By empowering people to take responsibility for their own health and make lasting, positive lifestyle changes, health coaching can have a real impact on spiralling healthcare costs and the nation’s wellbeing.
We’d like to play a part in helping health coaching become more widespread, by debating how best it can be offered and by whom.
Its growth will bring new opportunities for existing and wannabe practitioners, so coaches must ensure they have the right skills, and know where their boundaries of competence lie.
The following article marks the launch of our campaign: Coaching for Health
HANDLE WITH CARE
If most illnesses are preventable, why aren’t we preventing them?
Varya Shaw explains why health coaching, with its emphasis on wellness
and lifestyle changes – and all at a huge cost saving – is set to become
the next big thing, both in the UK and US
We all know that if someone gets high blood pressure or heart disease, a GP will advise them. If there are sudden complications, there’s always A&E. That’s what a healthcare system like the UK’s National Health Service (NHS) is for, right?
Wrong, actually. Healthcare that deals overwhelmingly with people getting sick, and offers care and counsel through GPs and hospitals, is just too expensive. Such an approach tends to encourage more illness, and that means the costs get steeper. Plus, it doesn’t work. On average, only about 50 per cent of people stick to their prescribed medication, while less than 10 per cent commit to healthy lifestyle changes (Bennett & Bodenheimer, 2010).
This is why health coaching, which has been gaining ground in the UK and US since the turn of the millennium, seems poised to become very big indeed.
Empowering the client
Long-term conditions, such as high blood pressure and heart disease, along with diabetes, obesity and emphysema, are often lifestyle-related – and largely preventable. Health coaching, like all coaching, secures lifestyle change by empowering the client.
Once a person is ill, they tend to feel better, both physically and mentally – and the treatment costs less – if they manage their condition themselves.
Dr Mark Atkinson trained at Imperial College London, but turned to health coaching early in his career. He explains: “It became obvious to me that the mainstream model of health was inadequate to support people with their health and wellbeing – it was all focused on disease and symptom management. But the vast majority of illness is preventable. Most people know what they need to do, however, few do it because of engagement and motivation.
But that’s what coaching specialises in.”
So what does health coaching actually consist of? Professor Stephen Palmer is director of the Coaching Psychology Unit at City University and director of the Centre for Coaching in London. He is one of the pioneers of health coaching and favours the use of cognitive behavioural techniques.
One example involves replacing health inhibiting thoughts (HITs) with health enhancing thoughts (HETs). Instead of thinking, “I ate too much today, I’ve ruined my weight-loss programme and may as well give up”, why not think,
“I ate too much today, but it’s just one day, and I can go back to my diet tomorrow.”
Other techniques used to great effect in health coaching are solution-focused coaching and motivational interviewing.
Health initiatives
Health coaching in the UK is growing, but it is still so small that nobody will put a figure on it. One of its biggest sources of demand ought to be the NHS. Certainly, initiatives are taking place at local level.
The London Deanery, which provides postgraduate medical and dental training in the capital, launched the London Deanery Coaching and Mentoring service in 2008, and has trained 500 doctors and dentists in coaching and mentoring since then, while
more than 1,000 doctors and dentists have applied to be mentored/coached.
The potential of health coaching has been recognised up to a point by the government. A January 2012 report by the Future Forum, set up to consult on the coalition’s controversial NHS reforms, recommended a focus on wellness and making “every contact count” between health professionals and the public. The government accepts this recommendation.
However, the Future Forum fell short of using the term health coaching. Dr Atkinson puts the omission down to “lack of clarity” and half-hearted NHS trials of health coaching that have yet to produce a return on investment.
US vs UK
Health coaching is much further ahead in the US though. Margaret Moore is the founder of training body Wellcoaches and a co-director of the Institute of Coaching at McLean Hospital/Harvard Medical School. She estimates there are 5,000-10,000 well-trained health coaches in the US, with a few thousand more who are not properly trained, but call themselves health coaches.
These figures are small compared to the 300,000 personal trainers in the US, but the field shows sign of a relative boom. In 2008, Wellcoaches trained 900 coaches a year and, despite the recession, that figure rose to 1,200 last year.
The upward trend in the US is partly because of the private health insurance system, which makes the cost of ill-health much more obvious. Health coaches are in huge demand with individuals, and employers – who often foot the bill for insurance.
The situation is different in the UK. The financial implications of ill-health are less obvious as there is a sense that the NHS is free. However, every year – and for some years now – NHS costs have risen by 9 per cent, so the need for an alternative approach is pressing.
There is, as yet, no recognised accreditation for health coaching in the UK (although in the US, work is being done to create one through the National Consortium for Credentialing Health and Wellness Coaches).
Health coaching is diverse – it can take place in gyms, peer groups, hospitals, GP surgeries or workplaces. But do you need to be a health professional?
The US National Society of Health Coaches teaches ‘evidence-based health coaching’, comprised of tried and tested techniques such as motivational interviewing. All but 3 per cent of its 1,000 members are licensed health professionals. Melinda Huffman, the society’s co-founder, says: “To be a true evidence-based health coach you need to be knowledgeable of the chronic condition management. Someone without the proper credentials, they’re a liability.”
But Dr Rebecca Viney, who heads up the London Deanery coach training for clinicians, says: “Doctors are overused. There are many ways to improve health, but fewer conditions require the input of a doctor than you might think. The way people access healthcare in the future will be different – people will be more self-reliant.”
Viable entry
Moore says a background in health sciences is essential, but should not be an obstacle: “Many people from other professions are moving into this field because they’ve been lifelong wellness champions. Maybe they run marathons, do yoga, teach meditation. They are taking basic credentials in fitness and nutrition, which give them a viable entry without going back to university. Health coaching is benefiting from corporate coaches moving into the field – they understand the pressures of corporate life.”
In April, the UK’s Academy of Coach Training, founded by
Dr Atkinson, will launch two new courses. One is aimed at health professionals – a 36-week course followed by a stringent certification process. Someone with the proper clinical training could then use these skills to work with some of the most distressing health problems such as cancer, as well as long-term conditions.
The second option is a five-day intensive course aimed at coaches with a general interest in health.
Dr Atkinson says: “Someone who does this isn’t equipped to work with people with ill-health. They are equipped to work with people who are healthy, but want to take health to the next level.”
The Centre for Coaching also offers health coaching training, a two-day Primary Certificate (next one 16-17 May) and a three-day Primary Certificate in Advanced Health Coaching (10-12 October).
Coaches trained in this way can also prevent illness. For example, you could help an existing, healthy, client act on GP advice that they are at risk of diabetes if they do not change their lifestyle.
Health coaching can save organisations money in the same way that it can save the NHS money. Other opportunities for health coaches include training for health professionals, expert patients and HR staff.
Dr Viney is enthusiastic about the future: “For those of us that have trained in coaching, it is as if a veil has been lifted from our eyes. There’s nothing more wonderful than seeing doctors empowering patients to realise their potential – a patient with a diagnosis of diabetes can leave the room with a smile and an action plan to turn their life around. n
See also our previous health articles:
www.coaching-at-work.com/2011/08/26/palmer-health-next-big-thing/
www.coaching-at-work.com/2008/07/04/be-well-and-prosper/
The economic case
According to the World Health Organisation (WHO; 2005), by 2020 three-quarters of all deaths will be from chronic diseases. People with these conditions will use a disproportionate amount of healthcare budgets
Up to 75 per cent of the budget in the US, and 70 per cent in the UK,is spent on chronic conditions
In the UK, around 80 per cent of GP time is taken up by patients with long-term conditions, including arthritis, asthma, bronchitis and emphysema
A total of 60 per cent of UK hospital beds are taken up with people suffering complications from long-term conditions
The government’s 2010 public health white paper, Healthy Lives, Healthy People, estimates that reducing working age ill-health could save £100bn a year
Healthy Lives, Healthy People estimates we spend £2.7bn annually on smoking-related diseases, but only £150m on smoking cessation
A 2010 WHO report, Innovative Care for Long Term Conditions, said health systems in both low- and high-income countries are spending billions on unnecessary admissions to hospital and expensive treatments for preventable diseases
Qualities and training needed
Energy People will come to you to recharge their batteries
A passion for wellness You need to live it, taking regular exercise and eating healthily
Patience It is a long journey from obesity, for example, back to full health
Curiosity About the bigger picture of health and wellbeing rather than the narrow medical view
A health credential (preferably) One in fitness, nutrition or psychology, which allows you to coach well people to make them healthier, or prevent illness
A clinical (medical) qualification If you want to coach ill people
Further information
London Deanery http://mentoring.londondeanery.ac.uk/
A Coulter, Engaging Patients in Healthcare, Open University Press, McGraw-Hill Education, Maidenhead and New York, 2011
Department of Health, 2011 www.dh.gov.uk/health/category/policy-areas/nhs/long-term-conditions/
D de Silva, Helping People Help Themselves: a Review of the Evidence Considering Whether it is Worthwhile to Support Self-management, The Health Foundation, London, 2011
M Driver, Coaching Positively: Lessons for Coaching from Positive Psychology, Open University Press, McGraw-Hill, Berkshire and New York, 2011
M Gaughan and S McMahon, 2007 www.healthscotland.com/uploads/documents/3932-health%20coaching%20%20-%20An%20Approach%20to%20CHD%20prevention.pdf
A McDowell, 2011 http://mentoring.londondeanery.ac.uk/downloads/files/masterclass-in-coaching-patients-for-health-delivered-by-andrew-mcdowell
GB Spence, MJ Cavanagh and AM Grant, “The integration of mindfulness training and health coaching: an exploratory study”, in Coaching: An International Journal of Theory, Research and Practice, 1(2), pp1-19, 2008