Integrated Wellness Service

Overview Rationale for developing new model What steps we have taken so far New model Challenges Levers for change

Rationale for changing model High prevalence of unhealthy lifestyle behaviours Many people with multiple lifestyle issues Wider health determinants - needs around debt, housing, learning, welfare reform Relatively low levels of wellbeing GPs wanted clear referral pathway Local insight supported joined up approach One third of adults smoke, a quarter binge drink, more than half are overweight or obese and less than one in five do sufficient exercise to keep healthy Multiple lifestyle issues - who smoke daily drink many more alcohol units per week than people who smoke occasionally or used to smoke 22 % worklessness rate, almost double England average Nearly 1 in 5 households (around 14,500) classed as living in fuel poverty. Nearly 20% Knowsley’s adult population have no qualifications, double England average . 32% children and young people assessed as living in poverty in Knowsley Wellbeing levels low compared to regional average In Knowsley mental well-being scores lower amongst groups who classify themselves as having poor physical health, lower levels of education, live in an area of deprivation Review early 2011 looked at local social marketing insight which identified importance of working more efficiently to make one contact with an individual count, rather than repeatedly targeted the same individual about numerous services and lifestyle factors. It also allows us to support an individual over a period of time to increase the likelihood of behaviour change. A long term, trusted relationship with an individual allows us to focus on their relevant issues systematically. We can support them to stop smoking, then ask them what else they are interested in and support that lifestyle area, rather than ‘bombard’ them with multiple advertising lead propositions.

Lifestyle Pathway – 2010 Number separate referrals Single lifestyle behavior based support. Limited cross referral. Limited conversations and connnections to wider wellness support, (except through HT service).

Changing our model SPOA 6mths pilot 2011 worked with 2 GP practices & lifestyle providers Single referral form & system to Health Trainer Service Full evaluation of the pilot, led to SPOA roll out to all GPs from Aug – Oct Benchmarking / action plan using wellness standards Lifestyle Service review meetings Redesign of service model & new specification

Single point of access referral form

IWS Model Client receives phone contact & brief intervention within 48 hours by hub, 6 wk follow up Holistic approach, joined up delivery, addresses multiple needs, person centered support, outcomes electronically fed back to GPs

Challenges Embedding new system of working Information sharing / duplication Information system for Health Trainer Service Information system across providers New training needs Pathways to services / support that are not PH commissioned services Accessible and interactive website

Levers for Change Public Health leadership Effective Use of Services – HWB priority Commitment to asset based working - JSAA PMS GP contract – sign up to SPOA & follow new referral pathway Involvement & relationship with lifestyle services Re-design Health Trainer & community health service – new contract 2 x CQUIN – Brief intervention training across frontline health staff, wellbeing training / hub IWS ongoing piece of work 24 PMS practices, 35 practices cost of redesign which has been great 120k database, over 150k CQUINs for  a start! TCS, QIPP, WCC other enablers HT target is 27 referrals a day, currently receiving around 240 referrals a month