1. The individual's perspective
This diagram was drawn on a table cloth at a world café event by people with long terms conditions. They said life is like this green wavy line with lots of ups and downs. The orange vertical lines represent their contacts with the health service which not only last a very short time ; over a year about 3 hours compared to 8757 hours when the person is managing things themselves but they occur regularly and often unrelated to the needs of the individual – they may be up or down.
There is a great deal of evidence that what goes on in those contacts is not as useful as it might be to the individual involved in terms of supporting them to live their lives with their long terms conditions. In only between 30 – 50 % of these visits do staff even discuss self management or ask about the individuals goals for their health. This represents not only poor quality but poor use of resources – The year of Care programme set out to see if this time could be used more effectively and productivity via personalised care planning using diabetes as an exemplar.
40 seconds

3. This is the Scottish version of the House of Care.

4. The centre is a dance – with the partners in that dance being the two experts in the room.
Helpfully it has Ginger on the left, who did everything that Fred did, but backwards and in high heels.

5. This is the Scottish version of the House of Care.

6. Realistic Medicine
How can we further reduce the burden and harm that patients experience from over-investigation and overtreatment?
How can we reduce unwarranted variation in clinical practice to achieve optimal outcomes for patients?
How can we ensure value for public money and prevent waste?
How can people (as patients) and professionals combine their expertise to share clinical decisions that focus on outcomes that matter to individuals?
How can we work to improve further the patient/doctor relationship?
How can we better identify and manage clinical risk?
How can all doctors release their creativity and become innovators improving outcomes for people they provide care for?

7. Through “Realistic Medicine” can we …?
Build a personalised approach to care
Change our style to shared decision-making
Reduce unnecessary variation in practice and outcomes
Reduce harm and waste
Manage risk better
Become improvers and innovators