1. Introduction and Background:
Providing education and support for patients and service users is a key activity in the Faculty of Health and Social Care at London South Bank University. We are committed to designing and delivering innovative engagement activities with external partners. In 2009 with funding from the Department for Innovation, Universities and Skills we delivered the Lambeth ALF (Active Learning Facilitators) Project. The Project was designed to test out a participatory model for engaging patients and service users in self-managed learning activities. We also wished to explore social production in a health context. The Project aimed to:
• Mobilise the potential of expert patients to become expert facilitators of informal adult learning.
• Co-design and implement a model of self-managed learning that drew its strength from self-management and self-care networks in the health sector.
• Engage with people from amongst those sections in our community who experience on a daily basis the human cost of social exclusion, health inequalities, loneliness and isolation.
• Situate the Project in three pilot GP surgeries, developing collaboration with doctors, nurses and practice staff in the co-production process.
• Explore the potential of GP surgeries as sites for innovative learning activities in support of active patient and public involvement.
We designed the Project as an experiment in bringing together people with long term health conditions and health care staff as a demonstration of our potential to create transformative relationships which will be of value to a future NHS. The Lambeth ALF Project is a partnership between patients, NHS Lambeth, Lambeth Council and local GP surgeries.
2. Benefits and Impact:
A total of 27 patients were recruited from NHS Lambeth’s Expert Patient Programme and other self-care networks in the borough. They attended initial half-day training workshops designed to provide access to skills, knowledge and understanding relevant to the ALF role with a focus on developing learning conversations. Participants were directly involved in co-producing training materials and additionally helped shape the emerging ALF role.
ALF’s were placed in one of the pilot GP surgery sites and during the first cycle of activity engaged in learning conversations with 321 patients. They were trained to engage in a learning conversation with a patient coming in to see a GP but their task did not include providing information on specific courses. Their role was explicitly to engage in a learning conversation and maintain a dialogue which focused on exploring unmet learning need amongst our target groups.
ALF’s would be present in a GP surgery on a weekly basis. At the end of each week we held a Friday morning reflective workshop where participants would explore issues that had emerged in their conversations with other patients and also reflect on their own personal and team learning. We aimed to create a peer learning community offering mutual support to group members. The Project improved personal learning skills of participants and in the words of one ALF:
‘In becoming involved in the Active Learning Facilitator Project, I had the opportunity to link it to my experience of becoming an expert patient. I now have the confidence to go and engage with patients and service users… I can understand and empathise with people with long term health conditions… [and] help facilitate their learning and focus on self-management and decision making skills.”
An impact assessment workshop was held at Lambeth Walk Surgery and facilitated by the Research Capability Programme, Department of Health. The workshop aimed to explore the Project’s impact on the health and wellbeing of participants. The Lambeth ALF’s were actively involved in the evaluation process along with GP’s, Lambeth Council and NHS staff. The impact assessment workshop generated evidence that the Project:
• Contributes to increasing confidence and capability amongst patients and service users participating in the Project.
• Contributes to NHS Lambeth’s Health and Wellbeing strategy focusing on improvements in capacity to engage in personal and social learning.
• Contributes to access and equity initiatives.
• Increased personal self-esteem and self-worth.
• Contributes to enhancing effective self-management/self-efficacy.
• Has the capacity to reduce social isolation, anxiety and depression.
• Contributes to improved pain management.
• Better use of GP’s time and resource available for patients with long term health conditions.
• Encourages patients to actively participate in new activities based in GP practices, for example, patient reading groups, growing your own food clubs.
• Better use of health information.
• Could help patients better understand health related research studies and become more knowledgeable of personal implications of health research.
• Capacity to offer a new role model to other patients and service users who are self managing a long term health condition.
At a time of rapid change in our health system we have demonstrated that patients with long term health conditions have the potential to learn new roles and contribute to improving health and wellbeing in our deprived communities. We have enabled a group of GP’s to rethink how their surgeries could be transformed into spaces which enable and empower patients to become active learners. At a time when public services are being reshaped within a constrained financial environment, we have illustrated how by working collaboratively we can increase learning activity without incurring additional costs. We are using existing resource creatively and efficiently.
The Lambeth ALF Project is continuing at the three original pilot GP sites with financial support from Lambeth Council. We are planning to extend our work to seven new GP sites over the coming year.
For many of the ALF’s the Project has been a personal learning journey which has re-stimulated their interest in further participation in education and training. There will be new employment opportunities open to them in the healthcare sector as we begin to explore new job roles for patients to support people with long term health conditions. Our collective learning from the Project has contributed to national thinking about these new roles.