Community action in the NHS is quietly building the Big Society

Indeed, in a recent poll for Third Sector magazine, 81 per cent of readers said they were bored with the whole idea.

Yet look beneath the politics, there are good examples of the Big Society in action. The energy of citizens was vital to the recovery efforts after the Australian floods. Research shows that engaged communities have lower rates of crime.

The NHS has been quietly building Big Society style programmes but has yet to get much of the credit. It deserves some, even though some initiatives have proved precarious as cuts start to bite. A new community organising strategy from the Department of Health should put such ideas on firmer footing. There is both a strong individual and community case for such programmes.

On an individual basis, patients with chronic conditions need help to stay well. Helping patients support each other can produce better results for less. Entrenched community health inequalities are best eroded by helping local people build skills, capacity and their own solutions.

A shining example is the patient and community engagement work in Hammersmith and Fulham. The team there has been quietly strengthening community health in parts of the borough, such as White City, with challenging poverty and health inequalities.

The team has worked with the local community to identify problems and potential solutions.

Thirty five volunteers became a live information and support network for the community, helping redesign primary care services, reaching out to people who typically did not engage with screening programmes and better integrating health, housing and social care for people with complex needs. Volunteers ran community initiatives such as exercise projects for women, football tournaments for children, walking groups and cooking projects. They also made 800 referrals to local health and social care services, an excellent example of targeted preventive care, which will have stopped many presenting with acute emergency admissions.

The team also encouraged 800 people with long term conditions to participate in the Expert Patients Programme, half of whom were from black and minority ethnic groups and in social housing with two in every five unemployed, unable to work due to illness or retired. Participation in the programme improved self care and saved £1,800 in health costs per patient on an annual basis.

As the NHS contemplates the need to reduce emergency admissions, which are often concentrated in areas of high disadvantage like White City, these are exactly the kind of solutions required. I was flabbergasted when the team was issued with redundancy notices and relieved when health minister Anne Milton stepped in.

The approach works, if given time. In the US, the REACH programme has been active in 40 communities which exhibit wide ethnic disparities in health outcome. Like the team at Hammersmith and Fulham, REACH looked for sustainable community solutions with three objectives: support for healthy lifestyles, signposting for long term conditions and community education. By empowering citizens, it found that deep health inequalities could be eroded. It saved money too.

Volunteers are a valuable supplement to time-pressured clinicians in targeting proven health interventions where the NHS fails to reach. Peripatetic lay educators are used as part of a “seek and treat” strategy in London, for example, to engage patients with chronic ill-health who do not turn up for primary care appointments.

Professor Aziz Sheikh has conducted a clinical trial into the effectiveness of trained community smoking cessation workers in helping Bangladeshi and Pakistani adults missed by traditional services kick the habit. Some of these models use volunteers, others paid staff, but both tap into local communities and achieve results.

One main criticism of the government’s vision is that it fails to recognise the role of the state in enabling Big Society to develop and thrive. Some communities organise themselves. Many others, especially those with deep seated problems, need a helping hand. The NHS has been extending a helping hand in places with poor health outcomes. Long may it continue.