Working with patients to manage long-term conditions: People Powered Health is an approach that can improve quality of life and save the NHS money.
The health system is going through significant upheaval and crisis provoked by the combined impact of the NHS reforms and the Francis Inquiry. The result is a sense of unease and uncertainty despite the NHS ranking excellently in international terms. At a recent Lord Darzi discussion on primary care, the mood was summed up as: 'Why does it feel so bad, if we're actually doing so well?'
Part of the answer is that the NHS is good at dealing with acute and infectious disease, but is still finding its way towards a model that effectively manages long-term conditions. Another element is the challenge of nurturing compassion in large, formal institutions, where staff are under considerable financial pressure.
People Powered Health is an approach to health and care that addresses both issues. It is based on innovations that have been developed over many years – from peer support networks to expert patients, doctors prescribing exercise to group consultations. It has been estimated that if the NHS adopts these innovations, it could save around £4.4bn a year. Nesta's Business Case for People Powered Health, published this week, sets out potential savings of 7% of the Clinical Commissioning Budget from reduced A&E attendance, planned and unplanned admissions, and outpatient admissions. The median of a wider range of studies generates potential savings of 20%, suggesting that 7% may be a conservative figure.
The approach ensures patients, their families and communities are active partners in managing long term conditions and that solutions are developed with people, not done to them.
The result is a fundamental shift in the relationship between professional and patient, which encourages compassion and long-term recovery. Patients are supported by a range of people such as nurse coaches, peers with direct experience or health trainers that accompany them to the gym.
All these interventions are designed with people and aimed at behaviour change and prevention to reduce demand on acute services. They also create social networks that improve health. At their heart, these approaches respect people, acknowledge their strengths and abilities, and help them gain confidence and control.
Nesta has been working with the Innovation Unit and six sites across England for 18 months to understand what needs to happen to implement People Powered Health at scale.
The first key element is redesigning consultations. Newcastle West CCG has been scaling social prescribing – a collaborative process in which GPs work with patients to make referrals to community-based services. These services – such as health trainers – meet people's wider social, physical and mental wellbeing goals.
Another key element is commissioning new 'more than medicine' services to complement clinical care by focusing on behaviour change and networks of support. Stockport council and the Pennine Care NHS Trust have been working with local voluntary and community sector providers to create peer support groups. So, not only are the public services improving the social resilience of the community by brokering new relationships between service users, they are doing so to improve health and reduce costs.
The final key element is co-designing pathways, so patients and professionals choose which services will do most to support the person to live well with their condition. In the Lambeth Living Well Collaborative, people discuss choices with the Community Options team and focus on long-term goals and moving into mainstream life and away from 'service land'.
The health system has tended to prioritise clinical and technological innovation. But we need to become as good at social innovation for health. On the face of it, this is as simple as connecting patients so they talk to one another. But this will require significant shifts in culture, incentives, measurement and practice. It will not be easy, but it is necessary, not just for the sake of individual patients, but because there is a financial imperative.
Halima Khan is director of the People Powered Health progamme at the charity Nesta Guardian Professional.
The health system is going through significant upheaval and crisis provoked by the combined impact of the NHS reforms and the Francis Inquiry. The result is a sense of unease and uncertainty despite the NHS ranking excellently in international terms. At a recent Lord Darzi discussion on primary care, the mood was summed up as: 'Why does it feel so bad, if we're actually doing so well?'
Part of the answer is that the NHS is good at dealing with acute and infectious disease, but is still finding its way towards a model that effectively manages long-term conditions. Another element is the challenge of nurturing compassion in large, formal institutions, where staff are under considerable financial pressure.
People Powered Health is an approach to health and care that addresses both issues. It is based on innovations that have been developed over many years – from peer support networks to expert patients, doctors prescribing exercise to group consultations. It has been estimated that if the NHS adopts these innovations, it could save around £4.4bn a year. Nesta's Business Case for People Powered Health, published this week, sets out potential savings of 7% of the Clinical Commissioning Budget from reduced A&E attendance, planned and unplanned admissions, and outpatient admissions. The median of a wider range of studies generates potential savings of 20%, suggesting that 7% may be a conservative figure.
The approach ensures patients, their families and communities are active partners in managing long term conditions and that solutions are developed with people, not done to them.
The result is a fundamental shift in the relationship between professional and patient, which encourages compassion and long-term recovery. Patients are supported by a range of people such as nurse coaches, peers with direct experience or health trainers that accompany them to the gym.
All these interventions are designed with people and aimed at behaviour change and prevention to reduce demand on acute services. They also create social networks that improve health. At their heart, these approaches respect people, acknowledge their strengths and abilities, and help them gain confidence and control.
Nesta has been working with the Innovation Unit and six sites across England for 18 months to understand what needs to happen to implement People Powered Health at scale.
The first key element is redesigning consultations. Newcastle West CCG has been scaling social prescribing – a collaborative process in which GPs work with patients to make referrals to community-based services. These services – such as health trainers – meet people's wider social, physical and mental wellbeing goals.
Another key element is commissioning new 'more than medicine' services to complement clinical care by focusing on behaviour change and networks of support. Stockport council and the Pennine Care NHS Trust have been working with local voluntary and community sector providers to create peer support groups. So, not only are the public services improving the social resilience of the community by brokering new relationships between service users, they are doing so to improve health and reduce costs.
The final key element is co-designing pathways, so patients and professionals choose which services will do most to support the person to live well with their condition. In the Lambeth Living Well Collaborative, people discuss choices with the Community Options team and focus on long-term goals and moving into mainstream life and away from 'service land'.
The health system has tended to prioritise clinical and technological innovation. But we need to become as good at social innovation for health. On the face of it, this is as simple as connecting patients so they talk to one another. But this will require significant shifts in culture, incentives, measurement and practice. It will not be easy, but it is necessary, not just for the sake of individual patients, but because there is a financial imperative.
Halima Khan is director of the People Powered Health progamme at the charity Nesta Guardian Professional.
No comments:
Post a Comment