Agenda item

This paper describes the overall Community Wellbeing Framework, its main components, including an innovative approach in achieving community health and wellbeing by focusing on community assets and better integration across the whole system.

Dr Tamara Djuretic, Assistant Director of Public Health, introduced the report as set out. The Panel was informed that there was a growing body of evidence to suggest non-medical interventions such as social prescribing were effective in improving health and wellbeing and reducing health care utilisation through promoting self management.

It was noted that Neighbourhood Connect (a social prescribing project) had piloted in Haringey in 2015. The Panel was informed that its evaluation had suggested some good outcomes however it had failed to demonstrate value for money and it had struggled to engage effectively with certain hard-to-reach communities to reduce social isolation.

Dr Djuretic explained that learning from this project had indicated a bottom-up approach, focusing on local community assets and building on existing local resources and expertise, was more likely to succeed both in improving health and in being cost-effective and sustainable. Furthermore, Dr Djuretic highlighted that a more strategic approach, with the development of an overall Community Wellbeing Framework, was required in order to initiate a community asset approach, integrate health and care services and to concentrate on preventative interventions that could subsequently reduce demand on services and increase the health and wellbeing of Haringey residents.

In response to questions, Dr Djuretic explained that Local Area Coordination was about providing a well integrated and co-ordinated care pathway with a single access point. It was noted that the pathway would be designed locally to address key priority objectives of primary, community and social care, to reduce social isolation, promote social connectiveness and reduce health and care needs.  

The following issues were considered by the Panel in relation to social prescribing and Local Area Coordination:

-       The Sustainability and Transformation Plan for North Central London, including Care Closer to Home Integrated Networks (CHINs).

-       A recent report by the London Healthy Partnership that suggested an opportunity for Haringey CCG to save £20,131,351 by 2021.

-       Governance arrangements for the Better Care Fund.

The Panel was informed that the new model would be delivered within existing services (e.g. primary care, libraries, VSC, etc) and would work alongside existing local programmes including Community Hubs. It was noted that an extended stakeholder engagement event would be held during the design phase of the programme to co-develop an evidence based programme that reflected and built upon previous learning and local circumstances and priorities. The Panel was informed that the model would integrate with other community schemes.

In response to questions, Dr Djuretic explained that the model would use a prevention based approach to proactively identify, and target, high risk and hard-to-reach groups, in particular:

-       Older people with multiple long term conditions

-       Groups identified by NHSE work e.g. falls, diabetes

-       People with disabilities

-       People that are socially isolated who don’t reach out for help before crisis   

The Panel was informed that the project would initially be rolled out in areas with high prevalence of poverty, health inequality and poor life expectancy. The service would then be evaluated before being expanded across the borough.

Dr Djuretic explained that local area co-ordinators would be recruited from local communities, would be located in a community hub and be supported by existing networks of care coordinators/navigators (as part of the integrated/locality teams). The Panel was informed that the coordinators would support people in a variety of ways, including:

-       People not yet known to services to help build resilience and to remain part of their community (staying strong – avoiding need for services).

-       People at risk of becoming dependent on services to remain strong in their own community diverting the need for more expensive “formal service” responses (reduce demand).

-       People already dependent on services to become less so and more resilient in their own community.

In terms of the components of the framework, it was noted that the following issues would be very important:

-       Asset mapping with an electronic, user friendly application, designed and informed by frontline staff and communities.

-       Change in mindset and culture across health and social care frontline staff.

-       Co-ordination across the borough.

-       The skill-set for the co-ordination role, including empathy, local knowledge, wellbeing coaching skills.

-       Having a range of different community interventions to support prevention and independence.

The Panel went on to discuss criteria for evaluating the success of the model. Dr Djuretic highlighted Local Area Coordination had a significant evidence base that had been built up over the past 28 years. It was noted that when designed properly, with input from local people together with strong leadership, there was evidence of consistent and positive outcomes, including reductions in: Isolation; Visits to GP and A&E; Dependence on formal health and social services; Referrals to Mental Health Team and Adult Social Care; Safeguarding concerns; Evictions and costs to housing; Smoking and alcohol consumption; and Dependence on day services.  In addition, it was noted that recent independent Social Return on Investment evaluations, in both Derby City and Thurrock Councils, had shown a £4 return for every £1 invested.

In terms of next steps, the Panel was informed that funding from the Better Care Fund had been approved and that a number of activities would take place to develop the model and to design how local area coordinators would operate across Haringey. The Panel was advised that the aim was to move from design phase to implementation by summer 2017 and that two co-ordinators would be employed by the Council for Year 1, increasing to three in Year 2.     

AGREED: That the update on the Community Wellbeing Framework be noted and that a further update be considered by the Panel in March 2018.