Category: Newsletter features

Guest Blog from Rashid Iqbal, CEO, the Winch

How might Brexit affect Camden’s For-Impact Sector?

At the recent Health and Wellbeing Event for the Voluntary and Community Sector, Sanjay Mackintosh, Director of Strategy at Camden Council, asked what the impact of Brexit might be to help inform the Council’s contingency arrangements. I offered the following four insights, which summarised a few (but not all!) of the things that are front of mind for me.

1. Economies of Surplus.

As ever, much of government thinking is focused on and wedded to ideas of scarcity – shortages of medicines, food, time, and people (reducing people to ‘salaries’ and ‘skills’). Much of our work in the sector attempts to seeks out and redistribute surplus, like time, money, food, assets and kindness- as well as tackling shortages.

So, if there are food shortages, for example, is anyone asking what the knock on effect will be on food banks? Its estimated 20,000 people in Camden experience food insecurity and around 7,600 children attend school feeling hungry. The limited data available shows that, even before Universal Credit hit Camden communities, too many of our neighbours rely on the safety net of foodbanks. Whilst we should be concerned with the systemic causes of childhood hunger, there remains a questions how the widely –anticipated Brexit shock will impact on those most in need of support if food or other supplies are reduced and supply chains are strained.

Similarly, with over £800bn worth of assets leaving the country and the relocation of thousands of jobs away from London, there is no doubt that charitable giving and CSR activities in support of VCS organisations will be affected.

2. A hostile environment

Over the last decade, we’ve witnessed the aggressive promotion of policies, narratives and people championing divisive and discriminatory attitudes and behaviours. The Brexit debate has contributed to legitimising prejudice and, in the battle for relevance, both the mainstream media and social media companies have facilitated the sharing of hate propaganda.

Whilst Brexit has nurtured the politics of resentment and manipulated distorted ideas of privilege and betrayal, Windrush and the handling of the Salima Begum case have accentuated the logic of the hostile environment policy to the point where all citizenship can now be seen as conditional- albeit for some ‘lesser’ or ‘underserving’ people. Civic institutions are being co-opted to amplify, police and enforce the structures of exclusion. This will only further entrench fundamental inequalities and diminish us all.

As we reflect on last week’s devastating massacre in Christchurch, civil society leaders and organisations may want to consider how they can best work to safeguard and advance civil rights for all, especially in the wake of a Brexit that threatens to be harnessed by hardliners for their own hateful purposes.

3. Inability to Listen

What makes our task harder is that Brexit has moved us to a policy environment beyond facts –facts are seen as weaponised. Brexit has become an article of faith or ideology, in which you either believe or you don’t, with consequences either way.

Unsurprisingly, this results in a polarised national debate and fragmented country. Analogue politics appears addicted to hopelessly binary approaches to resolve wickedly complex problems. MP’s commitment to a new set of ‘indicative votes’ suggest they have still not understood the limitations of a yes/no or win/lose mindset.

Enduring change in communities is long-term, adaptive and emerges from practices that are committed to reflection and learning. Government has clearly become something else. This reinforces existing challenges and creates new ones for those working to secure societal change.

If you are a young person striking to prevent climate change and preserve the planet for future generations, even within the overwhelming backing of the scientific community and with the ‘facts’ on your side, you will need different tactics. If you are a head teacher struggling with budgets, your hard-won expertise may not be enough to have your views on schools funding to be valued and accepted. We’ll need to think about how we effect change nationally and what efforts we therefore redirect to working locally and more collaboratively. I don’t say this to give up on government, but we have more agency in our immediate worlds that we should look too, whilst they work on themselves.

4 Paralysis of Government

After the economic reductionism of the austerity years, we may have hoped for a more positive, inspiring national politics.  But Brexit has broken government. We now risk a real ‘lost decade’, with little or no longer term vision for investment in our physical and social infrastructure.

As ever, there will be small pots of money made available for time-limited, short-term activity. We can expect this to be much more tightly aligned to and controlled by government, who will should also expect to attempt to leverage charitable funding to its agenda. Funding will also be fiercely contested and it’s going to be even more tough to secure resources for vital causes.

Camden’s voluntary and community sector has proven to be a resilient over this period, but it may be about to get a little more difficult for many of us and we’ll need to figure out how we will best manage this between us, for the benefits of the communities we serve.

Jake Ferguson, CEO of neighbouring Hackney CVS writes about the Violence Reduction Unit which has been set up by the London Mayor and MOPAC to reduce serious violence in the London through a multi-agency approach. What role can London’s local infrastructure play to reduce youth violence in the capital?

There is an awful lot going on with what is broadly known as ‘social prescribing’.  The term ‘social prescribing’ covers a range of complimentary community led initiatives that seek to bolster health (and the health service) by reconnecting the individual to the community.  This simple tactic leverages the power of community and connection to combat isolation and re-empower the individual to take control of their life (and health). There’s a lot of theory sitting behind this (from sociology, psychology, neurology etc) but most people instinctively ‘get’ that a patient who feels empowered to make health decisions, feels connected to their community and not isolated or alone is someone in a much better place – mentally and physically.  In other words, healthier. You can look on the King’s Fund website to see acres of research and theory but for now let’s assume this is a good thing.

And not just a good thing for individuals and society – but a good thing for public sector finances – as a healthier populace is a cheaper populace!  This is another one of those public policies that is trying to be win-win all round: saving money, improving health and strengthening communities. All the players have their preferred angle but the same end goals.  And though there are many different ways of doing this there is a fairly firm divide between those taking a tech led approach and those taking a human led approach. Essentially the question is, is it best to have a tidy transactional pathways  – a database of community activities accessible at the touch of a button to the GP? Or messy, relational, connections – a volunteer who chats to patients and connects them into the local community?

“A further variable is the extent to which the scheme is transactional or relational, offering GPs a pathway beyond general practice or creating a more fluid interface between general practice, community organisations and communities themselves.”
From the Kings Fund report “Volunteering in general practice; opportunities and insights”

There is a perception on the ground that a disproportionate amount of effort (and resources) are going into attempts to create tech led ‘solutions’.  Volunteering, talking to people ‘in real time’ is seen as somehow old fashioned. The tech vision is beguiling – a database of local activities that the GP can signpost the patient to – job done!  If only it was so simple. The barriers to this model of working are myriad: How do all the local opportunities get listed (don’t say distribute an API! it’s not going to happen! Ask those who have tried.) Will the GPs really go through the database and make recommendations or referrals (doubtful). Self referral – do the target demographic browse databases of local opportunities which they then select, book or turn up to?  No!

Our experience is that tech can help in many ways but the core principle of a model that works has to establishing trusted relationships. That means a cadre of regular volunteers, sitting in GP waiting rooms, striking up conversations. It’s all very much IRL (in real life), but that doesn’t mean that there isn’t a role for tech.  We’ve merely found that ‘live ware’ is the primary technology involved and ‘software and hardware’ are very much in a supporting role. Yet frustratingly the lure of the tech ‘solution’ means that the money is generally being scooped up by wizzy tech startups and the people led initiatives struggle to attract the small sums of money that are needed to make these schemes work. In our borough alone there are multiple, competing tech startups enjoying public sector support, but delivering a questionable amount of ROI (return on investment).

However, there is plenty of tech that we do find useful:

• Smartphones and tablets
• Survey monkey (for evaluation and needs analysis)
• Emails and Texts for contacts. Social Media.
• CRMs (Contact Relationship Management software)
• Websites for disseminating information, hosting databases and directories, sharing resources
• Eventbrite for organising and booking events. etc

But an all singing, all dancing social prescribing referrals system is not something that there is any evidence is needed or will work.  Granted, when the current generation of millennials start ageing in 30 or 40 years time they will find tech solutions come naturally to them. No doubt they will combat loneliness with an app (Lonlyr?) and continue to use their social networking (facebook, instagram etc) to keep social contacts alive. But I suspect they will still want to talk to someone IRL, at least occasionally.

Making sense of social prescribing
Produced by the Social Prescribing Network at the University of Westminster, this is a new document which covers various aspects including – What is social prescribing; why do social prescribing; what do different models look like; what makes a good link worker; what makes a good referral; governance and risk management; evaluation
~ Download an interactive version of the PDF that allows you to go into weblinks and click between sections
~ Download a PDF to print

What Makes Us Healthy?
The Health Foundation is launching a new series of infographics and accompanying blogs and commentaries to describe and explain the social determinants of health in an accessible and engaging way.
These determinants include political, social, economic, environmental and cultural factors which shape the conditions in which we are born, grow, live, work and age. Creating a healthy population requires greater action on these factors, not simply on treating ill health further down stream.
The first infographic shows the extent to which health is primarily shaped by factors outside the direct influence of health care and invites us to look at this bigger picture. It also highlights the gap of almost 20 years in health expectancy between people living in the most and least deprived areas of the UK – a gap that is explained not by our ability to see a doctor, but by differences in our experience of the things that make us healthy including good work, education, housing, resources, our physical environment and social connections. See The Health Foundation website for more.

The English health inequalities strategy (1997 – 2010) turns out to have been an extraordinary success
A landmark report into the English health inequalities strategy–a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. This was one of the most ambitious strategies of its kind ever undertaken and aimed to tackle the underlying social determinants of health (reducing poverty and disadvantage) rather than the current focus on individual ‘lifestyle’ changes. The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy. Details on the BMJ website.

Link Worker social prescribing to improve health and well-being for people with long-term conditions: qualitative study of service user perceptions
Findings suggest that tackling complex and long-term health problems requires an extensive holistic approach not possible in routine primary care. This model of social prescribing, which takes into account physical and mental health, and social and economic issues, was successful for patients who engaged with the service. Future research on a larger scale is required to assess when and for whom social prescribing is clinically effective and cost-effective. Read the full report here.

News, reports, research from the Social Prescribing Network
Read the July edition online here.

LGiU Report: Community collaboration: a councillor’s guide
Engaging people in the decisions that affect their lives is an essential feature of local democracy. This goes far beyond town hall meetings and opinion surveys: we must recognise that communities often hold the answers to their own problems and allow them an equal voice at the table. For the purposes of this report, we call this concept ‘Community Collaboration’. Read the full report at lgiu.org.uk

Creative Health
Creative Health: The Arts for Health and Wellbeing has been published this week, offering research and recommendations for better integration of arts and cultural activities in health and social care. The All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) was formed in 2014 and aims to improve awareness of the benefits that the arts can bring to health and wellbeing. Read more.

An interesting article on community and social care from Mark Gamsu who concludes his article with this point:
“It is very important that statutory organisations such as big NHS providers, Clinical Commissioning Groups and those professionals funded by the state like GPs understand that it is not good enough to just design pathways that reconnect people with communities.
Communities are not just waiting with lots of spare capacity for people to be referred to them. They need investment too – the Rotherham Social Prescribing scheme, one of the biggest in the country invests two thirds of its resources in local community and voluntary organisations.
We should support social prescribing and personalisation pathways but commissioners need to give at least as much weight to investing in grass roots community organisations and building their capacity.” Read the full article here.

Social prescribing is not a new idea – it is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of local, non-clinical services, often provided by the voluntary and community sector. It is most commonly used with patients with a mental health or long-term condition. You may have come across it in a variety of other guises such as ‘books on prescription’ or the University College London’s ‘Museums on Prescription’ project.

There are people working with a variety of therapeutic models – ecological, arts and complimentary among others. In Camden, there is a spectrum of social prescribing provision: you may have come across local initiatives like Care Navigators, Community Connectors and Community Health Advocates. These are helping to guide people with complex needs, older people, and patients in GP practices towards non-clinical interventions that help improve health and well-being.

However, social prescribing is not straightforward. Practitioners, GP’s, academics and others with an interest in social prescribing are exploring a variety of issues like definition, integrating non-clinical services with primary care, regulations and standards, creating quality provision and current research in the field.

Those involved in providing services that could be socially prescribed often encounter difficulty working with GPs who have been educated in the medical model. GPs have raised issues about the faith we have in them referring to prescribed medicines, where these are either not taken or are taken incorrectly, and the amount of medical research that offers no clear solution to a particular health problem. Social prescribing could be seen as the “Trojan horse” within the traditional medical model where “subversive commissioning” could occur and patients gain access to services such as complimentary therapies that would not have been commissioned directly by the local Clinical Commissioning Group.

There are challenges for non-clinical service providers too. What does social prescribing mean for the voluntary and community sector? Voluntary and community groups run most of the projects which patients are referred to. This places voluntary and community organisations at the core of any sustainable social prescribing project. What does this mean in the current austere climate where organisations are struggling to stay afloat?

We will be discussing the opportunities’ and challenges’ that social prescribing presents and what we can do to develop a more robust model that suits the Camden landscape at the seminar being held on the 27^th June 2 – 5pm at the St Pancras and Somers Town Living Centre. Booking is essential.

In the meantime, if you would like some further information about social prescribing please contact Peter Simonson, Referral and Signposting Co-ordinator projectsupport@vac.org.uk. 020 7284 6550.