Employee spotlight: Oliver Lake, Transition CEO for PRSB

We sat down with Oliver Lake, PRSB’s new Transition CEO, to ask him a few questions about his experience, what drives him, and a bit about life outside of work.

Oliver Lake portrait shot


What initially drew you to your field, and how has that passion evolved?

My first job at age 16 was in Data Input and IT support at a GP surgery after finishing my GCSEs (my mum was a receptionist there) …and I rapidly learnt about the importance of both having the right tools for the job and how vital training is to use clinical systems properly.  I will always remember the practice manager tearing her hair out because of the inconsistencies in quality between different teams, meaning that reporting was mixture of system-generated data, forms and in some cases referring back to the Lloyd George notes!  Since then, I have always had an interest in technology and data, and I also spent 15 years working in NHS communications and transformation to broaden my horizons.

 

What skill or expertise do you bring to the table at the PRSB?

I hope relevant background and experience in how to make change happen, taking the lesson that if you are over ambitious, persistent and determined you will see far greater improvement than if you hadn’t had such high aspirations in the first place.

 

What’s a recent project or initiative you’ve been involved in that you’re particularly proud of?

There are so many PRSB projects that I am proud of, but I’m going to pick our recent work on Person Characteristics for NHS England where we gathered intelligence on the clinical information requirements related to person characteristics – to help identify data items which are routinely needed when treating patients, but which aren’t generally available within IT systems in use in the NHS.  It was an incredibly thorough piece of work, delving into specifics which are vital to maintain patient safety and also dignity and respect.  Both our team (Sarah Jackson, James Critchlow and Steve Bentley) were amazingly dedicated to the quality of consultation and analysis, but also the NHS England team (Cath Chilcott and colleagues) were a delight to work with.  I really hope the report can be taken forward and we will support this as much as we can.

 

What difference do you think standards can/do make to health and care?

I don’t think that the vitality of standardised high-quality data can be underestimated – even little seemingly inconsequential differences in recording data can have a huge impact on patient outcomes and the ability to use data for population health.  More than that, listening to our patient representatives tell their stories (and I’m sure we can all relate to this) about having to repeat history, tests and personal preferences when they move between providers really incentivises us to solve that problem.

 

What changes do you hope your role/PRSB can make to health and care?

I want PRSB to provide more system leadership so that high quality standardised health and care data enables better and safer care, empowering innovation and building trust in technology-driven health such as AI.

 

If you could make one change to the health and care sector, what would it be?

To invest in implementation and evaluation, rather than just the procurement of a product of solution.

 

What is your favourite thing about your job?

The people – both in the PRSB, but working with our amazing clinical leads, patient representatives and across with our members and partners – I’ve not met anyone who does not want to make things better or is negative about the potential from the analogue to digital shift. What is so enjoyable about working at PRSB is that one minute you can be in the detail of diabetes, then it will be social care, then it’ll be maternity – there is so much learning possible by working across the sector and across the 4 nations.

 

Do you have any hobbies or talents?

In our house, painting is often referred to as my ‘hobby’, although I would much rather be riding my Vespa, or playing darts!  My ’talent’ is playing the piano by ear – you name a song, and I’ll bang it out!

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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.