Changing Lives, Changing Services
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Gateway Family Services

Changing Lives, Changing Services.
We work to improve health, develop skills and opportunities and fight inequalities. We change the way public services work.

Sharing data about sharing data Posted on by

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Last year, in a post called Saving Money for Local Government and NHS, I wrote about how we need to use the assets we have.

And this became the basis of a project. From November 2012, supported by the Department of Health’s Social Enterprise Investment Fund we looked at finding revolutionary ways of putting patient voices directly in line with national outcomes, using the latest digital technology – and sharing that with other organisations across the country.

So what was the project trying to achieve?

Replication

Our original aim was to replicate the Pregnancy Outreach Workers Service (POWs) into another area.

The POW service, developed from scratch and now seven years old, is efficient and effective. It has a clear role, with defined protocols, safeguarding and training all well established.

So we started by looking for organisations like ours in other parts of the country. We began sharing, leading and learning with other people in the third sector. When organisations work together, we can be stronger and make a better offer.

Data and Outcomes

We don’t think “data” has to be boring!  The illustrations dotted around this post, drawn by the talented Alex Hughes from Drawnalism throughout our event in Leeds last week, are an example of data that is accessible and engaging.

Better data works well for everyone; it increases efficiency. You can hear from your patients directly. You can hear from services directly and make decisions based on concrete evidence.

So we’ve been developing tools that allow us to gather data directly from clients and other organisations, and measure it against national outcome frameworks in different and interesting ways.

Our POW service uses three main data tools:

  • The Podnosh Uniqueref Database – collects quantitative, statistical data. This is our clients’ personal information, including names and address, and information on their issues and risks
  • The Podnosh Impact Assessment App – collects the qualitative data. Outreach workers, using their smart phones, collect views from clients. This data is directly from our clients, in their own words, including statements and happiness ratings.
  • The Outcomes Database – pulls together the outcome frameworks relevant to the ‘Starting Well’ phase of Marmot’s Life Course, against which we plot outcome data from us and from other organisations.
    (Some of the terms that organisations use are different to the terms used by government – for example, our POWs would call someone living in a hostel “homeless” but according to the government they’re “in temporary accommodation” – so alongside the Outcomes Database we created a Data Dictionary to help us to compare and measure more accurately.)

The findings

As we’ve come to the end of the project, we’ve realised that the priority for other organisations is to create and share data on their existing services rather than to replicate others. So we’re going to build on that.

We’re setting up an online forum to get the conversation going and we’ll be inviting providers and commissioners to join us in sharing and finding new ways to work.

The event

Last week we ran an event in Leeds called Measuring Outcomes – Producing Evidence – Demonstrating Outcomes to share our findings.

Here are the slides from the three presentations:

People who were not at the event were able to follow it on Twitter using the hashtag #mopedi.
View the tweets on Storify
View all the illustrations from Alex Hughes

Speaking our clients’ language – with a training course for interpreters Posted on by

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There are over 200 different languages spoken in Birmingham, so many of our client visits require interpreters. Our staff already speak a range of languages including Punjabi and Urdu; however, the clients who are really in need of our services are those who have recently arrived in the country. They bring new language needs and, generally, interpreting services are not geared up for that.

For a while now we’ve been using translation agencies but we find that it doesn’t allow us to deliver as flexible a service as we’d like. We occasionally need to access interpreters with short notice; POWs need to spend time before an appointment giving an interpreter background information and explaining what they are trying to get out of the visit.

Luckily, we are often able to interpret for clients using the skills of our own staff and volunteers. For example, a client who was recently referred to our POWs service is from Democratic Republic of Congo and speaks French. Although none of our POWs speak French,  one of the Gateway volunteers is from Madagascar, so it’s her first language. With help from the volunteer, our POW was able to introduce herself and Gateway to the client. Between them, they were able to start giving the client the support she needs.

In this video, Pregnancy Outreach Worker Shazia explains how, by offering her skills as an interpreter, she can persuade women to attend important appointments that they wouldn’t otherwise have the confidence to.

So we’ve decided to fill the gap – and formalise things – by setting up a training scheme for interpreters.

The training will lead to a formal qualification – an OCN Level 2 in “community interpreting”. But, like the training we give our volunteers, it will also include things like confidentiality, safeguarding, and work on boundaries. As well as giving us more control, this will give trainees a load of extra transferable skills that we hope will be useful to other organisations, leading to further interpreting work for them.

Many of the trainees already signed up are former clients themselves, so they are very well placed to understand how the service works, as well as a natural empathy for the client. As well as providing a translation service, they will be able to act as an assistant to the POW.

We’re hoping the course will open up work opportunities for people who wouldn’t otherwise have them. The opportunity to gain a formal qualification, and to start earning money by working for us and other organisations could be the beginning of a new career.

Want to find out more?

Our first group of interpreters will start on Thursday 16th May 2013, but there are still some places available.

You don’t need any prior qualifications – just a willingness to learn! However, although English will probably be your second language, you need to be able to speak English well.

So if you speak French, Somali, Arabic, Bengali, Romanian, or any other language that is spoken in Birmingham, and think you could benefit from our scheme, get in touch.

Pregnancy Outreach Workers Handing Over Posted on by

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POWs can support women all the way through their pregnancy and then for a short time post natally (usually a maximum of 8 weeks). In total the support can last for almost a year. This gives the POW the time they need to tackle the woman’s issues, but equally it gives them the opportunity to forge a useful and trusting relationship.  

However they always have an eye on when their support will end – and much of what they do is to prepare the woman for this.  Ideally she will be on a more stable footing and well able to be independent.  For some women the journey is longer so there will still need to be a support network in place that adequately meets her needs.  The aim to to ensure there is a seamless transition and that she doesn’t get lost in the system.

Michelle POW Programme Manager explains; “Ideally handover is something that is thought about before baby comes along.  We like to ensure that every woman has at least one professional to turn to, should they need them. Frequently the handover is to a Family Support Worker so what we’ll try and do is arrange a visit to the local Children’s Centre while mum is still pregnant.  Not only do they get to meet their Family Support Worker and begin to establish a relationship but they see what’s on offer and what they can tap into, so classes, groups etc.”

Michelle continues: “Sometimes mums-to-be, particularly those pregnant with their first baby, may worry about where to get support if they should need it once the POW is no longer around.  This shows them that it’s there.  It’s one less thing to worry about.  It also means that they get familiar with the facilities before baby comes along, which is always a busy time, and it won’t all be new to them.”

Natasha’s coming to the end of her support from Rachael, her POW.  She’s made real progress and it’s hoped that in a few months she’ll be ready to apply for her own house so she and her baby can live independently.  For now, though, Rachael feels Natasha still needs some extra help – which is why she’s introducing her to what her local Children’s Centre can offer – and Natasha’s already applied to do their Positive Parenting course.

Some of the women we support are going to need more help than others.  In many cases the POW has been able to solve the problems the woman was referred to us with, but in some complex cases this isn’t possible.  In this situation it’s about working in partnership with other professionals and ensuring that everyone knows the part they have to play.

Miriam, one of our POWs, has concerns about one of the women she’s supporting: “She had her baby six weeks ago but due to some recent changes both she and I feel she needs some specialist help.  So I’m going to initiate a CAF (Common Assessment Framework).  I’m just filling out the paperwork to get things underway because my aim is to make sure the initial meeting happens before my support ends. I’d like to see who’ll be responsible for doing what and make sure someone takes over the role I’ve been doing which has been sort of co-ordinating things”

Michelle adds: “It depends on the woman.  We take a lead from her and how well she’s coping.  What is set is that handover must happen. There are things we do as part of it that are standard, like making sure mum knows how to register the birth, that she’s getting the benefits she’s entitled to and that immunisations are booked in, but what support remains is a unique thing; it’s tailored to the individual.”

Breastfeeding 20% more likely with Gateway POWs Posted on by

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In the last quarter of 2012, 65 babies were born to clients of our Pregnancy Outreach Workers team, and 55 of those women initiated breastfeeding.

That’s 85%, compared to an average of 65% in the wider community*.

In December alone there were 17 births and 16 of the women initiated breastfeeding – a whopping 93%.

Increasing the rate of breastfeeding is something that’s important at both a national and local level, so we’re delighted to be doing our bit to reach the city’s targets.

Most clients want to breastfeed – they know it’s the natural thing to do and the benefits it brings – but sometimes they need just that extra bit of help. That’s why all of our POWs are trained in breastfeeding support as part of Unicef’s Baby Friendly Initiative.

Before the baby arrives, POWs give their clients lots of information, including leaflets and DVDs from the World Health Organisation and Unicef. Often, POWs will watch the DVD with the client so that they can explain or interpret it, talk about it and answer questions. We also run group sessions where POWs can demonstrate different breastfeeding techniques using dolls.

Sophia and Khadijah run a session at Springfield Children’s Centre. “It’s a six week course, where we show the DVD and give out handouts, as well as giving demonstrations of things like how to help baby latch on,” says Sophia. “We answer questions and discuss worries so that the mums are as prepared as possible. Then, for up to eight weeks postnatally, we visit mum and baby to give some extra support when they need it most.”

In this video of a typical breastfeeding group session run by the POWs, Colette uses a doll to show some different techniques for breastfeeding:

Another POW, Jacqui, says, “At the time of the birth, breastfeeding support is vital. We find that if the mother doesn’t get enough help and encouragement straight away, in the hospital, she’s more likely to start bottle feeding. That’s where POWs can really make a difference.”

Jahanara’s client had her baby on Sunday. “I was her birthing partner,” she explains. “Before the baby was born, the mum had told me that she wanted to breastfeed; this is her second child and she’d already told me how difficult she found it when she bottle fed her first baby. So I knew it’s what she wanted – but, after giving birth, she was so tired, she just didn’t want to do it. She wanted to give the baby a bottle. So I gently reminded her of everything she’d talked about before, and encouraged her to try again. Now she’s very happy to be breastfeeding.”

*published average breastfeeding rates for 2012 in the wards we cover. Source: Birmingham Public Health Health Inequalities Action Plan 2012.

POWs preventing Pre Natal Infections Posted on by

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Pre Natal Infection is one of the major causes of infant mortality.  Our Pregnancy Outreach Worker Service (POWs) works hard to reduce infant mortality here in Birmingham, so today, the first day of  Pre Natal Infection Prevention month seems the ideal time to explain what we do to help.

If women miss their ante natal appointments they and their babies are at more significant risk.  We see that part of our role is to get this message across but then it’s about taking practical steps to make sure they get there.  Many of the women we work with have missed appointments, in fact this is one of the reasons midwives refer people to us as they know we can be relied upon to tackle this issue.  We understand why what appears to be a routine thing can be a problem for some women.  Recognising the issues helps us put in place practical steps as Shazia one of our POWs explains:

 

Over the past 6 months we have supported 150 of the women we work with to attend their ante natal appointments, whether that be by helping them get them booked in, ringing them the day before to remind them,  explaining in advance what they can expect,  or accompanying them to give them some morale support (even  giving them a lift if they’re stuck for transport).

 

 

 

 

 

Short term cuts make long term holes Posted on by

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There is a lot less money around at the moment, so what little there is needs to be spent wisely. One of the easiest options is to make cuts to preventative services for people who aren’t in the system… yet.

This may be a quick win for the government, but they’re in danger of leaving a much bigger hole than anyone seems to realise. Cuts to support services may provide a small saving in the short term but, long term, the figures just don’t add up.

Take one of Gateway’s recent clients. Sarah* was referred to Gateway when she became pregnant. Given her troubled background, and the lifestyle that she was leading at the time, it was expected that her new baby would have to be taken into care.

For nine months, during and after her pregnancy, a Pregnancy Outreach Worker helped Sarah to access help from a variety of sources. Homeless, with one child already in care, Sarah needed practical and emotional support. Her POW listened without judging, made it easier for her to attend her appointments, and helped her understand what was happening at case conferences.

We helped Sarah apply for crisis loans to get her through the pregnancy and first few months after the birth. She underwent anger management counselling and drug counselling. We helped her to find local authority housing.

Eventually, after a lot of hard work by both Sarah and her POW, she was able to show that she could provide stability and proper care for her own child. And so, when the baby was born, social services came to the decision that mother and baby would be better off staying together.

I’m not telling you this story in the hope of warming your heart. I’m telling you because:

  • The approximate cost of taking a child into care for 9 months is £28,000
  • The approximate cost of the combined preventative services that Sarah accessed over 9 months is £6,000

Preventative services have saved our economy over £20,000. And that’s just for one child.

This theory works across all services, not just for Gateway POWs. Fall prevention, for example – everything from installing grab rails to making little lifestyle changes so that someone uses the stairs less – minimises the chance of someone having a fall. The estimated cost for the first time a person falls is about £40,000, but that £40,000 could pay for fall prevention staff to go into around 200 homes. Yes, that’s £40,000 per person vs £200 per person.

Often there is a perception of voluntary/third sector organisations as “do-gooders”, but we’re not just in this to be nice. Of course there is a moral, emotional, argument that says “people need to be helped”, but there’s also a compelling economic argument: people who are better supported, who are cared-for before their issues escalate into crises, simply don’t cost as much.

 

*names have been changed

Sources for figures:
Average cost of child in foster care: The Schools and Families Committee – 2008/9. £774 per week, so 9 months = £27,864. Costs of support services are estimated; based on Gateway FS’s POWs service, which is costed at £20 per hour. First falls costs: Birmingham Local Authority Strategic Shift to Prevention 2012.

Photo: Kriss Szkurlatowski, 12frames.eu

Gateway welcomes volunteers Posted on by

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This week saw the new volunteers start here at Gateway.  A really diverse bunch, the one thing they have in common is their desire to work with people who need some support in their own communities.

Once they’re out and about, the volunteers will be working as befrienders – offering a friendly face, a bit of a helping hand, some information about local services,going along to groups with people, help with shopping – whatever those who are feeling isolated need!

In the meantime, they’ve started work on the Employability course they’ll all complete as part of their training – a recognised qualification which, along with the work experience provided by volunteering, really helps enhance their readiness for work.  Next week they’ll be working with our Health Trainers and Pregnancy Outreach Workers to get a feel for how they can best support their clients, after that, it’s up to you.

If you know anyone who you think might benefit from a befriender, someone who can support them at home or in getting out and about, someone who can let them know about groups in their area and go along with them to those groups, go out walking with someone or just sit with them at home and share a cuppa, then please contact Chelsea Gaffey on either chelsea.gaffey@gatewayfs.org or call 0121 456 7820.

Investing in pregnant women needs to be the focus of family policy Posted on by

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We have been working with pregnant women in Birmingham over a number of years.  Many have difficult and complicated lives and while we primarily want to support them, we also want to help people understand how systems and services can let them down at times.   In particular we want to urge commissioners, policy and decision makers to examine if their services really support people who have greatest need.

The  Pregnancy Outreach Worker service  is increasingly showing us where there are gaps in services, these gaps lead to exclusion, inequality and injustice.  The picture we see is in contrast to the Troubled Families Unit report - which was compiled after talking to 16 families in poverty.    This report does not challenge services but does seem to lay blame   firmly at the door of the poor.

I reviewed the case of a current client we are working with,  her circumstances prompt a number of questions about  the way support services are structured :

Jodie was referred to us when she was 14 weeks pregnant,  22 years old, living in a hostel, an unplanned pregnancy, the father unwilling to be involved.  Jodie suffers from depression and self-harms, she has debts and is on medication.  Her baby is due in December –  her life is chaotic.

Jodie was referred to mental health support service by her GP, however she did not turn up for several appointments and so was discharged from their service.  She has not seen her named Midwife in 4 months.

Jodie has mental capacity and therefore does not meet the definition of a Vulnerable Adult, which would entitle her to support from Adult Social Care.

Jodie’s baby is unborn and does not have a Social Worker involved – the baby, when it is born, may generate Social Worker involvement.

Jodie has been re-housed but does not have any money for food – she is in receipt of food parcels

Jodie’s chaotic lifestyle did not start when she became pregnant and will not end when the baby is born – It appears that statutory support services will begin when the baby is born and considered at risk or in need.  The work we are doing with Jodie is to prepare her for parenting and being able to support a child, but crucially to understand causes of her chaotic life.  We are examining the gap with what is available to her and why she is not engaging with services.

We believe that investing time in her may prevent her child becoming at risk or in need.  Our aim ultimately is that Jodie and her child will be able to function well as a family unit.  - Jodie is one of over 200 pregnant women we are currently supporting in Birmingham

(names have been changed)

Photo by Nina Matthews Photography 

 

Pregnant Mothers helped with food poverty crisis in Birmingham Posted on by

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We are really pleased with the press attention being given to the food poverty amongst pregnant women in Birmingham and how we are able to help with food parcels.  Unfortunately this probably happens in most cities up and down the country.  What we should acknowledge is Birmingham is doing a great thing – over the last 6 years it has investing in helping vulnerable pregnant women be safe, healthy and supported, so that their babies are born healthier.

 

In 2006 the NHS Public Health in Birmingham acknowledged that something had to be done about the severe inequalities being faced by some people in the city, there is real hardship and Birmingham was experiencing the worst infant mortality rate in Europe.

 

They knew something needed to be done and they put their trust in us to deliver life-changing services to those that need it most.

 

We have worked with over 5,000 pregnant women since then and the NHS continue to support the service – this service is not available anywhere else – it is Brummie born and bred and we should be proud.

 

Many many women we support find themselves in circumstances that we could never imagine, I am proud that our organisation can support them and that this makes Birmingham a better place to live in.

 

Gateway Family Services is a Community Interest Company based in Birmingham since 2006

Saving Money for Local Government and the NHS Posted on by

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A  quick and simple public sector reform to save money

The innovation I am proposing is – don’t do anything new -  import things from other areas – exhaust all possibilities before starting from scratch – if it is needed it probably exists already.

We have a culture of showcasing our good work and covering up our mistakes – we feel our reputation may be damaged if we share the experiences of getting it wrong, and yet I think if we shared our experiences warts and all, millions of pounds could be saved across the country.  Delivering new services in tried and tested ways  is the most efficient thing to do.  It is about exchanging and unselfishly bringing about social change.

We know that projects are most inefficient at the beginning, cost more and achieve less – it takes at least a year, to test, trial fail and learn how to deliver – then we get really good at it.  In other parts of the country people are also testing, trialling failing and learning and getting good.

It’s widely acknowledged that there pockets of good practice – there are lots of them, all over the place.  The clever trick is to take the learning and the efficiencies and transplant them into other areas, so that they could benefit.

The constant drive for innovation is tiring and unnecessary – we should prohibit it for a year and see how we get on.  The tendency to overcomplicate matters  to save money is normal but some solutions are so simple – such as this one from Podnosh -  and this is another;

I listened to Sir Michael Marmot describe his findings in the review of Health Inequalities and he correctly identified that people were doing many good things in various places – yet no-one asked how do we replicate.  People agree they should ‘share good practice’ – one of the most overused phrases in the Health and Social Care Sector and probably other sectors too – yet no-one really imports good-practice from other areas.  I have yet to see anyone else benefit in practical terms from other peoples learning, development, successes and failures and be willing to share their own.

If we want to make cost savings, become efficient and deliver tested effective services then it’s time to stop innovating.