60. Bill Graham - universal healthcare in action

We are nearing the end of our mini series of podcasts about universal healthcare, in collaboration with London South Bank University and the Universal Healthcare Network.

With the NHS experiencing overwhelming demand, we need radical transformation with more power and resources within communities.

So today, Bill Graham, who is a Community Coordinator with Modality Partnership, focuses on community-based solutions!

Bill talks about the need for primary care to engage with communities and gives examples of how this works in practice, e.g maximising COVID-19 vaccine uptake among Asian populations and increasing childhood vaccination rates.

Bill highlights the success of community-led initiatives, such as health checks at sports events and baby days in shopping centres.

Bill also mentions the multi-generational home visiting project and digital outreach initiatives to enhance patient engagement. He calls for more investment in community solutions and stresses the importance of practical, asset-based approaches in healthcare.

Lemon lightbulbs 🍋💡🍋

🍋 Magic happens when primary care breaks out of the day-to-day cycle and starts to do things differently … High Street health!

🍋 Engage with local communities - they have a vital role to play in helping people look after their health
 
🍋 Get out and about, build relationships with your community and find out what is important to them

🍋 This episode has lots of practical examples of how to make healthcare more accessible by taking it out to where people are

🍋 Be culturally curious and find out what works for different populations

🍋 Shift power and  be imaginative with resources

🍋 Be proactive – if people are not coming forward for health checks, try multi-generational home visiting?

🍋 Support family carers too - often the unsung heroes of health care

🍋 Turn theory and data into ACTION to address health inequalities

🍋 Volunteers can help people access health-related technology and start to close the digital divide

🍋 Don’t overthink things – start somewhere!

Some  links :
Universal HealthCare National Inquiry
Easy Read Executive Summary
10 Leaps Forward - Innovation in the pandemic
Noreen Bukhari - supporting women from ‘BAME’ communities
Gill's Universal Healthcare work with MPFT

#coproduction #communities #funding #equity #healthinequalities #storytelling #passion #QI

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Chapters

• 0:00 Introducing Bill Graham
• 3:55 The magic is possible when GP practices are willing to come together as one primary care network
• 5:35 Come up for air. Get out of the day-to-day cycle and start to think about doing things differently.
• 6:39 Get to know your local community - get out there and build relationships
• 7:57 Turning theory and data into action to address health inequalities
• 9:28 It might not be perfect first time – but you need to START SOMEWHERE rather than just sitting in a room looking at data
• 11:40 Working together, even when imperfect, builds relationships and trust. You stick around and figure it out together.
• 12:16 Bill starts to give examples – the update uptake of Covid vaccines, particular amongst Asian populations
• 13:20 Tapping into what works for different cultures and groups by working WITH people
• 14:10 Another example – testing for undiagnosed hypertension or high blood pressure– at a rugby sports event!
• 14:57 Support for young families and babies – childhood vaccinations and more, with baby days in the shopping centre!
• 16:37 If you make it fun, with activities for the children and so on, you pull people in
• 17:25 Cancer prevention – via Women’s Health month and cancer champions programme
• 17:57 Increasing the uptake of preventative services amongst those who would not normally access them reduces health inequalities.
• 19:09 The community can really help with all of this!
• 20:00 The postcode lottery of average life expectancy! Shoutout to Dr Farzana Hussain doing similar work in East London
• 20:56 Being accessible is the key – why Bill loves shopping centres!
• 21:26 Support for family carers too - often the unseen heroes of the health service
• 23:49 Support for people with learning disabilities - Health Assessments as part of a fun day out
• 25:54 Being proactive. Multi-generational home visiting, taking primary care to the people
• 26:12 Success in getting people who need to, to make appointments at the GP surgery
• 28:41 Digital outreach work - fabulous examples of volunteers helping people get to grips with NHS App and other helpful health-related technology
• 31:12 So, how would you define this innovative approach? High Street health!
• 31:45 A simple call to action – don’t overthink everything. Be brave and imaginative with resources. Start somewhere!

Transcript

Bill Graham

Fri, Sep 20, 2024 12:23PM • 38:54

SUMMARY KEYWORDS

work, primary care, community, carers, health, services, keithley, talking, folk, appointments, challenges, patients, people, day, bill, practice, building, community partners, uptake, checks

SPEAKERS

Bill Graham, Gill Phillips

Gill Phillips  00:11

My name is Gill Phillips, and I'm the creator of Whose Shoes?, a popular approach to coproduction. I was named as an HSJ100 Wild Card, and want to help give a voice to others talking about their experiences and ideas. I love chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of health care, and like to hear what other people think or perhaps even contribute at some point, ‘Wildcard - Whose Shoes? is for you. So thank you for following this mini podcast series using our Wildcard: Whose Shoes? platform to discuss Universal Healthcare with the people who are actually making it happen. The series is in collaboration with London South Bank University and the Universal Healthcare Network. Today I'm talking to Bill Graham, who's another close ally of Professor Becky Malby. Becky is a co-author of the Universal Healthcare National Inquiry Report and the mastermind behind this set of podcasts. She will be back in the next episode telling us what she thinks about the conversations we've been having and how we can all take this forward. Bill is in an innovative role, serving as the linchpin between the community and primary care in West Yorkshire, building on the last episode with Kim Shuttler, who talked about the important role of the voluntary sector in transforming health care, Bill will give us some great examples of how this all works in practice, reaching out to where people are and helping them transition back to the NHS. So welcome Bill! Can you start by telling us a little bit more about yourself and how you got involved in this groundbreaking work?

Bill Graham  02:06

Hi, Gill, yes, thanks for asking me on the podcast. Yeah, my name's Bill Graham. My background isn't a health professional background. My background is more in community and social enterprise. So I kind of come from a different perspective to the challenges of primary care. So, you know, a lot of my work leading charities, working with community associations, and I was in that side of the fence trying to link in with health, and trying to show how communities and people could help some of the challenges and the health system and Leeds was facing at the time. And we took some of our projects from being grant funded to commissioned, and we built a fantastic community centre on a very, very, you know, a fantastic part of Leeds, but also a very deprived part of Leeds, yeah, but really showing how investing in community can really help produce better outcomes for people's health and opportunities in life. Then I got the opportunity to join the Modality Primary Care Network because one of the GPs I worked with in Leeds joined this Modality primary care network, and they wanted someone to come and maybe connect themselves better into their community. So I moved over there almost six years ago to work in Keithley, Airdale, parts of Washdale, and up towards Cleveland and Skipton, where we've now got eight GP practices, which we've merged together. We've got one big practice. So one practice, one primary care network with about 90,000 patients. So for me, that's been a fantastic opportunity to work with a primary care network that's determined to make the most of what a primary care network can be.

Gill Phillips  03:54

And a big one!

Bill Graham  03:55

And I think we're a really good example of what you can do if the constituent parts of a primary care network, which tends to be independent. GP practices are actually willing to come together, merge and become one practice, one PCN. It makes the whole process of doing the work I do a lot easier and to then bring in the resources to deliver the work I deliver as well, which is also something I I do.

Gill Phillips  04:21

So this is the fourth in our series of talking to the various guests, and we've heard quite a lot about what the challenges are coming through in terms of doing this work, and I'm sure you've got a lot to say about that, Bill, but if we can focus as far as possible on solutions now, you know, what can people actually do, to reach out, in the way that we're talking about to the community, and get people involved in their own health care?

Bill Graham  04:48

Yeah, I think, I think in primary care, again, as someone who's kind of jumped over the fence from the sort of voluntary community side into the primary care site, and. Yeah, it's actually a real privilege to see how general practice operates. And I don't think the general public really understand the, you know, the sort of the challenges general practice has on a day to day basis, about how it deals with the demand, about how it's an open door service, about how patients themselves can be very critical of the service they receive from general practices, and currently there's a lot of press and media about general practices around the country. So to be able to get behind the scenes and see how it operates, for me, has been it's been a real privilege. And I think the biggest challenge with general practice and being able to work with communities as in many ways, I think, general practices, they open their doors at eight in the morning, and when they shut their doors at six, they've survived the day and the next day's the next day, because they're focused on getting through the day quite often. Because quite often, understaffed, under resourced people will be off sick. There might be a lot of demand that day. And how do you deal with those challenges? It's really difficult. And for me, again, coming from the community side, I think a lot of community organizations work like that as well, where they just deal with the day-to-day challenge. So I've always thought you've got to get your head up and try and get yourself out of the day-to-day cycle and start to think about how you can do things differently. So first of all, the first solution, I always think, is trying to make some time to understand what's around you, to understand your community, get to meet your community and see how people and communities can help with some of the challenges you've got with that day to day issue. For me, then it's about, you know, those solutions. It's building those relationships. It's getting out there to, you know, and to build a relationship...  it's easy to say 'go out and build relationships', but the practicality of that is, what do you do? And what I would tend to is having walk around my local area and get a feel for what happens in your local area, and get to meet and talk to people. And then I noticed that being visible, being present in your community on a regular basis, and getting to know people, that's the key that helps you build that trust and get to all people and getting them to understand the challenges that we face and the challenges they face, and how we might work together on those problems. So I think that for me is the key building block and how we face up to these challenges, and that's the key part of solution, because unless you've got that in place, then you won't really find out what the answers are.

Gill Phillips  07:38

Yeah, and I think there was something around targeted work with communities really building directly on what you've just said, Bill, in terms of, this is the problem, this is the problem we're trying to solve, and bring community partners in to help with that specific problem is that one of the approaches that you're using?

Bill Graham  07:57

Yeah, I mean, I've always referred to it as it's a flexible approach that uses the data as well. I think the health service has got lots of data about what problems are about things like health inequalities, and it's great having that data, but you need to have a real flexible approach how to start to come up with plans about how to actually do stuff. In Kim's podcast that I was listening to, it was that idea of starting somewhere. And I'm a great believer in this, you start somewhere. You know, there's we can all sit round tables and plan and design and think about what a really good project would be. And in the health service, I think, you know, there's a lot of people, you know, a lot of people with a lot of brain power thinking about what the solutions can be. You know, yes, I'll get involved in processes like that. But I don't think anything beats just getting out there and getting something started, getting it going. And I think you learn as much by doing stuff as you will, by trying to produce the perfect plan on a on a table that you then try and implement. I'd much harder be out there getting something underway, and then you just pivot and adapt as the work continues. And that, for me, is the key thing. And I think we can be very guilty of sitting behind our desks and thinking about the problem and coming up with those plans. Well, for me, you know, rather than sitting behind the desk thinking about problem, I'd rather be out in the streets walking about, meeting folks, sharing the problem and then starting to do something about it. And it might not be right first time, but you know, by finessing what you do and working with partners, you know, you come up with a better solution, I think so that's always been my way of doing things. I'd rather be doing something than just sitting thinking about a problem and trying to come up with a solution, in a room with other people. I don't think that's the right way, and that's a bit of a top down way of doing things as well. I think people would say the way, the way I work, is that kind of asset based way, using what's around you, using the assets in the community, using the people around you in the community to help you come up with the answers, rather than thinking you can come up with the answers yourself. Rather than sitting in a room looking at the data. Anyway, that's that's just me, Gill.

Gill Phillips  10:22

And it's not just you in that, I think you've picked up there, Bill, really strongly that, kind of, call for action that's been running through the series in terms of the people I've been talking to, and obviously through the report itself. You know, I think one of the strongest recommendations is, is to start somewhere. Yeah, and I love the simplicity of that. And just hearing you talk feels exciting. You get out and you talk to people, rather than talk about them in a closed room and wondering what to do. And it just feels as if that way you start to hook people in to want to work with you.

Bill Graham  10:56

Yeah. I mean, people talk about things like coproduction and codesign all the time, but I think in reality, there's not a huge amount that goes on. And I think coproduction and codesign is actually getting out there and getting people involved. I think you have to accept that when you work with communities and people, it's going to be a bit messy, and it might not always go to plan, but I think if you accept that, then that's fine, you know? And, like, I say, it's better to be doing something and it's a bit messy than not to have done anything at all, yeah, and you're just worried about, you know, oh, we may do it this way, and it may get a bit messy. Don't worry about that. And the thing about things, if you do stuff with people, and things do get a bit of messy, but you're happy to talk about that. That kind of builds your relationships. It builds the trust between you. It shows folk that you're not a 'here today, gone tomorrow' type person: 'oh, they've encountered a problem', you know, if it's services, try and do something before they come along... if it doesn't work, they disappear. You know, you're kind of in there for the long term, and you're accepting it may not work first time, but we're going to stick at this, and we'll make it work, because the data tells us there's a problem here. So let's figure out a way to sort out together.

Gill Phillips  12:03

Brilliant. So what kind of examples? And I've heard bits and pieces about what you're up to, what could you tell us in terms of the practical examples of going out and reaching out to the community where they are? 

Bill Graham  12:15

Well, there's some terrific work we've done in the last few years. I think we always start with the COVID vaccination program where, because we had some great links into our local communities, we were able to really maximize the uptake of the COVID vaccines, particularly amongst groups of Asians who maybe were were a bit hesitant about vaccines at the time. So some of the Asian populations, some of the younger members of the population, we did lots of focused and targeted coproduced work. You know, we ran lots of education sessions. We ran lots of stuff on things like social media. Then we actually ran the sessions themselves and kind of shopping centres, mosques, churches, community centres, you know, we got out and about and delivered that work in the community where people were, which I think was hugely important, and also took advantage of the the voices of the leaders of those communities themselves. And also using the way different communities use different ways to communicate. You know, an example is the, you know, the Asian population easily use whatsapp groups, often as their means of communication, or they have the mosque radio is something they use. So taking it back, you know, getting to know your community. You understand how they communicate with each other, and you're able to take advantage of that, which I think's hugely important as well, and that gave us some fantastic links with a lot of community organizations. So now those networks were built up that trust we have with lots of different communities and groups around our area. We use that now to help us come up with the challenges we have in healthcare in our part of the world. So it's things like undiagnosed hypertension or blood pressure in general terms, and we go out into community settings. And a good, great example is we were at the rugby league game in July, where we have a rugby league team in Keithley  - Cougars - and last year we were playing Bradford. This year they were playing Rochdale. But we are there with our stand, and we work with our community group partners. We've trained their community workers in helping us do things like blood pressure and health checks, and we're out there getting the those middle-aged men that we know have undiagnosed hypertension, but we're turning up at a sports event where they may be. You know, kind of thinking about events. Where are the people going to be? It's much easier to go to where the people are than get the people to come to you. And the rugby league game's a great example of that. Other examples of going to where the people are is, you know, we've been on the road all summer. Actually, we've been at Yorkshire Day. So again, you're in this town centre. They're celebrating Yorkshire Day, lots of activities and things for the kids, things for the family, and we're there doing well-being checks, blood pressure checks, so really spreading the word about that sort of thing. And it's not just about hypertension. So the other challenges we have in Keithley is young families and babies. No, there's not a huge amount of support for young families and babies and and from a family care point of view, we have a low uptake of some of these childhood vaccines, right? So we've, we work with our community partners, and there's something called the maternity circle, and we've got other services, as well as some statutory services. We run our baby days, and we run them from the shopping centre. So again, it's, it's not in our primary care surgery setting. We're out in, you know, the shopping centre where we know there's going to be people, because people are out shopping, and we're there, able to catch the people with their prams as they're coming back. You know, are your kids up to date with your immunisations? Do you want to meet some of the community support that's available for young families? And it's hugely successful, and we've taken those immunization rates and Keithley from around 60% up to 90% in the last months, Gill,  you know? It's a fantastic example. And across Bradford, there's an issue around uptake of those Measles, Mumps, Rubella vaccinations, and I think we've shown a really effective way of working. We couldn't have done it without the community partners, because they have those activities that the kids, the little kids, see and they want to take part, and then that gives our nurses a chance to talk to them. All the community workers that are working with the families will be there, encouraging the families to make sure they're vaccinated, or have they had their baby checks up to date. And we've even now got those community groups running sessions, which is fantastic as well. So, I think in some ways it shows the hollowing out of health services. I think district nurses and health visitors used to do that, but they don't tend to do that anymore. So that's something general practice has lost over the last maybe 10, 15, years. But we're coming up with a solution with community partners to deliver that work.

Gill Phillips  17:21

It's solution that really makes sense, doesn't it? 

Bill Graham  17:23

I think so, yeah. Cancer, the prevention of cancer, there's another one! So next month, we are running our Women's Health Month, and again, it's with our we have community organizations. We've trained 20 cancer champions. So these are ladies from lots of different communities who are out there encouraging people to take up the offer of the cancer prevention services that are out there, whether it's the bowel screening service, breast screening service or the cervical screening. Because, again, and Keithley, we have a lower, you know, proportionally a lower uptake of cancer prevention services. And so that the upshot of that is that in our local hospitals, we have a higher number of people presenting with later stage cancer. So you know that the aim there is, obviously, if we can increase the uptake of the preventative services, then we might see less people presenting at accident&emergency or in secondary care with late stage cancer, which might have been preventable. And again, the figures from around the country will show those parts of the UK where people are very high users of the preventative services when they're offered, and they have better outcomes. They might have longer life expectancy those parts of the world, and we work across from Skipton to keep playing. We know that the life expectancy between Skipton, which is quite often voted one of the best places to stay in Britain, life expectancy between that in Keithley, which is pretty often voted one of them less enticing places to stay in Britain to put it politely, the life expensive differentials about maybe eight, nine years.

Gill Phillips  19:06

It's huge, yeah.

Bill Graham  19:08

But then, but, you know, very focused on, how can we use our community partners to help us with that big challenge? So the challenges don't have to be small or unimportant challenges. I think we're talking about undiagnosed blood pressure, we're talking about baby's health and young family's health, and we're talking about cancer. We can probably take on some of those really big challenges that the health service faces, and we can come up with solutions that the community and the people in the community can really help us with, and having people in the community trained as cancer champions, encouraging the folk in their communities to take up those appointments or take up those offers of cancer prevention and explaining what it is and what it is is really important, Gill, and I'm really looking forward to seeing the results of that type of work as well. 

Gill Phillips  19:58

I think it's fantastic work and I think for me, it's exciting as well, in terms of the podcast series, because the very first guest that I had, and again, a friend that I've made through Becky Malby, was Dr Farzana Hussain, a GP in London. And what you're saying obviously, completely different part of the country, but just the same issues, in terms of, I think, if you catch a train across London from east to west, there's something around each mile or two adds an extra year to your life in terms of average life expectancy. So it's all these health inequalities, isn't it? And again, Farzana came up with really innovative ideas and during the pandemic of getting those babies to come along to clinics and building trust with the Asian community and various communities in terms of finding out where they're coming from, to understand what's going to actually make them say yes and want to take up the offer of healthcare services. And it's trust, isn't it? In relationships. 

Bill Graham  20:58

Trust, relationships, it's being accessible. That's why I love the shopping centre. You know? I love being in the shopping centre because whatever you say about general practice, and maybe people aren't sure about how to access them, or it may be difficult to get an appointment - if you're in that shopping centre, you've got a lot of people walking past and seeing what you're trying to do. So we've done we've done baby days, we've done lots of vaccinations from there, we've done, obviously, flu campaigns as well. We've done diabetes days, we've done mental health promotion work from there, we've delivered work-around health checks and events to support our carers as a carers day, we run, every year from the shopping centre, where we invite our carers along to maybe have a health check, maybe speak to health professional, or maybe just have a massage, or have some services there may always have some refreshments and food. And in some ways, we also say that's a thank you to the carers. They'll be happy, looking after folk locally, because sometimes it's the unseen, the heroes of the health service as well. 

Gill Phillips  22:03

It really is. 

Bill Graham  22:04

And again, we link up with those community organizations who work with carers. We couldn't do this, we can't do this on our own so our local organizations, like Carers Resource and Keithley Healthy Living, they'll be there to support us, and also gives the carers the options you know, they can see what additional support might be available for them, for them in the community. So I think working that way is great.

Gill Phillips  22:25

I'm so glad, Bill, that you've mentioned carers, because, as you say, they can be really unrecognized, and I should think that's not only effective in terms of offering people the health checks and so on, but massively appreciated. So thank you for doing that. I do quite a lot of work with carers, and I just know how they're putting somebody else's health needs or just life first and getting that opportunity for somebody to to look after them. Don't underestimate how, how well you're doing there, I think.

Bill Graham  22:53

It's one of the best days of the year for me. 

Bill Graham  22:55

Is it? Yeah, I can believe it. I can feel that.

Bill Graham  22:58

Since I've turned up, I always make sure we do a do the Carers Day, during Carers Week. Carers Week's always in June. And we always have a Carers Day, one of those days in June. And the last few years we've run it out the shopping centre. And the thing is, people who care for folk, even in wheelchairs. The thing about the shopping centre is it's incredibly accessible, because they always know how to get to the shops. And the other thing about carers, they can obviously bring the person they care for as well, because quite often people who care for someone, they don't want to leave that person on their own. And we think the shopping centre is a place - we know from the feedback- it's a place people know they know how to park, or they know how to even get the bus there, beside the bus station. And it's all in the one level. It's easy to get in and out of even if you're in a wheelchair. And that, for me, is important as well.

Gill Phillips  23:46

It's simple, which makes it brilliant, I think.

Bill Graham  23:47

Yeah, no, no, it's good. And just touching on that, you know, just another group that we target with some of this work is a learning disability, patients with learning disabilities or mixed ability, I much prefer saying, and those mixed ability patients, we run events for them to come along to have their annual health check. We've run them at the Rugby Club, and again, we have the local VCS and charity organizations that support those with learning disabilities come along as well, so that people have the opportunity, if they haven't already, to get to know the people who might give them additional support, help, days out, you know, chances to get together, to meet and get together. So, you know, for me, that's another really important -  all patients are important, but that's a really important group of patients to make sure that we're doing as much as we can to support them and help them, and make sure they're aware of the help that's available in the community as well.

Bill Graham  23:48

So what I like about that is something like the annual health check for people with learning disabilities is a requirement, but you're turning it into an opportunity to offer them more. 

Bill Graham  24:12

Yeah? Well, absolutely, yeah, yeah. 

Gill Phillips  24:57

And that's what needs to happen, isn't it, rather than a tick box somewhere that you know something like that is an opportunity as well as a task to be delivered. And I can feel you doing that, Bill.

Bill Graham  25:07

Yeah, our links with the rugby league team means that we run our Keithley event at the rugby league ground. And if the weather's nice, we have the kids or the people learning disabilities, we have them on the pitch playing games with the International mixed ability, sport charity.

Gill Phillips  25:22

Oh my goodness, right!

Bill Graham  25:24

And we have them playing games, and they have a great day out. And obviously we, you know, we make sure there's some sandwiches and a cup of tea there, so that, you know, everyone can get a cup of tea and a sandwich. The carers obviously enjoy that as well. So, you know, the Health Check is part of the day. But, you know, it's also a lot of fun, Gill.

Gill Phillips  25:41

Yeah, brilliant. I love it. Yeah. 

Bill Graham  25:43

And it should be fun.

Gill Phillips  25:45

It should be fun. Yeah, life should be fun. So if you can build these things into day to day life, rather than a separate appointment in a building, that's what it's all about, isn't it? 

Bill Graham  25:53

Yes. So there was a couple of other things I wanted to mention. I mean, I said there at the start, we do a lot another project we've just started as our multi-generational home visiting, so we talk about taking primary care to, to the people, so we can identify, obviously, people who aren't turning up for their primary care appointments. So they're not coming to our GP practice. And in many ways, I think, you know, GPs will be...'well, that's somewhat that we don't do because they're not attending'. So we've got an active project at the moment where we're actively going out to folk, and it tends to be multi-generational households we've identified. So we'll identify households, but with various, you know, there might be several people in that household of different ages. So we are going out there and we're having an appointment with them, we'll have maybe a GP or a nurse, maybe a pharmacist, maybe a social prescriber will go, depending on the need, and we'll try and get that work done in the house, in the place. And that's to try and build that link again with primary care, because you're never sure what the reasons are why they're not coming forward with their health problems, or they're not taking up the offer of healthcare, and that's been terrific, because, you know, already the ones that we've been out to visit, we've now got them making those appointments that they should be making at the surgery. And again, that's that's building the trust back with some patients as well, or maybe just making yourself a bit more visible and accessible to them. But so for me, we call it the multi generational home visiting project. But for me, that's an absolutely fantastic piece of work, which we're in the middle of at the moment, but I'm sure we'll have some really good results from that, and I'm hopeful it may become work that will be more broadly available, because we know about health inequalities, and we know the parts of the geography where maybe people aren't coming forward for their health appointments, and that has an effect on health. And you know, there's lots of reasons why people don't come for those appointments, but this is a way of actually us using our... there's one thing about general practice, it's got great data on the patient population, and you can identify the folk who aren't coming for appointments, but maybe should be coming for appointments, and instead of just leaving out of that because they've been invited and not attended, to actually going out and maybe seeing them in their home. So that's that's interesting. I wanted to mention that, Gill.

Gill Phillips  28:13

Yeah, no, I'm glad you've mentioned that, because I've never heard of that as an example, multi-generational and going out to people's homes. And, you know, you hear about prevention, and that's exactly what you're doing.

Bill Graham  28:24

Yeah, it's also giving people the health care they should be having. 

Gill Phillips  28:26

Yes, yes. 

Bill Graham  28:27

And for whatever reason they've not attended the invite, or they've not attended the appointment. And maybe, you know, maybe there's a problem with the way we do the invites in primary care sometimes as well. So that's just a more proactive way of of maybe doing that work. Yeah, the one other thing I wanted to mention was a digital outreach stuff, and again, in primary care, you know, we're really keen for people to use the digital health services, whether it's the NHS app or, you know, the digital service you might use to contact your general practice or other digital health apps that might help with certain conditions. And of course, there's a lot of patients out there who aren't really keen on using digital services, but they can be incredibly helpful, so we have some volunteers. Again, we've trained up so you know, you're using the assets in the community, some of our patients, some of them, you know, I've got Martin, who's 70 years old as an example, so he's not a young man, but he loves the digital health, and he's a terrific advocate. So he goes out with me. We go into community settings. Sometimes we even do it in the waiting room in the surgery, and we chat to patients about using digital services. And Martin you know, will show them through on his iPad how to use services. He'll get them set up the NHS app. He'll get them set up for our digital services. He'll show them how to use other digital services that may help them. And that's terrific work as well, you know. And again, it's it's one of those barriers some people have. They don't feel they can use it. And there is lots of help out there for people to to get hold of actual tablets and computers or phones. So there are projects and programs out there that fund people who are digitally excluded to get them digitally enabled. So, you know, we can help folk with that as well, if they so wish. And it's not a, we're not demanding people use digital services, but the thing is, they're maybe missing out on what could be good for them. And I think when it comes to like ordering prescriptions and things like that, you know, things like the NHS app are hugely helpful for for folk, rather than bits of paper, which we know can get lost or, you know, people can't find then they have to make a trip to do something else. But it might be easier for folk sitting in their house and ordering stuff via their phone or their tablet. Yeah, so really keen to just to mention that as well.

Gill Phillips  30:54

I'm glad you have, and I'm sure that Martin gets a lot out of that as well. And that's what it's about, isn't it? Like you say, asset based community, using the skills that you've got.

Bill Graham  31:03

Yeah, it's one of my, definitely one of my top, top chaps, yeah, top volunteers.

Gill Phillips  31:09

Yeah, brilliant. So all this work that you're doing, bill and thank you so much for telling me about it. Do you have a way of defining it? Would you say?

Bill Graham  31:19

Yeah, I think we kind of call it high street health. So it's kind of that focus on being accessible, being in your community, being visible. I think it's all those things we chatted about, about the challenges, and we're trying to address them by being, you know, accessible and visible. We we kind of call it high street health. I think it's a terrific way of looking at things. That's that's how we kind of refer to it when we chat about this work.

Gill Phillips  31:45

I think that's really memorable. I've not heard of high street health before, and I think straight away it brings for me back all this conversation and the examples you've given. And I love the way that you've combined day to day things like shopping centres, where there will always just be people, and actually events like your rugby day, or the specific events the Yorkshire Day that you've mentioned. So this is the end of the series, other than coming back to Becky, and she's going to pull it together for us. What do you think Bill is, what would be your call for action, then, as to how other people can do the kind of things that you're doing in West Yorkshire?

Bill Graham  32:23

That phrase, you know, just doing something or something somewhere, you know, do something is, is really good. I think for me, again, I was listening to Kim's podcast, you know, the system and the leadership that we have, and I think across the health service, I mean, I think you know, any anyone looking into it's incredibly complicated. It's complex. You know, there's layers upon layers in our National Health Service, whether it's primary care, secondary care, trusts, ICBs, ICS', it's, it's almost impenetrable. And and I think there's a lot of good people in that system trying to do good stuff, yes, but I think when they design things, and maybe this is going back to, you know, they use the data and they try and come up with plans, I think when they design stuff, you're quite often in danger of of being the committee who tried to design a racehorse and came up with a camel. But you know, again, it's they're good people. They're doing it with the best intentions, yeah, but I don't always think what the end result is is what could be the best practice or the best thing to do. So I think in many ways, it's about, the call-to-action is to encourage people to get out there, meet people, make people in communities part of the solution, if not maybe helping lead the solutions. They've got to be brave with the resource and the funding they've got. They've really got to be brave with it. You know, you've got to take risks with that. I think when they think about investing in communities or community solutions, they see it as quite risky. But you know, I come from that background, and I think Kim mentioned this as well, you'll get much more value from the money you invest in the VCS than you will by just putting money into the same things you've done previously. It's that idea of the definition of madness is doing the same thing over and over again and expecting a different result. And I think those good people in the health system all want to do preventive stuff. They all want to involve the community more, but there maybe needs to be just that willingness and that bravery to actually turn those words into reality. That's what I've always noticed. There's always a new priority will come along in the health system, whether it's the cost of living crisis, whether it's COVID, and so those plans to do something differently are suddenly stopped, because No, we've got a bigger problem over here. And that's why prevention and that will always not be top of the agenda, because there's always something found to stop it being top of the agenda. So I think that's, that, for me, is a really key thing. I think you learn by doing, you know, getting out there and doing it. So it's that sort of idea of just doing something, you know, you learn by doing you'll make it better. And it's just get out there and make that change happen. And for me, it's think Vincent, who's our modality CEO, has said I'm like an army of one, because I'm out there making all this stuff happen. But you know what Vincent doesn't always realize is it's the relationships I've built that makes all this possible. Because it's not me doing it. No, I turn up sometimes, and things are just happening because I've brought the people together to make it happen, you know? And it's not me doing all the work, yeah, I'm just the person who can hopefully bring folk together to to make it happen. And, know, it'd be great if they had more of these kind of community connector type roles to make that link between primary care and community, Gill. I've added up our primary care network - now, bear in mind, there's 1500 primary care networks in England. Our primary care network in the last four years has invested not far off, 4 million pounds, a million pounds a year, into community services, whether it's integrating - I think Kim mentioned that we've got some of Kim's staff work for us -  and that's integration. That's the her staff talking to our staff every day about our patients, and they then have all those seller Trust Services, those specialized Community Health Services to get folk into. That's real integration. That's us spending our money with communities. We've also raised money with funders to deliver work as well. It's been terrific working with the modality group, because they've, you know, they've let me go on with what I think is the right thing to do. And obviously, I come from the community side, so that's what I truly believe in. But, yeah, I've always said, you know, the health system, if it keeps doing what it's doing and it just invests the same way, it's never going to get that result at once. It's never going to make that change. So the plea, or the call to action is, please make this community and preventative agenda top of the agenda, and let's not make it something that's the it's always warm words, but it's never followed through on with actual resources. 

Gill Phillips  37:24

Yeah. Oh, thank you, Bill. And I think that's what I'm hearing throughout the series. And I think the other thing I'd add is enabling people so I can feel that Tom, that George, that Kim and yourself work in a system that's enabling you to have that freedom, have that flexibility to make things happen, you know, to get out there and to do the things that are your assets, in terms of the things that you're good at, you know, to get out in your communities and talk to people and make things happen. So I think that's a fantastic call for action at the end. And thank you so much Bill for for joining me and for talking about this today. 

Bill Graham  38:01

Thanks Gill, It's been a pleasure. Thank you.

Gill Phillips  38:05

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