Mobilising Community Assets Response to Government’s Consultation

Mobilising Community Assets Responds to the Government’s Consultation on a 10-Year Health Plan.

Building an NHS Fit for the Future is one of the key missions set out by the new Government in its manifesto. A consultation has been live over the last few months, asking the public, healthcare staff and relevant organisations to share their opinions on what a 10-Year Health Plan to help achieve this mission should look like.

The consultation is informed by Lord Darzi’s Independent Investigation of the NHS, commissioned by the Government and published in September this year. The report highlighted the major challenges facing the NHS and suggested some shifts in approach to health and care that could help to relieve some of the pressure on the service.

• Shift 1: Moving more care from hospitals to communities
• Shift 2: Embracing digital transformation and shifting from analogue to digital
• Shift 3: From treating sickness to preventing it

Mobilising Community Assets

These three themes align with our approach to thinking about health. Mobilising Community Assets to Tackle Health Inequalities is a £30m UKRI-funded research programme, which investigates how community assets such as museums, libraries, creative, cultural and community organisations and green and blue spaces can be strategically integrated into healthcare systems. We know that community assets can have huge benefits for people’s health and wellbeing and should therefore be considered integral to a community health ecosystem.

Preventable disease places a considerable burden on the NHS, and the number of people living with multiple long-term conditions such as diabetes, heart disease and respiratory conditions is predicted to increase as the population ages. These increases are not distributed equally. People living in the poorest areas of the UK live up to 18 years less in good health than those in more affluent areas. If we are to build an NHS fit for the future, we must focus on prevention and addressing the causes of ill health, which are linked to the conditions in which people live, grow, work and age – the wider determinants of health.

The 40 projects funded in the Mobilising Community Assets Programme have been investigating the links between community assets and health inequalities, and exploring models through which communities, people with lived experience, local authorities, health systems and researchers can come together to develop innovative and effective solutions.

Our response to the consultation

Drawing on the evidence generated by these projects, we made recommendations for a 10-Year Health Plan that:

• Prioritises addressing the wider determinants of health to reduce health inequalities and adopts a cross-departmental and whole-system approach to achieve this
• Recognises the value of community-based approaches for population health and supports the integration of community and VCFSE partners into Integrated Care Systems (ICSs), including long-term funding models to ensure the work is sustainable
• Represents lived experience and community expertise
• Supports further multidisciplinary research into health inequalities and the value of community assets for health

Here, we summarise the key points from our submission and our recommendations. You can find our full response here.

Shift 1: Moving more care from hospitals to communities

We believe the shift to communities must incorporate the wide range of existing community assets that have such a significant impact on maintaining our health and wellbeing.

Community-based approaches offer targeted solutions to reaching those most affected by inequalities. These approaches are based on trust and understanding of the local context and can be co-produced with community members to best meet need. This was clear during COVID-19, when community-based organisations responded quickly and flexibly to provide activities which reduced isolation and loneliness and supported mental health and wellbeing. It is also recognised in social prescribing, which connects people to activities in their community to help them manage long-term conditions or poor mental health.

Community assets should be linked to primary care and other community health services to establish a thriving community health ecosystem, supporting the ‘Neighbourhood NHS’ envisioned by Lord Darzi. The Mobilising Community Assets programme has explored how community assets can be integrated into health systems, identifying the key necessary ingredients.

More detail on these ingredients can be found in the Mobilising Community Assets Interim Report - https://ncch.org.uk/uploads/MCA-Interim-Report.pdf

The establishment of effective cross-sectoral partnerships is vital. Based on our findings so far, we recommend long-term investment in these partnerships and the establishment of sustainable funding models for community-based organisations. This will provide time and capacity for relationship-building and allow community organisations to focus on delivery. It will also facilitate better understanding of impact over time, helping to demonstrate the full value to health systems of investing in communities.

REALITIES (Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems) (Mobilising Community Assets Phase 2 and 3) supports communities to build new systems based on their local needs to support health and wellbeing. It links personal experiences with local and national statistics, led by communities experiencing trauma, displacement, homelessness, poor mental health, addiction, social injustice and poverty. Working in three local asset hubs across Scotland, the project has already facilitated cross-sector partnerships and co-produced a systems-level model with community members, policymakers, practitioners and researchers, bringing together different types of knowledge and evidence to understand the complexities of health inequalities.

Shift 2: Embracing digital transformation and shifting from analogue to digital

Technology can be used to better capture, share and analyse data across a whole system, to identify underserved populations and target provision accordingly. Such data can be used to consistently monitor the impact of community assets and to demonstrate the benefits over time.

We recommend that health systems should develop data collection and monitoring systems and support community-based organisations to input data. This will streamline reporting for community-based organisations and generate a coherent dataset, relating to key system targets, which can measure impact over the long term. Analysis at system level will help to articulate the full value of investing in communities and preventative approaches.

Community-based activities could be incorporated into health apps and digital platforms. For example, digital databases can map assets available locally and record how and where people engage in community-based health activities.

Arts4Us (Mobilising Community Assets Phase 3) works in collaboration with Integrated Care Systems and community organisations, focusing on the mental health of young people aged 9 to 13, a group at significant risk of developing mental health problems while transitioning from childhood to adolescence. The project will create an easy-to-use digital platform where evidence-based local arts activities can be made accessible for children and young people, their families and relevant organisations and services.

Shift 3: From treating sickness to preventing it

Most health outcomes are caused by non-medical factors. This means that to keep people healthier for longer we need to look beyond the NHS and adopt a whole-system approach, in which communities should be central.

Mobilising Community Assets explores how community assets can be mobilised in primary prevention by addressing the wider determinants of health, improving the conditions in which people live, supporting people to live well for longer and reducing health inequalities. Whilst action is needed at national and system-level to address the structural causes of ill health, such as poverty, community-based approaches offer targeted solutions to reaching those most in need. They can encourage community connection and cohesion, address loneliness and isolation and build social capital and a sense of belonging, empowering communities to address the issues affecting them.

Drawing on community and lived experience expertise, projects have also established networks, referral routes and co-produced services linking people at greatest risk of ill health or living with long-term conditions to sources of support and early intervention. Barriers to accessing services such as structural racism or mistrust of the system can put people off attending primary care or screening opportunities, denying them early diagnosis and intervention. A prevention-focused system must overcome these barriers, and community-based approaches are well-placed to help achieve this.

ReCITE (Mobilising Community Assets Phase 2 and 3) worked in Primary Care Networks in areas of high deprivation in Merseyside to address low uptake and engagement with breast cancer screening services by co-developing poems, videos, photos and artwork for use in a roadshow that engaged women, family and friends in community settings. A community innovation team model brought together community organisations, creatives, volunteers, social prescribers, GP practices, nurses, care coordinators and data specialists. This community-led approach used data from community-collected behavioural insights and collaboration with local creatives to conduct targeted outreach activities that successfully reduced the number of women who did not attend their breast screening appointments by up to 24% at participating GP practices. Read their case study here.

Further research

Despite strong evidence of the importance of community assets in improving health and wellbeing, we need to know more about the best models to support and implement this work at scale, and the long-term benefits to systems of doing so. Understanding the full economic and social impact of integrating community assets into health systems will support future investment and ensure the approach is sustainable.

Lived experience and community expertise should be integral to this research. Mobilising community assets is a multi-disciplinary programme, with lived experience embedded across the programme and community-co-researchers in every project.

Continued support for this type of work from research funders will facilitate the development of innovative solutions and models of implementation.

We have recommended that the 10-Year Health Plan should include research into what works well when assessing the impact of community-based approaches. Qualitative evidence that demonstrates the impact on people and communities should be acknowledged in decision-making, alongside data and economic considerations.

Our recommendations

The consultation asked for specific policy ideas to build an NHS fit for the future. In addition to our suggestions for the three shifts, we recommended that:

- National government adopts a cross-departmental approach to health, recognising the need for a whole-systems approach to addressing health inequalities, and the vital role of community organisations in this system. HM Treasury must also recognise the value of investing in community assets as part of a preventative approach to population health. This is vital to the long-term future of the NHS.

- A Health in All Policies approach to policymaking is adopted. Community assets should be considered health assets and invested in as such. All governmental departments should consider their role in addressing the wider determinants of health and health inequalities. Arm’s Length Bodies such as Arts Council England, Natural England and Historic England should have health as a key strand of their missions.

At Integrated Care System level, we recommended that:

- Funding is made available to community assets to continue their contribution to health and wellbeing and the ICS should facilitate cross-sectoral partnerships, crucially incorporating community-based organisations across neighbourhoods (including primary care), at place, and at strategic level.

- Equitable and sustainable funding models that allow community-based organisations to thrive must be established. Resource should shift towards prevention, including support for community-based organisations, and decisions over how this resource should be spent should be devolved to place or community-based partnerships.

Next Steps

In Phase 3 of the Mobilising Community Assets Programme place-based partnerships across the UK will work with communities over three years to co-produce solutions for better integration between communities and health.

We look forward to using our collective findings to highlight the importance of community assets for health and to advocate for more equitable and sustainable partnerships between communities and health systems as the 10-Year Health Plan progresses.

Find out more about Mobilising Community Assets Programme here >>