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What good looks like: Example of cross-sector working in Pennine

In Lancashire and South Cumbria, Pennine Lancashire is often cited as an example of good practice in cross-sector working in the design and delivery of health and care services. It is a health and care improvement programme led by health, public sector and voluntary, community, faith and social enterprise sector (VCFSE) colleagues to improve the health and care system in Pennine Lancashire. Here we reflect on what we have learnt from our experiences of collaborating on this programme, in particular around the social prescribing agenda. We recognise that we haven’t got everything right yet, and much work is still to be done, but we hope that by sharing our experience it will contribute to wider discussions about what it means to develop meaningful cross-sector collaboration.

Over time, VCFSE and health sector colleagues in East Lancashire have developed a way of working that shows how being well positioned in the community and having good relationships enables a strong foundation. This has been highlighted in our social prescribing approach that supports people to make changes that improve their own health. The key enablers have been:

1. History of shared working

Our relationships have been solid for a long time and are well embedded. In order to be effective, local structures – e.g. Neighbourhood Teams – and programmes of work – e.g. The Better Care Fund and Community Safety Partnerships – required good partnership working. In such collaborations the voluntary sector feels like an equal partner and, while there is variation from region to region, overall, the sector feels they are sitting at the right tables. This has created a movement of cross-sector partnerships to support the health and social care agenda. We see the VCFSE sector as strong, thriving, flexible, open and passionate about local people and supporting them.

2. Motivation to form relationships

It comes down to our sheer determination not to be left behind. For us in the VCFSE sector, it has always been about the determination to deliver. ‘If we say we’ll do it, no matter the blood, sweat and tears, we’ll make sure it is done so that nobody can come back and say you didn’t do what you said you’d do’.

3. Strong local infrastructure

Structures like Primary Care Neighbourhoods (PCNs) and Integrated Neighbourhood Teams (INTs) have been key. They support integration and provide a space for the VCFSE to demonstrate what they can deliver, as well as reversing the challenge of primary care not knowing or understanding what the sector delivers. The PCNs and INTs were also key to making sure the voices of both large and small organisations were heard. There was a conscious decision to use the word ‘neighbourhoods’ as it conveys a ‘network plus’ approach, meaning it goes beyond just a network to involve communities and neighbourhoods in health and care conversations. Operationally, VCFSE partners are embedded in those structures, enabling the sector to have a strategic voice.

4. Having a common goal

We have tried to move toward being a whole system rather than individual organisations with separate goals. We also recognise that it is important to allow space for different roles within the common goal, and for each person to see how they fit together in the mosaic of things. For example, the VCFSE sector is better placed to engage with communities and understand their priorities, while the PCNs provide structures for better communication. However, everyone must also have sight of the bigger picture and understand how these different roles fit together.

5. Open and flexible commissioning

We have seen what happens when commissioning is open and flexible. Our ambition is to grow this approach, allowing the sector to do what it does best, without being heavy-handed and prescriptive. Two factors that have enabled this way of commissioning are:

  • Involving the VCFSE at a strategic level: Political leadership has supported decisions to involve the VCFSE sector in strategic decision-making.

  • Honest communication: Being transparent and sharing challenges; for example, the potential impact of cuts to public funding. 

6. Getting the relationship right with Primary Care Neighbourhoods (PCNs): 

While the above enablers have helped, when we started working with PCNs, VCFSE colleagues didn’t always feel their voice was represented. However, we were able to build on existing relationships with the Clinical Commissioning Group (CCG) and local authority, and the appointment of Social Prescribing Link Workers has enabled better links into services that can provide support. As the PCNs and partnership working has grown, Clinicians and PCN Clinical Directors are also visibly more involved than they were at the start, and this provides a focus to our relationships and a central contact point in a PCN (that avoids us trying to contact many busy GPs). These relationships feed into the Primary Care Neighbourhood structures, making the connections easier and communication more efficient.

Next steps

The picture is positive, but there is always room for improvement and more that still needs to be done to enable our partnerships to do more. Having made progress, we now need to ensure that the following areas of progress are maintained and strengthened:

  • Continuing to involve VCFSE colleagues at an earlier stage: We’d like to continue to see VCFSE colleagues brought in right at the beginning of the local programme or issue that we’re seeking to respond to, rather than partway through.

  • Increased understanding of breadth and quality of activities delivered by the VCFSE: There remains a risk that the VCFSE sector is seen only as delivering ‘lower level’ activities when there are many high-end services they deliver for vulnerable people and those with complex needs.

  • Increased representation for smaller organisations: With different models in place across the area and small organisations delivering high-end services for vulnerable communities, social prescribing is central to joining up health priorities with the voluntary sector. Social prescribing makes sure that smaller organisations are brought into discussions and there is equity at the table. It is important to ensure better resources are included for them in strategic level discussions. Having a good structure in place will help with engagement, making sure the voices of small organisations are heard.   

  • Continuing to make the best use of the VCFSE role at PCN meetings: It is important, more now than ever, to think about a way of partnership working that sees collaboration between the health and VCFSE sector within prevailing structures in the system is more involved. This way can demonstrate what the VCFSE sector can deliver so that those acting as sector representatives are supported more proactively, and can use these places and forums well to maximise the opportunity.

  • Maintaining a shared vision: With the PCNs taking a role in decision making around priorities, action planning and partnership development, it is important to have a shared vision of what success looks like in communities.

What good looks like

What good looks like 1.
What good looks like 2.



Bringing together VCFSEs and PCNs 

In Lancashire and South Cumbria, statutory and voluntary sector professionals have been working together to design, test and deliver improved health outcomes for local people. IVAR, as a Learning Partner, have supported the Lancashire and South Cumbria Integrated Care System to create and sustain meaningful connections in hyper-local, cross-sector partnerships within the Integrated Care System (ICS), as a part of the Test, Learn & Review initiative. Read more about the work and access resources, here. [add link – http://www.ivar.org.uk/vcfse-pcn-together-for-local-health/  when Live] 



Authors

This blog was authored by the following individuals in the Healthier Pennine Lancashire partnership. Please contact them for more information about their work.  

  • Vicky Shepherd, Chief Executive, Age UK Blackburn with Darwen – Vicky.Shepherd@ageukbwd.org.uk

  • Angela Allen, CEO, Spring North – angela.allen@springnorth.org.uk 

  • Elaine Barker, Chief Officer, Hyndburn & Ribble Valley Council for Voluntary Service – Elaine.Barker@hrv-cvs.org.uk

  • Christine Blythe, NASP north West lead coordinator, Burnley, Pendle and Rossendale Council for Voluntary Service (BPRCVS)

  • Andrea Dixon, Integration & Neighbourhood Lead, Blackburn with Darwen Borough Council – Andrea.Dixon@BLACKBURN.GOV.UK

  • Tim Birch, Community Support Unit Manager, Prevention, Neighbourhoods and Learning Service, Adult Services and Prevention Department, Blackburn with Darwen Borough Council

Talking points for cross-sector partnerships

Developed through Lancashire and South Cumbria’s test and learn initiative: ‘Talking points for cross-sector partnerships’.

In Lancashire and South Cumbria, statutory and voluntary sector professionals have been working together to design, test and deliver improved health outcomes for local people. These talking points can help to kick-start exploratory conversations about cross-sector partnership working, and demonstrate the potential value of working together. 

Download the resource

How to build an effective partnership

Developed through Lancashire and South Cumbria’s test and learn initiative: ‘How to build an effective partnership’.

In Lancashire and South Cumbria, statutory and voluntary sector professionals have been working together to design, test and deliver improved health outcomes for local people. We’ve identified nine puzzle pieces for creating connections that enable meaningful collaboration.

Download the resource

A Community Action Network – West End, Morecambe Bay

Since January 2020, the Institute for Voluntary Action Research (IVAR) has been supporting the Lancashire & South Cumbria Health and Care System on a test and learn initiative. Working at a place-based level, we looked at ways to draw on local leadership and the power and capacity of communities to improve their own health and wellbeing – in the context of the changing role of commissioning, with a more community-centred focus in the Integrated Care System (ICS).

The West End (Morecambe Bay) vision has been to find ways to improve local lives through sharing resources, seeking investment, supporting each other and, most importantly, involving local people in the conversations and decisions that affect them. In this case study, we review the journey so far, lessons learnt and the next steps forward. Not only is this a reflective document for the ICS in Lancashire and South Cumbria and the Community Action Network set up in the West End (Morecambe Bay), but inspiration for other locales developing and progressing cross-sector partnerships. 

To speak with IVAR about commissioning a project or for more information on cross-sector partnerships, please contact us on enquiries@ivar.org.uk 

For more information on this case study, please contact:

Yakub Patel – Chief Executive Officer of the Lancaster District Community and Voluntary Solutions –  yakpatel@lancastercvs.org.uk  

A social prescribing network in the Fylde coast

Since January 2020, the Institute for Voluntary Action Research (IVAR) has been supporting the Lancashire & South Cumbria Health and Care System on a test and learn initiative. Working at a place-based level, we looked at ways to draw on local leadership and the power and capacity of communities to improve their own health and wellbeing – in the context of the changing role of commissioning, with a more community-centred focus in the Integrated Care System (ICS).

In the Fylde Coast, the focus of the Test & Learn initiative was on the cross-sector gap where colleagues in Primary Care and the Voluntary Community Faith Social Enterprises (VCFSE) did not cross paths often, and on the need for a social prescribing community that works together. In response, a small steering group formed, combining the expertise and experience across the health and care systems. In this case study, we review the journey so far, participant feedback, what success looks like and the next steps forward. Not only is this a reflective document for the ICS in Lancashire and South Cumbria, but inspiration for other locales developing and progressing cross-sector partnerships. 

To speak with IVAR about commissioning a project or for more information on cross-sector partnerships, please contact us on enquiries@ivar.org.uk 

For more information on this case study, please contact:

 Tracy Hopkins – VCFSE leader-  tracy.hopkins@blackpoolcab.org.uk 

Debbie Lagette – Social Prescribing Link Worker – deborah.lagette@nhs.net

Health inequalities and Covid-19: How can we respond collaboratively?

In partnership with SEUK, IVAR hosted the Transforming Healthcare Together Virtual Conference on 17th and 18th November 2020. Panellists on the health inequalities and Covid-19 session, Dr Esther Oenga and Cecily Mwaniki from Utulivu, who co-ran the session with Sharmake Diriye from GOSAD (Golden Opportunity Skills and Development), reflect on how responding collaboratively can help us to address health inequalities among ethnically diverse and refugee communities.

‘Before Covid-19 it was bad, now it is worse’

Covid-19 has demonstrated the impact health inequalities has on individuals’ susceptibility to illness in real time. Health inequalities are not just about health, but the way that education, housing, poverty and opportunities interact to impact on an individuals’ health outcomes. Ethnically diverse and refugee communities have been affected disproportionately during the pandemic. Increased health inequalities and the Black Lives Matter movement highlighted a wide range of equality issues, often prompting difficult conversations and tensions.

From our experience of working with the communities and employing the Discover, Engage, Empower, and Collaborate model, here are four practical ways partnerships can adopt to engage with and respond better to health inequalities:

1. Changing the language

Changing the language is the first step for partnerships to consider when they aim to reduce health inequalities. While working in collaboration, partnerships must use terms like ‘less engaged communities’ and move away from terms such as ‘hard to reach’. ‘As the less people are ‘reached’, the more invisible they become.’

We need to stop using the term ‘BAME’ as it tries to group different communities into a single group when challenges faced by each community are very different.

For example, the needs of a Punjabi community are different to those of a Syrian one, which is why it is important to differentiate and ask them for the solution, rather than assuming one solution will work for all.

2. Person-centred approaches

Taking person-centred approaches is the second step partnerships must consider. By adopting a person-centred approach, we appreciate the differences individuals have, we move away from grouping people or communities and can help work with them towards change.

The tick box approach is undermining. We feel used and demotivated when services ‘pop in’ and don’t take time to actually engage and understand our needs.

 

3. Use asset-based approaches

Use asset-based approaches to understand and appreciate specialist organisations like GOSAD and Utulivu, among many others. Involving us to represent the voice of specific communities is key.

Organisations and community groups, who have worked with the communities you are trying to reach for a long time, can support you to understand what helps people respond better.

Small steps like involving experts from within the community make a big difference.

4. Collaborative co-production

When co-production is done well i.e. the approach is collaborative, instead of top-down; there is sharing of power. You reach out to groups where they are and addresses health inequalities.

We’d like to end with some Dos and Don’ts:

A diagram which shows the dos and donts with engaging the community to address health inequalities.
Here at IVAR, we’re thankful to hear and share the insights of experts in their fields. From the Transforming Healthcare Together project, we have gathered case studies and produced resources on cross-partnership working in the health and care system. You can view our findings here: https://www.ivar.org.uk/transforming-together/learning-resources

Never underestimate young potential

West Hertfordshire Hospitals NHs Trust is part of a network of 30 NHS Trusts and their respective charities who have been welcoming young volunteers since early 2018. 

 

“Volunteering is the ultimate exercise in democracy … when you volunteer, you vote every day about the kind of community you want to live in.”

 

In the world where you can be anything, be kind … It’s such a powerful sentence which we see around but do not think about more deeply. This is what I want you all to think about … be kind.

 

This year has been extremely difficult for everyone. The Covid-19 pandemic changed our world, our vision, our life and we’re still trying to get used to the new normal. We have faced an unprecedented situation which we need to deal with and quite often those working in the NHS are among the first people who need to adapt quickly and find solutions for swiftly changing demands.

 

The Voluntary Services Team at West Hertfordshire Hospital NHS Trust in Watford in a two week period, redeveloped services and created the Voluntary Response Hub, with most of the volunteers being aged 16 and over.

 

When the pandemic started, most of us adults believed that our children would be lying in bed until midday, spending their time on their phone, on social media or gaming, but not every teenager chose that route.

 

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From the 30th March, a group of 30 volunteers (many of whom were youths) stood up in the line to face the challenge of the unknown and served our community for the next couple of months with a smile, positive attitude, engagement and the belief that only together can we survive this difficult time.

 

Day by day, new cases, new admissions, more and more requests and yet we had the same number of youth volunteers. They were tirelessly running up and down the stairs, delivering patients belongings from their loved one; distributing meals, snacks and water to staff in isolation areas; serving tea for patients; helping housekeepers to serve lunches and dinners; and lots more. Throughout all of this, the most valuable thing they brought with them was “normality”, a smile, a hot tea … patients who they visited have been so thankful, for their willing attitudes and positive approach, their willingness to help, to listen to them and to spend time with them.

 

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These volunteers offered the most valuable gift – their time. Their great generosity has had a profound and lasting impact on our patients and the community as a whole.  They have started to forge a new path in patient experience, adding volunteers’ influence as a positive impact for the patient.

 

And so today, using this great opportunity, on behalf of all of the staff of West Hertfordshire Hospital NHS Trust, and any other NHS Trust where youths play key roles, I want to express how proud we are of all of you. We’re very thankful for your commitment to share your time, that most precious of resource, to make life better for those who are in need, to lend a helping hand and to show kindness and caring that makes the greatest difference in the lives of the individuals. We know that you choose to volunteer selflessly and without expectation of being recognised or rewarded, but today we wish to do just that. We want to let you know just how much your dedication was appreciated by us.          

 

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Whether you are a long-time volunteer or if you got involved fairly recently, and regardless of how many hours you choose to give, it’s important for you to know that what you do makes a difference. Please never forget that “volunteering is the ultimate exercise in democracy … when you volunteer, you vote every day about the kind of community you want to live in.”

 

So when you think about 16, 17, 18 year old students, what is your first thought about them?

 

Meet our young volunteers: 

https://raisewestherts.org.uk/monica-leitao/

https://raisewestherts.org.uk/alex-chase/

https://raisewestherts.org.uk/teodore-bate/

https://raisewestherts.org.uk/rachel-kelly/

 

You can find resources for setting up youth volunteering in your hospital here

My Volunteering Experience during Covid

Tahmed shares his experience of volunteering at Birmingham Children’s Hospital during Covid-19. The hospital is part of a network of 30 NHS Trusts and their respective charities who have been welcoming young volunteers since early 2018. 

 

Who am I? My name is Tahmed and I’m an 18 year old student from Birmingham. I’m currently in my 2nd year of college, studying a BTEC in Emergency Services and I hope to join one of the emergency services sometime in the future. In my free time I like to volunteer at Birmingham Children’s Hospital.

 

So where do I start, here’s a bit of a background on my volunteering journey: I’ve volunteered at the trust for just over 18 months; I was initially interested in volunteering as I wanted to take my passion of helping people to the next level and I thought what better place to start helping people than within an NHS children’s hospital.

 

YPAG: I joined the trust as a volunteer in February of 2019 with my first role being a member of YPAG (Young Persons’ Advisory Group). YPAG is the service user/youth group at Birmingham Children’s Hospital where the group do a multitude of things such as: being panellists on interview panels, expressing the opinions of young people and teaching medical staff how to effectively engage with young people, to name a few things!

 

YAV programme: A few months later (August 2019) I decided to take on a second voluntary role within the hospital, this time as a volunteer on the YAV (Young Adult Volunteer) programme. As a YAV I would regularly engage with patients and families on wards across 3 different placements over 6 months. I completed the YAV programme in February of 2020 whilst also being involved in a variety of YPAG projects throughout that period as well. It was just a few weeks after I had completed the YAV programme, when the Covid-19 pandemic hit.

 

The effects of Covid-19 on my volunteering experience: When the Covid-19 lockdown started, all volunteering opportunities in the Trust were put on hold. However, a few months into the lockdown, a handful of new volunteering opportunities began to slowly open up. These roles were completely different to the volunteering opportunities available pre-Covid-19.

 

I took up one of the roles which was a Meet and Greet Screening Volunteer, where I supported a member of staff at the front of house at Birmingham Children’s hospital. My responsibilities were to:

 

  • Screen visitors and patients before they came into the hospital to ensure they had no symptoms of Covid-19.
  • Provide visitors with a face mask if they didn’t have one of their own.
  • Direct visitors to their desired destination for appointments, consultations etc.
  • Help visitors with any general enquiries.
  • Be that friendly first point of contact for patients and visitors.

How I’ve found the role: The screening role has been varied. It’s been; fun, challenging, busy, funny, and hectic at times but above all an amazing opportunity! It’s also been a great learning experience and I’ve found that my general knowledge of the hospital and its services has improved immensely. I’ve also met loads of different staff members/medical students from different departments and faculties and have built a really good relationship with many of them.  The highlight of my role has to be the positive interactions that I’ve had with patients, families and staff.

 

Challenges I have faced: One of the regular challenges that I’ve faced is that I’ve had to inform parents/guardians about the “one adult with one patient” rule and, understandably, they’ve had their frustrations about it. These situations made me realise that on many occasions you can help people understand something from your perspective by simply being empathetic towards their situations and articulating your points in a calm and respectful manner. Most of the time people ended up respecting the rules and went about the situation in the right way because of it.

 

Skills that I have improved on:

  • Self-Discipline: I’ve had to have self-discipline to wake up really early in the morning for more than half of my screening shifts.
  • Empathy:  Empathy has been vital in communicating and engaging with people.
  • Adaptability: Things in the hospital continue to change on a regular basis, because of this, I’ve learnt how to adapt effectively in different situations.
  • Communication and Confidence:  My communication and confidence skills have improved a lot, I have done over 100 hours of volunteering in the Covid-19 period to date and have spoken to hundreds of people.

 

You can find resources for setting up youth volunteering in your hospital here

We’re better together

This report shares eight factors that have enabled health partnerships to respond effectively to Covid-19. Previous barriers to the NHS, councils and the voluntary sector working together – such as information governance, organisational boundaries or agendas, and lack of trust – were removed, or set aside, in order to respond swiftly to a ‘tsunami of need’. The research is based on learning from 11 partnerships in different areas of England, who took part in the Building Health Partnerships programme. 

 

As a result of working together, health partnerships:

 

  • Reached the most isolated and vulnerable community members
  • Protected against overwhelming demand on statutory health services
  • Improved referral pathways and access to services
  • Provided a more focused/targeted response when required
  • Ensured that services meet local needs
  • Distributed information to communities quickly and efficiently
  • Built on, and made best use of, community assets (e.g. volunteers)
  • Ensured the right people are at the decision-making table.

 

‘Without the third sector, Wirral wouldn’t have been able to cope and mitigate against the impact of Covid-19 the way it has.’

 

Who is the report for? 

The report is aimed at anyone interested in building cross-sector relationships to improve local health and care outcomes – NHS systems (particularly ICS/STP leads and PCNs), commissioners, clinicians, local authorities and professionals from the VCSE sector.

How we set up a social prescribing service during lockdown

As in many areas, the Social Prescribing Link Worker role is new in Lytham St Anne’s Primary Care Network. Two link workers were employed in March 2020, and in the midst of us learning the role, the country almost immediately went into lockdown due to the COVID-19 pandemic.

Working from home with restrictions on face-to-face meetings had an impact on the way we were able to reach patients, and the closure of local groups made it increasingly difficult to carry out the usual objectives of this kind of role.

Like many areas, Lytham St Anne’s saw an incredible response from local volunteers who were keen to help their neighbours, particularly the elderly, vulnerable and those advised to shield by the government.

We had access to the list of shielding patients and worked alongside primary care colleagues to contact each of these patients by telephone for a supportive chat, finding out what additional needs they may have during lockdown. For those that needed help with shopping, collecting medications or dog walking, we were able to signpost or refer to local mutual aid volunteer groups, as well as to NHS volunteers.

For patients who were found to be especially isolated or lonely, or struggling with their mental health, we provided regular check-up calls, in addition to signposting to telephone befriending services.

We found that patients were appreciative of the calls, even if they had no additional needs; they were grateful that they hadn’t been forgotten. Others chose to receive a weekly wellbeing call from us and reported that this helped them to get through the difficult months of lockdown.

Inevitably, a major challenge of this period has been the lack of active community groups and services to prescribe to patients. While some groups have gone online to hold virtual meetings, the large elderly population in Lytham St Anne’s faced barriers to accessing these groups. Age UK Lancashire provided tablets on loan to people who were without the relevant technology and there were volunteers available to teach people how to access apps such as Facetime or Zoom. Despite this, many patients proved to be reluctant to make the move online, and others do not have access to the internet at all. Furthermore, we found that many local groups did not create an online presence, and have simply been waiting to be allowed to meet again in person.

One prominent local group, Just Good Friends, usually provides regular meetings including dancing, quizzes, musical entertainment and exercise sessions. During lockdown, the group leaders kept in touch with their members via telephone and once guidelines lifted to allow people to meet outdoors in small groups, members began to meet in a local park in socially distanced “pods” of up to six. They have recently started some chair-based exercise sessions in the same pods. We have been able to refer new members to this group.

Although groups and services have been restricted during the pandemic, we have been able to build relationships with local group leaders, establishing a good network of contacts which will be invaluable as the community comes to terms with the “new normal”. We have also started seeing some patients for face-to-face appointments and hope to see more and more groups opening up following lockdown, depending on further restrictions that may arise. Drawing from our learning and the need to work more across sectors, we are looking at developing a local Social Prescribing Network in Lytham.

Sign up for our virtual Transforming Healthcare Together Conference to hear more stories about cross-sector partnership working during Covid. We’ll hear from some amazing speakers who will offer local, national and system perspectives.