Alyson McGregor

Director

Altogether Better

Who are we?

National network organisation- hosted by the NHS Working with experienced academics, researchers and clinicians have developed an award winning, evidenced based approach to engaging people and communities Pioneered Community Health Champion model starting in 2008 working with more than 21,000 health champions, gone on to develop champion models tailored to specific groups and settings Use a whole system approach which creates the conditions for a new relationship between citizens and services which has the potential to create a new model of general practice

• Changing role of the NHS - unprecedented challenge

• Paradigm shift away from the ‘medical model’

• Primary care no longer sustainable

• NHS 5YFV: need a “more engaged relationship with patients,

carers and citizens”

• Clinicians driven by desire for the best consultation – but need to see the right patients

• Multidisciplinary team needed to see patterns

• Living well with LTC best achieved in community context

Why Change?

• Much talked about in the NHS but rarely achieved

• Altogether Better working with citizens and services discovered

the potential to transform services

• Radical attempt at system change designed to enable the practice and population they serve to co-evolve

• Looks at the system as a whole

• More than a shift in boundaries from one practitioner to

another

System Change

• Experience of working in 60 innovation sites in General Practice

has led us to stumble across a new model for general practice: ‘Community Centred Practice’ which is designed to meet these

challenges

• Citizens/patients play a pivotal role in meeting this challenge

• Found new ways to be in conversation with citizens

• Not just in primary care

• National recognition & awards

Evolving Community

Centred Practice

What happens?

• People with myriad and unique skills, interests, values, beliefs, needs

• Multiple and fluid identities

• Human interaction

• Flexibility, improvisation

• Stories

• Relationships

• Non-monetary, fluid ideas of exchange and reward

• Emergent order

• Roles, qualifications, titles

• Fixed and legitimised identities

• Processes & structured interaction

• Protocols and pathways

• Fixed definitions

• Data

• Hierarchy, authority

• Monetary economy, fixed ideas of currencies and exchange

• Planned order

The ‘Lifeworld’ Practice Health

Champions

Formal Systems/Institutions

PHCs: balanced between two

world views

Reproduced with permission of Linguistic Landscapes Ltd. 2015

• Stronger link between practice and community

• Staff morale improves, workload shifts

• Patients get better outcomes

• The practice evolves new ways of doing things

• Patients better understand how to use services

• >90% & >94% Champions increase knowledge, confidence and social relationships

• Patients are supported to live well with LTCs

• The practice can offer alternatives

• Clinical consultations go down

• Practice list size increases

When it works …

“ Our Practice list size has increased by 18%, the number of appointments clinicians have with patients has decreased by 9%”

Sam Forbes , Partner Robin Lane Medical Centre, Pudsey

Impact

Valuing and Encouraging Community Volunteering in Health and Care

Reducing Pressures on Hospitals Fund

Ravneet Virdi, Cabinet Office

Ravneet.Virdi@cabinetoffice.gov.uk

Social action in health, care and ageing

● Social action can:

● Bring additional resource and knowledge ● Reduce demands on public services ● Empower individuals and communities ● Provide new people centred models

78,000 volunteers in acute trusts in England

13m hours per year

foster families

3m people

volunteer regularly

Over 50,000

Across health & social care

Centre for Social Action

£40m investment

Rigorous focus on

evaluation

215 projects

over 2 years

The goal? To identify and accelerate development and spread of

high impact social action

initiatives

● Reducing Pressures on Hospitals and Supporting Older People

● £3.7 million joint fund

● 7 Pilot sites - August 2014

● Additional 30 sites funded for rapid 12-14 week response - February 2015

Reducing Pressures on Hospitals Fund

Royal Voluntary Service

Photograph: Getty Images

Why?

● Rising demands on A&E during winter

● Cohort of vulnerable or socially isolated older people

● Scaling up and robustly test 7 existing local approaches that mobilise volunteers to reduce demands

● Aim to mainstream successful interventions

● 30 additional areas in February 2015 due to waiting time targets in A&E being missed - asked by DH to provide a rapid social action response

Nature of the interventions

● Teams of staff and volunteers are providing practical and emotional support in the community, hospitals and A&E and act as navigators into other local VCSE support

● Support includes:

● Support is time limited - aiming to support people to be independent

■ assisted shopping;

■ simple home adaptations;

■ befriending; and

■ transport.

Progress of pilots (June 2015)

500 volunteers

mobilised so far

Additional local

match funding of

£1m secured

6,300 people already

supported

● Impact report due from Nuffield Trust in January 2016

● 5 sites have been able to secure funding from their CCGs to continue their work and the rest are negotiating

● Interest from social investment partners

Results of rapid response (12-14 wk work)

500 volunteers

were mobilised

Pragmatic

partnership

working

9,000 people

were supported

● New way of working for central government and for voluntary sector organisations

● Positive feedback from local Acutes and CCGs - requests from other areas

● Some areas will be funded by Acute going forward

Lessons learned so far

● Local system leadership vital

● “Walk the wards”

● Invest in volunteers

● Roles for volunteers

● Target the service

● Focus on wards and community

● Refine the model depending on local need and structures

Opening the doors to citizen engagement: empowered

volunteers, quality care

NHS EXPO

September 2015

Care Homes and Beyond: Diverse citizens, diverse communities

Our hypothesis

That there exists a reservoir of social capital among volunteers to be deployed in health and social care. Some of these people already work in the sector, many in quite limited roles; our hypothesis is that if fully utilized and well-supported this group of volunteers has the potential to improve outcomes for citizens in radical ways.

The challenge

“There are huge opportunities for volunteering to help transform health and social care services and bring about real improvements for patients and the wider public. The challenge now is to ensure that the system can make the most of these opportunities. Many organisations lack a strategic vision for the role of volunteering within their workforce, and so miss the opportunities that exist.” (Kings Fund, 2013)

How will volunteers do this?

• By taking time to get to know people and build relationships

• By helping people build connections beyond services

• By looking and listening

• By advocating; and by passing on intelligence

Our questions

• What do volunteers do today?

• How might volunteers be supported?

• How might they pass on information?

• What about confidentiality and ethical issues?

• How do we see volunteers improving the quality of life for people in various caring situations?

Key players: who are we talking to about this?

The person

Commissioners

Managers

Emerging issues/what people have told us

• The Care Act: wellbeing, prevention, integration…

• Not about job substitution

• Some good practice exists today…

• Nevertheless: we need to test our thinking in diverse settings and situations

• Think about the full range of volunteers and volunteering arrangements

• Think more about volunteering around the person…matching

• Think more about people who use services as volunteers

Our next steps

• Consult with volunteering infrastructure organisations

• Continue discussions with CQC

• Think more about commissioning: engage TLAP and ADASS

• Develop a top-tips guide for providers

• Find providers to test out our tips

• An updated discussion paper and publicity

……..and talk to people using services, ULOs and carers’ groups; co-production in all

Today

• Continue to debate the role of volunteering in promoting quality

• Identify more allies

• Be clear about the challenges