10 july 2014 overview and interim report dr penny newman gp, consultant in public health director of...

10 July 2014

Overview and Interim Report

Dr Penny NewmanGP, Consultant in Public HealthDirector of Service Integration,

Colchester Hospital NHS University Foundation TrustClinical Lead, Health Coaching Programme

www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching

LTCs: A burning platform• Lifestyle causation: Cost of obesity £5 billion,

to double by 2050 when the population will be mainly obese.

• Comorbidity: The number of people with more than 3 LTCs will increase from 1 to 2.9m 2008 – 2018, and have 2-3 X more mental health problems

• Age and poverty related: 58% of people over 60yrs have one or more LTCs, the poorest 60% higher prevalence and 30% more severity

• Unaffordable: LTCs account for 50%, 64% and 70% of GP, OP appointments & inpatient bed days and £7/10 of health & social care spend Data Sources Kings Fund, RCP

Case study

Obese male, late 50's, DMT2 and history of cardiac failure. Wants to lose weight but puts many barriers in place to make changes. In past practice I have resulted to making suggestions to help him lose weight and each time he has returned having gained a bit more weight and not done anything differently and always has a valid reason/excuse.


Learnt dependency

Paternalism breeds dependency, encourages passivity and undermines people’s capacity to look after themselves. It may appear benign, comfortable and reassuring, but it is a hazard to health. (Coulter, 2011)


The impact is overwhelming


Health coaching is…Role of patientA patient centred approach wherein patients at least partially determine their goals, use self-discovery and active learning processes together with content education to work towards their goals, and self-monitor behaviours to increase accountability all within the context of an interpersonal relationship with a coach.

Role of clinicianThe coach is a healthcare professional trained in behaviour change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and wellbeing.

Wolever 2013


Clinical Skills

Behaviour Change Assistance

Coachingrelationship

Self determined goals and

accountability

Health Coaching integrates

7


“Give patients a fish” or “teach patients to fish”?

Bennett, H Coleman E, Parry C, Bodenheime T


• 13 practice nurses, 7 practices, 199 patients, >360 appointments

• 4 CCGs with multidisciplinary teams

NHS Suffolk RIF pilot

• 23 two day programmes • 355 participants and ~ 800 by October• 31 organisations• Nurses (44%), AHPs (28%), doctors (9%)

and pharmacists• 24 trainers

HEEoE Health Coaching

programme


0

100

200

300

400

500

600

700

800

Current and planned uptake of HEE EoE Health coaching programme 2013-2014

Month 2013-2014

Num

ber o

f par

ticip

ants


Includes theory & practice in

Foundations of coaching

Listening, trust and rapport

Range of approaches

Behaviour change techniques

Barriers to change

Readiness to change

Positive psychology

Supportive challenge

Patient self determined goals


Key learning – becoming patient centred • A mind set shift and belief in

patients potential • Shift from expert to empowering

patients to self-care • Problem solving using

collaboration & shared responsibility

• Help change patients relationship with their condition

• Greater self-awareness

• “change comes from the client”

• “Stop trying to fixing everything ”

• “patients find it difficult to argue with their own suggestions”

• “to see problems in different ways”


Key learning – applying new techniques• Identifying self-determined

goals• Using behaviour change

techniques • Building on core

consultation skills • Impact on the wider system

• “small changes make a difference”

• “the gap between where patients want to be and where they are - your opportunity”

• “listening more, speaking less”.• “this is very different from the

medical model which we generally follow


Health Coaching is about a mind-set: a mind-set of trying to promote client's own responsibility for their health and seeing this in the context of their situation. It is also about providing the information so clients can make an informed choice, and about being clear in what we can and cannot provide and how we can assist in finding the right way for this client. There are useful tools we can use in discussions with clients to help them to get clearer for themselves what is important to them.


As telling people what to do doesn’t work

Tailor Consultation style to varying patient needs

A tailored, flexible consultation style vs. premature focus on “fix” and “giving advice”


Based around patientsself determined goals


Long term conditions

•Respiratory, DM, CHD, neuro, pain, cancerLifestyle •Smoking,

obesity, alcohol

Mental health •Depression, anxiety, stress

Palliative care

Prescribing

Application of techniques

Use in behaviour change, all consultations and with colleagues


Reported benefits to patients and clinicians

Patients• Increased engagement &

motivation to change• Increased satisfaction with

consultation• Potential outcomeClinicians• Effective consultations • Resilience and job satisfaction• Use with colleagues and others


Benefits to NHS organisations

• Improved quality of care and standards e.g. CQC

• Meet strategic priorities e.g. LTC, integrated care, frail elderly

• Improved patient experience, reduce complaints

• Multidisciplinary with application across all sectors

• Experience of positive impact on utilisation, costs and outcomes


Next steps for HEEoEEvent Name Date of Event Who for?

Building and Integrating Health Coaching workshop Thursday 10th July Organisational Co-ordinators

and Trainers

Facilitation Workshop Wednesday 17th September Trainers

Health Coaching CPD Workshop Tuesday 23rd September All Health Coaching Practitioners

Building and Integrating Health Coaching workshop Tuesday 30th September

Organisational Co-ordinators and Trainers, Workforce Partnership leads

Overall Health Coaching Conference event

Tuesday 11th November

Organisational Co-ordinators/trainers/Health coaching practitioners


What are your next steps?

10 July 2014

Pulling it altogether – the House of Care

Dr Penny NewmanGP, Consultant in Public HealthDirector of Service Integration,

Colchester Hospital NHS University Foundation TrustClinical Lead, Health Coaching Programme


House of CarePurpose is to consider the different elements of the House of Care as a framework for considering how to embed health coaching


Person centred coordinated care

“I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” National Voices


In groups of 3-4 preferably in your

organisation or patch map on the House• What are you doing to deliver the different elements of

the House to improve the management of LTCs including health coaching?

• What do you notice about opportunities/what’s not working that can be replaced?

• What needs to happen in the system / your organisation to embed health coaching?


Resources

• http://www.kingsfund.org.uk – Angela Coulter Delivering better services for people with long term conditions

• NHS England House of Care http://www.england.nhs.uk/house-of-care/

http://www.kingsfund.org.uk/

http://www.kingsfund.org.uk/

http://www.england.nhs.uk/house-of-care/

http://www.england.nhs.uk/house-of-care/

10 July 2014

Essentials for on-going development and

sustainability/Next stepsDr Andrew McDowell and Dr Penny Newman


In thinking about what you need to do e.g. targeting patients, training more clinicians, supporting trainers, marketing and recruiting, communications, gaining support, resources, alignment with other strategies

Group A• What needs to be done to

grow and embed health coaching in your organisation?

• What is needed to support the health coaching co-trainers?

Group B• What support do you need

from outside your organisation and the system e.g. HEEoE, CCGs, other Trusts

• What is needed to support the co-ordinators?

Next steps for Health Coaching

10 july 2014 overview and interim report dr penny newman gp, consultant in public health director of...

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