Prof Andy Brooks
Clinical Chair
NAPC
Simon Billingham
Director for Health and Care
British Red Cross
In this episode of the NAPC podcast, Prof Andy Brooks speaks with Simon Billingham, Director for Health and Care at the British Red Cross, about the Community Health and Wellbeing Worker model in Torridge, Devon. Simon shares how trusted, locally based workers are helping tackle health inequalities through practical support, advocacy and strong community relationships.
Hear real examples of how the model is improving people’s lives, from supporting better diabetes management to addressing housing and financial challenges. Simon also reflects on the importance of partnership working, prevention and the future potential of community health and wellbeing workers within neighbourhood health services.
This conversation offers valuable insights for anyone interested in reducing health inequalities and building stronger, more connected communities.
Transcript
Welcome
Andy Brooks
Welcome to the NAPC podcast. For this episode, we’re bringing you a recording from a recent NAPC live session. Our guest is Simon Billingham from the British Red Cross, who joined us to talk about the rollout of the Community Health and Wellbeing Worker model in Torridge.
During the conversation, Simon shares how the model is being implemented, the difference it’s making for local communities and what primary care networks and their partners can learn from this innovative approach to improving health and well-being. As this is a recording of a live event, you may notice references to audience questions and the online format, but we hope you’ll enjoy listening to the discussion and find it as insightful as those who joined us live. So let’s hand over to the conversation.
Thank you everybody for joining NAPC Live. My name is Andy. I’m the Clinical Chair of NAPC. And it’s really great today to be joined by Simon, Simon Billingham from the Red Cross. Our subject today is thinking all about Community Health and Wellbeing Workers. So we’ve got half an hour for our webinar. So thank you, Simon, for joining us. Be great just to tell us a little bit about yourself and your role at British Red Cross.
Simon Billingham
Yeah, no, thank you for inviting me along, Andy. It’s my pleasure. So I’m the Director for Health and Care covering the southern region of England, but people don’t necessarily think of health and care, think of the Red Cross being involved in health and care. So it’s kind of our best kept secret. We support between sort of 50 and 60,000 people a year with our health and care services.
And really, we’ve been involved and had this idea of a Community Health and Wellbeing Worker model being tested for the last couple of years, but have only really been live operational for the past six months or so. But it really aligns well to our kind of our organisational purpose and goals. So we’d like to support people in their communities alongside clinical services, statutory services. So we had no prior kind of experience of delivering Community Health and Wellbeing Worker until the one that we’re delivering now in Devon.
We absolutely, the kind of the experience of talking to our colleagues in Westminster and Cornwall and internally, it’s kind of, it’s been infectious, to be honest with you. That enthusiasm for the model and the interest that the evidence is growing has meant that we were delighted to kind of find a pot of restricted funding that was targeted at supporting people experiencing health inequalities and kind of, and that’s where our kind of journey into the Community Health and Wellbeing Worker model started really a couple of years ago.
Andy Brooks
Well, thank you. Well, thank you for sharing what you described as your best kept secret. Now is a chance for a few more people to know about that secret. And your right health is so much more than just treating illness. It’s much broader than that. And here at NAPC, we’re big fans of Community Health and Wellbeing Workers. So it’s great that you can share some of your experience today. Just briefly, you know, share with us what are Community Health and Wellbeing Workers and why are they so important?
Simon Billingham
So I mean, I’m sure my definition might vary from others, but I think of them as non-clinical colleagues essentially working alongside primary care directly with individuals living within a defined kind of hyper-local neighbourhood, if you like. And their support, I would say, can probably be summarised in three ways. So it’s practical and emotional support and also advocacy. But those are fairly broad terms, I accept, so there’s quite a lot that sits underneath that.
But essentially, we are learning, like I said, from other kind of other operational services and what we’ve been delivering ourselves for these past six months or so, just the variety of the types of support that we’re able to provide. So I see them as a key link or a golden thread, if you like, kind of between those statutory services like primary care, social care, police, fire and rescue, all sorts really, and other VCSE providers in helping be able to draw in those sources of support and resources once we’ve kind of developed the Community Health and Wellbeing Worker has developed a relationship built on trust with an individual.
And it’s kind of that advocacy, the practical and emotional support that is delivering positive outcomes for people. And I mean, outcomes that are self-reported. So people are explaining, just what a difference it’s made to them personally. But we hope as, we go through the project, it will also tell us about the impact it’s had on the use of primary care and other services. But that’s kind of my best description of a Community Health and Wellbeing Worker.
Approach in Devon
Andy Brooks
Well, it sounds good to me. I like the description. I understand that you’re doing some work in Torridge in Devon. It would be interesting to just share a bit about the work that’s going on there and what led to the this approach you’re taking and perhaps about what it actually looks like practically on the ground.
Simon Billingham
Yeah, absolutely. So a previous director and myself really heard about the work that was going on initially in Westminster and reached out to NAPC and as I said, became very enthusiastic about the model and then was able to kind of have successfully ring fenced some restricted funding, which is, great news for us, that there was a level of investment there ready, and then sort of set about working with our teams. And again, we’re kind of lucky to have the benefit from insights and improvements teams to people that are great at kind of looking at looking at data and indicators as to the types of communities that we should be working in and cohorts of individuals and so on.
That mixed with where we had existing services and infrastructure, it kind of meant that we were able to narrow down where we thought we could possibly provide a Community Health and Wellbeing Worker model. We narrowed it down in Devon to Torridge eventually. So did prior to actually landing on the defined households, the population that we’d worked with, did some work with primary care and local voluntary community sector to further kind of distil down where we want to work and consider stuff that wasn’t being pulled through from the indices of multiple deprivation or through other kind of public sources of data and stuff to really get the actual, the insight from the local population and community to say why it wouldn’t work in this street, but it may work in that street.
I think that’s probably a bit of advice I would give to other areas that may be looking to stand up a service somewhere is to put the kind of the groundwork in, if you like, because I don’t feel that us parachuting into an area without having done that preliminary kind of work and scoping who’s already working there, what they’re doing and whether it will be well received. You know, ultimately that might have an impact on whether it’s successful or not.
So there was quite an extensive piece of work that went into planning the local neighbourhoods that we’ve worked with and then further refining that and it defined 2 areas that are both within the indices of multiple deprivation, the 20% and had good engagement from primary care. And since then, we’ve been able to move from kind of that planning phase through to implementation and really still learning while we’re operational, running the service. But essentially, it’s really, really positive feedback.
So yeah, we’re there in Devon. Luckily, we’ve been, you know, it’s well received and we’ve got a very good relationship there. So already some positive, positive things to report, really.
Examples
Andy Brooks
It’s interesting you’re saying that about the fact that you took your time, you were quite deliberate about where you did it, you thought it might have impact. I guess there’s maybe some thoughts there about sometimes… Programmes think we need one of these everywhere and just scatter ground as opposed to really thinking and working with the local community. And that’s came through quite strongly from what you’ve said.
You talked about then having impact. I was wondering, are there any stories that you’ve got or examples, you know, that really bring to life what these Community Health and Wellbeing Workers are doing and the impact that they’re having?
Simon Billingham
Yeah, no, absolutely. There are some examples having spoken to the team, definitely. But that piece on kind of understanding and the risk of duplication and so on, I see that kind of that does recur in conversations I have with other parts recently in an area of London, and they were talking about whether or not they may have what they need already, but almost need to reframe it to into the mould of Community Health and Wellbeing Worker rather than what’s being commissioned at the moment. So I think that’s definitely a worthwhile exercise.
But in terms of some more specific examples of the work we’ve done, So I suppose this really tells to the kind of the ability to work in partnership with other organisations. On a very practical basis, the fire and rescue service contacted us because they knew we were supporting individual within a certain area and there’s significant kind of risk of domestic fire. But they were unable to provide the kind of intervention that they would typically provide to try and reduce those risks, but actually, you know, sort us out, our Community Health and Wellbeing Worker, who was unable to have the conversation in a very different way, I think, probably about kind of what’s important to that individual, build that relationship, which is a great foundation for saying, would you be open to having the fire and rescue service come in and do some practical things that will reduce risk to you? And that happened successfully, which was fantastic.
Then there’s ones, I suppose, where working with primary care, we’ve had somebody who has type 2 diabetes and not being very well managed for one reason or another, but actually through some encouragement. And again, that kind of relationship with the Community Health and Wellbeing Worker has adopted, you know, they’ve used their own agency essentially. It’s not through our health worker prescribing what kind of, you know, meal plans or anything, if you like, adopting a healthy eating plan that has almost put the diabetes into remissions.
And I suppose the final example that sits with me that I keep thinking about, to be honest with you, as a couple, a married couple that we’ve supported. And unfortunately, the wife had a stage 4 cancer diagnosis in the past few years and hadn’t been leaving the house. I think there was some concerns about wellbeing and so on. But in a relatively short space of time, we were able to connect the couple with a cancer charity and we were able to make sure, I think they call it a radar key, a key that provides access to kind of disabled friendly toilets when somebody’s out in the public and receive an attendance allowance. So there’s additional income coming into the family, which they weren’t aware of at all.
And I think it may have been quite insular as a couple. So those changes with the radar key and with the attendance allowance has meant that they’ve been able to more confidently leave the house together as a couple and do things together as a couple in their local community. And it’s meant that the husband and is now in a position to be able to reduce his hours at work, to reduce his paid income, because the attendance allowance has enabled that and means that ultimately you get to spend more time together, more valuable time together, which I think is incredibly kind of powerful thing. Yeah, it’s kind of stuck with me.
Then other examples of mould being present, you know, so again, housing somebody suffering with asthma, had stopped using their bathroom because of the mould build up and they had advice from a, through our Community Health and Wellbeing Worker, were able to have an appointment with a, like a home energy advice person who was able to then support with utility bills, essentially a plan for utility bills and to put dehumidifiers in, which is meant that there’s a reduction in mould and the person’s able to use their bathroom again on a daily basis instead of, using it infrequently and it sort of really interrupting their daily routine.
So I think I sort of come back to that mix of it’s not simply practical support and it’s not emotional support, you know, it’s not kind of like a talking therapy support, it’s that with some advocacy. And I think it’s the combination of that very sort of very relational kind of approach, building trust with individuals that is what is eliciting the really positive outcomes.
Developed Relationships
Andy Brooks
Yeah, that’s what a variety of stories, fire safety, diabetes, a couple, being more active. You mentioned the word kind of active and agency and then issues with mould and housing. So, such a wide variety of stuff.
Thanks to Amanda. Amanda’s posted something about kind of a target based in real world difference as opposed to parachuting in. Am I right in thinking that Community Health and Wellbeing Workers are often from their local community, they know the community because they live there and often they have a small number of people that they deal with. So they develop those relationships. Is that right? Is that how the model works?
Simon Billingham
So and that was definitely something I omitted from my kind of explanation of a Community Health and Wellbeing Worker was the local element. So typically it’s people that are employed from their local community. How you kind of define that I think probably varies from one service to another. So we have a very small population from which to recruit from in Torridge. So our criteria is kind of 10 miles from Torridge from the communities, but it meant that people still really understood the area really well.
But it’s, that’s in direct contrast to Westminster or elsewhere, where it might be that somebody’s, that somebody is, so well within the 10 miles, it might be that they’re within the mile, easily of their community. But I think that does make a difference and that supports with the ability to plan and implement the service as well as the actual, the actual support that’s provided to people.
Number of Household per CHWW
Andy Brooks
And in terms of the number of households that people typically look after, how does that work with these Community Health and Wellbeing Workers?
Simon Billingham
Yeah, so we’ve tried to follow kind of the guidance, if you like, or the model from the NAPC. So that’s generally speaking 120 to 150 households per Community Health and Wellbeing Worker, and that would be as a full-time equivalent. So we have a team of four in Torridge that are aiming to support more than 300 households, but they don’t all work full time. It’s kind of, it’s part time positions that work well for them.
Quite a lot of work that goes into successfully engaging households. It’s obviously completely at the discretion of the people that live behind the front door to say, no thank you, or yes, but it’s only a kind of transactional thing and others, it would be, it’s not a time limited input or level of support or a very, I always feel bad for clinicians that are very restricted to their 10, 12, 15 minute appointment times. And what can you really, what can you cover if somebody has sort of multi-layered conversational issues?
And I think that’s another distinct kind of advantage of this model. So A, it doesn’t rely on a referral, so it’s kind of already going upstream. to try and get ahead of problems, I think, before they get worse. And the other bit is to say, our team don’t go in and say, I have a few, unfortunately, I’ve got a 15-minute slot, so when I leave, I need to then knock on your neighbour. It’s kind of, it’s much more of a, you know, it’s probably a less structured approach and allows for a longer, a longer conversation that’s probably kind of wider reaching.
Advice
Andy Brooks
What sort of advice would you have for people who are wanting to kind of do this kind of thing about genuinely kind of making it happen on the ground and then picking up again on Amanda’s point about and did the kind of Red Cross brand help to get that? What sort of barriers or things did you have to overcome and advice that you give to people trying to do this sort of thing?
Simon Billingham
Yeah, I think. Yeah, in summary, I’d say the Red Cross being a recognised kind of household brand, if you like, probably supports us with building trust. So I think that is to our advantage potentially, and that we look to probably seek to hold a different relationship with an individual, than you would sort of a registered health professional, the interactions would be different with us.
So I think on the, to give a balanced view there, on the negative side, I suppose, we can be kind of criticised as being one of those large organisations that decides to parachute in somewhere and deliver a service to people and whether they stay and hang around or not or whether it has an impact is kind of, you know, is less relevant. But that’s, I think because we’re aware of that, we obviously seek to try and avoid that and actually say, you know, it’s actually local people that we employ in, you know, these neighbourhoods that we’re working in. It’s not, we try and make it less important that we have, we have a larger team, we’re a large organisation, if you like.
And then the kind of point about sort of wellbeing and making it happen, I think it’s because we kind of start with trying to find out what’s important to someone. We can assume, we can follow guidance around healthy lifestyles and smoking and alcohol and diet and exercise and everything else. It’s so well known, but really, we don’t start from a point of trying to promote that, I don’t think. I think that is probably something that comes out through natural conversation where sometimes it might be not a penny drop moment, but somebody said, well, actually, you know, if I do want to have fewer sort of health crisis or want a better expression, or I do want to be able to enjoy, whether it, you know, play with my grandkids or do an X, Y and Z, then there are some stuff, there are some kind of choices that can be made, but it’s not, it’s not, It’s not a sort of a health, it’s not a condition specific health coaching approach that we would take. It’s much more of what’s important to that individual.
And actually, if it just means making some choices that are kind of slightly better for the person than otherwise, then great, that’s another good outcome in reality. I think from our perspective of what we’ve delivered so far, it’s kind of too early to say what the system impact is. So we couldn’t say whether there are fewer on the day duty doctor appointments and more attendance for routine annual checks or, vaccinations or cancer screening, those sorts of things. So that stuff will come in time, I’m sure. And there is a growing bank of evidence to support that, which is fantastic again, because I think you don’t need one over the other. You need to have you need to have both and you’d expect one to just kind of drive the value.
Future Plans
Andy Brooks
Again, that’s a really great reflection on how, putting people at the centre and listening to them and seeing what matters to them is really important. We’ve got 5 minutes left, Simon. I’d like to squeeze in a couple of questions if I can. The first of those would be, you know, where you’ve talked about what’s happening now. Briefly, what’s your plans for the future?
Simon Billingham
Yeah, so, well, I was going to say, I feel really enthusiastic because of this kind of groundswell, this acknowledgement that this model, this approach and the policy shifts towards kind of neighbourhood or community rather than acute and so on, preventative support. We’re all kind of, it feels like we’re all broadly saying in agreement and saying the same thing. I don’t hear anybody kind of contradicting it, but for me, I’d love the Community Health and Wellbeing Worker model to continue to deliver the great outcomes, but to essentially become part of the ongoing evolution of kind of primary care and preventative. So it just increases in scale.
We may refine the role of what we do according to what the research tells us and completely accept that. But I think that evidence is only growing really. It’s only making a stronger case for doing it. So we’d love to see it at scale really. And That may be slightly boring, but to have this kind of framework of what it looks like to hang it off of, I think, to help kind of define, better define what it is. And if we know then through the research which bits of it are working really well, what’s kind of an absolute critical component of the community health well, great, that’s in the framework in the model.
I just, my own sort of frustrations are like this change in the financial flows, you know, as in, is this kind of the way organisations are contracted at the moment and the way they’re remunerated for the work they do doesn’t kind of lend itself. There isn’t kind of this, you know, pot of funding that allows us to kind of scale up and adopt this as an approach, a universal approach, which in a, you know, in a kind of blue sky thinking would be what happens is that it’s kind of baked into how we work in neighbourhoods and in the community.
Because it doesn’t, all those other cause areas, all those other organisations that provide kind of debt support, housing, gambling, cancer, those sorts, they’re absolutely 100% needed as well because this model also relies on them being available. So it’s kind of can’t be seen. I suppose I’d be making the case strongly for the investment and saying this is forms part of the neighbourhood plan, integrated neighbourhood teams is in it, but I’d also be making sure that the other organisations that make the strength of the offer what it is, do not, are not kind of forgotten about or defunded or, those sorts of things.
Leadership Advice
Andy Brooks
It’s a question I always ask people. If you could give yourself a piece of advice 10 years ago or something that you’ve learned about leadership, what would that be?
Simon Billingham
Just quickly, yeah, don’t jump straight to kind of solve it mode. That’s a very personal reflection. I used to think, I think in my early sort of management, career in health and social care. As soon as there was an issue, you kind of just jumped to try and resolve it. Whereas now I think with time and age, I’ll probably step back and try and analyse it a bit more. But there’s one thing I also wish I’d known when I worked for a spin out social enterprise in 2011, was we’d still be talking about integrating health and social care in 2026. And I obviously didn’t have a crystal ball, so I didn’t know that.
Andy Brooks
Thank you for sharing. I’m being honest about that. It’s great what people can’t worry about the learning from things. Thank you very much for joining, Simon. We could extend this conversation much longer. We only have half an hour. Thank you, everybody, for joining. Thank you for your questions. They’d be great questions. And thanks again, Simon, for joining us. It’s been fantastic to have you. Thanks indeed.
Simon Billingham
Thanks all.
Andy Brooks
Take care.
Thank you for listening to this episode of the NAPC podcast. And our thanks again to Simon Billingham from the British Red Cross for sharing his insights and experiences. We hope you found the discussion thought-provoking and that it’s given you ideas you can take back to your own work and communities. Thank you again for listening and we’ll see you next time.
