19 Leading a community health & wellbeing service in a community NHS trust

Introduction National (OHID) data indicates that healthy life expectancy across Warrington significantly lags behind overall life expectancy. A recent survey by Warrington Borough Council found a decrease in the number of adults reporting good health, with a marked decline among more deprived populations. Warrington has a higher median age than England, and projections indicate a 50% increase in the over-65 population within two decades. To mitigate escalating demand and to arrest health crises before they emerge, early proactive engagement is required. Oakwood, a community in east Warrington, ranks in the top 20% of the most deprived regions in the UK. Aims and objectives of the research project or activity Oakwood contends with profound healthcare deficits, largely attributable to adverse social determinants of health. Challenges include underutilisation of healthcare resources, educational deficits, unemployment, housing issues, and insufficient social support, culminating in a broad spectrum of unmet healthcare needs. As underscored by the Marmot report, these inequalities are avoidable and unfair and require innovative approaches to tackle them. To better serve the Oakwood area, Bridgewater Community Healthcare Foundation Trust initiated a pioneering Community Health and Wellbeing Worker (CHWW) service. This initiative, developed in collaboration with local providers and the National Association of Primary Care (NAPC), employs proactive, universal and ongoing community outreach, to help residents access the support they need. Improvements in these areas are often difficult to measure, so the project aimed to put specific process and wellbeing measures around the project. Method or approach The Trust drew together in-house expertise and community partners to establish a service following the CHWW model, an example of evidence-based practice adopted from the Brazilian primary care Family Health Strategy and championed by the NPAC. In the model, each CHWW works in a patch of around 150 households, providing monthly visits on an ongoing basis. This enables CHWWs to proactively identify need and help residents access help before issues escalate. Their role is based on trust and local knowledge, with the CHWWs recruited locally to maximise cultural competency. It is a universal and holistic service, open to all ages, that seeks to develop a culture of preventive health and wellbeing and community enablement. As a novel approach, the service challenged established practice and demanded innovative thinking. The project's leadership has been instrumental in navigating systemic barriers to establishing the service and seeking to reduce health disparities. Findings In one year of service (up to December 2022), five CHWWs have proactively engaged with Oakwood's households to understand residents' health and social care needs and help them to access support in the community. Of 642 households offered the service, 37% have taken up the offer. The CHWWs have had 688 unique community engagements, identifying 125 previously unmet healthcare and making 161 referrals to community services. Combining public and population health approaches, the CHWWs have promoted vaccination, screening, health checks, and wellbeing services; they have identified, escalated and helped to resolve multiple situations involving isolation, inadequate housing and safeguarding issues. Measuring impact: An evidence-based wellbeing metric, used across CHWW services, assesses an individual's skill and confidence in managing their health and wellbeing. The service has seen a cumulative 21-point increase in the wellbeing scores among the engaged cohort. Each incremental point on the wellbeing scale corresponds to an annual healthcare cost saving of £540 across primary and secondary care. Key messages The CHWW service demonstrates a way of addressing social determinants, demonstrating that local, community-driven interventions can significantly influence overall healthcare outcomes. It demonstrates a scalable strategy to proactively mitigating health disparities and promoting equitable healthcare access. It serves as a standard for how a collaborative, leadership-driven approach can yield substantive improvements in healthcare access and outcomes. Financial sustainability is an ongoing priority, addressed by organisational leaders to develop partnerships aligned with community needs. Initial efforts have established a framework for engagement, with the aim of continuing collaborations for future funding stability. Communicating the service's objectives to some of our local partners posed challenges. Nonetheless, Bridgewater's medical leadership has been essential in maintaining and advancing these collaborations.