Care and Support Planning in practice
Lindsay Oliver: National Director for the Year of Care partnerships
Laura Robinson :...
Have confidence in doctors and nurses?
Feel listened to/involved?
Take their tablets as prescribed
Outcomes as good as cou...
Hours with health / social
care professional = 4 hours
in a year
Self-management
= 8756 hours in a
year
The individual’s p...
The Challenge!
15 Million people live with
long term conditions in
England
Care and support planning can
make it personal ...
International
Evidence Base
Reproducible intervention
>3000 practitioners and 40 quality assured trainers
Year of Care Tra...
Care and support plans versus
Care and support planning
Having better Conversations
 Year of Care
Care and Support Planning :
in the beginning
Agreed & shared
‘care plan’
Information
gathering
Professional
Story
Informat...
I got more information out of it
than I ….did previously. …they were
probably giving us the
information,(but) they were gi...
1. Prepare
Getting ready for the care
and support planning
discussion
• clear about purpose
• collecting useful and import...
2. Discuss
 Year of Care
Review
Action
planning
Goal setting
Explore and
discuss
Gather and
share stories
Care Planning
C...
3. Document
Writing down the main
points from the
discussion
• the main points that you have
talked about
• the plan belon...
4. Review
Checking how things
are going by
• Self monitoring
• Support programme /
friends
• Review with the care
and supp...
The House of Care
Preparation
for discussion
Information
Structured
education
Emotional &
psychological
support
Care and S...
Purpose of today’s event
More than Medicine
Building the House
• Part of local strategy for
LTCs
• Steering Group with
senior buy in
• Quality assured training
which ...
Impact
……I'm listened to
…….you may not have all the
answers
…….you’ve helped me work things
out
 Year of Care
Healthier living
‘I no longer smoke (Gave up 12
months ago) . I take the
symptoms more seriously - try
to nip chest infect...
Sustained improvement
‘Each time I get a greater
understanding of my
condition and understand
more about how I can go
abou...
“
‘I enjoy doing the clinic
a lot more now…
working with them
rather than at them’
Better for Staff too
 Year of Care
‘The new pathway …..
more efficient in time for
both patients and health
care professionals.’ (Practice
team member)
Pract...
Clinical care…….. Improving too!
Tower Hamlets
2006: Worst 10% in England
2012: 72% received all 9 processes in National
D...
Integration / coordination
•At the personal level
•Between health and social
care
•Between primary and
specialist health c...
Launching today
Supporting local
communities to
build their
House of Care
Find out more: www.coalitionforcollaborativecare.org.uk
Twitter ...
What is care and support planning?
An introduction to our guide
The ‘why’
1. Member feedback: improves outcomes but
despite commitments, is not happening
enough
2. House of Care: engaged...
Our aim
→ Create a common understanding of what care
and support planning means across health and
social care
→ Raise awar...
The ‘how’
• What is care and
support planning and
why do we need it?
• Overarching principle
• 4 stages
• Identified that ...
The ‘how’
The ‘how’
• c200 individuals
signed up.
• Health and social
care professionals,
commissioners,
providers,
academics, peopl...
The ‘what’
The ‘what’
The ‘what’
The ‘what’
The ‘what’
The ‘what’
The ‘what’
The ‘what’
Get involved
• Tweet about the guide
#careandsuppportplanning
• Share the guide and the films with your
networks
• Endorse...
Contact
Lindsay Oliver
Sue Roberts
Enquiries@yearofcare.co.uk
www.yearofcare.co.uk
Laura Robinson, National Voices
Laura.r...
S78 - Day 1 - 1430 - Care support and planning in practice
S78 - Day 1 - 1430 - Care support and planning in practice
S78 - Day 1 - 1430 - Care support and planning in practice
S78 - Day 1 - 1430 - Care support and planning in practice
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S78 - Day 1 - 1430 - Care support and planning in practice

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S78 - Day 1 - 1430 - Care support and planning in practice

  1. 1. Care and Support Planning in practice Lindsay Oliver: National Director for the Year of Care partnerships Laura Robinson : Policy and Communications Advisor ; National Voices Sue Roberts : Coalition for Collaborative care / Chair Year of Care Expo: Session S78: March 3rd 2014
  2. 2. Have confidence in doctors and nurses? Feel listened to/involved? Take their tablets as prescribed Outcomes as good as could be?  Get regular checkups? People with long term conditions…. Would like to do more for themselves ? Have confidence to manage day by day?        Year of Care
  3. 3. Hours with health / social care professional = 4 hours in a year Self-management = 8756 hours in a year The individual’s perspective
  4. 4. The Challenge! 15 Million people live with long term conditions in England Care and support planning can make it personal for everyone!
  5. 5. International Evidence Base Reproducible intervention >3000 practitioners and 40 quality assured trainers Year of Care Training and Support Team
  6. 6. Care and support plans versus Care and support planning Having better Conversations  Year of Care
  7. 7. Care and Support Planning : in the beginning Agreed & shared ‘care plan’ Information gathering Professional Story Information Sharing Person’s Story Goal Setting and Action Planning  Year of Care
  8. 8. I got more information out of it than I ….did previously. …they were probably giving us the information,(but) they were giving it us in a different way. [PWD12] Care and support planning – being systematic 1st visit/ contact Between contacts 2nd visit/ contact … Absolutely 100% better ……for me and for the patients.[GP} Information Sharing and Reflection Agreed and shared goals and actions (care plan) Consultation and joint decision making Information gathering  Year of Care
  9. 9. 1. Prepare Getting ready for the care and support planning discussion • clear about purpose • collecting useful and important information • taking time to think and talk with other people • what matters most to you • what do you want to get out of the consultation
  10. 10. 2. Discuss  Year of Care Review Action planning Goal setting Explore and discuss Gather and share stories Care Planning Consultation Information Sharing and Reflection Agreed and shared goals and actions (care plan) Consultation and joint decision making Information gathering
  11. 11. 3. Document Writing down the main points from the discussion • the main points that you have talked about • the plan belongs to the person • easy to understand and use • also part of the main health and care record
  12. 12. 4. Review Checking how things are going by • Self monitoring • Support programme / friends • Review with the care and support partner that helped create plan
  13. 13. The House of Care Preparation for discussion Information Structured education Emotional & psychological support Care and Support Planning Attitudes and Skills Integrated Team working Champions and role models Admin for prompts, tests, assessments IT support for care and support planning Identifying population Key contact and navigation
  14. 14. Purpose of today’s event More than Medicine
  15. 15. Building the House • Part of local strategy for LTCs • Steering Group with senior buy in • Quality assured training which links attitudes, skills and infrastructure • Hands on support for practical change
  16. 16. Impact ……I'm listened to …….you may not have all the answers …….you’ve helped me work things out  Year of Care
  17. 17. Healthier living ‘I no longer smoke (Gave up 12 months ago) . I take the symptoms more seriously - try to nip chest infection in the bud’ ‘I achieve a lot – I have become very conscious of what I eat and do more exercise. I started going to the gym to lose weight’  Year of Care
  18. 18. Sustained improvement ‘Each time I get a greater understanding of my condition and understand more about how I can go about maintaining and improving it’. (P8)  Year of Care
  19. 19. “ ‘I enjoy doing the clinic a lot more now… working with them rather than at them’ Better for Staff too  Year of Care
  20. 20. ‘The new pathway ….. more efficient in time for both patients and health care professionals.’ (Practice team member) Practice organisation and resources Cost neutral at practice level Pre Year of Care : £21 Post Year of Care : £21  Year of Care
  21. 21. Clinical care…….. Improving too! Tower Hamlets 2006: Worst 10% in England 2012: 72% received all 9 processes in National Diabetes Audit: Best in England Patient perceived ‘involvement in care’ rose from 52-82% Diabetes ‘control’: 24 - 35 % (national average = 19%)
  22. 22. Integration / coordination •At the personal level •Between health and social care •Between primary and specialist health care Tower Hamlets: 2012 Specialists attend 90% of quarterly primary care cluster multidisciplinary meetings  Year of Care
  23. 23. Launching today
  24. 24. Supporting local communities to build their House of Care Find out more: www.coalitionforcollaborativecare.org.uk Twitter : https://twitter.com/Co4CC
  25. 25. What is care and support planning? An introduction to our guide
  26. 26. The ‘why’ 1. Member feedback: improves outcomes but despite commitments, is not happening enough 2. House of Care: engaged, empowered individuals 3. Care Bill: care and support planning in legislation 4. Integration: care coordinated around the individual, integrated personal budgets
  27. 27. Our aim → Create a common understanding of what care and support planning means across health and social care → Raise awareness of the approach amongst those who could benefit.
  28. 28. The ‘how’ • What is care and support planning and why do we need it? • Overarching principle • 4 stages • Identified that it would be useful to have more information for people who use services and professionals
  29. 29. The ‘how’
  30. 30. The ‘how’ • c200 individuals signed up. • Health and social care professionals, commissioners, providers, academics, people who use services, carers
  31. 31. The ‘what’
  32. 32. The ‘what’
  33. 33. The ‘what’
  34. 34. The ‘what’
  35. 35. The ‘what’
  36. 36. The ‘what’
  37. 37. The ‘what’
  38. 38. The ‘what’
  39. 39. Get involved • Tweet about the guide #careandsuppportplanning • Share the guide and the films with your networks • Endorse the guide • Share you stories • Help us develop additional content • Share your views on professional summary
  40. 40. Contact Lindsay Oliver Sue Roberts Enquiries@yearofcare.co.uk www.yearofcare.co.uk Laura Robinson, National Voices Laura.robinson@nationalvoices.org.uk
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