Happy new year and welcome to the fourth Bulletin of the Community Participation Primary Care Funding Initiative!

 Sustaining community participation in the light of funding cuts

This bulletin is written at a time of huge uncertainty about funding, of a reorganisation and reconfiguration of community structures and doubts around  the sustainability of existing models of community participation. Despite the significant commitment to and positive outcomes from the projects, the concerns about sustainability are not just about the ending of the funding initiative, but also about the impact of funding cuts in the community and voluntary sector.

The announcement in December 2009 that up to 30 Community Development Projects are deemed ‘non-viable’ and that their core funding is to be withdrawn has led to concerns that the potential for community engagement and community participation will be lost. This, along with the ending of the Community Development Programme and the integration of CDPs into local development companies, will mean that many of the existing or planned community participation in primary care activities may need to be rethought in the light of these changes.

Despite this, as the funding initiative comes to an end it is important to celebrate the fantastic work that has taken place in community participation projects. A significant number of projects are already saying that they are able to sustainsome, if not all, of their activities, at least in the short-term, and particularly where there is support from the HSE, for example, from community workers. One of the difficulties for many community projects is how their competing priorities, commitments to other core areas work and a potential of loss of resources and staff, can be reconciled with a commitment to continue working on community participation in primary care.

There are currently twelve CDPs involved in the Community Participation in Primary Health Care Initiative. Greater Blanchardstown CDP and Equal Access CDP in Tallaght are currently appealing the decision of ‘non-viability’, and the role of Pavee Point as a support agency to the CDP may end.

 Feedback from the evaluation

The evaluation is going full steam ahead and second meetings are currently taking place with projects. There has been some inspiring work carried out during the year and this is leading to a good evidence base which will provide  very important learning for the further development of community participation in primary care in the future.

The wider context of health

Many of the community participation projects have focussed on the wider context of health ‘the social and economic determinants of health’, on the basis that health and well-being are closely related to the social and economic conditions in which people live. As a result issues such as poverty or social isolation are recognised as being key issues affecting health, all of which are relevant to primary care. It is interesting that these are issues that Primary Care Teams consider to be increasingly important to long term health outcomes, and through their work with local communities are able to tap into local community support services. As some Primary Care Team members have found, knowing what is available in the local community can play a key role in assisting people whose ill health arises from social factors, such as social isolation.

A number of the consultations have also raised the issue of how identified community health needs can be fed into a wider context of health care, including hospital care. This is an issue that has relevance for the establishment of the Integrated Services Areas (between PCCC and hospitals) as part of ongoing HSE reforms. 

Spotlight on two projects

Corduff and Greater Blanchardstown project

The Corduff  Community Development  Project  and the Greater Blanchardstown Community Development Project have a joint project with the HSE (covering the areas of Corduff, Mulhuddart, Wellview, Tyrrelstown, Warrenstown). The project builds on some important ground work to identify community health needs in Mulhuddart, Corduff and Tyrrelstown and particularly how disadvantaged communities can influence primary health care. A community participation steering group has been established between community representatives and members of the Primary Care Team (PCT) and the group drew up a Model for Community Participation in Primary Care. This is based on local Health Action Groups, which have a focus on local health awareness and the role that the community can play in shaping the development and delivery of Primary Care services in Corduff, Mulhuddart and Tyrrelstown. There have been a number of local events and activities. For example, a health information fair ‘Respect your health and wellness fair’, was held in Corduff in September 2009. This provided free blood and cholesterol checks and information about different HSE services and  about community groups and agencies. Over 25 different agencies were represented and this provided good evidence of the HSE and the community working together.

Community groups have developed excellent working relationships with the Primary Care Teams on the ground and the process of joint working has been beneficial to community and PCT members alike. As everyone has found community participation is time consuming and requires significant resources if it is to be meaningful. There has been some important learning for the projects in working with areas where there are different levels of community development and community readiness to engage in the primary care process. The project found difficulties in getting participation in those areas where there were no active community projects. One key area of learning according to the CDP is that ‘nothing can be taken for granted but always has to be worked at’.  The learning is that the importance of community development projects locally is essential for the process to continue. There is clear learning from this project that a huge level of support and time needs to be invested in community consultations, and this is particularly the case with the most marginalised communities who do not necessarily have the experience or capacity to participate.

WestCork Islandsproject

The project grew out of a concern about the vulnerability and isolation of the West Cork island communities, and particularly the health impacts of isolated islands suffering from depopulation, low income, lack of social and recreational services, isolation and social exclusion. The project is being run between the HSE and three community organisations covering the seven inhabited islands off West Cork (led by the Bere Island CDP and covering Bantry Bay islands; Sherkin Island Development Society, a Community Development Project covering the Roaring Water Bay islands; and Comhar Cumann Chleire a representative cooperative organisation for the Gaeltacht island of Cape Clear. This is the first time that the island projects and the HSE have formally engaged with each other.

The provision of health services in a small, dispersed and geographically spread population raises a number of challenges for health services, and particularly the engagement with the four PCTs in the area, two of which are running (Mizen Head and Skibereen) and two are in development (Bantry and Castletownbere). The experience of social isolation and issues of transport were made aware to me on the day of our first evaluation meeting: one of the community reps from Cape Clear was unable to attend because the ferry was cancelled due to poor weather and another because of other transport difficulties.

A Steering Group has been established of PCT representatives, the HSE’s community worker and representatives of the community organisations, and the island communities are represented on the West Cork Primary Care Local Implementation Team. This has provided a strategic role whereby all of the island communities can be represented together and across all teams. It is anticipated that two meetings will take place a year and that a structure for representation on the teams will be developed in time.

Activities have included a health information day attended by HSE services and community organisations (including the partners projects, the Citizens Information, rural transport, education providers, West Cork carers etc. This provided an opportunity for the project to be introduced to community and other agencies, and for PCT staff to give presentations to the community about the role of the PCT and the services provided and for the community to provide information about its roles. This was a very positive experience for community and HSE representatives and it was viewed as important for not only providing information but also in managing expectations. Other activities have included public meetings on three islands (hosted by the three CDPs), meetings between community representatives and local GPs, a mapping of HSE and community based services provided on the islands and the dissemination of this information through a leaflet. Plans have been put in place for a training day for community and HSE representatives and for a community health needs assessment to be carried out through focus groups with local people on each of the islands.

Setting up community health forums

The last bulletin highlighted some of the projects that have established community health forums. It is worth noting that the evaluation has identified some specific issues for projects in setting up and running a Community Health Forum. This includes ensuring that Forum representatives have a mechanism for feeding back issues discussed and the need for robust and clear terms of reference, setting out roles and responsibilities, and also for the managing of expectations. Several projects have grappled with how to ensure effective forms of geographic, age and gender representation, while others have looked at how training and capacity building can be provided for Forum members and for sustaining and harnessing the interest and motivation of the community.

Reconciling the perspectives and working methods of HSE and community organisations

For many projects joint working between community and health professionals has been hugely valuable – in many of the projects there have been successful and sometimes creative and inspiring outcomes from joint working. There are also mutual benefits from learning about and responding to different perspectives and ways of working. Some of these issues include improving the capacity of PCTs to ‘think outside of the box’ and recognise and realise the intrinsic value to them of community participation. On the whole, the evidence from the evaluation to date is that there has been a significant value to sharing of roles, perspectives, understandings and expectations.

For PCTs community participation provides an evidence base for prevention related work with specific groups in the community and has highlighted the role that the community can provide in a broader social context of health. For community representatives the value of engaging with PCT members is that they have become more aware of the role and scope of different services and their potential for coordination through the PCTs, particularly in connecting medical and social models of health.

HSE supports and networks

In many projects key roles have been played by HSE community workers whose expertise and experience provide the basis for HSE liaison and support in the community. Establishing a network of advocates and community workers working in the HSE has been identified as an important step forward. Utilising this expertise will be particularly important to building capacity and connections between PCTs and community groups, and ensuring that ‘local champions’ in the HSE are supported and networked. This will be crucial for future developments in community participation, particularly after the funding initiative has ended, but also in supporting and mainstreaming community participation in the roll out of future PCTs.

Other news / information

End of project reports

All projects are required to complete final reports for their projects by 29^th January 2010. These reports have been streamlined so that they can feed into the evaluation process (and replaces the second evaluation questionnaire that had originally been planned for projects to complete). The information in the reports will be treated sensitively and will remain confidential. Please get in touch with Elaine Houlihan if you need any further information on the final reports.

Networking event

A networking event is being organised for 20^th January in Dublin.  An agenda will follow shortly.

CAN Technical Support

CAN are organising two regional events and will be in touch with projects shortly.  The proposed dates are:

• 29^th January 2009 in Castlebar, Building Effective Partnerships.
• 5th February 2010 in Dublin, Developing Structures for Community Participation.

Community Participation and Primary Care Resource Document

A revised version of the 'Community Participation and Primary Care Resource Document' was circulated by Rachel McEvoy (HSE) to all 19 projects for their comments and feedback. As a result of this a final version will be completed by the end of January and circulated around to projects. The learning from the projects has been really useful in setting out a process for community participation.

Further information

For further information about community participation in health see:

Community Action Network (CAN): www.canaction.ie/can_php/index.php

Instituteof Public Health: www.publichealth.ie

Health Promotion: www.healthpromtion.ie

Health Services Executive: www.hse.ie

Or contact Elaine Houlihan in the Social Inclusion Division, DSFA at Elaine.houlihan@welfare.ie or Rachel McEvoy at rachel.mcevoy@hse.ie in the HSE.

For further information about the Lifford and Castlefinn community participation project see: http://www.liffordcastlefinnhealth.com/publications.html

For further information about the work undertaken by the West Offaly Project in their community consultations in rural areas: ‘The West Offaly Way’, see: http://www.westoffalypartnership.ie/West_Offaly_Way_Summary_Report.pdf

How can you contact me?

If you need to contact me regarding any element of the evaluation you can do so by email janep@iol.ie or by mobile: 086 809 3063.

Many thanks!

Dr Jane Pillinger, Evaluator for the Joint Community Participation Primary Care Funding Initiative