Last year The Seaview Project based at the Southwater Centre in St Leonards was deemed to have made such an impact on the community it serves that it was one of only eight national winners of a GSK/Kings Funds Impact Award in 2018.
The awards are made to voluntary sector organisations which are seen to have had an ‘exceptionally positive impact’ on the health and wellbeing of the communities they serve. Seaview has been providing an open access wellbeing centre since 1985 and is currently the only such facility focused on homelessness and mental health in East Sussex outside Brighton and Hove
Almost half the people Seaview supports have a diagnosed mental health problem and many also have issues with addictions. Its open access wellbeing centre focuses on both homelessness and mental health, while offering food, warmth, washing facilities and access to a range of other services.
Chief Executive Annie Whelan has written a piece for The Kings Fund about the challenges for her clients of the shift within the NHS to an ever more digitised and less paper-based environment.
Is it possible to use the digitisation of the NHS to reach the furthest first?
The digitisation of Health and Care is inevitably changing a system that has been historically reliant on massive amounts of paper to transfer information.
Since its inception in 2014, I’ve been an independent member of the Government’s National Information Board (NIB), responsible for better use of data and technology to share healthcare information and improve outcomes for patients. My principle purpose in involvement, has been to stretch the perception of inclusion to the most disenfranchised.
As Chief Executive of Seaview this is fundamental. Particularly since being selected alongside other organisations making a difference in their communities as a GSK impact award winner in 2018, we know that impact is not dependent on size but on voice.
In 2017 NHS Digital commissioned Seaview to carry out research. We interviewed 64 current and recent rough-sleepers with respect to digital-health. The participative approach in itself opened up a more equal dialogue.
Inviting members of the homeless community to engage in discussions around challenges they faced in accessing digital, instead of being assessed around problems, meant that individuals felt valued for opinions on issues impacting the whole population’s health. The research revealed an overwhelming appetite to learn and engage with digital transformation and not to be ‘left behind’.
When asked about barriers to using digital technology, a significant number of interviewees revealed the greatest barrier to be lack of confidence in digital skills (43 per cent), followed by lack of access (39 per cent), concerns about confidentiality (37 per cent) along with mental-health challenges (35 per cent) and physical-health challenges (24 per cent), limited literacy (20 per cent) and affordability (39 per cent). Several people expressed the need for one-to-one support and also experience of feeling stigmatised in public buildings such as libraries.
In early 2017 NHS Digital commissioned the Good Things Foundation to trial new approaches to digital-health inclusion through the implementation of 20 rolling Pathfinder sites over a three year period, looking at the needs of particular excluded communities.
With the advantage of our research serving as a foundation Seaview was commissioned to be one of these selected Pathfinder sites, focussing on the needs of those rough sleeping or homeless. While we involved a range of partners in the oversight of the Pathfinder, we also had the added value of being the first voluntary sector led digital health Pathfinder. Along with the supportive approach the Good Things Foundation took in implementation, we found that this gave us some unique advantages.
We discovered that the individuals best placed to champion change with respect to digitisation within local NHS and care organisations were often not the most senior. Leading from a voluntary sector perspective allowed us to bring together change-agents from different levels fairly uniquely.
Our Digital-Health Pathfinder ran from October 2017 until September 2018. We sent tablet computers out with outreach workers knowing that they are often first on the scene in situations of critical illness and realising that they are at times forced to clinically triage inappropriately. We found that this worked well in building better links with our existing charity health partner St John Ambulance, however due to the timing of clinics we weren’t able to action real-time clinical support. We weren’t able to summon the support of out-of-hours NHS services where linkage could have had a more effective impact.
We also set up digital-health computers and tablets within our own building and in partner organisations and provided intensive one-to-one sessions. We found that it was often just confidence-building in the use of a mouse or search engine that opened up access. Having a touch-screen monitor seemed to also be helpful. Simplifying processes that had seemed too complicated to attempt for many was key.
We also worked with individuals to register for GP online services, for a number of people who have experienced complex trauma with an inherent distrust of services this seemed safer. However we found the process itself clunky and not particularly user-friendly, requiring individuals to stop mid-way and to physically appear in their GP surgery which defeated the objective. Fortunately, this process is being improved.
One of the best parts of the work we have undertaken has been the formation of an open partnership with the local library who were keen to improve their hospitality to our client group and have worked hard to create a physically and psychologically more welcoming environment.
We have also been able to be part of the ‘three reconnected’ scheme to repurpose donated phones. This has allowed to be able to hand out smart phones allowing invaluable connection. Other businesses could easily follow this example of gifting and potentially save lives.
Good Things have plans to take learning from our Pathfinder to an urban population to trial the methodology for potential roll-out over the coming months.
Digitisation of our future NHS is not a matter of choice but of timing, and it will either release new channels of access, or further isolate societies most excluded.
From my own perspective, the work to create positive inclusion has only just begun. In order to succeed in reaching the furthest first, it will take concentrated investment in the simple and obvious as well as the innovative and interesting.
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