“Being able to explore and openly talk about my emotions has made me feel in more control over my life and the choices I make.”
Residents in an area of Merseyside are benefitting from an integrated approach to community-centred wellbeing.
NHS providers and commissioners in Halton have been working with a social enterprise, Wellbeing Enterprises, to deliver Community Wellbeing Practices which have reduced demand on services – and improved the health of local people.
The approach includes social prescribing, community navigation and volunteering programmes with healthcare pathways as a means of improving clinical outcomes – and budget efficiency.
“Wellbeing Enterprises have revolutionised my working life. Previously, there was little I could do and the counselling services couldn’t cope. Now, Wellbeing thoroughly assess my patients and get to the bottom of what makes them tick and a plan is put in place to help turn around their lives.”
Dr David Lyon, GP and Chair of NHS Halton Clinical Commissioning Group
The Community Wellbeing Practices initiative has evidence of a wide range of positive patient and community outcomes, sustained long term along with cost savings. A recent independent analysis of outcomes demonstrated savings to the public sector of £8.90 for every £1 invested. Moreover, Wellbeing Enterprises’ social prescribing initiatives in neighbouring localities have shown a return of more than £12 for every £1 invested.
In 2015 Wellbeing Enterprises CIC and NHS Halton CCG received the highly coveted Health Service Journal Award in the Primary Care Innovation Category. They also won the NAPC Health Innovation Award 2015.
“Since I have attended the courses with Wellbeing Enterprises, I have met new people and this has helped improve my confidence where I can now go to more groups. My eating disorder has always been a difficult area of my life but I have been connected to a local support group, which has helped me to manage so much better.”
Partnership working has been integral to the success of the Community Wellbeing Practices initiative and other community centred health initiatives. Wellbeing Enterprises have established relationships with GP practices, CCGs, local authorities and healthcare providers in primary, community and secondary care to understand the challenges that exist within these organisations. They direct community-based approaches to pressure points within the system as a way of improving outcomes, reducing readmissions and reducing demand, which ultimately leads to cost savings.
The Innovation Agency has been a critical partner as the initiative has expanded, providing expert advice and guidance and linking Wellbeing Enterprises to training opportunities and mentorship and making introductions to key partners and influencers, locally and nationally.
“Given many patients attend the GP for a non-medical reason it is now fantastic that we can enable them to access services in the local community, or jointly develop activities with the patient, that really improves their health and wellbeing and frees up GP capacity.”
Eileen O’Meara, Director of Public Health
There were a number of challenges to overcome:
- Tackling the growing demand for primary care services from patients whose underlying reason for presentation was largely social; such as debt, food poverty, housing, relationship breakdown and unemployment
- Ensuring that the service responded to these wider social issues in a holistic way by using community assets and support, alongside the strengths and capabilities of local people.
- Ensuring that patients played a central role in the co-design and co-delivery of the service.
- Ensuring that there were several ways patients could access the service and targeting provision at people with greatest need, including those living in areas of greatest disadvantage.
These challenges were overcome by working with a wide range of stakeholders and embracing an open innovation approach. The Community Wellbeing Officers who deliver the initiative are an integral part of the GP practice workforce, They are able to work with clinicians to offer support through multi-disciplinary team meetings and to receive direct referrals from clinicians.
Patients and the wider community are integral to the success of the scheme, volunteering their time, and sharing their skills and talents to help shape the direction of travel of the initiative.
The Community Wellbeing Practices provide:
- Community navigation – one to one personalised support from a non-medical Community Wellbeing Officer who helps co-design a personalised wellbeing plan to address social issues impacting on health
- Social prescribing – a raft of education and social inclusion learning opportunities including stress management, sleep and relaxation, self-care, life skills training and mindfulness.
- Social action – volunteering opportunities and grant schemes to put local people in the driving seat of the initiative.
The initiative was initially launched as a pilot project working with three GP practices who all opted in. The model was developed iteratively, and over time the initiative was expanded to include other GP practices because of the positive outcomes and feedback from patients and clinicians. From here, the model has been refined and is now fully integrated with all GP practices in the borough. Moreover, this has since expanded to include similar community centred wellbeing initiatives with acute and community care providers serving the borough as a way of augmenting patient outcomes and reducing demand and pressures on services.
Support from the Innovation Agency
The Innovation Agency connected Wellbeing Enterprises to influential contacts and thought leaders for advice on addressing challenges and obstacles as the initiative developed. Innovation Agency staff helped in the early stages of the Innovation Pathway – with developing ideas and exploring NHS and care markets.
Innovation Agency staff in different teams act as mentors and are continuing to provide advice and connections. There have been regular collaborative team meetings, events and introductions to a range of innovation initiatives in the region.
Impacts / outcomes
The initiative in Halton has supported more than 10,000 patients to date, and has collated a huge data set advocating for community centred health approaches like social prescribing and community navigation.
- 67% increase in wellbeing levels, sustained long term (SWEMWBS, validated subjective measure of wellbeing)
- 59% per cent reduction in depression levels, sustained longitudinally (PHQ9, clinical tool for measuring depression)
Independent economic analyses of Wellbeing Enterprises community centred health approaches using Social Return on Investment principles have shown:
- £1 invested generating £12.14 in cost savings to public purse for its social prescribing activities.
- £1 invested generating £8.90 return integrating community centred approaches with all GP practices in Halton
- £1 invested generating £6.90 return integrating similar approaches with CAMHs provision.
In addition there have been these unexpected outcomes:
- The funding has leveraged an additional £250,000 income per year through the acquisition of grants and other sources to expand the initiative.
- The investment has helped to fund jobs for 25 staff and resourced around 40 local social entrepreneurs to run their own community projects / ventures
- Preliminary research undertaken with academics at the University of Liverpool has shown that the CWP initiative is supporting the reconfiguration of community networks to ensure that resources and innovations flow more freely in the area.
- It has led to the expansion of the scheme to community and secondary care provision and in new localities including Liverpool.
Plans for the future
Plans have been agreed to integrate community centred health approaches in other areas, as follows:
- A wellbeing cancer service – working with NHS Liverpool CCG and funded by Macmillan Cancer Support
- CAMHS provision – working with NHS Halton CCG and North West Boroughs Healthcare NHS Foundation Trust
- Community healthcare provision – working with Bridgewater NHS Foundation Trust
- Improving Access to Psychological Therapies – working with NHS Halton CCG and North West Boroughs Healthcare
- Supporting other healthcare professionals to develop and implement such approaches through consultancy and training contracts across the UK.
The aim is to launch ‘wellbeing hubs’ across the UK, with Wellbeing Enterprises working with local partners to create the momentum needed to raise awareness of community centred health approaches.
Which national clinical or policy priorities does this example address?
Key policy drivers:
- Chapter Two of the Five Year Forward View
- The High Impact Goals of the GP Five Year Forward View
- PHE ‘Health Matters’ guidance on community centred health approaches
- Sustainable Development Goals of the UN convention.
Start and end dates
2012 – ongoing.
Find out more
Mark Swift, Chief Executive Officer, Wellbeing Enterprises CIC
Bridgewater House, Old Coach Road, Runcorn, Cheshire WA7 1QT
T: 01928 589 799
Caroline Kenyon, Director of Communications and Engagement, Innovation Agency
Vanguard House, Sci Tech Daresbury, Halton WA4 4AB
T: 01772 520280 / 07950 866394