Transcript After Francis: A National Voices perspective

People shaping services
Jeremy Taylor, CEO, National Voices
At COT 38th annual conference, Brighton
3 June 2014
National Voices is:
• “the leading coalition of health and social care
charities” Health Service Journal
• Our mission:
– Promoting person-centred health and care
– Being a valued membership organisation
• 160 organisations as members
• Founded in 2008
A service view
A person’s view
When people & services
come together......
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Putting patients first
Patients at the heart
Patient focussed healthcare
Person-centred healthcare
Shared decision making
Whole-person care
Engagement
Involvement
Participation
Patient and Public Voice
PPI/PPE
No decision about me without me
What matters? – the evidence
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Access
Information
Communication
Involvement
Family and friends
Privacy, confidentiality and dignity
Independence
Support for self-care and independent living
Personalised service, coordination and continuity
Practical support
Emotional support
What matters? – the testimony
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It’s so hard to get an appointment
I don’t know what’s going on
The receptionist wouldn’t even make eye contact
What are my choices?
I need to discuss it with my daughter
I’m not happy about the way they spoke to my Mum
I just want to get on with life
I’m fed up being passed from pillar to post
I know what to do if things change or go wrong
Macmillan were fantastic in helping explain about my
benefits
• Joining the walking group has made such a difference
What matters? – the things we
talk less about
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pain
exhaustion
fear
anxiety
depression
anger
hopelessness
confusion
loneliness
Living with .....
Traditional practice styles……
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Create dependency
Discourage self-care
Ignore preferences
Undermine confidence
Do not encourage healthy
behaviours
• Lead to fragmented care
Informed, engaged patients
Have the knowledge, skills and confidence
to manage their own health and
healthcare,
And they……
• Make healthy lifestyle choices
• Make informed and personally relevant
decisions about their treatment and care
• Stick with treatment regimes
• Experience fewer adverse events
• Use less costly healthcare
With thanks to Angela Coulter
The Web of
Care
Out-ofHours
Doctors
(Last 7 yrs)
Care team
2 live-in carers
(alternating weekly)
Replacement carer
[Some night nursing
– Health]
Emergency carers
& Barbara
Continence
Adviser
Consultant
District
Nurses
GP
Dietician
Dementia
Advisory
Nurse?
Malcolm &
Barbara
Oxygen
service
Alzheimer’s
Soc outreach
worker
Community
Dentist
Occupational
Therapist
Social
Worker
Direct
Payments
Team;
Rowan
Org.
Speech &
Language Adviser
Wheelchair
Service
Equipment
Service
Physiotherapist
Alternating
Mattress technician
Care planning
My
goals/outcomes
Person centred coordinated care
Information
“I can plan my care with people who
work together to understand me and my
carer(s), allow me control,
and bring together services
to achieve the outcomes important to
me.”
Communication
Transitions
Decision making
Care planning
• I work with my team to agree a care and support
plan.
• I know what is in my care and support plan. I know
what to do if things change or go wrong.
• I have as much control of planning my care and
support as I want.
I can decide the kind of support I need and how to
receive it.
• I have regular reviews of my care and treatment, and
of my care and support plan.
• I have systems in place to get help at an early stage
to avoid a crisis.
Communication
• I tell my story once.
• I am listened to about what works for me, in my life.
• I am always kept informed about what the next steps
will be.
• The professionals involved with my care talk to each
other. We all work as a team.
• I always know who is coordinating my care.
• I have one first point of contact. They understand
both me and my condition(s). I can go to them with
questions at any time.
Information
• I have the information, and support to use it, that I
need to make decisions and choices
• I have information, and support to use it, that helps
me manage my condition(s).
• I can see my health and care records at any time. I
can decide who to share them with. I can correct any
mistakes in the information.
• I am told about the other services that are available
to someone in my circumstances, including support
organisations.
Decision-making
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I am as involved in discussions and decisions about
my care, support and treatment as I want to be.
• My family or carer is also involved in these decisions
as much as I want them to be.
• I have help to make informed choices if I need and
want it.
• I know the amount of money available to me for care
and support needs, and I can determine how this is
used (whether it’s my own money, direct payment,
or a ‘personal budget’ from the council or NHS).
Organisational
processes
HCPs committed to
partnership working
Engaged,
informed patients
Personalised
care
planning
Responsive
commissioning
Coulter, Roberts, Dixon: Delivering better services for people with long-term conditions –
building the House of Care, King’s Fund, October 2013
IT: clinical record
of care planning
Test results and
agenda setting
Emotional and
psychological
support
Organisational
processes
Personalised
care and
support
planning
HCPs committed to
partnership working
Information and
structured
education
Engaged,
informed patients
Prepared for
consultation
Know your
population
Consultation skills
and attitudes
Integrated, multidisciplinary team
and expertise
Senior buy-in and
local champions
Responsive
commissioning
Develop market
Ensure time for
to meet current Identify
and future needs needs, map consultations,
resources training and IT
Establish and
publicise menu of
care, including
“more than
Quality assure
and monitor
“More than medicine”
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Self-management
Family
Friends
Neighbours
Peer-supporters
Befrienders
Advocates
Community health champions
Patient and lay leaders
Voluntary sector organisations
Changing models of care
From:
To:
Patients as recipients
People as partners and
managers of their health
Increasingly social
Primarily medical
Professionals designing
services
Mobilising doctors, nurses
and drugs
Treatment plans
Clinical outcomes
Hospital focus
Co-design of services
Mobilising citizens and
communities
Participative care and
support planning
Outcomes that matter to
people
Out of hospital focus
“Using the public voice”
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There’s no such thing as “the public”!
There’s no such thing as “voice”!
Please don’t “use” us; work with us!
Don’t just “hear our voice”; talk with us!
Don’t just talk with us, involve us!
Don’t just listen, do something about it!
Find out what matters, do it, measure it!
Torbay outcomes
• Reduced admissions to acute care – bed day usage per 1,000 pop
Highest 1281
Devon 977
Torbay 720
• Minimal delayed discharges from local DGH & fewest excess bed
days in South West
• Reablement saved 355K last year
• Halved admissions to long term care. Feb 2006; 1298 placements.
December 2013; 676 placements
• Quicker response to referrals e.g. MSK services same day
appointments
• Increased number of people “diverted" from care
“Using the public voice”
• People - in the end we are all people
• People engaged in their own health – understanding how
to help
• Partners in decisions – not just listening, but sharing
• Self-managers - information, planning, education, support
• Consumers – asking, listening, analysing, reacting
• Citizens - hearing everyone, respecting rights
• Commissioners – direct payments, personal budgets,
helping people take control
• People helping people - tapping into power of social action
• Leaders - embracing and working with patient leaders,
experts by experience etc
• Communities - reaching out, finding out, involving
How much do you want let
go?
References
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Health Foundation resources on shared decision making
NHS Networks: smart guides to engagement
NHS England guidance on participation
National Voices guide to care and support planning
National Voices narrative of coordinated care
Centre for Patient Leadership
School for healthcare radicals resources
Many to Many: how the relational state will transform public
services, Muir and Parker, IPPR, Feb 2014
• Volunteering in health and care. The King’s Fund. March 2013
• Altogether Better: evidence summary, community health
champions
"The starting point for any system
of care should be to ask what it
takes to lead a good life".
The Generation Strain: Collective solutions to care in an ageing
society. McNeil & Hunter IPPR April 2014
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Thanks for listening
www.nationalvoices.org.uk
Follow us on Twitter
@NVTweeting
@JeremyTaylorNV
For discussion:
how are you helping....?
• People - in the end we are all people
• People engaged in their own health – understanding how
to help
• Partners in decisions – not just listening, but sharing
• Self-managers - information, planning, education, support
• Consumers – asking, listening, analysing, reacting
• Citizens - hearing everyone, respecting rights
• Commissioners – direct payments, personal budgets,
helping people take control
• People helping people - tapping into power of social action
• Leaders - embracing and working with patient leaders,
experts by experience etc
• Communities - reaching out, finding out, involving
For discussion:
• What can you do personally?
• What can your service do?
• What can your organisation do?