Delivering timely, accessible and effective healthcare for all that addresses health inequalities can only be done collectively, writes Rukshana Kapasi.
When times are tough, it makes perfect sense to reach out to others for help and support. It may not be particularly newsworthy when the NHS works with partners across the voluntary, community and social enterprise (VCSE) sector – but the impact of that work and the results they garner, can be.
We know that non-clinical teams from charities, such as Barnardo’s, are well-placed to address the underlying causes of health issues and concerns with a targeted approach for people, including families, who need help.
Supporting families in A&E
Last year, we were approached by Hertfordshire Community NHS Trust to run a six-month trial which would help and support families with children under 12 who were coming into paediatric A&E at East and North Hertfordshire's Lister Hospital. The hospital was feeling the pressures being experienced on a national scale. Families were repeatedly visiting A&E thinking they would be seen quicker than if they made a GP appointment. Many visits were also for minor injuries, or conditions which could be managed at home with the right information, or be better addressed elsewhere.
In addition, the youth mental health crisis was spiralling, with the number of children with poor mental health increasing alongside groaning waiting lists for children and adolescent mental health services.
For the trial, a team of highly trained family support workers with experience and knowledge across parenting support, safeguarding or children’s health, spent time in Lister Hospital’s paediatric A&E. The team’s visibility, supported by a recognised brand, helped to open doors to have important and effective conversations with families at a time when they were receptive to help.
Families with an immediate need were given information on basic health or community support while at A&E
Support followed a triaged approach and covered parenting support, home environment assessments, safeguarding, links to support groups and further information to help build parents’ and carers’ confidence. Families with an immediate need were given information on basic health or community support while at A&E. When required, light-touch support at home was provided, including access to relevant services or advice on risk management. In some cases, more intensive outreach support was required for issues such as poor mental health or safeguarding, which often required further collaboration with other local authorities or organisations, including our family hubs.
…the trial reduced social isolation, improved family quality of life, accelerated access to support and boosted overall wellbeing for parents and carers
An independent evaluation of the trial by Oxford Brookes Institute of Public Health found that, out of the 173 families referred to us, 91 per cent of those engaged with the service, 87 per cent reported improvements to parents’ and carers’ confidence, and 84 per cent reported improvements in access to children’s health-related information. The evaluation also found that the trial reduced social isolation, improved family quality of life, accelerated access to support and boosted overall wellbeing for parents and carers.
Proud of our work
Our family support workers are particularly proud of two families we helped get to the root cause of what was contributing to their poor health. A mum brought her 16-week-old baby in after he had fallen off the sofa and she told our team about her poor mental health. We visited her at home where she also had a ten-year-old with special educational needs and disabilities, but they weren’t receiving any support. We put her in touch with her local Barnardo’s family hub who helped organise short breaks, food vouchers, benefits, a baby massage course, and sleep advice. She was also then able to regularly see a health visitor for the first time too.
Another family who had been to A&E several times with respiratory infections were visited at home following a chat at the hospital. Our family support worker found that there was severe damp on the walls of their home and began conversations with the local authority to address this. We offered advice on how the family could support their child’s health in the meantime too.
The model is also tapping into the real value of the VCSE sector to help collectively solve long-standing challenges for the NHS
The six-month trial in Hertfordshire has now developed to become Barnardo’s Emergency Care Model, providing deeper insight into how health inequalities are contributing to the pressures ICSs are facing in emergency care. The model is also tapping into the real value of the VCSE sector to help collectively solve long-standing challenges for the NHS, by acting on wider determinants of health and providing access to early intervention and prevention services.
If scaled up, the Emergency Care Model has huge potential to provide vital help to children, young people, and families at a time of need. It could also positively impact NHS workload and staff wellbeing by reducing pressures in the short and longer term by preventing recurrent admissions for wider social issues which cannot be solved by a clinical response alone.
With NHS services under huge strain, delivering timely, accessible, and effective healthcare for all is most definitely a joint venture.
Rukshana Kapasi is director of health for Barnardo’s. You can follow Rukshana on Twitter @rukshanakapasi