City and Hackney Innovation Fund
NHS City and Hackney Clinical Commissioning Group (CCG) is an NHS organisation. We want our services to reflect our local populations and their needs which is why local residents and patients are involved in all our decisions. Our plans and ideas are based on us talking to patients and members of public, as well as local GPs who form our membership.
The Innovation Fund is a £400k fund that was set up by the City and Hackney Clinical Commissioning Group (CCG) to identify community-based innovative ideas that have the potential to deliver significant improvements in the health and wellbeing of City and Hackney residents. Twenty-seven projects have received funding to test new and innovative ways of improving the health and wellbeing of local residents. A third round of the fund, focused on mainstreaming and scaling successful ideas as well as making them sustainable, has just launched.
Local residents and patients have been part of the fund from the beginning by articulating their needs, suggesting different ways of doing things and shaping the fund’s remit and application criteria. Patients and residents have been involved with scoring bids and making decisions about how the money should be spent. Priorities defined by the residents became the fund themes on which all the applicants were asked to base their project proposals on. These are
o Integrated Services
o Confident and informed users
o Building independence
o Involving and listening to patients
FOR SUPPORTING INFORMATION: City and Hackney CCG Innovation Fund report is available at http://www.cityandhackneyccg.nhs.uk/about-us/innovation-fund-2015.htm from 2 December 2016.
The case for innovation in healthcare settings is strong. Health and social care services are faced with new challenges; meeting the needs of an ageing population and increased numbers of people living with a long-term condition, not to mention the increasing financial pressures. Different and new solutions outside of the remit of mainstream health and social care services are needed to enable communities to better look after themselves.
The Innovation Fund was created in response to the thought-provoking ideas and comments received at one of the CCG’s public engagement events. These ideas were about more holistic and user-centred service solutions. Through the Innovation Fund we wanted to fund and explore local projects delivering community based health and wellbeing services and information, resulting in improved health, increased self-management and more effective use of services. There was also a genuine commitment from the CCG’s leadership and clinical membership, to champion public voice and use the fund as an opportunity to explore co-production.
Instead of running a traditional funding process we asked applicants to come up with their ideas and solutions for meeting local health needs. Anybody with the required skills and experience in the City & Hackney was eligible to submit an idea and apply for funding. This was important as we wanted to see proposals from a wide range of stakeholders including, local grass roots groups, community and voluntary organisations as well as individuals with relevant lived experiences. People were asked to focus on what made their ideas different and the impact these would have on people’s lives. See Fund Themes.
To be successful the applicants had to be able to demonstrate how patient voice was embedded into their project and how they proposed working together with their service users to develop their initiative. A review team consisting of commissioners, clinicians and local patients and service users scored the bids and awarded grants to those projects they deemed to have most potential.
The relationship between innovation and evaluation can be complicated. Innovation by nature requires an appetite for uncertainty and openness to on-going adaptation based on feedback from service users. Traditional approaches of evaluation on the other hand require a clearly defined idea of the intervention and desired outcomes. Naturally, it can become challenging for innovation projects to even gather baseline data as the interventions themselves are changing during the course of the evaluation period. Despite these challenges most projects found ways of monitoring activity and recording outcomes.
Many projects used both a quantitative and qualitative approach to measuring their outcomes and ran surveys with their service users comparing outcomes before and after the intervention. A large number translated complex wellbeing matrices into simplified questionnaires using visual representations to enable participants to understand and respond to the specific questions. However this was not always appropriate or necessary. Some projects captured outcomes through workshops and interviews at the end of the programme asking service users to reflect on their journeys throughout the course of the programme. Others developed a film where participants shared their experiences on the course. These are great examples of how outcomes can be captured in a meaningful way.
Projects that have received funding have been ‘adopted’ by the relevant commissioners at the CCG and have also received external support around their outcomes monitoring. More detailed information about the impact and outcomes is available in the Innovation Fund report which is available at http://www.cityandhackneyccg.nhs.uk/about-us/innovation-fund-2015.htm
The third round of the Innovation Fund will focus on scaling and mainstreaming successful ideas from the previous two years. Key ingredients to successful scaling and mainstreaming are the ability to make a case for the service, and the ability to develop effective partnerships with mainstream service providers.
We see this stage of the process as an opportunity for projects to collaborate and develop mutually beneficial partnerships. Statutory services have higher bureaucratic capacity as well as effective processes in place whilst voluntary and community organisations have a wider reach into, and often, a better understanding of specific communities. These respective strengths can be amplified by working more closely together.
The Innovation Fund was set up to find new ways of meeting the health needs of people in City and Hackney. Helping people look after themselves and find their way to the right service is a national challenge and we believe that service users, patient groups and community and voluntary sector have a critical role to play in tackling barriers to healthcare services. We know that many of the solutions lie within the community rather than within mainstream health and social care organisations and that there are important lessons for mainstream health service providers to gain from these projects.
For the CCG, the learning from the process is rich and varied. We have thoroughly enjoyed working with all the Innovation Fund partners and whilst we have always valued our relationship with the community and voluntary sector groups in City and Hackney, facilitating the fund has offered us an in-depth insight into how many of the local groups operate.
The fund has received interest from a wide pool of organisations ranging from local social enterprises to bigger and more established charities working nationally and internationally. During the two years of the fund, over 140 applications have been submitted in total, spanning physical and mental health conditions; acute, planned and long-term care; and addressing health and wellbeing from cradle to grave.
Several proposals have looked to make services more accessible to traditionally disadvantaged groups such as ethnic minorities, or people with conditions that can make the use of mainstream services difficult or stigmatising. There were also a high number of applications seeking to tackle mental health problems and long-term conditions, reflecting high levels of need for community-based solutions in these domains. A wide variety of delivery mechanisms were proposed for new services, including peer support and mentoring, volunteering, time-banking, activity groups, digital software, and mobile applications.
The strongest applications demonstrated a solid understanding of the need and demand for their proposed solutions which were often based on their hands-on experience of the issues they were trying to address. Their proposals were supported by feedback from prospective users/clients. The successful projects also communicated a compelling case for change and were able to articulate a clear vision of how their solution would help deliver better outcomes for City and Hackney residents. They had a clear understanding of where their proposal fitted in with the existing services and in some cases had already secured a partnership with other organisations or services working in the area.
The high potential ideas brought truly new ideas to discussions about how common health issues can be tackled differently. Their plans balanced an amount of experimentation and service learning with credible plans for future sustainability.
- The majority of City and Hackney CCG Innovation Fund projects targeted specific and often hard-to-reach service user groups such as refugees and migrants, homeless people, and people with severe mental health issues or with physical disabilities. The aim of all projects was to increase participants’ confidence and wellbeing.
- A strong theme emerging across all projects was the importance of understanding the conditions, preferences and constraints of service users in order to tailor a service to their needs. This requires significant investment in terms of resources and time as well as building relationships with the right community organisations who can signpost and refer to the specific user groups. Spending enough time with service users themselves is also crucial in order to understand what motivates people and whether there are health needs which aren’t met by current service provision. Being open and flexible to changing various elements of a service was thus very important as learning from service users may entail tweaking service elements again and again. This is not always easy as was pointed out by the project leads.
- Working with particularly vulnerable and disadvantaged groups can at times present its own challenges. It can be harder for participants to show up to appointments, sustain their engagement with a service, or to make changes in their lives. The transient nature of Hackney’s, and indeed, London’s population was highlighted as a specifically difficult condition for service providers. On the other end of the spectrum there were some participants, who were finding it difficult to leave programmes. Project leads pointed out the importance of setting clear boundaries and reminding participants of their capabilities.
- Co-production was a key enabler for engaging service users. Co-production recognises service users as assets and not as passive recipients. This approach changes the dynamic between the service user and the provider, shifting the power dynamic from the professional to the service user and acknowledging their skills and strengths. When done successfully, service users are able to share their vision for the service, co-deliver the service alongside staff and feedback on the shape of the service. Through peer-support participants applied and developed their own skills: From managing their long-term health conditions, to listening and advocating for their peers in health appointments, through to cooking more healthily and developing techniques to manage their mental and emotional wellbeing the participants applied a wide range of skills which increased their levels of confidence, presenting role models for new participants on the respective projects.
- Another strong theme from projects focused on recruitment and securing appropriate referrals from other service providers. Some projects found it particularly difficult to get referrals from the NHS because they were unable to engage the right professionals. Due to budgetary and time constraints the NHS staff had in some cases limited capacity to explore new ideas and collaborations. A concern for some of the projects was that they were potentially not reaching those groups that were most in need of support. Understanding where your service users spend their time and recruiting them at these locations, using the right language to promote services, and asking participants to ‘bring a friend’ were approaches that projects highlighted as particularly helpful.