Lord Victor Adebowale CBE Co-Chair of the APPG on Complex Needs and Dual Diagnosis

1. Welcome to the APPG meeting on Health Inequalities and Community Development 16 October 2014 Lord Victor Adebowale CBE Co-Chair of the APPG on Complex Needs and Dual Diagnosis

2. Speakers: Brian Fisher, Patient and Public Involvement Lead, NHS Alliance Elizabeth Bayliss, Chief Executive of ‘Social Action on Health’ - a London based Community development Charity Dr Niall Macleod, A practising GP in the South West

3. Community development in practice Elizabeth Bayliss

4. Social Action for Health • A community development charity with a focus on health and wellbeing • Promoting self determination • Building the confidence of local people, cross culturally, to become more creative, critical and reflective in their contributions to social life • Enlivening public life, since public life makes fruitful ground for the development of wellbeing

5. SAfH Spiral of participation

6. A range of projects – 20 projects a year • Advice and information – one to one sessions • Health improvement – individuals’ health improves • Community participation – in service improvement, based on direct experience • Community leadership – learning new skills to become more useful • Mutual support networks – sustaining changes in lifestyle, new ways of being in the world • Independent community action – people taking action for themselves on their own terms

7. Advice & information • Working with 10,000 people a year • across 40 GP surgeries • in Hackney and Tower Hamlets • Raising an extra £ 7 million a year for spending in local deprived communities • Supporting 3 networks of community organisations to collaborate; • 16 local organisations employ local people as qualified advisors who work in mother tongue (so no interpreting costs)

8. Evidence based direct health improvement • Weight management for adults in group settings • Diabetes health and wellbeing exercise groups • Self management courses (including now, epilepsy)

9. Community participation in service improvement • Maternity (Mothers Support Group) • Mental health (Peoples’ Network) • Chronic health conditions (Patient Network)

10. Mutual support networks • Peoples Network - mental health user-led, user-run self help network • Patients Network for living with long term health conditions • Peer Support Network for people with severe physical disabilities

11. Community leadership • Health Guides: running groups, giving information on services, gathering narrative on experiences to feed into policy (Tower Hamlets & Wimbledon) • Mothers support group: recent mothers come together to learn, mandating, supporting their chosen representatives on the Maternity Services Liaison Committee (Tower Hamlets & Newham) • Peer mentors: mentoring others with long term health conditions in self management (Westminster, Harrow) • Community educators: running groups, promoting health and wellbeing in community settings, giving information, promoting sharing of experiences, teaching people how to communicate with professionals (Waltham Forest & Harrow) • Compassionate Neighbours: supporting carers and families of people dying at home (Hackney) • Patient leaders: representatives of patients, feeding into Healthwatch (Tower Hamlets) • Community researchers: community asset auditing, evaluating service impact. (Hackney, Tower Hamlets & Harrow)

12. Independent community action Health wisdom groups: • Encourage people to use their own health intelligence • Get changes made (parks opening hours) through collective action • Raise awareness in schools and community settings of health threats (poor eating, transfats, vitamin D deficiency, drugs and alcohol, risk from no exercise) • Teach people how to communicate best with GPs to make best use of services • Promote community engagement in research projects (East London Genes and health) that will benefit society in the longer term.

13. Complementing the NHS SAfH brings people together, cross culturally, to take part in projects that improve their personal health, offers the opportunity to share their experiences and join networks for purposeful action in the public arena. We have found that many people want to help their community, and contribute however they can to the work of the NHS. (for many, many people, the NHS is the only public institution they can believe in)

14. A Charter for Community Development in Health Dr Niall MacLeod GP partner The Heavitree Practice, Exeter

15. System flawed • Created in 1948 • 93% treatment- 7% prevention • “Should be 50-50” Prof Robert Harris, Head of NHS strategy • System over medicalised • Need a new model

16. Right to Left Shift • All Stakeholders need to work together in an Integrated Coordinated strategy for this to work • ie Health and Wellbeing Boards, CCGs, Councils, Voluntary Sector, Faith Groups, Schools, Industry, Local media, general public etc • We need a Community Development Charter for Health……! Community Self Care Healthy Lifestyle Prevention Primary Care Secondary Care

17. Future NHS • Patient empowerment- involving them in own health management and prioritising local health needs • More emphasis on prevention and developing health and wellbeing in communities • Involve pre-existing community, voluntary and patient groups • All these groups working together • Utilise advances in IT to best effect

18. The Future • Patient empowerment • Do things WITH patient not To the patient • People and communities can help themselves • Co-produced activity- from the ground up (Robert Varnam, Head of GP Innovation) NHS England

19. EVIDENCE • “people with strong social networks live longer healthier lives compared to those poorly connected in social terms” • Prof Alex Haslam- Brisbane University 2012

20. Charter for Community Developmentin Health • Help focus CCGs, councils, industry on task at hand • Benefit NHS by helping reduce demand • Help develop resilience at grassroots level

21. My Vision-Integrated Coordinated Healthy Living Strategy- from GP to Community • Facilitate shift of healthcare from GP surgery out into healthy living in healthy communities • 2.5 years researching locally and nationally • Networked and liaised • All groups keen to be involved • Bring together the key players to share the vision- and get on with it….!

22. Current Model • Doctor centred model • We “sort” everything advice prescribe patient GP refer admit

23. The Health “Ferries”- no coordination… U N H E A L T H Y L I F E S T Y L E library H E A L T H Y Community Groups GP Friends Voluntary sector Public Health Campaigns

24. Working together- a Pontoon Bridge U N H E A L T H Y L I F E S T Y L E Community database H E A L T H Y Public Health Campaign Healthy Living Advisor Community Groups Friends library Apps GP Voluntary sector Specially Commissioned Services For High Risk Groups

25. Suggested New Future Community Focused Model Community database Community Community Health Team Voluntary Sector patient Healthy living facilitator GP Hospital medication referral

26. GP to Community Shift • Pharmacies take on minor ailment role • Practice Health Champions • Each surgery has healthy living advisor/facilitator • Neighbourhood Community Health worker created in each neighbourhood • Database of community activities- enroled in scheme

27. GP to Community Shift • Specially commissioned activities for at risk groups eg frail, dementia, obesity, alcohol, severe mental illness • GPs buy into change in working patterns • Develop IT self help – eg approved Apps, on line self help etc • Embrace and include all the great community and voluntary sector resources

28. The Project - “A Integrated Coordinated Healthy Living Strategy- from GP to Community” • All groups say it is a good idea FRUSTRATING +++ ! BLOCKS • Lack of funding- CCG in financial deficit • Fear of getting it wrong- lack of imaginitive thinking • Lack of body/organisation to coordinate • Population unaware of issues/crisis • Media and politicians partly to blame for avoiding real issues • Lack of direction from Government…..! • Lack of a Charter…..!

29. Good work • Bromley By Bow • Green Dreams, Burnley • Altogether Better, Leeds • Age UK, Living Well scheme • Westbank Healthy Living Centre, Exminster Devon • Turning Point • C2 Connecting Communities

30. Benefits to us all • Reduced consultation rate • Reduced prescribing • Reduced A and E attendances • Reduced admissions • Healthier and Happier population • Improved Wellbeing • Reduced crime/drug use • Patients connecting with their communities • Improved resilience- physically and mentally

31. Good Work • Is happening • Disjointed • Little overall strategy- no coordination • Patchy across UK • Poor sharing of good practice

32. Balance • Yes we do need high tech treatments • But with ageing population and increasing demands • Need to put more emphasis on prevention • Care in the community • Need a Charter for Community Development in Health

33. Charter for Community Developmentin Health • Good for Primary care • Good for NHS • Good for the individual • Good for the population

35. Get A Life

36. A CHARTER FOR COMMUNITY DEVELOPMENT IN HEALTH DR BRIAN FISHER NHS ALLIANCE HEALTH EMPOWERMENT LEVERAGE PROJECT

37. SHRINKING THE STATE + AUSTERITY Threat to community life Increasing inequality A crisis in democratic accountability

38. PARTICIPATORY ACCOUNTABILITY DEMOCRATIC

39. UNDER PRESSURE • Hollowed out communities • Threat to mental health • Attenuation of social networks • Weakening of associational life • Deterioration in health • AUSTERITY + REDUCING THE WELFARE STATE KILLS PEOPLE.

40. ASSET-BASED COMMUNITY DEVELOPMENT • Statutory services become more responsive • Promotes health protection and community resilience • Helps tackle health inequalities • Has an impact on behaviour change • Saves money

41. SOCIAL RETURN ON INVESTMENT • A saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8 • For £233,655 invested across four authorities the social return was £3.5 million. • For every £1 a local authority invests, £15 of value is created.

42. “No society has the money to buy, at market prices, what it takes to raise children, make a neighbourhood safe, care for the elderly, make democracy work or address systemic injustices... The only way the world is going to address social problems is by enlisting the very people who are now classified as ‘clients’ and ‘consumers’ and converting them into co-workers, partners and rebuilders of the core economy.” EDGAR KAHN

43. Stronger and deeper Social Networks CD RESILIENCE ENHANCED CONTROL Health protection Resilience to economic adversity Better mental health Can negotiate with services More strength for self-care Health inequalities reduce

44. Sources of support OUTCOMES – HEALTH

45. SOCIAL NETWORKS REDUCE MORTALITY RISK • 50 % increased likelihood of survival for people with stronger social relationships . • Comparable with risks such as smoking, alcohol, BMI and physical activity. • Consistent across age, sex, cause of death. • 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316

47. PRINCIPLES FOR SOCIAL ACTION ON HEALTH • Enable people to organise and collaborate to: • identify their own needs • take action to exert influence on the decisions which affect their lives • improve the quality of their own lives, the communities in which they live, and societies of which they are a part. • Address imbalances in power and bring about change founded on social justice, equality and inclusion. • Active communities make a marked difference to their own health and life expectancy. • Co-production between communities and service providers thrives if communities are enabled to become leading players in their own interests. • Look for the strong, not the wrong: a needs-and-assets based approach

48. WE CALL ON HEALTH AND OTHER AGENCIES TO: • Inspire residents to become key players in developing their own health and well-being. • Be prepared to listen, respond and work in new ways. • Harness the interventions that have the best evidence and are most reproducible. These include community development or community building or community transformation • Develop, through community building, community led neighbourhood partnerships of residents and service providers.

49. POLICIES FOR SOCIAL ACTION ON HEALTH • A community development strategy in every Health and Well-Being Board and CCG. • Joint Strategic Needs Assessments to become Joint Strategic Needs and Assets Assessments • Support investment in community development and social value. • Devolve decision making about service commissioning to communities undistorted by competition rules and commercial confidentiality. • All CCGs to collect evidence of localcommunity development.

50. POLICIES FOR SOCIAL ACTION ON HEALTH 2 • Workforce capacity and capability in community development ensured by Health Education England and LETBs. • A community development work programme developed by Public Health England. • Commissioning and delivering evidence based community development should be supported by Public Health England and NHSE Regional Teams in local authorities and other public health bodies.