Community Health and Wellbeing Workers - Cornwall

The neighbourhood

The neighbourhood that a single community health and wellbeing worker (CHWW) will cover is 120 houses, the group of houses is chosen through an assessment of indications of need such as the index of multiple deprivation carried out by the ICB and local primary care organisations.

CHWWs are currently supporting these 120 house groups across Cornwall in multiple locations with varying levels of rurality and high levels of deprivation. The key asset supporting this work is consistent funding secured through the ICB, each CHWW operates a model which harnesses local assets where available but does not rely on these assets for operation of the model.

The context

The model is specifically designed to address health inequalities at a hyper-local scale. Areas of need are identified through analysis of deprivation data, and the areas of the highest need are assigned a CHWW.

CHWWs aim to form long-term relationships that support health and wellbeing in a holistic way, supporting individuals with what matters most to them. In doing so they aim to connect residents to statutory and non-statutory organisations for help, connection and support where they are available.

The model

The work uses a tried-and-tested model from Brazil, which has already been adopted in Westminster. The team in Cornwall is closely connected with the Westminster team for shared learning.

Primarily, the partners are VCSEs, GP practices, Volunteer Cornwall and the ICB. The funding is secured through ICB Inequalities funding owing to the model being based on reducing inequality.

CHWWs are hired directly from VCSE organisations based on their understanding of a particular community. They receive training from Volunteer Cornwall in how to support communities and provide very broad and holistic support based around the person they are supporting’s health and wellbeing needs.

Each CHWW also has a small budget of their own to be spent supporting their community and often host events to bring people together and encourage participation in CHWW support.

It is a community-based model, there are no direct referrals from GPs and anyone in the 120 houses has access to support.

What makes this effective and resilient

Governance flows through PCNs, the ICB and partner organisations such as Volunteer Cornwall, who provide training to all CHWWs.

CHWWs have a monthly community of practice to share learning and discuss any problems arising in their 120-house neighbourhood. This ensures shared learning across the geography.

CHWWs are a well-established method, and funding has been secured by the ICB as the model is focused specifically on addressing inequalities.

The model is currently being scaled both into more areas of Cornwall and in the size of the CHWW workforce in each area.

Future plans include enhanced training for CHWWs to provide targeted healthcare advice on health challenges such as hypertension.

CHWWs can also be funded through PCN ARRS and some local parish councils are interested in funding in their own areas too – the level of interest from partners in funding the model is supportive of the resilience over time.

Voluntary sector organisations have been vital partners, and recruitment attracted far more applicants than were able to be CHWWs. The level of community interest and excitement about the scheme has been extremely large.

CHWWs are also a part of the integrated neighbourhood team in the areas that they cover, these teams are still emerging but further strengthens the status and longevity of CHWWs.

CHWWs have also begun to collect information from those they are supporting, and feed this back into GP surgeries, helping primary care identify the needs of their population.

What makes this challenging

PCN readiness to work in this way varies, it often takes powerful characters in PCNs to advocate for the work and bring others along.

Despite evidence of effectiveness in multiple settings, there is still a battle to convince some of the value proposition particularly in an environment of tight budgets across funding organisations.

It might be that only one in every ten individuals a CHWW reaches out to wants to invite their support, which can be disheartening.

Being a CHWW is stressful and sometimes harrowing, which means CHWWs themselves sometimes need support.

Impact and outcomes

CHWWs in Brazil have seen a 34 per cent reduction of cardiovascular mortality.

CHWWs in Westminster demonstrated increased vaccination and screening rates and a 7 per cent per cent drop in unscheduled GP visits in their first year of operation.

CHWWs Cornwall have recently started using MyCAW (a qualitative wellbeing survey) to monitor impact with individuals and at a service level, initial indications are very positive on the model's ability to improve holistic health and wellbeing.

Multiple examples exist of resident journeys demonstrating improved health and wellbeing.

"If this model were a pill, we would all be taking it”
Prof Matt Harris