Building healthy places through community-led health coaching

Earlier this year, before its demise, NHS England published  Neighbourhood Health Guidelines, which stated

“there is an urgent need to transform the health and care system. We need to move to a neighbourhood health service that will deliver more care at home or closer to home, improve people’s access, experience and outcomes, and ensure the sustainability of health and social care delivery. More people are living with multiple and more complex problems, and as highlighted by Lord Darzi, the absolute and relative proportion of our lives spent in ill-health has increased”

The Kings Fund recognised an inherent challenge to implementing this mission

“when reading the guidance, it’s hard not to notice the fundamental tension in trying to drive the shift to a neighbourhood health system from the centre. Delivering services in communities for communities is an inherently local undertaking, and a neighbourhood health service that is suited to one setting or population will look different to what would be required elsewhere”

Now that NHS England is no longer, and the budgets of Integrated Care Boards (ICBs), those NHS bodies responsible for planning and delivering health services in local areas, have been cut by half, has neighbourhood health been done with too?

According to the Kings Fund, cuts to ICBs will mean they have less power and funding to meet ambitions like shifting care into the community and reducing health inequalities across local areas. “As restructures and reshuffles and reorganisations take place, all eyes should be on what really matters” they conclude, asking “can beleaguered services continue to work together through it all to meet local needs and deliver better care in the long run?”

With this question hanging in the air the Health Secretary praised a pilot scheme in Westminster last week designed to send healthcare workers into the community to speak with residents as a way to reduce the number of people signed off work on sick leave. The scheme showed that by building a relationship with residents over a series of visits and helping them address problems and situations that were causing poor health, both hospital admissions and visits to A&E fell.

The Secretary said he wanted to see more of these. “I’m actually really interested in the community health worker model and the impact it’s having.”

Other approaches to delivering community-based healthcare are being talked about during this period of uncertainty, including investing in health visitors

and establishing multi-service community care clinics. The question remains on how to scale and, most importantly, how to fund given the NHS’s uncertain future structure.

What isn’t being talked about, but is quietly growing in scale and scope across the country, is another community-based approach to preventative health – health coaching. This form of practice has the potential to not only support individuals in making healthy choices but also, when led by local communities, to serve as a platform for social connection and  skill development.

The NHS defines health coaches as “trained professionals who

support people to increase their ability to self-manage motivation levels and commitment to change their lifestyle. They support people with both physical and mental health conditions  -- and those at risk of developing them -- by helping to set personalised goals and change behaviours, and in doing so they aim to improve health related outcomes”.

Health and wellbeing coaches can be an effective intervention for people experiencing a range of long term conditions, including respiratory, cardiovascular (including type 2 diabetes and hypertension), stress and low mood. They can also support people with weight management, diet and increasing activity levels.

Health coaching is a small but growing body of practitioners in the NHS. In December 2020, at the first headcount of the profession, there were 60 coaches; by September 2021 the number had risen to 252, and by October 2023, when the latest NHS data was published, there were 1,051 full-time equivalents. The Personalised Care Institute, which trains and certifies health coaches in the UK, says there are now 1700 working within the NHS, and it is building an evidence base on the impact this is having.

“There is increasing evidence to show that involving people in decisions about their healthcare leads to improvements in the quality of care, higher patient satisfaction and improved health outcomes, all of which lead to the more effective use of healthcare services.”

So where and how are health coaches being used in local communities and what impact is this having? I looked at several places.

In Somerset, the NHS Somerset Foundation Trust runs a Neighbourhood Health Coaching Team, which provides individual health coaches who “will spend time with you discussing your health and lifestyle. By listening to whatreally matters most to you the team will help you to identify realistic health goals and develop your confidence so you can successfully manage your own health and wellness.”

The trust offers its service through three local GP surgeries, and those registered can self-refer online. Patients are encouraged and supported to use the service:

Health coaches have transformational conversations that help you identify what is important to you. They help you make a plan and identify any barriers that may occur in achieving this.

They will help you make changes in your dailyroutine by:

• motivating and empowering you to identify achievable and realistic goals

• help you find relevant information

• suggest interventions specifically for your needs

• find local peer-support

  
  

The coaching sessions are one to one and can be by video call, telephone, or face to face within a community setting, for example, a local library, community centre, leisure centre or a walk in the park, whichever makes you feel at ease.

The Shoreditch Trust, in east London, is a non-profit organisation with over 23 years’ experience and specialist expertise in designing and implementing community-based civic, health and wellbeing programmes. Through deep local knowledge and strong partnership networks, it supports communities in City and Hackney and neighbouring boroughs. Programmes focus on serving people experiencing health, social and economic inequality: people with long-term health conditions, including stroke survivors and very isolated older people; young people (11-18) not in education, training or work; women experiencing multiple disadvantages in pregnancy and early parenthood.

 It runs a programme of health and wellbeing coaches who work alongside individuals who need additional support to improve their health and wellbeing. This might include someone who is:

·    Struggling to adapt their lifestyle to cope with a long-term condition

·    At risk of developing a long-term health condition

·    Concerned about recent health test results

·    Managing chronic pain

·    Living with depression or anxiety

·    Managing their weight

Crucially, the programme addresses social determinants of health: “We recognise that health is more than just medical concerns. Our coaches take into account the broader issues that may impact your wellbeing, including:

·    Income and financial challenges

·    Housing conditions

·    Social isolation or loneliness

By addressing these factors, we aim to provide support that enhances your overall quality of life.”

Coaches from the Shoreditch Trust work with local people to set personal goals that help build the skills and confidence to:

·    Take an active role in managing your health

·    Engage with local community resources

·    Access and understand health-related information

·    Find practical advice for day-to-day challenges

·    Connect with others who have similar experiences for mutual support

In Norwich, Age UK is working with a group of local GP practices on a health coaching initiative that is demonstrating impact amongst older residents.

Age Healthy Norwich works with people aged between 50 - 65 who have risk factors such as high blood pressure, asthma/COPD, diabetes or mobility issues. It offers free, one-to-one personalised weekly coaching for six months, followed by a six month self-care phase where participants are supported to access a wide range of clubs and activities. Goals can be around physical health, mobility, activity, weight loss and/or mental health and wellbeing. 

Initial results have shown:

• 84% felt their health has improved 

• 92% of participants felt more confident

• 53% felt less lonely

• 35% of people have moved from no activity to at least one self-motivated session 

• 55% felt more able to do things they previously enjoyed

• Blood pressure reduced by 11 - 12%

• 57% connected to community groups or clubs such as golf, bowling, gyms, walking football and mental health services

What kind of external validation has health coaching received?

The Health Foundation has funded Flow Coaching Academy in Sheffield. Over five years, 10 local coaching academies have been set up, and nearly 400 coaches from more than 30 NHS trusts and health boards across the UK have been trained.

Ollie Hart, a GP at Sloan Medical Centre at NHS Sheffield, trained as one of those coaches:

“People play a huge part in solving their own problems. Very often, this doesn’t involve as much medicine as we think. We know from studies that as little as 10% of our health is determined by health care. It is the wider social and behavioural factors that matter most, and often these are the best place to start.

The biggest challenge I see now is shaping our systems to make time for important conversations. My experience so far tells me that we can make this time by avoiding wasted medical input when people are either not ready, or already doing fine on their own. This will mean some changes in our expectations, but we are getting there”

In 2022, Richard Griffin, Professor of Healthcare Management at King’s College London conducted an evaluation of health and wellbeing coaches in Northeast London. Commissioned by the Northeast London Health and Care Partnership and the Shoreditch Trust, the evaluation found that coaches improve health and wellbeing outcomes for people experiencing a wide range of issues including diabetes, weight management, poor mental health, pain management and social isolation. It also found that coaches are reducing the workload of GPs, and other staff, in the practices they support.

Two other conclusions are noteworthy:

·      improved health and wellbeing outcomes that coaches support are likely to save the NHS money. For example, it is estimated that the NHS spends £6.1 billion a year treating illnesses related to overweight and obesity. There is a need to capture the long term impact of the role.

·      only a small proportion of Northeast London primary care employers utilise coaches at present, and the evaluation believes there is a need to promote and explain the role – including the impact it can have – across the area. “To enable this a personalised care strategy with a long-term vision for the role needs to be developed by partners.”

The challenge of strategic vision and scaling is being addressed by a volunteer peer programme in Devon. Health Connect Coaching has built a team of local coordinators to recruit, train, support and supervise volunteers with lived experience of managing their health conditions effectively and match them with local people (“peers”) who require additional support from their GP practice. 

Working with specialist secondary care teams and primary care colleagues, both potential coaches and peers are identified. Then over a 6-month period, peers receive targeted health coaching conversations, focusing on what matters to them, building optimal self-management capability, social connections, and resilience.  “This model is cost effective and scalable with each full-time coordinator being able to manage between 50-100 volunteer coaches and each coach having the potential to support up to 5 people a year” according to Health Connect’s founder, Helen Davies-Cox.

I came across many more examples of how health coaching is being deployed in local communities across the country with positive impact on local health outcomes. Confession: I trained as a health coach last year with Undivided Training, and am building an understanding of the practice and its impact through several growing networks led by the Personalised Care Institute and the UK & International Health Coaching Association.

I think anybody can potentially benefit from health coaching. Moreover I think that whole communities can benefit through the training and connectivity that coaching programmes offer. And, as the Kings College evaluation suggested, I think GP practices can benefit, particularly at a time when numbers are declining and GPs are experiencing unprecedented levels of stress and burnout.

Most importantly coaching addresses social determinants of health in a way that clinicians simply cannot. Last year the Royal College of GPs polled members and found that 30% spent a disproportionate amount of time on tasks not directly related to patient care, including requests related to housing and benefits.

As the national conversations around housing, new towns, regeneration and health prevention expand, intensify and intersect, we must embrace emerging models of healthcare that address the challenges these conversations present. Community-led health coaching provides a platform to meet some of these challenges – whether it’s an insufficiency of GPs on a new housing estate; rising obesity rates in a particular neighbourhood; or an ageing population living with chronic health conditions.  A pilot programme funded by developer contributions in all new housing developments would go a long way in easing tensions around health impact and provide a foundation for community health and wellbeing.

Clare Delmar

Listen to Locals

April  23, 2025