On 11th February 2016 the Big Lottery Fund and CBO evaluation team ran a peer learning event for people developing SIBs related to health. These slides are from the workshop on the Ways to Wellness SIB.

1. A new approach to long term
conditions in the west of Newcastle
Tara Case
Chief Executive
Ways to Wellness
Philippa Dodds
Delivery Project Lead
Newcastle Gateshead CCG
Mila Lukic
Investment Manager
Bridges Ventures

2. Provides help to people
with long-term health
conditions who live in the
west of Newcastle upon
Tyne
Non-medical ‘link workers’
help them to have better
quality of lives and, as a
result, to reduce the cost
of their care to the NHS
Ways to Wellness – an introduction

3. Evidence – Need and Benefits
• Need: 30% of the population have a long term health condition, accounting for:
– 50% of all GP appointments; 64% of outpatient appointments; 70% of all inpatient
bed days
– 70% of the total health and care spend in England
Source: Dept. of Health, Long Term Conditions Compendium of Information Third Edition 2012
• Benefit: Supporting people to manage their long term conditions is more effective
than conventional medical model approach alone
• Need: Commissioners struggle to fund prevention up front as well as take the risk
that it might not work
• Projected benefits:
– WtW intervention is predicted to save £10.8 million in secondary care costs
– Further predicted savings to public services of £13.6 million
– Social and economic benefits of a healthier population
Source: North East Quality Observatory System, 2013

4. What makes Ways to Wellness Unique?
• The first Social Impact bond (SIB) funding behind a health service
in the UK (funding from Bridges specialist SIB fund)
• Social prescribing is the use of non-medical interventions to
achieve sustained healthy behaviour change and improved self-
care
• Social prescribing at scale:
– Length of contract – 7 years
– Numbers of clients – over 11,000
– Link Worker works 1:1 with patients for an average of 18 to 21
months
• Degree of integration with GP practices
• 4 providers – varied expertise and collaborative approach

5. The Ways to Wellness Link Worker role—
supporting patients to achieve their goals

6. Ways to Wellness as a SIB
Focus on impact
• Outcome measures are chosen to best capture impact
• Payments are aligned directly to outcome measures
• All parties are incentivised contractually to demonstrate impact through
achieving outcomes
Supports innovation and best practice
• 7 year contract with the CCG enables a longer term approach to
addressing behavioural change, including elements of prevention
• Intervention approach can be adapted, as evidence of best practice
emerges, to improve outcomes
• Delivery through engagement with local community and not-for-profit
organisations
• Investment is fully at risk so commissioners are able to test a new service
without taking on a high amount of risk
• Enables coordination amongst multiple commissioners

7. The
Ways to
Wellness
Model

8. Outcome Measures
Two outcome measures
trigger payments:
• Outcome A: Well-being
star improvements
• Outcome B: Reductions in
secondary care (hospital)
costs compared to a
control group
Well-being Star
TM

9. Challenges and Lessons Learnt
Funding and Contracting
• Repayment metrics – keep as simple as possible
• Simplicity of outcome measures
• Alignment of incentives
• Sharing of risk
• Contract negotiation and legal advice significant
• Careful negotiations and complex choreographing of contracts
Modelling and Service Development
• Clarity about operational model and evidence
• Multiple provider sub-contractor model
• Modelling – financial and operational – require time, resources and flexibility
• Strong local team and local champions (including links with local commissioners)

10. Challenges and Lessons Learnt
Health and NHS
• Retro-fitting to the NHS commissioning processes and Information Governance
policies
• No new money to pay for the service but realising cashable savings in the NHS
is not straightforward
• Health and economic benefits are often long term in nature
Operations
• Management Information System – bespoke IT database to support effective
measurement of outcomes and management of operational delivery and
measurement
• Referral targets are ambitious and require push and pull factors to generate
 Engagement with referrers (GP practices)
• Innovation requires analysis and iteration in delivery stage too

11. Where are we now?
44
58
52
66
72 74
92
136
82
129
0 0
37
56
65
74 74 74
108 108 108
130 130 130
0
20
40
60
80
100
120
140
April May June July August September October November December January February March
0
20
40
60
80
100
120
140
Successful New Referrals
April 2015 – January 2016
Target against Actual
Successful New Referrals Target Successful New Referrals

12. What’s next?
• Increasing levels of new patient referrals
• Well-Being Star improvements for patients
• Reduction in secondary care (hospital) costs
• Build evidence of effectiveness of approach
• Share learning and spread the model

13. Patient Quotes
“I feel really proud
of myself that I’m
getting out and
about more.”
“I now have a totally
different outlook.”
“I feel so much
better – happier
and healthier.”
“This service has
resolved a lot of
issues that worried
me.”
“It has helped to focus my
mind and gave me belief
that things can change.”
“I do believe that knowing
the Ways to Wellness team
is like winning a lottery
ticket in life.”
“I felt my Link Worker
was on the same
wavelength as me and I
could trust her to help
me.”

14. Questions or Comments?
Website: http://waystowellness.org.uk

15. Workshop: Outcome Measures
Questions to consider for your context / service:
1. What are the key characteristics of your target
beneficiaries?
2. What key impact(s) will your service result in for them?
3. How are you going to measure this?
4. How will you access and/or collect the data?
5. How will you connect impact(s) to commissioner savings
and outcome payments?
6. How can you demonstrate that your service contributed to
the measured impact (attribution)