Creative Minds – South West Yorkshire Partnership NHS Foundation Trust

Creative Minds – South West Yorkshire Partnership NHS Foundation Trust
Category – Strengthening the Foundation

Introduction / Overview

South West Yorkshire Partnerships NHS Foundation Trust (SWYPFT) provides general community, mental health, learning disability and substance misuse services to the people of Barnsley, Calderdale, Kirklees and Wakefield, and forensic services to Yorkshire and the Humber. Our mission, which was developed from the ideas and opinions of all our stakeholders, is “enabling people to reach their potential and live well in their community”.

Summary

Creative Minds is an award-winning strategy that develops community partnerships and co-funds creative projects across South West Yorkshire Partnership NHS Foundation Trust’s localities in Barnsley, Calderdale, Kirklees, Wakefield, and in the Trust’s forensic services. It utilises creative activities such as arts, sports, recreation and leisure, delivered in partnership with over 70 local community organisations to increase the confidence, develop the social skills, and improve the lives of thousands of local people.

Creative Minds was launched in November 2011 in response to patients and carers expressing their desire for more creative approaches to understanding and supporting their health and wellbeing. The strategy was co-produced through a series of workshops which focused on working with and listening to the views of patients, carers, Trust staff and community organisations and groups, ensuring the Trust put the patient at the centre of the development of the initiative.

Where individuals have low expectations and poor self-image, the sense of achievement found in creativity gives them a chance to move away from negative and self-destructive patterns and habits, and start to write a new story of recovery.

An important element of Creative Minds is how it supports the Trust’s mission to help people to live well in their community through accessing local services that enable them to reach their full potential.

The main reason for developing the Creative Minds strategy was to meet a continued desire from patients and carers to be able to use more creative approaches to support their wellbeing. Workshops were held across the Trust to brought patients/carers, staff and community partners together to develop the strategy.

Creative engagement was seen as an opportunity for people to engage as equals, to shift the power imbalance between care providers and the cared for, and for people to progress towards personal autonomy. Many participants find that they discover a passion for a particular activity or talent they never knew they had, which gives them the means to maintain their health and wellbeing through finding a hobby they can continue to enjoy for the rest of their lives.

What Was Done?

A major aim of Creative Minds was to build a strong infrastructure of community and voluntary organisations able to work with the Trust providing excellent creative projects for all who access our services.

Partnerships and co-production was at the core of the conception and development of Creative Minds. It not only shows our commitment as an organisation to having a creative approach to service delivery but also showcases our passion for working in partnership with our communities.

Creative Minds has provided a way to build on existing good practice in our services, and to work more closely with a wide range of community organisations enhancing our service provision by delivering innovative, transformative and meaningful health and wellbeing projects. We have a network of internal and external champions whose passion and commitment to creative approaches has helped to bring Creative Minds to life.

We are now using this infrastructure to help embed this different way of working in all that we do.

Impacts / Outcomes

To date, Creative Minds has delivered almost 200 creative projects in partnership with over 70 community organisations and groups, benefitting over 4,000 participants.

Currently, most projects carry out their own internal evaluation. Two of our projects have also carried out their own social return on investment reports, and these show that for every £100 invested we get a £700 social return on investment. Work is underway to use our mental health clinical system to identify the pathway and package an individual is on prior to a Creative Minds project, then to re-evaluate once they have experienced the project in order to capture any decrease in need for services.

Creative Minds was chosen as the winner in the ‘compassionate patient care’ category at 2014’s Health Service Journal Awards – an accolade that proves its worth among healthcare professionals.

However, the most revealing and striking feedback comes from the participants themselves. The way they talk about themselves and their new lives with a new-found confidence and self-assuredness speaks volumes about the impact Creative Minds is having. A series of films featuring personal testimonies were created to show the success of the strategy first-hand.

Key Elements

The principles and philosophy of Creative Minds seemed to strike a chord with many people. We have initiated a genuine social movement of which people want to be part, and for which people feel a sense of ownership. A key component of the popularity of Creative Minds is the fact that it holds such a broad definition of ‘creativity’. Arts, sports, recreation and leisure activities are just some of the types of projects that Creative Minds co-funds, giving participants the opportunity to take control of their own care and recovery through feeling empowered to make their own choices – just one of the reasons why 4,000 people have been able to benefit from the initiative.

Participating creatively as a means of self-expression tackles social exclusion, promotes self-acceptance and raises aspirations through allowing the individual to discover talents, skills and abilities that combat the feelings of negativity surrounding their mental health. All of these things can help people to develop feelings of pride and satisfaction, enabling them to feel worthwhile. Finding an activity that they enjoy challenges negative self-images and where people have low expectations of themselves, the sense of achievement that can be found in creativity is unrivalled.

Our Creative Minds approach recognises that successful interventions which have an impact on mental health conditions through timely, targeted support will have substantial social and cost benefits.  In relation to meeting current needs, Local authority joint strategic needs assessments identify the importance of finding ways of bringing key partners together from across the sectors to understand how their actions can impact on health and wellbeing, and how by working collaboratively and adopting models of good practice, they can play an important role in maintaining and improving health and wellbeing.

Although Creative Minds has mainly provided for mental health patients, we have also projects specifically for people with learning disabilities, health and wellbeing teams and substance misuse services. Creative Minds is also starting to deliver benefits to people with long term physical health conditions and hidden impairments. Creative approaches offer a different way of engaging with communities and have worked especially well with people who have traditionally been more difficult to engage. Projects sensitive to different cultures and faiths have been developed, promoting a sense of inclusion.

Learning Points

  • Reducing stigma: Showcasing positive artistic achievement challenges negative stereotypes and celebrates participants’ talents and abilities.
  • Recovery: Creative activities have made a difference to participants’ wellbeing as well as helping them to feel as though they are a part of a community.
  • Prevention: Creative programmes have been shown to promote better health and wellbeing in vulnerable individuals and to foster social integration, community strength and cohesion.
  • Early intervention: Early engagement with ‘softer’ techniques avoids deterioration of health needs and the need for more expensive and intrusive interventions.
  • Personalised care: Offer real choice to individuals to develop self-determined packages of care.
  • Multi-agency working: Real opportunities for partnerships with creative groups and agencies, increasing the range of creative resources and approaches available to patients.
  • Innovation: The creativity agenda can be used at all levels within the organisation to seek innovative approaches to client care, team development, service development and organisational management.
  • Value for money: There are opportunities to lever additional funds through partnership working with external arts/health agencies.
  • Strengthening transition: New opportunities in the wider community, supporting progress away from acute services towards greater autonomy and independence.
  • Resilience: Creative approaches have been shown to be effective in building cohesion and strength in vulnerable communities and providing significant gains in personal resilience.

Bringing Safer Care Closer to Tanzania – Northumbria Healthcare NHS Foundation Trust

Category – Bringing Patient Care Closer to Home

Introduction / Overview

Northumbria delivers integrated acute and community health and social care to the residents of Northumberland and North Tyneside. It is the largest geographical Trust in the UK covering 2000+ square miles.

Employing over 9000 staff – together each year we:-

  • Care for over 73,000 patients and families on our wards.
  • Provide treatment to around 167,000 patients in our A&E departments and minor injuries units.
  • Perform almost 27,000 operations.
  • See more than 45,000 people for day-case procedures.
  • Carry out around 1.3 million appointments with patients outside of hospital.
  • Provide adult social care support during 70,000 home visits.

Summary

1

This project describes a unique partnership and global collaboration that has brought care closer to home by introducing laparoscopic surgery as a new service to Tanzania.

Northumbria, with full support from our Board and Charity Development Group, approached this as a long term training development programme. Successful implementation required the total commitment of a dedicated team to see it through over a decade.

People may say that laparoscopic surgery is not an obvious choice for implementation in a less developed country due to the high-tech nature of the equipment and the high-level skills required of the surgical team.

The real challenge was to be able to develop the new service from Northumberland, UK, 7000 kilometres away!

The ambitious programme required a team effort over a sustained period of time, working within a challenging environment, with few resources and frequently without electricity! Each year new procedures have been introduced and keyhole techniques are now routinely used for diagnostics and biopsy, improving the health outcomes for hundreds of patients.

Recently secured AHSN monies will enable the learning from this project to be shared across the UK, as well as promote the innovation that can result from volunteering in less developed healthcare systems.

The benefits of laparoscopic surgery are numerous. For the patient: less invasive surgery and less anaesthesia, much reduced chance of haemorrhage requiring transfusion (HIV risk), fewer days in hospital, reduced incidence of infection, less chance of complications, less requirement for post-operative medication and nursing care, reduced need for outpatient visits or district nurse follow up, return to work quickly and, most important, less overall cost to the patient for the healthcare intervention.

For the hospital: reduced theatre time , ability to manage day case elective surgery to ease congestion on surgical wards, less patient aftercare required and lower costs of service delivery.

In 2002, Northumbria was approached by the Chief Executive of Kilimanjaro Christian Medical Centre (Tanzania) to explore the possibility of introducing this service to address the backlog of patients on surgical wards. With an average occupancy of 116%, the hospital needed to be able to process more patients each month and discharge them quickly.


What Was Done?

Surgeon Liam Horgan, sister Lillian Broatch and sister Sue Colley provided dedicated support to the developing Tanzanian laparoscopic team through annual training visits to KCMC. In between, Tanzanian surgeons and senior theatre nurses visited Northumbria for specialist training. The project gained further momentum with the donation of two laparoscopic stacks from sponsors.

The development of a new service is a challenge and there are many stages in the acquirement of new knowledge and skills before competency is assured. With the full support of the KCMC Surgery Department, Northumbria was able to develop and implement innovative training methods to fast-track the creation of a new laparoscopic service for Tanzania.

Furthermore, since 2008 the Northumbria team has supported KCMC to deliver annual laparoscopic surgery training courses for surgeons and nurses from across Tanzania. This was followed in 2011 by the development of a laparoscopic surgery module within the medicine undergraduate course at Tumaini University.

With the UK training team so far away, thoughts turned to distance learning possibilities but an internet msn/skype link would not be sufficiently reliable and a dedicated satellite connection proved to be too costly. The team developed a dedicated audio-visual link between Theatre 1 at KCMC and Hexham General Hospital to support training. UK surgeons could view images from the laparoscopic endoscopy camera beamed from Tanzania and guide the surgeons while the surgery actually took place.

The innovative surgical tele-mentoring link gave the Tanzanian surgeons the opportunity to gain greater experience and confidence with each transmission. Within Tanzania, images from the endoscopic camera were also linked to the seminar room so that the surgeon could talk to students and answer questions throughout each procedure. Previously up to 20 medical students would be crammed into the operating theatre to observe.

2


Impacts / Outcomes

Before the introduction of laparoscopic surgery at KCMC, open surgery was performed on all patients. This led to a higher possibility of post-operative infection due to overcrowding on the wards and patients needed a longer stay in hospital to recover. Laparoscopic surgery offered an alternative for patients which significantly improved their health outcomes.

Following two years of intensive training, a regular weekly laparoscopic cholecystectomy list was established at KCMC during 2005, the first hospital in Tanzania to do so. Dozens of patients were treated with improved laparoscopic techniques within the first few months.

Further advanced training took place over successive years and as KCMC established itself as the only government hospital to offer a laparoscopic service, people began to travel from across Tanzania, and further afield from Kenya, to book laparoscopic interventions for gall bladder removal, removal of the appendix and inguinal hernia repair.

By 2013 keyhole surgery was also being used more widely for diagnostic procedures, reducing the number of multiple-site open incisions which may be required during emergency surgery, especially when high quality diagnostics may not be readily available.

Now all gall bladder and appendix removal is undertaken laparoscopically.

Keyhole surgery is also now being used in terms of diagnosis of potentially terminal conditions, providing a better chance of the patient being able to return home to their loved ones for their final days rather than remaining in hospital for post-operative care following conventional open surgery.

Key Elements

The project has been able to contribute to the development of Tanzania’s health service through the introduction of laparoscopic surgery as a new service for the population of Tanzania.  KCMC has prospective audit data for over 400 procedures. When, in future, laparoscopic surgery is available at all Tanzanian consultant-referral hospitals, the numbers of beneficiaries will be in the thousands.

Other factors contributing to the success of the project:-

  • Determination of the team to find innovative solutions despite the obvious and significant geographical, and financial barriers.
  • A shared vision, friendship and strong partnership between two organisations that has developed over more than 10 years now.
  • The support from Northumbria Trust Board and commitment to a long term partnership with Tanzania, from which everyone benefits.
  • The governance arrangements developed for this work are cited as best practice in government reports, including the recent All Party Parliamentary Group report on Global Health

Northumbria has launched a Global Health Fellowship as part of its leadership programme in acknowledgement of the unique developmental opportunities provided by international work.

There has been money secured from the North East Academic Health Science Network to continue the work
http://www.northumberlandgazette.co.uk/news/local-news/nhs-trust-putting-itself-at-forefront-of-global-volunteering-1-7027683


Learning Points

  • Firstly remember ‘Pamoja Tunaweza’, which in English means ‘together we can’.
  • This unique project brought together teams of engineers, surgeons, theatre nurses, operational managers and external stakeholders to work together over a number of years to advance surgical teaching and training in Tanzania and launch a new surgical service and bring vital care closer to home.. 
  • The shared vision and strong partnership working of the UK and Tanzanian teams gave the momentum needed to struggle through new uncharted territory and succeed on two levels: service development and innovative workforce development.
  • That while the benefits for Tanzania are obvious, Northumbria, as a well resourced organisation, has gained just as much from this partnership as Kilimanjaro Christian Medical Centre.

The value of patient information

A new report from PiF (the Patient Information Forum) and MHP Communications investigates patient experiences of health information and support. The report is based on a ComRes Poll carried out in February 2015 with 1,567 people living with long term conditions.

The findings included:

  • 36% of people disagreed that they were given helpful information when they were first diagnosed
  • 30% felt their views and opinions on care and treatment are not taken seriously by their doctor
  • 20% didn’t feel they had enough information to feel confident in discussing treatment options with their doctor

In the report PiF and MHP Communications call for health information and support to be better integrated into the treatment and care that is provided by health services. Information needs to be recognised as a key intervention for improving outcomes. This should be seen as a core part of a patient’s care, should be personalised and delivered as a standard part of engagement. Information should be accompanied by appropriate support structures to ensure it can be used effectively.

PiF is a non-profit organisation that seeks to champion the role of health information in improving patient outcomes and experiences, and provide support to organisations and individuals to help ensure the health information they produce is high quality and accessible.

Previous research from the organisation bought together evidence on the value of information, highlighting the central role it can play in improving experiences of care and patient outcomes.

PiF have recently launched a Toolkit for creating health information that works, including best practice guidance and links to practical tools and resources. In July they are holding their 10th anniversary conference that will focus on the role health information and support can play in empowering patients and the public to play an active role in their health and care.

You can find out more information at www.pifonline.org.uk .

Using Insight Across Health Systems to Improve Care

Midlands & Lancashire Commissioning Support Unit

Midland and Lancashire Commissioning Support Unit employs over 900 people and provides commissioning support services to 24 CCGs, NHS England, some acute providers and other related organisations. There are regional offices in Staffordshire, Lancashire and in West Bromwich.

Rationale & Summary

  1. Create a single repository for patient experience feedback from so that themes and trends could be established to ensure that a future Mid Staffs scandal was avoided by using real time feedback via dashboards confirmed based on a personal portfolio of service provision.
  2. The project was extended to include clinical feedback and safety information this creating a safety system this was to ensure that all data could aggregated and themes via standardised data set. The project allowed, multiple organisations to feed information on quality into one system to provider themes and trends the users of the system are outlined in figure 2
  3. The data aggregation was set up to allow data to be aggregated at a provider level across multiple locations and organisations/CCGs to ensure that a true picture of provider performance could be seen.

This innovation is 5 years old, and has grown from a small patient experience project to a holistic quality approach to collecting, theming and trending date from patient-experience, clinical-effectiveness and safety data across organisations to provide real time feedback on provider services. It was developed by the MLCSU working in partnership with CCGs to develop insight from real data and has the potential to be used by providers too. Some of the CCGs are considering this part of the contracting arrangement with their providers to report data using standardised data-sets.

1

Figure 1

In 2009 standardised data-sets were developed and a single database to record commissioning patient-experience data from complaints, focus groups, social media/media, and online source (Figure 1). It developed into a quality system that currently covers 12 CCGs, over 440 GP practices, NHS England local area team in Staffordshire/Shropshire, condition support groups and out of hour’s providers.

All data is fed into the system and themed as below(Figure 2)

2

Figure 2

All data covers of the three pillars of quality to provide information in real time across multiple organisations and locations. This has been achieved through system wide leadership and a health economy approach to sharing data and managing contracts/performance of providers.

Figure 3

Figure 3

The project has been supported by senior leadership and via clinical engagement with GPs has been extended to cover multiple sites and sources of data. It has been led and implemented by people who truly want to see patients at the heart decision making within the commissioning process learning has been gained through the delivery of the project.

Figure 4

Figure 4

The system has been developed to incorporate multi-site reporting with bespoke data entry and reporting options that encompasses the three pillars of quality, by collating, aggregating and triangulating data to pinpoint areas of improvement.

Figure 5

Figure 5

What Was Done

The system was developed to use the five domains of patient-experience to theme and trend data, CCGs to develop new ways of providing, theming and trading data. Stoke-on-Trent and Fylde and Wyre CCGs have been instrumental in the development of the system to record safety and clinical effectiveness data through events (incidents) reporting at GP Level

The project is now 5 years old and has grown organically as outlined

4 2009 – 1 PCT
5 2010 – 2 PCTs
6 2011 – 6 CCGs
7 2012 – 9 CCGs
8 2013 – 10 CCGs and 54 practices
9 2014 – 12 CCGs, 228 GP practices and an out of hours provider
10 2015 in progress 1 CCG, 66 practices and NHS England Midlands

The project continues to grow with the advent of co commissioning, federation and integration of health/social care and the fact that the approach is now embedded into the culture of the organisations will ensure its sustainability. We have interest from other strategic partners in creating network of sub regional data and are exploring the possibilities of working with other CSUs across the country.

Impacts / Outcomes

A total of 21,715 individual records have been entered into the system and are available via real time dashboards

1. Complaints 1738
2. Compliments 213
3. Voluntary Sector 275
4. Media 1590
5. Social-media 231
6. MP Letters 620
7. PALS 5530
8. Patient Story 58
9. Clinical Feedback 680
10. Soft Intelligence 7659


Events – Safety and Clinical Effectiveness -3121

 

Death (Caused by the event)

38

Good Event

25

Low (Minimal harm)

864

Moderate (Short term harm)

528

None (No harm)

1578

Severe (Permanent or long term harm)

88

Total

3121

1. 98% of events rated as severe and above have had follow up action taken on them.
2. All events and feedback are reviewed within 30 days
3. All data is shared across health economies figure 3
4. 1200 active users of the system
5. Over 600 hours per year reviewing the data and setting actions across the CCGs
6. Data is review at quality subcommittee and formally reported to the CCG board for primary and secondary care
7. 68% of cases that require action have an action formally recorded against them
8. 181 GP practices trained
9. Over 350 GP practice staff trained
10. Over 600 members of staff at CCGs trained
11. Over 150 CSU staff trained
12. Over 50 NHS England staff trained
13. Regular quarterly reporting for 12 CCGS by theme and trends
14. Over 300 individual real-time dashboards and reports
15. Top ten themes and trend identified

Changes initiated as result of the system

1. New system to inform practices in Blackpool when a patient dies in hospital
2. Changes to referral system for CAHMS
3. Contract review for WMAS to deal with suspected fractures
4. Use of locum radiographers to clear backlogs on imaging
5. Improved discharge reports and communications
6. Full clinical review of district nursing services
7. Review of the falls service
8. Themes and trends feeding into communications and engagement strategy
9. Review of coding in radiology and pathway
10. Improvements to the paediatric discharge pathway
11. Improvements to confidentiality and training on information governance
12. Plain film reporting has been improved
13. Standardised format for discharge summaries
14. Improvements to scripts for 111 service
15. Contract reviews of 111 and radiography service
16. Assurance measures for ophthalmology service
17. Adult protection and safeguarding referrals

Key Elements

1. Clinical leadership both initiating and sustaining sponsorship
2. Engagement with GPs and practice managers – linking into what important to them and what they are passionate about
3. Long project length and its organic growth based on what people can feel as the tangible benefits
4. Linking insight to involvement and giving the information about what patients experience to patients to ensure improvement, accountability and scrutiny.
5. Health system approach, data sharing and looking at themes and trends across primary scoriae and tertiary providers
6. Use of standardised data sets and pre designed forms to ensure data consistency and calibration
7. Use of real time data and the ability to set flags within the system – reposnvine4ss to patient and clinical feedback
8. The ability to have all data in one place so that smaller anecdotal feedback is turned into evidence
9. The use of clinical champions to encourage engagement with clinical staff and practices.
10. The CSUs ability to understand what CCGs need from the reporting in terms of quality and working in partnership to develop it
11. The cross health economy approach as outlined in figure 3 sharing data, comparing data at contract monitoring meetings and setting actions that have an audit trail.
12. Passion and commitment to the small team of people who have developed the system and have worked from a patient perspective to implement.

Learning Points

1. Taking a whole system approach
2. Developing standardised data sets
3. Calibrated data with clear entry instructions
4. Champions at local level
5. Clinical engagement about the things that practice value and find important
6. Tenacity in development
7. Vision about what the system could achieve rather than just a focus on what it does

This project has been the subject of national interest through the below accolades and through speaking at national conferences

http://youtube/W47m6MAxAlU

http://www.youtube.com/watch?v=Aq01dKqNz5c

http://healthandcare.dh.gov.uk/case-study-north-staffordshire/

http://www.pcc-cic.org.uk/sites/default/files/articles/attachments/lesley_goodburn.pdf

http://cdn.pcc-cic.org.uk/sites/default/files/comm_excellence_may_2012.pdf

http://cdn.pcc-cic.org.uk/sites/default/files/comm_excellence_june_2013.pdf

http://issuu.com/maritimemedia/docs/inno_in_healthcare_v7_web?mode=embed&layout=http%3A//skin.issuu.com/v/light/layout.xml

HIV Peer Support Improving Well-Being – Positively UK

Positively UK is a patient-led charity founded over 25 years ago by two women living with HIV, putting up hand drawn posters in HIV clinics across London and gathering together in their living room to offer each other support. We are now a medium sized charity with 19 members of staff and 50 volunteers; with all front-line staff and volunteers trained and accredited in delivering peer mentoring and advocacy. Our aim is to improve the physical, emotional and social well-being of people living with HIV; we believe good health and quality of life is determined by all three, they are equally important and often over-lapping.

Based in London we support 1,000 people per annum through outreach at HIV clinics, prisons and our base in Islington encompassing one-to-one assessment, information, guidance, mentoring and advocacy; culturally specific group support and recently diagnosed workshops.

Across the UK we support agencies developing local peer-led workstreams, advocate with national bodies e.g. BHIVA, NICE and promote the greater involvement of people living with HIV in care through initiatives including our biennial conference of people living with HIV.

HIV is now considered a long-term medical condition and the treatments mean people living with HIV can have a comparable life-expectancy with the general population.

However HIV brings challenges in managing medications and their side effects, sexual health when living with a communicable condition, and the psychological impact of living with a disease that is still met with stigma. Research also indicates that people with HIV experience poorer mental health than the general population.

Positively UK’s peer support service was developed to address all of these issues and aims to help people feel more in control of their condition.

Access to good quality peer support is vital for people living with HIV. This project set out to demonstrate that, and how our work contributes to both the NHS Outcomes Framework in managing longterm conditions, and Public Health Outcomes Framework in improving well-being.

Peer led support is an undervalued and underfunded service. This initiative stands out because:

  • it is patient-led, with services developed and delivered by people living with HIV
  • in obtaining the statistical it gives credence to the value of peer support in long-term condition management and improving well-being.
  • it is a collaboration drawing on the strengths of the voluntary sector to support clinical care
  • it demonstrates peer support is transferable and can help many people with many different conditions, not just HIV,
  • and the Warwick-Edinburgh scale could be used to measure impact on well-being in any setting

Positively UK’s peer support service is innovative in helping people manage HIV as a long-term condition. It is uniquely integrated into clinical settings with the continual investment into the professional development of peer workers and volunteers. It has demonstrated leadership across the sector in developing standards which are now being recognised within the new NHS 5-year vision.

External evaluation found peer support contributed to the NHS Outcomes in managing long-term conditions with patients reporting increased understanding of HIV, medications and engagement with clinical teams. It contributed to the Public Health Outcomes Framework with a significant improvement in mental well-being (p=<0.01) using the validated Warwick-Edinburgh scale. The initiative is sustainable with commissioners committing to continued funding of peer support in London boroughs and NHS Trusts directly commissioning Positively UK to establish peer-led support within their patient cohorts.

Project findings were disseminated across the health and social care sector including a launch event; as a result we are working with HIV voluntary sector and NHS Trust partners across the UK to implement a national programme pf accredited peer mentoring; and, showing transferability, working with NHS England, NESTA and National Voices in a wider evaluation in the role of peer support in long-term condition management.

Positively UK’s peer support service is currently being commissioned by Local Authorities and CCGs and supplemented by Trust funding.

Staff and volunteers who deliver the service are integrated into 10 clinics across London working as part of interdisciplinary teams providing support, advice, information and advocacy. They are qualified to a minimum NVQ Level 3 Guidance or equivalent.

To extend our reach, a new volunteer programme was developed and recruited 50 volunteers over two years, all living with HIV, all trained and accredited to Level 2 in Peer Mentoring through the Open College Network, and to the Mentoring and Befriending Foundation’s required standards.

Our primary measure for the success of Positively UK’s peer support service was to demonstrate its role in achieving statutory outcomes set out by the NHS (in managing long term conditions) and Public Health (in improving well-being).

Secondary measures included studying the perception of peer support, how it complements clinical care and enables people to better manage their health. This involved conducting a survey which was distributed to people who have used, or are currently using Positively UK’s peer support service. Participants were recruited through internal local meetings and word of mouth. The questions included the validated Warwick-Edinburgh Mental Well-being scale (WEMWBS)

Results were collected, analysed and presented at a launch event in Jan 2014. We also conducted a short HIV clinician perception survey with the 10 clinics where we deliver outreach to identifying how and in what way peer supports complements clinical care.

Results showed a significant improvement in mental well-being (p=<0.01) using the validated Warwick Edinburgh scale for those who accessed Positively UK’s peer led support services and participated in the survey. Graph 1 below reports on the average scores for each parameter. case1

Patients also reported that peer support has a positive impact on other aspects of living with HIV shown in the graph below:
case2

We also conducted a clinician survey which shows the HCP’s who offer this service within their clinics value it greatly, 100% stated that peer support complements clinical care and either significantly (60%) or considerably (40%) improves the understanding and management of HIV.

The impact of this research has been commissioners from Inner North West London confirming the continuation of the service with other commissioners committing to continued funding for peer support within required retendering. As a result of the launch event a large trust fund approached us and asked us to develop large scale proposal for a national roll out of accredited support.

The research was supported by a grant from MSD and the secondment of a researcher and employee of MSD

Peer support is now considered by the NHS as a key component of improving patient care within the 5-year review published in November 2014. Positively UK’s work has been identified by NESTA and NHS England as an example of best practice in the field. NESTA and NHS England are working with National Voices to undertake a wider evaluation of peer support across long-term chronic conditions, and Positively UK’s CEO will be involved in a steering group for this programme.

Positively UK’s peer support model could be used in any setting and in any therapeutic area. The service has humble beginnings, starting very small and growing to now supporting over 1000 patients a year with statutory funding in place. Other organisations could start with a small local peer-led service slowly establishing it in their therapeutic area and very quickly begin to see the significant results we report above.

We are currently working with agencies across the HIV sector in developing a framework for HIV support services seeking to influence the commissioning of effective services across the UK. Our evaluation is a key tool within this demonstrating the effectiveness of peer support.

The research has also been of relevance to others working in the HIV sector across the UK in demonstrating the role of peer support in long-term condition management and is easily transferrable to other areas, especially long term conditions. As member of National Voices, working with NEST and NHS England the work will have a wider impact and support the robust evaluation of peer support across other long-term conditions.

Peer led support services significantly improves the well-being of patients facing a long term condition and can be used in any healthcare setting in most therapeutic areas. Using validated questions to measure impact will definitely lead to more robust results and we would highly recommend using the Warwick-Edinburgh scale, it was easy (and free of charge) to obtain permission to use it.