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Under one roof

Under one roof
12 February 2016

In Mid-Nottinghamshire, mental health, GP practices and health and wellbeing services are being brought together for a self-care revolution

In Mid-Nottinghamshire, mental health, GP practices and health and wellbeing services are being brought together for a self-care revolution

In NHS land there is a term that has come to define the most universal of sayings – used by everyone, every day, everywhere, and interpreted in every language and culture. It means to take care.
We say it to people we love, people we work with and people we don’t even know.
The term is self-care – a byword for empowerment to remain healthy and in control of one’s own health, to maintain independence and to use the right services for the right problem at the right time.
It is yet another term coined in the ever-burgeoning dictionary of NHS jargon words that say something quite simple but in a different way.
However, in Mid-Nottinghamshire special focus is being placed on self-care by providing people with a new way of taking control of their health, to manage their long-term health problems, to live better and healthier lifestyles and to prepare well for winter.
Self-care is very much a hearts and minds campaign for NHS Mansfield and Ashfield Clinical Commissioning Group (CCG) who have responded to their local challenges by creating a physical solution to complement their ongoing campaign. They call it the self-care hub. This is not just an extension of the saying but is an extension in the very literal sense. The self-care hub in this context is a physical hub housed at the Ashfield Health and Wellbeing Centre – a former community hospital in Kirkby-in-Ashfield – a town built like much of its neighbours on the former coal mining and railway industries, which have been left with a legacy of communities with poor health and deprivation as a result of higher than average levels of unemployment.
The former hospital has seen a transformation in recent months to renew its purpose in the community. The centre already houses a range of NHS outpatient and mental health services as well as a GP surgery. Now, it has a very new focus as a place where people can seek advice about all aspects of their health and wellbeing. Former wards have undergone a £1.3 million refurbishment to accommodate a range of voluntary organisations such as Nottinghamshire Self Help Connect, Ashfield Citizens Advice, a group called Ashfield Voluntary Action, obesity and weight management services and stop smoking services.

Patient empowerment
What is happening in Ashfield is a very physical manifestation of what NHS commissioners are tirelessly campaigning about across the UK to encourage self-care. According to the self-care forum around 80% of all care in the UK is self-care with the majority of people comfortable to recognise and treat everyday minor ailments like coughs and colds themselves using an over-the-counter medicine.
Yet there are still 57 million GP consultations a year for minor ailment, costing the NHS £2 billion and taking
up around two hours a day on average for every GP.
Empowerment is part of the ethos of Ashfield Health and Wellbeing Centre that mirrors the objectives of the self-care forum who also stress the importance of giving patients the information they need to care for their common ailments; the need to make healthy lifestyle choices and the new focus on signposting people to the right local services.
This is one of the central aspects of the Ashfield Health and Wellbeing Centre.
Self-care has become a common fight to match the right people with the right services for them at the time they need it. It’s a battle that’s been going on for years – but it’s developed a renewed sense of importance against the backdrop of increased demands, so much so it’s even got a whole week named after it.

Across the country
Indeed, self-care for life was the subject of the conference at the Royal College of Nursing held to mark self-care week. NHS England’s director for patients and information Tim Kelsey drove home this message to health leaders from across England urging people to take control of their health to stay well during the winter. It came as figures were released that found that younger people are using A&E more to access health advice than older age groups.
The data gathered by consumer health body Proprietary Association of Great Britain (PAGB) found that 18-24 year olds are more likely than other age groups to use Google and NHS Choices to search for health information: at 42% they are the most regular users of A&E compared with 20% of people aged 55 and over.1
Pharmacy, however, was found to be comparatively underutilised with just 52% of younger people using it for advice, compared with 65% of the 55 years and older group. This, despite 99% of the population being able to get to a pharmacy within 20 minutes by car and 96% by walking or using public transport.
Of course, the issue is nothing new, but the response of the NHS has never been so unified or so acutely serious as it has recently become. While the scale of the problem may vary depending on the local challenges – the pressures are common wherever you live – increased demand on overstretched front line services, contrasted with and underutilisation of services such as pharmacies and voluntary services.

Serving the community
The ethos of the Ashfield Health and Wellbeing Centre has been developed on the principle that people who live in areas that are economically deprived are less likely to make their health a priority. Indeed the local population experience some of the highest levels of deprivation in the UK. This has resulted in associated health inequalities including, higher than average prevalence of smoking; higher incidences of most cancers, higher levels of obesity and poor diet, which inevitably lead to conditions such as heart disease, respiratory diseases and diabetes, which are a continual challenge for the local communities.
Ashfield Health and Wellbeing Centre is not just for Kirkby – it’s a centre that will benefit a much wider community across the parts of Nottinghamshire served by the CCGs. The ethos of the centre is that there is recognition that the barriers to good health and wellbeing are rooted to social problem, issues with personal finance, housing problems and unemployment. Personal health and wellbeing can be very low down on the list of priorities if people are anxious about immediate housing or financial needs. The aim of the centre is to provide for all aspects of individuals lifestyle so they can start on their path to better general health.
The centre has become a community project in itself – led by health commissioners but with input from a range of organisations working together with a common aim including local district and county councils.
The centre has been a labour of love. Organisations have committed a tenancy to the centre – having moved from other locations, so there has been a genuine commitment from the community to make the facility work, which is very satisfying. The centre is not just a place that offers something different to patients. It plays a pivotal role in the major transformation project called Better Together in which commissioners and health and social care providers are working closer together to join up care services.
The Ashfield Health and Wellbeing Centre hosts healthcare staff who are already working differently to integrate healthcare services. It hosts community health teams who can now refer patients for additional support available as part of the self-care hub – whether it’s advice about social care, housing needs, support in the home or financial advice, our approach to self-care is that it is part of any contact at any time and is offered to support people and their families at whatever stage of their care.
Self care advisors offer advice and information over the phone supported by an online service about the range of support groups for people with a spectrum of social and healthcare needs.
The Mid-Nottinghamshire self-care manager, Rosalind Pearce said: “All the services that we signpost to are local; we can help people to plan a path to achieve better health and wellbeing. We listen and can provide non-medical information to help people improve their own life experience. People can drop in or they can access the service by telephone.”

Andrea Brown is the director of programme delivery for NHS Mansfield and Ashfield CCG.

1 Proprietary Association of Great Britain. Younger people are relying on A&E for health advice. 2015 (accessed 1 February 2016).

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