Learning from the programme - a best practice guide

Building Health Partnerships (BHP) is a national programme designed to improve health outcomes through supporting the development of effective and productive partnerships between Clinical Commissioning Groups (CCG) and voluntary, community and social enterprise (VCSE) organisations, alongside Health and Wellbeing Boards and Local Authorities.

Supported by NHS England, the programme was managed by NAVCA (National Association for Voluntary and Community Action) in partnership with Social Enterprise UK and IVAR (the Institute for Voluntary Action Research).  

http://www.socialenterprise.org.uk/about/about-us/our-projects/building-health-partnerships-programme-2013

The focus in Manchester was on highlighting the inequalities faced by lesbian, gay, bisexual and trans (LGB&T) people; exploring the issues and barriers encountered in health and working with partners to identify solutions and reduce barriers for LGB&T people accessing healthcare services. 

This best practice guide has been compiled by IVAR and the Lesbian & Gay Foundation (LGF), in partnership with a range of BHP partners (listed at the end of this document) as requested by them, to share the learning and develop a replicable model that offers practical support to VCSE organisations on ways to develop a robust and recognisable evidence case to inform commissioning decisions for other [often under-represented] groups.  

From the BHP partnership:

‘An evidence base is the starting point and fundamental base for everything’

‘Because there isn’t a lot of money to ensure longevity and sustainability’

‘This approach could be developed for any setting’

Background

BHP Manchester kicked off with a series of cross sector group sessions that were designed to identify the main priorities also set out in an Expression of Interest by the LGF in partnership with South Manchester Clinical Commissioning Group (SMCCG).

At the initial ‘diagnostic’ session where the programme priorities were agreed and shaped with local partners, participants asked for support to:

  • Positively engage with trans people
  • Bring changes in outcomes for patients
  • Understand the differences for LGB&T people accessing health services
  • Explore what excellence should look like – seek to replicate
  • Learning for the broader VCSE sector
  • Make links between participants
  • Be action focused
  • Have a voice in the programme
  • Create a replicable model for other under-represented groups
  • Show how to demonstrate an economic benefit of services

There were local issues voiced around:

  • How the VCSE can work in equal partnership with commissioning bodies
  • JSNA engagement needing to be fully inclusive
  • The cost pressures on the CCG and the impact of the health cuts beginning to bite ‘so we need to work differently’
  • The shift from an acute to a prevention agenda – needs to be a change in culture, recognising the demand in this area for statutory sector funding - “ there seems to be a blindness to the voluntary sector delivering preventative work” and “an erosion of the equalities agenda”
  • Community budgets and collective commissioning –“ integrated care is the way we need to work across the city”
  • Creating a legacy from the BHP programme
  • Being mindful of changes to procurement legislation (Greater Manchester is a community budget pilot area for integrated care) 
  • Poverty is a key concern and its impact on the health and wellbeing of residents must not be underestimated
  • How the layers of bureaucracy can be reduced to meet Manchester’s health needs more directly 

“BHP is an opportunity for us to have some good quality conversations that bring benefits to all our organisations”

South Manchester CCG

Three key aspirations were identified for the BHP programme in Manchester as part of the original Expression of Interest:

  1. To capture and explore LGB&T people's experience: desk based research; patient experience survey; data sets; case studies.
  2. Make the economic case: research unmet needs; cross-boundary commissioning approach (across Greater Manchester); economic savings, clinical rationale
  3. Design a 'best practice' framework: get all South Manchester GP practices signed up and engaged with Pride in Practice; provide training to practice staff; enable access to face to face or telephone support, pilot in an acute setting

Additional gains have been the trans element, the replicable model approach, the partnership with The Bodey medical practice, the clinical rationale (additional funding drawn from SMCCG) and the decision to extend the work from South to include Greater Manchester.

The BHP project group have also developed a framework for public services to follow to ensure the reduction of health inequalities and to improve access for LGB&T people.

Anticipated outcomes of the BHP Manchester Action Plan

  • Economic case built on evidence of need: for investment in equitable health services for the LGB population, using the expertise of a health economist and GP, developing a clear and well evidenced economic argument
  • Greater Manchester dataset: providing a clear evidenced case to influence commissioning decisions in the future
  • Sexual Orientation Monitoring: introduce and extend to all South Manchester GP practices
  • Clinical rationale: a clear and well written argument for future investment
  • Pride in Practice: embed across all South Manchester GP practices: extend the learning  to include trans people and patients in partnership with TransForum Manchester
  • Replicable model: a clear pathway of practical and realistic actions (model) that could be applied to and inform other groups and disseminated learning via the LGF/BHP national event in spring 2014 and through LGF/BHP media/communication channels 

Method/approach:

The content of this best practice toolkit has been drawn specifically from BHP participant feedback, and suggestions as to which elements of the programme would be of most benefit to the learning of a wide range of large and small VCSE organisations.

Specific groups referred to in this guidance are; carers, BME communities, disabled people, stroke survivors, older people and trans people but of course the materials can be extended to include others.

 

5 question consultation with BHP partners to explore prioities and key policy areas

 

Group discussion to explore and agree the learning and priorities for replication

 

Draft a best practice guide capturing the key learning from the programme

 

Consult on and finalise content with partners

 

Best practice guide designed and online!

 

A framework to reduce health inequalities and improve access for LGB&T people

This framework captures and summarises all the work that has taken place as part of BHP Manchester 2013-4. It is a guide for all cross sector partners to follow when designing health services.

➢  EDUCATE the workforce of all service providers to create and maintain a safe, inclusive and respectful environment for all lesbian, gay, bisexual and trans people

➢  MONITOR the sexual orientation of your service users, patients and staff as part of your standard demographic dataset, and use the findings to inform future plans and inform services

➢  COMMUNICATE in a non-discriminatory way, without making assumptions about a person’s sexual orientation or gender identity

➢  INCLUDE lesbian, gay, bisexual and trans people’s needs within mainstream services, policies, strategies and commissioning plans

➢  TARGET when necessary, lesbian, gay, bisexual and trans people with specific health information and campaigns

➢  DEVELOP where appropriate, specialist health and support services for lesbian, gay, bisexual and trans people, their partners and their families

NEXT ⇒ How to use this guide