This example sets out the work done by the National Conversation on Health Inequalities (NCHI) using community outreach for better health.
Kerri and Lisa, 2 sisters in their 20s, were living on their own after their parents passed away. Having lost both their parents within a short space of time, the sisters were struggling to cope and had become extremely depressed; both felt unable to leave the house.
Lisa suffered from multiple health conditions including diabetes and a rare skin condition that often left her unable to get up or care for herself. She had developed acute agoraphobia. These conditions had gone untreated for at least 18 months. Lisa was consistently refused home visits from her local GP surgery. She could see no way out of their situation and had become suicidal. A Tendring Reach Out Officer said:
She was very very poorly with diabetes, and she also had another disease – a skin condition which really did disable her, she couldn’t go out, couldn’t move certain days, couldn’t wash herself…she couldn’t even go to the front door. A doctor hadn’t seen her for about a year and a half.
With the diabetes situation she was so unwell that she’d asked for a home visit but they’d said ‘no, in your age group, you can come and see us’. She had depression. Her sister had to go out and get the shopping for them.
Reach Out project
Kerri and Lisa live on a street that was targeted by Tendring’s Citizens Advice Bureau’s (CAB) Reach Out project. Funded by Essex County Council (and previously by North East Essex PCT), Reach Out targeted 2 areas in Tendring with high levels of deprivation.
The Reach Out service is a community engagement model, to bridge the gap between vulnerable groups and local support services. It addresses the wider determinants of health that contribute to health inequalities and improving well being. The project identifies the most vulnerable households who would not seek assistance until crisis point, and establishes contact via door knocking.
Reach Out advisors offer the full range of CAB services and advice. In 2013 and 2014, the project contacted 2062 residents, 382 of which required support with 1475 issues. 75% of clients said they would not have sought support if the advisors had not knocked on their door. The Tendring Reach Out Officer said:
People are quite surprised when we go out and knock on the door, we say ‘Hi, we’re CAB, we’re out to see you, we can tell you what services are available to you and help you with any problems, from housing to benefits to consumer issues, anything at all.
And people are really surprised, they go ‘Oh wow! What a brilliant service!’
A helping hand
The Reach Out advisor talked to Lisa about her health conditions and support needs. To help Lisa get access to medical care, the advisor called her GP surgery on her behalf to request that she receive a home visit from her GP. The GP then visited Lisa in her home and gave her the medication and ongoing monitoring that she needed, which helped her skin condition to improve and helped bring her diabetes under control. The improvements in Lisa’s physical health also had an impact on her mental health.
A few months later, a Reach Out advisor saw Lisa out of the house. Her situation and quality of life had greatly improved since receiving the intervention from Reach Out. The Tendring Reach Out Officer said:
We had to ring the doctors… and the doctor came out to her. They got her on the right medication. They’ve now got their own garden in the house they moved to so she’s actually been out of the house after 3 years. They are so happy now.
She can’t believe she’s actually walked out of the house, so it was a life saver to be honest.
Improving health and wellbeing through improving community outreach
Reach Out contributes to meeting underlying health and social care issues in the community, specifically in resolving individuals’ issues relating to wider determinants of health. These issues can range from welfare rights and debt, to housing and healthcare. Through support with claiming benefits and managing debts, the clients’ standard of living improves, which also improves their overall health.
In 2013 and 2014, the project managed £747,860 of debt, of which £280,867 was written off. It has supported clients to claim £301,576 of benefits.
Reach Out helps identify needs and increase the knowledge and awareness of local support services among vulnerable groups. In 2013 and 2014, Reach Out made referred 505 people to 131 organisations. By contacting adults before they reach crisis point, and putting them in touch with support services, Reach Out contributes to preventative support, reducing the need for further care. The Tendring Reach Out Officer said:
It’s been a fantastic project. We’ve been able to go out and help people in their own homes…you find that people relax a lot more, [and tell you more]. We try to find a problem, before it gets too big.
Debt can be a major problem; if people put their letters to one side then they can be evicted.They don’t realise what’s priority debt and what’s not, so to get them out of that situation and help them open these letters can be a really helpful thing. We go out and meet our own clients, nobody else does that.
Reach Out contributes to both the Public Health and Social Care Outcomes Frameworks as well as supporting the Essex County Council’s Corporate Plan and the Essex Health and wellbeing strategy.
Reach Out was included in the Marmot Review into health inequalities in February 2010 as an example of best practice in partnership working to address inequalities. The service was also chosen as an example of EU wide best practice and was presented to a range of European policy makers in Brussels in June 2010.
For queries relating to this case study and the NCHI, please contact the programme lead: Lina Toleikyte (Health Equity Unit, Public Health England).