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New project reveals Birmingham’s hidden extremes

4th December 2015

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.

gateway healthy futures team

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.


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.

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  1. Ann Forletta

    We always knew that the group of patients who are high users of GP and A&E services for non clinical reasons would be complex but early indications suggest that the situation for the majority of these clients is even worse than was realised. I’m sure that those fortunate enough to have been referred into the Healthy Futures service will benefit from the support that the experienced and caring Gateway staff will provide but how do we build long term resilience and sustainability for clients with such complex needs when public sector resources are so stretched? And where will the resources come from to help those equally needy clients registered with general practices that aren’t part of the MyHealthcare pilot?

  2. Katherine Hewitt

    Exactly Ann. This is my fear too. There is some comfort in that I know the Better Care Fund are planning on funding a similar type of intervention city wide. There seems to be lots of discussion about the need for this type of role but as is often the case the discussions seem a bit disjointed but at least they’re happening.