Working differently to transform population health

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Part of Integrated care collaborative programme for four communities

Stuart Cowley, director for adult social care and health, Wigan Council

It won’t be news to anybody that as health and care economies everywhere are seeking unprecedented revenue reductions, so we are increasingly realising that squeezing efficiencies from the current model will not get us close to where we need to be. 

Nor would we want to. In Wigan, we are increasingly recognising that the way we deliver public services in a place often makes it harder than it should be to deliver what residents and patients need. Services are often still fragmented, with agencies working independently, on different geographical footprints, with different thresholds and assessment criteria and often a focus on single issues. 

To test what we could improve by working in a place in a new way, we have been using the concept of ‘Perfect Week’, This is a seven-day experiment in which we suspend the usual rules, bring partner agencies together to identify assets in individuals and communities, and learn from working differently.

The first perfect week was centred on primary care, helping us to understand how an integrated approach could help to improve outcomes for patients visiting a GP practice. 

We aimed to test a different way of working, with a greater focus on prevention and earlier intervention. For example, key workers accompanied GPs on home visits to identify how the individual and family could be supported beyond the immediate clinical need. 

The results were compelling. By having a different conversation, we found it far easier to identify root cause issues such as debt, housing and social isolation, and to identify cost-effective ways to help people beyond the prescription pad. GPs appreciated the potential of working within a social model of prescribing, understanding that alternative options are real and accessible in the community. 

In Wigan, we are now developing a positive new approach to transforming services that is rooted in this learning, with two main elements:

  • preparing the health and care workforce to have ‘a different conversation’ with people who need health or social care support
  • helping the workforce to have these conversations armed with a more detailed knowledge of what is going on in their local communities.

So, in Wigan we are giving our teams permission to have ‘a different conversation’ based on assets – a conversation about people’s wishes, wants and talents. We have also invested in our community infrastructure and in mapping and understanding the informal support resources available in communities.

Focus on talents and wishes

I recently spoke to one of our frontline practitioners (an occupational therapist) about her experience of working in this way. She told me about an assessment visit she had made with an older woman who was recuperating after a serious fall. Because of the training she’d been on, she noticed some tapestries on the wall in the room as she was talking to the woman, and thought to ask her about them. It turned out the woman had a passion and talent for embroidery. 

The punch line of this story is that there is a sewing circle nearby, run in a community centre by friendly people who were happy to come and meet the lady, and they now help her to go to the sewing circle three times a week. If the conversation had centred just on the clinical and social care needs, there’s every chance we would be driving the lady to a more expensive day centre halfway across the borough. 

Early finding and next steps

We have a growing list of these kinds of examples, where by having a different conversation we are improving outcomes by helping people to connect and contribute to their local communities, while ensuring social care and clinical support is in place.  Many of these benefits will be to the NHS through reduced hospital admissions, reduced costs associated with mental health conditions and reduced GP attendance, and this way of working is now at the heart of our wider plans for health and care reform.

As leaders in the Wigan health economy we are realising that real and lasting improvements come through changes in the day-to-day practice and behaviour of the workforce. Through bringing together teams across the NHS, local authority and other partners we are seeing this transformation happen in Wigan in a really exciting way.