Community ideas into action - City and Hackney CCG and... · • Indirect links between health and...

Community ideas into action City and Hackney CCG Innovation Fund

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£400k The City & Hackney Innovation Fund is a £400k

fund that was set up by the City and Hackney

Clinical Commissioning Group (CCG) to identify

community-based innovative ideas that have the

potential to deliver significant improvements in the

health and wellbeing of City and Hackney residents.

To date, twenty-seven projects have received funding

to test new and different ways to improve the health

and wellbeing of local residents. A third round of the

fund, which focuses on mainstreaming and scaling

successful ideas, launched in November 2016.

Innovation, health and wellbeing

The case for innovation in healthcare settings is strong. Health and social care services are faced with new challenges; meeting the needs of an ageing population and increased numbers of people living with a long term condition, not to mention the increasing financial pressures. Different and new solutions outside of the remit of mainstream health and social care services are needed to enable communities to better look after themselves.

Delivering the Forward View: NHS planning guidance 2016/17- 2020/21 identifies prevention, patient activation, choice, control and community engagement as key enablers for addressing the national challenges around 1) closing the health and wellbeing gap, 2) closing the quality gap, and 3) achieving financial balance. Achieving these aims requires working in partnership with patients and the wider community in a range of different ways which are reflected in ‘The six principles of engagement and involvement’ designed to support CCGs with their plans for the next five years. City and Hackney CCG Innovation Fund reflects these principles:

• Care and support is person centred: personalised and empowering.

• Services are created in partnership with citizens and communities.

• Focus is on equality and narrowing health inequalities.

• Carers are identified, supported and involved.

• Voluntary, community, social enterprise and housing sectors as key partners and enablers.

• Volunteering and social action are recognised as key enablers.

Through the Innovation Fund we wanted to fund and explore local projects delivering community based health and wellbeing services and information, resulting in improved health, increased self-management and more effective use of services. As detailed in the Department of Health (2014) ‘Wellbeing Across the Lifecourse’ – paper, wellbeing has been found to have an impact on many aspects of people’s lives such as their health, work and social relationships.

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These relationships have also been found to impact on people’s wellbeing. Following points on the impact of holistic health and wellbeing initiatives are also made:

• Wellbeing has a wide range of determinants including health, learning, work, environment, social inclusion, activity and relationships, parenting and early years interventions.

• The relationship between health and wellbeing appears to have two way causality, i.e. good health improves wellbeing and good wellbeing improves health.

• There is evidence that happiness is linked to the physiological processes which affect health. For example, wellbeing can be a predictor of problems with inflammation and associated with immune systems’ health. Negative feelings can hinder cardiovascular, immune and endocrine systems.

• Indirect links between health and happiness exist; people with high levels of wellbeing are likely to have healthier lifestyles. For instance students at college with higher life satisfaction have demonstrated a higher propensity to exercise and eat healthier food, as well as being a healthier weight.

• Improvement in quality of diet leads to higher levels of good mental health in adolescents.

• High levels of wellbeing directly affect good health and it is estimated that high levels of subjective wellbeing can increase life by 4 to 10 years compared with low levels of subjective wellbeing.

These findings highlight the importance of wellbeing on the health of our communities. The Innovation Fund projects enable isolated individuals to connect with other people and activities in their communities, to learn new skills, to contribute to their communities through volunteering and helping others, and to create meaning for themselves and others.

We would not have been able to reach our residents without the outstanding community and voluntary sector organisations in City and Hackney who are often best placed to engage with groups considered

vulnerable and seldom heard. This includes BME groups, those with long term conditions or mental health problems and older people as well as children and young people, people with disabilities, those caring for others and many more. We wanted to use the fund to enable local community and voluntary sector groups and smaller, new and emerging not-for-profit groups to build their capacity, to access funding and form relationships with local commissioners and mainstream health and social care providers.

Instead of running a traditional funding process we asked applicants to come up with their ideas and solutions for meeting local health needs. Anybody with the required skills and experience in the City & Hackney was eligible to submit an idea and apply for funding. This was important as we wanted to see proposals from a wide range of stakeholders including, local grass roots groups, community and voluntary organisations as well as individuals with relevant lived experiences. People were asked to focus on what made their ideas different and the impact these would have on people’s lives.

Shaping the Innovation Fund with the community

In May 2014 the CCG issued an open call for new ideas and innovations that had the potential to deliver significant improvements in the health and wellbeing of

The Innovation Fund projects enable isolated individuals to connect with other people and activities in their communities.


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City and Hackney residents. Local residents and patients have been part of the fund from the beginning by articulating their needs, suggesting different ways of doing things and shaping the fund’s remit and application criteria. Patients and residents have also been involved with scoring bids and making decisions about how the money should be spent.

The following priorities defined by the residents in City and Hackney became the fund themes on which all the applicants were asked to base their project proposals on.

Round one (2014) of the fund was aimed at identifying projects that would deliver services aligned to the four priorities. Round two (2015) built on this with specific focus on helping people find their way to the right service and at the right time. Through round three (2016) we will support a number of projects that have been successful in the previous rounds, to continue developing and expanding their work. There are lots of potential benefits to be gained from the Innovation Fund projects working more closely with local mainstream providers and so partnership working is at the heart of the third round of the fund.

The Portfolio

The fund has received interest from a wide pool of organisations ranging from local social enterprises to bigger and more established charities working nationally and internationally. During the two years of the fund, over 140 applications have been submitted in total, spanning physical and mental health conditions; acute, planned and long term care; and addressing health and wellbeing from cradle to grave.

Several proposals have looked to make services more accessible to traditionally disadvantaged groups such as ethnic minorities, or people with conditions that can make the use of mainstream services difficult or stigmatising. There were also a high number of applications seeking to tackle mental health problems and long term conditions, reflecting high levels of need for community-based solutions in these domains.

A wide variety of delivery mechanisms were proposed for new services, including peer support and mentoring, volunteering, time-banking, activity groups, digital software, and mobile applications.

The strongest applications demonstrated a solid understanding of the need and demand for their proposed solutions which were often based on their hands on experience of the issues they were trying to address. Their proposals were supported by feedback from prospective users/clients. The successful projects also communicated a compelling case for change and were able to articulate a clear vision of how their solution would help deliver better outcomes for City and Hackney residents. They had a clear understanding of where their proposal fitted in with the existing services and in some cases had already secured a partnership with other organisations or services working in the area.

The high potential ideas brought truly new ideas to discussions about how common health issues can be tackled differently. Their plans balanced an amount of experimentation and service learning with credible plans for future sustainability. The portfolio presented below reflects the variety of projects that came forward through the call for ideas and application process.

Integrated Services

Building independence

Confident and informed users

Involving and listening to

patients

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Innovation Fund 2014

Organisation Project

Bikur Cholim www.bikurcholim.co.uk

Working with the Orthodox Jewish Community to set up peer support groups in particular focusing on Crohns, Colitis and other gastric conditions.

Core Arts www.corearts.co.uk

Core Sports and Physical Health project for adults with severe mental health problems.

Drs of the world www.doctorsoftheworld.org.uk

Programme to support members of migrant and refugee community into accessing mainstream services.

Epilepsy Society

www.epilepsysociety.org

Setting up and delivering self-management groups for people with epilepsy.

Family Action

www.family-action.org.uk

Social Prescribing Programme for children aged 5-11; promoting good health and independence, ensuring children have access to a range of services, support and activities.

Hackney People First

www.hackneypeoplefirst.com

Training for mental health professionals about dual diagnosis (mental health and learning disabilities). Delivered by expert patients.

Hackney Playbus

www.hackneyplaybus.org

Facilitating groups that take vulnerable mothers and carers of babies from the ‘one to one’ support offered by Shoreditch Trust’s Bump Buddies and support them in accessing maternity services, children’s centres and other health services.


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Mind

www.cityandhackneymind.org.uk

Establishing a Recovery Campus in a style of a college campus with the aim of empowering clients via delivering a range of self-management, improved access to information and a peer support system.

Off Centre

www.offcentre.org.uk

Peer support programme for young people with mental health problems.

Royal London Society for Blind People

www.rlsb.org.uk

Engaging with young visually impaired people through regular Saturday sports sessions.

Sickle Cell Society

www.sicklecellsociety.org

Programme to support the sickle cell patient group, patients transitioning to adult services and looking at alternative therapies.

St Joseph’s Hospice

www.stjh.org.uk

‘Compassionate Neighbours’ project will offer competent and confident social and practical support to people living at home with a long term or a terminal condition.

Sunbeams Peer support for vulnerable girls within the Orthodox Jewish Community.

Volunteer Centre Hackney

www.vchackney.org

Neighbourhood Skills Share project based on time banking. Supporting vulnerable people in taking more active role, building confidence and social networks.

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Bags of Taste Limited

www.bagsoftaste.org.uk

A project delivering dietary behaviour change courses with focus on using affordable ingredients. Aimed at residents at risk of food poverty.

Bikur Cholim

www.bikurcholim.co.uk

Peer-to-peer support for older people with LTC within the orthodox Jewish community.

Centre for Better Health

www.centreforbetterhealth.org.uk

Group counselling activities including mindfulness, drama therapy and art therapy. Delivered at a community setting.

Hackney Council for Voluntary Service

www.hcvs.org.uk

Supporting vulnerable mothers and increasing their engagement with mainstream maternity services.

Hackney Playbus

www.hackneyplaybus.org

Training for mental health professionals about dual diagnosis (mental health and learning disabilities). Delivered by expert patients.

Hands Inc

www.handsinc.co.uk

Promoting menopause wellbeing, improving health outcomes and empowering peri/menopausal women to better understand their health needs and navigate themselves to appropriate services.


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The Huddleston Centre

www.huddlestoncentre.org.uk

Pet/animal therapy for young people with disabilities. Aimed at reducing loneliness, depression, anger, and improving social skills, confidence and general wellbeing.

Koach Parenting Parenting support for families within the Orthodox Jewish community. Project uses the Solihull model to improve parent-child relationships, address behavioural problems and support healthy development. Project is delivered in partnership with First Steps psychology service.

Read Together

www.readtogether.org

Therapeutic reading group for people with mental health issues

Renaisi

www.renaisi.com

Renaisi’s Bilingual Parent Support Adviser (BPSA) service engages minority language families in schools, supporting them with resilience, attendance/ attainment and family wellbeing. The service provides 1-1 support/ advocacy, ESOL for Health Cafes; and mixed group workshops.

Spice Innovations

www.justaddspice.org

A time credit project co-designed and delivered together with residents at St Mungo’s homeless hostel to improve health outcomes for people experiencing homelessness.

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St Joseph’s Hospice

www.stjh.org.uk

Working with black, asian, ethnic and refugee (BAMER) hard to reach communities to help us understand what a patient centered end of life care service looks like for them, using a co-production approach, addressing gaps in cultural understanding, improving people’s understanding of the end of life care services available to these communities.

Tavistock Centre for Couple Relationships

www.tavistockrelationships.ac.uk

Supporting people with dementia building on the couple relationship, utilising its established resilience and, through psychological interventions, strengthening its ability to survive and act as a protective resource, able to make optimal adjustment to the dementia, support interdependence and contain care needs.


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Learning was a key element for the CCG as the Fund invested in genuinely new ideas. From working with hens to improve disabled children’s social skills, to testing low-budget healthy cooking classes to tackle obesity, through to co-designing a new hospice service for Hackney’s diversely ethnic communities, the ideas of the Innovation Fund had a degree of uncertainty with regards to the approaches they were taking and the outcomes they could achieve.

To support the learning from the process, the Innovation Unit have hosted two learning events for the projects. These were focused on measuring outcomes and sharing experiences. Additionally, each project was ‘adopted’ by the relevant CCG Programme Board responsible for commissioning related services. Support and guidance has also been available to projects from the CCG’s partner in outcomes monitoring, the University of East Anglia.

Effectively engaging service users

The majority of City and Hackney CCG Innovation Fund projects targeted specific and often hard-to-reach service user groups such as refugees and migrants, homeless people, and people with severe mental health issues or with physical disabilities. The aim of all projects was to increase participants’ confidence and wellbeing.

A strong theme emerging across all projects was the importance of understanding the conditions, preferences and constraints of service users in order to tailor a service to their needs. This requires significant investment in terms of resources and time as well as building relationships with the right community organisations who can signpost and refer to the specific user groups. Learning also demonstrated that spending enough time with service users themselves is also crucial in order to understand what motivates

Learning from the Innovation Fund

Volunteer Centre Hackney’s Step Up project is a supported volunteering and employment project for people with health support needs.

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people and whether there are health needs which aren’t met by current service provision. Being open and flexible to changing various elements of a service was thus very important as learning from service users may entail tweaking service elements again and again. This is not always easy as was pointed out by the project leads.

Working with particularly vulnerable and disadvantaged groups can at times present its own challenges. It can be harder for participants to show up to appointments, sustain their engagement with a service, or to make changes in their lives. The transient nature of Hackney’s, and indeed, London’s population was highlighted as a specifically difficult condition for service providers. On the other end of the spectrum there were some participants, who were finding it difficult to leave programmes. Project leads pointed out the importance of setting clear boundaries and reminding participants of their capabilities.

Co-production was a key enabler for engaging service users. Co-production recognises service users as assets and not as passive recipients. This approach changes the dynamic between the service user and the provider, shifting the power dynamic from the professional to the service user and acknowledging their skills and strengths. When done successfully, service users are able to share their vision for the service, co-deliver the service alongside staff and feedback on the shape of the service. Through peer-support participants applied and developed their own skills: From managing their long-term health conditions, to listening and advocating for their peers in health appointments, through to cooking more healthily and developing techniques to manage their mental and emotional wellbeing the participants applied a wide range of skills which increased their levels of confidence, presenting role models for new participants on the respective projects.

Another strong theme from projects focused on recruitment and securing appropriate referrals from other service providers. Some projects found it particularly difficult to get referrals from the NHS

because they were unable to engage the right professionals. Due to budgetary and time constraints the NHS staff had in some cases limited capacity to explore new ideas and collaborations. A concern for some of the projects was that they were potentially not reaching those groups that were most in need of support. Understanding where your service users spend their time and recruiting them at these locations, using the right language to promote services, and asking participants to ‘bring a friend’ were approaches that projects highlighted as particularly helpful for recruiting your target user group.

Measuring social outcomes

The relationship between innovation and evaluation can be complicated. Innovation by nature requires an appetite for uncertainty and openness to on-going adaptation based on feedback from service users. Traditional approaches of evaluation on the other hand require a clearly defined idea of the intervention and desired outcomes. Naturally, it can be challenging for innovation projects to gather baseline data as the interventions themselves are changing during the course of the evaluation period. Despite these challenges most projects found ways of monitoring activity and recording outcomes.

Many projects used both a quantitative and qualitative approach to measuring their outcomes. They ran surveys with their service users comparing outcomes before and after the intervention. A large number translated complex wellbeing matrices into simplified questionnaires using visual representations to enable participants to understand and respond to the specific questions. However this was not always appropriate or necessary. Some projects captured outcomes through workshops and interviews at the end of the programme, asking service users to reflect on their journeys throughout the course of the programme. Others developed a film where participants shared their experiences on the course. These are great examples of how outcomes can be captured in a meaningful way.


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Planning for mainstreaming and scaling

The third round of the Innovation Fund will focus on scaling and mainstreaming successful ideas from the previous two years. Key ingredients to successful scaling and mainstreaming are the ability to make a case for the service, and the ability to develop effective partnerships with mainstream service providers.

We see this stage of the process as an opportunity for projects to collaborate and develop mutually beneficial partnerships. Statutory services have higher bureaucratic capacity as well as effective processes in place whilst voluntary and community organisations have a wider reach into, and often, a better understanding of specific communities. These respective strengths can be amplified by working more closely together.

Some projects have been able to develop successful partnerships with statutory providers by highlighting how their offer complemented the existing services, or how what they do enables mainstream services to realise the strategic plans and reach new groups of patients. Project leads emphasised that the formation of such relationships required significant investment from both sides. Health professionals need to be sure of the quality of a community and voluntary care service before they can

refer or signpost projects. This therefore requires a deep understanding of the mutual service offers and their respective benefits. Both health professionals and representatives of the community and voluntary sector organisations expressed a strong interest in better understanding the structures and roles within statutory services and community and voluntary organisations. This was seen as a prerequisite for building better relationships. They emphasised the importance of creating a culture that encourages professionals to go in different environments and to learn from others.

Next steps

The Innovation Fund was set up to find new ways of meeting the health needs of people in City and Hackney. Helping people look after themselves and find their way to the right service is a national challenge and we believe that service users, patient groups and community and voluntary sector have a critical role to play in tackling barriers to healthcare services. We know that many of the solutions lie within the community rather than within mainstream health and social care organisations and that there are important lessons for mainstream health service providers to gain from these projects.

Wellbeing has been found to have an impact on many aspects of people’s lives such as their health, work and social relationships.

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Compassionate Neighbours

The Compassionate Neighbours project matched Community Members with terminal/long term conditions with fully trained volunteers to reduce social isolation, improve their access to local care, and build a wider network of local support. Compassionate Neighbours also offered practical support for families. The group of volunteers was very diverse – they spoke over 20 different languages and were from a variety of backgrounds, ethnicities and age groups – adding to the richness of the project.

Case studies from 2014

51 compassionate neighbours completed the extensive training to help people live well with their conditions, promote a better quality of life, and enable people to remain connected socially and stay in their own home where possible.

A socially isolated Community Member with dementia was always ‘happy’ and cheerful’ to see her Compassionate Neighbour. They enjoyed speaking together in Chinese and cooking together.

Trained Compassionate Neighbours were matched with three other Compassionate Neighbours to form a level of peer support. A small working group was set up to develop this element further. This will contribute to the aim of building a social network of lay people supporting people at the end of life.


People were encouraged to develop advanced care plans around care in later life, and they were supported with accessing local information, networks and services, including St Joeseph’s Hospice and local social prescribing initiatives. The service helped people to improve control and choice about their future care.

Compassionate Neighbours were able to identify and swiftly report issues for their Community member. The Compassionate Neighbours have been more empowered and networked to know what to report, when, and to whom.

The service was co-produced with local people. It recognised and responded to the different needs from Hackney’s diverse communties.

The in-depth matching process ensured that Compassionate Neighbours and Comminity Members be well suited for each other.

Confident and informed users Involving and listening to patients


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Everyone who started volunteering or sharing their skills reported feeling more confident, happier, less isolated and more connected to their community.

A volunteer said that volunteering at a local venue has enabled her to build realtionships with local residents, giving her ‘a sense of purpose’.

Groups of vounteers attended charity open days together, providing mutual support and sharing skills.

The project persistently engaged with volunteers throughout their volunteering journey and provided ongoing support.


With the team’s support, a service user began volunteering with a charity that has access to a range of courses and training. This will help her become more employable in the sector that she wants to build a career in.

Volunteers were able to increase their knowledge of self-managing long term conditions and develop support networks.

The initial holistic assesssment identifies volunteers’ skills and interests and the team engaged extensively with volunteers. The team were focused on finding roles that fitted people’s skill level and gave them opportunties to develop.


Volunteer Centre Hackney

The Skills-Share Project engaged and supported people referred by the Hackney Social Prescribing Programme to share skills and talents, and taken an active role in delivering mutually supportive activities. 187 people engaged with the project, 25 shared skills amongst each other, and 40 people are volunteering with local Hackney charities/organisations. There were six one-off activities and two on-going support groups.

An arts and crafts club launched by a service user has now expanded and an average of 5-10 local residents and other service users attend weekly.

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Epilepsy Society

The Epilepsy Society worked closely with the Homerton’s Epilepsy Nurse Specialist (ENS) and Social Action for Health to jointly develop a tailor-made epilepsy self-management course for people with epilepsy and their carers. The project aimed to increase awareness and understanding about epilepsy to improve seizure control amongst people with epilepsy. The course ran for eight weeks, which included Open Days/Coffee Mornings, and six weeks of structured topic-based sessions. With support from the ENS, the team were able to effectively target patients from the hospital register for recruitment and reached out to

more than 100 patients with epilepsy. 11 patients completed the whole course, but 15 people attended more than four sessions, which qualified for a certificate of attendance for the self-management course. The team used the Patient Activation Measure (PAM) 13 to assess the knowledge, skills, and confidence essential to self-managing health and health conditions.

A patient fed back that he was encouraged by meeting other people in similar situations. Apart from feeling more positive he reported ‘getting out of the house more’ and the way he dressed ‘also changed completely’.

The ENS was ‘really impressed that impact and effect on the patients had been fantastic’.

Most patients’ PAM scores increased. The evaluation form helped to identify patients who still needed support to boost their confidence even though they were becoming more aware of their epilepsy and starting to self-manage their condition.


The project provided knowledge of local specialist services and suppport.

Patients from the self-management courses have set up their own patient group, which meets once a month. They are sharing skills and encouraging each other.

Service users’ perspectives were actively sought and feedback informed the topics covered by the self-management course.



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About the project

Bags of Taste is a dietary behaviour change course which targets people with low income and low food literacy. On a four week course participants learn to cook healthy and tasty dishes that cost no more than £1 per portion. The key difference to other cooking classes is that the course is built on behavioural science principles which encourage healthy eating, and that the recipes are specifically adapted to low-budget and low cooking skills.

Each course lasts for an hour and participants learn to cook one vegetarian and one meat dish - anything from a vegetarian curry from Indonesia, to Indian sheek kebabs and salad and to Turkish vegetarian Guvec. All dishes are anchored in an existing cuisine and appeal to

people’s desire to learn exotic dishes. Most importantly each dish (also meat dishes) include at least two portions of vegetables. While the focus in the course is on learning how to cook the instructor also weaves in tips about healthy eating, where to find ingredients at low cost locally, and how to reduce food waste. Participants thus not only learn how to cook healthy dishes, but also learn where they can buy the ingredients cheaply and locally and what they can do with any food excess.

At the end of the class participants are able to buy the Bags of Taste which include all ingredients for the meals they cooked on the course, readily packaged in the appropriate portions. Participants are encouraged to do some homework by practicing cooking the meals

Case studies from 2015 Bags of Taste - Healthy cooking on a budget

Bags of Taste participants enjoying a meal they’ve learned to cook at one of the sessions.

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at home. In the next class they share their learnings. Once participants have completed the course they are encouraged to stay engaged by joining a Facebook group where recipes and other information are shared.

What difference is it making in the lives of the people in City and Hackney?

per week on food-related costs, which amounts to nearly £850 of savings per year.

They saved

£15-16of the participants who completed the course ate more healthy food.

92%Participants also felt significantly more confident in their cooking skills

The most enthusiastic participants are offered the opportunity to volunteer and support other participants in the cooking classes. Bags of Taste currently has 70 volunteers who get behind the scenes and get the opportunity to learn organisational and commercial skills alongside their cooking skills.

Working with people with complex issues around mental health, debt, illiteracy, or learning disabilities the course achieves impressive outcomes improving their dietary behaviour. According to their most recent surveys:


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Key messages and learning from the project so far

• Learning from the participants’ lives is key to designing a course which responds to the specific group of people. Alicia Weston, the founder of Bags of Taste has conducted rigorous research and observations with the people she wants the course to cater for. A key barrier to applying the newly learnt cooking skills, for example, was that it felt too cumbersome to buy the ingredients to cook the dishes at home. This is why the team decided to offer them Bags of Taste. Through constant learning from the participants the course has improved to respond better respond to their preferences.

• Behavioural science informs every aspect of the course - from the way the recipes have been designed, to how the course is being marketed through to how participants are encouraged to cook more healthy dishes and eat more vegetables themselves. Every aspect of the course is built on behavioural science. People’s cooking skills and food literacy improve over the duration of the course.

• Marketing needs to focus on what people want, not what is right - Bags of Taste’s marketing focuses on “eating better for less” instead of “healthy eating” because they learnt that “healthy eating” is often associated with expensive, organic and less tasty food. The team therefore does not advertise the course as a healthy eating course even though this is built in. Instead in their advertising Bags of Taste emphasise the exotic aspect, taste, and the presentation of the food as well as the budget.

• Developing partnerships with the NHS can take time - Bags of Taste were enthusiastic to work with primary care providers and get referrals from these providers. However, this can sometimes be challenging, meaning that the team has had to rely on direct marketing to fill their courses.

• Working with vulnerable people requires clear boundaries - The Bags of Taste team realised through their engagement with people with mental health issues that boundary setting was very important for their own wellbeing and the sustainability of their course. Volunteers are expecting to undertake a mental health awareness training to learn to better respond to people’s needs with mental health issues and manage expectations.

Future plans and ambitions

Bags of Taste have successfully applied for funding to replicate the course in Islington and Southwark and are also interested in running the course in Glasgow where food poverty and deprivation is a major issue.

All course materials are designed so that anybody can teach the course anywhere they want. Testing the course in Islington and Southwark will enable the team to understand what it takes to scale the course.

The team is also considering and exploring the option to deliver a “Bags of Taste course in a box” where a charity can order the bags with the ingredients, recipes and cooking instructions to teach the course themselves.

£15-16

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About the project

Health Buddies is a peer-support model for people with long-term conditions from the Charedi community in Hackney. With support from the City and Hackney Innovation Fund Bikur Cholim developed a peer support service that pairs up people who have recently been diagnosed with people who have experienced, or lived with the same condition.

During the first eight months of the service ,11 Health Buddies have been supporting 20 people diagnosed with health conditions including type 1 and type 2 diabetes, Crohn’s disease, post-natal depression, depression, epilepsy, asthma, breast cancer, and amyotrophic lateral sclerosis.

A Health Buddy will spend time talking to their client about their condition, help them understand it and come to terms with it. They will signpost people to support available in the area and will accompany their client to health appointments, help them fill out benefit forms and organise appointments. The support offered by this service focuses primarily on the client, but also extends to the family, for example by helping them to

better understand their loved one’s condition or by offering practical support. The practical support that Bikur Cholim can offer includes: hospital transport, cooked meals, babysitting, and house cleaning.

What difference has it made in the lives of people in City and Hackney?

The shared experience and personal support, as well as information and practical help provided by the service, is proving invaluable to clients, who report feeling more confident and better able to cope with their condition.

Talking to clients and peers, the most recurrent theme is the tremendous value of the emotional support for patients. Often, people that are diagnosed with a long term health condition feel overwhelmed, scared, and confused. To receive empathetic advice and help from someone who has experienced a similar condition makes people and their families feel safer; it helps them deal with important practical issues - such as finances or physical adaptations. It enables people to organise their lives and cope better; it makes the burden of illness less daunting to carry.

Bikur Cholim - Health buddies for people with Long Term Conditions

Ariel had been diagnosed with a brain tumour. Yakov, his Health Buddy, accompanied him to an appointment with the consultant. Before the appointment Ariel and Yakov discussed what Ariel wanted to ask the consultant and what he wanted to get out of the meeting. In the conversation Ariel was confused and Yakov stepped in and discussed Ariel’s questions with the doctor. He took notes and, after the meeting, he talked Ariel through them and helped him to understand what the consultant had said. Ariel and his family were grateful and felt they understood things better. Now, when the consultant feels that Ariel needs help in understanding the information, he calls on his Health Buddy Yakov for help. – Health Buddies facilitator


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Key messages and learning from the project

• It takes work to get clients in - To recruit clients for the service, staff have had to be proactive in reaching out to the community. Most clients have been identified by Bikur Cholim staff through other services they offer. In some cases, family members or friends called Bikur Cholim to find out more about the service. Very few people self-referred. Men, in particular, were more difficult to recruit. It was thought that this may be due to psychological factors such as not wanting to appear weak, or being anxious about the confidentiality of their relationship and issues.

• Selecting and matching peers - When selecting peers, Bikur Cholim look for people who have the experience, empathy and time to be involved. Prospective buddies go through health checks and attend various training sessions on confidentiality, benefits advice, advocacy, boundary setting and knowledge about informal support in the community. The Health Buddy co-ordinator matches peers and clients on the basis of their health condition, their interest, age and cultural background. In such a diverse community, matching is important to create the conditions for a trusting and open relationship.

• Going into appointments with a shared plan - Health Buddies discuss the health appointment with their client before accompanying them to an appointment. This helps both to be clear on the questions that the patient has and what they want to get out of their appointment. If necessary, the Buddy can step in and represent their client in the conversation.

• Not all health professionals get it - Buddies can be received with scepticism or mistrust by health professionals when representing their client in appointments. Obtaining recognition for them when acting as an advocate for the patient is important.

• Creating sharing spaces for Buddies is important - Through regular reflective group sessions peer supporters share their learnings and discuss particular challenges around their roles as Health Buddies. This provides a rich learning platform to problem-solve and take notice of helpful lessons. The team also take notice of systematic challenges that patients seem to face.


Bikur Cholim is keen to get more people signed up to this new peer-support model and understand its benefits for clients and families better.

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About the project

Based in the community and open for anyone to attend, the Centre for Better Health has been running services aimed at improving local residents’ mental health and wellbeing and supporting recovery from mental ill-health since 1958. It is this idea of inclusiveness and community focus that underpin the

centre’s Innovation Fund project, which has seen the centre open additional group therapy sessions which are open to a wide range of people all at the same time. This has enabled the centre to meet the growing need, offering a low cost alternative for group sessions that can often be high cost and only available in secondary care settings.

Centre for Better Health

The staff are calm and welcoming, the whole atmosphere creates a sense of a safe space. – By service user

The funding has enabled the centre to broaden their programme and to carry on running groups and building on them. This has also drawn interest from counsellors who have approached the centre, wanting to get involved in running groups.

Participants were assessed pre and post course using the Short Warwick Edinburgh Mental Health Wellbeing Scale.

The project has enabled some of the most vulnerable groups in the community to access group therapy services. A flexible, user-centred approach has allowed the sessions to be tailored to individuals’ needs and ensure that people have been able to access the group that is appropriate for their need. The benefits of attending the group sessions include attendees being able to examine their emotional needs in a secure and safe environment and access services that would normally be unaffordable. The group therapy sessions enabled meaningful interactions higher confidence levels having a direct impact on other areas of the individual’s life.



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Though this project, the Centre for Better Health wanted to improve peoples’ access to mental health services and make group therapy sessions available in the community. They ran six therapeutic groups, each accommodating up to 10 participants and offering 10 x 2 hour sessions. These included Mindfulness, Art Therapy and Drama therapy as well as a Personal Development Group.


• There is a need for community based, open and accessible group therapy sessions.

• Be prepared to learn. Delivering the project has given the centre some useful insights into how they may wish to tailor future services and make better use of the space they have available.

• Building relationships is important. Realising that the service was not reaching particular groups such as housing residents the centre are keen to explore ways of working together with Hackney Housing. There is an untapped group of potential clients that could benefit from the groups.

• Working well with other service providers in your area is crucial for ensuring effective referral systems.

• Group sessions can be a good way of offering interim support to patients in a wide range of settings and can help manage waiting lists to other services.


The Centre for Better Health is open to working with other service providers and commissioners in order to better meet the needs of local residents. They are thinking about different ways to build on the existing model and groups.

The anecdotal feedback from the project attendees has been moving and powerful especially in terms of the Art Therapy group. An attendee has told us that they could barely leave the house and now they are more able to interact socially and are volunteering themselves. – By project lead

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About the project

As a local grassroots organisation with extensive networks in the community, Hackney Council for Voluntary Service (HCVS) and Hackney Refugee Forum (HRF) have a deep understanding of local people and their needs. This includes insights into some of the barriers such as not speaking English as a first language as well as different cultural norms that can prevent people from seeking help and accessing health services. HCVS and HRF wanted to address this issue by partnering with community groups already working with people who may be at risk of not getting the right service at the right time.

The Innovation Fund enabled HCVS to identify and provide training for a number of local groups, each working with a different community in Hackney, providing signposting and health information in languages including Turkish/Kurdish, Polish, French English, Swahili, Rwandan, Lingala and a number of Ugandan languages. The community organisations involved are:

• African Community School

• African Project and Support Centre

• Alevi

• Halkevi

• Precious Lives

• Rise Community Action

Having been skilled up, the representatives of the identified groups were able to talk to people, give information as well as signpost, break down barriers and enable the migrant and refugee communities in Hackney to access the appropriate health services and develop an understanding of the NHS.

Community groups received training on:

• Customer care and telephone manner

• Managing volunteers

• NHS structures and services including information about self-care, pharmacies and out of hours care

• How to find out about local services and support groups

• How to promote your service

• Assertiveness and boundary setting

• Data entry and analysing feedback

• Using evidence to fundraise

What difference has the project made in the lives of people in the City and Hackney?

The benefits of this project are two-fold. Firstly, members of the identified communities benefit from access to increased information and advice. In addition to talking to people and raising awareness of how the NHS works and signposting to appropriate services, the trained signposters have been able to support people with filling in forms, reading appointment letters and making appointments. They have also supported some residents by accompanying them to medical appointments and advocating on their behalf.

Secondly, the project has enabled those community groups and their representatives involved in delivering the signposting project, to build their capacity, access training and gain some valuable experience. The project has helped signposters to build their confidence and to formalise and recognise the important work they do.

Hackney Council for Voluntary Service (HCVS) Signposting Project


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I have a member whose husband has learning difficulties. She came to ask for help to fill in a form for her. At the session I got to know more about her and what her husband’s health issues were. I realised that she got very emotional and she is suffering from stress of having to support her husband and making sure that their children are not affected by their father’s health issue. It is very challenging for them to socialise in the community as even relatives mostly disregard her husband. I asked her if she had had any professional help, and offered to speak to her GP and contact Derman. – Signposter

Six months into the delivery, the signposting project had engaged with 1,340 local residents representing over 15 different ethnic groups: 430 people through direct signposting and 412 people through health information sessions. The majority of people reached through the project represent working age population (19-65 years). People the signposters engage with most commonly need support with things like:

• Translating hospital and GP letters

• Support with booking GP appointments

• Referrals and signposting to community and voluntary sector groups

• Referrals to drug and alcohol services

• Signposting to services such as interpreting, diabetes services and sexual health services

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• There is a need for support around translating health related information such as referral and appointment letters and information about how the NHS works. People also need support so that they can access services and book appointments.

• Make use of existing community based assets in order to reach out to specific communities.

• People’s lives are not defined in line with services. Although the majority of the enquiries were health related, the signposters were also asked about benefits, housing, passport issues, domestic violence, education, immigration, social services and more.


This project is currently still on-going. University of East Anglia are supporting HCVS and Hackney Refugee Forum with outcomes monitoring and cost-benefit analysis.


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Hackney Playbus - Bonding with Baby and Pathway Manager Projects

About the project

Through their Bonding with Baby project, the Hackney Playbus aimed to engage vulnerable families with children under 5 using play, and play bus which travels around the borough going to where families live. The project received funding for two parts:

Supporting hard-to reach families

The first project focussed on supporting the development of the relationship between parent/carer and their child, to improve outcomes including child development, parental mental health, increased breastfeeding and uptake of healthy start vitamins. The project strived to engage with vulnerable families who may not normally access health and support services, for a number of reasons. The programme was delivered in three elements: drop-in groups with parent/carers; family support and volunteer support.

Improving referrals to community support groups

Additional funding was used to create a post for a Referrals Pathways Manager. The Referrals Pathways Manager aimed to strengthen the local vulnerable women’s pathway and increase referrals into the Bonding with Baby programme. Often the things that make families vulnerable (lack of trust, limited confidence and personal resources) act as barriers to accessing groups. The Referrals Pathway Manager post, along with trained volunteers, supported health professionals to confidently make referrals and support women to comfortably access groups and other sources of support.

Although it was more difficult to measure bonding and attachment and related positive outcomes, it felt evident from case studies that the project had had an impact of the lives of some of our most vulnerable families and babies.

had found other local services to access with their baby.

91%

All families accessing Bonding With Baby groups reported having made friends and/or enjoying the opportunity to socialise.


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The service reported a lot of learning from the Bonding with Baby pilot. The project has been very valued and well attended by local mothers but getting vulnerable women in to the service was the key challenge.

Engaging families

• Be prepared to spend time in contacting and engaging your target audience using a variety of different methods. A lot of time was spent contacting families, often by text, as families may have to pay for calls or voicemail but not texts.

• Clients may not want to travel far, preferring to stay in their own neighbourhood which could be a barrier to engagement.

• The use of volunteers enabled Hackney Playbus to reach families that wouldn’t normally access this type of support.

• Movement of families out of borough due to affordable housing availability was also a challenge to providing on-going support.

Engaging professionals

• The Referrals Pathways Manager role was developed to meet this key challenge, and to develop the links with health professionals and community

organisations to ensure everyone is aware of the services and how to refer or signpost.

• Health professionals will only refer clients to a trusted service that will engage women. The service also provides feedback to referrers following referral to flag up family engagement (or not) which is valued.

• Referrals to the pathway manager were initially inconsistent but were building. Around 1 in 3 families referred do engage with the service. The aim was for approximately 40 referrals in round 2 It took time to get the right name, right person, and right team meeting, to develop partnerships.

• Referrals pathway role could be potentially well placed in Hackney Council for Voluntary Service to help professionals refer and signpost to right services and to help broker a way in to services.

• Measuring outcomes - All those involved in the project agreed that it can be a challenge to measure longer term outcomes for families.


The service is looking at options for the Referral Pathways Manager role and how best to embed this locally. The service has struggled to identify further funding for the bonding with baby groups so these are currently not being delivered.

The BWB group has helped me in making friends in the local area. It’s different to the early years’ centres, it’s an intimate group to discuss personal issues, where I am heard and I’m listened to and where parents are encouraged to be friendly and welcoming. I’ve learnt to sing to my baby and play with my baby. – Participant


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About the project

The Menopause Project is a sexual health programme for women who are going through menopause. 45% of menopausal women find these symptoms distressing, yet there is currently very little support available for them beyond reliance upon costly medication for extensive periods of time. The Menopause Project targets both women and health professionals to raise awareness of the menopause and enable women to better manage their symptoms.

The course is built as a 12-week workshop and a separate 30-week exercising programme for women. Grounded in Cognitive Behaviour Therapy (CBT) women were invited to explore their triggers for their symptoms and how they can manage these better by

keeping an eye on their diet and daily activities. Participants kept a diary of their symptoms and monitored their stress and anxiety levels throughout the course. They learnt to respond to these triggers with mindful meditation techniques, along with challenging their beliefs systems and attitudes. In the weekly sessions the group explored issues like stress, diet, exercising and wider sexual health issues like body image, sexuality, work, family and ageing. Women were encouraged to discuss norms around their sexuality and their menopause. The team also delivered two awareness raising workshops for health professionals and the general public to respond to the need from health professionals to understand the symptoms and the management of these symptoms better.

Hands Inc - The Menopause Project

What difference is it making in the lives of people in City and Hackney?

Across the board women’s menopause symptoms and anxiety levels had decreased significantly.

Women also felt more confident in managing their symptoms.

Women who have participated in the programme felt they understood their symptoms and their triggers much better.

Women felt better able to communicate the changes they are going through to their partners and family members who were thus able to be more empathic with the women’s needs.

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The connection to other women was highlighted as a key enabler as women felt not alone in their struggles to make sense of the physical changes they were going through. One of the unexpected results of the course was that women became politically active. A large number of women participated in their patient participation groups (PPGs) and Healthwatch meetings to raise the need for better menopausal support for women.

One of the attendees created a +45 women’s support group at work to discuss how the menopause affects them at work and to come up with specific suggestions for their health and safety policy for menopausal women as this is currently an omitted issue.


• A gap in health service provision - The Menopause Project has identified an important gap in sexual healthcare services and addresses this gap effectively through their CBT & exercising classes. 82% of the health professionals who attended the menopause awareness raising workshop reported to not have received any training around the menopause and 47% not feeling comfortable to advise women on the issue. There was a clear demand for menopause awareness sessions both from the perspective of healthcare professionals and women.

• A safe space to explore sensitive issues around sexuality is necessary - this project highlighted a broader need to explore sexuality and sexual health for women which explores the menstrual cycle as a whole. The connection with other women was a key enabler for women to explore their menopausal issues and address their anxieties around it.

• Exercising helped women to reconnect with their bodies - The exercise sessions in the programme were an important element as most of the women hadn’t exercised for a long time and were put off from joining conventional exercise groups because of body image and confidence issues.

• CBT tools are used to reframe other challenges - The applicability of the CBT tools is wide-ranging and women started using them to reframe challenges in other parts of their lives, such as stress management at work, or in their family relationships. This indicates a wider impact of the Menopause Project.


The Menopause Project is exploring how they can work better with PPGs and NHS organisations to more effectively identify menopausal women and develop a menopause pathway. They contributed to the development of the new menopause pathway being created by the City and Hackney CCG and are keen to being involved in further conversations.

The Menopause Project emphasises the wholeness of the menstrual cycle and the need to look and address birth giving and the menopause as connected issues. They are keen to connect their workshops more closely with maternity services and women’s health in a more holistic way.

The team successfully applied for funding from the Public Health team to do further research into the needs of menopausal women.


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About the project

The Hen Power project introduces the benefits of working with animals to children and young people with disabilities such as autism, sensory impairment, paraplegia, sickle cell, developmental delay, Down’s syndrome, acquired brain injury and more.

Their project is based on the principles and benefits of animal/pet therapy, empowerment and social interaction. It aims to engage children and young people in the on-going care and maintenance of the Huddleston Hen House as well as encourage them to showcase the Hen Power project at public events. The

service wants to employ the ideas and enthusiasm of young people in planning for the on-going sustainability of the project and create a new means of ‘transitioning’ young people who age out of Huddleston services into an exciting and meaningful voluntary role.

A similar project run by Equal Arts in Northern England has received excellent results according to Northumbria University who evaluated the project. Facilitating this project will assist in achieving a shift to preventative, client-led therapeutic approaches to working with this highly vulnerable group of young people.

Huddleston Trust: Hen Power

Like many of the Innovation Fund projects, all Hen Power activities have been designed and delivered together with patients and services users, championing the idea of co-production.

The project is co-ordinated together with children and young people themselves and through outreach and showcasing the work, its remit has extended out to the surrounding community. The Hen Project has visited local nursing homes and events, contributing to an increased sense of community and brining different groups of people together.

The user led, flexible approach has meant that the children and young people involved in this work have been able to take real ownership of the work. Planning for the project included initial meeting with all participants to find out what creative activities they enjoy or already involved with and then showing a range of activities that they may have not done before to see if they would want to try any of them throughout the sessions.


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Feedback has been collected to establish the impact of the project on individual children and young people. Drawings and write ups describe recent work of the project and enable young people to articulate and identify how they are feeling before and after each activity. Attendees report:

• Reduced loneliness, anxiety and depression.

• Improved sense of wellbeing, attributed to interacting in a friendly, non-judgemental environment; there is no need to worry what hens think about you. Observations by group leaders also suggest improvement in cognitive and fine motor skills through learning to interact and care for the animals and through taking part in activities such as sowing and clay modelling.

• Being part of the group and its’ changing dynamics over eight months has led to improved interpersonal relationships and improved ability for emotional self-regulation.

B would get too angry in the previous sessions they attended and would be abusive to the other young people or staff, however in the Hen Power sessions this is not the case. One reason for this is the hens act as a distraction and a shift in focus from themselves and their peers. Their understanding of the hens’ vulnerability and sense of responsibility has really developed with this young person. Now with very rare anger outbursts this young person is able to take part in a club here at The Huddleston Centre reducing their time alone at home, away from other young people. – Hen Power facilitator

Children, young people and staff at the Huddleston Centre have been looking after the hen house.


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• Anxiety amongst children and young people with disabilities is often caused by what others think of them. Interacting with hens who do not judge their appearance or what they say or how they speak is often a refreshing change for young people who have spent all day at school or college. Getting stuck in an activity enables young people to ‘let go’ and feel safe to be themselves.

• Children and young people with disabilities spend a lot of their time being told what to do by adults. Looking after animals, sharing skills and having opportunities to be the ‘expert’ will help people feel valued and increase their confidence.

• Plan ahead and stick to a routine or a set of parameters. Knowing what’s coming will help people feel safe.

• Pick suitable ways of gathering feedback. Think creatively. Ask people to draw and or describe how they feel. Videos and pictures work well too.


• The outreach visit to the nearby care home has inspired a young person to start thinking about a possible work experience placement there and plans are in place to support him with this.

• Expanding the scope of the project and continue bringing people together through further outreach trips in the local community.

• Embarking on a long term arts project with support from an external professional artist this autumn.

• Welcoming the new chicks about to be hatched!

The main improvement in the young person C, has been verbal communication and confidence. They have become more engaged in sessions with the other young people they are laughing a lot more than when they first began and their conversations have developed from predominately talking about the hens to talking about themselves such as what they like and dislike and general chat about what they do with their spare time. The hens have acted as a catalyst for improving this person’s enjoyment of the session and in turn their wellbeing. – Hen Power facilitator

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About the project

Koach practitioners are a husband and wife team with background in Early Years Services, education, coaching and project management. The Innovation Fund has enabled them to set up and provide a community based support service for parents experiencing relationship difficulties with their children. The project uses the evidence based Solihull Parenting approach, providing culturally sensitive support service within the large Orthodox Jewish community in North Hackney, as well as reaching out to the wider community.

Koach practitioners have been trained and receive clinical supervision from First Steps, an Early Intervention and Community Psychology Service helping children, young people and their families with emotional concerns. First Steps make the referral to Koach Practitioners who then arrange to meet with the family for up to 10 times. The sessions can take place at a variety of locations, including GP practices, community centres or at practitioners’ home, depending on what best suits the clients’ needs. Clients are assessed at the start and at the end of the project and feedback is gathered at each session.

Koach Parenting

I believe Koach is a much needed, wonderful and unique bridge between the Orthodox Jewish community, their parenting practices based on culture and religion, and First Steps’ evidence based parenting support, as offered by the NHS.

What difference has the project made in the lives of people in City and Hackney?

Comments from stakeholders and families include:

A big part of the Koach Parenting project has been to work in partnership with NHS organisations and to reduce reliance on NHS services. During the course of the project these partnerships and referral processes have been established with not just First Steps, but also with Children and Adolescent Mental Health Services (CAMHS), Occupational Therapy Services and Hackney Ark Specialist Team.

First Steps report that they have benefitted from Koach Practitioners extensive knowledge of the local Orthodox Jewish community, including the independent schools as well as their understanding of the religious teaching, enabling therapeutic approaches to be adapted to fit clients’ lives.


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I started to understand myself and my feelings while doing my parenting. It was good discussing how to set limits – what’s right and wrong.

I find the sessions really empower me and make me feel really confident, my husband thinks I’ve changed. I took the pyramid diagram to remind me to work on positive communication, feel very well heard and feel like we’re making progress.

I learned how to understand my child’s feelings when misbehaving and will start setting limits.

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The project has resulted in some significant improvements in parents’ goals for themselves and their children’s behaviour, including:

• Parents reporting positive change around children being able to understand and manage difficult emotions and parents being more in tune with their children.

• Improved relationships between siblings and the overall atmosphere at home. More than half of the families supported by Koach Parenting no longer needed support from First Steps when they reached the top of the waiting list.


• Partnership working between NHS organisations and community and voluntary sector groups has the potential to improve service experience, support more people closer to home, reduce burden on the NHS services and help manage waiting lists as well as provide culturally sensitive service which is likely to result in improved outcomes.

• If your plan involves setting something up from scratch, make sure to build in sufficient time for things like setting up accounts, organising insurance and registering as a charity, all of which can be time consuming and involve a lot of paper work. Maintaining open and transparent communication with funders really helps keep things moving and ensures there won’t be unnecessary delays in the project getting started. Setting up a new service is a learning curve for all those involved. Being prepared to take risks, accepting advice and support and reflecting on your own practice will help your project move forward and support personal development.


• There is potential to extend the service delivery to cover training for school staff within the independent Orthodox Jewish schools, using the Solihull approach.

• The approach could lend itself very well to other communities and Koach practitioners would be happy to facilitate support sessions for setting up similar projects.

• Providing cultural awareness training to First Steps psychology team and/or other healthcare professionals.


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Read Together

About the project

Read Together is a social enterprise that promotes reading and creativity for pleasure and positive mental wellbeing. They support organisations to set up and run their reading groups through training and mentoring support. Through the Innovation Fund Read Together have been able to map existing reading groups and start new ones. They also offer additional support in form of an online database from which facilitators can select stories and poems, and monthly

networking meetings that enable facilitators to raise any particular challenges that may have come up while running the reading groups.

Participants can drop in a weekly shared reading group session, open to any literacy level. People listen to a short story or poem that is read aloud by a trained facilitator and any group members who are willing and able. The stories and poems are wide ranging and carefully selected by the facilitator to ensure people can connect with the content and they prompt and inspire.

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Adult literacy levels in the UK are low and reading has become associated only with education. Reading should not be just for functional or academic reasons - it can help us to escape, build empathy, use our imagination and realise we are not alone. Reading doesn’t need to be a solitary pursuit. Reading can bring people together. – Read Together facilitator

How is it making a difference?

The group is one of the only times I don’t think about my mental illness…. It feels as if my brain has woken up! – Group Member, Shoreditch Community Group

There are currently 40 reading groups which specifically target up to 400 participants at risk of or experiencing mental health issues along those with a range of complex needs including learning difficulties, substance misuse and those at risk of social isolation. The groups help to decrease social isolation by bringing them together on a weekly basis.

of participants feel more connected to the community and to each other. They report being more informed about community and primary care services and thus able to reach out.

report that their wellbeing has improved and that they feel more confident to speak about their issues and cope with them.

91%91%


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• Sharing learning through monthly networking meetings among the facilitators is important for the success of these reading groups - The members of these reading groups are vulnerable and facilitators need to know how to support them and themselves in the best way. The networking groups are there to help them to do this. People learn how to deal with various reactions and responses of participants. Since most facilitators are part of mental health organisations they can give practical tips to other community organisation facilitators and share reading materials that have worked well.

• You need buy-in from senior officers and from frontline staff for effective partnerships - Read Together have learnt that buy-in from senior officers is not enough for the reading groups to run effectively. They therefore target their training to senior officers and frontline staff

to ensure there are champions within frontline staff to run the reading groups with their patients and clients.

• Developing partnerships with the NHS can be challenging - Read Together were hoping to develop relationships with GP practices and the social prescribing teams in the City and Hackney to get referrals to their groups. Navigating confidentiality issues and communicating with busy GPs made this tricky. The timing of the project also meant that the time to get in touch with GPs was August, when most were on leave.

• Scaling the Read Together model requires open access – very few reading groups are open to all residents. This is due to the funding requirements or client criteria of the organisations which are running the reading groups. For the model to be successfully scaled they require more groups to be fully open, as otherwise referral processes are complicated.

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Next steps

There are currently 40 reading groups running across Hackney and The City. The team has just applied for funding to reach older housebound people at risk of social isolation to enable them to participate. They are also keen to train organisations in other boroughs of London to run reading groups. The network is continuing to meet every month, now funded by Hackney Parochial Charities. New organisations are welcome to attend and find out more.

The current reading groups are targeting English-speaking residents, however Read Together are keen to attract people with English as a second language who represent a significant share of Hackney’s residents. They are exploring ways to run the reading groups with some of the ethnic community groups in their own language. The group is also keen to engage local GP practices to pilot social prescribing to the groups for the Shared Reading Group Network.

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About the project

Renaisi’s Healthy Families Healthy Communities is an early intervention service aimed at building the confidence and health literacy of parents from ethnic minority communities in Hackney, helping them to overcome barriers which affect their ability to thrive, such as language, poverty, cultural isolation, stress and lack of access to health services.

This programme builds on the tested model that Renaisi have developed in partnership with Islington

schools. With support from the City and Hackney Innovation Fund, Renaisi brought this model to Hackney, in partnership with six Hackney primary schools testing a specific focus on health literacy.

The programme offer is comprised of: Bilingual Parent Support Advisers, who act as interpreters and advocates for parents in schools; English for Health Cafes, sessions where parents develop language skills through learning about health and wellbeing topics; Community workshops, designed and delivered in the community by parents engaged in the programme.

Renaisi – Healthy Families Healthy Communities

Women taking part at the Renaisi’s Healthy Families Healthy Communities project.

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Halima has two children. When meeting with the Bilingual Advisor she confided that two of her relatives had passed away recently and she found it difficult to talk about her feelings with her friends. She was seeing her GP about her headaches and he suggested that she do some relaxation activities, but she did not know what to do. She was very reluctant to use support services and just wanted to talk with the advisor. Over time, Halima opened up to the advisor’s suggestion to start taking some classes and the advisor helped her to enrol. She has now started yoga and soon will start cooking lessons with her children. She is more talkative in the classroom as well. – Renaisi facilitator

The aim of the programme has been to help parents with English as a second language to gain confidence and resilience to be able to navigate the health system with some autonomy.

The support provided by Bilingual Advisors has helped parents with practical issues ranging from mental health and emotional wellbeing, to navigating the health and care system, to women’s health, to help with children’s education.


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Evidence gathered suggests that

• Parents who have taken part in the programme have grown their confidence and feel less isolated, thanks to the support offered by Bilingual Advisers and being part of a group through the English for Health Cafes.

• Friendships have developed and social networks of support have been built and consolidated.

Through the programme, parents involved in Renaisi’s English for Health Cafes have been

planning and running Parent Health Fairs in their schools. Doing this, they have not only built their confidence and friendships with each other, but also offered their leadership and creativity to make something exciting happen in their community. A number of them have expressed the wish to do some volunteering in their spare time and have joined Renaisi’s Parent Champions scheme.

Involvement in the programme has also increased people’s knowledge of existing services, as well as their confidence to access them.

After attending ESOL classes I can go to my hospital appointment by myself, without a relative or friend! – Turkish mum of four children

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• People often don’t know about support that is available and struggle to navigate the system - many parents don’t know about support services available in Hackney and benefit greatly from the information and signposting provided by the advisors. A lot of the advisors’ casework has focused on booking appointments over the phone, filling forms, understanding letters and referring people to agencies who can advocate on their behalf.

• People in the target group know a fair bit about good nutrition - they struggle to access healthy food.Through the English for Health Cafe tutors and advisors realised that people know about healthy eating but can struggle to buy quality fresh food. The programme has been offering advice to parents on how to make healthy and ‘child appealing’ foods on limited budgets and finding healthy choices for snacks and avoiding processed foods.

• Stress, mental ill health and domestic violence are real issues - mental health and emotional wellbeing has been one of the most recurrent health topics of casework for advisors. A number of parents struggle mentally and emotionally as a result of trauma such as domestic violence, bereavement and low level and often undiagnosed mental health issues.

• The language barrier makes it difficult for women to seek the right support around women’s health - women with a low level of English proficiency need to communicate with health professionals through interpreters, who are often their husbands. This makes it difficult for them to explore issues like birth control and other women health issues freely and in confidence.


• Renaisi see the groups of parent leaders that are emerging out of the programme as an important legacy, which they hope won’t be lost. Their ambition is to embed and scale the programme in Hackney, as they have done in Islington.


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About the project

Spice Innovations Ltd and St Mungo’s Mare Street hostel teamed up to deliver this project aimed at addressing some of the stark health inequalities experienced by people who are homeless, whilst involving homeless people themselves in planning and delivering health and wellbeing related activities.

One of the key innovations of this project was to introduce the use of Time Credits, which hostel residents gained for contributing their time and sharing their skills. The City and Hackney Time Credit note which was developed as part of the project can be used locally or across London, to access a broad range of services and venues, including cinemas, leisure centres, museums and more.

Co-produced by a group of hostel residents, the project has a genuine, service user led focus and it has been allowed to grow and develop in line with what residents have felt is important.

Health and wellbeing as underlying themes, have been weaved into all activities, be it organising a social activity for other residents, sharing IT skills, talking about healthy eating whilst learning a new recipe or using time credits to access local health and fitness activities.

The project was designed to focus on at least three areas of activity which are proven to make significant impacts on health and lifestyle: peer support, self-management and improving access to information about health and related services.

Spice & St Mungo’s Time Credits Project

Residents of St Mungo’s homeless hostel and Spice staff together with Hackney based Graffiti artist Stik who helped design the City and Hackney Time Credit currency.

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As part of the Time Credits project, a group of hostel residents who have been involved in the project drew from their own lived experiences to make a short film titled ‘My Health: My Story’. They filmed each other’s experiences and ideas, and fed in to the final edit. Focus was on the barriers they’d experienced in

accessing healthcare services and the advice they’d give others as well as the things that have helped them overcome some of the challenges in their own lives.

You can view the video here www.youtube.com/watch?v=Tbaao10cYx8

Findings from other UK wide Spice Time Credit projects highlight three key areas of impact: quality of life, health and wellbeing, building stronger communities, building individual capacity and creating new opportunities.

of those who had participated in a Time Credit project reported increased level of s ocial contact.

reported feeling healthier, many people choosing to spend their credits on physical activity such as gyms and swimming pools.

said that they had less need to go to the doctor and 81% felt that taking part had had a positive impact on their quality of life.

58% 23%60%

What difference has the project made in the lives of people in City and Hackney?


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It’s allowed me to do things I wouldn’t usually be able to do. Things I have thought I’d never be interested in, I’m now interested in. It’s allowed me to do things I didn’t think I’d be capable of. – Resident

The opportunities are huge. You can create a network from people that have experienced a similar life to me. Being involved in helping each other and supporting each other feels more like a community. – Resident

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• Co-production has the potential to make services more effective and relevant to the communities you are trying to reach. Involving service users in the process from early encourages a real sense of ownership and pride.

• Time Credits as a service model lends itself to many settings and scenarios. It can be used to engage and improve outcomes on an individual level, as well as by organisations in order to encourage participation and gain genuine patient and service user insight. It also has the potential to increase community cohesion and civic engagement.

• Although there are lots of complex issues around homelessness there are some fairly simple things that all health services can do to better meet the needs of this population and help people look after themselves; appointment reminders, a simple phone call to ask people how they’re getting on and making sure people have access to clear and easy to understand information.

• Working in a setting such as homeless hostel can be challenging. Trust and relationships need to be built. People can be in crisis and have a range of issues. There is also a degree of instability that comes with people moving in and out of the hostel.

• Asking people to share their time, skills and knowledge is a great way to tap into existing assets, build confidence and enforce the idea that everyone can contribute regardless of their situation or status. Through City and Hackney Time Credits project St Mungo’s residents have been able to use their negative experiences towards something positive.

• There is a real need for more integrated approach within services for homeless people, in particular around substance misuse services and mental health services.


• The project has resulted in increased understanding of some of the issues experienced by homeless people in relation to health and health services. St Mungo’s Hostel indicated their interest in continuing subject to available resources. There is scope for building on this information and addressing some of the specific issues that were raised.

• Increased integration between services working with homeless people.

• Directory of services available locally, with specific focus on the needs of those experiencing homelessness.

• Looking at what could be done to implement some of the suggestions made by St Mungo’s residents; appointment reminders, calls from health services to see how people are getting on.

• A natural next step would be to look at how Time Credits could be used to support residents after they leave a hostel. This is often when people can feel vulnerable and lonely. Another opportunity would be to tie the Time Credits project into mainstream services such as homelessness pathways, Health Hubs, screening services, mental health services.


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About the project

St Joseph’s Hospice are constantly working to ensure that their services offer quality support and a great experience to people who use the Hospice and that they are equally accessible to people across Hackney.

Lots of time and resource go into making the Hospice a place where people go to feel well, yet most people’s idea of a Hospice is ‘a place where you go to die’. Challenging this view and raising awareness of the wide range of services that the Hospice offer, particularly the Day Service offer, is the aim of this project, funded by City and Hackney Innovation Fund.

The team that drive the project is drawn from across the Hospice and also involves champions and volunteers from the community. Their job is to make

the Day Service better known in the community and more accessible, particularly to the Polish, Turkish and Indian groups in Hackney, who are currently under-represented in its user population. The team are starting by engaging people in these communities to learn about their perceptions of the Hospice, what kind of support feels helpful when they or their loved ones are dealing with life limiting conditions and what might get in the way of them accessing the support that is available. They plan to use these insights as the starting point to co-design a refreshed Day Service offer, which is more accessible and culturally appropriate.

Their goal, through supporting more people in Hackney, is to reduce unnecessary hospital admissions and help people living with life limiting conditions be better supported in their community.

St Joseph’s Hospice – serving multicultural communities

It is still early days, as implementation of the service has only started recently. The team at St Joseph’s Hospice expect the project will grow the number of people who use and benefit from the Day Hospice service and improve experience by drawing on users’ knowledge to tailor the service to better meet their needs.

The project will also develop a community of active users and champions, who will help make sure that the service offer remains relevant and familiar to the wider Hackney community.


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• We need to challenge assumptions about hospice care – conventional wisdom sees hospices as places of death. Yet hospice care is not only about good death, it is also about good life. To expand their reach and impact, hospices need to create a new narrative for their services, shaped around a compelling offer that is grounded in understanding people’s lives and aspirations.

• Opportunities to connect are what people value the most – people generally come to the Day Hospice with the notion of receiving a ‘service’. Once they are in the Day Hospice, what they value the most is invariably the opportunity to connect with other people. Day Service is about a supportive community, a routine of interaction that shifts the focus from illness to activity and the discovery, through shared experience, that you are not alone.

• Some groups have been harder to reach – an analysis of St Joseph’s data shows that, while African and Caribbean communities are well represented in the Hospice User Group, the Polish, Turkish, Indian and Jewish communities are under-

represented. The same is true for people living with dementia and younger patients. The aim of the project is to understand the reasons why these groups are not coming through the door and, where appropriate, generate ideas to make the service more accessible and relevant to them.

• ‘Discharge’ is hard – people are referred to Day Service for a period of 12 weeks. The staff team work hard to ensure people are prepared for the transition out of the service, but this ‘hard stop’ often feels difficult to both patients and staff.

• Exploring greater flexibility – currently, Day Services at St Joseph is based on referral and runs for a set period of time. The manager is considering testing whether flexible drop in sessions could make it easier for a wider range of people to access and benefit from the service.


• The steering group will convene a group of users who will help them lead an enquiry in the community about perceptions, needs, barriers and ideas.


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About the project

Living Together with Dementia (LTWD) is an Innovation Fund project delivered by Tavistock Relationships. The project is focused on improving the quality of life, mental health and wellbeing of couples living with dementia. It aims to do this by increasing the couple’s resilience to maintain their independence, remain active and preserve an intimate and familiar relationship with their partner, thus reducing the burden and health impacts on the carer partner.

At the heart of the project is a training programme delivered to healthcare professionals who come into contact with people diagnosed with dementia. This training enables professionals to better support their patients and the couple as a unit.

Tavistock Relationships provides a number of services supporting couples and relationships and it is their aim to make these services accessible to everyone. Similar projects have taken place in Camden and in Islington and the Innovation Fund enabled the service to be trialled in City and Hackney.

Tavistock Centre for Couple Relationships - Living Together with Dementia


Tavistock Relationships believe that this approach provides a new and different way of supporting couples with dementia and other long term illnesses through keeping the couple involved and maintaining the protective aspects that this unique bond provides. The service helps people maintain the emotional contact through a painful and difficult time, when relationships can often break down. Living Together with Dementia project is still on-going and the feedback received from trainees to date is positive.

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• When setting up a new service it takes some time to understand what the best ways for reaching your target audience are, and in establishing effective referral routes.

• Anyone working with this cohort of patients’ needs to have the couple in mind, be it the social worker or the care worker. Illness really affects peoples’ relationships and relationships are a great source of strength for people.

• Supporting the couple as a unit has potential to be helpful in a number of settings. It can be applied when working with people with other long term health conditions, mental health issues, cancer diagnosis etc.

• Taking part in this process has broadened our focus. Other organisations have got in contact with us expressing interest to do something similar.

Person with dementia faces limitations in their capacities – feelings of inadequacy or self-criticism or criticism fom others

Person with dementia withdraws emotionally from partner and from everyday activities they might share

Carer partner’s response can lead to taking over and becoming critical or withdrawing themselves

The negative loop of withdrawal:

LTWD intervenes to change this negative loop of withdrawal by supporting not only the carer partner, but the person with dementia AND their relationship. One very important element is in helping the carer partner to have a greater understanding of the behaviour of their partner with dementia, and the feelings underlying their behaviour.


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Future plans

• Following the project being established in City and Hackney, Devon Partnership Trust have requested the service to be offered in Bristol. Individual and couples’ counselling has been set up for people with dementia.

• Tavistock Relationships have been contacted by people with an interest in dementia and by

organisations working with people with dementia, including Admiral Nurses from outside City and Hackney.

• In the future, in order to accommodate a wider range of professionals, it will be possible for participants to choose a level of training suitable to their role and the environment they work in.

Produced by Hackney Design, Communications & Print • December 2016 • HDS806

City & Hackney Clinical Commissioning Group3rd floor, A BlockSt LeonardsNuttall StreetLondon N1 5LZ

Tel: 020 3816 3222

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