FT governors and person centred care

a National Voices perspective

Jeremy Taylor, CEO, National VoicesAt Governor Focus

8 April 2015

National Voices

• Coalition of 160+ charities• Founded 2008• Our mission: person-centred care.• “Few bodies have done more than National

Voices to promote person centred care” Health Service Journal June 2014

What makes care good?

• Safe • Effective • Person-centred • Timely • Efficient • Equitable

From Institute of Medicine six domains of quality

What makes care person centred?It focuses on what matters to me:

• Caring – compassion, dignity, respect• Coordinated• Personalised• Enabling – information, support, voice, choice,

control, independencePerson centred care made simple, Health Foundation, 2014 Person centred care 2020: National Voices position statement 2015

What do people most want? What do they get?

Fast access to advice & help Frequent problems with access; problems with early diagnosis; rationing, especially social care;

Effective treatment Too much unwarranted variation; insufficient focus on quality; access to therapies an issue for some

Involved in decisions, respect for preference

50% inpatients not as involved as they want

Information and support for self care

5% have care plan; info, education & support for self care is not mainstream

Attention to physical and environmental needs

Generally good in formal settings –but real problems re dignity & nutrition

Emotional support, empathy, respect

Formal systems struggle with psychosocial aspects; vital role for vol sector

Involvement of /support for carers Often insufficient

Continuity of care, smooth transitions

Frequent fragmentation and poor transitions

Why “enabling” matters

Why “coordinated” matters

Out-of-Hours Doctors

GPDistrict Nurses

Social Worker

Malcolm &Barbara

ConsultantContinence

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….

Evidence based interventions• 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, including 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 and people’s commitment to courses of prevention and treatment

• personal budgets to give people greater control over the way they maintain their health and wellbeing

• training and development in the skills required for person centred care for large cohorts of practitioners – such as health coaching, motivational interviewing, risk communication and eliciting people’s values and preferences

www.nationalvoices.org.uk/evidence

People powered services• valuing and supporting carers and families• ‘social prescribing’, where statutory professionals have access to, and

refer people into, local community sector provision of health-supporting activities

• use of the Social Value Act 2012, which makes building social capital a key criterion in contracts and tenders, and which was intended to open up more opportunities for social enterprises

• 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

• investment in voluntary and community sector (VCS) infrastructure capacity to ensure that a full range of groups and organisations can play their part in developing and providing care and support locally

• investment in patient and lay leadership to help coproduce local strategies, plans and services and ensure a more powerful citizen voice in the governance of provider trusts, clinical commissioning groups, health and wellbeing boards and Healthwatch.

• encouraging volunteering

New care system (cont)

Traditional New

Condition Person (in context of family & community)

Care episode Pathway/journey

Hospitals communities Organisations systems & networks

Clinical focus Quality of life focus

Formal workforce Formal and informal workforce

Doing to Working with

Questions governors can ask

• Is our trust good enough? (safe, effective, person-centred, timely, efficient, equitable)

• Are we focussing on what really matters?• How do we know? • How does the trust use data and intelligence? What

changes?• Are we governors sufficiently involved? • Are we demanding that patients are sufficiently involved?• Are we sufficiently connected?

Making connections• Patients• Carers and families• Staff • Volunteers • Voluntary & community organisations• Healthwatch• Patient and lay leaders

Involving people

http://engagementcycle.org/

Involvement standards

Principles – shared, inclusive, listening, respectfulPurpose – clarity and transparencyPresence – diversity of people involved at all levelsProcess – carefully planned to maximise involvementImpact – did involvement make a difference?

4PI National Involvement Standards

Thanks for listening!

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