2. Choice
+ve -ve
Constraints – “The level of choice I want....” Sometimes I just want a coffee (not latté, cappuccino etc) Is true choice really possible within the current economic climate? Get the
how realistic? People don’t necessarily make expansive choice. Some evidence may scare many. basics right.
Need to get the basics of care right before choice We can’t afford it!
Young people may not have the confidence to access services. May prefer anonymous Can only have choice in a free (not quasi) market
access as first step.
Choice is constrained by what (others) decide is available
Pre-requisites – ‘The community’ is not homogenous – consult with all to find out what their
for all needs and beliefs are!
Health literacy
Socio-economic experiences
Some people (hard to reach) have no choice
Choice based on health needs of community
Consult with young people to know what the needs are
Pre-requisites – Patients can make the ‘wrong’ decisions about their care
support or risks Need to have capacity to enable choice fairness and incentive to make
too better services
Uniformed choice is worse than no choice
Do we have information to make wise choices?
Illusionary in Shire counties with one hospital
Building capabilities of making informed choices
Remember there is a ready pool of intelligence through PALs data, complaints
and existing experience data – don’t restart this
Making it Choice is not just information – evidence is that behaviour only changes when information is Choice needs to be relationship based “The Choice Culture”
Meaningful supported by a human Choice of what I want to know
Choice of treatment option – is empowering better outcome better experience Need to understand what choices are out there of services
And more appropriate use of services Need care over how this works for the frail, aspects of mental ill health
Needs to be primarily about choice of treatment and choice of “prime provider” for locality by
Commissioner
Potential for Most specific definition of what are critical success areas
choice Informed choice will drive efficiency
Choice (will drive requirement for better info on health care services) requires good and
accurate information to patients and commissioners
Choice of GP
Choice gives me control and convenience and drives quality
Could improve Choose & Book to deliver choice of diagnostics
Choice will lead to change in health services and deliver convenience and ensure control
Will promote quality diagnostics (test and interpreting) to drive choices
Opportunity to “transform” service”
Will increase quality
Services will have to respond to people’s preferences
Allows for variation and flexibility
Choice is correct at all points in pathway not just “transparency” up front of information
pressure points
Will promote real, real-time quality information about pathways
“Meaningful choice” will encompass having enough information, healthy literacy, access etc –
or that should be aspirations
3. Choice contd....
• The right incentives ensure I have the level of control I want at that point; services are responsive to
me and appropriate for my wider communities, tackling inequalities to create a different sense of
control and influence in service delivery and design grounded in mutual respect
• Effective and appropriate choice for all of us is supported by accurate, timely and relevant
information which highlights service quality to deliver effective decision-making in favour of best
outcomes
• services make best use of technology to ensure convenience efficiency and availability
4. Convenience
+ve -ve
People want it – so they can work / live There is a big risk that convenience will
their own way – relative to what they crowd out quality
want.
New ways of working (better quality
information) can make it more efficient
too. (Right care, right place, right time is
convenient.
Evolving and taking people with us
+ve -ve
• Created around the needs of human lives not structures and systems • Convenience should b e shaped by individual life / design. Technology is
• Technology has enormous potential to underpin control and transform helpful as one of a number of enablers
• Needs to be convenient to people’s lives – multiple and simple access • Putting resources into ‘convenience’ empowers people who are already
points. Navigators through system. empowered – leaving less resources for those who need them most
• .... is central to a partnership approach. Means different things to different • Not enough reference to people in the definition
people! • Least substantive. Follows choice and control
• Adopt the philosophy of customer services – fit the needs of the patient, not • Service – not the 9-5 mentality needs to be the culture
the systems of ‘the system’ • It’s not just about technology – people need information in different formats
• Able to do more myself if I have the tools / channels. Therefore definition too restrictive
• Technology key to accessing information / services but being in control of • Quality and access is more important than convenience
that • Does not necessarily deliver efficiency
• Will increase access. Can we cope with increased demand. • Costly and could limit quality
• Opportunities for doing more ourselves in different ways • Convenience is part of choice and control – don’t need separate ‘box’
• As the cuts bite I’ll be fighting to preserve convenience of existing services • Cynicism due to NHS history in its use of technology
• Simple to use, reliable systems which work (see OCADO or Tesco) • Can limit equity
• Young people ‘get’ technology – need to build services for them around this • Not a mechanism for change
– they are digital activists • ‘Convenience’ sounds very weak alongside choice and control
• Facebook consultations + video Skype + “track my healthcare”
5. Control
+ve -ve
Control for choice, self-empowering, local Poorly defined / vague. Negative
empowerment connotations “no control”, “control of
Control should be “partnership in what?”
decision making”
Democratic accountability
+ve -ve
First point of control: scrap the words patient, client, service Control = information sharing. Does this lead to choice?
user and talk about people! The politicians (and doctors?) are controlling this agenda – not the people
Control is dynamic – will continue no matter what stage in life Having / being in “control” comes from being well informed and empowered
Reform clinical education and training Much more support needed to empower clients / patients
Listen to young people Use simple language. Exercise respect for each other
Control frees people to get on with life Navigation is a key part. Control sounds too mechanistic. How can we effectively plan services
Service that is tailored for me as an individual on a population basis, achieve critical mass if individual / communities dictate control and
Lack of control is very stressful therefore provider market?
People centred This term will turn off health professionals and backfire
Putting communities in control – co-production Young people should be heard as equals. Do we have any control?
Because small changes can make a big difference Do people have access to core communication support to exercise it?
Makes best use of the person in bed 7 How will this work – not confident that this will happen
Control = choice and convenience (I agree – we only need Should be more ‘partnership’ – control implies unequal power relationship
‘control’) Need to discuss bigger ‘control’ issues – what do we pay for? What should NHS do?
“I have the level of control I want at any point” i.e. sometimes I It’s hard to share control – but actually health professionals and patients need to work together
do, sometimes I don’t Badly defined – I don’t understand what this means (not me, I agree)
Self efficacy is crucial as experience and outcome measure “I know my rights” – unpleasantness
Transparency Who controls? Negative connotations
Enabling individuals to co-ordinate in ways that work for them Do people have cognitive ability to exercise it?
Local and early input to all decisions Is confidence a better term. People have confidence in their role and services
Enables me to refer myself Patients empowered to challenge basic NHS care i.e. have you washed your hands? Have I
‘Giving’ control is doing things to people (again). Allow have m VTE risk assessment?
people to take control if they wish How do you integrate and differentiate services for any one individual?
Language is impenetrable. Articulate what this means in brief phrase or analogy
In this context, how are services designed strategically?
Opt in = no sharing
Opt out = progress
Control of what?
Specific services for young people and their needs – informed by young people
Language
6. New Goals
Cross cutting – preserve and protect what works now through transition
Create incentives and reduce cost Mutual respect
• £ Patients in reality! • Trust, respect, partnership
• Cash incentives understood • Valuing staff and service users and carers
• Carrots & sticks? Otherwise just nice ideas • Diversity within health care profession – able to put yourself in other’s shoes e.g. what
• £s must really – all citizens, patients, hearts and minds will follow does it feel like for a homeless young person with drug issues
• Cost less – more efficient better value and return • NHS constitution rights and responsibilities – individual good Vs community collective
good
• Confidence. Need to have trust in technology, services, information, people
• Integration. Professionals and services working around and with me
• Quality – reflected explicitly in all Tackle inequality
• Clinical outcomes – day/treatment remission • Fairness, access, equality
• Quality – 100 miles away –good surgeon doing operation he didn’t want • Unmet need – awareness, diagnosis, action
• I don’t care about convenience, control or choice. I just want quality • Consistency – fail safe for people without choice and control
• Better information and metrics to inform development of clinical outcomes • The private interests will have alternative agenda e.g. cancer drugs. What is this change
~~~~~~~~~~~ increases risk and uncertainty.
• I don’t want choice, control, convenience, I just want quality • Values and preferences of equal consideration when evaluation outcomes
• Choice, control, convenience is part of quality
• Accountability & responsibility Collective and Togetherness
• Leadership • Structure / models needed for communication to decision maker. What does quality
• Effective management as a driver mean to communities?
• Co-production communities and services
• Community / collectives – people coming together to drive quality and the system. The
current SCs are about isolated individuals.
• This agenda is about shifting power in the system. This will only happen if we help
communities to organise
• Localism and individualism – 65 million solutions required!
• Local / individual is not enough. Collective and national patient input is critical
• Developing community support – if this is about shifting power it has to be about
organising and collectivism
• Connection – this is too NHS centric – need to look at the connections outside of
healthcare – lifestyle / social determinants etc
• Using patient voice collectively to drive future change – not just choice, control,
convenience now
Health & Happiness
• Culture and relationship s – equity, resources to change, accountability, services
change, values, empowerment
• Happiness – why are we seeking good health and how?
• Train PE at medical school as core curriculum
• Leave people’s ‘culture’ along – just do things differently
• This should be about health. The NHS needs to look at creating and
maintaining wellness and wellbeing
• This needs to be all about people! Start with the person, their goals and what
they want in their lives and use that to shape services. Healthcare is important
but none of us is just a ‘disease’ or a ‘user’. Please – Choose Life!
7. World Cafe
Topic Description
1. Customer Insight and feedback To develop a systematic, increasingly comprehensive approach to customer insight including population
Host: Daniel Metcalf preferences and lay beliefs across the diversity of communities and client groups using health and social
care services, and systematic, comparable feedback about customer experience and expectations
3. Shared decision making To make a reality of ‘no decision about me without me’ as the norm of patient / service user experience’
Host: Marion Collict across health and social care interactions
4. Maximising the convenience of services Identify opportunities to significantly improve the convenience of service access and delivery, drawing on
Host: Nick Chapman learning from other sectors and the potential particularly of phone and digital technology to deliver
services in new more responsive, efficient and sustainable ways
5. Information and technology Architecture Identify architecture challenges and changes required to support information transparency, access,
to support system delivery remote and mobile working and other implied changes; including information standards and governance,
Host: Inderjit Singh inter-operability and ‘open’ systems
6. Choice (of style and provider) of services Significantly escalate scope and scale of current offer of choice of provider and extend to choice of style
Host: Rebecca Chaloner and type of treatment or service across an increasingly broad range of client groups.
7. Supporting people with Long Term
Conditions to self-manage
8. Community Accountability – Developing Drawing on feedback to recent consultations and learning from previous structures, to maximise the
Healthwatch arrangements opportunity for HealthWatch at a national and local level to act as a channel for local people to hold
Host: Mary Simpson commissioners and providers to account for the effectiveness, responsiveness and relevance of services.
9. Community Accountability - opportunity To explore opportunities to develop a range of mechanisms by which publicly funded health and care
for broader accountability investment is able to give an account to and be held to account by local people; which supports active
Host: Mike Warburton local participation in influencing and commenting upon service investment, design and performance.
10. Organisation & Visibility of Information Develop information supply, analysis and presentation to ensure informed decisions by commissioners,
Host: David Knight service providers and citizens supporting responsible choices in style, nature and provider of health and
care services at a system level. At an individual level this should support shared-decision-making and
choice and facilitate collation and analysis of individual experience and outcome.
8. Customer Insight and Feedback Success
factors
Applying insight, Leaders valuing
not just gathering insight, using it
it. Seeing it as and making
constructive changes as a
feedback, not
result Gathering the
‘criticism’
right sort of
Using the rich and Higher information –
Culture change
varied sources of patient/public segmenting but
– bringing
data in the system service also aggregating
patients, Better outcomes from the
already e.g. PALS, expectations where needed
carers, staff patient’s / people’s
complaints etc together perspective – putting the ‘S’
(service) in NHS. Using insight
to achieve all of this. Every rotation/Importance of
getting a refresher
Patient insight/improving services
•Training for new clinicians every
six months when they’re learning
•Discuss with patients the care they want
and work with them to set expectations
•Start a debate to challenge attitudes of different •Staff feeling dis-empowered
clinical professions to others to make changes
•Providers – being distinct, •Real time feedback on clinicians – individual level – every
offering better quality services to patient, every interaction, on key metrics and subjective drivers •Language – not speaking the
survive in a competitive market •Systematic publication of clinician data – easy to use, quick to access – language that patients use
•Commissioners – having realistic
showing success rates, applying peer pressure on others •Qual data becoming
•GPs have to ask patients if they’re happy with service at the end of meaningless – translates into
dialogue with patients / public each consultation
about the services they can reports which lose the human
Bold Steps to Delivery element
commission with money they Media
have A system that pulls together ALL the Governance / improvement at a local level.
Media Key Contacts existing data – qual/subjective and
quant surveys e.g. Picker, Dr Foster,
Enable every patient /service user to
feedback quant & qual data about their
Penny Woods, Picker Institute PETs, patient opinion, 1:1 interviews, interaction after every interaction and
complaints, In Your Shoes, publish the data/drivers about each
Tim Keogh, April Strategy compliments, NHS Choices and display individual clinician/service so they have the
Andy Donald, BEN it as insight I can do something about information to improve
9. Shared decision making Success
factors
A different
culture – the SDM access
public need health and
to get it as social care
Open well
SDM is the
sharing of
‘glue’
lack of
evidence
Involving and
Sharing of empowering the Map
information patient / customer to appropriate
and control make decisions that care
are right for them
Deep and broad strategy
-Patient access to info
- Community org/social marketing to • Communication – everyone
Regular feedback (Tahir’s model) shift power (clinicians) needs to know their rights
Decision support -Learning from Social Care and Maternity and responsibilities
QIPP, FIDM / Year of Care / GCGP - Change of clinical norm by patient •Values
Clinical Nurse Specialists - Co-signatory system in primary care •Technology
NHS Direct
Committed clinicians
•Lack of confidence
•Discrimination → BME!!
Specialist clinics
Record access / control
Bold Steps to Delivery
NICE standards
NHS-CB guidance
National strategies
Key Contacts
Tahir Mahmud (taher.mahmud@nhs.net)
Third Sector knowledge Helen Whitworth (helenwhitworth@nhs.net)
Evidence base Consultant forensic psychiatrist (Stafford Prison) – very
Social marketing to clinicians and interested in contributing (friend of Julie Beedon)
commissioners
10. Maximising the convenience of
services Success
factors
Multi- Affordable
channel and and
integrated sustainable
Easy
Appropriate
structured
management
self-service
of risk
Quality services,
Easy for efficient for patient High quality
both (effort) and NHS & evaluation
& insight
• Digital channels as default “web
first” to revolutionise access,
advice & response • Perverse financial
•Create new patient-focused processes and
incentives: i.e. Footfall
Convenient services: align financial incentives (GP consortia
contracts from NHS) • Cultural/attitudinal: fear,
• Can be cheaper and we’re risk aversion, low morale....
•Professional engagement and levers
beginning to notice there’s a •Amplify the patients voice Traditional
(severe!) cash shortage •GP choice – any willing provider • Lack of information for all
• Can be delivered with new • No harnessing innovation
technology and we’re Bold Steps to Delivery • Scale
recognising and learning from
how others use technology
• Can be found all over the NHS
and we’ve a great opportunity
to learn from the best
11. Information and Technology
architecture Success
factors
Catalogue – Information
consumer I can trust
guide
Using my Inter-
channel of operability
choice
Information available
Personalised in a form that allows Convenience
care plans informed decision in use – my
making and transact default
- Supported, relevant
information throughout
journey of care
3. Find – create market that will be
the best ways of making more use of
commercially / publicly available No incentive to publish
infrastructure Lack connectivity
Opt-out as default
2. Incentivise payment for treatment via non-F2F channels Lack permission “too NHS”
Publish existing data, with
interpretation Add cost, reduce value
1. Minimum dataset in correspondence between 20 care
Consortia demand and commissioner to trigger payment
Identify mutual benefit
Demonstrate best practice Bold Steps to Delivery
12. Choice (of style and provider) of
services Success
factors
Choice – 3 Listening
legged stool: better to
Choice, more people who
accessible info don’t get
Diversity of & confidence Get
listened to
integrated commissioning
providers right: balancing
offering joined different needs
up service
Safeguarding Letting things
the vulnerable: Improving quality /
fail: learning
not just up to health and wellbeing
from that to
market. Role get better
of the State
services
Provider reputation
•Baseline it!
•Introduce choice modules into
education, revalidation and appraisal •The NHS
•Increase patient input in commissioning and •Location and geography
•?Lack of resources
decommissioning •Technology
•Transparency of information •Service failure and best practice reviews involving
•Culture (good) •Bureaucracy
patients!
•Technology •Culture (bad)
•Introduce choice as early as possible
•Ask when well and after the •111 people make lousy
shoppers
event Bold Steps to Delivery •The evidence industry
13. Supporting people with LTC to
self-manage
Success
factors
Supporting ideas Build skills in people
- Capability & Collaboration
Integrated and
seamless care and
- Participative care
and actions confidence
- cognitive skills, plan
flows of
information
Health Literacy: - Help to navigate
- efficacious – see it
- Good access to up to date information as my thing to self through services
- That I understand manage Clinicians as
coaches and
- All looking at same info. Individual – tailored to facilitators &
Shared experience and peer support and my education style guides – NOT
- Language Incentives that
access to people like you plus valid gatekeepers / reward the right
- Abilities barriers
expertise interventions and
Use of info channels e.g. The media, behaviours –
new tech channels, social media Supporting people with LTCs to develop budget around
confidence and skills to manage their own care plans
Clinicians – new skills health including their LTC and helping
I’m the driver of decisions, treatment -self-management support High quality = BOTH –
clinicians to develop skills “let go” and help high quality evidence-
and setting my own goals – proactive so is a clinical skill people finally change how they work to
-Motivational interviewing based care and set and
I stay well, I feel I am doing better to develop self-management support as a manage my own goals
-Manage the conversation
feel better myself in a way that works for clinical skill – help people to find own
each individual solutions in context of own life.
1. Patients
- access to records
- access to meaningful information
•Use Health & Wellbeing Boards to influence local 2. HCP - coaching and support
commissioning decisions for SMS - training in SMS as a clinical skill Professionals don’t relate to / drive self-
•Self-advocacy - clinical advocates who say it improved their job
•Mobilise patients to expect / demand SMS from their health management
satisfaction & outcomes Variable quality of I.C. – from great to
professionals
- measuring confidence to self-manage and seeking unacceptable
•Connecting with community support
•Support learning across and from long-term conditions and
to improve it No way of knowing where/if we are
3. Systems: - measure, incentivise and reward clinicians and systems for
learning from other sectors e.g. Social Care, Housing getting it right
•Power of personal stories to influence attitudes and practice delivery of the aim above
Not having access to information
•Lots of different ways to learn Italian incl LA sponsored course Re-write the Hippocratic Oath around the aim above – rearticulate role of (patients)
•Clinical leadership & champions are critical heathcare Not part of a whole system (YOC House)
•Generic LTC guidance for commissioners from NCB not
condition by condition Bold Steps to Delivery We do it already – my patients don’t
want this
•Examples where this is being done successfully & lessons to
share
•Give GP commissioners the evidence re the effectiveness of
Key Contacts Incorporate SMS into re-validation
process and appraisal processes
self-management support inc courses Taher Mahmud Existing funding system doesn’t
•Do what we know works already Tim Keogh – April Strategies reward/fund peer support
•Quality standards reflect and incorporate best practice Health Foundation’s Co-Creating Health initiative (Natalie Grazin)
•Measuring meaningful outcomes: confidence, skills, support
•Peer support is a key enabler for individuals to self-manage
•What is good for patients is good for clinicians is good for NHS
14. Community Accountability – Developing
HealthWatch arrangements Success
factors
Independences Expertise
Robust, Services
clearly responsive to
accountable Healthwatch
governance (s?)
The local system responds to
HealthWatch as the
Inclusivity Committed
authentic, credible, influential
and diversity volunteers
voice for citizens, service-
users, carers, communities
Communicate the story. Develop
information to as well as from HW Behaviours – patients and
Duty to involve Make sure public health is included clinicians
Hwatch England Realistic discussion with LA and PCT/GPC Rt funding for HW Reputation of LINKS
Stronger governance HWE prioritise guidance / leadership on EDHR Cynicism
Links between consortia and HW to develop real participation Over-promised
Held to account for effectiveness
Focus on outcomes Funding pressures – LA as
well as Health
Bold Steps to Delivery
Key Contacts
Katy Wing - NAVCA
15. Community Accountability – Opportunity
for broader accountability
Success
factors
Partnership /
Confidence
co-design
Transparent
information
Responsive and useable
Real sanctions if services fail, information
otherwise it doesn’t support
engagement
Valuing it – money
Stability in the structures Appropriate engagement and
Clarity of involvement of local citizens is
purpose and holding all parts of the health Central shared
engagement and care system to account principles
Framework
-Local organisation CVs to be involved
-Communities of interest – how can
events be supported
-Leadership that champions PPI
•Use existing knowledge
- Inequalities duties – support needed
• use voluntary organisations, Charities,
Commitment to peer review → transparent and shared •Transaction cost of doing it →
Specialist groups share learning across
Build in partner experience into Tariff (NICE, CQC – engage,
•GP’s getting involved / ‘facing up’ •What do travellers with brain
consult and development) to underline the importance
•Use of GP Books to communicate injury need “generally?”
•Role modelling by DH/NHS CB leaders Centrally & Locally
-Engage Voluntary Organisations / Charities – existing knowledge / best practice •Reduction – management
•Transparency of Consortia – level data,
comparative data -Why should they engage them? Actions Locally / Nationally resource and infrastructure
•Clear accountability to the NHS CB -Need to be representative •Local politics / election → HOSC →
•Set of role / framework – expectations clear H&WBB
•Importance of leadership in developing a culture Bold Steps to Delivery •Money
that supports engagement •“Command & Control”
•Share existing Best Practice – practical resource Clear framework for NHS CB – needed early •Salient control
•Honesty Clarity of role of all staff in engagement
•Engage earlier and more “totally”
•Health & Wellbeing Board – need to ensure it Learn from other sectors/LA
happens -Participatory budgeting / personalised budgets
•Real engagement → change things Capture and package for Consortia
•Demonstrate it changed Help people navigate new system
16. Organisation and Visibility of
Information Success
factors
People Open
know how information
and where drives
to access quality
Share info
information – All electronic
effective recording is
communication normal
(talk!)
Success in
people who Patients have a right Intermediaries
have been to access their own are using
able to access information* *to records about
their own information
treatments etc, and
info! about hospitals etc
One “front end” to all on-line info (a la
“Facebook for Health” / Amazon) as a
way to get at all on-line “trusted” data Unequal access to I.T./digital
Clarify once for everyone rules on governance of exclusion
Transparency re cost of services records (access and control)
Universal information/self Lack of availability of data
Make all records join up across H/SC organisations
management as prevention Support in place for those who can’t access IT but need to Information sharing between
Clarifying information governance Set of clear Inf sites used by all agencies / systems not talking
Linked information that helps us Demonstrate how info has improved care / quality / experience to each other including health
understand public health issues & SC
Bold Steps to Delivery Problem of quality assurance /
Clear data standards
reliability / knowing what
D needs a Big National Push information to trust
