The nature of the health problem has changed. The 20th century problem of infectious disease has given way to the prevalence of chronic disease, problems such as diabetes and obesity. 12 million (one in five) Britons suffers from a chronic disease and these numbers are predicted to rise, threatening to financially overwhelm current health services, which were not designed to address these issues.
The challenge is not to build more hospitals or streamline administration practices to reduce waiting lists, but rather to understand what will support individuals and communities in changing their behaviour and sustaining lifestyle changes. It is motivation, not medicine that is required.
In 2004 Charles Leadbeater and I published a paper Health: Co-creating services outlining what we thought might be the principles that would need to under pin a new approach to collaboratively developing new services with service users and professionals, that would be distributed across communities and households, rather than solely located within institutions.
Open Health was a Design Council RED collaborative project that tested these ideas in practice, co-creating new services in Bolton for people with diabetes and a new service in Kent that would encourage residents to increase their physical activity, reducing their dependence on both health and social services.
Bolton has one of the best diabetes services in the country yet despite this the Bolton Diabetes Network estimate that 80 percent of those diagnosed with diabetes do not manage their condition correctly, leading to further complications. Various efforts at tackling the problem have failed. RED spent time in people’s homes understanding the complex everyday issues of living with diabetes. Together we developed a tool that would make consultations with professionals more dynamic and personal. The Agenda Cards enable people to start the process of life style change with small steps they feel are achievable, thus building personal confidence. They save 80 percent of front line worker time, opening up the resources for the ME2 service where people with diabetes can access personal coaches to work with them on sustaining lifestyle changes.
Kent County Council has been in the forefront of developments to create personalised services and promote policies of prevention. Our colleagues at Kent asked us if we could work on an estate in Maidstone, with very high deprivation indices to see how we could encourage physical activity. Again, we spent time with people at home to understand what might work.
The new co-created service Activmobs harnesses the power of existing social networks. Mobs are small groups that carry out an activity on a regular basis. They are connected by the Activmob system, simple web based tools, which help people find or start a mob, a coach, a space to go to and child care if necessary, monitor their progress, set goals and reward commitment. The wellie mob for example developed from a group of mums who walk their dogs after dropping their children at school, the provision of an occasional personal trainer has provided the encouragement to up the tempo of their activity. Kent is now rolling Activmobs out as a social enterprise.
Open Health illustrates the way we work: our transformation design methodology. Key components are the anthropological tools that help us understand individuals and their motivations and our rapid prototyping which helps us move rapidly from ideas to models that can be tested in action, improved and then rapidly scaled.
A highly visual approach provides a common language between service users and professionals and is instrumental in building the broad coalitions that are necessary for social change. As our pamphlet sets out, we believe these are approaches that have broad application to an increasing set of social challenges from those of an ageing society to those of the environment, which will depend on harnessing behaviour change if effective solutions are to be found.