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Realistic Medicine – Supporting Self Management Conference

Realistic Medicine and Supported Self-Management Conference

Personalising Realistic Medicine 10 October 2019

Dr Catherine Calderwood

Chief Medical Officer for Scotland

Obstetrician

@cathcalderwood1

The Scottish Government and The ALLIANCE are strategic partners

The partnership was agreed through a positive collaborative approach between our organisations.

• Health and Social Care Integration: Including – Third Sector Health and Social Care Support

• The Health and Social Care Academy

• Self Management Programme (Partnership and Practice Programme, Self Management Fund for Scotland, Self Management Awareness Raising Campaign)

• Digital Health and Care (ALISS and Digital Health Team)

• Dementia Carer Voices

• The Sensory Impairment Hub

• Self-directed Support

As healthcare professionals we must:

• Listen to our patients - find out what matters most to them - and help them make an informed choice;

• address over-treatment;

• challenge variation in clinical practice; and • offer higher value care

How do we know the public really want Realistic Medicine?

Where do I find the time?

Spending Time, Saves Time

• PACT care plans - deliver a measurable reduction in acute hospital demand that outweighs the cost, both in time and money

• The Silver City Project - reduced emergency hospital admissions (people aged >75) by 12%. Outpatient referrals to Geriatric Medicine reduced from 10 to 4. More effective use of Geriatrician time in contributing to Silver City multidisciplinary team (MDT) meetings.

• Orthopaedic Team at GRI’s opt in clinical helpline and virtual clinic -Now, less than 40% of patients require a face-to-face review. Evaluation shows that 79% of patients are satisfied with the pathway, outcome and helpline.

Jury’s top three recommendations:

1. A programme to inform and educate patients of their right to ask questions of health professionals and which questions to ask;

2. Training for all health and social care professionals on shared decision-making; and,

3. The opportunity for an independent person to join conversations between professionals and patients.

• NHS 24’s ‘It’s OK to Ask’To inform and educate patients of their right to ask questions of their health professionals by creating an accessible and effective digital first multichannel campaign.

• NHS Fife’s ‘Asking the Questions that Matter’To discover, devise and develop locally relevant “Questions that Matter” in patient consultations in collaboration with healthcare providers and patients.

• NHS Lanarkshire’s ‘5 Questions in a Secondary School’To introduce the concept of Realistic Medicine and the ‘5 Questions’ to school pupils.

• A more personalised approach towards our patients and our citizens can foster their engagement, allowing us to understand and co-create the care they really value.

• Giving time to patients can often save time for professionals, and the appropriate redistribution of work - using all the assets of our diverse teams – can improve patient care, rather than undermine it.

Scotland’s House of Care

10 Years of Scotland's Self Management Fund

This year is the 10th year of Scotland's Self Management Fund.

Since 2009 the fund has seen nearly £20 million invested to enable the development of 272 projects both large and small across Scotland.

Projects which have supported people living with a diverse range of long term conditions from epilepsy, to M.E. to those with anxiety and chronic pain.

Projects with the experience of people living with long-term conditions – and that of their unpaid carers – at their heart.

www.thecheynegang.comSCO47259

“Since joining the singing for breathing group my

breathing has improved very much.

I don’t have as many chest infections or need to use

steroids. I feel I can control it better. I now breathe from

my stomach instead of my chest, and no raised shoulders.

I don’t panic any longer when I can’t get a breath. I never

thought I’d be able to sing but now I can.”

“I have very bad anxiety, and now I find that

when I’m in a situation, I’m finding that I’m

doing the breathing.

It’s as if I’m going to burst into song”.

“They should have had this years ago! It could have

saved a lot of money for the health service!

And it’s not just for your breath, it gives you

confidence, you get out there.

My memory is better because you’re thinking of the

words.”

“Singing means calmness, confidence and

courage. I feel it has helped my breathing, I feel

healthier, singing brings us joy and laughter.”

www.thecheynegang.comSCO47259

• 60% of UK doctors reported that their satisfaction with their work-life balance had deteriorated in the past 2 years.

• 3/10 doctors felt unsupported by management or senior colleagues at least once a week.

• 1 out of 4 doctors said they had considered leaving the medical profession at least every month.

GMC 2018 report ‘The state of medical education and practice in the UK

•The Health and Care (Staffing) Bill

•Rotas of junior doctors will include mandatory 46 hour recovery periods

• ‘UK-wide review of students’ and doctors’ wellbeing

•GMC review of Scotland Deanery

Schwartz Rounds

• multi-disciplinary forum for staff to reflect on their work and its psycho-social and emotional impacts.

• strengthen relationships with patients, build empathy and compassion

• provide staff with a safe space to talk about all aspects of their work.

Schwartz Rounds

• people who attend half as likely to suffer psychological distress as non-attending colleagues.

• reduce isolation, make people feel more connected ,and puts them back in touch with the motives that brought them to healthcare in the first place.

4 Behaviours of Compassionate Leaders

• Attending

• Understanding

• Empathising

• Helping

‘Senior leaders must not be satisfied simply with attempting to understand their organisations through written reports.

Instead, they must invest time in visiting and listening to staff in their workplaces.’

Peter Homa

Scottish Atlas of Healthcare Variation

Our Vision for Scotland

‘By 2025, everyone who provides healthcare in Scotland will demonstrate their professionalism through the approaches, behaviours

and attitudes of Realistic Medicine’.

Stay in touch

cmo@gov.scot

Realisticmedicine.scot

@CathCalderwood1

Realistic Medicine in Grampian

Dr Malcolm Metcalfe

Associate Medical Director for Acute

NHS Grampian

The Vision

‘By 2025, everyone who provides healthcare in Scotland will demonstrate their professionalism through the approaches,

behaviours and attitudes of Realistic Medicine’.

More meaningful conversations will lead to less litigation, not more.

• Supporting our colleagues and ourselves

• www.projectlift.scot– Collaboration and influencing

– Creativity and innovation

– Empowering

– Motivating and inspiring

– Self-leadership

– Vision

• Challenging unacceptable behaviour

• Improving work/life balance

Scottish Burden of Disease

Next steps for Practising Realistic medicine

• Does your Board have a Realistic Medicine (RM) group?

• If so, how big/ what’s its structure/ make up/ purpose?

• What are they working on?

• Do they have any evaluations/ successes to share?

• Where have they made progress?

• Where are the pinch points/ drivers?

• Can you commit to sharing RM good practise ?

• Is RM included in your training programmes?

• How does your Board plan to support your RM Clinical Leads?

• Will you commit to sharing your progress at the RM Conference?

But what about Value for Money and Cost-Effectiveness

• Probably not so important if regard RM as a Quality Initiative.

• Focus on money does have problems

–Public think services are being cut

– Service providers think they are being worked harder.

• However it is inevitable that it needs to be considered.

What is happening in other HBs?

• NHSL

–Public engagement sessions

– Staff training events

–Response to Citizen Juries recommendations

– Shared Decision Making (tools and decision aids)

–Developing a Board Action Plan

– Embed RM principles into NHSL Qual Strategy

– Encourage local champions

– Standardise response to AoV maps – bulletin

– Fellows

What do we need?

• SLT and HB support (+ copy other HBs)

• Positioning of RM in structure

• Agreement of resources required (champions, implementers, fellows etc)

• Agreement to form team and to work in conjunction with QI.

• Agreement to start by holding open workshops to allow whole workforce to determine priorities

• Reporting structure to be determined

@stevebaguley steve.baguley@nhs.net

Supported self-management: a future role of the National

Digital PlatformDr Steve Baguley

Clinical Director of eHealth for NHS Grampian

a Clinical Lead for the NES Digital Service

Consultant Sexual Health & HIV Physician

@stevebaguley steve.baguley@nhs.net

What I’ll cover

• The weaknesses of current approaches to supported self-management.

• A short history of the National Digital Platform

• The future of the citizen portal on the NDP

@stevebaguley steve.baguley@nhs.net

Self-management information but no clinician support

@stevebaguley steve.baguley@nhs.net

Great but just covers a few conditions

@stevebaguley steve.baguley@nhs.net

Just covers diabetes. Can see info but not message clinicians

@stevebaguley steve.baguley@nhs.net

Key Information summary

@stevebaguley steve.baguley@nhs.net

Proportion of hospital patients with a Key Information Summary

0%

5%

10%

15%

20%

25%

30%

@stevebaguley steve.baguley@nhs.net

But…

• Patient can’t see it electronically or contribute to it.

• Hospital clinicians can see it but not add to it – even if they’re a specialist in that area and have the patient with them.

@stevebaguley steve.baguley@nhs.net

My Anticipatory Care Plan – site and app.Easy for patients to get to but can’t be seen by clinicians to edit and provide support.

@stevebaguley steve.baguley@nhs.net

What would the ideal supported self-management system be like?

• Information for the healthy, the newly diagnosed and for expert patients.

• Patient access to test results, care plans and correspondence.

• GPs, specialists and patients can agree and edit care plan together.

• Proxy access (carers, selected relatives, Power of Attorney for Health)

• Asking clinicians questions in an accessible and secure way.

• Easy to access but with secure data.

@stevebaguley steve.baguley@nhs.net

The National Digital Platform

@stevebaguley steve.baguley@nhs.net

“We believe it is imperative a person-centred approach should empower patients to control their own information, including how this is used. We would welcome information on what action the Scottish Government is taking to allow people control of their own information.”

• Citizens have limited access to their data – so self-service and self-management are difficult.

@stevebaguley steve.baguley@nhs.net

Slide by Paul Miller

“Digital technology now needs to transform the way in which health, housing and social care services are provided, empowering people to self-manage and live more independently.”

@stevebaguley steve.baguley@nhs.net

“The platform will allow for: Information capture and access at point of contact – providing up-to-date high quality and timely role based, secure access to multiple specialist health and care information and knowledge sources, which is essential and fundamental to enabling excellent care, supporting staff, empowering citizens and enabling self-care.”

@stevebaguley steve.baguley@nhs.net

Who’s building the National Digital Platform?

1. Scottish Government commissioned the work from NES

2. NES created the NES Digital Service – director Geoff Huggins

3. NES Digital Service (NDS) are:1. Procuring cloud environment for the NDP – decision in December

2. Developing first applications – ReSPECT, ACPs

3. Working with NSS to create the building blocks – AAD, CHI2 etc

4. Working with SG on citizen authentication

5. Working with SMEs on applications to connect to NDP – eg trauma

6. Working with board eHealth departments to implement and connect.

@stevebaguley steve.baguley@nhs.net

Structured data(CDR)

openEHR, SNOMED CT

ReSPECT application

Master citizen index (CHI)

Service Director

y (NHS24/

ISD)

Staff Identifier (Azure

AD)

Multiple ways to view and contribute – eg via TrakCare, CarePortal, GPIT

NDP

NDP cloud environment

National Digital Platform phase 1 - 2020

Citizen access by mid 2020

@stevebaguley steve.baguley@nhs.net

@stevebaguley steve.baguley@nhs.net

Structured data(CDR)

openEHR, SNOMED CT

Multiple Applications – eg ReSPECT, ACPs, acute trauma, medication record etc

Master citizen index (CHI)

Service Director

y (NHS24/

ISD)

Unstructured data

(Document & Media Store)

Staff Identifier (Azure

AD)

Multiple ways to view and contribute – eg via TrakCare, CarePortal, GPIT, citizen app etc

NDP

NDP cloud environment

National Digital Platform phase 2 – early 2020s

Linked applications, eg NoS HEPMA

@stevebaguley steve.baguley@nhs.net

Structured data(CDR)

openEHR, SNOMED CT

More Applications – eg GPIT, clinical noting, patient questionnaires, ACPs, medication record etc

Master citizen index (CHI)

Service Director

y (NHS24/

ISD)

Unstructured data

(Document & Media Store)

Staff Identifier (Azure

AD)

Multiple ways to view and contribute – eg via TrakCare, portals, citizen app etc

NDP

NDP cloud environment

National Digital Platform phase 3 – mid 2020s

Linked applications, eg National HEPMA

Direct access to applications – default route

@stevebaguley steve.baguley@nhs.net

Concept for supported self-management using NDP

• Citizen logs in to system – using MyAccount or equivalent.

• Sees letters, results, care plans. Can add questions or comments to these.

• Can message care providers.

• Sees national medication and vaccination record. Can add OTC meds and vaccinations from other sources.

• Can add own readings – eg BP.

• Can complete symptom or pre-op assessment questionnaires.

Supported Self-Management in Grampian

Chris Littlejohn, Deputy Director of Public Health

Dr Hannah Robertson, Consultant Physician, Clinical Lead for Supported Self-Management

https://en.wikipedia.org/wiki/Conveyor_system

https://www.scotpho.org.uk/media/1732/sbod2016-bubbles.pdf

CARE &

SUPPORT

PLANNING

HEALTH

LITERACY

EXPERT

PATIENT

DIGITAL

SOLUTIONS

LINK

WORKERS

PEER

SUPPORT

S - Situation

B - Background

A - Assessment

R - Recommendation

A – Assessment

• Grampian Self Management Network– 3/yr since 2016. 30 – 60 attendees– 4 Aberdeen City, 4 In Aberdeenshire, 3 in

Moray

• House of Care– 7 practices Implementing, 18 Practices

trained, – Acceptable to patients and HCPs– “ House of Care Significantly further ahead

in Grampian than other Scottish boards”

• Secondary Care– Information, education afternoon– Input today from many on network

Organisations

NHSG55%Third Sector 26%

Council 2%

HSCP 10%Other…

Public Health…

Specialist Services…

Primary Care…

Other 12%

Clinician33%

Manager

27%

Coordinator/ adviser /development officer

15%

Clinical lead 11%

Lead (non Clinical)…

Other 8%

Roles

NHS Sub

Groups

Supporting Self-

Management in Grampian

Peer support groups

Breathe

Reflect

Acknowledge

Appreciate

S

R

A

A

B

Recommendations

• Enhance knowledge and skills

• Make connections

• Professional insight and personal insight into LTC

• How to improve with in your own direct influence and how within wider Grampian SSM agenda

Thank you

• For coming today and being part of

this

• Feedback

• Feedforward

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Realistic Medicine – Supporting Self Management Conference