Research and analysis

Multi-disciplinary Hubs – Bradford

Published 10 April 2024

Applies to England

Partnership for People and Place

The PfPP programme has piloted a new approach to cross-government working to improve local outcomes and efficiency of policy and programmes designed and delivered in place. PfPP funded 13 local government partners to deliver pilot projects focusing on hyper-local issues that could be tackled through better central or local government coordination. The overall objective of the PfPP programme is to build a case for longer-term place-based programmes by creating a compelling evidence base on how close working between different central government departments and local places can bring measurable benefits to people who live there.

Local background – Bradford

The impact of COVID-19 on mental health disproportionately affected residents facing multiple disadvantages and living in areas of multiple deprivation. The pandemic also highlighted the value of multi-disciplinary, joined up working on improving outcomes for people with multiple disadvantages. In response, Bradford partnered with the VCS Alliance, to establish two multi-disciplinary Hubs in Manningham and Tong which offer a single point of contact for people with mental health issues or one other disadvantage (focusing on low-income families, no or little English, refugees, and asylum seekers, those with disabilities and complex needs, and victims of domestic abuse). PfPP funded two additional Hubs to complement 4 existing Hubs across Bradford. The Hubs provide a ‘Wellbeing Network’ and coordinate a range of innovative interventions. This includes interventions focused on employment and welfare support, alcohol and drug support, parental support, while achieving better co-ordination and reduced calls on statutory services. 

Central government collaboration

As described in the delivery plan, Bradford Council sought to connect with central government to support implementation of the Hubs by:

• Bringing central government into local governance groups and local government into central government structures
• Aligning with central government programmes to improve identification and engagement amongst the pilot’s target cohort
• Involving central government in the design and promotion of the grant scheme to avoid duplication of competing funding streams or initiatives

The pilot team had significant success generating central government participation in local governance and connecting with central government departments to unblock barriers. Notably, the DLUHC PfPP lead facilitated local engagement with Homes England. This resulted in an amendment to an existing grant agreement that expanded transitional housing access for patients discharged from local NHS hospitals.  The project team also successfully used the Cabinet Office grant portal system to administer local commissioning. Pilot leads attributed success to the DLUHC team brokering relationships with central government partners between February 2022 and January 2023 with DfE, Homes England, DHSC, NHS England and the Cabinet Office.

Bradford yielded mixed results from engagement with NHS England and NHS Digital which sought to explore and influence issues related to data sharing and information governance within and across the local health and care system. Constraints on data and information access were highlighted by the pilot team as preventing different organisations within the local Bradford health and care system from viewing and amending patient records. NHSE wanted to support Bradford to overcome issues with data sharing and prescribed models of care and explored using the pilot as a potential case study. However, to do so, the pilot team were asked to develop a map to showcase the individual pathways through the health system to highlight key blockers to data sharing along that journey. Resource within the local authority was constrained, and while the local authority was committed to finding time to continue the engagement, they did not have the resources required at the time of the PfPP programme.

The Bradford team was also connected with civil servants from the Home Office to explore how they could better liaise with the department when supporting Asylum Seekers. The pilot team highlighted significant wait times on current Migrant Help support lines and sought clarity on alternative avenues for support.  Home Office colleagues provided written responses to the Bradford team, but this did not result in further collaboration with the Home Office.

Delivery plans	Meetings	Visits	Involvement in delivery
CO, DHSC (OHID), DWP, DLUHC, DfE, HO were listed in Bradford’s initial delivery plan as departments with a potential interest in health inequality and community outreach.	DfE, HO, DWP, HE, DHSC (OHID) and NHSE were involved in meetings with the project team.	DLUHC, NHSE visited the neighbourhood and the Hub to understand more about the local landscape and the model of linking up of services.	CO facilitated the Bradford Hub grants being advertised on a cross-governmental funding portal. £9k of funding was awarded via this portal. Collaboration with Homes England resulted in an existing grant agreement being amended.

What was delivered?

The team launched the Tong and Manningham Wellbeing Hubs. The focus of support has been in relation to domestic abuse, welfare benefits, mental health, substance misuse, carers, and physical health as well as targeted support to refugees and asylum seekers. In the 8 months to April 2023, over 330 people accessed Hub services, with each visitor leading to between 3 and 4 service referrals or interventions on average.

The Hubs have a role to make onward referrals to direct individuals to the right support. VCS Alliance worked closely with system partners, to develop referral routes across health and care providers. As part of this work, over 50 individual organisations and services have been used, with the majority of these to voluntary and community service specialists in housing, welfare advice or drug/alcohol use.

Bradford piloted a national grants application portal by the Shared Outcomes Fund Grants Application team in the Cabinet Office, which was an efficient way for the Hubs to provide grants to local community organisations. The Find a Grant Portal was used for £9k of the £10k total awarded to local organisations.

PfPP supported Bradford to amend an existing housing grant agreement by connecting the pilot team with contacts in Homes England who co-ordinated relevant decision-makers. Amending the grant agreement has enabled better access to transitional housing for people under the age of 55 by allowing Bradford Council to use empty housing stock for outpatients, freeing up hospital beds.

Mobilisation of a marketing and communications strategy to develop a single brand. This has included a Wellbeing Network website for both practitioner referrals and communities and Wellbeing Hub Facebook pages established in June 2022.

Local communities

Hubs are providing co-ordinated preventative support, quick and equitable access to services and person-centred help as evidenced through case studies and feedback from attendees. This also provides greater reach with communities who would not traditionally access services. VCS Alliance attendee survey data shows that of 330 visits to the Manningham and Tong Hubs, 161 (49%) were unsure where else they would have gone.

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Delivery partners & local government

There is some evidence that Hubs are directing demand away from A&E and primary care networks. Of the 330 visits, 64 (19%) stated that they would have gone to a GP, 59 (18%) to VCS and 48 (15%) to A&E if they had not attended the Hubs.

Bradford was able to successfully administer grants through the SOF Grants Application platform. This connection also increased the awareness of the Hub leader about various opportunities for further funding available to them.

Relationships with partners in the Wellbeing Network have grown as evidenced through partner engagement with the Hubs. There is a collaborative care model in place developed through trusted partner relationships and over 30 partners have engaged in the Wellbeing Network. While the Network requires continued efforts, the sector report they feel heard.

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Central government

Bradford was able to provide feedback to the Cabinet Office on their experiences with the Grant Application portal to inform future iterations.

Snapshot: Breakeven analysis

Breakeven analysis provides an estimate of the level of change in outcomes within each of the pilot areas that would be necessary for the pilot’s benefits to meet costs. Where there is an absence of medium- or long-term person-level outcomes data, a breakeven analysis can provide an indication of how many beneficiaries would need to achieve specific outcomes for the programme to achieve a net positive economic value. Breakeven analysis was completed on outcomes identified in each pilot’s Theory of Change, for which monetisable benefits could be estimated through the Understanding Society Survey.^{[footnote 1]}

Based on the evidence collected to date, there is some uncertainty as to whether the Manningham and Tong Hubs have achieved breakeven. The Hubs have recorded positive outcomes data to date, and there is some evidence that the pilot is on track to achieving breakeven should further monitoring and reporting be collected. The breakeven does not account for outcomes specified within the Multi-disciplinary Hubs theory of change which could not be monetised such as those related to improved joint working, reduced health inequalities, improved life chances, as well as system level outcomes related to enhanced community engagement with policy making.   

The pilot intended for the Hubs to provide greater awareness of services, and increased reach within communities traditionally harder-to-reach in the area. The Hubs link people with mental health issues or one other disadvantage (described above), with a range of services that cover financial support, housing, physical and mental health. A review of the Theory of Change and in consultation with PfPP Bradford pilot team, the following outcomes are considered in-scope of the breakeven analysis:^{[footnote 2]}

Outcomes specified in the Manningham & Tong Hubs Theory of Change	Outcomes used in breakeven analysis
Increase in trusted relationships	Talks to neighbours regularly
Greater awareness of services available and how to access them	Able to obtain advice locally
Greater reach with communities who would not traditionally access or be able to access these services	Able to obtain advice locally
Reduced levels of depression and anxiety	Reduced loneliness
Improved physical and mental health	Measures of physical health

The outcomes targeted by the Hubs were used in a breakeven calculator to estimate the number of visitors that would need to benefit for the pilot to break even (with a range presented between the highest and lowest number of visitors that would need to benefit to breakeven). The analysis accounts only for outcomes to beneficiaries/participants. The analysis does not account for wider impacts.

The breakeven analysis provides an upper or lower bound range which accounts for some of the uncertainties inherent in predicting social value improvements in these outcomes in the local community, which can be calculated without direct primary data collection (out of scope of the evaluation). The table below displays the results of this breakeven analysis for the Hubs.

Outcome	Loneliness	Talks to neighbours regularly	Physical health	Able to obtain advice locally	Range
Value Per Beneficiary	£3,288	£1,850	£1,126	£888	£888-£3,288
Number of Beneficiaries to Breakeven	98	175	288	364	98-364

The breakeven analysis highlights that for the social welfare benefits of the Manningham and Tong Hubs to offset their cost, between 98 and 364 beneficiaries need to realise at least one outcome in scope. The estimated range accounts for the difference between highest and lowest values assigned to each outcome. For example, a reduction in loneliness has an associated value of £3,288. Should this outcome be realised for 98 residents, the total benefits of the project would equal the cost. This presents the lowest number of beneficiaries required to achieve breakeven and the outcome with the highest assigned value. Likewise, to be able to ‘obtain advice locally’ has an associated value of £888. If 364 residents report experiencing welfare improvements from being able to obtain advice locally through the Hubs, the total benefits would equal the cost of the programme. This presents the highest number of beneficiaries required to achieve breakeven and the outcome with the lowest assigned value.

Over the course of a full 12-month delivery period, it is feasible that the Hubs will positively impact visitors within the estimated range (98-364) to produce social welfare benefits equal to the costs of the pilot programme. Between August 2022 and April 2023 (8 months) the Hubs provided case management support to 330 individuals. Both Hubs are generating referrals to financial support (133), social support (77 referrals), housing (12) and mental health (41) services. Of the 330 residents who have accessed the Hubs, 141 highlighted that they ‘wouldn’t have known where else to go’ – providing some indication that the Hubs are contributing to improved local service access. There is high uncertainty for person-level outcomes such as (‘how often they feel lonely’ and ‘measures of physical health’) which are more likely require positive and ongoing interactions with services providers.

The Hubs are also generating system level impacts which may have some, albeit relatively small, economic impacts via reduced GP and A&E service use. By improving health service access for residents with multi-disadvantages, the Hubs aim to divert demand from other services including GP services and A&E in the medium term. To date, survey data shows both Hubs were likely to have contributed to a reduction of 64 GP visits and 10 A&E visits. Using NHS average cost of GP data (£44.47 per appointment), as well as average A&E visitation costs (£343.11 per visit), this will have resulted in total system savings of £2,846.08 (GP) and £3431.10 (A&E).

Note that the application of the breakeven calculator to a full business case would require data to be collected that evidences the number of beneficiaries who experienced these outcomes, either through primary surveys (e.g. by replicating the Understanding Society or Community Life survey question on which this analysis was based in a survey on the target population) or administrative data (e.g. administrative records of the number of residents who have been influenced by local health related initiatives).^{[footnote 3]}

1. Following the methodology set out in HMTs supplementary Green Book guidance for wellbeing appraisal, changes in reported life satisfaction can be used to monetise the social welfare implications of a policy. ↩

2. The extent to which the above outcomes are associated with marginal changes in life satisfaction was explored through statistical analysis of the Understanding Society survey. Baseline analysis of Understanding Society (wave 12) data shows that the mean reported life satisfaction score in Bradford had a value of 8.12 (when converted to an 11-point scale, uprated from 5.17 on a 7-point scale). This is higher than the national average of 5.22. ↩

3. It may also be possible to assess the wellbeing impacts of the programme through primary survey collection of life satisfaction questions. However, because this requires direct evidence through primary data collection before and after (outside of the scope of this evaluation), we do not provide breakeven analysis in the main body of this report. If it were possible to evidence how an intervention led to an improvement in life satisfaction (through direct primary survey questions compared to baseline levels of life satisfaction, recall 8.00 when converted to the 11-point scale) then a 1-point improvement in life satisfaction among 45 beneficiaries would lead to a breakeven in costs. Note the analyst should take care to ensure that the measure of life satisfaction refers to an 11-point scale, following the guidance set out in the Green Book Supplementary Guidance (2021). ↩