Community Links

Community Links blog

Sticking at the job

June 24th, 2016

My first proper job was as a relief worker in children’s residential care. For four months I worked in an adolescent home where I got to know one troubled 16 year old particularly well. Perhaps it was because I was just a few years older or that we had shared interests in football and boxing, whatever the reason, he talked to me as he didn’t talk to other members of staff.

One evening in my last week I told him that I was moving on. Probably ill-advisedly I promised to keep in touch, suggested we might fish together. It was late on a beautiful evening in July and we were talking at the bottom of the big garden. I can see him now, stand up, walk to the house, stop with his back to me, silhouetted against the open kitchen door and shout without turning round – “I wish I’d never met you Dave, then I’d have never had to fucking say goodbye”.

And he didn’t. For the next 4 days he refused to talk to me and when I did occasionally visit the house in later months he always left the room.

3 years later I met the family social worker on Stratford station. She told me that Patrick had taken his own life the day before his 18th birthday.

I know it wasn’t my fault – our relationship was far too fleeting for that. But if I wasn’t part of the problem for Patrick nor was I, as I had once fondly imagined, part of the solution.

I don’t think good social work necessarily involves years of engagement with the same families or the same individuals and I don’t think good community work necessarily demands an endless commitment to one community. There are times however when both do depend on strong, stretching, resilient, trusted relationships and they are not forged in the blinking of an eye.

Building organisations in this space is no different.  Steady turnover in the staff team and dependable consistency are like fast food and slow cooking, there is a place for both.

Sadly the third sector trade press and the wider media have published a relentless string of articles over the last year damming the long haul charity founder and attributing the collapse of Kids Co to something called “Founder Syndrome”. (I know, it sounds like a disease. Apparently it’s meant to)

I go part time next month after more than 35 years of working full time at Community Links – an organisation I cofounded. I have no plans for stopping entirely.  We will never know if Community Links would have been stronger or more successful without me, but at the risk of hubris I think the solid presence of our organisation in this east London community over the better part of 4 decades and the reliable relationships that have grown up around many staff colleagues and volunteers (not just me) who have worked here for sustained periods over that time is not a weakness. Sticking at the job isn’t the only way to succeed but it’s not wrong.

Smart organisations are those that understand how to continuously blend the fresh expertise, the new networks and vital insight of the latest recruit with the cherished relationships and hard won experience of existing colleagues.

Perhaps I would say that, wouldn’t I, but our Chief Executive has reached a similar conclusion from a different perspective:

Community Links” says Geraldine Blake “is unusual in many ways but not least that when our founders stepped down from managing the organisation they remained employees: David Robinson in our national research and policy unit and Kevin Jenkins in our trading development team.  A daunting prospect for a Chief Executive?  What you need to make this work is fierce focus on mission, values and impact right across the organisation, strong and regularly refreshed governance, and founders with a great sense of humility and humour.  Then you have the best of all worlds: new eyes, hard-won experience, and phenomenal intellectual assets to call on.”

One Kids Company doesn’t make a case and one Camilla doesn’t make a syndrome. One year on from its failure we are fast allowing the tribulations of an outlier to frame a sweeping, uncontested wisdom for our sector. Please stop, before we have.

Good old Bob

June 20th, 2016

Bob Holman, who died last week, wasn’t everybody’s cup of tea and I don’t think he’d mind that I said so. I think he would smile.

Our friend was a tireless critic of bunkum and conceit, of pomposity and privilege and he had the guts and the stamina to speak out over and over again, very courteously but fearlessly and relentlessly. Throughout his life Bob wrote and talked and campaigned against poverty and injustice but the many books, the numerous articles, the pithy letters to the newspapers, the lectures and presentations were only part of an extraordinary 79 years. To paraphrase Gandhi, Bob was the change that he wanted to see in the world, an active and dedicated community worker, forgoing his professorship, living and bringing up his family in the communities where he worked – Southdown in Bristol and Easterhouse in Glasgow.

Born in east London he never lost his early love for the place, writing biographies of local heroes George Lansbury and James Keir Hardie in his later years and often drawing on his childhood experience here. Bob was a friend of Community Links from our earliest days. This is an extract from a piece he published in 1990 drawing together that affection for this area, generous support for our work and above all his passion for radical change:

“I support Community Links for many reasons. First I believe Community Links is right to identify poverty as an issue to which it must give most attention…. lives characterised by material hardship and want… Britain is a prosperous nation and I cannot accept that so many of its families have so much while others have so little. The team at Community Links share this belief.”

“Second, I admire Community Links because their response is not one that patronises people with low incomes, not one which makes them feel inferior and demeaned. On the contrary, the users at Community Links have become its doers, its volunteers, its committee members, and its staff. Community Links shares opportunities, responsibilities and power and so treats others as equals…”

“George Lansbury would have approved of Community Links opposition to poverty, its insistence on local control and its integrity.… He served as an East End MP and borough Councillor for much of the period 1900 to 1940 and his home was always open to those in need. … Lansbury was not ashamed to talk about love. He wrote “I love England and especially dear, ugly east London.. I want people to join me in striving to bring love into all our lives” …

“Love of this nature” concluded Bob “will not allow one section of our population to be in luxury and power while others are poor and powerless. I commend Community Links because it is doing something to stimulate this kind of social love”

The Lansbury quote appeared also in Bobs 1990 biography of the politician. Its title recalled the Labour leader’s local epithet: “Good Old George.” I looked out my tatty edition last night along with an equally dog eared “Faith in the Poor” which he compiled eight years later. It was a simple collection of conversations with people in poverty – people, he said, who knew better than anybody what would be right for them, their families and others in similar positions. Tucked into the back of my copy are some of Bob’s letters, often angry but always resolutely hopeful and determined, generous, passionate, funny and humble. Helena Kennedy QC is quoted on the back cover: “Cabinet ministers should go and sit at the feet of Bob Holman”.

How very sad it is that that moment has passed. Now more than ever politicians and policy makers of all political persuasions, not to mention public service managers, third sector leaders and community workers everywhere, should surely read the book.

Good old Bob.

There’s nothing like a referendum to get young people voting?

June 13th, 2016

Last week the register to vote website crashed due to unprecedented demand from people under 35, forcing the Government to introduce legislation to extend the deadline. At the same time our own Youth Worker, Tola Jaiyeola was participating in a live EU referendum TV debate with Nigel Farage and David Cameron, smashing the stereotype that young people are not interested in the decisions that shape their lives.     

At Community Links our Talent Match London team have been working with Bite the Ballot engaging young people in East London in the EU referendum debate. The message has been clear, whether you’re in or out, make sure you turn up to vote and understand what you’re voting for.

In the past young people have been criticized for showing apathy and antipathy towards politics, with the likes of Ed Miliband recently issuing a ‘call to arms’ to young voters, urging them to register to vote for next week’s referendum. Leave or remain, politicians know that young people’s votes are an untapped resource, with turnout amongst 18-24 year olds in the 2015 general election nearly half that of the over 65s. In a previous blog we highlighted how low political participation is contributing to young people lagging behind their older relatives in-terms of income growth and homeownership.

Voter registration data published last week shows that this might be changing, with hundreds of thousands of young people making a last minute dash to register. Could the EU referendum be reconnecting young people with politics, the same as the Scottish referendum did? We won’t know until after the 23rd June, however, what is clear is that young people do care about these issues. Following Tola’s TV appearance, she wrote an opinion piece for the Guardian, outlining why she believes young people need to speak up:

“My final advice to my peers is not to be intimidated by politics or by political leaders, but to get involved. It was nerve-racking being on camera and putting my question to Farage, but a few days on from the debate, I feel proud to have stood up and had my voice heard. Let’s not leave the older generation, who may not be around for the consequences of these decisions, to decide our fate alone.”

Let’s hope that when the ballot boxes open next Thursday, young people from across the country follow Tola’s lead and take the future in their hands, proving, as they did in Scotland, that there’s nothing like a referendum to get young people voting.

Wales: Good reasons to be hopeful

June 13th, 2016

I met Sophie Howe – the Future Generations Commissioner for Wales – last week. Sophie started work at the helm of the newly minted Commission 4 months ago. I had been looking forward to our meeting for some time. The Act which created the Commission had been in gestation from the earliest days of the Task Force in 2011. Now the powers and responsibilities of the new Commissioner are wider and probably stronger than any of the small number of offices elsewhere in the world that are at all comparable.

Peter Davies previously held a much more limited role as the Commissioner for Sustainable Futures. He was a prime mover in the development of the legislation which created the Future Generations Commission and has been generous in his acknowledgement of the influence of the Early Action Task Force: “The work of the Early Action Task Force has been really influential in the development of the Well – being of Future Generations Act. The concept of early action should be at the heart of sustainable development. The Triple Dividend perfectly captured the essence of this approach and brought much needed focus on action that can take place now, preventing long term consequences and setting a pathway for a more sustainable future.”

Five “ways of working” were outlined in the act. Public bodies need to be demonstrating these in order to show that they applying the sustainable development principle. In essence it is the Commissioners job to ensure that they are and to help them do it well

These “ways of working” are intended to “help us work together better, avoid repeating past mistakes and tackle some of the long term challenges that we are facing”:

1) Long term: The importance of balancing short term needs with the need to safe guard the ability to also meet long term needs

2) Prevention: How acting to prevent problems occurring or getting worse may help public bodies to meet their objectives.

3) Integration: Considering how the public bodies well-being objectives may impact upon each of the well-being goals, on their objectives, or on the objectives of other public bodies.

4) Collaboration: Acting in collaboration with any other person (or different parts of the body itself) that could help the body to meet its well – being objectives.

5) Involvement: The importance of involving people with an interest in achieving the well-being goals and ensuring that those people reflect the diversity of the area which the body serves.”

It would be understandable if many of the leaders of those public bodies, and the list that are named in the act is very comprehensive, felt dispirited by a fresh set of demands on staff teams and departmental budgets that are, almost invariably, smaller now than they were when the Senedd first began to talk about the bill. However I spoke to a mainly public sector audience at the Equality and Human Rights Exchange Annual Conference in Mid Wales earlier in the day and, in the margins of my contribution, discovered that delegates were well informed about the purpose and the requirements of the act and almost unanimously enthusiastic. One told me that the act was “the most positive development in public services since devolution” and another that it was “the boldest thing that the Welsh government has ever done.” Ruth Marks CEO of the Wales Council for Voluntary Action, who I met on Wednesday, had been similarly affirmative.

Of course at the moment everyone was talking about the potential. It will be at least two years before anyone can begin to consider consequences but appetites were keen

The government guidance note answers its own question “Why do we need this law?” with this statement:

“Wales faces a number of challenges now and in the future, such as climate change, poverty, health inequalities and jobs and growth. To tackle these we need to work together. To give our children and grandchildren a good quality of life we need to think about how the decisions we make now will impact them. This law will make sure that our public sector does this”.

It is an ambitious objective and I left Cardiff conscious of the burden of expectation now resting on the Commission but also, and most importantly, impressed by the level of commitment on all sides. There are good reasons to be hopeful.

Filiz Aday: ‘I volunteer to provide a vital service to local mums in my area’

June 12th, 2016

As Volunteers Week comes to end, we would like to thank all of our dedicated volunteers who contribute so much to support our programmes.

Not only does volunteering contribute an estimated 23.9 billion to the UK economy, it makes a big difference to individuals and communities every day. We see these benefits at our Asta centre, which is located on the isolated Silvertown estate beside the flight path of City Airport and is one of four Community Hubs sited in areas of greatest need.

Our volunteer Filiz Aday describes why she volunteers at Asta’s parents and toddlers group twice a week. 

Filiz Aday – Parent of Pre Schoolers volunteer

I have been attending the Asta Hub for over 2 years. I moved into the local area 2 ½ years ago and didn’t know anyone. I met the hub manager outside the local school whilst she was giving out leaflets and she told me about the activities and groups that my children and I could attend.

My son started attending the after school Play Project two evenings a week and my young daughter who was 2 years old at the time, came with me to the parent and toddler group; Parents of Pre-Schoolers (POPs), three mornings a week.  Through these services I came to know many of my neighbours and have made many friends in the local area.

When the POPs volunteer coordinator left the area and could no longer volunteer and lead the group, I decided that I would like to take over as it is a vital service for the local mums in the area. I have now been volunteering twice a week since February this year.

The parents and toddlers group targets children from babies to pre-schoolers. We the parents, engage children in a range of age-appropriate activities such as soft play for the babies and other activities such as arts & crafts, baking, messy play and also outing and trips.

I find volunteering to be very rewarding, it gives me the opportunity to meet new friends and gain new skills. Also the challenge of recognising and accommodating different cultures and beliefs when raising children has been an eye opener for me and something that I have learnt a lot from. I love planning sessions, setting up and seeing the joy on the children’s faces as they take part. It’s great that the parents who attend have formed great friendships and feel part of the larger community through their engagement at the POPs group; Asta is another part of our home.

The best part of volunteering for POPs is being able to provide something like this for parents to come along with their children and feel comfortable, as a lot of us don’t have big homes or gardens and the children love spending time with their friends.

If you’re feeling inspired and would like to get involved in one of our individual or team volunteering opportunities, then please get in contact with Anila.ramanlal@community-links.org. Find out more about the programmes we run here

We need more progression and less conditionality for people on in-work benefits

June 10th, 2016

While the Work and Pensions Select Committee (WPSC) congratulate the government on piloting a “revolutionary” in-work support service for Universal Credit (UC) claimants, we look at some of the challenges in developing this untested welfare reform and consider what role conditionality should play.

Reading the WPSC’s recent report on in-work progression you can understand why they erred on the positive side. The in-work service being piloted by the DWP has the potential to break the cycle of people getting stuck in low pay, low prospects employment, whilst taking a small but significant step towards improving poor labour productivity in the UK. However, questions about the capacity of Job Centre Plus (JCP) to deliver a national programme of support, the additional skills required of Work Coaches, and the introduction of a conditionality regime for people already in-work leave us with more questions than answers.

Too many claimants, not enough coaches

The DWP intend for in-work UC claimants to receive support from the same JCP Work Coach throughout their claim, enabling them to build a relationship and receive continuity of support. We welcome the Government’s recognition of the importance of what we describe as deep value relationships, however, there is a gap between their intentions and the resources required to make them a reality. The committee’s report touches upon this issue, highlighting that a full JCP-led in-work service could apply to around one million people, compared to the 15,000 claimants currently involved in the pilot. This comes at a time when the DWP is expected to reduce its day-to-day spending by 19% between 2015-16 and 2019-20.

Alongside these budgetary pressures, Work Coaches will also need to dramatically expand their skills to address structural barriers to progressing in work. This requires them to have a far more detailed understanding of local labour markets and engage with employers much more. In response to these budgetary and skills challenges, the DWP said they would “think very carefully about how we differentiate the service”, and suggested providing online support in lieu of face-to-face interviews. They also said Work Coaches would receive “substantial” additional face-to-face training.

More progression and less conditionality

A cynic would say that in-work progression enables the Government to introduce an in-work conditionality regime and that the budgetary and skills gaps are clear indicators of this. As we highlighted in a previous blog on this subject, the introduction of in-work conditionality and imposition of sanctions on working claimants risks making people’s lives and employment more precarious. Just this week, a Government-backed employment project in Oxford found that docking welfare payments is not an incentive to work. In our submission to the WPSC inquiry we recommended that an in-work service should improve employment outcomes not enforce compliance. So as the DWP continues its pilots, we hope they place a greater emphasis on delivering a high quality in-work support service, and refrain from applying conditionality to people who have shown they do not lack the motivation to work.

Sending out an SOS: how early action can break the cycle of reoffending

June 8th, 2016

The Early Action Task Force is currently building on its latest report, ‘A Rough Guide to Early Action’, by creating an early action case study online gallery. Below is a sneak peek into one of our new case studies, the St Giles Trust SOS Project… 

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Junior Smart, Founder of SOS Project. (Image by Emmanuelle Purdon.)

St Giles Trust’s SOS project was founded by Junior Smart in 2006, an ex-offender working for the trust who had experienced the destructive cycle of gangs, violence and crime. The project is designed to help vulnerable young people caught up in criminal lifestyles – often gang related – to enable them to realise their aspirations in education, training or employment and ultimately reduce violent and weapons crime.

 Why is this early action?

According to the National Audit Office it costs nearly £250 million each year to detain young offenders, with 73% of them re-offending within a year. Gang crime is also hugely costly, both in terms of destroying the lives of gang members, their family members, and their victims, and of policing, prosecuting, and incarcerating offenders. The Government estimates that 50% of shootings and 22% of violent crime in London are perpetrated by gang members.

Preventing violent crime by breaking people’s involvement allows them to contribute to society, improves their family’s prospects, and makes their communities safer by reducing the likelihood that their peers are drawn into crime. SOS does so through an emphasis on shared experience and building relationships, training ex-offenders as caseworkers to work with gang members providing one-to-one holistic support tailored to the individual’s needs.

 How does it work?

Initially piloted in Southwark, SOS is now the largest gang exit service in London, operating in 14 boroughs and funded by local authorities, corporates, philanthropists, and charitable trusts. It operates through St. Giles Trust’s Peer Advisor model, using ex-offenders as frontline caseworkers and training them whilst in prison to give high-level advice and guidance. Not only is this experience powerful in breaking down barriers with gang members, it also provides caseworkers with a meaningful qualification to find well paid employment upon release.

SOS develops one-to-one relationships that are available 24/7 to build trust and encourage individuals to turn their lives around. Caseworkers provide support in family mediation, finding solutions to housing needs, enabling them to break ties with destructive friendships and move towards education or employment. SOS is about implementing pragmatic solutions that lead to behaviour change.

SOS also works in schools through SOS+, using ex-offenders to inform at risk young people about the dangers of gang involvement, de-glamorising the lifestyle, and raising awareness about how they can stay safe. One-to-one support is given to particularly vulnerable young people. SOS is also delivered through Expect Respect which works exclusively with young women, offering one-to-one support to those at risk of sexual and violent exploitation associated with gang involvement.

What has it achieved?

SOS ultimately aims to prevent gang crime by helping clients end gang involvement and getting them into work and decent housing. An evaluation by The Social Innovation Partnership found that 87% of SOS clients interviewed changed their attitude to offending. Over 75% of clients move into employment or training, and 75% into decent housing. Mainly, though, it was clients’ relationship with caseworkers that had the greatest effect in changing behaviour as caseworkers’ experience allowed them to challenge clients whilst ultimately giving support.

According to a cost benefit analysis of its work with high risk prison leavers, St. Giles Trust reduces reoffending by an additional 40% compared to the national average. It’s testament to St. Giles Trust’s transformative effect, not just among its clients but staff as well; of 23 SOS caseworkers who left school without any qualifications, eight now hold degrees. It demonstrates St. Giles Trust’s ethos of not dismissing individual’s capabilities because of their past, and caseworkers’ great determination to improve their clients’ lives, as well as their own.

 What can we learn?

The intensive, empathetic and 1:1 relation-building between caseworkers and clients is key to SOS’s success. 75% of clients said that their caseworker being an ex-offender was crucial in making them want to change their lives. Having a team of caseworkers who’ve experienced the hardships their clients face makes them particularly determined to persist in maintaining the relationship for as long as it takes, whilst also showing clients that they have to want to change for themselves. What’s significant about the SOS project and St. Giles Trust’s work more generally is in showing that changing behaviours of the most entrenched, challenging and complex clients only works through relation-building because people who are disengaged from all other services need a consistent, flexible and personal source of support.

 

Find out more

Further information on SOS can be found here.

Watch a film about the SOS Project here.

Displacement is not prevention: acting earlier to prevent homelessness

June 7th, 2016

Homelessness is a problem that has often been met with strange solutions. Take the so-called ‘homelessness prevention spikes’ that we’ve written about before, in which spikes are fitted near buildings to prevent rough sleeping. Rather than deal with the causes of that person’s homelessness and enable them to take steps towards finding a home, it merely displaces them somewhere else to be somebody else’s problem.

It is no wonder that many individuals find it hard to escape homelessness when such approaches not only exist, but are deemed suitable ways to address the issue. I was reminded of this ‘prevention’ technique when reading about Bournemouth Council’s homelessness strategy, which claims to be putting £200,000 towards “assertive techniques and procedures”. Part of this involves buying rough sleepers one-way train tickets to move them out of the area. As with the spikes, rather than dealing with causes of homelessness this strategy deals with their consequences; rendering rough sleepers invisible (to the residents of Bournemouth) and foisting their problems on somebody else. By this logic as long as rough sleepers are not in ‘our’ area then they are no longer ‘our’ problem.

A different approach

Over the past six months we’ve been collecting stories of early action, exploring how individuals and organisations are acting one step earlier in order to solve the root causes of social and economic problems such as homelessness.

To be fair to Bournemouth, their Housing Strategy does go into a bit more detail about their use of the central government Homelessness Prevention Grant (although, slightly worryingly, that has now been absorbed into general council funding) and provide some additional services for those experiencing or at risk of homelessness. Information is scant, however, and other areas seem to be taking a much more proactive, systemic and partnership based approach.

Most recently we heard about the Active Inclusion project in Newcastle (AIN). By working in partnership, AIN enables people to avoid homelessness wherever possible by making advice, information, and support from a range of organisations far easier to access. It works primarily on three levels, from primary prevention (‘information and support for all to identify risks and prevent crises’), through secondary prevention (‘specialist support, accommodation and advice for those at risk’), to crisis activities (‘for people who are literally homeless’). As a result of activities – which can be anything from welfare and debt advice to emergency accommodation – AIN has helped prevent 4,192 potential cases of homelessness in 2014/15.

Another example is Dundee City Council’s Homeless Service Unit. This unit runs a range of services targeted at those at risk of homelessness, from raising awareness among 16 year olds about planning for independent living, to giving people leaving care or prison support through a key worker. They make between 1,000 and 1,500 homelessness assessments each year and it adapts services to reflect need; for example one of the fastest growing reasons for homelessness is insecurity within the private rented sector (stay tuned for our private rented sector briefing that will be published in the coming weeks).

The Passage – a London based charity highlighted in our latest report – have also taken an explicitly preventative approach (whilst also maintaining essential crisis-oriented services). Most notably their Hospital Discharge Service identifies homeless patients (or those at risk of homelessness) who repeatedly present at A&E and refers them to more appropriate services that deal with their underlying crisis. After working with 300 people last year through this service, 70% of them ended up going into accommodation after leaving hospital. They also run a Home for Good service that enables formerly homeless people to connect with local voluntary and community sector organisations, with 97% of the people they worked with retaining their homes after 12 months (as opposed to 84% without this intervention).

Prevention is about more than displacement

These three examples – by no means the only ones to exist across the UK – highlight that homelessness prevention can (and indeed should) be about more than displacement. Early action at its core is about enabling people to flourish, rather than merely preventing them from experiencing negative outcomes (or, in some cases, simply displacing their problems elsewhere).

It also raises an important point about what we measure and how this drives activity. In much the same way as certain types of policing – traditionally driven by the enforcement model (i.e. charging around under blue flashing lights, making arrests, and ‘kicking down doors’) – can drive up arrest statistics, Bournemouth’s attempt to reduce levels of rough sleeping may well ‘work’ when we look at the statistics in a year’s time. But will their ‘assertive’ train-ticket buying ‘techniques’ have actually achieved anything positive for those at risk of or experiencing homelessness? Will they be securely housed and leading happier, healthier and more productive lives? Unless they catch a train to Newcastle or Dundee, I’d guess probably not.

Functional, fulfilling and friendly: Developing the Bumping Places

June 2nd, 2016

During a visit to an Age UK volunteering event on Wednesday, the new mayor of London outlined a series of plans “to improve social integration and ensure more Londoners develop strong relationships with people of different faiths, race, economic background and age”.  His intentions included “using design and planning to ensure people spend more time meeting people from different backgrounds, for example by ensuring all schools have a sheltered space at the entrance so parents can stop and talk as they drop their children at school.”  

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Regular readers of this blog will recognise the genesis of this simple idea, and parents of primary school children will have seen its potential for themselves. Local networks expand and improve when new parents join the school gate fraternity.  It is a physical locus, of course, but the shared interest and experience of the group makes it much more than just a physical intersection. A peer network evolves sharing knowledge, personal support and often practical help. My mother’s friendship group when she died at 79 still included women she met outside my first classroom.

We don’t need a research grant to understand why this works better at some schools than others. I think of two schools close to us here in Newham. One, on a very busy road, doesn’t allow adults into the playground. The other welcomes parents into an open sided shelter with a few benches in the playground just outside the Year One class rooms. Guess which one works betters as the kind of informal bumping place that, to use the mayors phrase, “improves social integration and ensures more Londoners develop strong relationships with people of different faiths, race, economic background and age”.

Why does this work naturally at the school gate but not, for instance, at the station where a regular crowd also gather at 8.05 day after day? We identified three characteristics of successful “platforms for community building”.

FUNCTIONALITY was the primary reason that people engaged with their platforms, whether that was to pick-up or drop-off their children, sing in a choir, or buy a cup of coffee. Each platform was also FULLFILLING in one way or another, allowing participants to reap benefits from involvement such as learning a new skill or feeling as if they had contributed to something. Finally, it was the FRIENDLINESS of each platform that cemented participant’s motivation to engage.”

Some of this can’t be achieved with Planning Guidance and Regulation or mayoral dictat, but simple observation shows that the design of the built environment is where it all begins and has a critical influence on the quality and quantity of our local networks. Just watch the parents hurry away, heads down, from the first aforementioned school and see how in the other playground parents stay and chat in the evening whilst their children play together.  We can design social integration into the places where we live or we can design it out.

A huge amount of evidence shows why this matters. The IPPR’s Shared Ground report for instance noted the importance of shared spaces as a way of building cohesion and countering anti-immigration sentiments. Stronger neighbourhoods have less crime. Loneliness is twice as deadly as obesity and 4 times more people find work through friends and neighbours than through the Jobcentre.

The Mayor described social integration as “the key to a more productive, healthier and ultimately more prosperous city for all Londoners”. Making the numerous bumping places in our complex urban environment “functional, fulfilling and friendly” isn’t an alternative to, or a distraction from, a big mayoral vision like tackling extremism, reducing crime or beating unemployment, it is the making of it.

From public benches to posties: how early action can change our approach to later life

May 28th, 2016

Faced with an ageing population and cuts to public spending, early action can provide an alternative way forward for local authorities and the NHS

Yesterday, the National Audit Office (NAO) published a report calling for radical action to tackle delays in discharging older patients from hospital and stop the costs adding further strain to the financial sustainability of both the NHS and local government. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million. Delayed discharge also has a huge personal cost as people that are delayed more than 72 hours are far more likely to fall ill again, lose independence or mobility and be admitted to residential care.

The evidence clearly indicates that the care system needs to be transformed. We believe that adopting early action is a common-sense approach for the NHS and local authorities who face the worrying combination of an ageing population and cuts to public spending.

When considering the problem of delayed discharges, an early action approach encourages us to ask the question ‘where could we intervene earlier?’

The ideal solution to reducing delays in discharge is to reduce the need for admissions altogether by focusing on primary or secondary prevention. Primary prevention enabling older people to lead thriving lives could focus on adapting our society to be more ‘age-friendly’ through a myriad of relatively small, innovative interventions, for example by installing grab rails in homes to prevent falls or providing more public benches. There is also a considerable amount of evidence that interventions throughout a generation’s lifespan, not just in the early and later years, will help reduce pressure on health and social services from an ageing population.

Secondary prevention to reduce hospital admission would target individuals with more clearly identified needs. A good example of a simple intervention that does just this is the Call & Check Service based in Jersey. Postmen ‘call and check’ on older people, reminding them of medical appointments / prescriptions and connecting them with other support services. It prevents social isolation and enables them to live independently for as long as possible. This simple concept demonstrates that communicating and linking people with existing services is an effective way of using resources to act earlier. It also shows the strength of combining normally disparate sectors by using an existing service to increase the efficiency and quality of health and social care. [1]

Emergency hospital admission rates are correlated with chronic illnesses, so secondary interventions should also focus on enabling people with chronic illnesses to manage their own care. The US Veterans Health Administration ‘Health Buddy’ uses innovative yet simple technology to produce dramatic outcomes – an evaluative study showed savings of $3,506 on average per patient, hospital admissions reduced by 66% and bed days reduced by 71%.[2]

Of course, even with the best of care some older people will need to be admitted to hospital, so early action is also about considering how services can be improved to ensure that older people can be discharged quickly and safely as soon as they no longer need acute care. The NAO report highlights that financial incentives for the NHS to reduce delayed discharges are not matched with incentives for local authorities to speed up receiving older people back into the community. One possible solution is to integrate health and social care, by pooling budgets in order to reduce departmental silos and encourage information sharing. The cost benefits accrued through improved efficiency could then also be shared.

The Government has shown some appetite for integration through the establishment of the ‘Better Care Fund’, designed to support local areas to plan and implement unified health and social care services. However, in a survey of local authority care directors, almost half (43%) said they believe the Better Care Fund has had little or no impact on care budgets and service quality. This is perhaps a somewhat negative outlook given the BCF is still in its infancy, but it does demonstrate that there is still a lot of work to do on integration. Different funding streams remain a major barrier and more must be done to bring them together.

Furthermore, integration alone is not enough. It is essential that services are designed with the involvement of both those who deliver the service and those who receive it to ensure buy-in to the new approach. ‘Co-production’ leads to a person-centred approach which focuses on the older person’s needs, rather than organisational targets. Hospital to Home, featured below, is one initiative which has adopted a co-production approach to redesigning integrated health and social care services in Scotland. The project is still ongoing, but practitioners from the working group report that the project has “greatly improved communication” with one respondent estimating that they have “reduced care home admissions from our hospital by about 50%”. Equally as important, interviews with older people and their carers evidenced positive relationships with staff but also helped to identify gaps in their care that still remained.

There is recognition amongst councils of the importance and benefits of investing in prevention – and the spirit of prevention is now embedded in the Care Act. However, overall funding pressures resulted in local authorities’ planned spend on preventative measures dropping from £937 million in 2014/15 to £880 million in 2015/16 – a 6 per cent reduction in real terms. If the government is serious about prevention, it needs to translate words into action – backed up with hard cash.

How can integrated services be designed whilst improving older people’s care experience?

Hospital to Home is an initiative aimed at improving the care experience of older people being discharged from hospital in the Tayside region of Scotland. Delivered by Iriss, the project worked with local health and social care practitioners, older people and their carers. This group shared their own experiences with each other and co-designed issues to be addressed. This resulted in three broad recommendations which have been adapted and embedded locally with partners from the case study areas of South Angus and Dundee over the past year.

Hospital to Home’s starting point is improving the experience of the person receiving care, yet its effect is increasing the efficiency of hospital discharge and improving community based care, with an aim to minimise hospital admissions in the first place. It demonstrates the process of redesigning services for early action, highlighting an approach that removes departmental silos by focusing on the desired outcomes of the person. Strengthening communication between practitioners, patients and their families and coordination between acute and community services is key in tailoring health and social care around patients’ needs and improving care and efficiency in hospital discharge.

We will be publishing a more detailed case study of Hospital to Home on our website soon. In the meantime, you can find out more about the project here.

 

[1] You can read more about Call & Check in our ‘Rough Guide to Early Action’

[2] Coye, M. (2009) Transformation in chronic disease management through technology: improving productivity and quality in the shift from acute to home based settings. San Francisco (CA), Health Technology Center