The patient voice:What are the workforce implications of

“putting patients at the heart of the NHS” Jeremy Taylor, CEO, National Voices

At NHS Employers Autumn Workforce Summit 2015

National Voices

• Coalition of 160+ charities• Founded 2008• We work for a strong patient and citizen voice,

and services built around people• We stand up for voluntary organisations and

their vital work for people’s health and care

What do people most want? http://www.nationalvoices.org.uk/evidence

Where are the pinch points?

Timely access Problems with waiting, access, eligibility for social care, access to particular therapies

Effective treatment unwarranted variation in outcomes

Involvement in decisions, respect for preference

Significant minorities of patients not as involved as they want

Information support for self care

Information often insufficient; care planning & supported self management not mainstream

Attention to physical & environmental needs

Problems re dignity & nutrition,Problems in home-care and care homes

Emotional support, empathy, respect

Can be a struggle for busy staff; poor communication a frequent complaint

Involvement of /support for carers Often insufficientContinuity of care, smooth transitions

Frequent fragmentation and poor transitions. Problems with discharge; too many visitors to home; “telling story over and over” etc

Out-of-Hours Doctors

GPDistrict Nurses

Social Worker

Malcolm &Barbara

Consultant Continence Adviser

Speech & Language Adviser

Dietician

CommunityDentist

OccupationalTherapist

Equipment Service

PhysiotherapistAlternating

Mattress technician

Wheelchair Service

Oxygen serviceDirect

PaymentsTeam; Rowan

Org.

Alzheimer’sSoc outreach

worker

Care team2 live-in carers (alternating weekly)Replacement carer[Some night nursing – Health]Emergency carers & Barbara

The Web of Care

(Last 7 yrs)

DementiaAdvisoryNurse?

Person centred coordinated care

“I can plan my care with people who work together to understand me and my

carer(s), give me control, and bring together services

to achieve the outcomes important to me.”

I have the Information

I need…

I am supported to achieve my

goals….

The professionals work as a team.

I always know who is coordinating my care

I’m involved as I want to be in

decisions…

I work with my team to agree a

care and support plan…

When I move between settings there is a plan in place….

Person centred coordinated care near the end of life

“I can make the last stage of my life as good as possible

because everyone works together confidently, honestly and consistently

to help me and the people who are important to me, including my carer(s).”

My goals and quality of life and

death

Honest discussion

and planning

The people who are important to me

My physical, emotional, spiritual and practical needs

Responsive and timely support

The Five Year Forward View

“We have not fully harnessed the renewable energy represented by patients and communities”

The Five Year Forward View

• People are fully engaged in their own health and care• Services are co-produced with communities• Inequalities are reduced• Carers are better identified, supported and involved• Health and care systems are fully realising the

potential of volunteering and social action • Health and care systems are fully realising the

potential of VCSE organisations

Why does this matter?

People engaged and supported in health behaviours and their care & treatment are more likely to:

• Have better health • Have better outcomes from care and treatment• Manage better• Make less use of high cost services

Why does this matter?

Communities actively involved in decisions that affect health and services

• Can help shape services that work for them (and therefore you)• Can solve many of their own problems• Are the source of people who help people

What works?• shared decisions about treatments• care and support planning, using the principles and stages outlined by National Voices and

others.• information, education and support for self-management for people living with long term

conditions and disabilities• peer support for people living with long term conditions and disabilities• coordinating care, following the narratives co-created by National Voices and partners• access to personal records – proven to support self management, & shared decisions • personal budgets to give people greater control • training and development in the skills required for person centred care – such as health

coaching, motivational interviewing, risk communication and eliciting people’s values and preferences

• ‘social prescribing’, where statutory professionals have access to, and refer people into, local community sector provision of health-supporting activities

• community development approaches, such as those piloted in Croydon and Halton, which involve the community in identifying their needs and demands, and determining how these can be met

www.nationalvoices.org.uk/evidence

How do we engage?How do we hear patient voice?

• prioritise clinical shared decision making and

personalised care planning• use your feedback data• work with your Healthwatch & voluntary groups• continuing dialogue with the local community,

not episodic consultation• work with service-users to co-design service

improvements• Embrace and develop patient and lay leaders

and avoid tokenism…

Are you really listening?

What do staff need to “put patients at the heart”

• a “working with” not “doing to” mindset• time • supportive, empowering management • multi-disciplinary team working, supported by IT• skills & capabilities in person centred approaches• skills & capabilities in engaging the “informal

workforce” • leaders and managers who prioritise all the above

Thanks for listening!

• www.nationalvoices.org.uk• You can follow us on Twitter

– @NVTweeting– @JeremyTaylorNV

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• You can become a member, partner or supporter: email info@nationalvoices.org.uk