Category Archives: C4CC

Embedding co-production at all levels of care

Margaret DangoorMargaret Dangoor, member of C4CC’s co-production group shares her experiences of helping to deliver co-production at a local level in celebration of national co-production week (2-6 July 2018) #coproweek.

In all the fanfare around the 70th anniversary of our wonderful NHS, it may have been easy to miss that it’s also been National Co-Production Week.

In PR terms, it could indeed be seen as an unfortunate clash, but as someone who has been promoting the principles of co-production on both a national and local level for a number of years, I take the opposite view.

If the NHS and our social care services are to continue to prosper and improve for the next 70 years and beyond then we need to firmly embed the principles of co-production at all levels of care.

It’s a model for the future and I’m heartened to see that it is gaining traction within NHS England and in many different local authority areas.

I have been actively involved for nearly 30 years in the London Borough of Richmond upon Thames. Initially I was involved in the community and voluntary sector, then focused on the development and chairing of statutory patient participation groups.  On becoming a carer for my husband who developed Alzheimer’s disease I became particularly involved with representing the voice of users and carers within the local NHS and borough health and social care services, whether at strategic level, influencing commissioning – or monitoring provision.  I am also currently chair of a local health centre’s patient and public involvement forum.

I’m pleased to say that Richmond was an early adopter of co-production several years ago and marked the national week with publicity around the work that is being carried out, particularly with carers.

“Involving the users of care and support services, and their families and carers in making decisions about how their care is delivered empowers them to be able to live full, independent lives,” was a quote from Cllr Piers Allen, Cabinet Member for Adult Services and Health.  I cared for my husband Eddie for many years until he sadly passed away in January of this year and was grateful for good local support, particularly a specialist dementia day centre and a Caring Café supported by the local authority.

From personal experience, I found that being able to have a say and being listened to is so important in end of life care. Properly planning for the final few weeks, in liaison with the family GP practice, when medical intervention was limited but supportive was so beneficial.

Following a short stay in hospital and discharge, we made a conscious decision that it was not in my husband Eddie’s best interest and agreed a plan as to how he would see out his final days in the community, with compassionate care and dignity.

I firmly believe that having a good death is an important part of having a good life, and the principles of co-production are so relevant in this area.

I’m determined to carry on this work locally as chair of the health centre patient participation group and my other local health and social care involvement.  I am also involved with social care research, through the NIHR school of social care research and the personal social services research unit based at the London School of Economics and Political Science, as well as my national involvement on the C4CC co-production group and as a trustee of the Centre for Ageing Better.  I also volunteer for Carers UK and the Alzheimer’s Society.

I think it is true to say that NHS England can promote and support strategies around co-production, but it needs to work at a local level and that is happening both in Richmond and other areas across the country so it is great to get both perspectives; in fact, it is essential.

The benefits of collaborative working across the health and social care system and using community assets to deliver care are a fundamental part of C4CC’s Three Cs and are so important as we celebrate the past successes of the NHS and build a service for the future.

 

What can healthcare commissioners do to get everyone involved with health and care in their own communities?

The need for community-based approaches to give people a real and effective voice in their own health and wellbeing needs has been validated and given greater weight by the NHS Five Year Forward View and its recommendations under Next Steps to utilise those assets as a catalyst for change.

Realising the Value has drilled down to provide the evidence of the validity of these approaches and is a call to action to make it happen.

All well and good, but it’s our contention as authors of Commissioning for Community Development for Health that there are many decision-makers in the health system who want to strengthen community action, but have no model for how to start going about it.

We wanted to produce a research-based publication that addresses this need and provides a framework for action, starting in priority neighbourhoods.

It offers a systematic approach to increasing resident involvement in health-giving activity, mutual aid and community effectiveness across a CCG area, and provides the tools to get it going.

It offers:

  • a down-to-earth explanation of what community development is and does
  • where it fits in to current health policy
  • the kinds of health benefit that these methods can generate
  • a rationale for partnership with other local services to boost community activity
  • mobilising participation through all community groups and networks
  • addressing both health and care and the social determinants of health
  • making services more responsive to communities
  • designing a two to five year community strengthening strategy
  • phasing the work across the CCG, starting with priority neighbourhoods
  • what skills should be sought in recruiting project leader and staff
  • model contract for provision of the community development project
  • model baselines, milestones and key performance indicators
  • reconciling planned outcomes and objective evaluation with scope for flexible fieldwork method.

The Handbook closely reflects C4CC’s own 3Cs. So we are proud to help spread the message to a wider network.

It has also been endorsed by the Royal College of GPs and Think Local Act Personal (TLAP). support we obviously welcome.

But our work does not end with its publication and we are offering introductory seminars and practical workshops to commissioners and others keen to learn more.

As well as explaining the key concepts and instruments and looking at case studies, these can be tailored to particular audiences, priority local issues and participants’ needs.

Contact gabriel.chanan@talktalk.net or brianfisher36@btinternet.com for more details.

 

C4CC welcomes new standards to be adopted for letters to outpatients

Hospital consultants will be encouraged to write clear, easy to understand and jargon-free letters directly to people and copied to their GPs, instead of the other way around, under proposals recently approved in principle by the Academy of Medical Royal Colleges (AoMRC) and championed by the Coalition for Collaborative Care (C4CC).

The AoMRC has been tasked with leading a programme of change to encourage and support clinicians across all disciplines to adopt this as good clinical practice and to incorporate it formally within the training curricula of both undergraduate and postgraduate doctors.

C4CC has long campaigned for this vital change, replacing the current practice of consultants writing to an outpatient’s GP, and referring to patients in the third person.

C4CC co-chair Nigel Mathers, the Honorary Secretary of the RCGP, said the plans had gained widespread support from doctors, including the Royal College of General Practitioners, and patient organisations.

“This will be a personal letter to you, with your GP copied in, who will also be supplied with more detailed technical information, which can also be discussed with you,” he said.

“It’s a big cultural change and naturally will take time to become standard practice because it requires training and a different way of thinking for all doctors, but the new policy framework is an important step in the right direction.”

Katie Clarke-Day, who works with NHS England and C4CC on projects to improve the lives of people, like her, with multiple long term conditions, said she had long advocated for more personalised communication between doctors and their patients.

“It may seem like a small change, but it is hugely important, particularly for people with long term conditions,” she said.

“It’s about relationship building with the people who are keeping you alive and trust is really important.

“From the start, from the very first letter that you receive, you should have all the information that you need, in plain English, so you can take ownership of your treatment and get the appropriate support,”

Making sure the right information is always included in outpatient letters is the first step.

New guidelines to help professionals do just that were published by the Professional Record Standards Body (PRSB) last summer.

Their new guidelines encourage professionals to produce consistently high quality letters.

“Many more people are treated in outpatient clinics including people with complex health and care needs so it is really important that outpatient letters are clearly written and contain the right information for hospital staff, GPs and teams looking after people in the community,” said Lorraine Foley, CEO of the PRSB.

“Our standards help professionals share information. We are right behind the proposals to ensure that letters to patients are written in plain English so that everyone has a good understanding of a person’s health needs and most importantly that patients can take greater control of their care.”

-End-

C4CC: HIV in Hackney

Kristi Adams, C4CC’s Senior Co-production Advisor, recently facilitated the second of two workshops, commissioned by the Homerton University Hospital NHS Trust, with the goal of improving the care and support available to people living with or at risk of HIV.

The first workshop back in March attracted more than 80 people, with a mix of people using services in Hackney, healthcare professionals, commissioners and other key stakeholders providing their input and expertise.

Participants explored what good would look like for people, from prevention and testing through to palliative care.  The group identified the good work already happening and how this could be built on to become even better.

The second workshop drew on a smaller group and was focused on the actions and key points raised from the earlier session, identifying what needed to change and how, and how gaps could be filled.

Below, you will hear from Kristi and the people involved in the workshops about why this work is important and how they will help to improve services for people living with or at risk of HIV.

Kristi Adams – Senior Co-Production Advisor, Coalition for Collaborative Care

I was delighted when C4CC was approached by the Homerton University Hospital Trust in Hackney to co-design and facilitate two workshops, with the aim of improving the quality of service it provides to people living with or at risk of HIV.

The hospital is already recognised for its innovative approach. It employs peer navigators who are themselves affected by HIV, to work alongside people in the co-production of their care and provide personalised support during, what can be for some people, a very stressful time.

There was an understanding by the hospital at senior level that more could be done to improve the patient experience through better co-ordination and collaboration with a whole range of stakeholders in Hackney, such as GPs, commissioners and the local authority. It was clear from the outset there was a collective willingness to engage and embrace new ideas and approaches.

This focus on better conversations, the use of community assets and co-production is the key message that C4CC is promoting with its national partners and we will continue to do our very best to provide support to any organisation that wishes to foster the same ethos.

I am confident that what will happen as a result of the workshops and other connections that were made will be to the benefit of the people of Hackney and we have pledged to continue our work with the Homerton as the programme develops.

Professor Jane Anderson –  Director for Centre for study of HIV and Sexual Health Homerton University Hospital NHS Trust

With more people living with HIV than ever before and at a time when the NHS is under enormous financial pressure, the need for all of us to collaborate across the whole health economy has never been greater.

At the Homerton, like other front-line hospitals, we are well aware of the scale of the challenge and we are committed to ensuring best outcomes for people by exploring new ideas and new ways of working.

It was in that context that we worked with C4CC to organise and facilitate two workshops to allow us to identify both areas where things were going well and also to look at where we need to make improvements for people with HIV in the local area.

It was crucial to ensure that everyone involved right across the care pathway could take part and give their point of view. That meant ensuring we included service users, specialist clinicians, commissioners, GPs, elected political representation and our public health team for Hackney.

The task was made easier because C4CC is an NHS England-based organisation, which gave the workshops credibility within the health system.

At the second event, we could build on the themes and outputs of the earlier workshop held in March, using the momentum that had been generated.

I believe that the relationships and potential working partnerships generated through this process will support the development of a ‘whole system’ approach to HIV prevention, treatment and care in our locality, that is based around the needs, perspectives and aspirations of those affected by HIV.

I am confident we have begun a process that will put the building blocks in place to ensure the best outcomes for those affected by HIV within our local area.

Janine McGregor-Read – Peer Navigator at Homerton Hospital For Positively UK

 As a long-term service user, diagnosed with HIV 25 years ago, I have been able to witness at first hand the vast improvements in the standard of treatment provided by the NHS.

In my job role at the Homerton as a peer navigator, I have been able to draw on my own experiences and others to help shape the service that is provided to people, and I believe what is happening here is above and beyond what is generally available.

But we must never be complacent, particularly with the challenges of a client base that is getting older, many with mental health issues and other complex problems. Faced with this challenge, I detect a real desire to find a way to make the system deliver the best that is available, whatever the funding.

The C4CC-facilitated workshops were able to connect people, to flesh out duplications and gaps in service so we can be as effective and tight as possible, giving priority to the areas that are most important to patients.

People have to trust the service they access and for that to happen we have to understand their needs, their concerns and provide the wrap around support to allow them to prosper.

At the second workshop the service user was put very firmly at the centre of the conversations as we look to develop a better working model. Every individual is different so the system has to be flexible to meet their needs rather than relying on the traditional linear model.

Meeting and sharing views and perspectives with people from outside the immediate hospital environment was an invaluable experience and I am hoping that our collective input will have a positive benefit for the residents of Hackney in the future.

Iain Reeves: Consultant specialist at Homerton Hospital

At the Homerton we pride ourselves on the quality of care that we provide for people living with HIV; most treatments are successful and we have good clinical outcomes. But there is a recognition that we need to move beyond that because we have many people with a complex range of physical and mental health issues, in the main, but not exclusively, because of ageing.

Initially, those problems may have arisen because of the impact of a positive diagnoses and the stigma and discrimination this can unfortunately attract.

For this and a host of other reasons, I believe it is vital that we place people at the very centre of a network of care services to provide the support and help they need.

I attended both workshops and found them very rewarding in terms of getting the right people into a room and stimulating the right conversations. For me, the most valuable connections were made with representatives of primary care and a really positive outcome is that we are now looking at new ways of delivering care and different ways to involve people living with HIV at GP and consultant level.

If you would like to know more about C4CC’s work with Homerton University Hospital NHS Trust, please contact Kristi Adams on kristi.adams@nhs.net

 

C4CC’s Reflections on Realising the Value

When it comes to transforming health and care, there are countless toolkits, guidance documents, and resources that provide information about what should be done and what could be done. There are numerous legal duties that set out what must be done. There is a growing abundance of evidence generated from what has been done. And there are plans about what will be done.

This can be overwhelming at times, but the wealth of information and conversation over recent years has led to a level of consensus about the fundamental shifts we need to achieve, that suggests that now might just be the right time to pursue and realise the ambition.

“More stars are aligned to this agenda this time, let’s make it happen,” RtV presenter at regional event.

The Realising the Value (RtV) programme has made a significant contribution to this sense of alignment and possibility. In bringing together much of the outspread evidence, strengthening the case for change and pointing to the breadth of behavioural, cultural and systemic change that would be needed to achieve the transformation, the programme marks a watershed in our approach to health and wellbeing, validating the community and person-centred approaches that are being championed by C4CC and its partners.

C4CC is committed to working with its partners and other key stakeholders to ‘become clearer about the difference that these approaches make to people’s own health and wellbeing and to the wider system (page18 ten key actions doc)’ and bring about the fundamental changes that are needed to enshrine these ideas into the mainstream.

We know that it’s not about re-inventing the wheel, but making the best of assets that are already in place and utilising them in coherent and sustainable plans. Our coalition is a diverse and vibrant partnership that spans disciplines and sectors and reaches into the complex networks of changemakers at local, regional and national levels.

Together we have articulated the enablers to change as the ‘three Cs’; better conversations, coproduction and community development. Through collaboration at a local, regional and national level we will:

  • Support the ‘do-ers’: increasing their awareness and understanding of the ‘three Cs’; building consensus about what the ‘three Cs’ mean in a particular place and to different groups; and, improving the knowledge, skills and capacity to do or deliver the ‘three Cs’.
  • Create the conditions: supporting the development of behaviours, practices, systems and cultures that will sustain the transformation being sought.

Change can happen in many different ways. The implementation of person and community centred approaches will be configured differently, will be experienced differently and will produce different results in different areas and for different people. Our challenge will be in developing the adaptive capacity of people, communities and systems to ensure that the changes can be sustained long term and become the norm.

All the evidence and resources produced as part of the Realising the Value programme can be found here. If you would like to get in touch with the team, you can email health@nesta.org.uk

To follow the work of the Coalition for Collaborative Care, you can join us, free of charge, as a member here, subscribe to our newsletter here and follow us on Twitter here.

C4CC’s Perspective on the Five Year Forward View Delivery Plan

Catherine Wilton, Director and Fiona Carey, Co-Chair of the Coalition for Collaborative Care, offer the partnership’s perspective on the new Five Year Forward View Delivery Plan:

Since the Five Year Forward View (FYFV) was published two and a half years ago, the Coalition has been working together with our 50 national partners to effect change at pace and scale across the whole health and care system, to provide a better deal for people with long-term conditions and their carers.

At the heart of our approach has been the ‘Three Cs’ of better conversations, building community capacity and co-production.  For people with long-term conditions this means a new relationship with the NHS – in which people have the opportunity to have a conversation about what matters to them and what good looks like, to explore the assets and supports they have available to them – among their family, friends and local communities – and to plan and coordinate with healthcare professionals the services and treatments they might need to ensure they get the best possible outcomes.  It also means NHS organisations behaving differently – actively supporting and working with local people and communities to build community resilience and to co-design the supports that people want.

The original ‘Chapter Two’ of the FYFW championed the importance of empowering people and communities, and while it doesn’t have a separate chapter in the new Delivery Plan, many of our partners know that to make the plan become a reality, the NHS needs to fully embrace the power of people and communities.  ‘Health’ is not just created by health services – it happens when people are able to take control of their own lives and have a voice in what needs to happen locally to support them, on a one-to-one, and on a collective, level.  It is great therefore that the delivery plan has recognised the need for Sustainability and Transformation Partnerships to develop the concept of and collective action for ‘Health Creation’, as advocated by NHS Alliance. 

Having access to health and care services is vitally important but it is the quality of conversations between people and professionals that will ensure the best outcomes for people with long-term conditions.  The RCGP have stated that it is a ‘necessity’ for care and support planning to become core business for general practice, as it is an effective way to support people with multiple long-term conditions.  And they believe it is so important that they have made it part of the RCGP curriculum, meaning that to qualify as a GP, new recruits will have to know the principles and have the skills to do care and support planning.  Over the coming year we will be working very closely with the RCGP and other C4CC partners to roll out care and support planning – not only is it the right thing to do for people themselves, we believe that it can reduce the pressure on acute services for two reasons – because people are able to look after themselves better, and better coordinated care is more efficient.

There are huge challenges facing health and care over the coming years but we also share the optimism of the delivery plan that a better and more effective NHS can be delivered. We strongly believe that a people- and community-centred vision of collaborative care, delivering the ‘Three Cs’ is the best way to build an NHS fit for the 21st Century and one that will continue to sustain us all in the future.

C4CC’s Co-production Team View 

Sue Denmark from C4CC’s Co-production Team reflects on what this means for people.

“As someone with multiple long-term conditions, I was glad to see GPs getting the recognition they deserve as I all too aware of how important they are. The increase in their numbers is good to see, but I did feel there was something missing around the quality of the conversation between the professional and the person – more access is great, but we need to ensure care and support coming from the time together is person-centred.

“I was also pleased to see such a focus on mental health and the increase in talking therapies, but I did feel this could have gone a step further, looking at how community-based services could provide support, in a different way to medical treatment.

“I know from my own personal experience how community-based groups and activities can contribute to a person’s health and wellbeing. A few years ago, myself and others needing regular leg treatments worked together with our GP practice to create our own group and receive our care there instead of making appointments. The group, simply by its existence, began to tackle other wider issues such as isolation and loneliness – friendships made there led to walking groups and learning new skills. This has helped to improve people’s physical and mental health and reduced pressure on the GP practice.

“Reading this plan, I was unsure how I as a person fitted in to it, but having considered it, I think we can help by taking the lead on looking at our own communities and helping to fill in any gaps with local, tailored solutions. This, together with the work of NHS England, will start to deliver real change where it is needed.”

Timebanking, Good Gym and Social Prescribing

From social isolation to valued sports coach in one move…

I have recently signed up to Reading’s ‘Ready Friends’ befriending network on behalf of the timebank that I set up and continue to chair. NHS England allows staff to spend a week, fully paid, volunteering in their community or on other charitable projects, so I took advantage this by spending half a day at a workshop with about 10 different community organisations, all committed to combatting loneliness and social isolation in our town.

The groups at the meeting spanned from traditional-type befriending services, like those run by Age UK, to community transport schemes and one small group of neighbours who provide a home cooked meal for someone else in their street by just cooking a little more than they would normally.

Our timebank is providing social opportunities and links between people who share interests or who need help, and we have lots of success stories – someone who got a longed for job as a result of the skills and experience that running the timebank gave them, a person whose path to alcohol recovery has been helped by meeting people outside their usual circle, and one older person who used to go away every Christmas because it was too painful to be alone stayed in Reading last year, to meet up with friends made through the timebank.

There are examples like this from timebanks across the UK – where fantastic outcomes that improve people’s lives are the result of people and communities helping each other and not about the services they receive.

Another organisation at the meeting sparked some interest – Good Gym is doing fantastic work, particularly in the London area, but now expanding its reach. It encourages people to take up running and help their community at the same time.

Participants have three choices – join a group that runs somewhere to do a community-based activity like a gardening project; run to do a job to help someone, usually an older person, like putting a shelf up, then run back again; or be paired with an older person, with the aim of running to their house at a given time in the week. The twist is the older person is designated as the runner’s ‘coach’, providing a real reason to turn out on a dark and cold night.

I have pledged to sign up when Good Gym comes to Reading, as goodness knows I need the extra motivation to drag myself out to exercise on a wet Wednesday.

And lastly, we heard how the social prescribing project being run by Reading Voluntary Action has really demonstrated the power of person-centred conversations. Coupled with signposting to other support and helping people get connected to people and groups in their local community it has delivered improvements in all aspects of wellbeing for those involved.

The key to all this continuing to happen is of course the statutory sector recognising the huge contribution that community groups make to health, even though some of the schemes in the network do not look like traditional ‘services’ and have grown from the bottom up rather than as the result of a commissioning process. We are hoping that by working together we can build a network of supports across the town so that people are less likely to fall through the net. And my vision is also that those ‘befriended’ start to be seen for what they can do for their community, not what their community can do for them.

Masterclass in Co-production

A masterclass in co-production, hosted by National Voices, in partnership with C4CC, has been hailed as a “classic collaboration” and is planned to be repeated during 2017.

National Voices, under its Wellbeing Our Way programme, used the event in December, as a practical introduction to co-production, including what it is and how to get started.

It was attended by representatives from a broad range of voluntary sector organisations such as Age UK and the Alzheimers Society, plus others with a specific interest or experience of utilising community assets.

“I think one of the big strengths the day is that it was co-produced in terms of planning and delivering the event,” said Natalie Koussa, programme lead for Wellbeing Our Way.

“We wanted to give people a real flavour of what co-production feels like,” she added.

The itinerary for the masterclass included a series of practical presentations on co-production and the use of personal health budgets, with attendees also breaking into smaller groups to discuss various scenarios and practical implementation.

There was also a very personal perspective from C4CC co-production group member Paula Fairweather, on how her life had turned around after she took control of her own treatment, in a classic example of co-production and the use of a personal health budget.

“Paula’s story really touched people,” said fellow C4CC co-production group member Anna Severwright, who also presented at the event.

“For me, personally it was great to meet people in all these different organisations keen to co-produce and to see how much interest in it there was. It was inspiring,” she added.

Innovative approaches to engage hard to reach communities were also highlighted, using website and marketing techniques.

“We asked organisations to really think about the communities they are reaching,” said Natalie.

Specific action points from the masterclass included a series of pledges by attendees, with C4CC co-production group members Anna, Paula and Sue Denmark each offering an hour per week of advice and support for interested organisations or individuals.

“This masterclass was important because we were able to pass on our knowledge and experience of co-production to a wide range of organisations who are actively involved in the health, social care, voluntary and community sector,” said Kristi Adams, C4CC’s Senior Co-production Advisor.

“Our co-production group members can bring real life experience to co-design and deliver workshops such as this and we are going to build on the success of the day at a second workshop in Manchester in March, as well as with other future collaborations with National Voices and other C4CC partners.

Details for the Manchester-based Co-production Masterclass have now been released:

Date: Thursday 30 March 2017
Time: 9.30am – 3pm
Please register for this event here:

Priority will be given to National Voices’ members and members of Wellbeing Our Way’s communities of practice; any remaining spaces will be available for Coalition for Collaborative Care partners.

For further details click here.

Engaging and Empowering Communities

I was delighted to speak at the November 2016 launch of Engaging and Empowering Communities: A Shared Commitment and Call to Action – an initiative headed up by Think Local Act Personal (TLAP) but co-authored by the Coalition for Collaborative Care, the Association of Directors of Adult Social Services, the Local Government Association, Public Health England, the Association of Directors of Public Health, the Department of Health and NHS England.

The document is a sector-wide commitment to developing and nurturing strong communities, something very close to our hearts in C4CC.  We know that things need to change- councils, clinical commissioning groups and doctors can’t ‘prescribe’ wellbeing- it comes from having friends, family, social contact and support, being able to get out and about, having the opportunity to do something for others and feeling valued for our contributions through paid and unpaid work or being part of a group.

With our partners, the Coalition for Collaborative Care wants to see a shift away from ‘What’s the matter with you?’ to ‘What matters to you?’ by local people and organisations coming together to nurture and build on the assets in local communities, reducing loneliness and social isolation, increasing community resilience and enabling people to take control of managing their  health.

This is something very personal to me as chair of my local Timebank in Reading, covering a diverse and thriving community in the Oxford Road area of the town. I have seen powerful examples of how the Timebanking model keeps previously isolated people, often people with multiple medical conditions, connected to others in their community in a positive way.  From what we know about the work carried out by C4CC partners Timebanking UK and Spice we know that people are likely to be less reliant on health services and more expensive interventions as a result of their involvement in community activity.  See the London School of Economics report that I was involved in, and Spice’s recent impact assessment here.

Whether through Timebanking or other innovative approaches, we need to drive forward on this agenda, particularly at a time when resources are stretched in the public sector.  It’s therefore fantastic that national sector leaders have been prepared to sign up for a paradigm shift in how we support citizens, families, people, to live happy and healthy lives.

Another key landmark, was this week’s publication of the conclusions of the Realising the Value (RTV) programme, undertaken by Nesta and the Health Foundation and funded by NHS England.

This builds the evidence base for person and community-centred approaches to health and wellbeing and how they can be developed across the country.

To quote from its key findings:  “The most successful examples of person – and community-centred approaches in practice are those that are developed by people and communities, working with and alongside commissioners and policymakers to build on existing assets and co-produce solutions that work.”

I hope that health professionals, providers, commissioners and those in charge of implementing local Sustainability and Transformation Plans will read the report and take on board its 10 key actions, and work with local authorities, the voluntary sector and local people to make the fine aims in our shared commitment happen in reality.