Health coaching and anticipatory care: improving patients’ health and reducing pressure on healthcare services

There’s little doubt that the health and social care system is under tremendous strain and experiencing some of the most severe pressures in its 70-year history. The Covid-19 pandemic was the event that finally tipped the balance following a decade of flatline funding and inadequate workforce planning.

The only slightly surprising aspect of the NHS pressures this time is the extent and severity of these challenges during the summer months – when traditionally the NHS is better able to cope compared to the struggles experienced each year through the impact of winter pressures.

The result of these pressures on ordinary people seeking care across the country is profound. Having worked as a Matron in Emergency Access for almost ten years, I have seen how overwhelmed Emergency Departments can become dealing with the diverse range of accident and emergency conditions that present. Since the pandemic this has dramatically increased. We know from the latest official figures more than 6.7 million people are on waiting lists, that ambulances are taking longer than ever to reach patients, and people needing hospital beds are left waiting on trolleys often in pain and discomfort, despite the best efforts of overstretched and fatigued NHS staff. Backlogs built up during the Covid pandemic as hospitals treated people with the virus, forcing patients with other illnesses to wait much longer than usual for surgery or treatment.

There is a similar story in primary care. The pandemic has understandably heightened people’s health anxiety, especially those with long term health conditions. Research from Attenborough Primary Care Network (PCN) showed that one third of primary care appointments are being taken up by 5% of the patient population. Often the appointment is not directly related to the patient’s condition/s or they require a different kind of care. As an example, one patient we worked with at HN had suffered a heart attack. He was discharged from hospital, but during his recovery he developed major health anxiety believing every minor issue was a further heart attack. This resulted in him being unable to work, a breakdown in family relationships, and an excessive number of appointments with his GP which never actually managed to successfully identify or resolve his issues. Once given the time, space and ear of a trained health coach, these issues were quickly resolved.

According to NHS England, there are 300m primary care consultations every year. So, if we were to extrapolate the findings from Attenborough PCN, potentially 100m appointments are being taken up by people who require a different kind of intervention. In emergency care, it is estimated that between 10% and 20% of attendances are not appropriate. With 23m A&E visits per year, this is an enormous burden on the NHS and results in an unacceptably high number of patients being denied access to the care that they need.

Health coaching – patient empowerment and breaking the chain of dependence on healthcare services

When someone is repeatedly going to their GP or A&E due to health concerns and associated anxiety related to an existing illness, they create a pattern of dependence which is both unhealthy and will never ultimately meet their needs. This places increased pressure on already over stretched services and perpetuates the downward spiral of continued anxiety with the underlying problem never being effectively managed or resolved. This situation has the propensity to precipitate a further deterioration in underlying health conditions.

Health coaching is one way in which people can gain control over their long-term condition and associated mental health. This can be achieved by addressing health literacy, developing an understanding of what they can do to improve their condition, supporting the development of empowerment and confidence, creating appropriate coping mechanisms, and supporting them to develop a willingness to effectively and pro-actively manage their own health rather than an instant reliance on their local A&E or GP surgery. Not only does this help to address the current system issues in terms of capacity and resource, but also from a patient perspective has a very real and positive impact on their quality of life.

Our work with diabetes patients in Lewisham

At HN, we have been working with a group of diabetic patients in Lewisham, many of whom were anxious about their access to the specialised services they need to safely and effectively manage their condition. This was exacerbated by the increased risks associated with contracting Covid-19. Through health coaching they developed the skills, knowledge and willingness they needed to make better choices about how to deal with their condition and associated anxieties, reducing usage of a range of primary and secondary health services.

Delivering personalised care and putting the patient in control

At the heart of what we do at HN – through the brilliant work of our skilled health coaches – we seek to deliver personalised care to the right people, at the right time. Effective, pro-active self-management of long-term conditions and all the associated issues will not be achieved via A&E or GP services. We need to take a different approach to empower the patient if we are going to achieve long term benefits for both patients and the system, enabling the NHS to fulfil its commitment to making personalised care business as usual, as set out in the NHS Long Term Plan.

Funding is available for HN’s transformative solution through the ARRS service

This is where the real power of technology enabled healthcare is being realised - we’re using AI to identify and predict high intensity users of GP and A&E services, and then supporting these patients through a coaching intervention, supporting the patient to achieve pro-active self-management as already described.

Being realistic, we are still a way off being able to deliver truly personalised care to all patients, but using a digitally enabled triage process like this, we can begin to identify and help patients in new and innovative ways that has profound and proven benefits. Funding is available for health coaches through the Additional Roles Reimbursement Scheme (ARRS), so delivering these personalised services need not cause additional financial burden. Also, companies like HN are already providing fully accredited, professional health coaches for trusts as a fully managed service, removing any additional people-management responsibility.

With the increasing pressure on services and winter fast approaching, the time is now to focus on prevention-based healthcare to ensure services have the greatest capacity, and patient care is prioritised.

Read more about health coaching and HN’s unique service here.

Creenagh Williamson, Chief Nursing and Operating Officer, HN