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.”
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 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.
It’s a sad time for Gateway, as funding from Birmingham Public Health comes to an end for one of our longest-running services.
The popular Health Trainers service, offering one-to-one support and advice to people who want to make lifestyle changes, has been decommissioned and will finish at the end of September.
All our Health Trainers are now working hard to finalise arrangements with their remaining clients and get everyone to a place where they feel they have achieved at least some of their goals.
Although it’s a sad time for us, it’s also bittersweet, as we reflect upon the Health Trainers’ many successes and achievements. So we thought this would be a good opportunity to have a look back at the service and share some of the stories and statistics with you.
The Health Trainers service was started in 2008. By the time the funding ends, we will have worked with more than 18,000 South Birmingham residents, with more than 90% completing their support.
Over the last two years, the service has changed very slightly. Rather than focusing our support in the most deprived areas of Birmingham, we now focus on people with a level of vulnerability. This can include recent offenders, people with substance misuse, people who have experienced domestic abuse, or mental ill health, and people who are in temporary accommodation. More than a third of the 2000 people we work with every year are in this group.
When a Health Trainer starts working with someone new, they help them to come up with a set of achievable goals to work towards. These often include losing weight and becoming more physically active, but they also include stopping smoking, or even becoming more confident and socially active.
Over the last decade, Gateway’s Health Trainers helped people to achieve, or part-achieve, the goals they set themselves in 84% of cases. For example:
Physical activity: 91% of the people we worked with needed to increase their levels of physical activity, and 85% did
Nutrition: Of those who were eating less than the recommended level of fruit and veg, 52% of those classed as “low” and 60% of those classed as “very low” resolved the risk
Alcohol: 45% of those who had a risk relating to drinking more than the recommended level of alcohol resolved that risk
Mental health: More than two-thirds saw an improvement in their mental wellbeing, according to WEMWBS measurements at the beginning and end of support
Dr. Asfia Aftab is a GP Partner at Vicarage Road Surgery, one of the GP surgeries that Gateway Health Trainers worked with. When told about the end of the service, she said, “I am sad to hear this news. As you know, we had a great experience with Health Trainer services for our patients in Kings Heath and say they were a very valuable part of the primary care services we provided. We had a lot of great anecdotal feedback from patients.”
As Josh explains, below, Health Trainers is a “whole person” service and one of the biggest benefits of the service has been the ability to offer people time. Time to build up a rapport, learn as much as possible about a person, and really talk things through.
Josh came to Gateway after completing a degree in Psychology; first as a volunteer, and then as a Health Trainer. He has used the skills and knowledge gained as part of his degree to back up his work with Gateway, helping people to make significant lifestyle and behavioural changes.
Thanks to a Discovery Grant from the Santander Foundation, we will be able to develop and deliver a new course this year – one that will help over 100 people in Birmingham to improve their mental health.
The course is designed around the “Five Ways to Wellbeing“, an evidence-based government strategy that sets out five simple actions a person can take to improve their wellbeing. The grant will allow us not only to develop the content for a five-session course, but to trial its delivery in eight venues around the city.
Mental wellbeing is a vital part of living well. This course is one that we have wanted to pilot for a while, so we’re really pleased to have been chosen to receive a grant that will help us to do this. The grant will help not only with research and development costs, but with practical costs too: things like training materials, room hire and the cost of a facilitator in each venue.
We’re already talking to a number of other local organisations about delivering the course to a range of people. As well as our community sector partners, we’re also speaking to employers because we feel this course could be really valuable in terms of encouraging healthier workforces. One place we’re looking to work is within the NHS; we think this could be a good way for the NHS to support the commitment made in its Five Year Forward View ‘to ensure the NHS as an employer sets a national example in the support it offers its own staff to stay healthy’.
The Gateway Five Ways to Wellbeing course
The course we’re developing will encourage participants to take part in activities based on the Five Ways to Wellbeing.
Like all of Gateway’s work, the content of each session will flexible, allowing participants to lead, and identifying and building on the strengths they already have.
The “five ways” are all simple suggestions – small steps that it will be easy to take – and based around self-awareness. By becoming more mindful of your own wellbeing, you can build confidence and resilience, and so reduce health risks.
“Be active” encourages physical activity because, put simply, exercise makes you feel better! The course will allow each group to tailor this step to their own mobility and fitness levels – so it could be anything from a ten minute stretch, or a walk in the park, to a bike ride or regular swim. As on our Pre-Diabetes courses, we’ll be encouraging people to decide as a group what activities they’d like to do – then we’ll help them to do it.
“Connect” will encourage participants to engage with the people around them. We’ll be looking at relationships and how to build them, whether that’s friends, family or neighbours. Gateway’s own staff and staff at the partner organisations will be able to direct people to activities in the area where they can meet likeminded people, and we’ll also be encouraging the people in the group to connect with each other to take part in future activities, if they want to.
“Give” is another way to create connections. After all, doing something for someone else is really rewarding, and it can be something as small as a smile! We’ll be looking at the ways in which people are already giving (whether they realise it or not) and how making some time to treat yourself can make it easier to do things for others. If people want to give more back to their communities, we may be able to put people in touch with volunteering opportunities, too.
“Keep learning” is all about challenging yourself to learn something new, or reconnecting with an old hobby or interest. Whether people want to learn to cook, learn a practical skill, or take on a new responsibility at home or work, we’ll be there to support them. We’ll be encouraging people to share their own skills and experiences with the others in the group and we’ll also be looking at other local activities and groups where people can try something new.
“Take notice” is probably the most important step for the people we will be working with. Becoming more aware of the world around you, and giving yourself time to reflect, is vital to your mental wellbeing. We’ll be encouraging people to take a little more notice of the little things, and to take time out for themselves, each day. So many of us complete our daily routines without taking much notice of nature or the changing seasons, but taking some time to reflect on the smallest experiences each day can help you to appreciate what matters to you.
We’re really pleased to have been chosen to receive a Santander Foundation Discovery Grant. Even the smallest funding awards – this one is £5000 – can make a huge difference to our work. We are looking forward to delivering this pilot course to at least 100 people, and hope that it will open the doors to allow us to support many more.
Could we deliver the Five Ways To Wellbeing course at your workplace? For more information, contact Michelle Smitten on 0121 456 7820.
Could your organisation benefit from Gateway Health Trainers’ expertise?
The Health Trainers service can now be tailored to the needs of a specific group or organisation, and commissioned directly. As well as traditional one-to-one support, Health Trainers now design and lead flexible wellbeing programmes for groups in a range of settings. If you are looking for creative ways to motivate your workforce or client base, a Health Trainer could be just the ticket.
After all, Health Trainers aren’t just about physical exercise and healthy eating; they offer preventative health advice and encouragement that changes people’s lives.
As well as weight management advice, Health Trainers help people to learn how to budget and how to cook. They help people who smoke, or are at risk of diabetes or high blood pressure, to reduce their risk in the long term. They help people to become more confident and more socially active, as well as offering practical help with things like housing, benefits, and finances.
Over 40% of the people we worked with last year have both physical and mental health needs. We understand healthy living goes hand in hand with good mental health, so our Health Trainers know what to do and who to involve to reach that balance.
We also know there are strong links between good health and wellbeing, and employment. Over the last decade we’ve supported many people back into work by helping them to reduce their anxiety and build their resilience. For those already in work, support from a Health Trainer can help to build confidence, lower sickness rates and raise morale.
Could this kind of support help your organisation too?
Over the last year, Gateway Health Trainers have worked not just alongside GPs in their surgeries, but with an increasing number of local organisations including Jobcentres, Cerebral Palsy Midlands, the Signing Tree and Better Pathways. Health Trainers’ tried and tested methods can be tailored to add value to all kinds of other services. Give us a ring on 0121 456 7820 to find out more.
Case Study: Better Pathways
Better Pathways (formerly BITA Pathways) is a mental health charity in Birmingham which specialises in offering training and work opportunities for adults with mental health problems. Gateway Health Trainer Wayne (pictured) got in touch with Michael Summers, a Recovery and Employment Adviser, to create a six-week Health Trainer package for service users at Better Pathways, supplementing the great work they already do around mental health recovery and employability.
The first thing Wayne did with the ten people who were referred into the sessions was to get everyone to start a food diary.
“It’s one of the easiest things you can do to kick-start a healthy lifestyle change, and yet it’s one of the most eye-opening,” explained Wayne. “It helps us to start to see patterns, and from there you can start making really simple changes.”
Mohammed’s diary showed that he rarely ate fresh food, but ate microwave meals twice a day. Together, he and Wayne looked at the food labels of some of his regular meals and Wayne pointed out the high levels of salt he was consuming. Mohammed started replacing some of the ready-meals with fresh fruit and veg, and managed to cut his intake to just two microwave meals a week. It’s a simple change, but it’s likely to drastically reduce his risk of having a stroke or a heart attack.
Dale was eating a lot of snacks throughout the day – and his food diary helped him to notice just how many! Thanks to the food diary and the weekly sessions with Wayne, he found it a lot easier than he thought he would to stop buying them, and put temptation out of his way. Not only is he losing weight as a result, but he’s saving so much money, he’s decided to save up for a bike!
As well as healthy eating advice, which included some fun, hands-on cookery sessions, Wayne offered one-to-one advice for everyone who came on the course. He also helped Better Pathways to set up a walking group for service users, which now meets every Friday for a sociable half-hour walk round the park – another simple lifestyle change that impacts mental wellbeing as well as physical health.
The positive social element of the Health Trainer support was a nice surprise for many of the participants – who started arriving earlier and earlier each week just to have a natter and a cup of tea, and continue to walk together regularly. But the biggest change was weight loss, with all ten clients losing weight as a direct result of the course. As a group, they lost a total of 5 stone 3 pounds (33kg)!
Michael, a Recovery and Employment Adviser at Better Pathways, says, “we believe that healthy living goes hand in hand with healthy mental health, so having the service with us was a huge benefit to our clients. All of them reported benefits such as weight loss, healthy eating, and knowing how to cook.”
You can hear more from Michael in the video below.
Wayne says, “it’s been really rewarding to see people make such big changes in just six weeks. I’m really proud of everyone I’ve worked with at Better Pathways. Not only have people lost weight – and they’ve lost a lot of weight! – they’ve gained confidence and made new friends. It just shows, no matter where you are in life and what your abilities are, a lot can happen if you have the right support.”
If you would like to talk about working with Gateway to deliver a Health Trainer service at your organisation or workplace, please contact Jemma Abbott on 0121 456 7820.
A note – and a message for GPs
Our funding from Birmingham Public Health comes to an end in September, when the Health Trainers service will be decommissioned. We’re continuing to support everyone who’s already been referred into the service, but after the end of September we will no longer be running the service in the same way.
The numbers show that Health Trainers has been a popular and successful service. By the time the funding ends, we will have worked with more than 18,000 South Birmingham residents, 85% of whom were referred by their GP or another member of practice staff. Health Trainers have assisted people to achieve or part-achieve the goals they set themselves in 84% of cases.
We’d like to express our gratitude to GPs for the way they’ve worked with us and supported our Health Trainers over the years. Many GPs hosted a Health Trainer in their surgeries and our Health Trainers tell us they really appreciate the way the GP Practices made them feel part of the team. Thank you for making them feel so welcome and valued.
We’re very keen to continue providing Health Trainer support to surgeries, as well as to other agencies and organisations, which is why we’ve come up with a cost-effective, flexible package for GPs. If you’re a GP or Practice Manager, please contact us to find out more about how we can continue our partnership.
As Solihull Lighten Up goes from strength to strength, we’ve been looking at ways we can improve the service, to help improve the health and wellbeing of more people across Solihull. So we’re pleased to announce we’re planning some exciting changes.
Solihull Lighten Up is a weight management service offering people a package of support tailored to their needs. As well as vouchers for commercial weight loss groups, it offers a range of extra specialist help and advice, including phone support from staff at our Lighten Up Help Centre and free referrals to activity groups in the area.
For people with slightly more complex needs (including people with learning disabilities, disabled people and their carers, people with mental health issues and recent ex-smokers) Solihull Lighten Up also offers up to 12 months of one-to-one support from a Behaviour Change Advisor or Dietitian.
It’s been running since Spring 2016 and in its first year, 772 clients lost a total of 2567.6kg, or 404st 3lbs. That’s an average of over half a stone each!
Having now talked to and worked with hundreds of people and numerous partner organisations in the area, we’re now liaising with commissioners to start implementing some new ideas, based on the conversations and feedback we’ve had.
Alternatives to weight management groups
For most of the people Solihull Lighten Up supports, weight management groups like Weight Watchers and Slimming World work really well. In the first year of service delivery, we supported over 800 people to go to groups (backed up by regular phonecalls from Lighten Up Help Centre staff) and, for most of these people, membership of a group was a good way to kickstart their weight loss.
But, for some people, groups are just not a perfect fit. There might be a practical reason; perhaps meeting times clash with work, or there are insurmountable childcare issues. Or it might be something less obvious; some people just don’t feel able to make the big lifestyle and dietary changes required by a group straight away, and some need more support with physical activity.
So we’re designing our own new 12-week weight management programme, strongly influenced by feedback from the people we work with. Delivered in community venues across Solihull, it will be family-friendly, so that kids can join in, with plenty of healthy eating and physical activity sessions.
The Solihull Lighten Up team has already taken on a new Behaviour Change advisor, Kavita, to enable us to do more tailored support, and we’ll be launching the new programme soon. We hope that, by offering some carefully designed alternatives, we’ll help more people to adopt the Behaviour Change principles that we know create long-term lifestyle change.
New “slow cooker” sessions
We currently run a few different cookery sessions. Many of our staff, across all our services, have been trained as Cooking Mentors and they run sessions showing people how to cook simple healthy recipes on a budget.
The feedback has been really positive and we’ve seen a demand for more healthy cooking support, especially for people who are short on time and space at home. So – with the support of Solihull Council – we’re putting together a “slow cooker” course.
Participants will be given a slow cooker that they can plug in anywhere at home (it doesn’t even have to go in the kitchen!), together with demonstrations and a variety of easy healthy recipes. Slow cookers are associated with winter meals but we have plenty of ideas for summer dishes that we look forward to sharing too!
If you live in Solihull and you’d like to kick-start your weight loss journey with a bit of extra help, contact us to find out if you are eligible for the Solihull Lighten Up programme. Contact our Lighten Up call centre on 0800 599 9880 or via email on email@example.com.
The Pre-Diabetes Courses we run as part of the National Diabetes Prevention Programme have been running for over a year now. Interestingly, referrals to the course dropped (to almost unviable levels) and then rose again significantly during that time – but why? We thought we’d share some of the lessons we’ve learned about the referral process since we’ve been running the course.
During the Pre-Diabetes Course pilot period, which started in late 2015, patients came to us via a mailshot from their GP. When someone was diagnosed with Pre-Diabetes, they received a letter from their surgery, which included a leaflet from us explaining what the Gateway course offered, with contact details. If they wanted to go on the course, they called or emailed to sign up.
This worked really well. By March 2016, we’d received around 600 referrals, and had run over 30 courses, with a 92% retention rate. Feedback from patients was overwhelmingly positive. The success of our pilot, along with others, contributed to the programme being rolled out nationally.
A worrying change
However, things changed when we amended the referral process.
Under the new process, referrals came from people who had received an NHS Health Check. If a Health Check revealed Pre-Diabetes, GPs sent the patient’s details to us, and we called them on the phone to personally invite them onto the course. It sounded like a good idea.
But, despite the personal touch, the number of referrals dropped dramatically. Even worse, very few of the patients who’d agreed to go onto the course over the phone actually turned up on the day! The people who did come along were still achieving great results, so we knew the problem wasn’t with the course itself, but we were struggling to get enough people through the doors to make each course viable.
So we approached our commissioners (Birmingham South Central CCG) and worked with them to go back to mailshots. We picked up the cost of the leaflets and postage ourselves, and started working with GPs to start getting them sent out to patients again.
Back on track
Now – happily – the number of referrals is shooting up again. In just the last four weeks, we’ve run ten courses (with 15 people on each course) and more than 65 people are on the waiting list to go on a course in the next few weeks.
So why do the mailshots work so much better than a personal phonecall? We think it’s down to the following factors:
Awareness. Put simply, fewer people were hearing about the course. When we switched to the phone method, we were only passed the details of people who’d had a Health Check, rather than everyone who’d been diagnosed. Without leaflets, GPs were less likely to suggest the course to people, and we weren’t able to promote it as easily.
GPs’ authority. People take more notice of something when they hear it from their GP, so when the GPs sent our leaflet to their patients, it implied that the course was “approved”. When we contacted people ourselves – even though we were phoning people personally, telling them their GP had asked us to call, and allowing them to sign up there and then – it just didn’t hold the same weight.
Letting the patient lead. Perhaps counter-intuitively, requiring the patient to refer themselves turned out to be a lot more successful than phoning and asking them to sign up. Why? Well, we’ve said this before, but letting the client lead their own support is beneficial for everyone. Giving the patient the reins and allowing them to decide what action to take and when (rather than telling them what to do, and suggesting we know best) creates resilience and sustainability. In other words, those who make the decision to refer themselves to the Pre-Diabetes Course are much more likely to turn up, and much more likely to stay on track once they’ve joined.
The Gateway Pre-Diabetes Course – better than a handout!
Anyone can read about taking steps to reduce their HbA1c levels, but going on a course with other people is much more likely to make it happen.
The biggest difference is the social interaction. 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!
Learning is a lot more fun in a group, and the Gateway Pre-Diabetes Course includes many hands-on activities, like games and cooking sessions.
If you’ve been diagnosed with Pre-Diabetes and you’d like to take part in a Gateway Pre-Diabetes Course, call Gateway on 0121 456 7820 and ask to speak to someone from the Pre-Diabetes team.
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.
Health Trainers are one of the few discretionary services provided by Public Health (ie they are not statutory services), which means they are most susceptible to cuts. It’s possible that funding to the Health Trainers service will be cut dramatically, if not completely, later this year. We are currently putting together a response to the consultation to explain why Health Trainers are important to the city, and to thousands of people who receive their support.
If you have benefited from a working with a Health Trainer, please let us know how they helped. What was your experience? What would your situation be like now if it wasn’t for your Health Trainer?
If you haven’t been supported directly, but you understand the value of the service, maybe as a partner or referrer, we’d still be very grateful for your feedback.
You can send comments to us via email at MichelleS@gatewayfs.org, or write to us at: Gateway Family Services, 5th Floor, Chamber of Commerce House, 75 Harborne Road, Edgbaston, Birmingham B15 3DH, and we’ll include your comments in the response we give to the consultation next week.
Alternatively, you can respond to the consultation directly by filling out the Council survey before next Wednesday, 18th January.
And if you’d like some inspiration, read on to hear why we think this service is so important…
Health Trainers: we give you extra!
The Health Trainer service isn’t just about weight management; it’s a long term, preventative service. Health Trainers help people to make lifestyle changes that have far-reaching consequences and so reduce the impact on other services.
In the last year, our Health Trainers have supported more than 2,000 people to increase their physical activity and to eat more healthily. But they’ve also helped hundreds of people to learn how to budget and to learn how to cook. They’ve helped people who were at risk of diabetes, or high blood pressure, to reduce their risk in the long term. They’ve set up group activities – which increase physical activity and reduce social isolation – and signposted people to many more. They’ve even helped people with housing issues, benefits claims and access to food parcels; issues that aren’t medical but nevertheless have a big impact on health.
Like all of Gateway’s services, our Health Trainers are an adaptable, flexible team. They offer home visits and phone support as well as community consultations. They respond to need as it happens and they put their wide network of contacts and skills to good use. They offer practical advice, but they also offer time, and someone to talk to.
More than 40% of the people Gateway Health Trainers have supported in the last year are from vulnerable groups, such as older people, people with mental health issues, and people who have an issue with substance misuse. And around 65% of Health Trainer clients are from deprived areas of the city. We know that people in these groups are much less likely to access resources on their own, which is why access to a Health Trainer is so vital: many of the people we work with would not otherwise receive any ongoing support at all.
Please help us to show why the service should stay.