Why you should care
Bespoke health solutions are showing that, with a little support, they could form the spine of Britain’s future health care system.
In the Phoenix Shed, a single-story building in the West Yorkshire town of Halifax in Britain, a group of men are sitting in relaxed amity, sipping coffee and putting the world to rights. But what is happening here is not simply fellowship, but healing. The Shed, which is supported by a mixture of charitable and local authority funding, provides refuge and new beginnings for men who, through redundancy or divorce, need to find fresh purpose in their lives.
As the National Health Service prepares for its future amid a historic funding squeeze — part of the government’s determination to demonstrate it maintains a substantial domestic agenda despite Brexit — initiatives such as the Shed offer a template for how to intervene before problems spiral and impose costly burdens on stretched budgets.
With loneliness known to inflict the same level of physical harm as smoking 15 cigarettes a day, this humble structure can plausibly claim to be saving lives, and it’s playing an essential role in helping the local health system to manage scarce resources by tackling the root causes of ill health.
Michael Leech says the project has helped him to “no end.” “I was a successful businessman. And I became really ill with bipolar disorder, became withdrawn,” says the 55-year-old. “I didn’t go out of the house for seven or eight years.” The Shed has provided “somewhere for me to belong,” he adds.
Crucially, Leech is now making far fewer demands on the conventional health system. Contact with his mental health support worker is now often only via text messages, with less need for face-to-face meetings.
Bringing together NHS, councils and voluntary services
The West Yorkshire and Harrogate Health and Care Partnership is bringing together NHS, local authorities and voluntary services in the area to develop a range of programs aimed at managing and easing demand for care. Rob Webster, leader of the partnership, says the NHS is facing challenges that were unimaginable when it was founded 70 years ago, and coping with this new world has involved the creation of roles and services “which are about joining up” different parts of the system.
At Bradford Royal Infirmary, for example, a new category of staff termed “care navigators” has helped reduce the number of delayed discharges — people medically fit to be sent home but who must occupy a bed due to a lack of support in the community — by linking people up to social support initiatives such as the Shed. There were 500 fewer “delayed days” this September than the one before, saving an estimated 150,000 pounds a month.
I wouldn’t be without this place.
Hannah Nutting, who found care at the Haven, Shipley
Another scheme involves matrons triaging elderly residents in care homes, backed by a team that includes a consultant geriatrician, a consultant psychiatrist and a pharmacist. The approach has markedly reduced the number of patients who have to undergo the disorienting disruption of a hospital admission.
Katie Berry, a matron who is part of the scheme, estimates that over the four years since it started, around 280,000 pounds have been saved, due in no small part to patients being taken off unnecessary — or unnecessarily high — doses of medication.
Joint working between different parts of the health and care system is also on display at the Haven in Shipley, near Bradford. Based at the Cellar Trust charity, this cheerful space is open every day of the year and offers help to people struggling with mental health issues before their condition escalates to the point where they can only be treated in the hospital.
Hannah Nutting, a former teacher, is one beneficiary of the scheme. The 28-year-old recalls waking up one morning six months ago and finding herself unable to get out of bed. “My marriage had broken down, so it was all change all at once. I was out of a marriage, out of a job, and it just tipped over … [it was like] a bucket and … it just overflowed,” she recalls.
Desperate to avoid being admitted to the hospital and losing the power to make her own decisions, she credits the Haven’s peer support workers and volunteers — all of whom have themselves experienced mental health problems — for getting her life back on track. She is about to start a master’s degree in psychology and hopes to begin training to become a peer support worker herself. “I wouldn’t be without this place,” she says.
Since the peer support scheme was set up two years ago, just five of the 1,300 people who have been through it have had to be referred for an assessment under the Mental Health Act, a far more serious step that could lead to them being treated against their will.
Along with other approaches implemented in Bradford, the scheme has also contributed to an easing of pressure on local resources: Patients no longer need to be sent outside the area for mental health treatment, saving 1.8 million pounds a year.
Bespoke local solutions test flexibility
The NHS’ spending plan, released in January, prioritizes preventive care over acute care, and allocates 7 billion pounds to community and mental health care. However, it is unclear how much of that will go to support these bespoke local solutions — or recognize the importance of the wider social fabric in treating or preventing illness.
Alison Haskins, who heads the Halifax Opportunities Trust, a charity that works with the West Yorkshire and Harrogate partnership, is all too aware of the fragility of funding in her sector. “Voluntary sector funding is always an issue because we’re not statutory services,” she says.
The Staying Well program that linked Leech to the Phoenix Shed gets part of its funding from the council’s public health budget. “At the moment we have no idea if it’s going to continue,” Haskins warns. “Really shortsightedly, [public health] budgets are being slashed, and if we’re talking about [the importance of] prevention, it’s crazy.”
Webster welcomes the government’s decision to inject additional funding into the NHS. “I know that the NHS is going to benefit from the 3.5 percent growth a year above inflation for the next five years, which is great,” he says.
But he adds: “What I don’t know yet — and what is essential for our partnership — is what support social care and … local government will get on that prevention, well-being, housing, education, environment-type agenda [that] is going to be essential for the future.
“I would want to see that backed by the government too.”
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