The Collaborative LIVE LONGER BETTER Programme

“A Collaborative approach to reducing Service Demand through knowledge, activity and fitness, frailty reduction, disease prevention, self-management and population health improvement.”

The covid pandemic led to significant disruption to the delivery of healthcare, new diagnoses and the treatment of chronic conditions. Appointments had to be cancelled and, in many cases, people chose not to seek treatment. Around 7 million people are now on NHS waiting lists for elective, non-urgent care, up more than 50% since before the pandemic. Additionally, there is the substantial hidden need of people who have not yet come forward for care, estimated to be another 7 million!

As the health and fitness of the population continues to decline, as many older people decondition further and become increasingly frail, and as long-term conditions increase and worsen, the NHS is coming under increasing pressure to find a way to support all of these people without adding to the existing workload.

In addition, it is now clear that there is a need to support self-care directly and not rely on primary care teams and NHS rehabilitation services to be the sole provider of knowledge and support. This of course can be done digitally, drawing on resources such as those provided by national disease specific charities and programmes like Live Longer Better. 

The aim must be to activate citizens, the elderly especially, to regain fitness by being more active and reducing the likelihood of hospital admission after a fall or because of deteriorating long term conditions. 

Such a solution has been described by NHS England - Harness the manpower, services and technologies of multiple allied sectors to supplement and support the service provision of the NHS, and use the NHS Number and NHS data to automatically target support to the right people in the right way at the right time through online public-facing digital technologies.

Phase One NHS Pilot

During 2021, The Central London Community Healthcare NHS Trust (CLCH) hosted a pilot project in South West London, supported by NHS Digital. The pilot validated this approach to using digital technology as a means of engaging the public, educating, motivating and encouraging them to adopt improved lifestyle behaviours and self-management that would improve physical, cognitive and emotional health and wellbeing. 

The trial team from CLCH worked with GPs from practices across Wandsworth and Merton in South West London to enrol people over the age of 65 into the programme. Citizens were offered the 'Live Longer Better' education programme to develop the knowledge and skills required, and were then encouraged to put their learning into practice with a range of local activity, fitness, health and wellbeing opportunities from a number of local health and fitness charities and support groups.

The programme was delivered online through a secure web portal designed to connect citizens with information, services and technologies from provider/support groups. The technology is integrated with NHS login and is now being developed for more extensive use supporting Phase 2 of the Initiative.

The research was undertaken by The Centre for Healthcare Communication Research (CHCR) at Bucks New University with a target population selected to represent older and more diverse groups. A key aim was to demonstrate that this approach could be implemented to support populations that may be less confident in their use of technology because of factors such as age, education, health-literacy, culture, diversity and inequalities.

A key measure is a behavioural concept called Patient Activation. It captures a number of core components of patient involvement, each of which is important for active engagement and participation. It is defined as 'an individual's knowledge, skill, motivation and confidence for managing their health and health care' (Hibbard et al 2005)

As a tool to support population health and disease prevention, the approach can be applied to a wide spectrum of people. There are those with complex needs who require support for a variety of established medical problems. These people seek to improve their health and limit deterioration in order to maintain their independence and avoid dependency on others. We also seek to empower younger, fitter, healthier people to stay healthy and to consider activity and personal health care as an investment in their future quality of life.

The aim of the Polyatrics Collaboration now is to widen the approach to have the greatest impact for citizens, patients and the health and care system. High priority groups include:

• The elderly, those at increasing risk of frailty, dementia and falls. 
• People deteriorating whilst on waiting lists for elective treatment.
• People with long term conditions including mental health and cancer.
• Those who have deconditioned during the pandemic restrictions.