Blackburn with Darwen Integrated Wellbeing Service

The key aims of the Wellbeing Service are:

• To create a simple and clear access point to support citizens to make healthier lifestyle choices rather than the multiple, traditional, single issue services that cause confusion for both referrers and patients alike.
• To reduce Health Inequalities by helping people to make changes they want in their lifestyle to improve their health and wellbeing by offering practical advice and supported signposting into appropriate services.

The key objectives of the Wellbeing Service are:

• Identify and engage with individuals from priority communities or groups as determined by local health evidence.
• Work with individual’s on a 1:1 basis to provide information, motivation and support to help individual’s move towards a healthier lifestyle.
• Support training and development of health champions and volunteers.
• Offer advice and support around healthy lifestyles and the wider determinants of health to people who live, work or go to school/college in Blackburn with Darwen.
• To provide supported signposting into partner agencies such as Age UK, Shelter, Lancashire Mind, where appropriate in order to provide a truly holistic approach to improving health and wellbeing.

Health Trainers are a fundamental part of the Wellbeing service, playing an important face to face role, providing information, support and guidance to individuals wanting to make changes towards a healthier lifestyle. They do this by offering both 1 to 1 support and group activities within the community. Behaviour change and motivational interviewing are their speciality and this shows a good reflection of the how our team are equipped with the correct skills to support behaviour change which is highlighted in the guidance.

PH6 also highlights the need to develop programmes based on sound knowledge of community needs and to build on the existing skills and resources within a community. This was what drove us to integrating services and we consistently use community led approaches to encourage engagement; we have built wider staff capability within existing resources and involve the community to take action on living well.

In early 2013 the Council, in partnership with the CCG commenced discussions around how the organisations could take a more systematic approach to Self-Care and Long Term Condition (LTC) Management and deliver a more integrated service to the public – a new ‘Wellbeing’ Service; rather than a range of individual service offerings. There was a strong desire to ensure that the new Wellbeing service also included the wider, social determinants as part of the model.

The rationale for this approach is well documented; it is known that people who experience the most disadvantage face multiple lifestyle risk factors (Buck, 2012) and that behaviour change is influenced by the social conditions in which people live. Principle 2 of the guidance recommends identifying and attempting to remove social, financial and environmental barriers that prevent people making positive changes in their lives; this reinforced the design of the service which includes Council led Information, Advice & Guidance Teams, Learning Courses and supported signposting to 3^rd Sector partners to tackle the wider/social determinants of health.

With the support of the CCG a comprehensive scoping exercise was undertaken to inform decisions and shape the new service, including a streamlined interface with GPs to improve and simplify the referral process to a single point of access and introduce a communication loop back to GPs following referral.

The local importance of the Wellbeing Service was reflected by its inclusion in the CCG strategy for 14/15–18/19 recognising the new service as a key initiative aimed at tackling health inequalities.

We identified the following benefits of an integrated wellbeing service:

• More systems/process driven for consistent results that is scalable.
• Removes reliance on individual knowledge of services.
• Defines ‘products on the shelf’ behind a single point of access.
• Provides a simple mechanism to improve support and appropriate access to services.
• Record outcomes more effectively and consistently.
• More efficient use of existing resources.

Population estimate currently stands at 147,000 and the health of people living here is generally worse that the England average. BwD is one of the 20% most deprived districts/unitary authorities and life expectancy for both men and women is lower than the England average.

• The 35% of the population with a LTC account for 70% of health care expenditure, about £200 million in BwD.
• These 62,000 people account for half of all GP consultations – nearly half a million consultations per year.
• They account for 70% of all days spent in hospital.
• The number of people with LTC will increase rapidly over the next 10-20 years.

This local focus on integrating resources, coordinating around the individual and delivering optimal value for money highlights the local desire to do things differently and put the person first.

The Wellbeing Service was launched in February 2014 and has continued to develop and grow since then. Developing existing links and creating new partnerships and closer working with GPs and a wide range of health providers/professionals has been a fundamental strategy for embedding the service and one of the reasons for its success to date. Also key has been developing a vast array of new working relationships across the third sector in order to create a more effective pathway to support people who live and work in the borough to make positive changes in their lives. 

NICE guidance PH6, recommendation 5 suggests building on strengths of individuals and communities; we were able to do this by investing in volunteers to promote participation in leisure. This in turn helped to promote resilience and created positive social networks for individuals. The external partnerships that the Wellbeing Service formed enabled these to happen across networks and organisations.

By remodelling existing resource, we were able to create a wellbeing hub where all referrals are channelled through to our hub advisors who have the necessary skills to offer brief advice and using motivational interviewing assess the person’s readiness to change and initiate a process of shared decision making.

The remodelling also meant that we could dedicate a manager to oversee the hub advisors and health trainers, working on processes with our delivery teams, leaving the service manager to concentrate on the pathways for GPs and other Health Professionals to refer and to establish our relationship within the new Integrated Locality Teams in health.

In terms of resources we co-branded our materials with Change4Life in order to reflect Public Health priorities and to reinforce their marketing communication which is approachable, friendly and encouraging yet firm and resolute. It doesn’t blame or criticise, but demonstrates understanding and makes dry information digestible, snappy and memorable.

We knew from experience and previous data collection by each project that GPs and health professionals within practices were by far our biggest referrers. We also know that we had started to make it complicated to refer because of the multiple forms, phone numbers etc.

We addressed this by talking to GPs about how to make it easier to refer patients. The solution was a single referral form that could be used for exercise referral but also for lifestyle/behaviour change with our Health Trainers. The referral form is now also available on EMIS and therefore makes completing easier still.

The Wellbeing Service performs against targets set within its service specification. These targets include reaching a predefined volume of brief interventions and more in-depth contacts with the public with some target population groups identified within that. Subsequently the targets are then focused around the quality of outcomes with individuals, how working with the service has improved their wellbeing and maintaining change.

With no additional investment, but remodelling existing resources, the service is now achieving almost three times the volume of brief interventions and double the volume of face to face engagements with the public and recording more detailed and relevant outcomes in the process.

At the end of the year for 2015/16, more people than ever contacted us to get help, advice and guidance and received the support they needed to make positive and sustainable changes to their lives.

The volume of those accessing the service continues to increase and all quality measure have been maintained or improved in this time.

We have delivered almost 2000 one-to-one interventions with over half of all clients living within the top 20% most deprived wards and we know that focusing on the whole person, including the wider determinants of health is making a difference to peoples’ lives because they tell us so; 76% report improvements in their mental health too.

 Of the 5242 contacts into the Wellbeing Service, 1831 were referrals (51% from Primary Care).

Outcome of those 1831 total referrals:

• 984 (54%) accessed a Health Trainer
• 847 (46%) accessed another healthy lifestyle intervention

Demographics of those accessing the Wellbeing Service:

• Gender: 64% female, 36% male.
• Ethnicity: 58% white, 21% BME, 21% not stated

Feedback from one servicer user provides a snapshot of their experience of the service:

“I found out about Health Trainers through Lancashire Mind and my GP. I wanted to try to be positive and manage my food and weight. I was introduced to a health trainer. I had a food diary of what I would eat, and then at my next appointment, we went through the good and bad things. Also, I wanted to do more exercise so I was referred to a local gym through my GP. It’s also given me the confidence to go on to courses. I am still eating healthier and using everything I have learned. It has made a big difference to my mood and confidence. I sleep and communicate better with people. I will continue to look at what I have to eat in everyday life. You are not judged, I found I was listened to and I have been honest with myself.”

The key for us has been getting buy-in strategically both in the Local Authority, CCG and the Third Sector. As referenced in an earlier paragraph, the scoping and implementation of the Wellbeing Service was strengthened because the CCG and Council have several joint commissioning posts and functions.

We also reviewed and discussed the proposed model for our Wellbeing Service with a number of other local authorities which were more advances in the development of their own wellbeing services. We also consulted with an independent Public Health Specialist who had worked on development of an integrated service extensively and was leading work in this field across other County Councils.

Communication is fundamental and this doesn’t just mean with potential referrers and partners. This has to be right in your own teams. All staff – managers and front line staff were kept up to date and consulted with on a regular basis. There has to be the recognition that the processes we had developed could change at any time and we need to be able to work flexibly in order to accommodate this. We also held regular meetings with colleagues across other council departments. After all, the wellbeing service was to become the gateway for all Council services that impacted on health and wellbeing – this included everything from adult learning to handyperson services.

We avoided mass marketing/promotion to the public from the start of the Wellbeing Service. Because we had configured teams differently, we knew that there was the potential to see more people and receive more contact. However, because this was new, we could only predict what these numbers could be. So by holding back on a huge public launch we could aim to control expectations on both sides.