Author: Katherine Hewitt

POWS: so much more than pregnancy outreach

When you hear “Pregnancy Outreach Work”, what do you think of? Breastfeeding education, perhaps? Blood pressure checks, or birth plans?

The truth is, the women we work with need much, much more than this. The risks our Pregnancy Outreach Workers Service (POWS) clients have include:

  • substance misuse
  • domestic abuse
  • safeguarding
  • mental ill health
  • housing and homelessness
  • issues linked to being a recent arrival to the UK
  • other issues linked to financial hardship

The Pregnancy Outreach Workers Service (POWS) provides crucial extra, early interventions needed to support women with these issues – often because no-one else can.

POWs are able to work with woman from a very early stage of pregnancy; often from as early as 10 weeks. Take away POWS, and the standard maternity pathway means no extra support until the Health Visitor gets involved at 26-28 weeks.

We can do this because of our close relationship with midwives, who alert us to women who would benefit from an early intervention. It means that we can start to tackle – and often resolve – issues as soon as possible, reducing risks that might otherwise have affected the unborn child.

As well as filling this gap, POWs work alongside many other services, including Housing Officers, Midwives, FNPs, Social Workers and the emergency services, to create a “wraparound” support service for families. And we do so in an efficient, cost-effective way.

Housing

More than two thirds of our clients have a housing risk. Around 47% are in temporary accommodation (eg living on a friend’s sofa, or in a B&B or hostel) and another 21% are in accommodation that, although more stable, is completely unsuitable for bringing up a baby (access issues, no power, problems with damp or rodents, etc).

POWS help women to access the support they need, including helping them to understand systems and processes, to access and fill in forms, to make homelessness and housing benefit applications, to bid on properties, and to furnish social letting properties (which are usually let without curtains, carpets or any furniture or white goods).

Importantly, POWS support also enables other services and agencies to do their jobs more efficiently. Having a POW on hand to offer social, emotional and practical support means that a Housing Officer, for example, can concentrate solely on their remit: finding a tenant suitable accommodation. POWS also save time for Housing Officers further down the line, because those who receive our support are more likely to understand how to sustain their tenancy. Together, we create a more efficient and less costly system.

Mental health

Nearly two-thirds (65%) of the women supported by POWS have a mental health need, but many would not have any support if it wasn’t for POWS.

All sorts of mental health problems, including “low level” depression and anxiety, can begin or escalate when a woman is pregnant or in her child’s first year. But with the right social support, many mental health risks can be reduced.

For women with a diagnosed mental health condition they’re struggling to control (medically “high risk”), POWS offer practical support, including help to manage medication and attend appointments. However, many of the women we see are medically “low risk”, with low reported wellbeing, or high levels of anxiety. Because they don’t meet the criteria of a clinically diagnosed mental health condition, they don’t qualify for extra support from other services. For these women, the one-to-one support a POW gives is vital, and has been proven to help.

We use the nationally-recognised DASS (Depression Anxiety and Stress Scales) to measure our impact and 50% of the women we worked with in the last year have seen an improvement in their DASS score as a result of support.

What’s more, a clinical study by researchers at the University of Birmingham, published last year, showed that the intervention of a POW was “beneficial in preventing postnatal depression in women with two or more social risk factors”.

Safeguarding

Most of the safeguarding advice for new mothers is based around the child. Of course, the safety of the child is paramount, but children aren’t the only people who need protection and support.

Collecting food and toiletries for our “baby bank”

So while social services and midwives are focusing on the child, our focus is on mum.

Just over a quarter of the women POWS support officially meet the threshold of “vulnerable adult”. Around a third of our clients have a child protection plan in place for the unborn baby. Often, we’re looking at a “double whammy”: a vulnerable adult with a protection plan in place for her unborn child.

If mum leads a chaotic lifestyle, with intermittent or no support from family or friends, then working on her own to build up the sorts of routines and networks that she will need as a parent – and that social workers and family courts will approve of – can be virtually impossible.

With a POW, however, there’s hope.

Not only will the POW work one-to-one with mum to come up with an action plan, helping her to tackle issues in a methodical way and providing her with important contacts, but she will also liaise with social workers and other services to ensure that they are aware of the changes being made.

In this way, mum is supported to be the best possible parent she can be, and mum and baby have a better chance of staying together.

This isn’t just a better outcome for mum and baby – it’s cost-efficient, too. The approximate cost of removing a child and caring for them in the foster system runs into tens of thousands of pounds.

Put simply: POWS solve issues and save money.

Chloe’s story

Chloe (not her real name) is a great example of the ways in which POWS can step in to break the cycle and stop someone slipping through the cracks. When we met Chloe, her two children had been taken into care and she had just found out she was pregnant again. She was deeply unhappy with her situation and desperate for things to change, but didn’t know where to start. Chloe has been brave enough to talk about what happened next.

Introducing our new brand and logo

As you may have noticed, Gateway Family Services has a new logo. In fact, we’ve got a whole new brand – so we thought it might be nice to give you a peek behind the scenes at the changes.

When Gateway was founded, over ten years ago, a standalone logo was created for use on all our marketing literature. At the same time, we created our Core Values, Aims and Objectives – and these remain at the heart of everything we do. But what we didn’t do at the time was to bring these together as part of a consistent overall “brand”. We have strong professional values, and very high standards for all of our work, but for many years, our marketing materials haven’t really matched those high standards.

The Gateway logo has been simplified and modernised

So, over the last few months, we have been working with designer and branding expert Lisa Barratt to understand and formalise the “Gateway brand”. This didn’t just mean creating a new logo, but looking at everything we put out into the wider world: making sure our public face reflects our values and the high standards of professionalism that we have internally, and giving everything a consistent, well thought-out look and feel.

Lisa worked closely with a panel of Gateway staff to find out everything about the way we work, and to make sure the new branding would be a realistic representation of our organisation.

Photographer David Rann did a great job of capturing moments between our staff and the people they support

Lisa recognised that, for Gateway, our brand is our people. So wherever possible, our marketing literature now uses our own photos showing staff and the people they work with in real situations. The new photos (taken by David Rann) show Gateway as we see ourselves – positive, professional, friendly and honest, with an emphasis on relationships and community.

Our “tone of voice” – the voice we use online and in printed materials – is key, so we’ve set out some formal rules for this too, based on the way our staff already communicate with people. Gateway is friendly, open and accessible, so our leaflets and posters will be written to speak directly to the people we support. All our marketing and social media will use a conversational, but professional, tone.

The new colour scheme brings services together

The new logo is a simplified, modernised version of the previous one, including the recognisable “G” symbol. But we now have a wider colour palette to use alongside the main logo’s blue and gold. We’ve assigned a specific colour to each service: pink for POWS, teal for Health Trainers, light blue for Lighten Up, and a pale purple for other services.

One of the things that staff really wanted was for the different services to feel more aligned with each other and with the Gateway name; we hope that the new colour palette and templates will not only provide consistency, but help people to recognise that each service is part of the Gateway whole.

We launched the new brand internally last week – with a quiz and some nibbles!

Working with staff to refresh the brand means we’ve also been able to pick up on some other useful ideas and requests from staff. In particular, we’re creating some specially-designed “congratulations” and “sorry I missed you” cards for support workers to give to clients.

We’ll also be publishing some new hand-outs focusing on some of our areas of expertise, including things like breastfeeding advice and healthy recipe suggestions. Our staff are full of knowledge, so it would be a shame not to share it more!

We hope you’ll enjoy spotting the new Gateway logo and marketing materials as they make their way out into the wider world.

Taking control

“Good health” can mean many things. When you hear of someone seeing a Health Trainer, you might assume they’re receiving help with diet and exercise, but that’s really only a small part of someone’s overall health.

Over the last couple of years, Gateway Health Trainers have worked with more and more people who have mental health issues. For some this is due to a diagnosed condition but for most it’s helping with anxiety, stress and just general feelings of low mood. All of which can, and do, lead to depression.

Helping someone to tackle low self-esteem, or a feeling of being overwhelmed by everyday life, can have a massive impact on their overall health. After all, making long-term changes to your activity levels or food intake are a lot more difficult when you don’t feel completely in control.

Diana’s story

Last year, Diana came to the Health Trainers service. She said:

“I want to lose weight to feel better about myself. I seem to be putting on weight each year.”

Diana was placed with Hana (pictured above), who started to get to know Diana. But Hana didn’t just want to know about Diana’s diet and activity levels. She wanted to know as much as possible about her lifestyle – all the other things that might be causing her to overeat and put on weight. As so often happens, Hana found that Diana had some other issues relating to her mental health that they needed to tackle first.

Hana said, “Diana initially said she wanted advice about comfort eating, but as we talked it through, I found that what she really wanted was to feel more organised. So that’s what we addressed first. Starting to plan her home life better would help her to feel more in control of her life, which in turn would help her eating habits.” You can hear Diana talking about this in her own words in the video, below.

We’ve written before about how looking at the “whole person” and taking into account social, economic and environmental factors saves time for GPs and saves money for the NHS. One of the wonderful things about Health Trainers is that they have the time and flexibility to do this.

Health Trainers meet people in their own home, or their local GP surgery or community centre. They have long appointments, where they get to know the person, building trust and allowing them time to talk.

Because Diana was able to work with Hana over time, unpicking some of the deeper issues, she’s been able to take control. And that means the other lifestyle changes she’s making now – like eating more healthily and becoming more active – are not just achievable, but more likely to be sustainable.

Saving time for GPs and money for the NHS

Social prescribing” (sometimes called “care navigation” or “care co-ordination”) is a bit of a buzz topic at the moment. Although similar approaches have been used for many years, the financial squeeze on clinical services is greater than ever, leading to greater interest in alternative pathways.

Social prescribing refers to the idea of GPs and other primary care professionals referring people to a range of local, non-clinical services, and treating people in a more holistic way; looking at the “whole person” and taking into account social, economic and environmental factors.

But does it work? Our experience running the Pregnancy Outreach Workers Service, Health Trainers and Gateway Healthy Futures, tells us that the answer is a resounding “yes”… but that creating a successful service depends on a number of factors.

Saving time and money… building resilience

Gateway Healthy Futures Team
Gateway Healthy Futures, a pilot programme that finished at the end of September 2016, was designed specifically to reduce the number of unnecessary GP visits by providing patients with a non-clinical alternative. GPs referred patients who had presented with risks including social isolation, low reported wellbeing, ongoing mental health conditions, alcohol or substance misuse, and financial hardship, and the Healthy Futures Practice Navigators provided them with practical support, reassurance and a point of contact.

It’s an idea that we had been batting around for a couple of years before we had the opportunity to develop it. Eventually, it came to fruition thanks to My Healthcare, a consortium of GPs in South Birmingham. Gateway Healthy Futures was one of a series of projects funded by MyHealthcare with money provided by the Prime Minister’s Challenge Fund.

It’s now five months since the Gateway Healthy Futures service ended, but we’re pleased to see initial reports from its formal evaluation (which was carried out by international development consultancy Mott Macdonald) are very positive. It shows that Gateway Healthy Futures reduced the time people spent with their GP (when a social intervention was more appropriate), and that the people our Practice Navigators worked with significantly increased their self-reliance and self-care during and after the support.

“…GPs are happy with the service because it is reducing the burden of social needs patients on primary care.”

“Feedback from patients … indicates that self-resilience levels have increased due to the scheme. Anecdotally, there is evidence of behaviour change; the scheme has helped some patients to understand that the GP is not always the most appropriate source of support for helping with non-clinical issues.”

The Gateway Healthy Futures service was also found to be cost-effective.

“The use of non-clinical staff members instead of GPs is cheaper by around one third of the cost.”

“… had [Gateway] not intervened, patients would likely have been referred on to social services at a much greater additional cost; the care navigation service is estimated to represent a saving in this scenario of approximately £10 per hour.”

Lessons for the future

One element that was key to the success of Gateway Healthy Futures was being able to work with GPs who engaged with the service. Because we already had a relationship with MyHealthcare (via Health Trainers) and the GPs had been involved with Gateway Healthy Futures from the start, they had confidence that it would work. This benefited everyone involved – including the patients, who trusted their GP’s recommendation and were more likely to engage themselves.

And thanks to experience gained from our other services, in particular from over a decade of running the Pregnancy Outreach Workers Service, we were also able to employ and train the right kind of staff. Our Practice Navigators provided a flexible, understanding and open-minded service, providing “whole person” support.

Rather than falling into the trap of “doing what’s best” for patients, without really consulting with them on a deeper level, Gateway’s services generally let the patient lead the support. We believe that asking someone what their priorities are, believing them, and working with them to build self-confidence and resilience creates a programme of support that is more successful and more sustainable.

Happy birthday, and happy clients!

It’s Gateway’s 11th birthday this week. Eleven years of connecting with hard-to-reach communities, filling the gaps and designing innovative wrap-around services that look after the whole person. Eleven years of changing people’s lives!

So, in this week’s story, we thought we’d mark our “happy birthday” by talking about “happiness”.

With so much going on in the world today, looking after yourself and your mental wellbeing is more difficult, but more important than ever. That’s why staff across all our services – Health Trainers, Pregnancy Outreach Workers Service (POWS), our Pre-Diabetes course and Solihull Lighten Up – work so hard to help people to look after themselves and to feel happier.

So, when we review the support we’re offering to people, we don’t just measure – for example – how much weight a person has lost, or whether they’ve reduced their blood sugar levels. It’s tricky, but we also measure things like “happiness” and “mental wellbeing” in a variety of ways.

Since May, Health Trainers have been using the WEMWBS (Warwick-Edinburgh Mental Wellbeing Scale) at the start and end of each person’s support. So far, results show that “mental wellbeing” improves for around half the people they work with during the time they are with a Health Trainer. Perhaps this is because they are achieving what they set out to do; after finishing support, 85% of Health Trainer clients say they feel they’ve either fully or partially achieved the goals they set out at the start. Setting goals and being supported to achieve them is a great way to start feeling happier.

In POWS, we use a similar tool, called DASS (the Depression, Anxiety and Stress Scale). Despite the fact that all POW clients have high levels of vulnerability, which can often mean that making changes takes longer, 34% of the women POWS work with see a definite improvement in their emotional state by the time they exit the service.

One of the things every client is asked at every appointment, across all services, is for a “happiness rating”. It’s a simple, unscientific question, and we leave it to the individual to decide what is meant by “happiness”, but we find it very useful because it means we can track how things are going on a session-by-session basis. To illustrate this, have a look at the comments and ratings given by some of our clients, from the first appointment and their most recent appointment:

Marika*

POWS client Marika* is in her 30s. Compare her first appointment with the most recent, just a few days ago:

28 Sep 2016:

I have found it helpful as we discussed depression and the kind of help I need. I am feeling really low and suffer from mood disorder and other health issues. I am struggling to bond with baby. I have my scan next week.

 

8 Feb 2017:

You brought baby clothes for me and I liked the knitted jumpers and hats. I can’t wait to have my baby now.

Elaine*

Health Trainers client Elaine* is in her 40s. Her first appointment with Susan, her Health Trainer, was in December. And look at her now!

8 Dec 2016:

I was going to the group sessions but due to work I couldn’t attend the six weeks. I’m not very keen on going to groups. I have been to slimming world in the past but I didn’t like it, I went to Zumba didn’t enjoy it. I am a bit lazy in making the effort to do things. But I will try to make some changes to what I eat.

 

8 Feb 2017:

Susan you will be shocked. I’m taking my main meal to work now instead of having it late in the evening and I am actually having vegetables every day with my meals. This has helped me with my digestion as well. And best of all I lost a few pounds in weight. People have been saying I look like I have lost weight.

It’s the same across all our services. For Health Trainers, happiness levels increase by an average of 14%. For people on the Pre-Diabetes course, it’s 9%. Solihull Lighten Up clients’ happiness increases by an average of 12%. And for POWS clients, the average increase is 16%.

Thanks to all of our brilliant staff and volunteers who make this happen, not to mention everyone who’s supported us for the past eleven years. Here’s to many more!

*names have been changed
† we do this via the Impact Assessment App.

The power of prevention

They say “prevention is better than cure”. But despite grand promises of investment to the NHS, the Government is still cutting preventative services.

£10 billion?

In a speech on 5th October, Theresa May said that the Conservative party would be investing an extra £10 billion in the NHS. It sounds great, doesn’t it? But last week, Dr Sarah Wollaston – Conservative MP and Chair of the Commons Health Committee – pointed out that the figure is misleading.

Sarah Wollaston MP
Dr Sarah Wollaston MP

Dr Wollaston (pictured) told BBC Radio 4’s Today programme: “You can only arrive at the £10 billion by shifting money from public health budgets, and health education and training, and also by changing the date at which you calculate real-terms increases.”

In real terms, the figure is more like £4.5 billion, and it won’t go towards public health services. It isn’t obvious from the headlines, but areas like social care and prevention are not receiving a financial boost at all; they have been cut. And there are plans for more cuts next year, and the year after that.

When waiting lists are getting longer, and help becoming so much harder to find, this talk of “giving the NHS more than they asked for” is misleading and potentially dangerous. It would be easy for people to get the impression that money is available, but being spent unwisely when, in fact, the money is just not there.

Prevention is cheaper than cure

GP and hospital costs far outweigh the costs of preventative services. So why not spend money on early intervention for things like obesity, diabetes, mental health crises and smoking-related disease, before they get to the stage of needing expensive GP and hospital care? It seems ridiculous.

Take the Gateway pre-diabetes course. People with a high level of HbA1c – indicating a high risk of developing diabetes – are referred to us to learn how to better manage their diet and lifestyle, in a course of sessions over nine months. Results so far show that more than 80% of patients reduce their HbA1c level thanks to the course, with 66% of patients showing that they are no longer at risk by the end of the course. The total cost per patient is as little as £130.

Compare this to the cost of a lifetime of diabetes. As well as GP and outpatient appointments, people with diabetes require long term medication and supplies. Diabetes can cause a huge number of complications; illnesses which come with their own costs for the NHS. And let’s not forget the hidden costs for the wider public purse, which include the costs of absenteeism, disability and social benefits, and early retirement.

It’s important to remember that health spending isn’t just about GPs and hospitals. Often, these are the reactive costs – the costs that occur when the opportunity to prevent has already passed. Investing in the preventative elements, like social care and public health, is the best chance we have to reign in spending. And who knows, if it was ever properly resourced, we may even see savings.

We thought this video, made for LBC by Full Fact, an independent fact checking organisation, summed up the issues with the Prime Minister’s “£10 billion” statement quite nicely.

How have I helped you today?

We thought we’d have a bit of a change from our usual fortnightly blog post and rather than a story from one of our services focus on something a bit more pictorial, with photos and comments from people we’re currently working with.  Hearing what people think of us and what they’re achieving or the changes they’re making is really important.  It’s essential in terms of us making sure we’re providing what people need and getting the level of support right but at the same time the information is often encouraging and thought provoking.

To make gathering this type of information quick and easy our Outreach Staff all have the www.impactassessmentapp.com installed on their phones.  At the end of each appointment or visit they use the app to gather a few simple things; a comment in response to the question “How have I helped you today”, a satisfaction rating – done by using a sliding scale and if they’re willing a photo, a bit of audio or even video.  We think it’s really important to record the comment as it’s said, sometimes the Outreach Worker will pass the phone to the client so they can type in what they want to say themselves or if not it’s entered exactly as it is said so it remains in the client’s voice.

We thought we’d give you an insight by showing you just a little of who we’ve been working with and what we’ve been doing together over the past few weeks.

img_20160818_120118871
Jenny (right), her baby daughter and Collette, Pregnancy Outreach Worker

“I am happier than I have been in a long time.  I love my new flat and have been along to the Children’s Centre where there are lots of groups going on which I’m going to go to.”

 

daibetes-group-2
Ken, who’s reached week 9 of our Pre Diabetes Programme

“I now have smaller portions, more fruit, more veg and I exercise more.  All the talk about healthy options has been noted! “

 

 

 

 

june-hf
June, a recent referral into the Healthy Futures Service

“By telling me all the things that are available if I need them you’ve helped me realise there are still things available for me to do.”

 

 

photo-2
Mohammed, Pre Diabetes Programme

“I’ve gained knowledge about food but I’ve also made friends.”                    

 

 

 

xiaoli-pow
Xiaoli, client of the Pregnancy Outreach Worker Service

“We’ve talked about my birth plan and the things to expect when I deliver.  I feel I understand a bit more about labour now.”

 

 

img_1555
Jody (left) and her Pregnancy Outreach Worker, Sarah

“We’ve looked at properties together and we’ve also filled in the Sure Start Grant form.” 

 

 

 

 

Paul one of our Health Futures
Paul who was referred to our Healthy Futures service by his GP.

“You’ve referred me to a couple of activities I can go to this week. I’m looking forward to going to them, it gets me out of the house, I’m sick of looking at the four walls.” 

 

 

margaret-hf
Margaret who was also referred to our Healthy Futures Service by her GP

 

“You’ve helped me fill in the PIP application and given me a bit more confidence.”       

 

From the information we’ve collected via the app we also know that over the past six months we have provided one to one support to 1424 people and as we gather some basic demographic information we know various things like age and work status.  We can see that we’re working with a wide range of people which is important.

In terms of age the largest single group are those aged 50-64 with 420 people falling into this group but then in total 1045 were of working age,  321 people were over 65 and at the other end of the scale 43 were aged 18 or younger.

In terms of work 439 were in either full time or part time employment and 648 were unemployed,  then 45 were in full time education and 292 were retired.

Satisfaction – we talked about this at the start and how at the end of each appointment or visit we ask people to rate their satisfaction or happiness by indicating where they feel they are on a sliding scale, which is out of 100.  70% is the average score, so that’s like 7 out of 10, but what we can see is that 57% is the average people are scoring at the start of their support but by the end it’s increased to 77%.  This shows that satisfaction increases significantly as time goes on, but then that stands to reason as when people start to see or feel the effect of what they’re doing then their belief and confidence grows in us and the changes we’re making together.

24 hours in POWS

It’s now 18 months since we changed the intake criteria for our Pregnancy Outreach Workers Service (POWS). We thought it would be interesting to show you how the POWS service looks now, on an average day.

What changed 18 months ago?

Some of our POWs, past and present, pictured in 2014
Some of our POWs, past and present, pictured in 2014

In Spring 2015, the way POWS was funded changed, which meant we had to make some changes to the service and the way we work.

One big, positive change was that we could start accepting referrals from across the city, rather than being restricted by postcode.

But at the same time, our intake criteria changed. Rather than working with everyone who was referred, we began to focus on the most complex, vulnerable clients. Each referral is now assessed prior to being assigned a POW, and those with fewer risks are instead signposted to other agencies, including our own Befrienders.

The principles are still the same, however. While other services are there for baby, POWs are there primarily for mum. The support is client-led – we decide with them what they need, then help them to prioritise and tackle the issues they’re facing in a methodical way. We offer a listening ear as well as practical support, and we help them to access every bit of assistance that is available to them.

24 hours in POWS

On any given day, up to 10 of our POWs are out and about. The number of visits they make varies, as some need to be longer than others and the distance can vary. In some situations a chat on the phone, or a text can be as useful as a face-to-face meeting. POWs then also need to fit in time to complete paperwork, make chase-up phonecalls and discuss issues with colleagues.

On 27th July this year – a very normal Wednesday – 15 visits took place. We’ve picked out a few of them to give you an idea of an average day.

Kelly visited Sadia
Kelly

Kelly works across Castle Vale, Erdington and Perry Common. Today she’s visiting a new client, Sadia, a vulnerable adult who was referred with the following risks: domestic abuse, financial hardship, social isolation, short term mental health and unsuitable accommodation.

Kelly’s notes from the visit say:

“This is Sadia’s second violent relationship. Her ex turns up uninvited, plays mind games and tries to scare her. He wants to be registered on the birth certificate. We talked about organisations who could help and did the usual first appointment check to see if she’s applied for maternity grants.”

Sadia’s statement on the Impact Assessment App says:

“We spoke about how I’m feeling at the moment due to having problems with my ex.”

Sarah visited Sophie
Sarah
Sarah

Sarah works across central and west Birmingham. She’s been supporting Sophie, a teenager, for five months now. Sophie was referred with the following risks: domestic abuse, diagnosed mental health condition, safeguarded (unborn) child.

Sarah’s notes from the visit say:

“A difficult visit. Following some things that Sophie told me last time I was worried I had to make a referral to social services. Today was about explaining why. Sophie was upset and angry at the start but then seemed to understand why this had to happen and that it was about getting her the support she needs. She is often confused and she’s also been self harming.”

Sophie’s statement on the Impact Assessment App says:

“We just talked and talked!”

Suad visited Munira
suad
Suad

Suad works primarily with women from Arabic speaking communities. Today she’s making her 12th visit to Munira, who is a vulnerable adult due to a learning disability. She was referred with the following risks: vulnerable adult, vulnerable child, social isolation, mental health – low reported wellbeing, financial hardship.

Suad’s notes from the visit say:

“Took the supporting letter for Sure Start grant. Munira lost the first application so she’s doing it again. Social services are unhappy about how little support Munira is getting from her partner, they need to see he will share parenting otherwise it could be too much for her on her own. They’re also unhappy about her living accommodation as it’s unsanitary and unsuitable for a baby. I talked with her again about the actions she needs to take, and I took her some items from the Gateway baby bank.”

Munira’s statement on the Impact Assessment App says:

“Suad gave me a supporting letter for the grant application as I need to do another one. We went to a charity shop to buy a mattress and talked about the next child protection meeting.”

Miriam visited Annette
Miriam
Miriam

Miriam was previously seconded to the council as a Temporary Accommodation support worker, so she often takes on clients who need housing help. On this day, she made her fifth visit to Annette, who is living in south Birmingham and was referred to the service with the following risks: she meets the vulnerable adult criteria and safeguarded (unborn) child, temporary accommodation, social isolation and smoking. On the way to see Annette, Miriam dropped off a food parcel for a family she’s supporting with no recourse to public funds.

Miriam’s notes from the visit say:

“Annette is now in a hostel, but some problems as there have been complaints about noise and unpaid rent. I’m working hard to help her see that she needs to keep to the rules so she can stay. Baby will be arriving soon.”

Annette’s statement on the Impact Assessment App says:

“You went with me to my appointment to discuss my accommodation and you’ve said you will help me move rooms. You also spoke to my support worker about the service charges at the hostel.”

Social support for GP patients

As Gateway Healthy Futures is in month 10 of its pilot period, we want to show you the range of support the service offers, by letting you hear two patients’ stories, in their own words.

mini_docGateway Healthy Futures is a GP-referred service, supporting patients with a broad range of social needs. GPs can refer anyone that needs non-medical help, and they’ll get one-to-one support from an experienced para-professional.

What sort of social needs?

From the discussions that took place before we started, we had made a few assumptions about the support that people would need. We had expected to see mostly older people, and for their issues to centre on long term conditions or isolation. We also expected that the level of support provided would vary, from a fairly light touch to working with people more intensively. But we quickly found that the cases being referred to us are a lot more complex than this.

Rather than the frail, elderly demographic that we were expecting, around 70% of the people GPs refer to us are under 65 – and all have needed intensive support from a para-professional Practice Navigator, rather than lower-level support from a Volunteer Befriender.

The most common issues GPs refer patients to us with are related to mental health (for example low reported wellbeing). Social isolation is a big issue, but this isn’t usually related to age – the reasons are many and varied. As well as people who want support to manage long term conditions, we are seeing a lot of alcohol dependency, anxiety and depression, accommodation issues and financial hardship.

How do we help?

The model we use is flexible and so it works for everyone, young and old. The Practice Navigators work one-to-one with patients to come up with a credible action plan, based not just on the needs highlighted by their GP, but on the patient’s own lifestyle and the pace that suits them. We help people to start living more independently almost immediately, and the network Gateway has built up over the years means that we can signpost people to a huge range of other services for help going forward.

Gateway Healthy Futures was designed, and is being piloted, in partnership with MyHealthcare. To find out more, or to refer patients into the service, GPs and Practice Managers should call 0121 456 7820 and ask for Gateway Healthy Futures.

Meet Arlene, Aisha and Brandon

ArleneArlene Lawrence (pictured) is a Practice Navigator with Gateway Healthy Futures. She joined the team from a background in childcare and family work and has been supporting a number of patients with very different needs.

Each patient gets around ten sessions of support, depending on their needs, and these sessions are patient-driven. Practice Navigators work closely with their clients to come up with an action plan based on their own priorities, which is often hugely helpful in itself as it forces people to focus.

Two of Arlene’s clients, Aisha and Brandon, have recorded some audio so you can hear their stories in their own words.

Aisha’s story

Aisha is in her 30s. She suffers from anxiety and depression and is dependent on alcohol, which has led to her leaving work and missing rent payments. Aisha’s immediate concern was that her landlord was taking her to court over unpaid rent, but she and Arlene have also talked through what she wants and needs in the longer term.

They’ve only been working together for a few weeks but Arlene has already accompanied Aisha to housing meetings, and to the court hearing. She’s referred Aisha to a recovery agency, a counselling organisation and a Health Trainer and – thanks to Arlene’s ongoing support – Aisha has been making the appointments. In the clip Aisha explains the difference the support has made and positive impact Gateway Healthy Futures has had on her life.

Arlene says, “it’s hard because I’m here in a professional capacity, but I do give out a lot of hugs! A lot of people just haven’t had any level of support before, so you have to work together to create the boundaries. Working with Aisha to create an action plan has been beneficial because she knows there’s a cut-off date and she’s had to decide exactly what she wants out of this support and her future. She’s already made a lot of positive changes.”

Brandon’s story

Brandon is 20 and has a learning disability, with related anxiety and depression. He has been living at home but because his family life is quite chaotic, he wants to start living independently. However, until he was referred to Gateway Healthy Futures, he didn’t know where to begin.

Arlene has worked with Brandon to come up with an action plan based on his immediate needs – in this case, applying for the PIP payments he was entitled to – and what he would like to do in the future. He indicated that he wasn’t sure whether he wanted to go to college or straight into work, so Arlene accompanied him to a college for people with learning difficulties to find out more about completing his GCSEs, and helped him to prepare for job interviews by helping him to find clothes and bus fare. In the audio clip, they’re on their way to Rathbone’s – an organisation that Brandon hadn’t been aware of before he met Arlene – who have helped him to find a flat with supported living.

Arlene says, “working with Brandon makes me feel quite positive about young people! The flat where he’ll be living, down the road from his mum’s, is perfect. He’ll have company from his housemates, and six hours of support a week, with cookery lessons and sports activities available to him. He’s finding out what he wants out of life and he’s on track to get a warehouse job or something similar. It’s looking good for him now.”

Brexit and the third sector

Katherine HewittThe country is in shock and coming to terms with what for many was a surprising result.

We often say, as an organisation, that we help people to build their resilience. But I must admit I feel like I’ve lost a bit of my own resilience this week.

I think what has been difficult for me to come to terms with is the feeling that Brexit is so at odds with the third sector ethos. Organisations like ours – the charities, voluntary groups, community groups and co-operatives – are all about coming together to do the best thing for everyone.

I’m still relatively new to the third sector in Birmingham, but I’ve noticed a much greater “coming together” over the last few years (albeit significantly thanks to the diminishing public purse). Ten years ago, organisations in the voluntary sector could work independently, duplicating services, saying “no-one knows what we do as well as we do”, but now we’re more questioning of the way we operate. The need is greater than ever, but we’ve learned to work together to try and address that need. We try to share resources and as a sector we provide a more cost-effective, joined-up service.

But the Leave vote feels like it takes us back to the bad old days. Brexit says, “we’re better off on our own; we don’t need friends”.

Of course, the reality is that we do need each other, and hopefully, as a sector, our response will reflect that.

The third sector response: reassurance

europe-1456246_1280I’d feel a fraud saying “everything’s going to be OK” – after all, the jury’s out on what’s going to happen next – but I have been heartened to read third sector commentary like this blog post from Stuart Etherington, and to hear about new initiatives like Birmingham’s own Love Your Neighbour campaign, which was launched today. I agree with the sentiments I’m hearing: that the most constructive thing we can do is to come together to provide reassurance to the people we work with.

As an organisation, we are used to a rapidly changing environment, so we will continue to work in the way we always have: quickly responding to crisis, dispelling myths and building people’s capacity. But I do feel that reassurance is going to be more important than ever in the coming months and years. Our Pregnancy Outreach Workers Service works with recently-arrived communities, who may face increased hostility now. Many of the people we work with already feel isolated, and I fear that the fallout from Brexit will mean even more people feeling even more isolated. As an organisation we will need to be even more aware of this and work closely with other organisations to provide that positive voice.

From a funding point of view, I suppose we are lucky in one way – none of the work we do is currently funded by the EU – but Brexit will close some doors. We had been looking at social funding for some work around employability – helping people who are a long way from finding work to become more employable is the sort of service our organisation was founded to do – but now we don’t know what the future holds for this work, or indeed the work of many other organisations across the region.

What’s clear is that the uncertainty, and the strain this causes, will stretch everyone more.

I hope that as a sector, we can all step up to this challenge – after all, we see inequality on a daily basis, so we know what to do. Let’s continue working as we have been: together. Let’s combat the feelings of division. Let’s work to reassure people, to offer positive encounters for our communities, and to cherish the good things.