Category: Closing the Gap

Innovative services and provision that bridge the gap between statutory services and the users they are trying to reach

How have I helped you today?

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

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

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

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

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

 

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Ken, who’s reached week 9 of our Pre Diabetes Programme

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

 

 

 

 

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June, a recent referral into the Healthy Futures Service

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

 

 

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Mohammed, Pre Diabetes Programme

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

 

 

 

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Xiaoli, client of the Pregnancy Outreach Worker Service

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

 

 

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Jody (left) and her Pregnancy Outreach Worker, Sarah

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

 

 

 

 

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

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

 

 

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

 

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

 

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

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

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

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

Clinical study shows that POWS improve maternal mental health

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

mum-and-baby

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

The study

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

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

The findings

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

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

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

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

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

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

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

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

Gaps in service leave women in danger

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

 

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

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

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

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

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

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

Not pregnant enough

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

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

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

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

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

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

We asked again, where is she supposed to go?

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

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

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

That evening, she went home to her partner.

What’s the answer?

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

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

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

Health Trainers go above and beyond

When you hear the term Health Trainer, you might think of the work they do to support people to diet and get down to the gym.

Health Trainers Josh and WayneBut a Health Trainer’s work isn’t all about healthy eating and exercise. Health Trainers, like all of our services, support the whole person.

We know that people who are in debt or worrying about their housing are less likely to stop smoking or to start eating well. Once someone feels like their life is on a more even keel, however, they are more likely to become physically healthier.

So, for us, it’s important that Health Trainers look at all the issues that their clients face and support them with any changes they want to make. This might mean signposting someone to another agency for help with substance misuse, finances, domestic abuse or housing; or it might mean giving them the opportunity to find – and the confidence to join – community groups or classes.

Health Trainers, like all Gateway’s staff, are trained extensively to equip clients with the latest information on, for example, changes to the benefits system and other social issues that could affect them.

They’re also experts in behavioural change, and the principles of behaviour change apply across the board – so seeing a Health Trainer, and learning how to recognise patterns of unhelpful behaviour, can have a positive impact on all areas of a person’s life.

And, of course, being part of Gateway means that Health Trainers have access to a huge knowledge base and network. So although they can’t be experts in everything, they are experts in finding someone who is!

In some cases Health Trainers get involved with organising groups, classes and events themselves. Just this week we received a letter from Pauline at the Long Term Conditions group that we help to run:

“…we would not have been able to continue with the group meetings without Gateway’s help. All the members of our small committee have long term health conditions and, as each year passes, we depend more and more on Gateway to expertly manage our budget, make all the arrangements for our speakers, catering and venue, arrange transport for those who need it and generally and enthusiastically make tea, answer questions, assist the less able with their lunch and much more………and all with a smile. They also help us to complete the CCG forms and signpost us to services that can help with specific problems…..as well as encouraging those who are able to go to the meetings that enable us to contribute our opinions (and needs) on health and social services matters.”

Wellbeing Advisor Scheme

One way in which we are currently building on the work that Health Trainers do, and evolving the service, is via a new Wellbeing Advisor scheme.

This is a pilot we set up with a group of nine Northfield Practices within Cross City CCG who form the Northfield Alliance.

All the practices have a Health Trainer assigned to them, so they’re already familiar with the service, but one practice and GP in particular, Dr Peter Arora from Jiggins Lane Surgery, wanted a service that also met the needs of patients who were presenting with an increasing range of social issues, including debt, caring responsibilities, housing problems and social isolation.

So we met with Dr Arora and our Health Trainer Commissioner, Elaine George, to agree how we might be able to support clients, and what sort of referral pathway would work best.

Now, GPs and other practice staff at Northfield Alliance practices directly refer to Health Trainers as before, but the referral form lists any additional social issues and Gateway effectively takes responsibility for that client and any interaction or engagement they have with other agencies.

walkingOur main partner in the scheme is Citizens Advice Bureau (CAB) and in agreeing to be referred to the scheme, patients agree to a referral to both Health Trainers and CAB. Obviously for some people, their social issue takes precedence and in those cases we refer them to CAB initially, but then follow up at a later date to establish if they are at the point at which they’d like to work with a Health Trainer for lifestyle support.

While CAB are the main partner, Health Trainers also direct people to other agencies, such as our own Befriending Service, and of course through setting up group activities themselves such as EXTEND classes, Long Term Conditions groups, and walking groups.

Being able to support the whole person, and provide behaviour change tools to influence all aspects of their life, from health, to wellbeing via finance and housing means, we believe, more sustainable results for that person, less pressure on services such as GP, Social Services, DWP etc and a happier, healthier population.

Sharing our knowledge with the Child Poverty Commission

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

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

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

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

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

POWs’ experiences of Child Poverty

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

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

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

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

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

Celina’s Story

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

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

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

*name has been changed

New project reveals Birmingham’s hidden extremes

PLEASE NOTE: this story is from 2015 and the Gateway Healthy Futures service ended in 2016. If you have been affected by the issues raised in this story, please click here to see a list of links and phone numbers that might be able to help.

Our new service, Gateway Healthy Futures was launched recently and I must admit that the first few weeks have brought some surprises.

What is Gateway Healthy Futures?

We have known for a long time that some patients repeatedly visit their GP (or even A&E) with issues that are not clinical but social, and therefore could be much better managed using a different set of skills.

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The Gateway Healthy Futures team

Using our many years of experience built up from supporting other groups of people in this way, we came up with a solution: Gateway Healthy Futures, a programme of intervention-based care into which GPs can refer patients. Some would then benefit from having regular meetings with a Befriender, and the more complex clients would work with a Practice Navigator: an experienced paraprofessional.

Thanks to a partnership with My Healthcare, we were finally able to pilot the approach and launched Gateway Healthy Futures in October. We are now very happy to be receiving referrals.

However, the people we are working with are surprising us in terms of need.

Extreme

After long conversations with GPs and CCGs we had anticipated clients with a range of complexities – some low in terms of need and some higher – but in practice we are finding that ALL our referrals so far have high level of need, and they are all complex cases. All require a Practice Navigator rather than a Befriender. Many have serious mental health issues and, it feels, are close to breaking point.

despair-513530_1920Of course, we expected social isolation to be a key factor and we also knew to expect instances of poor mental health. But some aspects are not in line with our predictions. We thought we’d be working with those aged 70+ but the demographic is much younger; most are in their 50s with our youngest referral being just 35. We also anticipated the client group would be largely male but in fact it’s a fairly even split.

We’ve been providing outreach support to people with intensive needs for years. We work with some of the most vulnerable people in the city. Between them our staff team, which includes two former Pregnancy Outreach Workers, have experienced pretty much all the issues we thought possible. But even so, what we are seeing now through this work is extreme.

In just six weeks our staff have begun working with people who haven’t eaten in days; people wrapped in blankets, too scared to turn on the heating; people who, just for a moment, barred the door because they didn’t want our staff to leave, as they hadn’t had social interaction in so long; and people who are having suicidal thoughts. Basically: people in crisis.

Our Practice Navigators are providing a new point of contact for these clients, giving them reassurance and a number to call when they need to talk. They’re also providing vital practical support, including helping people to learn to cook for themselves, to navigate the forms and systems that will give them the financial support they need, and (for those who can) to get out of the house a bit, as well as signposting them to specialist support. But, to be honest, it feels bleak.

But what about everyone else?

My concern isn’t the fact that we are having to deal with these patients – of course we are adapting; our staff are coping very well, and the feedback from patients so far is incredibly positive. In fact my overwhelming feeling is that it’s a good job we know about them, because we can help.

No, my main concern is: what about all those people who aren’t being referred?

We are only working with a fraction of the GPs in Birmingham. There are people like this – living alone, struggling to deal with everyday life – across the city and across the country. Who do they turn to?

And, even for the people we are able to work with, there are fewer services than ever that we can signpost them to for specialist help. If we can’t help, we will always know someone who can… but specialist services across the city have been cut and are pushed to the limit at the moment. We are signposting people to services who then tell us they have a waiting list of months.

Often people who are in dire need, like our clients, simply don’t know what help is available to them (which is why their natural instinct is to call their GP or the emergency services). We can help the small number of people we’re working with and give them the phone numbers and other resources they need – but, when Mental Health and Adult Social Care services are being reduced so severely, it feels like we’re fighting against a tide.

 

Gateway Food Bank

We are currently taking donations of tinned goods and baby items for the food and baby bank at Gateway. You can drop donations off at the Gateway offices, or give us a ring on 0121 456 7820 – if you’re local we can even collect.

You can find out more about donating to Gateway in the blog post called Why we are starting our Christmas collection early this year.

“I am here today because of you” – Bushra’s story

Bushra* was referred to the Gateway Pregnancy Outreach Workers Service when her life started unravelling and she didn’t know where to turn. In just a few months she had gone from being a college student, supported by friends and family, to being homeless with two mouths to feed and very little support.

Here, her Pregnancy Outreach Worker (POW) Jahanara tells us Bushra’s story, and we’ve also included some quotes from Bushra herself, because she logged her thoughts on our Impact Assessment App after every appointment.

 

“I am helping Bushra to build a new life without her family”

Case Study by Jahanara Begum, Pregnancy Outreach Worker.

 

Bushra had been referred to POWS because of social isolation and short term mental health issues.

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Bushra and her baby

When I first contacted her, she said she didn’t want me to meet her at home. So I first met Bushra at her GP surgery, where she was attending an antenatal class. She was stressed and tearful, and told me the story of her pregnancy.

Soon after arriving in the UK with a student visa, Bushra had met a man at a bus stop. They got chatting and, thinking that he came across as a very Islamic, “good” man, she gave him her number. Over the next few weeks they spoke on the phone and met once, at McDonalds. He told her he would like to marry her; that he had spoken to his family and they had agreed.

One evening he phoned and asked Bushra to go out and meet him in his car, which she did. It was only the third time they’d met, but he took her to a hotel, telling her it wouldn’t matter if they took their relationship further because they were going to get married.

Bushra believed him.

When Bushra found out she was pregnant, she phoned her boyfriend but he told her he wasn’t interested. Soon after that he changed his number and disappeared. She had never known his address, so she wasn’t able to find him.

Trapped

At our first meeting Bushra told me she just didn’t know what to do. She said her family would not accept her now that she was pregnant, and so it was impossible for her to go back to Pakistan. She told me her extended family are so strict that she was afraid for her life, and that of her unborn baby, if she was to return.

She was living with a family friend but she couldn’t stay there for much longer because, once her friend found out she was pregnant, she would probably tell her family. This was why she’d arranged to meet me at the doctors.

Bushra said her student visa would soon expire, which would make her an illegal immigrant, but she felt trapped. She couldn’t go back to Pakistan and had no money or recourse to public funds in the UK.

I am very stressed all the time but now that you’re going to support me, maybe things will get better. You have given me encouragement to think positive about my life.

The first thing we needed to do was to find out what support, if any, Bushra was entitled to. We went to a legal advice centre but they said she was not entitled to any legal aid, so I referred her to Asirt (Asylum Support and Immigration Resource Team) and the British Red Cross.

We went to British Red Cross together and they were very helpful. They made an appointment for Bushra at the Home Office and gave her food vouchers, and travel expenses to attend the appointment. They could only support her until her asylum application had been completed, because their funding is very limited, but advised that she should get support from NASS (National Asylum Support Service).

My family has found out I’m pregnant and they are sending me threatening email. My sister said I will not get away with getting pregnant.

By now, Bushra had moved in with another friend – although this friend had made it clear it was a temporary arrangement. Bushra attended the Home Office in Croydon and made an asylum application; however they did not apply for support for emergency accommodation or financial support because her friend had said she was willing to let her stay for another two weeks.

You have offered to get baby items from the Gateway baby bank, and a food bag. Although my friend provides me with food, I feel like a burden on her. I hate having to always ask her for money but I have no choice.

I contacted the migration helpline and got Bushra to speak to them via an interpreter and do an application over the phone for accommodation. I also gave her food, baby items, toiletries and a moses basket from Gateway’s baby bank.

Lonely

Bushra wasn’t happy staying at her friend’s property, and her friend made it very clear she wanted her to move out as soon as possible, but Bushra needed somewhere to stay while her application was processed. I spoke to the friend and she agreed to let her stay until she had the baby.

As soon as Bushra had the baby her friend asked her to move out. So I phoned the migration helpline again and explained the situation, and Bushra completed another emergency application over the phone. The Refugee Council rehoused her, on the same day, to accommodation where she will live until her application is processed. They are also providing her with some financial support and helping her with her rehousing application.

I do feel lonely here and miss my friend and her son, so please can you visit me regularly. I have lost my family forever but miss my mum so much. It’s been so long that I have not heard her voice. But what can I do, I just have to live with this reality.

I am still supporting Bushra. I occasionally give her food parcels and baby items, and recently I’ve been trying to get her to visit the local Children’s Centre to meet other mums.

I am grateful to you because you’re the one who directed me to the services that helped me, so I am here today because of you.

*not her real name

 

Gateway Food Bank

We are currently taking donations of tinned goods and baby items for the food and baby bank at Gateway. The bank is increasingly needed by clients of all our services, not just the Pregnancy Outreach Workers Service. You can drop donations off at the Gateway offices, or give us a ring on 0121 456 7820 – if you’re local we can even collect.

You can find out more about donating to Gateway in the blog post called Why we are starting our Christmas collection early this year.

Thank you.

Why we’re starting our Christmas collection early this year

hampers2It’s only November but we are already starting to ask for donations for our annual Christmas hampers.

Every year our Pregnancy Outreach Workers (POWS) put together hampers that include essentials – food and baby items – as well as a few extra treats that we hope will help families over the Christmas period. But this year, we’ve started collecting a bit earlier than usual.

To put it simply, this is because we are seeing an increased need for food parcels, foodbank vouchers, and money from our hardship fund.

foodbank2
Justine, who runs the POW service, said, “The amount of hardship money we’ve given out has increased steadily over the last few months. We have also been giving out more vouchers for the Trussell Food Banks this year, in addition to the food that we give out ourselves.”

Traditionally, our POW service has had the largest need for food parcels, but over the last year we have seen an increase in need across all our services, not just POWS. Health Trainers are reporting that more and more of their clients have been in need of basic essentials, and have needed to access our food bank and hardship funds.

These statements were recently made by Health Trainer clients on our Impact Assessment App:

It would be easier for me to get one bus [to the swimming pool, instead of two], because my benefits are being cut back by £120 fortnightly. I have to budget my money carefully. They are stopping my DLA and may put me on PIP. I don’t know how much money I will be getting.

and

My living conditions are quite bad and I don’t have much money to buy healthy food.

This one is from a Lighten Up client:

I had to give up on the classes, as when money is hard its the last thing you think about.

And worryingly, we’ve found that many of the older people we’ve met through our newest project, Healthy Futures, have significant financial hardship issues too. Despite only having a handful of referrals to date, we can already see that there will be a need to provide food parcels and hardship payments for many of the people who are being referred to us. (Of course this will be as well as helping them to access all the support they are entitled to and signposting them to other agencies who can help.)

How can you help?

For our food bank and baby bank, we are in need of everyday, non-perishable food items and baby essentials. For our Christmas hampers, we like to include some little treats, like toys for baby and sweets or ‘smellies’ for mum. If you think you could donate, you can bring items to us at the Gateway offices, or give us a call on 0121 456 7820 and we can arrange to collect.

  • Tins – beans, soup, custard, peas, beans, fish (tuna, mackerel, pilchards) etc.
  • Rice
  • Flour
  • Herbs and spices
  • Lentils
  • Pasta
  • Pasta sauces/jars of sauce
  • Biscuits
  • Some sweets and chocolate would be nice
  • Clothes – up to twelve months as we have little space to hold them
  • Sanitary towels – the larger “maxi pad” type is better for new mums
  • Soap
  • Toothpaste
  • ‘Smellies’ for mum
  • Shampoo – unopened
  • Body lotion – unopened
  • Newborn nappies
  • Baby wipes
  • Cotton wool
  • Baby bath wash
  • Baby lotion
  • Jigsaw puzzles
  • Books

We also have an Amazon Wishlist that contains some of the things we would like. (However, please be aware that it’s often cheaper to buy nappies, food and baby essentials in the supermarket!)

A new avenue for Gateway

mini_docWe’re very pleased to announce that we’ll be delivering a new piece of work in the next couple of months and, better still, it’s tackling a subject we’ve been investigating for a while: admissions avoidance.

The pilot project, part of My Healthcare, will be helping to tackle the thorny issue of patients repeatedly seeing their GP or going to A&E with issues that could be much better managed using social interventions.

The problem

Many of the GPs we know well tell us there is a small group of patients they see regularly for issues that don’t actually require medical support. This same group are also more likely to present at A&E.

For these patients, there is a clear need for a different kind of intervention; providing them with a service that addresses their needs directly and giving them the type of support they need.

The vast majority of CCG delivery plans, not just in Birmingham but across the country, include a need to reduce unnecessary admissions and free up GP time. So admissions avoidance is a national priority.

The solution

This is not about stopping people who genuinely need medical assistance from spending time with their GP or in hospital. This is about working with people who have largely social issues, or are mismanaging long term conditions.

The project that Gateway will be running includes two approaches, both of which have already been tried and tested – and proven to work – as part of Gateway’s current services:

1) Providing paraprofessional support for those with intensive needs

A proportion of the current “unnecessary” admissions are people with long term medical problems (such as mental health issues, or poorly-managed asthma or diabetes). Under the pilot scheme, the GP will refer them to Gateway where they’ll see a paraprofessional outreach worker. This will be someone who is experienced in working with vulnerable people, or those with complex needs. They will build up a supportive relationship with the client, addressing their needs directly and helping them to access a range of services that act as an alternative.

We know from running our Health Trainers and Pregnancy Outreach Services that this type of one-to-one support works; it builds resilience and can often start a “chain reaction” of beneficial lifestyle changes.

2) Providing befriender support for those with lower level needs

Many of the patients who are considered “unnecessary admissions” are lonely or socially isolated. They don’t need medical intervention but would benefit from social intervention and so, under the pilot scheme, the GP can refer them to Gateway for support. For this person, a befriender would be ideal.

Our volunteer befrienders provide emotional support and give the people they work with the time and space to talk. They can reintroduce people to their community and provide a bit of extra support going out. Again, we know that this type of help really works, because our experience – and our clients – tell us.

 

We know that intervention services have already been tested in other areas of the country and seem to work. But they tend to have a medical focus – community pharmacies, for example, or virtual wards – which we don’t believe is necessarily needed in these sorts of situations. It also makes them expensive.

If we can give patients with social needs an alternative to their GP, and resolve issues by giving them the time and type of attention they need, then GPs will get to spend valuable time with those who need their medical skills, and the NHS saves money.

“My Healthcare”

Gateway’s new service will be part of the My Healthcare Prime Minister’s Challenge Fund pilot, an initiative developed by 23 Birmingham South Central CCG General Practices.

Sajid-Javid-visit
Some of the My Healthcare team with Sajid Javid MP. (Photo: Central Midlands CSU / My Healthcare)
Earlier this year the group bid for, and won, funding from the Prime Minister’s Challenge Fund to set up a programme that aims to improve services with a range of innovations. These include the provision of additional appointment times, the adoption of new digital tools and applications, and improved partnerships and service integration.

We’re really pleased to be involved in the My Healthcare project. The sort of service we’ll be providing, based on our years of experience, is something that we’ve been talking to CCGs about for a long time. My Healthcare feels like the perfect vehicle within which to try it out.

The stories behind the stats

When we talk about the people our Pregnancy Outreach Workers (POWs) work with, it’s often in terms of their “risk factors”; the risks associated with a poor pregnancy. These are the issues the POWS are supporting clients to deal with, and these are the outcomes upon which the service is measured.

But the risk factors on their own don’t tell the whole story. So in this blog post we’re going to look at one of the real life stories behind the data.

rachael-harris
Rachael, Amy’s Pregnancy Outreach Worker

In the file for Amy*, a POW client, the risk factors that Gateway POW Rachael (pictured) addressed were:

  • homelessness
  • historic mental health issues
  • safeguarding
  • historic drug and alcohol use

So what were Amy’s actual circumstances, and how did Rachael support her to reduce all of these risks?

We’ve also included some quotes from Amy herself, because she logged her thoughts on our Impact Assessment App after every appointment.

 

“I helped Amy and Carl to build a new life together”

Case Study by Rachael Harris, Pregnancy Outreach Worker

When Amy* was first referred to me, I spent two weeks leaving voicemails and texts to no avail. Eventually her midwife passed on my details and we arranged to meet at the hostel where she and her partner Carl* were living.

At the visit, Amy explained that she and Carl had been homeless – in Carl’s case, for 13 years. After being in a relationship for two years, they’d decided to get into a hostel so that they could start building a life together. Then Amy discovered she was pregnant.

coupleThe hostel where I met them for that first visit mainly houses men who have drug and alcohol addictions, and Amy was the only woman there. Both Amy and Carl were clearly finding it a very stressful environment.

They told me they wanted to build a future for their family, so during that visit I supported them to complete a housing application. They didn’t have ID so I told them about the CitizenCard. I also booked an appointment at the Jobcentre for them to have a benefits check.

Amy told me she pawns her phone every couple of weeks to buy essentials, which is why I couldn’t get hold of her when she was first referred. She told me she wasn’t eating much, and that the only food they had were some vegetables that would soon go off, so I arranged to bring a food parcel the following day.

Over the next two weeks I wrote a supporting letter for the homeless team, helped the couple to apply for CitizenCards, and referred them to the local children’s centre. I also liaised with the midwife who’d referred Amy in the first place, as well as a specialist mental health midwife. Between us we decided to initiate a CAF, particularly because of Carl’s methadone and alcohol use. The couple agreed this would be helpful for them.

By week nine, Amy and Carl were becoming very down about the lack of progress with housing. Carl explained he found it difficult to live in a place surrounded by so many triggers for alcohol. Amy was finding it hard to chase up the housing application as she rarely had phone credit, which she found stressful. Money was being taken out of their benefits for loans and fines before they received it so, after rent and bills, there was very little left for food.

I did what I could by writing a supporting letter about the hostel conditions, giving them vouchers for a local foodbank, and bringing baby clothes from Gateway’s own baby bank. We also talked about the idea of breastfeeding when baby arrives. Amy was pleased, saying that the idea of being a mother was starting to feel more real.

“You brought me a moses basket and baby clothing and nappies. I’m so happy because I would definitely not be able to buy these things and I was worrying about it.”

Three months after initiating the housing application, it was still in progress. Social services were now involved, as midwives had expressed concerns about accommodation and the couple’s history of addiction and rough sleeping.

“I just want out of this horrible hostel. I’m annoyed I have to see a drug and alcohol specialist midwife, as I haven’t had a drink since December and not touched cannabis since becoming pregnant. I don’t intend on ever going back to my old lifestyle. I feel like I’m being treated unfairly by my midwife.”

A child protection conference was arranged.

Today we spoke about the child protection conference and you said you will come with me for support. Thank you.

Eventually, during the child protection meeting, which lasted five hours and involved many agencies, the couple were found temporary accommodation in a hotel. They moved that evening.

You came to see me today in [the hotel]. There is only me and one other pregnant girl living here so far and it’s like luxury.

Amy gave birth about six weeks later and the family moved to a two bedroom house shortly after that. Baby is doing well and Amy is breastfeeding. I helped her to apply for Child Benefit, Healthy Start vouchers and welfare provision, and referred her to a family worker at the local children’s centre for ongoing support.

Baby has remained on the child protection plan, but Amy and Carl have been praised for their engagement and the way they’ve worked together to turn their lives around.

*names have been changed