Jun 27, 2012 - Health & Wellbeing Board (shadow) ... Developing peer support networks .... higher for those with lar
Health & Wellbeing Board (shadow)
27 June 2012
Board’s principles and approach to citizen involvement Report by: HealthWatch (report 40/12-13) The attached detailed paper has been considered and recommended by the Health and Wellbeing [HWB] workshops and Lambeth Cabinet and is now being presented to the Health and Wellbeing board for approval. Pages 1 and 2 summarise the decisions sought from the Board. The Board is specifically invited to:
1. Approve the 6 Citizen Involvement Principles, as set out below, in the form of a Charter for all HWB partner organisations to consider , and decide whether to adopt. 2. All HWB partner organisations to be invited to sign up to the Charter or send back comments on how they would wish to amend it prior to sign up, and to feedback to the HWB Board on the impact of this on its work, at least annually. 3. Approve the adoption of the self-audit tool and work with the HWB to support its use. 4. Ensure the HWB use the principles in its work.
A CHARTER FOR EFFECTIVE CITIZEN INVOLVEMENT IN LAMBETH For Citizen Involvement to be effective a set of shared principles have been agreed across all Health and Wellbeing organisations in Lambeth. Each organisation will be expressly invited to sign up to these principles for all citizen engagement in Lambeth, or suggest amendments to them, and to report back to the Health and Wellbeing board on the impact these have made. PRINCIPLE 1: Working together for change [co-production] The concept of co-production is that people's needs are better met when they are involved in an equal and reciprocal relationship with professionals, working together to get things done. It is a radically different approach to public services that is built around six characteristics: • Recognising people as assets and using the skills and strengths they have to design and run services • Building on people's capabilities • Promoting mutuality and reciprocity • Developing peer support networks • Breaking down barriers between professionals and users • Facilitating rather than delivering PRINCIPLE 2: Leadership Leaders in HWB partner organisations will provide an explicit commitment to fostering a local innovation culture that places an emphasis on strong relationships with citizens, local voluntary and social enterprise organisations. This ambition needs to be explicit with clear objectives and measurable impact. Collaboration will be promoted at every level by all partners in HWB: • Individual: Involving individuals in the management of their own health and wellbeing Page 1 of 10
• • •
Collective: Involving the whole community in different ways e.g. patient cohorts, special interest groups, age groups, BME populations or the wider public Representative: Involving organisations and individuals that are enabled to act as representative of others (e.g. Third sector organisations, LINk/HealthWatch) Co-operative: Involving Health and Wellbeing agencies from all sectors in joint engagement activities
PRINCIPLE 3: All Involvement will be Purposeful The purpose of all Involvement activities will be clearly defined using the Popay model [see detailed paper] PRINCIPLE 4: All involvement will be Accessible and Fun! • • • • •
Increasing citizen participation in decision making should be both engaging and enjoyable Ensuring Equalities issues are addressed Working with existing forums and structures to reach people as well as creating new methods of engagement Taking place in a variety of locations and using many different methods – working with people in their communities, using different tools and approaches for different audiences Ensuring access needs are met to enable participation (e.g. around money, health needs, childcare, language, disability)
PRINCIPLE 5: All involvement will be well planned, appropriately resourced and accountable • Allowing adequate time for the planning of activities and the building of relationships • Ensuring full and correct information is available to people to respond to • Providing appropriate training and support to enable effective participation • Ensuring there is no costs for individuals involved – contributions are recognised and rewarded • establishing processes and accountability lines that are clear, concise and productive • developing effective support and project planning mechanisms (e.g. monitoring, establishment of criteria and use of qualitative feedback from citizens) PRINCIPLE 6: All involvement will be Transparent • Part of a published plan that sets out the planned activities, targets, and hoped for outcomes • Ensuring feedback to participants • Monitored and evaluated – showing the difference the engagement has made • Testing new ways of involving communities in managing health and wellbeing and transferring this knowledge to other neighbourhoods, through the HWB
A SELF AUDIT TOOL We are keen to promote a culture of self reflection for the HWB as part of demonstrating accountability to citizens for operating in line with the above principles. This must place the emphasis on the learning that is gained from self assessment rather than creating a ‘tickbox’ process. The Lambeth LINk together with engagement leads in the Council and NHS will support the Health and Wellbeing Board and its partner organisations to plan, self-assess and audit engagement with Lambeth’s communities in their work. We propose to do this through the use of a simple set of tools and by providing a panel of expert advisers already supporting engagement work in the Borough. In brief this would involve: • An audit tool for the HW Board to enable members to take a view on whether a piece of engagement work under its jurisdiction can be classified as purple (excellent), red (inadequate), amber (adequate, but some way to go), or green (good) – based on the above principles of involvement. • A self-assessment tool for programme/project managers under the HWB to use pre-audit • The systematic use of existing LBL / NHS engagement planning templates Page 2 of 10
•
A small ad-hoc expert panel to support engagement planning and the self-assessment process. Core Membership of the panel would comprise citizen representatives [recruited via LINk], third sector representatives, member of the HWB, LBL (ACS), LBL (Children’s Services), NHS Lambeth (Engagement Manager) and Lambeth LINk. A wider group of people could be involved in supporting self-assessment on particular areas, and this wider panel may be virtual in format.
Submitted: 12 June 2012 To be approved by the Health and Wellbeing Board: 27 June 2012
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This is the more detailed paper presented to the Health and Wellbeing workshop and to the Lambeth Cabinet.
Lambeth Health and Wellbeing Board Outline vision for Involving Citizens This document sets out the draft vision for Involving Citizens, produced by the work stream of the Health and Wellbeing board in Lambeth. [See Appendix 3 for membership] 1
Introduction
At the heart of this paper is a belief that by Involving Citizens in the development of their own solutions we empower communities, deliver sustainable interventions and improve health and wellbeing. People’s lives are most acutely influenced at the local level – in their homes, at school, in their places of work and in their neighbourhoods. This is also where citizens are most likely to come into contact with services and support mechanisms to improve their lives. 2 2.1
2.2
Setting the Context National context a. Public Health White Paper and requirements for HWBs to engage their local populations b. Health and Social Care Bill requirements which recognises that the population has rights regarding Involvement in their own health and social care. These include the right to: i. be involved in discussions and decisions about one's own health care, and to be given information to enable one to do this ii. be involved, directly or through representatives, in the planning of health and social care services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. Local Context c. Overall health outcomes for people living in our borough are still significantly below the national average and many residents experience outcomes significantly below our borough average d. There is a vibrant and diverse Third sector and a programme of support via the Council’s active communities programme e. The principles of engagement and co—production are at the heart of the Co-operative borough proposals f. We have some excellent examples of co designing services such as LLWC, Loughborough Speaks, Redthread which we should build on g. The LINk is effective and well established and has through its engagement events directly influenced the proposed principles in this paper.
3
Evidence base for community engagement: NICE (2008) found that: • Community engagement approaches can improve health literacy • Approaches that help communities to work as equal partners or which delegate some power to them may lead to more positive health outcomes. • Such co-production may also improve other aspects of people’s lives such as improving their sense of belonging to a community (social capital) empowering them or otherwise improving their sense of wellbeing). • Effectiveness depends upon the approach used and process used to implement it. Learning how to ask communities what they have to offer in terms of their existing skills and knowledge leads to Page 4 of 10
opportunities for them to work with professionals for mutual benefit. The guidance includes twelve recommendations for most effective community engagement which covers four interlocking themes: a. Long term investment b. Organisational and cultural change c. Level of engagement and power d. Mutual trust and respect Infrastructure e. Training and resources f. Partnership working Approaches g. Area-based interventions h. Community members as agents of change i. Community workshops j. Resident consultancy k. Evaluation The Marmot review found that: • Significant health benefits can occur for individuals actively involved in community empowerment or engagement initiatives including improvements in physical and mental health, health related behaviour and quality of life (Piachaud, 2009). • Evidence from seven studies suggests that community engagement may have a positive impact on social capital and social cohesion (NICE, 2008). • The state can intervene to create and deepen social networks and capital. Ideally, intervention needs to be local activity in a national context Marmot et al, 2010). 4
Evidence for impact of community engagement An important result of community involvement is the building of social networks or social capital which can also promote health and reduce inequality. Social capital impacts in a number of areas including: • Mortality A meta-analytic review including 148 studies and 308,849 participants found that loneliness and social isolation has a higher risk on mortality than lifelong smoking (Holt-Lunstad et al, 2010). A meta-analysis of social networks and cancer mortality found that high levels of perceived social support or larger social network was associated with decreases in relative risk for cancer mortality of 25% and 20% respectively (Pinquart and Duberstein, 2010). • Self reported health: A UK longitudinal study found that social participation and high levels of trust in others were independently associated with improved self-reported health (Giordano & Lindstrom, 2010). • Mental ill-health Low involvement and poor quality social support are associated with both onset and persistence of childhood mental disorders (Parry-Langdon et al, 2008). A systematic review of social capital and mental illness found strong evidence that common mental disorder was inversely associated with individual cognitive social capital (Da Silva et al, 2005). A longitudinal cohort study looking at Alzheimer's disease function found that cognitive function was higher for those with larger network sizes (Bennett et al, 2006). Mentally or socially oriented stimulating activity may also protect against dementia (Fratiglioni et al, 2007, 2004; Wang et al, 2002). The impact of community engagement is represented diagrammatically below:
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Pathways from community participation, empowerment and control to health improvement:
Health outcomes Improved health status & reduced health inequalities
Enhanced community empowerment improved social & material conditions
Delegated power
Intermediate social outcomes Impact on social capital
Community control
More appropriate and accessible service and improved uptake
Increasing community participation, empowerment and control
Service outcomes
Co-production
Consultation
Informing
Source: Popay 2010 5
Lambeth proposal
We are proposing four elements to Citizen Involvement : 1. Work up and agree a joint understanding of the principles of involvement, and a commitment to ensure that all commissioning in health and social care rests on good engagement, carried out within a supportive, equalities aware partnership. See Appendix I for proposed Principles 2. Agree a process of self evaluation and audit of engagement, based on the agreed principles, with an emphasis on recognising and rewarding excellence and building capacity in both commissioners and providers , and using "experts by experience " to assist in this work. See Appendix 2 3. Demonstrate and evaluate the value and impact of effective engagement at scale by working up a partnership bid between LINk, GPs, KHP, the Council and others partners to: • Develop Patient Participation Groups which promote health and wellbeing • Test and evaluate a range of community involvement approaches • Build capacity and skills of local people through engagement 4. Use the large public sector workforce as part of our belief that using peers as advocates of Health and Wellbeing is the best way forward, particularly in areas of health inequality. Employee wellbeing is one of the most important predictors of effectiveness and productivity at work, as well as loyalty to an organisation.1 As resources continue to be squeezed and the demand for efficiency increases, promoting the wellbeing of staff will become even more important. Despite job losses and spending reductions in a 1
Foresight Mental Capital and Wellbeing Project (2008) op. cit. Page 6 of 10
number of public funded organisations public services will remain major local Lambeth employers and buyers. Many staff and contractors are also local residents. Through the way that HR and procurement policies are implemented, the HWB can directly promote the wellbeing of individuals and communities. The HWB can improve satisfaction with services and foster trust of local institutions. One idea floated is that of a ‘Dragon’s den’ where local staff are invited to make proposals, within an agreed amount of funding for improving health and wellbeing to a panel to include a citizens jury and resources would be provided to make it happen!! There is enormous opportunity, therefore, for the Lambeth HWB to influence the wellbeing of its local population and to empower people to take a greater control in the management of health conditions. We believe that by involving citizens in meaningful ways in Lambeth we can also build teams of enthusiastic champions to spread positive word-of-mouth messages through informal networks. This process begins to share responsibility for creating healthy communities with local people whilst simultaneously building the confidence and capacity of the community to achieve healthier outcomes. In this way, we are also seeking to build social capital, and create citizens who are more engaged as well as helping us to develop more sustainable solutions and nurture healthier and more resilient communities. 6 Outcomes [ the anticipated impacts of improved community involvement which are also the basis of a set of outcomes]: • • • • • • • • • •
Improved health and reduced health inequalities Improved awareness of Health and Well Being More empowered local citizens to manage their own conditions Proactively engaging with the most deprived wards and communities and remove barriers that prevent them from participating Maximising the opportunity the HWB brings to create the conditions that enable meaningful engagement Capacity building individuals and communities to participate in meaningful engagement Achieving small successes as well as working for bigger cultural change around engagement Demonstrating that engagement contributes to positive health outcomes and healthy communities Use evidence based approaches and link to health outcomes Working co-operatively and collaboratively with citizens, across sectors and organisations
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Appendix 1 Shared Principles for effective Citizen Involvement For Citizen Involvement to be effective we need some shared principles that are agreed across the HWB, a set of which are proposed below but which would seek to test further with citizens. a.
Working together for change [co-production] The concept of co-production is that people's needs are better met when they are involved in an equal and reciprocal relationship with professionals, working together to get things done. It is a radically different approach to public services that is built around six characteristics: • Recognising people as assets and using the skills and strengths they have to design and run services • Building on people's capabilities • Promoting mutuality and reciprocity • Developing peer support networks • Breaking down barriers between professionals and users • Facilitating rather than delivering
b.
Leadership in HWB partner organisations will provide an explicit commitment to fostering a local innovation culture that places an emphasis on strong relationships with citizens, local voluntary and social enterprise organisations. This ambition needs to be explicit with clear objectives and measurable impact. Collaboration will be promoted at every level by all partners in HWB: • • • •
Individual: Involving individuals in the management of their own health and wellbeing Collective: Involving the whole community in different ways e.g. patient cohorts, special interest groups, age groups, BME populations or the wider public Representative: Involving organisations and individuals that are enabled to act as representative of others (e.g. Third sector organisations, LINk/HealthWatch) Co-operative: Involving Health and Wellbeing agencies from all sectors in joint engagement activities
c.
All Involvement will be Purposeful: The Purpose of all Involvement activities will be clearly defined using the Popay model above or similar.
d
Accessible and Fun! • • • • •
e. • • • • •
Increasing citizen participation in decision making should be both engaging and enjoyable Ensuring Equalities issues are addressed Working with existing forums and structures to reach people as well as creating new methods of engagement Taking place in a variety of locations and using many different methods – working with people in their communities, using different tools and approaches for different audiences Ensuring access needs are met to enable participation (e.g. around money, health needs, childcare, language, disability) Well planned, appropriately resourced and accountable Allowing adequate time for the planning of activities and the building of relationships Ensuring full and correct information is available to people to respond to Providing appropriate training and support to enable effective participation Ensuring there is no costs for individuals involved – contributions are recognised and rewarded establishing processes and accountability lines that are clear, concise and productive
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•
f.
developing effective support and project planning mechanisms (e.g. monitoring, establishment of criteria and use of qualitative feedback from citizens) Transparent • Part of a published plan that sets out the planned activities, targets, and hoped for outcomes • Ensuring feedback to participants • Monitored and evaluated – showing the difference the engagement has made • testing new ways of involving communities in managing health and wellbeing and transferring this knowledge to other neighbourhoods, through the HWB
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Appendix 2
Self Audit We are keen to promote a culture of self reflection for the HWB as part of demonstrating accountability to citizens for operating in line with the above principles. This must place the emphasis on the learning that is gained from self assessment rather than creating a ‘tickbox’ process. The engagement workstream will support the Health and Wellbeing Board and its partner organisations to plan, self-assess and audit engagement with Lambeth’s communities in their work. We propose to do this through the use of a simple set of tools and by providing a panel of expert advisers already supporting engagement work in the Borough. In brief this would involve: • An audit tool for the HW Board to enable members to take a view on whether a piece of engagement work under its jurisdiction can be classified as purple (excellent), red (inadequate), amber (adequate, but some way to go), or green (good) – based on the principles of engagement agreed by the Board • A self-assessment tool for programme/project managers under the HWB to use pre-audit • The systematic use of existing LBL / NHS engagement planning templates • A small ad-hoc expert panel to support engagement planning and the self-assessment process. Core Membership of the panel would comprise citizen representatives [recruited via LINk], third sector representatives, member of the HWB, LBL (ACS), LBL (Children’s Services), NHS Lambeth (Engagement Manager) and Lambeth LINk. A wider group of people could be involved in supporting self-assessment on particular areas, and this wider panel may be virtual in format.
Appendix 3: Workstream Membership Nicola Kingston, Lambeth LINk Aisling Duffy, Lambeth LINk Dr Raj Mitra, GP Valerie Dinsmore, Lambeth Council Kieron Williams, Health and Wellbeing Rachel Heywood, Lambeth Councillor Sarah Corlett, Public Health Heidi Fanning, Community Health Zoe Reed, KHP Dr Jonathon Campion, KHP Linda Linehan, Lambeth LINk Sophia Looney, Lambeth Council Catherine Flynn, NHS Lambeth
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