1. 10 July 2014 Overview and Interim Report Dr Penny Newman GP, Consultant in Public Health Director of Service Integration, Colchester Hospital NHS University Foundation Trust Clinical Lead, Health Coaching Programme

2. www.hee.nhs.uk www.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

3. 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.

4. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching 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)

5. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching The impact is overwhelming

6. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Health coaching is… Role of patient A 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 clinician The 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

7. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Clinical Skills Behaviour Change Assistance Coaching relationship Self determined goals and accountability Health Coaching integrates 7

8. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching “Give patients a fish” or “teach patients to fish”? Bennett, H Coleman E, Parry C, Bodenheime T

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

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

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

12. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching 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”

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

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

15. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching As telling people what to do doesn’t work Tailor Consultation style to varying patient needs Listen and follow Diagnose and fix Guide and advise Review and encourage Support self care A tailored, flexible consultation style vs. premature focus on “fix” and “giving advice”

16. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Based around patients self determined goals

17. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Long term conditions Respiratory, DM, CHD, neuro, pain, cancer Lifestyle Smoking, obesity, alcohol Mental health Depression, anxiety, stress Palliative care Prescribing Application of techniques Use in behaviour change, all consultations and with colleagues

18. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Reported benefits to patients and clinicians Patients Increased engagement & motivation to change Increased satisfaction with consultation Potential outcome Clinicians Effective consultations Resilience and job satisfaction Use with colleagues and others

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

20. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Next steps for HEEoE Event NameDate of EventWho for? Building and Integrating Health Coaching workshop Thursday 10 th July Organisational Co-ordinators and Trainers Facilitation Workshop Wednesday 17 th September Trainers Health Coaching CPD Workshop Tuesday 23 rd September All Health Coaching Practitioners Building and Integrating Health Coaching workshop Tuesday 30 th September Organisational Co-ordinators and Trainers, Workforce Partnership leads Overall Health Coaching Conference event Tuesday 11 th November Organisational Co- ordinators/trainers/Health coaching practitioners

21. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching What are your next steps?

22. 10 July 2014 Pulling it altogether – the House of Care Dr Penny Newman GP, Consultant in Public Health Director of Service Integration, Colchester Hospital NHS University Foundation Trust Clinical Lead, Health Coaching Programme

23. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching House of Care Purpose is to consider the different elements of the House of Care as a framework for considering how to embed health coaching

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

25. 25

26. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching 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?

27. www.hee.nhs.uk www.eoeleadership.nhs.uk/healthcoaching Resources http://www.kingsfund.org.uk – Angela Coulter Delivering better services for people with long term conditions http://www.kingsfund.org.uk NHS England House of Care http://www.england.nhs.uk/house-of-care/ http://www.england.nhs.uk/house-of-care/

28. 10 July 2014 Essentials for on-going development and sustainability/Next steps Dr Andrew McDowell and Dr Penny Newman

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