2016 NIA Fellows – Penny Newman (2/3)

A spotlight on NIA Fellow Penny Newman (2/3)

by Rebecca Wycliffe

The second inspiring woman, in this series of articles, is a Fellow of the 2015 NHS Innovation Accelerator cohort, Dr Penny Newman, and Co-Designer and Clinical Lead of the pioneering programme for clinicians, NHS Health Coaching.

(For the 1st full piece from the series please click here)

The NHS Five Year Forward View, which was launched in 2015, set out a positive vision for the future healthcare system. A triple aim was proposed: to improve population health, quality of care and to create a more financially sustainable NHS. With an aging population, and growing number of patients suffering from long-term chronic illnesses and mental health problems, health and social care services are under ever increasing pressures. These services need to grow to meet the demand of the increasing population and changes in patient health, but with surmounting financial pressures on the NHS, more sustainable and cost-effective solutions must be found. Patient engagement and quality of care have been a key focus to enable these solutions. Supporting patients to manage their own health and giving patients more direct control over their own care could lead to higher standards of care and patient satisfaction as well as more efficient and cost-effective services[1],[2].

Many health tech start-ups are transforming health and social services across the UK and helping to meet the goals set out in the Five Year Forward View. Initiatives such as the NHS Innovation Accelerator (NIA) Programme have been launched to support healthcare pioneers develop and integrate their evidence-based innovations into the NHS in the hope that they will revolutionize health and social care services and improve patient outcomes. Over the next few weeks, I want to share with you the work of several remarkable women who have developed innovative ways to educate and encourage patients to take more responsibility and become actively involved in their own health choices, and who are ultimately providing solutions to the key challenges facing the NHS today.

The NHS Health Coaching programme was first developed by Drs Penny Newman and Andrew McDowell. The aim is to transform the patient-clinician relationship and enable patients to become much more active in their own self-care. Based on the science of behaviour change, the 2-day training equips clinicians with new attitudes and communication skills to motivate and guide patients in managing their own long-term conditions (LTCs). The training gives clinicians, such as practice nurses, GPs and physiotherapists, new tools in their toolbox to have more effective conversations with their patients and help patients identify and achieve their own health goals. The training is complemented by an implementation toolkit developed by a range of experts with a film, patient stories, “know how” and infographics to grow the social movement so more people have a “better conversation” and as a result, have less need to use the NHS.

The Health Coaching initiative was first piloted in 2010/2011 in which thirteen practice nurses across seven GP surgeries in the East of England received a four-day health coaching training. NHS Health Coaching has since reached over 4000 clinicians and been implemented into a broad range of health and social care organisations, including several CCGs. Acute and mental health trusts, county councils and General Practices have also adopted Health Coaching in many regions across the country; in Leeds, the training has been adopted city-wide.

Research has shown that patients often do not comply with their prescribed medications and can find it hard to make changes to their lifestyle after seeing a healthcare practitioner1,2. Many people are aware that they need to change their lifestyle and behaviours in order to live a more healthy life, but often don’t know how. Health coaching is an innovative approach to improving the conversation and communication between clinician and practitioner and gives patients the confidence, skills and knowledge to become more active participants in their own care.

Health Coaching has been used to effectively aid patients in smoking cessation, weight reduction and diabetes control3. Clinicians participating in the NHS Health Coaching initiative reported that patients were more self-confident, more motivated to make positive behavioural and lifestyle changes to their health and more satisfied with consultations, than prior to the health coaching training4,5. Reports from clinicians suggest that the programme produces many benefits including: higher patient compliance, reductions in appointments per patient, improved care quality and consistency and less waste from unnecessary medication4,5. Health coaching also saves costs, as patients become less dependent6,7.

A few words from Dr Penny Newman on Health Coaching:

What motivated you to create the Health Coaching Programme?

“Firstly, as a GP, I felt that I could do more to help my patients, in terms of assisting them to help themselves, but I felt stuck because there wasn’t any training available to support behaviour change in one-to-one relationships in practice. In my other role in public health, I could see from the data that the growth in long term conditions due to detrimental health behaviours is a public health disaster, so felt that this needed to be addressed.

The main catalyst for me was when I went on a leadership training programme, led and co-ordinated by Dr Andrew McDowell, a psychologist and Partner at TPC Health. I realised that I could apply similar coaching techniques to help my patients identify their health goals and help them realise their full potential. I later formed a partnership with Andrew and together we developed the training for the NHS Health Coaching programme”.

Why do you think it is important for patients to become more active participants in their own care?

Penny Newman — NIA Fellow & Co Designer and Clinical Lead for NHS Health Coaching

“People are living much longer, although for many people with long term conditions and especially at the end of life, their quality of life is poor. There is mounting evidence to show that diabetes is a public health disaster. There is a need to reduce obesity, increase mobility and help people to take their medication as prescribed — only one third to a half of patients actually take their medication correctly.

These issues can be addressed by empowering people to change behaviour, using simple communication techniques. As clinicians, we want to encourage people to be healthy but telling people what to do doesn’t work — it’s ultimately a choice. It can be very hard for people to change bad habits and often they don’t know how, or don’t feel motivated to do so. However, we can help people by having a more effective conversation and by identifying the things that they can change in a small way that will help them make positive changes to their health and grow in their confidence. We’re giving clinicians the toolbox to help patients identify and plan their own goals, which are things important to them that are worth changing for, rather than when clinicians find solutions for them. If patients come up with their own goals and health solutions, they can’t argue with them.”

How do you feel the Health Coaching Programme aligns with the Five-Year Forward View?

“One of the aims of the Five Year Forward View is to empower people and communities to self-manage — it talks about “tapping into the renewable energy of patients.” Health Coaching does just that — it gives patients the knowledge, skills and confidence to manage their own long-term conditions, helping them to remain as independent as possible. I believe that having a better conversation to make people feel more empowered underpins everything in the Five Year Forward View as so much rests on the patient-clinician interaction — everything that happens in the NHS relies on good communication. If we could master communication we could reduce complaints, demand and costs.”

What are your plans for the Health Coaching Programme in the next year?

“We’re rolling out training and encouraging lots of areas across the country to become involved and champion better conversations. We believe this will help clinicians to feel more confident in their abilities to have these important conversations and share more responsibility with patients, which they find helps reduce the pressure they’re under. We also hope to partner with organisations, including the third sector, and increase knowledge, research, and standards in health coaching.

We’re encouraging people to spread the word about ‘better conversation’. We’d really like more people to join us in this social movement!”

1. Haynes, R.B., McDonald, H.P. and Garg, A.X. Helping patients follow prescribed treatment: clinical applications. 2002. JAMA. 288. 2880–2883.

2. Haynes, R.B. Improving patient adherence: state of the art, with special focus on medication taking for cardiovascular disorders. In: Burke LE, Okene IS, eds. Patient Compliance in Health Care Research: American Heart Association Monograph Series. Armonk, NY: Futura Publishing Co. 2001. 3–21.

3. Da Silva. Does health coaching work: summary of key themes from a rapid review of empirical evidence. 2014. Evidence Centre Commissioned by HEEoE.https://eoeleadership.hee.nhs.uk/ Evaluation.

4. Carter, A., Tamkin, P., Wilson, S. and Miller, L. The Case for Health Coaching. Lessons learned from implementing a training and development intervention for clinicians across the East of England. 2015. Institute for Employment Studies.

5. Newman, P. Health coaching for behaviour change: Interim progress report. 2014. HEEOE.

6. Kibble, S., Gray, D., Prat-Sala, M., Ross, K. Johnson., Packer, J., Shire, E., Cross. R. and Harden, B. Recovery coaching in an acute older people rehabilitation ward. 2014. BMJ Quality Improvement Reports. Accessible Via: http://qir.bmj.com/content/3/1/u205646. w2316.short.

7. Gray, D., Prat-Sala, M., Ross, K., Kibble, S. and Harden. B. Stepping Back and Listening: Staff Experiences of Using a Coaching Approach in an Acute Rehabilitation Ward for Older Adults. 2015. Qualitative Health Research.

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