Author: Katherine Hewitt

Services close… but people still need help

Every week, our office receives phone calls and emails from people who need help. Sadly, as some of our services – and others around us – are withdrawn, we are finding it harder and harder to offer appropriate support.

We thought it would be interesting to write about the sorts of calls and messages we receive, and share what we do when we can’t help directly.


Reg* phoned Gateway asking for someone who hasn’t worked here for nearly three years! After some confusion, he explained that he’s just come home from hospital and is recovering from heart surgery. At some point he’d picked up a leaflet for Gateway’s Volunteer Befriender service so he was phoning Gateway to see if he could get some support from a Befriender… not realising that the service closed two years ago after funding ended.

He told us, “I just want someone to talk to, really, on the bad days. I’ve been feeling down recently and I don’t have anyone I can just phone to just have a chat about everything.”

We explained to Reg that we are no longer able to offer a befriending service. We took a guess that he is over 50, and suggested that he contact Age UK, who do have befrienders (although there is a charge for the service), and he said he would look into it. He also said he had a rehab appointment at the hospital later that week and would ask them if they could recommend anything.


Aliyah* phoned wanting to know if she could get a Health Trainer. She’d been told about the service by her GP, and had found Gateway after a web search.

We explained that the service had closed, and she was very understanding, but disappointed. She said, “I’ve been suffering from depression and anxiety for a while, and I’ve put a lot of weight on recently. I want to sort myself out but I feel like I need some support. I’m on ESA so I can’t afford to pay for anything privately.”

A Health Trainer would have been perfect for Aliyah. Unfortunately, all we could do was suggest she go back to her GP.


Over the weekend, Sarah* left a comment on a blog post we published about three years ago, when some of our Pregnancy Outreach Workers were seconded as Support Workers to the council’s Temporary Accommodation team. Her comment said, “Hi please is it possible for you to help me and my two children (age under 5). We have been in temporary accommodation in a hotel for three months now and the council can’t offer any help.”

We didn’t publish the comment, but instead contacted Sarah directly. The only contact information she left was an email address, so a POW co-ordinator emailed her first thing on Monday morning with some advice, including links to Shelter, who offer specialist advice and legal support.

How many more?

Phonecalls and messages like this only go to show that the gaps we covered, and the needs we used to meet, are still there. And we have to wonder: how many more people are in need, but unable to get support from anywhere? If we are getting calls like this every week, how many more people are out there needing help and not knowing who to call or where to go?

Reg might be able to get support from an Age UK befriender, but many others wouldn’t even think to ask.

And we are frustrated to have to point Aliyah back to her GP, knowing how busy GPs are. It’s not a clinical intervention she needs; it’s someone who can spend an hour or two with her to chat through her current lifestyle habits and give her a bit of moral support and encouragement. Someone who’ll help her start a food diary, suggest some physical activity suited to her abilities, and come up with a motivational action plan. Someone like… a Health Trainer!

Sarah might have received help from a Temporary Accommodation Support Worker when our POWS were seconded there in the past – although in this case it sounds like she’d already been in touch with the Council and they have been unable to help. Now, all we can do is contact her to tell her that we no longer do this work, signpost her to Shelter, and hope that she receives the email.

So what can we do?

We’ve always prided ourselves on our ability to fill gaps. Although we’re finding it increasingly difficult, it’s what we’ll always try and do.

Many people contact us via the blog after a web search, not realising that the posts were published years ago and the information is out of date. So we’ve added messages to the most popular and relevant blog posts, pointing out that they are reading an old story, and linking to a new Further help and advice page. It covers the most popular topics (housing, safeguarding, befriending and pregnancy) and we’ve tried to make it helpful without overwhelming people with information.

We also keep a directory of services on hand in the office, so that we can try and signpost people who ring us, and we keep in contact with as many other services as possible to make sure it’s up to date.

Keeping ourselves informed is still really important. Having recently started some new work delivering courses, including “5 Ways To Wellbeing”, we are making new contacts, as well as updating what we already know. Everyone at Gateway shares information across the organisation – when we meet with organisations who are new to us, or find out something new, we come back and share it with everyone.

And, despite temptation, we’ve resisted automating our phone system. Instead, we endeavour to answer every call personally. Anyone who phones the office during working hours will speak to a member of staff, who will do their best to help, whatever the question or issue.

All of this doesn’t really add up to the solution we’d like – there are still many gaps, and we’d rather be able to help people ourselves – but it’s better than nothing.

By removing preventative services, the risk is that people’s problems will get much worse before they are able to get the support they need – which of course costs the NHS and the city even more.

And that’s really frustrating.

*names have been changed

New Early Years service may create gaps

Over the next few months, the dedicated Pregnancy Outreach Workers Service (POWS) will be closing. POWS is to be consumed into Birmingham’s new Early Years Health and Wellbeing service, which is a partnership led by Birmingham Community Healthcare NHS Foundation Trust (BCHC), so our POWs will be transferring to new roles with BCHC’s partners Barnardo’s, Spurgeons Children’s Charity, St Paul’s Community Development Trust and Springfield Project.

But what about the gaps?

We’re pleased our POWs will be able to continue to make use of their extensive knowledge and specialist skills, and that Public Health has recognised that this group of vulnerable women exist and need support. But POWS will no longer be an identifiable service, and I’m worried this will leave gaps.

Photo: nikoretro on Flickr (CC BY-SA 2.0)

As yet, there is little information about how exactly mums and mums-to-be who are at risk will be looked after under the broader Early Years service.

Details of the new model of service often refer to “children and families,” but not to pregnant women specifically. Will pregnant women still receive dedicated support from an early stage of pregnancy? And when a child is taken into care, will the mother continue to receive direct, one-to-one support?

We have asked for reassurance, and have received some further comments from Commissioners, but the information is still sparse. In my opinion there is a potential for gaps here which could, over time, become problematic.


At the moment, POWS offers intervention from as soon as a woman knows she’s pregnant. Often, a POW will get involved at 14 or 16 weeks – sometimes as early as ten – and the earlier we get there, the more we can do. Once the POW receives the woman’s contact details, she’ll be in touch within 48 hours.

These early weeks, while the baby is in the initial stages of development, are always vital, but even more so when a woman has complex needs. Amongst many other things, POWs can help women stop drug use or smoking, ensure she’s eating (and eating the right things), identify suitable accommodation, and make sure she is engaging with midwifery services and attending appointments.

Commissioners have told us: “The health visitors within the new service will receive referrals from midwifery in line with need. Where the woman is vulnerable or has additional needs this will be before 26 weeks.”

The earliest time mentioned in the documentation we have seen is 20 weeks, more than halfway through pregnancy.

Dedicated time, responsiveness and intensity of support

The information we have about the new model talks about an initial visit, and then a second visit. We know this isn’t enough for women with complex needs. Much of a POWs’ work is unpredictable and can include a lot of one-to-one crisis management. For example: taking women to appointments, providing phone and text message support at any time, supporting homeless women to ring round the Housing department and hostels, helping women to remove themselves from domestic abuse and taking them to a safe place, and providing support during mental health crises, including out-of-hours chats and accompanying women to get support from the Community Psychiatric team.

When we raised this with Commissioners, we were told: “The new integrated service will be able to meet needs of the type you set out. There will be the integration with other services across the city ensuring that the service responds at the right time and in the right way, especially as you say in situations of homelessness and DV. The single cross service record will provide assurance on the services and level of engagement of an individual which will also assist the service in supporting women through their pregnancies.”

What we’re not clear about is who will be providing this support. We’re not clear if women will have the chance to build a one-to-one relationship with a support worker who can help her to navigate through services, provide a single point of contact with regular phonecalls/texts and visits, and provide moral support.

Child Protection Plans

The potential gap that troubles us the most is safeguarding. When a child is taken into care, who is there for mum?

Women with a safeguarding need make up about 20% (80-90) of the women POWS support annually, with about 50 of these needing intensive support – between half a day and a day a week. Where a woman is facing the removal of her baby, the POW is often pivotal: ensuring mum understands what is being said, and being on hand to make sure she takes the necessary action in relation to the Child Protection Plan.

But, again, we’re not sure who will provide this support in the new model.

Commissioners told us: “The provision of support to enable parents to develop the skills they need to parent well and the provision of step down services for those who are in the social care system are important elements of the new model.

“Within the new model no specific timeframes have been set for support to this group, it is our expectation that support is provided in line with need. This flexibility will help to build upon the approach currently operated within the POWS service.

“The new model is health visitor led with the health visitors identifying and brokering support for children and families in line with need.”

But will it provide intensive support for mum? I would really like to be reassured that women will get the continuity, trust and flexibility that they need in these circumstances.


I feel like Commissioners have given us the opportunity to have our say. I’ve filled in impact assessment forms with input from the POWs, and when I’ve raised my concerns I’ve been invited to say where the gaps are.

But I’m just not convinced we’re being listened to or understood. Although I’ve received responses, they feel flimsy. I don’t feel they’ve been detailed enough to provide me with reassurance, and this leaves me worried.

I really hope the new service will prove me wrong.

photo by Bhavishya Goel

POWS changing lives: Suad and Fatima’s story

Suad has been working as a Pregnancy Outreach Worker for over six years. Because of her language skills, she works mainly with people who are new arrivals to the country.

Suad (pictured) says, “the POWs’ strength comes from being able to work one-to-one with mum. Many of the women I work with come from a background where women don’t have many rights, so in a lot of cases it’s my job to educate and empower them. I help them understand that they have rights, and that they have a voice.”

Fatima’s story

One of the women Suad worked with is Fatima*.

Originally from Yemen, Fatima had grown up in a small farming village where the culture dictated that girls weren’t allowed to go to school. So she had never learned to read or write and, even though she spoke Arabic, she often found it difficult to make herself understood.

At around the age of 20, Fatima moved to the UK with her husband to live with him, his mother and his two sisters, and over the next six years, she had three children.

During her fourth pregnancy, Fatima’s midwife referred her to POWS and she was assigned to Suad.

“It was difficult to communicate at first,” says Suad, “but I worked out pretty quickly that Fatima had been systematically abused and isolated by her husband and his family. When she was with them, she had been beaten every day. She’d only just managed to leave them, after six years of abuse.”

Fatima’s husband’s family had made sure that she only ever left the house either alone without her children, or with a family member. But one day she found herself outside, alone and with two of her children. So instead of going to the shops, she went to her neighbour’s house for help.

The neighbour, a friend of Fatima’s own family, who understood the situation (and had in fact contacted police in the past, although Fatima had declined their help) immediately put her in a taxi to Fatima’s uncle’s house, and told the husband’s family she didn’t know where she’d gone.

Now, with no belongings and no benefits, living in her uncle’s house with a baby on the way, Fatima needed urgent help. She had a supportive midwife, but she hadn’t been able to fill in any forms or pass any security tests, because she couldn’t speak English, and couldn’t read or write, even in Arabic. She didn’t know how to access any services or even what kind of help she was entitled to.

Over the three months that Suad supported Fatima, she helped her to apply for the benefits she was entitled to, as well as finding baby clothes and equipment for her, putting her in touch with a family solicitor, and getting her onto the housing waiting list.

When Suad finished supporting Fatima, she was still living with her uncle and two of her children, but her story is far from over. Her remaining son is still living with her husband’s family and, sadly, doesn’t have contact with his mum.

Thanks to the midwife who referred Fatima to Suad, and the support services that Suad has been able to help Fatima to access, including a family solicitor, Fatima is continuing to build a new life and working towards bringing her own family back together.


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.

*Fatima’s name has been changed

Become our new Chair


We’re looking for a new Chair to join and lead our established Board.  Over the past 11 years we have carved a strong reputation for the design and delivery of health and social care services. Equally we have gained a wealth of experience in a variety of fields and we have the ability to provide work that is, effective, high quality and cost effective. 

We need to grow and are looking for a person who can help us identify and secure new opportunities.  Also we are looking to raise our profile so we would like help to navigate us into advantageous new networks and forums. 

Knowledge of social enterprise or the wider not for profit sector would also be advantageous along with previous experience of being part of a Board.

This is a voluntary role.

Might you be interested?  If so please have a look at the information below.  There’s a full advert and then a Role Description.

If you’re not sure if the role would be for you, or if you have questions, our current Chair is available for a chat.  Further details of this and how to apply are in the advert. PLEASE NOTE: THE APPLICATION DEADLINE FOR THIS VACANCY HAS PASSED

Advert Aug 17

Chair Role Description  


Health Trainers: experts who add value

Could your organisation benefit from Gateway Health Trainers’ expertise?

The Health Trainers service can now be tailored to the needs of a specific group or organisation, and commissioned directly. As well as traditional one-to-one support, Health Trainers now design and lead flexible wellbeing programmes for groups in a range of settings. If you are looking for creative ways to motivate your workforce or client base, a Health Trainer could be just the ticket.

Health Trainer group at the Signing Tree
Health Trainer Richard (top row, 3rd from left) with interpreters and clients at the Signing Tree, where we have been working with BID Services to run a signed Health Trainer group.

After all, Health Trainers aren’t just about physical exercise and healthy eating; they offer preventative health advice and encouragement that changes people’s lives.

As well as weight management advice, Health Trainers help people to learn how to budget and how to cook. They help people who smoke, or are at risk of diabetes or high blood pressure, to reduce their risk in the long term. They help people to become more confident and more socially active, as well as offering practical help with things like housing, benefits, and finances.

Over 40% of the people we worked with last year have both physical and mental health needs. We understand healthy living goes hand in hand with good mental health, so our Health Trainers know what to do and who to involve to reach that balance.

We also know there are strong links between good health and wellbeing, and employment. Over the last decade we’ve supported many people back into work by helping them to reduce their anxiety and build their resilience. For those already in work, support from a Health Trainer can help to build confidence, lower sickness rates and raise morale.

Could this kind of support help your organisation too?

Over the last year, Gateway Health Trainers have worked not just alongside GPs in their surgeries, but with an increasing number of local organisations including Jobcentres, Cerebral Palsy Midlands, the Signing Tree and Better Pathways. Health Trainers’ tried and tested methods can be tailored to add value to all kinds of other services. Give us a ring on 0121 456 7820 to find out more.

Case Study: Better Pathways

Better Pathways (formerly BITA Pathways) is a mental health charity in Birmingham which specialises in offering training and work opportunities for adults with mental health problems. Gateway Health Trainer Wayne (pictured) got in touch with Michael Summers, a Recovery and Employment Adviser, to create a six-week Health Trainer package for service users at Better Pathways, supplementing the great work they already do around mental health recovery and employability.

Health Trainer Wayne pictured at the Gateway Family Health and Wellbeing Day

The first thing Wayne did with the ten people who were referred into the sessions was to get everyone to start a food diary.

“It’s one of the easiest things you can do to kick-start a healthy lifestyle change, and yet it’s one of the most eye-opening,” explained Wayne. “It helps us to start to see patterns, and from there you can start making really simple changes.”

Mohammed’s diary showed that he rarely ate fresh food, but ate microwave meals twice a day. Together, he and Wayne looked at the food labels of some of his regular meals and Wayne pointed out the high levels of salt he was consuming. Mohammed started replacing some of the ready-meals with fresh fruit and veg, and managed to cut his intake to just two microwave meals a week. It’s a simple change, but it’s likely to drastically reduce his risk of having a stroke or a heart attack.

Dale was eating a lot of snacks throughout the day – and his food diary helped him to notice just how many! Thanks to the food diary and the weekly sessions with Wayne, he found it a lot easier than he thought he would to stop buying them, and put temptation out of his way. Not only is he losing weight as a result, but he’s saving so much money, he’s decided to save up for a bike!

As well as healthy eating advice, which included some fun, hands-on cookery sessions, Wayne offered one-to-one advice for everyone who came on the course. He also helped Better Pathways to set up a walking group for service users, which now meets every Friday for a sociable half-hour walk round the park – another simple lifestyle change that impacts mental wellbeing as well as physical health.

The positive social element of the Health Trainer support was a nice surprise for many of the participants – who started arriving earlier and earlier each week just to have a natter and a cup of tea, and continue to walk together regularly. But the biggest change was weight loss, with all ten clients losing weight as a direct result of the course. As a group, they lost a total of 5 stone 3 pounds (33kg)!

Michael, a Recovery and Employment Adviser at Better Pathways, says, “we believe that healthy living goes hand in hand with healthy mental health, so having the service with us was a huge benefit to our clients. All of them reported benefits such as weight loss, healthy eating, and knowing how to cook.”

You can hear more from Michael in the video below.

Wayne says, “it’s been really rewarding to see people make such big changes in just six weeks. I’m really proud of everyone I’ve worked with at Better Pathways. Not only have people lost weight – and they’ve lost a lot of weight! – they’ve gained confidence and made new friends. It just shows, no matter where you are in life and what your abilities are, a lot can happen if you have the right support.”

If you would like to talk about working with Gateway to deliver a Health Trainer service at your organisation or workplace, please contact Jemma Abbott on 0121 456 7820.

A note – and a message for GPs

Our funding from Birmingham Public Health comes to an end in September, when the Health Trainers service will be decommissioned. We’re continuing to support everyone who’s already been referred into the service, but after the end of September we will no longer be running the service in the same way.

Some of Gateway’s Health Trainers, past and present

The numbers show that Health Trainers has been a popular and successful service. By the time the funding ends, we will have worked with more than 18,000 South Birmingham residents, 85% of whom were referred by their GP or another member of practice staff. Health Trainers have assisted people to achieve or part-achieve the goals they set themselves in 84% of cases.

We’d like to express our gratitude to GPs for the way they’ve worked with us and supported our Health Trainers over the years. Many GPs hosted a Health Trainer in their surgeries and our Health Trainers tell us they really appreciate the way the GP Practices made them feel part of the team. Thank you for making them feel so welcome and valued.

We’re very keen to continue providing Health Trainer support to surgeries, as well as to other agencies and organisations, which is why we’ve come up with a cost-effective, flexible package for GPs. If you’re a GP or Practice Manager, please contact us to find out more about how we can continue our partnership.

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.


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”.


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.


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.

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:


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.


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.