In this think piece the former community links worker in Insch, in Aberdeenshire, reflects on her three years of experience working on the project and what she learned.

By Alison McPherson, previously community links worker in Insch and now community health in partnership officer with Aberdeenshire Voluntary Action.

Note: This case study appeared as Appendix 3 in the Community Links Worker Report.

Here she reflects on her three years of experience working in Insch and explains:

1. How and why the project began
2. The actual developments, outputs and areas of good practice developed there
3. Other areas of good practice
4. The evaluation and learning from this project
5. What’s happened since the project finished
6. Work in Rhynie

1. Getting started

The context: it has been well documented and recognised that increasing numbers of people can now expect to live longer, but that these extra years are not necessarily spent in good health, with many people requiring interventions from statutory services in living with long term conditions and multiple morbidity. The Change Fund allowed new ways of working to be tested using a different approach; one which recognised that individuals were often best placed to determine what worked best for them in maintaining and supporting good health and wellbeing and that the resources to enable this could often be found within communities themselves.

A local initiative: At a local level the Friends of Insch Hospital & Community (FOIH&C), identified the potential for further development in supporting people aged 65 and over derived from the group’s existing knowledge of the community built up over 25 years from its close association with the Insch Medical Practice, Insch Community Hospital and the local population.  As a group of volunteers they felt they did not have the capacity to develop this potential into something more tangible but were best placed to support a Community Link Worker post.

An early Change Fund investment in Aberdeenshire involved the setting up of multi-agency, cross-sector Action Learning Sets (ALS) in various localities across the Shire. Discussions at the Insch ALS led to the ‘community anchor’ – FOIH&C – bidding successfully for further Change Fund money that enabled the local TSI (third sector interface, now Aberdeenshire Voluntary Action) to employ a full-time Community Link Worker to work with the Friends to promote volunteering and build community capacity across the Insch Hospital Catchment Area. This partnership project got under way in January 2013 and ran until the end of the Change Fund on 31st March 2015. Further funding from Integration monies supported development of the project during 2015-2016, with a specific focus on supporting the national outcomes linked to the Integration process.

The drivers supporting the project: were identified through national initiatives such as the Reshaping Care for Older People agenda, co-production as a way of working, and findings from the Christie Report – specifically around prevention and participation and using a community asset based approach to build community capacity.

2. Developments in Insch over the three years (2013-16)

The community: the community link worker post covered the catchment area of Insch Community Hospital encompassing the two GP practices of Insch and Rhynie. The main settlements within this rural locality included the villages of Insch, Rhynie and Rothienorman as well as a number of smaller hamlets. Patients aged 65 and over registered with the GP practices in 2013 were as follows, Insch – 1044 and Rhynie – 237.

The role and main responsibilities: of the community link worker were broadly outlined in the job description. Whilst not being restrictive or prescriptive, it allowed a degree of freedom to develop services and activities taking the lead from older people defining their own needs and priorities in improving or maintaining their own health and wellbeing.  Crucially, time was given in the first few months to establish a network of contacts and to become ‘a weel kent face’ locally, an important factor when working with small communities where trust has to be built in order to foster meaningful engagement.

Identifying needs, priorities and strengths of this community: The focus during the first year included mapping and understanding local networks and resources. Using the existing knowledge and extensive contacts of the Friends, links were made with organisations, groups and key individuals throughout the area. ‘Having the conversation’ many times over as well as listening was crucial in gaining an overview of what was already happening, what was not, what was working well and what could be improved. This provided a baseline for future developments.

Insch has seen rapid growth over recent years with a large number of people choosing to move to the area near or just after retirement. During the first few months of the post a community engagement process Planning for Real took place in Insch. More than 550 people of all ages contributed some 2,000 comments in their feedback on what would make Insch a better place to live and work in. Being involved in this consultation process provided contact with all sections of the community and provided a strong sense of what mattered to people.  Priorities from this consultation formed the basis for the Insch Community Plan with associated actions, including a section on health.

It was clear early on, that each community, although not geographical dispersed, had different needs. This was largely influenced by what existing resources, facilities and infrastructures were in place, however some common themes emerged such as transport issues, activities for men, opportunities to socialise and lack of clarity where to access information. These were all were identified as common gaps across the area.

Capacity-building: encouraging volunteering and building community capacity was a key aim of the project. Twenty people were registered as volunteers however most people were more willing to be involved if this was on an ‘informal helping out’ basis which they considered as being ‘community-spirited’ as opposed to a more formal volunteer role (the exception being regulated work).

A noticeboard for advertising local volunteering opportunities was purchased and placed in the centre of the village which other organisations were encouraged to use. This successfully linked several people to local volunteering opportunities. Support was also forthcoming from local businesses and groups with many donating goods or making small financial contributions, this helped raise the profile and aims of the project. People were generally keen to undertake training to enable them to take a more active role in supporting and delivering activities, however most preferred to take a lead only when the link worker was not present.

The outputs: during the initial three years of the community link worker project resulted in approximately 200 retired people engaging in activities each month. These were all activities which did not exist prior to the establishment of the post.

In addition to the setting up of regular activities and groups, partnership working with another local voluntary organisation resulted in the development of a volunteer driver patient transport service. An information directory for Insch was created in response to an identified need for an accessible source of information covering a wide range of topics. The directory is available in key places throughout the village and is also available online. Information is regularly updated and used by health/social care professionals and local people alike. Other activities saw retired people contributing to a Café Conversation in Insch as well as being involved in an Outside the Box research project which informed a guide to safer drinking for older people.

Some groups were time limited with several sessions delivered on specific themes such as IT or healthy eating. For these, the community link workers’ role was largely as facilitator in sourcing the expertise, funding, suitable venue etc. This enabled activities and supports to be delivered locally. Negotiating and highlighting levels of local need encouraged organisations to deliver services and activities in more rural locations.

3. Other areas of good practice

Learning more widely: keeping abreast of other initiatives nationally and locally enabled shared learning and joint working with contact and visits made to other projects in the North East. This provided ideas and possibilities for what might work locally in addressing some of these gaps as well as important learning in some of the pitfalls to be avoided.

Partnership working: Fostering connections between individuals and services was only one element of the community link worker role, connecting existing groups and organisations to each other, where there was the potential for mutual benefit was another aspect.  Partnerships were crucial to activities being successful and sustainable. Linking with the right person/organisation was only possible after the groundwork was done in the first few months in establishing networks and contacts. This meant a shared understanding of each others’ roles already existed and allowed appropriate connections to specialist skills, experience or knowledge to be levered in when necessary.

An informal approach: No formal referral pathway was used, individuals were encouraged to contact the Link Worker directly for more information or just come along and try activities. Community link worker leaflets with contact details were distributed throughout the area and actively promoted by health professionals. Direct enquiries from individuals however were infrequent with community nurses, occupational therapists (OTs), GPs and occasionally families getting in touch for more information.

Promoting activities: was carried out using all the traditional publicity methods however the most effective tool was word of mouth. Existing participants proved to be the best ambassadors and were more successful in encouraging others. Regular updates were provided to health professionals in person and by email. A Friends noticeboard in the GP waiting room was also used to promote activities and groups.

4. Ongoing learning and evaluation by the worker

Evaluation: on the benefits gained was usually through discussion and feedback, with individuals reporting on any notable difference in terms of their own health and wellbeing.  Participants generally had an awareness that they had some responsibility in maintaining their own health and wellbeing and the impact lifestyle choices have in keeping them well.  For some, an existing health issue was the main reason for participating whilst others sought benefit from increased companionship and a greater sense of belonging in the community.  Creating the opportunities which bring people together will generate numerous additional benefits far beyond the aims of the original activity. Acquaintances became friends and informal circles of support were developed. Peer support and encouragement led to people trying new activities, information was shared and confidence was increased.

 

Other benefits reported by participants include:

• “I am much more supple and my lower back problems have lessened.”
• “Feel much better, balance is good amongst other things.”
• “More relaxed, happier.”
• “I would not have lost weight had it not been for the support given, the doctor is really pleased with me.”
• “The Lunch Club was just what I needed – it was great.” Resident in sheltered housing.

Significant challenges faced in developing this project:

Covering a very rural area posed difficulties in reaching potentially isolated people who live outwith the main communities. Connecting with those harder to reach remained one of the greatest challenges.

It takes time to establish a relationship with people and for them to become familiar and engage with the project. Some people are fairly resistant to change and can have preconceived ideas about what is right and appropriate for them. This can sometimes cause a barrier and prevent engagement. A joint approach with the community nurses sometimes overcame this with a small number of people.

Other key learning points:

• Only a small number of people are required when starting a new activity.
• Investing time in getting to know people and place as well as researching what is happening further afield are essential in the initial phase.
• Be creative with limited resources, fully utilise all areas of support.
• Be willing to take the risk and try something different.
• Creating circumstances which bring people together will generate numerous additional benefits far beyond the aims of the original activity.
• Successful activities in one area may not work in another. Ideas tested on this basis failed to progress beyond the initial stage – didn’t match or fit with local need.
• Additional funding had to be sourced to cover start-up and activity costs – £15,000 from 11 different sources. Funding was not difficult to acquire although it was time-consuming completing applications and writing associated reports. Other Community Links models report having access to small budgets allowing for a quick response in progressing ideas.

5. What’s happened in Insch as the project finishes up?

In November 2015, the Community Link Worker accepted a new post as Community Health in Partnership Officer with Aberdeenshire Voluntary Action (AVA). Initially beneficiaries expressed disappointment, however, after a relatively short period the mindset appeared to shift and people started discussing and planning for the future.

The Friends of Insch Hospital & Community, with support from AVA, put forward a proposition which would see them employing someone on a sessional basis using the ‘underspend’ of funding allocated to the Community Link Worker post.  This support would be targeted to those activities which needed it and would allow more time for planning an exit strategy which would ensure sustainability.

Six months on, with this now in place, all activities continue to run and develop further with some attracting new participants.

A number of different solutions have made this possible:

• Participants and volunteers attended training giving them the skills and confidence which allowed them to take a more active role in running the group/activity. There would appear to be a greater feeling of ownership and determination by group members to continue, with greater clarity expressed around the benefits to be gained.
• Support from the sessional worker and volunteers has kept those activities going which require a greater deal of planning and organising, especially behind the scenes.
• Some activities, where appropriate have been anchored to other organisations such as the local leisure centre, Paths for All and the local Community Association.
• Other groups continue to be run very successfully by participants with no further input or support required.
• Where activities have been delivered by an external organisation or person, these continue as part of their core work and are now established groups requiring no further input.

6. Work in Rhynie

During the first year (2013) contact was made with the following to build a local picture of Rhynie: local minister; organiser of local volunteer car aid scheme supporting access to health appointments; and manager of supported housing complex (run by Castlehill) to get a better understanding of the community – what was already happening, views on gaps, local needs.

These discussions formed the basis of planning a community event which would cover a number of key topics, for example:

• information about services, supports and activities
• what was working well, what connected people now
• individual conversations re gaps and potential solutions

In planning the event, the worker linked with the community learning and development worker in Huntly (known contact) who was keen to do some work in more rural areas. Also the worker contacted voluntary organisations for information about their services, collated a wide range of leaflets and promotional materials and invited reps from more locally-based organisations to come along on the day so they could personally answer any queries/questions about services.

The venue was booked and the event promoted by the local minister with posters distributed. On the day only five people attended – the lack of response was very disappointing. People were aware of event but the links worker was largely unknown in the village. In hindsight, we should have probably done more work linking into existing groups and getting to know a larger number of people – more time and effort in raising the profile and local knowledge of what the links worker was trying to achieve might have seen a different outcome.

Progress in Rhynie came through linking with the health improvement officer (attached to Public Health Team) who already had links with the local GP practice and primary school. She organised a ‘Healthy Helping’ course (NHS) to be delivered in the village which the GP practice supported by contacting patients by letter they thought would benefit. From those attending this, work was done around setting up a Health Walk group and the support of the local Paths for All Co-ordinator was sought.  Both the Health Improvement Officer and Community Links Worker supported these weekly health walks by going along most weeks, promoting and encouraging. Weekly weigh-in sessions were included as well as dietary advice.

The health improvement officer used links with the primary school to involve them in the walks as well as sessions around healthy eating. This developed into doing monthly community social events which revolved around lunches, afternoon teas and entertainments or ‘Big Breakfasts’. Members of the walking group undertook food hygiene training and became very much a part of the organising and running of this type of event which benefitted not just the community of Rhynie but also the surrounding areas and made links to other groups in Huntly and Lumsden. Monies raised from these meant the walking group was self-sustaining financially and covered costs of venue hire to allow future events. Any extra funds were donated to the school, car aid scheme, Macmillan services in the North East and Charlie House in Aberdeen.

Following the departure of the health improvement officer, the community links worker continued to support activities in Rhynie. Additional funding secured from a local wind farm trust meant we were able to introduce a number of free taster sessions of Stretch & Relax, a short programme of IT classes all delivered in the village using contacts with other sector providers – introducing new activities not previously available (public transport being a big issue). These were offered on the basis of feedback we had received from people attending the community events.

Since the end of the Links Worker’s involvement in the area, the group The Tap O’ North Trampers have gone from strength to strength, expanding what they do to include a fortnightly rambling group, book club and community social events. As a group they have been recognised locally and asked to help out with other events. The group said as a team they have gelled and work very well together and their confidence has increased by their continued success and knowing ‘yes, they can do it’. What you can’t capture on paper is their enthusiasm, teamwork, good humour and community spirit …this they continually demonstrate by the bucket full.

The group received advice from Aberdeenshire Voluntary Action’s (AVA) Development Officer and set up their own bank account and manage their own finances ensuring they have funding to continue all their activities in the village in the future as well as support other good causes. Contact is maintained with Rhynie through the work of the AVA Community Health in Partnership Team and the representatives from the group have attended a recent Community Health Exchange event and have become members of AVA.

First published in 2016 as Appendix 3 in the Community Links Worker Report.