My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

People powered health and patient coordinated care

Filed Under (Health Policy, Patient centred coordinated care, Patient Choice, Patient involvement, Self Management) by Paul on 20-03-2014

I know it doesn’t feel like it in 2014, but the dynamics of disease will move the NHS into an era which will either fully utilise patients and their carer’s capacity to better self-manage their conditions – or collapse.

The old model of healthcare will not be able to muster sufficient resources to cope with the new model of disease.

Moving from here to there will be difficult, with many fits and starts, but patients and their organisations will be the main force that will drive this change.

That’s why yesterday I posted that too much of what is at the moment called “integrated care” is simply shuffling existing services around and hoping they will fit.

They don’t.

Given the multiple morbidity of many patients it will take much more than this to create care that is properly coordinated.

Above all it will need investment in the assets that patients, their carers, families and communities have to better manage their conditions.

This process starts with a very difficult set of changes from inside the existing model of care.

At the moment many medical staff, seeing a list of sick people – some of them very sick – fairly inevitably see their patients, carers, family and communities as a set of deficits. Patients are seen as lacking average blood pressure, good breathing, the ability to be active in the world, the ability to manage their condition themselves etc. etc. Patient after patient comes in expecting some external help from the doctors and the nurse.

This experience makes it fairly likely that the tenth person who comes into the clinic will be seen as a set of needs – and not as having any assets.

Which of course becomes a self-fulfilling prophecy. The NHS sees no assets amongst the patients and the patients therefore don’t feel, when they come into contact with the NHS, that they have any.

But if we continue in this way, treating patients as if they are nothing but deficits, the health service collapses under the weight of demand from co-morbidities and an insufficient supply of medical staff kit and drugs.

Finding out what assets people have is not a straightforward process. Different people have very different assets.

Many people have family and friends who can do much more than take a prescription to a chemist. But to do more they need some investment of time and effort from the NHS. Helping people to play a bigger role in helping other people first requires the recognition that there is something there to work with and then some time and effort to help them know how to improve the patient’s capacity to self-manage.

But others – the very old and the vulnerable – may be very isolated and have lost all their organic relationships with family and friends. Here the NHS needs to find ways in which local voluntary and community groups can stand in.

Last autumn the Red Cross fundraising campaign had a picture of an isolated older lady at home in this country. This, not the health outcomes from an earthquake in another country, was ‘the crisis’ that the Red Cross was pledged to help to solve. For some years now the Red Cross have been training volunteers to spend time with isolated patients.

Of course they are not alone in this.

Organising someone to visit an otherwise isolated person is not something that a busy GP can take on board themselves. It may only rarely make sense for a doctor to find out about all the voluntary groups in their area, but it always makes sense for them to have someone who knows to whom they can refer the patient. This practice of social prescribing is gaining recognition within the NHS.

If the increase in the number of people with several long term conditions is the disease burden with which our health and social care service needs to cope, then my point is that the only way that this can be done successfully is with the very active management of patients themselves.

Changing health and social care to achieve this will not be easy.

Last year, before I suspended blogging, I posted about the work that I and others had carried out with NESTA. There are several publications on their website that flesh out how investing in better self-management can work for the NHS.

Investing in the patient’s capacity to improve self-care – some more examples of better value healthcare for NHS patients.

Filed Under (Investment, Patient involvement, Self Management) by Paul on 23-01-2013

Last week I highlighted some of the work that Macmillan Cancer Support services provide for NHS patients and how their investment in increasing patient capacity for self-management will save NHS resources and improve patient care. Read the rest of this entry »

Some more examples of services aimed at improving NHS patient capacity to self-manage.

Filed Under (Patient involvement, Self Management) by Paul on 14-01-2013

Quite a lot of my day-to-day work with the NHS now centres on the ways in which NHS services need to be reconstructed to increase the capacity of patients to add much more value to their own health care. Last week I argued that the primary provider of most NHS healthcare was not the GP nor the GP practice nurse, nor even the community pharmacist, but was rather the patient and their family carer – who primarily cared for themselves. Read the rest of this entry »

Meeting the mandate and improving health literacy

Filed Under (National Commissioning Board, Patient involvement, Self Management) by Paul on 17-12-2012

The Secretary of State’s mandate for the National Commissioning Board lays clear responsibilities on it to improve the capacity of patients to self manage. In fact the mandate says that the board must become dramatically better at involving patients,

“2.5 The NHS commissioning board’s objective is to ensure the NHS becomes dramatically better at involving patients and their carers and empowering them to manage and make decisions about their own healthcare and treatment. For all the hours that most people spend with a doctor or nurse, they spend thousands more looking after themselves or a loved one.”

Readers will know that I have been working with a number of organisations to improve the ways in which the NHS can help patients to better self-manage. Read the rest of this entry »

How CCGs can stick to their mandate and develop patient-led value for the NHS.

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health Improvement, National Commissioning Board, Patient involvement, Self Management) by Paul on 21-11-2012

This evening, at about 18.15, I am speaking to the NHS Alliance conference in Bournemouth. My theme tonight, as it has been for some time now, is how the NHS can develop better public value by viewing people with long-term conditions as ‘assets’ rather than as ‘costs’. Read the rest of this entry »

How commissioners can develop new value with the NHS

Filed Under (GP Commissioning, Patient involvement, Reform of the NHS, Self Management) by Paul on 30-10-2012

This morning I will be on the platform at the beginning of the National Association of Primary Care’s (NAPC) conference talking to one of the two GP organisations that have helped develop GP led commissioning. I am one of four speakers speaking on the theme of “Transforming the NHS”. Unfortunately for the NHS, transformation is a topic that has been much discussed but rarely put into practice. Read the rest of this entry »

Fragmentation was built into the delivery of the NHS from its inception. That is why it finds creating strong patient pathways so very hard.

Filed Under (Integration, Patient involvement, Self Management) by Paul on 29-10-2012

There are many conservatives resisting NHS reform who sincerely believe that recent reforms (and for that matter those of 2001-7) have fragmented what has always been an integrated NHS. For them the reason the NHS finds integration so very hard is because all these reforms have introduced fragmentation through relationships such as commissioning and competition. Read the rest of this entry »

To the Confed Conference in Manchester…

Filed Under (Health Policy, Nicholson Challenge, Reform of the NHS, Self Management, Speaking) by Paul on 21-06-2012

The NHS Confederation Conference is the most high profile annual healthcare event in the UK. Every year, Chief Executives, Chairs and senior leadership teams from the most influential health care organisations attend the event. The Confed also attracts Government officials, Ministers and the national media. Potential private sector providers turn up to make contacts and it’s always a location for networking.

Read the rest of this entry »

Developing prices for a ‘year of care’

Filed Under (Health Improvement, Health Policy, Patient Choice, Self Management) by Paul on 29-05-2012

Over the last few weeks I have been outlining the nature of the reforms that NHS commissioners will need to implement if they are to transform NHS health care. Last week I explored two different forms of contractual relationships that are being created and will be necessary if there are to be different relationships with providers. Read the rest of this entry »

More thoughts on new models for creating more value from patients.

Filed Under (Health Improvement, Patient involvement, Public Health, Self Management) by Paul on 14-05-2012

I received some interesting comments on last week’s posts about the necessity for investment in improving self-care to improve value for the NHS. Most of my posts concerned the implications of some recent work on diabetes and also articles in the Lancet from last Friday on co-morbidities in Scotland. Read the rest of this entry »