The Scalpel's Blog

With hospitals going on red alert, communities can help take the strain

Guest blog by Ewan King, director of business development and delivery at the Social Care Institute for Excellence (SCIE)

Winter is fast approaching. For the NHS, it is a time for a period of intense collective worry. How will the NHS cope with another difficult winter? When the focus at times like this is almost entirely on how we maintain good A&E and hospital discharge, it may be a strange time to talk about community assets. But do hear me out.

In social care right now, a major focus is on keeping people independent and well in their own homes, wherever possible and when people want that to happen. That usually means keeping them out of hospital. Many services are deployed to make this happen, for home care and good residential care, but they can be expensive.

There is another way. This way involves building the capacity and capabilities of communities so that they are better equipped to support people with the care and support they need, keeping them healthier and independent for longer.

Unsurprisingly – given the financial hardships facing the sector – those extolling this new way of working understand too that costs will fall if they get this right.

What does this mean in practice? All of the schemes and initiatives we have looked at differ in size, scale and focus, but they share features in common. Firstly, they seek to target those who are most vulnerable and in need of support, using risk stratification approaches in many cases, to ensure that people who are at real risk of declining independence are identified before they increase their call on the formal health and care system. In Sheffield, for instance, a community-wide commissioning framework aims to build better community support; there, they have used health and care data sets to identify and target those most at risk (see page 20 of this document).

Many projects are co-produced and co-designed by the people who will most benefit from the services – people who use services, patients and carers. Co-production is a way of working whereby people who use services – and service providers – work together to create a decision or a service which works for them all. This ensures that the services, be they befriending support, peer groups, social and leisure clubs or useful information directories – reflect peoples’ needs and interests. In Sandwell, for instance, local service users have been directly involved in the design and ongoing delivering of local ‘friends and neighbours’ networks, which aim to support vulnerable people, keeping them independent and supported within their communities.

People are often confused and bewildered by the vast complexity of the care and support system, so one of the other key features of these initiatives is the use of care navigators, or agents, who signpost people to the most appropriate forms of support. Employed or working as volunteers, their role is to be the trusted first point of contact for vulnerable and worried people. In Thurrock, for instance, local care co-ordinators, selected by the local community, provide advice, guidance and support to help people find the support, companionship and care that they need. And in Shropshire, ‘Let’s Talk Local’ sessions, staffed by local coordinators, are run for people with moderate care needs to signpost them to alternative care and support services locally.

And finally, with all of these initiatives, it’s clear that evidence and good evaluation is important – not just as a way of convincing commissioners and local politicians, but also so that the services learn from practice. So a growing number of community capacity building and preventative projects are evaluated. Take the Cleveland & Redcar Community Agent scheme, for instance. This has been independently evaluated, with the evaluators finding that for every £1 of investment in the Community Agent project, £7.38 of ‘social value’ has been created.

But importantly, building local capacity is not a task for social care alone; it is a job for the whole health, housing and public service economy, starting with the health and wellbeing board. This is why a recent publication by Think Local, Act Personal is so useful, as it provides a framework for health & wellbeing boards to think about how they can grow the capacity within communities, to build more independent and resilient communities.

So whilst improving accident and emergency is vital work, the hospital is only one part of the jigsaw. Communities, with their networks, carers and volunteers, offer an alternative resource to help people stay fit, well and out of hospital. It is the job of social care, and their colleagues in health, to invest properly in this area over the coming years.

FOR MORE INFORMATION

W: www.scie.org.uk/care-act-2014/assessment-and-eligibility/strengths-based-approach