Background Information and Frequently Asked Questions
- ▶ How did Ways to Wellness come about?
The project is the culmination of several years of work by different organisations in the West of Newcastle-upon-Tyne to pilot services to improve peoples’ health. It represents a major scaling up of the work pioneered by the Year of Care Project in Thanks for the Petunias and the NESTA social prescribing project, People Powered Health.
The development of Ways to Wellness has been led by Voluntary Organisations’ Network North East (VONNE), supported by Newcastle West Clinical Commissioning Group (CCG) and ACEVO (Charity Leaders Network).
A project steering group oversaw the development of Ways to Wellness and subsequently become a sub-committee of the Board of Ways to Wellness in the year leading up to the service launch. Professor Chris Drinkwater, CBE, chaired this steering group and the subsequent sub-committee. The other members of the sub-committee were: Sandra King, Ways to Wellness Project Director; Jo Curry, Chief Executive of VONNE; Philip Angier, Capitalise; Nicola Weaver, GP and lead on prescribing for Newcastle West CCG; Guy Pilkington, GP and Chair of Newcastle West CCG; Andrew Walton, Executive Chair of Connect PHC; Peter Deans, independent consultant; Jane Hartley, Chair of VONNE; Karen Noakes, ACEVO; and Ralph Michel, Cabinet Office.
Prof Chris Drinkwater became chair of the Ways to Wellness board with Jane Hartley of VONNE as a founding director. After an open recruitment process a number of directors with relevant skills and experience were recruited to the board.
- ▶ Why is the Ways to Wellness service needed?
Over 15 million people in England suffer from long-term conditions (LTCs). They experience poorer health outcomes and reduced quality of life as a result. They are proportionately higher users of health services (GP appointments, prescription drugs, outpatient services and in-patient hospital bed days). 55 % of GP appointments are with patients with one or more LTCs.
Evidence from community health interventions, both locally and nationally, has shown that a contributory factor to health and wellbeing is being linked into a local community and reduced social isolation.
Social prescribing, based on the evidence, is expected to:
- help some patients with LTCs to manage their daily lives better, feel less isolated, look forward to a healthier and longer life expectancy
- reduce the costs to the CCG (and thus the NHS) of treating those patients with LTCs who benefit from social prescribing and to require fewer GP visits, prescription drugs and hospital visit
- ▶ What are long term conditions?
Long term conditions (LTCs) are conditions that cannot be cured but can be managed through medication and/or therapy. There is no definitive list of long-term conditions, but they would include conditions such as lung disease (COPD), diabetes, asthma and coronary heart disease.
Ways to Wellness’ service model is based on GPs referring patients living with certain LTCs: chronic breathing difficulties (COPD) or asthma, diabetes (type 1 or type 2), heart disease, epilepsy, thinning of the bones (osteoporosis), and any of the these LTCs with depression and/or anxiety. This list of LTCs may change in the future.
- ▶ What is Social Prescribing?
- ▶ Why was Newcastle West CCG (now part of Newcastle Gateshead CCG) chosen?
The west of Newcastle upon Tyne includes some of the most deprived areas in England. There is evidence that people in lower socio-economic groups tend to suffer proportionately more, and earlier in life, with long-term conditions (LTCs), have poorer health outcomes and consume more health service resources.
Newcastle West CCG had led the NESTA funded People Powered Health Social Prescribing Project. GP practices in Newcastle West had been involved in social prescribing in a small way for some years and wished to scale this provision up to offer this to more patients, in a more organised way.
It is estimated that some 30,000–40,000 people living in Newcastle West suffer with one or more LTCs. This project aims to reach about 5,000 patients per year, once it is fully up and running.
- ▶ How does this project address health inequalities?
The social impact predicted from a programme of social prescribing for long term conditions (LTCs) is based on a wide body of research carried out by researchers in the UK and others, such as the World Health Organization (WHO). This research links health inequalities directly to wider social determinants. The ability to cope with the complex issues raised by having a LTC is directly linked to advantage (or, inversely, to disadvantage). Having a good level of education, a steady income and being socially integrated provide a range of factors which bestow a higher level of perceived control, a confidence and a self-belief that gives a resilience enabling people to cope despite ill health.
A programme supporting those with LTCs from less advantaged areas looks to build confidence and enable people to participate in their own healthcare, rather than being ‘done to’.
Many cross sectional studies show a correlation between well-being, social ties and pro-social behaviour e.g. participation, civic engagement and volunteering; activities which all benefit individuals and the society they live in. Supporting people to increase their social connections via access to local activities increases uptake and use of local resources in a virtuous circle; maintaining and increasing social capital and reducing reliance on NHS and social care. Social participation increases the likelihood of recovery, while low contact with friends and low social support decreases the likelihood of a recovery by up to 25%.
- ▶ Is this a type of Social Impact Bond?
- ▶ How are the lessons learned being shared?
- ▶ Will it work?
There is a growing body of evidence that social prescribing services that support patients to more confidently manage their long-term conditions and improve their quality of life have positive impacts on:
- Patients’ quality of life and wellbeing
- Patients’ ability to self-manage their conditions
- Patients’ lifestyles and behaviours that influence their health
- Clinical outcomes
- Use of mainstream health services
The expected outcomes from the Ways to Wellness service include:-
- Improvements in patient self-management
- Improvements in patient’s health compared with predictions
- Reduction in hospital bed days
- Reduced visits to GPs
- Reduced reliance on prescription drugs for some conditions (such as those for depression)
- ▶ Relevant evidence and publications
Health Foundation report Helping People to Help Themselves
A review of the evidence considering whether it is worthwhile to support self-management
Health Foundation Co-creating Health: Evaluation of first phase
An independent evaluation of the Health Foundation's Co-creating Health improvement programme
NESTA report The Business Case for People Powered Health
The People Powered Health approach: what investments would it require and what benefits could it bring?
- ▶ How it is financed/ funded?
In the development phase, VONNE secured £130,000 of development funding from the Department of Health Social Enterprise Investment Fund (SEIF). In addition ACEVO (Charity Leaders Network) pledged £15,000 in cash and in-kind support. In January 2014, a further £150,000 of technical assistance funding was secured from the Big Lottery Fund.
This funding was used to develop the Ways to Wellness service model (financial and operational) and to build capacity, including preparing for delivery of the service in the lead up to seeing patients. For example, research was funded to better understand the evidence base related to potential cost savings that the service might be expected to generate.
Newcastle Healthcare Charities has also indicated that they will be offering monetary support during the delivery phase of the service, for building capacity and to fund peer support in the west of Newcastle.
Bridges Ventures are providing £1.65 million investment, in the form of Social Impact Bonds (SIBs) to support the establishments of the Ways to Wellness service. Their investment will help to pay for the cost of the service in the early years of mobilisation and delivery, ahead of the performance measures being achieved and payments being received from the Newcastle West Clinical Commissioning Group (now part of Newcastle Gateshead CCG).
Commissioners and Outcome-Based Funding
Newcastle West Clinical Commissioning Group (now part of Newcastle Gateshead CCG) have agreed to pay for the provision of social prescribing services to their patients if Ways to Wellness can demonstrate achievement of performance measures that demonstrate the value to patients and a reduction in the use of NHS resources in supporting those patients.
In recognition of both the innovative nature of Ways to Wellness’ approach, and the wider benefits to society and other public services, the Big Lottery Fund Commissioning Better Outcomes Fund and the Cabinet Office Social Outcomes Fund have also agreed to pay up to £2 million and £1million, respectively, in outcome-based funding. As with the CCG, the Big Lottery Fund and Cabinet Office payments will be based on Ways to Wellness’ achievement of the agreed performance measures.
This additional outcomes support is required to enable Ways to Wellness to build its capacity to support up to 3,000 patients a year, before the expected savings can be proven.
Based on projections, Ways to Wellness expects that social investors will be fully repaid within seven years, at which point Ways to Wellness will also be saving the CCG (and thus the NHS) money.
- ▶ What sorts of savings are expected?
An independent review by NEQOS (North East Quality Observatory Services) indicated that the net savings to Newcastle West CCG of adopting the Ways to Wellness approach are estimated to be between £2million and £7million.
- ▶ How will we know if this project has been a success?
The measurable impact will be threefold:
- for patients with LTCs; that they will be better able to manage their daily lives, look forward to a healthier and longer life expectancy and will use hospital services, their GP services and prescription drugs less frequently;
- for the CCG; it will reduce their annual costs of treating patients with LTCs allowing them to achieve savings and/or re-allocate resources and innovate its patient services;
- for the NHS; it will provide evidence of alternative treatment options for people with LTCs operating at scale and delivering savings. It will reduce the demand upon acute hospital trusts and offer a best practice model to be shared.
- ▶ How will the project develop? How can others become involved?
This project is designed in such a way that it can be scaled upwards and outwards once it proves to be successful. There will be opportunities for more organisations to deliver the social prescribing interventions and for more neighbouring CCGs and acute hospital trusts to be engaged. The project will also share learning with other emerging social investment solutions nationally.