Diabetes & Endocrinology Collaborative Patient Care: How might it look in the world of Diabetes? Dr Rohana Wright Consultant Physician Diabetes & Endocrinology St John’s Hospital

Objectives The case for change House of Care Care planning in practice

A year in the life of a person with diabetes 3 out of 8757 hours or 0.03%

had at least one check up in the last 12 months Poor quality of care and ineffective use of resources discussed ideas about best way to manage their diabetes agreed a plan to manage their diabetes over next 12 months discussed their goals in caring for their diabetes

LTCs are the most common cause of death and disability LTCs are the most common cause of death and disability. People with LTCs account for: 70% of the money spent on health and social care 55% of GP appointments 68% of hospital outpatients 77% of inpatient episodes Over half of the overall cost of looking after older people in residential homes

The ‘House of Care’ Approach What is it all about? Person-centredness Informed patients Constructive conversations with active participants Improved outcomes: Clinical Patient and Staff satisfaction the system needs to support individuals to develop the knowledge, skills and confidence to manage their own care Using ‘care planning’ to address these issues

The evidence for a new approach: Year of Care

Tower Hamlets 92% of registered population (Type 2 diabetes) taking part in care planning Patient perceived ‘involvement in care’ rose from 52-82% 72% received all 9 processes in National Diabetes Audit: Best in England (Average 49%)

Kirklees: Improvement programme : saved £225K Cost per patient practice level pre YOC: £21 post YOC: £21 Kirklees: Improvement programme : saved £225K Tower Hamlets: Emergency admissions reduced by 15%.. saved £700K

House of Care

Enabling good conversations Philosophical shift for some Skills and experience Learning from each other

Enabling good conversations Supported self-management/self-directed support: Sharing information Building confidence Problem solving skills Peer and group support

Enabling good conversations Making best use of resources across statutory and third sectors and in community Responding to need by allocating resources differently Is it working?

Care planning – what does this mean? This is the part where we usually do some role play…

Scenario 1 A bank contacts a customer and asks them to attend a meeting with the bank manager The customer attends…with some trepidation The manager announces the degree of debt/trouble that the customer is in and asks how they are going to fix the issue? The customer is scared and goes home feeling very confused/troubled/not clear at all where to go from here……

Scenario 2 The bank sends a customer some information about some spending/debt issues seen in their accounts, and suggests it might be good to meet up to discuss The customer looks through the information, discusses with family, can see where things may have gone wrong, and where some of the over spending can be curbed and finances recouped Bank manager and customer meet up to discuss – both fully understanding the issues in advance, and the customer has a plan of attack to set things moving in the right direction..

Care and support planning (Dr Sue Roberts) Care and support planning is about enabling better conversations between people living with long term conditions (LTCs) and health care practitioners that are focussed on what matters to the individual so that support and services can be tailored for each person. It is a meeting between those with technical expertise and those with lived experience in which the person is supported to identify their priorities and goals for living their life and the actions that they and/ or the service can take to help them achieve these.

“But we do all this already...” 2 core philosophies: They are in charge of their own lives and self-management of their diabetes, and are the primary decision makers and risk takers, about the actions they take in relation to their diabetes management. People are much more likely to undertake action in relation to the decisions they make themselves than decisions that are made for them.

Feedback “ Before, things seemed to get forced on you… whereas this way I prefer to discuss it myself… there’s more of a choice now, it’s my choice rather than someone else’s choice, that’s why I like it.” Person with diabetes, reporting on their experience of the YOC approach to care planning “ If I were a patient I would want to have a care planning system in place. I think it respects people more as individuals. It gives people more rights.” Practice nurse, involved in care planning

“ Care planning has made me look at patients differently “ Care planning has made me look at patients differently. I focus less on the disease and take a more holistic perspective.” Practice nurse “ Each time I get a greater understanding of my condition and understand more about how I can go about maintaining and improving it.” Person with diabetes

Any thoughts/questions?