Category: Service Provision

Services devised, developed and run to fulfill specific needs.

pinprick blood sugar test

Pre-Diabetes results show impressive retention rates and life-changing outcomes

Pre-diabetes course completers with their certificatesAs we finish the last few Pre-Diabetes courses we’ve been running, results are starting to come in from the most recent participants. And – as with previous course attendees – we’re really proud of their results!

Since the pilot scheme in October 2015, which led to the programme being rolled out across the country, hundreds of people across Birmingham and Solihull have completed a Gateway Pre-Diabetes course.

So how does Gateway compare with national Pre-Diabetes programme delivery?

Really well, as it turns out!

Our conversion rate – that is, the number of people referred to us who actually started a course – is 68%. That’s nearly twice as high as the national average of 37.5%*.

Why? We think more people make a start with Gateway because we work closely with GPs, so they feel able to recommend us personally. Once someone is referred, as well as getting leaflets from their GP, they’ll also get a call from us to explain exactly what the course is about, and what’s in it for them.

Retention rate is one of the main measurements of success used by the National Diabetes Prevention Programme and, when the national programme was rolled out, the expected retention rate (from registration to completion) was 20%**. Ours is 78%.

Maypole Methodist Church Group made mango and avocado salsaOf the 858 people who started, 711 (83%) attended most of the sessions, and 665 people (78%) completed the course.

Why? Again, we think this is down to the personal touch. Attendees meet in person, in small groups led by an enthusiastic tutor, and the course has many interactive elements. Like all of Gateway’s services, our Pre-Diabetes course is client-led; we give people the facts and tools they need, take the time to find out more about their personal circumstances, and support them to find an approach that will work for them in the longer term.

The course has 13 sessions, but these are spread over seven months because research shows that a long term sustained approach is more likely to achieve behaviour change.

Kings Norton Park walking group
In 2016, people in the Kings Norton groups decided they’d like to get active by going for walks together, so that’s what they did! Thanks to Friends of Kings Norton Park for the photo.

Social interaction, too, is a big part of the Gateway model. We know that when people with similar conditions get together and start talking about their experiences, they receive extra benefits that they wouldn’t get from making changes on their own. They are happier to talk about things like weight loss and physical exercise without feeling judged, and they inspire each other.

We’ve seen people who meet on the course start their own walking groups, share healthy recipes and exercise tips, and start good habits that spread throughout whole families!

Another key indicator of success for a pre-diabetes programme is weight loss, and we found that 46% of our attendees had lost weight by the end of the course, with 45% of those who lost weight losing more than 5% of their total body weight.

Finally, the most obvious measurement is the HbA1c reduction. Of the readings we’ve had back to date, 76% have shown a reduction, and 64% of those who reduced are no longer at risk of diabetes.

The Gateway Pre-Diabetes course is a great example of the Gateway service model. We focus on where the need is, and use our knowledge and networks to recruit not just the right number of people, but the people who need us. We use a data-driven approach to explore ways of delivering the service and we use outcomes based on individuals’ needs which don’t just get us the results that commissioners want, but improve satisfaction and retention rates.

Saving money for the NHS

Pre-diabetes courses are essential to save money for the NHS over the coming years by preventing what is, in fact, a really costly condition.

Annual diabetes outpatient costs, which include the cost of medications and monitoring supplies, are estimated at between £300 and £370 per patient. What’s more, the cost of prescribing medication for complications of diabetes is around three to four times the cost of prescribing diabetes medication. Annual inpatient care, to treat short and long term complications of diabetes, is estimated at between £1,800 and £2,500 per patient***.

Let’s use the example of a man who becomes diabetic at 60. In Birmingham, he is likely to live to 77, so he could have 17 diabetic years ahead of him. 17 x £300=£5,100. And that’s at a minimum – if his condition is poorly managed or he develops complications, the costs could rocket to over £20,000.

The cost of our intervention is as little as £270 per head, and that’s a one-off cost.

Sure, this social model has a slightly higher cost than one based on remote consultations, thanks to things like room hire, but we think it’s worth it, because it clearly brings better results. It also brings added value in the form of qualitative savings like the extra confidence and ability to engage in more social and physical activity.

It’s a tried and tested method, and it works.

*From https://www.england.nhs.uk/diabetes/diabetes-prevention/roll-out-of-the-programme/
**From https://www.england.nhs.uk/wp-content/uploads/2016/08/impact-assessment-ndpp.pdf [pdf]
***Source: a 2012 report from the London School of Economics, via https://www.diabetes.co.uk/cost-of-diabetes.html (Diabetes.co.uk – the global diabetes community).

Making voices heard: the Maternity Voices Partnership

Since Gateway began in 2006, our tag line has been “Changing Lives, Changing Services”.

To change services, we have to play an influencing and sometimes challenging role, sharing evidence of the need for change. That’s why we have always seen it as part of our responsibility to gather views from service users, ensuring that what they say is heard by decision-makers and other people of influence.

And that’s why we’re delighted to announce that Gateway will be providing Birmingham and Solihull’s Maternity Voices Partnership.

A Maternity Voices Partnership (MVP) is a team of people who work together to review and contribute to the development of their Local Maternity System (LMS). Gateway will be bringing together regular panels of service users (people with experience of maternity services, and their families) and service delivery representatives (like commissioners, midwives and doctors) to ensure that a wide range of voices are heard.

Why Gateway? Well, having run the Pregnancy Outreach Workers Service (POWS) for over a decade, we’re ideally placed to deliver – if you’ll excuse the pun – the Maternity Voices work. We know that there is often a lack of awareness of services in the places where those services are needed the most, so we’re particularly keen to be part of a national programme that wants to build better relationships with hard-to-reach communities, and hear from as many service users, from as many different backgrounds, as possible.

Through POWS, we have already established strong connections within those communities that are known to have a poor take-up of services. We also have strong connections with midwives, Children’s Centres, Social Services, housing providers and other third sector organisations who work with pregnant women – particularly in areas of multiple deprivation. Gateway’s staff are often from these communities themselves, and are experienced in working with and encouraging people who don’t typically come forward.

Gateway’s role will be to form the MVP, finding the right people to be part of it, ensure the quarterly meetings cover topics that are of relevance to service users. Then, we’ll provide the Partnership’s feedback to the LMS Board.

We will soon be advertising for service users to get involved, we’ll be providing training to prepare them for the first meeting in July. If you have recent experience of Birmingham and Solihull’s maternity services, and you’re interested in finding out more, please contact our MVP Co-ordinator Sharon Bartlett at s.bartlett@gatewayfs.org.

This MVP will be part of the new Birmingham and Solihull United Maternity and Newborn Partnership (BUMP), which has been set up as a result of the National Maternity Review (Better Births). We’re very much looking forward to being part of project BUMP, giving as many people as possible a voice, and bringing the ambitions of the National Maternity Review to life.

(The photos on this page were all taken by, or of, our Pregnancy Outreach Workers.)

Taking a risk to invest in people’s Healthy Futures

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.

“The care navigation service is estimated to represent a saving in this scenario of approximately £10 per hour”: read how the pilot of Healthy Futures saved time for GPs and money for the NHS, according to official reports.

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.

“Diane was lonely, anxious and at risk”: read how the Healthy Futures pilot programme helped Diane

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.

New year, new service: Lighten Up For Life!

The new year will see us launching a new service for people in Solihull: the Lighten Up For Life weight management group.

Lighten Up for Life has been designed as an extension of the Solihull Lighten Up service (SLU), which we’ve been running for a while. SLU supports people in a number of ways, but a very popular option is a weight management group, so we’ve used our in-house specialists – and over a decade of experience – to design a weight management group with a difference.

The free 12 week programme is funded by Solihull Metropolitan Borough Council and sessions will run at two venues (to begin with) in Chelmsley Wood.

The main difference between Lighten Up For Life and other groups is that this is intended to be a distinct 12 week course, rather than a group that people will continue to go to indefinitely. That’s because we believe weight loss should be a sustained, behavioural lifestyle change. By the end of 12 weeks, we hope the people who attend Lighten Up For Life won’t only have lost weight, but will have made the changes required to keep the weight off. We don’t want the people we work with to be attending weight management groups forever – we want to give them the tools they need to make the changes themselves. For life.

Over the last ten years, Gateway has helped thousands of people to lose weight and keep it off, through services like Health Trainers. The Lighten Up For Life team includes para-professional Health Promoters who have been helping people to make sustained lifestyle changes for many years, as well as an experienced Dietitian, and a Behaviour Change Adviser who is a trainee health psychologist.

And, unlike some other weight management groups, Lighten Up For Life isn’t just about diet. The 12 sessions will include physical activities, ways to manage stress, tips about “food and mood”, and the type of social peer support that we know from experience really helps everyone in a group.

We’re really looking forward to delivering the Lighten Up For Life course and we’re delighted that so many people have already signed up for the first sessions in January. If you’d like to join them, call 0121 456 7820 and ask for Lighten Up For Life to find out if you are eligible.

Pregnancy Outreach Worker interviews: Shazia

As the Pregnancy Outreach Workers Service comes to an end, we’re reflecting on the last decade by interviewing some of our POWs about their work.

Jacque
Jahanara
Shaista
Shazia
Sophia

Shazia’s story

Shazia

Shazia has been a POW since the start of the service in 2007. At the time, she wasn’t sure what she wanted to do – she’d done some teacher training but knew it wasn’t for her. However, as part of teacher training she’d met someone involved in the health sector, and felt immediately that she would be more suited to this sort of work.

Soon afterwards, she saw an advert for the new Pregnancy Outreach Workers Service and liked the idea of it. “I liked the fact that there would be no routine and I would be doing something different every day, and that I’d be in charge of my own caseloads. I always knew I wanted to help people and that’s exactly what I would be doing.”

Shazia puts her ability to engage with people down to her sense of humour. “I’ll make fun of myself if I have to. Helping clients to see the humour in situations breaks down barriers and brings people closer together.”

Shazia’s most memorable clients are those who have had issues with substance misuse. “When I started, my knowledge of drugs wasn’t great – I knew a bit about it but not much – but over the years I’ve learned a lot from my clients. Now, I understand the phrases people use, and the way users think.”

She continued, “the thing about addiction is: there’s no point in patronising someone or telling them they shouldn’t do what they’re doing. They know this already. They feel a terrible amount of guilt. They deserve to be treated nicely.”

She went on, “the pull of addiction is really, really strong. If the only people you know are dealers or addicts themselves, and they all have your number and know where you live, that’s a hard environment to get away from. Most of the addicts I’ve met started using in response to abuse or trauma from a young age – things they’ve never had any real support for – so the problems go very deep.”

Shaz recently bumped into someone she supported six years ago. As they chatted, the woman thanked her, saying, “you were the one who treated me like I mattered, and didn’t look down on me”.

Shazia says, “This person’s journey was special to me because I was the one who communicated with her the most, explaining what was happening and often being the person who had to give her bad news. She had a social worker, who was very good, but she didn’t trust her… So it was me who was her birthing partner, staying three nights in the hospital with her. And then it was me who explained to her that, because she hadn’t had four clean drug tests, it was unlikely her baby would be going home with her.”

When support ends, Shazia says it’s important to close cases properly by ending contact and making sure that clients are self-reliant. “It’s not fair on them if they continue to rely on me afterwards,” she says.

(Shazia went on maternity leave last month. When she returns next year, it will be to a new role within Birmingham’s new Early Years Health and Wellbeing service.)

Pregnancy Outreach Worker interviews: Jacque

As the Pregnancy Outreach Workers Service comes to an end, we’re reflecting on the last decade by interviewing some of our POWs about their work.

Jacque
Jahanara
Shaista
Shazia
Sophia

Jacque’s story

Jacque came to Gateway at the very start of the POW Service in 2007. For her, it was the ideal job.

“I have a degree in Family Work and before I joined POWS I was working with families as an outreach worker and social therapist. Working one to one with families is ideal for me.

“I love helping people face to face, helping them to find balance and meeting their needs. Sometimes people just need someone to listen to them, and even just a fifteen minute chat can have a big impact. This kind of social support is vital.

“One of the great things about POWS is that we are from the communities we support, so we know what’s out there and can engage at a community level. The women we work with trust us, because there’s a mutual understanding. We can have a real heart-to-heart … it’s mom to mom.

“Over the years the POWs have supported thousands of women between us. The original remit for the service was to support ‘marginalised’ women – those who have experienced domestic abuse; women with mental health issues; families with no recourse to public funds – and over the years the needs have become more acute.

“The women we’re supporting now are more vulnerable than ever. They include refugees and people who have been hit really, really hard by the recession, so we are dealing with a lot of homelessness, and language barriers.

“Although on paper we do a lot of the same things that other support workers do, the difference is that we are more available; more accessible than most. We will come out to see people wherever they need us to, whether that’s at home, at a Children’s Centre or at the shops, and they can call us at any time.

“It’s our job to make sure baby is born healthy, and to reduce inequality. And the way we do that is to make sure mom has support from as early a stage as possible. If she’s smoking or drinking, or if she isn’t eating properly, perhaps because she doesn’t have the finances to support herself – then of course the child will be born into inequality.

“Some of the happiest times with POWS have been seeing people’s excitement at a new house, or seeing women breastfeed happily when they never thought they’d be able to.”

Pregnancy Outreach Worker interviews: Jahanara

As the Pregnancy Outreach Workers Service comes to an end, we’re reflecting on the last decade by interviewing some of our POWs about their work.

Jacque
Jahanara
Shaista
Shazia
Sophia

Jahanara’s story

Jahanara has been with Gateway on and off for many years. Like many of our POWs, she originally joined as a Community Family support worker, but as a speaker of different Punjabi dialects, including Mirpuri, she’s also worked as a Gateway Interpreter.

As a POW, Jahanara works with a mix of women, but over the last couple of years has seen more and more women with mental health problems.

Recently she supported a client who has suffered severe depression and mental health issues after being raped. She had never told anyone about it – not even her husband – and it was only when she became pregnant with her husband that she finally started talking about what had happened.

“She’s in such poor health that she hasn’t really been able to look after herself,” says Jahanara. “But it’s my job to make sure that she will be able to look after her baby when it arrives. We have spent a long time talking and her husband now understands that he needs to really look after her at the moment.”

Sometimes it will take a while for women to admit they need help. On one visit to a new client, the pregnant woman told Jahanara everything was fine – but Jahanara noticed that her other children were going barefoot and wearing ill-fitting clothes. So, on the next visit, she took along some items from Gateway’s baby bank, including children’s clothes, baby clothes, toiletries and nappies. “She couldn’t believe it,” says Jahanara. “She said, ‘I only get £90 a week and it goes so quickly. You can’t believe how much you’ve helped me.’ It gave me peace in my heart.”

Often, women will have a number of support workers, but don’t feel like anyone is there to support them, themselves. “Sometimes women just need someone to make them smile, or to pop to the shops with them,” says Jahanara, “and provide a bit of moral support in everyday life. Most support workers are there for the child, but we are there for mum, giving her someone to rely on and a number to call in times of need.”

Pregnancy Outreach Worker interviews: Sophia

As the Pregnancy Outreach Workers Service comes to an end, we’re reflecting on the last decade by interviewing some of our POWs about their work.

Jacque
Jahanara
Shaista
Shazia
Sophia

Sophia’s story

Sophia has been here since the start of the service in 2006. She says, “it’s completely changed in that time!

“Over the last decade – and the last couple of years especially – it’s gone from simple signposting and accompanying women to appointments, to supporting women with issues around safeguarding and substance misuse, and helping them through court reports and procedures.”

Sophia says she’s learned a lot as a POW, both on the job and from her colleagues. “We’re a good team,” she says. “It’s important for us to be able to offload onto each other, bounce ideas around, and support each other through difficult cases.”

Sophia explains how important it is for POWs to meet women as early as possible during their pregnancy. “POWS is a preventative service. Often, if we meet women in the first few weeks of pregnancy, we can start helping them to begin the routines and habits that will lead to a healthy pregnancy. We can sort out a lot of issues before they get to the point where the woman or her unborn child go into safeguarding.”

Sophia is keen to point out that POWS are there for mum, when everyone else is there to support the child, and that they can prevent safeguarding issues. “The whole reason POWS were brought in was to empower women. If we can support them to make their own healthy choices from the beginning, then we can prevent a lot of issues later on down the line. In many cases we can help to stop babies being removed and going into care.”

Many of Sophia’s clients are women with a number of complex issues. “One woman who always stays in my mind already had a teenage child, and she’d had another baby years ago who’d died. When I met her she was pregnant with her third child, but she was not in a good way at all – she was drinking heavily, smoking cannabis and more. She’d been referred to drug workers and social services, but she needed more help during her pregnancy so she came to us.

“I helped her to focus, really. By taking her out of her environment a bit, and helping her to make sure that her money went onto the things she would need for her baby rather than drugs, I supported her to start new, healthier routines.

“For many women, the only support network they have is an unhealthy one, so we can provide a different outlet – we’re there for her to talk to at the end of the phone, we can meet up with her at home or in the community, and we can support her with all the admin that having a baby brings – filling in forms, shopping for essentials and getting to appointments on time.”

Pregnancy Outreach Worker interviews: Shaista

As the Pregnancy Outreach Workers Service comes to an end, we’re reflecting on the last decade by interviewing some of our POWs about their work.

Jacque
Jahanara
Shaista
Shazia
Sophia

Shaista’s story

Shaista’s been here for nine years so she’s a relative newbie!

“POWS used to work out of Children’s Centres, which was a bit isolating, so coming together to work out of the Gateway office a few years ago was the best thing. Being able to work as a team, sharing advice and supporting each other is important for us.

“I’ve worked across Birmingham, with all types of new mums, including teenagers and older mums, and in lots of different communities, from Washwood Heath to Handsworth.

“That’s what I love about the job: we’re out in the community, and anything can happen. But that’s also why POWS are good for pregnant women – because we can go to them.

“It’s all very well making an appointment for someone to visit a Children’s Centre, but it’s not always practical to expect a pregnant woman to travel, especially if they have other young children too. If they’re new to the area they may not be able to remember where to go, or how to get there on public transport, and if finances are an issue, then even bus fares can be prohibitive.

“We are also really accessible. We are there from early on in the pregnancy, because early intervention can be vital. The more that services are cut, the more vulnerable women need someone to help them prepare, and to navigate through what is often a very confusing and admin-heavy time.

“Clients have our phone number and they can call us any time. We can visit families in the evenings if necessary, and we can use our own transport to pick people up and take them to appointments. It’s this sort of flexibility that really sets us apart from other health professionals and helps us to build a more genuine, useful relationship with the women we work with. We’re not turning up in a suit with an official-looking badge, we’re just popping over to give them a bit of support.

“One of the things that has really helped us recently is the ability to use more modern technology in our roles. We all have tablets that we take to each appointment and that means we can help people to fill in forms, bid on council properties, and make appointments there and then. This can be really important for people who don’t have internet access at home, have limited phone credit, or find it hard to talk on the phone, perhaps due to language barriers.”

Health Trainers closure: reflecting on success

Gateway’s Health Trainers service, offering one-to-one support and advice to people who want to make lifestyle changes, will be closing at the end of September.

Health Trainer Wayne pictured at our Family Health and Wellbeing Day
Last week, we looked at some of the numbers and showed how successful the service has been during almost a decade of operation. Gateway Health Trainers supported more than 18,000 people over the years, with more than 90% of people completing their support, and 84% of those achieving or part-achieving their goals.

This week, we thought we’d share some more personal stories, both from the Health Trainers themselves and the people they’ve supported.

Beckie is moving over to work for Gateway’s Pre-Diabetes team, but here she reflects on her year as a Health Trainer and tells us about one of her most memorable clients during that time.

Ralph came to the Health Trainers from the Lighten Up service. Here, he tells us what he has found most satisfying about being a Health Trainer. Sometimes, the successes aren’t as obvious as you think!

Contrary to popular belief, the Health Trainers service wasn’t just about weight loss or physical activity (although of course they helped people with that too!) Many people reported improved mental health and wellbeing, reduced their alcohol intake, or became less socially isolated thanks to their Health Trainer.

Wayne (pictured above at our Health and Wellbeing Day in July) told us how one of his clients came in for help with her weight management, but went on to make many other changes.

“Once she’d made the decision to lose some weight, it felt easier for her to make other changes in her life too,” he says. “One of those things was smoking. She knew she had wanted to stop smoking for a while – especially after one of her grandchildren made a comment about it, saying ‘nanny, you don’t smell very nice’, so the next time she came to see me, she asked about smoking cessation services and I was able to refer her straight away to a stop smoking clinic. A lot of people think it’s really difficult to stop smoking without putting on weight, but because she’d made the decision to change, and made the changes in tandem, she found it a lot easier than she thought.”

Health Trainers pictured in 2016. Margaret is on the far left.
Health Trainer Margaret (left) told us about one of her clients, who was referred for weight loss, but whose issues went a bit deeper than that. “She rarely left the house,” says Margaret, “so she wasn’t doing any physical activity at all. She also had a diagnosed Obsessive Compulsive Disorder which meant that she had a lot of discomfort around eating. She hated certain foods because of her phobia of crumbs and dirt, and didn’t eat any fruit or vegetables.

“So I supported her by taking things really steady and helping her to mentally prepare for the changes to meals. First we substituted just one item of food at a time in each meal for a piece of fruit or veg. Then we started getting her out of the house, for just two or three minutes a day. And she really worked hard. Every time I met her she was going out for longer and longer periods of time and eating more and more healthy foods.

“By the end of the support, she had already lost a stone and a half, and was walking down the road to meet me in different locations. I’m so proud of her! And it’s so rewarding for me, too. I have really loved this job.”

As you can see, the service means a lot to staff and their clients. We hope that, in a future without Health Trainers, people will continue to get the support they need.