Why did we do this?

Long term health conditions are the biggest strategic challenge facing health systems around the world. But existing health systems were primarily designed to deliver hospital-based cures. That role remains hugely important. Yet it is becoming less relevant as the day to day management of chronic conditions has to happen in homes and workplaces rather than in medical settings.

In England, long term conditions affect more than 15 million people. People living with long-term conditions face significant challenges, but they also have strengths and abilities including the capacity to manage their own health, given the right support. Patients also have family, friends, communities and peer networks that can work alongside healthcare professionals to support them to live well with long-term conditions. While this is increasingly recognised, changes to practice remain patchy and inconsistent.

In addition to this, long-term conditions are placing a significant strain on the NHS financially, costing billions of pounds annually. Overall, half of all GP appointments, two-thirds of all outpatient appointments and 70 per cent of all inpatient bed days are attributed to patients living with long-term conditions. And over the next quarter of a century the number of people with long term conditions will rise by an estimated 23 per cent.

Finally, social factors are powerfully influences on long term conditions in both positive and negative ways - debt and loneliness can cause depression while peer support can help; smoking can cause pulmonary disease while doing exercise can ameliorate it. This means successful strategies to improve health must address the underlying drivers of poor health, not just the symptoms.

What happened?

People Powered Health was an eighteen-month programme involving teams from hospitals, GPs practices, community organisations and patients groups across England. The People Powered Health programme took innovations that have been developed over many years - from peer support networks to expert patient groups, doctors prescribing exercise to group consultations and timebanking - and asked what would happen if they became a normal part of life.

The People Powered Health programme was launched in England in spring 2011 with a call for ideas. In total 106 teams applied and after a three-stage selection process, six teams from across England took part in the programme. The local teams were each awarded a £100,000 grant and provided with a range of non-financial support to develop their capacity in fields such as co-production, service design, business case development and commissioning. We established a peer network between the teams to enable them to learn from one another as well as from external experts.

What makes the People Powered Health approach?

The People Powered Health approach offers a vision for a health service in which:

• the health and social care system mobilises people and recognises their assets, strengths and abilities, not just their needs
• the ability to live well with long-term conditions is powered by a redefined relationship, a partnership of equals between people and health care professionals
• the health and care system organises care around the patient in ways that blur the multiple boundaries between health, public health, social care and community and voluntary organisations

This vision is grounded in innovations that have emerged in health and social care over the last 20 years. It demands an urgent effort to make those innovations a normal part of our health and care systems. This will require a new balance between health provision for people, active health management by people, and mutual support with people.

The NHS in England could realise savings of at least £4.4bn a year if it adopted these People Powered Health innovations that involve patients, their families and communities more directly in the management of long term health conditions. These savings are based on the most reliable evidence and represent a 7 per cent reduction in terms of reduced A&E attendance, planned and unplanned admissions, and outpatient admissions.

Find out how Nesta and Innovation Unit delivered People Powered Health.

You can also find more information on our six teams and how our teams were originally selected.

The background

People Powered Health services build on the concept of co-production in which solutions are designed and delivered with people rather than 'to' and 'for' them. Co-production sets out an alternative to the dominant model of public services in which professionals design and deliver services for needy users.

Co-production often involves professionals enabling people to connect into mainstream life, rather than taxpayer funded services. By doing so it opens up opportunities for long-term recovery, less dependence on formal public services, and more effective ways of combining public resources with the assets of citizens and wider communities.