Anchoring on the Coast
Organisation: Blackpool Teaching Hospitals NHS Foundation Trust
Location: Blackpool
Populations served: Fylde Coast and Lancashire and South Cumbria for tertiary services
Our project, Anchoring on the Coast, set out to co-design an anchor framework for coastal communities and test a model of co-production. We embedded community researchers in the BTH research team to co-design an anchor framework for Blackpool Teaching Hospitals NHS Foundation Trust with the community, staff and other partners. The research team co-designed and delivered the research. Using these methods, the research team worked with stakeholders and communities facing multiple disadvantage across Blackpool and the Fylde Coast to understand the challenges faced in these communities and how the Trust can discharge its responsibility as an anchor organisation to better the lives of those living in the Fylde Coast and working for the Trust. The project will continue until the end of January 2023 when we will complete the Anchor Framework for Coastal Communities that can be adopted locally and shared nationally for other coastal areas.
Impact of the programme
Coastal communities have different challenges to urban communities and many existing frameworks on how anchor organisations can improve their social value do not necessarily apply to coastal areas. Communities living on the Fylde Coast, which comprises Blackpool, Fylde and Wyre, experience wide inequalities in health and wealth. Blackpool is the most deprived local authority in England and eight of England’s 10 most deprived small areas are in Blackpool. Being a coastal area adds additional dimensions to high levels of deprivation, due to longstanding challenges in the economy and employment. Through co-production with our community researchers, we decided to focus on how anchor organisations can help improve the socio-economic conditions of economically vulnerable groups within the Fylde Coast areas ranked as being in the 20% most deprived of all England’s small areas.
The links between employment and health are well evidenced, and the role of Anchor institutions in this context is therefore important. This project led by Blackpool Teaching Hospitals NHS Foundation Trust (BTH) aims to develop a framework to allow
BTH to use its economic power as an employer of 7,500 staff with turnover of £552 million to contribute to the economic, environmental and social fabric of the Fylde Coast and reduce health inequalities.
Measures of success
Recruitment of community researchers who will be embedded in the BTH research team to gain experience of research in an NHS organisation.
The co-production of an Anchor Framework for Coast Communities, which will be approved by the Trust Board and the Place Based Partnership Board.
Influence of the Anchor Framework in changing policy of the Trust.
How the programme was delivered
This was a qualitative research study involving surveys, focus groups and one to one interviews. We sought views from a wide range of stakeholders including members of the public from across our most disadvantaged communities, staff who work at the Trust, businesses, the local authority, etc.
BTH's Research Team worked with four community researchers to co-develop an Anchor framework for our coastal community. These researchers with lived-experience co-produced the research and took part in all elements. They designed the methods, including interview topics and communication pieces, led the focus groups and interviewed members of our community who are seldom heard from in typical consultations. They looked at the key challenges and opportunities that BTH faces in increasing its social value as an Anchor institution. The community researchers were provided with continual peer support and mentorship through weekly research team meetings with the Trust.
Partnerships were crucial to delivery and this was enabled through monthly project team meetings. These meetings provided guidance and support at crucial times. Members of the project team included key leaders form the local authority, VCFSE sector, the NIHR, and strategic leaders from the Trust, including the Deputy Chief Executive and a Non Executive Director with community experience.
The funding received from the Health Foundation and NHS England via the Test and Learn programme was vital to the project and it was decided early on that the bulk of this would go to the VCFSE organisations who employed the community researchers.
Gaining project support
The success of this project was built upon the expertise and support of the Trust’s Research and Development Department who expertly navigated the process of ethics, delivering the research and supporting the community researchers. The contribution of partners was invaluable to ensure that we focused on the right topics and on the right people, particularly in identifying interview participants from partner organisations.
Having an executive director as part of the project helped with securing buy in from other system leaders and ensure that the Board are aware and sighted on progress. This should help with Trust commitment to the resulting framework and engaging other anchor organisations in the final framework through a collaborative. Having a public health specialist in the Trust, in the form of a public health consultant, was a core criterion for the project. Without someone from this specialty in place, it was unlikely that the project would have happened at all.
Personal relationships were vital for the success of this project in a context of high demand for services and the financial crisis. We used a corporate email address to invite people to participate, but it was often individual contact by the research lead that secured participation.
What is the future of this programme?
Upon completion of the project, we will have coproduced an anchor framework that will support anchors in coastal communities to take action that is most relevant to their population. For the Fylde Coast, the framework will be signed off by the NHS Trust Board and the Place Based Partnership Board. We intend to launch the framework through a Celebration Event to be held in February with all participants and anchor organisations invited to attend.
In addition to producing a framework relevant to all anchor organisations, the research identified action that the Trust can take now to improve its social impact. Specific opportunities for BTH to work with partners across the Fylde Coast or deliver existing services or business functions in a different way were identified that will be explored outside the Anchor Framework.
Blackpool Teaching Hospitals NHS Trust will take a lead in a Fylde Coast Anchors Collaboration to embed the framework. We feel this is a strength of the project as NHS Trusts are often the most difficult to engage in this kind of work. Having the work embedded in and owned by the Trust should ensure it has impact. From the research activity, we have learned how keen other anchors and VCFSE organisations are to partner with the Trust so we have high hopes for a strong collaborative partnership in a framework that has been rooted in co-production.
We intend to publish two academic papers on this project. One focused on the Anchor Framework itself and one on the model of co-production. We will produce non-academic summaries for dissemination through appropriate channels.
Advice for others doing similar work
This was an innovative project which held the principles of co-production throughout. This was fundamental to this project and it can’t be stressed enough how important and valuable this approach was.
Co-production undoubtedly takes longer than working as a solo organisation or even as a partnership. However, the results are much more valuable as they ensure the capture of lived experience and build in a sense of responsibility and urgency that can be lost when organisational and system pressures arise. The extended time period was mainly due to organisational bureaucracy and lack of experience in our model of co-production.
We set out with the ambition to embed our community researchers in the NHS Trust research department, which we achieved. However, this took a long time due to the IG and HR requirements of the trust. We have identified the need to work with the trust to reduce the burden in terms of ID requirements and induction for community researcher roles and hope to extend this to other participation roles such as co-production of services and pathways. This is a work in progress but the learning gained through this project will support real change and support co-production going forward.
We struggled to recruit from some of our intended participation groups, particularly young people. We have learned lessons, in particular the value of different methods of engagement. For young people, we think that instead of putting an open offer out to volunteer, we can site the researchers in locations frequented by young people, e.g. colleges, work academies, to engage them in conversation and invite them to participate at the time. This approach worked well for other groups, e.g. people who are experiencing homelessness, leaving prison, and people from the armed forces community. The key here was having the people with lived experience who knew where to go and how to engage with them.
We also struggled with engaging with people who were unemployed or insecurely employed. We identified a route through the CAB but the cost of living crisis meant that individuals were facing such pressures and lack of trust in authorities that they were unwilling to participate in recorded interviews, despite the payment being offered for their time. In future projects we will consider different approaches than interviews, potentially creative and arts focused methods.
We wanted to engage with the private sector to learn from their experience, but again struggled. In future projects we would take a different approach, through the hosting of round table events rather than surveys and focus groups. Taking the research to their existing forums is key to engagement here.
For more information about the programme, contact Heather Catt at heather.catt@nhs.net