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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.

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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.

I received a number of comments pointing out that a wide range of patient groups have been investing in better capacity for self-management for some time. This is true, and I was not intending to say that Macmillan are alone in doing this work. I was highlighting Macmillan’s work on cancer because there will be those who believe that improving capacity for self-management can only be depended upon to improve the value of NHS services for non-life-threatening conditions. I have been in discussions where people have made this point.

I was highlighting Macmillan’s work to demonstrate how the investment in increased capacity for self-management can in fact improve value for NHS patients with very serious conditions.

I have, several times already, used what might appear to be the rather clumsy construction “investment in the capacity for improved self-management” because I want to underline that such investment costs resources. Doing this properly – using the third sector to improve value for NHS patients – needs resources and investment. The obvious point I am making is that this does not come for free.

Today I want to highlight another example of the outcomes from such investment. This one involves the British Red Cross. Again I use this example because it demonstrates how investment in increased capacity for patient self-improvement can have a direct impact on emergency and urgent care.

These are also services where many would believe that we need very high-tech and highly specialised medical staff and, just as with cancer, we do indeed need high-tech and highly qualified medical staff. But we can also use much better self-management to improve care for those people who end up in emergency beds.

It is this care with which the British Red Cross is involved. Last autumn many of you may have noticed a month long fundraising campaign for the British Red Cross. The pictures that appeared on the nation’s bus stops were not of earthquake emergencies but of the individual emergencies suffered by old people isolated in their own homes.

It is these services that I want to write about today.

Last November the accountancy firm Deloitte published an analysis of the economic impact of care in the home services  provided by the British Red Cross.

These services are for people going through an emergency. The two that I highlight below provide Red Cross volunteers and staff to help patients in emergency beds get home earlier. Many of these patients spend longer in hospital than medically required because they are anxious and isolated at home.

They are patients who do not, on their own, have the capacity to look after themselves when discharged from hospital, so they stay in hospital longer than they should or need to from a medical perspective. The British Red Cross assist in this process by providing the patient with more capacity – initially by being there but also by giving the patient much more confidence.

Of course the Red Cross ‘brand’ brings something to this relationship. The name gives people the confidence that they are dealing with people who know what to do in an emergency.

Deloitte’s economic analysis was of 6 different services and each of them, because they help in getting people home earlier, saves resources. But there is more to this than saving resources.

When you have had an emergency, the hospital may well have saved your life. But that doesn’t make it an any less confusing and, because of that, debilitating place. You want to go home – but you are afraid. Being able to go home, with the assistance of the British Red Cross, is a big relief.

To mention just two services:

The Camden Reablement Service is aimed at ensuring smooth transition of users from hospital to their own homes. It assists users to regain the skills to live independently safely and with dignity in their own homes. The Red Cross deliver an initial assessment at home or in hospital plus four to six weekly visits lasting up to three hours each followed by a final discharge visit. The service is aimed at doing things with people not for them.

If there was an extended hospital stay of one day before the scheme was introduced the total cost would be £517. The savings per patient from the British Red Cross scheme were £246.

Blackpool Victoria Hospital Fylde Coast’s Hospital to Home scheme provides support to service users who would benefit from being resettled at home following a hospital discharge. The project is aimed at patients who live alone and have no other support. The care provided comprises a short risk assessment, assistance in preparing a light meal, and signposting to other agencies’ services. Service users are supported to resettle comfortably and safely at home avoiding social admissions into residential care.

The expected savings per user is £284.

 

Just to underline my point above. Patients, even high acuity patients who have had a scary medical emergency, have assets to deploy in their self-care. Investing to derive more from those assets is worthwhile.

 

 

Comments:

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


  1. What concerns me is that the IT support for co-working between patient, GP, social services and acute sector is just not there and won’t be for another five years, as far as I can see. So how many people will fall through the gaps?


  2. Hi Paul
    Your thoughts are very similar to mine. I finished my Masters last year and my dissertation focussed on peer support for people with diabetes. As a person with Type 1 diabetes I was slightly disconcerted when I reviewed the evidence. I know the evidence is coloured by the lens of how funding for research is found but I discovered that it seemed to discount the expertise of patients. Peers were only considered to be skilled enough if they had been trained, I saw this as creating a type of para professional, which in some circumstances is not necessary. People themselves are a fantastic resource. I think self management is going to be vital in future and I would like to see patients with conditions like Diabetes forming a sort of communities of practice! Certainly social media is also likely to help.
    You might like some of my blogs BTW, those that relate to Diabetes.
    http://anniecoops.com/2012/10/16/to-whom-it-may-concern-or-a-year-of-care/

    A great blog! Thank you. Anne


  3. I can understand the desire to discharge patients who do not need full hospital care but going from round the clock care and three meals a day to one visit a week and assistance with preparing a light meal is inadequate.

    I have seen an elderly man who lives alone taken home from hospital after a stroke, carried into the house and left in an armchair, unable to stand alone, let alone walk as far as a tap or a toilet. He was dehydrated, hallucinating and not able even to crawl on his hands and knees without having his bum pushed. He was totally incapable of looking after himself and one visit a week would not have kept him alive.

    That is the reality of discharge from hospital for the elderly in England these days.

    As for signposting to other agencies’ services, you clearly don’t live where I do. (Birmingham.) The man I described above couldn’t even get an assessment by social services.

    I am that man’s daughter. I am myself disabled. I can get neither an assessment of my own needs as a disabled person nor a carer’s assessment.

    And now, in the sixth richest country in the world, we are expected to rely on half a dozen weekly visits from a charity.

    What did we pay our NI contributions for?


  4. I saw this as creating a type of para professional, which in some circumstances is not necessary. People themselves are a fantastic resource. I think self management is going to be vital in future and I would like to see patients with conditions like Diabetes forming a sort of communities of practice! Certainly social media is also likely to help.

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