Tag Archives: Three Cs

‘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

C4CC supports extending personal health budgets

C4CC co-chairs have welcomed the announcement yesterday that the Government is to back NHS England plans to make Personal Health Budgets (PHBs) more widely available as part of its Integrated Personal Commissioning (IPC) programme.

A formal consultation to extend legal rights to PHBs, which are currently restricted to people receiving NHS Continuing Health Care and children receiving continuing care, will be launched later this month, managed by the Department of Health.

Key C4CC partners have long pressed for people to be treated as equal partners and to have more control over their own health, care and support and believes PHBs are a key element in delivering better outcomes for people with long-terms conditions.

“PHBs can play a vital role in providing person-centred care to fit the needs of the individual and enable them to access resources that are available to them in their own community, ” said C4CC director Catherine Wilton.

“This proposed extension of PHBs aligns with our current work programme, which is focused on our ‘Three Cs’ of better conversations between patients and their care providers, co-production of health through better partnerships and the involvement of community resources in supporting people with long-term conditions.

“We will be liaising with our partners to provide our collective input into the consultation with the hope that our recommendations are fully taken into account when the plans are finalised.”

The consultation announced today will consider extending the legal right to PHBs to people who access wheelchair services; people with a learning disability or autism; armed forces personnel discharged from the service under medical grounds and people eligible for Section 117 aftercare services with ongoing mental health needs.

C4CC co-chair Anna Severwright said: “As somebody with multiple long-term conditions I warmly welcome the announcement yesterday to increase the number of personal health budgets.

“PHBs give people more choice and control over their care, allowing them to select the support that works best for them and to be able to live the life they want.”

Paula Fairweather, a member of the C4CC co-production team, said a PHB helped change her life and wants others to benefit.

“My PHB meant I was able to access different support in a way that worked for me, buying equipment for physio specific to my needs and improving my health and helping me be more independent.”

“I have also seen PHBs make a huge difference in many other people’s lives, improving their health and quality of life. For example enabling someone previously housebound to volunteer and help others in the community.”

C4CC helped develop the IPC programme, which aims to integrate health and social care to better meet the needs of the individual and empower people to play a more active role in their own health and wellbeing.

Our co-chair Nigel Mathers commented: “I am pleased with this announcement endorsing the roll out of IPC and PHBs and the forthcoming consultation on extending the legal right to have a PHB.”

“C4CC has been a supporter of PHBs since their inception and the rolling out of IPC will strengthen the voice of people with long-term conditions in the NHS. “

What can healthcare commissioners do to get everyone involved with health and care in their own communities?

The need for community-based approaches to give people a real and effective voice in their own health and wellbeing needs has been validated and given greater weight by the NHS Five Year Forward View and its recommendations under Next Steps to utilise those assets as a catalyst for change.

Realising the Value has drilled down to provide the evidence of the validity of these approaches and is a call to action to make it happen.

All well and good, but it’s our contention as authors of Commissioning for Community Development for Health that there are many decision-makers in the health system who want to strengthen community action, but have no model for how to start going about it.

We wanted to produce a research-based publication that addresses this need and provides a framework for action, starting in priority neighbourhoods.

It offers a systematic approach to increasing resident involvement in health-giving activity, mutual aid and community effectiveness across a CCG area, and provides the tools to get it going.

It offers:

  • a down-to-earth explanation of what community development is and does
  • where it fits in to current health policy
  • the kinds of health benefit that these methods can generate
  • a rationale for partnership with other local services to boost community activity
  • mobilising participation through all community groups and networks
  • addressing both health and care and the social determinants of health
  • making services more responsive to communities
  • designing a two to five year community strengthening strategy
  • phasing the work across the CCG, starting with priority neighbourhoods
  • what skills should be sought in recruiting project leader and staff
  • model contract for provision of the community development project
  • model baselines, milestones and key performance indicators
  • reconciling planned outcomes and objective evaluation with scope for flexible fieldwork method.

The Handbook closely reflects C4CC’s own 3Cs. So we are proud to help spread the message to a wider network.

It has also been endorsed by the Royal College of GPs and Think Local Act Personal (TLAP). support we obviously welcome.

But our work does not end with its publication and we are offering introductory seminars and practical workshops to commissioners and others keen to learn more.

As well as explaining the key concepts and instruments and looking at case studies, these can be tailored to particular audiences, priority local issues and participants’ needs.

Contact gabriel.chanan@talktalk.net or brianfisher36@btinternet.com for more details.

 

Reflections of a long time carer

I have been a carer for nearly 20 years, with firstly my mother, and then my husband developing Alzheimer’s and becoming dependent on me for their support.

My husband is now in the advanced stages of this cruel disease and I am drawing on all my experience as a former nurse in the NHS to fill in the gaps in his care.

Many people are in the same situation as me, but do not recognise themselves as carers, but when an individual becomes increasingly dependent in relation to their physical or mental health needs, there is a gradual realisation that the caring responsibilities are taking over more and more of their lives and the relationship changes.

This is perhaps when they first see themselves as carers and it can be daunting.

You are worrying about them, how best to support them and how you are going to cope.

It is a new world for most of us and vital that the carer and the cared for are supported at that stage and that there are easy pathways to relevant information.

One of my roles in life is to volunteer for the local Alzheimer’s Society and I chair an Experts by Experience peer support group at our local Caring Café.

The carers that attend our support group share their experiences of what information, help and support that they have received have been most beneficial. Also, what has been lacking or has not worked for them.

As a member of the C4CC Co-production Team, it has become clear to me that applying the principles of ‘Three Cs’ of the coalition; Better conversations – Stronger communities – Partners in co-production; provides people with long term conditions and their carers with that vital support in testing times.

Here are my thoughts, based on experiences over these many years.

Conversations

One of the recurring stories that arises is that when a carer and cared for person initially attend their GP surgery with short term memory problems, there may be a real need for signposting to appropriate support even before a firm diagnosis is made.

The experiences of carers are variable and some carers feel really let down at this initial stage, not knowing where to turn next.

Where a GP is able to signpost sensitively and is much more proactive and helpful the support is really beneficial.

But, information alone is not necessarily enough. I well remember a new member of our carers support group coming into a meeting with a large bag of leaflets and booklets. She sat down and said ‘Can anyone help me sort all this out?

The local authority had provided her with copious information appropriate for a carer looking after someone with dementia, but no other support in sorting and selecting the information to support her particular requirements.

This is where our group and others like it can add value through our conversations.

Growing strong communities

It has been said by a member of our carers’ group more than once that the experience has been ‘life changing’.

Quite often, carers come with trepidation into our group. They feel so vulnerable and at sea and don’t know what to expect.

The sharing of experiences; the informal advice and the emotional support which is sustainable over the long term, is invaluable and we all benefit.

Within the café there are also professionals to enlarge the conversations.

The Caring Café is supported by our local authority because of the excellent level of services it provides in a community setting.

Under the Care Act 2014, local authorities must offer or commission services that aim to prevent or delay the need for support and to promote wellbeing both for people needing support and their carers, and I know we are able to do this in the Caring Café as do similar groups all over the country.

Co-production

One of my best experiences of the right conversations and co-production at the right time was when I requested a home assessment for my husband, who was becoming increasingly frail at the time and in danger of repeat falls.

The GP referred us to the local CCG Response and Rehabilitation Team.

The professional team that assessed my husband over several weeks treated us as equal partners during the process, were willing to experiment with equipment and handling issues and set in course a mutually agreed programme of self-funded support.

This was co-production at the right time.

Now, my husband is receiving continuing care, co-production has been limited to the relationship developed between the individual carer support worker and myself, the package of care being put in place through a provider agency.

The standard of care delivered is very much dependent on my personal monitoring of the carer support workers.

With my health service background I can fill the gaps in care, but others are not so lucky, which is why C4CC has a vital role to play in its promotion of the co-designing and co-delivery of services and rigorous monitoring of commissioned services for people with long-term conditions, particularly where they lack capacity.

 

Margaret Dangoor, C4CC Co-production Team member

Twitter: @mpdrichmond

National network calls for more ‘asset-based areas’ to transform communities and services

You can focus on what’s wrong with someone in terms of their health and social care but what if you focus on what’s ‘right’? A national network of community practitioners calls for all public sector professionals and commissioners to work with people’s ‘assets’ rather than their ‘deficits’ if they are to build strong communities and sustainable public services, according to a briefing published today.

The briefing gives a compelling case for why asset-based approaches should be the basis of all local area planning and service delivery and follows on from the launch of Engaging and Empowering communities in 2016, which gained support from national leaders, including NHS England CE Simon Stevens.

The Asset–Based Area briefing was compiled by Alex Fox, CE Shared Lives Plus and Chair of the Building Community Capacity network, hosted by Think Local Act Personal (TLAP), which is leading the way.

In it, Fox and the network offer practical guidance with a description of the ten features of an ‘asset-based area’ that nurtures people’s wellbeing, resilience and influence so that they become equal partners, not passive recipients to the organisations and people who respond to their needs. They also suggest a number of planning and support models that use asset-based thinking and have been operating for years in different areas and with differing degrees of take up and success -models ranging from Homeshare schemes, dementia friendly communities, Time-banking and others.

Alex Fox OBE, Chief Executive of Shared Lives Plus, said:

“During this period where there’s huge pressure on money available to local areas it is more important than ever that every area can find value and build the full range of resources and assets that could be available to it. This would require leaders and decision makers to see their role as working with, not for, people. Working in co-production with people with health and care needs is at the heart of all asset-based methods”.

Clenton Farquharson MBE, Chair of Think Local Act Personal board, said:

“I have nearly 15 years’ experience of arranging my own support and employ a Personal Assistant who enables me to live a full and active life including spending time with family and running a Disabled People’s User Led organisation called Community Navigator Service CIC, besides other interests and ambitions. I don’t want to be part of the lucky few, I want more people to be supported and facilitated to live the type of life I enjoy”

Angela Boyle, Head of Programmes, Coalition for Collaborative Care, said:

“There is clear evidence that building asset-based areas works. By bringing together people and organisations we can nurture stronger, healthier communities. This paper supports community leaders with practical tools and models to effectively utilise the powerful assets that already exist in their communities for improved health and wellbeing”

-End-

Future Hospital Programme – Better Conversations

The past few weeks have been busy for me, meeting lots of C4CC partners and community groups and learning how the principle of ‘better conversations’ is being played out and reaping rewards for people with care and support needs across the country.

A few weeks ago, I was invited as an outside expert to attend a seminar on the Future Hospitals Programme run by the Royal College of Physicians.

It highlighted the fantastic work which is being done at a number of sites around the country to create a much better deal for people using their services, in particular older people with frailty and multiple long-term conditions.

All the ground-breaking projects were to be commended, but two in particular caught my interest.

Betsi Cadwaladr University Health Board serves a largely rural community in North Wales, which brings its own obvious challenges. Their C@rtref project (meaning ‘home’ in Welsh) is pioneering the use of teleconferencing video technology in local community clinics to enable people to have a follow-up consultation with a doctor in the main hospital, without the need to travel.

It has proved a much more effective use of time for staff, with clear efficiency savings, while for the older people themselves it has meant having a single, holistic conversation with a geriatrician rather than several different conversations with different doctors, as well as much less wasted time in travelling. Seventy-two per cent of those seen were aged over 75, yet more than 80 per cent were satisfied with this new way of doing business.

I was also struck by the project in East Lancashire Hospitals NHS Trust, which aims to provide personalised care for people at, or as close to home as is safe and appropriate. One study showed that their multi-disciplinary and co-designed approach prevented 59 per cent of admissions. I was impressed they had trained a team of volunteers to carry out detailed interviews with people in their own homes about their experience of care. In their words, in-ward surveys, ‘only tell you about a part of the journey.’

The examples showed that better conversations can be about the way we conduct doctor-patient consultations or how we take the time to really listen to what matters to people, whether in hospital or the community. And what struck me was that the staff involved were genuinely committed to making a difference to people, sometimes under very difficult circumstances. We are very much looking forward to working with the Royal College of Physicians and others over the coming months, to see if we can grow these person-centred approaches far and wide.