The document discusses the need for the NHS to shift from a factory model of care to a more community-engaged, person-centered approach. It outlines a phased strategy for identifying barriers and enablers to change, involving research, stakeholder engagement, and evidence gathering to support national bodies in implementing effective health care strategies. The ultimate goal is to empower patients and communities while improving collaboration and understanding among NHS bodies at all levels.

1. How does the system support
communities/individuals and
how could it do it better?
15th July 2015

2. One of the great strengths of this country is that we
have an NHS that – at its best - is ‘of the people, by
the people and for the people’. Yet sometimes the
health service has been prone to operating a ‘factory’
model of care and repair, with limited engagement
with the wider community, a shortsighted approach
to partnerships, and under-developed advocacy and
action on the broader influencers of health and
wellbeing. As a result we have not fully harnessed
the renewable energy represented by patients and
communities’
NHS Five Year Forward View

3. Levers and drivers
The levers and drivers national bodies put in place can have a
significant impact – either to support change to happen locally or to
hinder/create barriers to change.
By understanding the enablers and barriers to local change that
commissioners and providers face; combined with what we know
from the evidence on what works; as well as our expertise in this
area, we can then recommend the most impactful approaches for
national bodies to take to help deliver the Five Year Forward View
vision of truly person centred care delivered at scale.

4. NationalNHS
bodies
LocalNHS
bodies
Staff
Service
users
Focus of Constructive Comfort
What is the optimum role for
national policy, politics and the
‘system’ of NHS national bodies to
support significant change (both
incremental and transformational)
to ‘realise the value’?

5. Our approach
Phase
One – set
up &
rapid
research
Phase two
– find &
assess
• Initial mapping of all policy levers available – using 3 types as categories
• Review evidence
 Commission evidence scan of published UK & international literature?
 Combine with unpublished evidence – softer intell on current work underway in
those areas we know are pioneering this sort of approach
• Participation in 5-7 interviews with commissioners, key clinicians & innovators to
understand practical barriers to implementing person centred approaches to inform
best blend of approaches
• Develop a relationships with identified sites to get more under the skin of some of the
challenges identified and test back what we have heard from the evidence we have
gathered/testing our hypothesis as set out in Constructive Comfort.
• Link with the community of interest around the PC/IP/vanguards etc. Particularly so we can
understand the impact of any loosening of boundaries – more permission from national
bodies/aircover to try different approaches & how many of these related to person-centred
care explicitly
Phase Activity
Work with
consortia partners

6. Our approach
Phase three
– build the
model for
spread
• Structured process of testing and refining with sample
stakeholders – working with those areas we have interviewed, the
identified sites and community of interest and national bodies as
well as our broad consortia networks.
• 2 roundtable events, and possibly a wider deliberative event
depending on level of interest/outputs. Testing out the evidence
we have gathered; sharing where areas are making progress &
how; thinking through what the common themes & approaches
are; how these might be scaled & what might need to change in
national approach to further enable this work to grow & flourish.
Phase
four –
implement
& learn
Phase Activity
Work with
consortia partners
• Outputs to be ready for national bodies audience

7. What will success look like?
If we have been successful NHS England and other national bodies have a
detailed understanding of:
- the enablers and barriers that commissioners and providers encounter
when trying to implement such approaches;
- the evidence base around what levers and incentives do and do not
work in seeking to effect change in person-centred care
how they might use the wide range of levers that national players have
available to them & the best blend of approaches at their disposal to help
tackle those barriers and enable/encourage people to take an active role
in their own health and care and to engage better with their
communities.
- and how you would most effectively measure impact.

8. What are the barriers to empowering
patients and engaging communities?
Why does the obstacle exist?
Who is responsible for the obstacle?
Thinking about system levers
and drivers …

9. What would support active and
engaging communities?
Who is responsible for making this
happen?
Thinking about system levers
and drivers …

10. Constructive Comfort

11. NationalNHS
bodies
LocalNHS
bodies
Staff
Service
users
What helps change locally...

12. NationalNHS
bodies
LocalNHS
bodies
Staff
Service
users
... And what gets in the way

13. NationalNHS
bodies
LocalNHS
bodies
Staff
Service
users
A framework for action
‘We need a different message from the system; the real message
at the moment is not transformation.’
CEO, Acute Trust

14. Focused on support as a means to
improved performance/necessary
culture change
• Providing direct active support to providers &
commissioners to introduce person-centred care
– perhaps being seen in some pioneers/vangua
rds? – what impact will this have?
• Aligning measures with organisations ones e.g.
reputational – feedback comparable performance
information to an individual (and/or is publically
available)
• Using/aligning more of the levers around
individual contracts, professional regulation, clinical
standards and revalidation
• Giving greater voice to patients, carers and
families
• Perception of peers & opinion leaders
Phase one: generic mapping of system levers & drivers – starter for ten
How do they relate to PCC? How do they align? Help pls esp going beyond health!
Type 1 “prod organisations”
Type 2 “proactive support” Type 3 “people-focused”
This is the primary way national bodies currently seek to direct, prod or nudge local change
• Financial – linking income with i) penalties for poor care; ii) rewards for better care – maybe via CQUINs
(Newcastle Magic team developed a CQUIN to support SDM), contract sanctions, QOF or local scheme as in
Somerset incentivising the House of Care, Quality Premium, Tariff (Year of Care Tariff)
• Operational – via targets & performance management; regulation, audit & inspection; competition; NHS
standard contract & service specifications; contract renewal or extension
• Reputational – feedback comparable performance information to an organisation (and/or is publically
available)
• External Reputational Transparent reporting of outcomes, including patient experience; Public recognition
(awards/media coverage)