10% of a population’s health and wellbeing is linked to healthcare access according to a report by the Health Foundation, published in March 2018. The other 90% comes from wider health influences, such as: good work; money and resources; our surroundings; housing; education and skills; diet; transport; and our families, friends and communities. We’ve recognised this for a long time, experts such as Sir Michael Marmot have left us in no doubt.

This year we’ve been celebrating the NHS’s 70th anniversary but it’s also a reminder we need to think radically differently about how our health and care services support people, focusing on the whole person – their life and circumstances – not just treating their illness.

This is our focus in Greater Manchester.  We‘re committed to genuinely person and community-centred approaches supporting wider health and wellbeing.  We work in close partnership with the voluntary, community and social enterprise sector in all ten boroughs of Greater Manchester, so community-based support and activities align with health and care support. Key features of this approach are:

  • Listening to what matters to me: health and care professionals really listening and understanding an individual’s life circumstances, goals, motivations, interests and strengths. This means we can bring together care and treatment with support a person can draw from family, friends, carers and their community.
  • Solutions that are more than medicine: Social prescribing can be an alternative or addition to traditional medication which aids recovery by matching people with non-clinical support services such as befriending schemes, physical activities, social clubs, housing and debt support and much more. GPs, nurses, social workers and other health and care professionals can all make referrals.
  • Designing my own support: People managing their personal budgets helps secure co-ordinated, personal support for people with ongoing, and often more complex, care and support needs. It means people can co-design the support they need to keep them healthy, well and independent and makes the most of family and community support.
  • Recognising the strength of communities: a strong and vibrant voluntary, community and social enterprise (VCSE) sector, which connects people with their communities is essential.  Community-based activities, which promote self-care and improve health and wellbeing, are largely delivered by VCSE organisations and community groups. They can bring people together and combat isolation, either through befriending arrangements or as part of larger groups. There’s plenty of evidence that approaches like social prescribing really work, both in improving people’s wider health and wellbeing, but also reduces their need to see a GP or other health and care professionals as often. This improves the lives of Greater Manchester residents and takes pressure off our hard-pressed health and care services. There are many great examples of this is happening right now across Greater Manchester, where social prescribing is helping connect people with excellent community activities and support.

Our ambition is that this becomes the norm everywhere, not just an option in some areas; that GPs, nurses, social workers and other health and care professionals right across Greater Manchester are routinely able to help people with their non-clinical needs by connecting them with community groups and organisations that can help, as easily as they might prescribe medication, refer for specialist treatment or organise a social care package.

The purpose of our event on 19 July – Communities at the heart of health and wellbeing – is to celebrate the progress we are already making in Greater Manchester, learn from each other and further afield, but most importantly to inspire us to continue striving for a better approach to health and wellbeing. Join us in the conversation on twitter at #communitywellbeing

Social prescribing, personal budgets and other person and community-centred approaches need to be at the heart of all health and care services, working hand in glove with the VCSE, so that when we stand here in five years’ time – celebrating the next big NHS anniversary – we can say we truly have a system that supports health and wellbeing and addresses the wider health influences as well as it treats illness.

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  • Agree with what you say. But there’s a lot to unpick in, for example, “Recognising the strength of communities: a strong and vibrant voluntary, community and social enterprise (VCSE) sector… is essential.”
    The VCSE is a very varied umbrella term. Some of the most “successful” and eye-catching agencies are huge businesses dedicated to hoovering up contracts. This reduces resources puts for smaller organisations that may well have truer user involvement, may more genuinely represent marginalised communities and be more in touch with what really works for people with health and social care needs, neighbourhood by neighbourhood. Such organisations have already suffered from austerity which simultaneously exacerbates need and cuts the resources to tackle it. The contracting/financing of social prescribing and community wellbeing risks a worse service if it is set up so that the only agencies able realistically to bid for work are the giants with the machinery to draw up glossy bids and offer services across large geographical areas. Typically, to be effective, they need to get local knowledge and skills from the beleaguered smaller VCSE groups, but don’t pay adequately, if at all. The smaller organisations have little security and can’t plan. Projects are funded short term and close. The NHS and other referrers lose confidence in the sector.
    GMH&SCP therefore has to work out a way of paying for services we collectively need that focuses on where real value is in the VCSE – the best of the smaller community organisations and, where possible, economies of scale. It’s the smaller organisations which have often worked our practical partnerships with public and other services for the benefit of ordinary people.
    Finally the VCSE is not just about providing: it’s about representation of communities and their needs, and collective voices in framing policy – including telling those in power if their plans aren’t right. A funding environment that doesn’t recognise and value that will steadily kill off independent community voices and leave us all with worse services.

    • I agree very much with both your key points, that the contribution of smaller VCSE organisations is vital to successful social prescribing and community development, and that the VCSE is an important route to hearing people’s voices not just a provider of services and support.

      The work on person and community-centred approaches that the GM Health & Social Care Partnership is promoting absolutely recognises that you need a capacity to support social prescribing both in terms of link workers/care navigator roles and also small/local VCSE organisations and community groups having the capacity to respond to more people accessing their support through the social prescribing route. The approach we advocate therefore encourages commissioners to identify funding for both these areas and to ensure that link workers/care navigators have a detailed knowledge of their local VCSE and strong links with it – small, as well as larger organisations. We also encourage more flexible funding routes, such as grant funding, to encourage innovation from smaller organisations that are locally routed, and also avoids the need for large scale procurement processes.

      We are keen to see commissioners develop medium to longer term funding strategies, with a stronger emphasis on grant funding, for their local VCSE so that VCSE organisations can plan more sustainably. This should include a focus on how smaller VCSE organisations and community groups are supported to develop, for all the reasons you outline.

      I recognise that in an age of austerity there is significant pressure on budgets, but we will continue to make the case, based on an increasingly strong evidence base, that investment in community groups and infrastructure delivers both improvements in people’s health and wellbeing, as well as reducing demand for more expensive health and care services in the statutory sector. There are great examples of the type of approach I have outlined happening across Greater Manchester, but it is by no means as widespread or embedded as I would like to see, so our role is to keep the focus on these issues and press for the change we want to see.

      From: Giles Wilmore