Across the UK, our population is growing increasingly unhealthy, with more people developing chronic conditions. That in turn reduces their ability to work, live independently and participate in society. There are also significant inequalities, with those living in more deprived areas having significantly worse health outcomes. This places a financial burden on local authorities, pushing up the costs of social care, already challenged by austerity.
Local government, in addition to social care provision, has a statutory duty to improve the health and well-being of the population they serve.
The majority of diseases that people are living with, and dying from, in England, are preventable. A report by The King’s Fund shows that unhealthy behaviours cluster in the population. Seven in ten adults are living with two or more poor lifestyle behaviours (smoking, inactive, unhealthy diet, overweight, excessive alcohol consumption) the prevalence of which increases in areas of deprivation.
Historically, we have treated each of these behaviours individually by commissioning separate stop smoking, weight management, and exercise on referral services for our residents. GPs are then asked to refer eligible residents to these services, which are delivered through a one size fits all, face to face model. These services tend to have high levels of participant drop out, although are effective for those who complete the course.
National Institute for health and Care Excellence (NICE) guidance on individual behaviour change shows that people need support in the intensity, format, timing and location that works for them and that if that balance is achieved they are more likely to be successful.
In addition to the lack of personalisation, cuts to both the ring fenced public health budget and local authority budgets, means fewer people are able to access these services, if the authority are able to provide them at all.
We know that if we don’t act to proactively support our populations adopt healthier lifestyles the impact on local government is going to be significant. Local government simply can’t afford to continue to commission the same service offer, and we definitely can’t afford to decommission these services, which would lead to significant increases in social care costs and burden to the NHS.
We need to be able to be smarter in how we target and support our population to adopt healthier lifestyle behaviours. We believe that digital holds the solution.
Our hypotheses are
- Digital technology can be used to proactively case-find/identify residents living with multiple unhealthy lifestyle behaviours to increase both their awareness of the issue and their intention to change their behaviour.
- Digital technology can then support, encourage, enable and facilitate residents to make sustained changes to their lifestyle behaviours.
There are already positive indications for elements of this approach. For example
- London Sport co-created a digital journey to target specific groups through face book advertising and then providing ongoing motivational support increasing participants physical activity levels.
- The Diabetes Prevention Programme digital pilot, suggests that a digital approach is effective in supporting long term behaviour change.
We plan to research using the following methods:
- Primary research using F2F, individual and group interviews (focus groups) with specific user cohorts within hyper-local areas to understand the barriers and the motivators of different segments in responding to and accessing digital public health services. This will be underpinned by behaviour science theory.
- Development of personas which we will link to both Mosaic and The Healthy Foundations segmentation socio-demographic segmentation.
- Secondary research delivered using a grey literature search and a call for evidence of good and promising practice both nationally and globally.
- Ethnographic research that will allow us to learn by observation of people using current interventions to learn where the pain points are and why they behave in the way they do.
- Heat mapping by overlaying current service adoption patterns against the personas to see whether patterns and trends can be identified.
- Development of user stories and customer journey maps.
- Synthesis of insight built around themes.
Research will be carried out in partnership across councils, we will work together to bring together expertise and capacity from across our organisations.
At the end of discovery we will have achieved the following Outcomes
- We will have a clear understanding of how digital technology can be used to:
- target and engage residents living with multiple unhealthy lifestyle behaviours to increase both their awareness of the issue and their intention to change their behaviour.
- support and enable residents to make sustained changes to their lifestyle behaviours.
- We will have used deep dive research to understand user’s needs, desires and motivations. We will have run low-fi prototypes of a small number of ideas that will help us iterate and test and we will be in a position to pull together a business case for developing an alpha product.
The global burden of disease study shows that in England the main causes of disease and disability are
- Dietary risks; (what we eat)
- Tobacco smoke;
- High body-mass index; (overweight or obese)
- High systolic blood pressure (affected by various factors including alcohol, inactivity, weight, diet and smoking)
- Alcohol and drug use;
- High fasting plasma glucose (affected by various factors including alcohol, weight, inactivity, and diet)
- High total cholesterol (affected by various factors including alcohol, inactivity, weight, and diet)
- Low glomerular filtration rate (kidney function, affected by various factors including alcohol)
- Low physical activity
A report from the Richmond Group of Charities shows that:
- 1 in 4 of the UK adult population is at high risk of Type 2 diabetes, but up to 80% of cases could be delayed or prevented
- 75% of cardiovascular disease is preventable
- Two thirds of deaths from asthma attacks are preventable
- 80% of strokes are preventable
- Smoking is responsible for over 80% of all deaths from lung cancer and COPD
- Up to half of all cancers could be prevented by changes in lifestyle behaviours
- Modifiable factors account for over half of the disease burden in later life
- Up to 30% of cases of Alzheimer’s disease are attributable to modifiable risk factors
- If every woman in the UK was regularly physically active, 9,000 fewer women would develop breast cancer each year
- Walking for a mile at a moderate pace each day could reduce prostate cancer patients’ risk of dying from the disease by 30%
The cost to the nation of unhealthy lifestyle behaviours is significant; the data available is for individual behaviours rather than looking at the collective impact:
The cost of obesity in England to society is estimated to be £27 billion.
The cost of inactivity to the NHS is estimated to be £445m for 5 conditions.
The cost of alcohol to society is estimated to be 55.1 billion.
These costs aren’t comparable. However, they do clearly demonstrate the financial costs of these behaviours.
The latest data for these behaviours from PHE fingertips is as follows:
|Overweight and obese adults||62%||60.4%||51%||50.5%|
|Alcohol related hospital admissions||2224 people per 100,000||2,723 per 100,000||1,935 per 100,000||2,662 per 100,000|
As partner authorities we intend to collaborate closely in carrying out this discovery exercise. We would manage this project using Agile methodology, which will allow us to iterate quickly and fail fast.
We would expect to use the following software across partners to support delivering these tasks collaboratively .
- Stand ups, retrospectives, sprint planning and show and tells: Google hang outs; we expect to have daily standups, working in two week sprints.
- Daily communication on project tasks: Slack
- Product backlog and sprint tasks: Trello
- Virtual sharing of project documentation: Googledocs.
The exact software will be agreed between the partners.
In terms of governance, Southwark will be the lead council. The head of digital public health will provide overall project leadership and co-ordination, supported by a product manager, with additional public health and digital expertise from across the three councils.
In the spirit of agile, daily decision making will be delegated to the project team. Officers from each council will have a role on the project team, inputting from their area of expertise across both public health and digital service design and managing any external resource.
A community of influence, consisting of each borough’s director of public health, a senior officer from the lead council’s digital service design team, and key relevant councillors will be brought together. The chair will be a director of public health, and this will rotate between the councils. This group will sign of the discovery project road map. They will meet at the start of the project, either virtually or in person and at key points of project development. They will be kept up to date with regular briefings and invited to attend show and tells. This group will be expected to be the “unblocker” for any issues that arise for the project team.
In order to bring the team together across councils, and foster collaborative working, we would like to undertake agile training together, to ensure that we working together to the same principles.
We may require support accessing the digital market place to procure a specialist supplier
Our preference is to see the local digital collaboration unit as part of our project team, who would be invited to show and tells, to input their expertise.
We would also request access to MHCLG network to amplify findings and garner feedback.