Health Matters – Your questions on community-centred approaches answered

We hope our newest version of Health Matters – with reference to “Community-centred approaches for well being and wellbeing” – will assist you to and different professionals by compiling key details, figures and proof of efficient interventions.

Placing communities on the coronary heart of the general public’s well being can empower individuals, create related and resilient communities, have interaction these most prone to poor well being and cut back well being inequalities. Our newest version of Health Matters focuses on neighborhood belongings and the Family of Community-Centred Approaches, a framework developed to characterize a number of the sensible and evidence-based choices that can be utilized to enhance neighborhood well being and wellbeing.

In this weblog we’ve printed the solutions to a variety of Health Matters questions we acquired from professionals throughout the UK on the latest launch teleconference.

Our Q&A panel are Dr Ann Marie Connolly, Deputy Director, Health Equity and Mental Health, PHE, Professor Jane South, National Adviser, Healthy Communities, PHE and Leeds Beckett University, Jude Stansfield, National Adviser, Public Mental Health, PHE and Terry Blair-Stevens, Public Health Consultant in Health and Wellbeing, PHE South East.

Question 1  (How can we make the case for the associated fee effectiveness of community-centred approaches?)

We are doing a variety of work round community-centred and person-centred approaches. We make investments on this work loads and I’m very aware that we’re squeezing the funds. What is the panel’s method to make sure that we’re placing cash in the proper locations?


It’s a vital query as a result of the temptation at the moment is to squeeze the kind of funding in the way you have interaction with communities and supporting communities to be extra self-sustaining. We do have proof on the constructive advantages and the constructive outcomes, the social worth and the financial worth of participating communities. The proof round volunteering may be very robust right here, and likewise peer assist. It’s difficult as a result of the methods to calculate prices and the kind of wider advantages that may be felt when service fashions shift, is tougher to guage. But we do have the traits and proof that tends to point out that it brings financial and social worth, however we will probably be on the lookout for the place areas try to revamp their providers, and hoping that good evaluations will be capable of present a few of these solutions round service redesign and funding in prevention.

Question 2  (Demonstrating cost-effectiveness for the well being and social care system)

I’m a commissioner for these community-centred approaches and I’ve a lot of proof of impression on the particular person. Our finance division additionally understands the impression on the particular person. But what they need to measure is the impression on the system, displaying how this intervention (or basket of interventions) adjustments behaviour or utilization or makes individuals extra resilient and ready to make use of the well being and social care system appropriately. What I’m scuffling with is how do you present prevention, the factor that by no means occurred?


You elevate some helpful factors and acquainted ones in well being enchancment the place the targets are long-term and in the end about enhancing outcomes in good well being and wellbeing, which we have been addressing in our work right here. The first problem is probably that commissioners ought to worth well being and wellbeing outcomes as official targets to fee providers and interventions. That is, good well being within the inhabitants is the endpoint, utilizing a number of the neighborhood outcomes we talked about resembling social capital, wellbeing, participation, social connectedness – all issues that may be measured. There is sweet proof that these outcomes are additionally protecting elements for well being that impression on behaviours and sickness. There is proof for this within the Marmot Review and likewise in PHE’s just lately commissioned work from the Marmot group on psychosocial pathways for health outcomes.

This reveals the causal pathway that may assist illustrate a logic mannequin method – if we obtain x it’s prone to impression on y. The second problem is probably to make use of the present proof to mannequin native impression. Lastly, the problem is to have the capability to guage impacts on the system. Some native initiatives do that by becoming a member of up totally different components of the system of their analysis framework e.g. monitoring use of providers.  The Realising the Value programme produced some helpful sources for commissioners. Partnerships with native lecturers may be fruitful and there are funds available for evaluating native public well being apply.  NHS England is supporting social prescribing and this can hopefully present some system impression knowledge.

Question 3  (How can we maintain a venture that’s already working?)

We run a well being champion venture, which may be very profitable locally, the place we work from neighborhood centres, job centres and libraries. It’s about sustainability of the venture and we’re capturing proof that we’re making an impression. How can we proceed this service? Because it is restricted with regard to funding. And I simply need to know the panel’s concepts of supporting ongoing work.


It is essential that we measure outcomes of tasks and are ready to take a look at the native proof base about why a venture is required, what kind of outcomes end result and the communities which might be concerned in that venture. So, when you’ve bought a champions venture the place you’ll be reaching components of the communities that rather more conventional providers don’t handle to, then that’s a part of your case for additional funding. It’s the duty of individuals concerned in apply to interact in analysis, as you might have achieved, and get the proof. At the identical time, there’s a function for commissioners to try to put in place techniques to collect that proof appropriately and to grasp what’s wanted of their native space.

They must also use a number of the proof primarily based on massive analysis programmes, resembling via the National Institute for Health Research (NIHR). Hopefully you’re nicely engaged together with your native GPs and your CCGs to have the ability to proceed to advertise the worth that you’re already providing them, and to assist them perceive even higher what you’re truly delivering and offering on their behalf – speaking that it is a useful complementary service to different clinical-based providers. In the NHS, we have a tendency to seek out medical options whereas typically the options are proper there inside our native communities. There are many approaches to resilience by way of funding and the essential ingredient is absolutely relationships, each with the commissioners who’re funding the work, demonstrating the power of the impression of the work that you’re doing and the advantages for the viewers that you’re working with, and having these relationships together with your allies. NICE guidance states that this work wants long-term and sustainable approaches and that wants reflecting inside native commissioning plans.

Question 4  (What scalable initiatives are there?)

I’m a director of surroundings in a London borough and we’re aligning a few of our well being and environmental providers priorities. Health by way of getting communities extra engaged of their space, however we’re envisaging it will have the advantages that we will retract providers by passing over the management and the possession of providers to individuals. What proof do we now have for specific initiatives which might be significantly productive by way of well being in addition to by way of getting individuals engaged, and which might be scalable throughout a large space to make a huge impact?


The reply on one stage is that there isn’t a one intervention and that’s what the household of neighborhood approaches goals to point out – {that a} vary of sensible fashions are wanted. In phrases of a few of them that have gotten fairly an extended historical past, there are tasks such because the C2 Connecting Communities mannequin, which is about neighbourhood neighborhood improvement, a number of the scalable fashions round time banking that come below totally different guises, participatory budgeting and a number of the well being promotion planning fashions which were round a very long time. The key factor is that in some methods it doesn’t actually matter the place you begin and what you begin with, it’s concerning the relationships that you simply construct over time locally.

We know from a variety of proof that it’s the size of time that’s wanted to construct these relationships, and that’s what is absolutely essential. So, take one thing from the household and have a go and tell us what has occurred, as a result of we’d have an interest. You would additionally need to be on the lookout for robust native assist from the communities themselves as you have been selecting what you have been going to do. Ask your neighborhood concerned, your neighborhood members and neighborhood employees, see what they really feel would work greatest and contain them in deciding that and delivering it and measuring it. It is essential to have a neighborhood champion, maybe within the native authority. Local authority members are champions of the communities they characterize and so they’re typically the most effective individuals inside a council to advocate for the belongings inside a neighborhood, as a result of they know their communities nicely. Success breeds success as nicely, so the strain is at all times between beginning small and scaling up. Sometimes you possibly can’t do community-based grassroots backside up at scale till you might have began on the grassroots and constructed that belief and relationships and neighborhood improvement over a time frame.

Question 5  (How to interact with communities)

Firstly I simply wished to make an announcement. Everybody talks about engagement with communities, however truly that may be a very expert exercise, and I don’t suppose that’s at all times appreciated. When we go into communities, they don’t need a tick-box train and I believe they actually get fed up with totally different stakeholders coming in, asking them for his or her opinion, and so they by no means see that particular person again once more. So, I believe these kind of points at a really floor stage have gotten to be realised by commissioners and providers. They should perceive the significance of a really expert engagement exercise with the communities as a way to get individuals on board.

My query is that this: When we’re working with communities and positively for a well being promotion occasion the place we go to the communities, for instance with the bowel most cancers screening programme, what is the proof for truly incentivising communities to return and attend a workshop or an occasion?


To your first level concerning the nature of engagement, at PHE we now have been workforce improvement, what are the information and abilities wanted inside public well being to work actively with communities, to work throughout totally different sectors and to have a look at the required competencies of individuals which might be in these roles. Working throughout sectors and taking a place-based method to engagement and empowerment is what’s wanted. So public well being aren’t doing their very own factor with out working with social care, police and crime, NHS, as a result of all companies are eager to do extra of that engagement and we have to try this in a talented approach. It can be essential to grasp the well being literacy ranges of the neighborhood.  We have to keep away from tokenistic engagement and utilizing jargon. We’ve bought to make use of the proper phrase, the proper language and phrases that individuals perceive, once we actually need to try to get purchase in. Understanding the neighborhood language is significant and as commissioners and repair suppliers, we actually have to get it proper.

In reply to your query, we haven’t bought a lot proof round incentives round neighborhood engagement, however what we do have proof for is the significance of creating it straightforward for individuals to participate and likewise the truth that there are a selection of prices related to collaborating in issues. We shouldn’t make assumptions that individuals are simply going to show up and provides every thing totally free and presumably spend a day having a dialogue with out recognising that there must be some reciprocity. Different communities will method that in several methods, however individuals’s prices needs to be taken into consideration by way of getting there. That’s actually essential.  And additionally they need to get one thing out of occasions for themselves. They’re not going to interact once more if it’s only a chore.

Question 6  (Involving communities in defining outcomes)

I believe one of many widespread obstacles in participating communities is that we try to fulfil our personal agendas somewhat than the neighborhood’s. Are there any pointers or any proof round how that adjustments the connection and are you working in direction of outcomes which might be outlined by the neighborhood? As an adjunct to that, once we are chatting with communities we discover that it isn’t solely about being related to providers which might be essential to them, but in addition concerning the sort of alternatives to take part and alternatives to make a contribution to the area people. Is there any proof or examples of that within the work that you’ve got concluded?


It’s an extremely essential level. As far as steering on this, nicely we now have bought the NICE steering and significantly the NICE quality standards on neighborhood engagement, which have been printed in 2017. There are solely 4 high quality requirements and these are issues which might be anticipated of the broader well being system and certainly one of them is that communities needs to be engaged in analysis. What they imply is that communities needs to be concerned in deciding what are the essential issues to measure in a neighborhood venture, what the targets are and what the outcomes needs to be. So that may be a beneficial high quality commonplace and you need to use that as a little bit of ammunition for making a case. Practically talking, there’ll typically be a mixture of outcomes, issues that typically the well being system need and issues that communities need, however we have to put each collectively, in order that we will see the hyperlink between why somebody who’s feeling higher related results in them being extra prone to tackle more healthy behaviours.

A community-centred method is definitely asking a variety of professionals who aren’t usually concerned on this to vary rather a lot about the way in which they suppose, about methods to method their job, and so it is a reframing of our approaches and really ranging from the place native individuals in communities are coming from.  Participation in design and resolution making is a essential a part of this engagement as a result of that’s what will assist you to perceive what are the measures which might be essential and what’s going to assist individuals perceive when success has been achieved. And then the following time round while you need to speak about a brand new well being service programme, the neighborhood goes to be extra receptive if they’ve seen you ship the primary time round.

Question 7  (Mapping native belongings)

When we’re a venture throughout the system, how can we greatest enhance communication throughout the system and successfully map the belongings that there are as a way to cut back replication?


This has come up steadily, significantly in relation to points like social prescribing. The first step is in figuring out who your neighborhood is in all its richness and variety. So stepping in, mapping what the neighborhood is and the constructive belongings that it holds by way of the information, the abilities, the services that they’ve accessible to them regionally, is a good place to begin. This should not be undertaken by one accomplice within the system on their very own. With public well being being primarily based in native authorities, the default place could be that native authorities are seen to be main on this, however actually if we try to enhance well being and wellbeing for our communities, asset mapping must be shared throughout all of the companions within the system. This consists of the NHS companions and it needs to be achieved in partnership with these communities who’re a part of that wider system. There are many examples throughout the nation of how others have achieved this. Some are utilizing digital expertise and digital mapping processes to map the neighborhood belongings. Some are set as much as allow communities to place in their very own sources and what they’ve to supply on these digital mapping websites.

PHE has its personal Strategic Health Assets, Planning and Evaluation device (SHAPE), in order that we will map belongings extra rigorously. One of the issues that the National Information Board and others are engaged on is a taxonomy for these belongings, as a result of how one particular person describes an asset could also be very totally different from another person. There is a few scope to develop a standard language round how we describe belongings, so that individuals know what they’re and the way we will discover them. From a neighborhood engagement and empowerment perspective, one may say an asset is just an asset if the neighborhood says it’s. And actually once we are speaking concerning the neighborhood belongings of data, curiosity and fervour in networks, it is the neighborhood that may determine the place they’re and what they’re. In the Call to action section on this version of Health Matters, we have some details about using the SHAPE device. We even have examples from Wakefield the place they used SHAPE to do an built-in asset map to assist alcohol discount and one which Macmillan used to assist individuals dwelling with most cancers. So these are some examples and it will be good to listen to from elsewhere as nicely if individuals have achieved asset mapping and it’s labored.


If you might have any additional questions, the Healthy Communities group right here at PHE will probably be happy to reply them. So please ship your query by e mail to

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Health Matters is a useful resource for professionals which brings collectively the newest knowledge and proof, makes the case for efficient public well being interventions and highlights instruments and sources that may facilitate native or nationwide motion. Visit the Health Matters collection page on GOV.UK or sign up to receive the latest updates through our e-bulletin. If you discovered this weblog useful, please view different Health Matters blogs.