It is widely accepted that happy, healthy communities have timely access to health and social care support when they need it, they live in low crime areas, the people in them connect with each other socially, they have a good standard of housing and access to employment, transport links, education and spaces to enjoy.
The word “community” invokes a sense of togetherness, a common purpose, perhaps a sense of belonging. Whether we represent the health and social care sector, local government, voluntary sector, policing or local business or our families, neighbours and those we care about, we share a common interest in supporting communities and the people who live within them to stay safe and live well.
Increasingly, we share objectives across sectors to achieve healthy, safe communities and we are beginning to see more evidence of this alignment through community safety partnerships, concordat approaches, primary care networks and recently established integrated care boards and systems.
- As we develop shared spaces and estate in our communities, supporting inclusive collaboration between our communities and community focused services; leaders and operational teams recognise the significant value in sharing assets:
- working in the same buildings makes a variety of support visible, accessible and approachable in local communities
- quick shared resolution of the challenges arising from “gaps” between services, resulting in better experiences for patients
- we work more efficiently, meaning better use of public monies not only in reducing public estate cost but also by improving communication and reducing duplication across organisations
Policing and health working together in communities
Police officers have always been a part of our communities, they understand that the causal factors of offending and community safety are commonly caused by unmet human need and that measures taken in partnership to develop healthier, safer communities could be considered an investment in crime prevention and improved community safety.
Rebalancing Act is a resource provided by Revolving Doors Agency with support from Public Health England and the Home Office. It provides insight into the whole system approaches necessary to improve population health and wellbeing. If we are unable to create healthier, safer communities, the demand for police support will continue to rise alongside unmet need (at the cost of our communities). For this reason, the rise in police force demand should be considered a reliable symptom of unmet need at community level.
Shared spaces are a strong message for teams in working together around people and communities. They provide a foundation for shared conversations, solution finding and subsequent shared impact.
Why work together?
Case study:
Adam, whose real name has been omitted with permission, lived on the streets and on friends’ sofas for 24 months. He used drugs to manage anxiety, which caused him further anxiety and subsequent attempts at suicide. He described himself as being at risk of harming others. This would inevitably lead to police intervention and court attendance.
He sought help from addiction services. Social services were also involved in his case to try and house him and create some stability in his life, but this in isolation did not remove the cause of his anxiety. Adam would lose accommodation by resorting to substance misuse and familiar behaviours. Each time it would compound his anxiety and hopelessness. He frequently attempted suicide, meaning frequent ambulance journeys, police interventions and hospital attendances, in addition to occasional fire and rescue support. Mental health services would be called, but drug usage would be a barrier to effective treatment. During 24 months of being on the street he had contact with 19 different public service teams. Applying a cost allocation to each intervention we could trace, in 12 months cost public services over £280,000. Yet Adam remained street homeless and using drugs. The impact on his life was minimal.
When we met with Adam to map his experiences, he described difficulties in treatment or support because of his use of substances to cope and how this added to his sense of abandonment and worthlessness.
When we spoke to teams attempting to assess or support Adam either with housing, or addiction, or anxiety, or physical ailments, finances or getting community support to recover – very few had met before. When they met in person, they were able to find solutions for him, supporting each other to overcome any barriers to supporting him, those we had inadvertently created by service-focused working.
What did they do differently?
Those who had a trust relationship with Adam (community outreach) helped to encourage him to attend assessments with those he wasn’t as engaged with (Department of Work and Pensions, local government housing team, mental health and addiction services – all using the same information he provided on just one occasion). When assessments were completed, his treatment regime could be managed more efficiently (Addiction Services, GP, Community Outreach and Peer Support) and he was able to get help to be housed with a community support structure around him keeping him on track with activities of daily living (Community Voluntary Network and Community Outreach) and making sure appointments didn’t clash with his court appearances, meaning he didn’t have to make a choice between his health and recovery, or appointments with criminal justice services to avoid punitive action.
Updating police, ambulance, fire and rescue services with the names of his key trusted professionals and who he could get support from meant if there was a set-back the team who knew him were able to respond quickly, avoiding usage of emergency services and frustratingly cyclical usage of fragmented services.
Being able to share his story with the team helped them to empathise. Being able to work together and share appropriate personal information with permission and use that to better co-ordinate services meant the team worked differently, innovatively, and with impact to savings in public spend. At a co-ordinated time Adam was supported to rehabilitation, and his mental health treatment was co-ordinated so that he could start safely addressing the cause of his reliance on substances, knowing he had support from the community to stay on track and a safe place to stay. The initial plan around Adam took the team no longer than 20 minutes to devise together with him. Adam describes those 20 minutes as the most supported and cared for he had ever felt.
Co-location of blue light services and wider health and social care services can help to stop people just like Adam and many more falling through the cracks of fragmented and stretched public health services.
Additional reading:
- Birmingham Changing Futures Programme (2019) Evolution of the Impact of Psychologically Informed Environments. Available here: https://revolving-doors.org.uk/publications/bcft-impact-psychologically-informed-environments/ [last accessed 4th June 2021]
- Revolving Doors (2021) The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantage. Available here: https://revolving-doors.org.uk/wp-content/uploads/2021/02/The-Knot-The-interconnectedness-of-poverty-trauma-and-multiple-disadvantage-FINAL.pdf [last accessed 4th June 2021]
- Centre for Mental Health (2020). Covid19 and the nation’s mental health – forecasting needs and risks in the UK: May 2020. Available here: https://www.centreformentalhealth.org.uk/sites/default/files/2020-05/CentreforMentalHealth_COVID_MH_Forecasting_May20.pdf [last accessed 12th November 2020]
- Covid-19 National Foresight Group (2020) Mental Health & Wellbeing Impacts of COVID-19 Findings from analysis of Third Strategic Roundtable with Strategic Leaders 2020. Available here: https://www.ntu.ac.uk/__data/assets/pdf_file/0027/1177911/NTU-C19-NFG-Report-250620-Third-Strategic-Recovery-Roundtable-Report.pdf [Last accessed 1st July 2020]
- Kings Fund, The. (2018). Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England. Available here: https://www.kingsfund.org.uk/publications/making-sense-integrated-care-systems#change [last accessed 26th October 2010]
- Ministry of Justice, 2010. Statutory Partnerships and Responsibilities. Available here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/389746/statutory-partnerships.pdf [last accessed 26th October 2010]
- NPCC (2018) Policing Vision 2025. Available here: https://www.npcc.police.uk/documents/Policing%20Vision.pdf [last accessed 1st October 2020] Policing & Mental Health, Picking Up the Pieces, HMIC. London. 2018
https://www.justiceinspectorates.gov.uk/hmicfrs/publications/policing-and-mental-health-picking-up-the-pieces/
Claire Darbyshire wrote this article whilst she held a joint position between Lincolnshire Partnership NHS Foundation Trust and Lincolnshire Police and Crime Commissioner, leading on strategic collaboratives.
Claire continues to work in support of the public sector ecosystem.
For more insight on cross-sector working for population impact, follow Claire’s blog: http://www.empac.org.uk.
