1. Integrated Wellness Service

2. Overview Rationale for developing new model
What steps we have taken so far
New model
Challenges
Levers for change

3. Rationale for changing model
High prevalence of unhealthy lifestyle behaviours
Many people with multiple lifestyle issues
Wider health determinants - needs around debt, housing, learning, welfare reform
Relatively low levels of wellbeing
GPs wanted clear referral pathway
Local insight supported joined up approach
One third of adults smoke, a quarter binge drink, more than half are overweight or obese and less than one in five do sufficient exercise to keep healthy
Multiple lifestyle issues - who smoke daily drink many more alcohol units per week than people who smoke occasionally or used to smoke
22 % worklessness rate, almost double England average
Nearly 1 in 5 households (around 14,500) classed as living in fuel poverty.
Nearly 20% Knowsley’s adult population have no qualifications, double England average .
32% children and young people assessed as living in poverty in Knowsley
Wellbeing levels low compared to regional average
In Knowsley mental well-being scores lower amongst groups who classify themselves as having poor physical health, lower levels of education, live in an area of deprivation
Review early 2011 looked at local social marketing insight which identified importance of working more efficiently to make one contact with an individual count, rather than repeatedly targeted the same individual about numerous services and lifestyle factors.
It also allows us to support an individual over a period of time to increase the likelihood of behaviour change. A long term, trusted relationship with an individual allows us to focus on their relevant issues systematically. We can support them to stop smoking, then ask them what else they are interested in and support that lifestyle area, rather than ‘bombard’ them with multiple advertising lead propositions.

4. Lifestyle Pathway – 2010 Number separate referrals
Single lifestyle behavior based support.
Limited cross referral.
Limited conversations and connnections to wider wellness support, (except through HT service).

5. Changing our model
SPOA 6mths pilot 2011 worked with 2 GP practices & lifestyle providers
Single referral form & system to Health Trainer Service
Full evaluation of the pilot, led to SPOA roll out to all GPs from Aug – Oct
Benchmarking / action plan using wellness standards
Lifestyle Service review meetings
Redesign of service model & new specification

6. Single point of access referral form

7. IWS Model
Client receives phone contact & brief intervention within 48 hours by hub, 6 wk follow up
Holistic approach, joined up delivery, addresses multiple needs, person centered support, outcomes electronically fed back to GPs

8. Challenges Embedding new system of working
Information sharing / duplication
Information system for Health Trainer Service
Information system across providers
New training needs
Pathways to services / support that are not PH commissioned services
Accessible and interactive website

9. Levers for Change Public Health leadership
Effective Use of Services – HWB priority
Commitment to asset based working - JSAA
PMS GP contract – sign up to SPOA & follow new referral pathway
Involvement & relationship with lifestyle services
Re-design Health Trainer & community health service – new contract
2 x CQUIN – Brief intervention training across frontline health staff, wellbeing training / hub
IWS ongoing piece of work
24 PMS practices, 35 practices
cost of redesign which has been great 120k database, over 150k CQUINs for  a start!
TCS, QIPP, WCC other enablers
HT target is 27 referrals a day, currently receiving around 240 referrals a month