It was a natural partnership when Dr Matthew Harris and Dr Nav Chana teamed up to support the initiative of placing Community Health and Wellbeing Workers (CHWW) in Churchill Gardens, Westminster. Both doctors have championed a population health approach to health and wellbeing and were keen to see the programme embedded in a community that would benefit from an entirely new approach.
The initiative originated in Brazil where Matt witnessed the success of CHWW making a significant difference to the health and wellbeing of families living in deprived communities. The CHWWs were his ‘ears and eyes’ visiting a defined number of households, and addressing issues that didn’t need to be resolved by a clinician, which left Matt, who was working in primary care, time to deal with the many conditions that did.
NAPC Deputy CEO, Katrina Percy caught up with Matt and Nav to discuss the evolution and success of the CHWW programme that has been rolled out in the past 18 months largely due to the efforts of the NAPC to share this initiative across the country. There are established schemes in Calderdale, Warrington Norfolk & Waverley, Cornwall and isles of Scilly, Wandsworth, Westminster and in February of this year, Oxford.
Matt emigrated to Brazil and worked in primary care for 20 years before returning to the UK to share his knowledge and expertise with colleagues including Dr Connie Junghans-Minton, Dr Saul Kaufman Jackie Rosenberg, DCEO at Paddington Development Trust and CEO at One Westminster, Jeffrey Lake, Deputy Director of Public Health at Westminster City Council and Royal Borough of Kensington and Chelsea and of course Nav who all got behind the drive to roll out in deprived communities in England. Funding from Westminster Council to pump prime the initiative saw the first four CHWWs employed to serve the community of Churchill Gardens. Matt points out that we already have a number of roles based in the community that support various health issues but they focus on one disease or are issue specific, but the CHWWs fill an important gap that isn’t being addressed by other roles.
Knocking on doors and building trusted relationships with residents is key to unlocking the need that lay behind the doors. But working in isolation would never be enough or the right approach and Matt explains that the three core characteristics that are needed to ensure success of the scheme are 1) Universality – working with the entire number of households identified in a defined local area; 2) Comprehensive – the ability to deal with any and all issues within households from breast feeding and immunisation uptake to mental health issues, directly bridging the health and social care divide across the life course and 3) Integration – the CHWWs don’t operate in parallel but work with the wider system including primary care networks giving them access to records and working with local authorities supporting residents with housing issues and other social care needs.
Nav recognises that the 3 principles are also those of primary care but there has been an overwhelming focus on access targets and in some areas this overshadows greater need which is going unmet particularly in socially deprived areas of the country. He suggests the CHWWs are filling a gap that was previously filled by health visitors, district nurses and GPs, but as the focus has shifted towards access targets and we need to ensure population health initiatives are ubiquitous throughout the country.
Brazil scaled up their numbers of CHWW so that 80-100% in some of the communities was served which resulted in some impressive population health outcomes. Diabetes was spotted early, there was a 34% reduction in cardiovascular disease mortalities and people were supported to adhere to medication regimes. Despite early reservations that the CHWWS would be seen as ‘busy bodies’ they were able to form trusted relationships with residents and were soon identifying serious problems such as suicidal ideation and domestic violence through this proactive approach.
Both Matt and Nav recognised that it was evident that CHWWs were needed here as we battle continuing demand and an increasing lack of time to support those in most need.
And so it was that a coalition of the willing established the scheme that led to the first four CHWWs in Churchill Gardens, Westminster. Individuals who were recruited on character not on skills, people who were natural problem solvers, had the right attitude and recognised the need to be persistent, respectful and maintain confidentiality. Some of the CHWWs were previously community champions and this role was a natural evolution of that role. CHWWs are supported by several individuals in both primary care and the local authorities, and this has been important to ensure that they feel part of a team that addresses their safety, wellbeing, engenders a sense of professionalism, supporting development. It has taken up to a year to reach 70% of households who are ready to engage and trust the CHWW and so confidence is also vital. Matt reminds us that we know that people are willing to volunteer to help within their community as witnessed by the 750,000 people who signed up to the volunteer register during Covid.
Once the CHWWs gain the trust of the residents they were consequently able to pick up on issues that were detrimental to health and wellbeing in addition to encouraging immunisation, vaccination and improved lifestyle choices. Households that were visited by the CHWWs were much more likely to receive preventative health care too including screening and NHS health checks.
The four CHWWS in Westminster will be expanded to 24 in 2024 and they are working with Primary Care Networks (PCNs) and Local Authorities (LAs) to ensure system integration. There have already been instances of community midwives and district nurses working in partnership and collaborating with the CHWWs to ensure ongoing needs are met. Breakthroughs into health conversations are occurring in complex families because the CHWWs are in a position to support them with their more pressing concerns around the wider determinants such as housing, unemployment and antisocial behaviour. More importantly, these wider determinants are often the direct cause of the conditions which drive inequalities such as poor mental health, poor physical health, respiratory issues, hypertension, obesity, hence addressing them will not only make room for prevention conversations but actively improve health. Both Matt and Nav recognise that strong leadership in the PCNs and LAs is pivotal to the success of the scheme.
Katrina asked both Matt and Nav how the work of the CHWW sits alongside digital innovation in the community and the three discussed the merits of the digital front door providing great access to problem solving but recognising that not everyone is digitally able and the CHWWs actively get to know the households that they liaise with. Whilst it is important not to go completely in one way or the other and rather work hand in hand with digital playing a part in supporting individuals. Digital also allows the CHWWs to support households to connect with the wider system to ensure unmet need is no longer an issue in the communities that benefit from early intervention, and the positive impact of that, on both physical and mental health.
