People, families and communities can and should play a crucial role in their own health. As the NHS Five Year Forward View puts it, people with long term conditions are likely to spend less than 1% of their time in contact with health professionals. The rest of the time they spend with their carers, their families or manage on their own.
This means we need to think very differently about how we support people’s health and wellbeing. The question becomes how people can be most effectively supported to manage successfully in the ‘99%’ of time where they are not in direct contact with healthcare professionals.
Nesta and National Voices are both champions of a more person-centred, people powered health and care system. We believe that the healthcare system of the future needs to enable people to have the knowledge, skills and confidence to be in control of their health. The potential of such a shift is enormous, in terms of the impact it can have on people, communities and on the sustainability of the NHS.
A key building block for person-centred care is peer support – ways of connecting people with similar health conditions or experiences to provide each other with emotional and practical support. In effect peer support applies the power of social networks to improving health and wellbeing. We already know that peer support is highly valued by those that use it – it is powerful to be supported by someone who has experienced what you are going through. And the two-way, reciprocal nature of peer support means that everyone has something to give.
However, we also know that we need to better understand the evidence for different types of peer support and be clear which types are most effective, what costs they incur and what benefits they bring.
Nesta and National Voices have therefore come together to conduct a research review with the Evidence Centre, to explore what the evidence base tells us about whether peer support works.
Research findings - summary
Surveying more than 1,000 published research studies, we found evidence that peer support:
- can help people feel more knowledgeable, confident and happy, and less isolated and alone;
- has the potential to improve experience, psycho-social outcomes, behaviour, health outcomes and service use among people with long-term physical and mental health conditions;
- is most effective for improving health outcomes when delivered one-to-one or in groups of more than ten people;
- is most effective for improving health outcomes when it is based around specific activities (such as exercise or choirs) and focuses on education, social support and physical support; and
- is most effective for improving health outcomes when facilitated by trained peers, lay people (not necessarily peers) or professionals.
Overall we found that peer support is worth investing in as a way of supporting people living with long-term health conditions.
However, the research base is still in development and as yet incomplete:
- Evaluating effectiveness and outcomes has often not been systematic, and it is particularly difficult to determine whether one form of support creates more benefits than another.
- Knowledge could be strengthened by commissioning more robust and detailed evaluations of the impacts and reasons why peer support works better in some contexts and for some groups. This could be done through systematic reviews and randomised controlled trials or by evidence that specifies how support was offered or which components were most useful.
- There is little research that adequately assesses cost-effectiveness or would help commissioners to build business cases.
Peer support is one of the building blocks of a person-centred health and care system. It starts with the experience and perspective of the individual and supports people to live the life that is important to them, 100% of the time.
Building on the research findings as well as our previous work, Nesta and National Voices will continue to make the case for strengthening the research base underpinning peer support and other person-centred approaches – it is vital we get much better at understanding exactly what types of peer support work, for whom, under what circumstances.
We will also, over the coming year, work together on Realising the Value, a programme funded by NHS England to find, test and share the best existing ways that people can work with their health professionals and wider community to put person-centred care into practice.