Our clients’ journeys and experts by experience have highlighted that access points to the primary healthcare system are challenging for people with multiple and complex needs (MCN). These challenges grew for many during the start of the Covid-19 pandemic and at Fulfilling Lives South East (FLSE) we could also see the stresses and strains the system was trying to manage during 2020-21.
As a project, we knew that there are amazing healthcare services out there supporting people with MCN but we didn’t know exactly what separates those services from the mainstream ones. We wanted to better understand what enables people with MCN to access primary healthcare, and what constitutes as ‘good’.
So, we created a sub-group across our internal teams and experts by experience. Together, we developed our criteria for services that could be described as ‘good’ in enabling people with MCN to access primary healthcare services and engage with healthcare support. These criteria helped us decide who to interview and who we could learn from.
The criteria were:
- A caring attitude
- Continuity, consistency and collaboration
- Trauma-informed practice
- Psychologically informed environments
The group then identified the following four services across Sussex that [IH1] [MR2] encompass these criteria – these became our ‘Bright Spots’ in the system.
- ARCH Healthcare (Brighton)– a specialised GP practice for people experiencing homelessness in Brighton & Hove
- St John Ambulance Homeless service (Hastings)– a volunteer-led, first-aid charity which now provides mobile primary healthcare as well as static drop-in clinics.
- The Rough Sleeper Initiative East Sussex (Eastbourne, Lewes, Hastings, Rother & Wealden)– a multi-disciplinary team providing intensive assessment and support work for verified rough sleepers (through local authority checks) to help with access to accommodation. Ongoing wrap-around support is provided by the multi-disciplinary team and dedicated Housing First support workers.
- Seaview (St. Leonards-on-Sea)– a day service providing support for marginalised people with addiction problems, mental health issues, ex- and at-risk offenders, and rough sleepers.
The FLSE sub-group was keen to follow robust research processes to better understand and learn from these four services. That is why we used the Positive Deviance model as our main approach and the Appreciative Enquiry model to conduct our four separate interviews.
The interviews we conducted with ARCH Healthcare, Seaview, St. John Ambulance and the Rough Sleeper Initiative made it clear that there are recurrent issues across the healthcare services in Sussex. Some of them include lack of flexibility, being siloed and under-resourced. Our four Bright Spots services have also identified common practices that enable community and healthcare services to be efficient and effective for people experiencing MCN. Organisations, no matter how big or small they are, need to collaborate with each other, provide multi-disciplinary teams and put people they support at the centre of everything they do.
The Bright Spots
The four Bright Spots had shared views on the top three ways to improve health services for people with MCN:
1) bring the services to them in a flexible way;
‘We really recognise that it’s not the easiest thing for clients to attend booked appointments. So, we are trying to make it as flexible as possible for them. Our day centre is also open on weekends when other services are closed.’ Dave Perry, Chief Officer, Seaview.
2) a collaborative approach between services (not just signposting);
‘Multi-disciplinary drop-ins have allowed the team to work informally with individuals and to engage with historically hard-to-reach groups on their own terms.’ Becky Jackson, County Coordinator, RSI.
3) invest in staff, training and resources
For Roger Nutall at St.John’s ‘both, debriefing and training, is to make sure that the team has time and space for reflections in order to learn from each other, find solutions as well as gain new skills.’ Gary Bishop from ARCH Healthcare agrees and says that ‘(we) understand the importance of recruiting the right people for the job. (Our) workforce receives coaching, mentoring and supervision.’
At FLSE, we strongly believe in the power of partnership. We also believe that the role of commissioners is to nurture systems change and help services develop more accessible, responsive, flexible and coordinated approaches for those with the most complex needs.
We understand that due to Covid-19 and resource constraints, the health system is currently overburdened and treatment waiting times are increasing.
We do think though that there are quick wins which could be implemented in the short term by commissioners and healthcare providers to improve access to primary healthcare for people with MCN. These have been informed by our Bright Spots learning and are shared below in a set of recommendations:
- Investing in existing services with long term funding
We already have four very different Bright Spot services in Sussex and think that the first step is to expand and replicate services which are already working well for our clients. Continuity is a crucial element for our clients to start trusting services and only long-term funding and investing in staff members can help with that.
2. Putting people first
We need a cultural shift towards a trauma-informed system for patients, volunteers, experts by experience and staff members. This approach in turn will help facilitate more agile, multi-disciplinary collaborations.
3. Building relationships
Building trust, taking time to invest in relationships and connecting with patients, agencies and teams can improve care for patients. It’s about creating a community of best practice, learning from each other and sharing information. With this in mind, we advocate for the concept and practice of co-production to be introduced in primary healthcare settings to inform service design and delivery.
4. Offering choices
Our Bright Spots have identified that for people with MCN, a mix of contact-points is needed which include in-person appointments, phone calls, texting, outreach, mobile healthcare support out in the community, and access at weekends.
We would like current and future services to include a variety of engagement options as a standard way of working with people experiencing MCN, led by staff teams that are enabled to offer support in flexible ways.
Therefore, we would like to call on commissioners and decision makers to include the above set of recommendations in any future funded service that aims to improve the health and wellbeing of people with MCN.
Read the full report here: ‘Bright Spots’: What enables people with multiple and complex needs to access primary healthcare?
Michaela Rossmann, Systems Change Officer
Ian Harrison, Engagement and Coproduction Worker
For further information about Fulfilling Lives work in this area, please contact:
Rebecca Rieley, Systems Change Lead:
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