Get involved in Building Healthier and Happier Communities

Context

The third sector already plays an important role in health and social care - but there is scope for us to make even more of a difference. That is why SCVO and a range of partners – the ALLIANCE, Carers Scotland, CHEX, CCPS, Evaluation Support Scotland, Inclusion Scotland, SENScot, SFHA, Voluntary Action Scotland and Voluntary Health Scotland, along with the Joint Improvement Team and the Scottish Government - are working together as the Third Sector Health and Social Care Advisory Group to coordinate effort and maximise impact in the context of integration. This paper introduces a national programme – Building Healthier and Happier Communities – which is underpinned by a strategic partnership between SCVO at national level and Third Sector Interfaces at the local level. The Third Sector Health and Social Care Advisory Group oversees and steers the implementation of this programme.

Purpose of paper

The purpose of this paper is to introduce you to a new and distinctive approach to Building Healthier and Happier Communities. The Building Healthier and Happier Communities programme is particularly relevant in the context of health and social care integration and wider public service reform. As well as improving understanding of how increased community capacity can enable prevention at a locality and primary care level, our programme:

• Makes connections between organisations working in a particular locality or local authority area
• Brokers joint projects between community-based organisations and with national organisations, leading to increased quality and scale of activity
• Adds reach, scale and volume to existing activities
• Adapts and adopts approaches which have proven success in other areas, while ensuring they are anchored locally

In addition, Building Healthier and Happier Communities:

• Assists integration authorities to understand the contribution the third sector makes to improving health and wellbeing
• Promotes and enables cross-sector collaboration

The Integrated Care Fund presents a timely opportunity for strategic investment in third sector capacity. With the right connections, resources and support, charities, community groups, social enterprises and voluntary organisations of all shapes and sizes can extend their pioneering work on prevention and help to manage demand on public services. We estimate that an investment of £500,000 per local authority area will make a significant and timely contribution to the ambitions of health and social care integration. We hope our programme is of interest and would welcome an early opportunity to discuss how the approach we have developed can be extended and resourced to help enable healthier and happier communities across Scotland.

The Board and Staff of EDVA have very much welcomed this opportunity to work with SCVO and our local partners from the Community Health Partnership and East Dunbartonshire Council. We are particularly pleased about the capacity building approach which has been adopted and this has enabled our members to benefit from support and resources to engage in this meaningful and timely project. The project has helped us adapt to new ways of working, enabling us to bring out the best in local groups and show their worth as providers of local services. Gilbert Grieve, Chief Executive Officer, East Dunbartonshire Voluntary Action

About the programme

The Building Healthier and Happier Communities programme demonstrates how investment in the third sector can generate excellent returns, enabling prevention, managing demand on primary care services and supporting people to make a difference that matters to them. We work with local partners to identify the type of support third organisations need to ensure change happens. The first area we are working in is East Dunbartonshire. With the support of the Scottish Government, SCVO is delivering a pathfinder with East Dunbartonshire Voluntary Action (EDVA) – the Third Sector Interface (TSI) - East Dunbartonshire Community Health Partnership, East Dunbartonshire Council and local and national third sector organisations. The importance of partnership cannot be over-emphasised. In addition to the integration authority and the 'front-line' third sector, the TSI plays a pivotal role. Each local authority area in Scotland has a TSI to support, promote, develop and represent the third sector. Working with our local partners, our aim is to kick start a new approach to building healthier and happier communities and our offer is based on the third sector’s ability to help people do more for themselves and each other. Building on the great work which is already happening in East Dunbartonshire and working with active and engaged partners, our programme is having a positive impact on the health and happiness of people and communities. Our activity to date has included:

• Developing and strengthening relationships with local partners
• Identifying outcomes which meet local and national priorities
• Engaging with local communities to develop our programme of support
• Identifying and investing in projects which contribute to prevention, help to address health inequalities and improve health and happiness
• Developing connections and sharing learning between organisations and across sectors

The Community Health Partnership has welcomed the opportunity to work with SCVO in the implementation of this pathfinder. The programme so far has been able to demonstrate good involvement of local residents and community organisations in identifying local assets and opportunities to contribute to community health and wellbeing. The inclusive methodology has been well received and has increased the knowledge and skills of community and voluntary organisations involved in the programme, and provides a platform for future capacity building. We hope that the outputs from the pathfinder will provide us with further opportunities to identify sustainable activities that enable individuals and communities to look after their own health and wellbeing. Karen Murray, Director, East Dunbartonshire CHP and Oral Health Directorate

What our programme will deliver

Our programme will help to:

• Manage demand on statutory services by enabling and promoting access to community-led alternatives
• Prevent problems before they occur – for example, by getting people involved in opportunities which can make a positive difference to their lives
• Release the abilities, knowledge and resources of organisations and people by taking asset-based and collabortative approaches to building healthier and happier communities
• Address health inequalities

To achieve these aims, our programme will:

• Share a distinctive approach to building community capacity in the context of health and social care integration
• Adapt to local ambitions and circumstances, informed by our partners
• Invest in third sector organisations to enable and extend their work in building healthier and happier communities
• Illustrate the distinctive contribution the third sector makes to prevention and to managing demand on statutory services

Our programme will help to:

• Increase recognition of the current and potential roles of third sector organisations in the health and social care arena
• Improve the resourcefulness of the people who use health and social care services and the people who support them, equipping them to do things differently and work across boundaries
• Build resilience within organisations and in the people and communities they work with
• Build social capital and strengthen connections between citizens and staff which equip them to help themselves, each other and their wider community

[social capital is] the resources people develop and draw on to increase their confidence and self-esteem, their sense of connectedness, belonging, and ability to bring about change in their lives and communities Social Capital, Health and Wellbeing – Edinburgh Health Inequalities Standing Group

Our approach

Building Healthier and Happier Communities is a national programme, delivered locally. Charities, community groups, social enterprises and voluntary organisations of all shapes and sizes already make significant impacts in areas like early intervention, prevention and care and support for people with complex and multiple conditions - and with the right support, there is scope for them to make even more of a difference.

Primary health care “requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate” Declaration of Alma-Ata, International Conference on Primary Health Care (1978)

By shifting resources to build organisations’ capacity, extend their reach and improve their connections – enabling community-led interventions which are downstream and preventative – we aim to ensure that more people get the help and support they need without having to visit their GP or other health and social care services. In addition, we work with public sector colleagues to improve their understanding of how the third sector works with people to improve their health and happiness and how, by equipping people to do more for themselves and each other, third sector organisations play an important and ongoing role in building community resilience.

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. Achieving Sustainable Quality in Scotland’s Healthcare – A 20:20 Vision

The basis of our work and what we want to achieve

With the impetus provided by health and social care integration, we will evidence how investments in community capacity can build healthier and happier communities and enable prevention at locality and primary care levels. Our work is informed by the link between healthy and resilient people and healthy and resilient communities:

Individual and collective resilience are not separate qualities; they are interconnected. Characteristics that support resilience in individuals are also ones which build strong interpersonal relationships at a network level and allow transfers of information and support. Empathy, intelligence, interpersonal skills, the ability to ask for help (and being able to identify and navigate appropriate sources of help) are the building blocks of wider social capital. Promoting the resilience of individuals should not be seen as antithetical to collective endeavours but as a point of entry to building stronger networks and communities. Resilience for public health – supporting transformation in people and communities, Glasgow Centre for Population (February 2014)

In East Dunbartonshire, investments in a cohort of third sector organisations will:

• Improve their understanding of community needs and health inequalities
• Enable them to benefit strategic support which helps them to make more of a difference to people and communities
• Strengthen their ability to develop people, skills, structures and systems in line with organisational objectives
• Get better at evidencing the difference they make
• Benefit from improved connections within the third sector and across sectors
• Become more sustainable

We want to improve understanding in integration authorities of the approaches which inhibit or support community capacity and the ability of third sector organisations to play a full role in delivering the integration outcomes. By bringing colleagues from the public and third sectors together and encouraging cross-sector collaboration, we will remove some of the barriers to effective partnership working. By enabling more collaborative approaches within localities and across sectors, we will improve understanding of how community-based approaches to health and social care can release resources and help to manage demand on statutory services. Down the line, we anticipate a shift in resources from institutional settings to people and communities of place or interest – and ultimately, more effective use of public money.

Some partnerships stated that it takes time to build up relationships and trust. Many things can contribute to positive engagement including a focus on outcomes, getting beyond what is wrong to what matters, and understanding each other’s disciplines and contributions. An increased knowledge of third sector and community resources, along with building capacity through local needs assessments and mobilising volunteers, can increase involvement. Locality Planning Conversations (June 2014) – Joint Improvement Team

Our guiding principles

We are guided by the Christie Commission’s priorities:

• We recognise that effective interventions must be designed with and for people and communities - not delivered 'top down' for administrative convenience (co-production)
• We make the most of what we have by utilising all available resources from the public, private and third sectors, individuals, groups and communities (collaboration)
• We work closely with individuals, communities and organisations to understand their needs, maximise talents and resources, support self-reliance, and build resilience (assets-based approaches)
• We prioritise preventative measures to reduce demand and lessen inequalities (prevention, tackling health inequalities)

What distinguishes these approaches is that they are grounded in people’s lives, and the lives of communities (of place and of interest). Typically, people, communities and services work together to decide priorities and how to achieve their delivery while the focus is on fitting services to people, not people to services. They also maximise all the resources and assets available, and the process itself build the capacity of all those involved. Christie Commission on the Future Delivery of Public Services (2011)

Supporting health and care integration

The integration of health and social care in Scotland is the most significant public service reform in recent history. With two-thirds of the Scottish budget allocated to health and care, the implications are significant. Key changes include:

• Nationally agreed outcomes, which apply across health and social care, and for which NHS Boards and Local Authorities will be held jointly accountable
• A requirement on NHS Boards and local authorities to integrate health and social care budgets
• A requirement on partnerships to strengthen the role of clinicians and care professionals, along with the third and independent sectors, in the planning and delivery of services

Although the nine integration outcomes are currently out for consultation, the most ambitious is the first one: “People are able to look after and improve their own health and wellbeing and live in good health for longer.” As well as adopting an overtly social model of health, this outcome – accompanied by asset-based, co-produced and preventative approaches - changes the social contract between public services and the people and communities who use them. How can people and communities equip themselves to understand this shift and what it means for them and the people they care about? And how can the third sector support them to embrace change and work with public sector partners to give new meaning and shape to how we look after ourselves and each other?

Every person in Scotland will come into contact with health or social care services at some point in their life – be that through ensuring that a loved one gets the social support they need to get an education, or go to work, or helping an older family member to stay in their own home for longer. We should never underestimate how many people rely on health and social care services to lead a healthy, full and happy life. By legislating to integrate of health and social care, we are setting out our rightly high and ambitious goal to ensure our public services put people at the centre of their care – not the other way around. Alex Neil, Cabinet Secretary for Health and Wellbeing (2014)

The third sector offer

As the national umbrella body for the third sector in Scotland, SCVO is well-placed to assist all parties with an interest in health and social care integration to understand the current and potential contribution of charities, community groups, social enterprises and voluntary organisations of all shapes and sizes. By helping people to help themselves and others, the third sector can help deliver key integration outcomes – improving the quality of life (outcome 4) and reducing health inequalities (outcome 5) are further examples - and building healthier and happier communities across Scotland. As it stands, one third (£1.6bn) of the annual income of the third sector in Scotland is for activities and services related to health and social care activities and services. Meanwhile, 55% of the third sector’s paid workforce – 76,000 people – are employed in health and social care while 260,000 adults volunteer for a disability, health or social welfare organisation. Working with local and national partners, SCVO is well-placed to help integration authorities to embrace the third sector offer. In addition to developing and delivering the Building Healthier and Happier Communities programme, other examples of our work include:

• Bringing community assets to the health and social care planning table, with an emphasis on activities and services enabled or provided by the third sector
• Facilitating learning exchanges between local authorities, the NHS and the third sector in the context of integration

Both of these initiatives are intended to strengthen local partnerships and enable shared solutions.

A population’s needs can be met in a variety of ways, delivered at a variety of levels. If we make localities too weak they may wither on the vine, with professionals and others voting with their feet. On the other hand if we get this aspect right, much of the integration agenda falls into place, with genuine reshaping of care on the basis of clinical, community and voluntary solutions, leading not only to better outcomes for individuals but to communities growing in confidence and capacity and practitioners being more fulfilled in their role. All hands on deck (July 2013) – Scottish Government

The case for change

The case for change in how people and communities look after themselves and each other is irresistible and third sector organisations across Scotland are already making change happen in the context of health and social care integration,

We don’t change culture by saying we want to change culture. We change culture by helping people to do things differently. Paul Gray, Director-General Health and Social Care and Chief Executive NHS Scotland (2014)

Doing the same thing, all the time, and expecting different results is not a good strategy. We need to change what we are doing now. What we are doing is focusing on the problems people have and trying to fix those problems for them. You are a smoker? We tell them to stop. We tell people they are unemployed and give them unemployment benefit. When it becomes inconvenient to call them unemployed, we label them incapable of work. What does this approach do to someone’s sense of control? It is not the right way to do things. People become passive recipients of services rather than active agents in their own lives. We need to turn that around, and start thinking afresh. Sir Harry Burns Healthier Lives, Better Futures (2012)

Get involved in Building Healthier and Happier Communities

Drawing on the learning from our pathfinder activity in East Dunbartonshire, we are now in a position to extend our programme to other areas. Building Healthier, Happier Communities is founded on a commitment to collaboration. Our role in working with local partners is to add value to, amplify or augment their existing activity. Rather than duplicate what’s already happening, we dovetail our offer with the knowledge and networks of our partners in the integration authorities and the Third Sector Interfaces. If you are interested in finding out more about the programme and how you can get involved, please contact Paul White or Sarah Currie at SCVO (see contact details below).

Contact us

Paul White Director of Networks t: 0131 474 8034 m: 0771 852 6036 e: paul.white@scvo.scot Sarah Currie Building Healthier and Happier Communities Programme Manager t: 0141 559 5071 m: 0771 852 6033 e: sarah.currie@scvo.scot Or write to Paul and Sarah at: Building Healthier and Happier Communities Scottish Council for Voluntary Organisations Hayweight House 23 Lauriston Street Edinburgh EH3 9DQ