Changing the conversation about health

Altogether Better

CoM Tags:

health champions, community care, self help, innovations network, College of Medicine, prizewinners, 2013 award

Altogether Better has developed an evidence based approach to engaging, training and supporting individuals in communities to become volunteer Community Health Champions.

Our aim is to work together with champions, patients and health care practitioners to improve the health and wellbeing of communities across the country. We do this by:

• Strengthening the voice of Community Health Champions
Co-producing solutions which support health and well being
• Growing a transformational network
• Influencing policy and practice.

Read our interview with Altogether Better founder Alyson McGregor.

Year established
Number of staff
5 FT equivalent paid staff.  We have recruited and trained over 17,000 community health champions since 2008.
Number of users
Is there a charge to users?
No charge to users
How do you make your project sustainable environmentally and financially?
Altogether Better work collaboratively with national partners and we have benefited from a wide network of trusted stakeholders and by developing a track record and evidence base as innovators and through our passion and belief in the power of communities to transform lives.We have piloted the community health champion approach in a number of settings and we are very clear about the outcomes we need to achieve to ensure future investment in a peer to peer support approach. Our ambition has always been to create a movement of community led volunteers to influence lifestyle and behaviour change, to increase social capital, reduce health inequality and improve health and well-being. We have worked with academics to demonstrate the health and social impact of the work and the potential cost savings to the health system.

An overview of how we work towards sustainability is provided below:

Income generation: Successful grant applications; Development of income from Consultancy and Design strategy; Finance strategy developed which ensures full on-costs are built in to project costs

Staff: Small, contracted workforce; Clear roles and objectives for each staff member; Development of Associate roles

User demographics
Altogether Better’s 17,000 volunteer Community Health Champions normally range from 16 – 75+, majority are from communities in the Yorkshire & Humber area (although this is changing as the team’s work develops across other regions) and represent a range of communities, backgrounds and ethnicities.
How is the project innovative?
Innovation:• Principles & Practice: “working with” not “doing to”
• Co-design and Co-production: recognising the assets, expertise, individuality and skills within communities
• Evidence based
• Being prepared to take a risk

Problem solving:

• Working with an asset instead of a deficit model
• Inviting a wide range of people to create solutions together
• Recruiting from hard to reach communities to learn how to do things differently


• The landscape changes in the NHS and Public Health have disrupted some of the statutory and voluntary organisations who offered a well-supported infrastructure for volunteers

Worked Well:

• Given the right level of training and support, many volunteers have gone on to further learning and employment
• Champions are now seen as an important conduit to communities and health professionals are working with volunteers and creating the conditions for them to lead work and develop projects for mutual benefit Learning:
• Creating respectful, enabling conditions to work in partnership to solve problems, develop ideas and provide the right level of training and support is key to developing initiatives that improve health and well-being in communities

Patient centred, whole person preventative approach
Altogether Better (AB) has co-produced locally tailored Community Health Champion (CHC) approaches which particularly support vulnerable, disadvantaged and seldom heard groups and target individuals to be trained and empowered in their role as volunteer CHCs.Examples include:• Practice Health Champions (who work within the setting of their local community GP Practice)
• Emergency Department Champions
• Altogether Better Diabetes Champions

Read the full details here

Evidence-informed practice, audit and evaluation
Read a full list of references here
Multi-disciplinary collaboration, communication and professional practice
Altogether Better has been working with partners to demonstrate measures of improved productivity of services. AB’s work with the Right Conversation project has witnessed meaningful engagement of empowered citizens, patients and carers with the aim of improving planning and commissioning decisions.Within the last year, the prototyped Practice Health Champion model has started to deliver improved service outcomes. One example includes CHCs supporting patients to get more out of their consultation process with their GP and further to this, one local GP practice doubled its uptake of flu vaccinations with support from their team of volunteer Practice Health Champions reaching a new total of 800 patients in one weekend clinic session.

Other examples include Champions working with practice staff and patients to implement new groups and activities. This includes: running COPD groups, Young Mum’s Groups, Retirement groups, breastfeeding groups, incontinence support groups and pregnancy groups. These are all examples of introducing new resource into the system through collaboration, listening and learning from each other, and recognising that the needs of patients and community members are often unique to each setting.

Over in the Emergency Departments at Leeds General Infirmary and St. James’s, Altogether Better’s work with the Right Conversation project has led to the team training 32 individuals to become Champions within these settings. Early results are very encouraging, demonstrating the value of people in communities supporting patients through the process. A recent case study (currently in draft form) demonstrates the improvement in quality of services, increase in patient satisfaction and likelihood of improved outcomes are greatly enhanced by volunteer Champions who provide care, compassion, practical support and offer a safeguarding role.

Another example of AB’s multi-disciplinary and collaborative work, is its partnership with One plus One (a national organisation funded by the Department of Education) to develop their existing award winning e-resource around relationship support. This work is part of a pilot to test out a volunteer community based model of improving early intervention support for relationship distress. AB is testing out approaches in four localities and the programme team, project staff and CHCs have all worked with One plus One to rewrite the e-resource so that it is accessible to volunteers. The Healthy Relationship Champion training and e-resource will be evaluated in the Yorkshire and Humber before being replicated nationally.

As part of AB’s on-going evidence and evaluation, an economic Return on Investment report was produced to calculate the efficiency and cost effectiveness of AB activity and to inform future planning, sustainability and business models.

The Social Return on Investment was conducted by YHEC (York Health Economics Consortium) and included the analysis of a series of case studies of AB’s beneficiaries The analysis found that all AB’s 16 Big Lottery Funded projects demonstrated a positive social return on investment between £0.79 – £112.42 for every pound invested. Whilst this review of case studies was high level and there was a great deal of variability in the data available for each case study, the figures provide a useful indication of the potential levels of return for the Community Health Champion approach for funders. The learning from this report and that of others, is key to AB’s commitment to using an evidence-based approach to reviewing current projects and planning for the future.

In order to increase capacity within the team, AB occasionally works with associate members to support the delivery of work. This is alongside team members who are experienced in the delivery of training and support to volunteers, project management, business and administration, communications and a wide range of other key skills vital to delivering AB’s objectives and ambitions.

Team members are encouraged to seek new training and shadowing opportunities that support AB’s work, as well as professional and personal aspirations. Regular one-to-ones are held with each post-holder’s line manager and clear development plans are in place for every team member. The team also hold “Away Days” which are an opportunity to review work but also a chance to connect as a team, have some fun, and have some time and space to reflect individually and as a group. For further information on this, please get in touch.

Team members also actively look for new opportunities to introduce CHCs to – whether that is a training, networking or engagement type opportunity.

Examples include – CHCs from AB meeting directly with Ministers – Ann Milton (Public Health Minister) and Nick Hurd (Minister for Civil Society), being supported towards employment and new volunteering opportunities. Recently, a group undertook First Aid Training as part of their work with GP Practices.

There are lots of other examples from AB’s projects which also help to demonstrate AB’s overall commitment to not just professional practice and development but real, genuine interest in the personal development and wellbeing of its beneficiaries too.


Some quotes from participants
“It was such a relief – being able to talk to people who didn’t judge you; didn’t think you were attention seeking or self-harming. So often, in mental health services, all you see is people writing things down on a piece of paper, filling in a questionnaire, asking if you’re feeling suicidal – and that’s it until the next appointment. This wasn’t like that”
Lisa Cox, Community Health Champion“Never in my life did I think that I would get to walk through famous black door of 10 Downing Street and talk to a Prime Minister. I thought that that was the end of my journey and that was a good healing ending – I spoke to him and got my story across. But then his PA took me into the Cabinet Office and said I had really touched the Prime Minister’s heart.”
Lisa Cox, Community Health Champion

“I love being the cog that has brought organisations together and seeing the massive difference they make to people’s lives, when they work together for one goal.”
Caroline Waugh, Community Health Champion“Seniors Show the Way [my AB project] has opened up so many doors for me. I feel I can influence people and politics now. I also feel like I’ve become more trusting of people since my involvement with the project.People have sometimes given me negative vibes, but Seniors Show the Way has taken that away. I feel like I can communicate with and interpret people better. It’s been a very liberating experience.”
Mashud Haque, Community Health Champion

“I have learnt a lot from the [champion] training. It was very useful and I will use it in my community work e.g. how to set up a group and what barriers are there in community development. I used what I have learnt to set up a Chinese cook and eat session and Chinese healthy living group.” Community Health Champion “I have been put down a lot in my life but everyone involved in the course not only the people in the group but the trainers were very accepting, helpful and also very understanding.” Community Health Champion

“It’s more of a confidence thing as well because people were saying they don’t like to go to the gym because they feel insecure so it’s good, we get together to push our buggies and it’s free.”
Community Health Champion

“If I can go out and deliver gentle exercise to the elderly, its motivation for me and it gets me exercising and, as long as we all enjoy it and have a little laugh about it, it’s super!”
Community Health Champion


Contact details
Altogether Better
Block 10
Room 29
Ouchthorpe Lane
WF1 3SPt: 01924 398 428