The Church’s Impact on Health and Care 2017-18

David Simmons, May 2018

The Church’s Impact on Health and Care. Page 1 Table of Contents

Acknowledgements 3

Chapter One – Introduction 4 Methods 7

Chapter Two – Literature Review 13 Obesity and Diabetes 13 Loneliness and Isolation 17 Mental Health 20 Dementia 23 A&E 24

Chapter Three - Health Areas 28 General Health and Wellbeing 29 Intentional Health 28 Parish Nursing 34 Mega Fitness 45 The Pain Exchange 50 Loneliness and Isolation 55 Care Home Friends 55 Linking Lives UK 59 Dementia 63 Lyrics and Lunch 63 Mental Health 66 Peaced Together 66 Renew Wellbeing 72 Perinatal 75 Baby Basics 75 A&E 79 ED Pastors 79

Chapter Four – Themes 82 Value for Money 82 Giving the Gift of Time 88 Holistic Health Care 90 Creating Community 94

Chapter Five – Discussion 97 Discussion 101 Recommendations 103 Forming Strategic Partnerships 103 Practice Conferences 107 Incubate Further Health CRPs 107 A Consultation Group 108

Conclusion 108

References 110 Appendix One - Quotes from beneficiaries 116 Appendix Two - Research Information Sheet 119 Appendix Three - Topic Guide 121 Appendix Four - Other Faith Initiatives 123

The Church’s Impact on Health and Care. Page 2 Acknowledgements

I would like to thank all members of the steering group: Amanda Bindon, Marcus Chilaka, Jeremy Cooper, John Drew, Diana Gwyn, Fiona Hibberts, Sandie Keene CBE, Professor Paul McCrone, Dr Phil Moore, Jeremy Noles, Dr. Sue Protheroe, John Rouse, Professor Doug Simkiss.

All research participants: Tina English (Care Home Friends), Ben Woollard (ED Pastors), Hannah Peck (Baby Basics), Ros Moore (Parish Nursing), Claire Gillett (Parish Nursing, Cambridgeshire), Ruth McDonald (Parish Nursing, Morecambe Bay), Dr James Morrow (Granta Medical Practice, Cambridgeshire), Ruth Rice (Renew Wellbeing), Jeanette Main (Lyrics and Lunch), Niky Dix (Intentional Health), Sharon Morgans and Retha Welding (The Pain Exchange), Tina Riando and Matt Wisdom (Simply Limitless and Mega Fitness), Jeremy Sharpe (Linking Lives UK), Heidi Singleton (Peaced Together).

From the Cinnamon team: Mark Kitson, Matt Bird, Amanda Bindon, Danni Malone, Mike Royal.

From FaithAction: Rodie Garland.

Finally, the author would like to thank Allchurches Trust for their generous support of this research.

The Church’s Impact on Health and Care. Page 3 Chapter One. Introduction.

1.1 Introduction

This paper follows on from an early discussion document which looked at current financial pressures which affect health authorities, and in particular, faith and community-based strategies which have been developed which help to offset those pressures. Some aspects of that discussion paper have been replicated and developed further here. It also follows on from Cinnamon's previous research, “Police and Church Partnership Working” (Simmons, 2016) which highlighted best practice social action which helped to achieve the outcomes of local police authorities. That research has, in turn, led to many fruitful church and police partnerships across the UK, which has enabled churches to start social action projects from the list of Cinnamon Recognised Projects.

The important message is that of cost effectiveness; delivering a health-focused community project can save health authorities considerable amount of money as they focus particularly on creating an environment in which health messages (such as the importance of regular exercise, good diet, personal responsibility for health care and developing healthy relationships) can be effectively communicated.

This paper is written in five chapters. They cover the introductory elements (overview, methods, inclusion criteria), an analysis of some of the background literature to many of the chosen health issues, particularly when evaluating the cost of those issues to the NHS, a breakdown of the Cinnamon Recognised Projects by health category, the qualitative themes which were drawn from the data, and finally a chapter which focuses on recommendations, further research and closes this report.

1.2 Steering Group

This research was funded by Allchurches Trust. Oversight was provided by the Cinnamon Health Research Steering Group, the members of which were as follows (in alphabetical order):

Amanda Bindon, Executive Director of Communications, Cinnamon Network; Marcus Chilaka, Health consultant, GHEM Consultants;

The Church’s Impact on Health and Care. Page 4 Jeremy Cooper, Group Chair, Impower; John Drew, Partner, McKinsey Consultants; Diana Gwyn, Secretariat and Group Coordinator, Cinnamon Network; Fiona Hibberts, Senior Nurse, St Guy's and St Thomas's Trust Sandie Keene CBE, Independent Consultant; Professor Paul McCrone, Professor of Health Economics, King's College, London; Dr Phil Moore, Deputy Chair, NHS Clinical Commissioners; Jeremy Noles, Allchurches Trust; Dr. Sue Protheroe, Clinical Lead for Mental Health, Lincolnshire West CCG; John Rouse, Chief Officer, Greater Manchester Health & Social Care Partnership; Professor Doug Simkiss, Senior Lead (Children), Birmingham & Solihull STP; Dr David Simmons, Researcher, Cinnamon Network.

1.3 Aims of the Research

The aims of this research were to determine answers to the following questions: 1. What impact do faith and specifically, church communities currently have on health and social care? 2. What potential is there for them to be scalable and replicable, in order to have more impact?

Given the rather broad nature of the questions, in this paper I have concentrated my research mainly on Cinnamon Recognised Projects (which, from now on in this paper will be referred to by their acronym: CRPs), and in particular, upon explicitly health-based projects. The answer to the second question comes within the purview of the recommendations.

This also stems from the objectives set out by Cinnamon in their paper with Allchurches Trust: “Cinnamon Network & Allchurches Trust - ‘Health & Church Partnership Working’ ”. In that paper, the key research outcomes for this paper were:

1. To increase the confidence of health services to partner with local churches; 2. To increase the confidence of local churches to respond to the health and well-being needs they see in their community;

The Church’s Impact on Health and Care. Page 5 3. To increase innovation and to inspire churches to develop new church- led projects.

This paper therefore bears all those aims and objectives in mind.

1.4 A Note About the Projects

As outlined in Weir (2015), this paper specifically examines the work of Christian church-led social action projects, specifically those which are either recognised by Cinnamon Network, or affiliated in some way. Most of the projects selected here are CRPs (Cinnamon Recognised Projects); that is, projects which have been recognised and supported by the Cinnamon Network as having a clear vision to expand their reach nationally, through local churches. At the time of writing, three of the projects are in the process of being incubated by Cinnamon, six are officially recognised by Cinnamon, and two have been selected for this research owing to their innovative work, and desire to replicate through local churches.

The CRPs featured here are Baby Basics, Parish Nursing, Intentional Health, Mega Fitness, Linking Lives UK, and Peaced Together. The projects in the process of incubation are Care Home Friends, Renew Wellbeing, and Lyrics and Lunch. The two other projects are ED Pastors and The Pain Exchange. All case study data has been anonymised.

1.5 Referring to Local Health Authorities

Throughout this paper, it is tempting to refer to local health authorities in a variety of ways, as “local NHS services”, “local authority hubs”, or “GP surgeries and local health services”. For the purpose of this research, I shall limit all generic health authority references to “local health partnerships”, since many of the locations featured in the research had a combination of local authority hubs, local NHS services, hospitals, treatment centres, and so on. Where specific health partnerships are discussed, they will be referred to as such.

The Church’s Impact on Health and Care. Page 6 1.6 Methods

This section covers the methods used in this research. As a researcher, I visited the founder or key representative of each CRP which is featured here. All of the qualitative research was interview-based. This enabled me to ask questions about the project in question in terms of its record keeping, and what data was being collected (quantitative data), as well as to glean both quantitative and qualitative data from the interview itself. As expected, the projects were all at different stages of measuring their effectiveness. Each one was however, fully aware of the need not only to collect substantive evidence, but also to improve their data gathering methods, to improve the effectiveness of the process, both in terms of demonstrating outcomes, but also in terms of making it less onerous for the beneficiaries (particularly where mental health is concerned).

The interviews were conducted over a six-week period in the Autumn of 2017.

Date Project Town Project State 18-Oct Care Home Friends Twickenham Incubation 26-Oct ED Pastors Sheffield Not CRP 26-Oct Baby Basics Sheffield CRP 01-Nov Parish Nursing Peterborough CRP 07-Nov Renew Wellbeing Nottingham Incubation 13-Nov Lyrics and Lunch Lancaster Incubation 17-Nov Intentional Health Wadebridge CRP 20-Nov The Pain Exchange East Acton Not CRP 22-Nov Mega Fitness Kidderminster CRP 23-Nov Linking Lives UK Wokingham CRP 29-Nov Peaced Together Dagenham CRP

Table 1. Interview Schedule

Quantitative Approaches All of the participant projects recognised the importance of measuring the effectiveness of their work, particularly with regard to prospective partnerships. Given that they all had replication strategies and the desire to expand the reach of their programmes through local churches, they all understood the need to provide robust evidence of their effectiveness.

The Church’s Impact on Health and Care. Page 7 That being said, many were also acutely aware that data can be misleading. This will be dealt with later in this report (see Chapter Three, I - Renew Wellbeing), since some measures can, in fact, illustrate the opposite of what they were trying to communicate. Hospital admissions, for example; whilst they are costly, they are sometimes a necessary outcome of a home visit by a parish nurse. A reduction in hospital admissions does not always signify a positive outcome for a local area. Quantitative measures therefore have to be selected carefully, and results should always take into consideration local health care and community priorities. (See Table 2 - Outcome Measures Used).

Qualitative Approaches All interviews, where possible, were conducted on location at the headquarters of the project. Three of the subsequent interviews (for the Parish Nursing case studies) were conducted by telephone.

Given that the research was primarily interview-based, much of the data was analysed through constructivist grounded theory (Charmaz, 2007). The interviews were transcribed through a new online software platform called Trint, where they were corrected and validated, and then coded using Quirkos qualitative analysis software. From there, common themes were drawn out, which will be described in Chapter Four.

Topic Guide All interviews were conducted along the lines of a Topic Guide, which was drafted by the author, and reviewed by three of the members of the research steering group: David Simmons, Amanda Bindon and Professor Paul McCrone. As with all qualitative interviews, subjects were discussed, and from the responses, further questions were asked, so that interviews did not necessarily always follow exactly the same pattern as one another.

The original idea (which the Topic Guide reflects) was to conduct a first interview which examined quantitative elements, and then conduct a second which took a more free-form, open and qualitative approach. In practice, this did not always work, since many of the interviews crossed back and forth between quantitative and qualitative elements. The Topic Guide is included in Appendix 3.

The Church’s Impact on Health and Care. Page 8

Case Studies Case studies were by far, the most popular method used of recording the effectiveness of projects. In many cases, case studies were proactively collected on a regular (annual, or quarterly) basis. In some cases, case studies were written down as they came up in feedback or conversation. Many of the case studies have been included here in the sections which deal with the CRPs themselves, along with some of the quotes, which are broken down by project in Appendix 1.

Outcome Measures Used All of the projects that are featured in this research report used outcome measures; some formal, some informal. Some were in the process of developing more formal measures, often in partnership with other organisations or universities. Others aspired to work with universities, but the opportunity had not yet arisen.

Project Measures used SWEMWBS, Data Analysis (Jenkin, 2017), Jenkin et al (2015), Intentional Health Case Studies Parish Nursing Case studies and feedback Perceived Stress Scale, Outcomes Stars, SWEMWBS, Case Mega Fitness Studies The Pain Exchange Örebro MS Pain scale (Linton & Boersma, 2003), Case Studies Care Home Friends Case studies (where possible) and feedback Linking Lives UK Campaign to End Loneliness Measures, Case Studies Lyrics and Lunch Case studies and feedback Peaced Together Scales based on WEMWBS, Case studies Renew Wellbeing Case studies and feedback Baby Basics Case studies and feedback ED Pastors Case studies and feedback, Yaull (2016)

Table 2. Outcome Measures Used by Projects

The Church’s Impact on Health and Care. Page 9 Research Inclusion Criteria - Projects Following the distribution of the discussion paper, the Cinnamon Health Research steering group considered the issue of inclusion criteria. It was decided that it would be best to include research on CRPs which were explicitly health-related, and which addressed issues which were identified as a priority to the group, namely general health and wellbeing, mental health and isolation.

The larger health-based project list was then reduced to a smaller list, which included two large CRPs, two medium-sized ones, and two which, at the time of writing, were still in their developmental stages. Other health-related CRPs were noted.

The large CRPs were Parish Nursing and Linking Lives UK. The medium-sized CRPs were Intentional Health and Mega Fitness. The smaller CRPs (in development) were Care Home Friends, and Renew. It was also agreed that, while the overall quantitative data might be supplied at a national level by the CRP head offices, a variety of specific locations would be selected for consideration which matched the criteria: to be as geographically diverse as possible; and including urban, rural and coastal areas. (see map overleaf)

The Church’s Impact on Health and Care. Page 10 Figure 1. Research Map

The Church’s Impact on Health and Care. Page 11 Research Inclusion Criteria - Health Areas The list of health areas looked at by this research has been determined largely by consultation with the steering group, the areas tackled by the CRPs themselves, as well as the literature which was examined by the initial discussion paper.

The health areas dealt with by the projects featured here are:

• General health and well-being • Loneliness and Isolation • Dementia • Mental health and well-being • Perinatal services • A&E

In all areas, CRPs were interviewed and their perspectives gained with regard to the services offered, and the potential cost-benefit to local health partnerships when working together with churches which deliver these services. Addiction was looked at in the discussion paper, but is not featured in this paper (other than tangentially through mental wellbeing, for example).

1.7 Limitations of the Research

Each participant was given the opportunity to review the research guidelines, prior to participation (see Appendix 2). They were contacted by the Cinnamon Network Recognised Projects Team Leader, who briefed them as to the nature of the research process, and then they arranged an interview with me. Owing to time constraints, I was only able to spend between one to two hours with each participant, but there have been many email exchanges for clarification, additional information, and documentation where relevant.

The researcher, Dr David Simmons, has worked with Cinnamon Network since 2013.

The Church’s Impact on Health and Care. Page 12 Chapter Two. Literature Review.

2.0 Introduction

This chapter is primarily drawn from the Literature Review which was part of the original discussion paper, which formed the early basis and reasoning for this research. It covers several health topics, looking primarily at the cost of those topics to the NHS. For example, studies around the cost of obesity, the cost of Type 2 diabetes, and so on. Some areas have been enhanced (for example, loneliness and isolation) following the inclusion of new material. On the whole, the literature has been incorporated where it highlights the current costs of a particular health issue to the NHS, or where it illustrates the current demand in the UK at the time of writing. The section headings loosely follow the order of the Health Areas which are laid out in Chapter Three.

2.1 Obesity and Diabetes

Introduction Obesity and Type 2 diabetes are closely associated. Obesity indicators suggest that, “based on the adult population, 5.54 million men and 6.36 million women [are] at risk of [developing] Type 2 diabetes - 11.9 million people in the UK (ONS, 2014).

This section will look at obesity and diabetes, and ask how faith-based projects can help to alleviate pressures on health authorities.

Obesity Obesity is the single highest risk factor in developing diabetes (Hauner, in Holt et al, 2010). According to Diabetes UK (2017), almost two in every three people in the UK are overweight or obese. This equates to 59 per cent of women and 68 per cent of men. Obesity has increased by 13 percent since 1980-2013. The same study also suggested that 26 per cent of boys and 29 per cent of girls are also overweight or obese (p. 6).

In 2015/16 there were 525,000 hospital admissions where obesity was a factor (NHS Digital, 2017). That research estimated that 1 in 5 children in Reception classes were recorded as obese, as against 1 in 3 by the time they reach Year 6.

The Church’s Impact on Health and Care. Page 13 Diabetes According to Diabetes UK (2016), 3.5 million people have been diagnosed with diabetes in the UK. That equates to 5% of the UK population. It is also estimated that a further 1.1 million people are undiagnosed, and are only diagnosed when the patient begins to experience complications. Therefore, an estimated 5 to 6.8% of the population of the United Kingdom have diabetes (Public Health England, 2016).

Out of all people who have diabetes, 10% have Type 1, which is hereditary, treatable, but not easily preventable (National Diabetes Audit, 2012/3, Scottish audit). 90% of all diabetics have Type 2. The risk of developing Type 2 diabetes can be reduced (and the disease reversed) by changes in lifestyle (Tuomilehto et al, 2001).

This suggests that there are possibilities for community intervention, provided that those interventions focus on positive messaging, as well as addressing the issues which underpin these health statistics. See Chapter Three: General Health, particularly the sections regarding Intentional Health and Mega Fitness.

The Consequences of Diabetes Both forms of diabetes can lead to severe complications, which in turn, put significant strain upon the health economy (Hex et al, 2012). Complications include cardiovascular disease (CVD) and degeneration, kidney disease, eye disease, neuropathological disorders, depression, the need for limb amputation, sexual dysfunction, pregnancy complications, dementia and an overall lower life expectancy.

The Cost of Diabetes in the UK According to Hex et al, 2012, it was estimated that about £10 billion was spent by the NHS on diabetes in the previous year. That equated to 10 per cent of the NHS budget being spent on diabetes then. The cost to the NHS of Type 2 diabetes in 2016 was £8.8 million per annum (NHS England, 2016).

This works out to around: • £192 million a week; • £27 million a day; • £1 million an hour; • £19,000 a minute; • £315 a second.

The Church’s Impact on Health and Care. Page 14 The total cost (direct care and indirect costs) associated with diabetes in the UK currently stands at £23.7 billion and is predicted to rise to £39.8 billion by 2035-6 (Hex, N., et al, 2012 in Diabetes UK, 2017). One in seven hospital beds is occupied by someone who has diabetes. In some hospitals, it may be as many as 30 per cent (HSCIC National Diabetes Inpatient Audit, 2012). People with diabetes are twice as likely to be admitted to hospital (Sampson et al, 2007). In 2012, diabetes contributed 44 per cent of the combined angina, myocardial infarction, heart failure and stroke hospital bed days (HSCIC, 2012). 45.1 million diabetes prescription items were dispensed in primary care units across England in 2013/14 at a net ingredient cost of over £803 million. This represented an increase in cost of 5.1 per cent over 2012/13 (HSCIC, 2013-14).

The Importance of Exercise The Department of Health recommends that adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more. One way to do this is to carry out 30 minutes on at least 5 days a week (Department of Health Physical Activity Guidelines for Adults, 2011). Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous intensity activity. Adults should also undertake physical activity to improve muscle strength on at least two days a week. All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

Across Great Britain in 2010, only 39 per cent of men and 29 per cent of women were meeting recommended physical activity levels (ONS, 2010). Fock and Khoo (2013) recognised that the two most effective strategies for combating obesity are dietary (which can be effectively augmented by cognitive behavioural therapy, p.59) and exercise.

CRPs and Obesity Certain CRPs focus on exercise, well-being and lifestyle. Intentional Health, for example, educates people about how to live healthy lifestyles. It would have a direct impact on helping communities to deal with obesity, Type 2 diabetes risk, treatment and reversal. There are case studies of diabetes reversal in Intentional Health participants (see Chapter Three, A - Intentional Health).

Mega Fitness encourages local churches to use facilities to develop a local fitness programme, with classes for people of all ages, which are fun and help people to overcome issues of confidence. It would have a direct impact on helping communities to deal with obesity, Type 2 diabetes risk, treatment and

The Church’s Impact on Health and Care. Page 15 reversal. There are case studies of diabetes reversal in Mega Fitness participants (see Chapter Three, C - Mega Fitness).

Further interventions such as 4Family (which help struggling families to help themselves), or CAP Release Groups (which deal with addiction), neither of which are featured in this paper, could also help through educating participants about the risks around, and the nature of diabetes. There is clearly room for further project development and incubation in this area, as well as assisting existing projects to find effective ways of measuring their outcomes.

Measuring the Impact of CRPs on Obesity and Diabetes Measuring the impact of interventions on obesity and diabetes prevention could concentrate on areas around BMI, blood pressure, blood sugar and cholesterol levels. Frequency of hospital visits may also be considered for some.

In Bravis et al (2010), the authors established six monitors and results with regard to education of Muslim diabetics during the month of Ramadan. These included physical activity, meal planning, glucose monitoring, hypoglycaemia, dosage and timing of medications in one group, with no interventions for the control group.

Jiang et al (2007) and Singh et al (2009) both ran comprehensive randomised control trials for their work with Chinese schoolchildren and Dutch adolescents respectively.

It would be difficult to create an effective randomised controlled trial for these project interventions due to the complex nature and timescales involved. However, underpinning quantitative methodology should be considered, along with tested and tried instruments which measure before-and-after intervention statistically.

The Church’s Impact on Health and Care. Page 16 2.2 Loneliness and Isolation

Introduction Loneliness is closely aligned to mental health, and yet within communities it is arguably more extensive, and the costs to people’s health, although hard to quantify, has been written about. Authors in the subsequent brief analysis differentiate between social isolation (which is an objective factor in lifestyle, measured through surveys and instruments) and loneliness (which is arguably more subjective, and may be able to be treated as such). Despite the difference, however, both social isolation and loneliness carry with them serious health implications, which are similar to smoking and obesity (Holt-Lunstad et al, 2010, and 2015).

Recent political focus on loneliness in the UK, precipitated by the work by the Jo Cox Loneliness Commission reported that:

• Over 9 million people in the UK are either always, or often lonely (British Red Cross, 2016); • Disconnected communities could be costing the UK economy £32 billion every year (Eden Big Lunch); • Action for Children found that 43% of 17 – 25 year olds who used their service had experienced problems with loneliness, and that of this same group less than half said they felt loved; • Action for Children have also reported 24% of parents surveyed said they were always or often lonely; • Research by Sense has shown that up to 50% of disabled people will be lonely on any given day; • Research conducted by The Forum which examined loneliness amongst refugees and migrants in London found 58% of those surveyed described loneliness and isolation as their biggest challenge; • A report by Carers UK revealed that 8 out of 10 carers have felt lonely or isolated as a result of looking after a loved one; • A report by the Alzheimer’s Society found a third of people with dementia said they lost friends following a diagnosis. Almost 1 in 10 only leave the house once a month; • Analysis by Age UK shows 3.6 million people aged 65 and over agree that the television is their main form of company; • Polling conducted by Independent Age found more than 1 in 3 people aged 75 and over say that feelings of loneliness are out of their control (Statistics copied from the Jo Cox Loneliness Commission webpage).

The Church’s Impact on Health and Care. Page 17 Many of the CRPs featured in this project tackle social isolation and connectedness, whether directly (Linking Lives, Renew Wellbeing), or tangentially (Baby Basics, Peaced Together, Mega Fitness to name just a few. See also Chapter Four, Section 4, on Creating Community.)

Loneliness and Health Loneliness has been recognised as a contributory factor in several key personal health measures. Caccioppo et al (2002) recognised that loneliness plays a part in poor sleep and age-related blood pressure issues. Cornwell and Waite (2009) quoted the comparison between loneliness and poor health, stating that loneliness can be factored in as a critical health risk alongside smoking and obesity, leading to higher rates of infection, depression, and cognitive decline (p. 31). The authors recognised too, that further research needs to be carried out, to establish the causal link factors between these criteria.

The authors also quoted the use of the Social Disconnectedness Scale and Perceived Isolation Scale, which measure respondents’ social networks through a series of simple questions, and analyses them statistically. They wrote that a lack of social connectedness (as evidenced by the scales) are not always accompanied by feelings of loneliness and isolation (thus bringing about concepts of subjective and objective isolation).

Hawkley et al (2010) examined the relationship between loneliness and elevated Systolic Blood Pressure (SBP). The authors found that over a prolonged period of time, loneliness has a significant relationship with increased SBP, irrespective of respondents’ smoking, exercise, and other associated factors which normally constitute a risk for high SBP. The authors also challenged commonly-held assumptions that a greater network of relationships combats loneliness, arguing that loneliness is best dealt with subjectively with each individual.

Shankar et al (2011) broke apart the two elements of loneliness (which may be argued as a subjective perception - see Hawkley et al, above) and social isolation, so as to avoid potential conflict between the two elements. They did, however, conclude that higher health risks are associated with both, thus highlighting the issues associated with both:

“Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviours. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels” (abstract).

The Church’s Impact on Health and Care. Page 18 As outlined in Greaves (2006), isolation, loneliness, poor health and depression affects one in seven people over 65 (p.135). It would appear that, in this age of multi-connectivity and social media, loneliness is a persistent problem at the heart of society. As NHS England (2016) showed, loneliness is an issue which can affect anyone at any age (p. 21).

Holt-Lunstad et al published their landmark 2010 article on Loneliness and Social Isolation as risk factors in mortality. It was ground-breaking, because for the first-time loneliness was associated as a health risk factor similar to smoking 15 cigarettes per day. The same authors wrote a similar paper in 2015, which associated loneliness as a health risk factor similar to Grade 2 or 3 obesity, and the authors commented that loneliness needs to be treated as a public health concern (p. 235). That article also warned that unless action is taken, loneliness will reach epidemic proportions (particularly in affluent nations) by 2030.

CRPs and Loneliness In terms of social isolation (measured objectively), many CRPs focus on creating community and drawing in isolated individuals. Looking deeper, however, several stand out in particular with regard to helping individuals overcome isolation.

Linking Lives UK works by simply connecting isolated people with a befriender who visits them regularly, and connects them within a wider community. Parish Nursing frequently works when offering health care to isolated people in a community, Passing the Baton (not featured here) reaches people who are isolated and marginalised, and Welcome Boxes (not featured here) particularly works with isolated asylum seekers and refugees, many of whom have had very little contact with local people despite having lived in the UK for some time. Baby Basics identifies isolated mothers (typically teenage mums, people seeking asylum and women fleeing domestic abuse and trafficking) through midwives, who then connect them with the local community, who provide baby hampers, and signpost to other services.

Please note that dementia and isolation of older people are dealt with elsewhere in Chapter 3, Sections E and F.

The Church’s Impact on Health and Care. Page 19 Measuring CRP Impact on Loneliness Both loneliness and social isolation can be measured through instruments (such as Social Disconnectedness Scale (objective) and Perceived Isolation Scale (subjective) (Cornwell and Waite, 2009), or once again, the Warwick- Edinburgh Mental Well-Being Scale (WEMWBS - see Section 2.3 - Measuring CRP impact on Mental Health). As with all of the interventions, case studies and qualitative data are also important to collect.

2.3 Mental Health

Introduction Mental health is arguably finally getting some recognition from governments as an area of priority (World Health Organisation, 2012). For the UK government, this has meant outlining a set of priorities for the next five years (NHS England, 2016). According to that paper, mental health problems represent “the largest single cause of disability in the UK” (p.4), which costs the UK an estimated £105bn per annum, equating to “roughly the cost of the entire NHS”.

The paper drew up several priority areas: • Mental health in children and adolescents; • Perinatal mental health; • Severe and prolonged mental illness; • Mental illness related to physical illness (Type 2 diabetes is a strong associate of poor mental health, costing an estimated £1.8bn of additional costs to the NHS (p. 6 - see also section 2.1 on Obesity and Diabetes); • Employment and housing issues; • Post-traumatic stress disorder; • Depression and isolation in older people; • People in marginalised groups; • The prison population.

New initiatives are being introduced by NHS England, from Improving Access to Psychological Therapies (IAPT) – which includes digital therapies, to Crisis Care Concordats and Sustainability of Transformation Partnership (STP), which aim to join up mental health services across the country, with sustainable patient-centred care.

According to Wu et al (2015), at any time, 1 in 6 people in the UK have a mental health disorder, ranging from anxiety and depression to schizophrenia.

The Church’s Impact on Health and Care. Page 20 CRPs and Mental Health It can be stated with some confidence that all CRPs address mental health issues in some ways, whether directly or indirectly. Street Pastors And Street Angels frequently work with people who have presented issues relating to alcohol and substance abuse, depression, conduct disorders as well as suicide (see Simmons, 2016 and Simmons, 2017).

The following table shows nine priority health areas for the UK government and which CRPs address each one in turn.

Priority Area Related Cinnamon Recognised Projects 4Family All TLG Projects Children and Adolescent Mental Health Reflex MakeLunch Baby Basics Peaced Together Perinatal Mental Health Parish Nursing Peaced Together All CAP Projects Severe and prolonged mental illness Passing the Baton CMA Mega Fitness Intentional Health Mental Illness related to physical Parish Nursing MakeLunch Trussell Trust All CAP Projects Ignition Hope Into Action Night Shelters Employment and Housing Reflex Passing the Baton Germinate Enterprise PTSD Peaced Together Linking Lives UK Care Home Friends Depression & Isolation in older people Parish Nursing Passing the Baton Christmas Lunch Lyrics and Lunch Baby Basics Welcome Boxes People in marginalised groups All TLG Groups Christmas Lunch WLTDO? The prison population Clean Sheet Reflex Word for Weapons All CAP Projects

Street Pastors and Street Angels frequently come across mental health issues in their work, presenting as alcohol abuse, violence, suicide and depression

Table 3. Health Priority Areas and Cinnamon Recognised Projects

The Church’s Impact on Health and Care. Page 21 From this, we can see that some CRPs work in specific mental health areas (such as Clean Sheet and Reflex with the ex-offender and young offender populations respectively), and many have related effects on the mental health of participants.

Programmes such as Peaced Together, CAP Release Groups (not featured here) or CAP Life Skills (not featured here) enable participants to work through actual or perceived barriers to progressing with a healthy life, whereas Mega Fitness and Intentional Health work through helping people to regain physical confidence, and thereby increase their overall well-being. Intentional Health also features specific content about anxiety, conflict and effective communication. Linking Lives UK and Care Home Friends specifically target the isolated older population (see Chapter Three – E and F on Loneliness and G on Dementia), whether in the community or in care homes, and Parish Nursing aims to work holistically with people in the community by addressing physical, mental and spiritual well-being.

Renew Wellbeing, despite being a fledgling CRP (currently in incubation), nevertheless already has a strong track record in providing a refuge for all people with mental illness, and for providing care for them, for example through the five pathways to mental well-being, as created by the New Economics Foundation. Renew Wellbeing is featured in this research.

Measuring the Impact of CRPs on Mental Health In order to measure the impact of projects on mental health and wellbeing, it is important to use instruments which have been rigorously applied and tested over a number of years.

To that end, measures such as the Warwick-Edinburgh Mental Well Being Scale (WEMWBS) come into their own. The WEMWBS has been used extensively by many projects since its inception (Taggart et al, 2015), using a simple scale of fourteen characteristics in a Likert Scale, which can be used to measure before-and-after intervention responses, which in turn may be analysed statistically with paired sample t-tests and similar measures.

As well as a tested instrument such as the WEMWBS, case studies should be compiled, as well as interviews with participants and volunteers which enables the client’s process through the intervention to be tracked and measured in terms of effectiveness, and where the process may be incrementally improved for future participants.

Other measurement methods favoured by voluntary sector organisations include

The Church’s Impact on Health and Care. Page 22 the Ascot (Adult Social Care Outcomes Toolkit), the Outcomes Star (as used by Mega Fitness), Cost Benefit Analysis (which is favoured by Big Lottery), and Social Return on Investment (SROI).

2.4 Dementia

Introduction In 2009, Jönsson and Wimo wrote that within Europe, the average cost of supporting an individual with Alzheimer’s Disease in Europe was approximately €28,000 per annum. As our population increases in age, the instance of caring for older people with dementia will also increase. NHS England’s priority is to “upgrade” dementia care (NHS England, 2015-6), to improve diagnosis and care pathways.

Caring for People with Dementia Dementia care has increased in the public realm for one main reason: our population is ageing, and owning to this, the country now has a duty to care for something in the region of 850,000 people living with dementia in the UK today: numbers expecting to increase to 1 million by 2025 (Garland 2017b: 2). This places a great strain on local care services, and also presents a unique opportunity to both faith-based and non-faith-based voluntary sector organisations alike. In the FaithAction paper “How Faith Groups are Supporting People Living with Dementia” (Garland, 2017b), the author highlighted two key community interventions which could help with this particular client group:

The first is to help people with dementia to become mentally active: through reading, learning new things. The second is to improve lifestyles through regular physical activity, smoking cessation, weight loss, and reducing alcohol consumption (p. 6).

Singing In Camic et al (2013), the authors investigated the importance of singing for people living with dementia. The authors tracked ten participants and their carers over a period of weeks and, using many experimental instruments, measured the participants’ well-being at pre-, post- and ten-week follow-up to the trial. The results were that, despite the disease still progressing through that time, the well-being of all participants increased. Qualitative data also indicated a strong sense of well-being for all participants.

The Church’s Impact on Health and Care. Page 23 CRPs and Dementia Two relevant CRPs (both currently in incubation) target two key elements of dementia care, currently. Firstly, isolation (even within care homes). Care Home Friends (currently a CRP in incubation) aims to work through volunteers in care homes, both with and without dementia, to combat isolation and loneliness there. The second CRP, Lyrics and Lunch (also in incubation) work to improve the quality of life for those with dementia through group singing (Camic et al, 2013). Both are featured in this research.

Measuring CRP Impact on Dementia As Camic et al (2013) discovered, there are many potential scales, instruments and tools for measuring Quality of Life (QoL), cognitive well-being, as well as qualitative methods to be used in determining the effectiveness of dementia interventions. It must be noted, however, that subjecting participants to extensive survey instruments can be tiring and difficult for some participants with dementia (p. 160). In all cases, it would be wise to conduct research in collaboration with the primary carers, even with a local health authority, for reasons of ethical clearance.

2.5 A&E

Introduction Admissions to A&E form a constant bedrock of political discussions around NHS performance. This due, in part, to four-hour targets being consistently exceeded across all health authorities (Press Association, 2017). But it is also due to increased demand.

A&E Data Type 1 Accident and Emergency (A&E) admissions are major, providing a consultant-led 24-hour service with full resuscitation facilities.

According to NHS England Accident and Emergency (A&E) statistics, Type 1 attendance has increased monthly from below 1.15m in August 2010 to 1.3m in March 2017, with a drop to 1.25m in April. Percentage growth on admissions has fluctuated, with an 8 percent growth spike in attendance in March 2016. Emergency admissions have increased 290,000 in August 2010 to 350,000 in March 2017. Despite pressures on NHS funding and staffing levels, which are particularly keenly felt in A&E (King’s Fund, 2017). Almost 23 million people attended A&E in 2015-16 (NHS England, 2016).

The Church’s Impact on Health and Care. Page 24

Overall attendance, including Type 2 (less severe trauma) and Type 3 (walk-in) increased from an annual average of 14 million to 16.5 million in 2003/4. The numbers have increased steadily to 22.9 million in 2015/16 (more than 39%).

The King’s Fund wrote about the following reasons for unnecessary A&E attendance: • Lack of access to GPs: although this is not borne out by GP Patient Surveys; • Access to out-of-hours: most patients go to A&E between 9am and 5pm when surgeries are open. NHS district nurses also operate out-of-hours and manage to prevent unnecessary admissions. NHS district nurse numbers have however, fallen by 41 percent (King’s Fund, 2016); • Confusion: patients not knowing where to go, at what time. This is exacerbated by fragmented emergency care systems (Keogh Review, 2013).

Pressure is also felt by delays caused by the lack of transfer of care, caused by local authority budget cuts.

CRPs and A&E The issue of falling numbers of district nurses could be partly addressed through Parish Nursing - where local churches staff teams of qualified nurses (either paid, retired, or volunteering in their spare time). This also addresses issues of community social care, since it also works against isolation. It must be noted however, that parish nurses play a very different role to district nurses (this will be focused on elsewhere in the section on Parish Nursing, Chapter 3, Section B).

Creative English is in the process of becoming a CRP. Where Creative English helps is in the delivery of accessible and fun ESOL courses. Part of the philosophy is to create dramatic scenarios for participants to act out - including visiting GPs, doctors’ surgeries, and similar. Part of the aim of this is to reduce the confusion which surrounds much of the transition to UK-based healthcare. Welcome Boxes can also signpost to newly arrived refugees, as they welcome them with their community parcels. Neither CRP is featured in this research, but both CRPs work predominantly through creating community (see Chapter Four, Section 4: Creating Community).

Street Pastors and Street Angels also have a vital role to play, and one which is gaining increasing significance within many towns and rural areas. Bushfield (2016) argued that Street Pastors could have saved the NHS £13 million in avoided emergency admissions, as they frequently dealt with front-line emergencies on the street. Neither CRP is featured in this research, however

The Church’s Impact on Health and Care. Page 25 they are the main focus for the research carried out in partnership between Cinnamon Network and South England police authorities: Simmons, 2016 and Simmons, 2017.

Qualified Street Pastors have been known to restart a man’s heart on the street (Green and Johns, 2011), and in Simmons (2017), a team in East Grinstead were able to provide first aid to a young woman who was later found to have a rare and critical heart condition. In Simmons (2016), the Chichester City Angels were able to report that in the first year of their operation, they saw a 67% reduction in alcohol-related admissions to A&E.

Measuring CRP Impact on A&E Work would need to be done to establish how voluntary sector organisations are currently monitoring their effect on local health outcomes. This could be through monitoring local A&E admission data, reviewing ongoing costs, and by eliciting case studies where admissions have been prevented or enhanced through community intervention (as we have seen with studies in the previous section).

In addition, costs of running local programmes such as Street Pastors, Street Angels, Parish Nursing, Welcome Boxes and Creative English programmes would also have to be factored in on a programme-by-programme basis. For example, the annual running costs of City Angels in Chichester were estimated as £19,000 per annum (Simmons, 2016). It should be borne in mind however, that City Angels run a fully-functioning coffee van. Eastbourne Street Pastors 1 ran up a similar budget with a portable admissions unit ⁠ (Simmons, 2017), whereas the majority of voluntary street patrol groups run on considerably less.

Future CRP developments could focus on areas, such as the Emergency Department Pastors which have emerged in Sheffield (The Star, 2016). These volunteers are church-led, but are not (at present) affiliated with either the CNI Network (Street Angels) or Street Pastors. ED Pastors are featured in this research, in Chapter Three, Section K.

The UK has also seen a rise in volunteer First Responders, individuals who give up some of their time to appear first at an emergency, before ambulance staff and paramedics arrive.

1 Although the admissions unit may in itself ameliorate pressures on the local A&E systems, particularly if they were to receive the on-hand paramedic service for which they were negotiating with their local health authority.

The Church’s Impact on Health and Care. Page 26 Conclusion Where possible, the sections of this literature review have mapped to the health areas of the next chapter, which goes through the CRPs featured in this research, and details the interview process.

The Church’s Impact on Health and Care. Page 27 Chapter Three. Health Areas.

3.1 Introduction

From this point, the research is grouped into several health areas (this chapter) and then themes (Chapter Four). In this chapter, I cover the key health area which are represented by the respective CRPs and projects within those health areas. They are as follows:

General Health and Wellbeing: Intentional Health, Parish Nursing, Mega Fitness, The Pain Exchange; Loneliness: Care Home Friends, Linking Lives UK; Dementia: Care Home Friends, Lyrics and Lunch; Mental Health: Renew Wellbeing, Peaced Together; Other areas, incorporating perinatal: Baby Basics; and A&E: ED Pastors.

Care Home Friends could potentially feature in both Loneliness and Dementia, since it was the isolation of vulnerable older adults which caused Tina English to start the project in the first place (see Chapter Three, Section E). It is located in the Loneliness category, however.

In the chapter which follows this, I cover themes and concepts which emerge from the interviews, which then, together with elements from this chapter, contribute to the final discussion and recommendations.

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1.2 General Health and Wellbeing

A. Intentional Health

Interview Details Niky Dix, founder of Intentional Health was interviewed on Friday 17th November 2017, at the Wadebridge Christian Centre in Cornwall. The actual recorded time of the interview was 40 minutes in total, broken down into two segments.

What Intentional Health Does Intentional Health describes itself as a “root cause” charity - dealing with health issues at the very physical and emotional root of the participant themselves.

It is a ten-week programme designed to help participants with their physical wellbeing such as weight, BMI, diet and exercise, but also shines a spotlight on their personal and emotional wellbeing, by looking at habit breaking, boundary setting, self-esteem and sleep. The intention is for participants to live a healthy and more complete life, regardless of their current circumstances, and to help them to make informed choices about the things which contribute to their lifestyle.

Origins of Intentional Health In 2008-09, Niky Dix created and ran a family obesity Tier 2/3 intervention with a view to reducing childhood obesity and to improve self-esteem. She partnered with Health Promotion to replicate this around Cornwall in 2009- 2012. During this time, she became aware of a growing need for more a universally applicable peer-led health promotion programme.

She also realised that nothing currently existed for the promotion of healthy lifestyles through the local church. She therefore decided to bring together her experience in education, health promotion and the local church, to enable church volunteers to deliver an evidence-based health promotion programme.

She began to write and deliver the programme in 2012, and when it won a Gold

The Church’s Impact on Health and Care. Page 29 Mustard Seed Award (sponsored by Andrews Charitable Trust and Premier Radio), she realised that other people had picked up and applauded her vision. At that point, she realised that the programme had the potential to be embraced nationwide. It has currently been replicated 11 times: with 39 trained coaches, 21 programmes and approximately 200 beneficiaries.

Evidence for Intentional Health Intentional Health keeps records of participants through a registration form, which has basic contact details. Then anthropometric measures are taken (weight, height) and data is anonymised and submitted. All of that data is given voluntarily, and is not mandatory.

Then participants fill out questionnaires before and after the programme, which have been devised by Exeter University Medical School, along with Big Lottery core questionnaires, which are set up by the New Economics Foundation.

Qualitative data is then collected through case studies, and feedback with individual coaches, who then collate them with Intentional Health.

According to Nicholls et al (2016), participation in Intentional Health programme is associated with “statistically significant increases in subjective wellbeing” (p. 1). This is based on group mean scores of the Shorter Warwick- Edinburgh Well-Being Scale (SWEMWBS). Significant improvements were also seen in the following domains:

• Healthy eating – intentionality and confidence; • Personal wellbeing - resilience & optimism; • Personal wellbeing - competence and autonomy; • Mental wellbeing - stress.

There were, however, no significant changes in the following domains: • Physical activity – intentionality, self-efficacy and autonomy; • Social wellbeing; • Physical Health Parameters (pulse rate, BMI, weight).

Of course, as with all of the programmes featured in this research, more needs to be done to measure the effectiveness of the interventions, yet the early results are nevertheless impressive.

The Church’s Impact on Health and Care. Page 30 Intentional Health in the Literature Despite its relative infancy as a project, Intentional Health already features in some academic literature, owing to an informal working relationship between the founder and the University of Exeter.

Part of the research covers an eHealth2 technology intervention based around Intentional Health. Jenkin et al (2015) examined the effectiveness of a web- based Intentional Health platform with overall positive results. Intentionality was reflected in healthy eating, but not necessarily in physical activity. However, participation in the programme was associated with statistically significant increases in subjective wellbeing, according to the use of the Shorter WEMWBS. Statistically significant improvements were also recorded in healthy eating, resilience, optimism, competence, autonomy, stress, and no significant changes in physical activity (intentionality, self-efficacy and autonomy), social wellbeing, or pulse rate, BMI and weight.

Jenkin (2017) was a brief Intentional Health app feasibility study, looking at the possibilities of an app-based approach to Intentional Health which would enable participants to record their progress and for the anonymised results to be uploaded and analysed by the Intentional Health team. The idea was to collect data on: • BMI (using class 3 scales/height measure); • Resting Pre-post Pulse rate (BPM); • Health choices and self-esteem via validated Big Lottery Core Questionnaires (Recommended in consultation with Exeter University/European Centre for Environment and Human Health, collated anonymously and analysed centrally).

Additional in-depth questions would be included for: • Healthy eating, (evaluate goals, intentions; confidence); • Physical activity (evaluate goals, intentions; confidence); • Mental health (evaluate stress; anxiety); • Social wellbeing (evaluate engagement; participation; belongings and support).

The app would thus enable the programme staff to evaluate data longitudinally, but as yet, it remains a long-term goal for the project.

2 e-health is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999.

The Church’s Impact on Health and Care. Page 31 Intentional Health Partnerships Most Intentional Health partnerships are with GP surgeries local to practitioners, where coaches have been able to put posters up to promote the programme. There are some preliminary possibilities of working with Southwest Public Health England, but discussions are in their early stages.

The Cost to Run Intentional Health The annual license to a church is £300, with an up-front coach training cost of £600. The handbooks cost £225 for 10; it is suggested that this cost is passed on to the participant. A micro-grant of £2000 would more than cover this cost for the church in question.

Potential Cost Benefits of Intentional Health As many of the measures are still in the early stages, providing an overall cost- benefit analysis is difficult. Because the programme deals with the root of the participant’s wellbeing however, it looks at the emotional and psychological parameters with regard to the person’s health. So, a participant may lose weight, but that can only be sustained when the emotional root of the obesity is addressed (see also Chapter Four).

The same is true for health complications such as Type 2 diabetes, which can be prevented or brought into remission, in most cases (Lean et al, 2017). Assuming only outpatient appointments for one patient with Type 2 diabetes costing £700 per annum, as well as the cost of medication and dealing with complications, the cost of one iteration of Intentional Health can pay for itself with just one patient. Intentional Health have cited at least one participant who is no longer a Type 2 diabetic. This does not take into consideration the effectiveness of working with participants’ mental health, root causes of obesity, or overall wellbeing.

Intentional Health Case Studies Below are some examples of people who have been affected by Intentional Health. They come from the interview with Niky Dix, and are related by her. They illustrate the range of effects a health and wellbeing course such as Intentional Health can have; ranging from giving people the agency to live life the way they want to, to causing diabetes to go into remission (there may have been other variables in this instance), to enabling someone to reverse the habit of a lifetime, and to receive love from her husband and others.

The Church’s Impact on Health and Care. Page 32 Freedom to Choose. Niky: So … 74-year-old Sarah always yo-yo dieted, and … suddenly felt … because we'd told her about what was healthy and what wasn't, [that] she could make a choice. And if she was going to choose something, to enjoy it and not feel bad about it. She - for the first time - felt empowered to make a choice to have a pasty, and she didn't want one! And she said, ‘I’ve never realised’, and… it's freedom, isn't it? That's freedom, it's liberation, it's choices …

No Longer Diabetic. Niky: we've got one guy who's not Type 2 Diabetic now. Now assuming he only needed outpatient care, that's like, £3-700 a year (saved to the NHS).

Able to Receive Love. Niky: Sally's husband came to me (earlier) this year ... I didn't have any [previous] connection with her. She came bouncing over to our stand, saying, ‘I’ve just finished Intentional Health. It is amazing. The course is amazing. I went on it to lose weight’ - and … at this point she'd lost three stone, she's now lost six stone. And she said, ‘that was all good … but oh my goodness I was not expecting the second part’, which is all the emotional and wellbeing stuff, and she just … couldn't stop bouncing, and then her husband came over, and … she said, ‘tell them what … happened!’

And he stopped … and he looked at me, and he looked at her, and he said, ‘she has changed … Let me tell … you something about my wife … She is the most loving person you'll ever meet. She loves me, she loves God. She loves the kids. She loves her family, she loves her work. She just loves everybody. But she's never been able to receive my love.’ And … he said, ‘what … she's learned from Intentional Health is that she is lovable and that God loves her, and that I can love her.’ And he said, ‘it is amazing.’

The Church’s Impact on Health and Care. Page 33 B. Parish Nursing

Interview Details Ros Moore, CEO of Parish Nursing was interviewed on Wednesday 1st November 2017, at the Parish Nursing central offices in Peterborough. The actual recorded time of the interview was 52 minutes in total, broken down into several segments.

What Parish Nursing Does Parish Nursing Ministries UK helps churches to “appoint nurses, who in turn support people and communities toward whole person healthcare. This is care for the person’s overall wellbeing, incorporating mind, body and spirit” (website, 2017). The concerted focus is on holistic healthcare. Parish nurses supplement the work of local hospitals, GP surgeries and healthcare partnerships by working with hospitals in patient discharge, visiting patients who might be in an isolated rural community, and spending quality time with those patients. Their role can be as a conduit for communication, or a lynchpin within a healthcare partnership where other partners are unable to spend time with the patients or their families. Whilst a parish nurse is usually established as part of a local church, strong partnerships can and have been formed with local GP practices, and hospitals.

Origins of Parish Nursing Parish Nursing has been in existence for many years in the USA. It began in 1985 in Chicago with six pilot nurses, and now has over 12,000 trained nurses worldwide (Wordsworth, 2015). Parish nursing Ministries began in the UK in 2005, following a fact-finding trip in 2001 by Helen Wordsworth, the UK founder. Since then, it has replicated some 85 times around the UK at the time of writing. Also, Wordsworth quotes research by McDermott and Burke which listed the seven functions of a parish nurse: which are: integrator of faith and health; health educator; personal health counsellor; referral agent; trainer of volunteers; developer of support groups and health advocate (Wordsworth 2015, ch.2).

The Church’s Impact on Health and Care. Page 34 Evidence for Parish Nursing DeHaven et al (2004) examined the statistical effectiveness of faith-based organisations, including Parish Nursing, and determined that such interventions make a statistically significant difference in areas such as “reducing cholesterol and blood pressure levels, increasing fruit/vegetable consumption and reducing weight, increasing use of mammography and breast self-examination, increasing knowledge about prostate cancer, and increasing readiness to change regarding smoking cessation” (p. 1032). Wordsworth also cited statistical returns from parish nurses as a source of data for her work (2015).

Having said that, Parish Nursing Ministries UK tend to be wary of citing statistical evidence for their effectiveness. Part of this is due to the difference between a parish nurse and a district nurse. Whereas district nurses are measured in terms of time and task, and therefore have to see a certain set number of patients in any given time, parish nurses can sometimes spend more time with patients who need quality time to be spent on them (see also Chapter Four, Theme 2 - The Gift of Time).

District nurses will, for example, come to dress a wound, to attend to a specific health care need, and then leave; whereas parish nurses will take time to talk to, and listen to the patient, sometimes getting to a different root of the person’s wellbeing, which may not be addressed through treatment alone. The numbers of patients seen by parish nurses may therefore seem small in comparison with other practitioners.

According to Wordsworth, again, the underlying philosophy of Parish Nursing deals with the patient’s spiritual care, balancing nursing care with a pastoral function. Rather than as a part of the NHS, the parish nurse acts as an extension of the local church. It must be emphasised, however, that many local healthcare partnerships embrace the parish nurse as a vital part of their team (see case studies).

Parish Nursing in the Literature Much of the academic literature dealing with Parish Nursing is from the USA, which is appropriate, given that the project has American roots. Parish Nursing Ministries UK was founded by Dr Helen Wordsworth, whose own book “Rediscovering a Ministry of Health” delineates not only the background to the project, but the creation and ongoing practice of Parish Nursing in the UK (2015). Central to Dr Wordsworth’s thesis is that modern healthcare tends to

The Church’s Impact on Health and Care. Page 35 neglect the whole-person approach, and that Parish Nursing enables churches to embrace not only an active role in local health care, but also to deal with the emotional and spiritual wellbeing of the patient (see Chapter Four, Theme 3 - Holistic Health Care).

FaithAction have published research around holistic healthcare practices. November (2014) touched on the subject, and Garland (2017) explicitly looked at Parish Nursing as a model of a faith-based organisation which is actively “keeping pressure off hospitals” (see case studies).

Parish Nursing Partnerships Two of the partnerships with health providers (rural Cambridgeshire and Morecambe Bay) are cited in the case studies at the end of this section. The primary partnership for all Parish Nursing is with the local church, since Parish Nursing is not seen solely as a health provision, but also as a spiritual one (although it could be argued that the two exist coterminously). Partnerships are also frequently made with other local authority organisations, both public and voluntary sector. In some cases, the parish nurses work part-time, and still work for the NHS part-time (see case studies).

The Cost to Run Parish Nursing Parish Nursing need not cost anything to the local health service. This is because the funding should come primarily from the local church, or church partnerships (see case studies). The cost also varies, depending on whether the parish nurse is paid by the church, or comes as a volunteer (both models are being used across the UK).

At the time of interview, costs of setting-up Parish Nursing were: £120 - for the Expression of interest. To meet congregation members, the person in charge of finance. To determine whether Parish Nursing is for them. The church then forms a Vision, Mission, and Method statement. £220 - for recruitment and matching of a nurse. Includes advertisement packs and support from regional coordinator. £595 - for the Parish Nurse Preparation Programme. A five-day residential with portfolio verification. £395 - for the annual fee. With a dedicated Regional Coordinator, an annual quality assurance visit, further accreditation, support and supervision.

Total cost - £1,330. A micro-grant of £2000 would more than cover this cost for the church or church partnership in question.

The Church’s Impact on Health and Care. Page 36 Parish Nursing Case Studies

Introduction The Parish Nursing case studies take on a slightly different form, since I also interviewed Ruth McDonald from Parish Nursing in Morecambe Bay, and parish nurse Claire Gillett, and Dr James Morrow from the Granta GP practice in Cambridgeshire.

Interview with Parish Nurse Ruth McDonald (Morecambe Bay)

Ruth McDonald is an example of a parish nurse who works part-time as a NHS staff nurse at a hospital, and part-time as a parish nurse (and part-time as a Parish Nursing coordinator for the region). This interview is a good case study of how a local parish nurse can work effectively in partnership with a local NHS hospital. Here is an extract from the interview:

David: …how did you get involved in Parish Nursing in Morecambe Bay and with the local hospital?

Ruth: I've been a parish nurse actually for 8 years, so quite a long time here, but this only came about … 18 months ago. I was asked to speak [about Parish Nursing] at … a community engagement meeting … [with] different agencies. And at the meeting was one of the governors from the … NHS trust, who … approached me and said, ‘why don't I know about this?’ and, ‘are you working with the hospital?’ And I said, ‘Well, no,’ and it stemmed from that conversation really.

David: How does that actually work?

Ruth: So … last year, we did - a bit like a pilot really, just to see how it would work: me taking patients on discharge that have been in the surgical ward, because that's my background, really. So just taking a few wards, mainly orthopaedics, because that's was where I originally worked. So, we met with the staff there, and said, ‘how do you think it would be if … as a parish nurse, could I add quality to the discharge service, you know, with the NHS being extremely pushed and services limited at times?’

And they all thought it was a good idea. Ros (Moore, the Parish Nursing CEO) and I sort of formulated the plan really: … the expectations, what kind of services I could provide, as a parish nurse, because it's a … non-invasive [role] - [I] didn't want to replicate the district nurse's role, or any other services.

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… I just took ten patients initially, and then we did like an audit on that… and then after that … we fed it back to the Trust … to see ... how we could take it forward.

So that's it in a nutshell, and it was a very successful ... trial, and the partners engaged very well … and then we had a little gap while we did the auditing and researching on it, and then probably about March this year we've continued the service … in a formal partnership.

So … I’m in quite a good position ... my church pay me as a parish nurse, and I had to approach them to see if they would agree to let me use some of my hours to … visit … patients [from] hospital and agree to see me. So they agreed that yes, some of my hours could be used … because … we still obviously offer spiritual care to the patients that want it.

… And the NHS provides some equipment, some of my training needs … but, because I work for them anyway …. they can offer other parish nurses in the region [some training]. We're still sort of developing the model. There was sort of a discussion around … them paying my petrol expenses, because I am visiting patients up to about a five-mile radius.

Because Ros [Parish Nursing CEO] is a Chief Nurse … she's … on the executive board of a hospital trust, so she's obviously fully up-to-date with everything that's going on in the NHS … she knows health policy … very well from her previous roles. So, it was making sure [we had] governance in place. Looking at … what I was going to do, what I wasn't going to do … and how we were going to evaluate, and ... all the things that the NHS would expect … from a partnership.

David: … And how many patients … do you have?

Ruth: Right. So … as patients come out of hospital, … they're offered my leaflet [by the discharge team], my details, [they] say who I am, and what kind of services I can provide. And obviously that it's a faith organisation, and would they like me to come and see them at home? If they agree, then the referral comes to me, and then I pick up the referral … and … the patient … It might be that I just do a couple of visits, if the person's … well-supported, fairly well- settled, or... I can have situations where it's very complex … I can be … putting care in for a couple of months, dealing with other agencies, and it's been a really, really interesting thing to do, because lots of patients do go home, [but] they … can still be sick, and need further care, [and don’t] always have the support mechanisms in place … lots of things like that.

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… I’m up to 31 patients so it's actually increasing, really.

David: Sure.

Ruth: And it certainly is working well, they're very happy with the service. You know … [the partnership] were nominated for a Nursing Times Award … and the Trusts … are very happy for it to continue. And the plan in Morecambe Bay, is now that they would like to recruit a parish nurse in each of their integrated care communities. So they see it, you know, progressing. They see the value of it, in lots of ways [with] … good examples of ... care that's been essential, that's prevented re-admission. We've quickly got … services in to prevent people deteriorating. That kind of thing … So it's been … what I would describe as an ‘added value’ role to the normal spectrum of services that are there.

The Church’s Impact on Health and Care. Page 39 Interview with Parish Nurse Claire Gillett (Cambridgeshire)

Claire Gillett is a parish nurse who is wholly embedded within a GP practice which covers five locations, demonstrating an effective partnership between her and the staff and multi-agency teams of that practice. This section covers an interview with her, and also with the GP who brought her into the practice, Dr James Morrow. Claire is funded by a partnership of churches and parish councils in three-year stints.

David: How long have you been doing Parish Nursing in Cambridgeshire?

Claire: I've been doing Parish Nursing for seven years … So I work for the community and the church, [who] raised money to fund the post, and - with different trustees and community events and single people offering to support on a regular basis. And churches, and parish councils, they've raise enough money to support the project for three years … The GP, and four other highly qualified professionals in the community gathered together enough evidence … to support the funding of a three-days-a-week parish nurse.

As far as attachment to the surgery is concerned, the GP is on the management committee of the parish nurse … which has meant [I have] total access to the notes, and the support of the clinic staff.

And it's just worked for me, cause I've done parish nursing in a voluntary capacity in a City, where trying to get through to the GP by telephone would have maybe have taken a week to get a conversation, and … now, in this position, I have a computer provided by the medical practice. I have a smart card. I can access patient notes, and I can write backwards and forwards to the doctor … and patient care is definitely much more effective. And I get invited to, and attend multi-disciplinary team meetings where complex cases are discussed and the discharge planning people contact me … to get … some support that ... where there's a gap really, in discharge from hospital to fully- functioning rehab.

So… with - one particular case I can think of, I managed to get seven of the health professionals together: … speech therapy, OT, physio, social worker, GP, Parkinson's nurse, patient, relative, advocate ... about that many people together, to talk with the patient and her carer. To establish what we were all doing individually.

… And that was very positive, and you know, we had an action plan going forward with more effectiveness then it would have done if that meeting hadn't taken place.

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So the fact that ... I can have direct contact with district nursing, community matron, medicines manager, OT, physios, speech and language, Parkinson's nurses ... And it is over a year now that I've built that network, so people know who I am and refer back to me, and... it's integral to the work, now. I can't imagine doing it without.

[Before], it was very much more on-the-surface … suggesting to patients that maybe they should ask the doctor this, or supporting them by going to a GP appointment with them, so that there are some ... good conversations, and the appointments were well-used. But this way, I can access the notes, and I can see what's going on. And so patients understand better what's happening with them. So they can say to me, ‘I’ve had a blood test, I don't know what for.’

… So I can follow up appointments if necessary, and chase results and check out... Preventing crisis happening, advising people before that crisis happens, how - how to best avoid it, and how to make - to make the best choices in the difficult position they're in, without it [turning] into a crisis.

… People are quite isolated in the rural community. The care packages on discharge from hospital are very few and far between. And a lot of care agencies don't cover some of these areas. So it is quite difficult to get people out of hospital with the appropriate amount of care.

David: … And what sort of figures do you have, how many people do you see on a regular basis?

Claire: I have about 80 … contacts a month … So, that can mean visits or drop- ins … I get about four or five new patients a month. Of which, at the moment I'm discharging one or two. So it’s looking ... interesting ... my diary! We're looking at building a volunteer base now. And I've got a couple of new volunteers [who] are interested, that are now speaking to the management committee about getting DBSs and things, and how we manage that … So it is growing, because there is a parish nursing service, it is growing its volunteer base because of it …

Because [I’m] attached to the practice, I have lunch with the practice nurses … we have opportunity to discuss different patients. I'm in touch with social working, adult social care, care agencies, you know, it - and it - you become like a lynchpin to a lot of the services to bring them together.

The Church’s Impact on Health and Care. Page 41 Interview with Dr. James Morrow of the Granta Medical Practice, Cambridgeshire

Dr. James Morrow runs the extensive Grant Medical Practice which covers several towns and villages in Cambridgeshire. He is responsible for overseeing the funding of the parish nurse, Claire Gillet, and has also championed the parish nurse’s integration into the Practice.

David: Could you … describe the partnership … that the surgery has with the parish nurse?

James: We're a big practice, [with] 4 sites [and] 34,000 patients covering 250 square miles of South Cambridgeshire.

… And we've been involved right from the very beginning [with] the local parish nurse committee … saying that we … would work collaboratively with the parish nurse, which we felt was a real need. There was a gap in services and the parish nurse project is one that we thought would compliment … what we're already doing and also emphasise our key ... thoughts about the future of health care, which is about engaged community, is about communities taking responsibility for themselves and for each other, and providing a vehicle to allow people to help each other. [That] was very much what we envisaged as a practice.

… So we've made the parish nurse basically a member of the practice team as well. They have access to our site, our facilities, a desk, clinical support if they want it, from clinicians, nurses or doctors, some administrative support from our admin team is well, a place to base themselves, a place to see clients if they want to. So we make that all available, and we also provide the parish nurse with a computer access and a laptop. So that they have an NHS smart card, they're a member of the practice team, and if, with the patient consent - and it's only with patient consent - if the patients give consent to the parish nurse accessing the medical records, the parish nurse can do that.

So it's great for … individuals who are not sure what a discharge letter said, or are unclear about their medication or unclear what the doctors or nurses say to them, or don't when the next appointment is. The parish nurse is able to look at that and act as a conduit for information and communication.

The parish nurse also attends our multi-disciplinary team meetings for people they're involved with, and so they both feed information back to the multi- disciplinary team and also take referrals from the multi-disciplinary team …

The Church’s Impact on Health and Care. Page 42

We [may] look around, say, ‘do you think this might be one for the parish nurse?’ The parish nurse says, ‘I'm happy to take this one on. Will you check with the patient that they're happy for me to go and see them?’ So we do that, get the patient's consent and then the parish nurse provides an input.

So, from my perspective it has worked wonderfully well. [And] we are very, very happy to support it … it compliments what we are doing. And, you know, I think our patients appreciate it as well.

David: So what is the cost to you as a practice to have this engagement with a parish nurse? Is there any cost at all or is it minimal?

James: We haven't formally costed it … Really, there is very little direct cost to us. You know, the set-up cost in terms of the honorary contract, and IT and things … If you added all that up, it may have cost us, perhaps £1,000 is my guess as to what ... the integration costs might have been. But that's a cost that we're very happy to bear and subsidise, because we think that it enhances and complements the service that we can provide and it's been … another vehicle of community engagement.

We've run a series of evening meetings including ones with Libby Purves from Radio 4, The Bishop of Huntingdon, the professor of neurology. We've run evenings on becoming a dementia-friendly village, we've had evenings on resuscitation, basic life support, common paediatric illnesses, evenings on how to get the best from your GP and your surgery. So, you know, the Parish Nursing thing has provided us with a support mechanism as well, and a way of engaging with the voluntary sector, people who are supporting the parish nurse ... in a voluntary way, actually helping us as a practice to deliver some of our public health messages to the population.

So, I have really nothing but absolute enthusiasm … for it, and the fact that …increasingly, as we begin to think about population health and education, [then] engaged and informed communities are the keys to us having a sustainable health care system, and the voluntary sector … is absolutely key in that, from our perspective.

… I can’t say we're either typical as a practice, or typical as an expression of Parish Nursing, but I'm happy to say … it's not just me, I think the entire practice team has just found it really nice having this practical integration and team working with the third sector … having someone on the same computer

The Church’s Impact on Health and Care. Page 43 system, who joins us for tea and coffee. Who emails us about patients, who will pick up patients where existing services really don't do them justice, or are too restrictive. Well it just … improves the practice, I think. I think our parish nurse also appreciates the fact that they're not working in isolation, but actually … they have a broader support network clinically and socially. And actually feel that they're not ploughing a lone furrow, that what they're doing as part of the bigger picture. And an important part of it.

For us, it's just been great.

The Church’s Impact on Health and Care. Page 44 C. Mega Fitness

Interview Details Tina Riando, founder of Mega Fitness, and Matt Wisdom from the Simply Limitless Wellbeing Centre were interviewed on Wednesday 22nd November 2017, at the Simply Limitless Wellbeing Centre in Kidderminster. The actual recorded time of the interview was 51 minutes in total, broken down into two segments.

What Mega Fitness Does Mega Fitness is an all-encompassing brand which includes a variety of exercise and fitness programmes which are run by an instructor. Depending on which programmes are run, the level of necessary instructor qualification varies. Mega Movers for example, is specially designed for over 60s and those who have low mobility, and does not require a high level of instructor qualification. Mega Tods and the Family Activity Sessions are for whole family participation; Jungle Gym tends to be for pre-nursery toddlers. Further levels of training are available, including more intensive training, Zumba and aerobics.

Origins of Mega Fitness The founder of Mega Fitness, Tina Riando, was a qualified gym instructor, but found that work unfulfilling and limiting. In pursuit of a more holistic community-based approach, she partnered with the Simply Limitless Wellbeing Centre to create a programme of fitness and exercise which is wholly inclusive, multi-generational and places a strong emphasis on having fun, whilst benefiting from regular exercise. At the time of writing, there are two new replications of Mega Fitness in the UK.

Evidence for Mega Fitness The Simply Limitless Wellbeing Centre are currently running several projects which encompass Mega Fitness, and which require some degree of measurement. One is the OAP Feasibility Study - a pilot of the Optimistic Ageing Project, which was funded by the Lloyds Bank Foundation, which used the Perceived Stress Scale (PSS) and Outcomes Stars3 to measure the project’s effectiveness.

3 Outcomes Star measures in this instance were perceptions of where the client lived, ability to look after themselves, general health, being treated with dignity, being engaged in meaningful activity, a healthy social life, managing their money, and how they feel overall.

The Church’s Impact on Health and Care. Page 45 The idea was to enable participants to improve their social and physical activities through the week using the Wellbeing centre's facilities. Mega Fitness was central to this project, as the physical aspect was crucial in helping service users to exercise. Project Case Workers would meet weekly with each participant, go through a PSS form, and conduct an Outcomes Star evaluation at the start and end of the project. The participants were 10 women and 2 men in the age ranges of 50 to 85, all of whom struggled with loneliness, bereavement, unhealthy lifestyles and chronic health conditions. By the end of the project, PSS scores (i.e. stress levels) had reduced for 10 of the participants, and all Outcome Star scores had increased.

Since Mood Master began running at Simply Limitless, 89 participants attended. 30 of these have completed the shorter WEMWBS assessment at both the start and end, which has shown a mean improvement of 5 (with scores varying from +1 to +26).

The team are also beginning the SHAPE programme (Supporting Health and Promoting Exercise) which was originally created to target severe mental health issues. This particular iteration aims to work with young people who are experiencing early signs of depression and anxiety.

The core concept behind the work of the Simply Limitless Wellbeing Centre (and by extension, Mega Fitness), is one of creating community; drawing in and welcoming people from all parts of the community through a range of projects in order to improve their wellbeing (see Chapter Four, Theme 4: Creating Community). This is central to many of the projects that are run, such as the Reconnections programme, which is "aimed at tackling loneliness and social isolation for those in later life in Worcestershire" (website).

Mega Fitness Partnerships The Simply Limitless Wellbeing Centre has extensive partnerships with local providers, as the Centre runs numerous services for local people, of which Mega Fitness is one. Partnerships include The Lloyds Bank Foundation (the Optimistic Ageing Project), Worcestershire County Council (The Mood Master programme), the Worcester Wellbeing Hub, in partnership with Worcester NHS (referrals and signposting), Age UK Hereford and Worcester (the Reconnections programme), Sports Partnership Hereford and Worcester (strength and balance classes for falls prevention), and Worcestershire Football Association (Walking Football), to name but a few.

The Church’s Impact on Health and Care. Page 46 The Cost to Run Mega Fitness Mega Fitness work in three-year partnerships with churches. It costs £350 to establish a Mega Fitness centre, with £250 per annum thereafter. Apart from that, costs are down to the individual church centre in question, and the sort of programmes they wish to run. It’s important to have the use of a hall with associated costs, an instructor’s PA, the starting costs of which can be between £100-200, exercise mats which cost about £150. Churches wishing to set up Jungle Gym for toddlers can spend approximately £250 on tunnels, bean bags, crash mats, balls and a parachute. A micro-grant of £2000 would more than cover the cost of setting up Mega Fitness for the church in question.

Potential Cost Benefit of Mega Fitness Mega Fitness, like many exercise-based programmes, can be both low-cost and high impact at the same time. By focusing certain activities on the older generation, Mega Fitness is able to increase the wellbeing and socialisation of their participants as well as to improve balance and core strength. The focus for programmes like Strength & Balance is on falls prevention, also frequently working with service users who have Type 2 diabetes. In one case, the diabetes medication levels taken by the participant has been reduced, she is also losing weight, and has stopped walking with a stick.

As with Intentional Health, programmes such as Mega Fitness can have extensive long-term health benefits for participants of all ages. These benefits are important to measure (as they have with Optimistic Ageing), although as has already been said, a significant benefit is the sense of community inclusion which service users gain (see Chapter Four, Theme 4: Creating Community).

The Church’s Impact on Health and Care. Page 47 Mega Fitness Case Studies As many of these case studies and CRP focus sections illustrate, a large part of the process of a client becoming well again, alongside diabetes reversal, weight loss, core strength and fitness increasing, is the aspect of social integration (see Theme 4 in Chapter Four: Creating Community). The first case study is taken from the interview with Tina Riando, the second two are from a report about the Optimistic Ageing Project.

From Two Sticks to None Tina: I think that lady there (indicating a journal) ... when she first started coming along ... she had two walking-sticks ... She was quite hunched over, and ... was in a lot of pain with her hips and her knees. Arthritis ... was the cause of it. And she was quite negative as well. Understandably; she'd lost her husband. And she didn't really want to come out to an exercise class.

But ... through Reconnections ... [her] volunteer had spoken to her about coming and maybe trying out an exercise class, and staying and having lunch. So she did come along ... She was on medication for pain ... And she also took medication for diabetes ... [after a time] the doctor reduced ... her medication for diabetes. And it's still coming down.

She's been coming for two years. And her medication for diabetes ... is coming down all the time ... and she's losing weight. She ... doesn't use a walking stick now. So she went to one, to using none, and then she does all of the exercise sat down. She doesn't want to stand up, which is fine, but she's really confident and capable of doing the class now. And she encourages other people in the group as well. So she was probably one of our first participants in Mega Movers.

I think her whole life style has changed because ... when they're at home and alone, they're isolated it - it's as lethal as drinking - as smoking … as life- threatening as that. But … she’s got a new friendship group. She's got a purpose. She's not sat looking at her four walls, watching the TV.

Isolation to Integration Before the programme: “C2 is a 60-year-old woman who has bipolar disorder, however she is managing this very well. Lives on her own in a flat and struggles with loneliness, low confidence and sleep ... We have been helping her to become more active through participating in fitness classes at Simply Limitless

The Church’s Impact on Health and Care. Page 48 rather than going to gym on her own. No family nearby and meets friends occasionally.”

After the programme: “There has been an improvement in C2’s physical and mental wellbeing over twelve weeks. During [the programme] we have been helping her to become more active through participating in fitness classes at SL rather than going to gym on her own. We have also helped her with confidence issues which has led to her finding and initiating new friendships & becoming a volunteer. She is due to go on a trip with her local Knit & Natter group. She is also in touch with her family a lot more than she was twelve weeks ago. Her nephew came to stay with her for a week which she really enjoyed. Overall, she is feeling a lot more happy and motivated to make her life more colourful and meaningful.”

Hopelessness to Hope Before the programme: “C6 is an 83-year-old woman who lives in an annexe on her daughter’s farm in a rural area. She doesn’t have many friends and doesn’t see her family very often ... she suffers with osteoporosis and depression. Would like to be able to do more herself and have more of a social life.”

After the programme: Overall there has been a massive change in C6’s life. She has become more confident through coming to more activities and increasing her fitness levels. She has less anxiety through being busier. She can walk more easily and her balance has improved. Her social circle has widened too. She is not looking at how to improve her life and has goals for the future such as to bake more, be more sociable and to go to the shops.”

The Church’s Impact on Health and Care. Page 49 D. The Pain Exchange

Interview Details Sharon Morgans and Retha Welding, co-founders of The Pain Exchange were interviewed on Monday 20th November 2017, at St Dunstan’s Church in East Acton. The actual recorded time of the interview was 38 minutes in total.

What The Pain Exchange Does The Pain Exchange runs exercise classes for no more than 10 people at a time, who are experiencing long-term chronic musculoskeletal pain. The classes are run by qualified physiotherapists, and focus on pain reduction, coping strategies, relaxation and wellbeing. As well as the exercise, there are opportunities for participants to attend art classes, and where requested, to have spiritual pastoral time with other volunteers, and to request prayer if they so wish. They teach relaxation techniques, run workshops on nutrition, and aim to challenge their patients’ perspectives of pain through challenging long-held negative thoughts and beliefs.

Origins of The Pain Exchange The Pain Exchange was originated by Sharon Morgans and Retha Welding, two physiotherapists who decided to run the programme in their local church voluntarily, one day a week. Both still practice as physiotherapists for the rest of their working week. The programme is not a CRP, and has not replicated yet, but the founders are working on ways to create a replicable format for other churches to adopt.

Evidence for The Pain Exchange Because The Pain Exchange is still relatively new, in comparison to many of the projects, it has taken time to adopt appropriate quantitative measures. Data is still in the process of being collected. The scales which are being used are the Örebro Musculoskeletal Pain scale (Linton & Boersma, 2003), which measures pain and personal emotional wellbeing over a period of time. The team have used the scale for some time now, although results are not yet available, owing to an adoption of the incorrect scale at first. Therefore, the team rely currently on case study data and on observations of the changes taking place in their clients: changes which are not just musculoskeletal, but are also to do with

The Church’s Impact on Health and Care. Page 50 socialisation and personal confidence (see case studies).

The Pain Exchange in the Literature The Pain Exchange itself has yet to be featured in academic papers. There is, however, a growing body of literature which touches upon relevant themes to the project, namely psychosocial associations with long-term chronic pain. As written by Lumley et al (2011): “Emotions are integral to the conceptualisation, assessment, and treatment of persistent pain” (abstract). This demonstrated the need for programmes which address health care in a whole person (i.e. holistic) manner (see also Chapter Four, Theme 3: Holistic Health Care). Armon et al (2010) looked at the association between “burn-out” and musculoskeletal pain, and Åslund et al (2010) focused on social capital and depression, and their respective associations with long-term chronic musculoskeletal pain.

The associations between chronic pain and psychosocial roots was explored in the interview with The Pain Exchange, as was the related topic of creating community, and the positive outcomes that can provide for such patients.

The Pain Exchange was also featured in an article which was written by a local journalist, where the writer interviewed many of the participants, who explained how important the community around the project had become to them (see Chapter Four, Theme 4: Creating Community).

The Pain Exchange Partnerships The Pain Exchange has many existing partnerships, with Stayactive4Life (which looks at balance, and fitness for falls prevention), other local churches from all denominations, the Christian Healing Mission, Social Services and the winter Night Shelter. The team are in preliminary discussions with a professor from UCL to conduct an appropriate study, and are also in talks with local GP surgeries to look at patient referral, although they do not currently have the extensive resources which would be required to assist with all of the patients who may be referred.

According to one of the practitioners, in 2012 there are no fewer than 88,000 people who were out of work in outer London alone, due to chronic pain, with either a musculoskeletal or mental health component to it or both (Department of Work and Pensions, 2011-12). There is a significant need for such practice across the capital, along with the rest of the UK.

The Church’s Impact on Health and Care. Page 51 The Cost to Run The Pain Exchange The Pain Exchange is currently dependent upon having trained physiotherapists. Both Sharon Morgans and Retha Welding volunteer their services once a week, and some other physiotherapists work voluntarily, and one other is paid sessional rates. Given the primary team’s voluntary status, the overhead costs are primarily the mats required for the classes, a hall and associated costs for that. As The Pain Exchange is not a CRP, and is not yet replicable (although the team are working on a replicability package), there is no licensing system at present. The physiotherapists’ own insurance would cover community outreach activities.

The Church’s Impact on Health and Care. Page 52 The Pain Exchange Case Studies These case studies are taken from the interview with Sharon and Retha of The Pain Exchange. The team were very keen to share stories, and to discuss patient transformation and breakthrough. Some of these case studies sound similar to those in Mega Fitness, since both programmes enable people to regain lost motor confidence, to improve balance, but most of all, to create community and overall emotional wellbeing.

From withdrawal to laughter Retha: …when we initially started, the most significant one for me was this lady who came in the first time. She was struggling up the stairs, she was holding her back, really struggling to move. Crying for most of the class. And so ... withdrawn, and ... didn't ... want [to draw] any attention [to] her. And she just changed over the course of the programme. By the end of the year, when we had our Christmas party, she was playing charades with us ... jumping up and down, laughing, enjoying the classes.

Changing the Family Dynamic Sharon: And then we have another gentleman ... he'd been in the finance industry, he'd lost his job because of his condition. And he said it had had knock-on effects for his children, who were teenagers, they'd kind of lost a bit of respect in him. They had started acting up at school. Obviously, finances had changed dramatically in their household. And he said that coming here, had changed ... how he felt about himself. Which in turn had changed the family dynamic. And … then it got to the point where his son stopped mucking about at school. He's now at University doing a Music and Maths degree, and ... he [had been] in danger of being thrown out of school.

So it turned the family around. [And now] ... He's been fundraising for us this year … [he] has brought in some money for us.

Gaining Independence Retha: [There was] another lady who - I really enjoyed seeing this. When she came in, she couldn't get down on the floor and up from the floor by herself. She needed help.

The Church’s Impact on Health and Care. Page 53 And her husband came with her to assist, and then he would just leave ... during class, and come and get her again [afterward]. And the first time she got down on the floor by herself, I could see him just swallowing the tears, and being so moved and so proud of his wife, you know. Achieving so much.

And now she doesn't need any help. Up or down, she's just ... all on her own.

Put away the crutches Sharon: I mean ... some of them are just the people that come in ... hobbling on a stick or whatever, and then they walk out with no stick or no crutch ...

The Church’s Impact on Health and Care. Page 54 3.3 Loneliness and Isolation

E. Care Home Friends

Care Home Friends was chosen to be in the “Loneliness” category owing to its origin in the research of Tina English into the prevalence of loneliness in care homes. That said, almost all of the volunteers work with people who have some form of dementia, and some of the interview with Tina dealt with this topic as well as loneliness.

Interview Details Tina English, founder of Care Home Friends was interviewed on Wednesday 18th October 2017, at Tina’s home in Twickenham. The actual recorded time of the interview was 41 minutes in total, broken down into two segments.

What Care Home Friends Does Care Home Friends has been in incubation as a Cinnamon Recognised Project since 2016. The project operates as a part of Embracing Age, which is a charity based in the London borough of Richmond. Embracing Age currently engages volunteers to visit all care homes in the borough; the vision of Care Home Friends is to replicate the model across the UK, where volunteers from local churches and other groups “adopt” a local care home. As Tina says in the interview, there are 17,500 care homes in the UK, and 50,000 churches. The primary aim of Care Home Friends is to address loneliness.

Origins of Care Home Friends Tina English, the founder, conducted extensive research into loneliness in care homes in 2015 as part of a Master’s degree at St Mary’s University. Her research forms part of the literature for this study. Because of this focus on loneliness, it has been incorporated into the section of this research on loneliness, although Care Home Friends also focuses on dementia, in that almost all volunteers, who are trained accordingly, visit residents who have varying degrees and types of dementia.

Evidence for Care Home Friends Given that the origins of Care Home Friends comes from a research study into loneliness in care homes (English, 2015), the research underpinning the need for such a project is founded in the literature review of that study (which is included in the references of this paper). That paper cited many studies which highlight

The Church’s Impact on Health and Care. Page 55 the need for volunteers and visitors to care homes. Particular studies of interest included Hill (2015), where the author discussed a national care home volunteering project, and the need to focus on residents’ quality of life, alongside the quality of care (Schenk et al, 2013). Bradshaw et al (2012) listed four measures of quality of life within care homes. A particularly poignant study, Victor (2012) showed that people in care homes are twice as likely to be lonely, compared to their community living counterparts.

Care Home Friends: Record Keeping The evidence with which Care Home Friends work comes in several forms:

• A volunteer time log - this is submitted online by all volunteers which enables Care Home Friends to see how much time is being given to the project. • Annual Survey - this enables all volunteers to respond on an annual basis as to the effectiveness of their work, from their own point of view. • Email to Care Home Managers - this is sent by the volunteer coordinator for each care home, which invites the care home managers to feed back their perspective of the project to the main office. • Case Study - each care home is invited to submit one story from a resident about their relationship with their volunteer.

The team are keen to keep as light a burden as possible on the beneficiaries and the volunteers.

Care Home Friends Partnerships Care Home Friends has a very robust working partnership with Richmond Council, where, through Embracing Age (the founder charity of Care Home Friends) every care home now has an associated visitor, in a model not dissimilar to the Link Visiting Scheme in Wokingham. Apart from that, the main partnership focus for the project is with the care homes themselves, with whom they need to have strong relationships in order to function well.

The Cost to Run Care Home Friends At the time of writing, Care Home Friends charge a church £250 to start up a project. This covers all aspects of replication, a charter, manuals, processes and procedures. A Micro-Grant of £2,000 would be more than enough to cover the costs of a church wishing to set it up.

The Church’s Impact on Health and Care. Page 56 Care Home Friends Case Studies These are two case studies submitted by Care Home Friends, which illustrate the nature of much of their work.

From Anger to Thankfulness

Pauline⁠ 6 is a lady in her 80’s with no immediate family, living with dementia and diabetes, living in a local care home. On her first introduction to the Care Home Friends volunteer, Pauline shouted at her angrily, causing their relationship to get off to a difficult start. The volunteer duly chose to visit another resident instead, and every week, she would hear Pauline venting her anger at the nurses. Pauline did not want to be at the care home, and made sure that her opinion was registered. The volunteer went on specialist dementia training about validation, and subsequently learned that strong anger was a feeling sometimes expressed by people living with dementia. The trainer encouraged the volunteer to use her new skills to build bridges towards Pauline, which she did, and she has now been visiting Pauline weekly for a year. It transpired that Pauline loves the outdoors – she felt trapped living on a locked first floor dementia unit, and blamed the staff at the care home. She could be taken into the garden, but despite feeling trapped she refused to go out, always believing that she would be going home the next day. In fact, she did have a trial visit to her home with a full support package, but that was only sustainable for two days, and she soon forgot about it. Because the volunteer is not a member of staff, Pauline accepted her and developed a friendship. Each week at the end of the visit, Pauline would say, ‘Thank you so much for coming to visit me. It’s so lovely to have someone to talk to.’ Despite her dementia, Pauline began to recognise the volunteer. She did not remember what they talked about each week, but she remembered the good feelings with which she is left. Through the various conversations they had each week, the volunteer has been putting together the jigsaw of Pauline’s life and producing a life story book that will remind Pauline of who she is.

Expression Through Art Jean is a 90-year-old lady who has weekly visits from a Care Home Friend volunteer. Jean described how she did not feel mentally ready to move into a care home, but needed to do so, for physical reasons. She did not see much of

The Church’s Impact on Health and Care. Page 57 her family, as they spent a portion of the year out of the country, and felt cut off and in need of stimulation from the outside world. Jean was full of praise about the care she received from staff, but she felt there are not many residents with whom she could have a conversation, and she could not get out easily on her own. The volunteer took Jean for a walk along the River Thames for an hour; initially Jean walked with her walking aid, but latterly the volunteer pushed her in a wheelchair. She described how they have lovely discussions, ‘We talk about things that we wouldn’t talk about in here. I feel like I am out in the normal world talking about different things. It’s normal and it’s lovely! I look forward to his visits all week.’

Jean explained how, at one point, as she had been adjusting to life in a care home she started to have what she described as a ‘meltdown’. She felt like she had no-one to talk to, and no-one to tell. She channelled her emotional turmoil into painting, and produced the picture above, that depicted herself in a storm, not knowing how to get out. She had not done much art before, and found painting to be a therapeutic release. She also, however, felt frustrated - and had wanted to paint really rough seas, but didn’t know how to. She mentioned to her Care Home Friends volunteer that she would love someone to help her to develop her painting skills. The volunteer told Care Home Friends staff, who put a request out on Twitter, to which a local artist responded. Jean then had a number of sessions with the artist, which she enjoyed immensely. Jean says she could not do without the volunteers she has had from Care Home Friends. In her words, her volunteer ‘filled the gap’ and ‘transformed my life.’

The Church’s Impact on Health and Care. Page 58 F. Linking Lives UK

Interview Details Jeremy Sharpe of Linking Lives UK was interviewed on Thursday 23rd November 2017, at Costa Coffee in Winnersh Triangle, Berkshire. The actual recorded time of the interview was 35 minutes in total, broken down into two segments.

What Linking Lives UK Does Linking Lives UK works with local churches to train and send out volunteers to visit lonely and isolated people in their local community. Volunteers typically spend time with their “Link Friend” once a week. In addition to home visits, volunteers encourage their friends to attend community events, such as tea parties or pub lunches. In at least one project, the volunteers have formed a strong partnership with Sussex Police, and work effectively with the police to deliver key messages about safety, fraud and neighbourhood participation to the residents (see Simmons, 2016).

Origins of Linking Lives UK Linking Lives UK began life in 1998 as The Link Visiting Scheme in Wokingham, Berkshire. It began as a Christmas visiting programme, but grew to a year-long project which encompassed the whole of Wokingham borough from 2007. In 2010, Link Visiting Scheme was registered as a local charity. Subsequently, in 2012, opportunities began to be explored to replicate the model across the UK and a partnership was developed with Cinnamon. During 2016, it was decided to create a separate charity to focus on national expansion whilst the Link Visiting Scheme continued to serve the Wokingham Borough area. The new charity - Linking Lives UK - was registered in November 2016. At the time of writing, there are 20 projects which are linking church-led volunteers with people in their community across the UK.

Evidence for Linking Lives UK Linking Lives use wellbeing scales recommended by The Campaign to End Loneliness. Having looked at scales ranging from very extensive to light and usable, the team have opted to use the latter. The project’s use of statistical analysis is still in progress. A simple questionnaire is completed at the start of

The Church’s Impact on Health and Care. Page 59 the visiting process, and after six months.

Scaled questions which are dealt with include:

• I have enough people available if I need to talk to someone; • I would like more contact with other people; • How would you like to meet more people? • What is stopping you from accessing these activities already?

Linking Lives Partnerships Similar to Care Home Friends, Linking Lives began as the Link Visiting Scheme in the borough of Wokingham, where the team have worked in partnership extensively with the local authority for many years. Much of the partnership focus has been with local churches, as Linking Lives has expanded its reach across the UK. Different Linking Lives church partners have different partnerships - from the Brighton group working with Sussex Police (see Simmons, 2016), to a group in North London creating such strong bonds with their local authority that the local mayor volunteered to become a Link visitor.

The Cost to Run Linking Lives UK The CRPs which are often the most successful at replicating are those for which there is relatively little qualification or administration required. Linking Lives is one of those: it simply requires volunteers who are willing to visit a local person for an hour every week, or every two weeks. Having said that, there are certain safeguarding elements and coordinator responsibilities which should be considered, and Linking Lives provides training and support to cover all of these.

The cost to a participating church in the first year is £700 at the time of writing, which is payable as a £50 per month fee for 14 months. This covers the cost of an initial day training course (which up to four people can attend), key documentation, safeguarding procedures, other systems and support in setting up the project. Following that, there is an annual membership fee of £150, at least for the first three years. A micro-grant of £2000 would more than cover this overhead.

The Church’s Impact on Health and Care. Page 60 Linking Lives UK - Case Studies These case studies were submitted by Linking Lives UK. As with all case studies, the names have been changed.

From Isolation to Integration Eileen was a 91-year-old retired harpist living in a bungalow in Woodingdean, East Sussex. The volunteer first met Eileen when she delivered a hamper to her as part of the Time to Talk Befriending ‘Thinking of You at Christmas’ project in December 2016. This was a cross-sector partnership activity, aimed at identifying and reaching out to older people in the Woodingdean area who might be at risk of loneliness or social isolation.

Eileen’s address had been identified by Sussex Police as a property where an older person lived who had been a victim of crime. When Eileen opened the door – to the volunteer and a police community support officer - she said she hadn’t expected anyone to visit to wish her a happy Christmas, let alone to be a recipient of a hamper and card. When the volunteer double-checked the address, it turned out that they were at the sister property of a sheltered housing scheme several doors down the road. Making their apologies – and assuring Eileen that she could keep the hamper - they started to chat with Eileen, explaining the service they provided. Eileen said she liked the sound of a red button that she could press in an emergency, so the volunteer to make a follow-up visit to demonstrate the service. Following that demonstration, Eileen said she would very much like to take up the service as she’d had a recent fall and was rather unsteady on her feet.

In addition to providing the Care Link service, the volunteer noticed that Eileen had a dressing on her right foot and therefore wasn’t able to wear standard footwear. By asking Eileen if she would like additional support with this, she agreed to let the volunteer help her order a ‘Cosy Feet’ catalogue which caters for wider feet.

Eileen was then able to purchase the right kind of shoes that helped her to walk outside. Eileen also explained that she had stopped driving in the last year and that she missed getting out and about. She said she used to go to the library but was not able to get there, so the volunteer referred Eileen to the Brighton and Hove City Council library home delivery service. Eileen also said that her vision had been deteriorating, so she was also happy for me to refer her to a

The Church’s Impact on Health and Care. Page 61 home visiting optician.

The volunteer then asked Eileen if she was in receipt of Attendance Allowance, which could be a useful help towards care costs she might have. She said she wasn’t sure, so the volunteer made a referral for a home visit from the Department of Work and Pensions. At this appointment with the DWP, Eileen’s son was also present, and together they completed the application for Attendance Allowance to maximise her income. Some of this allowance went towards starting a small package of care to help Eileen have a bath once a week, as she finds it tricky to do this by herself.

Eileen's son said it gives him peace of mind knowing his mother has a button she could press in an emergency, as well as all the other things which together help to maintain and improve her quality of life.

Bringing Hope A Link volunteer visited a 90-year old lady with agoraphobia, who had not been outside of her house for about eight years. She often had panic attacks every time she went to leave the front door, to go into her garden.

She regularly expressed how much she enjoyed that interaction with her visitor. As the visitor said: “there's a real sense of satisfaction in having an impact on someone who otherwise wouldn't have that. We often use this in our training; she wouldn't have necessarily a good amount of good quality time … of someone sitting down with her for an hour and listening to what's going on with her. And she'll ask about my family and what I've been doing. So … on an individual level, that gives a real sense of satisfaction.”

The Church’s Impact on Health and Care. Page 62 3.4 Dementia4

G. Lyrics and Lunch

Interview Details Jeanette Main, founder of Lyrics and Lunch was interviewed on Monday 13th November 2017, at St Thomas’s Church in Lancaster. The actual recorded time of the interview was 30 minutes in total, broken down into two segments.

What Lyrics and Lunch Does Lyrics and Lunch runs fortnightly singing groups for people who have varying degrees of dementia, and their carers. The groups typically last about an hour, with community singing, and this segues into a healthy lunch for all participants. In Lancaster there are two groups; for one group, the singing ends with lunch, and for the other group it begins with lunch. Initially, there was an opportunity to give carers some respite time, but they tended to enjoy it so much that they stayed to take part in the singing.

Origins of Lyrics and Lunch Having recently been made redundant from her post as local music teacher with Lancaster Music Service, Lyrics and Lunch founder Jeanette Main’s attention was drawn to the benefits of singing for people living with dementia. After attending some Singing for the Brain sessions with the Alzheimer’s Society, she used her community contacts and musical expertise to trial a group in her local church. She has developed a repertoire and is hoping to produce a songbook so that other churches may begin the process of replicating the project. The project is currently in incubation with Cinnamon Network.

Evidence for Lyrics and Lunch Whilst as a CRP, Lyrics and Lunch has yet to feature in the body of academic literature, there is a lot of evidence in support of singing groups for people with all stages of dementia. In their literature review, Camic et al (2013) listed several benefits of singing for people who have dementia. As Garland (2017) wrote, Singing for the Brain groups create an emotional “‘boost’ which carries

4 For Care Home Friends, see Loneliness.

The Church’s Impact on Health and Care. Page 63 on beyond the session itself. The sessions also engage with people’s spirituality: for example, they will always include some well-known Hebrew songs and will link with Jewish festivals through the year” (p.13). This concept of aligning with spirituality echoes the arguments for holistic health care which encompasses not only physical wellbeing, but also mental and spiritual as well (see Chapter Four, Theme 3: Holistic Health Care).

Singing for people with dementia and their carers was also supported by Brannan and Montgomery-Smith (2008), Osman et al (2014), and Ward and Parkes (2017), where all studies reported a change in both people with dementia and their carers (in one study, the researchers could not always tell the two groups apart).

Lyrics and Lunch Partnerships Lyrics and Lunch was formed after Jeanette Main visited Singing for the Brain groups which are run by the Alzheimer’s Society. One main difference between Lyrics and Lunch and Singing for the Brain is the inclusion of a nutritious meal, which is an important factor in Lyrics and Lunch. The project’s partnerships are primarily based around the two churches which have pioneered this work; St Thomas’s and St Chad’s in Lancaster. In addition, the project works closely with Age UK who have taken an active role in providing referrals to the group, among other things.

Potential further partnerships are emerging with the dementia matron at the Royal Lancaster Infirmary, as well as the Lancaster Dementia Hub, which happens to be run by Dr. Penny Foulds, a researcher from Lancaster University, which is conducting regular research into dementia.

The Cost to Run Lyrics and Lunch The costs associated with running Lyrics and Lunch are minimal, particularly for any church with the use of a hall, a kitchen, and a musical instrument. As yet, the group do not have a license fee for churches wishing to adopt their model, with processes, licenses and songbook, but that is in progress. If the programme is run voluntarily, all costs involved are in running the hall or building itself, and the cost of the food, as the nutritious lunch is an integral part of the programme. Lyrics and Lunch also charge a small fee of £3 per person to cover costs.

The Church’s Impact on Health and Care. Page 64 Lyrics and Lunch - Case Studies Despite being a relatively new project, Lyrics and Lunch have nevertheless gathered some case studies to illustrate their work. The first case study comes from the interview with Jeanette Main, the founder of the project.

Arthur Arthur ... was really going quite downhill. He was in his late 80's and having all sorts of problems and closing himself away, really. Living with his son who did not really understand how to [care for him]. And he was becoming smelly, wasn't eating properly, was really going downhill. He got an infection which precipitated a hospital admission, which turned out to be the best thing that could have happened really, because ... while he was in hospital, he was diagnosed with dementia.

So he was brought along to Lyrics and Lunch, which has made such a difference to him. Some of his physical problems were sorted out by the hospital and things put in place to cope with them. So he doesn't smell anymore for example, which means you can take him into company. But he loves Lyrics and Lunch, and has really come alive again. And he's become our conductor. He had a musical background and I saw him conducting with a pen. And so I bought him a baton, and now he conducts, and he laughs, and he smiles, and he makes jokes. And he does funny little dances and everybody absolutely loves him, and he's got friends again. He's going out, he's enjoying himself. He's a completely different person.

Vignettes One lady has loved music all her life and was always talking about when she can next come to the group. She no longer recognises many people but always ... talks about the group, even if it is out of context.

A husband caring for his wife around the clock for nearly ten years, says that the group is such a lifeline for them; he can relax and talk to people who really understand how hard it is, while his wife is chatting with one of the team whom she has really developed a relationship with.

A wife whose husband is quite difficult, especially as he is in such pain with arthritis as well as issues caused by his dementia, who says, ‘this is the only place we ever go except for the doctor’s or the hospital. It’s wonderful.’

The Church’s Impact on Health and Care. Page 65 3.5 Mental Health H. Peaced Together

Interview Details Heidi Singleton, founder of Peaced Together was interviewed on Wednesday 29th November 2017, at her home in Ilford. The actual recorded time of the interview was 41 minutes in total, broken down into two segments.

What Peaced Together Does Peaced Together is a ten-week course for up to ten women in a two-hour session, which incorporates themes such as beauty, thankfulness, hope and courage with hands-on creative crafts. Participants are encouraged to keep a journal, which also acts as a scrapbook of their time on the course. They can also keep their created products. The emphasis of Peaced Together is about finding wholeness after brokenness, peace after trauma, reconciliation with the past and a hope for the future.

Origins of Peaced Together Heidi Singleton wrote Peaced Together in 2012 after a prolonged time of both physical and emotional difficulty. Inspired by the CrossRoads course5 from the USA, Heidi began to realise that life can be seen as a series of trials and successes, but that those trials need not be wasted, and can in fact be embraced as part of the journey from brokenness to wholeness, and from despair to hope. Since becoming a CRP, it has replicated 20 times in the UK and Republic of Ireland, as well as on the island of Dominica in the Caribbean.

Evidence for Peaced Together Like many of the CRPs, Peaced Together is still in the process of developing its record keeping and statistical analysis. Along with other CRPs, Heidi Singleton is keen to avoid a plethora of form-filling for participants, particularly the most vulnerable. Nevertheless, the team have worked on before and after scales based

5 Crossroads was written by Victoria Jeffs from Colorado Springs, USA. It is an enjoyable ten-week programme that challenges and inspires participants to discover their true purpose in life. It is delivered by Day2 in the UK, and is particularly successful for people in long- term unemployment, or just at a point of transition in their lives. It was evaluated by the author in 2012.

The Church’s Impact on Health and Care. Page 66 on the Warwick-Edinburgh model, and have analysed these figures6. Guidelines helping the trainers to administer these forms have also been drawn up. Data is collected at the start of the course, at the end of the course, and six months after course participation, to track long-term change.

The data for 125 participants has been analysed in terms of summative change; in other words, it gives a strong indication of distance travelled for the participants, if not yet being statistically significant7. Areas analysed include questions about self-esteem (“I’m happy being me”), community participation questions, confidence, thankfulness, positivity, relationships, and purpose among others.

Early data analysis indicates high positive change in the following areas: • I am confident to try new craft activities; • I am confident to say what I am thinking; • I believe I am beautiful; • I am happy being me; • I have a sense of purpose for what I do in life; • I have a positive impact on my areas of responsibility; • I have made more friends as a result of Peace Together.

Further analysis needs to be done, particularly with a model of statistical significance in partnership with a local University.

Peaced Together Partnerships Peaced Together have worked extensively with the local borough of Barking and Dagenham with regard to assisting women who are survivors of domestic violence (although as Heidi Singleton has remarked, Peaced Together takes participants from a model of just surviving, to thriving). There are also referrals from the Richmond Fellowship, which is a voluntary sector provider of mental health services.

6 Although it should be noted that the Peaced Together questionnaire is more extensive than Warwick-Edinburgh.

7 “Statistical significance” comes with the adoption of a correctly used statistical modelling tool, such as a paired sample t-test, or a multi-variate Anova, depending on the nature of the data.

The Church’s Impact on Health and Care. Page 67 As with all CRPs, many of the partnerships formed have been via the churches who also run the model:

• One Peaced Together location provides respite care for parents of children of special needs; • Another location has been runs Peaced Together for sex workers; • Another location works alongside probation services; • One location working alongside the homeless; • Many of the trainers have a medical and/or mental health background; • Peaced Together in Dominica works predominantly with victims of sexual violence.

The Cost to Run Peaced Together Many of the costs incurred by churches who wish to run Peaced Together are initial training and set-up costs. Because it is a craft-based course, resources such as sewing machines, tools, aprons, glue, fabrics. These come to approximately £350 for a church to run a ten-person course. Heidi Singleton has found that most churches do not incur such costs, as many of the resources are donated by the host church.

In order for a church to replicate Peaced Together, it costs £450 to train one person, or £650 to train two (two is recommended). This incorporates the initial annual fee. The annual fee thereafter is £125 per location per annum. A Micro- Grant of £2000 would more than cover these costs for a local church.

The Church’s Impact on Health and Care. Page 68 Peaced Together - Case Studies The main difficulty with Peaced Together case studies was selecting them, as there are so many. In the end, three were selected which had been submitted from the lead location of Barking and Dagenham, although there were case studies available from many other locations as well. These stories illustrate some of the range of clients which come onto the programme.

The first case study comes from Heidi Singleton’s interview, the rest from a paper which was also submitted.

Forgiveness After Significant Trauma Heidi: I had one lady who was going through the murder trial of her [son's murderer] at the time of doing the course.

David: Her son had been murdered?

Heidi: Her son had been murdered and she was at the trial of the person who had murdered, or she believed murdered her son. In the end, he got manslaughter, which was really difficult for her. And ... It was actually the week on forgiveness. I thought, ‘how am I going to do this session?’ And ... after the first session on brokenness ... she said, ‘Last week helped me more than all the ten sessions that I had in therapy.’

And she consistently said that.

And she did a lot of processing in the course and couldn't join in a lot of the discussion, because stuff was so raw for her at that time and that the trial was ongoing. And ... by the ninth session ... we touch on forgiveness very gently. The topic is: ‘Peace with the Past’ ... the forgiveness comes in through the quotes, and we'll just introduce that it as an as a theme, and let people respond to the quotes as they want. We're not doing anything more than that, because it's ... such a huge topic in itself.

But we're just introducing the possibility of freedom and hope … and peace through forgiveness. But she ... decided oh yes, she was going to read a quote this time. She wanted to take a quote from the books, and share it with the group. But ... the whole time, I'm thinking, ‘I know this is going to be a difficult topic for her. I know what the quotes say!’ So she's reading her quote on forgiveness. And she stopped halfway through,

The Church’s Impact on Health and Care. Page 69 and ... and physically shaking almost with anger, ‘how can I forgive, how can I forgive, how can I forgive?’ but in that moment ... it gave her voice. And she said ... first time, she shared her story with the [whole] group. And that in itself was hugely releasing for her in that moment, just to be able to share her story.

And she read her statement out to the group, and one of the sentences was: ‘… and I'm choosing to forgive.’ And ... that was quite a tear-jerking moment for ... for the whole group because they'd ... shared in her story the week before, so in the obviously a huge impact for her. It really impacted the group as well, her sharing that.

A Single Mother C came on the Peaced Together as a friend had recommended it to her. Her confidence was very low after six years of being a stay-at-home mum, and her husband had recently left her with no explanation or contact details. English was also her second language, and although she had very good understanding she didn’t feel her English was good enough to get a job. She had begun to study accountancy, but was unsure whether she could continue due to stress and confidence.

At the beginning of the Peaced Together course she was very shy and found it hard to join in with the discussion. Throughout the course, she began to relax and to talk about her concerns, and as the programme focused on thankfulness and finding hope, she began to look forward. As she joined in discussions, the team were able to encourage her about her spoken English. Through the centre where Peaced Together is run, the team were also able to offer her support to develop her CV and to give her the opportunity to volunteer to increase her confidence.

During the session on ‘Hope and Courage’, the course asks, ‘what do you hope for, and what steps of courage do you need to take towards this?’ C was really excited when she realised that she was already taking steps towards her hope, and understood that this took courage even when something is daunting prospect. Since completing the Peaced Together course, C has gone on to complete her studies and is now getting experience on a placement with an accountancy firm. Her confidence has really grown and she feels more hopeful about her future and her ability to be able to provide for her children on her own.

The Church’s Impact on Health and Care. Page 70 A Teenage Mother K was brought to our centre by her foster mother. She was 17 and pregnant she needed to be taken into foster care. Her foster mother (also a Peaced Together trainer) recommended the programme to her. When she joined the course, she was so shy that when she couldn’t be heard. She particularly enjoyed the sewing aspect of the course and was so proud of the different crafts she made. Towards the end of the course, she started to relax and even to laugh.

K went on to join the Peaced Together Enterprise group, making things to sell and also volunteered at our centre helping with the soup lunches. Her confidence grew and she felt as though she belonged. Selling products that she had played a part in making was a real boost for her. K is now studying to become a baker and recently won an award for her collage. She has stayed with her foster family even though she is now 18 and feels very settled there. She enjoys life and has been able to make peace with her past looking forward now with a sense of excitement and hope.

Choosing to be Thankful S currently lives with her partner and two of her children. She had another child during a time in her life when she was struggling with drugs and has been through probation services. She came on the Peaced Together through Ghost Academy which is funded by probation services in LBBD to train women to be hair dressers. Peaced Together partners with Ghost academy to provide a personal development aspect to their training. S had already made huge changes to her life, which meant she was now able to keep her younger two children and was very keen to build a positive future for her family.

During the session on thankfulness, the team talked about how thankfulness is a choice not a feeling, and so by choosing to be thankful even when experiencing difficulties, one's sense of wellbeing can be transformed. During this session, S choose to be thankful that her son had been adopted and that this was the best thing for him as she couldn’t look after him at that time in her life. She told us this story with tears streaming down her face. In a later session when we were looking at peace with the past, she suddenly realised, ‘when I choose to be thankful that my son had been adopted I forgave myself and the social workers, I have made peace with my past’. This was a very significant moment for S on her journey to build a more positive future. She is now completing her hairdressing training and planning her wedding with her partner.

The Church’s Impact on Health and Care. Page 71 I. Renew Wellbeing

Interview Details Ruth Rice, founder of Renew Wellbeing was interviewed on Tuesday 7th November 2017, at the Renew37 Centre and Café in West Bridgford, Nottingham. The actual recorded time of the interview was 43 minutes in total, broken down into two segments.

What Renew Wellbeing Does Renew Wellbeing helps local churches to create “open spaces of welcome and inclusion in partnership with mental health teams to improve mental and emotional wellbeing” (website, 2017). It may be a single room in a building, which is dedicated to providing a safe place for people, where “it’s OK not to be OK.”

Origins of Renew Wellbeing Renew Wellbeing has its origins in the wellbeing of its founder, Ruth Rice, who experienced mental health difficulties which led to a period of reflection and meditation. Whilst attending well-known Christian retreats which enabled her to find peace and rest, she wondered why such retreats were not available on every High Street in the UK. This led to her creating the Renew37 Wellbeing Centre in West Bridgford, Nottingham, which is a small centre with a quiet room, next to a bustling coffee shop. Participants can spend time simply talking with other people, or alone, quietly in contemplation. They can play games, they can share hobbies, or they can simply just come along and be accepted as themselves. Renew Wellbeing is in the process of replicating with between 7 and 10 iterations at the time of writing. It is a CRP in incubation.

Evidence for Renew Wellbeing Renew Wellbeing are currently working with ImROC (a local health advisory body which works closely with the NHS) on a project which is being quantitatively analysed by the University of Nottingham, looking at access to services within Nottingham mental health partnerships. That data will be available for analysis at the close of that particular project. Renew Wellbeing are understandably wary of straight statistics, as mental illness can sometimes appear to be dealt with in a participant, only for that person in question to

The Church’s Impact on Health and Care. Page 72 experience a significant relapse afterward. For projects such as Renew Wellbeing, longitudinal data will be the most effective measure of progress over an extensive period of time.

Renew Wellbeing Partnerships Partnership is a central tenet to the work of Renew Wellbeing, whose philosophy is “be present, be prayerful, and be in partnership”. Beginning with the Nottinghamshire County Council mental health co-production team, then ImROC, the local health and wellbeing consultancy partnership and through whom Renew Wellbeing work with the NHS. The team have made partnership a major focus of their work, and that of their franchisors.

The Cost to Run Renew Wellbeing As with many CRPs, costs vary according to how the project is run; whether the project “champion” is a volunteer or paid, whether there are premises costs, and other potential overheads. In terms of licensing, Renew Wellbeing asks for a £500 initial set-up to help the franchisor church to get the project established, and then they ask for a monthly contribution to their costs, in the region of about £40 a month, according to what the church can afford. That comes to £500 for the first year and £500 pound per annum thereafter to be part of Renew Wellbeing. A micro-grant of £2000 will more than cover this cost for a local church.

Potential Cost Benefits to Running Renew Wellbeing A typical hospital stay is estimated to cost £400 per day. One of the participants at Renew 37 (the originating hub of Renew Wellbeing in Nottingham) had spent much of his life in continuous critical hospital admissions. Upon attending Renew 37, he had a period of 18 months with no hospital visits and no admissions. He had a relapse since (something Renew are keen to be honest about), but those 18 months out of hospital would have saved the NHS approximately £26,000 during that time.

For many people who access services such as these, the establishment of community is the main factor which draws them in and gives them a sense of belonging. This is often why they are able to spend time away from some care services (see also Simmons, 2017, and Chapter Four, Theme 4: Creating Community).

The Church’s Impact on Health and Care. Page 73 Renew Wellbeing Case Studies These case studies came from the interview with Ruth Rice of Renew Wellbeing. The first case does not seem positive, but has been chosen to illustrate the severe need that still exists for mental health services in the UK today.

No Resources Ruth: I went to complain [on behalf of] one particular lady who had had four years on a section in a mental health unit. She came out of hospital to the best package of care they could offer her, which was eight hours a week support … Mondays to Fridays. And of course, she wasn't coping. And twenty-two suicide attempts later ...

The church had been involved with her and her family from the very outset. She is only in her 20s. I just was going to case reviews with her, as her minister. I'm thinking there are 17 people in this room, and I know that they know, that this isn't the best they can do for this lady, but they're all arguing about their budgets. And it incensed me, but at the same time I thought, ‘bless them. These people are doing the best they can within the system they've got, and people are falling through the net.’

Out of Hospital Ruth: There's another lady whose name I won't mention, who had been in hospital every Christmas - every Christmas - since she'd been unwell for 20 years. So even if you could retrospectively look at that. But actually, this year [because of the project] the she wasn't in hospital ... [a potential] £7,000 saving, as she was always in for a number of weeks.

Saving on Hospital Stays So N ... said [Renew] has saved his life. He will still have some hospital stays, but his hospital stays were normally six months at a time. And then when he came out, he used services so much, so he was in and out of hospital to get back to ... where he was at. After he'd been attending here for a few weeks and he felt he had some support, he was only in for six weeks. So if you take the six months, and you say, ’actually that's [been reduced to] six weeks.’ Well that's a massive saving.

The Church’s Impact on Health and Care. Page 74 3.6 Perinatal

J. Baby Basics

Interview Details Hannah Peck, CEO of Baby Basics was interviewed on Thursday 26th October 2017, at Network Church, Sheffield. The actual recorded time of the interview was 39 minutes in total, broken down into two segments.

What Baby Basics Does Baby Basics provides a Moses basket full of basic necessities for vulnerable mothers who have just had a baby, as referred by local midwives. Many of the mothers are young mothers, or are experiencing domestic violence, or have been trafficked, or cannot afford such basic amenities. A team of church-led volunteers will gather the contents of the baskets, and give them to the midwives, who then pass them on to the mothers in question.

Origins of Baby Basics Baby Basics began when a midwife approached members of Network Church in Sheffield in 2008, asking whether there was any possibility that the church could provide a basket of supplies for a young mother who was in need. The idea then grew, became a charity and was taken on by the current CEO, Hannah Peck, who has helped the project to grow from small beginnings to a CRP which has replicated 32 times across the UK, at the time of writing.

The Cost of Baby Basics Baby Basics runs in a church, typically staffed by volunteers (unless the church in question has received some specific funding to run it). Many of the items given as supplies to midwives are donated, but wherever possible, Baby Basics are keen that the items are either donated new, or in very good condition (with the exception of mattresses, which must be new).

The monthly fee for being part of Baby Basics is £15 per month, at the time of writing, £180 per annum. This means that a £2000 Micro-Grant will more than cover a church’s cost in starting up the project.

The Church’s Impact on Health and Care. Page 75 Baby Basics Case Studies The first two case studies are taken from the interview with Hannah Peck, the CEO of Baby Basics. The second tranche are case studies from midwives.

Giving A Sense of Pride to Vulnerable Mothers Hannah: We had a story of a lady who had been offered a place in an English class. She was a lady who was seeking asylum. She had been offered this free place to have English lessons, but she couldn't get to them, because she didn't have a pushchair for her baby, so she was unable to do that. And then when she received a pushchair from us, she was able to take up her English lessons.

And we also had feedback from a nurse about her clinic, and she was saying that some of the women she knew that people were missing their appointments, and the concern was in the conversations that [she] ... subsequently had, was that if they if the ladies didn't have ... clothes that fit their babies, or they didn't have nappies, they were actually a bit afraid to take their child to the clinic, looking like they couldn't cope, looking like their child wasn't well cared for. So they were missing appointments and then they saw that actually they were getting women who were coming in, delighted to be … presenting their baby, really - you know, full of pride in their baby.

Learning to Receive Hannah: There was a lady who, when her midwife arrived at the house with the basket, initially, she wouldn't let her in. She didn't know how to receive help and she closed the door on her. She said, ‘no.’ And the midwife persisted and she allowed her to come in, and they had this conversation, and the lady sort of said to her, ‘well ... previously, whenever I've been given help, it's always essentially come with strings attached. There's always been some something. And this is - this is different.’ But ... she [had been] wary of it, because of … where help had come from previously. But ... the midwife … described that as something that helped her to … deepen that relationship with her clients, so ... there was a level of trust that had been … built there, because she was able to take [the equipment].

Midwife case studies I’ve known women miss appointments and not attend the clinic because they are ashamed and afraid for their babies to be seen in clothes that no longer fit, some are unable to leave the house because they don’t have nappies. People can sometimes be afraid of ‘the system’ and afraid for their babies to be seen like

The Church’s Impact on Health and Care. Page 76 this so they avoid coming in. And I’ve seen those same women come confidently into the clinic ready to show off their babies dressed in clean clothes, they are so proud. It’s simple but for some of our mums’ clothes and nappies from Baby Basics is the difference between them attending clinic and not.

The same is true of the pushchairs and slings that are given out from Baby Basics, they make it possible for women to attend appointments and to socialise. It was fed back to us that a woman had been offered English lessons but that until she had received a pushchair from Baby Basics she was unable to take up her place in this class as she was simply unable to make the journey.

Preventing Social Isolation We issued out a brief questionnaire to the agencies that refer clients to Baby Basics in Sheffield this year and 100% of them reported back to us that pushchairs and slings helped prevent social isolation in their clients. We are also told that for some women it is the start of them learning to trust again.

Able to Say Goodbye In August, a midwifery team were asked to provide a cot and mattress to a family whose baby daughter had spent her whole life in hospital. She had been born prematurely and had a condition that meant she wouldn’t live beyond her first year. After months in hospital, the family wished to take their daughter home, to spend their last few weeks together. In order for this to happen the family needed a cot for their daughter. However, the months of travelling back and forth to the hospital and being unable to maintain employment in the midst of hospital visits and grief meant that this expense was beyond them. Baby Basics was able to provide them with a cot and mattress, and their daughter was able to spend time at home with her parents. The cot was a practical help but it also allowed the family to be together in their home for the first time, and to connect in a way they hadn’t been able to previously. It allowed them to say goodbye to their child in a way that brought them some comfort. Their social worker told the team: ‘I can’t tell you what this means, it’s everything to them. At the moment, they really feel like they’ve lost everything but they’ll have (their daughter) home and that’s honestly everything to them.’

A buggy is not just a buggy Sometimes clothing, pushchairs, and cots can seem like just basic provision of

The Church’s Impact on Health and Care. Page 77 items. However, underneath the need, there is so much more. These items can allow connections to be made, they can help to free people from the isolation that previous experience and practical circumstances trap them in. A buggy isn’t just a buggy, it’s the ability to shop, to attend medical appointments and it can be the difference between engaging with classes and agencies that can transform a woman and a family’s life.

Thank you for helping us to bring this practical support and connection to more and more people.

The Church’s Impact on Health and Care. Page 78

3.7 A&E

K. ED Pastors

Interview Details Ben Woollard of ED Pastors was interviewed on Thursday 26th October 2017, at the Metropole Hotel in Sheffield. The actual recorded time of the interview was 30 minutes in total, broken down into several segments.

What ED Pastors Does ED Pastors acts as an extension of the local hospital chaplaincy. Volunteers are trained in active listening skills, and work with A&E staff in Northern General Hospital in Sheffield. They work on the hospital A&E wards, spending time with patients and their families, many of whom are often disorientated and confused by the emergency process. Because A&E staff have limited time to spend dealing with the welfare of patients, ED Pastors fulfil that role of listener and supporter.

Origins of ED Pastors ED Pastors was set up by husband and wife team Ben and Amanda Woollard in 2016. Amanda is an NHS nurse, and she noticed a gap in services which staff were able to provide, owing to the intense time demand of A&E. At the time of writing, the project is not a CRP, and has yet to replicate.

Evidence for ED Pastors ED Pastors was the subject of a study by Louise Yaull for Leeds Beckett University in 2016, where the focus was how ED Pastors might "add value to an A&E department by spending time with service users and addressing their human and spiritual needs" (abstract). The method of the study was constructivist grounded theory (similar to this paper), interviewing five people alongside a questionnaire which was completed by 29 people out of a possible 120. The study showed that the addition of volunteer ED Pastors to the A&E staff team added value to patients, hospital staff, the NHS and the local church.

The Church’s Impact on Health and Care. Page 79 ED Pastors Partnerships ED Pastors is still relatively new. The key partnership relationships are, however, with the hospital chaplaincy team (of which ED Pastors is a vital extension) and with the hospital themselves (Northern General in Sheffield, in this instance).

The Church’s Impact on Health and Care. Page 80 ED Pastors Case Studies The work of ED Pastors reflects that of Street Pastors and Street Angels in many ways, in that it gives time to people who otherwise might be left on their own, due to staff working pressures (see Chapter Four, Theme 2: The Gift of Time). These two case studies illustrate this.

Just a Drink of Water An ED Pastor ... was ... called over by someone with a neck brace. And he basically hadn't been given any water for over four hours. He was really thirsty. Staff were rushing around; it was a particularly busy day, so the Pastor went and gave that patient some water. Really insignificant. It's not going to reach newspaper headlines. But the change in the disposition of that patient was huge.

A Significant Conversation An ED Pastor was referred by the nurse in charge to a patient in his thirties. The patient was there because he had been having suicidal thoughts. And as he spoke to the ED Pastor, he ... talked ... about how he used to have a Christian faith. And that used to be part of his life, and the ED Pastor was just able to ask questions about that. And as the patient talked and the ED Pastor listened, the patient just became ... more animated and they spoke for over an hour ... And at the end of the interaction, the patient said that they felt so much better and were feeling more positive. And the staff commented on the positive change in a patient's disposition.

The Church’s Impact on Health and Care. Page 81 Chapter Four. Themes.

4.1 Introduction

Having looked at each health area in turn, and the CRPs most closely associated with those areas, this report will now look at several themes which can be found in the interview data. These themes are repeating concepts, thoughts and ideas which, when encountered in one interview, give pause for thought, but when found in three or more interviews, become a strong thread which runs throughout the interview data, and therefore this research as a whole.

I have selected themes which I think are or will become important to the relationship between CRPs and local health partnerships, particularly when thinking about potential recommendations for the future. These themes have occurred throughout the interview data, have been marked using Quirkos qualitative research software, and a report compiled from those data. That report then serves as a foundation for the themes which appear in this chapter.

The four main themes which I have selected are: • Value for Money • The Gift of Time • Holistic Health Care • Creating Community

4.2 Primary Themes

1. Value for Money

A normal Cinnamon Micro-Grant will come to £2,000, to enable a local church to establish a CRP. Statistics to date show that over 90% of CRPs set up in local churches sustain beyond two years. The average cost of a CRP is £650 to start- up, with average annual follow-on fees (to cover process, updates, continual support) of £280. That means that a £2,000 Micro-Grant will be more than enough for a church to begin delivering a programme. Naturally, costs will vary according to staffing, volunteer availability, premises costs and storage (in the case of some projects, such as Baby Basics). The overall costs per project (at the time of writing) are as follows:

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Set-Up Annual Number of Project Category Project Summary Cost Cost Replications Evidence for the Need Measures used by the Project SWEMWBS, Data Analysis Intentional Ten-week course in active health and Boseley (2017), Diabetes Health and Wellbeing £600 £300 11 (Jenkin, 2017), Jenkin et al (2015), Health wellbeing UK (2017) Case Studies De Haven et al (2004), Parish Nursing Health and Wellbeing Community-based holistic nursing practice £1,000 £395 100 Case studies and feedback Wordsworth (2015) Boseley (2017), Diabetes Perceived Stress Scale, Outcomes Mega Fitness Health and Wellbeing Fun, family-focused exercise groups £350 £250 3 UK (2017) Stars, SWEMWBS, Case Studies The Pain Örebro MS Pain scale (Linton & Health and Wellbeing Physio groups to manage chronic pain N/A N/A 1 Fayaz et al (2016) Exchange Boersma, 2003), Case Studies Care Home Schenk et al (2013), Case studies (where possible) and Loneliness Volunteers to visit local care homes £250 £250 4 Friends English (2015) feedback Linking Lives Campaign to End Loneliness Loneliness Volunteers to visit local isolated people £700 £150 20 Holt-Lunstad et al (2010) UK Measures, Case Studies Lyrics and Camic et al (2013), Dementia Singing groups with a nutritious lunch N/A N/A 1 Case studies and feedback Lunch Garland (2017) Peaced Scales based on WEMWBS, Case Mental Health Ten-week course to help women find peace £650 £125 17 NHS England (2016) Together studies Renew NHS Digital (2017), WHO Mental Health A place to go where it's OK not to be OK £1,000 £500 10 Case studies and feedback Wellbeing (2012) Moses baskets of provisions for vulnerable Baby Basics Perinatal / Isolation N/A £180 30 Midwife demand Case studies and feedback mums A&E chaplaincy volunteers for patients & NHS England (2016), Case studies and feedback, Yaull ED Pastors A&E N/A N/A 1 staff Garland (2017) (2016)

Table 1. Projects, Categories and Outcome Measures. Prices and number of replications at the time of writing.

The Church’s Impact on Health and Care. Page 83 Health & Mental Loneliness Dementia Perinatal A&E Wellbeing Health (0.85m) (0.65m) (65m) (9m) (16m) (24m)

Intentional Parish Renew Health Nursing Wellbeing (£600) (£1,000) (£500)

Parish Parish Parish Linking Lives Nursing Nursing Nursing UK (£700) (£1,000) (£1,000) (£1,000)

Mega Care Home Care Home Peaced Fitness Friends Friends Together (£350) (£250) (£250) (£650)

Lyrics and The Pain Mega Intentional Baby Basics ED Pastors Exchange Fitness Lunch Health (£180) (N/A) (£350) (N/A) (£600) (N/A)

Figure 1. Graphic illustrating health arenas, populations affected (red bold), CRPs addressing those issues, and cost to establish those CRPs.

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When these costs are aligned with potential benefits (volunteers visiting care home residents, spending time with people in A&E, visiting patients over a wide area, dealing with the whole person and not just physical symptoms, and working to achieve overall patient wellbeing), the cost-value potential is very great. The difficulty arises when attempting to provide direct quantification for these benefits, but each CRP is addressing the need for cost-benefit models.

The cost benefit for ED Pastors has been recognised by the NHS Trust in Sheffield, who said, “every hour you can give, we want you.” The presence of ED Pastors enhances morale, not just of the patients, but as importantly, the staff themselves. In many cases, costs are covered by churches themselves, who often donate equipment wherever necessary (as in the case of Baby Basics and Peaced Together) in order to make a project work.

Parish Nursing - “A Value-Add” Although much of Parish Nursing is about preventing hospital re-admission, CEO Ros Moore pointed out that sometimes patients need to be sent back to hospital; the parish nurse in Morecambe Bay had noticed things that the district nurse had not seen, because of time (see also Chapter Four: Theme 1: Giving the Gift of Time). Because the cost of the Granta Medical Practice parish nurse in Cambridgeshire was being paid for by the parish, the cost to that practice was minimal. The parish nurse added value to the excellent work that was already being done (as they do not replace district nurses - they see themselves as “value added”: see also Chapter Four, Theme 1: Value for Money), at a negligible cost. A parish nurse will look at a patient’s diet, and advise on appropriate medicine (if, for example, the patient is in more pain than they might admit to a GP). They also assess risk: “…a parish nurse of being able to identify and manage risk in a timely way is what makes parish nurses different” (Ros Moore, Parish Nursing CEO).

Morecambe Bay have recognised the value of the parish nurse to such an extent that they would like to recruit a parish nurse into every integrated care community (see Chapter Four, Theme 2: The Gift of Time). Because Claire Gillett, the Cambridgeshire parish nurse is part of the wider staff team, she is able to convene multi-agency teams to assess a patient’s needs: “… I can have direct contact with district nursing, community matron, medicines manager, OT, physios, speech and language, Parkinson's nurses ...

The Church’s Impact on Health and Care. Page 85 And it is over a year now that I've built that network, so people know who I am and refer back to me, and... it's integral to the work, now. I can't imagine doing it without. It wouldn't be as effective, it isn't ... you know, I do far more effective work in this than I was doing in my previous position” (Claire Gillett, Cambridgeshire parish nurse).

That parish nurse also saw her role as one of enabling communication: “You know, people get lost in the system because of communication. So you aid communication really, with Parish Nursing, you know, you can get different agencies to communicate with each other in a more effective way, I believe” (Claire Gillett, Cambridgeshire parish nurse).

Dr Morrow, the GP in charge of the Granta Medical Practice expressed it in this way: “There was a gap in services, and the parish nurse project is one that we thought would compliment … what we're already doing and also emphasise our key ... thoughts about the future of health care. Which is about engaged community, is about communities taking responsibility for themselves and for each other, and providing a vehicle to allow people to help each other.

“I have really nothing but absolute enthusiasm ... for [Parish Nursing]. Increasingly, as we begin to think about population health [and] education; engaged and informed communities are the keys to us having a sustainable health care system, and the voluntary sector, which Parish Nursing is the one we're involved with, is absolutely key in that, from our perspective.”

Adding Value to Mental Health Services Mental Health is a complex area to determine cost-benefit, since much of it is hidden. In the case of Renew Wellbeing, the savings were achieved through keeping people out of hospital (although again, that can be hard to quantify, since episodes of mental illness are, themselves, unpredictable):

“…it's very hard to say, ‘look we've saved you money,’ but I know some of these guys next door usually spend up to three months of their year in hospital because of their mental health. When they've got us here, the evidence for even just two people was that they didn't spend any time in hospital at all, because they knew we were here. Now, we haven't got lots of evidence, but the small amount we've got [is] based on one or two people's ...

The Church’s Impact on Health and Care. Page 86 loneliness, which sent them into a spiral of despair, which sent them to hospital” (Ruth Rice, Renew Wellbeing).

As written in Chapter Three, Section I on the potential cost benefits of Renew Wellbeing, costing hospital visits can be complicated by sudden or unexpected readmissions, yet providing community-based services such as this one enable belonging and integration to occur, something that is vital to recovery (see also Chapter Four, Theme 4: Creating Community).

In the case of The Pain Exchange, much of the pain with which the practitioners were dealing was rooted in trauma, and alleviating their symptoms was partly based in practice, and partly based in addressing the root of the issue, through art therapy, discussion, and prayer. Trauma also played a large part in the lives of many of the participants of Peaced Together, and for many of those women, the course became an opportunity not just to reflect on the past, but to look towards the future with hope (see The Origins of Peaced Together, Chapter Three, Section H).

Summary The cost of running a CRP may be easily off-set both by Cinnamon Micro- Grants, and by church donations; of equipment, of money and of volunteer hours. The value that they bring is significant, both from the viewpoint of partners, such as the hospitals and GP practices which are assisted by parish nurses, but also the beneficiaries and the churches themselves, who are able to see the difference their investment is making.

A key benefit to health partnerships with CRPs is the added value of time; bringing an element of a quality service which ordinary public health services are not always able to provide.

The Church’s Impact on Health and Care. Page 87 2. Giving the Gift of Time

Simmons (2016) deals with the effectiveness of CRPs which aim to help the police to achieve their dual outcomes of reducing crime and reducing demand. The CRPs which were focused on in particular were Street Angels and Linking Lives UK. One of the main themes to emerge from that report was “The Gift of Time”, which came from a comment made by a police constable about the added value which CRPs can bring, which is time. Where public services (such as the police, GPs or hospitals) are often measured by time and task, CRPs are able to add the value of time. Once again, this surfaced in the data of this research.

ED Pastors say the added value of time is pivotal to their work:

"... one of the things that staff have said most, in different ways, is, ‘we feel like we - we are vicariously giving really good care through you. Because I'm a stressed-out nurse. I've got 15 patients in my ward. And they're all on their trolley beds lined up through the middle. I don't have time to hear so- and-so's story. I'm just there to give him the basic medical care.’ ”

“Which is just the nature of austerity and pressure. So there is a gap, and that's why there's a need. So one of our chaplains did their Masters project on ED Pastors (see Yaull, 2015). So we have a full dissertation available that has been presented to NHS England ... qualitative research on ED Pastors has shown evidence of added value to volunteers, staff, and service users, as well as the wider NHS. And we also ... free up time of staff to engage with clinical tasks, and create healthy boundaries which adds economic value to the NHS as well” (Ben Woollard, ED Pastors).

Ruth McDonald, the parish nurse in Morecambe Bay understood the value of the gift of time to the work of their integrated care communities:

“… the plan in Morecambe Bay is now that they would like to recruit a parish nurse in each of their integrated care communities. So they see it, you know, progressing. They see the value of it, in lots of ways, cause got lots of good examples of ... you know, care that's been essential, that's prevented readmission. We've quickly got, you know, services in to prevent people deteriorating. That kind of thing … so it's been a really, what we'd call, I would describe as an ‘added value’ role to the normal spectrum of services that are there” (Ruth McDonald, parish nurse, Morecambe Bay).

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That nurse also describes the nature of the time spent:

“the NHS staff that I work closely with describe it as ‘a quality service’, because you are able to give extra quality - time, being one. Like the other - district nurses, in particular, are very much ... scurrying these days, as they have to go in and do a dressing, do an injection ... and they don't really have that time to spend with the patient ... identifying other needs, whereas ... we can spend time with the patient, and get to the bottom of ... issues and ongoing problems” (Ruth McDonald, parish nurse, Morecambe Bay).

Time was a thread throughout the interview with Ruth Rice of Renew Wellbeing, as she pointed out that busy-ness and the lack of time is often a determining factor in the rise of stress, anxiety and mental illness. Too often, the treatment of patients who are mentally unwell is also reflected in this:

“the regulars who are using the spaces are so sick of being measured [by staff] and then going, ‘right, you've had six weeks of CBT, now it's time - you should be better by now.’ The nature of mental ill health means that this is going to be as long as it's going to be. So our strap-line is, ‘quiet, shared spaces where it's okay not to be okay’ ” (Ruth Rice, Renew Wellbeing).

With the extra time which is given to participants comes the further added values of integration, and community, which is also picked up in Chapter Four, Theme 4: Creating Community.

Summary At the heart of a professional relationship is the core element of costed time; for every interaction, there is a corresponding transaction which has to be accounted for in a budget. Nowhere is this more understood than in a busy hospital or community practice; due to both financial and patient demand, every appointment is meticulously scheduled, and time is a commodity which simply cannot be wasted.

At the heart of volunteering is the freely-given time of the volunteer, which has no such ties with a budget. Whether it is ED Pastors, Care Home Friends, parish nurses or a member of Renew Wellbeing; spending time, making a cup of tea, discussing all aspects of a beneficiary’s life (not just the prevailing symptoms) are central to the care relationship. As well as the time, the underlying philosophy of all CRPs is one of seeing all beneficiaries as whole people,

The Church’s Impact on Health and Care. Page 89 people who have presenting physical or mental health symptoms, but who are mind, body, emotion, spirit - and should be treated as such. This holistic approach to health is the next theme within this chapter.

3. Holistic Health Care

The trauma which so often underlies the chronic musculoskeletal pain which is treated by the physiotherapists in The Pain Exchange (see Chapter Three, D - The Pain Exchange) illustrates the importance of treating all beneficiaries as whole people, who are presenting physical symptoms, which may well have roots in the person’s past, their psychological makeup, or their spiritual well- being. It is this perspective on health care which recurs frequently in the literature around Parish Nursing, particularly Wordsworth (2015):

“…any attempt by medical staff to treat the physical needs of a person without thinking about their mental health, social need, or environmental conditions would be contrary to wholistic 8principles” (Chapter One).

Holistic health care is evident throughout all health-based CRPs (and the care demonstrated by all CRPs). From the perspective of Parish Nursing, again:

“Plus the attention to spiritual care. Whatever that looks like for the individual. That can be ... religious practices if it's for them. But if it's not, and they're a walker or something like that, it will be about: ‘how can we get that ... person back in touch with ... whatever spirituality is to the person?’ ” (Ros Moore, CEO, Parish Nursing).

Intentional Health also places an emphasis on the whole person. To be physically healthy, yet to neglect one’s boundaries, or work-life balance, is an anathema. From Niky Dix’s perspective, making choices to be disciplined physically will also affect one’s spirit:

“actually, what I've noticed is if I can be disciplined in [the physical] area, it spills out into my spiritual health. So it's just having integrity. It's really important to be a whole person and to … be on the inside the same as you are on the outside” (Niky Dix, Intentional Health).

8 Wordsworth choses the “wholistic” spelling. I have opted for the more common “holistic”. Both are acceptable.

The Church’s Impact on Health and Care. Page 90 This work-life balance is the thing which Ruth Rice understood precipitated her own need for mental health services, which ultimately resulted in the creation of Renew 37, the forerunner of Renew Wellbeing. For the physiotherapists of The Pain Exchange, as explained above, the whole person is central to their treatment philosophy:

“…we use the physiotherapy to meet that particular need. But what it usually unveils is a whole hoard of other things ... for me, with my faith ... we're mind, body and soul. And if your ... spiritual heart is not in the right place, your resilience to deal with what life throws at you is often very poor. So for me, the Pain Exchange is about helping people build their resilience” (Sharon Morgans, The Pain Exchange).

Simply Limitless call their building a “Wellbeing Centre”, where Mega Fitness is just one of a plethora of services which beneficiaries can access to achieve wellness, whether physical, emotional, spiritual, as shown in this exchange between Matt Wisdom and Tina Riando of Simply Limitless:

“Matt ... we see there's a real need to help people in a holistic manner, socially, physically.

Tina: Spiritually.

Matt: And spiritually.

Matt: And it's the whole lot together.”

ED Pastors also recognise this. They recognise the physical need is being met (often under extreme pressure) by the doctors and nurses of the A&E ward, but that they are in a unique position:

“…my vision would be every major trauma centre in the UK has access to Emergency Department Pastors, because people deserve holistic care” (Ben Woollard, ED Pastors).

This philosophy of holistic care can be seen acutely in the work of Care Home Friends and Lyrics and Lunch. The volunteers for those CRPs do not treat the people who have dementia differently from anyone else (apart from where training necessitates it, of course). Despite the severity of the dementia symptoms, the beneficiaries are encouraged to participate, to sing, to receive the visitor. It may mean (in the case of Lyrics and Lunch) that the same jokes are repeated again and again, and never wear thin with the hearers. It may mean (in the case of Care Home Friends) that the person being visited does not remember the visitor (despite the frequency of the visits), only that the visitor makes them

The Church’s Impact on Health and Care. Page 91 feel happy, for whatever reason.

Prevention as Holistic Part of seeing people in a holistic manner is recognising the need for prevention within healthcare. So often, the NHS is understandably swamped with alleviating symptoms, dealing with treatment and medication, performing important life-saving surgery on individuals. CRPs create opportunities to take the issues “upstream” from their presented symptoms, and this is particularly true of many of the health-based CRPs.

In Cambridgeshire, Claire Gillett (the parish nurse) talks about the added value which time can bring in helping prevent further illness:

“I can follow up appointments if necessary, chase results and ... prevent crisis happening, advise people before that crisis happens, how to best avoid it, and how ... to make the best choices in the difficult position they're in, without it going into a crisis position” (Claire Gillett, Cambridgeshire parish nurse).

For Intentional Health, that prevention comes in education; helping people to understand the way in which their bodies work, or how their emotions are linked to the choices they make, or how unhealthy boundaries can cause stress, all help to prevent many of the issues which ultimately result in physical symptoms. For them, it is all about helping people to take responsibility for the choices which affect their own lives.

Both The Pain Exchange and Mega Fitness have programmes to prevent falls in older people, another source of hospital admission. For both Mega Fitness and Intentional Health, the right type of education can help people to avoid Type 2 diabetes, or, if they already have it, to reverse it. Both projects have experienced participants reversing the symptoms of Type 2 diabetes, both through simple exercise and diet management.

Summary The importance of providing holistic health care runs throughout the data; each beneficiary, patient, participant or service user is a whole person: their presented symptoms (musculoskeletal pain, loneliness, dementia, Type 2 diabetes) are

The Church’s Impact on Health and Care. Page 92 only one aspect of who they are. The job of the CRP, together with the community is to address the needs of the whole person: by alleviating an emotional need, the chronic pain is not as severe; by connecting people to others, and bringing with that, the attendant sense of belonging, the physical symptoms can be just one part of the individual’s life, and can frequently be dealt with more effectively than otherwise. This is where health and social care align, given that social care is also concerned with serving the needs of the whole person.

A final value-add which CRPs bring therefore, and one which is arguably the most important of all, is community. CRPs can bring people into communities, which bring them into relationships, which in turn, brings belonging, and hope.

The Church’s Impact on Health and Care. Page 93 4. Creating Community

Introduction The final theme which I have selected is the most important. Community connects. It also embraces the marginalised, the isolated, the lonely, the bereaved, the dispossessed, the hopeless, those who are struggling to care for loved ones. In very different ways, each of the CRPs featured in this paper (and those which are not) create community as a vital part of their work. Many do so deliberately, and for many it is an outcome which may not necessarily have been the main focus, but is essential nonetheless.

In their report, What Is Community? (Simmons, 2017), FaithAction shone a spotlight on ten different faith-based and non-faith-based community hubs which, through the work of their volunteers, draw in and include those who are on the margins of society. Each hub looked unique, and delivered unique services, yet all had one thing in common: they created a sense of belonging for those who felt that they do not belong.

In her interview for this research, Ruth Rice of Renew Wellbeing summarised it in one sentence, spoken by one of the people in the Renew Café: “Now someone knows my name.”

Creating Community Parish Nursing recognises the need to embed their workers in a community. The name creates images of a parish volunteer visiting isolated people within the rural or urban community, and in a very real sense, that is exactly what they are:

“[Parish nurses are] where people are, they're in the community. So they know what's happening in their community, whereas a district nurse coming in, lives somewhere [else] ... they might be visiting people 50 miles away. They don't really know that community. So they're not networked in. Whereas the parish nurses deal with the place. They're in the place” (Ros Moore, CEO, Parish Nursing).

With community comes belonging, and with that comes dignity. Lyrics and Lunch have been advised that for many people with dementia, lunch has to be a dignified affair:

The Church’s Impact on Health and Care. Page 94 “I was told ... by a medical professional that, if people with dementia all sit down together, at tables with tablecloths, if possible pretty cutlery, serviettes, things like that, flowers on the table perhaps even, that they would be much more likely to eat because ... it would remind them of how things used to be. And so we've taken that, and ... people certainly comment on how much they enjoy the food” (Jeanette Main, Lyrics & Lunch).

Intentional Health see their work as creating community “around a kitchen table”. Niky Dix emphasises the importance of coaches (check the word) not “knowing everything” - she does not want experts to deliver the course, she wants people who can get alongside participants, and discuss the content together, thus creating a sense of family:

“We talk to them about how we make sure they don't have all the answers, and how they can facilitate the group to come up with the answers, because their role is to help that community be embedded beyond 10 weeks” (Niky Dix, Intentional Health).

The creation of community is a central outcome in all CRPs therefore, one that is not always deliberate, but always occurs.

Loneliness and Community As evidenced by the research (see Section 2.2 on Loneliness in the Literature Review), loneliness has serious health implications not just for individuals, but for society as a whole (Holt-Lunstad et al, 2015: 235). It is a public health concern. As previously discussed, the authors of that paper wrote that it is as serious as Grade 2 and Grade2 obesity, smoking 15 cigarettes a day, air pollution and physical inactivity9. Loneliness also exacerbates existing conditions, and as The Pain Exchange have seen that there are close associations between chronic pain and a patient’s psychology. The section on holistic health care (Chapter Four, Theme 3) also serves to illustrate the holistic nature of health: there are close associations between a person’s mental and emotional wellbeing, their health choices and behaviour, and their physical health.

One of the significant moments for Lyrics and Lunch was the recognition that

9 Indeed, many of these lifestyle choices can be, in themselves, indicators of loneliness.

The Church’s Impact on Health and Care. Page 95 the carers of people with dementia wanted to remain in the group. They were given the option of using the time as respite, but unanimously chose to remain, because they appreciated the friendship of other carers. Long-term carers were also one of the people groups who were experiencing severe loneliness, and who were described in the Carers UK report, Alone and Caring (2015). In the words of Jeanette Main:

“…we've discovered that the carers get so much out of it. Such that, when we try to give carers a chance to have half an hour off, and go and have coffee in another room and a chat, we found they didn't want to. They enjoyed the singing too much. They enjoyed being together, they enjoyed seeing their loved one having a great time. But also, they get a lot out of sharing together over lunch. And in the corridor, and everything else. The chance to offload a little bit to somebody who completely understands what they're going through, and because everyone makes such good friends” (Jeanette Main, Lyrics and Lunch).

In her interview about Baby Basics, founder Hannah Peck said that the most important characteristic running throughout the stories of mothers who had been helped had been one of “connection” - many of the vulnerable mothers who were on the margins of inclusion, found that the gift of baby clothes and essential items in a Moses basket helped them to feel connected to their local communities:

“…there was a real theme of ... connection, and people ... breaking ... through their own circumstances... it was something that was enabled ... that isolation to start to break” (Hannah Peck, Baby Basics).

Renew Wellbeing see it as bringing a person’s daily life to their café:

“So if you can, encourage people that it's not rocket science, ‘Have you got a hobby? Come and do it here, rather than doing it at home. And whilst you're here, here's the Mental Health team, they're doing the same thing. Let them hang out with you’ ” (Ruth Rice, Renew Wellbeing).

Sharon Morgans and Retha Welding of The Pain Exchange talk about the moment when they realised that their group of patients had turned into a community. Where people who were isolated by their chronic pain found a reason to leave their home every Monday:

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“And the social time I would say, is really important to them. That's when they're making and building their community. So ... I hadn't realised you know, there's a bit of a book library that goes on between them. There's a bit of a meeting up and phoning each other outside of here. But ... if you ask them to ... quantify what they like about here, and why they come, they say the tender loving care that they receive ... That was one of our objectives, wasn't it? And it was reducing fear and isolation in a way that I hadn't quite fully comprehended” (Sharon Morgans, The Pain Exchange).

Reducing isolation, and thereby reducing pain, is also vital to the work of Mega Fitness:

“I mean, for [participant] ... she's got a new friendship group. She's got a purpose. She's not sat looking at her four walls ... having TV as company. So … there's a massive social element to it that just, I think, lifts a lot of pain away from them really because ... when they're sedentary they they're not communicating they're not moving" (Tina Riando, Mega Fitness).

For Tina, belonging is also core to creating community:

“Everybody's made to feel really ... included, and I think you said it earlier ... they belong. It's a place where people feel they belong. And that's quite motivating, I think. I think, for all of us. It doesn't matter what age they are, could be the youngest” (Tina Riando, Mega Fitness).

With Linking Lives, part of the role of a visiting volunteer is to encourage their Linking Friend to socialise, wherever possible, with others. That may be church events, singing groups, and in Wokingham particularly, Pie and Pint groups - social events where normally isolated people can get out and get to know one another:

“And ... that's often a better option ... than going say, for example, to a day centre where they might not particularly be enthusiastic about going ... So … we're trying to encourage as much socialising outside of the home if they are physically able to get out and do that” (Jeremy Sharpe, Linking Lives UK).

Because she recognises the role community plays in integrating people, Heidi Singleton is working on a “Peaced Together Plus” model, whereby people can

The Church’s Impact on Health and Care. Page 97 go through aspects of the programme with mentors:

“… at our local hub, we offer mentoring as well. So ... I've looked at that ... is there a ‘Peaced Together Plus’, a second tier of training for churches for ... helping them have additional support for their participants on the course ... and one of the Peaced Together Plus would be that kind of mentor training and another way of engaging a wider [group of volunteers] across your church ... to come and get on board with that” (Heidi Singleton, Peaced Together).

Community and Fun As FaithAction detailed in their report “What is Community?” (Simmons, 2017), one of the most important aspects of creating community is shared humour, being able to laugh together, of having fun. For many people, fun is not a part of their daily vocabulary, so therefore creating opportunities for them to be able to laugh together can be very healing, as Lyrics and Lunch have discovered:

“And one or two new [songs] and … simple rounds. We have an awful lot of fun. We have a lot of laughter. People like it best when we make a bit of a mistake, or the leaders knock spots off each other or something. Causes a great deal of hilarity and a lot of smiles” (Jeanette Main, Lyrics & Lunch).

Jeanette also describes the mirth which ensues from renditions of My Darling Clementine, or a little-known round called “Black Socks”. The jokes can be repeated every single time, as participants may well forget them from one week to the next, but somehow, they still find the jokes as funny as they did the first time.

For Care Home Friends, a sure way of recognising that someone is enjoying the visit is when they smile and laugh - many care home residents do not remember their visitor; but their faces do light up, because they recognise that their visitor brings happiness with them.

Sharon and Retha in The Pain Exchange mention their groups, in terms of physiotherapy practice, but also in terms of fun and laughter. In one of the case studies, they talk about a woman who had been withdrawn, slowly becoming

The Church’s Impact on Health and Care. Page 98 animated week by week until, at the Christmas party, she was “jumping up and down, laughing”.

Heidi Singleton talked about a participant changing physically week by week: “opening up like a flower, starting to engage, starting to smile, starting to laugh”. Niky Dix illustrates how people are now able to enjoy their food, because they have chosen to eat it, rather than have a constant guilt association with it.

For many of the exercise participants in Mega Fitness, enjoyment, fun and laughter play a key role. Sometimes the exercises encourage people to use muscles that they have not used for a long time, and the atmosphere is light- hearted. Frequently the classes are inter-generational as well, where grandparents, parents and children all exercise together:

“Matt: It's still active, you know, having to do the Hokey-Cokey requires … some physical activity - Tina: Yeah! I have to say, that's quite energetic!” (Matt Wisdom and Tina Riando, Simply Limitless).

Humour not only plays a pivotal role in the creation of community, but also enhances a patient’s wellbeing (given the principle of holistic care as set out in Chapter Four, Theme 3). According to Savage et al (2017):

“Humour reduced cortisol and catecholamine levels as well as increased the production of antibodies, constituents of the adaptive immune system, as well as endorphins, the body’s natural pain killers” (p. 342).

The research of Hunter “Patch” Adams in the 1970s also recognised the need for humour in healthcare, who wrote that “healing should be a loving human interchange, not a business transaction”. Despite the UK’s free-at-the-point-of- use NHS, this is still very relevant today.

The other point about humour is that it causes groups to bond; something recognised by Intentional Health and Peaced Together participants. Causing groups of people to bond, so that they individually feel as though they belong to a corporate whole, is, of course, the genesis of community:

“When people share laughter, there is a special connection between them. By

The Church’s Impact on Health and Care. Page 99 creating positive emotional and social connections, using humour may lower defences and establish rapport” (Savage et al, 2017: 344).

Summary Creating community is a core process running throughout this research; the CRPs in question deal with their work by tackling the issues at hand, whether that is raising an individual’s metabolic levels through exercise, or visiting them in their homes, advising them about medicine, or working with a group to give them strategies to live healthy lives. Yet a key outcome (and so often unnoticed) is the creation of a welcoming, embracing community, where people who have experienced a lot of isolation, depression, and in many cases chronic pain, can once again (in some cases for the first time ever) enjoy being in a group of people where they matter, where someone will ask about their wellbeing week after week, and where someone knows their name.

Belonging

Fun Identity

Community

Dignity Integration

Figure 2. Essential Outcomes of Community

The Church’s Impact on Health and Care. Page 100 Chapter Five. Discussion.

5.1 Introduction

The original aims of this research were to determine answers to the following questions: 1. What impact do faith and specifically, church communities currently have on health and social care? 2. What potential is there for them to be scalable and replicable, in order to have more impact?

Having narrowed the scope to specifically health-related Cinnamon Recognised Projects (CRPs), I have examined their work in the light of six areas of health work, whilst also highlighting the role of local churches and volunteers in this work. I have analysed the aims of the projects in question, and also have looked at their ability to quantify the achievement of those aims, both in terms of statistical data (where available) but also the use of semi-structured interviews with the staff of those projects, and case studies.

This final chapter will look at recommendations for CRPs and local health partnerships, in order to achieve the research outcomes of this paper, which were: 1. To increase the confidence of health services to partner with local churches; 2. To increase the confidence of local churches to respond to the health and well-being needs they see in their community; 3. To increase innovation and to inspire churches to develop new church- led projects.

Those recommendations will then close this chapter, and this report.

The Church’s Impact on Health and Care. Page 101 5.2 Discussion

Given the particularly constrained nature of the UK economy at the time of writing, and the subsequent pressures on the NHS10, this discussion about faith- led health practice is pertinent to the national debate. With A&E under unprecedented strain, and one in every four people who have some form of mental illness, loneliness at record levels (9 million are either always or often lonely - Red Cross, 2016), obesity remaining a national crisis with Type 2 diabetes on the increase, it makes perfect sense for NHS practitioners to seek to work creatively with other partners, particularly within the voluntary sector.

Part of the complex nature of the problem is within the NHS itself; as one respondent put it, the NHS is not a single entity, it is a vast network of small businesses, each struggling to balance budget books, to provide market-leading healthcare within the constraints of current quality standards, and to stay current and relevant in a constantly changing world, within urban and rural communities alike. How can one work effectively with such a diverse partner? The answer must surely lie in forming strategic partnerships with the relevant entities for each locality, whether that be a thriving medical practice (such as Granta in Cambridgeshire – Chapter Three, Case Studies, Section B), or a pioneering hospital such as at Morecambe Bay, as previous) or an official third- party organisation set up to facilitate such partnership working (such as ImROC – Chapter Three, Section I). Just as there is no series of identical local NHS bodies, so there cannot be a single unified approach to partnership; each must be unique.

The cost effectiveness of working with the voluntary sector cannot be underestimated, and faith-based health practices can have a significant effect in supplementing local health services (Garland, 2017). Each of the CRPs can be deployed within a local church for less than £2,000, which will enable most of them not only to begin practice, but also to sustain for the next year as well. With that in mind, the next section of this document aims to lay out some recommendations for local health and church partnerships.

10 Although, to be fair, it is hard to note a time within the past 40 years when the NHS was not under a significant degree of pressure.

The Church’s Impact on Health and Care. Page 102 5.3 Recommendations

R1. Forming Strategic Partnerships Given the strained nature of local health services across the UK, and the consequent need to save budgets, partnership models with the voluntary sector afford the best approach for effective working practice. This section of the recommendations will look at potential partnerships for the NHS and local churches.

i. For CRPs: University Partnerships To partner effectively with the NHS in its myriad forms, every Cinnamon Recognised Project should be able to name a local University and/or Academic partner with whom they are developing outcome measurements for the continuous improvement of their charity. The partnership may be formal, but is more likely to be informal, with researchers or students focusing on the CRP in question, writing papers which critique the outcomes, and increase its robust approach to measuring its effectiveness. Measures should be both quantitative and qualitative (the university will advise on the best methods).

“Home-grown” statistical analysis is adequate in helping a CRP to measure their work, but there can be no substitute for effective, rigorous and academically tested measurement processes. There is a danger that CRP leaders, in aiming to make evaluation as light as possible for their participants, end up making it even more onerous, because they choose to use their own models, rather than academically tested ones. This is because academically tested statistical models, correctly applied, can actually be quite lightweight11.

Intentional Health, for example, has worked extensively with the University of Exeter, Renew Wellbeing is fostering a relationship with Nottingham (through its partnership with ImROC). These partnerships may be through existing University relationships with volunteers, or more formal partnerships at a management level. Both ED Pastors (Leeds Beckett) and The Pain Exchange (UCL), although not yet CRPs, are seeking to work actively with a University to improve their track record.

11 The simplicity of a measurement scale is one of the most important elements which will be judged by academic practitioners. This is why there are often shorter forms of such scales.

The Church’s Impact on Health and Care. Page 103

University partnerships not only help the organisation to provide evidence of their own effectiveness, they also improve their fund-raising potential.

ii. For NHS and CRPs: Local Partnerships Every location has a unique set of challenges, and partnerships to meet those challenges. This is borne out by the active partnership between Renew Wellbeing and ImROC; Parish Nursing and local hospitals, GP practices, NHS partnerships; Lyrics and Lunch with the Dementia Hub; Mega Fitness with the Worcester Wellbeing Hub, or Sports Partnership Hereford and Worcester, to name just a few. All of these partnerships are important to the effective work of health-based community projects, and vary according to location and demand. At the very least, it is important to develop a strong association with the local authority, the local CVS12, and social services so as to develop local relationships, and to establish the local need.

A mapping exercise of local health services may also be necessary, to understand the way in which local services work, and how they operate together. Some local authorities (such as Nottingham) favour co-production teams, where social services and health can work in partnership with beneficiaries themselves to design services. Others (such as Hereford and Worcester) favour partnership hubs, around common themes - business, wellbeing, exercise and fitness. CRPs should also consider partnerships at three levels: national, city, and neighbourhood/community.

Given the current focus on mental health IAPT, Crisis Care Concordats and the 44 areas of the Sustainability of Transformation Partnership, (see Literature Review 2.3: Mental Health), churches would do well to find out how these mental health initiatives are worked out in their local communities and health care regions.

Essentially, CRPs within any locality will be a core part of any multidisciplinary offer. It is important therefore, for churches to think strategically within their local area, and to form partnerships which directly serve the unique characteristics of their locality. This also leads to the next recommendation.

12 Council for Voluntary Services

The Church’s Impact on Health and Care. Page 104 iii. For Local Churches: Inter-Church partnerships Some locations form charities which are the combination of churches in partnership together. As individual churches, they lack the strength of influence, but together, they can present a strong voice into local issues. This has benefits on a number of levels: in terms of volunteers and resourcing, the project is not dependent on one source alone. In terms of financial and management burden, the load is shared. Funding track records are easier to establish, and the vision of many churches pulling together to serve their local community is enhanced.

Refresh in Weymouth and Portland in Dorset, is one such example. The trustees are drawn from local churches, and together they are able to deliver over twenty projects to their local area, around worklessness, food poverty, safety, health, working with young people, working with older people. The church has the opportunity to model community to their local world.

iv. For Cinnamon: Partnership with FaithAction Having been a partner with the Department of Health for many years, FaithAction have completed a lot of research in the area of faith, health, and partnership. They have held regional round tables in all locations around issues as dementia, mental health, homelessness, and alcohol use. FaithAction are also members of the VCSE Health and Wellbeing Alliance founded by the Department of Health, NHS England and Public Health England, along with representatives from organisations as diverse as Age UK, Citizen’s Advice, Homeless Link, The National LGBT Partnership, NVCO, Race Equality Foundation among others.

They have a wealth of resources at their fingertips, garnered through over ten years of active work in this area. Their health publications and associated round tables include:

Keeping Pressure off Hospitals (2017) Working with faith groups to promote health and wellbeing (2017) Building Dementia-Friendly Faith Communities (2017) Making the Case for Faith and Health (2016) What a Difference Faith Makes to Alcohol Use (2015) Friendly Places for mental wellbeing (2015) Faith and Domestic Abuse (2015) What A Difference Faith Makes to Homelessness (2015)

The Church’s Impact on Health and Care. Page 105 Foetal Alcohol Spectrum Disorder (2015)

Partnership with FaithAction (through partnership research, round table participation, conferences) would be a considerable asset in terms of strengthening the foundations for Cinnamon to understand more fully the world of local and national health care.

The Church’s Impact on Health and Care. Page 106 R2. For Cinnamon and NHS: Practice Conferences One of the more common elements to recur in all of the interviews for this research was the importance of effective communication with “the gatekeepers” within the local health arena. These are frequently practice managers within a GP surgery or practice, but they may be representatives from local CCGs, or interested third party organisations who have a voice into local health care.

Regular regional (and national) conferences with such stakeholders and gatekeepers would be beneficial, in order to ensure that practitioners in the NHS are aware of such relatively inexpensive services such as the CRPs provide, which could contribute significantly to the health and wellbeing of their local population, for very little cost. All of the CRPs would be able to exhibit their work, and begin discussions towards partnership practice within relevant health areas.

R3. For Cinnamon: Incubate Future Health CRPs As this report has demonstrated, CRPs can add significant weight to local health services for very little cost. CRPs within this document cover many of the health areas, yet there is always room for expansion, and the incubation of further health-focused projects. Projects could be incubated which deal further with mental health issues (targeting specific areas, such as addiction13, self- harm, suicide prevention), personal agency and wellbeing (such as the CrossRoads course which helps participants to discover their purpose in life – see Chapter Three, H- Peaced Together), perinatal care (courses such as Getting Ready for Your Baby which was evaluated by the University of Greenwich in 2009), work with perinatal mental health and postnatal depression, eating disorders, further work around obesity, further work around loneliness, further work around dementia care, and working with the NHS around issues presented by the LGBT community. Care should also be taken to incubate projects which reduce demand on the NHS.

It would be beneficial if both projects which are featured in this paper: The Pain Exchange and ED Pastors are able to be developed and incubated effectively towards replication.

13 CAP Release Groups is one CRP which deals with addiction.

The Church’s Impact on Health and Care. Page 107 R4. For NHS and Cinnamon: A Consultation Group An oversight group should be created, to ensure that current practice is in line with the nature of the NHS (which does change on a regular basis). It should be drawn from practitioners within the NHS, Clinical Commissioning Groups, Academia, GP surgeries, Cinnamon, local churches, to meet regularly (quarterly), to review opportunities and developments in all of the health areas, and to ensure that the outcomes from this research (and subsequent work) are carried forward. Its aim should be to assist the NHS from the viewpoint of activating voluntary sector solutions (such as Cinnamon Recognised Projects) wherever possible, to help deliver projects which help the NHS to achieve its outcomes for patients and the community.

5.4 Conclusion

The aims of this research were to answer: 1. What impact do faith and specifically, church communities currently have on health and social care? 2. What potential is there for them to be scalable and replicable, in order to have more impact?

Focusing specifically on Cinnamon Recognised Projects (CRPs) highlighted the breadth and strength of these projects in improving patient outcomes, embracing marginalised communities, creating community, increasing health and wellbeing, working with people who have dementia, working in partnership with the NHS and third parties to achieve those outcomes, and continually finding ways to improve their processes, working practices and self-evaluation.

This report has looked at projects which work in general health and wellbeing, loneliness and isolation, dementia, mental health, perinatal care and A&E. Every CRP can be created and sustained for at least two years for £2,000 (in many cases a lot less), and the Cinnamon track record is that 90% of all projects which are created with Cinnamon Micro-Grants are still practicing after more than two years.

As well as expected benefits - better health and wellbeing, beneficiaries exercising more, feeling less lonely, dealing with long-term chronic pain, or long-term and seemingly insurmountable mental illness, the CRPs have also succeeded in the secondary outcome, namely creating community, and a place where isolated individuals can feel they belong.

The Church’s Impact on Health and Care. Page 108 Most of the projects named here (although not all, at the time of writing) have proven themselves able to scale and replicate to a national level, and, given Cinnamon’s track record in helping old and new projects to do this, illustrates that the CRPs have the potential to go further. This was the case when churches adopted new projects in line with police partnerships, following the 2016 Cinnamon Research report, Police and Church Partnerships.

This report has made recommendations for CRPs, many of which embrace partnership, and for Cinnamon Network, as well as in itself being a recommendation to the NHS to embrace these projects as part of a 21st Century healthcare solution which seeks to address major national health needs (such as obesity, Type 2 diabetes, mental illness, loneliness and isolation, dementia) for a fraction of a normal budget.

The UK faces an uncertain future with a minority government at the time of writing, the unknown effects of Brexit and the continuing programme of austerity causing a significant constriction of services at local government and NHS level. It is precisely at such a time when the voluntary sector can come into its own, particularly faith-based, and in the case of the projects in this report, replicated through the UK churches, facilitated wherever possible by Cinnamon Network. Through incubation, development and replication, each project named here and many others can assist their local authorities and NHS partnerships in making a sustainable difference to the lives of people in their community.

The main unique selling point of these projects is not only that they are low- cost, but that they offer holistic health care for all individuals at a time of constrained budgets, and more importantly, they create community and belonging at a time when isolation and loneliness is at an all-time high.

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The Church’s Impact on Health and Care. Page 115 Appendix One - Quotes from Beneficiaries

Many of the examples and case studies were enhanced by quotes. These quotes are taken from the interviews, and occasionally from submitted reports. There were so many quotes for each project that I had to select some, and include them here, in the Appendix.

Care Home Friends "Thank you so much for coming to see me. It's so nice to have someone to talk to."

“Can I have Care Home Friends in my area?”

ED Pastors "I'm an atheist and I think the ED Pastors are fantastic."

a member of staff showing some new recruits round, and they saw an ED Pastor cross their path and they said, "these are the ED Pastors, and they're best thing that's ever happened to this department."

"they're a valuable part of the team in supporting patients. Also a friendly and listening ear for staff during times of high pressure. We'd love to have them all the time."

The NHS Trust in Sheffield has consistently said to us: "every hour you can give, we want you."

"An ED Pastor had been spending time with a disruptive alcoholic patient prior to my assessment. By the time I came to do my assessment, the patient was calm and focussed. It really sped up my assessment."

When an ED Pastor had finished praying for a patient, they said, "no-one has ever prayed for me like that. I feel amazing."

"It's no secret that emergency departments across the UK are under unprecedented pressure. To have ED Pastors available to comfort and support patients is making a huge difference to both staff and patient morale."

The Church’s Impact on Health and Care. Page 116 Renew Wellbeing "I've met friendly people at 37 - that's what this one's called - who helped me cope with my depression and lifted my mood. I feel I've learned a lot from different people. And I will keep and treasure every experience."

"we walk alone without someone to care, but now I've found friends a new family, in a new place. It is such a blessing to have a safe place in a crazy world. Now someone knows my name."

"you don't know what a luxury it is, Ruth, to have someone present to you on a day like this."

Mega Fitness "I wouldn't be here if it wasn't for you."

"This feels like my home and I haven't got any family around here, you've become like family to me."

"I don't know what I'd do with you."

Linking Lives UK "I don't know where I'd be without the Linking Lives coordinator."

"I've got through this crisis"

Peaced Together "brokenness might be a chapter in your journey but it doesn't have to be the end of the story."

"since doing Peaced Together, I'm taking my medication every day."

"I'm choosing to be thankful even when things are difficult."

Parish Nursing "it's been … what I would describe as an 'added value' role to the normal spectrum of services that are there."

"Preventing crisis happening, advising people before that crisis happens, how - how to best avoid it, and how to make - to make the best choices in the

The Church’s Impact on Health and Care. Page 117 difficult position they're in, without it [turning] into a crisis."

"So we've made the parish nurse basically a member of the practice team as well."

"The parish nurse is able to look at that and act as a conduit for information and communication."

"from my perspective, it has worked wonderfully well."

"So really, I have nothing but absolutely enthusiasm for it."

"For us, it's just been great."

Baby Basics "previously, whenever I've been given help it's always essentially come with strings attached - there's always been some something. And this is different."

Lyrics and Lunch "this is the one place I can bring him and he doesn't stick out like a sore thumb."

"he doesn't smile much, but he always smiles here."

Intentional Health "I've just finished Intentional Health. It is amazing. The course is amazing. I went on it to lose weight, and that was all good. But oh my goodness I was not expecting the second part."

"... let me tell you something about my wife. She is the most loving person you'll ever meet. She loves me, she loves God. She loves the kids. She lives her family, she loves her work. She just loves everybody. But she's never been able to receive my love. And what she's learned from Intentional Health is that she is lovable and that God loves her and that I can love her. It is amazing."

The Church’s Impact on Health and Care. Page 118 Appendix Two - Research Information Sheet

You are being invited to take part in a research study. Before you decide, it is important for you to understand why the study is being done and what it will involve. Please take time to read the following information carefully and by all means, discuss it with others if you wish. Ask us if there is anything that is not clear or if you would like more information. Take time to decide whether or not you wish to take part.

What is the aim of this research? Cinnamon has identified the need to carry out this research, which examines best practice models for church-led partnerships focused on delivering health and well-being outcomes for local communities. The findings of this research could then be used to broker partnerships between church and health services.

What will be the outcome? It will result in a full piece of academic research, which will be overseen by colleagues in the steering group and a 16-page summary report. The summary report will contain findings and actionable guidance for church leaders and health partners, and will be most widely distributed, including at a national launch event attended by health sector leaders, social action projects and church leaders. The overall aim is to: • increase the confidence of health services to partner with local churches; • increase the confidence of local churches to respond to the health and well- being needs of their community; • increase innovation and inspire churches to develop new church-led projects.

Why have I been invited to participate? Your practice has been chosen as an exemplar of innovative community practice.

How will the research take place? The research will take place in two stages (approx. 1 hour – 90 minutes) Quantitative – to determine what outputs, outcomes and evidence is being gathered in order to support your programme; Qualitative – which will be in an interview or focus group format; following research questions, we will discuss the issues arising from those questions. The researcher will act as individual or group moderator, steering the discussion around a Topic Guide.

How will the conversation be used in research?

The Church’s Impact on Health and Care. Page 119 The conversation will be recorded and transcribed, and the discussion points analysed for thematic content as part of the research process.

Thank you for taking the time to read this information sheet.

The Church’s Impact on Health and Care. Page 120 Appendix Three - Topic Guide

Quantitative overview • How long has your project been in existence? • How many times has it replicated? • What sort of beneficiary records do you keep? • What sort of volunteer records do you keep? • How do you measure your project's success? • Do you use any form of statistical measure? If so, what kind? • What macro (large scale) measures do you use? What micro (personal, small-scale, e.g. BMI) measures do you use? • What statistics (if any) do you use to measure the changes? • What are your project's key outputs (also known as key performance indicators)? • What are your project's intended outcomes (long-term changes, benefits to the community, to local health care, etc.)? • Do you have any financial measures (such as Social Return on Investment, or Cost Benefit Analysis)? How do you provide value for money? • Do you know how much one iteration of your project costs to run (on average)? • How do you make sure that local churches around the country who use your project measure their work accurately? • Are there any existing research papers which feature your work?

Qualitative overview • Tell me about your project. • What made you begin? What needs did you notice? How did you get started? What has been the process since then? • Who are your local community partners/stakeholders? • Local authority? Church network? Local health authorities? Housing Trusts? Colleges? • Do you work in conjunction with any local health authorities? If yes - • Which ones? • How did that working relationship come about? • Is there any contractual basis (or SLA) to that relationship? • How regularly do you meet with them? If no - • What plans do you have to develop working partnerships with local health authorities?

• Describe a typical beneficiary's interaction with your project.

The Church’s Impact on Health and Care. Page 121 • Does your project affect the health of the people who come to you? How? • What are your main pressure points? • How does your project keep pressure off the NHS? • What gives you the most satisfaction in this work? • What effect does your project have on mental health? (Beneficiaries - volunteers - wider community) • Is there anything else you would like to discuss?

(If it's a local franchise of a larger network) ** quantitative and qualitative questions, as above ** • How do you report to the main office of your project? • Describe the working relationship. • Do you have any case studies, and may we use them (anonymous, of course)?

The Church’s Impact on Health and Care. Page 122 Appendix Four - Other Faith Health Initiatives

Introduction As written in Garland (2017), there are many faith-based health providers working in communities in the UK. Particular foci include primary care, pharmacy provision, first aid, training delivery, among other services. This section will aim to draw out some of the models used, and where they have had particular success.

The effectiveness of faith-based health provision is described in the US-based article, DeHaven et al (2004), where the authors investigated the rigour of such organisations using a systematic review of the literature (articles n = 386). The conclusion was that, based on the cumulative evidence of all papers:

“faith-based interventions can improve health outcomes. Most programmes evaluated in those papers which were reviewed looked at prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), and cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination” (from abstract).

This section will look at particular faith-based health interventions (other than Christian) which have been prominent in the UK over the past few years. As we can see, the work which is being done by Christian groups and CRPs are in the context of a wide amount of work being done by faith-based health providers across the UK.

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The outline of the interventions can be seen in the Table, below:

Name Health Work Location Faith

Nishkam Centre Primary Health Care, advice, fitness Birmingham Sikh

The Friendship Café General health awareness & diet Gloucester Muslim

Hatzola Ambulance Volunteer-run ambulance service North London Jewish

Jewish Care Helpline, Dementia, Disability, Home, Mental Health London Jewish

Peepal Care Domiciliary Care North London Hindu

BIMA Network of Muslim Healthcare professionals UK Muslim

Jami Mental Health care services London Jewish

Maslaha Heart, Diabetes, Mental health, Hepatitis UK Muslim

Breathing Space Mindfulness-inspired therapy for health London Buddhist

Breathworks Mindfulness-inspired therapy for health Manchester Buddhist

Namaste Care Support for people with long-term conditions London Hindu Dementia Friendly Providing Gurdwara access for people with dementia Bradford Sikh Gurdwaras East London Mosque Runs several health-based projects London Muslim

Perhaps understandably, many of the organisations listed keep their faith as a background influence, sometimes not even mentioning it at all. In all of the examples below, I have listed their “primary ethos” - the basis of faith from which they operate to people of faith, or no faith at all. All are keen to emphasise that they offer their services to all, although in some cases (Jewish Care, for example), the focus is on a particular people-group.

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Nishkam Centre, Birmingham (Primary Ethos: Sikh)

The Nishkam Civic Association was established in 2003, out of the Guru Nanak Nishkam Sewak Jatha (GNNSJ), which aims to promote the core Sikh values of Nishkam (selflessness) and Sewa (serving) in the local community. The Civic Association inspired five centres of excellence, which are the Gurdwara (GNNSJ), the Nishkam Centre itself, the Marg Sat Santokh (MSS) which is an economic cooperative which provides purposeful employment to local people, the Nishkam Education Trust, which oversees five independent schools, and the Nishkam Health Care Trust (NHCT).

The NHCT began as a pharmacy which offers a dispensary, blood tests, health checks and “medicine use reviews”. The Nishkam Centre now also hosts a gymnasium, offering fitness programmes and alternative therapies. It also offers a befriending and chaplaincy services. According to Garland (2016):

“The centre promotes faith-inspired, values-driven healthcare, and aims to empower patients and foster compassion among health professionals. In addition, GNNSJ supports older people through services including: provision of free hot meals (of the 20,000-25,000 meals served weekly, 60-70% are served to elderly members of the community); counselling and guidance; opportunities to undertake Nishkam Sewa (selfless service), e.g. in prayer services, cooking, cleaning, or infrastructure work; and provision of a gym in a culturally sensitive environment” (p.6).

The Friendship Café (Primary Ethos: Muslim)

The Friendship Café is based in the Barton and Tredworth area of Gloucester. It was initially set up by a group of young Muslim men hoping to reach young people in their community through a gym.

Focusing primarily on creating community cohesion and healthy lifestyles for people of all ages, the Friendship Café is now actively used by people of all faiths and none in the local community. Focusing initially on a gymnasium (using the original nickname “Sunni Gym”), the work has expanded to incorporate St James’s City Farm as well. Services originally included the gym (now closed), martial arts classes, Dads and Lads groups, swimming, archery and horse riding.

Hatzola Ambulance (Primary Ethos: Jewish)

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Hatzola describes itself as a “fast and free volunteer-run ambulance service”. It is primarily run by Jewish volunteers. Hatzola is the Hebrew word for “rescue’, and it involves the work of 35 first responders, providing a 24-hour 365-day service. It focuses primarily on the area of North London, and responds to 6,000 emergency calls per annum. In particular, it provides specialist services to children, mental health patients and vulnerable adults.

According to the Hatzola website:

“… our response time to emergencies is within minutes – because we cherish the value of a life, and know that those vital minutes can spell the difference between life and death.”

Jewish Care (Primary Ethos: Jewish)

Jewish Care is the largest health and social care provider for the Jewish community in the UK. Funded through voluntary contributions, it lists its services as working with:

• Older people • People with mental health needs • Holocaust survivors • People with dementia • People who care for others who have a variety of needs – e.g. mental health, older people, people with disabilities • People with MS, Parkinson’s, strokes and those who are visually impaired • People who are bereaved and those recently separated.

It is the amalgamation of no fewer than ten organisations which have combined to care for 10,000 people a week, primarily focused on the Jewish community.

Peepal Care (Primary Ethos: Hindu)

Peepal Care (named after the Peepal tree, not a misspelling of “people”) is a Hindu-inspired organisation serving primarily the Gujarati community in North West London. It describes its services as providing “affordable domiciliary care” which enables the people being cared for to live in their own homes, while being cared for by a member of the Peepal Care team. They offer palliative care, respite care, cancer support, dementia care and stroke care, as well as “hospice at home” services.

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British Islamic Medical Association (Primary Ethos: Muslim)

The British Islamic Medical Association (BIMA) aims to create a united network of Muslim health professionals across the UK. It has six national programmes, which focus on community service, trainee development, advocacy, Islamic Medical Ethics, running events and helping to offer professional development.

In 2016, BIMA ran a project called Lifesavers in collaboration with the Muslim Council of Britain and The British Heart Foundation which aimed to train mosque-based volunteers in CPR and life support skills. According to the BIMA project webpage:

“BIMA Lifesavers is on track to become the largest, free, accredited, national basic life support training programme in the country, and is looking to help Britain become a nation of lifesavers.”

Jami (Primary Ethos: Jewish)

Jami is a Jewish mental health recovery service. The focus is on recovery - not just on the illness, but focusing the patient on a recovered future. As it says in the website:

“Jami’s focus is on recovery; moving from lack of control and autonomy to becoming an active member of the Jami, Jewish and wider community, taking responsibility and having control over one’s life. Jami’s challenge is to assist people on this journey, from enabling them to become an expert in their own self-care to being supported, where appropriate, back into employment.”

98% voluntary funded, Jami focuses on community health and wellbeing, independent living, carers support, hospital visiting in mental health units or care homes, a befriending scheme, recovery and peer support, as well as having an enterprise focus with Jami Enterprises, which gives people an opportunity to give back to their community. Jami is also a provider of mental health first aid.

Maslaha (Primary Ethos: Muslim)

According to their website, Maslaha “creates new ways of tackling long- standing issues affecting Muslim communities. We combine imagination and

The Church’s Impact on Health and Care. Page 127 craftsmanship to improve services, change attitudes and challenge systems of inequality.”

Maslaha’s range of work is eclectic: among many other projects, the organisation tackles diabetes, heart health, mental health, perinatal care, hepatitis, entrepreneurship, gender equality, Islam and Feminism, and violence in the home. The organisation also states that their “range of projects means we understand the multiple identities communities hold, and the multiple deprivations that can exist” (website).

In 2008, Maslaha made a film in collaboration with Tower Hamlets PCT to address the issue of rising diabetes in the Muslim community. Other PCTs have subsequently commissioned Maslaha to work on “smoking cessation, alcohol and drug abuse, depression and obesity.”

Maslaha is funded by many, including Esmée Fairbairn, Tower Hamlets, Comic Relief, Calouste Gulbenkian Foundation, Barts, The British Council, the Arts Council, UnLtd among others.

Breathing Space (Primary Ethos: Buddhist)

Breathing Space offers its services as a London centre for health and wellbeing. Run along Triratna Buddhist lines, it uses Mindfulness techniques to help people to come to terms with and overcome mental health issues. It uses Mindfulness Based Approaches (which it shortens to MBA) to combat depression, anxiety, addiction and stress. As it says on the website, “our teachers are trained and supervised by an NHS consultant psychiatrist and have extensive experience of mindfulness practice and teaching.”

All of the practitioners at Breathing Space use Buddhist ethics, encapsulated in the principles of loving kindness, generosity, stillness, simplicity and contentment, truthful communication, and mindfulness. The teaching is free, and conducted by a team of Buddhist practitioners with various specialisms (for example, Dr Paramabandhu Groves is a consultant psychiatrist working in the NHS, with a specialism in addiction).

Breathworks (Primary Ethos: Buddhist)

Similar to Breathing Space, Breathworks focuses on achieving mental health and well-being through the Buddhist practice of Mindfulness. Mindfulness is promoted in the home, the workplace, and in healthcare as well, in particular for

The Church’s Impact on Health and Care. Page 128 health care professionals. Breathworks runs an eight-week Mindfulness for Health course, which is aimed at helping people who are in chronic pain, who have long-term health conditions, with any associated stress. The organisation runs taster sessions, online courses, courses at client facilities, at their own base, and meditation retreats for participants.

It should be emphasised with Breathworks and Breathing Space, that despite the Buddhist roots of the practice of Mindfulness meditation, both claim that their practice is “secular” and that there is “no religious element whatsoever” (Breathworks website). See also my note in the introduction about organisations often wanting to keep their faith element in the background, wherever that is practicable.

Namaste Care (Primary Ethos: Hindu)

Established by Varsha Dodhia in response to the treatment of her parents-in-law, Namaste Care CIC helps people from South Asian backgrounds in North West London to receive effective health care, with a particular focus on dementia. It is established as a bridge between communities and the local health system. Namaste Care “is now employed by a GP network and shared between four GP practices as a care coordinator, and specialises in dementia in BAME communities” (Garland, 2016).

At the centre of the organisation’s philosophy is bringing a faith perspective to the health system, particularly with regard to the last phase of life, caring for older people and maintaining their dignity chimes with belief in Karma, which in particular, affects disability and end-of-life care.

Dementia Friendly Gurdwaras (Primary Ethos: Sikh)

This organisation, based in Bradford, has made its focus the removal of dementia-related stigma in the Sikh community, modification of the environment within a Gurdwara to accommodate people with dementia, sharing information with other dementia-related services, and continually reassessing their work in order to help others.

When Gurdwaras apply to become “dementia friendly”, DFG will provide a series of guidelines:

1.) A review of the Gurdwara with a view towards making it Dementia Friendly; 2.) Providing assistance in developing a workable action plan;

The Church’s Impact on Health and Care. Page 129 3.) A mentor scheme to provide ongoing support and advice; 4.) “Dementia Friends” workshop delivered in English and Punjabi at the Gurdwara in question for congregation members including children and volunteers until such time as local volunteers have completed their Dementia Champions training; 5.) Full access to the DFG virtual information portal.

(Source: DFG website)

East London Mosque (Primary Ethos: Muslim)

The East London Mosque and London Muslim Centre serves the large proportion of Muslims in Tower Hamlets in East London. As well as promoting Muslim values and ethics, “to see a world of God consciousness, respect, dignity and justice” (website), it has also run health-based projects under the banner “Faith In Health” together with NHS Tower Hamlets.

Their service Health Connex is held three times a year, and is a “health fair” when people can access health checks, ranging from blood pressure screening to dental checks, seminars are given on health and wellbeing, and people can discuss issues with medical practitioners. Faith in Health also works with all mosques and GP surgeries in Tower Hamlets.

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