At Here, we believe that designing exceptional care means working in true partnership with the people who use our services. In this blog, Health Builder Norman Webster shares how our unique approach puts lived experience at the heart of service design and delivery. 

Designing and delivering exceptional care surely has to include those for whom the care is being designed and delivered? “Do with” rather than “Do to” has to be the way forward to improve outcomes and shift responsibility from clinicians to a shared responsibility with patients. 

Patients and carers are involved as Health Builders in this design and delivery journey at Here.

What is a Health Builder? 

What is a Health Builder, I hear you ask.  

We are a small team of people with various long-term health conditions who work across services at Here, including Sussex MSK Health: Brighton & Hove and West Sussex. We are involved in patient empowerment initiatives like Shared Decision Making and Personalised Care. Our work spans advising on policy documents and public-facing communications, observing clinics to provide feedback for clinicians’ Continuing Professional Development, and helping improve pathways in areas such as stroke aftercare. One of our team members has even provided the voice-over for our informative patient videos.

Holding space in service design 

We are confident in holding our space at the table when important, exceptional care service design conversations happen. We know one another and can speak up for each other in these spaces. We hold regular “Big Conversations” in community settings to gather the views and feelings of our communities. We explore current themes in health care delivery in local communities.  We explore how people currently access our services and what could make the experience smoother and more accessible for everyone. We do this so that we can represent them in the policy and governance decisions as they are made. 

Building accountability into new governance structures 

There is a formal route of reporting our work through the Clinical Quality Oversight Group. This is a new group set up following the creation of the Sussex MSK Health: Brighton & Hove and West Sussex in December 2024. It is vital that, during this period of change within our service, we put patient experience at the heart of building this new MSK service with colleagues from across Brighton & Hove and West Sussex. 

More than a tick-box: meaningful involvement 

The Health Builder team is unique in that we are paid according to NHS guidelines for honoraria and we are involved in areas of work as true partners in creating exceptional care.  We are also unafraid to point out inadequacies in service creation and delivery. We are not simply a group of people with lived experience, wheeled out when “consultation” is required, as part of a tick box exercise. 

Valuing local and cultural connections 

We value community connections and are active members of groups such as Crawley Community Action, Community People, West Area Health Forum and Voluntary Action Adur and Chichester.  

The delivery of services to marginalised groups is important to us. We have facilitated health events with the Gurjar Hindu Indian community, Crawley Islamic Centre and Masjid, West Hove Health Forum and others. Apart from providing on-site health care, we are keen to hear the views of local communities. We provide feedback information via the Clinical Quality Oversight Group. 

Listening, acting and learning through feedback 

Our priority is providing community health and networking events to build long-term and meaningful relationships where those communities feel safe in expressing their health interactions with NHS services. Sometimes these conversations can be difficult, but we value and act upon all feedback through our community engagement efforts. 

One example of this in action is our work to improve stroke pathways. Health Builders collaborated with clinicians and service leads to gather and reflect the real experiences of people who had accessed stroke aftercare services. Through community conversations and targeted engagement, we identified areas where patients and carers felt unsupported, particularly in transitions between acute care and community rehabilitation. Our insights helped to shape clearer signposting, better continuity of care, and more personalised support for stroke survivors and their families.  

Our ultimate aim is to seek out marginalised groups and ensure members of those groups begin to feel that care is accessible and safe for them. 

Why Health Builders matter more than ever 

The NHS has been under immense financial pressure for years. Rising staffing, medicines, energy and fuel costs, a growing maintenance and estates backlog and the post-pandemic situation have tightened the NHS’s purse strings. The people in charge are forced to make tough decisions to balance the books. It is ever more important that patients derive maximum benefit from each interaction with the NHS and that they are treated in the most cost-effective ways possible. 

Making every contact count 

Health Builders provide wrap-around care to people who access our service by welcoming them at CAD and Hub events, supporting them at Peer Support Groups and ensuring that all services and communications are delivered in the most appropriate ways. 

By knowing our communities and understanding their needs through our “Big Conversations” and other activities, we can identify marginalised groups. We make every effort to engage with them to understand their specific needs. We try to make care feel accessible and safe for them. 

The bottom line is that we need to make every contact count in the current health economy. 

By Norman Webster – Health Builder.  

We know people living with multiple long-term conditions is fast becoming one of the defining challenges of modern healthcare.

Despite the prevalence of complex health needs, care systems are still largely designed around single conditions with separate appointments, professionals, and pathways that rarely speak to each other. For the individual, this can feel like navigating a maze of services with no map.

The King’s Fund’s recent piece on clinical coordination puts this issue into sharp focus. It calls for a shift from fragmented models of care to those built around the person as a whole recognising that people don’t live in silos, and neither should their care.

At Here, we’ve been working to build what this looks like in practice. Whether through integrated musculoskeletal services, faster and more compassionate dementia assessments, or data tools that support local systems to act more holistically, we’ve seen the difference it makes when care is designed for real life, not just clinical pathways.

This blog reflects on the themes raised by The King’s Fund and shares some of what we’ve learned as we try to build care around people, not problems.

1: From care pathways to life pathways 

Care that works well for a single condition can quickly become burdensome for a person managing several. Our MSK services in Sussex take a whole-person view—connecting people to physiotherapy, mental health support, community groups, and social prescribing, depending on what matters most to them. 

Crucially, this joined-up approach doesn’t just feel better for patients—it’s more efficient for the system. Avoiding duplication, reducing unnecessary referrals, and helping people access the right support first time leads to better outcomes and lower overall costs. Supporting someone to live well with multiple conditions is not just good care—it’s smart use of resources. 

2. Design with, not for

One of the clearest lessons from our work is that services should be co-designed with the people who use them.

When we partnered with Age UK to deliver a new dementia assessment service, we built it around what people told us they needed: faster answers, fewer handoffs, more clarity and kindness. That feedback shaped everything from the clinical model to the language we use in our leaflets.

The result is a service that feels more personal, more efficient, and more trustworthy.

3. Make the tech work for people, not the other way round

As The King’s Fund rightly notes, good coordination relies on systems that talk to each other—and to the people using them. But all too often, technology ends up serving organisational or system demands rather than patient needs.

We’ve invested in data and analytics platforms that help different parts of the system understand population health and work together. The aim isn’t just efficiency, it’s insight that leads to better, more joined-up decisions.

4. Equity must be built in, not bolted on

People in more deprived areas are more likely to experience multiple long-term conditions—and to face greater barriers in accessing support. Reviewing data with people on the ground tells you where to focus.

By working alongside VCSE collaborators, we’ve created community health days in parts of Sussex where need is high and engagement is low, bringing services directly to people and reducing the friction of navigating formal systems. It’s a small step, but it reflects our belief that access and equity must be considered from the start, not retrofitted later.

5. Relationships matter more than structures

Changing systems is complex. But often, it’s the quality of relationships – between professionals, teams, and organisations – that determines whether care feels joined-up.

In our work, we’ve seen integrated teams flourish when they’re built on trust, mutual understanding, and shared purpose. Creating time and space for professionals to learn from each other and build those connections is just as important as any formal process redesign.

6: Measure what matters – to people and the systems

We’re still too focused on activity and throughput. While these metrics have their place, they don’t capture whether someone feels better, more supported, or more able to manage their health.

At the same time, understanding what matters to people gives us a clearer picture of what works and what doesn’t. That leads to better decision-making, better commissioning, and better value. It means investing in what genuinely helps and scaling back what doesn’t. True efficiency starts with understanding the person, not just the pathway.

Looking ahead

Supporting people with multiple long-term conditions is one of the most complex tasks in modern healthcare but it’s also where some of the greatest gains lie.

When we design care that reflects real life rather than idealised pathways, we unlock better outcomes and better use of resources. Coordinated, whole-person care doesn’t just improve people’s experiences; it reduces duplication, lowers demand on stretched services, and allows professionals to work more effectively.

At Here, we’re learning that care built around complexity doesn’t have to be more complicated. In fact, when we listen to people and work collaboratively across the system, we often find simpler, more sustainable solutions. 

We’re excited to be embarking on a new project with The King’s Fund to explore how a deeper understanding of multiple long-term conditions – and more intentional co-creation with the people living with them – can help shape healthcare that works better for both individuals and the system as a whole. 

Integrated, person-centred care is not a luxury – it’s essential to delivering quality and value in the NHS of the future. 

We’re looking forward to sharing what we learn through our collaboration with The King’s Fund, follow along for open and honest reflections, challenges, and learning as we go. 

This Dementia Action Week, the spotlight is on diagnosis, helping people recognise the signs of dementia and take that all-important first step. At Here, we know how important it is that people feel supported not just after diagnosis, but from the moment they’re referred.

That’s why we’ve deepened our partnership with Alzheimer’s Society as part of our work to improve the Memory Assessment Service (MAS) in Brighton & Hove.

Together, we’ve worked to expand our support offer and connect more people to vital support services. From the point of referral, Alzheimer’s Society provides support, practical advice and signposting for people with memory concerns or a diagnosis of dementia and their families.

This partnership complements the work of our MAS team, who continue to offer regular check-ins and What Matters to You conversations. With increasing demand for memory assessments, this joined-up approach has helped us deliver care that is timely, person-centred and grounded in dignity.

We’re proud of what we’ve achieved together so far and committed to building on it, so that no one has to face the waiting period alone and everyone accessing our service feels informed, supported and seen.

Care Navigation/Social Prescribing is a model that enables health and social care professionals to refer people to a range of non-medical services within their community to improve and support social, mental and physical health and wellbeing.

Recognising that people’s health and wellbeing is affected by a range of social, economic, and environmental factors.

Care Navigation takes a holistic approach that enables people to take control of their own health. With the practical and emotional support of a Care Navigator this allows people to identify ways to improve how they are feeling.

How does it work?

Our Care Navigators spend time helping people to focus on ‘what matters’ to them. They assess the needs of each individual and together create a personalised care and support plan. This may involve connecting them to community groups, classes, workshops, or even advisory bodies for legal advice or debt counselling.

Care Navigating success

There is increasing evidence in the success of Care Navigating/Social Prescribing and the impact it has on both individuals and communities.

“In one evaluation, six care navigators from voluntary care organisations worked in integrated health and social care teams across and county. They carried out up to six face to face interviews with an older person, with a unit cost of £42 (compared to £213 per visit for adult social worker). Health related quality of life measures improved by 17%, people needed to use fewer health services and the project was overall cost effective.” ~ Care Navigation: A Competency Framework

“Thank you so much, you’ve helped me to realise there are resources out there for me” – Patient was experiencing homelessness

Is there a difference between Care Navigators and Social Prescribers?

There is no universal definition of care navigation a variety of titles are used, including ‘care navigator (CN)’, ‘social prescriber (SP)’ and ‘link worker’. All these roles provide effective navigation and is a key element of delivering coordinated, person-centred care and support.

Care Navigators are often existing members of staff within Community Services and GP practices. At Sussex MSK Health, our Care Navigators work closely with clinicians, which helps to free up valuable clinical time for addressing physical health needs, while Care Navigators can focusing on non-medical and wellbeing concerns. By providing this additional support patients receive holistic care that extends beyond clinical treatment.

Why have Care Navigators as part of our MSK service?

• Help and support with barriers to appointments.
• Liaise with clinicians/admin teams/clinical teams.
• A chance for patients to unpack, reflect and think about their next steps.
• Help people in multiple pathways within MSK and help make sense of their treatment plans.
• Help stop people falling through the cracks and bouncing in and out of the service.
• There are incredible resources out in the community – directing people more quickly to these can benefit the person.

Many things affect our health and wellbeing. We can all sometimes feel isolated, lonely, or stressed out by work or money. It can also be very difficult dealing with the stress of managing a long-term condition.

We now have a team of 8 people who are helping patients deal with similar concerns every day, creating personalised support plans for our patients giving them access the support and resources they need to help them feel better.

Read more about Personalised Care/ Social Prescribing on the NHS website: NHS England » Social prescribing

Or if you’d like to learn more about our MSK service you can find out more here: Community MSK Services in Sussex – Here

We know that getting a dementia diagnosis can be tough. Waiting lists are long, private options are expensive, and too many people are left without the answers and support they need. That’s why we’re proud to work with  Age UK West Sussex, Brighton & Hove, a trusted organisation dedicated to supporting older people, to make expert dementia assessments more accessible in Sussex.

Why increased access to dementia assessments matters

At Here, we run the Brighton & Hove Memory Assessment Service (MAS), part of the NHS’s vital network of dementia diagnosis and support. We know first-hand how essential these services are and how stretched they can be. Demand is high, and while we continue to innovate within our MAS service, the reality is that the NHS operates with limited finances. This means capacity is constrained, and waiting lists for NHS memory assessments can be long. 

Right now, around 40% of people over 65 with dementia remain undiagnosed in the UK. That means thousands of people in Sussex are navigating life without the right support, missing out on treatment, guidance, and the chance to plan for the future.  An early diagnosis can make all the difference, not just for the person with dementia but for their family and support network, too. It opens the door to practical help, medical care, and a better quality of life.  

This is where alternative options, like our collaboration with Age UK, can make a real difference. By complementing NHS services, we give people more choice, ensuring that more people can get the answers and support they need, without unnecessary delays.

A partnership rooted in care 

Our collaboration combines Here’s clinical expertise in dementia assessment with Age UK’s trusted support for older people.  Age UK WSBH is an independent charity dedicated to helping people over 50 stay independent, informed, and connected. From practical advice and information to social clubs and wellbeing support, their work helps older people make the most of life.  For over a decade, Here has delivered dementia services built on compassion, trust, and person-centred care. This partnership allows us to expand that work, ensuring people feel heard, respected, and supported throughout their journey.

More accessible dementia assessments

As a first step, we have launched The Dementia Clinic, a not-for-profit, paid-for service that offers the highest standards of compassionate care while keeping costs as low as possible. We focus on people, not profit, as two not-for-profit, purpose-driven organisations.  We are committed to making dementia assessments more accessible by: 

• Keeping costs as low as possible while maintaining the highest standards of care. 
• Making assessments easier to access without unnecessary delays. 
• Providing compassionate, person-centred support tailored to each person. 

Our vision 

Our vision is simple: a dementia care system that puts people first. We want to give people control over their care, provide real alternatives to long waiting lists, and reinvest in services that reach even more people. This partnership is a significant step towards making this happen.

We know we can’t fix everything overnight. But by working with partners like Age UK, listening to the people who need these services, and challenging the barriers to access, we can make a real difference. 

If you’d like to learn more about our partnership or working with Here, drop us a line at collab@hereweare.org.uk. If you’re looking for expert dementia support, find out more about The Dementia Clinic.

We are delighted to announce the launch of Sussex MSK Health Brighton & Hove and West Sussex, our brand-new Musculoskeletal (MSK) service, which officially begins today – 2nd December 2024.

This launch marks a new chapter in delivering joined-up, person-centred care. Together with our partners Sussex Community NHS Foundation Trust (SCFT), we’re building on over 10 years of expertise in designing and delivering innovative long-term conditions services, including CQC outstanding MSK care. 

A new era of integrated care

The new community service covers Brighton & Hove and West Sussex, replacing Sussex MSK Partnership Central (SMSKPC), University Hospitals Sussex (UHSussex) and Coastal Sussex Integrated MSK Service (CSIMS).

Key highlights of our approach 

• Integrated care pathways: We connect primary, community, and secondary care, creating seamless experiences for orthopaedics, pain management, and rheumatology. 

• Patient-first design: Our care begins with meaningful “what matters to you” conversations, empowering people to make informed decisions about their health. 

• Equitable access: From digital self-management tools to flexible in-person and virtual appointments, our service adapts to meet diverse needs. 

• Improving outcomes: Focusing on reducing health inequalities, we ensure timely, high-quality care for all. 

What sets us apart 

• 10+ Years of quality: Building on a decade of pioneering MSK care, we have consistently delivered high-quality, patient-centred outcomes. 

• Collaborative innovation: Our partnership with SCFT exemplifies integrated working across the NHS and beyond. 

• Ambitious vision: This service is part of a five-year transformation programme, aligning with Sussex’s health strategy, Improving Lives Together.

Why it matters 

Musculoskeletal conditions are one of the most common long-term conditions in the UK. Affecting one in three people and significantly impacting their quality of life and independence.

As specialists in long-term condition care, we understand the importance of creating services that are easy to navigate, responsive, and effective at supporting people to live well. 

We’re proud to be shaping the future of MSK care, ensuring that everyone in Brighton & Hove and West Sussex has access to exceptional, personalised support. 

To learn more about our approach and the impact we’re making, visit Community MSK Services in Sussex – Here

As we approach the conclusion of the Sussex MSK Partnership Central (SMSKPC) service, we’re taking a moment to celebrate the extraordinary journey we’ve shared.

Over the past decade, this partnership has been more than a service – it’s been a community, a purpose, and a shared commitment to making a real difference in people’s lives.

To mark this special occasion, we’ve created a series of videos that highlight the many achievements of SMSKPC and the incredible people who’ve made it all possible. Each focuses on a key aspect of our journey, showcasing the impact and the values that have defined our partnership.

Celebrating 10 years together 

Our first video takes us back to May 2024, when we celebrated ten years of SMSKPC at our annual conference. This event marked a special moment for us – a chance to look back on all that’s been achieved, and to recognise the people who’ve made it possible. 

Over the past decade, it’s been our team’s commitment and shared purpose that have shaped our success, and May’s celebration was a reminder of just how much we’ve accomplished together.

Making an Impact Person to Person 

This video shines a light on the tangible difference our service has made to people and our communities – it’s the personal connections that have been at the heart of everything we do.

Showcasing the positive feedback and gratitude of those who’ve benefited from our service, these stories of care and support truly bring our partnership’s impact to life.

Living Our Values 

It’s the culture that has defined our service – a culture built on strong relationships, shared values, and a deep commitment to patient care. The camaraderie, teamwork, and dedication of our team highlight the connections that have shaped our partnership and made it more than just a service, but a community. 

From the kindness shown in small gestures and moments of support to the collaborative efforts that have made a big difference – and the friendships formed along the way – this video is a chance to honour everyone who has contributed to delivering SMSKPC.

Each individual’s hard work, passion, and care have made this service possible.

A celebration of togetherness 

As SMSKPC comes to a close, this series is our way of looking back with pride and gratitude. We’ve come so far over the last 10 years, and it’s all thanks to the incredible individuals hard work, passion, and care have made our service possible. Together, we’ve built something truly special.

We hope our work inspires others to see the power of community, the importance of shared purpose, and the enduring impact of truly personalised care.

Thank you to everyone involved in being part of this incredible story. 

Stay tuned as we celebrate this final chapter of the Sussex MSK Partnership Central journey and say hello to MSK Health.

New Musculoskeletal service set to transform care for patients in Sussex

“We are delighted to be awarded this contract along with SCFT as part of an innovative new Sussex MSK collaborative. Working closely with partners, professionals, patients, and our communities, this collaboration builds on our long-standing set of innovations that are leading the way nationally in how MSK healthcare is delivered. This marks another significant step on our journey to deliver exceptional care for those we serve. 

Our vision is to deliver the highest standards of patient care by providing equitable, personalised, and seamless services across the entire MSK pathway.” ~ Helen Curr, chief executive officer at Here.

Health and care partners across Sussex are delighted to announce that an innovative new Musculoskeletal (MSK) service is set to start for local people in December 2024.  

This is the culmination of four years of work and engagement with many stakeholders across the Sussex health and care system to design a transformed, integrated, MSK service for patients in Sussex.    

Following a robust procurement process, Sussex Community NHS Foundation Trust, working alongside University Hospitals Sussex NHS Foundation Trust and Here, have been awarded a new contract to deliver MSK services in West Sussex and Brighton and Hove; and East Sussex Healthcare NHS Trust, working alongside Horder Healthcare will cover East Sussex.  

The approach taken across Sussex is considered national best practice and is clear in its ambition to improve care and experience for local people.   

The new service will see a fully integrated MSK pathway across primary, community and secondary care for orthopaedics, pain and rheumatology, and include services such as physiotherapy, diagnostics, and surgical treatment.   

The new service will focus on improving access, experience, and outcomes for patients, with providers working together to ensure patients receive a consistent experience, feel supported throughout the whole pathway, and get the best treatment first time.   

Other planned improvements to Sussex MSK services, under this new contract, are: 

• Better communication and information for patients to empower them to be in-charge of their own care and make informed choices about treatment options 

• A more joined-up and coordinated care offering which breaks-down traditional barriers between organisations 

• Streamlining access to care and advice: providing much more choice about how people can access care, and that services are available in their community when they need them 

• Helping people to live and work well for longer and offer more personalised care, including supported self-management when they need it, via digital platforms   

• A more concerted and systematic approach to reducing health inequalities and addressing variation in terms of access, waiting times and service provision.   

• Offering a personalised model of delivery for outpatient appointments, including virtual appointments where clinically and personally appropriate (considering other factors relevant to the individual) and face-to-face appointments. 

The new service’s specification is fully aligned to Sussex’s five year health and care strategy, Improving Lives Together, by working to a new, joined-up, community-based approach to MSK care, by growing and developing the Sussex health and care workforce, by improving the use digital technology and information, and by maximising the power of partnership working across health and care organisations in Sussex.   

The specification and awarding of the successful bid were developed with a range of different partners, including patient representatives and Healthwatch. The service contract is worth around £41m per year of the contract – which is for five years, with the option of two additional years after the initial five.  

MSK conditions can affect joints, bones and muscles and sometimes associated tissues such as nerves. They can range from minor injuries to long-term conditions.

Over 20 million people in the UK, almost one third of the population, have a MSK condition such as arthritis or back pain.

Symptoms can include pain, stiffness, limited movement, and disability which affect quality of life and independence. 

In Sussex, MSK services are in high demand, so the new service is an important step for providing quality services for local people. For example, in 2019-20, over 172,000 referrals were made to MSK services, which resulted in 225,000 community appointments and 67,000 referrals on to secondary care.

Work is taking place at pace to implement changes which are required to develop the new service, which is due to go live on 1 December 2024.

World Stroke Day 2024

This World Stroke Day we wanted to share Alasdair’s story. In this video stroke survivor Alasdair and his wife Emma talk about their experience of what it was like to be invited to be a part of the Stroke Health and Wellbeing Service, and the difference this support has had on Alasdair’s recovery to date.

Delivering care to stroke survivors

The Stroke Health and Wellbeing Service was a pilot project set up as part of the National Stroke Service Model to test new, innovative ways of delivering care to stroke survivors. Working in partnership with NHS Sussex, Sussex Community NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust, NHS England, Stroke Association, Headway Sussex, Kent Surrey Sussex Academic Health Science Network.

You can learn more about the project on our service page – Stroke Care Pathway Design – Here

The project has now come to an end, but over the coming months we will be sharing more about this transformative pilot and its impact, showing what can be achieved through building strong, collaborative partnerships across the system, the role of Health Builders and the importance of including people with lived experience as a part of service design.

In the video above you’ll hear Alasdair talk about how much of an inspiration Shreddie, one of our Lead Health Builders was to him and his recovery. You can learn about Shreddie’s story in our case study – Health Builders, improving stroke services – Here

We’re delighted to publish the Sussex MSK Partnership Community Appointment Days Evidence Review & Evaluation, and share our learnings.

As a not-for-profit, we’re always focused on learning from our work and pushing to improve our services, ensuring exceptional care reaches everyone. This review highlights the tangible impact CADs are having on MSK care delivery and reveals key insights that will help us build on this progress. 

One of the standout successes of the initiative has been the rise in Patient-Initiated Follow-Up (PIFU) rates. More than 50% of CAD attendees opted for this approach, a significant increase compared to the 12% seen in other services. Although national evidence on PIFU’s effectiveness is still emerging, these figures suggest that CADs are making a real difference in promoting long-term self-management.

How are Community Appointment Days making a difference? 

• Supporting self-care: Over 50% of patients who attended CADs were able to move to self-care after just one session, reducing the need for ongoing clinic visits. 

• Boost in Patient-Initiated Follow-Up (PIFU): More than half of CAD attendees opted for PIFU, compared to just 12% in other services. This shows that patients are taking charge of their long-term care. 

• Overwhelmingly positive feedback: Patients and staff alike have praised the expert advice, personalised care, and collaborative environment that CADs offer. 

Helping to manage waiting times 

Although CADs weren’t specifically designed to reduce waiting times, we’ve seen another benefit: they’ve helped us keep waiting lists stable, a big achievement given national trends of increasing backlogs. 

Read evaluation in full 

We’re excited to share these findings with you. You can download the complete Evaluation Review and Report and dive into all the details. 

If you’re thinking of starting your own Community Appointment Days, check out our Essential Ingredients guide for tips on how to get started.  

Curious about how CADs work? Read more in our blog series:

• Community Appointment Days – An idea that rapidly turned into an innovation
• Community Appointment Days – What makes them tick
• What if we made community powered health, for everyone

Evaluation overview

Support for self-management: 

• CAD effectiveness: The initiative has significantly improved patient self-management, with over 50% discharged to self-care after just one CAD appointment. This suggests a reduction in the need for multiple follow-up appointments, potentially easing the burden on downstream clinics. 

• PIFU outcomes: CAD patients had a much higher rate (over 50%) of Patient Initiated Follow-Up (PIFU) as an outcome compared to other services (12%). Although the evidence base for PIFU’s effectiveness is limited, the higher rate in CAD indicates a positive impact on long-term self-management.

Patient experience: 

• Positive feedback: Patients reported overwhelmingly positive experiences, especially regarding face-to-face expert advice and personalised care. Despite some operational concerns like waiting times, patients felt involved and heard, meeting the initiative’s goal of enabling active participation in care.

Staff experience: 

• Professional development: Staff enjoyed the CAD events, appreciating the opportunity to spend quality time with patients, understand their needs, and provide tailored advice. The collaborative environment also fostered a sense of collegiality. However, there were some negative comments about operational issues, such as workflow and IT challenges. 

Adoption and attendance: 

• Good adoption: High conversion rates from invitations to attendance indicate strong adoption of CAD across different areas. However, attendance variations by age group suggest barriers for working-age adults, who may benefit from more advanced information and preparation. 

Exploration of broader health issues: 

• Broader services: Feedback indicates that CAD attendees could explore broader issues affecting their musculoskeletal (MSK) conditions giving people the opportunity to access support from other health and wellbeing services.

Impact on equity: 

• No perpetuation of inequalities: Analysis by age, gender, and deprivation suggests that the CAD initiative does not exacerbate inequalities. However, higher DNA (Did Not Attend) and cancellation rates among working-age adults indicate accessibility issues for this group. 

Waiting Times Impact:

Stable waiting times: The CAD initiative was not specifically designed to reduce waiting lists, but has shown a potential positive impact. From January to May 2024, the waiting list for Sussex MSK Partnership remained stable, while national trends show increasing volumes. Sussex MSK has also reduced the number of patients waiting over 18 weeks, outperforming the national average. Although a direct causal link between CAD and waiting list reductions cannot be confirmed, timing correlations and qualitative findings suggest a positive influence.

Potential long-term effect: Further analysis is required to determine CAD’s long-term impact on waiting times, but current patterns, combined with low Patient Initiated Follow-Up (PIFU) rates, indicate that CAD may contribute to sustained reductions if the initiative continues.

Limitations and recommendations: 

• Data and methodology limitations: The report is based on limited data from six CAD events without a comparator group. Longitudinal data and independent qualitative data collection are recommended for a more robust evaluation. 

• Key recommendations: 

• Commission independent qualitative data collection and follow-up with non-attendees. 

• Link CAD attendee data to primary and secondary care records to assess service utilisation. 

• Refine data on PIFU usage by CAD attendees, stratified by key demographics. 

• Maintain records of review and learning activities related to CAD and implement operational improvements. 

Background on MSK care: 

• Growing demand for MSK care: MSK conditions are a leading cause of disability in the UK, significantly impacting individuals and the healthcare system. The CAD initiative in Sussex aims to address these challenges by providing a comprehensive, integrated care model in a community setting. 

Conclusion: 

The CAD initiative has achieved its goals of improving patient self-management and staff engagement. There are opportunities for further operational improvements and more comprehensive data collection to enhance future evaluations.

Download the full Community Appointment Days Evidence Review & Evaluation PDF

If you’ve looked at our work at Here and you think we’d make a good partner for your next project or you’d like to share ideas, we’d love to hear from you. 

To get in touch email: collab@hereweare.org.uk