Children’s language skills at a population level in Hackney are below the national average by the time they finish their first year of school. Research shows that when children have poor early language, their later life outcomes are significantly impacted: children with poor early vocabulary skills are more than twice as likely to be unemployed in their 30s than those who have good early vocabulary skills; young people who are referred to mental health services are 3 times more likely to have communication needs; and over 60% of young people who are accessing Youth Justice services present with Speech, Language and Communication Needs (Bercow: Ten Years On, 2018). We also know children from socially disadvantaged families are more than twice as likely to be identified with speech and language needs, and that in areas of high social deprivation, like Hackney, more than 50% of children may be starting school with delayed communication skills (Bercow: Ten Years On, 2018).

The project has a focus on place-based working and uniting staff working across Health, Education, and the Voluntary and Community sector in the Neighbourhood to work together with parents around the common aim of improving how we are supporting children’s early language skills.

Project Objectives:

1. Parents will have a good understanding of how they can support their child’s language development at home.
2. The children’s workforce is skilled in identifying children who are not meeting their language and communication milestones.
3. Key settings which a child may access in the early years provide a language-rich environment which support their early language development.
4. Children who are identified as not meeting their early communication milestones are able to access a range of opportunities in their local area which are supportive for their language development.

Outcomes

• The early stage of the project focused on engagement with key stakeholders. This included a stall run at Kingsland Shopping Centre in December 22, and a parent focus group at Clapton Library in March 23, where we were able to have valuable conversations with parents and carers about challenges they faced in supporting their child’s early language development. This feedback helped to inform the direction of this project.

The focus was on supporting residents with accessing healthcare services online, especially for those with long term conditions. The event was created in partnership with the Clissold Park Primary Care Network (PCN), Clissold Park Neighbourhood Forum, as well as other community and healthcare organisations. It was the first joint Primary Care Network (PCN)/Neighbourhood event for Clissold Park. The PCN health equity lead chaired a partnership group bringing key stakeholders including secondary, community and voluntary sector partners together.

The Neighbourhood Forum supported this event by providing funding and arranging the logistics of the event. Barriers to accessing information had been identified as a significant issue for residents at forum meetings. The Clissold Park PCN was keen to respond to resident insights gathered. The digitalisation of essential services, such as hospital appointments, transportation, and prescription orders, means those who are not digitally included can be impacted as a result. The Forum’s involvement aimed to help reduce the impact of digital exclusion by empowering residents with the tools and knowledge to access digital health services.

The 4 surgeries in Clissold Park Primary Care Network – Brooke Road, Barton House, Barretts Grove & Somerford Grove – each had stalls at the event. Staff were helping patients navigate their websites and online services. The PCN team including dietician, pharmacists and first contact physiotherapists were able to speak to residents about the services they offer within the surgeries. Digital buddies and the NHS app team were on hand to support residents taking their first steps to using the app.

• Organisations represented at the health fair:
• Clissold Park PCN
• Neighbourhood Forum
• Brook Road Surgery
• Barton House Group Practice
• Somerford Grove Practice
• Barrets Grove Surgery
• Hackney Library Services
• Moneyhub
• Hackney Council Housing
• Hoxton Trust
• MRS Independent Living
• Shoreditch Trust
• Homerton Locomotor Services
• Hackney Healthwatch

Outcomes

• Participant feedback
• 73% had not used online services (GP websites, econsultations, self-booking SMS links or NHS app) prior to the event
• 82% agreed or strongly agreed that the event met their needs
• 88% agreed or strongly agreed that the event improved confidence or knowledge about the online support available
• Clissold Park Primary Care Network will use the insights gathered to plan future events.
• The Neighbourhood Forum’s new Action Group will be discussing digital inclusion as a potential priority to focus on this year

Autistic people experience high levels of health inequalities compared to their non autistic counterparts. They are more likely to develop a range of health conditions and are more likely to experience mental health issues. Current research shows that autistic people experience barriers when trying to access healthcare services including things like professionals having inadequate knowledge or holding incorrect assumptions about autism as well as patient related factors such as being able to manage the sensory environment of healthcare settings themselves. Difficulties accessing primary care services can lead to significant consequences such as untreated mental or physical health needs and more frequent visits to emergency services.

Contrary to commonly held myths, many autistic people are interested in social connections with others. Autistic people often rate themselves as lonelier than non-autistic people, despite wanting same levels of social connection. Heightened levels of anxiety, previous negative experiences when socialising, others lack understanding and awareness around autism, sensory avoidance and masking are associated with increased loneliness in autistic adults.

The Autistic friendly pilot in London Fields aimed to remove some of these barriers experienced by autistic people in primary care and looked at how to make GPs more accessible so that autistic people can get the healthcare they need, at the time they need it, and to prevent healthcare crises further down the line. The project also widened its scope by looking at accessibility of community spaces and how to promote autism acceptance as well as support our public spaces to be more accessible to autistic people in the community.

Outcomes

• The Autistic friendly pilot key achievements:
• • Creation of the City and Hackney Autistic friendly standards, coproduced guidance designed to support local businesses, community spaces and health and social care settings to self-audit their accessibility to autistic people and then develop a plan to become more welcoming to autistic people visiting or using their space.
• • Hackney Museum becomes our first community autistic friendly space which has included all staff attending codesigned and co-delivered training around reasonable adjustments, a social story for schools visiting the museum, adaptations to the website. Mayor Woodley visited the site In December 2023 and made a pledge to support the work as part of Hackney becoming an inclusive borough.
• • The London Field Primary Care Network were involved in the NHS ENGLAND pilot for autistic specific annual health checks.
• • In January 2024, Beechwood Medical practice becomes City and Hackney’s first autistic friendly GP practice, by completing the autistic friendly checklists for Primary Care Networks and health care settings.
• • A number of codesigned autism acceptance training sessions (delivered with a lived experience expert) have been delivered to different professional groups (including community navigation, GP practice staff, care service providers). We received very positive feedback, with many attendees valuing the perspective of an autistic person.
• • In June 2023, we hosted our first Autistic pride event at Homerton Hospital, a coproduced event where local autistic residents and people who work with the autistic community came together to celebrate autistic talent.

Over the past two years, The Adult Community Nursing Team has undergone remodelling work to deliver their service through eight Neighbourhood Nursing Teams alongside a new Single Point of Access (SPA). Moving from larger cluster localities to eight Neighbourhood Teams has been beneficial in providing smaller and more multiple teams, able to focus on the needs of their local populations.

There is now one central point for triaging referrals to the SPA clinical staff who can carry out initial assessments for patients new to the service and manage short episodes of care; like blood tests and post-operative wound care. This means that those patients requiring longer term care can be triaged or transferred to their relevant Neighbourhood team so the nursing team can really get to know their local patients and their holistic needs. They also have a good understanding of local services & practitioners who can support them in their care.

Key Leads:

Dr Shaine Mehta -Quality Improvement Clinical Lead GP Confederation & Diabetes Lead in City & Hackney

Shanaz Begum – Health & Wellbeing Coach, Shoreditch Trust

Outcomes

• Although it was challenging to support the team through changes in roles, teams and processes, restructuring has meant managers can better identify specific Neighbourhoods with high demand and can distribute work evenly across the borough to prevent staff burnout.
• The new Single Point of Access has made it easier for management to collect data from one central place on the nature of their referrals (who they’re coming from and what for) meaning they can better plan the service.
• Having smaller teams with dedicated budgets works well both for GPs who now have a few local named contacts who they know and can easily contact.
• Neighbourhood Multi-disciplinary meetings have been great spaces for nurses who cover that patch to get the expert advice they need from other professionals involved in a patient’s care, as well as pulling in specialist advice quickly where necessary.

Southgate Road Medical Centre in Shoreditch Park and City Neighbourhood saw the pandemic significantly impact patient’s levels of physical activity and ability to manage their weight. In response the GP Practice aimed to increase the amount of referrals to North East London NHS’s Digital Weight Management programme.

In order to make sure as many referrals as possible were successfully taken up, additional wraparound support for patients was brought in. The GP Practice trialled the use of a local Health & Wellbeing (H&W) Coach to initiate contact with patients at the surgery who had diabetes or hypertension who were identified as being overweight. The intention was that having a professional H&W coach start a conversation about weight management with a target group of known patients, would mean the individuals may feel more informed and confident about accessing weight management support.

Key Leads:

Dr Shaine Mehta -Quality Improvement Clinical Lead GP Confederation & Diabetes Lead in City & Hackney

Shanaz Begum – Health & Wellbeing Coach, Shoreditch Trust

Outcomes

• The practice has the highest referrals to Digital Weight Management (March 2022) and accounts for 25.9% of all practice referrals from City & Hackney (October 2021).
• 40% of patients accepted referral to a weight management programme following a consultation with a H&W Coach
• For patients, being informed that somebody will call them about weight management helps them to feel prepared and gives the coach a better opportunity to spend more time on talking about the programme in-depth if asked.
• Calling at a time not too early or late in the day and sending a text with a link to the Digital Weight Management Programme information in advance was useful for patients to think about before a call

Whole person approach to mental health

Neighbourhoods Mental Health Team was developed to support people who have serious mental health care needs, as well as wider social factors that may be impacting their life. The 8 Neighbourhood teams take a multi-disciplinary and trauma-informed approach, involving a broad range of support and expertise so that they can consider all the health and social care factors and complexities impacting on someone’s mental health.

Outcomes

• Previously referrals would have come through a central assessment team on a weekly basis. Now each Neighbourhood team looks at their specific area’s referrals and follow up at a daily meeting.
• The range of groups and activities in each Neighbourhood are specially curated, working with the local voluntary sector. This includes social activities, trauma-informed and psycho-educational groups, and sports.
• Working on an open access basis means once you are successfully referred you become a ‘member’ of the service and can access support for up to 2 years without having to be re-referred. This means you can quickly get support if your mental health starts to deteriorate.
• More partnership working is happening between mental health teams and local support services.

Hackney Playbus run stay and play sessions for families with children under five. The charity regularly attends Neighbourhood Conversations in all eight Neighbourhoods to link up with local services and people and learn about new opportunities for them to collaborate with other services to bring families’ support to their doorstep.

Outcomes

• Neighbourhood conversations have provided a dedicated space to learn about what other activities and events are going on in the Neighbourhoods.
• Accessing services can be difficult. By linking in with new services at Neighbourhood Conversations and bringing them to the community in the bus makes them more accessible.
• Grant funding from Neighbourhoods to renovate the bus has improved its exterior and created an even more interactive space for the children.

Accessible services for children and young people

Well Street Common Primary Care Network appointed a Social Prescriber role to support children and young people (age 0-25) and families as a whole to access local services and support.

The experienced Social Prescriber can create personalised action plans for individuals, and has begun working with local schools to better connect them with local health, social care and voluntary sector support, and act as a link between the schools and GPs as necessary. 

Outcomes

• Families appreciate direct access to support rather than navigating a range of local services alone
• Some families feel more comfortable accessing this support since the role has no affiliation with social services
• Families working with the Social Prescriber in the medium term experience increase in self-confidence, motivation and general wellbeing
• Parents and carers report being listened to, and supported to engage with services including social care where necessary
• Children and young people are made aware of the local activities available which are relevant to their interests

Bringing communities together after isolation

Working with the local authorities, donations and funding from the Neighbourhoods grant, the Newington Green Alliance in collaboration with Minis Kardes organised the ‘Unity Festival’ to bring their community together after pandemic restrictions eased. 

The festival celebrated the diverse area by hosting music and food from the different cultures in Newington Green, and brought a great sense of community cohesion. 

Outcomes

• Neighbourhoods funding provided budget towards the stage, and advertising
• The Neighbourhoods Conversation provided a forum to advertise and collaborate with other organisations and residents
• The event provided an opportunity to bring local people together in celebration and mourning following the first 18 months of the pandemic
• New connections have been fostered to support further collaboration and sharing of cultures and resources in the area