Amplifying Notting Hill Genesis’s impact on health and wellbeing in Grahame Park, Barnet. Supporting the shifts from Hospital to Community and from Sickness to Prevention.

Background

This project was a partnership between Locality Matters, SocioEconomics and Notting Hill Genesis and emerged from identifying a gap between health systems and housing associations.  These organisations are supporting the same people but don’t commonly work in partnership or join resources to create wider impact. We sought to demonstrate that by working across systems within a neighbourhood, reviewing how resources are used and finding new ways of working, better outcomes could be produced for local people and less pressure placed upon the health and care system.

Housing associations have significant responsibilities in our most deprived neighbourhoods. Often, alongside local authority partners they oversee long-term programmes of regeneration (10-30 years) that seek to transform a place physically, economically and socially.  Whilst community engagement for these housing organisations is often a strength, their resources are often not coordinated with other providers with a focus on health and wellbeing.  Often, whilst these programmes may well impact on health outcomes these are not measured or at least not measured in ways that are meaningful for the health system.

What did we do?

We believed there was more that Notting Hill Genesis (NHG) could do to help build a stronger and healthier community in Grahame Park.  To test this we needed to understand how health related services were currently configured in Grahame Park.

There are a wide range of statutory and voluntary sector organisations operating in the estate.  In terms of voluntary sector organisations these range from tiny organisations, with a focus solely on the estate, to borough wide or national charities that work in the area.  We held structured interviews with over 30 organisations and reviewed surveys, reports and plans that related to Grahame Park.  There is no shortage of ideas and strategies but as is often the case, genuine impact is less easy to find!

What emerged was that (common to many places where there is high deprivation) there were several health issues that remain stubbornly present in the estate despite repeated efforts to address. These include:

  • Mental health challenges
  • Obesity
  • Cardiovascular disease
  • Respiratory disease
  • High blood pressure
  • Diabetes

We also identified several factors (wider determinants) that were contributing to these health issues including:

  • Access to Health services
  • Limited agency among residents
  • Poor nutrition
  • Access to health checks, screening and vaccinations
  • Smoking and substance misuse
  • Poor communication
  • Lack of physical activity
  • Limited employment and training opportunities
  • Structural racism
  • Debt support
  • Crime

We alighted on five areas where there was widespread agreement that opportunities existed to make a positive impact.  These were:

  1. Measuring impact on health systems – It was clear that whilst much fantastic work was happening in the estate, that related to improving health and wellbeing, this was not being measured in a way that would be significant for key health providers and commissioners. So (for example) organisations were measuring issues like attendance at group events rather than asking “is this project stopping people from unnecessarily attending A&E?”
  2. Better coordinating support for Diabetes, Hypertension, and cardiovascular disease – these are all key health issues in Grahame Park, and their prevalence is a high barrier to employment for residents
  3. Improving access to health and wellbeing services (treatment and prevention).
  4. Developing the local health and wellbeing partnership. Whilst a partnership existed, we heard that it had become somewhat redundant and local organisations were becoming disengaged
  5. Improving Mental health

Taking these research findings, we ran two well attended community meetings. The aim of these meetings was to work with local organisations (both statutory and voluntary) to agree a project idea (or ideas) that could be worked up into a costed proposal.

Holistic Case workers

The idea, that was co-produced, was to secure funding to create a small team of holistic case workers.  These will be local people employed by a local VCSE organisation targeted with supporting people living in Grahame Park who have or at risk of long term health conditions.  The aims of this project will be to deliver:

  • Improved health outcomes for individuals
  • Improved access to health services and other community support
  • Reduced demand on health systems e.g.
    • Reduced Did Not Attends (DNAs) in primary and secondary care
    • Speeding up hospital discharge
    • Reducing prescriptions
    • Reducing readmission rates
  • Case finding of people at risk of certain diseases
  • Helping people adopt healthy lifestyles
  • Reducing unemployment benefits by addressing health issues
  • Positively impacting on integrated working between services

What have we achieved?

Supported by the Barnet Borough Partnership local stakeholders have secured funding of £120,000, from the North Central London Integrated Care Board, to fund the Holistic Case worker project.  This funding will come from the funding allocated to address health inequalities in North Central London. Beyond securing this funding there are other significant achievements.

  • We have brought the different organisations working in Grahame Park together in a way that had not been achieved before.
  • We have demonstrated a way of working at a Neighbourhood Level that we know is influencing the way that the North Central London Integrated Care Board (NCL ICB) is thinking about the development of Integrated Neighbourhood Teams (INTs) in the region.
  • We have shifted the way that statutory providers think about housing organisations and their role in addressing local health challenges.
  • We have highlighted unmet needs in the community and co-produced a way of addressing these needs.
  • We have encouraged (through their participation in this project) North London NHS Foundation Trust to devote more resources to support mental health challenges in Grahame Park.
  • NHG has recognised the impact of this approach and has now commissioned similar projects to take place in Woodberry Down (in Hackney) and The Aylesbury Estate in Southwark.