Earlier this month, I chaired the Transforming Patient Experience conference at the King’s Fund. Discussion focused on some of the most vulnerable people in our society, which felt timely.
Many would see the way we care for the most vulnerable in society as indicative of the health of our society as a whole.
We all want to improve outcomes for vulnerable people by supporting the way they interact with the health and social care system. If this was done better, it would reduce the strain on the system and nurses would have more time to provide compassionate care.
In the current climate of financial restraint, it is more important than ever to support staff to collaborate with patients and families about their care. Health and social care organisations are being asked to transform their services, while maintaining quality and safety and, at the same time, improving staff engagement – without any real-terms funding increase.
To bring about sustained culture change, frontline staff must be empowered to effect change. Our patient and family-centred care programme worked with a multidisciplinary team at the Royal United Hospital in Bath to support staff to improve care for people reaching the end of their lives. This led to the preferences of patients and families being better understood by the team, and care was planned more effectively. Staff also reported feeling more confident. We have had similar successes working with teams caring for people with advanced dementia and children with life-limiting conditions.
Last week, NHS England announced plans to halve the number of beds for people with learning disabilities. While I agree with the aim of providing care for vulnerable people in the community, rather than in hospital, details of how this would be achieved are hazy.
People with learning disabilities have to be involved – along with their families and healthcare team – to design improved services; these people are best placed, drawing on their own experience, to know what would work for them. Co-design methodology enables this and is being used with success in various parts of the UK.
We were recently commissioned by NHS England to undertake a pilot programme using the experience-based co-design model, in partnership with the Oxford Health Experiences Institute. We hope the lessons from these pilots will inform policy and practice on managing the integration of people with learning disabilities into their communities.
The success of these initiatives rests on leaders creating a culture in which staff feel supported to make this transition. But these improvement programmes are ultimately about empowering frontline care-givers to effect change themselves.
To provide the compassionate care that is the cornerstone of nursing, resources must be managed more effectively. The best way to do that is to understand the needs of the patient and allow them to shape how and where they receive care.
There is strong evidence that efforts to improve the quality of care have the greatest chance of success if they appeal to the intrinsic motivation of frontline staff to provide excellent care. Patient-centred quality improvement does this by reconnecting healthcare staff with the reason they entered their chosen profession – the patients – and putting them in the driving seat to transform care.
There is no underestimating the scale of this challenge, when applied to some of the most vulnerable people using services. But it is one that we have seen NHS staff are more than ready to meet.
Jocelyn Cornwell is chief executive of the Point of Care Foundation