Background – population health approach in Mersey Care NHS Foundation Trust
Mersey Care NHS Foundation Trust (Mersey Care) offers specialist inpatient and community services to support physical and mental health, learning disability, addiction and brain injury services to a population of 1.5 million people across Merseyside, and parts of Lancashire and Cheshire, in the North West of England. There are long-standing health inequalities within the region. For example, all the boroughs within the Liverpool city region are associated with higher levels of deprivation, linked with lower levels of life expectancy and higher levels of mental ill health compared to the wider England average.
Mersey Care has embedded population health management as a key component of their long-term organisational strategy – acknowledging the impact of deprivation and the wider determinants of health on levels of mental ill health and how patients are accessing the trust's services. The trust is committed to using data and intelligence to better understand their population's healthcare needs. Their analysis has found that 51% of mental health patients in the Mid Mersey area live in the most deprived areas and rates of emergency hospital admissions are three times higher among mental health service users in North Mersey compared to the rest of the population. To address these disparities, the trust has developed several population health projects, has signed up to the NHS Prevention Pledge, hosts the Global Centre for Research on Mental Health Inequalities and, in partnership with the University of Liverpool, hosts the newly formed Mental Health Research and Innovation Centre. A key component of this approach has been the creation of Mersey Care's the Life Rooms project.
The Life Rooms – holistic, community-based care
In 2015-2016, the trust undertook a large-scale listening exercise with patients and communities to understand patient's recovery processes, recognising high levels of demand with low levels of recovery and discharge. The results highlighted several challenges patients face in both accessing and leaving services – the majority of which were focused on the wider circumstances and environment of patients' lives. Social isolation, stigma, poor housing quality, complex debt and financial insecurity, and struggles accessing employment were all impacting on patients' recovery from mental ill health.
In response, The Life Rooms were created – providing holistic, wrap-around support services in community-based settings. Mersey Care describes the Life Rooms as 'an open door to a better day'. The primary purpose of the service is to improve population health, by preventing ill-health, managing patient recovery and mitigating against the risks posed by the wider determinants of health. The first Life Rooms site was launched in 2016, and the trust has since developed a hub and spoke model covering a range of community locations across the region, focussing particularly on areas of social deprivation.
The services provide a core offer of social prescribing services alongside improving access to learning and into employment opportunities for service users. Mersey Care describes the model of care as 'bio-psycho-social care'. The social prescribers are known as 'pathway advisors', who provide a bridge between patients and over 250 local voluntary, community, faith and social enterprise sector (VCFSE) sector organisations – highlighting how the service makes connections between clinical and social infrastructure. Partnership working with VCFSE organisations has been essential in providing support for patients on a range of areas, from housing, benefits/money, to mental wellbeing. Via The Life Rooms, Mersey Care has been able to commission specific VCFSE organisations to deliver targeted interventions with communities, such as working with Age Concern to deliver a project on social isolation for older adults. The non-clinical aspects of the service have encouraged a range of opportunities for communities to access services, including wellbeing initiatives such as community choirs and theatre performances, dance schools and open mic nights. Alongside this, the services have run behaviour change programmes to enable patients to better mange their health and wellbeing, by focusing on the skills, knowledge and confidence of patients.
The Life Rooms services are open to all community members and are not restricted to Mersey Care service users – although it is expected that the services help to reduce pressure on secondary care services by providing early help interventions and avoiding acute incidents of mental ill health. The trust has also engaged in targeted outreach with specific population groups that are more likely to experience inequalities, including refugees and asylum seekers. As the services are open-access, patients do not need a referral to access and most people hear about the service through word-of-mouth, support workers and social media. Mersey Care has created an identity for Life Rooms that is distinct from the trust, through a unique logo, website and communication channels – which is particularly important for gaining trust among local communities. Many of the staff employed by the Life Rooms have lived experience of mental health challenges and/or of accessing mental health services, providing lived experience in the day-to-day operational running of services. Alongside this, the trust regularly engages with communities to hear feedback and co-design changes to services.
Impact of Life Rooms services
Mersey Care's 2022-23 annual report of the Life Rooms records over 4,000 visits and 8,000 social prescriptions over the course of the year. Feedback from service users has been extremely positive, with 99% stating that 'accessing the Life Rooms was easy for me' and 97% recommending the service to a friend or family member. Services have worked specifically with disadvantaged groups, by supporting 2,800 patients to register with their GP and working with over 30 different nationalities.
Evaluation is embedded into the delivery of the Life Rooms services, as the trust employs a Quality and Research Lead to oversee this work and publishes a regular series of research reports on their website. They are currently working with data scientists to better understand the impact of the services on health outcomes and use of other healthcare services in the area. Initial research matching the NHS number of users of The Life Rooms services with wider NHS usage data across the system, has found that many of the service users are also patients of secondary care and A&E services – suggesting the trust is targeting the right populations to prevent avoidable, frequent attendance.
In future, Mersey Care hopes to be able to embed their services into existing community settings, alongside their existing community-based health hubs – in a mixed hub and spoke model. The trust understands that communities have already established trust with existing organisations and centres, particularly for those least likely to engage with traditional forms of healthcare services. In 2022, Mersey Care was commissioned by Liverpool City Council public health department to embed their services within 13 children's centres and other one-stop shops across the city, providing wrap around care for young mothers and wider family units experiencing financial strain and who may be at risk of poorer mental health. This specific project led to 1,500 contacts with service users and 2,600 social prescriptions – alongside provision of training to 129 members of staff within children's centres.
For more information about Mersey Care’s The Life Rooms, please contact: liferooms@merseycare.nhs.uk
More information about The Life Rooms can be found online at: liferooms.org