Better care in my hands: A review of how people are involved in their care

 Better Care In My Hands describes how well people are involved in their own care and what good involvement looks like. | Care Quality Commission

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People’s right to being involved in their own care is enshrined in law in the fundamental standards of care. It is an essential part of person-centred care and leads to better and often more cost effective outcomes.

This report is based on newly analysed evidence from CQC national reports and inspection findings, as well as national patient surveys and a literature review. It identifies what enables people and their families to work in partnership with health and social care staff and illustrates this with good practice examples from our inspection findings.

Key findings

  • Just over half of people asked say they feel definitely involved in decisions about their health care and treatment.
  • Women who use maternity services are particularly positive about how well they are involved in decisions about their care.
  • We found examples of good practice of people’s involvement in their care in our inspections over the last year.
  • There has been little change in people’s perceptions of how well they are involved in their health or social care over the last five years.
  • Some groups of people are less involved in their care than others. They are:
    • Adults and young people with long term physical and mental health conditions.
    • People with a learning disability.
    • People over 75 years old.
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For commissioners:

The CQC are encouraging commissioners to support this effort by making sure that there is:

  • Accessible information about health and care options and treatment or support for people and their families/carers
  • Flexible advocacy provision as people use different services
  • Coordinated community and peer support for people to manage their care through programmes with voluntary sector partners

Integrated personal commissioning framework

NHS England and the Local Government Association has published Integrated  personal commissioning: emerging framework.  This document is for commissioners in both CCGs and local authorities, their delivery partners in education and the VCSE sector, and for local authority and NHS-funded care providers.  The framework sets out the future model of care for patients and families with the most complex needs.

The emerging IPC framework is characterised by five key shifts in the model of care, underpinned by a number of specific service components. Together these drive improved outcomes for people, the system and the tax payer:

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ANTIMICROBIAL RESISTANCE: A Patients Association report to assess whether Clinical Commissioning Groups are fulfilling their stewardship responsibilities in the battle against antibiotic resistance

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The threat of antimicrobial resistance (AMR) represents arguably the greatest patient safety challenge of our time. It has been widely reported that the world is on the cusp of a ‘post-antibiotic era’, with the growth in treatment-resistant bacteria raising the prospect that modern medicine will be increasingly unable to treat what are currently considered to be routine infections. Without effective antibiotics, cancer treatments, childbirth and many other operations would also be far riskier. If we are unable to reverse this trend, it has been estimated that AMR could kill up to 10 million people a year by 2050, with a cumulative cost to the global economy of £70 trillion.

Evidence suggests that we may also be nearing this cusp sooner than originally thought. In December 2015, a report in the Lancet Journal of Infectious Diseases demonstrated that certain strains of bacteria found in patients and livestock across China had started to become resistant to the ‘last resort’ antibiotic colistin.8 This development effectively means that bacteria causing a number of gut, urinary and blood infections in humans are at risk of developing pan-resistance, and could become untreatable by all currently-available antibiotics.

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In recognition, this report explores the extent to which Clinical Commissioning Groups (CCGs), key organisations in terms of delivering local antimicrobial stewardship (AMS) programmes, are taking the challenge on-board and enacting key recommendations helping to manage the threat of AMR.

Read the full report here

Place-based services of care

Public Health England. Published online:12 May 2016

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The government requires all local areas to integrate health and care services by 2020. The place-based approach offers new opportunities to help meet the challenges facing the NHS.

The place-based approach offers new opportunities to help meet the challenges facing the NHS.

Place-based systems of care (PDF, 1.27MB, 51 pages).

Healthcare professionals are essential to the commissioning and delivery of integrated services for individuals, communities and population and provide Right Care, that maximises:

  • the value that the patient derives from their own care and treatment
  • the value the whole population derives from the investment in their healthcare
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See Right Care programme

Local government has been leading the place-based agenda using influence to promote the general wellbeing of communities and citizens.

Read the full guidance here

NHSCC and Hunter Healthcare report launch new report ‘What makes a top clinical commissioning leader?’

NHSCC. Published online: 10 May 2016

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Clarity about the future of the commissioning system, a commitment to developing GP leadership, and improved leadership programmes, have been identified as critical to supporting current and prospective clinical commissioning leaders, in our new report with Hunter Healthcare.

Through a series of interviews with both clinical and managerial CCG leaders, the report, sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning.

The report highlights how both clinical and managerial leaders are integral to the success of a CCG, bringing different strengths to the organisation and its ability to deliver more for patients. For example, clinical leaders bring a working knowledge of their local healthcare system and are able to draw on their clinical expertise to make a credible case for change, whereas leaders with a professional managerial background tend to have clearer insight into operational and financial details.

It also identifies qualities that make a top clinical commissioning leader including resilience, openness, emotional intelligence and being good communicators, with excellent listening skills and the ability to instil clarity of purpose.

Read the full report here

What makes a top clinical commissioning leader?

NHS Clinical Commissioners has published What makes a top clinical commissioning leader?

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This report highlights how both clinical and managerial leaders are integral to the success of a CCG, bringing different strengths to the organisation and its ability to deliver more for patients. The report sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning.

Read the report ‘What makes a top clinical commissioning leader?’ here.

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Report challenges ability of NHS to achieve parity of esteem

Centre for Mental Health Blog. Published online: 9 May 2016

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A report published today by NHS Providers and the Healthcare Financial Management Association has once again raised questions about the ability of the NHS to achieve its stated ambition of ‘parity’ for mental health care. The report, based on a survey of mental health provider trusts and local clinical commissioning groups, found that in many areas, NHS England’s requirement of a real terms rise in mental health service funding was not getting through to the organisations providing most of the specialist services that are available.

The report is one of many in recent months and years, based on surveys or Freedom of Information requests, that have tried to piece together what is happening with NHS mental health spending. The picture that emerges is an incomplete one, but it strongly suggests wide variations between local areas amid widespread pressures on services everywhere.

It is possible, of course, for a CCG to increase mental health spending without passing it all to mental health trusts, for example through expanding primary care provision. But data from the NHS Benchmarking Network shows that the number of people using mental health trusts’ services is growing year on year, and if funding isn’t rising commensurately, this raises concerns about the quality or intensity of support people are being offered.

Read the full commentary here

Read the full report here