A Django site.
June 22, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» Integrated care–Home Again service

Why not bring the Home Care providers into the hospitals to give families and patients the opportunity to plan for their own return home?

Accompanying the growth of retail shops and other services for the patient can be a Home Care store staffed to match visiting hours 7 days a week. The store should advise on all aspects of home care, telecare, live in care and even end of life. And it can provide assessment visits to people’s homes, recommending adaptations and aids for when the patient comes home.

This could be a very positive answer to the gap between the acute sector and primary care sector. The meeting of 2 systems in one building can be the missing link to the integrated care system that is talked about (the “Grail” for excellent individual patient care).

There is such a service being trialled in the Mid Essex Hospital trust, focussed on social service users and paid for by social services – since the Home Again service began there have been no fines for bed blocking because there are no blockers. For example 8 Patients last weekend were safely being cared for at home over the weekend rather than having to remain in hospital. Of course Wales don’t have fines but we do have blockers.

David Nicholson’s quote is 25% of all patients in hospital shouldn’t be there – here is a way to make sure that those patients who don’t want to be there can get back to heir own homes safely!

Can we set up a working party to champion this initiative?

Written by Justin Jewitt, Visiting Professor

» Integrated care–Home Again service

Why not bring the Home Care providers into the hospitals to give families and patients the opportunity to plan for their own return home?

Accompanying the growth of retail shops and other services for the patient can be a Home Care store staffed to match visiting hours 7 days a week. The store should advise on all aspects of home care, telecare, live in care and even end of life. And it can provide assessment visits to people’s homes, recommending adaptations and aids for when the patient comes home.

This could be a very positive answer to the gap between the acute sector and primary care sector. The meeting of 2 systems in one building can be the missing link to the integrated care system that is talked about (the “Grail” for excellent individual patient care).

There is such a service being trialled in the Mid Essex Hospital trust, focussed on social service users and paid for by social services – since the Home Again service began there have been no fines for bed blocking because there are no blockers. For example 8 Patients last weekend were safely being cared for at home over the weekend rather than having to remain in hospital. Of course Wales don’t have fines but we do have blockers.

David Nicholson’s quote is 25% of all patients in hospital shouldn’t be there – here is a way to make sure that those patients who don’t want to be there can get back to heir own homes safely!

Can we set up a working party to champion this initiative?

Written by Justin Jewitt, Visiting Professor

June 9, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» Across the border

The horizon looks set for interesting times in the English NHS. The coalition agreement Our Programme for Government has no less than 30 pledges on the NHS and 4 for Public Health. Additional policy messages are also coming thick and fast, including promises this week to get tough on emergency readmissions.

There are already immediately tangible signs of the new broom. The proposed reconfiguration of services in London has been halted, all major DoH capital spending commitments have been called in for review and there’s confirmation that SHA’s will be gone by 2012.

Other themes have emerged. Patients must be “at the heart of everything we do”; this includes greater engagement in service redesign, directly elected representatives on PCT Boards, ability to choose your GP and hints at the possibility of patient-held budgets for long term conditions.

GPs are also coming back centre stage; given a pivotal voice on service reorganisation and a role as ‘patient’s expert guides’ through the healthcare system. The phrase ‘GP commissioner’ abounds, but more details on what this means in practice (particularly in relation to hard budgets) are still awaited. We’re no longer talking the language of targets, but outcomes and national quality measures will be the new performance barometer. Watch this space for more on these, we’re told. The customary messages about reduced bureaucracy are there, with promises of no more top-down re-organisation, but the responsibility for appointing PCT CEs now lies not with PCTs themselves, but with the SoS, advised by a new independent NHS Board.

There’s much more, but already questions are begged; what’s the detail of GP commissioning ? With any changed commissioning landscape (and no SHAs), what’s the accountability structure ? How can we deliver difficult service reshaping, increased efficiency and savings as well as effective engagement and achieving public and clinical support ? It promises to keep us all exercised and invigorated.

Written by Dr Paul Worthington

» Across the border

The horizon looks set for interesting times in the English NHS. The coalition agreement Our Programme for Government has no less than 30 pledges on the NHS and 4 for Public Health. Additional policy messages are also coming thick and fast, including promises this week to get tough on emergency readmissions.

There are already immediately tangible signs of the new broom. The proposed reconfiguration of services in London has been halted, all major DoH capital spending commitments have been called in for review and there’s confirmation that SHA’s will be gone by 2012.

Other themes have emerged. Patients must be “at the heart of everything we do”; this includes greater engagement in service redesign, directly elected representatives on PCT Boards, ability to choose your GP and hints at the possibility of patient-held budgets for long term conditions.

GPs are also coming back centre stage; given a pivotal voice on service reorganisation and a role as ‘patient’s expert guides’ through the healthcare system. The phrase ‘GP commissioner’ abounds, but more details on what this means in practice (particularly in relation to hard budgets) are still awaited. We’re no longer talking the language of targets, but outcomes and national quality measures will be the new performance barometer. Watch this space for more on these, we’re told. The customary messages about reduced bureaucracy are there, with promises of no more top-down re-organisation, but the responsibility for appointing PCT CEs now lies not with PCTs themselves, but with the SoS, advised by a new independent NHS Board.

There’s much more, but already questions are begged; what’s the detail of GP commissioning ? With any changed commissioning landscape (and no SHAs), what’s the accountability structure ? How can we deliver difficult service reshaping, increased efficiency and savings as well as effective engagement and achieving public and clinical support ? It promises to keep us all exercised and invigorated.

Written by Dr Paul Worthington

April 15, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» What’s the Story?

The Election Campaign Express is now gathering speed as the competing voices of politicians grow ever louder and – dare I say it? – become almost interchangeable, merging into a relentless cacophony whipped up by the media. There’s blogging and twittering, there’s Dave Cam and live television debates – the electorate now has more access to the views of its political leaders (and would be leaders) than ever before. So why does the hubbub of this election soundtrack often seem so far removed from the reality of our daily lives? Why do so many people simply “switch off” when politicians begin to ramp up their campaign battle cries? Is it perhaps because the talk, debate, argument, questioning, is almost always about policy, not people?

As human beings we make sense of our lives through our own personal narratives, not by studying a policy framework or a set of guidelines. It is through creating and sharing our stories that we connect with each other, with our past and with our future, and the constant reshaping and retelling of our own life story lies at the heart of who we are.

After over a decade of working with “ordinary” people and helping them to share their real-life stories, I continue to be dismayed by the deference with which individuals offer their testimony. They will often describe their story as “not very interesting” or preface their narrative with “who would want to listen to what I have to say?” (Not phrases we would often hear a politician using). In fact their stories are always of interest and value to the listener and, in turn, their experience of being listened to is immensely rewarding and validating for them.

We have been privileged recently at StoryWorks (1) to have gathered a series of rich stories from carers of people with dementia in Wales, and the insight this has afforded into the complexities of the condition and its impact on the individual and their family has been profound. The glimpse into the minutiae of daily living, and the accompanying emotional rollercoaster, say more to me about the need for this condition to be seen as one of the major challenges facing our ever ageing population than any report on dementia care.

Similarly, the powerful stories that cancer patients at Velindre Cancer Centre have shared with us have offered a very human glimpse into the real experiences that lie behind the shocking statistics. When these stories were shared with staff at Velindre, there was a genuine sense of a different type of learning about what it means to live with cancer and a view that the narratives highlighted

“…the importance of remembering that patients are people with their own lives.”

Of course we need our politicians and leaders to create and implement policies and procedures; that’s what we pay them for. But we also need them to be reminded of the human impact of their decisions and the stories of the individuals whose lives that they will affect. In the age of sound bite and spin let us ensure that we – and our decision makers – continue to listen to the real stories of real people, and learn from them.

Written by Karen Lewis, Project Leader, StoryWorks, WIHSC

1. To see more about our work visit Storyworks.

2. Quote from Velindre staff member on feedback form