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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.

5 things that help system leaders ‘have difficult conversations’

In order to change the culture within a health and care system, health, voluntary, community and social enterprise sectors (VCSE) leaders need to be open-minded, build on the diversity of people around them and have conversations that are engaging and curious, rather than sparking debate. However, the very nature of developing creative partnerships aiming to disrupt the status quo means that from time-to-time it is likely you will need to have a difficult conversation with someone. So, it is no surprise that delegates at our BHP leadership workshops – attended by health and VCSE sector leaders working to re-shape their local health and care systems – regularly raise the question ‘how do I handle tricky conversations?’  

Here are the five things we suggest will help:

 

  1. Ask the right questions (appreciative inquiry): Leaders must aim to have instrumental conversations and employ the practice of asking constructive and open-ended questions that help to identify a positive core among the group. You can then use the responses as a basis for building meaningful strategies for change. 
  2. Start a dialogue, not a debate: A debate assumes there is only one right answer (the one you have), tries to prove others wrong, defends assumptions as truth and seeks closure around personal views; whereas a dialogue assumes that many people are a part of the answer and fosters an environment of collaboration with others to find common understanding. Through meaningful dialogue, a system leader can listen to understand and seek agreement; and discover multiple options from others in the system. 
  3. Manage polarities in partnership working: System leaders operate in complex environments, and most challenges they face are not problems, but rather dilemmas or polarities. Problems have an end-point, are solvable and use either-or thinking, whereas polarities are ongoing, unsolvable, have interdependent solutions that must be managed together. They require ‘both and’ thinking. So, the next time you are faced with a polarity, ask ‘how do we ensure we access the best of both while avoiding as much of the negative as possible?’ 
  4. Avoid unconscious bias: Be aware of generalisations and understand that we don’t see things as they are, rather we see them as we have been conditioned to see them. We as leaders must openly and continuously challenge our decision-making in our respective systems and organisations, to work towards better and more inclusive conversations. 
  5. Make time to reflect: Making time to be self-reflective, before and after difficult conversations, helps in the long-term.

“I learnt the need to be more self-aware.”

“I will use open ended questions regularly and find time to reflect and practice reflexivity”

 

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Building Health Partnerships


Visit www.ivar.org.uk/transforming-together to access free support including:

 

  • Online resource library
  • Workshops and webinars
  • Coaching delivered by The King’s Fund
  • Practice Development Network
  • Practical and individual support

 

We are currently working with four areas for 2019/20. Please get in touch if you are based in one of the following: Bedfordshire, Luton and Milton Keynes; Surrey Heartlands – Guildford and Waverly; Dorset; and North Cumbria.

 

The leadership workshops referred to in this blog were delivered as part of the Building Health Partnerships (BHP) programme by Mark Doughty, The King’s Fund and Helen Garforth, Institute for Voluntary Action Research. They are attended by leaders from health, voluntary, community and social enterprise sectors, help to develop the skills, behaviours, attitudes and resilience that help in being a ‘change agent’.

Drowning in jargon? Squeaky ducks may be the answer

Given all the attention we are paying to co-design and co-production these days – some of the language we are using around health and care is not helping. In short, it has become a barrier to getting things done. People are put off and alienated, even avoiding opportunities to attend meetings and events for fear of not knowing what’s being talked about (or of not having the time to translate!).


What’s the problem?


Now more than ever we are faced with a blizzard of acronyms, whizzing past us at pace with often little or no opportunity to question (or at least feel safe to) or better understand what is actually being said.

 

Through the national Building Health Partnerships: Self-care programme, cross-sector partners are working hard to address the problem – and are being guided by community leaders and lived experience patient representatives who are helping us all get better at the way we communicate and get things done.

One of the more fun ways we are keeping people on their toes with language, for participants and presenters and facilitators, is to have a few squeaky ducks on each table – for squeaking when abbreviations or language needs to be explained a bit more.

IMG_0186

 

One thing I have noticed is that the number of ducks is diminishing but the use of language is improving!


Getting it wrong, then right


In a recent invitation co-produced for a partnership session in the South West, one community leader fed back that the wording was too statutory, academic and high-level and that it may not attract the smaller, very grounded voluntary and community groups we are so keen to involve and give a voice to.

For example; let’s take the term Sustainability & Transformation Partnership – what is that? If not known then groups may be excluded.

 

‘Who cares what ‘programme’ this initiative is part of, isn’t it the outcomes, differences or impact that the idea or development wishes to achieve that is the hook to get a range of players (and different players) to engage?’


Some more examples from the North East


Some concerns were raised about what we call things and what we are really trying to do here:

 

‘The terminology ‘self-care’ could be a barrier in itself’

 

‘The language of social prescribing pushes activities into medical language’


A new language altogether?


It’s funny to recall, in a recent session at the Pioneering Care Centre in Durham, after showing The Parable of the Blobs & Squares video – the language in the room changed quite a bit and we had GPs talking about the need to be more ‘blobby’ and voluntary organisations recognising their ‘square-ish’ tendencies – but somehow this language worked better. Perhaps it helped us find more common ground. At the end of the day, that is the whole point isn’t it?

Three public sector leaders on why they work with the voluntary sector

Three public sector leaders taking part in our Building Health Partnerships: Self-care programme share why they work with voluntary and community organisations. 

 

 

Professor Mark Pietroni
Director of Public Health, South Gloucestershire

 

‘Working with the voluntary and community sector is a great way to deliver local solutions in the areas in which people live in the ways that they want.

More importantly perhaps, it is a great way to hear from local people and understand what the issues are and what a local solution looks like and how the capabilities of the local population can be supported to deliver local solutions. Doing this well requires a commitment to listening and change on both sides but the potential to do good things for our communities is great.’

 

 

 


Susan Harris
Director of Strategy and Partnerships (Worcestershire Health and Care Trust) and Sustainability and Transformation Plan (STP) Communications and Engagement Lead

 

‘As a community and mental health provider, Worcestershire Health and Care NHS Trust has always worked in partnership with the voluntary sector to improve outcomes for local people.

We engage with our voluntary sector partners on a regular basis and in a variety of ways, both informal and formal. For example, we are a member of the Carers Partnership which brings together all local health and care partners to work together to advance the support offered to carers and a member of staff from our local Carers organisation is involved in our Equality Advisory Group which offers advice on the impact of proposed service changes on various groups so that additional engagement work can be undertaken if necessary.

We have a contract with another local voluntary sector partner to provide the local Well-being Hub which is integrated into the clinical triage function for secondary care mental health services and they also broker a range of local community groups to deliver a menu of services for the Well-being Hub to signpost into. When we undertake service re-designs, the local voluntary sector is key to the co-production process and always feed in their thoughts, ideas and concerns. They also help extend our engagement reach by communicating proposed changes to people on their database, and inviting them to offer their views and thoughts. As a Trust, we have learnt and benefited from these initiatives and we believe it is important to recognise all the value that the sector can bring. For example, in operational services, having volunteers at our Stroke unit as well-being strategic partners offering a broader view, often advocating on behalf of patient groups and communities. As part of our Sustainability and Transformation Plan we see these opportunities increasing and the benefits of cross sector working being better understood and core to the future delivery model of health and social care across our local area.’

 

 

 

 

 

Tom Hall
Director of Public Health for South Tyneside

 

‘The challenge for a modern health and care system is to be greater than the sum of its parts.

In South Tyneside we have recognised that to achieve the best we can for our population we can only do this by working together and making best use of the South Tyneside Pound. The South Tyneside Pound is the collective finite resources we have as a system and we have to use it wisely. It recognises that there is no new money and indeed that resources are reducing, and that there is no benefit from grappling within South Tyneside over that resource, bouncing it around for no real gain. The concept of the South Tyneside Pound is important to us and our local Alliance (a model we have pinched with pride from Canterbury New Zealand). We have a mantra that says “what is best for the person is best for the system”. We have recognised that this can only be achieved through strong system leadership and we have an Alliance Leadership Team which consists of the third sector, clinical commissioners, care commissioners, care providers, health providers (including acute, community, mental health and primary care). Our leadership team is focused on four areas: role modelling the behaviours we want to see in the system, coaching the system in these behaviours, challenging ourselves and the system to act in line with those behaviours, and learning from our successes and challenges.’



What works for setting up cross sector partnerships?

Two voluntary sector leaders taking part in our Building Health Partnerships: Self-care programme share what they think works when setting up cross-sector partnerships. 

 

Dr Simon D Hankins
CEO, BS3 Community Development (formerly Southville Community Development Association)

 

‘Patience, building trust, respect, recognising the expertise that exists within each partner organisation, identifying and working to achieve mutual benefits, stumbling across people with the appropriate mind-sets and attitudes and people that you feel that you can work with and, overlaid with a huge dose of realism are, for me, all key components in establishing partnership working between the voluntary and public sectors.

From my experience at BS3 Community Development charity, to achieve a targeted, short-lived or enduring working relationship with parts of the public sector, it takes time, lots of time; it requires patience from all involved as we get to know one-another and build trust and confidence in each other, after all, why would you work with someone you don’t know or with an organisation that you have no idea how good a quality their services are? However, the rewards can be immense for all parties and particularly the people that you are setting-out to work with, support, help or whatever it is that is being developed; so it can be worth the effort as long as the statutory sector and VCSE (Voluntary, Community and Social Enterprise) sector partners approach the development of the working relationship on an equal-voice and mutual respect basis.’



 

Jacqui Bremner
Herefordshire Carers

 

‘I think true partnership working is when you know that you both work as hard for your partner to succeed in the joint venture, as you do for your own organisation, because you know that failing impacts on you both!!’



Self-care – A new chapter for the Building Health Partnerships programme

Background
The Building Health Partnerships programme brings local people, local authorities, Clinical Commissioning Groups, voluntary, community and social enterprise organisations together to grapple with health related themes like mental health, or social value. Over the last year, in partnership with Social Enterprise UK, we have delivered over 135 workshops in 22 areas across the UK.  

The programme is carefully tailored to the specific needs of each area and every workshop is designed to share learning, experience, expertise and ideas. Read more and watch films about our work in Bolton and Brighton and Hove.

A new programme focussing on self care
We are pleased to announce that NHS England and the Big Lottery Fund are jointly funding a new programme focussing on self care in 8 Sustainability and Transformation Plan (STP) areas. Self care is about helping people to understand what they can do to better look after their own health and that of their family, as well as living as healthily as possible.

The focus will be on building relationships at a local level to develop, agree and implement a joint action. STP areas in the programme will be able to access a mixture of facilitated support, expert input, links to other networks and initiatives and communications expertise.

The programme is intended to support STPs to more effectively engage with all the providers and people necessary to meet their plan objectives – in line with the Five Year Forward View

What type of project is it?
Bespoke, facilitated workshops in 8 areas with work behind the scenes to engage, motivate and share cross area insights.

The brief – What is the purpose of the work?
To advance cross sector working to encourage and promote self care
Capture learning and ideas from 8 areas to share across all 44 STP areas

What difference will it make?

  • Build on and embed cross sector working relationships at a local level
  • To collectively develop an implementation plan around self care ensuring buy in and commitment 

 
Time frames:
June 2016 to June 2017
The eight selected areas will be announced by 21st April 2017

 

Email contact 
Houda@ivar.org.uk