Our priority outcome: preventing ill health and enabling people to live happier, healthier lives.
We want to help more people avoid people getting ill in the first place. This means more people living healthier, early diagnosising of disease, and supporting and giving people as much independence as possible to manage their condition when they do become ill.
People and communities know best what they need and should be involved in shaping what and how health and care support is provided.
Context and key challenges
Many people in Lambeth suffer from poor health which could be avoided. The number of people under 75 years old who die from a cause that could have been prevented is 152 deaths per 100,000 people (2020). This is worse than other London boroughs. There are also significant inequality issues, for example, our poorest communities are more likely to suffer from conditions such as cardiovascular disease and diabetes.
What we offer
To overcome these challenges, and support more people to live well for longer, we’ve prioritised three important projects:
- Thriving Communities
- Building Healthier Communities
- High blood pressure (hypertension)
Thriving Communities
We know some of the most effective improvements in health tackling health inequalities are where GP surgeries work together with their local communities and local council colleagues. This approach works by building relationships with residents in their neighbourhoods, listening to their needs and bringing services to them.
Our Thriving Communities approach is a collaboration of voluntary, community, faith and social enterprises in Lambeth. They meet to talk about the needs of the communities they represent and discuss ways they can work together to provide support. This could be an event designed with the community, held in a local and accessible venue such as the Health and Wellbeing Hubs (see more under ‘our impact’ below).
There are currently five Thriving Communities and our objective is to expand them into more areas. The current Thriving Communities are:
- Thriving Stockwell – linked to Beckett House Practice, Binfield Road Practice, Grantham Practice, Springfield Medical Centre, Stockwell Group Practice
- Thriving Streatham – linked to Edith Cavell Practice, Streatham High Practice, Palace Road Surgery, Prentis Medical Centre, Streatham Common Group Practice, The Exchange Surgery, The Streatham Hill Group Practice, The Vale Surgery, Valley Road Surgery
- Thriving Fiveways – linked to Herne Hill Road Medical Practice, The Corner Surgery, Minet Green Health Practice, Vassall Medical Centre, and Akerman Medical Practice
- Thriving Hills, Brook and Dales – linked to Brixton Hill Group Practice, Herne Hill Group Practice, Knights Hill Surgery, Lambeth Healthcare Practice, North Wood Group Practice, The Deerbrook Surgery
- Thriving Norwood – linked to Brockwell Park Surgery, Paxton Green Group Practice, The Old Dairy Health Centre and some HBD General Practices
Building Healthier Communities
The Building Healthier Communities programme is focused on working with residents and local communities at a neighbourhood level to build trust, support better access to health and care, raise awareness and sign-post to a wide range of other services that support wellbeing.
The key elements of the programme are:
- The Lambeth Together Health and Wellbeing Bus which provides free signposting to health services as well as health screening, such as blood pressure checks, to residents around the borough on a walk-in basis
- Health and Wellbeing Hubs – these are community-led and includes the Ascension Trust Beacon Project. They deliver a range of support to residents, including access to nutritious food, welfare advice, mental health support and other activities that tackle social isolation and support wellbeing. They’re hosted in trusted settings such as community halls and places of worship.
High Blood Pressure (hypertension)
It’s estimated that there are around 28,000 Lambeth residents with high blood pressure, but many have not been diagnosed. Inequalities are also observed with residents from the most deprived areas of Lambeth and Black African and Black Caribbean people are less likely to monitor and reduce their high blood pressure.
New community insight
To understand more about how we can improve blood pressure detection and control among our Black African and Black Caribbean residents, we undertook some community research. This involved setting up a patient advisory group to help us understand:
- what new approaches are needed to improve access to information and blood pressure management services,
- and how to better share blood pressure data between the voluntary and community sector and GPs.
Our impact
Thriving communities
Since April 2023, there have been six health and wellbeing events run from North Lambeth to Streatham, engaging with hundreds of residents. Events were run in partnership with social prescribing link workers, GP’s, public health and voluntary, community and faith organisations. They included:
- A Black health and wellbeing event in Streatham, attended by over 300 people,
- Events on women’s health and chronic pain,
- An LGBTQ+ lunch,
- A wellbeing event for the Latin community.
We’ve also provided small grants to local organisations, such as the Lambeth Somali Community Association, to assist in promoting health activities for Somali men. The funding has aided the development of health promotion resources for the community and the provision of blood pressure monitors.
Building Healthier Communities (BHC) Programme
The BHC Programme has engaged many residents, bringing health and wellbeing support directly into communities experiencing greater health disparities via the Lambeth Together Health and Wellbeing Bus and our 13 health and wellbeing hubs, with a further two in development.
High blood pressure
Our impact in supporting more residents to better monitor and reduce their high blood pressure in 2022/23 includes:
Fresh insight – we had great engagement with our community research with some helpful findings. These have been used to develop our next steps improving blood pressure management across Lambeth. Read the summary findings here.
Increased awareness – we produced a video, involving a patient with lived experience, to raise awareness of the dangers of high blood pressure and how to monitor this among our population.
Proactive work to identify more people with high blood pressure – we’ve worked with GP practices and community pharmacies to raise the awareness of how important it is to find more people with high blood pressure and to protect them from the associated risks. Whilst we don’t have all the data, we know it has had a huge impact. For example, at just one GP practice alone, text messages to 300+ high-risk patients resulted in a number of them getting their blood pressure checked and two patients being referred onwards for treatment.
Health champions working in our GP practices have also prioritised reaching into communities where high blood pressure is a concern. They’ve run a number of new initiatives where people can get their blood pressure checked, including health and wellbeing fairs and clinics at GP practices.
As of 1 March 2024, the percentage of people under 79 years with blood pressure control is 66.4% which has increased by 4% in comparison to last year. We’re continuing to work towards our 77% control of blood pressure target.
The Lambeth Together Health and Wellbeing Bus
Public health clinicians have also been piloting a programme on the bus to help more people detect early signs and symptoms of high blood pressure. So far, their impact has been:
*87% were Lambeth residents or work in Lambeth
Our Next Steps
Thriving Communities and Building Healthier Communities
Over the next year we will continue to:
- Provide support and space for residents to be included in the design and delivery of health and care services.
- Improve coordination of support across a larger area of voluntary, community, faith and social enterprises and health and social care organisations
- Create closer working relationships between social care, GP’s, hospitals and public health for the benefit of residents
- Provide more opportunities for learning across the health and care system
- Improve and align communication of what is happening, when and where to residents
There will be three more “Thriving Community” areas established in partnership with the Neighbourhood Wellbeing Delivery Alliance and Lambeth Public Health:
- Thriving Clapham – linked to Clapham Park Group Practice, Hetherington at the Pavilion, Hetherington Group Practice, Clapham Family Practice, Dr Curran & Partners, Grafton Square Surgery, Sandmere Practice.
- Thriving North Lambeth – linked to Hurley and Riverside Practices, Lambeth Walk Group Practice, Mawbey Group Practice, The South Lambeth Road Practice, The Vauxhall Surgery, Waterloo Health Centre.
- Thriving Norwood – linked to Brockwell Park Surgery, Paxton Green Group Practice, The Old Dairy Health Centre.
High Blood Pressure
We will use the information shared from our communities to help:
- Improve cultural awareness so GP practices and community pharmacies can have better conversations about the risks of high blood pressure.
- Make it easier to identify and refer patients with high blood pressure
- Support better reach into Black Caribbean and African communities
- Identify how digital tools can help residents to monitor their own blood pressure
Case Study: Hills, Brook & Dale PCN Women’s Health Network
The Women’s Health Network run monthly support sessions to engage women in conversation and help them learn more about health and wellbeing support in Lambeth. Coordinated by the Social Prescribing Link Worker Team, their events in the community cover a range of subjects, from healthy eating and pain management to mental wellbeing or cost of living advice.
Social prescribing link workers are based at GP practises across Lambeth. Their role is to help people with practical, social, and emotional needs affecting their health and wellbeing. The Hills, Brook and Dale Link Worker team set up this programme to proactively meet the needs of women in their primary care network, rather than waiting for them to be referred.
They support women to find out about local opportunities such as exercise classes, health education workshops and wellbeing-related activities. They can also access more support from a social prescribing link worker if needed.
Since October 2022, the Women’s Health Network team have hosted 36 sessions, attended by 733 patients, allowing them to impact more people than they would have on a one-to-one basis. This has also enabled some of the most vulnerable women in Lambeth to build their local support network, share and process their experiences, and give one another peer support.
So far, the Women’s Health Network has partnered with 19 community groups, giving patients the chance to find out about these projects and services directly from the people who run them. This has been invaluable in helping more women feel confident going directly to the organisations and joining in with the activities they have on offer.
When asked what they enjoy about the network, the women fed back they liked:
“Finding out about the variety of services offered”
“Meeting new people”
“The sessions are thrilling, everyone is enthusiastic and always very practical”
“Taking time out from home for myself”
“Having people to talk to face to face”