People Powered Health is a new programme from NESTA, working with the Innovation Unit, to support the design and delivery of innovative services for people that are living with long term health conditions.
Over the next fifteen months, we will be providing investment and support to partnerships of commissioners, providers and consumers of health and social care services to develop new ways of achieving better outcomes for people living with long term health conditions and reducing the pressure on health services.
The programme focuses on co-production - that people's needs are better met when they are involved in an equal and reciprocal relationship with professionals, working together to get things done. It is a radically different approach to public services that is built around six characteristics:
The number of people living with a long term health condition is rising rapidly, impacting on quality of life and significantly driving the pressure on health budgets. There is evidence across different areas of public service that co-production offers the potential for substantially better outcomes at lower costs. Our ambition is to demonstrate how co-production can be applied at scale to transform the way that people live with long term health conditions.
Our aim is both to provide practical support to the partnerships involved in the programme to successfully develop and implement their ideas, and to generate practical learning and inspiration that can be applied across the health sector and beyond.
In early June 2011 we published a call for ideas open to partnerships comprising producers and consumers of services for people with long term conditions. The call was targeted to partnerships that had a track record of joint working and a shared vision of how coproduction would help them improve their services and change the lives of their patients and communities for the better. With a clear ambition for scale in mind, we wanted to support approaches that had the potential to deliver tangible results within the life of the programme and could be replicated and scaled.
We received 108 applications from a range of organisations across England which revealed an appetite for coproduction and a breadth and depth of practice that exceeded our expectations.
The portfolio of applications ranged from individual service solutions to city-wide pathway redesign. Proposed projects involved PCTs, GP practices, community service providers, local authorities, charities and social enterprises. The strength and credibility of partnerships was a common feature to many of the applications, suggesting that, when driven by a shared goal, organisations are increasingly successful at working together across silos.
While applications covered a wide range of long term conditions, mental health and cardio pulmonary obstructive disease were the most represented. Many of the applications cut across conditions or addressed co-morbidity reflecting the "whole life" outlook that underpins coproduction approaches.
Geographically, applicants were split between the southern (50%) and northern (32%) English regions, with a smaller proportion (18%) in the Midlands and East of England. London was the region with the most applicants (38%).
In terms of co-production, the portfolio included a mix of peer support groups, timebanks, self management support, group consultations, narrative based assessments, service co-design, service navigators, motivational interviewing, innovative uses of personal budgets, social prescribing, staff and patient training and support and multi-purpose service centres. While only a small number of partnerships could demonstrate a strong and long-term track record of co-production, many were firmly on the way to establishing more equal and asset-based ways of working across organisations and with people and communities.
The picture emerging from the portfolio conveys a genuine desire to find solutions that give people more control over their lives and that recognise their experience and seek their contribution, including through peer support. Finding solutions that promote authentic reciprocity among patients, communities and health professionals appears to be more difficult, as is enabling professionals to move away from the traditional mode of delivering services to people and towards co-creating them with people.
We whittled down an impressive 108 application portfolio to a group of six localities through a rigorous selection process, which followed the initial shortlisting with a pitching/interviewing/peer review exercise for twenty-five shortlisted partnerships; visits to each of the ten final-stage localities and the input of a panel of health and innovation experts in the final decision.
The six locations that we will be working with are partnerships led by the following organisations:
Calderdale: Calderdale and Huddersfield Foundation Trust
Calderdale and Huddersfield Foundation Trust’s vision is to turn into an integrated care organisation and shift service provision for people with long term conditions away from the acute setting and into the community. Building on the work of the Co-creating Health programme, they want to mainstream coproduction by: rolling out Self Management Support patient groups; creating a formal buddy system to provide ongoing support in the community to people living with long term conditions; introducing group consultations and system navigators; and redesigning services for pain management with service professionals, patients and carers. The trust has already trained up service users to be tutors in their self management course and is committed to using these routes to enable service users to become more employable in services and beyond.
Lambeth: Lambeth Living Well Collaborative
The Lambeth Living Well Collaborative is working to enable people with severe mental illness and complex life problems to recover and stay well, and to participate fully and on an equal footing in family, community life and in the wider society. They will deliver this vision by collaboratively redesigning mental health pathways in Lambeth based on an “easy in easy out” principle. They expect that this will produce a greater supply of low and medium level services in the community, for example an information and referral “navigator” service for people who are experiencing mental health problems, a choice of services like talking therapies, peer support groups, exercise groups, health and wellbeing activities and a network of mutual support provided through timebanks. This will create a preventative infrastructure that frees up capacity for secondary services to see the people they need to see right at the time when they need to be seen.
Leeds: Leeds Community Healthcare NHS Trust
Two key innovations are already being introduced in health and social care services in Leeds: the use of risk stratification and the integration of health and social care teams. These will enable the proactive and systematic management of people identified as being at risk of needing health and social care.
The partnership in Leeds will build on this work to bring a strong emphasis on personalised care and co-production. The project will establish a third innovation - a systematic approach to self management at a neighbourhood level. The partnership – composed of the senior executives and frontline staff from Leeds Community Healthcare, the three clinical commissioning consortia, NHS Leeds, Leeds Partnership Foundation Trust, LINK representatives, public health and adult social care commissioners – wants to deliver better outcomes for those most at risk. It will test integrated teams delivering person centred assessment and care in three neighbourhoods and then roll out this approach across the whole Leeds area.
Newcastle: Newcastle Bridges Commissioning Consortium, a pathfinder GP consortium
The project is led by the Newcastle Bridges commissioning consortium and aims to develop a single cohesive approach to social prescribing in primary care for the city of Newcastle that will improve the quality of life for vulnerable adults with the full range of LTCs and mental health problems. By developing a model to meet the range of needs of patients with LTCs the project will move away from a disease specific view of LTCs. The partnership’s approach is underpinned by the recognition of the importance of non traditional service provision as complementary to traditionally commissioned services. The ambition is for the social prescribing system to be embedded in all LTC pathways used across Newcastle, therefore enabling better responses to co-morbidity. When Newcastle Bridges develops into a commissioning consortium it expects to implement the medico-social model underpinning its vision.
Kensington and Chelsea: Turning Point
A partnership between Turning Point, Greenbrook - a GP-led primary care provider, Terrence Higgins Trust & NHS Dentists proposes to hardwire co-production into the running of a brand new Health and Wellbeing Centre which includes a GP led health centre, community sexual health services and NHS dentistry. This innovative new Centre includes an extended community offering including: a team of wellbeing navigators working on reception providing signposting, employment and healthy lifestyles support, community space, a wellbeing motivational coaching service for patients with long term conditions and a peer support programme run through a timebank.
Stockport: Stockport Metropolitan Borough Council: Adult Social Care
Stockport Council with Pennine Care NHS Trust are redesigning mental health services to discharge people from specialist services through to supportive and welcoming community alternatives. Through the development of local wellbeing centres, by enlisting the support of volunteers and peer support groups, and by giving people the use of personal budgets to direct their own recovery, many people will go on to find support in non- clinical services after discharge. These same opportunities, including a voluntary sector co-produced crisis service, extend options for GP referral providing an alternative to the Mental Health Trust for people experiencing mental distress and for people wishing to manage their difficulties and build resilience in a community setting. By bringing staff from the Trust and local user led organisations to work together in a team, the principles of co-production will inspire this project to transform people’s lives.
Over the next fifteen months we will be supporting these partnerships with grants of up to £100,000 each and up to 20 days of non financial support from leading experts in the fields of co-production, service design, economic modelling, health economics, change management, leadership, commissioning and procurement.
We will share the learning emerging from the programme with people and organisations who are interested in exploring, implementing or mainstreaming co-production in health and beyond.
To find out more about this programme please read the People Powered Health FAQs. Read more about NESTA's work on co-production.
If you have any further questions please contact Ajay Khandelwal on ajay.khandelwal@nesta.org.uk or on 020 7438 2500.
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Download the project summaries on the six People Powered Health localities we're working with
T +44 (0)20 7438 2500
F +44 (0)20 7438 2501
National Endowment for Science Technology and the Arts
