On 9 February 2016 Guy's and St Thomas' Charity brought together health professionals, decision-makers, voluntary organisations, patient representatives and others in Lambeth and Southwark to explore ways of improving health by looking outside the confines of healthcare. We wanted to showcase and discuss approaches to improving health outcomes which tackle the wider aspects that impact on people’s wellbeing – from housing to education or social connections. Speakers: - Imogen Moore – Citizens UK - Jeremy Swain – Thames Reach - Catherine Pearson – Healthwatch Lambeth - Ollie Smith – Guy’s and St Thomas’ Charity Find out more about the event and our work supporting new ideas in health at www.gsttcharity.org.uk

1. Beyond healthcare – exploring new
approaches to local health
Tuesday 9 February 2016
Follow the conversation on Twitter at #beyondhealthcare

2. What we’re learning about approaching
health beyond healthcare
— In 2014 Guy’s and St Thomas’ Charity commissioned an agency to get out
and about and talk to local people on the street about what health meant to
them, how they looked after their own health and what they saw as
important.
— We learned that:
– people are largely aware of how to stay healthy but do not prioritise their
health;
– key life events can lead some people to focus on their health, whilst
others no longer prioritise their health;
– mental health is seen as a core part of being healthy; and
– people see health as more than just the ‘avoidance of illness’, and that
there is a strong interaction between health and self-betterment
Follow the conversation on Twitter at #beyondhealthcare

3. What we’re learning about approaching
health beyond healthcare
— In 2015 we decided to build on that insight and commissioned a piece of
research into community-defined approaches to health. We wanted to
review the evidence available to answer one question:
Whether increasing individual and community
agency – to define and achieve health on their
terms – leads to improved health outcomes
Follow the conversation on Twitter at #beyondhealthcare

4. What we’re learning about approaching
health beyond healthcare
— Work is in progress but initial insights suggest that:
– The word “health” is rather slippery. It can have a broad meaning, but
because it can also mean absence of illness, it is easy for discussions and
programmes to fall into that narrower focus.
– That agency is a tricky idea as well. Whilst this is a complex area, the
research suggests that the vital ingredient is that people believe that they are
able to change the things in their life that are important to them.
– It is not enough to recognise that there is more to life than avoiding illness,
and that housing, education, jobs or the quality of your street are important.
How we go about supporting change really matters – citizens and
residents need to feel ownership of the change, not subjects of it.
Follow the conversation on Twitter at #beyondhealthcare

5. Beyond healthcare – exploring new
approaches to local health
Parents and Communities Together (PACT)
Imogen Moore, Citizens UK
Follow the conversation on Twitter at #beyondhealthcare

6. Parents and Communities Together (PACT)
Strengthening Babies’ Futures Through Community Organising

7. COLLECTIVE AND SELF-EFFICACY
FOR HEALTH
A HOLISTIC
PREVENTATIVE
APPROACH
SUPPORTING PARENTS
- Reducing social isolation
- Peer to peer support
- Parents sharing expertise
- Understanding how to
access health services and
articulate needs
A SUPPORTIVE COMMUNITY
- Community organisations
sharing information and best
practice
A COMMUNITY TAKING ACTION
- Informing the design and
delivery of health services
- Housing; repairs, exploitative
landlords, affordable housing
Parents
developing
as leaders
Parent Champions
- Signposting to
relevant support
(housing,
immigration etc.)
Community leaders
ready to respond
proactively to issues
affecting parents

8. • MUMSPACE & DADSPACE - parent led supportive communities where the
focus is on parental wellbeing and peer to peer support.
• PARENT UNIVERSITY – a parent and health professional co-designed course
for pregnancy and the first year of life, supporting parents to be better informed
about healthy behaviours, access to services, and how to articulate their health
needs.
• THE PARENT CHAMPION NETWORK - members of civic institutions are
trained to support and signpost pregnant parents and parents of babies to
services.
• PARENT LEADERSHIP – parents are encouraged and supported to take action
to improve their communities and health services and to find solutions to tackle
the social determinants of health.

9. IMPACT
RESULTS FROM THE PILOT
2013 pilot funded by GSTT Charity followed 15 mothers over 9 months and
showed:
• Feasibility acceptability
• NICE compliance
• Significant improvements in GHQ-12 assessed distress and social capital
EXPECTED OUTCOMES
Protective factors, building resilience:
1. Parental social capital, mental health, health literacy & parenting
2. Infant health & development to 18 months, e.g.
- weight gain trajectory
- social & emotional
- early language (school readiness)
Evaluated in a matched case control design (NIHR RDS)
3. Communities working with Maternity Services
4. Group of organised local mothers able to express views on health
priorities and service improvements

10. LESSONS SO FAR
Tackling issues beyond healthcare
• Many health professionals are frustrated about the wider societal
issues which negatively impact on the health of their patients. There is
appetite to engage in campaigns and to work with civil society to find
solutions. They are often frustrated that there is little scope in their clinical
role to do this.
• Engaging women in their own language and providing support with
learning English has enabled Spanish speaking mothers to grow in
confidence and to access other parts of the project and services that require
them to speak English.
• Sharing food is a great way to break down cultural and language barriers.
• Parental engagement in a housing campaign and teams working to
improve local GP surgeries has demonstrated that parents have capacity
and want to lend their voices to improving their community and services.
Parents as leaders
• Parental leadership can start with something as simple as being asked to
make the tea, before moving on to running sessions. Parents often have
lots to share, they are just waiting to be asked.
• Involving parents in the design and implementation of activities and
programmes increases their confidence and contributes to their self-efficacy
and wellbeing.
• It is more sustainable supporting a parent to develop their skills to solve
their issue themselves.
• Parents appreciated not being treated as just clients.
Organising communities
• The recruitment of twelve organisations to the parent champion
network has demonstrated that there is appetite to work collaboratively to
support community led early intervention.

11. Project Manager – PACT
Imogen.moore@citizensuk.org
07799138114
@imogenmooreuk

12. Beyond healthcare – exploring new
approaches to local health
Lambeth Living Well Network Hub
Jeremy Swain, Thames Reach
Follow the conversation on Twitter at #beyondhealthcare

13. Jeremy Swain – Chief Executive of Thames Reach
and chair of the Provider Alliance Group
Lambeth Living Well Network Hub

14. Living Well Network Hub:
the problem it is seeking to address
• Shifting resources from a crisis-response model to an early
intervention model
• High cost/low volume lower cost, higher volume, higher
quality
• A networked offer of community support with strong primary
care links - 1500 people to be diverted from secondary care
each year (by year 3)
• Shifting of funding from secondary care to the wider Living
Well Network

15. Proposed change in £69 million total investment
– 2014-15 to 2018-19

16. The Hub:
the new front door to mental health services
• Thames Reach (Community Options Team)
• Certitude (peer support)
• SLaM (clinical expertise)
• London Borough of Lambeth (social workers)
• Clapham Family Practice (GP+ nurses, OT)
Not: IAPT, LEO or specialist mental health services

17. Living Well Network Hub:
the model

18. Living Well Network Hub:
the principles

19. Beyond the medical intervention…
• Housing – retaining accommodation, improving living
situation
• Employment and skills – increasing employability and
confidence
• Strengthening family relationships and social networks
• Broadening interests

20. For example… the tale of M
• Exhibiting problem – depressive symptoms
• Underlying issue – family relationships and lack of personal
control
• Self-selected aims: Meet new people, get away from home,
get a job
• Achievements: maths and IT classes at the Mosaic clubhouse,
move to an area closer to his family, greatly improved self-
sufficiency

21. Introductions are medically focused

22. Achievements and learning
• 1056 people offered personalised support
• Earlier (‘wobbly day’) interventions because of lower referral
threshold
• Reduction in secondary care caseloads of 25% (NB: the Hub is
part of a wider system change)
• 32% reduction in the amount of referrals to secondary care
compare to pre-Hub period
• Increase of the flow from secondary care through GP+ Team
(70 people)

23. What else needs to change?
• Improved data around measurement of progress (WASAS)
• Strengthening of contacts with housing
• Improved engagement with some GP practices
• Strengthening of the peer support element
• Stability in staffing
• More self-introductions

24. Follow the conversation on Twitter at #beyondhealthcare
Thank you
Visit www.gsttcharity.org.uk or follow @GSTTCharity
to find out more about our work