PRSB launch the #CareAboutMe campaign at the Digital Healthcare Show

PRSB exhibited across both days of the Health Plus Care Show, and took the opportunity to launch the #CareAboutMe campaign. Following a rush of social media activity, attendees made their way over to PRSB’s stand to share their About Me story and find out more about how the standard can help them. You can watch professionals and suppliers sharing their thoughts on the campaign here.

The Health Plus Care Show, a multi-strand event, took place in the ExCeL London on 18 and 19 May, with keynote speeches from leaders in the digital health space, including Simon Bolton. The agenda was expansive, with several themes including the technology and innovation, digital transformation and integrated care.

PRSB Stakeholder Manager, Alannah McGovern, and Head of Marketing, Andy Hall

We also led on two speaking sessions. PRSB social prescribing lead and Link Worker, Sarah Moreton, kicked things off on the Wednesday with her talk on the evolution of the social prescribing standard and its importance to the profession. She explained that social prescribing is highlighted in the NHS Long Term Plan as being essential for accelerating the provision of personalised care, but this can only happen if the data collected is structured and standardised for easy use by Link Workers. Using the standard not only helps deliver personalised care but also supports joined-up care across service providers and produces research ready information that can be used for taking action on inequalities.

Sarah Moreton at the Digital Healthcare Show

Later that day, the PRSB data and analytics panel took to the stage to give attendees their perspectives on how data analytics is improving prevention, prediction and treatment in health care. Hosted by PRSB Chair, Professor Maureen Baker CBE, PRSB Clinical Director, Dr Nilesh Bharakhada, was joined by Owner of Ramsey Systems, Charlie McCay, and Barts Research Data Scientist, Sophie Williams, to share their expertise.

The Data Analytics Panel

Charlie was the first to highlight the importance of standards for structuring data and making it ready for exploration and research. He explained that a person’s data needs to be available wherever they interact with the system, rather than just at their GP, which is why need a framework of standards so this data can be transferred, viewed and then meaningfully used for analysis.

Sophie and Nilesh then shared two case studies where structured data had supported good analysis. Sophie stated that Barts have created a standardised data set for COVID-19 information data set that has been used to flag diversity issues in covid trials and Nilesh said that by using structured diabetes data, GPs across North West London have been able to spot poor performance on check-ups and level up services accordingly.

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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.