Building Health Partnerships: Summary of Partnership Session and Future Activities

1. ‘A good life in old age’Building Health Partnerships Partnership session 3 summaryTuesday 20th February 2018 @IVAR_UK @SocialEnt_UK #BHPselfcare

2. Introduction These slides summarise the journey so far for Building Health Partnerships in Bristol, North Somerset and South Gloucestershire - from expression of interest (aims and objectives) and activity to date, up to the third partnership session. The purpose of this slide deck is to show how ideas developed and were actioned to inform planning of further activity and the final partnership session.

3. How we got here…

4. Overarching aims of Building Health Partnerships in BNSSG Through BHP the BNSSG partnership aim has been to better understand the extent to which people can be supported to look after themselves and stay well and how non-medical community support can contribute to this, using a collaborative working approach to ensure that: • VCSE organisations are involved at the earliest stages in setting principles and in designing the new models of care. • The STP has a trustworthy, efficient access point into a myriad of VCS providers to test ideas, develop new solutions and meet the challenges above. • The options for future commissioning or ‘test and learn’ approaches build upon the learning from local experts committed to delivering wellbeing and long term, sustainable solutions. • The VCSE has early notice of what the wider health, social care and housing system needs so that they can prepare and align their efforts accordingly.

5. Objectives/proposed activities • A formal process of co-producing and co-implementing the changes needed to deliver our collective aims with citizens and partner organisations. It is only in this way that we will obtain the ownership and understanding needed to deliver credible and assured plans that benefit both individuals and the health and care system. • The West of England Civil Society Partnership (WoECSP) to provide a consistent point of reference and access to the VCSE in taking transformation forward to the STP. Through this vehicle, specific pieces work can be co-produced with the STP to pilot and scale-up new approaches, working with those VCSE organisations that have the best understanding of - and links to target populations. This will provide direct involvement from citizens in general, service users, VCSE organisations and individuals, and the assurance that the developing plans deliver the intended outcomes of the STP initially through a VCSE working group (The Care Forum, VOSCUR and VANS) • A requirement for increased stakeholder engagement was fed back to us by NHS England following our original STP submission, and we will use this programme to ensure we have meaningful and enhanced input from citizens, local communities and the VCSE. • The output will be a series of pilot projects, co-produced with citizens and with the VCSE sector, tested and consulted upon.

6. What people said about self-care in P1 Self-care in the local context… Means different things to different people but broadly understood as: People managing their own conditions/ supported to promote own wellbeing/ self management. What worries people about self-care locally? • Self-care places responsibility of care on the individual when issues may be systemic. • A lack of community engagement in the STP • A lack of understanding between medicalised approaches and community approaches • A lack of resource @SocialEnt_UK @IVAR_UK #BHPselfcare

7. Emerging areas of work at P2

8. Updates at P3 on work since P2 We also heard from DhekBhal, a local care organisation for the south Asian community in Bristol and South Gloucestershire

9. Local perspectives: DhekBhal DhekBhal’smission is to promote the health and social wellbeing of South Asian people living in Bristol & South Gloucestershire through a range of services. DhekBhal offersculturally and religiously appropriate support, tailored interests and needs; they also train and recruit staff, especially women, from the local community; providing activities that are enjoyable and convenient. “I can’t wait for the lunchtime club” (Service user) Get in touch with DhekBhal: 43 Ducie Road, Barton Hill, Bristol, BS5 0AX Tel: 0117 9146671/ 9146672 Email: dhekbhal@yahoo.co.uk Opening Hours - Monday - Friday 9.00am to 5.00pm

10. Influence

11. Local health structures & opportunities Update from Julia Clarke (Bristol Community Health) on local health structures and opportunities with a suggestion to use the next session to present some strong worked up ideas to the STP and other decision makers and a strategic interface for drawing in the Voluntary and Community sector based on work to date. In January 2018 a paper was presented to the STP Sponsoring Board describing the key activity necessary to enable effective community led approaches to self-care along with some key recommendations: Sponsoring Board should: • Note the ongoing Building Health Partnerships work and support (through attendance) the final event in April • Recognise the importance of the contribution of the V&CS in delivering it’s ambitions • Agree to develop a dialogue with the V&CS through the West of England Civil Society Partnership

12. VCSE voice and influence • Update from Vicki Morris (The Care Forum) who is developing a business case for the West of England Civil Society Partnership [WoE CSP] working with Voscur and Voluntary Action North Somerset to outline shared objectives of the STP and the VCSE sectors. The aim is to strengthen the link between the statutory and VCSE sectors, giving smaller organisations a say in local service design. The remit will be set by members once established. • Ideas include the possible pairing of very small organisations with larger more established ones through the Civil Society Partnership. The remit and activities of the Partnership would be set by members but might include helping organisations access funding. The idea would be that there is one single point of contact for the sector and a conduit for information and dissemination across the BNSSG patch.

13. Research

14. Social prescribing survey: Key findings One Care, a GP owned company established to ensure GPs thrive, undertook a survey to find out more about how social prescribing is viewed in General Practice. There were 65 responses from 85 practices from across BNSSG providing a snap shot of what’s currently happening and to establish a baseline from which to measure progress. Lots of responses suggested models were set up around local link worker type roles (although this role is described differently so language is a hindrance). The results suggest GPs are really interested in social prescribing and what it can offer. Most practices seem to be in early stages of development. Key messages: • Training staff takes time and investment • There is little equity across BNSSG • Language can be an issue • Link Worker/Patient Champion (paid/voluntary) are key • Self-care groups  Ingredients for success: cluster-based working, sharing best practice and resources, better links with community providers and more resources and proper funding.

15. Social prescribing survey: Responses We need to better understand what social prescribing involves: • “It’s not just about signposting, it’s about triage” “Taking time to understand the whole person, their situation, their health conditions and then make a social prescription not just signpost” • “Social prescribing is about reaching people that wouldn’t do things for themselves” • “This is not just about training. We need to understand what it is we are trying to do.” • Social prescribing is not a health visiting service but there does need to be some parity in how health navigators triage and this will really depend on local community needs Being able to prove it makes a difference: • There is no point in evaluating what we are doing now because it’s so low level .There is also a huge disparity in what’s happening across BNSSG. We need to know that social prescribing services are robust and work  • Find ways to demonstrate benefits to patients which translate as less visits to GPs • Pilots could capture the live experience and demonstrate change so that from a commissioning perspective, there is evidence of a cohort of patients going to the GP less – then it is an easy sell • Look at how it’s [social prescribing] is managed and link it with Asset Based Community Development approaches so giving people the skills to manage their own health and build cohesive communities .

16. Thoughts on social prescribing in the room… • Really important that social prescribing (connectors etc.) also takes place for people seeking help for mental ill health as well as physical health in primary care. • There exists (and is growing) a bank of evidence regarding the effectiveness of social prescribing and a number of GPs who are strong advocates of SP and great spokespeople. Perhaps we need to improve the interface between GPs (and their membership organisations such as One Care) and the available evidence • GPs need to refer to a link worker who had time to talk to the person/patient and help determine the root causes of their presenting issues. Not use GPs or other surgery staff (i.e. receptionists) • We do not need top- down, one size fits all approach to SP. What is needed is a number of frameworks within which the SP service can be developed/tweaked to meet local conditions and needs. • Social prescription model needs to follow medical prescription money in the sense that the money follows the person and ends with the services/groups who provide these services

17. Digital platform research Aim: To review the current databases and platforms available in BNSSG to support social prescribing, signposting, self-care (and maybe peer support too), documenting the functionality of each (what can be asked for). This has included the following with a more in depth focus (at the time of the partnership meeting on the 20/2) on 2 local platforms – Wellaware and Rova • A digital platform may be the thing we are missing- that ties everything together and provides continuity in terms of patient records. • Other platforms being looked at include Elemental that is connected to EMIS and could integrate with Wellaware and Evergreen Life – which patient/citizens can use to view their medical records. Also reviewed: • ieg4 http://www.ieg4.com/news-events-webinars/?category=1441 • VC Connect http://www.vcconnect.org.uk/services/vc-connect-for-wellbeing/ • Signum Health https://www.signum-health.com/referrals A summary report is being prepared for the Building Health Partnerships core group.

18. Key points & questions • Information governance needs to be developed in line with data protection • Need to connect with local landscape and what is happening/being developed already • Whatever platform is chosen – it will need funding, from where? • Need to develop a shared understanding of what social prescribing is and how it differs from signposting • A new system needs to integrate with other platforms • Directory part of any system needs to self-update • What scale? What would health professionals want to know? What is the task? What are we comparing? Do we need to separate a referrals system from the database? • Do we want the tool before we have the opportunities? This is beginning of a big discussion

19. Explore

20. Intergenerational care & the diabetes pathway, Gillian Cook, BNSSG CCGs • The Diabetes Digital Coach Testbed period is currently running until end of July 18, if this was extended, there would be an opportunity to work with BS3 and Curo building on their existing work in this area. There is also a connection to work coming from the West of England Academic Health Science Network (WEAHSN) who have been/are working on similar style approaches. • Following a meeting at BS3 in January and a raised awareness of the community links across Bristol it has been identified that there are opportunities to work closely to access the groups who do not engage in healthcare services, however third sector organisations need to be paid and are not able to take on extra work from healthcare with no additional funds. • There have been discussions on how digital care links with diabetes education so a partnership business case to the Director of Transformation in BNSSG CCGs is the next step to show how many hard to reach patients could benefit from this and the impact on their health.

21. Future activity - suggested • Use next partnership meeting to present ideas to local decision makers (including Out of Hospital Care) and feed into Out of Hospital Care newly established steering group • Draft a paper of the findings from BHP to share with the NHS Leaders Integrated Care Group • Ensure local authority representation at the next meeting and connect with Bristol City Plan • Develop relationship with WEAHSN & The Health Foundation – both interested in peer support and self-management • Other opportunities to support intergenerational work around self-care? Thinking about social prescribing… • Share GP survey; analyse level/quality; survey VCSE partners AND define ‘full fat’ social prescribing before/at next event • A uniform service may lead to loss of local/grassroots solutions. Which would not help – so universal standards and offer, not model. • Explore how any community referral system/platform might link in with CAS –CCG • Connect up with body of knowledge and research including Social Return on Investment on social prescribing