A CHARTER FOR COMMUNITY DEVELOPMENT IN HEALTH

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1 A CHARTER FOR COMMUNITY DEVELOPMENT IN HEALTH DR BRIAN FISHER NHS ALLIANCE HEALTH EMPOWERMENT LEVERAGE PROJECT TLAP

2 EMPLOY COMMUNITY DEVELOPMENT WORKERS COMMISSION COMMUNITY DEVELOPMENT HEALTH PROTECTION RESPONSIVE SERVICES TACKLE HEALTH INEQUALITIES SAVE MONEY

3 Shrinking the state + Austerity Threat to community life Increasing inequality KILLS PEOPLE

4 UNDER PRESSURE Hollowed out communities Threat to mental health Attenuation of social networks Weakening of associational life Deterioration in health

5 COMMUNITY BUILDING/DEVELOPMENT Local people identify their own needs and aspirations Influence the decisions that affect their lives Improve the quality of their lives, communities and society in general. Co-production where individuals, communities and public service organisations pool skills, knowledge and abilities to create opportunities and solve problems

6 The family of community-centred approaches (South 2014) Community-centred approaches for health & wellbeing Strengthening communities Volunteer and peer roles Collaborations & partnerships Access to community resources Community development Bridging Community-Based Participatory Research Pathways to participation Asset based approaches Peer interventions Area based Initiatives Community hubs Social network approaches Peer support Community engagement in planning Community-based commissioning Peer education Peer mentoring Co-production projects Volunteer health roles

7 DISRUPTIVE COMMISSIONING Using community development workers Create resident led neighbourhood partnership Agencies and residents together Build community activity from the partnership s agenda

8 A RESIDENT-LED PARTNERSHIP LED BY RESIDENTS THEIR EXPERIENCE DRIVES CHANGE FORMAL STRUCTURES MAY BE NEEDED A CORE REACHES OUT

9 ASSET-BASED COMMUNITY DEVELOPMENT Statutory services become more responsive Promotes health protection and community resilience Helps tackle health inequalities Has an impact on behaviour change Saves money

10 CD Stronger and deeper Social Networks RESILIENCE ENHANCED CONTROL Health protection Resilience to economic adversity Better mental health Can negotiate with services More strength for self-care Health inequalities reduce

11 OUTCOMES HEALTH 6-Month Survival after Heart Attack, by Level of Emotional Support Percent died Men Women Sources of support or more

12 ASSOCIATIONAL LIFE PROTECTS HEALTH Lomas estimates to what extent CD activities would reduce cardiac disease. Social cohesion would prevent 2.9 fatal heart attacks or heart failure Conventional care inc statins would prevent 4 fatal heart attacks in screened males.

13 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 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. doi: /journal.pmed

14 LEWISHAM CD PROGRAMME IN 2 DEPRIVED WARDS By public health to improve health, using a CD approach Working with GP practices Within a strategic framework and including participatory budgeting A return on investment of between 2:1 and 3 :1 suggests good value for money. Improvement_Programme_Sep13.pdf

15 PHYSICAL HEALTH OUTCOMES IN LEWISHAM HEALTH BEHAVIOUR Quitting smoking - 62% increase, 7% increase rest of Lewisham Increased consumption of fruit & veg - 22% inc Increased levels of physical activity - 33% inc Weight loss WORKING WITH PRIMARY CARE Increased uptake of & improvements in services Big increase in recording of BP for people with high blood pressure 4x increase in people expressing concern or referred with suspected cancer symptoms 3x number of cancer referrals per month Improved management of chronic problems like diabetes & back pain

16 MENTAL HEALTH OUTCOMES IN LEWISHAM Improved physical and mental health outcomes 13% increase in those Feel very/quite happy with life in general Increased confidence, self-esteem 24% increase in those not feeling anxious or depressed Many social, work and financial outcomes

17 SAVINGS TO THE NHS Peer support in mental health in Leeds saved bed days and reduced hospital re-admissions by 50% Partnerships for Older People s Project overnight hospital stays reduced by 47% use of A & E Departments by 29%; phone calls to GPs fell by 28% and appointments by 10%. Every 1 spent on POPP services generated 1.20 in savings on emergency beds People Powered Health savings of 7 % for CCGs : 21m per CCG reductions in A&E attendance, planned and unplanned hospital admissions, and outpatient attendance

18 SOCIAL RETURN ON INVESTMENT 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.

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20 PRINCIPLES FOR SOCIAL ACTION ON HEALTH Enable people to organise and collaborate to: identify their own needs take action to exert influence on the decisions which affect their lives improve the quality of their own lives, the communities in which they live, and societies of which they are a part. Address imbalances in power and bring about change founded on social justice, equality and inclusion. Active communities make a marked difference to their own health and life expectancy. Co-production between communities and service providers thrives if communities are enabled to become leading players in their own interests. Look for the strong, not the wrong: a needs-and-assets based approach

21 POLICIES FOR SOCIAL ACTION ON HEALTH A community development strategy in every Health and Well-Being Board and CCG. Joint Strategic Needs Assessments to become Joint Strategic Needs and Assets Assessments Support investment in community development and social value. All CCGs to collect evidence of local community development.

22 POLICIES FOR SOCIAL ACTION ON HEALTH 2 Workforce capacity and capability in community development ensured by Health Education England and LETBs. A community development work programme developed by Public Health England. Commissioning and delivering evidence based community development should be part of CCG Assurance. A Transformation Fund

23 WE CALL ON HEALTH AND OTHER AGENCIES TO: Inspire residents to become key players in developing their own health and well-being. Be prepared to listen, respond and work in new ways. Harness the interventions that have the best evidence and are most reproducible. These include community development or community building or community transformation Develop, through community building, community led neighbourhood partnerships of residents and service providers.

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