We are very pleased to feature a guest blog this month written by Chris Easton. Chris is Head of Person and Community Centred Approaches for Tameside and Glossop Integrated Care NHS Foundation Trust. He leads programmes of work which seek to transform health and care systems to become more person centred, connect better with their communities and to understand the strength of people and communities in meeting some of the health and wellbeing challenges we face.

Never has the health and care system faced such incredible challenge.  There has been an exponential rise in demand associated with growth in people living with long term conditions or ongoing care and support needs, but not accompanied with funding to support this growth.  In many ways our health and care system is a victim of its own success. 

We are consistently challenged to become more efficient, to do more with less and change the way in which services are delivered but if we are not careful this has the potential to be a little like bailing out the bath water without turning off the taps, demand will continue to grow and we have to run faster and faster to keep up. 

A number of years ago, whilst running a charity for disabled children I was involved in a conversation with a health commissioner and a social care commissioner about whether or not a child had a ‘health need’ or a ‘social care need’.  I remember thinking at the time that we have designed a system that can’t see people as people, it sees them as a collection of needs, conditions and issues that we attempt to delineate by institution, largely driven by how funding flows through the system.  This can’t be the best way to deliver modern health and care.

A short while later I was involved in the review of a young man who was held securely in a learning disability hospital in the Midlands.  As a review team, our challenge was to understand whether hospital was an appropriate environment for this man to live.  Over the course of our two day visit we spoke with commissioners, nurses, psychiatrists, occupational therapists and many other professionals – all of whom made a strong case for what they were doing, its effectiveness and its appropriateness.  What became clear however was that what they were doing was totally out of kilter with this man’s ambitions for the future and realistic chance of discharge.  The system was viewing the situation through a series of individual lenses rather than the one that really mattered – the person in receipt of care. 

This all leads us to wonder whether we sometimes have it wrong.  Whether the health and care system we currently have is fit for the population we have, and also whether the answers to the health and wellbeing challenges faced by our populations lie quite so heavily at the doors of hospitals and GP surgeries. 

In 2017 the Health Foundation produced the infographic below:

What this tells us, is that as little as 10% of the things that make us healthy and well are linked to access to health care with the vast majority being linked to social determinants like work, money, housing, education etc.  The answers to these challenges cannot lie within the scope of the health and care system alone. 

Around 15 million people in England live with one or more long term conditions.  Yet the treatment for this population accounts for 70% of all health and care spend.  However at the same time, someone with a long term condition spends fewer than ten hours a year receiving support from the health and care system.

In a conversation with a GP recently she suggested that as many as 50% of GP appointments are for issues that a GP is not best placed to deal with – often driven by more socially orientated issues – this is not the first time that sort of statistic has been presented to me.    

These issues point to a need to reimagine how we see the health and care system, how we approach and deal with health and wellbeing and how we support people living with long term conditions. 

Many of the answers to transforming health and care therefore lie not only in the reorganisation of institutions or clinical pathways, but within people’s homes, their families and their communities and in the relationship they have with their health and the healthcare system.  The solutions to many of the challenges our communities face lie within communities themselves, aligned with the resources the health and care system can bring.  It’s important to be clear – this isn’t a question of either or, this is a question of building a health and care system that views itself entirely through the eyes of people receiving support and collaborates effectively with people and communities to improve population health.  We need to recognise the brilliance of the health and care system, but also ensure that people are not passive recipients of it – we need actively engaged citizens who have the knowledge, skills and confidence to play a powerful and active role in their health and wellbeing and that of their community.    

There are many examples where thinking differently about the health and care system’s relationship with people and communities has had a profound impact on both outcomes and experiences of people, and also in terms of people’s use of the health and care system. 

In Tameside and Glossop we have worked with our voluntary and community sector to develop an extensive programme of social prescribing.  Social prescribing supports people to access support with the social determinants of health, supporting them with issues such as housing, loneliness, isolation etc.  The scheme supports over 2,000 people a year, usually referred into by an NHS professional.  This is an example of how the ‘system’ and community based organisations can come together to align both great clinical care and support with the social drivers of health.  Evidence repeatedly highlights that if you support people with the wider social determinants of health then they are likely to use less in terms of health and care activity. 

Hattersley Health Champions is a programme that takes place in an area of Tameside that experiences significant levels of deprivation and is orientated around the area’s GP practice.  The basic idea is that communities come together with general practice to work together on shared goals.  Initially in October 2018 we began with extremely low engagement, but a surprising and memorable engagement method which used apples, with luggage label invitations tied on to invite patients to become Health Champions yielded significant results.

Now 35 local people and five members of staff work together to provide a range of activities for their communities, a series of one-off events, practice based campaigns and information sessions for patients.  A number of Champions now volunteer for other organisations and others have encouraged their friends to become more active at their own GP practice.  Healthcare and communities coming together.

In December 2017 we brought health and care professionals together with voluntary sector organisations and members of the public to consider how we could more effectively support people at risk of diabetes (pre-diabetic).  Delivered over the course of 100 days, partners worked together to target people who had been told they were at risk but had since not engaged with services.  By approaching the issue differently, collaborating and understanding people’s specific needs to help them manage their risk the programme led to 49% of participants no longer being categorised as pre-diabetic at the end of the 100 days.  Not only is this potentially life changing at an individual level, it has huge significance in terms of future health and care activity. 

It’s important to re-emphasise that this isn’t and nor should it be a question of medical vs. social, or community support vs. system support– it’s about finding ways to move towards true and authentic collaboration between the health and care system and people and communities – when that works in harmony, health and care can become genuinely people powered. 

The future of health and care lies in collaboration, in new relationships and a broader approach to what supports us to be and remain healthy and well. 

Follow Chris on Twitter @Chris_Easton1