Care City Case Study – Is it feasible for communities to play a far more significant role in reducing demand for public services through supporting healthy ageing?

Care City is an organisation jointly funded by London Borough of Barking and Dagenham (LBBD) and North East London Foundation Trust (NELFT).  Care City is a unique organisation and one of its fundamental aims is to improve healthy ageing for people living in the London Boroughs of Barking and Dagenham, Havering and Redbridge.

Background to project

One of Care City’s aims is to ensure that they effectively engage with local communities. Locality Matters, working with two key associates (Greg Wilkinson and Neil Reeder) met with Care City to explore their approach to working with local communities.  In that initial discussion, it became apparent that whilst Care City had a clear view of why they wanted to work more closely with their communities they had not settled on an approach for doing this.  Ultimately, after a procurement exercise, Locality Matters was commissioned to undertake a pilot or feasibility study in a community in Barking and Dagenham.  The aim of this project was to test a hypothesis that local people, if supported in the right way, can play a significantly greater role in the delivery of public services aimed at supporting people as they age.  In particular, the aim was to test the community’s capacity to prevent demand for services materialising.

What we did

We agreed with Care City that we should focus on one community or locality in Barking and Dagenham.  There were several criteria we looked at to determine which community.  These included:

  • Does the community place a significant burden on health and social care providers?
  • Is the community recognisable to the people that live there (i.e. do they associate with the place)?
  • Is there some degree of social capital we could build upon?
  • Is the community close to Barking Town centre? Care City were keen to see their office as a hub for community based activity, and picking a community close to the centre of Barking would therefore potentially deliver additional benefits to the project.

We ranked every ward in B&D according to these and other criteria.  We emerged with a shortlist of communities and from that shortlist selected Gascoigne.  Gascoigne is a notoriously deprived community but also one that has a very strong sense of community.  One of the other factors about Gascoigne which, in normal circumstances, might have discouraged us from focusing there, is that in the middle of the ward is an estate of c.20 tower blocks that is in the middle of a massive regeneration project.  This involves knocking down the tower blocks and replacing a large part of the residential estate.  However, because there is so much development going on across LBBD we agreed, that to work in an area undergoing such a transformation, would be of real value, in terms of building the case for rolling out the programme of work subsequently.

Once we had agreed on Gascoigne the aim of the project was to undertake two key tasks: firstly, build a detailed understanding of what was going on in the community, in terms of what local people and local third sector organisations were doing, and secondly assess what demands older people were placing on statutory services. Essentially, we were hoping that a greater understanding of local capacity and capability would provide opportunities for public service commissioners to think differently about service delivery and particularly to draw on local capabilities when commissioning services.

We got a very varied reaction when we told people we were going to focus on Gascoigne from “its an amazing community” to “your project will fall flat there”.

During the research we uncovered a huge amount of activity going on in and around the ward. As ever with projects of this kind there was little shared information about what was going on and no effective forums to share with each other, or share with the statutory sector the scale and appetite of the voluntary sector. Talking to local people and organisations all manner of opportunities emerged:

  • Churches helping to visit vulnerable elderly people
  • Other groups wanting to help speed up hospital discharges
  • Groups that felt they could be used to deliver a “social prescription”
  • A mosque that wanted to run a mental health support group
  • People that offered to help with transport
  • Many groups that wanted to help with promoting public health messages

In almost every case we asked if they had talked to statutory providers about doing these things and the response was generally that they had never considered doing that although, to be fair, they had typically not been approached by the statutory sector.

We then turned our gaze to what demands the over 45 year olds were placing on local public services.  Unsurprisingly from a community such as Gascoigne we found substantial pressures being placed on the health and social care system in areas such as:

  • Delayed hospital discharges
  • Unnecessary A&E visits
  • Loneliness and isolation leading to unwarranted pressure on GP services
  • Significant demands on domiciliary and residential care services
  • Widespread and deep evidence of people suffering with long term conditions such as hypertension and diabetes

Having gathered the information, we brought the community together to a meeting where we shared our findings and explored the potential for greater collaboration between local people, local voluntary organisations and statutory providers.

What was the outcome?

There is real power in sharing with statutory providers the scale of activity that is going on in any community and it is also revealing for local people to see the scale of demand that they place upon the statutory sector.  What emerged, from the meeting, was both a realisation and a commitment to work more closely together to look at ways in which people in Gascoigne could live longer, healthier, more independent lives.    Our original project had been to see if it was feasible that services could be improved and demand could be reduced by taking a more targeted approach to community development.  From what we discovered the answer to this was an emphatic yes and acceptance that more could be done.  We now embark on the next stage of the project which is to look in more detail at the business case and implementation plan for several the projects we have identified, as well as moving forward with some “quick wins”

Our aim is to demonstrate the positive impact greater community participation will have on:

  1. Demand for health and social care services
  2. Public service cost
  3. Community and personal wellbeing

This post will be updated following the completion of the next stage of the project.