FLOW Programme

The health and wellbeing of individuals are shaped far more by their social and economic environment than by medical care alone. In fact, only around 10% of a person’s health is directly influenced by the NHS, with the remaining 90% shaped by wider factors such as income, housing, relationships, and access to support.

More people than ever are living with multiple physical and mental health conditions, often while facing significant barriers to achieving even the basic building blocks of good health: safe housing, financial security, and social connection. Often these are interdependent which, means it can be difficult for services to address these issues in isolation. This situation ultimately leads to poor treatment outcomes, for the individual and for providers.

These challenges can lead to unhealthy coping strategies, such as smoking, poor diet, or medication overuse. Mental health difficulties often accompany these issues, creating a vicious cycle: unmet needs → unhealthy coping → further complexity → more unmet needs.

Many people are caught in a gap: they don’t meet the threshold for statutory services, but their needs are too multifaceted for what’s currently on offer. Or they do meet the threshold but due to the multifaceted nature of their needs they are unable to engage in the expected way. This can lead to avoidable crises, repeated inefficient use of unplanned services, and frustration for individuals and professionals alike.

As a result, many people in these situations describe feeling overwhelmed and powerless. Services designed to support them are often fragmented, inflexible, or difficult to for them to access. This leads to experiences of being “bounced around” the system, repeating their story to professionals who may not fully understand their context. The system, however well-meaning, can become part of the problem by adding to the complexity of persons life.

Professionals working within this system also feel the strain. Many describe frustration at not being able to help in ways they know are needed but fall outside the remit of their service. This means the impact of their intervention can be limited as it is affected by factors which are outside their control. This disempowers both the people being supported and those trying to support them.

At a system level, this results in high levels of avoidable demand, inefficiency, and cost. When support doesn’t factor in, and address wider issues, it can worsen outcomes and increase long-term reliance on services.

As Helen, a woman from North Devon said:

My head was so full of chaos and trauma … I just couldn’t think straight. I was being bombarded with appointments. You have to recount your story over and over. And then you go home and sit with it. You’re constantly triggered. I’m doing this interview because I don’t want people to go through that.

To create better outcomes, support must start from a different place: a move away from what’s the matters with you – to what matters to you? – in the context of the person’s whole life.

Flow is a practical approach to delivering person-centred, value-based care. It was initially developed in Northern Devon to help people with complex needs receive joined-up, holistic support tailored to their life context.

The Flow model is flexible and  can be used by any team or organisation. At its heart are two key principles:

• Start with what matters. Support begins by understanding what matters most to the person, not what service professionals think is needed. See video
• Joined up working: Flow ensures professionals from different agencies work together towards the things that matter for the person. Instead of multiple disconnected interventions, support ‘flows’ around the person. This could involve MDTs, joint case working, informal joined up conversations.

This approach recognises that people’s needs don’t fall neatly into organisational boxes. It puts people’s goals and strengths at the centre, focusing on what’s most important to them — whether that’s housing, health, finance, or relationships — and builds a support network around that- with everyone having their individual contribution – but as part of a wider team working towards the things that matter.  For example a medical professional working in hospital is not solely fixed on treating/curing a health condition – they work with the patient to do so in the context of contributing towards the patient being able to achieve the things that matter for them.

System Change:

• Flow acknowledges that the system is not currently set up to work in this way and that organisations mostly sit in isolation performing their specific roles. Flow still works within these set ups by using the principles above. However, in order for this way of working to reach as many people as possible, and reduce the current levels of failure demand within the system, we recognise that greater system change is needed – and this is the ultimate goal.