More Than Medicine

There’s a lot more to medicine than tests and
measurements and bio-medical markers, which
we’ve been so focussed on in the last ten years.
The impact that mental health and social circumstances
has on the ability for someone to live well with a longterm
condition is something that I don’t think you
can quantify and it’s something that we shouldn’t be
ignoring either. I think this just gives the opportunity to
bring that into the conversation and I think More than
Medicine is crucial – I think third-party and voluntary
organisations have a huge part to play in supporting
people with long term conditions just to live a better
life. I think we’re so focussed, or we were so focussed,
on a pill for every ill and wanting to fix everything, where
it’s not always about fixing something, it’s just about
making life maybe a wee bit more bearable or a wee bit
more enjoyable sometimes and just accepting things for
what they are and appreciating that’s there more out
there for people than just what I can do really. GP

ALISS and Scotland’s House of Care
The ‘More Than Medicine’ foundation of
Scotland’s House of Care recognises that
positive health outcomes are intrinsically
linked to social connectedness and being able
to live as well as possible within a community
setting. But how do people, including our
health and social care professionals, know
what type and range of support is available in
local communities? ALISS (A Local Information
System for Scotland) has the answer!
Funded by the Scottish Government and
delivered by the Health and Social Care
ALLIANCE Scotland, ALISS helps people find
and share information about local assets
and services (including those delivered by
volunteers and the third sector) that support
health and wellbeing. ALISS does so by
offering a unique digital service that allows
information from lots of different sources to
be brought together on http://www.aliss.org and
which can be made searchable on virtually any
other website or digital platform. This means
that people can find resources that support
them to live well from whichever place is most
familiar and accessible for them.
ALISS allows information to be collaboratively
managed – so enabling people, communities
and professionals to work together to keep
the information up to date and accurate.
Alongside the digital service, ALISS can also support activities like asset mapping and
community engagement. Like House of
Care, ALISS is grounded in the principle of
co-production having been co-designed with
people living with disabilities, people living
with long term conditions, unpaid carers,
health and social care professionals and IT /
data experts.
ALISS is now widely used across the Scottish
health and social care landscape. The ALISS
programme is working with a diverse range
of partners including NHS 24, Community
Pharmacy Scotland, Living It Up, The National
Link Worker Programme, HSCPs and third
sector interfaces. This partnership activity was
commended in the 2015 NHS Scotland Chief
Executive Annual Report. The impact and
value of ALISS is also recognised by the Chief
Medical Officer, Dr Catherine Calderwood who
has stated that;
ALISS is a fantastic aid to joining people to
supports that fit their situation based on the
needs they have identified….as professionals,
it encourages us to be equally curious about
our patients, not just trying to help address
their illness, but also in drawing upon what
keeps them well. Asking people to think about
what matters to them is in itself a hugely
powerful therapeutic intervention.

aliss

What does the future hold?
The House of Care and ALISS programmes
are now collaborating to build an information
platform that will ensure that everyone
working within the House of Care framework
can access the ‘More than Medicine’
information relevant to their localities. The
ALISS team have also began a programme of
engagement with House of Care practitioners
to help them turn the information they gather
as part of their interactions with people and
communities into a tangible resource that
can benefit others. We are also exploring
exciting opportunities to generate and share
analytic and other data that can be used to
support future service planning and strategic
outcomes focused decision making.
https://www.aliss.org/about
hello@aliss.org
@alissprogramme

In Development
We are currently testing a House of Care More Than Medicine page where you can search for community assets – click on the link below to have a look:

https://www.aliss.org/signpost/HoC/

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More Than Medicine

House of Care in Lanarkshire

IMG_2065

It’s been a couple of years since Tim Warren and I visited NHS Lanarkshire to introduce the principles of Care and Support Planning (C&SP) and House of Care. I was therefore very excited to be travelling back to the second of two Lanarkshire House of Care Launch events, this time in Coatbridge, accompanied by Blythe Robertson, policy lead for self management and health literacy.

 

It was clear from the start they have a serious ambition to embrace C&SP and the House of Care framework to help transform primary care services across Lanarkshire. Their Primary Care Clinical Director Dr Eamonn Brankin, Medical Director Dr Christopher Mackintosh and Lead Nurse Irene Barkby all spoke unanimously about the need to change (business as usual is not an option) and the benefits of redesigning the system around the identified needs of people and communities. There was warm regard for the CMO’s annual report Realistic Medicine which highlights the need for a values and systems shift to support collaborative working between professionals and people-formally known as patients- to reduce the harms of overdiagnosis and overtreatment. Chris Mackintosh highlighted the need for collective leadership, sharing the responsibilities  and taking turns to drive us all forwards (skein of geese analogy)

Dr Eamonn Brankin

Dr Eamonn Brankin welcomes everyone to Coatbridge’s House of Care Launch

 

Dr Sue Arnott, the newly appointed, yet clearly skilled, Clinical Champion for NHS Lanarkshire’s House of Care programme gave a very articulate summary of the principles of Care and Support Planning. It was pleasing to see her emphasise that this is not “patient” centred care-care done to patients – but care that places productive, collaborative, relational conversations between people AND professionals at the centre. This recognises that the needs and contributions of both parties are equally important for the best outcomes.

Sue Arnott

Dr Sue Arnott and her brick House

 

I gave a brief summary of national activity to date driven by Year of Care Partnerships  and in Scotland in partnership with Scotland’s House of Care Programme  . I explained the benefits this approach can bring for people, professionals and indeed whole communities. I hoped I conveyed how C&SP is a stepping stone to individual and community empowerment.  It can be a useful vehicle to inform the  commissioning and sustainability of  “more than medicine” –releasing the assets of third, voluntary and communities in supporting and promoting well-being.

 

We then watched a couple of Year of Care videos illustrating the processes of adopting C&SP in practice and the benefits for people experiencing this approach.

 

We were then treated to a fantastic and inspiring talk by Jacqui Melville from Voluntary Action North Lanarkshire (VANL) on the difference the Third Sector and Voluntary organisations can make. She illustrated the internationally recognised benefits they have brought through Re-shaping Care for Older People. She also brought our attention to their useful web-based local Locator Tool which helps people connect with community assets. Lanarkshire clearly already has the basis of a great foundation to their Houses of Care.

 

At the close of the meeting there was a useful panel discussion. The audience were clearly enthusiastic and engaged. Local GPs could see the benefits and already began identifying challenges such as whole team engagement and need to resource and develop health care assistants to facilitate information gathering and sharing as part of the C&SP process.

 

Blythe and I came away feeling uplifted and proud of the achievements and ambition of NHS Lanarkshire. Special mention to Change and Innovation Manager, Kate Bell, whose recognition of the House of Care approach has been instrumental in NHS Lanarkshire’s “buy in”, kick-started with some important funding from Scottish Government’s Primary Care Division.  Also to Maureen Carroll who is skilfully and energetically managing NHS Lanarkshire’s House of Care Programme.

 

For further details, particularly about signing up for “Year of Care” training, please email Maureen at Maureen.Carroll@lanarkshire.scot.nhs.uk

 

House of Care in Lanarkshire

Strictly Come Care Planning

The following ideas resulted from an email conversation about care planning. The discussion included some ideas about practitioners dancing with people rather than dictating the care planning conversation. The focus of the House of Care is the collaborative care planning conversation at the centre. Graham Kramer (a GP and self-confessed dad-dancer) reflects on his own experience of care planning conversations:

“I’m drawn to Year of Care’s metaphor of Care and Support Planning (CSP) being a dance. The outcome is hugely dependent on the confidence, skills etc. of each individual and their ability to interact. The more they practice together the better they will be, however skillful one is it will be held back by the lesser skills of the other. Each needs to help and support each other to bring out the best of the double act.

I see the pre-consultation sharing of results very much akin to giving the patient some choreographic notes beforehand. It will help a little but measuring its impact on the overall dance performance will probably prove disappointing and irrelevant. There is a need to measure the dance performance in the context of all the other elements (including lights, music, dance shoes, sequins etc). Some of our patients will be Jill Halfpennys but many will be John Sergeants. More importantly most of their professional dance partners have, up until now, been skilled in a different technical dance paradigm and are needing to learn Ballroom!

Occasionally I’m like Anton du Beke… but all too often relapse into (paternalistic) Dad dancing!”

But seriously – let’s make a step-change and transform every care planning conversation into a harmonious waltz or a foxtrot.

Strictly Come Care Planning

Scotlands House of Care in one page….

We have needed to capture all we can about the House of Care on one page – this is our latest attempt…..there will undoubtedly be more

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Collaborative care and support planning for people living with multiple conditions

simple House as jpeg

The House of Care provides a simple visual model of a house built around a collaborative care planning conversation between people and their professionals, which then organises care and support around what matters to them and their carers, rooted in the assets of local communities. Building the House of Care requires kind the kind of whole-system transformation needed to recognise the assets, rights and capabilities of people, and place them in the driving seat of their care.

Its values and aims are rooted in a shift from the current curative, compliant approach of health care provision to one that is more suited to people with long term health problems; one that is collaborative, enabling and empowering. This requires an effective and integrated model of health, social and community support.  

The House of Care comes to life when the collaborative skills and leadership of professionals align with local community leadership. Critical to the successful adoption of the House of Care is well supported clinical leadership that enables individuals and communities to co create the necessary conditions for care planning and system wide change. This model also fits well with other important models including Talking Points, including the five and eight models of dementia support and People Powered Health and Wellbeing.

Collaborative care and support planning enables the individual to identify their own goals, develop action plans and link with any support they may need. This support may be from usual traditional services or may make use of less formal community assets.

The Care and Support planning approach supported by the House of Care has been shown to:

  • Support self-management, putting people in the driving seat of their care
  • Improve the coordination of care around each person’s needs
  • Improve both personal and health outcomes for individuals
  • Improve health service use
  • Improve the lived experience of both people and their professionals
  • Keep up-to-date with progress at www.houseofcare.wordpress.com.

Follow us on Twitter @HoCScot

Contact Programme Director : Tim Warren

tim.warren@alliance-scotland.org.uk

07764960620

Scotlands House of Care in one page….

Effects of personalised care planning for people with long-term conditions

Graham has made the House of Care team aware of an interesting study that looks at the impact of personalised care planning for people with long-term conditions. They analysed the effect of personalised care planning by working with over 10,000 people with a variety of long-term conditions from diabetes to asthma to mental health conditions.

The conclusion was made that: “Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people’s capability to self-manage their condition when compared to usual care.” And it goes on to confirm that the effects “appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.”

It was too good not to share – enjoy!

You can read it here: http://www.cochrane.org/CD010523/COMMUN_effects-of-personalised-care-planning-for-people-with-long-term-conditions

Effects of personalised care planning for people with long-term conditions