On the 24th and 25th January, the NHS ran a hackday in Cardiff, organised by the fantastic Anne-Marie Cunningham. A lot of fun was had by all and some of the projects are still being developed. Here is John Greensway’s excellent writeup.
While there’s a lot of truth in that statement, it’s not helpful. The NHS clearly is struggling with very tight budgets, and more money would definitely help… but it’s not the answer. The NHS is capable of absorbing more money, and then coming back for even more. This was the story of the first decade of this century, when NHS funding increased by more than 50% in real terms (a staggering, unprecedented and unrepeatable deal), but it wasn’t enough.
No, the answer has to be a radical re-think about how the NHS does its job. First, this means re-designing the way we do things now – doing things better. For example, patients should not be kept in hospital for days and even weeks after their medical care is completed – euphemistically called ‘delayed transfers of care’ in the sanitised NHS jargon. We need to adjust each of the component parts of the care system – everything from supporting frail people better in the community, through in- and out-of-hours GP services, A&E and hospital wards, through to more and better options for supporting people with failing independence in their own home – to get the right balance for each community. Imagine a control panel with a series of dials for each component – we need to calibrate each bit properly if we are to get rid of those inhumane blockages which can ruin people’s chances of good quality life and independence.
Second, it means working differently – doing better things. And this is where co-production really comes in. It means helping people maintain what matters to them most in life, by focusing on their outcomes, and delivering support in a way which maximises their contribution, not minimises and infantilises what they can do. People know what a ‘good life’ means to them, and it’s the job of the NHS and its partners to deliver that, by getting alongside people and offering them whatever support they need. There are hundreds of ways in which the statutory services can bolster people’s independence, rather than unwittingly undermining it by thinking of what people can’t do, rather than what they can. It’s about providing information, practical support, training in coping skills, links to people in a similar situation… as well as more specialised provision.
The great thing is that people usually want very little intervention, if you can wrap that support around them soon enough, while they still have coping skills. ‘Minimal intervention’ really is what most people would choose, if they had the choice. In simple terms, we need a three-way partnership. We need systems designed to support and empower citizens and staff; professionals who know how to listen and respond; and service users and carers who know how to get the best out of the service on offer, and expect to be in control.
The trouble is, that’s much harder to bring about than bunging another few millions at the problem!
Marcus Longley is Professor of Applied Health Policy at the University of South Wales, and Director of the Welsh Institute for Health and Social Care.
Wales will soon have its own co-produced version of the free 111 phone-line service.
The project will build on the strengths of current NHS Direct Wales and Out-of-Hours services, combining them in one single service. The new service will be accessible on a multi-channel basis, with initial access focussed on telephone based contact. It will deliver general health information and advice, including details of available local services and provide symptomatic callers with telephone clinical assessment by clinical staff. Clinical assessors will then be able to provide self-care advice or direct, refer or book callers into appropriate services such as GP Out of Hours appointments, community nursing services, Emergency Departments and, ultimately, non-NHS services.
This is an exciting opportunity to demonstrate the values of the government’s Prudent Health policy, promoting independence and shared responsibility by co-ordinating the services around what people want, motivating self care and meeting their needs as close to home as possible. The Director General and Chief Executive of NHS Wales, Andrew Goodall is promoting the need to better align services around the citizen, our communities, and our patients. He has acknowledged that, ‘it is easy to frame our delivery as traditional targets rather than […] aspirations for our population. Success means an understanding that health and wellbeing is not just for the NHS.’ Through explicitly embedding co-production principles throughout the implementation of the 111 / OOH project we hope to make that understanding tangible – and effective.
Our intention is to demonstrate this collectivist and co-produced approach throughout the 111/GP OOH implementation project. Drawing on the expertise of communities in Caerau, Ely and Glyncoch, we have begun to establish what the new service could achieve, and to bring together a group of enthusiastic and expert community volunteers who have offered to help us with the implementation phase. Fired up by their commitment, we are planning to work collaboratively with each local community as the service is rolled out across Wales. We will start in Abertawe Bro Morgannwg Health Board as soon as possible with a view to going live before the end of the year.
Over time, we will continue to extend this provision through to community services, working with the statutory sector, third-sector and community members to signpost callers to a range of local providers and support networks. We are planning to continue to improve our Directory of Services that will support self-care, early action and prevention. The Directory will forge links between the NHS and social care professionals, with those working to build community resilience and peer-support networks, and with community members themselves.
For more information and/or offers of help and support, please contact the Project Director, Richard Bowen: Richard.Bowen@wales.nhs.uk.
The ability to see the world through others’ eyes – to walk in their shoes – is arguably an essential co-production skill. It’s not, unfortunately, a skill which is regularly demonstrated by organisational leaders or senior professionals. In this informative and energising blog post, Gill Phillips (inventor of the superb ‘Whose Shoes?’ training game) reflects on her recent experience at the ‘Thought Diversity Hothouse‘ organised by NHS IQ and the NHS Confederation.
“Inevitably, I wondered who would be in the room. I felt that, whoever they were, there would be accusations of them (us!) being the ‘usual suspects’. I don’t think they were. I’m not quite sure who the ‘usual suspects’ are at an event of this kind but ‘my table’ had a lead from a CCG, someone from the police, a CEO from a Foundation Trust, an equality activist and other interesting roles… and me and Ken. It felt exciting that my friend and colleague Ken Howard was invited – a person living with dementia at a non-dementia specific event.
‘Chatham rules’ were to be observed and I thought this was only right. Fear seems to be a big part of the transformation to a new, more enlightened era of honesty and transparency in many quarters, so people needed to be able to speak out with freedom.
There was a poster inviting us to note down any elephants in the room. For me the biggest elephant seemed to be that some passionate people (and inevitably the room was full of passionate people) are really not very good at … listening. And until people listen, listen really deeply, and are prepared to think and behave differently themselves, nothing much will change.
I was glad to be there to support Ken to have a voice. I have never had to do this before but, to be fair, we have generally worked together at ‘dementia-specific’ events. This perhaps reinforced for me how ‘silo-ed’ things are. Ken is very charismatic, speaks huge common sense but in a quiet way. Any quieter voice in that room was going to struggle.
We need to hear the quietest voice in the room, and not just pay lip service to this.”
Instead of reforming structures, policymakers should try to put patients and communities at the heart of the health service. The year 2015 will bring not only an election, but also an anniversary: it will be 15 years since a UK government first declared the intention to create a “patient-centred NHS”. Don Redding of National Voices publishing via the Guardian Healthcare Network.
By Rebecca Atkinson
“Growing up with the NHS also fed into a sense of identity, one where I was not reliant on the charitable benevolence of others to give me access to sound, but one where I just received it without question, the same as the next person or the one after that, regardless of who we were or what we had in our pocket. And for a child growing up deaf or disabled what more important message is there than to tell them they are equal to others. That their financial or social position won’t impact on their medical chances, they won’t have to stand cap in hand, or watch a richer person hear the world with hearing aids or a cochlear implant whilst they can’t afford to try out anything but the deafness nature gave them. Harry Smith told the Manchester conference that Britain ‘must never let the NHS free from our grasp’. I can only agree.”
The Welsh NHS Confederation has recently published a briefing highlighting the impact welfare reform will have on people’s health and wellbeing in Wales. It is predicted that there will be an increase in a wide variety of health-related conditions. “It is now the time for all sectors in Wales to work together in an integrated and holistic way to minimise the health and wellbeing implications for people in Wales affected by welfare reform. Through supporting each other we will ensure positive outcomes for people.”