Birmingham is known as the second city in the United Kingdom (UK) with a population of just over one million residents. It is one of the most culturally diverse cities in England and is the home of several universities, rival football clubs and a richness of arts and culture.
Birmingham has a large City Council, NHS community Trust, large teaching hospitals, mental health trust, lots of GP practices, a significant number of voluntary sector organisations supported by the voluntary sector council and hospices.
There have been several steering groups for frailty and for palliative and end of life care over the past 10 years. The focus has been on tackling the many challenges of the changing demographics, inequity of access, cancer dominance, hospital deaths, lack of coordinated care etc.
Compassionate Communities in the context of this earlier work grew out of the emerging interest in the work of Allan Kellehear, Public Health Palliative Care International (PHPCI) and Dying Matters campaigns.
The focus was on engaging with communities to reduce the taboo of talking about death and dying and to equip communities to better support each other through capacity building (National Council for Palliative Care, 2016).
Compassionate Communities has been a theme of activity within the Birmingham hospices and End of Life Care strategy for many years, dating back to the Pathfinder Projects as part of the Dying Well Charter by National Council for Palliative Care in 2014 (National Council for Palliative Care, 2016).
There were several key advocates for compassionate communities as an ethos for care of the dying and bereaved and their early leadership in this area is part of the foundation of which the accreditation stands.
The Compassionate City Charter (revised Kellehear, 2020) has thirteen standards across multiple sectors and parts of society.
The first city to announce their intention to be a Compassionate City in the UK was Plymouth. For Birmingham, aspiration to be recognised as a Compassionate City existed but progress often stalled due to capacity, changing system priorities or structures and funding constraints. However, the commitment to the ethos and the aspiration was retained during all these changes and challenges.
In 2020 momentum to relook at the concept of Birmingham as a Compassionate City was growing as part of a healthcare system focus on end-of-life care, whilst COVID had an impact on progress, it also brought system partners closer together.
New structures and groups emerged including a group focusing on Neighbourhood Integration and another on end-of-life care and the implementation of the Ambitions Framework for Palliative and End of Life Care which was relaunched in 2021 (NHS England, 2021). The aspiration that Birmingham become a recognised Compassionate city was again tabled as part of the aims for these new committees.
One of the challenges in a city the size of Birmingham was how and where to start. Birmingham City Council had adopted a Neighbourhood Network Scheme (NNS) as a way of supporting residents at place level. Two NNS areas started some work on compassionate communities as a pilot project. These areas made progress in raising issues and having conversations about death, dying and loss with improved signposting and understanding.
Alongside Birmingham’s journey, the charity Compassionate Communities UK (CC-UK) was also evolving. An accreditation process was brought in for places who wanted to be known as a Compassionate City (or other size of place).
Using the label of compassion without demonstrating progress, change or improvements didn’t provide assurance that places were adopting the principles behind the Compassionate City Charter. In addition, to support places in better embedding the understanding and principles a Foundation Programme was developed to demonstrate the scientific evidence for compassion, how this applies to public health palliative care, the importance or understanding power structure and inequity, community development thinking and practical steps towards charter accreditation.
The timing of these developments very much suited the timescales and aspiration of Birmingham. In gaining sign up from the Interim Chief Executive of the City Council and the Accountable Officer for the Clinical Commissioning Group during winter 2021, the challenge was to achieve accreditation before the Commonwealth Games in July 2022. The only reason this ambitious timescale was feasible was due to the work and commitment over many years.
The first thing that was necessary was to better articulate the difference between a Compassionate Community and the Compassionate City Charter.
The Charter is a civic commitment across sectors to have policies, strategies, and activities in place to encourage, educate and enable improvements in the experiences of people who are seriously ill, care giving, dying, or grieving.
A compassionate community is the grass roots clubs, groups, association, and people who are engaged in improving the experiences within their community.
Arguably, it could be possible to have one or other. There could be active compassionate communities without a compassionate city. However, the concern would be that the ‘system’ would inadvertently squash such activity by commissioning services, or funding criteria too challenging for grass roots organisations.
John McKnight writes about the advent of bereavement counsellors removing the natural conversations and support that previously had taken place in community (McKnight, 2013). Equally, it could be possible to have a city that complies with the charter at a civic commitment level, e.g., the best policies and strategies without really engaging with the community. Whilst technically possible, neither of these approaches would achieve accreditation!
After several presentations to the Adult Social Care team who are strong advocates of Compassionate Communities, the Neighbourhood Integration Project, and End of Life Care Board, that distinction was understood.
This understanding reassured key stakeholders that this work wasn’t a ‘project’ or a ‘pilot’ and didn’t need significant upfront investment but that this was a different way of approaching many areas of business-as-usual activity.
There were anxieties about how much it might cost, what it meant practically and how much time might be needed of very busy people across the system. The relevant MPs and key leadership forums in the city were kept updated and the aspiration of Birmingham as an accredited Compassionate City was supported.
The City Council funded two cohorts of people from across the system and fairly well matched to the sectors within the charter standards (Kellehear, 2020) to go through the CC-UK Foundation Programme. This created a Compassionate City Network of people with some shared knowledge to work through the accreditation process.
On this network are representatives from schools, universities, healthcare organisations, public health, adult social care, neighbourhood forums, hospices, arts and culture and voluntary sector bodies. Connected to the network are lots of other networks that already existed including with prisons, homelessness forums, neighbourhoods and the Chamber of Commerce.
Language is important and being a Compassionate City Network is different to having a Steering Group and a Terms of Reference etc. In the Foundation Programme delegates learn to put their professional hats to one side and connect on these very common human issues. Delegates also discuss power structures. Therefore, going forwards in their work it is important to reflect this learning in how the compassionate city movement progresses in their community.
The accreditation process consists of a self-assessment against the thirteen standards.
Not only is the assessment asking for examples of activities, it is also asking for the level of community participation i.e. is it done to, done with or done by communities (Sallnow & Paul, 2014).
The self-assessment also prompts consideration of next steps and further development which might be shifting more power into community or scaling up something that is working well in some areas or maybe something that hasn’t started yet. It might be that the gaps are better understanding community experiences. The second part of the accreditation process is a presentation to member of the Compassionate Communities UK Board.
The self-assessment process is best described as a treasure hunt as the group of people who do this are sharing all the wonderful work already happening in communities. Birmingham was particularly strong in their assessment on activities related to arts and culture due to the work of BrumYODO (you only die once) a local movement that has been running taboo busting activities for several years. There was also wonderful examples from the hospices around peer bereavement support and end of life care for people who are experiencing homelessness.
The Accreditation Panel look for three key elements i) the recognition of what is already in place in communities ii) significant sign up from civic leaders across sectors to adopt the principles behind the charter and evidence of that in policies and strategies and iii) acknowledgement and understanding of what more is needed in terms of developing greater community participation/ownership, ensuring equity, depth and breadth in relation to the sectors in the standards and others that might emerge.
There is no complete Compassionate City that has everything in place – this is a continually evolving journey. The award recognises a significant staging post along the way. An annual update report is expected and a full review after five years.
The CC-UK Board were very impressed with the variety and diversity of people involved in the network, the range of activities already in place and the commitment at all levels going forwards.
Accreditation was awarded in February 2022. The network continues to meet and are engaging in a wide range of activities that support the ongoing embedding, amplifying, and deepening of improving experiences for local people on issues to do with serious illness, death, dying and loss.
Public Health Palliative Care in which Compassionate Cities is an element, is consistent with the Ottawa Charter for Health Promotion. It applies the principles of prevention, harm reduction and communities having greater power in relation to their health outcomes, to the field of palliative and end of life care.
Public Health Palliative Care is a complimentary strategy to clinical models of care. It focuses on the 95% of the time that someone isn’t in front of a healthcare professional and, as part of a cohesive place-based strategy, can not only improve the experiences of those who are dying and their loved ones but can also take pressure off existing health and care services.
The strong network with the support of the Integrated Care System (ICS) and interlocking strategies of compassionate communities is now embedded in policy approaches to homelessness, neighbourhood support, bereavement, and inequity. It doesn’t take away the immense challenges being faced particularly on issues of appropriate services and support for such a diverse city. However, it provides a good foundation for the new ICS system to tackle many of the challenges facing palliative and end of life care and our communities.
To read more about Birmingham’s accreditation click below
We watch with interest as Compassionate Birmingham grows.
Emma Hodges, Development Director, Compassionate Communities UK, Kathryn Drysdale, Senior Integration Manager: Frailty NHS Birmingham and Solihull and Emil Prysak, Commissioning Manager Prevention & Communities Adults Social Care Directorate
Kellehear, A., 2020. Compassionate City Charter. [Online]
Available at: https://compassionate-communitiesuk.co.uk/wp-content/uploads/2021/12/The-Compassionate-City-Charter.pdf
[Accessed 30 June 2022].
McKnight, J., 2013. John Deere and the Bereavement Counselor (Annual E. F. Schumacher Lectures Book 4). Great Barrington: Schumacher Centre for New Economics.
National Council for Palliative Care, 2016. Dying Well Community Charter Pathfinder Project – Evaluation Report, London: National Council for Palliative Care.
NHS England, 2021. Ambitions for Palliative and End of Life Care: A national framework for local action 2021-26, London: NHS England.
Sallnow, L. & Paul, S., 2014. Understanding community engagementin end-of-life care: developingconceptual clarity. Critical Public Health.