Chunking up chapter two of the Five Year Forward View

Chapter two of the NHS England Five Year Forward View starts by saying that the NHS has not yet ‘fully harnessed the renewable energy represented by patients and communities’ and then goes on to consider what the future would look like if we managed to do this.

The culmination of the Realising the Value programme this month signifies a new combination of evidence, vision and leadership for person- and community-centred approaches, taking the NHS one step closer to being able to achieve this vision.

The Behavioural Insights Team has been involved in this work over the last 18 months, working as part of the Realising the Value coalition. It’s given us a chance to go back to basics when thinking about how to bring about behaviour change.

In the Realising the Value report Making the Change, we took a well-established formula for behaviour (outlined in the diagram below) and used it to identify the different components that need to come together to produce behaviour change: both in terms of increasing self-management by people and communities, and switching practitioners and system leaders on to a more person-centred way of doing things.

You can read more detail about these in this blog about the five factors for supporting people to take a more active role in health and wellbeing.

In the second half of the programme, we had a welcome opportunity to look into five person-centred care sites and bring theory and reality together.

These five partner sites were:

• Peer support: Positively UK
• Health coaching: Big Life Group
• Self-management education: Penny Brohn UK
• Community asset-based approaches in a health and wellbeing context: Unlimited Potential
• Group activities to promote health and wellbeing: South West Yorkshire Partnership NHS Foundation Trust: Creative Minds

We have combined academic research and lived experiences from these five areas in two guides. The guides are crammed with case studies of the ‘active ingredients’ that these exemplar areas demonstrate.

The first guide – Supporting self-management – provides 15 action-focused suggestions that show promise for boosting the efficacy of person- and community-centred programmes:

The second guide – Spreading change – synthesises strategies for successfully encouraging systems to change. These 20 strategies have been identified by leaders of the five partner organisations and their commissioning partners through years of experience, and they too are bolstered by other evidence. Leaders and champions from within the health and care system and community-based networks can use these simple tactics to forge more person- and community-centred approaches in their own areas, bringing naysayers on board as they go.

The following two diagrams indicate 20 strategies for spreading person- and community-centred approaches in health and care, and from a community base respectively.

Certainly, evidence gaps persist. Nonetheless, we have been able to identify actionable ways forward. By taking and testing the incremental steps summarised in the guides, we will build that evidence base. Doing so will bring people, communities and health systems together to move things forward, making things better with and for people living with long-term conditions.

Hannah Burd is a Senior Advisor at the Behavioural Insights Team