Realising the Value

Publications produced as a part of the Realising the Value project.

Realising the Value Animated

Thursday, February 2nd, 2017

This animation sets out what person- and community-centred approaches in health and care are and some of the many benefits they bring. It was developed by the Realising the Value programme in collaboration with Positively UK and other local partner sites across the country, drawing on the real-life experience of the people they work with.

 

To find out more about Realising the Value, check out the website here…

Realising the value: Ten key actions to put people and communities at the heart of health and wellbeing

Thursday, February 2nd, 2017

Click here to download the report

This report sets out what the Realising the Value programme found about the difference person- and community-centred approaches can make – and what needs to happen to support their successful implementation and spread.

We want a health and care system that listens to what is important to people and works with them to build the best care to meet their goals. A system in which excellent clinical and social care is combined with support that equips people to take an active role in their health and to live as well as possible with health conditions. A system in which people feel in control, valued, motivated and supported.

This is what it means to realise the value of people and communities at the heart of health and wellbeing – a ‘social model’ of health and wellbeing that combines a deep understanding of what matters to people with excellent clinical and social care, timely data and strong, sustained social support.

For this vision to become reality, 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 ‘nice to have’. They need to be woven into not just the infrastructure of the system but also the culture of how things are done. Every health and care professional needs to understand their role in this way and every health and care service needs to be designed and delivered this way. This will look and feel very different across the system (whether in A&E or wellbeing checks) but there should be a universal commitment to a future in which care that is not person-centred is viewed as a ‘never event’ across the system.

The system has committed to this broad agenda and much work is underway to embed person- and community-centred approaches in national programmes and in the delivery of local services. There now needs to be a step change in ambition, leadership and alignment – combined with sustained implementation – to move from intent to action.

The Realising the Value programme has moved this field on by drawing together the evidence base, establishing new networks and creating practical resources for commissioners, practitioners and others.
We have aimed to build on, amplify and reinforce existing work. We hope the Realising the Value programme will help future work marshal resources to create the transformational shift that is needed.

 

To find out more about Realising the Value, check out the website here…

Making it happen: Practical learning and tips from the five Realising the Value local partner sites

Thursday, February 2nd, 2017

Click here to download the report

This catalogue of learning forms part of a final package of recommendations and resources from the Realising the Value programme. Over the course of the last 18 months, we have sought 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.

While there is significant breadth and variety across person- and community-centred approaches, they are united by a common purpose: to genuinely put people and communities at the heart of health and wellbeing, focusing on what is important to people, what skills and attributes they have and on the role of their family, friends and communities.

The most successful examples of person- and community-centred approaches in practice are those which are developed by people and communities, working with and alongside commissioners and policymakers, to build on existing assets and co-produce solutions that work.

The Realising the Value programme has focused on five approaches in particular, to develop a richer understanding of how they add value, and what works to embed and spread them. In practice, person- and community-centred approaches are often not separate or distinct interventions – for example, peer support can include elements of self-management education and health coaching. However, some distinction has been necessary to enable greater understanding of what they look like and how they work.

This catalogue of learning has been produced in close collaboration with the partner sites, including Positively UK, drawing on evidence combined with their practical learning and tips to others seeking to get to grips with the practicalities of person- and community-centred approaches.

 

To find out more about Realising the Value, check out the website here…

What the system can do: The role of national bodies in realising the value of people and communities in health and care

Thursday, February 2nd, 2017

Click here to download the report

It is welcome that national policies, including the NHS Five Year Forward View, increasingly recognise that to improve health and the quality of care, people and communities should be active in co-creating health and wellbeing with the formal services and the staff who support them, not passive recipients of care or services. Evidence is growing that more person- and community-centred approaches to promoting health and providing care will lead to improved health and wellbeing for individuals, as well as stronger and more resilient communities and social networks. In time the hope is that these approaches may also contribute to reducing demand on formal services.

In England, a wide range of person- and community-centred approaches for health and wellbeing are already in full operation or being tested, spanning health, social care, wider public services and communities. NHS England has also been developing a self-care programme ensuring that person- and community-centred approaches are embedded in key national programmes. If the policy direction is clear, the key question addressed in this report is how can we achieve faster progress?

Learning from Realising the Value (RtV), highlights that most of the factors associated with successful implementation of person- and community-centred approaches for health and wellbeing are to do with local context. This could involve passionate individuals leading change, local partnerships growing strong on the back of successful pilots, supportive local leadership, or time spent building and sustaining relationships across organisations and with communities. Clearly, the local context is the primary responsibility of local organisations and communities.

However, local context is influenced by the policies designed by national bodies, such as NHS England, Health Education England (HEE), NHS Improvement, the Care Quality Commission (CQC) and the National Institute for Health and Care Excellence (NICE). And while national policies can help progress, they can also unintentionally hinder. Commonly cited obstacles include: contracting arrangements, commissioning structures, competition, information governance, and competing national directives. National bodies have a crucially important role in identifying and reducing or removing these avoidable barriers.

Some of these barriers have arisen because they may serve other policy goals, rather than encouraging person- or community-centred approaches. And there are a great number of policy priorities and initiatives at present. The most obvious is work to ensure that the NHS in England lives within its growth-constrained budget, while still achieving the goals set out in the NHS Constitution and the changes set out in the NHS Five Year Forward View. In the 18 months since the RtV programme was commissioned, the New Care Models and Integrated Personal Commissioning programmes have started; the second wave of Integrated Care and Support Pioneers was announced (and the early evaluation of the first wave was published); there have been several ‘devolution deals’ in health care;1 and Sustainability and Transformation Plans (STPs) were announced.

This report focuses on how national bodies can best remove barriers to progressing person- and community-centred approaches for health and wellbeing. It reviews the range of mechanisms (often called system levers) national bodies use to influence health and care services to achieve policy objectives, and the impact these have on person- and community- centred approaches for health and wellbeing. It suggests what national bodies might best do to help implement and spread these approaches, including the five approaches that the RtV programme focused on: self-management education; peer support; health coaching; group activities; and community asset based approaches.

Local action will continue to be the main driver of change towards more person- and community-centred approaches, particularly in the current complex, pressurised and dynamic context. However, this report identifies six key findings relevant for policymakers and national system leaders, and a range of specific actions that could be taken in areas such as education and training, regulation and commissioning to help create an environment conducive to these approaches flourishing.

 

To find out more about Realising the Value, check out the website here…

Impact and cost: Economic modelling tool for commissioners

Thursday, February 2nd, 2017

Click here to download the report

The Realising the Value programme has developed an economic modelling tool to help commissioners evaluate the potential impact of investing in person- and community-centred approaches.

The economic modelling undertaken by the Realising the Value programme and detailed in the summary report suggests that implementing person- and community-centred approaches at scale has the potential to contribute to efforts to slow the demand pressures on the system and may yield efficiency savings.
The summary report also suggests how the evidence base can be enhanced in the future, in order to produce more robust modelling and local business cases.

The Realising the Value economic modelling tool allows commissioners to assess the potential impact of commissioning person- and community-centred approaches in their local area. It aims to help people who want to commission these approaches build the business case for doing so.

The tool has been developed in close collaboration with local sites, commissioners and experts in economic modelling and person- and community-centred approaches. It draws on high-quality research evidence as well as data collected from the five Realising the Value local partner sites across the country. These sites are all mature practitioners in the area of person- and community-centred approaches.

 

To find out more about Realising the Value, check out the website here…

New approaches to value in health and care

Thursday, February 2nd, 2017

Click here to download the report

Why do we need new approaches to value in health and care?

The NHS has set new directions for itself. Its ‘new care models’, with new purposes (population health), new ways of working with communities and new cultures of care (engagement and empowerment) need new frameworks and measures for the value they are seeking to achieve.

This means starting now to develop better measures that will be capable, in three to five years’ time, of capturing whether integrated local systems are maximising the value created by people and communities, and securing the outcomes that matter most to them.

When people are actively involved in their own health and wellbeing, or support others to stay well, it creates value for them and the health and care system in a number of ways.

On an individual level: People make decisions every day that can impact on their longer-term health and wellbeing – for example in relation to exercise, managing stress, taking part in social activities or developing skills to successfully look after a health condition. The Wanless Review suggested that ‘for every £100 spent on encouraging self-care, around £150 worth of benefits can be delivered in return’.

Caring for others: Over six million people are involved in informal caring, a quarter of them full time, with the total value estimated at £132bn a year – greater than the NHS budget. They are the biggest ‘workforce’ and deliver the bulk of care.

Volunteering: Around a quarter of all adults are involved in regular volunteering, with the Office for National Statistics (ONS) estimating formal volunteering to be worth almost £24bn per year. Only a portion of this activity is directly related to health or care, but much of it supports individual and community wellbeing.

The majority of this value, however, goes unrecognised by formal systems. The Realising the Value programme therefore set out to explore what ‘value’ means for people and communities, and how this can be understood most appropriately by the NHS.

This paper builds on a discussion paper published in 2015 and subsequent engagement undertaken as part of the Realising the Value programme. It makes a series of calls to action to ensure that the approach to understanding, capturing, measuring and assessing value in health and care takes full account of value, as it is experienced and created by people and communities. The calls to action include:

  • building a consensus on replacing the National Outcomes Frameworks with a simplified cross system framework
  • basing core national outcomes on the health and wellbeing outcomes that are most important to people and communities
  • prioritising support for commissioners to build skills, knowledge and confidence to commission for the outcomes that people and communities value
  • ensuring widespread use of the Public Services (Social Value) Act 20125 in health commissioning

These calls to action will enable a shift to a future articulation of value that is aligned across health and social care and community organisations.

The report also proposes a set of value statements and accompanying pledges. These could be adopted immediately by local areas or New Care Model programme vanguard sites, seeking to add value to people’s lives and mobilise the value that people and communities themselves can create for health and wellbeing.

 

To find out more about Realising the Value, check out the website here…

Supporting self-management: A guide to enabling behaviour change for health and wellbeing using person- and community-centred approaches

Thursday, February 2nd, 2017

Click here to download the report

This guide is for people who support those living with long-term conditions, their carers, families or communities. It summarises practical ways to support people to self manage effectively using person and community-centred approaches. Many of these activities are useful also for people who work to prevent the development of long-term conditions in the first place.

This guide offers two things: a framework for understanding and changing behaviour, and real-world examples of how these changes happen in practice.

A framework for understanding and changing behaviour

This guide uses the Behavioural Insights Team’s EAST framework to organise ideas and examples. It is intended to be a user-friendly and memorable tool for considering the main drivers of behaviour and generating effective approaches for addressing them.

The Realising the Value programme has published an accompanying report that looks at the theories relevant to the ideas outlined in this guide in more depth: Making the change: Behavioural factors in person- and community-centred approaches to health and wellbeing. Readers may find that report useful to read alongside this action-focused guide.

Real-world examples of changing behaviours to spread person- and community-centred approaches

This guide provides examples from the five Realising the Value partner sites, including Positively UK, categorised by the EAST framework. It features a number of low-tech, pragmatic and manageable activities which can increase the spread of person- and community-centred health and wellbeing programmes.

We have taken effective approaches from both academic theory and the five sites and boiled them down to the mechanisms that seem to work most effectively. These are featured in coloured boxes throughout the guide. Practitioners can then incorporate these elements into the design of their own health and wellbeing programmes.

 

To find out more about Realising the Value, check out the website here…

Spreading Change: A guide to enabling the spread of person- and community-centred approaches for health and wellbeing

Thursday, February 2nd, 2017

Click here to download the report

This guide is for people who champion person- and community-centred approaches in health and social care, in other statutory bodies and in community-based organisations. Change is more likely to spread when both statutory organisations and community-based organisations align approaches. For this reason we feature case studies from both parts of the system. They are colour coded to enable different audiences to navigate the guide easily.

This guide offers two things: a framework for understanding and changing behaviour, and real-world examples of how these changes happen in practice.

A framework for understanding and changing behaviour

This guide uses the Behavioural Insights Team’s EAST framework to organise ideas and examples. It is intended to be a user-friendly and memorable tool for considering the main drivers of behaviour and generating effective approaches for addressing them.

The Realising the Value programme has published an accompanying report that looks at the theories relevant to the ideas outlined in this guide in more depth: Making the change: Behavioural factors in person- and community-centred approaches to health and wellbeing. Readers may find that report useful to read alongside this action-focused guide.

Real-world examples of changing behaviours to spread person- and community-centred approaches

This guide provides examples from the five Realising the Value partner sites, including Positively UK, categorised by the EAST framework. It features a number of low-tech, pragmatic and manageable activities which can increase the spread of person- and community-centred health and wellbeing programmes.

We have taken effective approaches from both academic theory and the five sites and boiled them down to the mechanisms that seem to work most effectively. These are featured in coloured boxes throughout the guide. Practitioners can then incorporate these elements into the design of their own health and wellbeing programmes.

 

To find out more about Realising the Value, check out the website here…

Making the change: Behavioural factors in person- and community-centred approaches for health and wellbeing

Thursday, February 2nd, 2017

Click here to download the report

A key objective of Realising the Value is to change the relationship between citizens and the health system from one of passive patient to active participant. This paper starts from the principle that person- and community-centred health and care approaches require a certain set of behaviours.

This paper aims to understand the drivers of these behaviours and the barriers to achieving them. It presents five broad factors that have been shown to influence engagement and self-management behaviours, and suggests how they can be targeted in order to increase such behaviours. These factors all emerge from robust studies on what influences behaviour.

However, they are not the products of a systematic review of the literature on person- and community centred approaches to health and wellbeing: we have made two deliberate choices that shape the content of this paper.

Firstly, we have taken the view that our target audience wants to put theory into practice (rather than rehearsing theory for the sake of it). Therefore, we have selected factors or concepts that can be communicated and acted upon easily. We have also drawn on interviews conducted during the summer of 2015, with 12 champions of person- and community-centred approaches, to inform the focus of this paper and to ground it in practice. Several of the case studies featured in this paper were identified during this interview process.

Secondly, we have drawn on both health and non-health examples, in order to bring new perspectives to the field. There are many existing reports on increasing self-management in health and we do not wish to duplicate their content. The examples cited from outside the field of healthcare each require a comparable change in behaviour (for example, learning how to do something new in adult education or overcoming the challenge of searching for a job). We believe that looking to other sectors will offer new routes to realising the value of people and communities in a health and wellbeing context.

Finally, we recognise that we are focusing only on a single aspect of person- and community-centred approaches, at the expense of others, such as educating and changing attitudes. We touch on these aspects in the following report, but only if there is clear evidence that they result in changes in behaviour. We believe that this focus on behaviour will bring results.

 

To find out more about Realising the Value, check out the website here…

At the Heart of Health: Realising the value of people and communities

Monday, January 23rd, 2017

Click here to download the At the Heart of Health report

This report explores the value of people and communities at the heart of health, in support of the NHS Five Year Forward View vision to develop a new relationship with people and communities. Our starting point is that health and care services need to work alongside individuals, carers, families, social networks and thriving communities. This report seeks to bring together in one place a wide range of person- and community-centred approaches for health and wellbeing. It provides an overview of the existing evidence base with a particular focus on the potential benefits of adopting person- and community-centred approaches.

We hope this report will help commissioners, policymakers and practitioners to understand the range of approaches available, some of the key components and their potential to improve health and wellbeing outcomes, NHS sustainability and social value.

Person- and community-centred approaches to health and wellbeing have come a long way over the past fifteen years: from pioneering practice situated outside of the mainstream, to a central place in NHS England’s vision for the NHS. There is growing consensus about the need for health and care services to embrace the benefits of taking a more person- and community-centred approach.

Yet, despite this policy focus and many good examples of person- and community-centred approaches being implemented in frontline practice, it is still far from being ‘the way we do things’ within health and care services.

It is important that we now do much more to better understand which person- and community-centred approaches work in what circumstances and how to achieve much greater take up and spread of the most effective approaches.

 

To find out more about Realising the Value, check out the website here…