With need constantly outstripping resources in our health system, we can no longer leave the assets and expertise of communities untapped
Last week 500 people came together for this year’s People Powered Health conference supported by Nesta and Power to Change. Community-led health was high on the agenda, with no shortage of impressive examples to inspire attendees. Whether Healthy’n’Happy on the edge of Glasgow, Ideal for All or White City Enterprise in London, the audience was persuaded that community businesses and local people themselves have an important part to play in improving health and wellbeing.
With their deep local knowledge and position of trust in their community, community-led businesses can provide more tailored, more personal healthcare provision. But why then does community-led health remain on the margins and community businesses struggle for resources to keep up their vital health work? What would it take for community-led health to go mainstream?
A logical step
Let’s be clear: a lack of evidence is not the problem. The Marmot Review, among others, is clear that families and communities provide the foundations for good health where they create positive relationships. Communities, of both place and interest, can provide opportunities for us to connect to others, get involved in social activities and to feel a sense of purpose and control. We know that people with stronger networks are happier and healthier. If it’s not more evidence we need, what does need to change?
A power shift
To shift current thinking and practice, those who traditionally hold power in the health system – commissioners and professionals – need more opportunities to build relationships with community businesses and fully understand their capabilities and the ‘community dividend’ they can offer. We heard from Oxfordshire County Council on how it has embedded co-production with its communities across its adult social care commissioning, and how Telford & Wrekin Council is working closely with TACT. Too often though, there is a lack of belief among professionals that community businesses can really deliver. Such a process of relationship building is starting to pay off for New Wortley Community Centre, a community business in Leeds that is developing health and wellbeing services. Investing time with commissioners is slowly starting to change their mindset and helping to divert resources towards community-run programmes.
Growing a sustainable market
We also need to grow the market of community organisations that can support health and wellbeing so the range of options is greater and richer across all our communities. But if we want this vital social infrastructure to remain resilient, it must not become solely dependent on funding from commissioners. We need to develop community with diverse income streams that can support health and wellbeing but do not rise or fall based on the decisions of commissioners. Stocksbridge Leisure Centre in Sheffield is a good example. A loss-making asset transfer from the local authority, it is now a sustainable business with much to offer health and wellbeing but not dependent solely on commissioners for its survival.
New models for modern healthcare
In addition to building a strong foundation of community businesses, we also need to explore new models that knit community ownership and leadership into the heart of the health system. Community owned GP practices is one exciting opportunity. More and more GPs want to be employed and work part-time rather than being co-owners of a practice. Using community shares, communities could raise the funds to become part owners of their local GP practice, building on pioneers such as the Bromley-by-Bow Centre. Such an approach would align the interests and assets of the community with those of primary care. This would be a step on from current approaches such as social prescribing which still leave the power in the hands of professionals who act as gatekeepers to community resources. Co-ownership, which was a huge theme at the People Powered Health conference, would mean power is more equally shared.
With need constantly outstripping resources in our health system, we can no longer leave the assets and expertise of communities untapped. Communities need to be at the table and share power meaningfully with professionals and commissioners if we want to make the resources we have stretch further and tackle our glaring health inequalities. It’s time for community-led health to go mainstream.