Community health and wellbeing workers: an off-the-peg solution for improving health and care in England

Last year, Keir Starmer emphasised the need for timely community-based treatment to address health issues before they become expensive to treat in hospitals. We know that small changes at population level dramatically improve overall health, and that public health spending is four times more cost-effective than NHS spending. Yet the current budget allocation to public health is 2%. In the context of strained health and social care budgets and the current workforce crisis, resources pool at the sharp end. We propose reduced reliance on highly skilled professionals and a focus on health literacy, self-activation, and community care.

Drawing inspiration from Brazil, we suggest building a community infrastructure of trained and paid Community Health and Wellbeing Workers (CHWWs) who work with GPs, community services, and local authority. By integrating CHWWs, they can play a pivotal role in coordinating services as trusted contacts within communities that often feel marginalised. The Brazilian model has shown significant improvements in outcomes over the last two decades including the reduction of cardiovascular mortality, hospital admissions, and inequity. CHWWs exist globally, but the Brazilian model with its integrated, universal, and holistic household approach holds most promise. Proportionate universalism that targets the population in a deprived area can effectively address health inequalities, as opposed to initiatives that segment particular groups.

A pilot in Westminster tested the acceptability and feasibility of this model in England. The programme demonstrated increased vaccination and screening rates and a 7% drop in unscheduled GP visits in the first year. Rather than create demand, CHWWs reduced it, while finding those who need care but do not seek it.

Training and upskilling volunteers and connecting them to employment opportunities in the NHS will also address the current workforce crisis. Becoming an effective CHWW requires cultural competence, passion for the community, non-judgemental attitudes, good listening skills, and problem-solving abilities. The CHWW apprenticeship provides a basis for learning and professionalism, enabling individuals to start working in the community immediately and acquiring a foundation for further development within NHS Integrated Care Systems (ICS). This investment in community would raise health literacy levels and foster self-care.

CHWWs in England could be even more impactful in the UK than in Brazil given wider availability of services, acting as a catalyst between health care, social care, and public health, and providing vital community infrastructure to improve population health status and outcomes. If we deployed CHWWs nationwide to promote health, address wider determinants, and support chronic disease management, considerable savings are likely to be achieved within public health, social care, and NHS budgets, alongside significant health improvements. Funding for this initiative should be secured through long-term and reliable sources, such as an addition to the fixed part of the Public Health Grant.

Creating an English family health strategy, similar to Brazil, is a feasible and frugal political choice to address the current challenges in the healthcare system and has already scaled to other locations across the country. Long-term funding and widespread support to implement this effective and timely intervention are essential to make it sustainable.