How Community Health Trainers in Manchester enable positive lifestyle changes

Change management

As a so-called ‘early adopter’ site, Manchester developed the Health Trainer Programme via a partnership arrangement comprising the Manchester PCT, the Local Authority (Joint Health Unit) and the Manchester Public Health Development Service. Key drivers at the time were David Regan (Leader of Joint Health Unit, currently Director of Public Health in Manchester), Chris Love (Deputy Head of Service Manchester Public Health Development Service, NHS Manchester) and Ged Devereux (Joint Health Unit Senior Strategy Officer)

Manchester Public Health Development Service is responsible for the recruitment and training of Health Trainers and also the line management of all programme staff. The first  challenge was recruiting and training a first cohort of Health Trainers. This involved advertising the posts through a number of channels in communities at risk, including the local radio, buses and community events. The recruitment drive met a lot of interest from local communities. Applicants took part in interviews and a workshop to establish mutual expectations and to assess social skills. As a result, 17 local people were trained up as Community Health Trainers by May 2006, including six men, representing 12 WTE posts. In this initial stage of the programme’s development, Health Trainers completed a 3 month training induction during which they were employed for 3 days a week to attend classroom-based training. Some of the Health Trainers of the first cohort moved on to find employment in health-related services. For example, two senior Community Health Trainers now work in an NHS mental health agency. In May 2007 ten new Health Trainers were trained up and were based within a range of different placement settings. They bring new skills and ideas into the programme, but, at the same time, the Health Trainer Programme benefits from the fact that the new trainers are supported by three trainers from the first cohort.

Altogether, in February 2014, there are 16 people who are employed as Health Trainers. It is intended that more will be recruited in the near future. The Health Trainer is an employment opportunity aimed at local people who want to support others to improve their health. NHS Health Trainers must have either acquired or be working towards City and Guilds National Health Trainer Qualification Level 3. With full training and support, Health Trainers provide personalised support to others within communities, enabling those most at risk of ill-health to access a healthier way of life. Health Trainers are currently required to make 15 client contacts per week (pro-rata) and contract with 85 unique clients each (pro-rata) over a 12 month period.

Health Trainers speak a number of languages; these include Somali, Urdu, Punjabi, Hindi, Arabic, Mirpuri, Gujarati, Dutch and Greek. Every effort has been made to attract people to the scheme from a range of backgrounds, many of whom may not have considered anything like this before. No formal qualifications or experience of employment in the health service are necessary. What is most important is the ability and desire to work with others and to bring about a real improvement in people’s health. The testimonial of Steve Hoy, a former wrestler based on Manchester United’s old training ground, provides a great insight into a day of the life of a Community Health Trainer.

Health Trainers have been based with Tung Sing Housing Association and Northwards Sheltered Housing Association Scheme thus providing direct integrated healthy lifestyle support to tenants across Manchester.  The programme works more generally across communities through “City in the Community”, Manchester United Foundation and the “Tree of Life Project”.  Consideration is now also being given to how Health Trainers can assist with enhancing the recovery of people who have suffered from stroke, hence placing a Health Trainer within the Community Stroke Rehabilitation Team. This has enabled the programme to effectively target the most marginalised, and people who may not be in contact with services. 

With the introduction of a more holistic health and wellbeing assessment, Health Trainers now work more broadly in Manchester. This also involves working with the Arts Council to improve the wellbeing of clients using creative techniques such as painting. They can now offer assistance around alcohol consumption, smoking, social isolation, stress and anxiety. The role of Health Trainers is not to give advice but to empower the client to develop and use his/her own skills to change their behaviour. The approach is person-centred with the clients making their own decisions. Interventions are also brief, with the aim being to assist clients to move towards specific self-defined goals. The first assessment session includes a health stock-take in order to assess the person’s opinion of their current general health, well-being and health goals. Health Trainers work with individuals, supporting them to identify barriers within their own lives which hinder them from adopting good habits and opportunities which could support healthy change. Health Trainers meet with clients on no more than 6 separate occasions. At each session, the clients’ progress towards goals is monitored and recorded.

The programme is both a third party referral and self-referral scheme. If the client has any pre-existing health issues, they are asked to see their GP before working on any changes. In many cases, clients will have had an assessment carried out by the referring agency, e.g. a physical activity referral scheme, which will eliminate inappropriate referrals to Health Trainers and ensure clients are able to access appropriate services more readily. In Manchester most clients have heard about the service through the NHS or word of mouth. Whereas in the early years of the programme self-referral was the most common form of referral, GPs have now become the biggest referral source.

The relationship between the Health Trainer and the client is a collaborative, equal and non-judgemental one. By offering practical support and guidance in key topic areas, they help individuals to make small changes that will make a big difference to both the quality of life and life expectancy.