Bulletin 3: November 2009: Joint Community Participation Primary Care Funding Initiative

Welcome to the third Bulletin of the Community Participation Primary Care Funding Initiative!

Feedback from the formative evaluation to date

There is great work taking place in the projects and some really good examples of community consultations, work to establish Community Health Forums, and training in community participation.

Community consultations

All projects have engaged in some form of community consultation, through public meetings, workshops or focus groups. Some community consultations have identified the most appropriate and representative structure with which to engage with Primary Care Teams. For example, in Finglas a consultation exercise with local groups has made recommendations for a range of models of community representation, including a community health structure that works with and is integrated with existing consultative structures. This is particularly relevant in Finglas where community representation already exists through agencies such as the Local Drugs Task Force.

Community consultations have been held to identify local health needs, where the focus is usually on the broader social and economic determinants of health. Social isolation, the impact of poverty on inequalities in health, mental health and well-being, and the environment in which people live are key issues raised. In Erris, Co Mayo, a rural area of a highly dispersed population, social isolation from living in a rural location, and access to services and transport were key issues raised by local people. In the case of the project with Mayo Intercultural Action, access to health services and information for migrant and minority ethnic groups were highlighted.

Many groups see these consultations and needs assessments as being very important to establishing an evidence base, which can be presented to or discussed with Primary Care Teams. In the case of one project in Rialto, Dublin, the outcome of a series of workshops was that local people wanted access to more information about local health services and local community groups. The result is that the project is now drawing up a directory to local health and community services.

There have also been different approaches to community consultations. In some cases the consultations have been jointly organised by community and HSE primary care staff, while in others they have been organised solely by the community. All approaches have worked extremely well.

Establishing a Community Health Forum

A large number of projects have a Community Health Forum or are in the process of forming one. A Community Health Forum has the advantage of enabling a representative group of people from the community to be the voice of the local community on health issues. It is envisaged that a minimum of two representatives from the Community Health Forum should be invited onto the Primary Health Care Team to attend business meetings or periodic meetings.

There are different models emerging about how to establish a Forum. In several projects the Forum has been established on the as part of the process of community consultations, where nominations are invited from those participating. In others, nominations have been sought from different groups in the local community. In most cases there have been criteria established from the outset about representation, for example, from disadvantaged communities and representation from different target groups, such as older people, disabled people, women, unemployed people etc. Some have established terms of reference. This was something that the Donegal project (Lifford/Castlefinn, Ballyshannon/Bundoran, the Finn Valley and the Lagan Valley) found to be very important in setting out the role, scope and purpose of their local Community Health Forums.

The creation of a Forum has raised an issue about what stage to engage with the Primary Care Team; whether this should be at an early stage when the team is in its formative stage or once it is established and working. It appears there are different approaches to this depending on how well developed the Primary Care Teams are and how prepared community groups are to engage.

Training and capacity building

A number of projects have undertaken training and capacity building for community and Primary Care Team staff. Training has been important to providing information and awareness about community health issues, the organisation and delivery of health services, models of community consultation and decision-making skills.

In the Paul Partnership, working with other community and statutory organisations, a model of training has been developed that has enabled community representatives to carry out community consultations to identify local health needs. This training was successfully delivered to both community representatives and staff from the local Primary Care Team.

In other projects training has been carried out with community representatives only, as a means building capacity and knowledge prior to their engagement with the Primary Care Team. In North Roscommon, training was provided for community representatives, who worked with a facilitator to establish the course content and objectives. Participants found the course to be a real confidence booster and this has equipped them with the capacity to engage with the Primary Care Team. This has led to some joint training with the Primary Care Team and the community representatives, and joint work to discuss structures for community representation. In Wexford, community representatives through the Wolfe Tone CDP, organised two FETAC accredited training courses with the local VEC, for local community representatives. This was hugely important to building capacity and enabling local people to organise and engage in community consultations.

The Community Action Network (CAN) has also provided three regional training sessions to date in Mayo, Dublin and Cork. These sessions have been really useful in setting out different models of community participation and helping projects to discuss and learn from each other about the different approaches taken.

Learning to date

Joint work has been really important to breaking down misunderstandings between the community and the HSE, and in finding the common ground to work together.

It is vitally important to have an active TDO who can support the Primary Care Teams in their development and to show the benefits of community consultation.

Training and capacity building is equally important for community groups and also for Primary Care Teams.

Having the resources to support community participation has been key to achieving the positive outcomes from projects to date. As mentioned by many projects, sustainability is an issue for the future, and funding will be needed for this.

The benefits of the initiative to date

There has been a huge learning curve for local community groups and primary health care staff. For the majority of community groups this has been the first time that they have formally engaged with health service providers, and the first time that primary health care staff have engaged and consulted with local communities on health issues. The projects have created a genuine sense of excitement and momentum to the ongoing work of Primary Care Teams. There have been significant benefits to joint working. The relationship building and the sharing of knowledge and information have been eye openers for many people.

Primary health care staff have developed a better knowledge of the health issues facing local communities and also of the supports, networking and services that local communities can provide. Community groups have leant about the services available, and in some cases have influenced service provision, while they have also seen the connection between the role and importance of primary health care services to the broader social determinants of health.

Other news

Community Action Network (CAN) support for projects

CAN is still available to give technical support for projects up until the end of the year. If you need some technical support or advice over the telephone contact Pat Tobin or Cecilia Forrestal at CAN by Pat@canaction.ie or Cecilia@canaction.ie or by telephoning CAN at 01 878 8005.

Funding Initiative for the European Year for Combating Poverty and Social Exclusion (2010)

The European Council and the European Commission have designated 2010 as the European Year for combating poverty and social exclusion. As part of the European Year, the Social Inclusion Division (former Combat Poverty Agency & Office for Social Inclusion) within the Department of Social and Family Affairs are providing once-off funding to facilitate anti-poverty groups or organisations to undertake work at local or national level to promote awareness of poverty and social exclusion and the European Year. The maximum amount available under this initiative is €5,000 per proposal. The deadline for applications is 5pm Friday 27 November 2009. Further information: Elaine Byrne, Tel: 01 7043757, email: elaine.byrne@welfare.ie. For further information or advice on applications contact: Sharon Keane, Tel: 01 7043485, email: sharon.keane@welfare.ie

HSELand

For project participants that have not done so far, you are really encouraged to register for the networking forum www.hseland.ie. You can do so by registering on hseland.ie. Projects have also been emailed with the instructions of how to access the forum. Alternatively you can contact Rachel McEvoy for details of how to access the forum on: rachel.mcevoy@hse.ie