North  Lincolnshire  ELC™  PATH  Planning  Workshop:  Keeping  Well  and  Living  an  

Independent  Life    PATH  Planning  Event    

   26  JUNE  2013    

 

WELCOME    

Alison Manson And

Georgina Craig

The  Team  today    

Hilary, Maria, Wendy N Linc ELC™ Practitioner

By  the  end  of  today  we  will  have:  1.  A clear understanding of what

matters around keeping well and living independently

2.  Co created our vision of great support around keeping well in 2016

3.  Co created an action plan 4.  Individual actions of what we and our

organisations will contribute 5.  HAD FUN - doing this in a new,

participative and inspiring way!

The    commissioning  quesOon    

“What needs to happen to keep YOU and YOURS well and living an independent life in North Lincs?”

What  we  did:  talked  and  learnt  from  you  (March  2013)  

Building on existing assets and insights – listening and learning from the community about how best to reach people with this conversation

You  said.  We  did  

YOU  SAID  •  “You  need  to  do  an  on  line  

survey  as  well”  •  “Talk  with  parents  of  pre  

school  children  -­‐  in  Children’s  Centres”  

•  “Don’t  run  sessions  in  colleges.  Young  people  won’t  engage  there”    

•  “Think  about  people  living  with  disabili@es”  

WE….  •  Developed  and  are  running  

an  online  survey  in  parallel  •  Ran  5  events  in  Children’s  

Centres,  talking  to  different  groups  of  parents  

•  Looked  for  other  ways  to  reach  out  to  young  people  

•  Talked  to  parents  of  children  living  with  disabili@es  

AND  supported  20  Community  Networkers    (April  2013)  

AND  exisOng  assets…  Reviewing all relevant existing insights: •  JSNA summary •  CCG stakeholder consultation •  Carers needs assessment (n=230 people) •  Who cares? GP access report •  Reports: people living with mental health issues •  Ulseby and Haxeby Plans •  ELC™ Programmes: Outpatient and End of Life

Care •  Reports mental health services •  N Lincolnshire ‘In the Pink’ data……AND MANY

MORE!!

This  ELC™  Co  Design  Work   A chance to listen deeply to what matters most to people

What  we  did  (07  May  –  27  June  2013)  

Mapped local peoples’ current and desired experience from the following perspectives: •  Parents with young families •  Parents of children living with disabilities •  Care home residents •  Older people •  People living in recovery from drug and alcohol issues •  People who work (mainly in public services including frontline health professionals and caregivers

The  engagement  numbers  

•  13 Events in 4 weeks

• Over 160 people

•  Thousands of insights into what matters around keeping well and independent

What  we  would  like  to  learn  more  about  in  the  next  6  months  Peoples’ current and desired experience from the following perspectives on keeping well: •  Experience of pregnancy and caring for babies 0-2 years •  Young people in education and school leavers •  Housebound older people •  People working (private sector) •  Unemployed people •  Experiences people from Eastern Europe

INSIGHTS  SO  FAR  

What  ma^ers  most….   RELATIONSHIPS, RELATIONSHIPS, RELATIONSHIPS •  Feeling supported and understood (listened to) by

1. family/friends AND 2. care givers •  NHS recognition of importance emotional well being

to keep well / remaining independent •  Flexible, reassuring care during crises/ transition •  Connection with someone with similar lived

experience (role model/peer who has overcome) to support people through transition/crisis

•  Well honed life skills: setting up home; parenting, caring / supporting a loved with a long term health issues – parent, spouse, child

What  ma^ers  most….   RELATIONSHIPS, RELATIONSHIPS, RELATIONSHIPS •  Having a safe person to connect with (relationship)

within the ‘system’ (not always or necessarily a health care professional)

•  Keeping mobile as long as possible •  Caring for others / contributing •  Being happy and feeling safe

People  say…   DON’T BELIEVE CURRENT SERVICES HELP KEEP THEM WELL AND LIVING INDEPENDENTLY Yet this the essence of what the NHS/Council commissioners seek to do (AND could do as an employer)

People  say…   ITS FEELS LIKE UNTIL YOU HIT CRISIS, HEALTH SERVICES ARE ABSENT. WHEN YOU ARE IN CRISIS, PEOPLE FEEL UNSUPPORTED Currently commissioned services are reactive – not proactive and do not focus on prevention

We  saw…   FAMILIES WITH PRE SCHOOL CHILDREN, CARERS, OLDER PEOPLE, PEOPLE EARLY IN RECOVERY ARE ESPECIALLY VULNERABLE They are often in transition. They need a close relationship with someone supportive connected to the ‘system’ (not always a health care professional)

We  saw…   THE LIFE SKILLS YOU LEARN DETERMINE YOUR ABILITY TO KEEP WELL – AS DOES THE COPING STRATEGIES YOU ARE ABLE TO CHOOSE AND EMOTIONAL WELL BEING Commissioners can invest in building these skills and emotional well being

We  say  and  people  say…   WE WANT TO GIVE BACK / MAKE A DIFFERENCE – INCLUDING THOSE WHO MAY HAVE BEEN/FEEL ‘WRITTEN OFF’ Commissioners can build on this by investing in managing and developing the rich seam of community good will through volunteering

Emotional maps CURRENT

Keeping Well in North Lincolnshire Emotional Map: CURRENT EXPERIENCE

Childhood

Copyright GCA Ltd 2012. All Rights Reserved.

Life skills Transition Emotional

loss Crisis Positive coping strategies

Physical health

Mental well being Relationships

Purpose

uninformed about stroke

prevention

Guided, supported

Parents always there

Learnt myself Positive role

models

SUPPORTED good

networks Understood

Helped Lucky

Listened to

Brilliant Awesome

Loved Supported

Encouraged happy

Confused lost

vulnerable

Sad depressed Vulnerable

Alone Awful

frustrated

CARING FOR FAMILY CARING

AT WORK CONTRBUTING

DOING THINGS I LIKE

Happy understood Content

Independent Keeping well

Pragmatic Family support Advised buddy relieved

Optimistic positive attitude

Not aware NHS helps with this

Lost Worried

about falling Pathetic

No support young people

SUPPORTED BY FAMILY FRIENDS

COLLEAGUES Key worker

GP Care home staff kind/ know me

Gardening /

sport makes me happy

positive Upbeat happy

Talking variety exciting

Less isolated Gets you out

Confident Heal yourself

Vulnerable depressing shocking Isolated

hated angry classed as

trouble

Confused depressed

little no support NO SUPPORT Confusing Inflexible

Vulnerable Distressing

angry

Good

Low morale, vulnerable, bored, dependent, depressed, misunderstood Stressed angry no control

Want to meet peers, Seldom see GP, scared to seek help, frustrated, unsupportive employer

Bored, no variety, no one to look after ,

emotional, challenged Don’t know

Comfort eating no job

Emotional maps DESIRED

Keeping Well in North Lincolnshire Emotional Map: DESIRED EXPERIENCE

Childhood

Copyright GCA Ltd 2012. All Rights Reserved.

Supported Stable Loved

Encouraged Guided

Life skills Transition Emotional

loss Crisis Positive coping strategies

Physical health

Mental well being Relationship

Purpose

uninformed about stroke

prevention

Guided Encouraged Prepared Involved

Supported Informed Cared for

CARING FOR FAMILY

CARING THROUGH WORK

Gardening sport Sharing knowledge

Volunteering Learning

Being independent Hopeful

Optimistic engaged

SUPPORTED Competent

Easy to access/ navigate Compassion

Understanding Flexible

non judgemental Safe

Dr fantastic

Listened to Support

Reassured Understood Cared for

Guided Able

Prepared

Listened to understood

SAFE At ease Inspired informed

Supportive Peer support

GP knows me well Flexible

HAPPY Support each

other family\ Friends

Colleagues Understood independent

Fresh air Accessible cheap

Connected Walking Guided

Reassured Motivated Confident

Family activity

Current  emoOonal  ‘lows’   •  Coping with emotional loss •  Maintaining emotional well being •  Feeling support through times of transition (especially if a person has no family support) •  Improved experience of crises in care

The  essence  of  keeping  well   •  Support •  Being listened to/understood as a person •  Caring for others (making a difference)

This fits with what we know from the evidence and research into well being /

happiness

The  mismatch  with  health  and  care  service  experience   The things services often fail to do are: •  Support people when life is tough •  Listen to/understanding the person •  Support people to retain their sense of purpose e.g. care for others, make a difference, do things that make them happy ESPECIALLY DURING CRISIS/TRANSITIONS

What  we  found  out  (exisOng  insights  from  other  CCG  work)  

•  Carers •  People at end of life •  People living with 4 long term conditions

Key  messages:  carers  •  Do not see themselves as ‘carers’ – get a huge sense of

meaning and purpose from caring for their loved ones…. (this keeps them well!)

•  Unaware of welfare benefits, local ‘carers payments’/’breaks services’, training they can tap into ( poor uptake impacts on their financial health and emotional/physical wellbeing – and life chances young carers)

•  Scared /reluctant about leaving loved ones with others; need lots of reassurance about quality (FIRST respite experience really matters)

•  Want greater understanding of loved one’s health condition so they can care/ advocate better. Feel ignored by health/care system.

Key  messages:  carers    •  FLEXIBLE support (training) ‘life skills’; managing personal/

medical care •  Ignore their own health needs and focus instead on the

person. Often means seek help too late and become ill – HIGH RISK GROUP

•  Great local assets to build on: the voluntary sector - especially Carers Support Centre – potential for a hub and network to support carers/families to keep well and live independently (can be COMMISSIONED TO IMPROVE OUTCOMES for carers)

•  Being able to work keeps carers well. Understanding, flexible employers critical - public sector = major employer – ‘could do better’

Key  messages:  people  at  end  of  life  •  Talk  more  about  death  and  dying–  a  big  culture  change    •  Create  a  systemaOc  way  to  support  forward  plans  for  

desired  end  of  life  experience  –  so  friends/  family/health  care  system  all  know  what  ma^ers  

•  Involve  nurses  in  sharing  bad  news  •  Focus  on  improving  end  of  life  care  older  people  and  

those  without  a  diagnosis  of  cancer  •  Make  end  of  life  care  ‘everybody’s  business’  •  Support  carers  around  end  of  life  especially  well  Vision  of  great  care:  “Person  centred,  community  based  24/7  care  that  focuses  on    ‘what  ma;ers  to  person/family’  delivered  by  compassionate,  well  supported  teams  working  flexibly  because  of  great  relaDonships  with  each  other  (care  professionals)  and  with  people/families  -­‐  coupled  with  smooth,  appropriate  admission/discharge  from  hospital  and  peer  support.”    

Key  messages:  people  with  long  term  health  

Outpatient services: •  Frustrating experience that adds little value;

unclear why need to go there. Often wait hours for tests; appointments cancelled or no one expecting them when they arrive

•  Learn nothing to help improve ability to self care and manage their condition.

•  Often have mobility issues so getting to outpatients difficult - because of location, car parking. Going to bursars office on a separate floor and pharmacy difficult too

•  Staff frustrated and buried in paperwork that adds no value to care quality. Can’t book transport; leaves them feeling guilty/powerless

•  Going through discharge lounge improves experience; even if long wait, at least this is a nice place to wait

What  we  found  out  about  talking  with  the  community   •  Pre school families •  Families with children at school •  Families with a disabled child •  Older people who live in care homes •  Older people living in their own homes •  People in recovery drug and alcohol misuse •  People who work (mainly in public services)

Key  messages:  preschool  families  (Childrens  Centres)   •  Invisible to system unless have a child •  Want to learn life skills. Crave connection with older role models

(male/female). If no family, less able to develop coping strategies •  Deny impact smoking on child health (CCG work) •  UNSUPPORTED through transition e.g. birth, crises and emotional

loss e.g. relationship break up •  UNSUPPORTED (no relationship) midwives; evidence undiagnosed

depression; no help with bottle feeding only breast feeding = pressure

•  Want to be listened to (esp single parents) and trusted. •  No emotional support NHS; want information about sources

support and easy DROP IN INFORMAL ACCESS SUPPORT including: child health advice, someone to talk to (feel alone)

•  Childrens Centres ‘fantastic’ – build on this asset; support from other mums valued too. More family orientated fitness activities; not much for babies (less than used to be)

Key  messages:  families  with  children  at  school   •  Mixed experiences of learning life skills •  NHS not a source of support with emotional loss •  Poor experiences of crises in care •  Parents mixed confidence levels around keeping physically/

emotionally well; coping strategies. •  Signs of a sub group not coping well (underlying anxiety) – may be

they at high risk mental health issues •  Friends/family - and caring for others = key purpose •  Some struggle to exercise / keep physically well

This group are keeping well and coping better than younger parents. They may be an asset to support younger parents to

transition and others. There are some who may be at risk

Key  messages:  families  with  disabled  children     •  Strong sense of community - special school acts as a source of support (access hub) to keep well •  Siblings and grandchildren play a key role in supporting parents /grandparents with disabled children •  Working provides respite, keeps parents well and able to care •  Are a resilient group

Key  messages:  older  people  living  in  care  homes     •  Feel well cared for; ‘wonderful’ care home staff •  Seeing a GP/nurse is rare. NHS absent. Scared to go to GP when ill.

Fear what the GP will say. Worry about health issues; especially falling and failing mobility - frustrates and depresses them

•  Crave variety: meeting new people; more fresh air, ‘getting out’, exercise, music, being alone – regardless of mobility. Some would like more control and choice – including more privacy; more space

•  Want to keep as independent as possible - do things for themselves as long as possible. Being dependent gets people down

•  Looking after and talking with other residents keeps people well –- PURPOSE

•  Visits from family are VERY important. Supporting older family members to live in the same home and close to relatives makes visiting and keeping connection easier. This keeps people well

•  Good care home staff with a bit more time to ‘understand who I am’ critical to well being

Key  messages:  older  people  living  independently   •  Worry about dementia (failing mental health) more

than physical health •  As get older, easier to cope with life’s ups and

downs •  Want to look after themselves as much as possible

e.g. emergency medication to prevent exacerbation, information and support to self care

•  Volunteering and caring for others (family, friends) keeps older people well

•  Regular health checks reassure people •  Walking and getting out and about is really

important – doing it together gives people confidence; sense of being safe and provides a chance to meet others / connect. Facilitating this is key

Key  messages:  people  in  recovery  drug  /alcohol  misuse     •  Common trigger for substance misuse is not coping with

emotional loss; child hood experiences; being in care •  Often learnt life skills from peers – less often from parents. May

have had few inspirational adult role models when growing up •  Put off and fear seeking help – in case they are arrested when they

are in crisis •  May be happy in what other see as crisis. Get huge sense of

belonging from taking drugs; numbs emotional pain. •  Through recovery, the pain is still there. This is a critical transition

to support and it is often neglected / less well supported •  Close, supportive relationships with care workers are critical and

support recovery and keeping well •  People in recovery have learnt to embed positive coping strategies.

They have a lot of experience and wisdom to share with others – not just those who – like them - are in recovery!

Key  messages:  people  who  work  (mainly  in  public  services)     •  Strong sense of energy around ‘purpose’ = to care and make a

difference to people’s lives and experience of hospital •  NLAG workforce feels very low at the current time •  Front line do not feel NHS supports them to keep well – even

routine check ups difficult = ironic •  People feel guilty taking time off when ill = letting colleagues down •  Peer support is massively important to well being; needs to be built

with intention and supported by managers •  Management disconnected from front line staff – unaware of the

value staff are adding – and so missing opportunities to accelerate improvement in services and care experience

•  Strong dissatisfaction to GP service provision •  Perception that managers do not understand what adds value

(including discharge lounge) •  Clinical supervision helps; buddy system gone; peer support key

EMERGING  IMPROVEMENT  CHALLENGES  NORTH  LINCS  

 Emerging  improvement        challenges  N  Lincs  

•  Build relationship based care and community – especially around existing community hubs (including childrens centres, hospital, special schools, care homes, outpatients, carers centre)

•  GPs more proactive (especially in care homes)

•  Look after NHS employees better •  Understand and leverage services that are

delivering value (and those not)

Emerging  improvement  challenges  N  Lincs  

•  Get transition right •  Prevent crisis by understanding/mapping

how people experience transitions – including emotional loss

•  Support carers •  Be understanding employer; keep

employees well •  Improve experience of crisis •  Focus on supporting people with

emotional well being; building positive coping strategies

Emerging  improvement  challenges  N  Lincs  

•  Invest in life skills support – especially for vulnerable young people (those in care; less supportive family background)

•  Build peer support networks / mentoring/ role models

•  Give NHS staff space to support each other

•  Help people maintain sense of purpose (especially older people; those in care homes)

•  Measure different things

IntroducOon  to  PATH  Planning    

Alison Manson ELC™

Today’s  work…..     Develop a PATH Plan and focus on the question: “What needs to happen to

keep people well and independent around

here?”

EXAMPLE  PATH  PLAN  

PATH  FLOW    1.  Or Ambition: North Star Dream 2.  Our possible, positive future in

3 years 3.  Now 4.  Enrolment 5.  Strengths 6.  Bold Steps 7.  Next Month 8.  Next Steps

PATH  Process    •  Working in our table groups –

highly participative •  Table top facilitator at each

table to support you •  Feedback from the room;

individually and by table •  Consensus building as we

complete graphics and commit anything to the PATH

THIS IS YOUR PATH !

Our  AmbiOon:  North  Star  Dream  Orientation: our guide; draws us toward our best work. Unreachable and inspiring, The north star reminds why we are doing this work on our bad days… Action: •  Slow down. Think deeply. •  Notice what comes to your mind first. •  Jot down the words. Notice and hold onto the images •  Share the words and images that come to mind.

PosiOve  Possible  Future  2016  Orientation: after HARD WORK and GOOD LUCK, we have made great progress. Standing in the future, describe what we have achieved... Actions: •  Describe the detail of the vision •  Focus on possible and positive change

Now  Orientation: Come back to now. We want to realise that future. Describe where we are starting today. It's about describing the facts. Not fixing them Action: •  Capture the top three things we need to notice about now

Enrolment   •  Sign the PATH if you want to come with us and make this improvement happen •  Who else do we need to enroll to make this happen?

Strengths  Orientation: now we know who is coming with us, what assets/ strengths do we already have and what do we need to build? Action: •  Complete proforma table provided •  Pick the most important strengths and share with the group

Our  Bold  Moves  Orientation: these are our ‘headlines’ - the main themes in our story of change. They are game changers that accelerate progress and our best work. They are the brave risks – the leaps we will take to make big change happen. Action: •  Identify 2-3 Bold Moves •  For each, agree 3 key actions

Next  month  Orientation: to maintain momentum, taking action in the next month is critical. What happens now sets the tone and the foundations for success. We want quick wins to spur us on. Action: •  Identify key actions for next month •  Share and agree the critical ones

First  Steps  Orientation: what you personally commit to doing in the next 24 hours? A social interaction works best e.g. telling someone something; asking for help Action: •  Think of ONE thing YOU will do to move this work forward •  Write it down. Commit to doing it

AppreciaOon  Orientation: reflect on how doing PATH planning has made you feel. Action: •  Discuss and reflect •  Share your thoughts •  Write them on the PATH •  NAME the PATH together

Feedback  is  a  gid  …    

1. What went well today? 2. What could we improve?

Thank you for your hard work and commitment today

Close  &  Next  Steps    

Caroline Briggs North Lincolnshire CCG

Two  ways  we  will  be  using  this  work  to  help  us  

Pioneers for integration Sustainable services

Our  framework  for  supporOng  our  community  to  keep  well  

•  Conception to 2 years •  Children with disabilities •  16-24 year olds •  Frail older people

THANK  YOU  SO  MUCH