The Hewitt Review: An opportunity to invest in the power of communities to achieve greater wellbeing?

The recently published review of Integrated Care Systems led by Rt Hon Patricia Hewitt examined the oversight, governance and accountability of integrated care systems (ICSs) against their four main statutory purposes: improving health outcomes and services, reducing health inequalities, delivering a financially sustainable health and care system and supporting our communities’ social and economic development. 

The conclusions and recommendations of the Hewitt review focus on enabling local systems to prioritise how they use their resources to meet the needs of their local populations. Of particular interest to us at Imroc are two of their recommendations: the emphasis placed on enabling and improving whole system working, and the priority placed on health promotion  and prevention. 

ICSs are partnerships that bring together local government, the NHS, social care providers, voluntary, community, faith and social enterprise (VCSFE) organisations and other partners to improve the lives of people who live and work in their area. These partnerships are not token gestures of inclusion of small and diverse groups, they are essential if the difference between good health and a good health service are to be achieved. Improved population wellbeing relies on so much more than merely the treatment of illness: the social conditions necessary to reduce inequalities and improve wellbeing require alignment and collaboration across government departments of housing, work and pensions, environment, transport and so on. 

The review focuses on financial structures and funding systems that enable budgets for local government and the NHs to be aligned for longer term planning, the role of the CQC in quality improvement and increasing funding for and understanding of prevention. It also recognises the importance of citizens’ own role in understanding and maintaining wellbeing, managing their own conditions – and thereby living more fulfilled lives.  

All of this chimes with Imroc’s work in and with communities, building the confidence and capacity of individuals, groups, mainstream facilities, activities and resources to recognise and realise the contribution of people with health conditions. The core of every locality is not the services provided but the people and communities that are the very fabric of any place. Whilst the Hewitt review envisages the development and delivery of effective and accessible treatment and support by identifying and integrating all of the resources that exist in a defined locality, the processes through which engagement in planning, delivery and funding decision are made is not clear. This means that despite policy intentions, many – if not most – community groups remain unfunded or reliant on precarious short term funding, with minimal support to realise their full potential. 

Imroc works at all levels and in all sectors to build recognition and inclusion of all community groups and to build capacity and capability of community groups.  We have found Locality based Coproduction Forums are a really successful way of engaging with numerous services, groups, activities, businesses and citizens around a shared topic related to local population wellbeing.  As an independent facilitator we have supported the development of such forums both face to face and on-line. In every case, membership has rapidly grown over time as local people often want to see a problem solved or want to find a way to support their people in their locality.   

Regular meetings to both bring challenges to the group and to offer support and solutions are helpful. The agenda must reflect the priorities of the group and participants with specialist knowledge and experience can be invited to join and/or speak for particular meetings. The groups have led to new collaborations and networks, coproduction of innovative projects to meet local needs and a rapidly growing respect for the generosity and expertise of people who live in these communities but do not have formal professional health and social qualifications. 

Alongside the importance of building community engagement and working in and with community resources, we have found that people who have lived experience can provide really effective peer support to others who are struggling with long term conditions of all kinds, loneliness, exclusion, feelings of helplessness and hopelessness. 

Peer support workers based in GP practices and in local voluntary sector groups can change lives offering primary, secondary and tertiary prevention.  In our Live Well project https://imroc.org/resource/16-developing-primary-care-networks-and-community-focused-approaches-a-case-study/ Imroc recruited people living with long term conditions to provide person centred, home based support based on ‘Five Ways to Welbeing’ and personal recovery planning.  These peer support workers  were trained to engage with people, explore what they are finding difficult, support them to work out what they might find helpful and offer practical and emotional support as they begin to take steps towards living a more connected and fulfilling life. Referrals came from primary and secondary health services, social care, public health, self referrals and referrals from family members. 1200 people were seen in the first year and outcomes demonstrated significant improvements in physical health and mental health and an increase in social networks alongside a significant reduction in use of primary, secondary and emergency care services as well as social care services.  Indeed, the projected ROI (return on investment) was 100% within five years.    

Imroc is currently supporting the development of Live Well projects across Cardiff Vale supporting people with long term conditions to engage with their communities and find ways of managing their conditions so that they can live well https://imroc.org/locations/imroc-wales/ 

Coproduction lies at the heart of the Hewitt review recommendations.  Better integration across the whole system reduces gaps and duplications, building productive relationships and partnerships. Imroc offers support to achieve this by: 

Supporting Integrated Care Boards to work inclusively with all local resources through intentional and skilful coproduction of planning, decision making, funding and commissioning of services. 

Working with local people at ICP and PCN level to map local assets and build on the strengths of mainstream, statutory, VCSE and informal community based and user led groups in achieving integrated, inclusive accessible health and social support at preventative, primary and secondary care levels. 

Supporting voluntary sector, social enterprise, community based groups to raise their own profile, articulate their purpose and achievements, access decision making forums and develop proposals for funding to enable them to achieve their full potential for particular groups within their communities. 

Providing training for Peer Support Workers https://imroc.org/why-imroc/peer-support/ 

Employed in all sectors, including voluntary sector groups, that is matched to their purpose and needs, to enable them to offer mutual and reciprocal support safely, appropriately and effectively. This includes a variety of training options: 

• all training to achieve all peer support competencies on the National Peer Support Competency Framework (16 modules) 

• an introductory training to peer support focusing on values and principles, building recovery focused relationships, relational safety and building confidence, efficacy and community engagement of the people they support (8 modules) 

• one day workshops offering an introduction to specific elements of the role of a volunteer.  Topics mutually agreed with organisation they work with but including for example: 

  • What skills do we bring to pour work as a volunteer (how does our personal and lived experience contribute)? 

  • Offering acknowledgement, time and practical support without being ‘an expert’ 

  • Staying safe: relational and physical safety as a mutual responsibility 

  • Asset mapping your local area… and then what? 

  • Personal goal setting based on Five ways to wellbeing.