Healthy Futures was a social prescribing service that we funded ourselves and this was a typical client story, showing just how much a Social Prescribing was needed in Birmingham. However, although Healthy Futures was highly successful from a healthcare perspective — supporting over 200 people with tailored non-medical support, and saving time and money for local GPs — eventually, a lack of external financial support made it unsustainable.
Since last year’s Social Prescribing Day, though, we’re pleased to say that things have changed considerably.
This year, the concept of Social Prescribing is much more widely known and understood.
NHS England have rolled out Social Prescribing services nationally, funding PCNs (Primary Care Networks, which are groups of GP practices) across the country to offer a model that is very similar to Healthy Futures. Many GPs, practice staff and other primary care providers can now refer patients to a Link Worker, who works one-to-one with the patient to offer direct support and signposting.
Now, people in Birmingham like Alia will be able to once again access support from a trusted para-professional, trained to support people with all sorts of social, non-clinical needs. Gateway is working in partnership with SDSmyhealthcare to deliver a Social Prescribing Link Worker service to 11 PCNs across Birmingham and Solihull, and our new Link Workers are already settling into their surgeries.
Each Social Prescribing Link Worker works from a number of different surgeries throughout the week, offering patients one-to-one, person-centred support.
GPs and Practice staff can refer anyone who needs non-medical help, and the Link Worker will work with that person to help them take control of their own health and wellbeing and increase their active involvement with their local community.
People with social rather than medical needs
People needing help to access or navigate services
People experiencing social isolation or poor mental health
People with issues relating to advice, housing or income
“Sure, we can walk with you through a door – but ultimately it is your door.”
Zeshaan is one of Gateway’s new Social Prescribing Link Workers. He works with GP practices in the NSAR Primary Care Network, covering Nechells, Saltley and Alum Rock. Find out more about his role, and how he feels about social prescribing, in this short video.
Over the last few months we’ve been blogging about the work our Straight Talking Peer Educators do in schools, drawing on their own experiences to educate young people about early parenthood and helping them learn about making healthy choices.
But the scheme has a lot of benefits for the Peer Educators themselves, too.
That’s because the point of Straight Talking’s Peer Educators scheme is not only to reduce teenage pregnancy and child sexual exploitation in the UK, but to support teenage parents to achieve economic wellbeing and quality of life.
Paid work with training
The work is paid (including expenses), with full training, and flexible enough to fit around childcare and other needs – so it offers really good work experience for young parents, many of whom have not had a career before, and opens the door to potential longer term employment.
As well as the training the Peer Educators receive through Straight Talking – which includes things like classroom management and presentation skills, and workshops on the subjects covered in the sessions, including child sexual exploitation – they can take advantage of further training through Gateway. This includes things like our own Safeguarding and Health and Safety courses, and courses from external providers, such as Umbrella sexual health services.
Two of our Peer Educators, Che and Casey, have already moved up to become Assistant Co-ordinators, a salaried part-time role with more responsibilities, including things like interviewing new recruits and calling schools to book sessions.
“Sometimes problem-solving in the classroom means managing challenging groups of students; having behaviour management training from Straight Talking has made me more confident when overcoming this problem and has helped improve my decision-making skills.” — Natalie, in her latest feedback
New confidence and new friends
When delivering sessions in schools or youth groups, the Peer Educators are the experts. With the support of their colleagues and the training they’ve been given, they use their own experiences to share knowledge and open up discussions with the children, and get the whole classroom listening to and engaging with the topics they cover. All of our Peer Educators say they find the work empowering and rewarding, and that it is helping them to build confidence in other areas of their life, too.
And, importantly, working for Straight Talking also offers the opportunities for new friendships. Being a young parent can be very isolating, but working for Straight Talking means they have the opportunity to meet and work with others who understand what it’s like and can empathise. Many have gone on to make friendships outside work with other young parents, which could otherwise have been difficult.
Overall, the Peer Educators that have worked for us so far have found it an incredibly positive experience. Don’t take our word for it, though: listen to our Peer Educators talking about what it’s like to work for Straight Talking!
After a period of illness and a series of surgeries, Karen (pictured above, left) found it hard to bounce back to her old self. Although her physical health was generally improving, she was still feeling low.
“I’d always managed to maintain a good weight before my illness,” Karen says, “but even though I’d recovered from my operations, things weren’t the same. I had no energy, I felt low and suddenly I couldn’t seem to keep the weight off like I used to.”
One of the things Karen used to enjoy was cooking. But since her illness, she’d stopped spending time in the kitchen and instead would grab something quick and easy.
“I was tired all the time,” she says, “so I just wanted a quick fix. But those quick fixes had to be cheap, too. So instead of cooking from fresh, I was just grabbing a snack or a ready meal at the end of the day.”
Karen mentioned how she was feeling to her GP during a routine appointment, and her GP asked if she’d be interested in a free 12 week Lifestyle Programme.
“I jumped at the chance!” says Karen. “I’m on my own at home, with quite a tight budget, plus I work all day so I’m short on time, too, but I could fit in an evening class. And it wouldn’t cost me anything! I felt like I was being offered a chance to take advantage of free help with all the things I’d been worried about, so of course I said yes.”
The 12 week course
The Lifestyle Programme is part of the new Solihull Lifestyle Service. It replaces the Solihull Lighten Up service, and is designed to be a distinct 12-week behavioural change course, rather than a slimming group that people continue to go to indefinitely. The group Karen went to was at the Bosworth Community Centre in Fordbridge, North Solihull, but we hold meetings at a number of community venues in the borough.
By the end of 12 weeks, we hope the people who attend won’t only have lost weight (and all of the participants on Karen’s course had indeed lost weight by the final session) but will have made the changes required to keep the weight off. We don’t want the people we work with to be attending weight management groups forever; we want to give them the tools they need to make the changes themselves.
“A real boost”
Karen says that she enjoyed the programme because she didn’t feel pressured to lose weight.
“The course leader was really supportive and I liked the fact that it wasn’t all about getting your weight down – it was much deeper than that,” she says. “It was really educational. It’s not just buying branded diet meals or allowing yourself a certain number of ‘naughty’ foods. I feel like I’ve actually been on a proper course and learned a lot about food and how the body works.”
One of the big revelations for Karen was the fact that her low energy and low moods might be caused by the type of food she was eating.
“I thought I was knowledgeable, but a lot of the things I’ve learned here have shocked me. It turns out I was in a vicious circle. After learning about healthy fats, and salt and sugar levels, I realised that the quick meals were just sapping my energy and making me feel worse.
“I’d also stopped buying some of the things I really enjoy eating, like smoked mackerel and avocado, because I was under the impression that if they contained fat, they must be bad. Now I’ve learned that they’re OK and you actually need some of that in your diet.”
Thinking about food in a new way was the kick-start Karen needed to get back into healthier eating habits and to start cooking again. She says she’s already got more energy than she has had in years, which has stopped her downward spiral and given her motivation.
She says, “This programme has given me a real boost. It’s made me go back into the kitchen and spend time making nice meals again, from scratch, with the type of fresh food that I really want to eat. And the more I do it, the more energy I have to do it – it’s like I’ve found my mojo and I’m doing what I love again!”
Here are some of the things that attendees learned on the course, which they told us were “eye openers” for them:
Portion control, with examples and easy ways to measure out the right portions of popular foods
The importance of drinking water, and how staying hydrated helps your body to process everything
Cooking healthily on a budget: simple recipes including a pizza that costs a quarter of the price of a takeaway
The Change4Life mobile app, which you can use when shopping to scan food items and make healthier choices
The Lifestyle Programme is part of the new Solihull Lifestyle Service, offering a range of tailored health and wellbeing advice and support to help you make positive lifestyle changes. If you live in Solihull, or have a Solihull GP, call 0800 599 9880 and ask about signing up — or complete an online referral form.
At Solihull Lighten Up, Gateway’s call centre staff support people who want to lose weight. As well as referrals to our own weight management course “Lighten Up For Life“, and vouchers for commercial groups Slimming World and Weight Watchers, Solihull Lighten Up offers extra telephone support – regular phonecalls to check in with people, making sure they’re happy with the help they’re getting, talking through issues, and hopefully providing a bit of extra motivation for people on their way to achieving their goals.
One thing our Solihull Lighten Up call centre team rarely do, however, is meet their clients in person.
This week, six months after first contacting Solihull Lighten Up – and now an amazing 3st 8lb lighter! – Tracy came into the Gateway office and met Lighten Up Administrator Sue for the first time. It was emotional for both of them.
“This time last year, I was unhappy with my weight. I’ve always struggled with it, on and off, but nothing has ever felt permanent.
“I’d been to Slimming World before and by the summer I was wondering about going back – even going so far as having a conversation with the consultant I’d had before – but I hadn’t quite made the decision to go. I had also picked up a leaflet for Solihull Lighten Up at my GP surgery, and thought about contacting them, but after carrying the leaflet around for a bit, I eventually threw it away!
“The turning point came when I was invited to my friend’s barbecue, on the August bank holiday weekend. I knew there would be people there I hadn’t seen for years and, to be honest, it scared me. The last time I’d seen them, I’d lost a lot of weight thanks to a meal replacement diet and at that time, they’d made comments like, ‘you’re looking much better now,’ and ‘you used to be so big!’
“But since then, I’d put a lot of it back on.
“I couldn’t face it. In the car on the way there, I had what I can only describe as a panic attack. The thought of seeing the people who’d commented before … I couldn’t go. I remember my son saying, ‘what’s the matter, mom?!’ I really panicked.
“It was a lightbulb moment for me. I’d had depression in the past and I could see that the signs were there again. That experience really shook me into action.
“I knew I wanted to join a group again, but I liked the idea of extra support, so I found the details for Solihull Lighten Up and I phoned as soon as I could.
“I spoke to Sue the day before my birthday and she was just amazing. She really listened to me and we talked about how I was feeling, which I hadn’t really expected … but Sue made it easy. I found I could be completely honest with her and I hadn’t done that before. I ended up pouring my heart out to her for what must have been 30 or 40 minutes and I felt a lot better. It had already helped.
“When Sue told me that I was eligible for support from Solihull Lighten Up, I was a bit overwhelmed, to be honest. I was certainly surprised – I’m in full time work and I had thought that only people on benefits would be eligible, but she assured me I fit all the criteria and deserved the help.
“I started at Slimming World that weekend.
“The thing is, though, it feels really different this time. I’ve done diets before, and I’ve been to Slimming World before, and I’ve had successes – I’ve lost weight. But it didn’t feel like a long-term change. I’d lose the weight, and then I would put it back on at the first sign of stress (and at the time, I did have a lot of work stress). I was always up and down.
“This time, everything feels like it’s come together a lot better. I feel even more responsible because there’s someone who believes in me, getting in touch and giving me that extra push.
“Before, I would eat the right number of ‘syns’ and lose the weight, but this time round it feels like I’m doing more than that. I’ve certainly changed the way I eat – I’m having my five a day as a matter of routine now. I’m making fresh, healthy food, and enjoying it! Slimming World is really good but with the support from Lighten Up on top, I feel like people have invested in me, which makes me feel more motivated.
“I’ve actually changed my lifestyle. It feels sustainable.”
Shazia has been a POW since the start of the service in 2007. At the time, she wasn’t sure what she wanted to do – she’d done some teacher training but knew it wasn’t for her. However, as part of teacher training she’d met someone involved in the health sector, and felt immediately that she would be more suited to this sort of work.
Soon afterwards, she saw an advert for the new Pregnancy Outreach Workers Service and liked the idea of it. “I liked the fact that there would be no routine and I would be doing something different every day, and that I’d be in charge of my own caseloads. I always knew I wanted to help people and that’s exactly what I would be doing.”
Shazia puts her ability to engage with people down to her sense of humour. “I’ll make fun of myself if I have to. Helping clients to see the humour in situations breaks down barriers and brings people closer together.”
Shazia’s most memorable clients are those who have had issues with substance misuse. “When I started, my knowledge of drugs wasn’t great – I knew a bit about it but not much – but over the years I’ve learned a lot from my clients. Now, I understand the phrases people use, and the way users think.”
She continued, “the thing about addiction is: there’s no point in patronising someone or telling them they shouldn’t do what they’re doing. They know this already. They feel a terrible amount of guilt. They deserve to be treated nicely.”
She went on, “the pull of addiction is really, really strong. If the only people you know are dealers or addicts themselves, and they all have your number and know where you live, that’s a hard environment to get away from. Most of the addicts I’ve met started using in response to abuse or trauma from a young age – things they’ve never had any real support for – so the problems go very deep.”
Shaz recently bumped into someone she supported six years ago. As they chatted, the woman thanked her, saying, “you were the one who treated me like I mattered, and didn’t look down on me”.
Shazia says, “This person’s journey was special to me because I was the one who communicated with her the most, explaining what was happening and often being the person who had to give her bad news. She had a social worker, who was very good, but she didn’t trust her… So it was me who was her birthing partner, staying three nights in the hospital with her. And then it was me who explained to her that, because she hadn’t had four clean drug tests, it was unlikely her baby would be going home with her.”
When support ends, Shazia says it’s important to close cases properly by ending contact and making sure that clients are self-reliant. “It’s not fair on them if they continue to rely on me afterwards,” she says.
(Shazia went on maternity leave last month. When she returns next year, it will be to a new role within Birmingham’s new Early Years Health and Wellbeing service.)
Jacque came to Gateway at the very start of the POW Service in 2007. For her, it was the ideal job.
“I have a degree in Family Work and before I joined POWS I was working with families as an outreach worker and social therapist. Working one to one with families is ideal for me.
“I love helping people face to face, helping them to find balance and meeting their needs. Sometimes people just need someone to listen to them, and even just a fifteen minute chat can have a big impact. This kind of social support is vital.
“One of the great things about POWS is that we are from the communities we support, so we know what’s out there and can engage at a community level. The women we work with trust us, because there’s a mutual understanding. We can have a real heart-to-heart … it’s mom to mom.
“Over the years the POWs have supported thousands of women between us. The original remit for the service was to support ‘marginalised’ women – those who have experienced domestic abuse; women with mental health issues; families with no recourse to public funds – and over the years the needs have become more acute.
“The women we’re supporting now are more vulnerable than ever. They include refugees and people who have been hit really, really hard by the recession, so we are dealing with a lot of homelessness, and language barriers.
“Although on paper we do a lot of the same things that other support workers do, the difference is that we are more available; more accessible than most. We will come out to see people wherever they need us to, whether that’s at home, at a Children’s Centre or at the shops, and they can call us at any time.
“It’s our job to make sure baby is born healthy, and to reduce inequality. And the way we do that is to make sure mom has support from as early a stage as possible. If she’s smoking or drinking, or if she isn’t eating properly, perhaps because she doesn’t have the finances to support herself – then of course the child will be born into inequality.
“Some of the happiest times with POWS have been seeing people’s excitement at a new house, or seeing women breastfeed happily when they never thought they’d be able to.”
Jahanara has been with Gateway on and off for many years. Like many of our POWs, she originally joined as a Community Family support worker, but as a speaker of different Punjabi dialects, including Mirpuri, she’s also worked as a Gateway Interpreter.
As a POW, Jahanara works with a mix of women, but over the last couple of years has seen more and more women with mental health problems.
Recently she supported a client who has suffered severe depression and mental health issues after being raped. She had never told anyone about it – not even her husband – and it was only when she became pregnant with her husband that she finally started talking about what had happened.
“She’s in such poor health that she hasn’t really been able to look after herself,” says Jahanara. “But it’s my job to make sure that she will be able to look after her baby when it arrives. We have spent a long time talking and her husband now understands that he needs to really look after her at the moment.”
Sometimes it will take a while for women to admit they need help. On one visit to a new client, the pregnant woman told Jahanara everything was fine – but Jahanara noticed that her other children were going barefoot and wearing ill-fitting clothes. So, on the next visit, she took along some items from Gateway’s baby bank, including children’s clothes, baby clothes, toiletries and nappies. “She couldn’t believe it,” says Jahanara. “She said, ‘I only get £90 a week and it goes so quickly. You can’t believe how much you’ve helped me.’ It gave me peace in my heart.”
Often, women will have a number of support workers, but don’t feel like anyone is there to support them, themselves. “Sometimes women just need someone to make them smile, or to pop to the shops with them,” says Jahanara, “and provide a bit of moral support in everyday life. Most support workers are there for the child, but we are there for mum, giving her someone to rely on and a number to call in times of need.”
Sophia has been here since the start of the service in 2006. She says, “it’s completely changed in that time!
“Over the last decade – and the last couple of years especially – it’s gone from simple signposting and accompanying women to appointments, to supporting women with issues around safeguarding and substance misuse, and helping them through court reports and procedures.”
Sophia says she’s learned a lot as a POW, both on the job and from her colleagues. “We’re a good team,” she says. “It’s important for us to be able to offload onto each other, bounce ideas around, and support each other through difficult cases.”
Sophia explains how important it is for POWs to meet women as early as possible during their pregnancy. “POWS is a preventative service. Often, if we meet women in the first few weeks of pregnancy, we can start helping them to begin the routines and habits that will lead to a healthy pregnancy. We can sort out a lot of issues before they get to the point where the woman or her unborn child go into safeguarding.”
Sophia is keen to point out that POWS are there for mum, when everyone else is there to support the child, and that they can prevent safeguarding issues. “The whole reason POWS were brought in was to empower women. If we can support them to make their own healthy choices from the beginning, then we can prevent a lot of issues later on down the line. In many cases we can help to stop babies being removed and going into care.”
Many of Sophia’s clients are women with a number of complex issues. “One woman who always stays in my mind already had a teenage child, and she’d had another baby years ago who’d died. When I met her she was pregnant with her third child, but she was not in a good way at all – she was drinking heavily, smoking cannabis and more. She’d been referred to drug workers and social services, but she needed more help during her pregnancy so she came to us.
“I helped her to focus, really. By taking her out of her environment a bit, and helping her to make sure that her money went onto the things she would need for her baby rather than drugs, I supported her to start new, healthier routines.
“For many women, the only support network they have is an unhealthy one, so we can provide a different outlet – we’re there for her to talk to at the end of the phone, we can meet up with her at home or in the community, and we can support her with all the admin that having a baby brings – filling in forms, shopping for essentials and getting to appointments on time.”
Shaista’s been here for nine years so she’s a relative newbie!
“POWS used to work out of Children’s Centres, which was a bit isolating, so coming together to work out of the Gateway office a few years ago was the best thing. Being able to work as a team, sharing advice and supporting each other is important for us.
“I’ve worked across Birmingham, with all types of new mums, including teenagers and older mums, and in lots of different communities, from Washwood Heath to Handsworth.
“That’s what I love about the job: we’re out in the community, and anything can happen. But that’s also why POWS are good for pregnant women – because we can go to them.
“It’s all very well making an appointment for someone to visit a Children’s Centre, but it’s not always practical to expect a pregnant woman to travel, especially if they have other young children too. If they’re new to the area they may not be able to remember where to go, or how to get there on public transport, and if finances are an issue, then even bus fares can be prohibitive.
“We are also really accessible. We are there from early on in the pregnancy, because early intervention can be vital. The more that services are cut, the more vulnerable women need someone to help them prepare, and to navigate through what is often a very confusing and admin-heavy time.
“Clients have our phone number and they can call us any time. We can visit families in the evenings if necessary, and we can use our own transport to pick people up and take them to appointments. It’s this sort of flexibility that really sets us apart from other health professionals and helps us to build a more genuine, useful relationship with the women we work with. We’re not turning up in a suit with an official-looking badge, we’re just popping over to give them a bit of support.
“One of the things that has really helped us recently is the ability to use more modern technology in our roles. We all have tablets that we take to each appointment and that means we can help people to fill in forms, bid on council properties, and make appointments there and then. This can be really important for people who don’t have internet access at home, have limited phone credit, or find it hard to talk on the phone, perhaps due to language barriers.”
Bushra* was referred to the Gateway Pregnancy Outreach Workers Service when her life started unravelling and she didn’t know where to turn. In just a few months she had gone from being a college student, supported by friends and family, to being homeless with two mouths to feed and very little support.
Here, her Pregnancy Outreach Worker (POW) Jahanara tells us Bushra’s story, and we’ve also included some quotes from Bushra herself, because she logged her thoughts on our Impact Assessment App after every appointment.
“I am helping Bushra to build a new life without her family”
Case Study by Jahanara Begum, Pregnancy Outreach Worker.
Bushra had been referred to POWS because of social isolation and short term mental health issues.
When I first contacted her, she said she didn’t want me to meet her at home. So I first met Bushra at her GP surgery, where she was attending an antenatal class. She was stressed and tearful, and told me the story of her pregnancy.
Soon after arriving in the UK with a student visa, Bushra had met a man at a bus stop. They got chatting and, thinking that he came across as a very Islamic, “good” man, she gave him her number. Over the next few weeks they spoke on the phone and met once, at McDonalds. He told her he would like to marry her; that he had spoken to his family and they had agreed.
One evening he phoned and asked Bushra to go out and meet him in his car, which she did. It was only the third time they’d met, but he took her to a hotel, telling her it wouldn’t matter if they took their relationship further because they were going to get married.
Bushra believed him.
When Bushra found out she was pregnant, she phoned her boyfriend but he told her he wasn’t interested. Soon after that he changed his number and disappeared. She had never known his address, so she wasn’t able to find him.
At our first meeting Bushra told me she just didn’t know what to do. She said her family would not accept her now that she was pregnant, and so it was impossible for her to go back to Pakistan. She told me her extended family are so strict that she was afraid for her life, and that of her unborn baby, if she was to return.
She was living with a family friend but she couldn’t stay there for much longer because, once her friend found out she was pregnant, she would probably tell her family. This was why she’d arranged to meet me at the doctors.
Bushra said her student visa would soon expire, which would make her an illegal immigrant, but she felt trapped. She couldn’t go back to Pakistan and had no money or recourse to public funds in the UK.
I am very stressed all the time but now that you’re going to support me, maybe things will get better. You have given me encouragement to think positive about my life.
The first thing we needed to do was to find out what support, if any, Bushra was entitled to. We went to a legal advice centre but they said she was not entitled to any legal aid, so I referred her to Asirt (Asylum Support and Immigration Resource Team) and the British Red Cross.
We went to British Red Cross together and they were very helpful. They made an appointment for Bushra at the Home Office and gave her food vouchers, and travel expenses to attend the appointment. They could only support her until her asylum application had been completed, because their funding is very limited, but advised that she should get support from NASS (National Asylum Support Service).
My family has found out I’m pregnant and they are sending me threatening email. My sister said I will not get away with getting pregnant.
By now, Bushra had moved in with another friend – although this friend had made it clear it was a temporary arrangement. Bushra attended the Home Office in Croydon and made an asylum application; however they did not apply for support for emergency accommodation or financial support because her friend had said she was willing to let her stay for another two weeks.
You have offered to get baby items from the Gateway baby bank, and a food bag. Although my friend provides me with food, I feel like a burden on her. I hate having to always ask her for money but I have no choice.
I contacted the migration helpline and got Bushra to speak to them via an interpreter and do an application over the phone for accommodation. I also gave her food, baby items, toiletries and a moses basket from Gateway’s baby bank.
Bushra wasn’t happy staying at her friend’s property, and her friend made it very clear she wanted her to move out as soon as possible, but Bushra needed somewhere to stay while her application was processed. I spoke to the friend and she agreed to let her stay until she had the baby.
As soon as Bushra had the baby her friend asked her to move out. So I phoned the migration helpline again and explained the situation, and Bushra completed another emergency application over the phone. The Refugee Council rehoused her, on the same day, to accommodation where she will live until her application is processed. They are also providing her with some financial support and helping her with her rehousing application.
I do feel lonely here and miss my friend and her son, so please can you visit me regularly. I have lost my family forever but miss my mum so much. It’s been so long that I have not heard her voice. But what can I do, I just have to live with this reality.
I am still supporting Bushra. I occasionally give her food parcels and baby items, and recently I’ve been trying to get her to visit the local Children’s Centre to meet other mums.
I am grateful to you because you’re the one who directed me to the services that helped me, so I am here today because of you.
*not her real name
Gateway Food Bank
We are currently taking donations of tinned goods and baby items for the food and baby bank at Gateway. The bank is increasingly needed by clients of all our services, not just the Pregnancy Outreach Workers Service. You can drop donations off at the Gateway offices, or give us a ring on 0121 456 7820 – if you’re local we can even collect.