Creenagh Williamson, chief nursing and operating officer at HN, discusses how the health service needs to focus on prevention-based healthcare, such as health coaching, to ensure capacity as the winter approaches
6.7 million people are currently waiting for NHS treatment, but many of these can be supported by other means, including education and help to self manage their conditions
There’s little doubt that the health and social care system is under tremendous strain and experiencing some of the most-severe pressures in its 70-year history.
The COVID-19 pandemic was the event that finally tipped the balance following a decade of flatline funding and inadequate workforce planning.
The only slightly surprising aspect of the NHS pressures this time is the extent and severity of these challenges during the summer months – when traditionally the NHS is better able to cope compared to the struggles and impact of winter pressures.
The result of these pressures on ordinary people seeking care across the country is profound.
Having worked as a matron in emergency access for almost 10 years, I’ve seen how overwhelmed emergency departments can become in dealing with the diverse range of accident and emergency conditions that present.
And, since the pandemic this has dramatically increased.
Not only does coaching help to address the current system issues in terms of capacity and resource, but also from a patient perspective has a very real and positive impact on their quality of life
We know from the latest official figures that more than 6.7 million people are on waiting lists; that ambulances are taking longer than ever to reach patients; and people who need hospital beds are left waiting on trolleys, often in pain and discomfort despite the best efforts of overstretched and fatigued NHS staff.
Backlogs built up during the COVID pandemic as hospitals treated people with the virus, forcing patients with other illnesses to wait much longer than usual for surgery or treatment.
There is a similar story in primary care.
The pandemic has understandably heightened people’s health anxiety, especially those with long-term health conditions and research from Attenborough Primary Care Network (PCN) showed that one third of primary care appointments are being taken up by just 5% of the patient population.
Often the appointment is not directly related to the patient’s condition/s or they require a different kind of care.
As an example, one patient we worked with at HN had suffered a heart attack. He was discharged from hospital, but during his recovery he developed major health anxiety believing every minor issue was a further heart attack.
This resulted in him being unable to work, a breakdown in family relationships, and an excessive number of appointments with his GP, which never actually managed to successfully identify or resolve his issues.
Once given the time, space, and ear of a trained health coach, these issues were quickly resolved.
According to NHS England, there are 300 million primary care consultations every year. So, if we were to extrapolate the findings from Attenborough PCN, potentially 100 million appointments are being taken up by people who require a different kind of intervention.
In emergency care, it is estimated that between 10-20% of attendances are not appropriate.
We are still a way off being able to deliver truly-personalised care to all patients, but using a digitally-enabled triage process like this, we can begin to identify and help patients in new and innovative ways that have profound and proven benefits
With 23 million A&E visits per year, this is an enormous burden on the NHS and results in an unacceptably-high number of patients being denied access to the care that they need.
So, how can we break the chain of dependence on healthcare services?
When someone is repeatedly going to their GP or A&E because of anxiety related to an existing illness or concerns about their health, they create a pattern of dependence which is both unhealthy and will never ultimately meet their needs.
This places increased pressure on already-overstretched services and perpetuates the downward spiral of continued anxiety with the underlying problem never being effectively managed or resolved.
And the situation has the propensity to precipitate a further deterioration in underlying health conditions.
Health coaching is one way in which people can gain control over their long-term condition and associated mental health. This can be achieved by addressing health literacy, developing an understanding of what they can do to improve their condition, supporting the development of empowerment and confidence, creating appropriate coping mechanisms, and supporting them to develop a willingness to effectively and pro-actively manage their own health rather than an instant reliance on their local A&E or GP surgery.
At HN, we have been working with a group of diabetic patients in Lewisham, many of whom were anxious about their access to the specialised services they need to safely and effectively manage their condition.
Health coaching can be a useful tool in reducing pressure on health services by identifying those who need support to self manage their condition, rather than hospital treatment
This was exacerbated by the increased risks associated with contracting COVID-19.
Through health coaching they developed the skills, knowledge, and willingness they needed to make better choices about how to deal with their condition and associated anxieties, reducing usage of a range of primary and secondary health services.
Not only does coaching help to address the current system issues in terms of capacity and resource, but also from a patient perspective has a very real and positive impact on their quality of life.
Delivering personalised care, and putting the patient in control, is at the heart of what we do at HN. Through the work of our skilled health coaches we seek to deliver personalised care to the right people, at the right time.
With the increasing pressure on services and winter fast approaching, now is the time to focus on prevention-based healthcare to ensure services have the greatest capacity, and patient care is prioritised
Effective, pro-active self-management of long-term conditions and all the associated issues will not be achieved via A&E or GP services. We need to take a different approach to empower the patient if we are going to achieve long-term benefits for both patients and the system, enabling the NHS to fulfil its commitment to making personalised care business as usual, as set out in the NHS Long Term Plan.
This is where the real power of technology-enabled healthcare is being realised – we’re using AI to identify and predict high-intensity users of GP and A&E services and we then support these patients through a coaching intervention, enabling the patient to achieve the pro-active self management described above.
Being realistic, we are still a way off being able to deliver truly-personalised care to all patients, but using a digitally-enabled triage process like this, we can begin to identify and help patients in new and innovative ways that have profound and proven benefits.
Funding is available for health coaches through the Additional Roles Reimbursement Scheme (ARRS), so delivering these personalised services need not cause additional financial burden.
Also, companies like HN are already providing fully-accredited, professional health coaches for trusts as a fully-managed service, removing any additional people-management responsibility.
With the increasing pressure on services and winter fast approaching, now is the time to focus on prevention-based healthcare to ensure services have the greatest capacity, and patient care is prioritised.