Special Edition - Realising the Value - Four Months On
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Welcome From Catherine Wilton, C4CC Director

Hello and welcome to this special 'Realising the Value - Four Months On' edition of our newsletter.

Realising the Value (RtV) was an 18-month, NHS England funded programme, led by two of our partners, Nesta and The Health Foundation, supporting the NHS Five Year Forward View vision to develop a new relationship with people and communities and providing a practical resource to support the work of commissioners, providers, communities and others to help empower people and communities in their health and care.

The programme ended in November 2016, publishing a suite of resources, including publications and tools, which we have outlined below, together with the views of the people and organisations involved in the programme of work to look at why this work was important, and how it is being used to transform health and care four months on. 

We wanted to pull together a special edition of our newsletter to place a focus on this important work, and showcase how the system values and is benefiting from this work. This programme of work was never just about gathering the evidence of what works in person and community-centred care, it had the vital focus of how it can work for people at all levels of the health and care system, developing tools and approaches that make a practical difference.

As you will be able to see from this newsletter and the accompanying blogs and publications, this was a large and detailed piece of work. I hope you will take the time to read, understand and share this widely to encourage greater person and community-centred care across the health and care system.
Realising the Value
Realising the Value Animation
This animation sets out what person- and community-centred approaches in health and care are and some of the many benefits they bring. It was developed by the Realising the Value programme in collaboration with local partner sites across the country, drawing on the real-life experience of the people they work with.
Realising the Value - Four Months On by Annie Finnis

In November 2016, the final reports from the Realising the Value programme were launched, identifying evidence based approaches and strengthening the case to enable people to take an active role in their own health and care.
Over 18 months we looked at the existing
evidence and brought this together in one place,  developed an economic tool for commissioners, created tools to support behaviour and culture change, pulled together a catalogue of practical lessons from local areas putting this into practice and set out ten key actions looking at what needs to happen and how people need to work differently.
Now, four months on from the programme coming to an end, we felt it was a good opportunity to look back on the work we have done. The programme has reached a large number of people, and behind this there are some wonderful stories that have informed the way we think about what good health and care looks like.
It’s fantastic to see the impact the work is already having across the system. We are now in a much better place to understand what should be done and how people need to work differently to put people and communities at the heart of health and wellbeing. Read Annie's full blog here.
The Coalition's Commitment to Transforming Health and Care

C4CC's Senior Programme Manager, Rebecca Daddow attended the launch event, where the Realising the Value team showcased how they had brought the evidence together to create a set of recommendations and developed a range of publications.

Rebecca has been reflecting on the evidence highlighted in this work, how it links to the Coalition's work plan for the coming year, and in particular how the Realising the Value work has made a significant contribution to the sense of alignment and possibility in realising the ambition of transforming health and care.

In bringing together much of the evidence, strengthening the case for change and pointing to the breadth of behavioural, cultural and systematic change needed to do this, the Realising the Value programme marks a watershed in our approach to health and wellbeing, validating the community and person-centred approaches that are being championed by C4CC and our partners.

We are committed to working with our partners and other key stakeholders to 'become clearer about the difference these approaches make to people's own health and wellbeing, and to the wider system' and bring about the fundamental changes needed to embed these ideas into the mainstream.

You can read Rebecca's full blog here.
Supporting Self Management and Spreading Change 

People’s behaviour strongly influences their health – often people know the healthy option to take, and may intend to do it, but significant barriers are often encountered. Awareness and intent is not enough, people need support to make changes to their behaviour and sustain them.

The Behavioural Insights Team (BIT) used 18 months of learning to develop two guides that outline how the science of behaviour can help people to self-manage their health and wellbeing, and spread the use of person- and community-centred approaches, using the EAST (Easy, Attractive, Simple and Timely) framework to help understand and change behaviour, together with real life examples of how these changes happen in action.

Supporting Self Management is written for people who support those living with long-term conditions, or who help people to avoid developing these conditions.

Spreading Change is for people who are championing person and community-centred approaches in health and social care, statutory bodies and community-based organisations.

You can read further insights from BIT on the reports here.
What the System Can Do

Suzanne Wood, an Improvement Fellow at the Health Foundation, as part of her work on the Realising the Value programme investigated the role of national bodies in removing barriers to progressing person- and community-centred approaches for health and wellbeing.

In the report, What the system can do, Suzanne and her colleague Sarah Henderson review the range of mechanisms, or system levers, that national bodies such as NHS England, Health Education England and NICE use to influence health and care services and suggest what national bodies might do to help implement and spread these approaches.

The report, which is aimed at policymakers in government departments and arm’s-length bodies, highlights a number of key themes that emerged, including:
- National bodies should focus on people as well as systems
- How is as important as what
- A thriving and sustainable voluntary and community sector is key
- More needs to be done to ensure meaningful co-design and co-production at all levels of the system.

Suzanne explains more about the themes in this blog and what the system can do to support those working with people and communities to create better health and wellbeing.
Using Evidence to Support Commissioners

Many commissioners understand the benefits and potential savings of introducing new models of care, but often face barriers to doing so – one in particular is the lack of a robust economic case.
As part of the Realising the Value work, PPL, an independent consultancy, developed an economic modelling tool, which draws on high-quality research evidence as well as data collected from RtV’s five partner sites to help evaluate the impact of person- and community-centred approaches. Designed for local commissioners and STP prevention teams to help them develop business cases and inform priorities, it has already been used by NHS England for planning and strategy purposes. You can read more about the PPL tool here.

To complement this work the Long Term Conditions Financial Model uses simulation to predict the financial impact of person- and community-centred approaches against a “do nothing” approach.
To share these tools PPL, SIMUL8, NHS England, and Nesta will be hosting a Webex for commissioners in April 2017 (date to be confirmed), highlighting how both tools can be used to help commissioners who want to implement new models of care. For further details, please contact the organisers here.

Making It Happen

The Realising the Value consortium brought together the perspectives of people with lived experience, the voluntary, community and social enterprise (VCSE) sector, practitioners, academics, commissioners, providers and policymakers to consolidate what is known about person- and community-centred approaches for health and wellbeing and make recommendations on how they can have maximum impact.

Making it Happen brings together the work of the five local partner sites and their wealth of experience working with these approaches. Produced in collaboration with the sites, it is written for practitioners and local commissioners seeking to get to grips with the practicalities of implementing person- and community-centred approaches for health and wellbeing. 

Mark works for one of the sites - Creative Minds, an organisation offering group activities to promote health and wellbeing. Here, he shares how he struggled with poor mental health for nearly 40 years, and how a series of chance conversations which happened while he was at his lowest started him on a different path. Alongside his psychiatrist's support, he was signposted to an afternoon football session, close to where he lived, something that seemed quite small but was a huge thing for Mark. Now, his work for Creative Minds and their creative partners, supporting more than 20,000 people on hundreds of projects, and shared their learning with Realising the Value. Read more here.
What is 'value'?

Andrew McCracken from National Voices shares his thoughts on 'value' in health and care.
People do not think purely in terms of their health or their interactions with services, but about their quality of life (and death). They are concerned about the impact their health and their care has on their ability to live a good life.
As part of Realising the Value, National Voices explored the health and care system’s concepts of value and found that we should not just focus on clinical outcomes, but wider wellbeing impacts. Not just the performance of a single service, but the outcomes over time of all the services a person may draw upon and not just a person’s experience of one service, but their quality of life, whether they feel supported, socially connected and independent.
Our report on New approaches to value in health and care is aimed at decision and policy-makers, as well as practitioners and professionals seeking to add value to people's lives and mobilise the value that people and communities themselves can create for health and wellbeing. It makes recommendations for developing a single, cross system outcomes framework based on what matters most to people, not systems, to be shared across all sectors of health and social care, including the voluntary and community sector.

Read the report in full here.

Ten Key Actions

As part of the final report, the Realising the Value Consortium, set out ten key actions on what should be done and how people need to work differently to put people and communities at the heart of health and wellbeing.

The ten actions are set out below, but you can read more in this blog from Halima Khan and Will Warburton and the full report here.

What needs to happen:

1. Implement person- and community-centred ways of working across the system, using the best available tools and evidence.
2. Develop a simplified outcomes framework focused on what matters to people.
3. Continue to learn by doing, alongside further research.
4. Make better use of existing levers such as legislation, regulation and accountability.
5. Trial new outcomes-based payment mechanisms and implement as part of wider national payment reform.

How people need to work differently:

6. Enable health and care professionals and the wider workforce to understand and work in person- and community-centred ways.
7. Develop strong and sustained networks as an integral part of implementation.
8. Value the role of people and communities in their health and wellbeing, including through co-production, volunteering and social movements for health.
9. Make greater use of behavioural insights to increase effectiveness and uptake.
10. Support a thriving and sustainable voluntary, community and social enterprise sector, working alongside people, families, communities and the health and care system.
All the evidence and resources produced as part of the Realising the Value programme can be found here. If you would like to get in touch with the team, you can email 
Copyright © 2017 Coalition for Collaborative Care, All rights reserved.

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