HEALTHIER COMMUNITIES AND
DATE
ITEM NO
ADULT SOCIAL CARE SCRUTINY
20 June 2019
9
PANEL
Social Prescribing: Live Well Greenwich Update
WARD (S)
All
CHIEF OFFICER
CABINET MEMBER
Director of Public Health
Adult’s Social Care and Health
1.
Decision required
1.1
Scrutiny is requested to:
Consider the progress made in relation to the development of the Live
Well Greenwich Prevention System and continue to champion the
prevention at scale approach for Greenwich.
Note the current delivery of social prescribing in Greenwich and
proposals for expansion.
Note areas for future development including opportunities to develop
social prescribing within the Primary Care Networks.
2.
Links to the Royal Greenwich high-level objectives
2.1
This report relates to the Council’s agreed high-level objectives as follows:
A Healthier Greenwich
A Safer Greenwich
A Great Place to Grow Up
Economic Prosperity for all
A Great Place to be
3.
Purpose of Report
3.1 This report provides an update on progress on the delivery of the Live Well
Greenwich prevention at scale programme, including social prescribing in
Greenwich.
4.
Introduction and Background
4.1 In August 2016, the Health and Wellbeing Board approved a new whole
system approach to prevention - Live Well Greenwich. The approach aimed
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to unite efforts across organisations to maximise opportunities for prevention
through existing strategies, infrastructures and services and by ensuring a
single comprehensive approach to preventing poor health and wellbeing at an
individual, community and population level, making improving health
everybody’s business.
4.2 Our partnership approach to prevention, Live Well Greenwich, officially
launched in November 2017 and is now one of the core priorities of the
refreshed Health and Wellbeing Strategy. This approach is summarised in
Figure 1 below.
Figure 1: Prevention approach to delivery of Live Well Greenwich
4.3
Live Well Greenwich is strongly supported by NHS Greenwich CCG. Its
recently published Commissioning Strategy: Transforming our Health and
Social Care System; 2018-2022, sets out prevention of poor health and
wellbeing as one of its four core priorities. Live Well Greenwich is clearly
identified as a central approach to deliver this priority.
4.4 Community life, social connections and having a voice in local decisions are all
factors that have a vital contribution to promoting health and wellbeing.
These factors help people build confidence and resilience, helping to reduce
the risk of illness and influence positive health-related behaviour. Community-
centred approaches are important for the delivery of health and social care
services. The
National Institute for Health and Care Excellence (NICE)
guidance reiterates the importance of community engagement as a strategy
for health improvement, particularly as it leads to services that better meet
the community members’ needs.
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4.5
Recognising the wider social factors that affect people’s health means that as
well supporting medical needs we also need to focus on supporting people to
address their social circumstances, building on the assets they have.
4.6
One approach being advocated nationally by the NHS is social prescribing.
Social prescribing involves supporting patients/clients to improve their health,
by focusing on wellbeing and social welfare (e.g. employment, lifestyle, finance,
housing or social isolation) connecting them to a range of local, non-clinical
community services.
4.7
The aim of social prescribing is to deliver holistic, person-centred approaches
to improve confidence, independence and resilience to reduce the need for
healthcare services through non-medical solutions.
4.8
The NHS Long Term Plan, launched earlier this year, sets out how the NHS
will improve the quality of patient care and health outcomes over the next 5
years. As part of the plan, there is a commitment to develop link workers
(social prescribers) within newly established Primary Care Networks (PCN’s).
4.9
Link workers will support people to develop tailored plans, connecting them
to local groups and services.
4.10 The commitment nationally is for the delivery of over 1000 trained social
prescribing link workers by the end of 20/21, rising further, with the aim that
over 900,000 people are able to be referred to social prescribing schemes by
23/ 24. Live Well Greenwich provides a local mechanism to be able to
support the approach set out in the NHS Plan.
4.11 Since Live Well Greenwich launched, a major focus has been on developing
the individual level (social prescribing) infrastructure for the borough;
supported by the work around community development and a ‘health in all
policies’ approach with partner organisations.
4.12 The following section outlines progress made in the first eighteen months of
Live Well Greenwich.
5.
Available Options: current programme delivery
5.1
Live Well Greenwich infrastructure – including Greenwich social
prescribing
5.1.1 The Live Well Greenwich infrastructure provides the mechanism by which
individuals are connected to a range of community-based support/services
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including voluntary and community services (VCS). This is more commonly
known as social prescribing. Insight led engagement within local communities
has supported the development of the infrastructure which aims to empower
individuals and communities to build independence and resilience. The Live
Well Greenwich infrastructure is set out in Figure 2.
Figure 2 Live Well Greenwich Infrastructure
5.1.2 The infrastructure consists of the Greenwich Community Directory (GCD),
the Live Well Line and Live Well Coaches. This infrastructure is also
supported by Live Well Champions - volunteers and members of local
communities trained in Royal Society of Public Health’s Understanding Health
Improvement and/or Improving Public’s Health training programme.
5.1.3 Live Well Coaches provide one to one support for clients over six sessions
using a motivational interviewing approach to support and enable individuals
to take action to improve their health, building independence and resilience.
Greenwich is unique in having a telephone based social prescribing service
which supplements the face to face provision delivered by the Live Well
Coaches. This provides individuals with a choice of timely support.
5.1.4 The individual (social prescribing) element of Live Well Greenwich – Live
Well Coaching - was informed by local insight with users of the Adult Social
Services Contact Assessment Team and frequent users of general practice
(more than12 times per year).
5.1.5 The insight research identified that social isolation, housing and financial
worries were the most frequently expressed additional needs for which
clients contacted services and for which additional support was required. A
single integrated model for infrastructure delivery will be in place from
Autumn 2019, illustrated by Figure 3 below.
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Figure 3 Live Well Greenwich Integrated Model
5.1.6 The Live Well Line supported in the region of 10,000 people last year and this
is likely to increase. From this year, the Live Well Coach provision based in
primary care and community settings will have capacity to support 1500
clients per year.
5.1.7 In 2018, Charlton Community Athletic Trust (CACT) and METROGAVS, in
partnership with RBG, were successful in securing £300,000 over three years
from the Department of Health to further support the roll out of social
prescribing in primary care. RBG/CACT are in the process of identifying host
practices for the new Live Well Coaches. A vital part of the funding supports
the VCS to develop information and support services to meet emerging
patient needs, ensuring they are connected to the current infrastructure.
5.1.8 Additionally, as part of the NHS Plan’s commitment to establish link workers
(social prescribers) within Primary Care Networks, NHS England is
encouraging local partners including CCG commissioners, Local Authorities,
Primary Care Networks, VCS leaders, and existing social prescribing
schemes, to work together to develop a shared local plan for social
prescribing.
5.1.9 The timing of these arrangements aligns with the development of the new
Live Well infrastructure and provides a significant opportunity to work in a
more strategic and collaborative way. The contractual arrangements for the
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new PCN link workers will be for the local PCNs to decide and the new
funding will be routed via a Directed Enhanced Service (DES) Contract with
the PCN. Live Well Greenwich is well placed to deliver this on behalf of the
networks if agreed.
5.2
Special Interest Live Well Coaches
5.2.1 A Live Well Coach is based with Greenwich Local Labour and Business
(GLLaB) one day per week funded by GLLaB. In five months 60 clients were
supported by the coach. The majority were referred by GLLaB staff for
support focusing on improving confidence, reducing anxiety and to learn how
to best present within an interview session. This model of 'special interest'
Live Well Coaches is an area of future development for the programme; for
example: housing, fuel poverty, end of life, or mental health.
5.3 Integration of Greenwich Community Directory & Children’s
Directories
5.3.1 The Greenwich Community directory is a resource of local services and
support available for adults and provides the universal tier of support within
Live Well Greenwich; as well as being an invaluable resource for the Live
Well teams. Sitting separately to this, are the statutory Children’s
Directories. RBG has recognised the benefits of bringing these resources
together in a user-friendly integrated design which is intended to be launched
in Autumn 2019.
5.4 Development of Live Well Primary Care Centres
5.4.1 It is essential that the Live Well infrastructure links to high quality support
services that are responsive to the needs of individuals. These include lifestyle
services and those addressing wider needs such as social isolation, money
worries or housing.
5.4.2 A key element is making our own commissioned services more responsive
and better aligned to Live Well Greenwich. Between November 2017 and
March 2018, we undertook a review of public health services commissioned
from primary care practices (NHS Health Checks, Stop Smoking Services and
Long Acting Reversible Contraception).
5.4.3 As a consequence, RBG Public Health transformed the way it delivered public
health services through Primary Care. In July 2018 it commissioned the
development of four Primary Care Live Well Centres, managed through the
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single GP Federation, Greenwich Health. These centres now provide a range
of open access public health services; these are expected to grow in size and
scale as they develop as centres of excellence targeting those in most need.
5.4.4 This model of integration across Public Health and the GP Federation is now
being recognised as a model of good practice across London. We will be
proposing to identify further mechanisms to strengthen our integrated
approach including possibly expanding the range of services delivered through
the Live Well Centres.
5.5 Implementing the system and building sustainability
5.5.1 To achieve the aim of Live Well Greenwich, to make improving health
everyone’s business, we need people and communities to recognise how they
can help others and themselves, and to be aware of the support that is
available.
5.5.2 We have developed training, at different levels, to support the infrastructure.
Universal training ‘Make Every Opportunity Count’ (MEOC) helps people
know when, where and how to best signpost local people to Live Well
Greenwich.
5.5.3 From November 2017 to January 2019, over 600 people have been trained in
Greenwich with the course achieving an average rating on 4.5 stars. We will
continue to roll out MEOC to both front line staff and the community and
are developing further training to further enhance the skills of those trained.
5.5.4 A key target for this training is the Primary Care workforce. Facilitated by
Greenwich CCG funding, RBG Public Health have developed a stepped
training programme to embed navigation and coaching skills within existing
staff as outlined in Figure 4. This model of training may provide opportunities
for RBG to roll out to other workforces; both paid and volunteer.
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Figure 4: Live Well Training pathway
Coaching
Navigation
Universal in
action -
Universal
frontline staff
awareness -
everyone
5.5.5 We have been working with partners and within the Council to embed the
Live Well Greenwich infrastructure into broader pathways. This includes
HAS’s Adult Customer Journey, Greenwich CCG Diabetes pathway, Falls and
Frailty and End of Life Pathways. We have also embedded Live Well
Greenwich as part of the VCS Commissioning Process where provider
commitment to Make Every Opportunity Count Training and signposting to
Live Well was considered as part of the selection criteria.
5.6
Raising population awareness
5.6.1 Improving population awareness of the factors impacting on individual’s health
is a core element of Live Well Greenwich. This includes population level
roadshows e.g. alcohol awareness, BeSure Blood Pressure; Change4Life.
Critically the programme is underpinned by Make Every Opportunity Count
training programme.
5.7
Community Development focus
5.7.1 The
United Nations defines
community development as "a process where
community members come together to take collective action and generate
solutions to common problems."
[1] It is a broad term given to the practices of
civic leaders, activists, involved citizens and professionals to improve various
aspects of communities, typically aiming to build stronger and more resilient
local communities.
5.7.2 Strengthening, empowering and connecting these people and communities is
essential to deliver equitable and sustainable health gains. Evidence shows that
‘community engagement’ or ‘community development’ has a positive impact
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on a range of health behaviours and health outcomes, as well as broader
outcomes such as social networks, community cohesion and self-efficacy.1
5.7.3 People in Greenwich - and the communities in which they live - have
resources, connections and ability to influence locally. Working with the
communities we can harness, develop and join up these assets in order to
maintain and improve health and wellbeing: this ‘asset-based approach’ has the
potential to lead to substantial health and wellbeing gains and reduced costs.
5.7.4 Assets within the community include individuals, local informal groups, official
and statutory organisations, physical spaces such as parks or buildings,
businesses, and even social bonds and knowledge about the area.
5.7.5 By strengthening and linking these assets, we are improving the community’s
capacity to ensure sustainable health benefits in the long-term. We apply an
asset-based approach at all stages: from mapping assets and needs within a
community, to planning and delivering an intervention and evaluating what has
been done.
5.8
Rolling out Live Well Champions
5.8.1 Approximately 200 people per year are trained in the Royal Society of Public
Health’s (RSPH) Understanding Health Improvement Training. This accredited
training supports people to understand the principles of promoting health and
wellbeing and enables them to direct individuals towards further practical
support in their efforts to attain a healthier lifestyle.
5.8.2 Greenwich has a strong history of RSPH training, has trained over 1000
individuals over the last ten years and has the largest number of completers
than any other London Borough. Those trained includes members of
community, churches, professionals and volunteers including staff from
children’s centres.
5.8.3 Those trained become Live Well Champions and roll out key Live Well
messages to their own communities and some become volunteers to support
Live Well Coaches. Public Health continues to engage with Live Well
1 For further information on the evidence behind Community Development, see:
NICE guideline NG44 (2016). “Community Engagement: improving health and wellbeing and reducing health inequalities”.
Here
PHE and NHSE (2015).
A guide to community-centred approaches for health and wellbeing. Available
here.
NICE Local Government Briefing (2014). Community engagement to improve health. Available
here.
WHO (2002). Community Participation in Local Health and Sustainable Development – Approaches and Techniques. Available
here
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Champions through regular meetings and runs an ongoing programme of
training throughout the year.
5.9
A life course approach to prevention
5.9.1 Taking a life course approach to the prevention of poor health and wellbeing
provides opportunities to work with our population at all stages of their life,
from preconception to early childhood, adolescents, young adults, older
adults and older people. By supporting people to improve health and
wellbeing at all ages not only improves health and wellbeing outcomes but
also the life chances of our younger population.
5.9.2 Live Well Greenwich initially focused predominantly on adults but has always
recognised the relevance of its approaches to support younger age groups.
Furthermore, significant support is provided through Live Well to parents and
carers of young children.
5.9.3 Public Health in partnership with Children’s Services, has a joint
commissioning plan to remodel children and young peoples’ wellbeing
services including Health Visiting, School Nursing, Universal Youth and
Children’s Centres. This has afforded the opportunity to develop the Start
Well Greenwich programme which will be aligned with the wider Live Well
Greenwich prevention system.
5.9.4 In a similar way to Live Well Greenwich, Start Well Greenwich staff,
volunteers and others will be supported to improve their identification and
signposting skills, so that children, young people and their carers/parents are
empowered to find the right support.
6.
Governance
6.1 Live Well Greenwich is a priority of the Health and Wellbeing Board and is
steered by the Live Well Partnership Board, chaired by the Cabinet Member
of Adult’s Social Care and Health. The Live Well Partnership Board reports
directly to the Health and Wellbeing Board. Figure 5 below sets out the
wider range of partners contributing to the Live Well programme.
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Figure 5: local leadership for Live Well Greenwich
7.
Next steps
7.1
Live Well Greenwich is a priority of the Health and Wellbeing Strategy which
includes an implementation covering the next 5 years. The leadership of the
action plan sits with the Live Well Greenwich Partnership Board. Core
elements of the Live Well Greenwich prevention at scale programme are
below:
Delivery of the improved Live Well infrastructure with partners to ensure
a multi-layered and integrated service for the Borough
Co-production of an action plan with the Live Well Champions and jointly
work with volunteers to deliver this
Ensure broad uptake of Making Every Opportunity Counts across the
Borough
Embed the health in all policies approach
Maximising opportunities to embed Live Well in other pathways or
commissioning approaches
Working alongside the Primary Care Networks to develop a systematic
approach to social prescribing in primary care and communities.
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8.
Cross-Cutting Issues and Implications
Issue
Implications
Sign-off
Legal including
There are no legal or Human Rights Act Cynthia Erove –
Human Rights Act
implication in asking the Scrutiny Panel
Senior Lawyer,
to consider and note the items in
Regeneration
Section 1 of the report.
and
procurement.
28/05/19
Finance and
This report requests the Scrutiny Panel Samina Yasir –
other resources
to note and consider the progress
Accountancy
including
made in relation to the development of Business Change
procurement
the Live Well Prevention System and
Manager
implications
proposals around the development and 28/05/19
delivery of social prescribing.
There are no immediate financial
implications arising from this report.
Separate reports have been presented
for some of the individual plans outlined
in the report (e.g. Live Well
Infrastructure) and detailed finance
comments have been provided.
Equalities
Live Well Greenwich aims to identify,
Aideen Silke –
target and support the most
Head of Live
vulnerable people in the borough,
Well
reduce health inequalities and
23/05/19
contribute towards the prioritisation
of social prescribing as outlined in the
Mayor of London’s Health Inequality
Strategy.
There is increasing evidence regards
social prescribing as a means of
addressing complex health,
psychological and social issues
presented in primary care, as well as
its potential to reduce health
inequalities. We do not anticipate any
negative impacts.
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Report Author:
Aideen Silke, Head of Live Well
Tel No.
020 8921 5333
Email.
xxxxxx.xxxxx@xxxxxxxxxxxxxx.xxx.xx
Reporting to:
Jackie Davidson, Assistant Director of Public Health
Tel No.
020 8921 5403
Email.
xxxxxxx.xxxxxxxx@xxxxxxxxxxxxxx.xxx.xx
Chief Officer:
Steve Whiteman, Director of Public Health
Tel No.
020 8921 5514
Email.
xxxxx.xxxxxxxx@xxxxxxxxxxxxxx.xxx.xx
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