In the summer, we welcomed a new Chair for our Maternity Voices Partnership: Chloe Cadby.
The role of Chair is a busy one, and we’re happy to say Chloe has thrown herself into it over the last four months!
The Maternity Voices Partnership is made up of maternity professionals (like midwives and doctors), and service users (women who have been pregnant and given birth and their family members) and it’s Chloe’s job to speak on behalf of services users in these external meetings.
So as well as attending the regular MVP sessions, which are once a quarter, she has also been attending focus groups, quarterly meetings with Bump, meetings with us here at Gateway, and other events like the “15 Steps for Maternity” walks we’ve organised.
As a mum of two children, who each had very different births, Chloe has had experience of the local maternity services herself. She’s also experienced in helping new mums, thanks to her work in Children’s Centres over the last few years. But she’s also very interested in making things better for others, as she tells us here.
“I love anything maternity. A few years ago I started volunteering in my local Children’s Centre and as part of that I’ve done lots of training, including a 12 week breastfeeding course, which means I can give new moms really useful, practical, help.
“When my baby was about four months old, I found out about the MVP meetings. At first, I wasn’t really sure what it was all about but I went along anyway because it sounded interesting and I could take him along with me.
“I continued going, and found myself reading up on everything we talked about, and learning more and more. So when the chair position came up, I went for it.
“I really like the idea of being able to feed back into the system through the MVP. I love hearing people’s birth stories, and at the MVP meetings we don’t just get to talk about our maternity experiences, we can share important opinions with maternity professionals, and they listen. We’re working together to make things better for other women and families.
“Eventually, I want to go back to work, and I’d love to work in this area if I can, so working with the MVP is a good foot in the door. Having children, you sometimes feel like your brain has gone to mush, but this is helping me to stay challenged and feel like I’m really using my brain. I love listening to others, learning more, reading up on what we talk about at each meeting. It’s a chance to really be me, not just a mom!”
Want to get involved?
If you have personal experience of local maternity services, we welcome all “service user” voices and we aim to make all meetings accessible and child-friendly. Call Reshma at Gateway on 0121 456 7820 to find out about the next MVP event.
“I love that it’s giving women a voice!”
Hear from Chloe in her own words in this short video.
To celebrate the first Social Prescribing Day, we wanted to share a recent story from Healthy Futures, our social prescribing service.
Social Prescribing Day aims to highlight the importance and significance of social prescribing within healthcare. Created by the Social Prescribing Network, a collaboration of doctors, colleges and the NHS, it’s a chance for services like ours to share stories about a way of working that has become a social movement.
In just over two years, our Healthy Futures “Wellbeing Navigators” have worked with over 200 people in Birmingham to support them with social and other non-medical issues. People are usually referred into the service by their GP, and then we work with them to provide a range of tailored interventions.
Those interventions might be as simple as a cup of tea and a chat, or — more often — help applying for the benefits people are entitled to, help bidding for social housing, understanding and filling in forms, calling the utilities to sort out bills, travelling with people to appointments, finding social groups people might enjoy (and going with them, if needed), and signposting to other organisations and agencies. Sometimes, as Alia’s story below illustrates, our staff are the only support workers available to listen at a time of crisis.
How Ralph helped Alia and her son to put down roots
When Wellbeing Navigator Ralph first met Alia* last summer, she and her young disabled son were living in a homeless centre after moving away from her abusive partner. Socially, they were very isolated, with no local family and few friends. Alia cared for her son 24/7 with very little respite, and told Ralph she was suffering from depression and anxiety.
Alia’s risks were recorded as:
caring responsibilities (disabled son)
Alia told Ralph she was looking for social activities so that she and her son, nearly two, could make some friends – important not just for her, but for her son’s development. And of course, she was keen to move out of the homeless centre. With support from Shelter, she had applied to move into social housing and was waiting for a decision.
Ralph was in the office one evening when he received a frantic call from Alia: her housing application had been rejected. Extremely upset, she hadn’t been able to speak to anyone. They talked and Ralph changed his plans so he could meet her the next day.
The following day, Ralph found Alia feeling very low. He explained that the next step would be to appeal against the decision, then called Shelter to arrange a visit from her support worker for the following week. Worried about her mental and physical health, he asked her to consider going to her GP. When he left, he told the Centre staff his concerns and told Alia that he would be available over the weekend if she needed him. (Later, Alia admitted to Ralph just how ill she’d felt that day, and that she had been considering self-harm, but that his friendly advice encouraged her to seek help.)
Since then, things have started to look up. Alia’s Shelter support worker and their legal team made the appeal against the social housing decision, and Ralph helped to arrange an Occupational Therapy assessment for her son as part of that appeal.
Ralph also found lots of activities for them to get out and meet people. Alia’s son likes animals, so he told them about the local nature centre and farms, which they have since enjoyed visiting. He referred them to their local Children’s Centre, and a support team helped them access free nursery care and activities. Alia’s GP surgery offered her a stress management course which she took up and really enjoyed. And, although Alia had originally refused Home-Start support, she changed her mind and began to receive support from volunteers providing temporary at-home respite.
Three months on, Ralph was overjoyed when Alia called to say the appeal had been successful. Now, they live in their own temporary accommodation. Alia’s making new friends and her son’s doing really well at nursery. They still have a long road ahead, but they’re happier and healthier – thanks to Ralph, Shelter, and her new support networks.
Unfortunately, we’ve had to stop taking referrals to our social prescribing service Healthy Futures again, leaving dozens of vulnerable people in Birmingham without support. Right now, we simply don’t have the money to continue.
Back in February, we announced that we would be continuing to fund the service using our own savings. At the time, we knew there was a risk we wouldn’t secure external funding before the allocated reserves ran out. Now, sadly, that risk has become a reality. We’ve had to stop taking referrals and our Wellbeing Navigators have spent the last two months winding down people’s support.
How Healthy Futures works
We have two Healthy Futures outreach workers, or Wellbeing Navigators: Ralph and Margaret, who work with people who’ve been referred by their GP. We work in partnership with SDSMyHealthcare, a consortium of GPs in Birmingham, and receive referrals from them and other organisations in the area.
Put bluntly, Healthy Futures clients are usually “frequent flyers” at their GP surgery — but it’s not medical help they need, it’s social.
When someone is referred into the service, Ralph or Margaret will go out to visit them and find out what they need.
Issues they support people with include housing (many are in hostels or temporary accommodation), financial hardship (many are entitled to benefits but are not receiving them, or have difficulty managing them), alcohol or substance misuse, and ongoing mental health issues like anxiety and depression. Some just need a bit of direction to help them start forming their own friendships and networks. The support given is practical, emotional and, importantly, builds people’s independence.
Here are some examples of the feedback we’ve had from Healthy Futures clients in just the last six weeks.
Judith* is in her 50s and unemployed:
I feel more positive and less confused about my benefits now, thanks for calling them today for me, and helping to sort it and update things with them. I feel like I have my mojo back. I think walking more is helping me too, and your support.
James* is in his 40s and has seen a few support workers over the years. He said to Ralph:
I have had a few issues and problems with support workers in the past, even still these days, but not with you. You don’t judge me, you listen to me, and I know how much you really want to help me. I can see that you really care.
Laura* is a mum in her 30s. She works full time but she and her child have been living in temporary accommodation:
I will look forward to my appointment with [the outreach worker] at Anawim [women’s centre], thanks so much for referring me to her, and telling me more about the support they provide. I am sure they will be of great help to me, like you. I am feeling upbeat.
Cath* is in her 50s and currently unable to work due to her depression:
Thanks so much, I really do feel the need to move on in my life now to look at volunteering and work, either temporary or otherwise. It’s thanks to you I feel like that. You have been so patient and supportive.
We know there is huge demand for the service; since February we have a steady stream of referrals from GPs.
And we know that the service works: an official study carried out in 2017 found that Healthy Futures is a cost-effective way to reduce the time people spend with their GP (when a social intervention is more appropriate), and significantly increases people’s self-reliance and self-care.
But, despite searching and applying for funding from many sources, we haven’t yet been able to secure any external funding and, unfortunately, we just can’t continue under our own steam.
A country in crisis?
Over the last year we’ve applied for many bids and tenders, and there are more in the pipeline, but haven’t won any funding for Healthy Futures so far. Occasionally we have been pipped to the post by larger organisations or partnerships whose reputation will allow them to reach more people — dare we say, it seems that quantity is sometimes given priority over quality.
We’ve even looked at crowdfunding — asking members of the public to donate — but really, should this be necessary?
Of course we understand that not every service can be funded, but it’s clear that more and more money is being needed across the third sector. Feedback tells us that every social fund we apply for is massively oversubscribed; for example, the Challenge Fund told us they had received more than twice as many applications as they’d been expecting. Building Connections told us they had a £9m budget but if they had funded everyone who applied they would have needed a £191m budget.
It feels like the country is in crisis when it comes to social support. It’s frustrating to watch and, believe us, even more frustrating to experience.
Watch the video
Watch the video below to find out how Margaret recently helped someone who had had to move house because of ill health, but found herself socially isolated in an area she didn’t know.
Recently, we have decided to take a bit of a risk and relaunch a service, despite a lack of external funding. Using our own reserves, we have relaunched Healthy Futures, a programme supporting socially isolated people. In partnership with MyHealthcare, we are now taking referrals from GPs across South Birmingham.
Why? Because we know this service is desperately needed in Birmingham… and we know it works.
We know that Healthy Futures works because we ran a pilot programme in 2016. GPs and surgeries referred people who were socially isolated – for a variety of reasons – and Gateway’s para-professional staff and volunteer befrienders supported them. It was found to be a cost-effective way to reduce the time people spent with their GP (when a social intervention was more appropriate), as well as significantly increasing people’s self-reliance and self-care.
Importantly, we learned a number of things from the pilot, which means we know what works and what doesn’t. This has allowed us to design and relaunch a streamlined version of the service, despite limited resources.
For example, we were surprised at the age of many of the people we worked with in the pilot – we had been expecting to see a lot of elderly people, but in fact 70% of the people we saw were under 65. As well as people who wanted support to manage long term conditions, we saw a lot of alcohol dependency, anxiety and depression, accommodation issues and financial hardship.
It meant that every person we worked with initially needed intensive support from a para-professional Practice Navigator, rather than lower-level support from a Volunteer Befriender.
So, to start with, all staff working on Healthy Futures are para-professional Wellbeing Navigators. We hope that once the programme has been running for a while – depending on future income – we can introduce volunteer befrienders again, to allow people who no longer need intensive help to continue receiving a phased-down, lower level of support.
And, of course, we are continuing to apply for funding, so we’ve designed the new Healthy Futures in a way that will allow us to build capacity quickly and efficiently once we secure outside investment. With a little help, we could be supporting hundreds of socially isolated people across a wider area in no time.
Healthy Futures was designed, and is being relaunched, 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 Healthy Futures.
Social isolation is a big issue for people of all ages, but research shows that it’s a particular problem for those who live in cities, older people and people with a long term health condition. That’s why having more opportunities to get together with others for a cuppa and a chat is really important.
A great example of a group supporting those at risk of social isolation is the Patient Health Forum. It’s for anyone in South Birmingham who has a long term health condition, and its members include people with everything from asthma to arthritis, Alzheimers and anxiety.
Although it can be useful for people to talk about their health condition during the meetings (and, in fact, the meetings are funded by South Birmingham CCG in return for feedback about the health services they use), the biggest benefit that the Patient Health Forum brings is the opportunity to meet and talk to others.
Our first session of the year took place a couple of weeks ago in Stirchley, and 31 attendees enjoyed a buffet lunch, a talk from Wayne on the Five Ways to Wellbeing, and entertainment from a Michael Bublé tribute act. Some, like Irene, even had a sing and a dance!
Committee member Pauline Hartley said, “It matters not what health condition people have – but how they can be helped to deal with the isolation, the social problems and the access to services that will help them. Our members constantly ask if the group will stay open because it so important to them and even sometimes is the only place they go to for social interaction.”
Although the Forum had already been running for a number of years, Gateway became involved in 2014 to help facilitate the meetings. Since then, we’ve been supporting the committee with the general running and budgeting of the group, organising the venue, transport and refreshments, bringing in speakers and entertainment, and sharing our knowledge and contacts. And although funding for the group has dipped recently – meaning we’ve had to go from monthly to quarterly sessions – we’ve seen numbers continue to grow. We’re particularly pleased that older people and carers are coming along because, according to research evidence:
In the UK, 17% of older people are in contact with family, friends and neighbours less than once a week, and 11% in contact less than once a month.
Loneliness is common in carers, especially resident carers. Other groups at risk of loneliness include older married women, older people who live with married children, those living in sheltered housing or residential care and older people who emigrated from other countries (especially those who do not speak the language well).
Loneliness seems to be less prevalent in those rural areas where a sense or community still remains than it is in more densely populated urban areas.
Lack of money limits the opportunities for overcoming loneliness: those on lower incomes are more prone to feelings of loneliness than those who are better off.
Membership of the Patient Health Forum is open to anyone who lives in South Birmingham, or is registered with a South Birmingham GP, and lives with a long term health condition. If you’d like to get involved, give us a call on 0121 456 7820 and ask to speak to someone about the Patient Health Forum.
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.
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:
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.
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.
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.
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 (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.
Forming strong partnerships with other local organisations is a very important part of Gateway’s work.
By sharing resources we are able to provide a more cost-effective, joined-up service – both as an individual organisation and as a sector. In an environment where budgets are shrinking, effective partnerships mean less duplication of work, which saves vital resources. It also means less “pushing from pillar to post” for clients, easier access to services and one point of contact to help someone navigate through services.
People rarely have one issue they need support with, so all our services have always worked in partnership with other organisations, either formally or informally. Over the last couple of years, however, partnership work has become even more important to the Health Trainer service as they have started working with broader groups of people, reaching out to communities who might not otherwise be able to access the service.
Health Trainers at The Signing Tree
One partnership that we’ve set up relatively recently is with BID Services, a charity supporting people who are deaf, hard of hearing, visually impaired or have a dual sensory loss. BID Services runs a social enterprise called the Signing Tree, based at the Deaf Cultural Centre in Ladywood – and it’s here we now run a Health Trainer service with interpreters (one provided by Gateway, and the other by BID).
Gateway Health Trainer Richard, pictured, says, “I visit the Signing Tree once a month, where I set up a classroom together with two interpreters. If it wasn’t for them, the communication barrier would definitely be a sticking point – I don’t think many of the people I see at the Signing Tree would contact the Health Trainer service otherwise. The interpreters are brilliant – they actually get involved and help me to provide an informative yet fun session each month. We have 15 clients per session and it’s very popular – in fact last time, I had to turn four people away.”
Bhavana Jamin, Specialist Enablement Co-ordinator at BID, says, “This has been a positive experience for all the deaf people involved. The trainers make the pace of the sessions meet the clients’ needs and by this the clients became confident to participate and engage with the sessions. They gain access to information about their health and wellbeing that they may not be able to access from other areas, so they now have some knowledge of healthy food choices, and the information is presented visually.
“Word of mouth has been used to promote these sessions within the community and I now have a waiting list of people who would also like training in the future. So I look forward to working with Gateway again in the future.”
Strong partnerships allow us to do several things, especially when clients have more complex needs. They enable us to have an up-to-date knowledge of the issues that people in Birmingham are facing, so we can adapt the services we offer and respond to need as quickly and usefully as possible. It means more opportunity to help clients prioritise their needs, and to deal with issues in a way that suits the individual, by taking the services to them.
As well as the Signing Tree, we now also deliver services in partnership with a number of other organisations, including Jobcentres in South Birmingham, and Cerebral Palsy Midlands, based in Harborne.
If you would like to know more about working with Gateway, whether that’s to work with our Health Trainer service, or any other Gateway services, for example the Pregnancy Outreach Workers Service, do contact us – we’d be very pleased to hear from you.
“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, 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.
When social services become involved to protect an unborn child, who is there for mum?
Gateway Pregnancy Outreach Workers Service (POWS) is a unique service in this respect. Because, while social services and midwives – quite rightly – are focusing on the child, our focus is on mum. As far as we know, we’re the only organisation that can provide this intensive level of support to women during and after pregnancy.
The women POWS work with are referred to the service for many reasons. Many have issues with unsuitable accommodation, financial difficulties, problems with substance misuse, or risky relationships. All are vulnerable. Some have had children removed from them in the past, which means that their current pregnancy will be under increased scrutiny, bringing added pressures to an already difficult situation.
While this scrutiny and focus on the unborn child is necessary, it can often leave mum feeling bereft and unsupported, with her original needs unmet. And if she 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 a parent needs (and that social workers and family courts will approve of) can be virtually impossible.
This is where POWS support is invaluable. Not only does a POW work one-to-one with mum to come up with an action plan, helping her to tackle issues in a methodical way, but she will also liaise with social workers and other services to ensure that they are aware of the changes being made.
In the video below, you can hear from Chloe*, who tells us about the support her POW Shazia gave to her, and how it changed the outcome of her social services intervention.
Shazia says, “Chloe was proactive – she knew the dangers and wanted to change – but she needed emotional and practical support to actually get stuff done. I was able to be there for her throughout the pregnancy, not just at the end of the phone, but with practical advice – signposting her to other services, going with her to appointments, writing letters on her behalf and making sure social services knew she was making progress.”
Just having someone available to talk to is really important, so POWS work together to make sure all their clients get constant access to support. Shazia works part time, so she introduced Chloe to another POW she could contact, and made sure she had the number for the office too. If anything happened and Shazia wasn’t around, someone else would be.
Shazia continues, “There were times when Chloe doubted herself and times when she struggled to understand what she needed to do, but as time went on she started to believe in herself and that’s when she really started to make changes. She was keen to prove herself – even requesting things like additional drug tests – and just generally needing me to do things for her less and less. A nice example is when I rang her to remind her she needed to register the baby’s birth – and she’d already done it!”
As you’ll see from the video, Chloe is still making progress. She’s a lot happier now, and a lot more confident in herself. In fact, we found out this week that she has been given unsupervised access to her other two children on a regular basis.
Even when a mum doesn’t get the outcome she wishes for, and a child is removed, POWS are able to continue supporting her for up to eight weeks. However, it frustrates us that we can only work with her for such a short time. A mother is extremely vulnerable – and likely to fall into old patterns – during this period, so continued practical and emotional support and guidance is absolutely vital at this time.
Finally: the sort of support offered by POWS isn’t just something that would be “nice to have” for hundreds of families – it also saves a surprising amount of money. The approximate cost of taking a child into care for nine months runs into tens of thousands of pounds, but the approximate cost of the combined preventative services accessed by a vulnerable mum over nine months is less than a quarter of that.