Health and wellbeing

seen from the ground

Elizabeth Bayliss

Social Action for Health March 2013

On the ground in east London

• People are fearful of the changes to benefits

• People are fearful that the NHS is going to be lost

• People are fearful that they will never work again

• People are fearful of a government that does not care

NHS seen from the ground

• GPs are now in charge; they are so busy they do not listen; they never do an examination;

• GPs only ever give me paracetomol; • My GP will not refer me to a specialist so I wait til I go

home (abroad) and pay for examination there; • Why not go to A&E when I need medical help quickly?• Out of hours doctors do not have my records so what is

the point? • Where are the interpreters now? How can I describe my

condition when the doctor does not understand me/• Why are there no ESOL classes anymore?

It takes two to tango!

• NHS behaves as though it can sort out health inequalities and rising demand on its own or somehow through the mystical intervention of the market

• The relationship between the NHS and local communities is squeezed through the narrow conduit of ‘community engagement’ which is a reductionist process that leads to an impoverished relationship

The relationship matters

• There are no shortcuts

• Relationships between human beings are always transactional - what is the nature of the transaction;

• There has to be a balance of expectations

• Professionalism can get in the way, leading to a manufacturing of dependency

SAfH values

• We start with the people • People have the right to take control of

their own lives • People’s health can be improved by

tackling isolation, poverty, racism and unemployment

• Healthy communities are good for the whole society

SAfH Spiral of Participation

• SAfH spiral of participation

SAfH’s role

SAfH sits in the community, encouraging local people to take more responsibility, to reduce their dependency, increasing their ability to be self determining;

We find that people to want to take responsibility - to be of use in their community – no place for paternalism;

We work within social mores , respecting leaders;We listen to what people say, preferably in mother tongue, drawing out

meaning from their experiences;We give local people accurate information about complex issues like

morbidity and mortality rates so that people can see themselves in relation to the wider world;

We teach people how to engage with professionals so that the communication both ways is richer and more useful;

We tell people with power and authority what we have heard in words the powerful understand.

What this means on the ground

Focus on the people:√ reach out (on the streets, in community centres, in public

places);

√ start conversations (We use the promotion of cancer screening to start conversations about self care).

√ bring people together – cross culturally

√ teach people new skills – go step by step

√ encourage these to be shared - Build up mutuality

√ promote health intelligence – ability to make sensible

decisions about own health and wellbeing

Who does the work?• Local people, who are lay, trained, paid, supervised

and supported, with multiple languages • We have 100 people at any one time whom we have trained as

Health Guides, Mental Health Guides, Self Management and Good Move tutors, Ambassadors, Community Health Champions, Mentors, Representatives.

• We have a staff team of around 25 people who support, record, report, manage, coordinate, teach these local people; manage networks of community groups providing information and advice; evaluate work and aim to influence policy and practice.

Is the work useful?

• Screening take – up increased• Demand on GPs from people who have been through a

self management course reduced• Benefit entitlements secured and appeals won • People empowered personally, with evidenced

improvement in health and wellbeing;• People more confident in communicating with their GP; • Voices heard by decision makers through platforms eg.

Open events; • Health Action groups formed• Community groups forming networks.

Scale and impact

SAfH works with 11,000 people a year directly but this feels like small fry;

Work needs to be rolled out big time;

Funding needed to evaluate work eg. Impact on A&E; eg. impact on communities

Tips on policy direction!

• Funding for evaluation on community development approach

• Hospitals and primary care to be encouraged to collaborate on such evaluations

• Funding for community work at a local level necessary

• Meta narrative – honour the public arena