WELCOMEThursday 25 June 2015 Webinar

Why care planning is not happening in the NHS

 Why care planning is not happening in the NHS

 Thursday 25 June 201512.30pm – 1.30pm

Angela CoulterHealthcare analyst/researcher

&Beverley Matthews

LTC Programme Lead, NHS Improving Quality

#LTCImp

Bev Matthews, LTC Programme Lead – NHS Improving QualityA nurse by background, Beverley has worked extensively throughout the NHS in a variety of clinical, managerial and strategic roles.  Beverley’s current role as Programme Delivery Lead for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of NHS Kidney Care and NHS Liver Care.  

Passionate about service transformation through developing networks and leading complex programmes.   Providing strategic leadership to partners within health communities, managing stakeholders and working across agencies.

Beverley.matthews@nhsiq.nhs.uk

Meet the Speakers

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Angela CoulterAngela Coulter is a health policy analyst and researcher who specialises in patient and public involvement in healthcare. She is Director of Global Initiatives at the Informed Medical Decisions Foundation, Boston, and Senior Research Scientist in the Nuffield Department of Population Health, University of Oxford. A social scientist by training, Angela has a doctorate in health services research from the University of London. From 2000 to 2008 she was Chief Executive of Picker Institute Europe. Previous roles included Director of Policy and Development at the King’s Fund, and Director of the Health Services Research Unit at the University of Oxford. She is a Senior Visiting Fellow at the King’s Fund in London, holds Honorary Fellowships at the UK Faculty of Public Health and the Royal College of General Practitioners and is a Trustee of National Voices.  Angela has published more than 300 research papers and reports and several books including The Autonomous Patient, The European Patient of the Future (winner of the 2004 Baxter Award), The Global Challenge of Healthcare Rationing, Hospital Referrals, Engaging Patients in Healthcare (highly commended by the BMA), and Understanding and Using Health Experiences. She was the founding editor of Health Expectations, an international peer-reviewed journal on patient and public involvement in health care and health policy. She has won awards for her work from the Donabedian Foundation of Barcelona in 2012 and the International Shared Decision Making Conference in 2013.

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To request registration details contact LTC@nhsiq.nhs.uk

Date Webinar Hosted by Bev Matthews &Wed 8 July12.00pm – 1.00pm

Practical strategies for innovating in health and housing

Paul TaylorInnovation Coach

Bromford Lab

Coming soon…Sept 2015

Health coaching for people with long term conditions

Penny NewmanColchester Hospital University NHS FT

LTC Lunch & Learn E-SeminarsEstablishing a Virtual Community for All to Share and Learn

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Why Isn’t Care Planning Happening in the NHS?

Angela CoulterNuffield Department of Population Health, University of Oxford

and Informed Medical Decisions Foundation

Policy Commitments

• “We will ensure that, ultimately, everyone who requires and wants one has a personal health and social care plan as part of an integrated health and social care record.

• By 2008 we would expect everyone with both health and social care needs to have an integrated care plan if they want one.

• By 2010 we would expect everyone with a long-term condition to be offered a care plan.”

Department of Health: Our Health, Our Care, Our Say, 2006

Percentage of patients with long-term conditions who had a written care plan

90

Yes Don't know No

Source: GP patient survey 2014

15 million people in England live with a long-term condition.

More than 2 mil-lion people have multiple long-term conditions.

Of those with a writ-ten care plan, only 72% helped to put the plan together.

Managing Long Term Conditions

Professional care – 3 hours per year (1 x 15 mins

per month)

Self-care – 8,757 hours per year

Diabetes Web of Care

Dementia Web of Care

Person centred coordinated care

“I can plan my care with people who work together to understand me and

my carer(s), allow me control, and bring together services

to achieve the outcomes important to me.”

Information

My goals/outcomes

Communication Decision making

Care planning

Transitions

Personalised Care and Support Planning

• Aims to ensure that individuals’ values and concerns shape the way in which they are supported to live with and self-manage their long-term condition(s)

Clinician• Diagnosis• Disease aetiology• Prognosis• Treatment options• Outcome probabilities

Patient• Experience of illness• Social circumstances• Attitude to risk• Goals, values, preferences• Support needs

Sharing Expertise

Patients’ Goals may be Different from Clinicians’ Goals

• To better manage my pain relief so I don’t wake up at night• To stay in my own home as long as possible• To stop taking anti-depressants because I don’t like the side-

effects• To learn how to cook healthy meals that the whole family

will enjoy• To have the same person caring for me from 9am to 3pm so

my parents can go to work• To receive end-of-life care at the hospice close to where my

sister lives

Source: Coalition for Collaborative Care. Personalised care and support planning handbook. NHS England 2015

Selecting Tests or Treatments

Wellness and Health

Promotion

Managing Long-Term Conditions

Care Planning

Shared Decision Making

A Systematic Process

Personalised care planning - a conversation, or series of conversations, between a patient and a clinician to jointly agree goals and actions for managing the patient’s health problems.

It should be systematic (targeted, proactive, anticipatory, collaborative) and regularly reviewed.

Care Planning Conversations

Patient’s agenda Professional’s agenda

Goal setting and action planning

Information sharing

Agreed and shared care plan

Information gathering

Information sharing

1. Preparation

2. Goal setting

3. Action planning

4. Documenting

5. Coordinating

6. Supporting

7. Reviewing

Care planning

cycle

Care Planning: the Evidence

• In 19 trials involving 10,856 participants, personalised care planning led to:

• Better physical health (blood glucose, blood pressure)

• Better emotional health (depression)

• Better capabilities for self-management (self-efficacy)

Coulter et al. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database of Systematic Reviews, 2015

Care planning works best when it is ………

• Comprehensive:• more stages of care planning cycle completed

• Higher intensity• more contacts over a longer period

• Integrated with usual care• usual doctor informed and involved

• Well-supported• training, supervision and support for clinicians as well as

patients

Barriers

• Time/resources• Inflexible systems• Clinical culture

En

gag

ed,

inform

ed

pa

tien

ts

HC

Ps co

mm

itted to

p

artne

rship w

orkin

g

Organisationalprocesses

Responsive commissioning

Personalised care

planning

Coulter, Roberts, Dixon: Delivering better services for people with long-term conditions – building the House of Care, King’s Fund, October 2013

En

gag

ed,

inform

ed

pa

tien

ts

HC

Ps co

mm

itted to

p

artne

rship w

orkin

g

Organisationalprocesses

Responsive commissioning

Accurate contact details

IT: clinical record of care planning

Know your population

Test results and agenda setting

Consultation skills and attitudes

Integrated, multi-disciplinary team

and expertise

Senior buy-in and local champions

Prepared for consultation

Information and structured education

Emotional and psychological

support

Develop market to meet current and future needs

Identify needs, map resources

Quality assure and monitor

Establish and publicise menu of care

Ensure time for consultations, training and IT

Personalised care

planning

What’s Wrong with the Clinical Culture? 1. Attitudes

• Dominance of biomedical agenda – reactive not proactive

• Care planning not incentivised in QOF

• Low opinion of patients’ capabilities (staff AND patients)

• Self-management support not seen as core business or ‘part of the job’ in primary care

What’s Wrong with the Clinical Culture? 2. Skills and resources

• Lack of skills in patient engagement

• Inadequate understanding of shared decision making

• Poor communication and dysfunctional teams (silos)

• Lack of performance indicators for self-monitoring

What’s Wrong with the Clinical Culture? 3. Leadership

• Inadequate local/national leadership

• Insufficient training• Inadequate supervision• Lack of support for social

prescribing

What We Have Learnt

Traditional practice styles…….

• Create dependency• Discourage self-care• Ignore preferences• Undermine confidence• Do not encourage

healthy behaviours• Lead to fragmented care

Informed, Empowered Patients

Have the knowledge, skills and confidence to manage their own health and healthcare,

And they……• Make healthy lifestyle choices• Make informed and personally

relevant decisions about their treatment and care

• Adhere to treatment regimes • Experience fewer adverse events• Use less costly healthcare Health Affairs Feb

2013

Further Information

• Coalition for Collaborative Care: http://coalitionforcollaborativecare.org.uk/

• Year of Care Partnerships: http://www.yearofcare.co.uk/

• National Voices: http://www.nationalvoices.org.uk/

• NHS England: http://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/ltc-care/

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To request registration details contact LTC@nhsiq.nhs.uk

Date Webinar Hosted by Bev Matthews &Wed 8 July12.00pm – 1.00pm

Practical strategies for innovating in health and housing

Paul TaylorInnovation Coach

Bromford Lab

Coming soon…Sept 2015

Health coaching for people with long term conditions

Penny NewmanColchester Hospital University NHS FT

LTC Lunch & Learn E-SeminarsEstablishing a Virtual Community for All to Share and Learn

#LTCImp