Late last week, NHS England published its business plan for 2015/16. It includes 10 priorities, of which ‘tackling obesity and preventing diabetes’ comes 4th, after improving, upgrading and transforming care for, respectively, cancer treatment, mental health & dementia and learning disabilities. It’s ahead, in the list of priorities, of urgent and emergency care, primary care, elective care, specialized care, whole systems care and foundations for improvement.
Of course, the list isn’t really about priorities of decreasing importance, all of these issues are of equal importance and will, we hope, receive equal attention, not to mention equal share of the some £2bn budget. Having a list of 10 makes it easier for people, including presumably NHS England staff and politicians themselves, to read and remember. It’s unarguable that all these issues need to be acted upon and also that system change is badly needed to address the early 21st century health ‘state of the art’. On that note, the business plan is to be welcomed and being 4th doesn’t mean losing out.
The targets for ‘tackling obesity and preventing diabetes', focuses on Type 2 diabetes (a detail unfortunately left out of the title) are ambitious for a year’s work. By March 2016, a prevention programme will be ‘available’ for 10,000 people at risk of Type 2 diabetes. NHS England will be working with Diabetes UK and Public Health England to develop the programme and roll it out, partly via the NHS Health Checks system. The plans are to ‘enroll’ people identified onto a lifestyle management programme to address their ‘smoking, alcohol intake, nutrition and physical activity’. The latter also applies to plans in priority 4 to also encourage these factors to be addressed by NHS staff themselves. It’s not clear if the latter will be among the 10,000 initial 'enrollees' or if there is to be a separate programme for healthcare staff.
While the forthcoming programme sounds admirable, we have a concern, based on the old saying ‘you can take a horse to water, but you cannot make it drink’. That is, it is one thing to ‘refer’ or ‘enroll’ people onto a lifestyle programme, but quite another to ensure attendance or participation. These the only things that are likely to make a difference to the health of the 10,000 souls to be identified. So, in the spirit of ‘4s’, we hope that the prevention programme in development includes this ‘top 4’ of evidence-based, vital components for success in encouraging lifestyle change:
1. ‘Invite’, ‘encourage’ or ‘welcome’ people to take part, rather than ‘refer', ‘enroll’, ‘send’ or any other paternalistic term that removes any suggestion of free choice
2. Focus on success and the future in interactive and participatory, enjoyable activities
3. Scrutinise the programme for, and remove any evidence of, judgement, tellings off, compliance-orientation, school or classroom-like environments
4. Prize autonomy, choice and personal decision-making
As we have said before, we wish this programme well and sincerely hope that this time next year, despite the election and our reservations, our blog will be trumpeting the success and ongoing delivery of type 2 diabetes prevention.
Reference
NHS England Business Plan
Showing posts with label targets. Show all posts
Showing posts with label targets. Show all posts
Monday, 30 March 2015
Sunday, 6 July 2014
Will Commons Health Committee Help Turn Rhetoric into Reality?
Brilliant this week, to see a UK Government Health Committee report into the management of Long Term Conditions. It’s very long, over 200 pages and contains some very fine words indeed, based on a great deal of evidence gathered from a large number of organisations and individuals. It’s a fascinating read, including the transcripts of the discussions between the committee members and those giving evidence.
The committee gives its view that care for people with long term conditions cannot fit into the traditional model of health care, which is based on curable, ‘single episode’ illnesses. It says that more time is needed to hold more personalised discussions with people about their wants and needs, that the person, as well as the condition, needs to be treated, and that care planning, including results sharing and giving people access to their medical records is an appealing way forward. It urges NHS England to take note of their findings and implement new ways of long term conditions care. It seems to challenge the Government and NHS England’s response to the growing numbers and needs of people with long term conditions by describing their strategic response as unclear and insufficiently urgent.
This is very welcome news, and absolutely bears out our own experience when offering our training and skills development, which is that the rhetoric of policy is very far removed from the reality. This is particularly noticeable in relation to promoting person-centred approaches, and collaboration in care. Practitioners understand the need for this and are keen to put it into practice, but the systems that they are working in and with (for example the targets to be achieved to receive funding and payment) simply do not support it. A particular example recently has been cited in a number of our workshops. It concerns the target to reduce unplanned hospital admissions among older people. Each organisation needs to identify a certain percentage of people, upon which they are rigorously measured. It is taking up a great deal of time and effort, to the extent that trying to discuss, let alone implement, any other practices (for example care planning among the younger, able bodied) that might actually prevent people in future being vulnerable to admission, is almost impossible. The short term nature of these kind of initiatives is striking and the idea of ‘cart before horse’ often springs to mind, as does the expression ‘what gets measured, gets done’ (and, sadly, its reverse)
Two passages of the report are worthy of reproducing here as they so resonate with the above:
‘We are not convinced that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of long term conditions which seem to be driving patients….into acute care (Page 5, Summary)
and
‘we have been struck by the mismatch between the needs of 15 million service users with one or more long term conditions, and the design of health and care system set up principally to treat and cure episodes of ill-health’ (page 43)
Although reports such as this one take time to circulate and get attention, we are at least cheered that it seems that some aspects of Government are not only listening, but hearing, and producing strong words. Seeing those words turned into action – and quickly – could really make a difference. We watch and wait, while continuing to spread the word about these important issues in our own publications. Well done, that Health Committee.
References
House of Commons Health Committee (2014). Managing the care of people with long-term conditions. London. The Stationary Office.
Person-Centred Practice for Long Term Conditions: a Concise Guide to Success
The committee gives its view that care for people with long term conditions cannot fit into the traditional model of health care, which is based on curable, ‘single episode’ illnesses. It says that more time is needed to hold more personalised discussions with people about their wants and needs, that the person, as well as the condition, needs to be treated, and that care planning, including results sharing and giving people access to their medical records is an appealing way forward. It urges NHS England to take note of their findings and implement new ways of long term conditions care. It seems to challenge the Government and NHS England’s response to the growing numbers and needs of people with long term conditions by describing their strategic response as unclear and insufficiently urgent.
This is very welcome news, and absolutely bears out our own experience when offering our training and skills development, which is that the rhetoric of policy is very far removed from the reality. This is particularly noticeable in relation to promoting person-centred approaches, and collaboration in care. Practitioners understand the need for this and are keen to put it into practice, but the systems that they are working in and with (for example the targets to be achieved to receive funding and payment) simply do not support it. A particular example recently has been cited in a number of our workshops. It concerns the target to reduce unplanned hospital admissions among older people. Each organisation needs to identify a certain percentage of people, upon which they are rigorously measured. It is taking up a great deal of time and effort, to the extent that trying to discuss, let alone implement, any other practices (for example care planning among the younger, able bodied) that might actually prevent people in future being vulnerable to admission, is almost impossible. The short term nature of these kind of initiatives is striking and the idea of ‘cart before horse’ often springs to mind, as does the expression ‘what gets measured, gets done’ (and, sadly, its reverse)
Two passages of the report are worthy of reproducing here as they so resonate with the above:
‘We are not convinced that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of long term conditions which seem to be driving patients….into acute care (Page 5, Summary)
and
‘we have been struck by the mismatch between the needs of 15 million service users with one or more long term conditions, and the design of health and care system set up principally to treat and cure episodes of ill-health’ (page 43)
Although reports such as this one take time to circulate and get attention, we are at least cheered that it seems that some aspects of Government are not only listening, but hearing, and producing strong words. Seeing those words turned into action – and quickly – could really make a difference. We watch and wait, while continuing to spread the word about these important issues in our own publications. Well done, that Health Committee.
References
House of Commons Health Committee (2014). Managing the care of people with long-term conditions. London. The Stationary Office.
Person-Centred Practice for Long Term Conditions: a Concise Guide to Success
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