A person centered approaches and services user involvement in health and social care

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Week 3

NHS Guidance / Policy

Person Centered Care/Service User Involvement

Bimpe Kuti

Session overview

To review

  • structural arrangements of the NHS over the years.

  • the NHS ambition in relation to person centered care/service user involvement

  • Policy and its evaluation in relation to service user involvement

Structure of the NHS

NHS Structure Roles
The Secretary of State Overall responsibility of the Department of Health. Provide leadership for public health, NHS and social care in England
Department of Health Strategic leadership and funding for both health and social care in England.
NHS England Independent body separate to the government. To set priorities and direction for the NHS on improving health and care outcomes. Have a duty to involve patients, carers and the public in decisions about services commissioned.
Clinical Commissioning Groups (CCGs) Clinically led statutory regulatory bodies. Responsible for planning and commissioning of healthcare services for local areas. Have a duty to involve patients, carers and the public in decisions about services commissioned.

Structure of the NHS

NHS Structure Roles
Health and Wellbeing Boards Established by the local authorities to act as forum for local commissioners across NHS, social care, public health and other services. To increase democratic input into strategic decisions, strengthen working relationships between health and social care, encourage integrated commissioning of health and social care services
Public Health England (PHE) Provides national leadership and expert services to support public health. Coordinates national public health services.
Vanguards Introduced in 2015 as part of the NHS Five Year Forward View. The 50 chosen vanguards are tasked to develop new care models and potentially redesign the health and care system. It is envisaged that this could lead to better patient care, service access and a more simplified system.

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Structure of the NHS

NHS Structure Roles
Regulation – Safeguarding People’s Interest Responsibility for regulating particular aspects of care is now shared across a number of different bodies, such as: CQC, Monitor, NHS Trust Development Authority, Patient Safety, the National Reporting and Learning System, the Advancing Change team and the Intensive Support Teams, the General Medical Council, Nursing and Midwifery Council, General Dental Council and the Health and Care Professions Council

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Focus of the structural arrangements

  • To provide guidance on service user involvement and person centered care.

  • To ensure there are clear regulatory bodies within the NHS guide and direct the affairs of the NHS in England

  • There is still a strong and growing discourse that embeds service user participation in policy, regulations and strategies for the future within the NHS.

Despite the challenges the NHS has endured such as major re-structuring, staffing, finance and funding, regulation and access to treatment,

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Structural arrangements / TRUST VALUES

  • Each Foundation Trusts creates its set of values in terms of ethos of working with patients/service users

  • Bolton NHS Foundation Trust – Trust Values
  • (Bolton VOICE) - V=VISON ; O=OPENESS; I= INTEGRITY; C=COMPASSION; E=EXCELLENCE)

http://www.boltonft.nhs.uk/about-us/trust-values/

RATIONALE FOR THIS VISON (BOLTON NHS FT)

  • To listen to the voices of staff, patients and stakeholders as a means to provide better care.

  • The value statements are underpinned by a set of practices which staff and managers are expected to display on a day to day basis when dealing with our patients and each other.

  • The Trust values form part of its recruitment, induction, appraisal and leadership development processes. (this is who we are)

RATIONALE FOR THIS VISON (BOLTON FT)

  • By living the values every day it will encourage a culture where patients are treated, as healthcare professionals would like their family to be treated.

  • We want all of our patients to be safe and receive the best possible care.

PUBLIC HEALTH POLICY

KEY QUESTION?

What is public policy and why is it important for public health practitioners to understand it?

Effective engagement with policy process is an increasingly important ROLE for those involved in health promotion and recognised as a core competency for PROFESSIONAL PRACTICE.

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POLICY – SUI / PCA

SUI has had its share of debates, values and conflicts about the responsibility of the state and individuals in matters relating health and social care

Hence there is an ever increasing need to legitimise actions or create state intervention for service user involvement / person centred approaches in care

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POLICY – SUI / PCA

Seen as a vehicle for creating supportive environments – to enable people have a say in their care delivery

Could be decisions made by individuals, communities or groups (e.g. access to care services)

This could be given in the form of legislation, regulation and guidance

To ensure that policies and the activities across different care sectors are aligned in relation to achieving person centered care goals.

Why is it important for health practitioners to be engaged with health policy process?

Policy set priorities and guides the allocation of resources

A CONSISTENT THEME GENERALLY RUNS THROUGH MAJOR POLICY DOCUMENTS – avoiding harm, protecting environment, promoting health.

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PUBLIC HEALTH POLICY

Review Handout on the historical perspectives and development of service user involvement policies – (provided last week)

Discuss – What does this list portray?

Policy paper –The NHS White Paper – Equity and Excellence: Liberating the NHS

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213823/dh_117794.pdf

The National Institute for Health and Care Excellence – Patient and Public Involvement (PPI) Policy

https://www.nice.o rg. uk/media/default/About/NICE-Communities/Public-involvement/Patient-and-public-involvement-policy/Patient-and-public-involvement-policy-November-2013.pdf

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POLICY – Equity & Excellence

Context – Overview

  • The White Paper, ‘Equity and Excellence: Liberating the NHS’ (July 2010) set out the Government’s vision for health services;

  • It describes a new commissioning architecture for the NHS as one of the key drivers through which real improvements for patients will be made…

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How will patients have a say?

The White Paper, ‘Equity and Excellence: Liberating the NHS’ (July 2010)

  • Patients are being put in the driving seat;
  • Through improved choice and better information, patients will be able to hold their GPs to account;
  • Services are being made more responsive to the needs of local communities;

How will patients have a say?

The White Paper, ‘Equity and Excellence: Liberating the NHS’ (July 2010)

  • Those buying in services will be under a duty to reduce inequalities in healthcare provision;

  • And the National Institute for Health and Clinical Excellence will set clear national standards of care;

  • So patients can be confident that – wherever they live or are treated – the care they receive will meet NHS standards.

REVIEW HANDOUT ON NICE – PPI POLICY

  • How will patients have a say?

  • Review and come up with 6 key points from within this document on how service users will have a say in their care

POLICY – SUI /PCA

  • AUTHORITATIVE INTENT ABOUT SATUTORY ACTIONS – i.e. Government has the ULTIMATE authority to act!!

  • POLICIES – becomes focus for debate and action.

  • **Not all POLICIES require legislation**

  • Some are REGULATIONS/GUIDANCE for professional practice.

  • They become the basis for FORMAL PROCESSES OF MANAGEMENT within healthcare systems.

NHS - Quality Ambition: Patient-Centred Care

  • There will be mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

NHS - Quality Ambition: Patient-Centred Care – overall aim

  • To improve and embed patient-reported outcomes and experience across all NHSScotland staff

  • To support staff, patients and carers to create partnerships that result in shared decision-making

  • To inform and support people to manage and maintain their health, and to manage ill-health

Overall ambition – national agenda on SUI / PCA

  • To create more opportunities for service-users to get involved in all parts of the Trust and to co-produce service improvements and new service design.

  • This is clearly set out as an objective in the ‘Five Year Forward View’ which says ‘Co-Production with experts by experience should also be a standard approach to commissioning and service design’.

Key websites

  • The Department of Health and Social Care
  • National Institute for Health and Care Excellence
  • The Health Foundation
  • The King’s Fund
  • Social Care Institute for Excellence
  • National Health Service

REFERENCES