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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

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

6 reflections on collaboration during Covid-19

Since April, over 70 leaders from healthcare, VCSE and local authorities have joined IVAR and SEUK-run peer support groups, sharing experiences and thoughts on cross-sector partnership working in healthcare settings during the pandemic. Last week, we hosted the fourth meeting in this series. Here we discuss the current challenges and pressures highlighted by those attending.

1. Identifying priorities for the next six months

The participants listed a focus on recovery as top of the list. Many said that the response to the pandemic has improved relationships across sectors and meant that planning is now a more collaborative process than it was before.

We’ve worked more in partnership with our counterparts than before.’


‘These last three months have been about relationships and communications and we’d like to keep it this way and focus on making this our new normal for the next 6 to 12 months.’

A social prescribing professional was concerned that their services might be used in the wrong way, or be seen as a solution to a different problem if they weren’t very clear ‘who they are for but also trying to increase the referrals and to make it possible for community groups to refer to social prescribing’.


2. Addressing health inequalities and the digital challenge

The switch to digital and virtual healthcare support has made stark the impact for those without access to digital access. One participant spoke about how they have been contacting local community networks and the voluntary sector to reach those left behind by the digital divide. This has led to good relationships being built: ‘It is important to join up with these networks and have conversations and partnerships with them, when you are trying to respond to a crisis like Covid-19’.

 

Secondly with the amount of support being provided in this way, many organisations and services had introduced new, more frequent ways of engaging with users. Whilst this has been welcomed by users, it has become overwhelming and exhausting for providers. Organisations are assessing how to continue to work this way and how to balance this with face-to-face support.  

 

3. Supporting not squashing local community action

Many were keen to support the new micro/hyper local groups and mutual aid systems that have emerged as a huge source of community strength and cohesion over the last few months. At the same time, they are aware of the potentially negative impact on drive and reach that can be caused by over control of local voluntary service councils or ‘professionalisation’.

 

Wirral CVS was able to share some excellent examples of the approach they had taken to supporting local mutual aid groups. Including connecting with groups, but standing back and only offering advice and support when needed. 

 

4. Finding time and space to assess impact

 

Working at pace and re-designing services at speed to support users has meant evaluation and assessing impact hasn’t been at the forefront of many people’s minds. Many commissioners and funders had responded to the emergency by reducing reporting requirements for funded services and organisations. One participant explained they are not thinking about impact yet, being still in the response phase, but are starting to look at recovery and realise that it’s going to be tough.

We are having to fight fires while watching our house burning down.’

At the moment it seems like local charities are just making an impact with the hope that they can assess it at a later stage. However, there is increasing demand from NHS England and NHS Improvement and others to understand what has worked and what systems and new ways of working would be helpful to adopt and retained in a recovery phase.

5. Recording impact with qualitative data and stories

A social prescriber described how she had been encouraging her colleagues to write up the case studies and stories of people they have been supporting during Covid-19 as a way of keeping the individuals at the centre of thinking, both for them and their commissioners. This approach struck a chord with the webinar group, along with the impact of simply documenting what has, and is, taking place. What is ‘normal’ is changing on a daily basis. It was noted how important it is to document this, to capture the new ways of working and support arguments for not slipping back into previous less successful approaches, systems and relationships. Furthermore, some commissioner’s mindsets are changing and becoming more open to hearing individual case studies and patient’s experiences.

 

‘Our commissioners have actually said that they want to hear more case studies than statistics! So, our quarterly reports now have a reasonable amount of case studies and I think commissioners are seeing this as the way forward.’

 

One CCG has a slot for ‘patient voice/experience’ at board meetings and sees the current digital transformation as a valuable as a way of engaging more people with the meetings in order to hear more directly from those experiencing care.

 

It feels like progress is being made if these reflective practices are being adopted more widely and those with lived experience of conditions and care are being put at the centre of decisions and planning. 

 

6. The challenges on the horizon

 

It is worth noting that these conversations and discussions are taking place against a backdrop of uncertainty particularly in statutory sector funding. Many local authorities are nearing bankruptcy making it difficult for them to support anything other than essential services and the NHS will not be able to ‘reset’ back to pre-Covid-19 levels of service and care quickly. It is increasingly important that local areas and their communities are able to leverage the full extent of their local assets, knowledge and experience through collaboration across the sectors.

If you would like to access support for cross-sector partnership in health and care: 

 

  • The next and final peer support session will take place in September 2020. Email nancy.towers@socialenterprise.org.uk to register your interest. 
  • The Building Health Partnership’s programme will host a virtual national conference, sharing best practice and developing relationships in the late Autumn, email vanessa@ivar.org.uk to register your interest.
  • You can register for a 1-2-1 coaching session with Mark Doughty from The King’s Fund here

What would enable a sustained transformation in cross-sector working in the long term?

Recognising the tremendous pressure that health, VCSE and local authority leaders are under as a result of the Covid-19 outbreak, IVAR and SEUK are facilitating online peer support groups through their Practice Development Network[i] (PDN), which supports cross-sector partnership working in healthcare settings. The aim is to create a space for people to share experience thoughts and learning, during the pandemic at a time of pressure on the health system for those working navigating and delivering in partnership.

We find them a fascinating snapshot of hope and perseverance, and it is brilliant to see connections being made in real time that can help unblock a challenging situation, in another region.

We were joined by 20 cross-sector health and care leaders on 21st May for our two virtual peer support sessions. They were from different parts of England including: Bedfordshire, Luton and Milton Keynes; Dorset; Surrey Heartlands, Northamptonshire; Worcestershire; Liverpool; Leeds; Stoke-on-Trent; Nottinghamshire; Lancashire and South Cumbria; Northumberland; and London.

 

Please join us for the next peer support session on 24th June


Building trust rapidly

It was interesting to hear the positive stories that people shared about the speed and flexibility in their processes to re-designed or developed their services to cope with the new way of working for their varied service users. For example, a mental health support service is now being run digitally and is having more interaction with people than before when it was a drop-in, face-to-face service.  Not only had this made a huge difference to many people, in some cases preventing suicide, it also offers solutions to those in rural areas facing transport issues. ‘People tend to enjoy a bit more anonymity on the call, especially those we have less motivation to physically take themselves to the clinic.’

Key to this was a change in focus from box checking governance to pursuing relationships based on trust, and an assumption by all partners that people would do the ‘right thing’. This was something that all wanted to hold onto, to sustain as areas began to look at their priorities for starting up services that had been suspended to cope with Covid-19.


‘There is a massive desire amongst a few of us to keep pushing cross-sector working.’

‘We need to take time to pause and reflect, the good stuff that is going on and plan to continue this in the future.’


Long term versus short term

This is where discussion turned to barriers in cross-sector working and how to support systems’ need to see past immediate priorities –  of catching up with waiting lists – and not ignoring equally important projects that seek to address longer-term issues through community resilience. This is the paradox that for some areas the experience of the last two to three months have made this incredibly easy, and convinced leaders within their ICS or system that prioritising community resilience and supporting the VCSE to be an equal partner in this is key, while others have drawn up the metaphorical drawbridge and have even less time and money for approaches of this kind.

It is often about the art of the possible, and perhaps this is where sharing experiences and learning is even more important, if people can see others taking a different approach, it can lead to adopting different ways of working.  


Using data to embed social prescribing and tackle health inequalities

This was further emphasized by a case study in North Dorset, shared by Dr Simone Yule. She leads on Population Health Management (PHM)[ii] for the ICS. North Dorset previously received support from NHS England and Improvement to develop their PHM skills and data. Dr Yule shared how they were using this approach to managing data to ensure those most in need during the pandemic were getting the support that they needed. Being able to search their Practice data for people with a number of underlying health conditions that might make them more vulnerable to Covid-19, and were then able to link them up with appropriate support either via a health champion or social prescriber. See matrix below for intervention.  

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See this image in full size

 

Data sharing

Many people on the call were keen to understand the approach to data sharing, since this has been a barrier for many to develop a comprehensive and embedded approach to social prescribing in primary healthcare. It had also hampered people’s ability to respond in the current pandemic, with CCGs being unwilling to share shielding data with the VCSE due to existing data sharing agreements. From Dr Yules’ perspective, their CCG had been very supportive, waiving some governance control to ensure the right people were supported in a timely manner, letting link workers know that they were trusted to do the right thing. Even though some patients had withdrawn consent to be contacted, the emergency situation allowed the Practice to override this request and all at risk patients had been contacted. There have been no complaints.

Enabling transformation 

Returning to the theme throughout the discussion, many were nervous that things would return to pre-pandemic ways, with a focus on governance and reporting outputs and counting interactions which would not support an ongoing transformation of care and support within the healthcare system. As the last few months have demonstrated, relaxing governance and trusting organisations and individuals to do the right thing has enormous benefits and can support radical and rapid change for the better. We need to ensure that this can be adopted in a sustainable way to drive forward the positive benefits seen in the collective response to Covid-19.

 

Please join us for the next peer support session on 24th June


Resources

Resources for building cross-sector relationships that improve community-based healthcare can be viewed and downloaded from here.


[i] Practice Development Network (PDN): The PDN is designed to support the sharing of learning, experiences and challenges of working in a collaborative way across sectors in health and social care. Its core members are people who have been involved in Building Health Partnerships and Transforming Healthcare Together, however it is open to all who are working or would like to work across sectors to deliver better health and social care outcomes. The network consists of an email group, allowing individuals to share helpful resources and make useful connections between each other as well as regular webinars. To join the email group email: Nancy.towers@socialenterprise.org.uk

[ii] Population Health Management is an emerging technique for local health and care partnerships to use data to design new models of proactive care and deliver improvements in health and wellbeing which make best use of the collective resources

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.’

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