Taking a rigorous evidence-based approach to improving health and wellbeing was seen as a priority by the Mid Essex Alliance. Find out what happened two years down the line, after it engaged Centre for Thriving Places to help it in its mission.
One of the foundational beliefs at Centre for Thriving Places is that a whole mix of ‘shared ingredients’ go into the makings of good health and wellbeing. From good housing to safer streets, to good accessibility and transport – everything is interconnected.
The pioneering professionals at the Mid Essex Alliance have long known this. The Mid Essex Alliance is a partnership of NHS workers, district councils, emergency services, voluntary and community sector partners and education and county council representatives. Together they work together to improve life across three districts in Essex – Braintree, Maldon and Chelmsford. The Alliance aims to tackle major health issues, with a focus on suicide prevention and childhood obesity, through a more joined up and data driven approach.
In 2023, Adrian Coggins, Head of Wellbeing and Public Health and Alison Connolly of Mid and South Essex Integrated Care Board invited Centre for Thriving Places to provide its unique Thriving Places Index (TPI) dashboard, trained on these areas.
The Thriving Places dashboard gives you hyperlocal, up to the minute data – and a framework to bring together budgets, targets and an overall vision.
For a long time, Adrian had felt a whole system approach to tackling inequalities ‘was simply the future.’ His aim? To enable better cooperation across the myriad organisations that make up the alliance, foster teamwork and motivation and make progress on the issues residents care about.
Why the Thriving Places approach?
Adrian Coggins: “Nothing happens in public health in isolation. One element of life impacts another. Even if you know that, the way in which public sector organisations often work – in commissioning projects, setting goals and running projects – does happen in isolation! There is a need to take a place-based approach, which still isn’t understood. There is a theoretical understanding of the fact that so many elements are interlinked – access to green spaces, access to healthy sources of food, easy enough access to sources of local jobs, good quality housing and so on. But public sector staff, especially when they are working with multiple agencies, really need help to make a practical, actual difference. We at the Mid Essex Alliance got in touch with Centre for Thriving Places because we just loved its approach. It feels right to focus on the elements that help people and places to thrive and how they interlink.”
“We had a real need for a data driven, evidence-based and needs driven approach that could be managed across agencies with everyone reporting in on the same goals. Thriving Places provides exactly this. I have a very broad definition of public health. It is not just about behaviour change, telling someone what to do and leaving the blame at their door. What people need is the conditions to thrive.”
“One real challenge is that not everyone in a place will work on your same remit – in my case public health. Their north star may be community cohesion agenda, economic regeneration or housing. The beauty is that the Thriving Places data and approach brings all this together. You can see how the parts interplay.”
“There is a need to make the datasets clear and understandable for everyone. I have seen people absolutely swamped with datasets at a place. Like in The Firm with Tom Cruise where people stack file after file on his desk on his first day. What you need is data that allows you to see the meaningful associations between the wider determinants of health and wellbeing, as the Thriving Places approach allows.”
“The other difference is the personal approach. CTP goes in depth on the practical, personal support – on the ‘how to’. So many people now end up working in places with no knowledge of what a data driven, whole system approach means. CTP helps you to go through a methodologically sound process with them. It’s how you can build a really engaged, positive team.”
The challenges, area by area
Matt Turner is a Health Integration and Community Manager, working in Maldon District, a very rural area with a coastline. He says:
“Maldon is a very rural coastal area, and many of the issues we see and hear about are challenges regarding accessibility to services, mental health and social isolation.”
Joan Ogiugo works in public health at Chelmsford City Council. She says:
“Though Chelmsford is seen as a relatively affluent area, it does have some pockets of deprivation. Obesity and unemployment are core issues. We need to change the narrative – to increase investment in the area. Rates of obesity are also an issue – and so many more factors are linked to this, which the Thriving Places approach helps us to understand. If your transport is poor, it becomes too expensive to access sources of healthier food, for example. Jobless people are referred to training but they can’t afford to travel to get there. All the determinants that go into the make-up of good health are interlinked. It’s hard to quantify how severe the issues that fall under the umbrella of ‘public health’ are. The Thriving Places approach has taught me that we need to ‘zoom out’, to take a wider view, to truly tackle all the different influences. One of the biggest challenges is to help all departments to share the same vision. The Thriving Places approach moves you from an insular view – for instance, about mental health – to what goes into truly supporting good mental health. Access to sources of good jobs, and therefore good transport links, access to green spaces and sources of healthy food and so on. It really opened my view. For example, I hadn’t looked at housing specifically before in direct connection to improving public health. It encourages that wider, fuller look at the world around you, and challenges you to fit together public health and sustainability and wellbeing. They all belong together. Lose one part, and the deck of cards falls down.”
Alexandra Card is a Senior Wellbeing and Public Health Officer at Essex County Council. She says:
“Within Essex healthy weight is high on our agenda. It is an ever-increasing problem, with employment, skills and health not always a joined up as they could be. The NHS now has a unit to help people to get into employment – focused on mental health – which is great but there are still challenges. We need to ‘interrupt the circle’ – to go upstream and help before problems begin. For example, before we get to the point of mental illness, are we looking after mental wellbeing?”
Working with CTP – what was it like?
Joan: “I came across CTP for the first time one year into being an apprentice. At that time everything still felt quite new to me and at first, the data felt overwhelming to engage with, but I soon came to understand it and the rationale. I appreciated the deeper CTP approach to help give answers to my questions. It was great, being able to ask Rachel. Often my questions prompted more questions, which allowed me to dig deeper. The answers I arrived at were unique to my locality and my needs. By unearthing deeper and deeper questions, you begin to address the root causes of key issues in your area. You need to embrace the complexity and interconnectivity if you really want to make change happen.”
“The experience in part led me to study Population Health Science at the University of Cambridge. It prompted me to get on this journey. Public health is so deep – understanding local context is everything. There is so much around really understanding human behaviour. I could try something great in Maldon, apply it to Chelmsford in the exact same way and it might not work. This actually happened! We ran a dementia tour bus in Maldon that was a great success and very well attended. We tried it in Chelmsford and the numbers were much lower. You have to ask questions such as: do people on this area want to be reminded of dementia? Is it so much in their lives already that this is too overt an event to engage with? What approach could work better?”
Matt: “We were excited to work with the CTP team and learn more about their evidence led approach. They held workshops with our partners and encouraged us to use local insight in combination with their dataset to jointly agree our priorities. The team then worked with us to codesign a thriving places grant framework for our wider community network. They facilitated a community of practice with successful applicants, so they too had the opportunity to shape our thriving places outcomes approach. CTP were with us every step of the way and at the end of the project their research team pulled together a qualitative report to help us all understand what we had learned from each other. This report has helped us to further embed our thriving places community of practice across the district.”
Alex: “I’ve had a journey with CTP. I was so excited to work with you for the first time. I love the ethos. It was more than just a dataset – it was about how we worked. Often people talk about the wider determinants of health but then go back to whatever they have been done before. People usually work with KPIs, but the Thriving Places approach makes you think holistically. It was so useful for my professional development. And now I have moved across to Essex, where I was told this would be a major part of my job. I learnt to find the questions, under the questions, under the questions. This led to real change. Place based learning is about more than just doing something in a place – it’s about getting into the heartbeat of how a place works. I have seen that really make change happen. We had several conversations around the dataset and sometimes people want to add things – and you can! It gives you a broader mindset. For example, social isolation really impacts mental health. The approach enables healthy conversations and makes it easier to reach out and have discussions across different determinants.”
“The workshops and working with Rachel helped us to ask different questions. I would say CTP helps put a different lens on things – makes us see how we can get multiple benefits. For example, one thing we looked at in a workshop was a handyman scheme. We were told that one of the major blocks in hospitals is that there are no key safes – because there are not enough handymen to fit them. A recruitment drive here could help free up more hospital beds. It is pioneering stuff.”
Adrian adds: “Rachel has so much experience and I feel am just starting to tap into some of it. As a facilitator she is very astute in terms of reading the room and understanding people’s drives. She is very relationally capable and provides high levels of expertise.”
How CTP’s holistic approach helped to deliver on goals
Adrian: “CTP really helped us in combining datasets. You get a dataset on health, and a data set on housing. I said: ‘we need a SHARED dataset called ‘healthy housing’, which had never been done before. CTP provided it and ran a workshop on it. They unify what has previously been separate and hard to meaningfully interpret. Another example is to look at people who have asthma. The NHS is one organisation which interacts with them, by managing their medication. But if they are living in cold damp housing that exacerbates their condition, primary care caseloads will still be overwhelmed. Now those people have been made a priority to address cold and damp as well as clinically manage their condition. Combining the datasets allowed us to look at and start tackling the two issues together.”
Adrian continues: “The CTP approach has really landed with the three districts. They are taking on apprentices to take on the CTP approach. I truly believe that place-based working is the future of public health. We still have such a strong focus on behaviour change, for example with obesity. To reduce obesity, you cannot shut down every restaurant serving an unhealthy item on the menu, because there are other factors – doing this could destroy the local economy. Place based approaches help you find a win-win. For example, could we find and encourage entrepreneurs offering healthier food choices to create healthier food AND create healthier and more inclusive economic growth.”
“We need a common place-based currency where the job is to maximise the positives for everybody. If everyone signs up to this, progress can happen faster. “Developing a collective place-based approach means leaving egos and logos at the door. You start with an objective dataset, put aside organisational priorities and personal opinion. We need to be a bit more challenging on how we meaningfully bring people together, to create the conditions for people to thrive and stay focused on that goal.”
The roots of wider culture change
Alex: “I think CTP has changed the way I look at places – I now look wider. I was public health focused but now I see that as part of a jigsaw. I am still public heath focused but I understand that it creates ripples.”
Matt: “The Thriving Places approach has helped local partners understand how we can best help local communities to thrive. The process has taught us to listen to each other’s motivations and passions, and to work together to strengthen each other’s work. We are now looking to expand our community of practice across our broader partnership network.”
Joan: “The CTP approach has changed mindsets of department leads at Chelmsford. Trying to get departments to align KPIs is difficult in any organisation, especially when you factor in staffing, time and budgets. But the TPI approach helps transcend that and pinpoint where we are receiving value. The tool shows how things are relatable and interconnected, in an evidenced away. It’s an eye opener. We may feel you have good solid programmes, but we need to take a step back. That’s CTP for me.”
Adrian: “I strongly believe place-based working is the future of public health. This is how to make a difference. Ask yourself, what is the methodological framework for how you set priorities and distribute resources? So often in the public sector the process is to ‘get all the stakeholders in a room’. When you do that, people are bound to try to land their specific priority. It is not a process without bias.. With public money – spending it fairly and justly and assigning it to the greatest need – we must start with an objective dataset and use the collective evidence base to drive what we collectively do. This evidence base is a combination of evidence of need, what the determinants are to address that need, what effective interventions there are, and what is the best way of locally manifesting effectiveness in local communities. If we can turn public health and wider public sector practice towards this approach the evidence suggests we’d be more effective at reducing inequalities, improving health and wellbeing and creating places that thrive.”
Do you want to explore a Thriving Places approach in your area? Email us to set up a chat hello@centreforthrivingplaces.org