Westminster City Council is to launch a unique scheme that could transform the face of community health care in the country. In a first for the UK, it will see specially appointed community health workers making regular visits to every household to ensure that anyone who needs a service receives it.
Modelled on a programme that has successfully operated in Brazil for more than 30 years, it is to begin next month [April 2021] on the Churchill Gardens Estate in Pimlico as part of a one-year pilot project.
The trial is being run in collaboration with public health experts at Imperial College London, who say that the fragmented nature of current community health care provision sees too many people falling through the gaps.
“The pilot aims to improve access to health services for residents whose health and wellbeing could benefit the most and will also help residents navigate the system so they can get the most out of local support and services available,” Cllr Tim Mitchell, Westminster City Council’s cabinet member for public health told Extra.
It also seeks to “mitigate the impacts” of Covid 19 by helping people manage long term conditions such as diabetes, increasing the uptake of screening and immunisations and providing mental health support, he added.
“I’m delighted we’re able to begin this pilot at Churchill Gardens and we hope these community health workers will serve as an integral part of local health care.”
Costing £100,000, the scheme consists of five community health workers attached to the Pimlico Health Centre who will visit the 500 households on the estate once a month. “It is unique because it is independent of people’s needs,” said Cornelia Junghans, a part time GP who doubles up as an epidemiologist at Imperial College. “They may not need anything, just a cup of tea or a friendly face round the door, but the service is there. In terms of Covid 19, it couldn’t have come at a better time because of the social isolation people are experiencing. That monthly visit could be very important to an old person.”
The prime mover behind the scheme is Matthew Harris, a senior lecturer at Imperial’s School of Public Health, who witnessed the community health worker programme in action while working as a GP in Brazil in the 1990s.
“This began more than 30 years ago and is fully integrated into the primary health care system. It involves a continuous engagement with people, a building up of relationships and trust so that you are in a position to deal with something when it is small before it becomes too big, which is the basis of the whole prevention agenda,” he explained. “The result is fewer hospitalisations and ultimately fewer deaths, Yet interventions are low level, nothing more than little nudges.”
He has been advocating for such a model to be taken up in the UK for 16 years with little success, until now. “I get the feeling that Covid has shifted things a little bit,” he said. “There is more of an appetite for low cost, resilient systems where you get more for less. Westminster has been insightful enough to to put their hands in their pockets and invest in such a programme.”
In a joint article for the Journal of the Royal Society of Medicine last autumn, Dr Junghans and Dr Harris point out how the economic consequences of the Covid 19 emergency are set to widen existing health inequalities, while increased unemployment, debt and social isolation will add to the health burden. Community-based services need to be stepped up in order to meet these challenges, they say.
“Primary care services are fragmented and quite a crowded field,” Dr Junghans told Extra. “We have a lot of services but there is a lot of duplication and a lot of gaps, too.”
NHS England’s recent roll out of 55,000 link workers to connect people to various social services is “good but it is too little and too targeted” and depends on referral processes, which further limits the number of individuals they see, she added.
In terms of spending, community health workers are a modest investment, insists Dr Harris, comparing a projected £1.7billion cost of 85,000 community health workers to the £22billion spent on the government’s largely failed test and trace programme. “Community health workers could do contact tracing at a 20th of the cost,” he said.
As in Brazil, Westminster’s new community health workers are being recruited locally. “They are part of the community and they know what’s going on,” said Junghans. “They are in a perfect place to observe, offer advice and make suggestions about services like screening and immunisation. They are someone who connects up services.”
With others now expressing an interest in the programme elsewhere in the country, the hope is that the Westminster trial will encourage a wider take up. “It is an exciting initiative that has been a long time coming,” said Dr Harris.
This article first appeared in Westminster Extra on March 18 2021