Care Plans, Care Planning or both?

Everywhere I go, people are talking about building the House of Care and putting in place collaborative care and support planning. It all looks so simple doesn’t it? Ask people to set a goal, tell them what local support is available to help them get there and you’ve got a basic care plan. Add in a few pieces of information (medical data and details of who to contact in case of emergency) and there it is - job done.

And professionals can do care planning even more easily by using templates which automatically develop a care plan. Even the Kings Fund website has a cartoon of a happy patient with a care plan - it must be the right thing to do….

Well, people living with long term conditions working in partnership with professionals to develop a high quality, personalized care plan is the right thing to do - it’s just not as easy as it sounds.

Professionals need to be trained before they can do the job well - ‘doing’ care planning well doesn’t come naturally. Have a look at these 2 scenarios:

Scenario 1
Professional (filling in a template): “what goals do you have?’
Chris - who lives with 3 long term conditions: ‘I don’t understand’
Professional: ‘I think you should take more exercise- let’s make that your goal”

Scenario 2
Professional (engaged in a conversation): ‘what sorts of things are you missing out on in everyday life Chris?’
Chris: ‘……..I don’t really know’
Professional: (curious, supportive, gentle)….’what comes to mind Chris?’
Chris: ‘Well, I really want to walk to the shops by myself’

The professional ticking boxes in scenario 1 has cut corners with Chris, who is low in confidence and hesitant. And if you tell people with low confidence what to do, it’s a pretty good way of making sure that a) they don’t do it and b) remain low in confidence.

In scenario 2, Chris is digging deep into himself and figuring out what matters - he’s being supported to engage with his own source of motivation. He is working hard.

Goal setting often is hard work, especially when we start doing it. Our goals are about our hopes, our wishes and our desires. Setting a goal is a statement about who we are, or who we want to be, and moving towards a goal can be a profoundly rewarding experience. On the other hand, figuring out that a goal isn’t attainable requires adjustment and can be upsetting. It follows that goal setting needs expert, empathetic, enabling support.

The problem is, a care planning template makes goal-setting look easy - like having your blood pressure taken. And letting the care planning template dictate the conversation can lead to corners being cut - like in scenario 1 where Chris didn’t get the chance to do the work of setting a goal; the clinician did the work for him and the conversation was wasted.

There seem to be some important principles here. Firstly, professionals should be trained to have enabling conversations with people who live with long term conditions. Secondly, the products of those conversations should be captured ina care plan that also contains other data such as medical information and details of who to contact in an emergency. Lastly, developing the care plan shouldn’t get in the way of the conversation - perhaps the care plan should only be filled in when the hard work of goal-setting is complete.

So, let’s make sure we build the House of Care and let’s make sure that we train teams in high quality care and support planning. When we’ve done that, let’s put in place an IT system that captures the outputs from those enabling conversations and develops a care plan.

Which leads to perhaps the most important point of all - who is the care plan for? Is it ‘for’ people who live with long term conditions or ‘for’ the system? There are a number of commercial templates available; take a look at a few of them and decide for yourself - would you want one?