Patient-centred Care – still top of the 2009 agenda

ΤThe Healthcare Commission came out its 5th and last report on the State of Healthcare in December. The report summarised the overall picture as “positive, with targets relating to the health of the population either met or on the way to being met with life expectancy increasing and rates of premature death due to cancer and circulatory disease are falling. However the report went on to make the general point that “we have seen little change in the scores that trusts get for the experience of patients.”

What has to happen for the dials to move in the year to come? A recent report from the Kings Fund saw the authors Joanne Goodrich and Jocelyn Cornwell worry about how hard it was to find good evidence about the impact of patient-centred initiatives. They assess the evidence as all too frequently “patchy, fragmented and tends to be descriptive”. What is the mechanism that connects the intervention and a positive outcome? National policies and strategies are often no help at all.

The MAC Partnership have long been sure of a key part in that mechanism is. It is the people delivering the care. And they are helped enormously by users who know what they want and say so in a way that does not come over as aggressive and abusive. If staff feel good about the service they give, then they will convey that feeling to the people they serve. The greatest early failure of customer care was the imprisonment of unempowered and under-resourced people in the call centre factories manufacturing (if you get through) a response but never service, never a human connection to the person on the other end of the phone.   One of the two heartening examples quoted in ‘Seeing the Person in the Patient’ shows how compassionate and empathic staff can deliver effective patient-centred care. The example comes from the Kenneth B. Schwartz Center a non-profit organisation based in the Massachusetts General Hospital and its biggest programme ‘The Schwartz Center Rounds®’.

If you want to understand more about these two virtues of compassion and empathy and how to apply them in a practical way in both your professional and personal life, in my experience you can do no better than to seek out UK practitioners and trainers of Nonviolent Communication® at this website.

A good point, I think, both to finish and to begin again. All the best in 2009 from all of us in the Partnership.

Mining the NHS Operating Framework 09-10

 
The NHS Operating Framework 2009-10 for England  (OF) sets out a brief overview of the priorities for the NHS in the next financial year.  PCT managers are sweating over the framework as I write, producing their operating plans for the same period to reflect these national ”must dos” and their own commissioning strategy objectives.   And there will be no relief over the hols for many – in London we have to have our plans to the SHA by mid-January so Christmas reading can’t be avoided.

At its most basic the OF sets out four domains.  Each of these can be mined for opportunities to advance involvement and engagement and to further partnerships between statutory and 3rd sector bodies.  We shall be banging the drum about these opportunities with out clients in the New Year – and we believe NHS managers will be ready to listen, especially as World Class Commissioning competencies are making the same sort of demands.

1. The health and service priorities for 2009/10:  This is about strengthening the focus on subsidiarity  -  the first use of that useful EU word I’ve seen in the NHS – while still delivering national priorities in the current 3 year comprehensive spending round .  How they do it is up to each PCT.   The “PPI prize” in this is succinctly put on the DH website:  ”Patient experience is the final arbiter of success.”

2. A system designed to deliver quality:  The Darzi mantra to make quality the organising principle of the NHS gets the emphasis here- and so it should.    Each SHA has its “vision” of Darzi – including Healthcare for London – and the OF focuses on the levers and incentives to further build on these.  Right at the front is staff engagement for the benefit of patients and the public.  Hurrah! Finally the NHS has woken up at the 11th hour to the fact that its staff are the best enggement tool it has.  For that tool to do its job, people working in the NHS must be treated fairly and rewarded well in return for consistently excellent performance. 

3. The financial regime:  The NHS has to go further to ensure it makes the best use of taxpayers’ money.   The comprehensive spending round made it clear that the NHS tap would be turned down after two years of plenty even before the world financial system nosedived, so no one should be surprised by the admonition to continue to do better with less in the near future.  “Delivering Darzi” is a big part of that of course.  But so is learning how to get close to customers (aka patients) and realising that they have choices and voices, especially in primary care.  That’s where the biggest changes have to take place.   All the solutions to the “problems” of secondary care lie in primary care.

4. The business processes:  Planning should be based on locally led decision making  – subsidiarity again -and maintaining the emphasis on genuine partnership working at a local level with local government and other partners. For “other” in this part of the OF read not only 3rd sector bodies and social businesses but really any health and social care organisation which wants to get into delivering public services to the right level of quality and price under the NHS brand.  The old certainties about whose job it is to do certain things are on the way out.

If you are wading through the OF because you have to, then persevere because it has some really positive things to say about new ways of doing public business. If you’ve given it a miss up to now, then think again and don’t judge the OF by its rather austere cover.  Anyone wanting to make connections between NHS “must dos”, opportunities for user involvement and more ways to develop the mixed economy in delivering public services will find plenty they can use in here.  

And keep an eye out for the PCTs’ Operating Plans 09-10 appearing from mid January to see how they are tackling all of this.  Will they all be up to the challenge?  If you find some outstanding examples of local planning, you can always post it here.

A Merry December Newsletter

LINKSLEARNING – hot off the press

Fresh on the main Moore Adamson Craig site, is the first article under our LINKsLEARNING banner – how we set about building the Wandworth LINk website from scratch and at speed. Check it out here: http://www.mooreadamsoncraig.co.uk/LINks.php and if you have any questions about what we did, contact me (email info here).

Bradford in the lead

We report on new developments in Bradford where the first of 152 GP-led Health Centres has opened. Andrew Craig points that there is a big window of opportunity for social enterprises to be set up with the latest news that Ministers have agreed a 3-year guarantee of uncontested contracts for new social enterprises in the health sector. So future social entrepreneurs need to get in quick before the arrival in this market (the current term) of what Andrew characterises as “aggressive super Foundation Trusts moving into primary and community health care“. http://www.publicinvolvement.org.uk/2008/12/do-the-citizens-of-bradford-know-something-about-primary-care-that-londoners-dont/

Best Practice

Also in the lead is the Motor Neurone Disease Association. The Year of Care commissing tool features as case history No 1 in the National Audit Office’s report on End of Life Care (http://www.nao.org.uk/pn/07-08/07081043.htm ) as an example of best practice in the area.

The Public Accounts Committee is taking evidence on the report on 17th December 2008.

After that they and all the rest of us can perhaps wind down for a decent holiday and a Happy Christmas – something we wish for all our readers.

Engaging Health & Social Care Communities Online

Just published on the main Moore Adamson Craig site – a case history of building the website for the Wandsworth LINk:

Engaging Health & Social Care Communities Online – setting up a website for Local Involvement Networks (opens as Adobe PDF file).

Do the citizens of Bradford know something about primary care that Londoners don’t?

The first of the new 152 GP Led Health Centres around England opened last week in Bradford. The provider is an established Yorkshire social enterprise called Local Care Direct. Staff and local people are members and owners of the company.  Sounds like we could be behind the times in London yet again if Bradford turns out to point the way forward in this new form of social healthcare business.

Is the social enterprise idea something that the patients and public can latch onto?  We think so. For social enterprises to arise from within the NHS, the Next Stage Review gave primary care staff the “right to request” this and guidance on how to do it.  The latest news is that Ministers have agreed a 3-year guarantee of uncontested contracts for new social enterprises in the health sector.  That could be a very strong incentive for some practices to ring the Social Enterprise Coalition about how to get started.

If I were a primary care business having sleepless nights because of aggressive super Foundation Trusts moving into primary and community health care, this sort of armour plating and guaranteed time to develop viable co-created business with my customers (formerly known as “patients”) would be attractive.  Let’s see if anyone takes up the ministerial offer in the Metropolis.