Building on Covid-19 – what next for community-centred approaches to health?
There’s general agreement across health and care systems that the current approach to delivering health and care is unsustainable and that there needs to be a fundamental shift from treating illness to improving the population’s health. One part of this is about ensuring early intervention and, where possible, preventing the onset of poor health. But it also requires a better understanding of the needs of communities and a shifting of power to communities and community-based organisations best placed to meet those needs.
The family of community-centred approaches developed by the Office for Health Improvement and Disparities (OHID) provides an evidence base for the varied ways this can be achieved. Many of these approaches played a crucial role during the Covid-19 pandemic, and our recent report, commissioned by the Department of Health and Social Care and OHID through the National Institute for Health and Care Research Policy Research Programme, explores the role of one of these approaches – community champions.
In particular, community champions were valued for bridging the gap in relationships between statutory bodies and communities traditionally seen as marginalised from existing public health and engagement mechanisms.
Community champions are typically members of the community who volunteer to promote health and wellbeing or improve conditions in their local community. Stakeholders we spoke to reported how community champions were able to build trust and support the sharing of information and engagement with communities. In particular, community champions were valued for bridging the gap in relationships between statutory bodies and communities traditionally seen as marginalised from existing public health and engagement mechanisms. Although community champions programmes were particularly targeted towards supporting the uptake of vaccinations during Covid-19, the flexibility of these roles has enabled many to be repurposed to meet wider community needs.
One element we looked at was sustainability. During the Covid-19 pandemic, community champions programmes were supported by funding from the Department for Levelling up, Housing and Communities, but when that ended, many struggled to find alternative sources of funding at a local level. This situation is not unique. Learning from the Core20PLUS5 connectors – a national programme of community-based support to address health inequalities – has reported similar challenges to the sustainability of individual programmes.
Many of the activities that connect with communities are supported by voluntary, community and social enterprise (VCSE) sector organisations. In 2023, a survey of VCSE organisations found that overall income in the sector had declined for the first time in a decade. Many VCSE organisations have found themselves at the coalface of public sector cuts, increased competition for funding, and increased demand for support. A consequence of this is that VCSE leaders, such as those who form part of our GSK Impact Awards network, are having to make hard decisions about the services they provide.
In 2023, a survey of VCSE organisations found that overall income in the sector had declined for the first time in a decade.
This has a knock-on effect on the relationship between communities and health and care services. A key finding of our research was that the value of community champions doesn’t just lie in delivering an intervention but in their contribution to a bigger picture of building engagement and trust. This is particularly evident in our ongoing work with the survivors and bereaved of the Grenfell Tower fire, members of the community, and local health and care stakeholders where community connectors have been important in building trust and responding to community needs. (The King’s Fund report People power: lessons from the health care response to the Grenfell Tower fire is due to be published this summer.)
While some community champions programmes continue to thrive, the availability of local funding and the lack of a clear function for community champions post-pandemic has led to other programmes being cut or decommissioned. Our research suggests that getting the most from community champions requires leaders to consider the local picture of community-centred approaches and the aims and value of each approach rather than seeing them as interchangeable. In our report we present a list of key questions to help guide commissioners in their decision making.
The prioritisation of community-based approaches remains challenging. Changes at a national level have left a vacuum in policy leadership in this space, and with it the ability to signal the role of communities at a strategic level and in relation to other policy areas. Yet emerging leadership on population health within integrated care systems, alongside the role of public health professionals, provides opportunities to embed community-centred approaches in local strategic plans.
During the Covid-19 pandemic, it was local people such as community champions who stepped in to provide essential support where the public sector couldn’t. Leaders tackling the current crisis in public services would be remiss to think that they can do it again without the community. And when done well, evidence suggests that building a social infrastructure of community action may be able to deliver many of the health outcomes those systems are seeking to achieve and provide insurance for responding to future public health emergencies.
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