Month: February 2018

PRSB starts work on Burden Assessment of CDSs

NHS Digital has commissioned the PRSB to undertake a new project to assess the burden placed on healthcare providers when they are collecting and reporting on the Commissioning Data Sets (CDSs). The purpose of this project is for the PRSB to undertake burden assessments of the data sets across a representative sample of the health and care systems. This will help us obtain a rich and accurate picture of what information is […]

PRSB boosts patient engagement

People are at the centre of what we do, and this year the PRSB is aiming to boost our engagement with patients, carers and citizens. Since we began creating standards for information sharing, we have consulted patients at all stages of the journey, to ensure their voices are always reflected in our work. In 2018, we […]

PRSB supporting development of a digital ReSPECT form

A PRSB workshop is being planned to bring together end-of-life clinicians, system suppliers and informatics professionals to review proposals for a digital ReSPECT form. This is the next step in the work PRSB is currently undertaking with NHS Scotland and Resuscitation Council UK to develop a digital specification for the ReSPECT form, which outlines a […]

PRSB visits NHS Grampian

Further developing our relationships in Scotland, the PRSB recently visited NHS Grampian, to better understand how the health board is pioneering an integrated approach to health and care information sharing and to promote the use of PRSB standards. The PRSB presented our work on transfer of care and integrated care standards and our role in […]

PRSB launches new website

This month we launched our new website to improve how we share information about our growing portfolio of standards for health and care records and our work to support their adoption. The updated site is easy to navigate, with a new tool that allows people to view the contents of a standard in a user […]

Sharing lessons helps trusts to implement standards

PRSB to share lessons learned from trust visits to help others implement standards. A webinar hosted by the PRSB this month outlined some of the key actions that need to be addressed for wider implementation of the e-discharge standard to ensure information in care records is shared between hospitals and GPs in primary care.  We realise that […]

Reducing errors and improving standards of care for patients

Sharing information on patient medications with community pharmacists after hospital discharge is helping to improve care, according to NHS Wales Informatics Service. Following the implementation of the e-discharge summary standard, many hospitals are sharing specific discharge information on medications with community pharmacists, provided they have the patient’s permission. This means that pharmacists can have access […]

Animations bring patient data to life

New series of animations will help raise awareness about patient data In a bid to bring to life its messages, the Wellcome Trust have been working with the PRSB and other supporters to produce a series of animations to demonstrate how patient data is used in the NHS and beyond. The animations, part of the Understanding Patient Data project, […]

Patient portal is helping improve care

Long-term patient at Addenbrooke’s Hospital, Alan Craig, speaks to the PRSB about his experience using the patient portal tool MyChart. Why did you start using the MyChart patient portal? I first got in touch with Dr Afzal Chaudhry, (renal consultant and chief medical information officer at Cambridge University Hospitals NHS Foundation Trust (CUH)), some years […]

Help us improve the quality of GP referral letters

We’re asking for your help with a survey to develop a standard for clinical referral letters to improve the quality of information sent by GPs. When finished, the clinical referral letters standard will complete our suite of transfer of care standards, and will enable hospital clinicians to reduce inappropriate referrals and better manage heavy caseloads.Working […]

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”