NHS Boards in Ayrshire and Arran, Fife, Dumfries and Galloway, along with NHS Education for Scotland (NES), are hosting this free opportunity to attend the Humanising Healthcare Conference to share learning, explore health and social care today, consider the impact of working in this environment and what can be done to support staff to be more resilient. The conference is taking place on Tuesday 9th and Wednesday 10th June 2015 in the Beardmore Conference Centre, Glasgow.
Huw Davies, Co-Director of SDHI of Professor of Health Care Policy and Management at the University of St Andrews. is engaged in Nuffield Trust funded work on NHS management and culture on the back of the Francis inquiry and report into the failures of care at Mid Staffordshire NHS Trust. Read about Huw’s insights and views in a recent blog post on the Nuffield Trust website.
SDHI in collaboration with NHS Fife, the Scottish Improvement Science Collaborating Centre (SISCC) and the International Futures Forum (IFF) hosted an interprofessional and interdisciplinary seminar and workshop with 20 participants to envision the future of a healthcare system currently under strain. Dr Margaret Hannah, Consultant and Deputy Director of Public Health in the NHS Fife and author of ‘Humanising Healthcare: Patterns of Hope for a System under Strain’ and Graham Leicester, Director of the International Futures Forum (IFF) facilitated the afternoon with SDHI Co-Director Thilo Kroll.
Healthcare systems are under ever increasing performance pressures and exposed to massive rises in expenditures. At the same time criticism of the way we deliver health care grows highlighting the lack of compassion and a detachment of people’s life priorities and choices. Inequalities in health care access, treatment use and outcomes are not being tackled adequately. The research that supposedly generates the evidence base for effective therapies and interventions is selective, exclusionary, de-contextualised and for many long-term conditions flawed. Faced with a growing number of people who manage not one but multiple long-term conditions outside institutions in diverse community settings health care systems lack co-ordinated, integrated quality practice models that are centred around people’s lives and not primary their health conditions.
So, what are the alternatives to the status quo? What can we learn from the past? Perhaps, very timely 2015 saw a re-publication of the book ‘A Fortunate Man: The Story of a Country Doctor’ by John Berger and Jean Mohr. The book had originally been written in 1967 and was based on the sensitive portrait of John Sassall, a GP in the Forest of Dean. It illustrates his relationships with the diverse residents of this rural community and his approach to understanding the delivery of health care in the context of the social and environmental fabric of rural living. A quote from the book illustrates this very well
“Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place. For those who, with the inhabitants, are behind the curtain, landmarks are no longer only geographic but also biographical and personal.” (pp 18-21)
Margaret Hannah describes in her book the way our current healthcare arrangements are costly, guideline driven and dis-ease and disorder focused. Hope lies in adopting a salutogenic, asset-based approach that works with (not for) individuals and communities as co-creators of health. The workshop identified opportunities for transformational change in the way we deliver healthcare through co-creation approaches and participatory action research. It also requires the collaboration with non-traditional partners in health, i.e. community organisations, local authorities.
We are currently working on a briefing paper based on the workshop, which we will make available for reflection and discussion shortly.
SDHI Team Member, Deborah Baldie reports on findings from this study. For the full article, please see citation at the end as well as the links provided to the full publication.
A UK wide four country case study of patient choice of secondary care provider has recently been published in the Journal of Health Services Research. Researchers from SDHI worked with research teams across the UK to compare patients’ choices when referred to secondary care providers by their general practitioner (GP) to examine the changes that have resulted from the explicitly pro choice policy in England.
Interviews were conducted with providers of two high-volume surgical specialties, Ear, Nose and Throat and Orthopaedics, purchasers of these services and those responsible for referring to acute services.
Choice of provider
In England, patients had a choice of any provider, but in practice patients were only provided with a limited list of local providers. There was no national system for facilitating choice in the three other countries and therefore patients tended to be referred to the local provider and may have a choice of hospital sites managed by that provider. Referral further afield in all countries was very rare and only occurred in exceptional cases.
Choice of Specialist
Choice of specialists was reported to be available at the discretion of providers in England, Scotland and Wales but not Northern Ireland. The reason for restricting choice of specialist in all cases was reported to be the need to reduce or control waiting times. Most GPs in all cases were asked to refer to generic teams rather than individual consultants.
Choice of date and time of appointment
Choice of date and time of appointment was available to patients when they were referred to a provider in all cases through two key systems – partial and full booking. Data collected indicates that rather than enhance choice these systems operated primarily to manage waiting times.
Management of choice along the referral pathway
A range of triage systems to direct patients to appropriate secondary care services operated in orthopaedic services. They appeared to limit choice for patients, particularly in triage systems that had no access to the electronic booking system. GPs did however GPs often bypass the triage service if they felt this was clinically indicated.
Referrer’s communication of choices to patients
Interviewees’ understanding of the availability of choices was often confused and differed within sites. A common area of confusion concerned referral pathways and if triage systems existed and were mandatory or optional. Discussion of choice with patients tended to be very limited with GPs in England and most tended to limit choice to 5 local providers. In the three other countries discussion of choice was largely not commenced unless initiated by the patient. GPs indicated that lack of discussion of choice with patients was largely due to patients being confused by and not interested in choice.
While the explicit patient choice policy in England would suggest greater possibilities for choice compared with Scotland, Wales and Northern Ireland, in practice differences were more nuanced. All countries had some degree of choice of provider, limited choice of specialist but restricted choice of date and time of appointment or admission. Choices were far more limited in Scotland, Wales and Northern Ireland. The limited range of choices made available in these countries were seen to be affected by geography and population spread however even in urban areas in England, GPs reported patients preferring stay close to home and this acted as a further limiting factor.
Choice of time and date of appointment were was viewed as a very useful tool for managing capacity. Confusion over referral pathways and choice of specialist was there at times amongst GPs in all four countries. Patient experience of choice was therefore dependant to some extent on GPs’ knowledge. GPs reported having similar conversations with patients about choice in all four countries and tended to be led by what they thought best suited the needs of individual patients and patients’ appetite for choice which was perceived by GPs in all cases to be small.
Lack of difference between countries may because free choice of any provider in England was still bedding down at the time of this study. Other factors more closely related to GPs perceptions and knowledge of choices available indicated however that overall, a longer term culture shift on the part of GPs is needed in all four countries if patients are to be made fully aware of choices available to them.
Sanderson M , Allen P, Peckham S, Hughes D, Brown M, Kelly G, Baldie D, Mays N , Linyard A, Duguid A. Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?J Health Serv Res Policy 2013 18: 202 -208
A new round of NRS fellowships was announced by the Chief Scientist Office (CSO) on 1 October. The scheme will allow the successful applicants protected time up to March 2016 to engage in the following activities:
Clinical research planning and protocol development
Carrying out clinical research
Leading or hosting multi-centre trials as Chief Investigator or local Principal
Investigator participation in commercial research
Dissemination of research findings, such as writing papers and presentations at major national and international scientific meetings
NHS Research Scotland (NRS) is inviting applications from clinical NHS staff for funding for a minimum of 0.2 and maximum of 0.4 whole time equivalent (WTE) that may replace or add to existing clinical commitments within the individual’s work plan. Exceptionally applications for 0.5 WTE funding may be considered.
Please find more details and download the application form on the CSO website. The closing date for applications is Friday 9th November.