What links a social prescription in Newcastle, a peer retreat in Lambeth, and a neighbourhood network in Leeds? Well, these were three of the six frontline teams in the People Powered Health programme, which finished last year after running for 18 months. The programme—supported by the charity Nesta, along with the Innovation Unit—supported these six health teams in England to test and scale collaborative approaches to supporting people with long term conditions.
The teams were diverse—from primary to secondary care and mental health to musculoskeletal problems—but they were united by their commitment to creating an approach to healthcare that was powered by the people who work within it, and with the people it’s there for.
So, what does people powered health look like in practice?
• Collaborative consultations: In which patients are active partners, exemplified by the Year of Care partnerships approach and National Voices’s guide to care and support planning. These truly patient centred consultations enable goals to be set, encourage positive behaviour change, and take account of how people want to live, e.g. to feel less lonely, to eat better food. People are supported to take responsibility for their health and wellbeing; and they can tap into help from, for example, nurse coaches and peer supporters.
• “More than medicine”: After collaborative consultations, people are supported to access a variety of interventions— such as peer support groups, health coaching, and walking groups—in addition to clinical prescriptions. Whether this is described as social prescribing or co-producing care pathways, it creates a link between the formal healthcare system and informal, voluntary sector activities that happen in local communities. “More than medicine” gives people skills and confidence, working on the social fabric of communities to improve health and wellbeing. It also enables positive behaviour change, which feeds back into the ongoing care and support planning process.
One year on, and the people powered health agenda is as relevant as ever. There is strong consensus that a different approach is needed to address the current healthcare system’s financial unsustainability, which is driven by the increasing prevalence of long term conditions. As well as the recognition that long term conditions need social treatments, as well as medical, and behaviour change is a key component of improving health.
The People Powered Health teams continue to provide practical ways to build people’s confidence so that they can manage their health conditions, improve their living circumstances, and become active contributors to their health—instead of passive consumers of formal services. For example:
• The Lambeth Living Well Collaborative has agreed in principle, with their clinical commissioning group (CCG) and Lambeth Council, to implement an alliance contract. This will also include social care, the voluntary sector, and secondary care, and will deliver co-produced care and support for people with long term, complex mental health and support problems.
• The CCG and GPs in Newcastle are working closely with the Voluntary Organisations Network North East to explore a social investment model for social prescribing by voluntary sector providers.
• Stockport Metropolitan Council is being supported by Nesta and the Cabinet Office, through the Centre for Social Action Innovation Fund, to scale up their co-production approach to mental health and other long term conditions.
• Leeds is continuing with its transformation of integrated healthcare and social care across the city, with GP practices the focal point. This work includes a focus on supported self management, putting care planning into practice, and strengthening links with community services.
• Turning Point is looking at applying its experience with a GP practice in Earls Court to other primary care sites.
Beyond the People Powered Health teams there is a growing momentum around the agenda, and national and local organisations are mobilizing to create real change. We are helping to bring together a national alliance of organisations committed to making person centred, coordinated care a reality for people with long term conditions.
The Coalition for Collaborative Care is just getting started. The coalition will influence the hard-wiring of the health system to make it more conducive to collaborative care, for example changing financial incentives and workforce development. It will also broker practical help to local areas that want to make the shift happen on the ground. We think this combination—improving the system conditions and accelerating practice at the local level—will help achieve the necessary systemic change.
Looking forward, I would highlight two particularly important gaps to address if we are to make the most of the potential of people powered health: gathering more evidence of this work’s impact and using digital technology. The business case for people powered health indicated that savings of approximately £4.4bn might be possible from implementing its practice across England. However, much more work needs to be done to improve the evidence base overall. For example, which type of peer support is most appropriate for whom, and under what circumstances?
Through the Centre for Social Action, Nesta and the Cabinet Office are backing a portfolio of peer support innovations in the field of long term conditions—so far this has included grants to the British Lung Foundation and Diabetes UK . Each innovation is being supported to improve its evidence of effectiveness, and to contribute towards a greater understanding about the efficacy of peer support.
Another priority is to integrate digital technology with collaborative care. Online communities of patients have great potential to offer remote peer support, support self management, and to harness the power of patient generated data to improve treatment. Already, communities of patients are using data from smartphones and sensors alongside clinical data to manage their condition, spot problems early, decide on their best treatment collaboratively with their doctor, and contribute to research.
Nesta has written about this in the Doctor Know report and we have a new digital fund that is looking to back innovations in this area. In particular, we are looking for digital innovations that mobilise communities to work alongside public services—such as peer support groups for health—and innovations that enable people to donate their health data for the public good.
So, one year on, and the People Powered Health agenda still remains important. It not’s just a way of making our healthcare system more collaborative, it also enables people to live better everyday lives away from formal health settings. There are many different ways to get involved: do get in touch with the Coalition for Collaborative Care if you’d like to know more, or drop us a line at Nesta if you’re interested in applying to our new digital social action fund. We’re also holding a national conference on this agenda on 3 September 2014 in London, where you’ll be able to meet innovators in the health field directly. Do get in touch to find out more at firstname.lastname@example.org.
The future of the health system is people powered: join us to help make it happen.
Halima Khan is director of the Innovation Lab at Nesta, an independent charity that works to increase the innovation capacity of the UK.
Competing interests: I have read and understood the BMJ policy on declaration of interests and I hereby declare the following interests: I am on the board of trustees for Diabetes UK, and I work for Nesta, which has a portfolio of grants on which the article is based.