Category Archives: Martin Routledge, Director, Coalition for Collaborative Care

C4CC Welcomes New NICE Guidance

Coalition for Collaborative Care (C4CC) welcomes new NICE guidance supporting person-centred integration for older people with long term health conditions.

This month C4CC partner NICE has produced guidelines relating to the social care of older people with multiple long term health conditions which should provide an important steer for both commissioners and providers.

The guidance makes recommendations on:

  • Identifying and assessing social care needs
  • Care planning
  • Supporting carers
  • Integrating health and social care planning
  • Delivering care
  • Preventing social isolation
  • Training health and social care practitioners

C4CC strongly welcomes the guidance and especially its focus on person-centred integration and engagement with community assets and supports. The guidance reflects an increasing understanding of the importance of good care and support planning that enables real partnership between people and professionals and helps see the whole person.

It says “Despite recent policy focusing on integrated health and social care services, some people are still being treated as a collection of conditions or symptoms, rather than as a whole person” and that “People with multiple long-term conditions want joined-up, coordinated services but often find they are hard to access and fragmented”.

We welcome also the heavy emphasis on supporting self-care and on looking beyond traditional ideas of need and solutions – including tackling social isolation via helping people connect to community based groups and support.

The guidance is helpfully short and focused, offering outline advice on implementation while linking to supportive resources and materials. Readers looking to use the guidance in their practice and systems may also be interested in work being undertaken by C4CC partners such as the integrated care and support planning and Building Community Capacity materials produced by Think Local Act Personal (TLAP) and the materials on People Powered Health from Nesta .

Towards person centred, community-led health and care

How do we get the change we want to see?

Last week I attended my first meeting of the Realising the Value (RTV) Advisory Board. RTV is the programme bringing together the evidence base for person centred and community focused solutions to the challenges of health and care and to develop tools and approaches to get that evidence effectively used to drive change. I was struck in the conversations amongst those attending by a kind of “concerned optimism”. Elements of this were:

• Concern about resources and the implications of massive pressures
• A sense that perhaps for the first time person centred and community led approaches might be coming seriously onto the agenda in health
• Thinking about best strategy and tactics to take the opportunity and avoid re-freezing the system with only structural changes for another generation post Five Year Forward View

There was some self-criticism – why have we not managed to get traction for approaches that have been around for quite some time now. Why do eyes sometimes glaze over when we are pitching how person centred care and support planning and people powered health approaches can be powerful solutions to major problems, rather than cake icing or nice to have when the money is available?

The “concerned optimism” came in strongly when we listed the possible drivers for radical change, We have a resource crisis not solvable through existing approaches, chapter two of the 5YFV, the New Care Models Vanguards, Integrated Personal Commissioning and other demonstrator programmes, a sector starting to come together around person centred care – including via C4CC and Think Local Act Personal (TLAP). These are all present or coming into place, but what should be our best strategy and tactics to really take the opportunity when existing cultures, behaviours and interests are resilient. How do we persuasively demonstrate that person centred approaches and community led solutions must complement system re-configuration to achieve the win-win of sustainability and better outcomes?

We were agreed that the approach of RTV – not just gathering evidence of what works, but also looking at how to get it to work in the real world, is vital – including working with some local systems to see how approaches and tools make a practical difference.

In the same week two of C4CC’s partners – Nesta and the Health Foundation in collaboration and synergy with the Kings Fund and IPPR made their latest attempts to paint the picture of a possible future and offer key means to achieve it.

Three reports were published:
Nesta: The NHS in 2030 – a vision of a better future
Making Change Possible, A Transformation Fund for the NHS: King’s Fund and Health Foundation
Powerful People: Reinforcing the power of citizens and communities in health and care: IPPR

The three reports make quite strongly consistent pitches for the change they want to see – with person centred care and support at their heart – and two of them propose the specific mechanism of a Transformation Fund. The argument for the Fund is that even if £8bn extra funding is found by the Government, unless some is targeted at supporting radical new approaches, the risk is the impact will be limited to temporarily maintaining a system that is not long term sustainable and will not deliver the shifts called for in the 5YFV.

Take a look and see what you think. In the meantime – if you want to join us in turning our “concerned optimism” into an increasingly smart and powerful drive for the change we want to see – join C4CC and share your ideas and energy with a growing movement.

Person-centred care and support – a moment of opportunity (part two)

Martin continues his two part blog to ask the question – What else can we do?

So what else can we all do to make sure that Vanguards and IPC help light the blue touch paper for person-centred care rather than fizzling out like a damp squib?

I have read a number of sceptical but persuasive pieces raising understandable doubts about both the ability of pilots (by whatever name) and top down initiatives to actually drive desired changes to delivery and culture across services and systems. As someone who has worked for more than 30 years at both local and central levels and as part of efforts to drive user-driven change I generally sympathise with this kind of analysis. The problem is they rarely offer real world solutions – sometimes suggesting over-simple alternative routes to achieving broad based change or ones that will be clearly impossible to bring about.

For those who are seriously committed to person-centred care, engagement with the (inevitably messy) real world and multi-faceted approaches to making deep change happen will be necessary. We need thoughtful action at the ‘top’, the ‘bottom’ and in the middle!

So, while the national initiatives themselves will not transform health and care services, they are inevitably an important part of the picture and we need to help them to play the best part they can. We will have to powerfully and persuasively describe how person-centred approaches are necessary to achieving their objectives and how they can be delivered.

In parallel though, we will need to do a number of other things. In very brief outline these include:

  • Connecting (in a two way process) what is happening and being learnt in the programmes to a broader group of people and places, who want to see person-centred care at the heart of future public services, so they are not waiting for ’results’ from central initiatives but can offer and use learning in real time. This will include supporting ’early adopters’ outside of national programmes – who have some advantages in being able to act outside of programme constraints.
  • Supporting people using health and social care to themselves drive change at local levels, through groups and organisations looking to co-produce support and shift services in the direction of person-centred care. This is about gradually building a powerful movement that will demand and support better forms of public service delivery, based on real partnerships between people and professionals and better use of all types of resources.
  • Work with professional leaders, groups and networks: sharing person-centred solutions to the problems they face in their work and energising their shift to co-production with those they serve. Linking these professionals to the growing movement of people using public services to become a joint force for person-centred support.
  • Act to ’create the conditions’ for person-centred care in a range of ways, including sharing powerful evidence in different ways and influencing professional bodies and funders of training and development to prioritise person-centred approaches. We will have to support commissioners to prioritise person-centred care and increasingly support the building of non-traditional, non-medical supports and capacity. Action to create the right conditions also includes helping policymakers to see person-centred care as core to what they are trying to achieve and how they can pull system levers to support and incentivise them

None of these things will be easy to do and it is not any single group or organisation’s job to do them. This focus on person-centred approaches will be hard to achieve in an environment of unprecedented financial pressures, competing priorities and the current lack of experience within the health system in particular.

This is why the Coalition for Collaborative Care came together and launched in November of last year. We are a voluntary alliance of organisations and people with an unapologetic focus on person-centred care and support. We are bringing our energies and influence together to achieve, over time, a sea change in how people with long-term conditions and professionals work together. We are modelling this by working in co-production with people with long-term conditions, carers and professionals. We don’t have a multi-million pound budget and we don’t want one – our model for action and influence will be through the activity of our partners and members and our support and assistance to them. If you are interested in hearing more please see here, and there are still a few places left at our gathering in Manchester on Thursday May 21.

So, in conclusion, will the Vanguards and Integrated Personal Commissioning transform health and care and initiate the era of person-centred care? No, of course they won’t, on their own. But those of us who want to see this new era should take the opportunity they offer us with both hands. The Vanguards and the IPC programme are an opportunity to show what is possible if we really put people at the heart of public services and work in partnership, together. C4CC will be doing all we can to take this opportunity – please join with us and help build the person centred health and care system of the future.

Person-centred care and support – a moment of opportunity (Part one)

Today I’m attending the launch of the New Care Models Vanguard Programme and reflecting on what I think will come to be seen as an important period in NHS history. There are real opportunities to build on the great strengths of our NHS while making important shifts which reflect a changing society. But these opportunities will not take themselves.

March saw the announcement of the Vanguard sites and the Integrated Personal Commissioning (IPC) sites. Both national programmes have been broadly welcomed as the start of bringing Simon Stevens’ Five Year Forward View to life. The next few years are likely to determine the shape of health and care services for decades to come as these initiatives point the way for the rest of the system.

My personal experience of similar programmes over the past 15 years tells me that for those of us advocating person-centred care and co-production alongside people using public services, this is a moment of great opportunity but at the same time risk. We must ensure that the opportunity is taken and the risks minimised.

There is a strong tendency for those involved in these kinds of programmes, both centrally and locally, to focus almost exclusively on making changes to organisational systems. Under great pressure to deliver, usually with very difficult timescales, programme leaders are always at risk, whatever their motivations, of focusing on the plumbing and wiring rather than the people. This is not to say, of course, that the structural and system elements – like joined up budgets and integrated organisational and professional arrangements are not vital – they are. It does, however, mean there is a tendency, right from the design stage, not to place person-centred approaches centre stage. They are always there in public pronouncements and stated goals but the link between them and the detailed strategies and plans is often weak.

There are many reasons for this. Co-production with the users of public services in designing and delivering them is still quite novel, perhaps especially in health. The reality is that, for many, it is also still quite still counter-cultural and made difficult by our systems. As professionals we feel we are already person-centred and usually try to be so, but the experience of those we serve often tells a different story. Doing this properly takes time – something that high profile programmes often feel they don’t have. This can lead to superficial engagement rather than serious co-production – itself undermining trust and even generating cynicism.

In addition, although the evidence base for achieving person-centred care is increasingly strong, these approaches have not yet gained serious traction in health. For example, only small numbers of people with long-term health conditions report having a care plan they co-developed with their health professionals. Programmes which aid self-management, shared decision making, enable peer support or link people to community supports for well-being are not routinely commissioned at the necessary scale.

So there is a potential nightmare scenario here, of merely shifting deckchairs, rather than realising a serious person-centred win-win.  This win-win will require people using health and social care services, and wider communities, taking responsibility and action for their own health and well-being. It will require strong communities, local third sector organisations and universal services playing a much more significant role. This can’t be achieved just by joining up organisations or integrated teams working in a more co-ordinated way with people. It also requires the release of capacity and energy from people, families and communities, which only comes from them being at the heart of how things are done and through different, supportive uses of professional skills and system resources.

This is where the opportunity lies. We increasingly know what works in generating much more effective relationships between practitioners and people using health and social care services, and so better outcomes. Two key means are personalised care and support planning and what C4CC partner Nesta has called More than Medicine. It is therefore vital that right from the start, the localities involved in NMC and IPC do the following things:

  • Co-produce the design of the local initiative with local people using public services and maintain this co-production at strategic and operational levels of decision making throughout. This requires going well beyond consultation.
  • Ensure the powerful involvement of local voluntary and community sectors and re-direct resources during the period of the programmes to community based support
  • Give at least as much attention (probably more) to the model of care as to the financial and organisational model.
  • From the start, design key elements of person-centred care to be at the heart of the care model – including personalised care and support planning, support for shared decision making and self-management, peer support, community based support for health and well-being and help for people to connect to these.
  • Design evaluation approaches with people using health and social care and incorporate outcomes that are meaningful to people, not just to the systems commissioning them.

Our early involvement with the IPC programme gives us encouragement as the selection of sites and early design of delivery support has prioritised and committed to these things. I have heard Simon Stevens say that three things he wants to see from the programme are:

  • Joined up services and supports
  • More powerful users of health and social care
  • A very different relationship between the NHS and the voluntary and community sector

The sites will be challenged in keeping on this track, and we would advise local people and organisations to do all they can to help them maintain this focus. It will be necessary for those involved with the Vanguards programme to do the same. C4CC will offer as much advice and assistance as possible to the initiatives.

Part two of this blog, What else can we do? will be published tomorrow, Thursday 23 April 2015.

Towards a new deal for people with long-term conditions

By Martin Routledge

Director of Coalition for Collaborative Care

The Coalition for Collaborative Care is now formally launched, at the Future of Health Conference – a major event in the Health calendar – addressed this year by Simon Stevens following his recent Five Year Forward View. We want this launch to light the blue touch paper for big changes in how people with long term conditions and professionals work together to produce better lives. We have launched our Vision for the Future but of course the future has to start now. Over the past couple of months I’ve met with many health professionals and many people with long term conditions. I think there is a mutual recognition of great potential for new and better ways that people’s expertise can come together for improved outcomes. But this is accompanied by frustration that the promising practice that can be seen in patches around the country is not quickly becoming mainstream.

C4CC wants to work with those determined to move person centred collaborative care from the margins to the centre of practice and experience. How will we do this? Our approach might be summed up as is “Supporting the doers, changing the conditions”. Changing the conditions will involve attention to workforce development, providing powerful evidence and pulling the system levers to drive positive change in practice. This will be of vital importance in achieving the kind of paradigm shift we are looking for – but it won’t be enough. The bottom line is that the health and care workforce and the people who use the health and care system will increasingly need to change their ways of working and interacting so that they can get the win-wins that person centred approaches can provide. People will need help to do this and C4CC aims to be an important part of that help. We want to support the building of a powerful movement for change amongst both practitioners and people living with long term conditions and give this movement the tools, connections and support it needs to help fully realise the potential for person centred care and support. We know that this can’t be simply mandated by policymakers or system leaders, it has to be built by the people delivering and using health and care services. That is why the partners and members of C4CC will be people and organisations who don’t represent a single part of the system but bring together a wide coalition that can have impact in all key areas and at all levels – with people living with long-term conditions at the heart, energising positive change

We will be taking a “depth and breadth” approach to supporting the “doers”. As well as playing an important part in key developments that will shape the future of health – like the Integrated Personal Commissioning Programme, we will be looking for all opportunities to get significant support targeted to those local systems showing clear commitment to transform practice and to the people with long term conditions contributing to this. Sometimes this will involve partners of the Coalition taking direct initiatives, alone or in partnership with others with C4CC, at other times we will aim to direct resources and support emerging from NHSE and other programmes.

At a breadth level we want to support members to become better informed, to link together for support and develop their ability to have positive local impact. We will be consulting members on how best to do this but we expect to support in various ways including through provision of targeted information and tools, establishment of networks and the identification and activation of champions nationally and locally.

We are confident that the unique nature of our coalition – bringing key organisations and people from across the system and with lived experience into the room together with a clear focus and purpose – models the change we are trying to make. We believe we can have a real impact. But for deep, large scale change to happen we need all those who believe there is real potential for person centred collaborative care to transform people’s experience and use resources better to join us on this journey.  Here’s how people can get involved.

Of the people, by the people, for the people

Simon Stevens fires the starting gun for a new deal for people with long term conditions

Major editorials in the serious papers, leading the national TV news, immediate responses from political and professional leadership – The NHS Five Year Forward View certainly grabbed attention.

The powerful focus on people with long term conditions and on a serious shift towards person centred collaborative care is long overdue and very welcome to the Coalition for Collaborative Care. Point 5 in the executive summary was music to my ears, following through on the messages Simon Stevens has started to send over recent months:

When patients do need health services, patients will gain far greater support over their own care – including the option of joint budgets combining health and social care. The 1.4 million unpaid carers in England will get new support and the NHS will become a better partner with voluntary organisations and local communities

The Forward View reminds us that people with long term conditions spend less that 1% of their time with health professionals and that the rest of the time they manage their own lives in their families and communities. It quotes our partner organisation National Voices, quite rightly saying:

Personalised care will only happen when statutory services recognise that patients own life goals are what counts;- that services need to support families, carers and communities; that promoting well-being and independence need to be the key outcomes of care; and that patients, their families and carers are…experts by experience

C4CC believes:

  • That people with long term conditions are in charge of their own lives and should be the main decision makers about the actions they take in managing their conditions. People can express their own needs and decide on their own priorities in partnership with professionals. Professionals need to recognise people’s assets, strengths and abilities, not just their needs, and support them to live their lives as well as possible.
  • People are interested in their lives rather than just their conditions and help should be coordinated around the whole person’s needs. The relationship between a person and a professional should be one of equals where each is seen as having expertise.
  • That as well as being the right way to support people, this approach works. People are more likely to follow through on decisions they make in partnership, which helps people manage their conditions and so stay well and independent. For people approaching the end of their life, taking this approach to decisions is often especially crucial

The NHSE Chief Executive is telling us that now is the time to take this seriously.

The future of care and support – person centred and collaborative

Last week saw the publication of the final report by the Commission on the Future of Health and Social Care in England and the Integrated Personal Commissioning Prospectus along with Getting serious about personalisation in the NHS. A common theme is the need for a sea change in how health and social care is delivered.

Amongst many important proposals I was pleased to see a focus on personalised care and support planning as a key means through which people can be full partners with health and care professionals. The proposals also included advocacy, peer support and brokerage as well as the option of a personal budget for those who would benefit and want one.

More people than ever before within the health and care system now recognise that in order to improve the lives of people with long-term conditions a major re-think of our current approach is required. This will mean many changes across the entire health and care system. For instance, it will mean a change to GP consultations, changing how our clinicians and professionals are trained, changing the support that people have access to, including for carers and family members.

People with long-term conditions often spend just a few hours a year with health and care professionals, and mostly manage their conditions themselves. The health and care system must therefore support individuals to develop the knowledge, skills and confidence to manage their own health and care, and to support one another in the context of their wider families and communities.

Over recent years there has been a wide range of initiatives aimed to help make the shift we want to see. What we need now is action to forge connections across the health and care system to make these initiatives a success and at the same time put more power behind them. Our coalition is developing plans to support all those in the health and social care system who are determined to make person centred care and support a reality – both professionals and people using health and social care.

People using public services increasingly want to shape and steer them so that the support received fits with their individual lives and goals. This support should build on rather than replace their own resources and connections in their communities. Pioneering professionals are supporting these shifts by working in partnership with these people not just delivering to them because this approach is more effective, efficient and rewarding.

This change is not easy. Organisations and cultures do not shift quickly and this is why we need a coalition of partner organisations and individuals to help make a faster and deeper change towards more collaborative, person-centred care. For me, it is only through partnership, placing people at the centre and working with key organisations, professional groups and policy-makers that systems and cultures can achieve significant change.

That is why we want to create the conditions for change in policy and delivery and also offer help and support to the ‘doers’ out there who are making a change to their lives and their practice. Core to our work will be the leadership of people using the care and support system – experts by experience. They will co-produce our work programme, be represented in all our decision making and help deliver the work of the coalition. Over the next few months we will be setting out our vision and our practical commitments.

Martin Routledge is the new director of the team supporting The Coalition for Collaborative Care.