the social determinants of health.

IMPACTRESULTS FROM THE PILOT2013 pilot funded by GSTT Charity followed 15 mothers over 9 months and showed:• Feasibility acceptability• NICE compliance• Significant improvements in GHQ-12 assessed distress and social capital

EXPECTED OUTCOMESProtective factors, building resilience: 1. Parental social capital, mental health, health literacy & parenting2. Infant health & development to 18 months, e.g.- weight gain trajectory- social & emotional- early language (school readiness)Evaluated in a matched case control design (NIHR RDS)3. Communities working with Maternity Services4. Group of organised local mothers able to express views on health

priorities and service improvements

LESSONS SO FAR

Tackling issues beyond healthcare• Many health professionals are frustrated about the wider societal issues

which negatively impact on the health of their patients. There is appetite to engage in campaigns and to work with civil society to find solutions. They are often frustrated that there is little scope in their clinical role to do this.

• Engaging women in their own language and providing support with learning English has enabled Spanish speaking mothers to grow in confidence and to access other parts of the project and services that require them to speak English.

• Sharing food is a great way to break down cultural and language barriers.• Parental engagement in a housing campaign and teams working to improve

local GP surgeries has demonstrated that parents have capacity and want to lend their voices to improving their community and services.

Parents as leaders• Parental leadership can start with something as simple as being asked to

make the tea, before moving on to running sessions. Parents often have lots to share, they are just waiting to be asked.

• Involving parents in the design and implementation of activities and programmes increases their confidence and contributes to their self-efficacy and wellbeing.

• It is more sustainable supporting a parent to develop their skills to solve their issue themselves.

• Parents appreciated not being treated as just clients.Organising communities• The recruitment of twelve organisations to the parent champion

network has demonstrated that there is appetite to work collaboratively to support community led early intervention.

Project Manager – [email protected]@imogenmooreuk

mailto:[email protected]


Lambeth Living Well Network HubJeremy Swain, Thames Reach


Jeremy Swain – Chief Executive of Thames Reach and chair of the Provider Alliance Group

Lambeth Living Well Network Hub

Living Well Network Hub: the problem it is seeking to address

• Shifting resources from a crisis-response model to an early intervention model

• High cost/low volume lower cost, higher volume, higher quality

• A networked offer of community support with strong primary care links - 1500 people to be diverted from secondary care each year (by year 3)

• Shifting of funding from secondary care to the wider Living Well Network

Proposed change in £69 million total investment – 2014-15 to 2018-19

The Hub:the new front door to mental health services

• Thames Reach (Community Options Team)• Certitude (peer support)• SLaM (clinical expertise)• London Borough of Lambeth (social workers)• Clapham Family Practice (GP+ nurses, OT)

Not: IAPT, LEO or specialist mental health services

Living Well Network Hub:the model

Living Well Network Hub:the principles

Beyond the medical intervention…

• Housing – retaining accommodation, improving living situation

• Employment and skills – increasing employability and confidence

• Strengthening family relationships and social networks• Broadening interests

For example… the tale of M

• Exhibiting problem – depressive symptoms• Underlying issue – family relationships and lack of personal

control• Self-selected aims: Meet new people, get away from home,

get a job• Achievements: maths and IT classes at the Mosaic clubhouse,

move to an area closer to his family, greatly improved self-sufficiency

Introductions are medically focused

Achievements and learning

• 1056 people offered personalised support• Earlier (‘wobbly day’) interventions because of lower referral

threshold • Reduction in secondary care caseloads of 25% (NB: the Hub is

part of a wider system change)• 32% reduction in the amount of referrals to secondary care

compare to pre-Hub period• Increase of the flow from secondary care through GP+ Team

(70 people)

What else needs to change?

• Improved data around measurement of progress (WASAS)• Strengthening of contacts with housing • Improved engagement with some GP practices• Strengthening of the peer support element• Stability in staffing• More self-introductions


Thank you

Visit www.gsttcharity.org.uk or follow @GSTTCharity to find out more about our work

beyond healthcare - exploring new approaches to local health

Health & Medicine