Neighbourhood and Integrated Care Summit: putting people at the heart of health and care - reflections from NCCH Director, Alex Coulter
On the 15th of July, I attended the Neighbourhood and Integrated Care Summit at the King’s Fund. I was particularly keen to be there because David Moss, from the Bristol, North Somerset and South Gloucestershire ICB, was leading one of the breakout sessions and would be talking about their work in creative health. David was also a panellist for the opening plenary, along with Dr Minal Bakhai, both of whom spoke in the APPG roundtable on Creative Health and Neighbourhood Health last November. In every session throughout the day the emphasis was on relational work and building trust with community partners. Minal said that if greater value was placed on trust and relationships then we would surely have commitment to longer term goals and sustainability in the NHS rather than constant re-structuring from the top. She was very insightful on the financial architecture which creates a barrier to the left shift that everyone recognises is needed. Instead, we have a right drift which continues to incentivise and centre power in the acute sector. David Moss said that the contracting and commissioning environment is not set up to be agile but that using the principle of subsidiarity and working with the VCSFE sector alongside, there are effective ways to fund grassroots organisations. The third speaker on the panel was Charley Wilkinson, CEO of the Fleetwood Trust. I had read about Fleetwood in a recent article on the BBC and it was fascinating to better understand this community-led model which began with a passionate GP, Dr Mark Spencer. The community purchased an NHS building that had been empty for 10 years which is now a community facility including health services, but also a café, food bank, a resident artist, and activities based on what the community wants. They have created a Youth Hub through the Youth Investment Fund which has seen a 60% reduction in anti-social behaviour and the knock-on benefits of people feeling safer and more connected.
The breakout session with David Moss included Fiona Matthews, CEO of Super Culture, an organisation I worked closely with in my time at Arts & Health South West, so that was a very nice surprise. David talked about their relational and person-centred approach to Neighbourhood Health with an emphasis on hyper-local intelligence gathering and distributed leadership. When asked whether it was right that the NHS should be leading the work, he said no one was leading it and that it is a 3D spiders web of connections with very light touch governance using an open space convening approach to bringing people together and levelling power. They all talked about the Good Grief Festival and two people with lived experience brought powerful and authentic personal stories into the presentation. The Good Grief Festival is part of the Coastal Communities and Creative Health research project which brings North Somerset together with coastal communities in Blackpool and Hastings and is part of the Mobilising Community Assets programme. Bristol University brings evaluation capacity and expertise and has led to a continuous learning process with new interventions in this year’s festival aimed at engaging more men and wider reach through outdoor events such as a Grief Rave in the streets of Weston-super-Mare.
At lunch I met Kris Mackay, Chief Social Impact Officer at an organisation called 360 Degree Society, a spin off from the Well North programme which ran from 2014-16. Kris has been working with Huddersfield University on the Creative Health Hub, part of the system-wide creative health programme funded by the Mayoral Authority and the ICB. They are one of the systems in the first phase of our Creative Health Leads in Systems programme. Kris was in a panel in the afternoon on Creative Estates: physical spaces to support neighbourhood health. Speakers included a GP in Chesterfield in Derby, talking about a project in Barrow Hill to transform the old Memorial Hall into a Heritage and Health community centre with the GP practice inside it – but also, unusually, a pub which was what the community most wanted! A major theme coming through was around regenerating abandoned and old buildings into Neighbourhood Health Centres and ensuring that the space in existing health buildings is used more effectively, with an open door approach to communities. It gave me a sense of hope. If this takes hold it could also support local creative groups who struggle to find accessible and affordable spaces to deliver their activities, an issue highlighted in a recent report by Creative Lives.
There was a definite feeling of optimism in the day with a very strong emphasis on communities knowing what they need and imaginative ways to support them to provide the solutions. In the final plenary, Siobhan Melia, national advisor on community health services to NHSE, re-iterated that Neighbourhood Health is not about reducing hospital utilisation, although of course if done well it will eventually help to reduce pressure on acute services, it is about a power shift to communities. She said that the ‘left shift’ to prevention and community is now a line in the treasury settlement and that targets need to broaden. Matt Ashton, Director of Public Health in Liverpool, focussed on the importance of community champions and the people who can join the dots and reminded us that alongside Joint Strategic Needs Assessments, many places are also developing Joint Strategic Assets Assessments. We have to change how decisions are made, who holds the power and find the answers to intractable problems in our communities. Creative health and creativity permeated the whole day and arts and creativity are now seen as part of the solution in national conversations about health and wellbeing.
