Self-care Building Health Partnerships

1. Self-careBuilding Health Partnerships @IVAR_UK @SocialEnt_UK #BHPselfcare

2. National programme aims ‘…build trust and mutual understanding around work with the Voluntary Community & Social Enterprise sector and citizens in 8 areas of the country.’ ‘Support senior, cross-sector leaders to develop and exercise shared local leadership to wellbeing and self-care.’ @SocialEnt_UK @IVAR_UK #BHPselfcare

3. Programme core group • Members of the Prevention workstreams for the 2 North East • Sustainability and Transformation Plans (STPs) • Guy Pilkington – Chair Newcastle Gateshead Clinical Commissioning Group • Jane Hartley – Chief Executive, VONNE • Amanda Healy – Director of Public Health, Durham County Council • Chris Drinkwater – Chair Ways to Wellness • Tom Hall – Acting Director of Public Health, South Tyneside • Catherine Parker - Health & Wellbeing Programme, Lead Public Health England North East @SocialEnt_UK @IVAR_UK #BHPselfcare

4. Look at how this programme can engage with the 2 North East Sustainability • & Transformation Plans • Define what we mean by self-care in relation to community asset based approaches • Build on the recommendations from the North East Combined Authority NHS Health and Social Care Commission • Build consensus around where we want to get to • Look at what we have that supports us • Explore how we will communicate/share beyond today Why we're here today… @SocialEnt_UK @IVAR_UK #BHPselfcare

5. Guy Pilkington Chair of STP Prevention Work streamChair of Newcastle Gateshead CCG

7. STP CCG CCG CCG CCG CCG CCG

8. Prevention Workstream Work Plan • COMMUNITY CENTRED AND ASSET BASED APPROACHES Ambitions: • Enhance people’s ability to self-care, increase their independence, self-esteem and self-efficacy

9. Asset based approaches and health creation

10. Challenges • Beyond a medical model • Shifting to prevention • Using your assets • Moving the money

11. Jane HartleySTP Prevention Work stream VCSE, Chief Executive - VONNE

12. VCSE role in Health, Wellbeing & Care • ‘VCSE sector has significant expertise that is invaluable in helping us achieve improvements across the health, social care and public health system’ Department of Health, NHS England and Public Health England • Support focus on early intervention, prevention & self care/management – NHS & LA (Care Act) • Key to NHS strategic shift - acute care > prevention, community based care & support & self management

13. Joint review of role of the VCSE sector in improving health, wellbeing and care outcomes & partnerships Department of Health, Public Health England, and NHS England

14. The VCSE supporting health & wellbeing and tackling inequalities No wrong door -The sector’s strength lies in its holistic, community-embedded and personalised approaches. Track record of trust – local people trust us! VCSE organisations promote understanding of the specific needs of their communities. Its diversity, flexibility and level of innovation helps it reach and support those hardest to engage Builds emotional resilience and promotes self-care and independence Facilitate asset based approaches and co-production Expertise of lived experience in designing more effective, sustainable services

15. Developing services and policies together • Many small organisations are struggling to make links with and gain acceptance among local GPs and commissioners. • For health and wellbeing to be community-based and collaborative, statutory systems need to learn to work with the VCSE sector- large and small • Co-production requires “mutual respect between commissioners and VCSE organisations”

16. How do we carry through a principle of asset based approaches to improving health outcomes?And…What do we need to do to implement a common approach?

17. A virtual network of local authority leads on community and asset based approach's who have developed 3x annual conferences which have included; - Opportunities to share emerging practice and lessons learned from differing models of integrated wellness services - Learning from existing community based approaches across the 12 Local Authorities in the North East - Reviewing local practice against the “Family of community interventions” and emerging evidence. - Identifying priorities for shared action on workforce competencies and measuring success. • Stakeholder engagement exercise informing Report of Commission for Health and Social Care Integration. What have we got to build on? @SocialEnt_UK @IVAR_UK #BHPselfcare #BHPselfcare

19. Realising the Value ‘…health and care system to support people to have the knowledge, skills and confidence to play an active role in managing their own health and to work with communities and their assets. Realising the Value was not about inventing new approaches, but rather about strengthening the case for change and identifying evidence-based approaches…. It also sought to develop tools to support implementation across the NHS and local communities…..therefore considered the behavioural, cultural and systemic change needed to achieve meaningful transformation.’

20. Person- and community- centred approaches

21. How can we embed social prescribing across the NHS? July 2017 Bev Taylor

22. NHS England Commitment: “ We will work collaboratively with the voluntary sector and primary care to design a common approach to self-care and social prescribing, including how to make it systematic and equitable” (p.45 Next Steps for the Five Year Forward View)

23. Introduction to Social Prescribing What matters to you? ‘Co-produced’ – meeting people, getting active, support

24. Different Models: Not one size fits allbut here’s the Rotherham Model • IMPACT (Independent evaluation by Sheffield Hallam University) • In-patient spells reduced by 11% and 17% drop A&E attendance for all patients • For U80’s, receiving long term support from VCSE groups, 51% drop in-patient stays, 35% fall in A&E attendances.

25. Key Ingredients An asset-based approach – what do you already have ? No one size fits all – different models Shared local leadership – don’t worry about hierarchies Build it together, all partners important Can’t expect the voluntary sector to do everything for free! Collaboration and generosity, in spades – what offer can you make? Willingness to learn and share with others

26. We’re building a ‘social prescribing movement’ Support for local commissioners Working across government – broader than NHS We’ve got lots of support, from different places What have we done so far?

27. Priorities for the future: We’re starting to work on developing a Common Framework to build the evidence base – measure impact on people, system and communities Quality Assurance Framework Develop the national and regional support networks Support to CCGs, STPs and Accountable Care Organisations

28. About the Social Prescribing Network • Join the National Network and get on the mailing list – socialprescribing@outlook.com • Attend regional social prescribing network events • Contact me for connections to others: bev.taylor1@nhs.net

29. Engaging citizens What’s most important about planning health and social care? @SocialEnt_UK @IVAR_UK #BHPselfcare

30. NHSE Five Year Forward View

31. What do community asset based approaches to self -care look like here in the North East? ? @SocialEnt_UK @IVAR_UK #BHPselfcare

32. Asset Based Approaches to Wellbeing in NE- Examples • Ways to Wellness – Social Prescribing via Social Impact Bond, Clinical Commissioning Group (CCG), VCSE, Social Investors in Newcastle West • Wellbeing For Life Co. Durham – Partnership VCSE, NHS Foundation Trust, Local Authority (LA) • Stockton & Hartlepool Health Initiatives – Compact Award- collaboration between CVS/CCG & LA • Ageing Well Middlesbrough – collaborative approach including VCSE, LA and CCG • Live Well Centre Middlesbrough- Health Champions & Health Trainers • ReCoCo Recovery College Collective – mental health • Hartlepool Action Lab – Community Researchers , Community Projects • Live Well Gateshead - 1:1, group work, asset-based community capacity building –now decommissioned • Pattinson House & Edberts House – Community Projects Gateshead • Community Agents Service Redcar & Cleveland – Tees Valley Rural Community Council

33. What might be the best ways to utilise these approaches to tackle some key (costly) health problems? And to see this better reflected in the North East STPs?

34. Possible options for development through Building Health Partnerships • A – across the North East • A co-produced, standardised framework for asset based commissioning • Develop a more consistent approach to Social Prescribing • B - health condition locality based • A reduction in prescribed anti-depressant/antibiotics use in [X] area • Musculo Skeletal conditions - looking at what people’s choices/alternatives are • Tackling poor mental health through asset based approaches @SocialEnt_UK @IVAR_UK #BHPselfcare #BHPselfcare

35. Tasks to take away • What do I bring/what we can collectively do? twitter.com/SocialEnt_UK @SocialEnt_UK @IVAR_UK #BHPselfcare

36. Language: Jargon that might get in the way • The terminology ‘self-care’ could be a barrier in itself • ‘The language of social prescribing pushes activities into medical language’ • ‘self-care is professionals’ agenda, my community would say self-preservation’ • ‘self-care is heard as ‘no care’!’ • What does self-care and social prescribing really mean to communities? What do communities want? Need to acknowledge that these terms mean little to people or may be understood as self-care means no care! • If you want to encourage people to think beyond health then you need to drop the ‘prescribing’ from social prescribing. There is a risk of pathologizing the human social experience @SocialEnt_UK @IVAR_UK #BHPselfcare

37. Self care in the local context • Commissioning beyond outcomes • Lack of understanding/too medicalised understanding of self-care e.g. going to GP to get pills to make you better • On the ground/media view is focussed on cuts and negativity ‘left to fend for yourself’ – language/image is a problem • Self-care = control of your own health/health condition as a road to independence and happiness • Self-care to prevent illness • Cultural shift of responsibility to patient • Elderly communities coming together to tackle social isolation and support one another • A system in which organisations share information, community connector/link workers connect people with services and the community decides what this looks like to the local community @SocialEnt_UK @IVAR_UK #BHPselfcare

39. What worries people about self-care locally? • The medicalised model dominates and doesn’t take into account other issues – for example housing, employment and finance which may be impacting on someone’s health. • The language and context around self-care is too health focused. • Potential that NHS will medicalise community led approaches and imposing a top-down view. • GPs do not recognise peoples’ non-medical/wider issues or understand what the VCSE brings. • Role of social prescribing navigators and level of knowledge and training given to those people. • Smaller groups working in social prescribing don’t have governance structures to allow commissioners to use them. • Sustainability depends on change being user-led/citizen-led in complex social environments. • Self-care blames the victim / the individual. • The ‘prevention lag’ – no short timescale prevention programme will see results in its lifetime. • Resources are not currently organised in a way to support these self-care approaches. Voluntary sector organisations are under-resourced. • The challenge of convincing funders that it is the right thing to do: ‘we need trust in the evidence and confidence that outcomes will follow’. @SocialEnt_UK @IVAR_UK #BHPselfcare

40. Shared understanding of local priorities • Resources need to be organised in a way which supports VCSE organisations deliver self-care - genuine shared resources and shared commissioning across sectors • VCSE organsations need to be able to demonstrate the difference they make and to be recognised and valued. VCSE organisations need help to make better use of what they currently measure • Prevention should be an integral part of all care pathways and demands longer term thinking. • More training needed for GPs. Assessments that aren’t just health focused: ‘you won’t treat alcoholism if they don’t have a roof over their heads’. • A broad cultural shift is needed away from medicalised thinking (‘which presents a pill as the first form of treatment’) within health sector and in communities. • Think about how STP goals transfer to the local • Understand what’s out there and how we might scale it. • Improve communications and sharing @SocialEnt_UK @IVAR_UK #BHPselfcare

41. Worked up themes: 3 possible areas for joint action • The ‘prevention lag’ – ‘a system that is confident and trusts that it is doing the right thing’ -making sure VCSE organisations are able to demonstrate their impact/outcomes/difference in a meaningful way and that commissioners recognise that results of prevention programmes may not be evident until well after a programme has finished. • Money (shared/doing the right thing) – shifting the funds – this means commissioning beyond outcomes for the longer term and changing language and mindsets. ‘Evolution of services in health and beyond.’ Effective allocation of resources, effective partnership (system), holistic approach to health prevention, Citizens value non-medical help, money follows the individual not the organisation, individuals have control over the support they receive. • Investing in community assets – coproduction to identify community assets. VCS inclusion in multi-disciplinary teams ‘making every contact count’ approach. Maximise on local environment and physical assets. VCSE is valued Thematic/underpinning principles for self-care/prevention Developing aconsistent approach to self-care and prevention, where services are available, accessible and ‘person centred’. Resources are shared across the system and decision-making and accountability are shared. Culture change, leadership, supporting link workers, prevention as integral to all pathways with a longer term view. @SocialEnt_UK @IVAR_UK #BHPselfcare

42. Summary of actions to take away • Describe the common goals and challenges and create a mechanism to connect to Health/NHS bodies (catch upwards, bottom up – not top down) • Creative joint ownership at local level – what works? Model the approach • Explore ways to move away from the medical model, including use of language • Share community engagement ethos priorities with Public Health workforce transformation. Include STP workforce group and local Workforce Action Boards (Health Education England) • Make links to the mental health workstream of STP • Review /share the Durham model • Use principles from here in the development of the cancer framework • Share learning from the ‘health as social movement vanguard’ • Learn from/link into the NHS Distributed Leadership model • Invite Newcastle Uni social leaders network • Target children and young people’s organisations in next meeting @SocialEnt_UK @IVAR_UK #BHPselfcare

43. Thank you.