LEVELLING UP

SPOTLIGHT ON D R VI VIENNE MCVEY AND VIRGIN CARE

LEVELLING UP through a civic health model

VIRGIN CARE IS TAKING A NEW APPROACH TO ACHIEVING EQUALITY OF OPPORTUNITY IN HEALTH AND WELLBEING, AS WE REPORT.

Health inequality in the UK is not just a medical issue; it’s a socioeconomic one too. There is a growing body of evidence that indicates there is a large difference in health outcomes between the least and most privileged groups in society, despite living in a country where healthcare is free at the point of use. This is because the health inequalities often occur not during the point of treatment, nor inside hospitals or GPs practices, but throughout communities, due to a complex series of interrelated factors. For example, a child born into a low-income background or into poverty in the UK, is more likely to have a low birth weight, shorter life expectancy and a higher risk of death in the first year of life. To this end, Virgin Care has demonstrated a new way of working in Essex, to help make a difference on the stark reality of health inequality, and break the barrier it presents to social mobility and opportunity. Virgin Care’s Civic Health Model, which it launched in its delivery of services in Essex, having been commissioned by Essex County Council and West Essex CCG, has adopted a proactive (rather than reactive) approach to promoting better health outcomes, by working with communities. It has demonstrated how healthcare can be more than treatment - and working upstream to help those furthest away from privilege to make the right choices everyday in regards to their own health. It has delivered a purposeful collaborative community approach to the delivery of healthcare services in Essex, focussed on outcomes which enable it to tailor the business to maximise its effectiveness and bringing together the skills of the organisations involved with, through volunteering, the community’s own skills. This new model is called “a Civic Health approach”. It is about service providers using their skills not only to deliver services, but empowering local communities, working with civil society and supporting local people to tackle both health inequalities and, in doing so, boosting social mobility by focusing on long term outcomes which are proven to make a difference over short term activity targets. This Civic Health approach has meant that local programmes have been more successful and developed long term value because they are based on what local people and communities want and need and build skills rather than solve immediate problems. Involving local communities in developing and delivering these programmes has also brought greater diversity of thought and innovation, helping to produce bottom up creative solutions and more inclusive approaches. Through strong leadership, the Essex Child and Family Wellbeing Service is a fantastic example of successful partnership in action. In working on behalf of Essex County Council and NHS West Essex Clinical Commissioning Group, the Service provides health visiting, school nursing, family health education and support, and specialist children’s community health services across the County. These are services which exist across the country, commissioned by local authorities, but in Essex the County Council, Virgin Care and Barnardo’s have changed their focus to the impacts of what they do – and the approach is reflected first in the way that the service was commissioned, and then in how it is operated. Its work ranges from parenting support, support for young people with special educational needs and disabilities, providing information for children, parents and school staff on health issues and support for physical, emotional and developmental issues.

The service has 29 multidisciplinary Healthy Family Teams that work from district-based Family Hubs and Delivery Sites across the county. They provide pre-birth to 19 services centred around GP practices and clusters of secondary schools, feeder primary schools, nurseries and their communities. It clearly demonstrates how Virgin Care, in partnership with Barnardo’s and Essex County Council, has facilitated more effective health services in the community which improve health outcomes. This in turn boosts life chances, social mobility and opportunity for the community it serves. The “Civic Health” model used in Essex is similar to the model Justine Greening introduced for Opportunity Areas at the Department for Education where local communities and businesses work together on key local priorities to lift outcomes for young people in the area. That collaborative approach was shown to have “helped to create a step change in the level of enthusiasm and support for our shared mission - by drawing on and empowering local educators and local talent.” Virgin Care has shown how this can also succeed in the health and care sector, provided the right conditions are created. Both Essex County Council and Virgin Care were keen to highlight that the delivery of the service in this way was only possible due to the approach to commissioning and managing the service towards a common, longer term aim. The Essex experience also shows that, while investment is important, it is possible to achieve a greater impact by working with, and seeking to understand, local communities and their needs – and at the same time, by recognising that all local communities are different. The way in which social mobility is improved in Darlington or Oldham is likely to be different from the way it is approached in Harlow, but there are common approaches which can be taken to identifying these solutions – and these are captured within the Civic Health Approach. Solutions need to be more responsive to local needs than the more centrally controlled approaches we are used to.

It is a genuinely different working model and contrasts markedly with the more cumbersome models where accounting rules can inhibit long term investment and activity monitoring can take precedence over longer term achievements. The more responsive and nimble system in Essex makes for a much more effective strategic approach to dealing with social problems. It is important, however, that there is a way of evaluating social mobility outcomes in this context. Virgin Care has 27 outcomes specified in its formal contract with the County Council, but that contract is a ten year one. Although this enables progress to be made and shown achieving social mobility, and therefore being able to measure it, can be a 20 or 30-year process. Virgin Care is an organisation which nurtures its employees and it works hard to recruit from within the community, both to paid employment and through empowering volunteering. Its use of systematic career pathways means that people who join the organisation can, with support, work their way through to qualifications in administrative, healthcare and leadership fields and to the associated jobs, with Virgin Care or elsewhere. Virgin Care works towards creating opportunities for people at all stages of their careers. It has shown how volunteering can not only be part of community health provision but also part of a wider mechanism as a pathway into employment. The Civic Health Model it has adopted also shows that successful community engagement can boost social mobility, offering new opportunities and improving access to services for marginalised and vulnerable people at the same time. In Essex, as in many models that tackle social mobility, one entry point is schools. Virgin Care acknowledges that early years intervention is crucial in ensuring that a child’s education outcomes are as positive as possible. The way in which the work internally and with schools is connected with other stakeholders in the community may vary. Different communities may choose to put together different core priorities and these should be supported. Virgin Care’s approach has enabled it to build effective and meaningful local partnerships. It has facilitated the community to look after itself and has changed the emphasis from one which purely commissions services. It demonstrates the synergy between treatment and health prevention at its most preliminary and shows that, to be most effective, you should go to the source – the community itself. • Two years ago there were four volunteers, now there are 40 • Three years ago there were 35 unfilled nursing vacancies, by 2021 there will be none • Essex Council had previously employed no care leavers, now it employs many The innovative cross-organisational approach has brought benefits to all parties. Local, smaller scale solutions are supported by a local community which is fully engaged and the business has credibility and accountability as a result. Health outcomes and social mobility are inextricably linked and it is well known that the least advantaged in society generally have access to the least high-quality health services, relative to their needs, compared to higher income groups. That inequality means that, amongst other poor outcomes, there is a 19-year gap in average life expectancy between the least and most deprived areas of the UK. Those living in the most deprived areas spend nearly a third of their lives in poor health, compared with only a sixth for those in the least deprived areas. Health outcomes, whether at early years, schools or young adult stages are huge barriers to positive social mobility. The success of the collaborative community approach we have looked at in this report in Essex demonstrates that its bottom-up approach, its adaptability to local conditions and its willingness to invest up front for the long term is a model that other areas with an opportunity gap should replicate. It provides real value to that community by helping to address their own health inequalities and boost social mobility as a result.