It’s time for people-powered health services

Public health inequalities can be tackled by moving towards co-produced health services, argues John Craig

Public health inequalities in the UK are rising, despite medical advances. People from poorer neighbourhoods are more likely to smoke, eat unhealthy foods, drink too much and are less likely to exercise.  They die earlier than their richer peers and experience a poorer quality of life. The NHS has done little to reverse this trend, despite serious investment in public health campaigns such as Change4Life. The current fiscal crisis makes this even more of a challenge.

But it’s not all doom and gloom. In pockets all over the globe there are health innovators addressing these challenges, delivering better health outcomes at significantly lower cost by fostering community capacity, what we call co-production.

Co-produced services draw on the often untapped resources at our fingertips; the patients and communities themselves. They build the capacity for individuals to play a more active role in their own health, and the health of others.

In the UK, the shifting of public health responsibilities and funding (£2.7bn a year) from the NHS onto local authorities offers a crucial opportunity for change. Public health teams will be closer to the levers that can affect social determinants of health, such as leisure, housing and employment services. To succeed where the NHS has failed they need to learn from these innovative success stories.

Firstly, they need to unlock the capacity within people to manage their own health, rather than fostering a dependency on health services. This is already being addressed by an abundance of health apps and technologies designed to enable self-management. Public health teams could be working with GPs to better integrate health and wellbeing apps, such as TicTrac, which provides dashboards of personal data from different sources and helps motivate people to achieve self defined goals.

Secondly, building on relationships between peers provides a useful alternative to intimidating health services which turn off certain demographics. We used group appointments and an online social networking tool to connect mums in London as part of Mumspower,  building on the lessons from CenteringPregnancy™, a model of group antenatal care that holisitically prepares women and their partners for pregnancy and parenthood.

Thirdly, services must harness resources from our communities which could all play their part in tackling public health issues. Newcastle Council has already identified this with their city-wide scheme of social prescribing, which uses community assets to help people with long term conditions. Frontline workers, such as GPs, could benefit from mapping out local community assets and prescribing them to patients – like the Crafty Needles knitting group, where people with long-term conditions come together to knit clothes for the local hospital.

The biggest impact can be seen if all of these ideas are combined. Innovation Unit and Nesta’s People Powered Health programme supported six localities around the UK to do just this through a variety of co-designed methods. Estimates suggest that if these innovations were scaled up across England, the NHS could save £4.4bn and radically improve health outcomes.

Public health teams should be making the most of their new responsibilities by working with their Health and Wellbeing Boards to produce services with the communities they serve. While innovative, co-produced services are emerging in clusters around the world, we need to bring them out of the periphery and into the mainstream if we are to tackle  the public health crisis we are facing.