How to make care and support planning a two-way dynamic - presentation from webinar held on 1 October 2014 This relates to the first NHS IQ Long Term Conditions Improvement Programmes Wednesday Lunch & Learn Webinar Series. How to make care and support planning a 2 way dynamic hosted by Dr Alan Nye & Brook Howells from AQuA. This webinar discussed how to encourage patients, carers and the public to work alongside (in equal partnership) with clinicians and managers

1. How to make Care & Support Planning a
2-way Dynamic
Wednesday 1 October 2014 (13:00 – 13:45)
Dr Alan Nye
Clinical Lead Shared Decision Making, AQuA
Brook Howells
Programme Manager Shared Decision Making, AQuA
Beverley Matthews
NHS Improving Quality Programme Delivery Lead for Long Term
Conditions

2. Meet the Speakers
Bev Matthews
A nurse by background, Beverley has worked extensively throughout the NHS in a variety of
clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead for
Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and
LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of
NHS Kidney Care an NHS Liver Care. Passionate about service transformation through
developing networks and leading complex programmes. Providing strategic leadership to
partners within health communities, managing stakeholders and working across agencies.
Dr Alan Nye
General practitioner with a special interest in rheumatology, he also is the Director of Pennine
MSK Partnership, which is a clinically owned accountable care organisation delivering
rheumatology, orthopaedics and chronic pain services in Oldham. Clinical lead for shared
decision making (SDM) at AQuA . In 2012 AQuA was commissioned to deliver NHS England’s
programme to implement SDM across the country. He is president of the primary care
rheumatology society
Brook Howells
Programme Manager with the Advancing Quality Alliance (AQuA), assisting clinical teams from
a number of NHS trusts across the North West. Currently workinig with the Shared Decision
Making and Self-Management Support Programme, supporting the challenge of improving
culture such that clinicians and patients work more collaboratively and in partnership with each
other. She has previously facilitated improvement projects with the Collaboration for
Leadership in Applied Health and Research Care (CLAHRC) for Greater Manchester.

3. Learning Outcomes
How to make Care & Support Planning a
2-way Dynamic
• Have a different kind of conversation.
• Make a partnership approach the ‘business as usual’ for
individual/care professional interaction.
• Hear the views of care professionals who have front-line
experience of implementation.
• Know how to encourage patients, carers and the public
to alongside (in equal partnership) with clinicians and
managers.
• Understanding the paradigm of shared decision making.

4. Bespoke Support

5. The approach:
• Identify sites guided by intelligence from the LTC Dashboard
and local advice
• Support local health economies to understand their baseline
position through the self assessment Diagnostic Tool
• Provide coaching support to start identifying interventions
that will drive change and develop the local action plan.
• Agree bespoke support package with memorandum of
understanding
• Developing a facilitators network of local champions
• Use evidenced based improvement methodologies to
facilitate change
• Embed measurement and evaluation expertise throughout
the delivery
• Development of implementation guide in real time

6. Tools and Resources

7. Links
Long Term Conditions Dashboard
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-house-of-care-framework.aspx#
Long Term Conditions House of Care Toolkit
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
LTC House of Care Personal Level
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/personal.aspx
LTC House of Care Local Level
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/local.aspx
LTC House of Care National Level
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care/national.aspx
#LTCyearofcare #LTCframework #NHSIQ
Follow Team @NHSIQ @Bev_J_Matthews @Catherinestro17

8. LTC Learning Forum
Wednesday “Lunch & Learn” Webinar Series
&
Bite Size Master-classes

9. Virtual Learning Network
Wednesday “Lunch & Learn”
• 45 minute “real time” Webinar
sessions
• Topics agreed and learning outcomes
identified
• Faculty of Speakers identified
• Speakers support package being
developed
• Marketing of series to commence
September 2014
Open invitation
Bite Size Learning Master-Classes
• Pre-recorded 20 minute Master-classes
• Master-class either as stand alone
sessions or pre-requisites for
Wednesday “Lunch & Learn”
Webinars
• Faculty of Speakers identified
• Speakers support pack developed
• Marketing to commence September
2014
Open invitation

10. How to make Care & Support Planning a
2-way Dynamic
Dr Alan Nye
Clinical Lead Shared Decision Making, AQuA
Brook Howells
Programme Manager Shared Decision Making, AQuA

11. Shared Decision Making
and Self-Management Support
Dr Alan Nye, Clinical Lead
Brook Howells, Programme Manager

12. The AQuA SDM and
SMS Programmes
• 2012-13: National SDM Programme
– 33 teams
– Maternity, MSK and Renal settings
• 2013-14: AQuA SDM/SMS Collaborative
– 28 teams
– North West rather than national
– Incorporating Self-Management Support (SMS) as well as Shared Decision
Making
– Focusing on long term conditions
• 2014-16: SDM/SMS in Transition, Health Foundation funded Closing the
Gap in Patient Safety Programme
– 7 teams recruited
– Network of interested people in development

13. What is it all about?
• Collaboration and
partnership working
• Patient-centred care
• Personalised,
individual
choices/treatment
• Sensitivity to
preferences
• Sharing information
and responsibility
• Good health[care]
beyond clinic visits
Social; interactions
with family, friends,
workmates
Psychological;
reactions, thoughts,
feelings
Biological; bodily
symptoms

14. “It’s about clinicians “letting go” and allowing patients to
make a different choice to the one they may have made.”
Chris Goldsmith, Renal Consultant,
Aintree University Hospital NHS Foundation Trust
Feedback from 2012/13 SDM Collaborative

15. The Benefits
• Better consultations
• Clearer risk
communication
• Improved health
literacy
• Improved confidence
and self-efficacy
• Improved health
behaviours
• Reduced costs
• Fewer unwanted
treatments
• More appropriate
decisions
• Greater compliance
with ethical standards
• Greater equality of care
• Safer care
• Improved patient
experience
Courtesy of Angela Coulter, Informed
Medical Decisions Foundation

16. Where are we now-unwarranted
variation

17. “In the past we would often have known the patient’s
preferences, circumstances or values because we had
worked with them over a long period of time as their
GP. Nowadays however, patients do not always see
the same clinician because the practices are so large
or because there are trainee GPs in the practice, so
perhaps we do need to be asking them what their
preferences and values are.”
General Practitioner, NHS Trafford
Feedback from 2012/13 SDM Collaborative

18. Recognised
Challenges
Patients
Working with patients of cultural/ethnic minorities, differing expectations
Patients often need time and support to self-manage outside of appointments
Denial
Service
structure
Insufficient elf-management support commissioned to change culture?
Getting protocols working between providers
Lack of choice in treatment available locally
Staffing
structure
Staff skill mix/capacity to provide service/support developments
Time to educate patients, talk to people and offer a range of information
Skills/
knowledge
Using the most up to date evidence
Peer v professional led self-management
Communication skills
Nature of
change
Breaking old patterns of practice
Improving efficiency in small things
Institutional practices
Measuring change to see the impact is positive

19. How is it done?
• Supporting patients to
get involved
• Structuring
conversations
differently
• Providing evidence-based,
balanced
information
• Asking patients what
they’d like more of

20. Supporting and encouraging
patients to get involved
Leaflets, posters, animations,
postcards…
A prompt for patients to ask
three basic, but important,
questions about what options
are available to them
Useful prompts for clinicians
too.

21. Agenda setting
Information gathering
Decision making
• Experience of illness
• Social circumstances
• Attitude to risk
• Values
• Preferences
• Diagnosis
• Cause of disease
• Prognosis
• Treatment options
• Outcome probabilities
Adapted from The King’s Fund (2013)
Restructuring
Conversations
Patient’s Input Professional’s Input

22. Agenda Setting

23. Informing, comparing,
deciding on options
The Model for SDM
(Elwyn et al 2012)
Choice
Talk
Option
Talk
Decision
Talk
Decision Support
Brief (inside) &
Extensive (outside)
Good
Decision
D E L I B E R A T I O N
Prior
Preferences
Informed
Preferences
J Gen Intern Med. 2012 October; 27(10): 1361–1367.

24. “C O D”
D e l i b e r a t i o n
Prior Preferences Informed Preferences
Choice
Talk
Option
Talk
Decision
Talk
Good
Decision
Decision Support
Brief – during Long – External
Adapted from The Model for SDM by Elwyn et al and MAGIC programme (2012)

25. “In terms of using with patients: I recently had a discussion
with a patient about a very difficult and complicated
decision regarding the possible use of a second course of
strong immunosuppression for a long term condition. The
choice/option/decision structure was very helpful as a way
both to approach the consultation and to reflect on the
discussion in my letter to the patient afterwards.”
Renal Consultant
Feedback from 2012/13 SDM Collaborative

28. “It’s a great idea and should be of real benefit to patients once
rolled out to all clinical areas of the NHS.”
“It was fairly easy to implement into our practice because we
were already using SDM, although not formally or in a
measured way.”
Stephen Bunting, Physiotherapy Extended Scope Practitioner
Aintree University Hospitals NHS Foundation Trust
Feedback from 2012/13 SDM Collaborative

29. Measuring involvement
with decisions
Elwyn et al, 2013
Legare et al, 2010

30. Measuring impact
of involvement
50
40
30
20
10
0
Percentage of monthly DNAs
Percentage of DNAs for
Adolescence Diabetic Clinic
DNA% Average
40
30
20
10
0
Median Length of Stay
Jan Feb Mar Apr May Jun Jul Sep Oct Nov Dec
No of reported problems with
equipment on handover
315
173
253
132
350
300
250
200
150
100
50
0
March - April 2013 Sept-Oct 2013
LWS
MH
Monitoring relevant key
performance indicators to
assess the impact of Shared
Decision Making

31. “I feel SDM is something we think we have always done, but
when considering SDM probably never have shared choices
fully. I think this gives a good template to guide discussions.
It has improved working together with the vulnerable team.
It has improved discussion with the women who have
engaged with the SDM Project
The women have been really receptive to it. I feel that they
have responded well to being involved in decision making. I
feel this is particularly positive with the vulnerable women
that we work with.”
Blackpool Maternity Team
Feedback from 2012/13 SDM Collaborative

32. Further Resources
• Training and advice from facilitators experienced in
working with over 50 clinical teams;
– Introductory workshops
– Half day training workshops
– Train the Trainer Programme
• Case studies of staff and patient experience
• www.advancingqualityalliance.nhs.uk/sdm
• Brook.Howells@srft.nhs.uk
• Alan.Nye@nhs.net

34. Useful Resources
AQuA SDM
www.advancingqualityalliance.nhs.uk/
Programme Budging for Shared Decision making
www.advancingqualityalliance.nhs.uk/wp-content/uploads/2013/04/PENNINE-MSK-CASE-STUDY-FINAL.pdf
Making shared decision making a reality: A Coulter & A
Collins (July 2011) www.kingsfund.org.uk/publications
SDM Programme measuring shared decision making a
review of evidence
www.rightcare.nhs.uk/wp-content/uploads/2012/12/Measuring_Shared_Decision_Making_Dec12.pdf

35. Wednesday Lunch & Learn Series
Coming next
Date Webinar Hosted by
15 October @ 12noon Co-morbidity and cost
implications
Dr Umesh Kadam
22 October @ 1pm Commissioning for
Outcomes
Bob Ricketts
To register email catherine.strong@nhsiq.nhs.uk