Two years ago Manchester embarked on plans that connect better health with all the other factors that affect wellbeing like work, housing, social conditions and where we live
That was the city’s Population Health Plan which split into themes including the first 1000 days of a child’s life; work and health; and community and the local area.
And that Plan, epitomised the findings in the original landmark Marmot Review from 2010 – which looked at evidence across the country and said that the conditions in which people are born, grow, live work and age can all have an effect on health and health inequalities.
It’s now a decade on from the first Review – and since then Manchester City Council’s Chief Executive Joanne Roney has been part of the national Marmot steering committee involved with today’s updated report..
“It’s absolutely vital that people understand that 80 per cent of what keeps us fit, well and happy isn’t linked to medical intervention,” says Joanne. “It’s far wider than that and it all starts with the communities we live in, and social, educational and living conditions.”
In particular, Manchester’s citywide response to these broader issues is through a social prescribing service called Be Well. Social prescribing is the term that links support in the community that can improve individual health and wellbeing.
Over the last 14 months, 8,000 people have been helped by the service after referrals into it from their GP. At Manchester’s recent Health Scrutiny Committee here, members heard from Linda, – who had been helped by the Be Well team. She described her experience of losing her confidence and how it had affected her. The team gave her support including help with her CV, joining LinkedIn, and she went on to gain a new job listen to her story here.
Councillor Bev Craig, Executive Member for Adult Health and Wellbeing at Manchester City Council, said: “Be Well is a way of making the most of all that our communities have to offer and then connecting those facilities and services in a way that’s important to an individual.”
Other examples of this holistic approach in the city include support around teenage pregnancy.
For example a 15-year-old who found she was pregnant at a time when she had health, school and other family problems was helped during the pregnancy and birth by specialist teenage pregnancy midwives. She also had a dedicated support worker which meant that she was able to continue with her education and get the grades she needed for college. Alongside all of this she was able to develop parenting skills and attend her local children’s centre. All of this meant that she was able to look after her baby, increase her confidence and also go on to university.
Additional case study that shows how Manchester has a new approach to solving medical and social problems at the same time.
On the case: Now Manchester is giving advice on prescription
Why dedicated Citizens Advice ‘hotlines’ have been brought into city’s GP surgeries
They put patient straight through to advice worker
Call can help with debt, housing, benefits or other living issues
Move helps GPs tackle medical matters in tandem with social help
Results show that more than half the calls to date are benefits-related
Callers said these sort of worries had been affecting their health
Dedicated phone lines that put patients straight through to a Citizens Advice worker are now available in more than half of Manchester’s GP surgeries.
The move – which started initially as a test project in late 2016 – is designed to help those people whose visit to the doctor is linked to other social or living issues, such as debt, benefits or heating, which could also be having an impact on their health or wellbeing.
Evaluation showed that half the calls were related to benefits questions or advice.
Prior national research from Citizens Advice also found that 8 out of 10 GPs felt that they didn’t have enough time to focus on clinical care in appointments because they were being asked to help with other tasks such as writing up debt plans or helping to fill in benefits forms.
Now, in Manchester, a patient who needs this type of help will be told by the GP about the telephone service so that they can use it after the consultation and be put straight through to an adviser for confidential help. Alternatively, for patients who may not be confident about making that initial call, the GP can also refer the patient straight into the Manchester arm of Citizens Advice so that he or she receives a call back.
The project and associated staffing and has been funded by Manchester Health and Care Commissioning (a partnership between Manchester City Council and Manchester Clinical Commissioning Group) – has led to phones being installed in more than half of Manchester’s surgeries with more to have the facility by summer.
Independent evaluation of the project shows that around a third of the clients using the service had multiple issues for which they required support. In most instances the issues were resolved quickly – with almost 65% being resolved in one phone call.
Rosi Avis, Citizens Advice project lead for Manchester, said: “We know that GPs need to use that ten-minute appointment as effectively as possible – and very often helping with social issues can also help the medical ones too.
“For example, there was a patient who went to see her GP with frostbite in her fingers. The GP could address those medical problems – but the key issue was how she got frostbite at home in the first place. This all happened during the ‘Beast from the East’ cold spell and it transpired that the patient was in debt and didn’t want to put the heating on.
“Our debt advice team were able to help sort payment plans and write off at least two of the debts for the patient, who was then confident to put the heating on at home. It also helped put the patient in control by explaining all the different options available to meet her own needs.
“This is the sort of example that shows how combining practical advice with medical care can give broader and better result for the patient.”
Dr Umar Tahir, a practice GP at Manchester Medical in Moss Side, which has one of the dedicated phone lines, said: “As doctors we know there is no separation between what’s going on in people’s lives and how that can affect their mental and physical health. All too often, anxiety-related conditions are caused by or exacerbated by the need for practical help for concerns related to benefits or other worries. Practical advice combined with medical care is more holistic approach for the patient and their families.”
Councillor Bev Craig, Executive Member for Adult Health and Wellbeing at Manchester City Council, said: “This project embodies our firm belief that listening to people and hearing about what’s important – or of concern – to them has to be the starting point for making long-term improvements to individual health and wellbeing.”