Let’s start promoting wellbeing, not just treating illness

The NHS Five Year Forward View promises unprecedented opportunities for the ways in which people with long-term health needs are enabled to live well, in the ways which matter to them. It calls for a ‘more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health’.

This is a fundamental shift from treating illness to promoting wellbeing. To be successful, we must make use of collaborative approaches.

For most of us, contact with formal health services is only a tiny fraction of our lives. Indeed, the bulk of our care comes from informal sources such as our spouses, children and other unpaid carers.

But wellbeing is so much more than health. Wellbeing starts with us, our communities and the daily opportunities, challenges and habits which shape the bigger picture of our lives.

How then can the Forward View’s dual ambitions of more engaged relationships and promoting wellbeing be achieved? Three broad approaches may offer a good start…

Firstly, the active involvement of people with long-term health needs in managing their health and working towards personal goals, in partnership with their professionals and supporters.

Medicine adherence or managing blood glucose levels, for example, may not be meaningful goals without some wider context for how they will lead to personal benefits. Instead, people may want to run 5k, attend a loved one’s wedding or keep on top of their garden – these personal goals are powerful motivation for people to better manage their health conditions.

We know that community approaches, such as group-based learning, improve health outcomes for people with long-term conditions. These approaches can reduce the use of health services, create opportunities for wellbeing and offer mutual support to overcome challenges.

These and other approaches to support self-management can be a fundamental aspect of people developing and working towards their personal goals. In doing so, people with long-term conditions may be better able to manage their health needs and improve their longer term health outcomes.

Secondly, we need to enable people to make decisions about the care, support and treatment they receive, in relation to what’s important for their lives. Approaches like shared decision-making and care and support planning should place people’s strengths, preferences and aspirations at the heart of health and care planning.

When we enable people to develop their wellbeing according to what fits their lives – a healthy diet within the context of their religious and cultural background, hobbies which fit into daily routines or linking with peer support when making decisions about the right treatment for them – we provide the tools for people to become more confident and active in managing their health.

The use of personal budgets, for example, can enable people to make decisions based on what’s important for their lives – a personal assistant to enable them to socialise or a weekly exercise class which helps to manage their pain and keep them moving, for instance.

Crucially, these approaches shift the focus from patient as passive recipient of health care, to an engaging, equal relationship in which the person and those working with them each bring valuable and different experiences and skills. Together, they can choose a range of clinical and community support which enables the person to live their life in the ways they want.

Finally, we need to enable people to shape the health and care support which would be of most benefit to them. Voluntary and community organisations already have significant experience in engaging those at most risk of poor health outcomes, on which we can build.

With this experience comes responsibility. The voluntary and community sector must focus on developing these approaches so that they become the experience of many more people – particularly those at most risk of poor health outcomes.

Commissioners also have a proactive role to play in supporting the development of these community approaches, through the leverage of the Social Value Act 2012. By identifying local population needs and commissioning high quality, community-based support, commissioners can transform the experiences of many living with long-term health needs.

Those involved in implementing the Forward View also have a role to play in encouraging a strong and diverse range of community approaches to promoting wellbeing. These approaches need to be embedded, not as ‘icing on the cake’ but as ‘business as usual’ – at the heart of these new models.

We need to ensure that people have the knowledge, skills, confidence and motivation to influence their local health structures, ensuring that our health service works for us all – not just those most able to meet it on its terms.

Simon Stevens’ vision of a health service which engages people in promoting wellbeing has a wealth of tools with which to begin. Let’s seize the opportunities to promote wellbeing collaboratively – between us, our communities and our health service.

Natalie leads National Voices’ Wellbeing Our Way programme (supported by The Health Foundation), www.twitter.com/NatalieKoussa