Building Health Partnerships
Drawn from our experience of running a number of large-scale programmes.
Developed and delivered in partnership with:
Big Lottery Fund
Department of Health
The Building Health Partnerships (BHP) programme builds relationships between the NHS, local government, citizens and voluntary, community and social enterprise (VCSE) organisations to facilitate joint action that improves health and care priorities.
With the NHS facing a series of well-known critical challenges, it is in desperate need of new care models that are sustainable and flexible to our changing society.
Using action learning approaches, we support tangible improvements to the design, commissioning and delivery of local health services.
Details of the projects in our current five STP/ICS areas are below.
Nottingham and Nottinghamshire
We are working to reduce delayed transfers of care in Greater Nottingham – where a local study showed 42% of patients could have had a better pathway home from hospital.
Community researchers will be interviewing voluntary organisations to understand:
- How can the voluntary and community sector support patients over 75 going home with Dementia who are medically fit for transfer to leave hospital, back into their own home
- If and how existing services could be scaled up and/or expanded to support this group (and potentially others with long term conditions) to leave hospital earlier.
This research will result in a plan to engage with a range of community support services, a business case to build capacity in the community and shift investment – and pressure – away from acute services. By end of July 2019, we expect to have the knowledge, developed cross-sector relationships, senior buy-in and investment plans required to build the capacity of providers and reduce delayed transfers of care for this patient cohort. Our aim is to increase opportunities for patients to leave hospital and live independently for longer, with a ‘home first’ approach that will reduce delayed transfers of care from the acute trust.
Further resources from Nottingham and Nottinghamshire:
Building Health Partnerships brings together people from the NHS, public health, local authorities, the voluntary, community and social enterprise sector and patient groups to achieve transformational change to our health and care system.
80% of strokes are preventable, yet in one ward in Copeland, people are 104% more likely to have a stroke than the national average.
The NHS is working with local communities and organisations to identify people at risk of stroke and raise awareness of the ways stroke can be prevented. They are planning to hold a community health ‘mela’ as well as exploring a range of other outreach opportunities via a locally developed community calendar to target high risk populations who often don’t seek health advice through events such as fairs and auction marts as well as through their own community pharmacy.
By July 2019, they will have identified up to 50 people who are potentially at-risk and have developed a method for reaching them together to reduce stroke in Copeland. The project aims to reach them with health advice and information to reduce that risk. It also plans to raise awareness generally of how to live in a way which supports people to live better for longer. It is key we do this in the areas where people live and feel comfortable rather than expecting them to travel into a medical setting.
Further resources for North Cumbria:
Frimley Health and Care
Building Health Partnerships brings together people from the NHS, local authorities, the voluntary, community and social enterprise sector and patient groups to achieve transformational change to our health and care system.
Looking after the health and well-being of our people in the workplace is a challenge for the health system. The ICS wants to lead from the front and role model healthy workplace behaviour across the Frimley Health and Care footprint. Proactive support for healthier lifestyles around the workplace will support staff retention and workplace satisfaction, whilst also aiming to prevent the development of long-term conditions for a significant proportion of the Frimley population.
The ICS partnership in Frimley will be teaming up with employers, starting with those in the ICS to design a campaign aimed at workplace health and developing a collective commitment to looking after our people, and sharing our resources, skills and expertise to really care for those people who work in the system.
By July 2019, we will have co-produced a campaign to increase take-up of a tailored approach to prevention/health-promoting behaviours, based on what our local people tell us about how they live their lives and what we can do to support and influence their lifestyle choices, and making best use of community based activities provided by the voluntary sector, health and care.
Healthier Lancashire and South Cumbria
Building Health Partnerships brings together people from the NHS, local authorities, public health and the voluntary, community and social enterprise sector and patient groups to achieve transformational change to our health and care system.
We are exploring how open, transparent and shared leadership between statutory health and care partners and the voluntary, community and faith sector (VCFS) at neighbourhood level can improve health and wellbeing of our communities.
The ICS is investing up to £50,000 across five neighbourhoods, each of which will pilot a project working in partnership with the voluntary sector on a specific health or wellbeing area, which they will decide based on the needs of their local population.
By July 2019, we expect to have set up these five pilot projects to test the value of working in this way between NHS and VCFS leaders in health and care service design and delivery at a neighbourhood level. Through this we will identify:
- What are the core requirements to create and sustain a new culture of leadership in each neighbourhood, for example, the importance of the link workers and their understanding of the VCFS assets in communities
- The value of this relationship at an ICP level and an intention to create shared understanding across statutory health and care partners.
Patient activation measures and business intelligence will be considered to determine whether any initiatives within the test sites have an impact on demand and outcomes of local services. The outcomes are expected to be focused on the wider determinants of health and examples of where partnership work has improved lives will be captured as part of the tests – therefore demonstrating the value of the VCFS sector on health and wellbeing of communities.
Further resources from Healthier Lancashire and South Cumbria;
- Talking Points for VCFS Leaders
- Partnership meeting slides
- Lancashire and South Cumbria Partnership Meeting 1
- Lancashire and South Cumbria Partnership Meeting 2
- Lancashire and South Cumbria Partnership Meeting 3
- A Whole New World: Funding and Commissioning in Complexity
- Funding, commissioning and managing health and care- Toby Lowe
West Yorkshire and Harrogate Health and Care Partnership
The Integrated Care System of West Yorkshire and Harrogate have worked with local people and service users to identify two health conditions that are associated with complex patient needs, and two sites to try a new way of working:
- Eye conditions and blindness are linked to poor outcomes including loss of independence, social isolation and even dementia. 50% of sight loss is preventable. By July 2019, the NHS and Public Health will have co-produced a public health campaign with local communities that leads to earlier diagnosis of eye conditions in Wakefield. Interim findings of an eye health survey conducted with Wakefield residents revealed that more than half of those surveyed did not know how to keep their eyes healthy. 20% of respondents do not have regular eye tests and the top reasons for this were ‘my vision is fine’, ‘it’s too expensive’ and ‘it’s not a priority’. Interventions therefore will include raising awareness of the importance of eye tests and education on how to keep eyes healthy.
- Exercise is proven to improve emotional and physical health. In Calderdale 37% of the population is inactive, doing less than 30 minutes moderate exercise per week. Inactivity is associated with potential complex conditions such as obesity, cardio-vascular ill health, muscular skeletal conditions and poor mental health. Working with local young people and voluntary and community organisations, we will co-design and develop public health messages and a series of initiatives that help young people become more active and improve their long term health. By July 2019, we expect to have co-produced, funded, delivered and assessed the impact of a number of youth-led projects that lead to improved access for young people to activity, and improved health and wellbeing.
Through developing these two community-led public health initiatives, we expect the ICS to establish an internal capability for co-producing solutions to local health and care issues with patient groups and communities – supporting a new model of service design.
07 March 2019
Community Health Melas
Kevin Walsh | District Governor for Rotary Clubs throughout Cumbria and Lancashire 2013-14
The concept is simple; give people the opportunity to have a Health MOT in a friendly, safe environment and provide them with the advice required to make appropriate lifestyle choices. This provides a framework for the NHS and local government to work with volunteers around priorities highlighted in the NHS Long Term Plan – particularly around early diagnosis and prevention.
BHP in ...
The BHP programme is about facilitating a conversation between local people, VCSEs and public agencies. The process involves the following elements:
- The ‘core group’. This is made up of people from all relevant sectors within the STP area. This group is central to the process. They help set the context for the facilitators, drive activity and model good ways of working. Making sure this group has the right membership is essential. It must include champions of collaborative working from the statutory and VCSE sectors.
- Full partnership sessions. Four to five half-day sessions, involving all interested parties within the STP area. They provide the space for people from different sectors to work together to design change to local health services and to develop joint action plans.
- Independent facilitators from IVAR. The facilitator ‘holds’ the process. They develop an understanding of the context, and design partnership meetings that are spaces where multiple voices can be heard. They also organise agendas, troubleshoot and help build relationships and networks, drawing in new perspectives. Facilitators are experienced in bringing together multi-agency and multi-disciplinary groups of people to build consensus, solve dilemmas, implement plans, deliver training and develop strategy.
- Leadership training. Cross-sector individuals from each area are invited to attend training, delivered by IVAR and The Kings Fund, in order to develop their skills, behaviours and attitudes to support local transformation. People attending can then take back what they have learned in order to champion this way of working, locally and nationally, and sow the seeds for further collaborative approaches. This enables individuals to play an ongoing role in transformation and influence and helps to create a legacy of collaboration in the BHP areas.
The NHS is facing a number of critical challenges including an ever-increasing population and people living longer, with more complex, long-term conditions. In this climate of changing health needs and stretched resources, multi-stakeholder partnerships at a community level are needed to develop new ways of working in order to find local solutions.
People’s health is determined by a range of social, economic and environmental factors. For example, there is a clear correlation between poverty, poor health and early death. There is also evidence that links the amount of control people have over their lives with their and health and wellbeing. Health agencies are, therefore, increasingly interested in the role of prevention and partnership working. By listening to local people’s concerns and increasing their confidence and skills in self care, and by fostering relationships between communities, health professionals and VCSE organisations, we can address people’s needs in a more holistic way, tackle health inequalities and support individuals to take greater control of their own health.
In order to support people to stay well, for longer, in their communities we need to look together at the support people need alongside hospital and GP care. Community-centred and social prescribing approaches, as well as the role of VCSE organisations in delivering them, are increasingly being recognised as a way to address the wider factors that affect people’s health and wellbeing.
Small VCSE organisations are often the first to respond to ‘hyper-local’ needs and provide spaces where people feel safe and respected. They tend to focus on general wellbeing and have been described by public sector stakeholders as ‘the glue that holds communities together’. They are valued for having an ‘open door approach that means people are not turned away’. However, evidence also points to a mismatch between what many small community organisations do (their distinctiveness and social value) and how many public and voluntary sector programmes are funded.
There are of course challenges on both sides to community-centred working. It is not easy to reach the most marginalised populations or to identify where your approach or organisational culture may need to change. There are also financial constraints and limitations of short-term projects and programmes.
The NHS Five Year Forward View recognised the role VCSE organisations could play, in partnership with the NHS, to help deliver its vision. At a strategic level, NHS England is committed to working with VCSEs and establishing models for more equitable partnerships and better integration, and to increase the influence of the voice of patients. More locally, STPs, as with any relatively new player in a system, are taking time to build consistently high and constructive levels of engagement with VCSE organisations and communities more widely.
The BHP programme was designed in response to all these challenges, to work intensively with statutory services to test and pilot new approaches to partnership working. Over the last year, the programme has run in eight STP areas, with learning being shared across England.
‘We will work collaboratively with the voluntary sector and primary care to design a common approach to self care and social prescribing, including how to make it systematic and equitable.’
NHS England, Five Year Forward View
More from BHP Self Care
There are a number of reports you may find useful – find a full list of further reading on the Social Enterprise UK website.
Patients and communities driving progress in self care
This briefing reports on the Building Health Partnerships Self Care programme and the seven areas where it operated in 2017-2018.
It breaks the usual mould and enables a new and fresh dialogue between statutory organisations/services and the voluntary and community sector.’
Briefing One: Improving self care at a local level.
Are you interested in how STPs are working with the voluntary sector and local people to design health and care services? Do you want to know how self care is perceived at a local level? Or where to start with setting up partnership working?
What are the benefits?
- Establish cross sector relationships, working together to overcome obstacles
- Senior level appreciation and commitment to the VCSE offer
- VCSEs become strategic partners with public agencies
- Creates readiness for change and challenge – allowing ideas to be turned into action
- A common language for talking about improvements to health and well-being
- Co-designed, integrated, asset-based approaches that provide local solutions
- Meets the health and well-being needs of local people more effectively
What factors make it work?
- Timing: The importance of seeing change as a process, rather than an event, allowing relationships to be built and ideas to be turned into action
- Commitment and buy-in: Senior level, cross sector, diverse involvement
- Bespoke and independent facilitation: A high level of support and access to experts and resources
- Dual focus: On relationship building as well as joint action
- Not rushing into action: Participants are grappling with complex, emerging structures and unfamiliar opportunities: for new, joint initiatives to have a chance of being useful and effective, the foundations (relationships, common ground, mutual understanding) will need to be in place
We definitely got in shape quicker and made more progress in a short space of time because of the programme.”
What are the challenges?
- Too many competing drivers and outcome frameworks for cross sector working e.g inconsistent approaches to integration and silo working
- The voluntary sector is diverse: there are community links to tap into and expertise, but little capacity to engage and a high risk of duplication and overlap
- A lack of opportunity to stand back, reflect and explore possibilities to tackle the difficult issues that block progress
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