The document discusses a meeting held with stakeholders to address the lack of Parkinson's nurses in Stoke-on-Trent. A problem tree was created to explore the causes and effects. It identified problems such as long wait times, poor funding, and a lack of understanding. These problems led to outcomes like lower well-being, social isolation, and increased care needs for patients. Next steps discussed gathering evidence on the outputs and outcomes to prove the need for more support for Parkinson's patients.

1. Parkinson’s Project
Background
Healthwatch Stoke-on-Trent was approached by a Care Manager concerned
about the lack of Parkinson’s Nurses in Stoke-on-Trent.
An exploratory meeting was held with stakeholders at the Dudson Centre to
discuss the issues and find a way forward.
The following slides are the result of this meeting.
Please feel free to share, adapt or add to these diagrams.

2. Problem Tree
Problem trees are useful for exploring cause and effect. In this case, a
conversation was held around Parkinson’s, the problem tree was then
populated with a member of Healthwatch staff facilitating.
Results
The next slide is divided into 4 sections. Problems far and near, and effects far
and near. You can read the diagram by starting at ‘Problems Far’, which relate s
to large, difficult to change problems. Falling from this below, are the (near)
problems which could be said to be caused by the far problems. This then falls
into near and far effects which are the result of the problems. Its logical.

3. Lack of
understanding
No
Parkinson’s
Nurses
Not Trendy
Long wait for
appointments
Changeable
condition
Staff
shortages
Multidisciplinary
No Reviews
Discrimination
No support
information
Nobody
to talk to
about the
issues
Poor
communication
No central
point of
control
Nobody takes
responsibility
Stigma
No specialist
OT’s/physios
Staff
attitude
Lack of
knowledge
and skills
No
continuity
of care
Less Social
Interaction
Lower Self
esteem
GP’s shy away
Poor
funding
Unsuitable
medication
Nurses fire-fighting
Unidentified
illness
Personal
Finances
suffer
(no NCC
budget)
Injuries
from
falls.
Poor
mobility
Lack of
dignity
Unplanned
Hospital
Admissions
Lack of
independence
Isolation
Suicide
Increased
Care need
Medication
at wrong
time
Mental
Health
costs
Drop in
wellbeing
Creation of
‘the unseen’
Lower
wellbeing
No
Continuing
NHS care.
Under
resourced

4. Context
Mechanism
Outputs
Outcome
CMO Evaluation
CMO means Context, Mechanism, Output.
In the following slides the information from the problem
tree is taken and moved into a different table. In this
format it is easier to see how the context and mechanisms
can produce outputs and outcomes.
It is possible to change items in the context or mechanism
section to better understand how these alterations can
change outcomes and outputs.

5. Outcome
Context
Hard to define
condition
Outputs
Stigma
Mechanism Lack of
understanding
Not Trendy
Changeable
Staff condition
shortages Poor
funding
Multidisciplinary
Discrimination
Nobody takes
responsibility
Staff
attitude
Long wait for
appointments
Lack of
knowledge
and skills
No
continuity
of care
GP’s shy away
Nurses fire-fighting
Unidentified
illness
Personal
Finances
suffer
(no NCC
budget)
Medication
at wrong
time
No
Continuing
NHS care.
No specialist
OT’s/physios
Unplanned
Hospital
Admissions Suicide
Mental
Health
costs
Creation of
‘the unseen’

6. Context
Lack of
understanding
Not Trendy
Changeable
Staff condition
shortages
Outputs
Mechanism
Hard to define
condition
Stigma
Poor
funding
Multidisciplinary
Lower
wellbeing
Unidentified
illness
No
continuity
of care
No central
point of
control
GP’s shy away
Lack of
knowledge
and skills
Lower Self
esteem
Injuries
from
falls.
Poor
mobility
Lack of
independence
Isolation
Increased
Care need
Unplanned
Hospital
Admissions Suicide
Mental
Health
costs
Creation of
‘the unseen’
No support
information
Improper
Equipment
Outcome
No
Parkinson’s
Nurses

7. Next Steps
Evidence Gathering.
There is a need to evidence the outputs and outcomes.
Therefore, it would be helpful for stakeholders and partners to consider
collection of case studies and data which can help prove the following.
Less Social
Lower Self Interaction
esteem Unsuitable
medication Nurses fire-Unidentified
fighting
illness
Personal
Finances
suffer
(no NCC
budget)
Injuries
from
falls.
Poor
mobility
Unplanned
Hospital
Admissions
Lack of
dignity
Lack of
independence
Isolation
Suicide
Increased
Care need
Medication
at wrong
time
Drop in
wellbeing Creation of
‘the unseen’
Lower
wellbeing
No
Continuing
NHS care.