How to… scale up community development for health

Many health commissioners would like to use community development to boost health on their patch but don’t know where to start. A new handbook by Gabriel Chanan and Brian Fisher offers a step-by-step guide.

Community development (CD) can be a confusing and contested field, overlapping with newer concepts such as asset based approaches and health creation.

Different practitioners swear by different methods, and it is often unclear how results can be assessed. Additionally, the demise of national CD umbrella groups in England during austerity has left few visible sources of authoritative guidance. At the same time, new conditions and policies in health and care demand some rethinking of CD experience.

Drawing on wide sources, we therefore set out to reframe how CD should be applied in the health and care field now. The result is our handbook, Commissioning Community Development for Health, just published by the Coalition for Collaborative Care.

Where most CD literature addresses the concerns of practitioners, we adopt the viewpoint of commissioners. The resulting framework has some new features. It focuses on the tools needed to set up and oversee the project, aiming to reach ultimately the whole population of the area, neighbourhood by neighbourhood, and the whole sector of community groups that are active there. And it stresses objective evaluation of results, by levels of community activity across the population, strengthening of the community sector and improvement in responsiveness of public service agencies towards the community.

We outline a five year project conducted in three stages, each stage dependent on demonstrable progress in the one before it. The aim is to improve health and care both directly and through the full range of social determinants. So a partnership project with the local authority and other public services is the best vehicle. This would also, of course, help mobilise shared resources and investment. But if a partnership can’t be established at the start, it can be built along the way.

To achieve significant health improvement across a CCG area over five years might need a staff team building up to 15 people. Pooled resources could be largely in the form of staff secondment rather than cash. Many public service delivery agencies, whether located in the public, voluntary or private sector, have some personnel working on community involvement.

Since these are usually very few in any one agency, they often feel isolated, lack peer support and lack leverage in their own agency. Additionally, the definition of community involvement to which they are working could well be unnecessarily limited – a common source of frustration, since communities often see the links between issues more clearly than specialist agencies. A successful project design could bring together many of these workers around a shared agenda and clear leadership, permitting fruitful cross-referral and richer feedback of intelligence to their parent agencies.

The first stage establishes priority neighbourhoods, and profiles the current level of community activity, the extent and condition of the community sector and any existing CD input. Existing activity should always be valued and built upon, not bypassed. The second stage provides eighteen months’ support to a first wave of priority neighbourhoods, stimulating new community groups, boosting existing ones, improving networking and collaboration and above all spreading the ethos of active involvement to the uninvolved majority. The health value of participation is well researched but what is often overlooked is the need to demonstrate increase in participation itself.

The third stage moves on to another wave of neighbourhoods while providing a maintenance service to the first wave. The conclusion of the project, with well organised evidence and specific learning about local issues, should inform discussion of how the methods can be refined and extended to the whole area.

The handbook offers concepts and tools to help in setting up this process. Following a concise explanation of CD and its role in relation to current health policy, sections deal with selecting neighbourhoods, building cross-sector partnership, criteria for the project leader, a model contract for the delivery organisation, menu of indicators for evaluation and an example of what successful results would look like.

All this is done as concisely as possible, not only for digestible reading but because each of these factors will have its own local variations and complications. We have provided, we hope, a framework which will enable commissioners and their partners to keep all these elements in a coherent perspective while they wrestle with the local factors which only they know in detail.

Will practitioners be able to deliver this new kind of project? If commissioners are clear about what they want, skilled practitioners will find the ways to deliver it. That said, the handbook only provides the framework. Applying it in specific local conditions needs a lot more input, and we will be travelling alongside both commissioners and practitioners to give further help, learn more about the challenges and develop additional materials.

• Read the handbook here.