There’s a buzz about community hubs. Some places are rethinking children’s centres as Family Hubs, others are shifting NHS delivery to the community as part of their integrated care system reforms, and perhaps more are taking the opportunity to close central buildings and move staff to localities. But for all these drivers there’s a stronger reason (and I think inevitability) that will change public service delivery across many if not all sectors.
Austerity is returning, and with that turgid years of reviewing budgets, salami slicing and cutting services that we know are helping citizens. The low hanging fruit is long gone, putrid — we need a more cost-effective way to support our local residents.
There are two big changes left for public services first to support people earlier to reduce the cost of acute delivery, and second to integrate delivery with partners.
What is a community hub?
The concept of a community hub is not new. There are excellent examples such as the Bromley-by-Bow centre in London which includes a GP surgery, employment services, debt and housing advice, language learning, church, activity and lifestyle courses, foodbank, buzzing cafe, park and voluntary services. The Oasis hub in Waterloo that is built around two schools and include an advice centre, foodbank, library, coffee house, adult learning courses and a farm. And new Community Solutions multi-agency centres established by Barking and Dagenham.
Community hubs are first and foremost part of the community, established from the perspective of what support people want to access, with the public services added where that makes sense. Design from the ground up.
How could a community hub work?
The usual principles of building relationships, trust, compassion, co-production and whole family working apply. But we might want to consider the following to help design community hubs from the ground up:
- A community hub is first based on good local engagement and intelligence about needs and service demand. So we’re talking community based steering groups, JSNA split into enough detail (at least ten areas), understanding lived experience / ethnographic research, local leadership of the hub and services.
- A community hub is accessible, so it’s in a place residents recognise / understand, feels welcoming and open, the people working there reflect the local community, and we consider gang-territories that can prevent young people from accessing.
- A community hub is about the locality more than the public services, so may include a section for business incubators, rooms and spaces for voluntary service or community groups, a place for residents to meet or enjoy group activities (think buzzing cafe), as well as health, care, justice, housing etc.
There is a debate about how many community hubs are right for a local area. I’m a fan of the 30,000 to 50,000 population level of Primary Care Networks, but consider the following questions in deriving an answer:
- What sort of size of area do residents recognise as their community, such that they would feel they have a stake in the development and future of their community hub?
- What is the economy of scale of public sector services that enables disaggregation of delivery? If each partner answers that question separately, we come up with a distinctly different answer to if we pooled all the services together and then thought about delivering through hubs. This requires a level of maturity.
What public services are in a community hub?
This one’s easy, it’s all the services that can be delivered more efficiently or effectively from the community, and the services that people want to access locally. For some services such as mental health, there is a good evidence base that delivery of most (certainly not all) services in a locality and in an integrated way with other services, is more efficient (see What works for whom?). For other services, we’ll need to test the theory, but in principle it’s about whether needs come in neat packages which fit that service model (unusual), or whether they are co-morbid / linked to other services. Services might include (not exclusive):
- Community, faith and voluntary sector services including a foodbank
- Family support and early help
- Nurseries, children’s centres, health visiting, community midwifery
- Therapies, school nursing, mental health
- SEND support, educational psychologists, school support
- Libraries, youth centres, youth workers
- Neighbourhood policing, police locality front-doors, youth offending
- Housing, homelessness, revenue and benefits, debt advice, DWP Jobcentre Plus
- Social care, nursing / home care (think Buutzorg model), GP practices / PCNs
Some hubs will be large places and may, for example, help to anchor the economic development of their community, linked to business incubators and accessible housing.
The next question is, if we brought these services together in the local hub, and enabled them to work for the residents in the community, would they all stay the same or would the model of delivery evolve?
But we can’t rush at this, there are levels of maturity to step through, that build trust and shared risk and reward over time:
- Level 1 — dating. Bringing together professionals and teams in localities, starting to share some processes, vision, guidance and aims. Developing personal relationships between professionals, aligning the cultures and respect for each other.
- Level 2 — moving in. Collocation of professionals in hubs, joint triage of work (where appropriate), joint working, shared IT, common processes, common tea and coffee rota.
- Level 3 — married. Shared line management (one organisation line managing another’s staff), risk and reward fully shared through combined governance and pooled budgets, professionals taking on non-traditional responsibilities because that’s best for the locality.
- Level 4 — Brangelina. When a subset of local public services integrate to the extent that you can’t see the differences, although there is still different expertise in the hubs and teams. Legislation is likely to follow as we cement the new model nationally.
This arc is probably on a ten-to-twenty-year timeline; most local areas are on level one or two.
What does it feel like?
Amrita knows her local community hub and has been in a few times for a library book and once when she was meeting a friend and it was an easy location half-way between their homes. Amrita has been given an eviction notice but this is only the presenting need. The housing officer asks about her children and identifies safeguarding issues and educational needs, and is able to introduce her colleague working in early help.
Amrita’s partner has been suffering from ill-mental health and the housing officer is trained in mental health first aid and can give early help support and advice about more extensive needs. The family isn’t eating well, so are introduced to the food bank, and a local community group which has been set up to help residents to learn to cook. Over time Amrita comes back and builds up links with the hub, engaging with activities and eventually volunteering to “give something back”, as she says.
When there are several incidents of domestic abuse, she doesn’t just tolerate it, but Amrita has the community links to be able to report and get help. When the school identifies issues with a child’s behaviour they get in touch with the hub through the shared case management system and the team around the school, so additional support is given early.
Over time, the small interventions, compassion, connections to community resources and Amrita’s own confidence lead to her and her family becoming more resilient and less reliant on public services.
Practical next steps
Something we learnt from the pandemic is to try things out, take managed risks and adapt quickly. As the phrase goes, you only learn about systems when you try to change them. We now know we can improve services at a pace of three, four or five times faster if we use agile approaches, so it makes sense to test a community hub technology demonstrator and accelerate our learning. I leave a few things to try here:
- Identify a potential site for the technology demonstrator. Chose somewhere where partners are all enthusiastic, including local schools, early help locality and the primary care network. Agree for the cost of the site and facilities management to be met centrally, this is the type of thing that could delay progress.
- Bring in example services that demonstrate the future, but don’t be held back because a slow partner can always join later. Top of this list for testing: early help localities, GP surgery, children’s centre, neighbourhood policing, housing, library, Jobcentre Plus, social care, mental health, a cafe or activities to draw the community in, and of course local voluntary, community and faith groups.
- The project will need to feel special for services to go the extra mile, want to collaborate, and test out new and sometimes alien ways of working. The community hub leader is an important post. It sounds counter-intuitive but focus on the quality of relationships and the system, more than the quality of individual services.
- Develop simple shared processes (keep everything as simple as possible). Until there is a good process for triage, we can have regular case meetings. Roll out a shared case management system or connect different partners’ IT.
- Physically and culturally design the community hub to be as open as possible. Invite a local steering group from the community to be in charge, ensure local residents want to use the facility, put signs outside saying what it does.
- Build relationships with residents who are brought into, or walk into, the community hub. The presenting need is never the totality of need for them or their families. Think Making Every Contact Count, whole family working and co- production of outcomes. Develop quality relationships and quality conversations as the mechanism for change.
- Get learning quickly, through staff working groups, residents’ feedback, an evaluation. There will be lots of small things to redesign, so enable and encourage those changes from the staff group and community steering group.
- Spread the learning and make it the first community hub famous in your areas, so others will want to adopt and work towards their own community hub. Prioritise the communications and culture change.
Scale and pace
Community hubs are a fundamental building block for the next phase of national public service transformation. The pandemic presents ongoing challenges: it created more demand, shone a light on forgotten groups who needed more help, and in repaying the costs, will bring further austerity. However, successive Covid-19 lockdowns showed how the community and voluntary groups can rally around the most vulnerable families, public services will need to be more connected to this resource. And if we are to bounce back, community hubs and early help must develop now, with scale and pace.
Bromley-by-Bow Community Centre, a great example of a community hub http://www.bbbc.org.uk
Oasis community hubs, putting education at the centre of the model https://www.oasiscommunitylearning.org/community/community-hubs
What works for whom? by Peter Fonagy, see chapter 16 for evidence of which mental health services work best in a multi-agency locality setting. https://www.amazon.co.uk/What-Works-Whom-Second-Psychotherapy-ebook/dp/B004D4Z6BM
Buurtzorg model showing how local health and care can be re-organised to put the user and staff first http://www.buurtzorg.com/about-us/buurtzorgmodel/
Making Every Contact Count, it’s about the curious conversations and all public service staff offering a little help during their interactions with residents https://www.makingeverycontactcount.co.uk