"putting patients at the heart": the workforce implications
TRANSCRIPT
The patient voice:What are the workforce implications of
“putting patients at the heart of the NHS” Jeremy Taylor, CEO, National Voices
At NHS Employers Autumn Workforce Summit 2015
National Voices
• Coalition of 160+ charities• Founded 2008• We work for a strong patient and citizen voice,
and services built around people• We stand up for voluntary organisations and
their vital work for people’s health and care
What do people most want? http://www.nationalvoices.org.uk/evidence
Where are the pinch points?
Timely access Problems with waiting, access, eligibility for social care, access to particular therapies
Effective treatment unwarranted variation in outcomes
Involvement in decisions, respect for preference
Significant minorities of patients not as involved as they want
Information support for self care
Information often insufficient; care planning & supported self management not mainstream
Attention to physical & environmental needs
Problems re dignity & nutrition,Problems in home-care and care homes
Emotional support, empathy, respect
Can be a struggle for busy staff; poor communication a frequent complaint
Involvement of /support for carers Often insufficientContinuity of care, smooth transitions
Frequent fragmentation and poor transitions. Problems with discharge; too many visitors to home; “telling story over and over” etc
Out-of-Hours Doctors
GPDistrict Nurses
Social Worker
Malcolm &Barbara
Consultant Continence Adviser
Speech & Language Adviser
Dietician
CommunityDentist
OccupationalTherapist
Equipment Service
PhysiotherapistAlternating
Mattress technician
Wheelchair Service
Oxygen serviceDirect
PaymentsTeam; Rowan
Org.
Alzheimer’sSoc outreach
worker
Care team2 live-in carers (alternating weekly)Replacement carer[Some night nursing – Health]Emergency carers & Barbara
The Web of Care
(Last 7 yrs)
DementiaAdvisoryNurse?
Person centred coordinated care
“I can plan my care with people who work together to understand me and my
carer(s), give me control, and bring together services
to achieve the outcomes important to me.”
I have the Information
I need…
I am supported to achieve my
goals….
The professionals work as a team.
I always know who is coordinating my care
I’m involved as I want to be in
decisions…
I work with my team to agree a
care and support plan…
When I move between settings there is a plan in place….
Person centred coordinated care near the end of life
“I can make the last stage of my life as good as possible
because everyone works together confidently, honestly and consistently
to help me and the people who are important to me, including my carer(s).”
My goals and quality of life and
death
Honest discussion
and planning
The people who are important to me
My physical, emotional, spiritual and practical needs
Responsive and timely support
The Five Year Forward View
“We have not fully harnessed the renewable energy represented by patients and communities”
The Five Year Forward View
• People are fully engaged in their own health and care• Services are co-produced with communities• Inequalities are reduced• Carers are better identified, supported and involved• Health and care systems are fully realising the
potential of volunteering and social action • Health and care systems are fully realising the
potential of VCSE organisations
Why does this matter?
People engaged and supported in health behaviours and their care & treatment are more likely to:
• Have better health • Have better outcomes from care and treatment• Manage better• Make less use of high cost services
Why does this matter?
Communities actively involved in decisions that affect health and services
• Can help shape services that work for them (and therefore you)• Can solve many of their own problems• Are the source of people who help people
What works?• shared decisions about treatments• care and support planning, using the principles and stages outlined by National Voices and
others.• information, education and support for self-management for people living with long term
conditions and disabilities• peer support for people living with long term conditions and disabilities• coordinating care, following the narratives co-created by National Voices and partners• access to personal records – proven to support self management, & shared decisions • personal budgets to give people greater control • training and development in the skills required for person centred care – such as health
coaching, motivational interviewing, risk communication and eliciting people’s values and preferences
• ‘social prescribing’, where statutory professionals have access to, and refer people into, local community sector provision of health-supporting activities
• community development approaches, such as those piloted in Croydon and Halton, which involve the community in identifying their needs and demands, and determining how these can be met
www.nationalvoices.org.uk/evidence
How do we engage?How do we hear patient voice?
• prioritise clinical shared decision making and
personalised care planning• use your feedback data• work with your Healthwatch & voluntary groups• continuing dialogue with the local community,
not episodic consultation• work with service-users to co-design service
improvements• Embrace and develop patient and lay leaders
What do staff need to “put patients at the heart”
• a “working with” not “doing to” mindset• time • supportive, empowering management • multi-disciplinary team working, supported by IT• skills & capabilities in person centred approaches• skills & capabilities in engaging the “informal
workforce” • leaders and managers who prioritise all the above
Thanks for listening!
• www.nationalvoices.org.uk• You can follow us on Twitter
– @NVTweeting– @JeremyTaylorNV
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