Housing associations and charities join forces to deliver NHS service

A West Midlands consortium is hoping to improve residents’ health by rolling out a confidence and wellbeing programme

Rachel holds up a “joy jar”. The different colour salts she was encouraged to put inside the jar represent five strands of happiness in her life. She says that this simple activity made a fellow user of a local wellbeing service smile for the first time since attending group sessions.

“One lady that attended never spoke, never smiled, and then when we did this activity with the joy jar, the change in her was unbelievable,” says Rachel, who has the long-term condition scoliosis. “I think anything that is preventative is probably better than a cure. It’s a bit like group counselling.”

She attends the Health for Living consortium’s recently launched confidence and wellbeing service in Sandwell. It carries out low-level interventions through programmes that aim to help people cope with conditions including mild depression, obesity and anxiety.

Rachel attends to help deal with anxiety, a knock-on effect of her long-term condition. Service users meet every week at various venues to discuss topics that are relevant to them and their condition, with a self-help coach helping to steer the group.

But rather than being provided by the NHS the service, which includes programmes of six to 12 weeks, is provided by a consortium made up of two charities and two housing associations.

Sandwell Mind, the Accord Housing Group, Murray Hall Community Trust and Black Country Housing Group came together to win its first contract as a consortium. It was awarded a £1.2m three-year deal by Sandwell primary care trust (PCT), which decided to outsource the service.

To access the programmes people can be referred by their GP, or can find out where programmes and activities will be held via an online hub managed by Sandwell PCT. This is followed by an initial assessment to gauge how a person feels and identify which service may be most appropriate for them. This process is designed to measure a person’s emotions before using one of the programmes against how they feel afterwards.

Chris Handy, group chief executive of the Accord Group, says that the formulation of the government’s health and social care bill was one of the main reasons behind the decision to collaborate.

“That’s one of the drivers to come together. We’re not making a comment about the political approach, but we thought that quite a lot of work was going to come out of the NHS and local authorities. We’re not saying we’re doing it better than other people, but we can provide services differently and we felt we wanted to position ourselves to win some of that work,” he says.

Monica Shafaq, chief executive of mental health charity Sandwell Mind, believes that if each organisation had tried to win the contract individually, they probably would have been unsuccessful.

She says: “The way some of the commissioning works means that there are certain policies, practices and assurances you need in place. This is something that smaller organisations don’t necessarily have. So we may have the skills and resources to deliver it, but might not have met the eligibility criteria in the first place, so working in partnership has hopefully allowed us to do that.”

Shafaq and Handy acknowledge that some people may find it strange that housing associations and charities are delivering an NHS service, but both believe that the consortium makes sense.

“Health and wellbeing is not just about the health service you get, it is made up of a wide range of factors, and housing is crucial to that,” says Handy. “Good quality accommodation, which is easy and cheap to heat, is not everything, but it’s a good foundation to a healthy satisfying life. I think there is an angle here for housing organisations to actually get involved in health.”

Shafaq says that there is also a place for health charities to have more input in delivering similar services, but adds that it is not always easy to do in practice.

“I think there is a place for charities, but I think it can be quite difficult for smaller organisations to do that. There are lots of opportunities and it’s really important that charities position themselves effectively, and that means working differently and working more collaboratively,” according to Shafaq.

Around 20% of the population in Sandwell has a long-term illness. Handy says that there is also a high unemployment rate among what he describes as a predominantly low socio-economic population. He believes that the most important requirement to help tackle such issues is for an effective service to be rolled out, rather than be concerned about who the organisations delivering it are. He adds that intervention and prevention have major benefits for the whole community.

“The idea behind this is that it is upstream intervention, which actually saves the NHS and social services money. If you stop a relapse and a reoccurrence of certain kinds of issues, people aren’t in the health system getting this kind of lower cost service which helps save money,” he explains.

The consortium has a target of making 2,500 contacts annually, although Shafaq says that it is still early days.

There are around 2,500 staff from all four organisations working on the service and the new setup required the transfer of some PCT staff to the consortium. Terri Rutter, a self-help coach at Health for Living, was one of eight employees transferred from the NHS when the PCT outsourced the service. She says that the transition did not cause the upheaval she anticipated.

“We’ve had full support from the PCT and full support from Health for Living. They communicated together as well as with us the workers. We moved over on the 1 December, and it’s like we just moved buildings and that was it,” she says.

In the future the consortium hopes to win contracts in other areas. Handy reveals that it would like to do something to help reduce excess winter deaths in Sandwell, which he says are the highest in Europe.

“Obesity, coronary heart disease, and other linked problems like diabetes and so on – all those things are heightened within the Black Country and surrounding areas,” he says.

Health for Living’s plans to branch out will depend on the success of the confidence and wellbeing service. Although in its embryonic stages, the service’s holistic approach seems to have already had a profound effect on some of the users.

“In all the times that I experienced depression, it has never been addressed in such a proactive way. In the past, it has always been pill treatment,” says Ann Marks, a service user of the health improvement programme. “It has changed me immensely. I have a better understanding of myself and a greater insight into my issue and to other people’s.”