'person-centred care' related prevention examples and research

Growing old together: sharing new ways to support older people

COMMISSION ON IMPROVING URGENT CARE FOR OLDER PEOPLE
2016

Final report from the Commission on Improving Urgent Care for Older People which provides guidance for those involved in designing care for older people and outlines eight key principles the health and care sector can adopt to improve urgent care for older people. The Commission was established out of a concern that the care system was not meeting the needs of older people, resulting in lower quality of care, a lack of out-of-hospital services as an alternative to A&E, not enough focus on prevention and early intervention, and delayed transfers of care. It brought together a range of experts, received over 60 evidence submissions; carried out visits to sites using innovative ways to deliver care; consulted with NHS Confederation members and patient and carer groups; and commissioned an evidence review. The report draws on the evidence to look at the case for change. It then outlines eight key principles that can be used when redesigning health and social care system: start with care driven by the person’s needs and personal goals; a greater focus on proactive care; acknowledge current strains on the system and allow time to think; the importance of care co-ordination and navigation; greater use of multi-disciplinary and multi-agency teams; ensure workforce, training and core skills reflect modern day requirements; leadership should encourage us to do things differently; and metrics must truly reflect the care experience for older people. Short case studies of innovative practice are included in the report, covering acute and primary care, voluntary sector and local government partners and commissioners.

People helping people: year two of the pioneer programme

NHS ENGLAND
2016

Describes the journey taken over the last year by the integrated care pioneers. The 25 pioneer sites are developing and testing new and different ways of joining up health and social care services across England, utilising the expertise of the voluntary and community sector, with the aim of improving care, quality and effectiveness of services being provided. The report describes the progress, challenges and lessons learnt across the pioneers. A number of key themes have emerged, including: population segmentation to determine people’s characteristics, their needs and care demands; using the experience of people; providing proactive care; providing integrated care services; supporting integration through using shared care records; using technology to support different access points; analysing impacts through data; and removing financial disincentives. Also included within the report are pioneers’ stories which describe the core elements of their care models and showcase how these are impacting real people.

Place-based health: a position paper

STUDDERT Jessica, STOPFORTH Sarah
2015

This position paper sets out some of the challenges in achieving a fundamental structural shift in the health system, citing new evidence from health and local government professionals. The paper sets out the potential of reimagining health as place-based, taking an asset-based approach and focusing on shaping demands in the longer term and ultimately producing better health and wellbeing outcomes. Underpinning this approach is the recognition of the wider determinants of health, where fewer health outcomes result from clinical treatment and the majority are determined by wider factors such as lifestyle choices, the physical environment and family and social networks. Place-based health would mean reconceptualising ‘health’ from something that happens primarily within institutions, to involve all local assets and stakeholders in a shift towards something that all parts of the community, and individuals themselves, recognise and feel part of. This would mean the individual would move from being a recipient of interventions from separate institutions to being at the heart of place-based health. The paper intends to lay out the challenge for the Place-Based Health Commission, which will report in March 2016 and recommend practical steps for professionals in health and care to overcome organisational barriers – real and perceived – and make a fundamental shift towards an integrated system that puts people at the heart of it.

How do we develop a person-centred, community-centred workforce, to support people with long-term conditions?

COALITION FOR COLLABORATIVE CARE
2015

This discussion paper explores how to plan, develop and support an integrated workforce that routinely works in a person-centred, community-centred way. The paper focuses in four areas, looking at: mind-set challenges for person and community-centred care; the specific knowledge and skills that are needed; the importance of supportive working environments; and capacity, roles and workforce planning. The paper is intended to stimulate discussion. It briefly sets out some ideas on: the context and what we mean by person-centred, community-centred care; the workforce challenge; what is needed to create change at the local and national levels; and what action the C4CC partnership might take.

Building contingent capacity: shifting power in organisations to become more responsive to the people they serve

KAUR-STUBBS Sukhvinder
2015

This paper sets out research to understand and work within the emerging landscape in which organisations find that the people they serve acquire greater prominence among their multiple stakeholders and power gradients have to adjust accordingly. Respect for the dignity of people and how organisations respond to their needs, wishes, gifts and aspirations are becoming pivotal. Drawing on a survey and participation of 20 sector leaders at a roundtable hosted by the University of Birmingham and funded by the Barrow Cadbury Trust, the research proposes a framework for organisations to review and, if necessary, restate the priority given to people (commonly called users), develop practice that encourages reciprocity in the design and delivery of products and services, and establish processes that are pervious and accountable to people and their networks. At the core of the framework is the concept of contingent capacity. Contingent capacity is purposeful, distributive and empowers workers (staff and volunteers), to listen to and respect people and, inspire their participation. The approach comprises three stages, which include: Purpose and Power – against a backdrop of more assertive citizens and a changing socio-economic environment, reviewing how the organisation continues to respect the dignity of the people it serves and ensures they are able to contribute to decisions that affect them; Reciprocal Engagement – recalibrating practice and culture to give greater priority to people and encourage deep and iterative engagement; and Outcome Plus – ensuring processes optimise value, not just to the organisation but, also, to the people and the wider communities around them.

Care Act guidance on Strengths-based approaches

SOCIAL CARE INSTITUTE FOR EXCELLENCE
2015

This guide summarises the process and the key elements to consider in relation to using a strengths-based approach. Sections provide information on what a strength-based approach is; the information practitioners need to carry out an assessment; using strength-based mapping; and key factors that make a good assessment. It also looks at how local authorities can extend the use of the strengths-based approach from assessments to meeting needs and provides a summary of core local authority duties in relation to conducting a strengths-based approach. It should be read in conjunction with the Care and Support (Assessment) Regulations 2014 and Chapter 6 of the 'Care and support statutory guidance', published by the Department of Health.

Fit for frailty: part 2: developing, commissioning and managing services for people living with frailty in community settings

BRITISH GERIATRICS SOCIETY, ROYAL COLLEGE OF GENERAL PRACTITIONERS
2015

Provides advice and guidance on the development, commissioning and management of services for people living with frailty in community settings. The first section introduces the concept of frailty and sets out the rationale for developing frailty services. The second section explores the essential characteristics of a good service. The third section considers the issue of performance and outcome measures for frailty services. The appendix to the report includes eight case studies of services which are operating in different parts of the UK. The audience for this guidance comprises GPs, geriatricians, health service managers, social service managers and commissioners of services. It is a companion report to an earlier BGS publication, Fit for Frailty Part 1 which provided advice and guidance on the care of older people living with frailty in community and outpatient settings.

Supporting self-management: summarising evidence from systematic reviews

NATIONAL VOICES
2014

This booklet sets out research findings of the benefits of supporting people to self-manage. It also sets out the evidence for the impact of self-management education for patients, proactive telephone and psychosocial support, home-based self-monitoring and simplified dosing strategies and information. Self-management includes all the actions taken by people to recognise, treat and manage their own healthcare independently of or in partnership with the healthcare system. People feel more confident and engaged when they are encouraged to self-manage by professionals, therefore supporting self-management is key to prioritising person-centred care. Drawing on the findings from 228 systematic reviews, the paper concludes that the top three things that might most usefully be invested in are disease specific, generic and on-line self-management courses, proactive telephone support and self monitoring of symptoms and vital signs.

MDT development: working toward an effective multidisciplinary/multiagency team

NHS ENGLAND
2015

One of three handbooks to support commissioners, GP practices and community health and care professionals in planning and providing personalised care for people living with long term conditions. The handbook brings together information about multi-disciplinary and integrated teams and looks at the types of teams that need to be in place to deliver integrated healthcare. It provides definitions of multi-disciplinary and multi-agency teams and also sets out a tool, the MDT Continuum, that describes different types of care team functioning. Four models or stages of multidisciplinary teams are presented, ranging from from unidisciplinary to transdisciplinary team working. Good practice examples representing each of the stages or models. The final section provide information to help integrated commissioning. Other handbooks published separately cover risk stratification and case finding and personalised care and support planning.

Care Act 2014: a strengths-based approach

SOCIAL CARE INSTITUTE FOR EXCELLENCE
2015

One of the aims of the Care Act 2014 is to promote people's wellbeing and independence. By using a strengths-based approach to the assessment process, people can be supported to understand their needs, realise what they can do, and how to best use their skills and networks, to achieve their outcomes. This film looks at what is meant by a strengths-based approach and how practitioners through the assessment process can enable people to be at the centre of their own care and support needs. [This film is no longer available].