TARGETING WELLBEING
HOW WE HELPED
205,237
PEOPLE LIVE HEALTHIER
AND HAPPIER LIVES
Portfolio Impact Report August 2015 1
2
TARGETING WELLBEING: EIGHT YEARS OF SUCCESS
From 2007 to 2015, 109 Target: Wellbeing projects worked with 205,237 people to increase physical activity, encourage healthy eating and improve mental wellbeing. Each local community project aimed to make a difference to wellbeing in a targeted local area. A wide variety of organisations – mostly from the voluntary sector – were involved in running projects and the portfolio as a whole was managed by Groundwork UK. Funded by £12.8m from the National Lottery through the Big Lottery Fund, Target: Wellbeing was one of 14 similar regional portfolios established in 2007. The programme began in the North West and later expanded to both the North East and West Midlands.
Target: Wellbeing has been one of Groundwork’s longest running programmes and one of our most important. The annual cost of health inequalities is between £25.5 to £37.5 billion1 through lost taxes, welfare payments and costs to the NHS. Many health conditions are preventable, and community wellbeing projects provide a friendly first step for people to start taking control of their own health and wellbeing. This report shows the impact of our eight year programme and recommends actions based on insights we’ve gained as a result of our ongoing evaluation.
1 Fair Society, Healthy Lives: The Marmot Review, Marmot, 2010
3
ABOUT OUR PORTFOLIO Impact 2013-2015 (final phase)
24,046
Beneficiary numbers by target audience of projects: Young people (15%)
Total beneficiaries, exceeding our original target by 1876 (8.5%)
Children & families (14%)
Asylum seekers (7%) General population (48%)
People with mental health problems (6%) Older people (5%) Women-only (2%)
Our projects
How did we measure impact?
The selection of Target: Wellbeing projects has always been driven by local need. We have never specified the types of intervention, simply the outcomes we have expected them to deliver. That means our projects have been highly diverse, ranging from counselling to table tennis to bicycle recycling.
We asked our projects to encourage beneficiaries to fill in simple questionnaires about how the project had impacted on their everyday lives. Those questionnaires were analysed and outcomes recorded against wellbeing indicators. Some of our indicators relate to an increase in awareness, while others measure actual lifestyle change.
The majority of our projects fit into nine categories of activities and interventions, as shown in the chart on page 5. Broadly though, our projects have tended to have the following characteristics: • Community-based: our projects are usually located in community centres, parks and other similar venues. • Non-health organisations: our projects are mostly delivered by organisations that do not primarily work in the healthcare sector. • Social: most of our projects bring a group of people together in an informal setting and encourage interaction between people. Some of our projects have been open-access, targeting all members of a community while others have been designed around particular beneficiary groups. The chart above shows how the programme is split between those target audiences.
4
We also commissioned the University of Central Lancashire to visit a sample of projects and carry out qualitative evaluation, including in-depth interviews of individuals and focus groups2. In addition, many of the projects commissioned their own independent evaluations with some requiring beneficiaries to provide additional information about their progress. Unless otherwise stated, the data presented in this report is for the final phase of our programme, 20132015. As outcome measures have changed since Target: Wellbeing began in 2007 it is not possible to easily calculate figures for the lifetime of the programme. You can find our previous impact report on our website3. 2 Evaluation includes reports focusing on beneficiary, project, programme and portfolio that can be accessed at: http://www.uclan.ac.uk/research/explore/projects/ target_wellbeing_regional_portfolio_process_evaluation. php 3 See www.targetwellbeing.org.uk
Main interventions and activities, by project (2013-15) Arts activities: Arts on Prescription Great Outdoors Refugee Wellbeing
Children’s play & development Active Play Cycling Together First Steps 4 Families Let’s Play
Conservation: Greener on the Outside of Prisons (GOOP) Great Outdoors Green Days Heal: Health Environment and Allotments Healthy Parks Healthy Minds
Cooking & nutrition: Addy Activity Clubs Asylum Link Better Lives Bite Families Fit for Life First Steps 4 Families Grow, Cook, Eat and Exercise on the Farm Healthy Eating Herbie Living Well for Less Physical Activity Street Eats Working Our Way to Health
Cycling: Activate Asylum Link Better Lives Cycling Together Health on Wheels Physical Activity Recreational Cycling Partnership Refugee Wellbeing
Food growing: Active Green Living Asylum Link Better Lives Bite Grow, Cook, Eat and Exercise on the Farm Heal: Health Environment and Allotments Street Eats Supported Volunteering
One-to-one support & advice: Families Fit for Life Knowsley Retain Linkbridge Refugee Wellbeing Supported Volunteering Trust Matters Women’s Wellbeing Working Our Way to Health
Personal development courses: Families Fit for Life Linkbridge Living Well for Less My5 Women’s Wellbeing Working Our Way to Health
Walking and exercise: Activate Addy Activity Clubs Asylum Link Better Lives First Steps 4 Families Get Up and Go Great Outdoors Physical Activity Street Eats
5
IMPACT: MENTAL WELLBEING 92% People feeling more confident to manage their everyday lives
Participants have reported their lives improving as a result of being involved with Target: Wellbeing, especially through improved self-confidence and self-esteem:
““
An unexpected effect of my involvement with BITE, is that it has re-instigated routine into my life, not only on Tuesday when I attend the allotment, but throughout the entire week. It has alleviated the symptoms of my deep depression and inspired me once again to take pride in both myself and my home.
—— Participant, BITE
““ ““
I have suffered with mental health problems for over 25 years but working in the GOOP project has helped me to feel more confident, social and healthier.
—— Participant, GOOP
It’s built my confidence up because I weren’t, when I lost my job, I went through a really bad time and I was doing anything to just distract myself from what had actually gone on, when I should have been grieving… And when I started this course and I started getting into it and stuff, it’s made me want to go back out to work.
—— Participant, Linkbridge
6
Volunteers working the the HEAL project
““ ““ ““
I was a bit shy when first started but after the first session I have come out of my shell I have more confidence.
—— Participant, First Steps for Families
I’ve made things I’m really proud of and my self confidence has taken a much needed boost.
—— Participant, Health Environment and Allotments (HEAL)
Running with a group has given me loads more confidence - it’s very motivational.
—— Participant, Physical Activity
90% People experiencing increased opportunities for social interaction
People who got involved with Target: Wellbeing have told us time and time again that they most value the social aspect of the project that they attend. Meeting new people and making new connections and friendships has transformed lives:
““
I really enjoyed it. It was freezing cold, snow on the ground, we were outside, it was just terrible conditions but I loved it. Just meeting people and talking… normal conversations again, rather than being trapped in my own little world. That was a doorway I think, yes. I realised that I could actually converse with other people.
—— Participant, Great Outdoors
““ ““
I’m a semi carer and since retiring it’s given me an outlet for energy and meeting people, it’s really, really amazing what it’s done, I’m really grateful for it.
—— Participant, Health on Wheels
I was quite nervous and paranoid about going places and mixing with people. I’ve overcome this a little more than before I joined the group.
Drawing class, part of Arts on Prescription
““
…it’s different ages as well, so you’re interacting with different age groups, not just like going to a normal college and you’ve got your sixteen to eighteen year olds in one classroom. You’re getting out, you’re meeting new people and just being able to talk to different people is good. It’s quite a relaxed environment as well.
—— Participant, Linkbridge
—— Participant, Arts on Prescription
7
89% People reporting new skills or knowledge gained
Target: Wellbeing projects are diverse so new skills and knowledge gained has ranged from gardening skills to budgeting to encouraging child development:
““
I’ve learnt quite a lot during the time here, stuff that I wouldn’t have picked up on the outside…I’ve learnt such a lot about growing stuff. And from my very limited exposure to it here, I’m confident in growing tomatoes, chillies, peppers, aubergines, all stuff that I can take away with me and do when I get out, whether for my own use at home or whether to sell the stuff.
—— Participant, GOOP
““ ““ ““
I have gained a lot of new skills, including stress management and home costings.
—— Participant, Families Fit For Life
I’ve learnt how easy it is to plant my own fruit and veg and it’s become something I enjoy.
—— Participant, Healthy Eating
I have learned many new skills as supporting children and families was new to me.
—— Participant, Supported Volunteering
8
The BITE allotment project in Manchester
““ ““
Learnt about mental health which I can apply at work when dealing with people with mental health issues.
—— Participant, Linkbridge
I’ve never planted anything before - I now feel confident to use my new skills at home and share them with my son.
—— Participant, BITE
Case Study:
Linkbridge Community Support Centre Linkbridge is a beacon of hope and change offering vital community support in a neighbourhood that faces many challenges. Services tackle the root causes of poor health and reach people missed by mainstream providers. Linkbridge works with people in need, offering a tailormade individual support package. Each person is given an action plan outlining activities and training that aims to help tackle mental health issues and boost overall wellbeing. Beneficiaries can also take part in accredited and non-accredited courses in confidence building, adult learning and employment training. Other activities on offer include counselling, information and advice on a range of issues that affect mental health. These issues largely focus around substance misuse, healthcare, housing, education, employment and money management. The project has a dramatic positive impact on beneficiaries’ mental wellbeing with scores of over 90% in all three of our mental wellbeing indicators.
““ ““
I just love coming here and it has made me more confident applying for jobs.
—— Participant
I haven’t worked in about ten years or something, ten years or more. And now that I’m getting the qualifications and certificates and working towards it all, I feel the confidence enough to get, you know, trying to go back in to work now.
—— Participant
““
It’s a little community centre. I mean there’s people doing these courses that would be too frightened to go into a big classroom… There’s some like groups of a dozen or fourteen or something and they feel comfortable in that.
—— Participant
The project is enabling learning and progression amongst marginalised groups and people who have been out of the labour market for some time. The individually tailored nature of the support on offer keeps beneficiaries engaged and able to expand their horizons.
9
IMPACT: PHYSICAL ACTIVITY 79% People reporting an increased awareness and understanding of the benefits of physical activity Participants have reported developing positive attitudes to the role of physical activity in their lives, and an awareness of how it makes them feel:
““ ““
My mindset is changed around how physical activity can make a big difference.
—— Participant, Activate
That’s the benefit of working on the farms and gardens…I’ve lost a lot of weight and I feel fitter than I did when I came in…It’s about four stone I’ve lost… you know, although nobody wants to come inside [prison], you have to look at the positive aspects and that’s a big one, you know, is the health aspect.
—— Participant, GOOP
““ ““
[I have] a greater understanding of the benefits of physical activity for babies - to encourage their development.
—— Participant, Let’s Play
It’s not been that I’ve been on a diet, I’ve just been eating healthily and being active really…It’s been a good thing to do [for my] physical health, as well as mental health.
—— Participant, Great Outdoors
10
““ ““ ““ ““ ““
[It] made me aware my asthma doesn’t stop me running, [that I can] get fit and improve my cardio system to assist with my asthma.
—— Participant, Physical Activity
I think that we just enjoy doing it because, obviously, you know the difference between exercise and sitting down watching telly.
—— Participant, Addy Activity Clubs
I love gardening in my life and it’s a good occupation for me [rather] than to stay home, eat and [get] fat. It’s like, for me, a gym there. I am sixty!
—— Participant, Asylum Link Better Lives
I already understand the importance of physical activity but more aware that it needs to take place more outside.
—— Participant, Green Days
I’ve learned how to set goals and follow a fitness programme - I’ve been really inspired by others attending training sessions.
—— Participant, Physical Activity
70% People reporting increased levels of physical activity in daily life There is clear evidence that advice given and activity learned within our projects has translated into wider benefits in everyday life:
““
It just makes me want to be outside more because before I went to Addy I never went outside basically…I just didn’t. I was just always upstairs in my bedroom. I’m hardly ever in my room now.
—— Participant, Addy Activity Clubs
““
I walk three times a week, five miles at a time. People tend to wave at me now, so I’m dead proud of myself. How long I can carry on…through the winter or not, I don’t know, but at the moment…I’m quite capable of doing it. And I wouldn’t have been able to do that at one time.
Get Up and Go older people’s exercise group, Oldham
““
I enjoyed the walk immensely; it was well planned and catered for everyone’s pace and physical limitations, but still inspired me to walk more often, even though I suffer from arthritis and spinal issues.
…the first few weeks I was conscious of having to exert myself. And, you know, even sort of bending down and ripping a tomato plant out of the ground, I’d be catching my breath. You know, I was thinking, well yes, you really are in bad shape, you know, if bending over like that is giving you sort of shortness of breath. [I wanted to] just to sort of get a bit fitter and, you know, do it that way by working outside.
—— Participant, Street Eats
—— Participant, GOOP
—— Participant, Get Up and Go
““ ““
I do a lot more walking and take the kids to the park... before I used to take the car.
—— Participant, Families Fit for Life
11
67% People reporting reduced barriers to exercise or having taken up a new activity
We have encountered many examples of project participants reporting that they have decided to start attending fitness classes or joined a gym, or that the improvement in fitness caused by attendance at the project has meant that they can now exercise more effectively:
““
I have never been great at running - since taking part in the project my stamina has improved – I can run four times around the track without stopping, something I could never imagine at the beginning.
—— Participant, Activate
““
There was very limited garden jobs and you’re in closed conditions…you go to a yard, just a yard for an hour a day…It felt good being able to walk out and about because after being banged up for so long, it’s like the complete opposite.
—— Participant, GOOP
““ ““ ““
I felt I couldn’t exercise with the baby but now I realise I can.
—— Particiant, First Steps For Families
[We] managed to get second hand bikes and now go on rides as a family
—— Participant, Families Fit for Life
Today is my first time riding a bike. I learnt how to balance. Learning how to pedal the bike and speed off.
—— Participant, Refugee Action
12
Let’s Play provides physical activity sessions for parents and their babies and toddlers in Greater Manchester
““ ““ ““
I had never attended a total tone or boxercise class... I’ve started a new part of my life with the adventure of sport.
—— Participant, Addy Activity Clubs
I have also joined a gym! Go me!
—— Participant, BITE
Helped me to do something that I hadn’t done before and didn’t think was possible.
—— Participant, Physical Activity
Case study:
Health on Wheels, Cycling Projects Health on Wheels is a community-based cycling initiative. It targets those with sedentary lifestyles and gets them back in the saddle – increasing physical activity and boosting mental wellbeing Two weekly sessions have been taking place in both Preston and Knowsley: • a ‘beginner’ ride, including beneficiaries who have been referred to the project by their GP. • an ‘intermediate’ ride of up to twelve miles, with a café stop for socialising. As well as GP referrals, there are a number of pathways in which beneficiaries become involved: from seeing an advertisement in the local newspaper to being approached by a project volunteer. The project has been tailored to allow people of all physical abilities to benefit (including the provision of adapted bikes) and longer rides are provided to enable progression into local cycling clubs. Participants often go on to be volunteers and ride leaders, helping make the project sustainable. This project has a dramatic positive impact on mental wellbeing with scores of over 90% on all indicators. 94% report that the project has directly caused them to increase their levels of exercise in daily life. The project has been particularly valued by people taking part for its social benefits – creating new connections between people of different backgrounds.
““
The project helped me to increase my self confidence – helped me to get active again and due to this my mental and physical health improved... after a year with the project, I had the confidence to get a job, and staying with the project has helped.
—— Participant
““
I see [Frank] here now [compared] to when he first came, and he was very slow on his bike, and you see him… it’s when you see a person and they’re getting faster and faster going along and having to wait. And so many people come here and are struggling and after a few months they’re away.
—— Participant
““
I’m confident on the road now, where[as] before…it’s dead easy with a group, you know though, all the route’s planned, but you feel more safe in a group than being on your own.
—— Participant
13
IMPACT: HEALTHY EATING 76% People reporting increased access to healthy food choices
Healthy eating has been less of a focus of the portfolio is a whole. However, a number of our projects have enabled people to have access to healthier diet primarily by expanding their horizons and allowing them to discover new foods. Our Herbie project in particular has directly aimed to increase access to healthy food through providing a delivery service within the community and workplaces.
““
I do always try and snack healthily at work but the Herbie fruit boxes have made it a lot easier as I don’t have to remember to bring in fruit from home every day.
—— Participant, Herbie
““
You made stuff with porridge and that bird seed stuff (granola), never had it before, I didn’t know what it was, eat it all the time now...
—— Parent of participant, Active Play
Growing healthy food at ‘Great Outdoors’
““
The whole healthy eating, healthy lifestyle, really appealed to me…just to give [my children] healthy food. I like cooking from scratch and just having really fresh, you know, freshly grown food. Knowing that there’s no pesticides or chemicals on it at all… I really enjoyed doing that. And I could see the benefits in myself and in them. They suddenly had more energy, they were better at school. I was feeling better about life in general.
—— Participant, Great Outdoors
14
61% People having developed new skills regarding growing or cooking nutritional food Participants have reported a change in their diets thanks to now having the skills and confidence to cook healthy food.
““
…you get to learn new skills and you get to cook healthier things than you normally would. Like say for your breakfast or your lunch, you want a bacon butty, you would have different options to make different like healthier things. Because you can’t always live off greasy foods, you have to have vegetables and things.
—— Participant, Addy Activity Clubs
““ ““ ““
[I’ve got a] better understanding on how to create healthier food and meals... better preparation of ingredients.
—— Participant, Healthy Eating
[I’ve] gained experience in cooking - can now cook at home!
—— Participant, Living Well For Less
…instead of watching your parents just do it, you can just do it yourself.
—— Participant, Addy Activity Clubs
Campfire cooking as part of ‘Living Well for Less’
““ ““
I’m cooking from scratch... new recipes, using fresh ingredients, grew some herbs...
—— Participant, Families Fit For Life
I have learnt so much from this course and can now see where I was going wrong before. I don’t need a faddy diet; I just need to watch what I eat each day.
—— Participant, Healthy Eating
15
76% People displaying an increase in knowledge around nutrition and healthy eating
Beneficiaries have given clear examples of how their knowledge of good nutrition has increased:
““ ““ ““ ““
Since working on the allotment project, I’ve started eating vegetables for the first time and with all the physical activity I do, I’ve lost half a stone – which is great!
—— Participant, Healthy Parks Healthy Minds
My kids know fruit and veggies in Morrisons better than I do, they’ve learnt shed loads about healthy stuff, shows me up....but in a good way! Creating salad boxes as part of ‘Street Eats’
—— Parent of participant, Active Play
[I] Definitely learnt about healthier options and why it is important to go for lower fat versions.
—— Participant, Healthy Eating
[We cook] different healthy things, and [the instructor] tells us what’s in it. So then like we know that we’re eating something healthy and she tells us the difference between like, say if it’s healthy, like the difference of sugar or anything between them.
—— Participant, Addy Activity Clubs
““
It has made me want to start trying different foods.
—— Participant, Living Well For Less
16
““
I’m up half six in the morning, you know, I naturally wake up now at that time. By 7 o’clock I’m eating my breakfast and then you come back at 12, you have a salad lunch. And then you have your main meal at 5 o’clock and it’s a sort of a healthier way of eating really.
—— Participant, Greener on the Outside
Case Study:
Healthy Eating, Groundwork West Midlands Groundwork West Midlands’ Healthy Eating service works with targeted groups such as the long-term unemployed and new mums to identify and help address barriers to eating healthily – be they motivation, understanding, time, cost, skill level or confidence. The Healthy Eating service works with partners such as childrens’ centres, community centres and supported housing schemes to reach targeted groups. Sessions are provided tailored to the participants, and include a mixture of cooking skills classes, cooking clubs, community food growing and children’s learning sessions. Lots of participants have reported using their new skills back in the ‘real world’ – changing the way they prepare and cook food for their families. 100% of participants who responded reported that they had developed new skills in growing or cooking, with 91% reporting increased access to healthy food choices. Although a healthy eating initiative, mental wellbeing outcomes have been equally impressive. This demonstrates the value of projects that boost social interaction and building of local social networks.
““
The course has also helped my children and grandchildren as I thought I was feeding them healthy food before but I now realise I wasn’t, so have made lots of swaps, especially with my granddaughter.
—— Participant
““ ““
I’ve never really been shown how to cook... how quick you can do a healthy meal that is cheaper than fast food like takeaways!
—— Participant
Been to similar sessions with the people who run it before and enjoyed it. Good to learn new things, like the group, nobody judges you!
—— Participant
The project was valued as being a ‘safe space’ – underlining the importance of a supportive atmosphere to these kind of behavioural change projects.
17
IMPACT: ADDED VALUE The impact of Target: Wellbeing has gone beyond the outcome targets set out by the Big Lottery Fund. Our evaluation recorded a range of additional benefits of the programme.
Indirect beneficiaries in families and communities There is evidence that the knowledge and skills learned by participants in our projects have been passed on to their families and friends, creating a ‘ripple effect’ within communities:
““
I was telling everyone who came into my taxi all about the course and my regular customers began asking me what I had cooked that week.
—— Participant, Healthy Eating
Increased aspirations We’ve noted examples of beneficiaries changing the way they think about their abilities and their futures. This has included physical activity goals that are far in excess of the capabilities of the participant before joining the project, and the development of new horizons in terms of future careers and life choices:
““
Some of the rides that have sprang from this…which you would have never thought, even myself, I’ve always cycled but I’ve never done any distance… So yes, a nice long ride…thirty five mile, I wouldn’t have done that before.
—— Participant, Health on Wheels
““
When we’re down the gardens, you know, you say to each other, what are you going to do when you get out? And a couple of lads have said, “well, you know, do you realise, you can actually sell that stuff?
—— Participant, GOOP
““
…it can boost your self-confidence, you know what I mean? Since I’ve started this course and started coming to Linkbridge, my confidence has shot up... You know, the background that I come from and things like that, I wouldn’t have gone to college. But here it’s helped me to believe in myself, that I can do things… and progress to the things that you want to, the goals you want to reach…
—— Participant, Linkbridge
Reconnection with the environment Many of our projects are based in the outdoors and this has been viewed as positive by many beneficiaries who have noted the benefits. People with mental health problems have particularly valued our projects which involved working outside and have reported that this has had an impact on their mental health:
““
I love the fresh air, the sense that I am at one with nature, and the knowledge that in a small way I am making a difference. All these things are helping me to rebuild my shattered self-esteem.
—— Participant, BITE
““ ““ ““
Coming here has given me the chance to enjoy being back in nature.
—— Participant, Healthy Parks, Healthy Minds
The walks have helped me to connect with nature. They have helped me to develop a greater level of calm and to socialise with other group members.
—— Participant, Activate
Being outdoors with planned activities as a family unit is fantastic. No sibling rivalry – happy family.
—— Participant, Green Days
18
Enabling self-management Participants with existing medical conditions have reported being able to manage them more effectively after involvement in our projects, particularly people with mental health conditions:
““
I’ve had schizophrenia all my life.. It’s hard to explain when I hear things but it comes and goes, and can feel worse when I’m stressed or if things are not going well. [The project] helps me to manage my schizophrenia better... Since starting with Groundwork, I feel a lot calmer and I am a lot better I’ve learnt how to open up to people and talk about how I feel, which helps me control things.
—— Participant, Healthy Parks Healthy Minds
““
Concentrating on an activity reduces my anxiety level and this makes me feel happier.
—— Participant, Street Eats
Progression towards employment Many participants on Target: Wellbeing have been people who are long-term unemployed or economically inactive due to medical conditions. That has led our projects to develop progression pathways for people who have gained in confidence and skills – enabling them to become a volunteer project leader or mentor to others. Many projects have also enabled people to gain recognised qualifications. Target: Wellbeing projects have proved to be an important first stepping stone in the journey towards employment for many beneficiaries.
““
Just being outside and talking to people and like as new folk come along, I’ve started to pass on my experience and my knowledge to those people, mentoring kind of, but not officially mentoring, which has been a big confidence boost for me as well. And they look to me because I have answers, I can answer their questions, which I never really thought about being able to do before, just talk to people.
—— Participant, Great Outdoors
19
““
“…before I started doing these courses, my track record.. I’ve been in and out of jail all my life. I’d no chance of getting a job, you know, with my record. But with me doing this, these courses, has bettered me, you know, a hundred percent of me getting work in the near future.
—— Participant, Linkbridge
““ ““ ““
This has inspired me to go to college and do an English and Maths course.
—— Participant, Healthy Parks Healthy Minds
I did a course in Whalley and enjoyed it so much decided to volunteer and it [has] been great.
—— Participant, Arts on Prescription
I need…future work in a restaurant, take away. Yes, in the future…next year, hopefully.
—— Participant, Asylum Link Better Lives
Benefiting people in particular disadvantage One of the features of Target: Wellbeing that we are particularly proud of is the focus throughout on niche groups of people at particular disadvantage within our society. Three of our projects have worked extensively with refugees and asylum seekers: a group who often live in extreme poverty and have few opportunities to socialise or eat healthily.4 Also, our Greener on the Outside project has worked with prisoners across the North West. Research consistently shows that prisoners have high levels of poor health, particularly mental health. Poor physical, mental and social health – alongside poor levels of literacy and numeracy and educational achievement – is strongly associated with offending behaviour.
Sustaining community assets Some of our most successful projects have been based around physical community assets such as Rice Lane City Farm, the National Wildflower Centre and the Linkbridge community centre. The Target: Wellbeing funding has helped to sustain these important assets and shape them as hubs of community wellbeing activity. 4 Newly Arrived Refugee and Asylum Seekers in Trafford: Life stories, needs and assets, Buffin, J., Roy, A., Farrier, A. & Poursanidou, D., University of Central Lancashire, 2011
20
Organisational benefits One of the original aims of the Target: Wellbeing programme was to give voluntary sector organisations a better understanding of health and wellbeing and how to work effectively with the health sector. Over the eight years of the programme we have provided a wide range of advice, support, training and networking opportunities to our projects. We’ve helped projects learn from each other and from experts in the field. Towards the end of the portfolio we sought to help our projects to be in the best position possible to find continuation funding by commissioning sustainability research. This aimed to look forward and provide an overview of the funding marketplace in which our projects would be competing to secure revenue sustainability. Each project has also been provided with a tailored Impact Report that can be used to help position the organisation for future opportunities.
““ ““
The thing that’s [been] particularly good for me and from a fundraising point of view, is learning about wellbeing, getting involved in different aspects of healthcare
—— Project Manager, Asylum Link
Groundwork UK has provided excellent support throughout the project. [Target: Wellbeing] has helped us grow as an organisation, increasing our understanding of complex issues that people are faced with on a daily basis. We have also gained invaluable skills that will further help us to build on this work
—— Project Manager, Linkbridge For Groundwork UK as accountable body for the programme, the benefits of being involved have been twofold. We have been much better able to understand the opportunities and challenges of embedding health and wellbeing within our work in communities and with young people, which has given us a firm foundation to build on in the next phase of our wellbeing work. Secondly we have worked with new partners – such as prisons and the rehabilitation sector – which we are developing to create future innovative programmes.
Case study:
Greener on the Outside of Prisons, University of Central Lancashire Poor health and lack of marketable skills are common amongst offenders5. Greener on the Outside of Prisons (GOOP) tackles this by providing a tailored and sustainable ‘green health’ programme for addressing mental health, physical activity and promoting healthier eating. The project works with prisons and probation (approved premises) around the north west to develop horticultural and environmental training and work for prisoners, both within the prison environment and within the community. Activities include: • Establishment of outdoor areas for growing food, horticulture and for prisoner relaxation. • Training of prisoners in horticulture and landscaping. • Maintenance of gardens and outdoor spaces. • Growing of fruit, vegetables and garden plants, and in some cases animal rearing. At some prisons produce is sold to staff, visitors or external businesses such as local cafes. • Landscaping and horticultural work within the local community. GOOP has been one of Target: Wellbeing’s big success stories. Prisons have reported that GOOP has had a major impact both on behaviour of prisoners and the prison environment. Since we started funding GOOP it has expanded to all state-run prisons in the North West – a huge vote of confidence in the benefits of the project.
““ ““
Being involved in the group has helped me with my social anxieties and helped me gain self-belief again.
—— Participant
…with the encouragement of the garden staff…we were there doing the selling direct to the public. And after, you know, nearly a year inside, to interact with the public and actually sell stuff to them, that was quite good, you know, I enjoyed that.
—— Participant
““ ““
I can honestly say, I wouldn’t have become as fit as I am if I’d continued doing my job sitting in an office.
—— Participant
I wish I’d have done all this at school, right, because it has been the making of me. I absolutely love it. Because it’s like, when you put a seed in the soil, right, and then you watch it, and it’s like, you’re growing with that seed.
—— Participant
5 Reducing Re-offending by Ex-prisoners, Social Exclusion Unit, London: Office of the Deputy Prime Minister, 2002
21
SUCCESS FACTORS... The Big Lottery Fund conducted research6 ‘What works for Wellbeing’ which outlines a range of learning about what works in wellbeing projects. Our experience is strongly in line with those findings. The following factors have been crucial to the success of Target: Wellbeing.
Holistic nature of wellbeing Participants have noted that projects that explicitly tackle one area of wellbeing have in fact helped them in other ways. This is most notable in terms of the mental health benefits of physical exercise. We have also noted that many of our projects have achieved outcomes that were not expected – for example physical activity projects that did not set out to tackle healthy eating have done so indirectly through raising personal aspirations for a healthy lifestyle.
““ ““
It’s not just a physical thing, it’s another thing as well, people feel better coming here, it lifts you.
—— Participant, Health on Wheels
I have learnt how physical activity affects your mental...wellbeing.
—— Participant, My5
Safe spaces and venues People who took part in Target: Wellbeing projects have often reported their sense of feeling safe. People have valued a non-judgemental atmosphere, and there is evidence that this has particularly benefited people with mental health problems who have struggled to take the first steps towards a more active life. The majority of our projects are not located in venues with an NHS or statutory focus – something which we know helps to build confidence to attend.
““
[A] safe and quiet place to come to.
—— Participant, Healthy Eating
Supportive staff The staff working to deliver our outcomes are the real heroes of Target: Wellbeing. We have seen countless examples of people going the extra mile to help people get the most from our projects.
““ ““ ““
[The project has] friendly staff who got involved with the children.
—— Participant, Green Days
[The tutor] made everyone feel so welcome.
—— Participant, Healthy Eating
[The instructor] is a fantastic person… very friendly…easy going…dedicated to this course.
—— Participant, Physical Activity
Personalised support Every person’s needs are different and they require different forms of support to make lifestyle changes. Our best projects have understood this and have been able to tailor their programmes effectively to the needs of participants.
Beneficiary recruitment and retention Successful projects have a range of methods of recruitment and referral rather than relying on just one source of new participants. We’ve observed the following recruitment pathways through our evaluation: • Open access events • Word of mouth • Outreach by staff • Referrals by GP • Referrals by community centre staff / churches etc • Marketing via leaflets, posters and newspaper adverts
““
...my mates used to go…I just wanted to see what it was like. Because they used to always buzz of it at the school, all my mates, so I just wanted to try it.
—— Participant, Addy Activity Clubs 6 What works for Wellbeing, Big Lottery Fund,
22
Retention of participants after the first contact is often due to the social atmosphere even more than the enjoyment of the activity on offer:
““
I really enjoyed it. It was freezing cold, snow on the ground, we were outside, it was just terrible conditions but I loved it. Just meeting people and talking… normal conversations again, rather than being trapped in my own little word. That was a doorway I think, yes. I realised that I could actually converse with other people.
—— Participant, Great Outdoors
Value of long-term programmes Target: Wellbeing’s longevity is unusual for this type of funding stream. Often, initiatives scrape funding together year-by-year, coping with ever-changing targets and expectations. This longevity has allowed our most long-standing projects to hone their provision based on lessons learned over years rather than months.
““
…that length of working that you’ve got, allows you to put things in place and embed them…over a long time... we’ve become…professional… wiser about a lot of things, whether it’s healthcare and how we interact with the council and CCG, environmental health, the way we prepare food and the way we do things.
—— Project Manager, Asylum Link Merseyside
Health by stealth Our projects are generally not framed in terms of health and do not take place in health-focused venues. This has helped to attract people to get involved who might feel intimidated by attending a ‘healthy’ activity. Our most successful projects have delivered ‘health by stealth’ – they have helped people become more active and positive about themselves without lecturing or ‘nannying’.
Free at the point of delivery Our projects have been free to access and that has proved crucial to attracting those beneficiaries who are most in need. Free access has enabled many participants to attend, as has other practical support such as free childcare or subsidised transport. People living in poverty cannot easily make healthy choices if there is an added cost.
The portfolio approach The portfolio approach of Target: Wellbeing has been a significant factor in success. Our central team, acting as a buffer between the funder and the small local project, has been able to act as a source of support rather than simply a manager of grant funding. We have been able to deliver a significant training programme and upskilled projects in undertaking effective evaluation crucial to future funding. The portfolio approach has also meant we have been able to network together projects on a geographic and thematic basis which has brought about learning and practical linkages through signposting and referrals.
23
...AND THE CHALLENGES All of our projects have faced challenges but some have been able to overcome them more effectively than others. We have identified the following factors as the most difficult challenges faced by our portfolio as a whole:
Effective targeting Not all of our projects have been able to effectively target the people most in need of the interventions available. All too often not enough time is spent at the development stage of projects understanding the target audience and the best ways of reaching them. Commonly, this ‘social marketing’ is seen as an add-on later when it should be built into the very design of the project. Involvement of potential beneficiaries at this early stage is also key to success.
Understanding the marketplace We have seen examples of projects failing because they did not adequately understand the existing range of similar provision on offer in the target area and how to complement them rather than try to compete.
Measuring impact Effective evaluation has been one of our biggest challenges. At portfolio level, designing an impact measurement system that can work across a diverse set of projects with differing target groups has been difficult. In our early phases of work our questionnaires for beneficiaries were much too complex, while our later model has not allowed us to track the progress of individuals. Projects often underestimate the challenge of carrying out effective evaluation and do not allocate enough resources to do so. Our learning from Target: Wellbeing has encouraged Groundwork to further identify the health and wellbeing outcomes achieved through our work. We have started the process of developing consistent monitoring and evaluation tools that will enable effective comparison of and measurement of impact. Building on the portfolio evaluation and a Social Return on Investment (SROI) assessment model developed for
24
Amira demonstrating cooking techniques at Asylum Link Merseyside
Groundwork by Sheffield Hallam University, the intention is to develop a “Wellbeing Return on Investment” model that takes the best from existing SROI methodology and quantitative and qualitative evaluation methods.
Quantity vs quality of intervention Some of our projects have worked with the same group of people for long periods of time. While this points to a depth of intervention that may be very effective for those individuals, this increases the cost of each outcome significantly and demonstrates limited targeting of potential beneficiaries. Some other projects have seen a churn of participants that may suggest a lack of sustained behaviour change.
Changing policy and structures Target: Wellbeing was conceived in a very different health and wellbeing landscape. The original portfolio was designed to be integrated with the objectives of local Primary Care Trusts (PCTs) and worked closely with the regional public health teams. The advent of the coalition government saw a complete restructure of this landscape with established networks and relationships dispersed. It has sometimes been challenging to recreate the strong partnerships that existed at the beginning of the portfolio.
Participant story:
Patrick, Health Environment and Allotments (HEAL), Groundwork North East & Cumbria Patrick is a volunteer with Health, Environment and Allotments (HEAL). He has autism, and joined the project after encouragement from his mother. He comes to the project every Friday and enjoys the challenge:
““
It’s a great environment. No mucking on here, if there’s a job needs doing, you don’t whinge about it, you do it. That’s what we do, it needs doing and that’s like final.
He is now doing additional tasks to assist the staff outside of the gardens, such as taking the register of attendees for the sessions on the Friday, a role which also gives him the autonomy to assess what tasks in particular will need more attention from him. This is something he has learnt during his time on the project:
““
I just picked it up. I’m an organiser, I love organising. …I’m a planner... I’ve got to think ‘which tasks are more important, which one needs doing straight away than what’s going to be the best, the most impact on the site?’
A member of staff described Patrick as is essentially in charge of the groups, able to delegate tasks to appropriate beneficiaries according to their particular skills:
““
So I know that [one beneficiary], his strength and I know he can dig. So if there’s a job coming up with digging, I give him the job... I know the jobs I need to give them to.
He describes himself as proud of what he is doing on the project and getting more confident as a result. This confidence has led to changes in behaviour outside of the project, such as walking around in public by himself, which he was reluctant to do before. He also mentioned talking to volunteers outside of the sessions at local social events. Joining the project appears to have had a beneficial effect on his overall mood. Patrick is involved with some entrepreneurial plans at the project to sell some of the produce of the gardens to the public:
““
We’re going to start selling them to the public. You guys can come in, get the plants you need or you can buy what you want…we’re going to make it presentable [with] a sign saying underneath, ‘plants for sale’, or something like that.
Ultimately, he would like to have paid employment in relation to the project, however he believes it has also stood him in stead for:
““
It’s a volunteering bit now but if a job comes up, I’ll take it because I would like it, I love working here, I love it…if another job comes up anywhere else, I’d be fine... I can get myself out, I can do it!
25
OUR KEY FINDINGS For policy makers and commissioners 1.
Recognise that simple, social interventions can have a big impact on mental wellbeing The big lesson from Target: Wellbeing is that these types of projects have a particularly big impact on mental wellbeing. We’ve seen our beneficiaries report positive mental health outcomes across the board and we have collected case studies demonstrating that getting involved in our projects has had a major impact on people with serious mental health conditions. Previous research into community wellbeing projects7 has identified that improving mental health is often a necessary precursor for adopting a healthier lifestyle. It is important that any serious attempt to tackle poor levels of mental health in the UK considers positive social activity as part of the treatment mix8. Social activity also needs to be focused at a broader group than just the mentally ill in order to gain the full benefits of people with different levels of skills, confidence and life experience coming together within their community.
2. View wellbeing projects as a vital
step towards employment
Projects such as those developed by Target: Wellbeing are highly effective at building confidence levels, personal efficacy and social networks. These are vital precursors to successful engagement in mainstream employment support, and ones which many people with mental health conditions lack. The government-commissioned report into evidence relating to mental health and work states “People with severe mental illness who do not believe they are ready for paid employment should... have access to meaningful occupation such as voluntary work... of a nature that builds work skills and confidence.”9 Referral to community wellbeing schemes, especially those which offer forms of progression through volunteering, could be an effective way of providing a realistic pathway towards sustainable employment. 7 Big Lottery Fund National Wellbeing Evaluation, CLES, 2013 8 New Horizons: Confident Communities, Brighter Futures: A framework for developing well-being, HM Government & Department of Health, 2010. 9 Mental Health and Work, Royal Society of Psychiatrists, 2008
26
3. Value community assets Some of our projects are based around valued local assets – both environmental such as parks and allotments and buildings, such as community centres. These assets are often at the centre of a network of skills and knowledge created over decades and that capacity has helped our projects to be successful. When such an asset vanishes or is radically scaled back, it is likely to have a huge knock-on effect locally. We welcome the increasing focus on asset-based approaches in many local wellbeing strategies10.
4. Commission projects that
address multiple strands of wellbeing
We have found that projects focused on physical activity also benefit mental wellbeing and encourage healthy eating despite not being designed to do so. This mirrors other research by the Big Lottery Fund11. It may be most effective to commission projects which have a whole-person approach, addressing multiple strands of wellbeing. These will lead to lifestyle changes and create a positive self-reinforcing cycle of improved wellbeing.
5. Fund longer term initiatives The longevity of Target: Wellbeing has allowed greater learning, investment in interventions and a level of financial stability for delivery organisations while considerable change took place outside the portfolio. To some extent we have been able to refine our ideas and therefore be more effective. We would recommend to funders such as the Big Lottery Fund that future programmes are designed with long-term (five years+) funding, but including an initial pilot phase that tests models of delivery before final commissioning.
6.
Accept that nothing is free
We’ve come to understand that projects will require ongoing funding: whether that’s volunteers that require support and training or where target beneficiaries cannot afford to pay for valued services.
10 A glass half-full: how an asset approach can improve community health and well-being, Improvement and Development Agency, March 2010. 11 Big Lottery Fund National Wellbeing Evaluation, CLES, 2013
Many of our projects have examined co-payment as an option but have found it would not be viable because of the limited disposable income of the target group.
7.
Stick to the principles of intelligent commissioning
Small local voluntary-sector projects are often best funded through grants and often cannot easily access other sources of funding. For example, the introduction of personal budgets is challenging to many organisations as they are not able to take the financial risk of being unable to fully cover their costs. Commissioners need to stick to the principles of intelligent commissioning12 and ensure that services are procured using a variety of funding models and approaches including grants where appropriate.
8. Be clear on how to measure
impact
There is widespread confusion within the third sector organisations that we have worked with about the best way of measuring the impact of this type of project. Commissioners should be clearer about the standard of evidence required and help develop the capability of providers to meet those standards. This nuturing will help ensure a diverse supply chain of providers.
9. Cutting local community
projects is a false economy
While almost all of our projects will continue in some form, the majority will do so with reduced capacity to make an impact. The continued pressure on local authority budgets makes this type of project vulnerable to austerity measures. This is a false economy given the costs of treating poor mental health. In England alone, mental illness costs over £105.2 billion a year, through the costs of medical or social care, and production output losses.13 It is estimated that 35 per cent of those with depression and 51 per cent of those with anxiety disorders are not in contact with services. If those people were to improve their conditions and reduce their days of sickness or return to the labour market the reduction in lost employment costs should outweigh treatment costs.14 12 A Better Return: Setting the Foundations for Intelligent Commissioning to Achieve Value for Money, Cabinet Office/ NEF, January 2009 13 Economic and social costs of mental health problems in 2009/10,Centre for Mental Health, 2010 14 Paying the Price: The cost of mental health care in England to 2026, King’s Fund, 2008
Our projects’ boost to mental wellbeing costs around £90 per outcome on average.
10. A portfolio approach can
create added value
Research has shown that working collectively within this type of initiative improves the performance of providers15. A portfolio model allows greater learning and flexibility within a programme. Funders and commissioners should invest in the strategic management of networks of providers as this increases skills and capacity locally.
For delivery organisations 11. Volunteers are vital to success In many projects we have seen the crucial role played by volunteers in adding value to projects. Volunteering has allowed beneficiaries to develop their skills and provide a progression pathway towards employment16, and creating a network of volunteers can help sustain some level of activity during times when funding is reduced. Organisations should ensure that volunteers are properly supported and trained and that funding strategies take account of this resource requirement.
12. Understand the marketplace Our less successful projects have often failed to hit their outcome targets due to poor planning in the early stages. Enthusiastic staff and excellent delivery can fall flat if improperly targeted and many organisations need to better understand the market and community need when planning their interventions. This means understanding current service provision, local need, and designing projects that will meet that need in a format that is accessible and communicable to the target audience.
13. Get a robust evidence base Providers need to be better at systematic evidence gathering. Robust data collection, quantitative and qualitative, is challenging in community settings, but we need to be able to demonstrate sustained behaviour change. Groundwork believes that we can create a wellbeing return on investment model and we expect to work with other organisations in developing this in the future. 15 North West Wellbeing Portfolio, Impact and Insights, Hall Aitken, 2013 16 In giving, how much do we receive? The social value of volunteering, http://www.bankofengland.co.uk/ publications/Documents/speeches/2014/speech756.pdf, Haldane, A. G., 2014
27
Further information You can find out more about the Target: Wellbeing portfolio of projects at: www.targetwellbeing.org.uk
Contact details Groundwork UK Lockside 5 Scotland St Birmingham B1 2RR Tel: 0121 236 8565 Email: info@groundwork.org.uk
www.groundwork.org.uk
Report produced by Jon Kedwards