COMMUNITY DEVELOPMENT,  TRANSFORMATION AND DEPRIVED COMMUNITIES        Dr Brian Fisher MBE   GP and lead for the HELP proj...
THE CONVERSATION TODAY• An opportunity for change• The evidence for community  development in health• The HELP approach• O...
AN OPPORTUNITY• A new approach to population health through  community development• Wraps around primary care• Enhances co...
CCGs AND COMMUNITIES• GPs have a strong sense of place. Like  councillors• The new architecture connects LAs,  HWBs and pr...
A BIT OF THEORY
WHAT COMMUNITY DEVELOPMENT CAN    DO, ALL AT THE SAME TIME• Statutory services become more  responsive• Promotes health pr...
Stronger and CD                       deeper Social                          NetworksRESILIENCE                  ENHANCED ...
OUTCOMES – HEALTH                      6-Month Survival after Heart Attack,                         by Level of Emotional ...
SOCIAL NETWORKS        REDUCE MORTALITY RISK• 50 % increased likelihood of survival for people  with stronger social relat...
www.healthempowermentgroup.org.uk
THE HELP PROJECT• A business case for investment in CD  in health• Small team supporting work in 3  estates in 3 areas - D...
THE HELP APPROACH             We start from issues              raised by local people             We bring people and  ...
HELP – THE 7 STEPS1. Identify and nurture key     4. Create formal partnership - links   residents. Establish a           ...
A RESIDENT-LEDPARTNERSHIP  LED BY RESIDENTS  THEIR EXPERIENCE DRIVES CHANGE  FORMAL STRUCTURES MAY BE NEEDED  A CORE REACH...
WHAT COMMUNITY DEVELOPMENT CAN    DO, ALL AT THE SAME TIME• Statutory services become more  responsive• Promotes health pr...
OUTCOMES - RESPONSIVE         SERVICES• Services begin to change within 6  months• Affects many sectors simultaneously  (h...
RESPONSIVE SERVICES• A new dental service established• Funding of £95k to transform a derelict area into  a playpark award...
Operation Goodnight
OUTCOMES - TACKLING     HEALTH INEQUALITIES• Strong communities are key• Health Inequalities are mediated through  feeling...
Before & After
OUTCOMES - BEHAVIOUR         CHANGE – NICE•   safer cycling•   improved housing•   reducing alcohol-related crashes,•   im...
COST-BENEFIT MODEL• Agreed baseline indicators relevant to  partnership activity• Evidence base relevant to indicator• Cos...
INDICATORS•   Cardiovascular disease admissions age <75•   Depression – GP practice data•   Obesity – adult and child•   O...
A WORKED EXAMPLE - CVD    •More trust, cooperation, social and physical activity• weight management;• smoking cessation;• ...
CRIME – A CASE STUDY• “This downward trend is more than likely due to  the introduction of a permanent PCSO for  Townstal ...
SOCIAL RETURN ON           INVESTMENT• With modest gains on the eight indicators, the  model posits a saving of £559,000 o...
Wanless           Place-based budgetsAnd the engagedpopulationHealth with                             Agencies workingroot...
A HELP INTERVENTION• Options   – Evaluation   – Advice   – Support for intervention• The Full Monty   – Assessment of loca...
Community development, transformation and deprived communities
Community development, transformation and deprived communities
Community development, transformation and deprived communities
Community development, transformation and deprived communities
Community development, transformation and deprived communities
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Community development, transformation and deprived communities

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Community development, transformation and deprived communities

  1. 1. COMMUNITY DEVELOPMENT, TRANSFORMATION AND DEPRIVED COMMUNITIES Dr Brian Fisher MBE GP and lead for the HELP project Chair of the Socialist Health Association
  2. 2. THE CONVERSATION TODAY• An opportunity for change• The evidence for community development in health• The HELP approach• Outcomes of HELP• Cost-benefit
  3. 3. AN OPPORTUNITY• A new approach to population health through community development• Wraps around primary care• Enhances community strength and resilience.• Saves money – joint funding from LA/CCG through HWBs• A number of models to choose from – HELP – Altogether Better – Turning Point
  4. 4. CCGs AND COMMUNITIES• GPs have a strong sense of place. Like councillors• The new architecture connects LAs, HWBs and practices• Community budget pilots are beginning A MARRIAGE OPPORTUNITY!
  5. 5. A BIT OF THEORY
  6. 6. WHAT COMMUNITY DEVELOPMENT CAN DO, ALL AT THE SAME TIME• Statutory services become more responsive• Promotes health protection and community resilience• Helps tackle health inequalities• Has an impact on behaviour change• Saves money
  7. 7. Stronger and CD deeper Social NetworksRESILIENCE ENHANCED CONTROL Health protection Can negotiate with services Resilience to economic More strength for self-care adversity Health inequalities reduce Better mental health
  8. 8. OUTCOMES – HEALTH 6-Month Survival after Heart Attack, by Level of Emotional Support 70 Sources of support 60 50 0Percent died 40 1 30 2 or more 20 10 0 Men Women
  9. 9. SOCIAL NETWORKS REDUCE MORTALITY RISK• 50 % increased likelihood of survival for people with stronger social relationships .• Comparable with risks such as smoking, alcohol, BMI and physical activity.• Consistent across age, sex, cause of death.• 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316
  10. 10. www.healthempowermentgroup.org.uk
  11. 11. THE HELP PROJECT• A business case for investment in CD in health• Small team supporting work in 3 estates in 3 areas - Devon, Wandsworth, Solihull• Builds on 12 years experience• Evidence-based, replicable
  12. 12. THE HELP APPROACH  We start from issues raised by local people  We bring people and services together  We develop sustainable partnerships  We work with other local projects  We do this in ‘7 steps’
  13. 13. HELP – THE 7 STEPS1. Identify and nurture key 4. Create formal partnership - links residents. Establish a with community & service residents & service providers learning set 5. Establish monthly public partnership meetings2. Joint workshops and learning to develop skills 6. Evidence of change, social capital, organisational, key indicators3. Organise ‘listening events’ - residents and 7. Embedding sustainability - services coordination, facilitation, communications
  14. 14. A RESIDENT-LEDPARTNERSHIP LED BY RESIDENTS THEIR EXPERIENCE DRIVES CHANGE FORMAL STRUCTURES MAY BE NEEDED A CORE REACHES OUT
  15. 15. WHAT COMMUNITY DEVELOPMENT CAN DO, ALL AT THE SAME TIME• Statutory services become more responsive• Promotes health protection and community resilience• Helps tackle health inequalities• Has an impact on behaviour change• Saves money
  16. 16. OUTCOMES - RESPONSIVE SERVICES• Services begin to change within 6 months• Affects many sectors simultaneously (health, police, education)• Communities gain confidence and leaders emerge• Staff enjoy their jobs more
  17. 17. RESPONSIVE SERVICES• A new dental service established• Funding of £95k to transform a derelict area into a playpark awarded• A new GP surgery planned• Well attended social events and football sessions• Relations with the housing department improved and tenants more satisfied.• Summer holiday activities for all ages• A cooperative plan for social renewal agreed between the community and public agencies
  18. 18. Operation Goodnight
  19. 19. OUTCOMES - TACKLING HEALTH INEQUALITIES• Strong communities are key• Health Inequalities are mediated through feelings of lack of control• Unequal communities have few SNs and lack a sense of control• More confidence breeds more SNs, stronger more vibrant communities
  20. 20. Before & After
  21. 21. OUTCOMES - BEHAVIOUR CHANGE – NICE• safer cycling• improved housing• reducing alcohol-related crashes,• improving alcohol-related behaviours• helping prevent injuries to children,• promoting a healthy diet in children.• effective promotion of physical activity through walking.
  22. 22. COST-BENEFIT MODEL• Agreed baseline indicators relevant to partnership activity• Evidence base relevant to indicator• Cost indicator: agreed indicative reduction applied to current baseline• Add social capital dividend• Add value of extension of healthcare pathways into active community
  23. 23. INDICATORS• Cardiovascular disease admissions age <75• Depression – GP practice data• Obesity – adult and child• Older people falls• Emergency hospital admissions• A&E Attendance• Emergency ambulance calls• Crime and fear of crime• NEET• Special Educational Needs
  24. 24. A WORKED EXAMPLE - CVD •More trust, cooperation, social and physical activity• weight management;• smoking cessation;• buggy walking route;• health trainers;• Pedal Power - bikes supplied by Police, aimed at ‘families with complex needs’ (older sibs as well as parents teaching younger sibs);• woodland management including coppicing and den building;• dance initiatives •Higher levels of social trust are associated with lower rates ofCHD; areas with higher social capital have lower CHD espamongst people with lower income. Physical activitybeneficial • Indicative 5% reduction in CVD admissions to besubstantiated: 12 admissions in n’hood of 4,200, saving£55,000
  25. 25. CRIME – A CASE STUDY• “This downward trend is more than likely due to the introduction of a permanent PCSO for Townstal and a more regular link with the Dartmouth Community College and the school.”• “The community involvement of the Townstal Community Partnership giving the residents ownership and a ‘say’ in what they want for Townstal has brought the community together and must be considered as a factor in this reduction of crime.” • Townstal Beat Police sergeant
  26. 26. SOCIAL RETURN ON INVESTMENT• With modest gains on the eight indicators, the model posits a saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8• For £233,655 invested across four authorities the social return was £3.5 million.• For every £1 a local authority invests, £15 of value is created.
  27. 27. Wanless Place-based budgetsAnd the engagedpopulationHealth with Agencies workingroots in the together,community with residents Engaged primary care
  28. 28. A HELP INTERVENTION• Options – Evaluation – Advice – Support for intervention• The Full Monty – Assessment of local scene, working with existing activities and people – Training your staff, leaving lasting skills – CD worker, a HELP associate – 90K per community

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