Promotion of Self Care and Commissioning College of Medicine 3rd Annual Conference 11 June 2013 Susan Summers Head of Long Term Conditions NHS England

David Nicholson - patient power and the future of the NHS NHS Confederation 32013 “the future of the NHS depends on people…taking control of their own condition” What would it mean if our patients took more control or power….controlled their own health and healthcare? …took more control of their own records and administration”? The NHS needs to do more to recognise the contribution that our patients can make directly to the improvement of the NHS, and the financial consequences of that. to then shift the conversation away from “what we as health professionals can do for you but what we can do for each other…that would genuinely transform the relationship between the NHS and the patients and communities we serve”.

The self-care continuum Pure self care Responsible individual Pure medical care Professional responsibility Daily choices Lifestyle Self-managed ailments Long-term conditions Compulsory psychiatric care Minor ailments Acute conditions Major trauma Healthy living Minor aliments Long-term conditions In-hospital care BACKGROUND INFORMATION The aim of this slide is to demonstrate how any particular example of care lies on a spectrum ranging from 100% self care to 100% professional care – the self-care continuum. 100% self care represents daily choices (such as brushing teeth regularly), while 100% professional care represents major trauma (such as neurosurgery). In between these two ends of the spectrum is shared care – healthcare professionals supporting individuals to care for themselves.1 REFERENCE Department of Health (2005). Self Care – A Real Choice: Self Care Support – A Practical Option. London: Department of Health.

Data… Health: Population: Workforce: LTC’s account for some: Activity: 62.26 million in 2010 projected growth to 71.39 million by 2030. No. of people over 65 expected to grow from 10.49m to 15.77m by 2031 Life expectancy men in 2008-10 78.2yrs and for women 82.3yrs Health: Between 1993 – 2010, obesity in men inc. from 13.2% to 26.2% and in women from 16.4% to 26.1%; 2.8 m people with diabetes in 2010, double the number from 1996 with 4 million predicted by 2025; 15.4m people in England with LTCs; more than half the people attending primary care have multiple chronic conditions. Workforce: NHS employs 1.358 m staff of which 146,075 are doctors and 369,868 are qualified nursing staff. 50.5% are professionally qualified clinical staff LTC’s account for some: 50% of all GP appointments 64% of all outpatient appointments 70% of all inpatient bed days Around 70% of the total health and care spend in England Activity: The NHS deals with over 1 million patients every 36 hours.

NHS England – national team, 4 regional teams, 27 area teams And then 211 CCG’s the eight components of our operating model to ensure that the commissioning system is in the best possible place to make a difference for the people of England: a. Supporting, developing and assuring the commissioning system b.Direct Commissioning: NHS England directly commissions specialist services, primary care, public health services, dental services, armed forces health services and offender health services c. Emergency Preparedness d.Partnership for quality e. Strategy, research and innovation for outcomes and growth f. Clinical and professional leadership g.World class customer service: Information, Transparency and Participation h.Developing Commissioning Support

Our vision and values 6

The vision for Nurses, Midwives and Care Staff Developed in partnership with a range of health professionals, patients and stakeholder groups

6Cs - Values essential to Compassionate Care Competence Care is our core business and that of our organisations; and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life Compassion is how care is given through relationships based on empathy, respect and dignity. It can also be described as intelligent kindness and is central to how people perceive their care Competence means all those in caring roles mist have the ability to understand an individual’s health and social needs It is also about having the expertise, clinical and technical knowledge to deliver effective dare and treatments based on research and evidence Communication Courage Commitment Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say. It is essential for ‘No decision without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike Courage enables us to do the right thing for the people we care for, to speak up when we have concerns. It means we have the personal strength and vision to innovate and to embrace new ways of working A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients. We need to take action to make this vision and strategy a reality for all and meet the health and social care challenges ahead

Six areas of action Improving Patient Experience Helping People Stay Independent Measuring Levels of Care Positive Staff Experience Action area 1- Helping people to stay independent, maximising well-being and improving health outcomes Action area 2- Working with people to provide a positive experience of care Action area 3- Delivering high quality care and measuring impact Action area 4- Building and strengthening leadership Action area 5- Ensuring we have the right staff, with the right skills in the right place Action area 6- Supporting positive staff experience Each area of action is being led by a senior nurse, from within the CNO Team and they will be the champion for this area, across England Strengthening Leadership Getting Staffing Right

The self-care continuum Pure self care Responsible individual Pure medical care Professional responsibility Daily choices Lifestyle Self-managed ailments Long-term conditions Compulsory psychiatric care Minor ailments Acute conditions Major trauma Healthy living Minor aliments Long-term conditions In-hospital care

November 28, 2018November 28, 2018

What are the Fact Sheets for? The Self Care Forum Fact Sheets for common ailments aim to help clinicians and patients discuss issues around self care within the practice consultation and especially how to handle the symptoms in the future. They provide patients with information around: Useful facts What patients can expect to happen (the natural history) What people can do to help themselves – now and in the future When to seek medical help (the ‘red flags’) Where to find out more

What is included in a Fact Sheet Description Useful facts What can I expect What can I do myself to get better- now and in the future When should I seek medical help Where can I find more (http://www.nhs.uk/conditions/indigestion/Pages/Introduction.aspx) has more

The conditions they cover: Low back pain Eczema Heartburn and Indigestion Fever in children Constipation Headache and migraine Coughs Acne Sprains and strains Sore throat

The self-care continuum Pure self care Responsible individual Pure medical care Professional responsibility Daily choices Lifestyle Self-managed ailments Long-term conditions Compulsory psychiatric care Minor ailments Acute conditions Major trauma Healthy living Minor aliments Long-term conditions In-hospital care

The LTC Model of Care Structured around the needs of patients and carers using the best evidence available Central to the ‘house of care’ is collaborative care planning. Listening, supporting and collaborating for continuity of care Enabling individuals to self manage…no decision about me without me should be the reality. Start with person at the centre of the house Foundation – commissioning It reinforces the ‘whole system’ approach; it acts as a great metaphor, but also as an implementation checklist. (you can use this model as a lens in which to look at Background – builds on the Wagners chronic disease model; etc etc – ref year of care and QIPP – great and good have got us to this point. Everything about this model is completely inter-dependent eg good commissioning entails good organisational and clinical processes; and engaged informed individuals and carers will be supported by partnership working, etc etc This is the aspiration…….how do we make this a reality for everyone all of the time? But more importantly, how do we ensure that primary care is in the driving seat and taking the lead for change? Should be seen as a quality improvement process

DoH QIPP LTC workstream eDSM/EPaCCs DoH QIPP LTC workstream Risk Profiling Skills audit & development Albert & Mary! ‘Year of Care’ MDT meetings Multi-provider pathways Primary care at the centre Self-care & care planning Patient representation Volunteer co-ordinators Systematic engagement

What the people we serve want wants…. My goals/outcomes Communication Person centred coordinated care “My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes” Emergencies Information NATIONAL VOICES WORK Transitions Care planning Decision-making

3 levels of me… Me as an individual – ‘first look to thyself’ Me as a professional – how do I help and support you? Me and my organisation – how do I support the vision and values to achieve 1 and 2? NHS | Presentation to [XXXX Company] | [Type Date]

The NHS Constitution Patients and Public – your responsibilities Please recognise that you can make a significant contribution to your own, and your family’s good health and wellbeing, and take personal responsibility for it.

Thankyou. Susan.summers3@nhs.net @susansummers16