Simply, sensibly, person-centredly brilliant
A fantastic thing has happened to me in the NHS over this last month. It involves care planning and it goes like this.
I have a 15 year old repetitive strain injury (RSI) which means it is painful to use computers and keyboards at times. As my work is office based, this has quite an impact on my life. I have been managing it OK-ish and have had support from several different physios and osteopaths at various times, with varying degrees of success. However, during a recent nasty flare up I was sent to meet Chris Williams, a physiotherapist at Sherwood Forest Hospitals.
Chris was different to the other professionals.
He introduced himself, sat me down to for a chat, and asked, ‘what are your aims?’ This prompted a great discussion about the problem which I’d like to manage better mainly so I can stay in work and cut down on the pain. Chris asked me what I had tried already; what worked and what hadn’t. Then he booked for a double appointment for a full assessment ‘so we can really get to the bottom of things and take it from there’.
Together we agreed a plan, based on a new exercise regime and I have struck to this because I felt comfortable with it – it felt doable in the context of a busy life. I have had a couple of appointments since and Chris always starts the discussion with the way I manage my RSI. He asks for my assessment of progress before offering his because, as he says, ‘while, I can have a professional view, you are the only person who knows how you feel’.
It was almost uncannily good, it was as if Chris was following the National Voices Guide to Care and Support Planning step by step. I asked him if he had read the guide. He hadn’t. So I asked him if he’d had training in great conversations with patients. His reply was: ‘actually I used to work in mental health’. Well that made sense, we know professionals in mental health tend to be ahead of the game in their conversations with people who use services, probably, in some ways, as a natural consequence of focusing on the mind and wellbeing.
It also explains why the other professionals I have met over the years haven’t quite understood me, my strengths, my weaknesses and my needs in the way Chris has.
The strange thing is, the conversations Chris leads don’t feel hugely different, but they do start in the right place, and they focus on you. ‘It’s about listening,’ says Chris, ‘sometimes we can hear without listening because we want to get on to the thing we are focused on, rather than the things our patients find important’.
And with that, Chris has found a little, vital lever that opens the door to the big exciting new world that people who use services and carers are calling for, the world that people in the health and care policy world are calling person centred care. His approach is simply, sensibly, person-centredly brilliant.
So the big question now is, why aren’t all people with long term conditions and disabilities treated in this way? Research tells us that good care planning and shared decision making lead to better outcomes. People stick to their treatments better, have better results and a happier experience. From a pure value for money perspective, this makes sense. Yet, as National Voices trustee, Angela Coulter, in her recent Health Foundation blog says: “In January 2006, a government White Paper promised that patients would be given the opportunity to shape their own care plans and successive governments have reconfirmed their commitment to this policy. Ten years on, only 1 in 20 say they were involved in a collaborative care planning process."
Angela’s blog outlines barriers to good care planning, calling for ‘a clear understanding of what needs to change, especially how staff view their roles and those of their patients’. She adds that we need incentives aligned around care planning and performance management that focuses on this. She also says leaders need support in making it happen. National Voices’ vision for Person Centred Care 2020 sets out further ideas for ways forward.
And I think there is something else, that perhaps we can all get involved with and that is, inspiring other people to take this approach. So I would like to end with a couple of questions:
How can National Voices and the service user movement – indeed all of us - inspire more clinicians to take Chris’s approach?
How can we make good conversations with patients go viral?
I’d love your ideas so we can create change and so that, every time someone with a long term condition or a disability has a meeting with a professional, they too use the word ‘fantastic’. Please send me your thoughts by responding below, or on Twitter @Jules Acton.