Category Archives: Three Cs

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.

 

C4CC supports extending personal health budgets

C4CC co-chairs have welcomed the announcement yesterday that the Government is to back NHS England plans to make Personal Health Budgets (PHBs) more widely available as part of its Integrated Personal Commissioning (IPC) programme.

A formal consultation to extend legal rights to PHBs, which are currently restricted to people receiving NHS Continuing Health Care and children receiving continuing care, will be launched later this month, managed by the Department of Health.

Key C4CC partners have long pressed for people to be treated as equal partners and to have more control over their own health, care and support and believes PHBs are a key element in delivering better outcomes for people with long-terms conditions.

“PHBs can play a vital role in providing person-centred care to fit the needs of the individual and enable them to access resources that are available to them in their own community, ” said C4CC director Catherine Wilton.

“This proposed extension of PHBs aligns with our current work programme, which is focused on our ‘Three Cs’ of better conversations between patients and their care providers, co-production of health through better partnerships and the involvement of community resources in supporting people with long-term conditions.

“We will be liaising with our partners to provide our collective input into the consultation with the hope that our recommendations are fully taken into account when the plans are finalised.”

The consultation announced today will consider extending the legal right to PHBs to people who access wheelchair services; people with a learning disability or autism; armed forces personnel discharged from the service under medical grounds and people eligible for Section 117 aftercare services with ongoing mental health needs.

C4CC co-chair Anna Severwright said: “As somebody with multiple long-term conditions I warmly welcome the announcement yesterday to increase the number of personal health budgets.

“PHBs give people more choice and control over their care, allowing them to select the support that works best for them and to be able to live the life they want.”

Paula Fairweather, a member of the C4CC co-production team, said a PHB helped change her life and wants others to benefit.

“My PHB meant I was able to access different support in a way that worked for me, buying equipment for physio specific to my needs and improving my health and helping me be more independent.”

“I have also seen PHBs make a huge difference in many other people’s lives, improving their health and quality of life. For example enabling someone previously housebound to volunteer and help others in the community.”

C4CC helped develop the IPC programme, which aims to integrate health and social care to better meet the needs of the individual and empower people to play a more active role in their own health and wellbeing.

Our co-chair Nigel Mathers commented: “I am pleased with this announcement endorsing the roll out of IPC and PHBs and the forthcoming consultation on extending the legal right to have a PHB.”

“C4CC has been a supporter of PHBs since their inception and the rolling out of IPC will strengthen the voice of people with long-term conditions in the NHS. “

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.

 

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.

Future Hospital Programme – Better Conversations

The past few weeks have been busy for me, meeting lots of C4CC partners and community groups and learning how the principle of ‘better conversations’ is being played out and reaping rewards for people with care and support needs across the country.

A few weeks ago, I was invited as an outside expert to attend a seminar on the Future Hospitals Programme run by the Royal College of Physicians.

It highlighted the fantastic work which is being done at a number of sites around the country to create a much better deal for people using their services, in particular older people with frailty and multiple long-term conditions.

All the ground-breaking projects were to be commended, but two in particular caught my interest.

Betsi Cadwaladr University Health Board serves a largely rural community in North Wales, which brings its own obvious challenges. Their C@rtref project (meaning ‘home’ in Welsh) is pioneering the use of teleconferencing video technology in local community clinics to enable people to have a follow-up consultation with a doctor in the main hospital, without the need to travel.

It has proved a much more effective use of time for staff, with clear efficiency savings, while for the older people themselves it has meant having a single, holistic conversation with a geriatrician rather than several different conversations with different doctors, as well as much less wasted time in travelling. Seventy-two per cent of those seen were aged over 75, yet more than 80 per cent were satisfied with this new way of doing business.

I was also struck by the project in East Lancashire Hospitals NHS Trust, which aims to provide personalised care for people at, or as close to home as is safe and appropriate. One study showed that their multi-disciplinary and co-designed approach prevented 59 per cent of admissions. I was impressed they had trained a team of volunteers to carry out detailed interviews with people in their own homes about their experience of care. In their words, in-ward surveys, ‘only tell you about a part of the journey.’

The examples showed that better conversations can be about the way we conduct doctor-patient consultations or how we take the time to really listen to what matters to people, whether in hospital or the community. And what struck me was that the staff involved were genuinely committed to making a difference to people, sometimes under very difficult circumstances. We are very much looking forward to working with the Royal College of Physicians and others over the coming months, to see if we can grow these person-centred approaches far and wide.

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.

Who decides what health means?

Claire Tomkinson, Trustee at Timebanking UK and Wellbeing Development Lead at Macc writes for C4CC about her reflections on the differing views on what makes us healthy and keeps us well.

I was recently running an activity at a large event in South Manchester to celebrate the launch of the hospital trusts Community Service Directorate. There was a huge variety of stalls ranging from health advice to support from local housing providers and myself and a colleague were asking local people a very simple question. What makes us healthy and what keeps us well?

The answers overwhelmingly included the following: having a role to play, having a purpose, not feeling useless, having days out, seeing friends and family, being connected to local people, volunteering, gardening in the front garden so I can talk to neighbours and stroke their dogs, going to different groups and activities and spending time with the grandkids.

We then covered the responses and asked clinicians how they thought people had responded. Their answers included: losing weight, smoking less, reducing alcohol intake, eating more fruit and veg and getting more exercise.

My concern is that in communities we have two completely different views on what being healthy and keeping well means and these tend to conflict with each other rather than complement each other- but how often do we ask people that we work with what is important to them, what matters to them and how this impacts upon their health and wellbeing?

We know that 30 per cent of health is determined by clinical factors while 70 per cent is affected by social determinants yet in health we spend the majority of time responding to health needs and fixing people’s lists of medical conditions without thinking about the protective nature of being an active, valued and connected member of the community. Defining people by their skills, strengths and capabilities and building upon what already exists in communities will have a massive impact on peoples resilience and ability to cope whilst preventing needs arising and enabling people to support themselves and each other within their community. A great starting point is to ask- what can you do for yourselves and each other to have an impact on health and wellbeing in your community, what can you do with support from the voluntary, community and social enterprise sector and what is left for public health to do?

Chapter Two of the Five Year Forward View talks about new ways of working with people and communities and Nesta are doing great work as part of Realising the Value, but something that I’m asked over and over again is “how do we do it?” How do we adopt a community asset based approach and how do we see people as more than a list of medical conditions to be fixed? One highly effective approach is Timebanking. It is simple and it works.

Timebanking only defines people by their strengths, capabilities, aspirations and what they can do for others. It’s based on mutual support, trust, respect and reciprocity. Everyone’s time and skills and valued equally and is a great equaliser as we all have the same amount of time each day. A common misconception about Timebanking is that it is all about volunteering, incentivising volunteering or rewarding volunteers. It isn’t. Timebanking isn’t about connecting volunteers to services and claiming something in return. Timebanking is about connecting people to people and making the most of things that happen in communities everyday yet go unseen and undervalued.

It’s about an older lady depressed that she’s struggling to maintain her garden but used to work in a dress shop and can make curtains and repair clothes as an equal exchange of time. She meets people, uses her skills, feels valued and doesn’t go to her GP as much.

It’s about a lady that had to give up her job as a nurse because of ill health and struggles to get to her many hospital appointments having a lift from local person in exchange for baking cakes for community events and knitting cardigans for babies.

It’s about a man who recently lost his wife, can’t cook a meal and was incredibly isolated attending a cookery class delivered by another Timebank member in exchange for doing small jobs and DIY for someone else.
As a result we see a huge impact upon the issues raised again and again by our health colleagues- people were less isolated, less lonely, more confident, more motivated and better able to cope just by self-organising around their assets and what they had.

It’s time that we started seeing people in communities as part of the solution instead of constantly being defined as the problem. It’s time to be a good listener instead of a good teller. It’s time to stop deciding what people’s needs are without ever asking what their strengths are and it’s time to celebrate and recognise what already exists within communities and see what happens when you connect people around their assets.

Claire Tomkinson is Wellbeing Development Lead at Macc, the voluntary, community and social enterprise sector support organisation for Manchester and is Vice-Chair of the Board of Trustees at Timebanking UK.