Leeds City Council and the local NHS have adopted the House of Care model as a framework for developing self care. Health and care professionals have been given training and patients are being empowered with the skills and confidence to self-manage their own health. This forms part of our resource on self care.
Back in 2011/12, Leeds City Council and the local NHS were working closely with Sir John Oldham, from the Department of Health, on a new model for integrated care focused on supporting people living with long-term conditions.
There were three strands to the work – developing integrated neighbourhood teams, risk stratification and supporting people to self-manage their conditions.
Leeds Public Health Consultant Lucy Jackson said: “It’s fair to say the first two proved to have more traction at the time than selfmanagement, but through committed people across the health and care system in both the statutory and third sectors we have continued to work on that in the preceding years. Selfmanagement requires a culture change – that is more difficult to achieve.”
Working together, the NHS and Leeds City Council set up a self-management steering group and adopted the House of Care model to centre care around people and ensure they have the appropriate skills to be able to selfmanage their condition.
One of the first steps – started in 2013 – was the implementation and roll out of Collaborative Care and Support Planning across primary care. The aim of this approach is to transform the annual longterm conditions review to become a more collaborative process, putting the person in the driving seat of their care and helping them set realistic goals. In order to establish this approach, a programme of training for staff was put in place to embed the approach. This represents one of the ‘walls of the house’.
The other wall is about developing engaged people. One example of how this has been achieved is peer support. There have been 10 ‘Breathe Easy’ peer support and exercise groups set up across the city for people in partnership with the British Lung Foundation for people living with respiratory disease. A peer support worker has also been appointed to help encourage other similar schemes to get off the ground.
But it is not all about group working, said Ms Jackson. “You have to realise some people do not like to take part in groups so the key thing is to support people to connect in a way that is important and fits for them. For example, it can be via apps or WhatsApp groups in a much more informal way. We have also encouraged community champions to help push this forward, working in their local community.”
People have also benefited from the well established social prescribing services that has developed over the last four years. There are currently three separate schemes – a legacy of the fact there were once three CCGs in Leeds.
They support people to consider what is important to them and offer people access to everything from social or economic support to physical activity opportunities. Those who are referred on to the scheme are given a link worker who helps them find the right ‘prescription’.
Training on Collaborative Care and Support Planning has been provided to over 80 per cent of staff from across all 101 GP practices. It means in the last quarter more than 17,000 consultations have taken place using this approach.
Those who are prescribed on to social prescribing report high levels of satisfaction. Over 70 per cent of those referred take up the offer of a social prescription with one of the schemes reporting that over three-quarters of participants have improved health and wellbeing, around 5,000 people are taking up this opportunity every year.
The success has also been recognised by the Health Foundation think-tank. It has praised Leeds for its “dedicated” approach and for “creating change and shifting old ways of working”.
Ms Jackson said she was delighted with how it has gone. “We wanted to ensure people in Leeds felt confident and supported to manage their own health and live independent and active lives.”
Developing work like this requires patience and time. To date, much of the work has had to be funded from either the NHS or the public health budget.
Ms Jackson said: “We have spent a lot of time in the past few years talking to commissioners and providers. You cannot underestimate the amount of time and effort needed to keep people from directors down to the frontline involved in a culture change programme such as this.
“They understand the importance of the concept but finding the money to pay for it is difficult. It does not generate immediate results, so I have used an economic modelling tool developed by the Health Foundation – called Realising the Value – to help put the case.”
How is the approach being sustained?
The work has recently being given Improved Better Care Funding to help invest in a culture change programme named ‘Better Conversations’ alongside other self care programmes.
These are now at the heart of the Leeds Health and Care Plan. The ‘Better Conversations’ training will include mental health and hospital services to ensure the entire NHS will be engaged.
Three facilitators and two support workers have been employed to carry out the training. The facilitators will also work directly with frontline staff looking at how they can embed self care into their everyday activities.
Ms Jackson said: “Previously we’ve relied on training members of staff to deliver it to their colleagues, but having these dedicated people will allow us to do much more and really embed this approach across the system.
“We are picking an number of key areas for focus, such as respiratory disease, people living with frailty and cancer. But eventually we want all the different parts of the NHS and social care to be encouraging and empowering patients to self manage.”
Public Health Consultant
Leeds City Council