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Dr Martin McShane, NHS England’s Director for Patients with Long Term Conditions, opened the two-day Future of Health Conference with this welcome:
“First of all I would like to thank Ed Wagner for coming and sharing his thoughts and insights. It is a thrill for me to share a platform with him as he has been so influential in guiding my thinking and beliefs about how we need to re-orientate our health and care system to meet the challenges of the future not those of the past.
That is why we are holding this conference. One mind, alone, is insufficient to grasp and grapple with the challenges we face. But we live in a new era. An era where information is constantly at our fingertips. Where communication is easy and hugely interactive. Where it is entirely possible, in fact desirable that we should harness the power of the collective mind to help address the problems we face.
If you haven’t seen it go to the web, look at the document NHS England has just published Transforming Participation in Health and Care (document is available on our archived website). This sets out the new way and ways we need to work with and unleash the potential of the people we serve.
I was trained before the internet. I trained to be the expert, the repository of knowledge and experience that people would come to for advice, help and care. I was trained to believe that, invariably, there was a singular diagnosis and by applying my intellect and skills I could make that diagnosis and offer a cure. I was trained to be autonomous, accountable for my actions (and inactions).
I was trained to meet the challenges of the 20th century. The challenges of the past.
Those challenges have changed.
We are all aware of the demographic changes. People are living longer and, let us not forget, the majority living a good quality of life but a substantial number are experiencing the impact of long term conditions. And the change in life expectancy and disease patterns have been accompanied by huge societal changes – beliefs, attitudes and expectations have shifted enormously.
The NHS and professions can either act like King Canute or we can roll up our sleeves and be innovative, adaptive and accept that change happens all the time and we need to work with it not fight it – a fight which is invariably futile. We need to help shape the future not fear it.
This was brought home to me by colleagues in General Practice when a few years ago I talked to them about care pathways for single conditions. They looked at me wearily and reminded me that the people they saw in practice did not have diabetes, they did not have arthritis, they did not have dementia or heart failure or depression. They had depression, diabetes, arthritis and heart failure. They could make a pathway fit the patient – the trouble was the whole patient didn’t fit a single condition pathway.
It struck me that we had a system that wanted the people we serve to fit the care we wanted to provide. That is a broken model. What we need to be thinking about is how we fit care around the person.
Analysis after analysis reveals the emergence of comorbidities, multiple conditions, being the challenge for the future. We should not discard the successes and progress we have made but we need to prepare for the complexity of the future. We need to make our care person-centred.
After all that is what people have said they want. If you have not visited the National Voices website please could I urge you to do so. The work they completed a year ago has informed and influenced the work we have been doing in NHS England.
I make no apology for reading out the statement they arrived at: My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes.
This is the starting point for the House of Care. This is what we are here today and tomorrow to help shape and design and ultimately build – a new model for the 21st century.
The House of Care is a model, a metaphor to help construct systems and support personal interactions. It recognises and acknowledges the complexity of the system. There is no singular action, no magic bullet which will solve the complexity of the care we need to be able to deliver.
The foundations are built on commissioning. I have been involved in commissioning for nearly two decades. I would like to reframe what commissioning is so that people see it as a quality improvement cycle. It is about planning, doing, studying – the impact – and acting to plan differently, if we are not delivering the outcomes desired.
Note: I said outcomes. Inputs and process is important but process must always be linked to purpose. Our purpose, as commissioners, is to deliver high quality care for all. Quality which is constructed from safe, effective care, with a positive experience. Effective care which prevents premature mortality, enhances the quality of life for people with long term conditions and helps people recover from episodes of acute care and trauma – some of you will have spotted that I have just set out the link between the NHS Outcomes Framework and High Quality Care. The NHS has taken a bold step to put outcomes central to purpose.
In commissioning we must also deploy the best practice, clinical and organisational available to us all. We are envied by many other health systems because we have NICE. We must continue to use the guidelines and standards, intelligently, to support high quality care. This is the roof of the House of Care.
But between the foundations and roof we need to create the space for person centred co-ordinated care. To do that we need to put equal focus on building two strong pillars.
The first is to give people and carers as much control as they want. As a GP I might see a person for five hours in a year if they have long term conditions. Their carers will see them far more often. They, the individual, will live with it constantly. Who needs to be in control? Who needs to be the expert? Who needs to feel that they can get the support they want, to help them live the life they want and meet the goals they set?
I was fortunate to meet Penny at the launch for this conference. She recounted her life after she was paralysed in a riding accident and how much she had had to work against the assumptions, perceptions and decisions made about her and for her by professionals. About the inordinate difficulty of navigating the system to replace £200 Velcro strap on her hoist – a process which she calculated cost the system tens of thousands of pounds – let alone the problems it caused her.
Recently I met her on a train, heading up North. She mischievously recounted how since our last meeting she had to get her kitchen redone and decided to let the care system know. A panicky professional exclaimed: “Well we will have to move you into a nursing home. You won’t be able to cope!” To which Penny drily replied – “I manage quite well when I go to Africa…”
Please, let us build a house of care that gives people the control they want of their care and their lives.
The final pillar is to build on professional collaboration. I was trained to be the autonomous individual heroically curing people. That era is over. We now need to work in teams. We need to collaborate. Generalists and Specialists, doctors, nurses, allied health professionals, pharmacists, volunteers, communities, social workers mental health professionals.
Professional collaboration needs to be supported and I read an article in the BMJ which talked about continuity having three components:
- Informational continuity – the information about me is with me wherever I am
- Management continuity – we design management systems to support continuity
- Relational continuity – there is a professional who is a trusted adviser and known to the person.
This all makes sense but it struck me that the last component did not go far enough. Continuity of care is supported by professional relational continuity – professionals who are not strangers to each other. The best care I ever gave was not only due to the continuity of relationship I had with individuals but also with my colleagues – the experts I called on to help with delivering person centred co-ordinated care.
This is why we need to build a pillar that supports that collaboration, that team working and understands that transactions and process are important but the pillars of care are built with human beings and with humanity and cemented by values and principles which are what attract so many people to work for the NHS and in care.
Thank you for coming and thank you, in advance, for your contributions.