Tell me something I don’t know!

The Realising the Value programme is designed to ‘develop the field of person and community-centred approaches for health and wellbeing by building the evidence base and developing tools, resources and networks to support the spread and increase the impact of key approaches.’

To you and me this simply means that a bunch of folk, who are much cleverer than I, have looked at what works and what doesn’t when it comes to enabling people to take an active role in their own health and care. They have measured the benefits of person-centred care by looking at cost savings (no surprises there!) but also at the improvement in peoples’ well-being and the wider social impact.

I was invited to Manchester to hear the findings of this 18 month project. I travelled down somewhat reluctantly, wondering if there was any new learning in this for me and if it was possible to go beyond the rhetoric and provide evidence robust enough to convince any sceptical commissioners.

The context….

You might need to sit down for this…

People are living longer.

People are living longer with long term conditions.

It’s costing the NHS a lot of money.

The NHS has no money!

Basically, if we are gonna keep our lovely NHS, stuff needs to change… a lot.  We need to get super-smart and spend our limited resources in ways that have the biggest impact.  I know, you’ve heard this all before, but seriously if we keep doing stuff the way we’ve always done it, we are throwing our money into a bottomless pit. When it comes to doing things differently, the ‘why’ is pretty convincing.

What needs to change?

Lots of things need to change but let’s focus on that well-worn sound bite ‘putting people and communities at the heart of our health and wellbeing’.  Our NHS still focuses on a medical model where the ‘clinician knows best’; except it’s becoming clearer that they don’t always. Not only is this over-medicalised model wasteful, it’s also pretty disempowering and thtoy-story-memeis acknowledgement has seen a rise in calls for a more person-centred, social model of health and social care.

Without a doubt, outcomes are important; I mean who doesn’t want to get cured, but what about those millions of people for whom there is no magic bullet. Up to 58% of people in the UK live with a long term condition, a condition that cannot, at present be cured. Contact with a clinician is infrequent and treatment with medication often has varying degrees of success, so these people have become experts in managing their own condition. Imagine that, over 30 million experts just wandering around aimlessly. Harnessing and networking these experts by experience could potentially help empower whole communities and at the same time free up valuable resources through reducing inappropriate and unplanned use of stretched services.

Oh crumbs, this is brilliant! Why haven’t we thought of it before?

Sounds good in theory, but does it really work?

Of course we have thought of it before and there are great examples of these person- and community-centred approaches across the country.  The problem is more one of evaluation. Anecdotal evidence simply doesn’t cut it these days; commissioners want cold, hard facts and databases overflowing with convincing statistics. For too long the ‘fluffy’ social model of health and wellbeing has taken a back seat on the medical express to Futureville.

Please stand up Realising the Value.

Over the last 18 months NHS England has funded NESTA and The Health Foundation to identify what social interventions have the biggest impact on people and communities’ health and wellbeing.  This event gave the project an opportunity to share their findings with people itching for evidence to give their social approach real traction. There was nothing new here, the examples included co-produced community projects which have engaged local people and used their experience, skills and knowledge to develop peer led activities. Inspiring, yes; valued by people, yes; but hardly innovative. This project however, wasn’t about creating new, clever initiatives, it was about measuring the ones that already exist.  It was about generating evidence that these approaches actually work (even though the people delivering them know this already!).

This event shared the final report and featured the experience of people who battled the system and won. The stories they shared were beyond moving and demonstrated just how much the health and social care system can let people down. On the upside it also showed how resistant people can be and how community organisations can galvanise peoples’ spirit and give them a reason to live again; it was inspiring stuff.

Working with their partners, NESTA and the Health Foundation have written a series of useful documents and in their final report they outline 10 key actions to put people and communities at the heart of health and well-being. They have also developed an economic modelling tool that allows commissioners to assess the potential impact of commissioning person and community centred approaches in their local area.

So now that I’ve returned from Manchester, what are my reflections and what can I do to help push forward this agenda?

My learning:

  • Manchester has a much better German market than Leeds and that disappoints me.involvement-modelling-iceberg
  • There are lots of people out there who, like me, wholeheartedly believe that a social model of healthcare holds the answer to many of the challenges in our health and social care system.
  • These approaches are not just ‘nice to have’, they should be woven into the very culture of our organisation.
  • We are all a bit flawed and that’s ok.
  • As well as making me over-emotional, patient stories are the best way to demonstrate the difference these person-centred approaches make to people and communities.
  • We now have evidence that person-centred approaches to care can save huge amounts of money.
  • The true value of patient-centred care lies in personal growth and the benefits to individuals and families.
  • The savings that have been modelled are the tip of the iceberg 

 My pledge:

  • I will share the economic modelling tool with commissioners in Leeds and encourage them to use it when planning services.
  • I will raise awareness of the findings from this project with our patient champions and encourage them to press home the message in the steering groups that they attend.
  • I will be confident that person-centred care really does work.
  • I will write a blog about the event and share it with people in Leeds (and here it is!)

The evolution of medical science has saved literally millions of lives and it will continue to play an essential role in improving the nations’ health. Many clinicians are now signed up to a more social model of healthcare and this can been seen in local models like this social prescribing initiative in Leeds: https://www.youtube.com/watch?v=7I0ztfPq_cQ. This social approach now has real momentum but the historic domination of the medical model has been unhelpful.  Its focus on fixing and curing has failed many people in the system. It has disempowered people and drawn our attention away from our responsibilities and collective action. Oh, and it’s REALLY expensive!

It comes as no surprise to me that person- and community-centred approaches have an important role to play in future health and social care. Having a bank of evidence and tools will be a huge help to me in my role at the CCG but that’s not the only thing I’ll take from this event. I’ll remember the energy in the room, the passion for positive change and the feeling you get when you’re surrounded by people who think the same way you do. But most of all I’ll remember the people who told shared their personal stories. I’ll remember how the system let them down and their community helped them back up.

Chris Bridle

Engagement Lead, NHS Leeds West CCG