Putting heart back into the community

A rare piece of co-operation in the public sector is having a healthy effect on patients, hospital budgets - and jobs.
Birkenhead's most deprived area, the Citylands, is becoming healthier thanks to a pioneering initiative by a group of public sector organisations working with Liverpool University.

People are taking more exercise, stopping smoking, cutting back on drink and changing their diet. The local health authority looks set to save money with fewer drugs prescribed and less patients re-admitted to hospital. Heart attack victims are getting back to work more quickly, and the demand for fitness classes is creating jobs for instructors.

The Life Project in Wirral, a pilot scheme bringing together several statutory agencies to promote healthy lifestyles and exercise, could become a model across the country. Liverpool University, Wirral council, Merseyside Health Authority and general practitioners have been working together for two years, funded by the local City Challenge scheme, persuading people to take more exercise to prevent illness and to get well more quickly. GPs are writing out "exercise prescriptions" for patients to take to fitness classes to get them into better shape.

Sue Drew, the Life Project leader, says: "If we can promote self-esteem, people will take steps to improve their lifestyle. Then they may go on to give up smoking. Local people take leadership roles, and we train them to become exercise leaders, self-employed or working for the council's leisure services, or for local companies, or for our community programme."

Each patient receives six weeks' free use of the council's leisure centres, when their progress is reviewed. Then they are given a further programme for the next six weeks, which the patient pays for. Evaluation of a random group of patients found them to be regularly going for exercise, and on reduced levels of medication.

Dr Mohammad Salahuddin, a local GP, says the project is having a beneficial effect on patients, especially in improving cardiac rehabilitation. "Before, when patients came out of hospital they were getting different advice from different people, including specialists and GPs. Now they have the confidence that someone is looking after them. People are going back to work much earlier now, I think. Quite a few people come back to me asking to reduce their drugs, and there are fewer re-admissions to hospital. The situation has changed drastically."

The role of Liverpool University has been central. The idea arose from discussions between the university and Wirral council, the university recommended which equipment should be used, undertook project evaluation, and is represented on the management committee.

Evaluation has shown that the project is working. "There is little doubt that it saves money," says David Brodie, professor of movement science and physical education at Liverpool's Faculty of Science. "At the moment the main evidence is with client satisfaction. Once people start on the programme they become very enthusiastic and keep coming. We are getting clear evidence of improved physiological capacity, and our psychological tests show improvements.

"The referral scheme is showing a reduction in drugs use, which is saving the health authority money. The test is whether there is a reduction in heart disease, but we won't see that for 10 years. So we have to look at known risk factors, like cholesterol levels, fitness and smoking, and we can see there are changes which should be advantageous."

Mandie Winstanley has also found her life changed for the better. She had been working as a supermarket cashier when she saw advertisements offering RSA and NVQ standard training, run by the Life Project, for fitness instructors. Now she is employed by the project and a local health club, running classes for elderly people and children. "It's absolutely fabulous," she says. "It got me a full-time job. More people are starting to be aware of health and exercise."

The success of the Life Project is just beginning to become more widely known. In April, it won a national award from the Department of Health. Local authorities are asking for details, and in September it is hosting a national conference jointly with the Association of Metropolitan Authorities encouraging councils to copy it.

Ian McNichol, assistant secretary for leisure at the AMA, believes that the project has established a style of working that should be copied widely. "It is directed into a clearly defined area with clear objectives, and is properly resourced. It is extremely important for the future promotion of healthy lifestyles. It is the most important single project in the country."

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