There is an already established and increasing recognition across the NHS that the future of healthcare revolves around empowering patients and personalising and coordinating care. This is particularly true for the millions of people who live with two or more long-term conditions or co-morbidities, who often require care and support from different care settings and health professions, and for whom care planning and care coordination is essential to receiving ‘the care they need and no less, the care they want, and no more’.
Having worked in the area of arthritis and musculoskeletal conditions for eight years, I know how important it is for people with sometimes fluctuating, often debilitating conditions which can be difficult to diagnose and which often carry many comorbidities to have a care plan, and for their care to be as personalised and coordinated as possible across different care settings.
However, care planning is just as important for urgent and emergency situations as it is for long-term conditions, and this is an area which has historically been relatively neglected when talking about person-centred, coordinated care. Emergency situations also often involve many different parts of the system working closely together: not just acute care and ambulance services but primary care and fire services too, among others. Emergencies can occur anywhere, at any time, to anyone. Yet failure to understand what a person would want in these situations, or to have an informed conversation with them or those close to them, can have serious implications, for example in relation to DNACPR decisions.
ReSPECT planning process
ReSPECT is a new, UK-wide planning process for patients and healthcare professionals to discuss and record agreed recommendations for care and treatment in a medical emergency. It includes but is not limited to decisions about CPR, and is designed to be applicable for all patients and in all care settings, from hospitals to hospices to community and ambulance services. Most of all, it is designed to encourage an informed and open discussion between patients and health professionals capable of ensuring that decisions which need to be taken in an emergency situation reflect a person’s own preferences and wishes as much as possible.
Developed by representatives of many stakeholders including patients, bereaved carers, doctors, nurses, and ambulance clinicians, ReSPECT can be for anyone, though it’s more likely to be of benefit to people with complex or specific health needs, people who may be nearing the end of their lives, people at risk of sudden deterioration or cardiac arrest, or people who want to record their care and treatment preferences in case of an unforeseen emergency.
Since launching just over a year ago, there has been an enormous interest and enthusiasm for ReSPECT across the NHS. ReSPECT is already being used in a number of localities, and many more are planning to begin using it over the course of 2018. The Resuscitation Council (UK) is leading the support for and development of a fast-growing, UK-wide Implementation Network for ReSPECT, whose aim is to facilitate discussion and peer learning between both current and emerging local and regional networks wishing to adopt ReSPECT in their health communities. In addition to providing guidance, key resources and an online hub for early implementers, we are holding a first-ever national ReSPECT conference on 1 May which is already full to capacity, and which includes a workshop on patient and public involvement which will be co-led by National Voices’ Don Redding.
I remember clearly the day I went to a ReSPECT workshop in Southampton, just a few months into my current role. The title was “Should Southampton implement ReSPECT?”, but the actual discussions quickly turned towards the “how”, not “if”. Most of the challenges raised were of a very practical nature, around the lack of integrated IT systems, how best to train health professionals, and even the colour of the form. At the end of the meeting, a woman stood up at the back of the room and said:
“I’m a patient. Yes, there are challenges in implementing ReSPECT. But for me, having a document capable of telling healthcare professionals what my preferences are in an emergency situation, regardless of where I am receiving the care, is very important. You’re all intelligent, capable people. Please find a way to make it work.”
For me, those words sum up both the reason for doing what we do, and the need to persevere.
Insofar as the future of healthcare lies in personalisation, multidisciplinary networks and a combination of top-down and bottom-up approaches centred around local solutions to system-wide challenges, ReSPECT very much reflects the way forward for person-centred healthcare, and aims to achieve for emergency care what care planning in a broad sense aims to achieve for all people with complex and long-term conditions in particular.
Person-centred, coordinated care is not a chimera: it is achievable, but it is up to all of us, working together, to make it happen.
Find out more: www.respectprocess.org.uk.