Tag Archives: conversations

‘Thank God for the NHS and Nye Bevan!’

Photo of C4CC co-chair Nigel MathersTo mark 70 years of the NHS, C4CC’s co-chair, Nigel Mathers, writes this blog post on why he owes so much to the NHS and what his hopes are for the future.

I owe so much to the NHS.

I had severe asthma as a child and without the NHS, back then in the early 1950s – in its infancy, it would have been very difficult to get a good quality of treatment.

After training at medical school, I spent my entire working life in general practice, a fulfilling and rewarding career.

And just last year it proved a life-saver after I suffered a major heart attack and collapsed in the street.

Fortunately, an ambulance crew arrived in only seven minutes and was able to resuscitate me at the roadside. I had just a five percent chance of survival and was rushed to the coronary care unit at our local hospital.

Thanks to the skill of the surgeons and the wonders of modern medical technology I pulled through and have made a great recovery with a good quality of life.

Of course, this is one of the major success stories of the NHS, survival rates from heart attacks, many forms of cancer, particularly breast cancer, and a host of other diseases have dramatically improved over the past 70 years.

Way back then, heart attack victims were prescribed prolonged bed rest, while my rehabilitation has been based around daily four to five mile walks – tough at first but necessary and now part of my daily routine.

So it is easy to see why I care so much about the service launched by good old Nye Bevan in 1948 and now having to adapt to the very different landscape of 21st Century Britain, with all the challenges that brings.

As a former Honorary Secretary of the Royal College of General Practitioners (RCGP) and as co-chair of the Coalition for Collaborative Care (C4CC), I have been campaigning to bring about the changes to the health system that I believe can help it thrive for the next 70 years and beyond.

The NHS and social care services are currently under immense pressure through a combination of an ageing population and over 15 million people living with complex long-term conditions.

C4CC believes that the answer to easing these pressures, and providing people with the high-quality care and treatment they deserve, lies in our Three Cs – Better Conversations, Co-production, and Stronger Communities and happily there is now general consensus that this is the way forward. This personalisation of care has captured the zeitgeist – ‘spirit of our times’

As I look back on my career in general practice, which spanned over half of the 70 years since the NHS started, many of us were already using or beginning to harness these key principles in our daily work.

When I started as a GP, consultations with patients lasted the grand total of five minutes, the relationship was much more formal, with nobody calling me by my first name, and conversation and interaction was strictly limited, not least because of time.

In my inner-city practice, we tried hard to break down these artificial barriers by dressing informally, having soft furnishings in the rooms and never sitting directly behind a big desk when talking to people we adopted a conversational style across the side of a desk for consultations.

It was innovative at the time, but is now seen as best practice and of course consultations can now last up to 15 minutes, giving the opportunity to get to the root of a problem, which may not require costly medical intervention.

Co-production as a notion has also been around for a long time, it was just not called it.

In the 1980s we talked about a meeting of experts, with people experts on themselves and what might work best for them, and doctors the experts because of their medical training.

This evolved into RCGP best practice around shared decision-making, designed to encourage the patient to be an equal partner in their own care, the basic principle of what is now called co-production.

I’m particularly proud that C4CC has developed a model for co-production that seems to work and which has been adopted by our partner NHS England in its planning in this key area.

Finally, we have always relied on community and the voluntary services to address the unmet needs of our patients and sometimes [sadly] to fill the gaps in health and wellbeing provision for our communities.

My practice and many others were prescribing exercise in the 1980s, organising bi-weekly walks from our surgery for those we felt might benefit.

We now call this social prescribing and whether it is running, walking, joining other community groups or simply volunteering it has been found that these non-medical referrals can relieve the burden on the NHS and tackle issues such as loneliness and social isolation, themselves major causes of illness.

So while our Three Cs may not be new, I believe they really have captured the spirit of our times and as the NHS looks to the next 70 years will play an increasingly important role in policy direction and strategy.

It’s about changing the culture – about helping people to become active participants in their own care rather than passive recipients of that care – to encourage them to be far more involved in their own care and treatment.

The staggering pace of scientific development will, I believe help play a major part to facilitate this.

Wearable technology such as Fitbits and other devices allow people to monitor their fitness and general health.

There will be far greater interaction with people and health professionals through the Internet and advances in genetic technology [eg individually tailored drug treatments] are another area that has such tremendous possibilities for everyone.

Despite the current challenges, I believe we can look forward to the future with optimism.

I know C4CC and our partners in the coalition have a key role to play in shaping that future and to lead this social movement for change in the way that we work with people to improve their care and deliver better health outcomes for all – ‘personalised care’ for all – right across our NHS.

Nigel Mathers, Co-Chair of C4CC



Communication: The first step to ensuring person-centred care at the end of life

Picture of Natalie Koussa from Compassion in DyingNatalie Koussa is Director of Partnerships and Services for Compassion in Dying, one of the Coalition for Collaborative Care’s (C4CC) partners. In this blog post Natalie stresses how conversations are a critical part of delivering person-centred care at end of life. Natalie shares two experiences to highlight the impact that good communication can have and shares a newly published booklet that can help people consider and record their wishes for healthcare and treatment.

Picture this: a man in his 90s with memory problems. He is widowed and living alone in his own home with help from family and carers for daily tasks. His health takes a downward turn when his kidneys begin to fail. His doctors tell his family that the man doesn’t have the capacity to make a decision over whether or not to receive dialysis treatment.

His family are at a loss – they have never spoken to him about what he would or wouldn’t want in a situation like this, and now he can no longer tell them. They are trying to work out how to make this weighty decision while dealing with the news that a loved one is seriously ill. Family members might disagree with each other or doctors about what they think is best, compounding what is already a difficult and upsetting situation.

Now picture an alternative scenario: the man takes the time to talk about his wishes with his family while he is still able. They speak about what is important to him (living at home, spending days in the garden and watching the sea) and what he finds difficult (travelling and having to visit new places). They talk about who he would want to make decisions on his behalf if he no longer could, and he decides to appoint his son as his attorney for health and welfare.

When his health takes a turn for the worse and doctors look to his family for guidance, they are still deeply saddened, but instead of feeling lost they feel empowered. The dialysis might delay things for a few more months but would cause major upheaval in his life, with frequent and lengthy trips to the hospital. It is not an easy decision, but having had those all-important conversations his son is able to reflect on what his father would have wanted and refuse treatment on his behalf while keeping him comfortable and pain-free. This allows his father to spend his final months doing the things he enjoyed most – seeing his family and enjoying his garden.

Fortunately, the second version is the truth. The name of the man is Christopher, and his son Peter Coe, 69 from Lyme Regis, has shared his experience in Compassion in Dying’s new booklet, Planning Ahead: My Treatment and Care.

Planning Ahead is designed to help people consider and record their wishes for healthcare and treatment, so that they can get on with living life safe in the knowledge that they have prepared for the future. It explains in clear, straightforward language the information people need to understand how treatment and care decisions are made, how they can plan ahead to ensure they stay in control of these decisions, and who to talk to and share their wishes with. What Christopher and Peter’s story illustrates so well is how helpful honest conversations are to this process.

‘Conversation’ is one of the Coalition for Collaborative Care’s ‘Three Cs’ precisely because conversations are an important way to build the shared understanding needed to offer compassionate and personalised care; but talking about the end of life can seem a daunting and difficult task for individuals, family members and healthcare professionals alike. That’s where Planning Ahead comes in – it serves as an easy-to-follow guide which can prompt different discussion topics and ease conversations about people’s values and concerns when it comes to their future treatment and care.

If we are to ensure that people receive person-centred care at the end of life, talking is the first step. We hope that Planning Ahead will help encourage and inform these conversations so that more people have experiences like Christopher and Peter’s.

@NatalieKoussa / @AGoodDeath