Supporting perinatal mental health: from peer-support to specialist services

There is a societal expectation that pregnancy and the arrival of a new baby are happy and exciting times.  However, it may come as a surprise to learn that up to 1 in 5 women develop a mental illness during pregnancy or within the first year after having a baby (also known as the ‘perinatal period’).

Up to 1 in 10 women may develop postnatal depression, however, there are actually a number of other mental illnesses that can affect women during pregnancy or following birth.  These include:

  • Antenatal depression
  • Perinatal anxiety
  • Perinatal obsessive compulsive disorder
  • Post-traumatic stress disorder (PTSD)
  • Post-partum psychosis

These illnesses can range from mild to severe.  Left untreated, perinatal mental illnesses can have a devastating effect on mental and physical health.  In fact, suicide is the leading cause of death for mothers during the first year after pregnancy.

The wider impact on children and families

Perinatal mental illnesses can also impact upon children, partners and significant others.  Research shows links to depression in partners, higher rates of divorces, lower levels of emotional and cognitive development and higher levels of behavioural problems and psychological disorders among children.

As well as the high human cost, there are also a number of economic costs associated with failing to address perinatal mental health needs. Research commissioned by the Maternal Mental Health Alliance found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.

Access to specialist services is a ‘postcode lottery’

The good news is that most mothers who experience mental ill health can and do make a full recovery.

At present, mild to moderate cases of mental ill health in pregnancy and following birth are treated by the GP through anti-depressants, talking therapies and/or support from a community mental health team.  For more complex or serious illnesses, GPs can make a referral to specialist perinatal mental health services for expert advice and support.  This may involve staying in a specialist psychiatric Mother and Baby Unit (MBU) – where mothers and their baby can be admitted together.

However, despite the high prevalence of, and risks associated with, perinatal mental illness, access to specialist perinatal mental health services across the UK is a postcode lottery.

Maps by the Maternal Mental Health Alliance show that women in around half of the UK have no access to specialist perinatal mental health services.  There are currently no MBUs in Wales or Northern Ireland, meaning mothers with more serious or complex mental illnesses often face either being admitted to a MBU far from home, or being admitted to a general psychiatric ward without their babies, in order to receive treatment.

For those with mild to moderate mental illness, waiting times for NHS talking treatments can be many months.  Lack of awareness means that many cases of mild to moderate mental ill health go undiagnosed and untreated.  There is an urgent need for both greater awareness of mental illness and better access to mental health services across the country.

The role of peer-support

In recognition of and response to the need for better access to mental health support for pregnant and new mothers, a number of local ‘grassroots’ peer-support projects have been established by dedicated volunteers and campaigners.

One such project is Blank Canvas.  Blank Canvas is a creative journaling workshop in Lanarkshire, aimed at women during pregnancy or in the first two years since birth, who are experiencing mental health difficulties.

The project was set up earlier this year by midwife Elaine Connell, together with some of her midwife colleagues, who shared her dedication to improving mental health support for women in the perinatal period.

Elaine was keen to start her own peer support group following her own personal and professional experiences of perinatal mental ill health, and was inspired by the success of other projects focusing on art and creativity, such as Maternal Journal.

As Elaine explains:

It is free… …to access, and each attendee is given their own art kit to keep. We have a different theme each week and have guest speakers coming to do sessions also. During the group they can explore new art materials and create reflections in their journal, whilst chatting over some tea and cake. Each session they will take home a prompt card which can inspire their journalling during the week until the group meets next.”

Blank Canvas is free to access and works on a self-referral basis, with advertising mainly through Facebook.  A local shop and community space (Swaddle in Hamilton) donated a venue space, and all other costs (including materials) have been raised by volunteers committed to the project, through fundraisers such as coffee mornings and participation in the Kiltwalk.

Elaine has conducted an evaluation of the first 10-week block and feedback from participants has been extremely positive.  Word about the project has spread and the next block of Blank Canvas – which started on the 18th September – is fully subscribed (with a waiting list).  As Elaine notes, this is fantastic for the project, but highlights the high level of demand that exists for mental health support among new mothers.

The long term plan is to run 6-week blocks frequently throughout the year, moving to separate antenatal and postnatal sessions in 2020.  Elaine also hopes to start up a creative journaling group aimed at fathers too – noting that father’s mental health is often overlooked.

One of the key things Elaine has learned from the creation of Blank Canvas is that there is a lack of support available for people who want to establish their own peer-support groups:

What has been clear when forming the group, is that there is very little support to establish peer support. There are lots of people who want to help others but who won’t because they don’t know where to begin, or how to access funding, or lack of training opportunities.”

Grassroots peer-support groups are an important source of support for mothers in the perinatal period, particularly in cases of mild to moderate mental ill health, where NHS capacity is strained.

Attending peer-support groups such as Blank Canvas may also have a preventative effect for mums who attend during pregnancy. Statistically, women who experience antenatal anxiety are more likely to develop postnatal depression, and so early intervention could help to reduce that risk.

Urgent need for better access to specialist services

While these projects have been successful, they are aimed predominantly at women experiencing mild to moderate mental ill health.

For those experiencing more complex or serious mental ill health, there remains an urgent need for better access to specialist treatment and support.  The Maternal Mental Health Alliance ‘Everyone’s Business’ campaign calls for all women throughout the UK who experience perinatal mental ill health to receive the care that they and their families need.  Specifically, it demands that:

  • perinatal mental health care should be clearly set at a national level and complied with
  • specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK
  • training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth

Promising signs of progress

There have been some promising signs of progress.  NHS England recently announced their plans to rollout specialist perinatal community services across the whole of England, including the opening of four new Mother and Baby Units.

And in Scotland, the Scottish Government recently announced the rollout of an initial £1 million for perinatal mental health services, as part of a wider £50 million investment in mental health services.  This initial investment will support a range of areas, including supporting the third sector to provide counselling, befriending and peer support for women and their families.  It will also help provide more consistent access to psychological assessment and treatment, by increasing staffing levels and training at Mother and Baby Units, for women with the most serious illnesses.

The Scottish Government also established a Perinatal and Infant Mental Health Programme Board earlier this year.  The PIMH Programme Board aims to help implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland.

Clare Thomson, Everyone’s Business Co-ordinator for Scotland, says “It’s fantastic to see the evidence-based approach to developing community perinatal mental health services and look forward to hearing about the first steps – particularly in the North of Scotland“.

Perinatal mental health is Everyone’s Business

However, there is still much to do, including ensuring that this funding translates into services on the ground.  Wales and Northern Ireland are still without MBUs and there is a pressing need to raise awareness of and address mental illness among fathers.

The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.  It clearly makes sense to invest in improving this care – not only from an economic perspective, but to help improve the lives of women, their children and families across the country. And while more funding is essential to achieve this, raising awareness of the importance of perinatal mental health really is ‘everyone’s business’.


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Rolling the dice with sexual health? New challenges for STI services

Today is the start of Sexual Health Week, which aims to raise awareness about services for the testing and treatment of sexually transmitted infections (STIs). The UK has a strong track record in the provision of STI services. But they are now facing new challenges, including a rise in demand, significant cutbacks in public health funding, and the emergence of infections that are resistant to treatment.

A historical perspective

STIs go back a long way. Syphilis first became widely reported in Europe during the late fifteenth century, while gonorrhoea was first described 3,500 years ago. For a long time, these diseases were incurable, afflicting millions of people and leading to infertility, disfigurement and insanity. Early attempts at treatment with mercury often proved fatal. With the development of penicillin in the 1940s, along with improvements in sex education, the rates of STIs fell dramatically. More recently, new drugs have revolutionised the treatment of people living with HIV.

A growing problem

Today, the instances of STIs are rising. In Australia, rates of syphilis, gonorrhoea and chlamydia are the highest since the 1990s. It’s a similar story in the United States and Canada, while in the European Union reported syphilis cases have continued to grow. HIV remains a major public health concern, with recent data indicating a significant number of new infections in eastern Europe.

In the UK, a 2019 report by the House of Commons Health and Social Care Committee found that overall STIs fell between 2013 and 2017. But more recent figures have revealed worrying developments:

  • In 2017 there was a 20% increase in cases of syphilis in England, and a 22% increase in gonorrhoea.
  • In Scotland, the number of cases of syphilis recorded has reached a 15-year high.
  • Public Health Wales has reported a 79% increase in syphilis cases in the country between 2016 and 2018.
  • The number of people in Northern Ireland diagnosed with gonorrhoea in 2018 was the highest on record.

The committee found that the impact of STIs in England is greatest among young people. Men who have sex with men are also disproportionately affected by STIs, while in black and minority ethnic populations, the rates of STI are higher than in the general population.

Along with the rise in the number of infections, the demand for sexual health services is increasing. At the same time, sexual health services say they are facing unprecedented threats from government cuts to local authority public health budgets.

In 2017, a Public Health England survey highlighted the concerns of commissioners of sexual health services. Respondents raised concerns about a decrease in capacity and an increase in demand, in both primary care and specialist services. They believe the consequences could include a worsening of health inequalities and a shift from prevention to treatment.

Debbie Laycock from the Terence Higgins Trust HIV charity told BBC News:

“The number of people accessing sexual health services has continued to rise, demand is on the increase and we’re hearing day-to-day more and more people are saying they’re being turned away from sexual health clinics. When it becomes harder to get an appointment, this is likely to deter people who don’t have symptoms, but just want a routine test. Those routine tests pick up infections at an early stage and stop them being spread to too many other people.”

Services at “breaking point”

There are concerns that this situation will worsen: from April 2020, previously ring-fenced sexual health, drug and alcohol services, which in England are funded by local authorities, will be competing for increasingly scarce funds alongside other council services such as social care.

The Health and Social Care Committee argues that budget cutbacks are not only bad for individuals’ health, but also increase overall costs to the NHS:

“Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health system. Inadequate sexual health services may also lead to serious personal long-term health consequences for individuals and jeopardise other public health campaigns such as the fight against antimicrobial resistance.”

This last point refers to a worrying new issue in the treatment of STIs. In recent months, several cases have been reported of new infections that have developed resistance to antibiotics.

Dr Tim Jinks, head of Wellcome’s Drug Resistant Infection programme, believes that increasing resistance to antibiotics will make treating and curing STIs harder:

“Untreatable cases of gonorrhoea are harbingers of a wider crisis, where common infections are harder and harder to treat. We urgently need to reduce the spread of these infections and invest in new antibiotics and treatments to replace those that no longer work.”

Some health professionals, such as Duncan Stephenson from the Royal Society for Public Health have warned that sexual health services are already at breaking point:

“With continued increases in rates of STIs such as syphilis…and the future threats posed by issues such as drug resistant gonorrhoea, the government is rolling the dice with the public’s sexual health.”

 Sexual health services for people with disabilities

This year, Sexual Health Week is focused on people with disabilities, who often face barriers that prevent access to information and support. To overcome these obstacles, sexual health services need to make changes, such as providing longer consultation periods for people with learning disabilities, and training for health professionals in advising and treating patients with special needs. With sexual health services already under pressure, the challenges of meeting the particular needs of people with disabilities are all the greater.

Final thoughts

In its report, the Commons Health and Social Care Committee recommended that Public Health England should collaborate with the sectors involved in commissioning and providing sexual health services to develop a new strategy. The report’s authors believe that this strategy:

“should help both providers and commissioners in their attempts to deliver sexual health services to a high quality and consistent level, in the face of the challenges of fragmented structures and reduced funding.

The committee also identified priority areas to be addressed by the strategy, including:

  • the provision of services which meet the needs of vulnerable populations
  • testing for the full range of sexually transmitted infections
  • access to pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV
  • preventative interventions within all aspects of sexual health

Sexual health is an important part of physical and mental health, as well as ensuring emotional and social well-being. Modern, rapid testing can reduce the rate of onward transmission, and ensure that patients receive the right care, leading to long and healthy lives. Ensuring that those benefits continue will be the greatest challenge facing sexual health services now and in the future.


Effective clinical management for sexual health services

Effective record-keeping is an understated, but fundamentally important element of sexual health services. Increasingly, sexual health clinics are turning to electronic systems to maintain records, improve services and deliver cost savings.

Lilie is a clinical management software system specifically designed by Idox Health for sexual health services. Its electronic patient record (EPR) system provides fast access to patient information and greatly reduces administrative functions.

The system also provides sexual health services with a range of options, including:

    • patient communication via SMS
    • modules for contraceptive and reproductive health, chlamydia screening, HIV, and prescribing services
    • laboratory test results automatically received and entered into the electronic patient record

This market-leading software is now in use in more than 140 sites.

Further information about Lilie is available from Idox Health.

“The ‘frustrated’ housing aspirations of generation rent”

house prices

A key change in the UK’s housing market over the past twenty years has been the growth of the private rented sector (PRS), with more living in the sector than ever before. This growth has led to the view that there is now a ‘generation rent’ who are priced out of home ownership and stranded in insecure short-term lets for prolonged periods of their lives – fuelling concerns about intergenerational inequality.

At a recent seminar, hosted by the Public Services and Governance research group at the University of Stirling, Dr Kim McKee, a co-investigator for The UK Collaborative Centre for Housing Research (CaCHE), presented the key findings from her research on ‘generation rent’ and precarity in the contemporary housing market.

Who are ‘generation rent’?

The UK 2011 Census highlighted that 40% of private renters were young people under the age of 35. With a challenging labour market, rising student debt and welfare reforms, home ownership and social housing is increasingly out of reach for these young people, who end up stuck private renting for much longer than the previous generation.

It was noted by Dr McKee that there is a clear age dimension to the recent shifts in housing tenure, but that the ‘generation rent’ label is more complex than portrayed. Income and family support were emphasised as just as critical in the understanding of young people’s experiences and future plans, as was geography.

Indeed, other research has highlighted that income and family background have a huge impact on young people’s housing market experiences. The Resolution Foundation’s recent report highlights that young people from wealthier families are more likely to become homeowners, suggesting that there are also intra-generational inequalities.

Dr McKee’s study focused on the inequalities facing these young people through qualitative research with 16 young people aged 35 and under living in the PRS in Scotland or England. Those on low incomes were explicitly targeted with the aim of giving them a voice, which was considered to be largely absent in previous research.

Aspirations vs expectations

There was a long-term aspiration for home ownership among the majority of participants, with a smaller number aspiring to social housing. But private renting was seen as the only short-term option as a host of challenges thwart them from realising their ambitions:

  • mortgage finance
  • family support
  • labour markets
  • student debt
  • welfare reform

The fact that housing tenure was highlighted by respondents rather than housing type or location, as previous research has highlighted, suggests there is a general dissatisfaction with living in the PRS. Indeed, it was noted that the PRS was discussed largely negatively, perceived as the ‘tenure of last resort’.

Despite the continued aspirations for home ownership, there was a marked difference between aspirations and expectations. There was a levelling down of expectations to own and a gap emerging between what the young people aspired to as their ideal and what they expected to achieve. A small minority even remarked that a more realistic goal may in fact be improvements in the PRS. The study showed that such expectations were due, mainly, to low earnings and insecure employment, combined with a lack of family financial support.

While the short-term nature of private renting makes it a very flexible rental option, it also makes it insecure and precarious, creating barriers for tenants who want to settle into a home and community. This is particularly worrying for families with children, who can be greatly affected by the upheaval of having to regularly move.

Emotional impacts

The study was particularly interested in the more intangible and emotional impacts on ‘generation rent’ and how the frustrations in realising their aspirations impacted negatively on their wellbeing.

It was stressed that issues in the PRS are having serious negative impacts on the wellbeing of young people – insecure, expensive and poor quality housing are contributing to depression, stress and anxiety. Moreover, for those on the lowest incomes, such issues are even contributing to homelessness.

Not only is mental wellbeing affected but their physical health has also been impacted by poor quality housing. Problems with rodents, damp and mould, broken white goods and poor quality accommodation in general were all reported by participants.

The experiences of the young people in the study were described as a “sad reflection of housing in the UK today” and raises questions over whether the PRS can really meet the needs of low income groups in particular.

Geography matters 

Another key finding was that where people live really matters, not only because of the spatial nature of housing and labour markets, but also as tenancy rights and regulations vary across the UK.

Recent reforms in Scotland have provided tenants with greater security of tenure and more predictable rent increases. England was highlighted as lagging behind the rest of the UK in terms of regulation and tenants’ rights as it lacks any national landlord registration scheme. Letting agent fees in England were also highlighted as a real issue in relation to affordability.

It was suggested that the rest of the UK could learn much from the Scottish experience, although there is a need to go further, particularly in relation to affordability.

Way forward

A key message from the study was that security of tenure really matters for those living in the PRS but reform of the housing system can only go so far. Participants identified more affordable housing, more protection for renters and income inequalities as areas where the government could intervene to improve things.

Based on the findings, six key policy recommendations were made:

  • ensure security of tenure;
  • take action on rents;
  • provide better education for tenants on their rights, and indeed for landlords;
  • provide more affordable housing; and
  • ensure greater understanding of intra-generational inequalities.

If the wider inequalities within society are also addressed, perhaps the PRS could become an aspiration rather than the ‘tenure of last resort’.


If you enjoyed reading this, you may also be interested in our previous posts on build to rent and meeting demand and improving data in the private rented sector.

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Grandparents – the ‘hidden army’ of kinship carers

mamy and the little boy

By Heather Cameron

Tomorrow is the International Day of Older Persons, designated by the United Nations in order to recognise the important contributions made by older people, while raising awareness of the issues of ageing.

Today there are around 600 million people aged 60 years and over world-wide. A number that is set to double by 2025 and reach 2 billion by 2050.

With people living longer and healthier lives, it is not surprising older people are playing a considerably more active and increasingly important role in society. Not least when it comes to contributing to the care of their grandchildren.

Extent of kinship care

Kinship care – when children are brought up by relatives or family friends in the absence of their parents – has grown markedly in recent years.

It is estimated that between 200,000 and 300,000 grandparents and other relatives are raising children who are unable to live with their parents. Common reasons cited for this include abuse and neglect, parental illness or disability, parental substance misuse, domestic violence or death of a parent.

In examining the prevalence of kinship care, drawing on census data, a recent University of Bristol study found that there has been a 7% increase in the kinship child population in England since 2001 – more than three times that of the population growth rate of all children in England, which was 2% over the same time period.

The study also found that one in two (51%) children were growing up in households headed by grandparents.

Positive outcomes

With regard to the children in kinship care, research suggests that they do ‘significantly better than children in care’, both emotionally and academically.

Indeed, a recent study on the educational outcomes of looked after children found that children in long-term foster or kinship care made better progress than children in other care settings.

The largest kinship carer survey in the UK, conducted by Family Rights Group, also highlights the effectiveness of kinship care in preventing children entering or remaining within the care system, to the benefit of both the child and the public purse. The data found that 56% of children had come to live with the kinship carer straight from the parents’ home, with 27% having been in unrelated foster care.

The caring contribution of grandparents has also been shown to have made a material difference to maternal rates of employment.

And as 95% of children being raised in kinship care are not officially ‘looked after’, billions of pounds are saved each year on care costs.

But while benefiting the public purse, and despite evidence that kinship children have better outcomes, many kinship families face a financial burden. The University of Bristol study found that 40% of all children in kinship care in England were living in households located in the 20% of the poorest areas in England (an improvement of only 4% since 2001), and three quarters (76%) of kinship children were living in a deprived household.

Impact on grandparents

As there is no statutory requirement for local authorities to make provision for kinship carers and no automatic right to child benefit, many receive no formal support; leading to financial hardship, and the stress that comes with it.

Many kinship carers have had to give up work or reduce their working hours, either permanently or temporarily. And this is often their main source of income.

A study from Grandparents Plus on discrimination against kinship carers found that of the 77% of grandparents that have asked for professional help, only 33% received the help they needed. And 30% said they didn’t receive any support at all.

The study also found that, overall, kinship carers score ‘significantly below average’ when it comes to their wellbeing.

Other recent research has suggested that regular and occasional care for grandchildren can impact on the mental health of grandparents. The findings indicated that ten additional hours of childcare per month increases the probability of developing depressive symptoms by 3.0 and 3.2 percentage point for grandmothers and 5.4 to 5.9 percentage points for grandfathers.

Policies that substitute informal with formal childcare, it argued, could improve the mental wellbeing of grandparents.

Of course there are positive impacts on grandparents too, many of whom find caring for grandchildren rewarding and who enjoy closer relationships with them, which can in turn have a positive effect on their health. As the research suggests:

the effect of grandchild care provision on grandparents’ health seems to depend on its intensity, the cultural context, as well as on its stability and change.”

Final thoughts

It is clear that grandparents play an increasingly vital role in family life. But it seems this role is in need of greater recognition and support, if society is to continue to benefit from this ‘hidden army’ of kinship carers.


If you enjoyed reading this, you may also be interested in our previous blog on the economic opportunities of an ageing society, published on last year’s International Day of Older Persons.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Housing matters: our recent publications cover issues from homelessness to housing and health

tiny houses 4

By Heather Cameron

The Chartered Institute of Housing (CIH) annual conference and exhibition, the largest housing-focused event in Europe, takes place this week. Over the next three days the conference will examine and explore the political and policy environment, the economic outlook and the latest thinking across the sector.

A variety of topics will be addressed, including housing supply, housing policy, social housing, welfare reform, regeneration and homelessness. These topic areas feature extensively on our database, some of which we have also written about. So this is a good opportunity to highlight some of our recent publications in this area.

What we’ve published

Our most recent ‘In focus’ briefing looks at housing retrofitting, something that has been highlighted as essential for improving the energy efficiency of our housing stock. It considers the benefits of renovating domestic properties to improve energy efficiency and environmental performance and describes the features and technologies of retrofit, such as heat pumps, combined heat and power and various types of insulation. The environmental, economic and social benefits as well as the barriers are summarised. Recent developments concerning retrofit schemes introduced by the UK government and the devolved administrations are also described, and there are examples of good practice from the Netherlands, Sweden and the UK.

Last month we published Delivering solutions to tackle homelessness (Ideas in practice), which looks at the scale of homelessness across the UK and its causes, and provides innovative examples of projects and initiatives that are tackling the problem.

The examples of innovative approaches highlighted include:

We have also written a series of blogs on the topic of homelessness. These include a look at the Christmas Dinner campaign for the homeless run by Scotland’s not-for-profit sandwich shop, Social Bite, while also highlighting the recent increase in homelessness in Scotland and the UK, and the shocking number of homeless children at Christmas.

Another blog post looks at the problem of the hidden homeless and its financial and human costs.

Digital inclusion and the social housing sector is the topic of another ‘In focus’ briefing. This looks at the benefits of digital inclusion, the barriers to digital inclusion for social housing tenants, and how these might be overcome. It refers to a 2012 report which found that almost half of the UK’s adult population who do not use the internet live in social housing, suggesting digital exclusion is a particular problem in the sector. It includes examples of good practice and highlights the importance of digital inclusion in the context of welfare reform.

We also recently blogged on this topic, highlighting one of the examples of best practice featured in our briefing: a case study of a collaboration between Reading Room – a digital consultancy which joined the Idox Group in 2015 – and Catalyst, one of the leading housing associations in London and the South East. This collaboration highlights the potential of technology for improving communications between social housing providers and their tenants, and for encouraging more people to reap the benefits of going online.

Another topic we have looked at is the integration between housing and health. Housing conditions can affect the physical and mental health of people, and can contribute to many preventable diseases and injuries. The ageing population is also putting pressure on the NHS, and growing numbers of older people have to stay in hospital longer because their homes are unsuitable for their recovery. Our briefing notes that housing associations, local authorities and healthcare providers have been working on solutions to tackle these challenges, and provides case studies from London, Tyneside and Bristol as examples of greater collaboration between housing and health services.

The challenges of an ageing population for the housing sector has also been highlighted in our briefing on meeting the housing needs of older people. It indicates that there will be a need for: adaptations to existing housing stock; mainstream rented accommodation built to accommodate wheelchair users; and newly built specialist accommodation. Examples of good practice – including case studies of extra care housing from Calderdale Council, and adapting homes for older and disabled residents in Knowsley, Merseyside – are highlighted.

This is just a flavour of what we’ve recently covered on housing-related topics, and we will inevitably produce more as the sector responds to a time of change and uncertainty.


Some of our briefings are only available to members of the Idox Information Service.

Follow us on Twitter to see what developments in policy and practice are interesting our research team. 

The Town Meeting: the award-winning planning engagement project, one year on

Scene from the "Town Meeting"

Scene from the “Town Meeting”

In this guest blog post, Dr Paul Cowie from the University of Newcastle reflects on an exciting year for the Town Meeting project, which uses theatre to engage communities in planning.

It’s now a year since we started the Town Meeting project and 7 months since the project won the Sir Peter Hall Award for Wider Engagement at the 2015 RTPI Research Excellence awards.

The Town Meeting uses theatre as a way of co-producing research into public participation in planning with communities themselves. The Town Meeting has been performed in 12 communities across the north of England. The use of theatre in this way is unique and has engaged audiences in the issues in a way that traditional forms of research cannot. If you are interested to find out more about the project and the play, we have written a blog about it here and produced a ‘behind the scenes’ podcast about the development process here.

The impacts of the RTPI award

One of the major impacts of winning the award has been to develop the credibility of the project with both professionals and funders. The initial phase of the research was all about understanding the issues in more detail. We’ve now had a chance to do that and the second phase of the project has been to try to change planning practice to address some of the concerns raised by the participants in the project.

To undertake this new phase of the project we have been fortunate to get funding from the ESRC Impact Accelerator Account scheme and Newcastle Institute for Social Renewal. Having the research recognised by a professional body, the RTPI, through the Research Excellence Awards was invaluable in making the case for further funding.

The new phase of the project aims to take the lessons learnt from the play and turn that into a tool which planners can use to co-produce knowledge which can inform strategic planning.

Bringing planning and health together

So far we have worked with health professionals and planners to explore how planning and health can be reunited. In the workshop, health professionals and planners were presented with a proposal to build a super-casino in a run-down seaside town. The play provided a forum for the planners and health professionals to discuss the wider implications of development proposals in a new way.

The event highlighted the lack of understanding that health professionals have of the planning system. It’s often felt that planning can be the solution to many problems but it has been clear from the project how little citizens and professionals alike understand the process of planning and its limitations.

Collaborative planning

We are now about to start working with Northumberland National Park Authority to assist in the development of their new local plan. Through a new version of the play it is hoped communities can understand the importance of the local plan in framing any later planning decision that may affect them.

Previous performances of the play and discussions with audiences have made it clear people only get involved in planning issues at the point when it’s often too late to have any meaningful impact on that decision. The paradox is that at the point at which they can make a meaningful difference, the preparation of the local plan, it is often difficult for communities to see the relevance to them.

Using a play as a tool in collaborative planning can therefore turn the abstract process of preparing a local plan into something meaningful by showing how it has a direct impact on later planning decisions which may affect them greatly. The play also allows the community the freedom to create a vision for their local area, in this case the National Park.

Gaining the trust of planners from the National Park was helped greatly by the award. There is a degree of risk on their part in taking on this untested, and some may say frivolous, method of plan production. The award has given the planners the confidence to take that risk.

We are hopeful that the next year will lead to some concrete outcomes for the project, and to the play making a meaningful difference to the way communities and planners co-produce knowledge about places that matter to them.

Final thoughts

At a recent performance of the play in Cockermouth, the ‘Blennerhasset Village Parliament’ was mentioned. I had not heard of this and asking around the department, neither had any of my colleagues. Started in 1866 as a way involving the whole population in the governance of the community, the village parliament was an example of community governance in the 19th Century.

It was a reminder that sometimes we think we are being innovative when in fact we are merely repeating history – and of the fundamental value of engaging people in the process of research.


Dr Paul Cowie is a Research Assistant in the School of Architecture, Planning and Landscape at the University of Newcastle. Paul’s research focuses on community planning and community representation in the planning process. In 2015, Paul and his project The Town Meeting won the Sir Peter Hall Award for Wider Engagement at the RTPI Awards for Research Excellence.

This year, the Idox Information Service will again be sponsoring the RTPI Sir Peter Hall Award for Wider Engagement, as well as the Student and Planning Consultancy Awards.

The closing date for applications to the awards is 31 May 2016. Further information and application forms are available here.

Evidence use in health and social care – introducing Social Policy and Practice

SPP screenshotWith public sector austerity and the integration of health and social care, it seems as though the need for access to evidence-based policy and practice has never been stronger. Initiatives such as those from the Alliance for Useful Evidence, most recently its practice guide to using research evidence, have highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The journey to a new resource

A recent article in CILIP Update has explored the background to the Social Policy and Practice database, and its contribution to ensuring the inclusion of grey literature and a UK-perspective within systematic reviews. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article with our blog readers.

We’ve written before about the value of UK-produced databases within a global publishing context. The CILIP Update article makes the point that when conducting any search for evidence, it’s important to look beyond the major databases to more specialist collections, to source grey literature and to look beyond geographical borders.

This was one of the major drivers in 2003, when the heads of the Centre for Policy on Ageing, the Greater London Authority, Idox Information Service, National Children’s Bureau and Social Care Institute for Excellence agreed to pool their resources and create the first national social science database embracing social care, social policy, social services, and public policy.

The proposal was met with great enthusiasm by the sector which recognised a gap in provision. The new Social Policy and Practice database was launched in November 2004.

The strengths of consortium working

Bringing together these organisations was relatively simple. They were all striving to provide evidence and information to their staff, members or customers. They all also had a professional drive to share their focused collections with the wider world of researchers and to influence policy and practice.

Through developing best practice and troubleshooting problems together, we have improved not only the Social Policy and Practice database for users but also improved our own individual collections. All whilst remaining independent and focused on our individual specialities.

Continuing to evolve

The NSPCC joined the database consortium in 2015, bringing its collection of resources focused on child abuse, child neglect and child protection. The NSPCC library is Europe’s largest collection of publications dedicated to safeguarding children. It includes journal articles, books, academic papers, leaflets, reports, audio-visual material, websites and digital media on all subjects that help researchers, policy makes and practitioners protect children from abuse and neglect.

Social Policy and Practice now boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature. Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care.

We’re proud to be contributing to the knowledge base for social research, policy and practice!


To find out more about Social Policy and Practice (SPP) database for evidence and research in health and social care, or to get a free trial, please visit www.spandp.net

Read some of our other blogs on evidence use in public policy:

What is Reablement in healthcare and how is it done?

By Rebecca Jackson

Reablement, or enablement is the process of rehabilitating people to allow them to regain some or all of their independence. Often promoted as a form of intermediary care, reablement programmes are recommended for patients who have had a stay in hospital, in order to reduce dependence on the local social care system or traditional ‘care at home’ programmes.

They often result in longer periods of one-to-one contact than ‘care at home’ programmes  – trained professionals work with patients and their family to encourage and promote the achievement of personal goals. It also provides an intermediary stage between health care and social care, which can help the patient transition. Effective reablement programmes are an example of health and social care bodies working together to deliver holistic, person-centred care.

Cooking Together

What makes an effective reablement programme?

Reablement programmes cover a range of everyday tasks such as how to tackle stairs, how to wash and dress and how to prepare and cook meals. It encourages service users to develop the confidence and skills to carry out these activities themselves in order to continue to live at home.

The programmes are planned and delivered by trained reablement professionals – they involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.

Much of the literature around reablement (enablement) practice centres on core issues which are vital to ensure success:

  • focus on early intervention and prevention;
  • a positive, enabling, co-productive approach adopted by all;
  • a workforce with an ethos of working with people, rather than doing something to them;
  • the active participation of the service user and their family in reablement;
  • ongoing training for staff;
  • information and support for families and carers;
  • integration and collaborative working between health, housing and social services;
  • strong leadership in commissioning, and adequate funding of services to deliver sustainable outcomes;
  • evaluation that incorporates both social and financial service outcomes to demonstrate value;
  • good quality assessment by a practitioner with the right skills and abilities to determine an effective programme.

Senior resting in a wheelchair

Reablement in local authorities

Research has shown that these intensive programmes are effective. A 2007 study for the Department of Health’s Care Services Efficiency Delivery Network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.

Almost all of England’s councils are planning, implementing or running a reablement service. One driver is that it is seen as a tool for managing the costs of an ageing population. In the UK, reablement programmes usually last for 6 weeks, at which time care is either passed to a social worker, adult social care team, or patients are asked to pay for the continuation of the programme themselves.

Reablement has been criticised as expensive, and time- and resource-intensive. Like any service working with vulnerable people, it can also be difficult to demonstrate value as there are differing success rates for different patients. However, interviews conducted with people who have received reablement packages have suggested the emotional and long term benefits are significant as are potential savings to care budgets in the future. This is especially the case in terms of the cost of readmission to hospital, which studies have found is reduced in cases where people received effective reablement care.

The local authority in Croydon was recognised in 2013 for its work in promoting and expanding reablement practices. They also developed a programme of pre-ablement, which saw training delivered to vulnerable people before they became unable to carry out tasks. By showing them alternative ways to do tasks, they were able to change things before being forced to. This preventative approach worked within the local authority and is something which could be considered more widely as pressure increases on local authority funding and care capacity.

There is a growing consensus that properly funded and effective preventative services, such as reablement, can deliver cost-savings to health and social care services, as well as improving the lives of patients.


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read some of our other bogs on health and social care:

Co-production in social care … a need for systems change

meeting

By Rebecca Jackson

One of our most popular member briefings has been our 2014 introduction to co-production in public services. In fact, it was so popular that we made it freely available to download from our website. For those who don’t know, co-production is an approach to improving or developing services by working collaboratively with the people who use those services. It has become increasingly popular within many types of public services in the UK, but especially in health and social care.

The components of co-production

But what does co-production actually mean in practice? Although every case is different, generally it can be broken down into several processes:

  • Co-design – the planning of services
  • Co-decision making – with regards to the distribution of resources and the allocation of services
  • Co-delivery (of services) – including outlining the role of volunteers and the third sector, and including them in the process if necessary
  • Co-evaluation (of services) – assessment of the outcomes and whether they have been successful for all parties involved.

Legislation and implementation

The 2014 Care Act was one of the first pieces of UK legislation to include co-production as a concept in its statutory guidance, stating that:

‘Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.’

Co-production is now a key part of the implementation of health and social care strategy across the UK. It provides service users with an input on which elements of services are of most use, and which could be altered to make them more effective – particularly important at a time when local authorities are under pressure to deliver more efficient and cost-effective services.

Co-production relates to other strategic priorities such as prevention, wellbeing, a focus on outcomes and the personalisation agenda. It allows people who use services to have a direct input into the design of care services and care plans, so as to create more effective programmes of care.

Implementing co-production can be a difficult transition and requires a whole system approach to change. This means that organisations, such as local authorities, must adopt change at every level to encourage meaningful participation and to embed co-production in day-to-day practices.

Managing change

The SCIE co-production guidance uses a jigsaw model for management of change which may be a helpful way to identify the elements of an organisation which must be altered to effectively incorporate co production.

jigsaw 3The guidance provided by the Social Care Institute for Excellence (SCIE) recommends that:

  • organisations must change at every level, from senior management to front-line staff,  if they want to achieve meaningful participation
  • participation should become part of daily practice – and not be a one-off activity
  • participation operates at different levels, as there are many ways to involve people who use services in different types of decisions

Social care co-production in practice

  • The project PRESENT is a joint initiative between East Dunbartonshire Council, the local Dementia Network, the Joint Improvement Team and Governance International, which uses co-production to engage people with dementia and enable dementia sufferers to make a positive contribution to their communities.
  • Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and has impact. The council worked with people who use services and carers to produce the Framework. Local statutory and voluntary sector organisations, including the Making it Real Experts by Experience and Project Team, and Healthwatch Islington, were also involved.
  • A report produced in 2013 by the Scottish Co-production Network, Governance International, the Scottish Joint Improvement Team and the Social Care Alliance,  also provided comparisons between the approaches to co-production in social care between Scotland and Sweden.

These are just a few examples of innovative practice, more of which can be found on the SCIE website.

The potential of co-production

Co-production has the potential to transform the way social care is delivered in the UK. However, implementing co-production approaches into existing organisations, with their own culture, structures and operating procedures, as well as their own expectations about services and how they should be created and delivered, remains a challenge for commissioners, the third and private sectors, politicians and the public.

In order to be successful and to produce sustainable and effective relationships, total change will be required and it will take a huge commitment and long term vision to ensure its success. Once implemented, though, it is clear that co-production has the potential to contribute greatly to prevention, personalisation and outcomes-focused service delivery – which are all key agendas in the current health and social care policy climate.


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Health Champions – “unlocking the power of communities”

Health Cubes_iStock_000022075266Large

By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.


If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.