Author: Katherine Hewitt

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.

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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.”

 

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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! “

 

 

 

 

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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.”

 

 

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Mohammed, Pre Diabetes Programme

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

 

 

 

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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.”

 

 

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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.” 

 

 

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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.

Clinical study shows that POWS improve maternal mental health

We talk about “evidence-based” services a lot, but for social interventions such as our Pregnancy Outreach Workers Service (POWS) it can be difficult to find proof that the service is successful without resorting to anecdotes and self-reported data.

mum-and-baby

However, a group of researchers at the University of Birmingham, funded by CLAHRC (Collaboration for Leadership in Applied Research and Care) West Midlands, have recently published their findings from a clinical study into the POW service – and we’re very pleased to note that it shows clear statistical evidence of benefit to the women we support, particularly with regards to their mental health.

The study

The research took the form of a Randomised Controlled Trial (RCT) – the most academically rigorous way of determining whether a cause-effect relation exists between treatment and outcome.

It looked at 1324 women, some of whom received standard maternity care and some of whom were supported by POWS, and compared outcomes such as antenatal attendance, postnatal depression and mother-to-infant bonding.

The findings

The study found that mother-to-infant bonding is better when mum has the support of a POW.

It also found that, for women who have two or more social risk factors, the intervention of a Pregnancy Outreach Worker was beneficial in preventing postnatal depression.

The study adds, “this finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes”. It concludes:

This trial provides evidence that a lay support service targeted to women with two or more social risk factors improves aspects of maternal psychological health relative to controls; such improvements are likely to be of lasting impact due to the known effect of maternal depression and poor attachment on longer term childhood outcomes.

This, together with the relatively low costs of the service, means that consideration should be given by policymakers to introduction of a lay support service.

When the trial was being carried out, we worked with a much wider group of women than we do now. The research showed that our interventions have the biggest impact on women with two more more social risk factors – and it is this group that we now work with exclusively.

Our POWs work hard to offer early help to women who are at risk; to make sure that baby arrives safely, and to support mum to be the best parent she possibly can. This study is incredibly helpful in validating the work our brilliant POWs do, and we’re delighted to see it published.

You can read the full study on the BMJ Open website here.

Gaps in service leave women in danger

If you are affected by the issues in this story, please click here to see a list of links and phone numbers that might be able to help.

 

Mind the gapAt Gateway we often find ourselves “filling in the gaps” – in funding and in service. And on Thursday last week we were faced with a very stark reminder of this.

Julie (not her real name) was referred to the Gateway Pregnancy Outreach Workers Service (POWS) by her midwife, and assigned to Denise. They met for the first time on Thursday, at the house Julie shares with her partner.

Within minutes of meeting, Julie told Denise that she felt unsafe in the house, especially now that she was pregnant. She explained that her partner was extremely controlling and regularly violent. Although the police had been involved already, she’d denied the abuse when questioned in front of him because she was frightened. She told Denise, “right now, he’s asleep upstairs. If I leave him, I need to do it now.”

In a situation like this, the plan is always the same, and POWS know it by heart: get the woman to a place of safety, give her an opportunity to talk, and find her somewhere to stay.

Denise immediately called a colleague to pick them both up and let her manager know what was happening. While they were making their way to the Gateway offices so that they could talk openly, her manager was calling the relevant agencies to find Julie some accommodation.

However, it soon became clear that all was not going to go to plan.

Not pregnant enough

Denise and her manager Michelle made nearly 30 phonecalls on Thursday and not a single agency was able to accommodate her. Julie fell outside the criteria for every organisation.

None of the places of refuge, charities and other organisations – and yes, we tried them all – could take her because she is an overstayer (she had originally come to the UK on a short term visa, and hadn’t returned at the due time).

Apparently the fact that she is here illegally – despite having lived in the UK for many years and having a National Insurance number and NHS number – overrides the potential danger to her life.

Birmingham MASH (Multi Agency Safeguarding Hub) can help pregnant women, even those with immigration issues… but only from 20 weeks. At 15 weeks, Julie is not yet pregnant enough.

We are absolutely not looking for blame here; we are looking for solutions. Each organisation has to have boundaries, and for good reason, but… where is someone like Julie supposed to go?

By late afternoon things were looking desperate, so Denise took Julie to the police station (although of course this met with some resistance from Julie). After waiting to be seen for an hour, Julie told them everything; how she was trafficked here in the first place, why she can’t return to her home country, and the history of violence with her partner. But, again, it came down to “this is an immigration issue”.

We asked again, where is she supposed to go?

The police suggested many of the places we had already tried and eventually persuaded the Salvation Army, who had already refused her a place, to give Julie a bed for that night. But it was for one night only, and she would have to leave by 9am on Friday. They also suggested we go to the Neighbourhood Office first thing the next day.

In the morning Denise picked Julie up from the hostel. Together with a council officer at the Neighbourhood Office, Denise, Julie and Michelle spent another frustrating day speaking to agencies – many of which they’d already tried – and coming up against the same barriers. Referrals would go so far, only to be refused due to Julie’s immigration status and the fact she has no recourse to public funds.

By the time the office closed, Julie had had enough. She was tired.

That evening, she went home to her partner.

What’s the answer?

We don’t know what else we could have done for Julie, but her situation is by no means unique. It’s so frustrating to see someone in need and not be able to help them.

We are still supporting her, of course; we’re helping her to find out if she has grounds for citizenship and helping her to put together all the paperwork and information she needs to “become legal”. In five weeks’ time she will be able to re-apply to MASH for housing because she will be 20 weeks pregnant – and we will help her through that process too. We are giving her food and toiletries and ensuring she has access to her midwife, despite what is now an even more dangerous situation at home.

But we can’t make sure she’s safe, and that is incredibly, horribly frustrating.

Cuts to weight management services in Birmingham

UPDATE: We have been notified that the Health Trainer service will now continue for at least the next 12 months, which is excellent news. However, Lighten Up will cease at the end of April. We are disappointed by this decision, as we see it as a backwards step. As we mention below, it goes against the city’s pledge to tackle obesity in Birmingham.

The following blog post was published in February 2016:

moneyWe have been given notice that our Health Trainers and Lighten Up services are likely to close in May. This is due to budget cuts by Birmingham Public Health (part of Birmingham City Council), who fund these services.

The Government has announced significant reductions in the Public Health grant, so the notice follows proposals in the Council’s budget consultation that all weight management services should cease.

Of course, we responded to this consultation, as did many of the individuals and groups we’ve worked with, to challenge this decision. We are now awaiting the outcome.

We believe that cutting funding for weight management services goes against the city’s key public health messages: in particular that Birmingham needs to tackle obesity, and that we should have a preventative health agenda.

This morning (17 Feb), BBC WM ran this story as their headline news and we heard from Professor Nick Finer, doctor and leading obesity expert. He called the decision to pull funding “disastrous for the health of the city”, saying “it goes against all the guidelines, and indeed requirements, for local authorities to engage in the public health issue of trying to help people with issues of overweight and obesity.”

You can listen to the programme in full on the BBC iPlayer here (Prof. Finer is at 01:07:50).

It’s not just about vouchers

Neither Lighten Up or Health Trainers are solely about weight management, or free slimming classes. They’re about achieving behaviour change – and that can only happen when a person is motivated to change.

Enabling people to go to a slimming group for 12 weeks free gives people a really vital kickstart and we know, because we hear it from our clients time and time again, that many people simply wouldn’t ever go to a group if it wasn’t for this extra push. It’s not about whether people can afford to go on their own – although many people in fact wouldn’t be able to afford it – it’s about whether they would ever be motivated enough to take the plunge in the first place without a referral from their GP.

It’s also really important to point out that Lighten Up doesn’t just pass on vouchers; it offers wraparound care. We find that many people make more progress if they have someone to support them, which is why the follow up calls from our staff are so valuable. For a number of our clients who are a bit more isolated, the social contact that the phone service offers is really important too – it builds confidence and resilience, which is vital to help behaviour change.

Our Health Trainers service offers even more personal support for behaviour change: one to one consultations, for a lengthy period of time, tailored to individual needs… but again, it is a real kickstart for people to go on to achieve great things on their own. And so we agree that losing either of these kickstart services would indeed be disastrous for the health of the city.

Testimonials from our clients

We’re starting to get more and more letters and emails of support from people we’ve worked with over the years, protesting at the closure of these services and pointing out how Health Trainers and Lighten Up have helped them.

Steve, who has been working with Keiran, a Health Trainer, explains that his referral actually saved the NHS money:

I feel very strongly about the service closure due in May with no planned replacement. I have just completed my last session with Keiran and I am delighted with the fact that my blood sugar levels have improved from 72 (last three 6 monthly results) down to 49 as a result of planned weight loss and a much improved exercise regime ably facilitated by Keiran. This means for me, instead of having to take additional medication, I am in the position to reduce or possible eliminate my current Metformin prescription (2000mg daily) subject to discussion with my GP.

With diabetes on the increase and the massive costs needed by the NHS to treat this debilitating condition it does not seem logical to stop this type of service which is capable of achieving very positive outcomes just by lifestyle changes and without prescription drugs. Anything that can successfully make these changes should invested in and fully supported.

Carol has been working with Wayne, also a Health Trainer. Her letter points out that closing these services would leave a significant gap:

Gateway Family Services is a service that we all need – they help thousands of people like myself. If you take this service away from us where do we all go for help as the GPs cannot deal with issues like diets […] GPs are only there for medical problems.

We are collecting testimonials to send to our commissioners at Public Health. If you’d like to add your voice, please contact Jane Piggott Smith on email at Jane.PiggottSmith@gatewayfs.org or by writing to us at our office address.

Finally, if you did hear the BBC WM programme, you might remember Lesley, who says that she wouldn’t be where she is today without her Health Trainer or the Lighten Up service. Last year Lesley kindly spoke to us on camera about her journey with Gateway – and you can watch that below.

Happy 10th birthday to us!

Gateway's Chair Ann Forletta cuts the birthday cake
Ten today! Gateway’s Chair Ann Forletta cuts the birthday cake on Weds 10th Feb, our official birthday.

This week is Gateway Family Services’ official tenth birthday. We can’t believe it either!

We’re so proud of everything that the organisation has achieved over the last decade. In ten years we’ve created and delivered nearly 20 services to support over 70,000 people across Birmingham. And there are more in the pipeline – our teams are working with partners all over the city to develop new ideas all the time.

What all of our services, past and present, have in common is “people who need help” and everything we do has an impact on people’s health and wellbeing. Many people in the city have a consistently poor relationship with health and social care services, and Gateway is here to make a difference to the experience and outcomes of those people.

How do we do it?

All of our services support the whole person, not just single issues.

We train all our staff, across all our services, to support people to be more resilient by equipping them with knowledge. Knowledge about (for example) changes to the benefits system and other social issues that could affect them; knowledge about their rights, about the opportunities available to them, and knowledge to help them navigate a maze of systems and processes. Our outreach staff are also experts in behavioural change, so we often hear from people who were referred to us for one thing but have gone on to make positive changes in all areas of their life.

Eight POWs and one Health Trainer who were all part of our original intake a decade ago
Eight POWs and one Health Trainer who were all part of our original intake a decade ago

We work directly with the people who most need help by going to where they are. We recruit and employ people who are part of the communities we support, to ensure we are truly reflective of those neighbourhoods. In fact, 62% of our staff live in areas defined (by the indices of multiple deprivation) as the most deprived in the city.

We’re especially proud to say that many of our staff stay with us long term; 20% of our current workforce were part of the very first intake of staff all those years ago. But we’re equally proud of those staff members who learned with us, trained with us, and gained experience to go on to other jobs in health and social care. People like Farzana and Lynette, who worked as POWS while studying for their eventual careers in nursing. Farzana described working for Gateway as “a ladder that you can step onto – and if you want to climb to the top you can.”

When Gateway was first set up, the CEO and board worked closely with staff to come up with four core values. Those were:

  • We do what we say we are going to.
  • We invest in people.
  • Everything we do has a positive social impact.
  • We work hard and never stop learning.

These values have never changed and they never will. They are integrated into the very heart of Gateway’s work and as an organisation we constantly check ourselves against these statements. We are proud of our achievements and we look forward to working with many, many more people to achieve even greater things in the future.

Have you got a Gateway memory?

Have you been helped by Gateway at any time over the years? Maybe you had some support from a POW and you’d like to show us how your baby is growing up; or maybe you’re living a healthier, happier lifestyle thanks to the kickstart your Health Trainer gave you. You might be part of an organisation that’s partnered with Gateway in the past. Or perhaps you’re a commissioner who has contracted or funded us to do great things!

If you’ve got a good memory of Gateway, we’d love to hear from you. We’re putting together an online scrapbook that we hope to fill with stories from people we’ve worked with over the last decade. So if you’d like to share your story, email info@gatewayfs.org to let us know.

Sharing our knowledge with the Child Poverty Commission

Did you know that Birmingham has a Child Poverty Commission? The cross-partner Commission, which includes the Council, the University of Birmingham and The Children’s Society, was set up in March last year to look at ways of reducing child poverty and making sure children are not disadvantaged by their background.

It’s early days for this group, though, and the first stage is for them to get the fullest picture of the extent of the issue. So we’re very pleased that they’ve asked us to get involved and share our knowledge.

At its launch, the Council’s press release about the Commission said:

“As well as asking professionals to give evidence, the commission wants to listen to the everyday experiences of children and families living in poverty and understand poverty from their perspective and bring to life the stories of children and families behind the hard statistics.”

We were asked by the City Council to get involved as they recognise that our Pregnancy Outreach Workers Service (POWS) works with some of the most in-need families in the city. The Commission is keen to see case studies and information compiled via our Impact Assessment App, but they’re also really keen to hear some experiences first hand, so they’ll be visiting us in a few weeks’ time to meet some of the families we work with and hear how life is for them.

POWs’ experiences of Child Poverty

mother-babyPOWs support some of the most vulnerable women and families in the city, and they come face to face with child poverty on a daily basis. The issue is immense… and it’s growing.

Some of the women we work with don’t yet have a child so, in these cases, “child poverty” includes the strong potential for the baby to be born into poverty.

More than 75% of the women we support record “Financial Hardship” as a current issue when they are assessed. This means they have unmanaged debt, rent arrears, or a low income and, in many cases, all three. For many of the women we visit, we also record that their living accommodation is unsuitable. This could mean overcrowded, in need of repair, or unsafe, and of course we have to take into account the imminent arrival of a baby. The main barrier the women have to changing this is financial hardship.

Since the POW service changed last April to working with the most vulnerable women only, we’ve seen demand for food parcels and hardship payments double. We are also seeing a growing number of women who are underweight or suffering from dietary deficiencies. This issue becomes a real danger during pregnancy, both to mother and child.

Although we do what we can, there’s a limit. Frequently, despite the hard work of our POWs, we’re not able to make things all that much better. To be honest, we often feel a bit helpless. So we’re very pleased to be able to talk about our experiences to the Commission and, hopefully, help to make a difference.

Celina’s Story

Celina* came to the UK from the Caribbean because she had been suffering domestic abuse from her partner (she has actually suffered a miscarriage in the past as a result of the abuse). Legally she should have returned to her home country by now, but her partner has been threatening her family and she is understandably frightened to return.

Celina’s had a lot of complications and medical issues during and since the birth, but her baby is doing OK. Like most of the women POWS support, Celina has dire financial hardship, and because she is now an overstayer, she doesn’t have any access to funds at all. She cannot claim any financial support and wouldn’t be allowed to work even if she could. She has told us she is worried for her own survival.

Just before Christmas, Celina’s Pregnancy Outreach Worker Jacque took Celina a Christmas hamper which included a few essentials – food, baby items and toiletries – as well as a couple of treats for mum and baby. You can hear Celina’s reaction in the video below.

*name has been changed