Professor Dame Sue Bailey DBE FRCPsych • Senior Clinical Advisor Mental Health and Learning Disability at

HEE; • Chair, Academy of Medical Royal Colleges ; • Chair , Childrens‘ and Young Peoples' Mental Health Coalition;

‎Learning Together to Work Better Together

September 2016

Bringing it all together through values based inter-professional practice and education

Whistle Stop Tour

• Context – understanding the Fundamental challenge in context of who we are;

• Values based practice – Values Base CAMHS Commission; an update – Launch November 2016;

• Social Identity approach to health care ; • (Working together at HEE ); • HEE; • What we have to do; • Working together at Academy ; - Choosing Wisely and Shared Clinical Decision Making ; ‎ -Developing a healthier workforce through Enabling Environments;

Understanding

generational

characteristics –

understanding each other

Baby Boomers 1946 – 1964

The ‘Post War children’ ambitious, work

alcoholics driven by career progression

Generation X 1965 - 1979

The ‘Latch Key kids’ both parents worked,

frequently looked after by friends, family or

supervised childcare

Generation Y 1980 - 1994

The ‘Millenials’nutured by Baby Boomers

parents who have tried to protect them

from negative experiences in the world

Generation Z 1995- 2010

The true ‘Digitals’ born into an age of

technology. Generation X parents have

encouraged more independence.

Values based Child and Adolescent Mental Health System – The story so far – Launch

November 2016

Values based across the whole system – underpinned by Values Based Education

‘Underpinning all we do is the art of

communication’

Kim Williams, Speech and Language Therapist, Manchester – June 2013

• To ask for what we need; • To express likes and dislikes; • To express opinions; • To reject something/someone; • To ask for information; • To respond to others questions and instructions; • To form relationships with others; • To express our feelings; • To organise ourselves/make plans; • To solve problems;

What health professionals need to understand alongside

GENOMICS

Social Identity approach to healthcare

There are important interconnections between social identity group behaviour and health • The capacity for social identity to deliver positive health outcomes rests on

its capacity to give individuals access to important resources; • Resources both psychological and material; • Relate not only to people's sense of support meaning and control but to the

social realities of life ; • Groups are fundamental to a sense of self but also to our capacity to do

things in the world ; • ‎Collective action for social change; • Basis on which to help those who are disadvantaged and in need; • To build hospitals care homes as enabling environments for staff and

patients ; • ‎To make progress in science and society ; • Person to person interaction Gene – Gene interaction;

• That will involve discussion with our patient and making decisions together about what is best for them Choosing Wisely and Shared Clinical Decision Making;

• ‎Values based is a fundamental strand of how we bring the art and science of medicine together to cope and learn together in a future of promise and challenge;

Who We Are – Family

What We Do -

Clinicians Changing Health Care

Education, training & professional development

Revalidation

Healthcare policy and delivery

• Shape of training • Build supportive environment for

trainees • Leadership • Medical Training Initiative

• Choosing Wisely/Shared Decision Making • Support implementation of 5YFW • Sustainability • Informatics • Prevention and inequalities • Quality Improvement • Atlas of Variations

• Ensure effective and robust process • Evaluation of revalidation • Training for appraisers and

responsible officers

Choosing Wisely UK - Aims

To promote conversations between doctors and patients by helping patients choose care that is: • Supported by evidence; • Not duplicative of other tests or procedures already received; • Free from harm; • Truly necessary; • Consistent with the patient’s values; Having these conversations will: • Improve clinical outcomes; • Deliver compassionate and patient centered care; • Reduce unwarranted variation; • Create a just distribution of finite resources;

Phase 3 – What is Shared Decision

Making?

• Clinicians and patients working together to select tests, treatments, management or support options based on clinical evidence and the patient’s informed preferences.

Phase 3

• Shared Decision Making – led by Dr Angela Coulter; • Developing tools, guidance and support for patients and clinicians, which

will support a “Choosing Wisely” conversations;

Reduces variation

Reduces waste

Appropriate care

Better outcomes

Health Information is often unbalanced

What patients need to know

• What are my options?

• What are the benefits and possible harms?

• How likely are these benefits and harms?

• How can you help me make a decision that’s right for me?

Key components to Share Decision Making

1. Information Reliable, balanced, evidence-based information outlining prevention, treatment, or management options, outcomes and uncertainties

2. Deliberation Decision support with clinician or health coach to clarify options, preferences, goals and action plan

(personalised care planning)

What patients need to know

Clinicians

• Diagnosis

• Disease aetiology

• Prognosis

• Treatment options

• Outcome probabilities

Patients • Experience of illness • Social circumstances • Attitude to risk • Goals, values,

preferences • Support needs

Appraising Options and Trade Offs

Appraising Options and Trade Offs

• Explain uncertainty; • Numbers are often better than words; • Use natural frequencies, not percentages or relative risk; • Use specific time frames; • Constant denominators are better than constant numerators; • Use both positive and negative framing where possible; • Use simple graphics; • Give individually-tailored probabilities adjusted for baseline risk where possible ; • Make risks relevant with everyday

examples;

• What we know (Centre for Quality Improvement RCPsych 2014 Enabling Environments)

Enabling environments are places where:-

• Positive relationships promote well being for all involved in them ;

• People experience a sense of belonging ;

• All people involved contribute to growth and well being of others ;

• People can learn new ways of relating ;

• ‎The contributions of all involved in helping relationships are both recognised and respected;

Enabling Enabled Healthcare Professionals

• How we learn • How we think • How we act • Values Based Practice • WHO Long Term Conditions - classification

Diagnosis Functioning Social Context

Needs led risk managed Interventions – Choosing Wisely

Shared Clinical Decision Making

• That will involve discussion with our patient and making decisions together about what is best for them Choosing Wisely and Shared Clinical Decision Making;

• ‎Values based is a fundamental strand of how we bring the art and science of medicine together to cope and learn together in a future of promise and challenge;

• Core to this is how we train future health professionals ;

• ‎So training doctors to think "Not what can I do " but "What should I do " and more importantly what does the patient want me to do ;

Professional practice - how to recognise 'emotional ' labour.

Across the breadth and depth of health and social care

different settings make different emotional demands on staff

Enabling Environments – Royal College of

Psychiatrists

• Human beings are inherently social : they need honest positive connections with others to survive and thrive in the workplace;

• EEs improve quality of care and thus measurable patient outcomes;

• EEs promote wellbeing of patients optimising conditions for recovery;

• EEs enhance workforce engagement; • EEs reduce staff sick leave;

Delivering a healthy workforce (Williams Kemp Bailey 2016 Press)

Popular belief now enshrined in myth has been that health service workers will remain resilient and resourceful under whatever pressure.

• EEs are good for the organisations bottom line ;

• EEs are good for an organisations reputation;

• EEs reduce the risk of adverse outcomes;

• ‎EEs support positive mood;

• EE's nurture the collaborative ethos that is fundamental effective teamwork ;

• Enabled healthy workers are more productive workers and are better at handling adversity;

• Culture of continuous improvement not based on blame shame culture (need Junior Doctors eyes and ears)

• Feel able without fear to learn from failure • Bottom up local innovation meets top down through small steps • Failure to learn becomes ability to learn and act • Spiral of learning • Don’t allow complexity to be an excuse for ‘too difficult to change’ • Face reality of what we are uncertain about with patients and public • Ten top tips for uncertainty – e.g. Brains

Competency Frameworks

Families Education

Physical Health

• Competence frameworks to be

developed in parallel with

evidence based treatment

pathways (EBTP)

• Development of generic

competences and higher level

competences

• Providers and commissioners

could use tools to carry out gap

analysis

• Frameworks will complement the

MH core skills and knowledge

framework

• Frameworks offer workforce

solutions to multi-professional

environments

Perinatal Mental Health

• Develop tiered competency and skills

portfolio for professions across

perinatal care pathway

• Review current training programmes

available across regions and

professions in PMH (working with

RCPsych and HEE local teams) and

develop training to increase specialist

support

• Work with RCPsych to develop project

to increase number of perinatal

psychiatrists

• Work with IAPT programme in training

more psychologists to work within

perinatal mental health

• Research project with Institute of

Health Visitors on perinatal support

Children and Young People’s Mental Health

Families Education

Physical Health

• New training routes - “ThinkAhead”‎for‎

psychological therapies

• Self-harm awareness package

• £1M Innovation Fund – Vulnerable

Groups - Round 2

• Enable high-level apprenticeship to

deliver psychological therapies

• C & YP MH physical health

competences for staff

• Introduction of Psychological Wellbeing

• Practitioners into CYP MH services

• Crisis and liaison

• Support Expert Reference Group on

vulnerable groups (LAC, CSE/CSA

etc.)

Only Connect and Collaborate

Or? The price of failing to connect and

collaborate

Questions?

sue.bailey@aomrc.org.uk

Academy of Medical Royal Colleges

10 Dallington Street

London EC1V 0DB

Tel. No. 020 7 490 6810

Welcome to All Together Better Health Viii

6-9th September 2016