How can local Voluntary, Community, Faith & Social Enterprise Support Services (VCFSEs) and the North & West Bristol Locality Partnership (LP) be better jointly mobilised to improve the health and well-being of residents identified as a priority in North and West Bristol?

Funding:

BNSSG ICB Research Capability Funding.

What is the problem?

North & West Bristol Locality Partnership (henceforth the LP) utilised data and ‘on the ground’ intelligence from partners to define a population cohort in which to invest additional support. The chosen cohort are aged 50-70, with 2 or fewer long term health conditions (e.g. COPD, diabetes) and some low-level mental health conditions (depression/anxiety). This cohort would not normally be identified as in need of additional care as they are neither sick, frail nor elderly (people aged 70 or above). However, investigation revealed that this population has an average non-elective spend that is considerably higher than the BNSSG average for residents in this age group. Given that this population is not ‘ill’, per se, this higher spend suggests that interventions need to be put in place to help cohort members manage their health in a more sustainable and cost-effective way and prevent rapid decline in health. Since this population is concentrated in the least affluent areas of North and West Bristol, it is likely that social determinants are the most significant causes of their poor and rapid ageing.

Conversations led by Neighbourly Lab with Voluntary, Community, Faith & Social Enterprise sector organisations (henceforth VCFSEs) in the northern arc area revealed that members of this cohort rarely attend community support and are often not known to community organisations, suggesting that current community support is ill suited to their needs and interests. Furthermore, these VCFSEs identified a lack of awareness about the specific needs of this cohort, and about the Locality Partnership’s (henceforth LP) strategy for managing the health and wellbeing of residents more generally, suggesting that work needs to be done to align the LP and local VCFSEs so community support can be better delivered to residents.

The problem to address in this project is:

How can the LP and VCFSE sector form a synergistic structured arrangement to effectively work together, so that
The community support service delivery to residents identified as part of the LP’s target cohort is improved?

What is the aim of the research?

The overarching aim of our research is to design, implement and evaluate intervention(s) that will modify the service delivery of community support to residents identified as part of the LP’s target cohort. Our plans for this RCF grant are to do the required community engagement work to co-design these interventions with residents, members of the Locality Partnership, and VCFSE organisations.

There are three core aims we would like to achieve with this RCF grant:

To understand how cohort members currently live within their community, including the current community support on offer to them, how they engage with it, any gaps in provision they may see and how they would like it to be different to help their health thrive.
To identify cohort members’ attitudes surrounding their health and wellbeing, focusing on the motivations and barriers to behaviour change in order to ensure that all mitigating circumstances are considered from the outset
To co-design with cohort members, VCFSE staff, healthcare staff and the LP a set of viable, community-based initiatives to be delivered in the community by relevant community organisations and supported by the LP.

Our core aim with our proposed NIHR funded project is to evaluate the impact of the recommended interventions that emerge from our RCF work. Evaluation will consist of:

- Measuring cost effectiveness of community-based interventions in terms of change in average non-elective spend in cohort members and change in wellbeing of cohort members
- Qualitative research into how the relationship between the LP, Emergency Care, Primary Care and VCFSEs has changed as a result of the interventions introduced

How will this be achieved?

How we will achieve the RCF aims:

The primary focus of this RCF grant is to have the resources to do the necessary prior public engagement work, before we can implement and evaluate community-based interventions to address the needs of the cohort.

The public outreach will take the form of ethnographic interviews with 20 cohort members which will explore their views and experiences of their health and wellbeing, motivations and barriers to better health and wellbeing as well as an understanding of their community life and support they give and receive. The outcomes from these in-depth enquiries will be combined with insights collected through ongoing work by the LP’s frontline community engagement staff, such as Bristol Council Community Development Team, Sirona, and Healthwatch. This will give us a breadth as well as depth of understanding of the barriers to and perceptions of health and wellbeing support in North & West Bristol.

These interviews will form the design of up to five co-design workshops, in which cohort members will be invited to ideate solutions to health and wellbeing barriers with VCFSE staff and volunteers, health and care workforce, the research team and members from the LP.

After these workshops, partners at the LP, UWE and from the VCFSE sector will come together to review the proposed interventions from the co-design workshops in terms of their desirability and practical feasibility. This will result in a finalised list of 1-5 interventions to take forward for development by the LP and VCFSE partners.

How we will achieve the NIHR funded project aims:

We will achieve the goals of our NIHR funded project by continuing to work through the partnerships forged through our RCF work. This will include:

For cost-effectiveness research:
- consulting and partnering with experts in the field of health economic evaluation who work locally and have a deep understanding of the challenges facing North and West Bristol. We have engaged with academics from both UWE and University of Bristol for this stage.
- Building space into our evaluation for cohort members and VCFSE partners to take part as community researchers, offering peer-to-peer evaluation where appropriate. This will create the capacity and infrastructure for data collection with a wide range of community members over a long period of time.

For qualitative evaluation research: conducting regular stakeholder interviews and collaborative sessions with partners from across the LP and VCFSE sector, exploring what is working in the new partnership dynamics and what can work better. The RCF work will form the basis of partnership working between the LP, VCFSEs, and other healthcare partners which will be evaluated as part of our full proposal.

Who is leading the research?

This work is being led by Professor Matthew Jones, Professor of Public Health and Community Development, University of the West of England. It is a collaboration between UWE researchers, Neighbourly Lab and BNSSG ICB North & West Bristol Locality Partnership.

Further information

For more information or to get involved with this project, please contact bnssg.research@nhs.net.