Liverpool Health Trainers Social Impact Report
Section 1: Who We Are Health Trainers began as a government initiative which came from the Department of Health 2004 White Paper Choosing Health : Making healthier choices easier. The aims of health trainer services are to reduce health inequalities and improve health outcomes locally while enabling and empowering people to lead a healthier lifestyle by changing their behaviour. By 2006 Liverpool had its very own health trainer service, which has been managed by PSS since 2007. It was originally commissioned by Liverpool PCT, and is now currently commissioned by Liverpool City Council. The Health Trainer scheme provides free and confidential support to people who are 16 or above and takes a person-centred approach to behaviour change. We support people to understand the negative impact of unhealthy choices, uninformed behaviour and lack of awareness of local and citywide resources on their health and wellbeing. On a practical level the purpose of health trainers is to provide one to one support to people who have been referred by a clinician, stakeholder and/or service or where they have referred themselves. 2 Liverpool Health Trainers Social Impact Report
Section 2: What we are looking to achieve As a city, Liverpool has one of the highest levels of poor health and health inequalities when compared to the rest of the country. Men in Liverpool live 3.1 years less, and women 2.8 years less, than the England average. The difference in life expectancy between areas of the city can vary by almost 10 years for men and just over 9 years for women. (Liverpool JSNA: Statement of Need Update 2014). In terms of health inequalities, challenges facing Liverpool are as follows: Liverpool has one of the highest cancer mortality rates in the country 86% of people in Liverpool are not active enough to maintain good health 30% of people in Liverpool live with one or more longterm conditions To work to address these issues, Liverpool Health Trainer service is a support service that aims to improve the health of the local population by engaging with and supporting people to: reduce health inequalities, reduce mortality rates, increase life expectancy, improve local health outcomes, prevent ill health and disease. Over half of adults in Liverpool are overweight or obese An estimated 11,300 people in Liverpool drink at high risk levels 25% of adults in Liverpool smoke (Liverpool CCG, 2015) Liverpool Health Trainers Social Impact Report 3
Section 3: Who we work with About the people we work with... In 2015-2016 we worked with nearly 5000 individuals: 38% were Men 62% were Women 31% Employed 13% Unemployed 31% Retired 11% Sick / Disabled 14% Carers / Students / Volunteers 7% 12% 13% 21% 21% 25% 25 years and under 26-35 years 36-45 years 46-55 years 56-65 years 66 years and over 80% White British 9% BME 11% Unknown About where people live... Areas where our clients live: We work with individuals classed as hard to reach as they live and work in the most disadvantaged areas of Liverpool. This is demonstrated by looking at where the people we work with live, with 69% of our clients living in the most deprived areas. Liverpool Health Trainers are based in 88 out of 93 GP surgeries across Liverpool and work across the city. Recently we have started providing lifestyle and physical activity group work and physical activity. We have worked with groups of hard to reach men in areas experiencing health inequalities, women at risk of offending and people experiencing mental health issues. Second least deprived: 5% Third most deprived: 11% Second most deprived: 14% Least deprived: 1% Most deprived: 69% 4 Liverpool Health Trainers Social Impact Report
Section 4: What our clients journey is like Referrals can be received from clinicians, health practitioners, stakeholders or self-referrals from the clients themselves. 1 The service is based in primary care (GP practices) and community settings to increase availability and access to a health trainer. Health Trainers will carry out a lifestyle and wellbeing assessment, which will determine if there is an area of a person s life that would benefit from creating a health plan. 2 3 The service maximises its effectiveness by signposting and referring to other local and national services, agencies and organisations. This social prescribing approach allows the Health Trainer to provide a wider range of support options. 5 Specific health goals are then set between the client and Health Trainer. The Health Trainer will Motivate, Enable, Empower and Encourage the client to improve their own health and wellbeing. The Health Trainer can also provide a range of health education and health resources, promoting healthier lifestyle choices. 4 The Health Trainer will meet with the client a number of times over 12 weeks to review goals and offer ongoing support, particularly if the client is struggling to achieve their goals. 6 The service lasts up to 12 weeks and at the exit meeting, progress and goals are reviewed and celebrated. New goals can be set if a client wants to continue with the service. 7 Liverpool Health Trainers Social Impact Report 5
Section 5: What we have achieved Person Shaped Support The below graphic shows the scale of the work we have undertaken between 1st April 2015-31st March 2016; as well as the 5 years from 1st April 2011-31st March 2016. In 2015-2016 From 2011-2016 5,542 referrals have been received 23,273 referrals have been received 3,745 assessments have been completed 16,934 assessments have been completed 3,660 health plans have been completed 16,185 health plans have been completed 24,691 goals have been set 72,385 goals have been set 18,023 goals have been achieved (73%) 49,634 goals have been achieved (69%) Health Trainers have made more than 12,000 signposts or referrals to other services across Liverpool and Merseyside since 2011. We have increased our operation being based in fewer than 5 GP surgeries in 2011 to now being based in 88 out of 93 recognised GP surgeries across Liverpool, and consistently support our clients in every ward of Liverpool. We have increased our staff numbers from 14 to 24. We have continually increased our targets set by our Commissioners every year for the last five years. 58% of all staff have worked for the Health Trainer service over 5 years or more. 6 Liverpool Health Trainers Social Impact Report
Helping to prevent type 2 diabetes Type 2 diabetes is on the increase as more people are either overweight or obese, due to unhealthy lifestyles or being physically inactive. The biggest risk factor is obesity, however small lifestyle changes can significantly postpone or prevent type 2 diabetes and these changes can be more effective than diabetes drugs. How do we help to prevent it? Weight loss is the most important factor in preventing type 2 diabetes. Inputs from PSS and Client During 15/16, we received 410 referrals and completed 327 Health Plans with people at risk of Type 2 diabetes. We carried out 600 reviews and set 2,182 goals. Goals set to achieve weight loss included increasing physical activity and improved diet including reducing sugar intake and increasing the intake of fresh fruit and vegetables. Outputs and Achievements of Client Of the 327 people who set one or more primary goal, 84% of those goals were achieved and 14% part achieved. Pre and post-data for clients who completed a health plan showed there was an average 2.91% decrease in BMI and a 5.64% decrease in waist circumference. Stakeholder NHS and Health Partners Local Authority Clients Outcome and Value Added 90% of people with diabetes have type 2 and over 11 billion a year is spent on type 2 by the NHS alone. By helping clients to achieve this weight loss, this reduces their risk of developing Type 2 Diabetes and will result in a cost saving to the NHS, in time, treatment and development of other conditions. Improvements to wider public health, reduced risk of developing further conditions which could result in need for social care. 75% of the primary goals set were diet related goals, with 86% of those goals being achieved and 12% part achieved. 17% of primary goals set were physical activity relate goals, with 80% of those goals being achieved and 16% part achieved. Reductions in BMI and waist circumference leading to lower risk of type 2 diabetes. Case Study: Grace Grace, who is 75 was referred by a practise nurse as blood tests revealed she was at risk of type 2 diabetes. She was eating a lot of convenience and fast foods, not exercising and drinking to excess. Her mood was low and she was feeling stressed, worrying about family matters. Her main motivation for working with a health trainer was to improve her blood sugar level enough to reduce her risk of type 2 diabetes. The Health Trainer worked with Grace over 12 weeks and they set 10 goals focussing on her diet and physical activity. The Health Trainer offered support and motivation to Grace and signposted her to other services to help her as part of the intervention. At the end of the 12 weeks, Grace achieved all her goals; she lost 11kg in weight, reduced her waist size by 9cm and now exercises 5 times a week. Her self-reported health, mood and confidence levels also increased. Liverpool Health Trainers Social Impact Report 7
Breast cancer pathway Around 50, 000 women a year are diagnosed with breast cancer, 8 in 10 of those diagnosed are over 50 years of age. Overall, breast cancer causes almost 12,000 deaths a year in the UK and costs the NHS an estimated 1.5 billion per year. Breast cancer risk increases with age but there are a number of other risk factors which include a BMI of 35 or more, smoking, a high alcohol intake and low levels of physical activity. According to Cancer Research UK, 9% of all cancers can be prevented by making healthier diet choices and 5% could be avoided by maintaining a healthy body weight. How do we help to prevent it? Liverpool Health Trainer service partnered with the Linda McCartney Centre and Marina Dalglish Centre to offer a new risk reduction service to Liverpool residents. The two sites offer specialist breast cancer support and survivorship programmes. The Health Trainers offered additional support to women who have been diagnosed with breast cancer to increase survival rates and prevent reoccurrence of cancer by promoting healthier lifestyles. Women who are at different stages of treatment or have completed their survivorship programme are referred by specialist nurses through the Moving on Programme. Health Trainers take a person centred approach to support women s engagement with behavioural and lifestyle change. Inputs from PSS and Client In 2015-2016 we engaged with 75 women referred to the pathway. 76% of clients received a health plan and 522 goals were set. We have raised awareness of the risks of breast cancer through one-to-one and group and group discussions in 91 CCG surgeries and community settings. We provided information and leaflets from the Be Clear on Cancer campaign to more than 300 people in different settings across Liverpool. Outputs and Achievements of Client Of the 522 goals that were set - 84% were achieved and 13% were part achieved. 33% of clients who completed pre- and postassessment decreased their body weight by 1.88%. Stakeholder NHS and Health Partners Local Authority Clients Outcome and Value Added Our breast cancer awareness raising activities for women over the age of 70 have contributed to the outcomes of the national awareness raising campaign Be Clear on Cancer. Our one-to-one work with women around behavioural and lifestyle changes is prevention focused, helping to tackle the lifestyle factors responsible for over a third of cancers as outlined in the national Strategy for Cancer, 2014. The outcomes of the awareness raising activities and one to one support work have contributed to the achievement of the local strategic health improvement objectives relating to the increase in the percentage of people receiving breast cancer screening and increasing the 1 and 5 year survival rates for breast cancer. 378 healthy eating diet goals were achieved. 48 physical activity goals were achieved. 11 alcohol reduction goals were achieved. 8 Liverpool Health Trainers Social Impact Report
Case Study: Kay Kay who is 69 was referred to the Health Trainer Breast Cancer Pathway by a specialist breast cancer nurse at the end of her treatment for support with weight loss. She had a high BMI, low mood and did not do any physical exercise. Kay s Health Trainer helped her to set goals to increase physical activity and provided her with a pedometer. They also discussed healthy food choices and Kay was given a food labelling card to use when shopping for food. At the post assessment meeting Kay reported that she engaged in physical activity 3 out of 7 days per week, she had lost 3kg and her BMI had decreased by 1.3. 3 months later at a follow up meeting Kay told her Health Trainer that she now exercised 4 out of 7 days per week, her sleep quality had improved, she was feeling less stressed and her confidence level had increased. She had lost another 6.1kg and her BMI had reduced to 29.7. Telehealth: Blood pressure monitoring using Florence Around 7 million people in the UK live with undiagnosed hypertension also known as high blood pressure (BP). A high BP is one of the biggest risk factors for premature death as it can lead to heart disease, stroke, vascular dementia and chronic kidney disease. 12% of all visits to the GP are because of high BP and it is estimated that treating conditions caused by high BP costs the NHS 2 billion every year. How do we help to prevent it? High blood pressure can be prevented or controlled through lifestyle changes. The detection of high blood pressure is also very important, and this can be done through regular checks. Health Trainers have combined the delivery of an intervention focused on lifestyle and behaviour change with the use of a telehealth system to address both the prevention and detection of high blood pressure. This is in line with the NICE Guideline - Hypertension in adults: diagnosis and management. Florence, also known as simple telehealth technology, is designed to enable people to manage their blood pressure independently by taking readings at their convenience and sending them in by SMS. A response is sent back by the system aligned to a blood pressure protocol. Florence can remind patients to take their readings and to tell them if their blood pressure is too high or too low. Health Trainers have been introducing the technology to patients who may be at risk or have been diagnosed with high blood pressure. The aims of this approach were to enable patients to manage their condition better and to take more responsibility for their own health with the support of a Health Trainer. Inputs from PSS and Client In 2015-2016 our Digital Health Trainers worked with 373 people referred or self-referred to the service. 347 people who used Florence also received a brief blood pressure intervention and selfmanagement guidance. Outputs and Achievements of Client 93% of referrals signed up to use Florence. 81 goals set were achieved. Most of the goals related to using the technology and following the blood pressure guidance. 46 people set up a health plan for further lifestyle support. Liverpool Health Trainers Social Impact Report 9
Stakeholder NHS and Health Partners Local Authority Clients Outcome and Value Added 13% of our clients reported lower blood pressure - it was estimated that if 15% of patients nationally were to control their blood pressure better - the NHS would save 120m over 10 years. A reduction in the number of GP visits which account for 12% due to high blood pressure. Significant illnesses can result from high blood pressure including heart disease, stroke, dementia and kidney disease. Individuals who have one or more of these longterm conditions are also likely to require social care input, rehabilitation services and potentially long-term care. Therefore from a preventative perspective, reducing high blood pressure will reduce the burden on social care. Blood pressure explained: Blood pressure is often expressed as one number over another - both are different types of pressure known as systolic pressure and diastolic pressure. Systolic blood pressure is the pressure on arteries when the heart pumps blood through them - and a normal reading is 120 mmhg. Diastolic blood pressure is the pressure in arteries when the heart rests between beats and a normal reading is 80 mmhg. Therefore, according to NHS choices a BP of 120/80 mmhg or under is considered normal. Blood pressure below 90/60 is considered low and over 139/89 is considered very high. 45 patients completed pre and post assessments on their systolic and diastolic blood pressure readings. In the pre-test study, the average Blood pressure of clients was 143.93/89.4 mmhg. In the post test study, the average Blood pressure of clients was 137.67/86.2 mmhg. This represents decreases of 4.35% in the systolic rate and 3.78% in the diastolic rates respectively which moves clients closer to the normal blood pressure rates, and therefore reduces those risks. Case Study: Jimmy When Jimmy visited his GP with an eye complaint, his blood pressure measurement revealed a higher than normal reading of 169/96mmHg. At the time Jimmy s weight was 93.5 kg, his BMI was 34.3 points and he was physically inactive. The GP referred Jimmy to a Health Trainer who showed him how to use Florence technology. Jimmy learnt about the risks of having a high blood pressure and how lifestyle choices impact on the development of hypertension. He was also shown how to use his phone to send his BP readings to Florence, and after 7 days these were sent to his GP. Jimmy was also supported by the Health Trainer for a further 12 weeks to make changes to his lifestyle. At the post-assessment Jimmy s blood pressure reading showed a reduction to 143/81 mmhg, his weight also reduced to 90.5 kg and his physical activity levels went up to 3 days per week. Jimmy reported that his diet had improved significantly, he no longer consumed processed foods and fizzy drinks, exercised at least 3 times a week and managed his stress levels by delegating and working shorter hours. 10 Liverpool Health Trainers Social Impact Report
Over 75 Social Isolation Project The highest proportion of socially isolated people in the UK are aged 75 and above. 51% of people over 75 live alone, with 5 million reporting that TV is their main source of social company. Being isolated can have a negative impact on health, leading to depression and serious decline in physical health and wellbeing. The Campaign to End Loneliness states that social isolation is as comparable risk factor for early death as smoking 15 cigarettes a day, and more harmful than other well-known risk factors such as obesity and physical inactivity. How do we help to prevent it? In November 2014 Liverpool Health Trainers partnered with four primary care GP Surgeries (Woolton Village, Hunts Cross, Gateacre, The Village) working together to reduce social isolation and improve the health and wellbeing of older people aged 75 and over living in the above neighbourhoods. Patients at risk of becoming socially isolated are referred by GPs and clinicians to the Health Trainers who make contact with the individual and arrange a home visit. At the visit the person s health, wellbeing and quality of life needs are assessed and they are also invited to join a local monthly social group set up by the Health Trainer. The group offers a friendly environment where people can interact, participate in activities or just talk to one another. Transport is provided to reduce any barriers to attendance. Inputs from PSS and Client Between January 2015 and March 2016 Health Trainers worked with 76 socially isolated older people aged over 75 who were referred to the service by their GP. 76 initial assessments at the service users homes were completed. Outputs and Achievements of Client 62 people were referred to the monthly social group. 43 people set health plans with a total of 61 goals. 33 goals were achieved and 3 part achieved. 31 reviews completed. Stakeholder NHS and Health Partners Local Authority Clients Outcome and Value Added The project s work with socially isolated older people has contributed to the achievement of the CCG s vision for community services set out in the Healthy Liverpool Blueprint 2015. Research carried out by the Department of Health has shown that those involved in group activities, such as low level lunch clubs, have improved wellbeing outcomes which contribute to the reduction in hospital admissions and emergency bed days. Such services are cost effective as they contribute to the reduction in health service use. This community-based service has supported older people to improve their mental health and physical wellbeing, and contributed to the reduction in dependence on more costly social care services. The clients who attended the tea parties reported feeling less lonely. Before joining the tea party group 45% of respondents rated their quality of life as a whole as very good and good. This increased to 67.5% following the intervention. Case Study: Brenda Brenda age 75, Neighbourhood: Hunts Cross: Brenda is a carer for her husband who is blind and partially deaf and has type 2 diabetes. The GP referred her to the Health Trainer as she felt alone and unsure of whom to contact for help. The Health Trainer visited her at home to carry out an assessment with her and her husband. He provided information on managing diabetes, relaxation techniques and services they could both access such as Bradbury Fields and Henshaws Society to help with respite for Brenda and support for her husband. They were both invited to the monthly Over 75s tea party and now regularly get out and meet people. They also both attended the Christmas celebrations with a choir organised by the Health Trainers and really enjoyed themselves. Brenda is more aware of services she can call on for respite and is feeling much more confident and happier and less depressed. She said she was so happy she had met the Health Trainer and received the support she needed. Liverpool Health Trainers Social Impact Report 11
Section 6: What else have we done to add value? We have also added value by promoting and taking part in initiatives to reduce health inequalities and tackle the underlying determinants of ill health. Dry January - January 2015/16 - We promoted this campaign to hundreds of people and worked with a number of workplaces to support their staff to abstain for one month and drink more sensibly in general, and we also promoted Dry January through alcohol week. We received training from Liverpool Community Alcohol Service and Liverpool Community Health to help us achieve our objectives. Be Clear On Cancer - July 2015 - We engaged with hundreds of people to raise awareness of signs & symptoms of cancer and we asked over 3,000 people if you have noticed any changes to your body and the people who recognised an unusual change were referred back to their GP. Health Checks - Health Trainers asked 3,756 people if they have had a health check. 963 hadn t attended a health check and were referred back to their GP. Winter Self Care Campaign - We provided long term condition and selfcare leaflets and resources ( managing your condition during winter and COPD/Type 2 Diabetes) to city wide clients/patients and local services to provide to their service users to self-manage their conditions. Care To Know Campaign - Health trainers raised the profile of Adult Social and Public Health services so that local people have a greater understanding of the range of services available from Liverpool City Council. These services can help people to stay independent for as long as possible and improve their wellbeing. We promoted this information in all 88 surgeries we are based in as well as to other care providers. Smoke Free Cars / Home - Health Trainers promoted the key messages across Liverpool through their networks and provided handouts in all 88 surgeries we were based in, children s centres, lifestyle centres and to local key workers and school nurses who engage with families. Time To Change Campaign - Health Trainers as part of PSS were involved in this campaign, facilitating and encouraging discussions regarding mental health. We encourage our clients to talk about their mental health which leads to our service signposting or referring service users to their GP or to local or national services that specialise in mental health, for example; Talk Liverpool, Samaritans, Rethink, Mind, Merseycare, Saneline and the local PSS wellbeing service. 12 Liverpool Health Trainers Social Impact Report
Section 7: What our service users say about us: Service users were asked: Would you recommend a Health Trainer to a friend or family member? Using a 1-10 scale, all respondents gave a rating of 9 or above, which helped the service to achieve an overall Friends and Family rating of 96 out of 100. Our service users say: The support from the Health Trainer really encouraged me to change what I eat and become more active I walk 40-50 minutes every day now and feel much healthier The Health Trainer gave me a great deal of confidence Tremendous Motivational Force 91% of service users believe that since they began using the Health Trainer service their health and wellbeing has improved Life changing Experience could not fault the service Health Trainer Service helped me maintain my efforts to improve my health and wellbeing I have had very good support, which has helped me change some of my... Liverpool Health Trainers Social Impact Report 13
What our service users say about us: Older persons group evaluation: What benefits have you found by being involved in this project? Meeting nice friendly people. Better than looking at 4 walls The organisers are wonderful, very welcoming to me at 85 and alone in Liverpool. Please continue this service, it is a lifeline for me Meeting new people, only people I see all week. Love my lunch, saves me making anything. Thank you! Meeting all the other people. I get all made up and dressed all nice for our day. Love the free lunch and lift. I feel so much better for these get togethers Company. Getting information, speaking with other people. Everybody is friendly and helpful Socialising with folk my age, getting out of the house, meeting very nice people. Thank you, much appreciated 19 service users filled out the evaluation questionnaire. 18 respondents said that they felt very socially connected as a result of attending the meetings and getting involved in the group activities. All respondents said that their overall enjoyment was very good which was the highest score on the scale. 14 Liverpool Health Trainers Social Impact Report
What our stakeholders say about us: Health Trainers enable patients to focus on improving their wellbeing & reducing their risk of illness in the future, they are proactive in encouraging people to change their lifestyle rather than take medication Great Homer St GP Our health trainer is wonderful, I feel that she has improved the patients lifestyles. We have had a huge positive feedback about the service from patients and they feel they are able to carry on practicing what she has taught them Fairfield General Practise Manager Excellent & welcome service, would like to see them be an integral part of the team, as they support work of clinicians and give more treatment options Brownlow & Ropewalks GP Many of our staff have limited time and resources, so signposting to health trainers compliments what our organisation does and enhances the experience of the service user Liverpool Community Health I value the information that health trainers share about services and opportunities in the community Mental Health Project worker PSS Health Trainers are very friendly, approachable & helpful and are a joy to work with Bridge Chapel & Community Centre Manager Health trainers are marvellous and have inspired numerous people to get more active Woolton House Practise Manager Our Health Trainer has built up a good rapport with the patients and has significantly improved their health outcomes, as the Borderline diabetes input from the HT has made such a difference Stanley Practise Nurse Health Trainers have more time to discuss patient problems and have access to more services appropriate to the patient s needs Practise Manager Moss Way Health trainers refer women who may not otherwise have accessed our services but who are often those most in need of what we have to offer. It s always a pleasure to work together and I have always found health trainers to be dedicated, enthusiastic and caring Maggi Williams, Community Worker, Whisc Liverpool Health Trainers Social Impact Report 15
For more information please contact Liverpool Health Trainers: T 0151 706 6705 E healthtrainerliverpool@pss.org.uk psspeople.com Copyright 2016 PSS (UK). A company limited by guarantee, registered in England and Wales (214077) A charity registered in England and Wales (224469)