Published on: 09,Sep 2023

By James Hammond, Policy and Partnerships Co-ordinator, Richmond Group.

Improving the health and wellbeing of our communities isn’t just the job of the NHS. The King’s Fund’s recent online conference, Community-led approaches to health and wellbeing, highlighted the invaluable contribution of the VCSE sector to building healthier, resilient communities.

Heather McLean, Head of Partnerships for the North of England at Macmillan Cancer Support, a Richmond Group member, spoke about the charity’s work to develop solutions in and with communities through initiatives such as their Cancer Champions programme, a scheme where Macmillan funds trusted community organisations to offer tailored help and guidance to people furthest from accessing cancer support and information.

The conference gave me plenty of food for thought about how community-based initiatives can be applied to a key piece of the Richmond Group puzzle: improving care and support for people living with multiple long-term health conditions.

People living with multiple conditions face a host of problems when trying to navigate the system and manage their health. A confusing, demoralising experience where appointments stack up and the different health professionals involved in a person’s care don’t speak to each other is sadly the norm for most patients.

Beyond the immediate emotional toll this takes, this ‘treatment burden,’ as it’s known, can have a profound and detrimental impact on someone’s health. Patients can feel overwhelmed to the point that they miss appointments or stop adhering to their medication regimes. Conversely, combinations of medications can sometimes interact negatively with each other, and this phenomenon is frequently missed by healthcare professionals. This all leads to what is nothing more than an avoidable worsening of people’s health.

Around one in four adults live with multiple conditions, with numbers predicted to grow significantly in the coming years. This presents a real problem to our health and care system. As we fail to support people living with multiple conditions, their complex needs will continue to drive disproportionate demand for services. People with 2 or more long-term health conditions account for 55% of the cost to the NHS for hospital admissions and outpatient visits, and given that we are unlikely to see a significant increase in spending on health in the near future, now seems a good a time as any to look to cost-effective measures. Using community-led assets can be exactly that.

Not only affordable, supporting community-led assets (a term that captures a wide range of resources such as clubs, volunteer groups and local services) can offer so much to people living with multiple conditions. They can be an excellent and sometimes quite simple way of allowing people to regain some feeling of agency, and in turn improve their health. This proves vital for those whose lives can often be completely defined by their conditions.

Keith Cunliffe, Deputy Leader of Wigan Council, provided a great example of how this can work in practice. He spoke of a frail, isolated older woman who was essentially house bound before finding an opportunity to get involved in her local community. As she was at home during the week while her neighbours were out at work, she began to run a de facto click and collect point for people doing online shopping. Not only did this boost her self-esteem, as she felt she was making a difference, it also had the added bonus of creating a host of social interactions, with people coming to pick up their parcels regularly stopping for a cup of tea and a chat. This led to an improvement in her health and wellbeing, and vitally this improvement was in a manner that’s not particularly feasible for more ‘traditional’ care services.

This example perfectly captures a crucial aspect of community-led approaches. Many unfairly dismiss them as woolly, nice-to-haves which ultimately lack robust evidence that they improve health outcomes.  The truth is the complete opposite. Jane South, Professor of Healthy Communities at Leeds Beckett University, argued that there is a substantial body of technical classifications and evidence to show that community-based initiatives do work.

Beyond simply empowering people to act independently and provide their own solutions to their communities’ health needs, these assets should be seen as a vital component of any service design. Local organisations and groups know how the people in their own communities actually use and access services, and when you take into account the exceeding complexity people living with multiple conditions face, this perspective and clarity is even more necessary.

Impact on Urban Health and Community Southwark did just so in their 2022 pilot catalyst grant scheme, allowing local voluntary organisations to select people for grants of up to £500 to improve their health and wellbeing.

These approaches are not just a means to an end. Dan Mobbs, CEO of MAP, a youth charity based in Norfolk, explained that empowering people by involving them in decision making can directly improve their health. It’s not, and never has been, a trade-off between this and clinical excellence.

Head over to the King’s Fund website to check out future virtual and in-person conferences, including the upcoming From listening to action: putting the voices of people and communities at the heart of health and care, as well as the free events programme.