Donna Rowe, Integrated Care Development Manager, NHS Cornwall and Isle of Scilly, and Julie Pollard, Cornwall Operations Manager for Community Health and Wellbeing Workers, Volunteer Cornwall, spoke to us about the successful introduction of community health and wellbeing workers in Cornwall.
This formed part of a larger conversation about the importance of social connection and how this contributes to Neighbourhood Health and the future of our communities’ wellbeing.
Can you tell me more about the programme, how, when and why it started, what the situation is now and how it links to social connection?
“The thought process was, if you can have really good trusted relationships built in the community and have that social connection, then that breeds positivity”
Back in 2022, when the ICB was first established, the NHS Cornwall and Isles of Scilly Integrated Care Board was organised into three integrated care areas.
Each of the three geographical patches were given a three-year funding stream to work on inequalities. I heard about the community health and wellbeing workers (CHWWs) and I thought this could be an option for investing our inequalities funding in Cornwall.
CHWWs come from the Brazilian Family Health Strategy, which started in the 1990s. We, with colleagues from Westminster, visited Brazil in September 2022 to visit CHWWs out in their communities and residents’ homes. We saw how fantastic social connections are with generations of families in these communities. This role has been in place for more than 30 years in Brazil. What we’re doing is replicating that model of the hyperlocal comprehensiveness, working in micro areas. Each worker has a predefined area of up to 120 households. It’s a universal service, for all ages.
Initially, I did some research and I met with the team in Westminster to understand the model in more details. I also looked to see if, in Brazil, it was actively working in rural areas and it was. All my local partners agreed that this was a good opportunity to address inequality, to invest our funding and to support the population that most needed it. So that’s where we started and we went live in February 2023.
It was important to have an overarching support mechanism for CHWWs and their host organisations. We chose the voluntary sector to host the CHWWs and that’s why we partnered with Volunteer Cornwall. Volunteer Cornwall provides overarching oversight, training and development, advice on recruitment and ensure that the principles of the CHWW model are upheld.
During 2024, we began scaling from being a time limited pilot to cover more areas across Cornwall. We are also planning to scale up further over the next few years. We now have 60 CHWWs in the service. We cover 12 different sites from Liskeard in the north and east to Penzance and Newlyn in the far southwest.
It’s a preventative programme and the thought process was, if you can have really good trusted relationships built in the community and have that social connection, then that actually breeds that positivity and health promotion. They’re the central bridge between residents and services and they work with other professionals and other services as well in that community.
Social connection supports health creation and this will support the reduction in the number of times that someone might need unplanned care and access services in a more planned way.
The NHS is a big beast with lots of moving parts with it. So, in Cornwall, when you introduced these community health and wellbeing workers, how did it link in with GPs, with pharmacists, with a 111 and other healthcare professionals?
“That’s what we’re working towards — fully integrating CHWWs into neighbourhood teams.”
When we first started, what was really important was that there were strong links between the GP practice, the primary care network and the host organisation.
Part of the induction was that CHWWs would spend some time in the GP practice, so we fostered that partnership right from the beginning. CHWWs were an extension of the general practice out in the community — their ears and the eyes.
As we’ve scaled up, we haven’t been able kept to the plan as much as we wanted to. The bigger you get, the more there is to do and the more services, the more surgeries, the more primary care networks there are to manage relationships
If there’s a bit of turnover in staff, both with the GP practice side and the CHWW side, we have to keep revisiting those relationships until they get to the place where CHWWs are seen as an integral part of the practice. In some places that’s working really well, in others not quite as well.We have to keep on ensuring there are appropriate access to medical records and clinical systems.
We organise an NHS e-mail address plus equipment such as NHS laptops or tablets to best provide them with the tools to integrate.
One of the things that stuck with us was, in Brazil, CHWWs actually tell the clinical team “I’m going to do this and this for this resident”. They actually do the triaging and they actually lead the multi-disciplinary team conversation. To get to that point would be amazing.
They’re very well integrated because they’re employed as local government workers, whereas the majority of ours are hosted by voluntary sector.
And that’s what we’re working towards — fully integrating CHWWs into neighbourhood teams.
What should Cornwall residents expect from CHWWs? Should they be knocking on people’s doors soon? Should people ask about them next time they go to the GP? What role will do they have in rural areas?
“Initially, it took about 11 door knocks to get someone to engage with a CHWW and say yes. Now it’s down to about four or five”
CHWWs work within the 10% most deprived. Because we are not able to cover the whole population at the moment, it would be difficult to do a sweeping marketing generalisation to the whole county to say a CHWW will be with you soon because there’s not enough of them for everyone.
In many areas, it started with identifying the post codes through public health data for indices of multiple deprivation and that’s overlaid with local intelligence. We then narrowed that down to the streets you’re going to be working in.
So, a resident might get a text or a letter from their surgery introducing the CHWWs and that they will be knocking on doors in your area soon. CHWWs will knock on the door, put a card or a leaflet through the door with their details and listing the types of things they can help with as in introduction.
CHWWs will also ask people ‘what matters to them’ and what their main concerns are. Initially in Westminster, it took about 11 door knocks to get someone to engage and say yes. Now it’s down to about four or five as workers get more confident with that approach.
It’s also a bit of word of mouth from neighbours that might have been helped. When you go around and knock next time, the door will be answered and somebody will say, “Oh, I know you’ve helped number 22, can you can you help me?”
CHWWs might help someone with the forms and the phone calls to move from where they are because the building they’re living or the house is totally unsuitable for their conditions. They might get someone a little bit of funding to get their ears syringed because they can’t hear their children on the phone or they can’t hear the television. They might arrange a group for them to come together and just have a cup of tea and a chat with other people. Set up a craft group, set up a cinema club — all sorts of things. It could be getting them to a pain relief cafe where the CHWWs could help them organise some transport or someone to go to a bereavement group if there is one. If not, they will look at gaps and possible set those up.
What is your ultimate goal? Is it fewer people turning up to emergency departments? Is it just better community health? Is it fewer calls to GPs? Is it taking the pressure off 111 and 999?
Between 2024-2025, we have seen reductions in A&E attendance compared to populations in the most deprived areas that don’t have CHWWs.
We currently have nine teams of CHWWs. The plan is to expand this so we’re supporting the 20% most deprived in Cornwall as a minimum.
Between 2024-2025, we have seen reduction in % reduction in A&E attendance compared to populations in the most deprived areas that don’t have CHWWs. We’ve also seen a reduction in referrals by 40% to adult community service nursing etc so we’ve seen some big shifts quite quickly for medical use from one of our CHWW sites. We are constantly looking at the data to understand underlying factors.
Our initial aim is to improve wellbeing, which in turn will have a knock-on effect in terms of health improvement and more appropriate use of health and care resources. We have seen a 90% improvement in wellbeing over the first year. Of course, the health and care system wants to understand what impact investments will have on health and care use. So being able to demonstrate reductions in inappropriate healthcare use and an increase in planned use, plus uptakes in vaccinations and screening, is also an important by-product.
This article is part of our new series: Neighbourhood Health: the future of our communities’ wellbeing, launched in the wake of the recently devised NHS 10-Year-Plan that outlines the approach of the NHS for the coming decade.
A key part of the plan is Neighbourhood Health, an aspect we’re well-versed in, here at Intelligent Health.
Why? Because we believe that Neighbourhood Health’s focus on a ‘healthy, active and independent lives for as long as possible’ will support the growth of healthy places and engaged communities.
Our aim is for our community-led programmes, like Beat the Street, to work in tandem with Neighbourhood Health to deliver more care closer to home, improve people’s access to health and to ensure the sustainability of health and social care.
We want to be part of this catalyst to creating health and reducing workload on the NHS.
Neighbourhood Health and Intelligent Health share the goal of improving the health and wellbeing of our communities. But, who will deliver it and help to make it a success?
In this new series of articles, we’ll take a deep dive into each aspect of Neighbourhood Health and outline how it can work and who can facilitate it.
