Prevention is better than cure Social Action for Health and Tower Hamlets PCT

1. Prevention is better than cure Social Action for Health and Tower Hamlets PCT Elizabeth Bayliss Social Action for Health Chief Executive March 2012

2. SAfH values • We start with the people • People have the right to take control of their own lives • People’s health can be improved by tackling isolation, poverty, racism and unemployment • Healthy communities are good for the whole society

3. SAfH Spiral of Participation

4. Scale of work • SAfH direct impact on – 11,403 people • Through partners, another 4281 people • The number of contacts – 25,790

5. Partnership working: PCT, GPs and SAfH Several areas: • Information and advice • Diabetes • Cancer screening and awareness raising • Self management • Health Guides

6. SAfH role The context: • Local people in communities • Public services Challenging health inequalities is about redefining the relationship between the two.

7. In practice SAfH’s works in communities which are informal, relational: • Through the networks and relationships that people have with each other • Going with the flow of what emerges, what people themselves bring into conversation On the issues that affect peoples’ health and well being SAfH works with the NHS which is formal: • On service or clinically specific issues • With preplanned content There is a tension here……….

8. Community participation “Communities not only have a right to be involved in decisions that affect them, but they can also help to improve the quality of decisions made” Twyford 2008

10. Measurement A critical issue (what you measure, you manage): • Target setting takes too little account of community dynamics (eg. numbers of people reached with specific conditions, not enough taken of influencers) • Demand management is key to the NHS and we want to measure shifts but proving very difficult to secure buy-in of GPs • Anecdotal information is dismissed often in the NHS but when you get tot alk to a GP directly, that’s what they want.

11. Measurement We want to evaluate the way we work? • We don’t start with a blank piece of paper, we join in with what is already happening and build on what is already there (relationships, networks, groupings, pacing) • We work with lay people, so that at the heart of projects lie local people delivering to local people, building skill and know-how.

12. Context The context for our work is changing: • GP commissioning and the drive for evidence • Commissioning is become more prescriptive • Public sector cuts • Global economic crisis • People are starving

13. Co-production (sharing the design and delivery of services with users) “- a continuing and respectful relationship with a supportive professional – is less and less on offer.” (p.6 NESTA The challenge of co-production) “If relationships between professionals and clients are part of what makes change possible, then management systems that undermine these are likely to make services more expensive to run. They are driving in the wrong direction.” (p.7 NESTA)