From May 2017 until April 2018, the Q Improvement Lab (Q Lab) has worked with nearly 200 participants including Q members to explore what it would take for effective peer support to be available to everyone who needs it, to help manage their health and wellbeing needs.

The Q Exchange is an exciting opportunity for Q members to win funding for their peer support ideas. To help with this, the Q Lab has summarised our learning on peer support, using existing evidence and highlighting new insights and knowledge surfaced through the Lab process.

This is not a comprehensive review of all that is known on peer support. It is a working document that will be added to and improved over the coming months. However, it is the nuts and bolts of our learning, outlining some clear challenges and opportunities that we hope Q members can seize and develop during the Q Exchange process.

What the Q Lab has learned about peer support – read the essay

Read on for a summary

(Any questions or feedback? Please get in touch with us at Qlab@health.org.uk)

What is peer support?

This question comes up regularly as there is no one definition of peer support. The description below is our interpretation of peer support as a result of the last year of work. Please feel free to use it.

Peer support in health and care is where people with shared experiences, characteristics or circumstances, support each other to improve health and wellbeing. Peers can be people with similar health conditions, or from similar communities or backgrounds.

Three key challenges

During the Lab’s research and discovery phase, working with a diverse group of people with different experience and expertise in peer support, we did desk research, a survey and ethnographic interviews to understand the challenges and opportunities within peer support. From this we identified challenges around evidence for and access to peer support, as well as broader cultural and workforce challenges.

We held a two-day workshop in July 2017 to delve deeper, explore the root causes of the challenges and identify opportunities where we – the Lab and Lab participants – could make progress and improve peer support.

Since July, we have undertaken in-depth work on evidencing and accessing peer support, and so this is where most of the learning is captured below and in the working document. We have also captured our understanding of how peer support fits alongside other health and care services and interventions.

1.    Evidence and measurement of peer support

• There is evidence which demonstrates the benefits of peer support but there are some still some questions about how best to measure its impact and which metrics would be most suitable.
• People delivering peer support have shared how difficult it is to demonstrate the benefits that they see. The Lab worked with National Voices, Mind and Positively UK to design a new online hub for the evidence of peer support. National Voices are now taking forward this work.

Food for thought:

• Services and commissioners should continue to invest in the measurement of peer support, focusing this research on areas where the evidence base needs strengthening. This includes the role of peer support in physical health, understanding what works for who, when, and how the different models and approaches may lead to different outcomes.
• There are opportunities to trial novel approaches to research that are more likely to demonstrate the holistic impact of peer support, such as participatory research.
• Storytelling as a form of evidence emerged as an area of interest. However, to take this work forward it is important to consider what people want to achieve by using stories, and how this can help build the evidence base.

2.    Making peer support more widely available and accessible

• Engaging the general public is challenging because the different types of peer support services / activities and the language used is diverse.
• Knowing what peer support is available is an issue. Some organisations and locations have tried to combat this by developing signposting tools while others have tried to address this issue by embedding peer support alongside other services.
• Promoting and finding peer support services can be challenging: people are having to be creative to get their services known about and understood.

Food for thought:

• The Lab has recently conducted a large scale survey into understanding why different groups of people refer to, recommend or use peer support. The results will be published in May.
• To better understand the range of peer support it would be useful to have a who’s-who of peer support. The Lab has started this with profile cards and an online space. Q Exchange applicants can use the profile cards to connect, share ideas and develop applications.
• There are opportunities to support people who are interested in setting up peer support. While there are a number of ‘how to guides’, there is also value in better capturing the learning from people’s practical experience of setting up peer support.

3.    Peer support in wider health and care services

• Research suggests that peer support is most effective when underpinned by values and principles that recognise people’s resources and potential, is driven by what people want and need, is co-produced and provided by people with experience of living with the condition, and that establishes a culture of mutual benefit and sharing experiences with each other as equals.
• The fact that peer support establishes a culture of mutual benefit can set it apart from other health services. Issues around ownership of clinical risk are genuinely complex and can cause confusion or concern for people who are wanting to use peer support, as well as for health care workers and the people delivering peer support.

Food for thought:

• Peer support sits at a boundary between formal, statutory health and care support and community-based support. As such, there is a question of whether it should be driven formally, from within the system, or supported to grow in a more organic, informal way.
• Echoing Realising the Value, we need to recognise patients and voluntary, community and social enterprise workforce as an essential part of the wider health and care workforce and ensure they are provided with appropriate support and training, as well as those working for statutory services.