Health trainers in Liverpool

In fact chatting to people in pubs is just one of the strategies used as part of a successful health trainers programme in Liverpool.  We spoke to Paul Clitheroe of Liverpool Personal Service Society about why a grassroots approach works.

 The Department of Health has called for health training to be set up across the country.  The idea is to catch people with healthy living messages long before they need treatment for acute problems.  Liverpool PCT decided to do something a little different and involve the charity sector delivering these services. 

Paul Clitheroe's organisation, the Liverpool Personal Service Society is the charity leading the work.  The organisation has been working in Liverpool for 90 years and already had a mindset of developing locals, rather than imposing a new layer of medical bureaucracy from the outside. 

He says 'because it was quite a radical approach we thought we'd spread the risk and asked Age Concern to work with us. Smaller, community groups have joined  the partnership and are now delivering services under sub-contract. '

These smaller communities can include neighbourhood groups, but the Fire Service have got involved too.  They are also hoping to run a project in Liverpool prison, with some inmates working as health trainers  to help their peers.

The scheme employs 14 health trainers, who largely work in their own communities. 

'We did pretty targeted recruitment from the communities, so we are deploying people in places where they live and where they know the networks and the community leaders.  A high proportion of people haven't been through formal education - they've spent their lives bringing up families and caring for relatives.  But when they start work they've completed the City & Guilds Level 3 health trainer course, which is a nationally recognised award now.'

It's still an  innovative move for the NHS.  'There's this NHS professional suspicion of people working in health that are not deemed to be  professionals because they don't have a nursing qualification, but secondly there's a suspicion because we're not part of the NHS.'  Despite this, the results have been encouraging. 'The health trainers are highly professional and our third-sector is delivering first class results ! '

The job of health trainers is both to give healthy living messages and to signpost people to specialist services such as diabetes clinics, opticians or dentists.  They don't diagnose or treat chronic illness,  but they can provide ancillary support after a diagnosis. 

Clitheroe says 'you  may have poor health that's the result of  an unhealthy lifestyle,  too many ciggies, booze, not  enough exercising  and a poor  diet .  You're hit with all the  public information  thats telling you to do X, Y and Z and then you're left spinning thinking "how do I do that" or "I haven't got the willpower to do that".'

A health trainer will be able to offer three or four sessions to  support someone through the issues of good eating and exercise and help people to face their problems. 

Poverty and health

'We all recognise that economic situation is a determiner of health and wellbeing.  We make sure that our relationship with the welfare rights and benefits agencies is good.  We're in the early stages of  discussion with local Citizens Advice Bureaux, exploring the potential for giving its workers a health trainer capacity.   

'We're also linked to employment services - sometimes someone's in poor health because they just don't have the roots back into education, employment or training.  Sometimes it's about making sure that someone's getting all the benefits they are entitled to.'

So do health trainers really wander into the Dog & Duck with a big pile of virtuous leaflets and try to chat to people?  Clitheroe says 'There are various approaches. We've  work closely with Liverpool's Community Health  Ambassadors Team (CHATs) who put on awareness raising events for communities.  Those are around smoking cessation, healthy eating and so forth.  But there are other less planned events where trainers will go to pubs, shopping centres, bingo halls.  By hitting the streets and distributing information they pull people into the trainer service. 

'We also look at groups - like men for instance - who are bad at accessing mainstream services.  For example, PSS runs  a number of groups for guys who have got mental health needs.   The health trainers approach such groups to establish if there's a need and inclination to change unhealthy aspects of their lives.'  Similarly Age Concern (Liverpool) operates a number of services for people 50+ in Liverpool. The partners target existing services and networks. 'Its what gives the third sector the edge over public service provision every time. We are closer to the individuals and communities we serve.'   

Talking to Clitheroe about this organised fluidity, it sounds as though the scheme has solved the problem of getting through the territorial lines between institutions.  He says they are not there yet:

'What frustrates us all, charities and PCT commissioners is that things aren't joined up.  The health trainers work has given us an opportunity to identify  what's not working .  But it also gives us a chance to try and push things forward a little  towards solution.   We've had a real commitment to recruiting people from local communities.  When we extend the service, we increase the  local workforce,  our sub-contractors are community organisations and we do all that we can to invest in local resources. As a consequence we are contributing to local social enterprise and making neighbourhoods more economically vibrant and  sustainable .'

The wealth of community knowledge and networks that comes with health training may be one of the answers for GPs who feel that a huge wedge of  'other stuff' is underlying a patient's presentation with obesity or depression or diabetes.  The Liverpool design offers the chance for both healthcare workers and patients to get away from the silos of 'well' and 'ill' and into a more naturalistic model of care.

Case Studies

Man in his sixties from Garston

'I saw an advertisement for health trainers in the local paper.  I am overweight and thought I should try to diet.  So I telephoned the number in the newspaper and they put me in touch with my nearest health trainers

'They were very helpful.  We met weekly for two months.  The health trainer made it clear that it was my choice and that she couldn't’t force me to change my diet. She gave me good dietary advice and suggested slow changes to my diet that have made a difference, such as replacing some of the cups of tea I drink with water.  I now drink water before I go to bed and I find I get a better night’s sleep.  I still have her contact number if I need help.

'The health trainer has helped me by suggesting ways that I can moderate my diet to help with my cholesterol and blood pressure.  Now instead of a fried breakfast I regularly have porridge and I have switched to wholemeal bread.  Cutting down on the number of cups of tea I have has helped me cut down a lot on the amount of sugar I have.

'The health trainer was very knowledgeable, considering that she wasn’t a health professional, and very down to earth.  The location couldn't’t be more convenient and the suggestion of a gradual change in my diet suited me.'

Mother in her thirties, Toxteth

'I heard about the health trainers from a leaflet in Boots.  I felt ready to commit myself to changing my lifestyle and to start exercising.

'I met with the health trainer three times and we wrote down a plan of what I was going to do and what might be obstacles for me and what might help me.  The health trainer gave me information about exercise classes and groups.

'The health trainer was brilliant – she made me feel relaxed and she was very knowledgeable.  She could come to the house and fit in around my young daughter.

'I have now got a bike (a goal identified in the health plan) and cycle most of the time.  I have even got a child seat on the bike.   I also follow an exercise plan for thirty minutes five times a week.'

Contacts

Want to know more?  Contact Paul Clitheroe by email  or phone 0151 226 3721.