In 2015, GPs across York were reporting an increase in visits for non-clinical reasons, such as loneliness and isolation. The council decided to embed a health and wellbeing strategy at the heart of its delivery, which proactively engaged with health, voluntary, housing and other cross-sector teams to set up a system that would not only help to curtail levels of social isolation, but reduce GP visits for non-clinical reasons.
Key benefits and outcomes
- GP visits for non-clinical reasons have reduced by a third.
- Local area coordination (LAC) is recognised as having a £4 social return on investment for every £1 invested.
- LAC teams, which have increased in number from three (2017) to 11, can respond rapidly to crises within their own communities.
- Between 76 per cent and 96 per cent of LAC work is diverting the need for services in people’s lives, through supporting non-service solutions instead.
What the organisation faced
York is commonly perceived to be a wealthy city, with a large tourist economy. Away from the tourist crowds the reality is different; York has some of the most extreme health inequalities outside London, with associated social exclusion and a rapidly ageing population. There are huge life expectancy variations across York’s different demographics and communities, with an eight-year gap between those living in wealthier and disadvantaged areas, according to the Index of Multiple Deprivation (IMD, 2019).
Five years ago, many York residents were making repeated visits to their GPs for non-clinical issues linked to loneliness and isolation. This was proving to be a huge drain on health, care and social resources.
Recognising that people have complex lives and problems requiring multi-faceted solutions and interventions, City of York Council decided to take a more holistic and targeted approach to health. This would require a collaborative approach, focused on early intervention support. It would involve supporting citizens to have a conversation about what a ‘good life’ could look like for them, and would require the backing of other partners across the health and voluntary sector.
What the organisation did
In 2016, City of York Council involved health and voluntary partners in setting up a leadership group to devise a health and wellbeing strategy.
The leadership group, chaired by a senior council member, quickly secured unanimous support for an asset-based community development model that views its citizens’ lived experiences within their own communities as assets. Local GP Lesley Godfey was a valuable participant, as her passion for prevention work opened doors and enabled strategic connections to be made.
A new head of communities role was tasked with liaising with GPs and teams from across the local voluntary sector (VSO) to quickly establish and develop a number of evidence-based initiatives to reflect this person-centred working and strengths-based approach. This entailed setting up:
- a local area coordination [LAC] team. City of York Council liaised with the national Local Area Coordination Network (LACN) to recruit and train around a dozen place-based workers, to provide social support to residents and signpost to VCSO groups such as the good gym / home share/ walking groups etc, to reduce levels of social isolation amongst all age groups. These volunteer workers are embedded in the local communities to develop better health outcomes for people, so they can enjoy a better life without the need for services. LAC coordinators live in the neighbourhood covered by the LAC and typically help around 50 to 60 people. The relationship between the LAC and the person they support is also voluntary and after an initial conversation or face-to-face meeting a mini action plan is created to build on the person’s gifts and talents and signpost to voluntary and social groups.
- a practitioners forum. Regular meetings bring together link workers across the sectors to share learning. This deep cross-team collaboration has enabled a welcoming culture for people requiring support, and also provides a space for reflective practice and mutual support.
This bridge of local area coordination has enabled people to move from social isolation and loneliness to active citizenship.
A good example of this collaborative approach in practice can be illustrated by a recently bereaved woman in her late 70s, who approached her local Housing Association, admitting to suicidal thoughts following the death of her only son. They contacted social services, who in turn suggested making an introduction to the LAC team. Towards the end of a lengthy and supportive conversation, the LAC support worker and the bereaved parent met for a walk, which the woman then revealed was previously a passion of hers. The LAC support walker then signposted her to Move Mates – a walking group which teams people up with a local ‘walking buddy’ volunteer for emotional support. The woman instead suggested that she’d rather be a walking buddy volunteer herself, so is now in the process of being trained, to help more people facing difficult times who would benefit from such an intervention. This is a great example of supporting people to have the ‘good life conversation’ rather than a reliance on always needing, or being signposted, to health services for support.
Work on the development of a set of cultural values for the city is led by the York Multiple Complex Needs Network, which brings together people with lived experience of multiple and complex needs, including severe mental health, homelessness, poverty, and substance misuse. This has amplified voices in the city from the most excluded, to enable new and more inclusive conversations and recognise the power of relationships and connection.
Results and benefits
There are now 11 LAC teams (up from three when first established in 2017) which can provide a quick on-the-ground response to crises in their local communities. This has undoubtedly saved many lives.
This bridge of local area coordination has enabled people to move from social isolation and loneliness to active citizenship, as well as providing an excellent return on investment of £4 social return for every £1 invested.
The city now recognises the value of mixing qualitative and quantitative data through both the stories and impact metrics associated with volunteering and social action. The most common feedback received from people receiving support from LAC teams is: “I feel like a citizen again and member of society.”
GPs in areas where the LACs operate are reporting a decline of around a third in visits for non-clinical reasons.
Although great progress has already been made, there are challenges in embedding strength-based approaches into practice, which were exacerbated by the pandemic.
For example, it was initially a slow process to get referrals/ introductions from GPs, despite the team quickly establishing good relationships. It transpired that GPs work under a time pressure, whereas a LAC has the luxury of time to build up a trusted relationship with a person to find out about their skills and gifts. It’s often the first time a person might have been asked what a good or better life might look like, and that’s because this strength or asset-based approach focuses on people’s goals and resources, rather than their problems.
Although supporting people to have these ‘good life conversations’ can sometimes be fiscally challenging, City of York Council remains committed to strengthening and embedding asset-based approaches in its day-to-day working. It is also bringing on board other local partners to encourage co-production with local people.
- See people as valuable, not vulnerable. Recognise that everyone has gifts, talents and skills, which empower people as active citizens and gives them hope, rather than simply being a passive recipient of services.
- Focus on what’s strong, rather than what’s wrong. This is a key part of asset-based community development that can help change the relationship between the local authority, its citizens and communities.
- Encourage a culture of openness, collaboration and learning. This is an essential first step to tackling complex problems in new ways.
For more information on the work in this case study, please contact Joe Micheli, head of communities at City of York Council: Joe.Micheli@york.gov.uk