This month, together with Nesta and our partners in the Realising the Value consortium, the Health Foundation has launched a set of practical resources to show how person- and community- centred approaches can help to shift power to people and communities.

Based on our new learning and evidence, we believe that supporting this shift can improve the health and wellbeing of people, while also offering strong potential for making better use of health and care system resources.

The Realising the Value programme was commissioned by NHS England to support delivery of the NHS Five Year Forward View, which recognises that new ways of working with people and communities are needed to address current challenges.

What are person- and community-centred approaches, and why do they matter?

Person- and community-centred approaches for health and wellbeing encompass a very broad spectrum of practice. This can range from support that complements and enhances clinical care for people with long-term conditions, such as peer support, to everyday community activities that enable people to improve their health and wellbeing, such as playing in a local football team.

This month’s newsletter includes powerful stories about the impact of these approaches. We look at the transformative impact of peer support for people diagnosed with HIV in a case study about Realising the Value partner Positively UK. We also explore the inspiring example of how a group of dads are helping each other to help their children, through the community group Salford Dadz (supported by another Realising the Value partner site, Unlimited Potential).

‘I’m still amazed by how much my perspective on my diagnosis and future has changed. I feel so invigorated. For the first time since being diagnosed I feel like I am being treated as a whole person.’

Person living with HIV receiving peer support from Positively UK

During the 18-month Realising the Value programme, we worked with five of these partner sites across the country to show how different person- and community-centred approaches (peer support, self-education management, health coaching, asset-based approaches and group activities) can have a positive impact on people’s lives and improve health and wellbeing.

Our local partners have years of experience of putting these approaches into practice, and the impact for the people they work with is significant.

‘It’s made a huge difference to my life, because I am not self-harming anymore,  I’m not taking overdoses, and it’s made me feel a lot happier’

Person living with mental health issues participating in creative group activities, South West Yorkshire.

The Realising the Value programme has taken a whole system view to increase understanding of how the five approaches add value, and of what works to embed and spread them in practice.

We’ve developed an economic model for commissioners to help them understand the potential of the approaches to create and provide value. We’ve analysed how national bodies can best support these approaches. We’ve explored how behavioural insights can help us understand more about the motivation of individuals and the choices they make, and published our findings in a series of reports and guides (Hannah Burd from the Behavioural Insights Team introduces these in more detail in her blog), and we’ve looked at the values underpinning our health and care system, asking what matters to people.

What’s next?

In our final programme report, we have identified ten actions that we believe would help to put people and communities at the heart of health and care.

What needs to happen:

  • Implement person- and community-centred ways of working across the system, using the best available tools and evidence.
  • Develop a simplified outcomes framework focused on what matters to people.
  • Continue to learn by doing, alongside further research.
  • Make better use of existing levers such as legislation, regulation and accountability.
  • Trial new outcomes-based payment mechanisms and implement as part of wider national payment reform.

How people need to work differently:

  • Enable health and care professionals and the wider workforce to understand and work in person- and community-centred ways.
  • Develop strong and sustained networks as an integral part of implementation.
  • Value the role of people and communities in their health and wellbeing, including through co-production, volunteering and social movements for health.
  • Make greater use of behavioural insights to increase effectiveness and uptake.
  • Support a thriving and sustainable voluntary, community and social enterprise sector, working alongside people, families, communities and the health and care system.

It’s encouraging to hear from the national Director of Patient and Public Voice and Insight, Anu Singh, this month. She explains how NHS England is already making use of the findings and resources developed through the programme.

Person- and community-centred ways of working need to become widely understood and valued as core to the whole health and care system, not just a ‘nice to have’. They need to be woven not just into the infrastructure of the system but also the culture of how things are done. We hope that the ten actions and the practical resources developed as part of the Realising the Value programme will form an integral part of this tapestry as it is emerging in the coming years and months.

This is an updated version of the blog written by Will Warburton, Director of Improvement at the Health Foundation and co-authored by Halima Khan, Executive Director of Health Lab at Nesta, originally published 15 November 2016.

About Realising the Value

Nesta and the Health Foundation have co-led the Realising the Value consortium in an ambitious programme of work over the last 18 months. We have brought together the perspectives of people with lived experience, the voluntary, community and social enterprise (VCSE) sector, practitioners, academics, commissioners, providers and policymakers to consolidate what is known about person- and community-centred approaches for health and wellbeing and make recommendations on how they can have maximum impact. The Realising the Value programme was funded by NHS England, to support the NHS Five Year Forward View vision to enable a ‘new relationship with patients and communities.

Further reading

Comments

mary morrissey



hi the heading says Ten key actions to put people and communities at the heart of health and wellbeing.
it would be helpful to number the points. Hope ok to say?
best wishes Mary



Naomi



I first of all want to say how much I wholeheartedly support the philosophy behind this work. I do, however, have a few concerns.
It seems to me that, along people most people thinking they already have a 'good sense of humour', that they also already believe they are working in people and community-centred way.
I love the role peer-support can play but that needs to be integrated somehow into the support that the individual is getting through services, so that it really is co-production. If those people have 'been there before' perhaps they can also make parts of the service/system better for those they are supporting, and get the opinions of those experiencing the change at the time.
When you say about an 'outcomes framework that matters to people' - which people? And at what time? Surely this is different for different people today, compared to tomorrow? Although simplified this screams 'inflexibility' to me also.
I would be very up for a conversation about any of this...



Will



Thanks for the thoughtful comments Naomi - you raise many of the issues that we and our partners have been grappling with. As we say in the report, peer support along with other person- and community-centred ways of working need to become widely valued and understood as core to the whole health and care system. Engaging and supporting health and care staff to develop the knowledge, skills and confidence to work in partnership with people using services and their families and carers is critical. (see more in our report ‘What the system can do: the role of national bodies in realising the value of people and communities in health and care’).

On the issue of outcomes that matter to people, you touch on a really important and challenging question about how we balance the aim to achieve outcomes that matter to an individual in a their particular situation at a given time and place, and the need for measures at a population level. The Realising the Value consortium also published ‘New approaches to value’ alongside the final report which is a discussion of how we could move to an outcomes framework more based on outcomes that matter to people and communities, co-produced with people using services, frontline teams and others. You are right that this is not about prescribing inflexible, detailed outcome measures for every situation, rather agreeing some core national health and wellbeing outcomes that can then be adapted by local areas depending on their circumstances and the assets and needs of their local populations.

All the reports I mention above are available at http://www.health.org.uk/collection/realising-value

Will



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