Last year we invited Viv Bennett, Chief Nurse at Public Health England, to visit our city and experience and learn more about what we are doing to promote healthy living and wellbeing, preventing ill health and reducing inequalities. Viv is passionate about empowering health and care professionals (HCPs) to make a difference and is leading a call to action entitled ‘All Our Health’, which aims to foster a social movement for health and which provides a range of resources to equip HCPs with the knowledge and skills to make every contact count. A number of core topics within All Our Health, covering areas such as homelessness, TB, alcohol and smoking and tobacco, particularly resonated with some of the services we showed Viv around.
After her visit Viv wrote a lovely letter in which she reflected that ‘the integrated approach to care, partnership working and utilisation of technology came across as an exemplar for the delivery of community services and, combined with the dedication and devotion of those I met delivering the services, this offers the people of Leeds an exceptional opportunity to improve their health and wellbeing and tackle inequalities.’ We thought we would showcase this approach to a wider audience with this blog post.
The term ‘working in partnership’ is a regular feature of public health strategy, at all levels of governance. However, articulating how joint-working translates to practice is often less consistent.
In Leeds – one of the UK’s largest cities, with a diverse population of over 750,000 – there are a wide range of statutory and voluntary health and care providers and a long history of public health interventions to improve the health of citizens. Working in partnership has happened for years, and the introduction of the city’s Health and Wellbeing Board, with its Joint Health and Wellbeing Strategy means there are a range of formal and informal mechanisms to enable partnership working.
A systematic review entitled Partnership Working and the Implications for Governance produced by the National Institute for Health Research (2011) highlighted the positive impact partnership working can have on process and the positive role integrated relationships can have in cultivating meaningful joined-up working Intuitively it feels that if effective processes and common understanding of priorities are developed, then improved health outcomes would follow, but the reviewers did not find evidence to support this in the literature. What the reviewers do recommend is experimentation with, and evaluation of “different forms of partnership which rely less on formal structures and more on what appears necessary to tackle complex public health challenges”. It is this pragmatic experimentation around partnership working which is evident in Leeds.
Leeds, like other UK cities, faces significant challenges around health and wellbeing. For example, deprivation is higher than the average for England; about 21.6% (29,800) children live in poverty and life expectancy for both men and women is lower than average.
With growing health and care needs and a shrinking local authority budget there is a shared belief amongst city leaders that in order to meet the city’s vision set out in Leeds Health and Wellbeing Strategy there is a need to ‘do things differently’. Partnerships (or more accurately relationships) are at the heart of this change. These relationships aren’t just between the senior hierarchy of institutions, but relationships at all levels, everyone plays a part. Supporting this citywide approach, Leeds has established systems to enable data sharing, maximising use of ‘the Leeds pound’ and for sustained dialogue.
Exemplifying how this approach has impacted on practice is the work of St. George’s Crypt. The Crypt is a charity in the heart of Leeds offering outcome focussed services, which they deliver in partnership with service users as well as organisations from a range of sectors, including colleagues in the NHS, Leeds Beckett University and the local authority.
Andrew Omond, project manager at the Crypt is clear of the benefits of this approach: “Working in partnership has helped us augment our service by developing clinical services, providing research and evaluation into the needs of our homeless population and aiding strategic development to look towards truly innovative multi-partnership opportunities.
“As highlighted by our Occupational Therapy service, delivering clinical care at source with a broad and robust research and evaluation framework as a foundation, developed in partnership with Leeds Beckett University, has helped us create a very successful engagement driven model. It not only provides well-documented positive outcomes, but more and better quality engagements and links to all our other ‘softer’ training opportunities. It is these added benefits that really drive the social gains derived from the partnership.
“We’ve developed many of these projects, through staff and student engagement with Beckett. For instance with initial research into the Occupational Therapy needs within the homeless sector leading to our pilot Occupational Therapy project, looking into client experiences of our physiotherapy service and MBA students researching the broader cost benefit profile of our projects. However, at a strategic level, it is skills and expertise offered through the university and broader networks opened by the partnership approach in Leeds that allow us to aim for and achieve goals with direct and positive consequences for the way we care for and support our clients, the homeless and marginalised of Leeds.”
As fresh health and care challenges face communities - not just in Leeds, but elsewhere too – strong and effective partnerships can play a key role unlocking both financial and non-financial resources which make a difference to the people living in those communities. The importance of public health, with its focus on prevention and the long term impact it can have on health and care spending, will continue to be crucial – as will the impact of partnerships and successful relationships.