I visited the Bromley-by-Bow Centre (BBBC) last week for a presentation, tour and chat with its insights director Dan Hopewell. Quite by coincidence my visit overlapped with a group of Darzi Fellows – all medics spending a year investigating alternative models of delivering health and care – and their questions, combined with the stories and insights from the incredibly knowledgeable, experienced and compassionate BBBC staff, showed how listening to locals really can create a healthy and engaged community.
Dan Hopewell, Director of Insights at BBBC, discussed how the centre’s origins and its current approach fit into the more general history of healthcare provision in the UK through the NHS. Two things stood out to me.
First, that Aneurin Bevan, architect of the NHS, was at the time in 1948 Minister of both Health and Housing. This is, perhaps, unsurprising and unnotable as back then a leading cause of ill health and disease was poor housing and the conditions of sanitation and overcrowding that defined it. That connection between health, place and homes addressed in 1948 by establishing the NHS has only grown stronger, and is something we are acutely aware of today as health inequalities stemming from poor housing continues to compromise health – tragically manifested recently with the death of a child due to mould in his housing association flat.
Second, that while there appears to be, since the pandemic, a renewed focus and growing consensus on the importance of preventative health, this hasn’t translated into primary care budgets where programmes and measures to keep people out of hospital are concentrated. The real NHS spend on primary care has decreased over the last few decades, and hover around 9% today according to the Royal College of General Practitioners.
The connection between these two points is what underpins the mindset, mission, and operation of the Bromley by Bow Centre. Notably, that health begins at home and given the trends in primary care budgets, its activity will focus and leverage on health creation at home and in the community. Indeed, everything in the BBBC DNA is about the connection between health, place and community.
It starts with the “place” BBBC has created, located in the heart of the Bromley-by-Bow community, accessible by foot, cycle and public transport. Set near the underground station, adjacent to a motorway, the centre has created a connected set of buildings encompassed by a green space which includes art, gardening, play and relaxation areas. It’s open all day and accessible to anyone who wants to come and meet other locals or hang out in the café. While some come for scheduled appointments with a GP, others come to sit in the green space or participate in an art class.
Deeply embedded in BBBC’s vision and practice are the principles and findings from the Marmot review, and its focus on the social determinants of health. Here the centre sets itself apart from most Marmot advocates by moving beyond talking the talk to walking the walk. And, like all walks, the first steps are crucial to success. Here those steps focus on understanding the local determinants of health by listening to locals.
A continual series of programmes are designed to engage locals, understand what they care about and identify particular needs. These are aimed at bringing local residents together through common interests in place, activity, age, and culture, and they form the foundation of knowing and understanding local residents, and motivating, inspiring and supporting them in ways that promote good health.
Some of these activities are specifically targeted to identify vulnerable and at risk members of the community, so that programmes can be designed to serve their needs. People who visit the GP repeatedly is one example of a target group for whom specific programmes are developed to help them become more aware of their health and to demonstrate how the local community can support them in maintaining good health. New mothers are another group that benefit from programmes run by BBBC, and with this group there is an added bonus that many programme participants become invested in supporting other new mothers
This is one example of how the centre ensures its own sustainability. Most if not all programmes run on a “train the trainers” basis where, like the new mothers’ groups, participants gain knowledge and confidence and establish their own groups.
The café, which serves as a hub for locals to eat and socialise is run and staffed by a disability charity, is another example of sustainability – sourcing food locally and from its own gardening projects, and providing employment, training and support for vulnerable members of the community.
The strength in connections between the centre and members of the local community – the continuous practice of listening to locals -- makes another practice at the centre viable and effective - social prescribing.
BBBC’s social prescribing practice reflects the centre’s commitment to addressing the social determinants of health in its community:
“Many of life’s problems can make you feel unwell …..social prescribing enables a GP, nurse or other healthcare professional to refer you to a specialist link worker to talk about the issues you’re facing and find the right services to support you…the service helps you improve your health and wellbeing and to make positive life changes through
Housing, benefits, financial and advice
Employment, training and volunteering
Education and learning
Healthy lifestyle advice and physical activity
Arts, gardening, creative activities
Befriending, counselling and groups”
BBBC gives us an opportunity to see how healthy communities can be created and supported through investment in places, homes, and people. Regeneration schemes and new housing programmes would greatly benefit – and probably gain more public support -- from embedding its principles into their planning. As Lord Nigel Crisp explained to me recently in describing his commitment to promoting the Healthy Homes Bill, “health begins at home; hospitals are for repairs.”
Clare Delmar
Listen to Locals
22 November 2022
