Slides for a workshop as part of the HIN Leading & Managing Change Across Boundaries programme

1. What makes person-centred care?
Leading & Managing Change Across Boundaries
Module 3
Jeremy Taylor, chief executive
National Voices
March 2018

2. The plan for this workshop
• Introduction & “ice- breaker” 9.30
• Initial discussions 9.40
• Some slides and discussion 10.00
• Coffee 10.45
• Recap 11.00
• Exercise 11.10
• A few more slides 11.55
• Final discussion: learning points, 12.10
take-aways
• Lunch 12.30

3. National Voices
We are the coalition of charities in England that stands for
people being in control of their health and care. We have
160 member organisations.
We care about:
• Person centred care
• Living well with long term conditions
• Engaging people in decisions about health, care and
services
• The things that contribute to health and wellbeing
• The role of the voluntary & community sector

4. What we do
• Speak up
• Seek to influence national policy & system
design
• Support leaders & change-makers in the
NHS
• Enable our own sector and the people
they represent

5. What I want to cover:
• What is person centred care?
• What’s the case for it?
• What does good look like?
• Is it happening?
• What stands in the way of it?
• What do leaders need to do?

6. In pairs:
• How does the theme of this workshop relate to
you personally or professionally (or both)?
• What would you like to get out of this session?

7. In your groups
• How person centred is your place of work?
• What has given you the most positivity?
• What has made you most angry?

8. What is person centred care?
• See me! – unique, a whole person, not my
condition/body parts etc
• Care for me - expertly, safely, compassionately,
within guidelines
• Join up your services around me (or my loved
one)
• No decision about me without me – I need
information, choices, control, independence; to
be involved; to get on with my life
With apologies to: person centred care made simple, Health Foundation, 2014

9. What are some of the ingredients?
• Shared decision making
• Personalised care and support planning
• Support for self management
• Involvement of carers
• Multi-disciplinary team working

10. Shared decisions

11. An aside on terminology
• Person centred care (& support)
• Whole person care (& support)
• Personalised care (& support)
• Personalisation
• Person and community centred care (&
support)
• People powered health

12. Engaging
individuals in
their health and
care
Working with
groups of people
– eg to redesign
services
Working to reduce
inequalities
Engaging
relatives and
carers
Working with
communities,
volunteers,
voluntary sector
person
centred and
people
powered

13. What’s the case for it?
• It’s policy and a requirement
• It’s evidence based - leads to better decisions
and outcomes
• What matters to me is not the same as
“what’s the matter with me”
• It creates social & economic value

14. The case for shared decision making
Graphic courtesy Angela Coulter

16. People involved
in own care:
£150 return on
£100 invested
People powered
health:
£4.4 bn pa
Informal
carers:
Over 6m
people
1.5m full time
£132 bn pa
Volunteers
Quarter of
all adults
£24 bn pa
Voluntary
sector:
160,000
organisations
£12.2 bn GVA

17. What does good look like?

18. “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….

19. Going up the ladder

20. Engaging
individuals in
their health and
care
Working with
groups of people
– eg to redesign
services
Working to reduce
inequalities
Engaging
relatives and
carers
Working with
communities,
volunteers,
voluntary sector
person
centred and
people
powered

21. Going where the energy is
• Personal health budgets
• Health coaching
• Social prescribing
• Peer support
• Patients on interview panels
• Patients as mentors
• Experience based co-design
• Etc

23. “The doctors and nurses and drugs had all helped and
worked miracles to get him into remission, but it was Neil
who was getting dad back to being dad again. It was Neil
that was getting dad back up the garden to see his veg. Neil
meant dad could walk to and cuddle my son, again. Neil
that was giving dad a glimmer of hope that he might get out
walking in his beloved Yorkshire Dales again.
The pressure on Neil and his colleagues is the price we pay
for “innovation”. Do we want a health system that
purchases Michaelangelo robots and FemtoSecond Lasers,
which are shiny and new and high-tech but offer no real
benefit – and may even harm. The opportunity cost of
spending our health service pounds on these shiny
prestigious gadgets are Neil and his colleagues and the
health they create.”
From a blog by Chris Gibbons
https://donteatthechalk.wordpress.com/2018/02/19/innovation/

24. Person-centred care: is it happening?

25. Person-centred care: is it happening?

27. Personalised care and support
planning: a key enabler

28. More to do to support carers
Family involvement is
not central, and most
carers do not get
much support.

29. It’s all about integrated care, yet:
Coordination
of care is not
measured.
The best indicators
we have show poor
results.

30. Some indicators
of inequality.

31. Groups with worse experiences (on various
measures)
• people with long-term conditions
• people aged over 75
• people with dementia
• young people with complex health needs
• children with physical disabilities
• people with both physical & mental health needs
• people with a learning disability
• people detained under the Mental Health Act or with
mental health conditions
• people from some BME communities
• people who are LGB or T

32. What I want to cover:
• What is person centred care?
• What’s the case for it?
• What does good look like?
• Is it happening?
• What stands in the way of it?
• What do leaders need to do?

33. Exercise: step 1
On your tables:
What actions would you take to deliberately
minimise your organisations’ engagement
with patients, people and communities?
Think creatively and out of the box! Policy,
process, procedure, behaviour, incentives
etc etc

34. Exercise: step 2
Which of these actions are similar to actual
barriers to being person centred in your
organisations?

35. Exercise: step 3
As leaders, what steps do you need to take
to overcome these barriers and create a
positive climate for person centred
approaches?

36. Being person centred: it’s partly
about technique - eg
• shared decision making
• personalised care and support planning
• health coaching
• education and support for self-management
• peer support
• group activities
• social prescribing
• asset based approaches
• experience based co-design
• co-production models
• patient leadership

37. Being person-centred: it’s hugely
about leadership
• Making what matters to people as the goal for
healthcare
• Treating people as people
• Listening
• Better conversations
• Working collaboratively
• Reaching out
• Letting go/sharing power
• Balancing the medical/technical with the human
• Enabling your staff to do likewise

38. What National Voices has learned
about leadership across boundaries
• The boundaries between the voices
• The boundaries between our sector & those we
represent
• The boundaries between our sector & those that
design & deliver services
• The boundaries between policy & practice

39. What National Voices has learned
about leadership across boundaries
• Bring people together
• Develop common purpose around what
matters to people
• Work with change makers
• Be solutions focussed

40. In pairs
• What have you learned?
• What’s changed in your thinking?
• What will you do differently back at the
ranch?

41. Some sources
National Voices evidence summaries
https://www.nationalvoices.org.uk/publications/our-publications?combine=+&tid=101
NHS England guidance on involving people in health and care
www.england.nhs.uk/participation/involvementguidance/
Resources from Realising the Value Programme
https://improvement.nhs.uk/resources/realising-value-person-and-community-centred-approaches-
healthcare/
Six principles for engaging people and communities
https://improvement.nhs.uk/resources/Six-principles-for-engaging-people-and-communities/
Nice guideline: Community engagement: improving health and wellbeing and reducing
health inequalities
www.nice.org.uk/guidance/ng44
PHE: guide to community-centred approaches for health and wellbeing
www.gov.uk/government/uploads/system/uploads/attachment_data/file/417515/A_guide_to_communit
y-centred_approaches_for_health_and_wellbeing__full_report_.pdf
NSUN: National Involvement Standards
https://www.nsun.org.uk/FAQs/4pi-national-involvement-standards

42. Thanks for engaging!
www.nationalvoices.org.uk
@NVTweeting
@JeremyTaylorNV
jeremy.taylor@nationalvoices.org.uk