Thursday, July 20, 2017
Case Study: Exploratory research project on the 1290 expulsion of the Jews from England for the Migration Museum Project
The Migration Museum Project (MMP) are planning a new London-based exhibition in September 2017 called “No Turning Back.” The UK charity, which aims to create a museum on migration for Britain, is working with volunteer researchers on six different moments of significance in Britain’s migration past and present to build their knowledge of these moments and develop a public exhibit that is accessible to all ages and a range of audiences.
OPM Group’s Corporate Responsibility Working Group (CRWG) volunteered to contribute to this exploratory research with the MMP. Research on one moment, “The 1290 Expulsion of the Jews from England” began in March 2017 and was completed in June 2017.
OPM Group provided a team of eight volunteer researchers to gather data and manage the collection of facts, images and stories relating to one of six moments the MMP will feature in “No Turning Back”. For the research, we also identified key artists and experts for the MMP to gain additional insight and resources. Volunteer researchers used Google searching and contacts established through the MMP to develop an initial scoping of extant information on the moment.
We then wrote an interim report for the MMP and received guidance on areas for further exploration from the its research and curatorial leads. Volunteer researchers completed additional research on the moment and a final report was submitted to the MMP in June 2017.
Our detailed and accessible report has allowed the MMProject to incorporate an exhibit on the 1290 expulsion of the Jews because of the information we collected. The MMP is pleased with the result of this voluntary work:
“Thank you so much for all your hard work on our account and for your beautifully presented and detailed document. It has helped us a great deal, saved us a huge amount of time and we would never have managed this without you. I hope we can do you justice in the final exhibition.” – Museum Curator.
Monday, September 19, 2016
Health and social care integration in Kirklees
We have worked to develop collaborative leadership across health and social care systems in a number of localities. In Kirklees we were asked to support the creation of a integrated mental health commissioning system as an exemplar from which the whole system could learn.
What did we do
A very senior group of leaders worked together over a number of sessions to develop a shared set of principles and goal – and a series of practitioner workshops began to flesh out what this would mean for front line services. Recognising that success would depend on the strength of relationships between staff in different organisations, we designed and delivered a ‘Skills for Systems Leadership Programme’ for the public health, social care and CCG senior teams – agreeing key health outcomes and providing the skills and techniques that enabled cross-organisational teams to develop shared approaches to changing behaviour and tackling long-standing problems.
The programme built a strong network of organisations and individual leaders, a shared understanding of systems pressures and agreement about the way forward. The work included providing individual coaching and support to key leaders, facilitation and team coaching sessions for top managers and partnerships. The final stage of the programme was to create a dramatic ‘future scenario’ event for fifty or so participants including the voluntary and community sector, from which partner organisations developed a set of principles to guide future shared direction.
Wednesday, April 1, 2015
Introduction of the new Care Act
The launch of the new Care Act today marks the biggest set of changes to adult social care legislation since the formation of the NHS in 1948.
At OPM we’re really looking forward to seeing the impact of this policy in practice, having delivered a variety of projects for different clients in this area. Last year we worked with the Department of Health on a system-wide event exploring the impact of the Act on residential care markets, with an eagerly anticipated report in the works. More recently Hertfordshire County Council (@HertsTraining) tweeted pictures from the launch workshops for the toolkit we’ve developed with them which uses case scenarios to support social workers in the new ways of working the Act requires.
Tuesday, March 31, 2015
Person-centred care: putting patients in control
In England, more than 15 million people have a long term condition. Improving the treatment and management of long term conditions (LTCs) is one of the most important challenges facing the NHS. This requires a shift towards models that are proactive, holistic and preventive where people with LTCs are encouraged to play a central role in managing their care.
Working with rather than doing to
The Health and Social Care Act (2012) requires CCG Boards to promote the involvement of patients, their carers and representatives (if any) in decisions which relate to the prevention and diagnosis of illness, as well as their care or treatment. As recognised by, amongst others, Nesta: people living with long-term conditions face significant challenges, but they also have strengths and abilities including the capacity to manage their own health, given the right support.
While the benefits of person-centred care are increasingly recognised, changes to practice remains patchy and inconsistent (Nesta). King’s Fund (2013), amongst others, argued strongly that encouraging better support for self-management and better use of community assets could create greater value at a cost lower than is possible with the current fragmented network of services. Their call is that CCGs will need to be ambitious if they are to change traditional ways of working and realise the benefits in terms of better outcomes and greater value for money.
Supporting patients to be more active and engaged in their own health
OPM has been commissioned by South East Commissioning Support Unit to develop an online menu of resources – toolkits, training and support, to help commissioners develop transformational models of integrated, personalised care co-designed with patients and carers to better manage long term conditions, reduce emergency admissions and promote prevention.
One of the resources is a an online searchable directory to support self-management, bringing together a useful selection of well known evidence-based tools to encourage and support patients to manage their own health through, for example, shared decision making, social prescribing and personal health budgets.
A directory of online resources alone won’t develop the culture, systems and processes to make the vision of patients in control a reality. To truly put patients at the centre of their own care, attitudes and practice of commissioners, clinicians and patients need to change. It will also require capacity building efforts and CCGs identifying what might provide the most value in their local area.
Creating a better understanding of local offer to support person centred care
Support may not be confined to those normally supplied by traditional health services. To be useful in a local context, GPs and other clinical staff need to have a much better understanding of what’s available locally to support patients in managing their own health and care. Commissioners should be encouraged to work with their local partners (NHS, voluntary and community sector organisations or private sector) to map local social prescribing options in any local area.
Islington is one area where there has been a concerted effort over a number of years to support patients to take a more active role in their care. Islington was a pilot site for the Co-creating Health programme to transform local diabetes care. As one of the first wave national integrated care and support pioneers, Islington have been working with people who have long term conditions such as COPD and diabetes to develop self-management plans, looking at their goals and wishes around care. This has involved more referrals to self-management support programmes, and longer appointments to ensure that better conversations take place in primary care. Islington also recognised the need for greater collaborative working across the area, and one approach has involved commissioning a VCS organisation to run a Health Navigator service that identifies and signposts to different sources of support locally to help improve patient quality of life and maintain independence, in turn delaying the need for more intensive health and social care services.
“Across the country colleagues are embarking on similar projects based on the evidence that shows what a difference person centred care makes to people’s lives… The challenge for commissioners is to respond to this and work with colleagues inside and outside of NHS structures to move person centred care in to the mainstream of healthcare provision.” Dr Katie Coleman, a GP and Vice-Chair of Islington CCG
So, to put patients in control of managing their own health and care there is a clear role for community services and self help. This requires identifying a portfolio or menu of local services for people to choose from, and a willingness on the part of commissioners to fund non-traditional services.
This is the first in a series of blogs to be published following the development of a set of online tools and resources by OPM in support of the person-centred care agenda for South East Commissioning Support Unit. The second is entitled: Person-centred care: measuring impact and the third: Patients in control: ‘assume it’s possible’.
Friday, January 30, 2015
Towards a hate crime care pathway: lessons from Leicestershire
It is Hate Crime Awareness Week, and I would like to take the opportunity to assert the importance of reframing hate crime beyond its narrow criminal justice focus. In a blog for the International Network for Hate Studies last year, I argued that health and social care agencies can play three critical roles in relation to hate crime: (1) to provide treatment and support to hate crime victims; (2) to help prevent hate crimes by identifying and acting on the early indicators of repeat victimization; and (3) as potential offenders, particularly in institutional care settings, where professionals may perpetrate acts commonly termed ‘abuse’ against inpatients.
In the latter half of 2014, I started working with Leicestershire Partnership NHS Trust and its partners on developing a hate crime care pathway. We hope to share learning in order to inspire and encourage others to develop joined up approaches to tackle hate crime and support hate crime victims.
Making it real for health and social care
As a first step, we need to understand the context in which health and social care professionals are working within. For example:
- Effective care is more than simply treating the condition or symptom that a patient or service user may present with. It should be about working to secure wellbeing holistically for the individual.
- Effective care is not simply about individual practice, but is also influenced by the structural issues around how care services are commissioned and delivered.
- Holistic care requires seamless care pathways, with effective referral and signposting.
- Health and social care agencies are working in a context of significant transformations while resources are increasingly scarce. While there are drivers for better integration (e.g. between health and social care), other forces may lead to greater fragmentation (e.g. diversification in the service provider market).
The implications of all the above are then drawn out for health and social care professionals and agencies so that the issues are ‘made real’ for them. For example:
- Victims are not likely to be talking about their experiences using the language of hate crime. Instead, they will be presenting with a range of physical and/or mental health issues.
- Self-harm, depression, anxiety, self-exclusion, hyper-tension, etc. may be proxy indicators of ‘something else’ happening in the lives of patients. Having conversations around the reasons behind manifest symptoms will be important.
- Certain institutional care settings may exacerbate power imbalance between care provider and care recipient. This may lead, for instance, to care workers perpetrating ‘abuse’ against patients and service users.
- The terminology of ‘abuse’ and ‘care failing’ can mean that effective redress through the criminal justice system does not take place.
A conceptual framework
Building on the above, we developed a conceptual framework for informing potential solutions. This involved clustering services into ‘acute’, ‘primary’, ‘community’ and ‘specialised’. Within each of these headings, we worked with partners to identify the types of services that played a supportive and/or prevention function, as well as whether service users are likely to present with physical and/or mental health conditions.
As a result of this, we came to the following recommendations:
- Key ‘points of entry/ contact’ for prioritisation should be community and primary care.
- Mental health appears to be particularly important as a point of intervention. We suggest, in the first instance, to target relevant agencies.
- With the agreed focus, work is underway to clarify procedures for detection, referral, assessment, signposting, following-up, and reporting on to the police. This involves working in collaboration with a plethora of agencies and individuals to co-produce solutions.
Thursday, July 17, 2014
Evaluation of the Integrated Care Communities 2 Programme (incorporating the Integration Discovery Community)
In April 2013 the Advancing Quality Alliance (AQuA) commissioned OPM to evaluate its Integrated Care Community 2 (ICC2) programme; the remit was subsequently expanded to incorporate learning from the Integration Discovery Community (IDC) programme.
The evaluation focuses on assessing which programme elements are:
— Most valued by the members and why
— High impact and the evidence to support this
— Least valued by the members and why
— Missing from the programmes and the value they would add
The evaluation also explores the economic implications and impact of integrated care, and presents short case studies examining the activities within the participating economies.
Overall, the support provided by the AQuA programmes is highly valued by the economies. Economies reported that the community wide events were particularly valuable with specific mention for events focussing on workforce and finance, and contracting and those that included external speakers. Other support that was useful included action learning sets (ALS), peer support sessions and bespoke support provided by The King’s Fund and AQuA, with WebEx sessionsless liked. Participants also valued the critical friend role played by AQuA and the King’s Fund, which provided advice, leadership, expertise and guidance. The tools provided by the programme, especially the Integration Framework helped economies structure their work and measure their progress.
Participants report that the AQuA programme had a positive impact on their progress through for example, acting as a ‘kick starter’ and catalyst for progress, providing motivational support and an impetus to get things done and problem solving and programme development.
Patterns of uptake of support by the economies have changed over time, with some reductions in waves 2 and 3. As economies make progress towards implementing integration their requirements for support change, with bespoke support becoming more important and community wide events becoming less applicable.
Monday, March 31, 2014
Making change happen: Lessons from OPM’s evaluation of AQuA’s Integrated Care Communities Programme
Integrated care is the initiative on everyone’s mind. Currently, NHS England is busy scrutinising applications from localities to access the £3.8 billion Better Care Fund. In order to be successful these plans will have to show how they will make integrated care a reality in their local area. This is of course no easy task. It will require partners to work together more effectively in a climate of increasing financial constraint and growing service demands.
But what does it actually take to make change happen – to create truly integrated care?
For the past 12 months, OPM has been evaluating the Advancing Quality Alliance’s (AQuA’s) Integrated Care Communities Programme. We’ve worked with the 12 participating health and social care economies across the North West of England, to generate learning regarding ‘what works’ in developing and implementing integrated care.
Our evaluation of AQuA’s Integrated Care Communities Programme shows that there is no ‘one size fits all’ approach to making these changes, and prioritising the local context is crucial to the success of any programme.
From the evaluation, we identified a handful of key lessons for those charged with leading integrated care:
- It sounds obvious, but strong, engaged leaders who set out and truly believe in the vision really are vital. Clinical leaders can also play a key role in developing plans for integrated care. They understand how the system currently works, see and hear first-hand how service users experience current provision, and can communicate messages to their peers. We suggest engaging some clinical champions at the outset, and really using their insights to inform the integrated care model.
- Don’t forget the leadership provided by your local project manager – having a dedicated post-holder with time to commit to taking the work forward, as well as the skills and experience needed, is vital. Tagging integrated care development onto someone’s existing job is not likely to be a recipe for success, however difficult a dedicated post might prove to resource in the short-term.
- Having effective governance arrangements within each key partner organisation, as well as across the partnership as a whole, is vital for success. Partners need to have confidence that what’s been promised will be delivered. It’s also important that there are named, accountable managers in key partner organisations: we’ve seen successful examples where there are named leads in the CCG, local authority, community care provider and the local acute trust.
- Ensure there is clarity regarding reporting arrangements and decision making processes. Again, it sounds obvious, but if these aren’t agreed in writing and adhered to, progress is likely to stall. Having an operations group, supported by short-term task and finish groups and reporting up to the board, has proved very effective in sustaining progress in some of the economies.
Service user and carer engagement
- There is an important distinction between service user engagement, consultation, and co-production. However, the terms are often used inter-changeably. We suggest careful consideration at the outset about how you want to engage service users and carers; what do you hope to achieve, how can they add value to the process? To truly co-produce an integrated care approach requires ongoing involvement from the outset, to inform, shape and test out the model of care. It might not be possible to co-produce the model with all harder to reach groups and communities, and so ongoing engagement activities with these groups should also be built in to plans.
- Our evaluation has highlighted that many economies have taken steps to engage service users in the development of their integrated care plans, including testing out tools such as websites and leaflets, giving their views on what currently works well or less well, and helping to shape the vision. However, we’ve seen far less evidence of carers being engaged in these processes. It’s important that the voice of carers – who may be representing some of the most vulnerable service users – is not lost.
- Integrated care models can be developed at team, service or system level. Learning from our evaluation indicates that team level integration may prove easier to realise, but system level integration is likely to offer the greatest potential benefits for service users, commissioners and providers. It is important to be clear about the level of integration being sought, and consider how team or service integration may form vital components of larger scale system integration.
- Our evaluation has highlighted some effective reflective learning processes being used by local health and social care partners. For example, one economy successfully holds regular review meetings involving representative from all the MDTs, using the PDSA cycle to reflect on learning emerging and rolling out good practice across their locality.
In addition to the issues outlined above, it is also vital to consider organisational culture and workforce issues, financial arrangements across the partners (and any associated economic impacts expected from the integrated care model) and contractual mechanisms in place between commissioners and providers.
There are no quick fix solutions to developing an effective integrated care approach. However, evidence from our evaluation indicates that exploring these issues in depth during the early stages of planning your model will enable you to mitigate some of the potential risks and challenges further down the line.
OPM’s evaluation of AQuA’s Integrated Care Communities Programme runs until April 2014 and the full evaluation report will be published on the OPM website.
Thursday, March 6, 2014
Opportunities to exploit and challenges to overcome in the implementation of integrated care
This policy paper is intended to aid policy makers and local health and social care leaders who are taking the integration agenda forward. Informed by a recent roundtable discussion, as well as OPM’s own experience, the paper shares lessons and insights from people actively implementing different integration models.
Tuesday, February 25, 2014
Organisational development of North East Lincolnshire Clinical Commissioning Group
The initial phase of work with North East Lincolnshire CCG (NEL) was one of early governing body development, with a particular focus on distributed leadership and operating as a membership organisation, in line with authorisation requirements. OPM offered learning from elsewhere on these key topics as well as encouragement for new ways of working. NEL were successful in the first wave of authorisation. They now have clear clinical leadership in place and have worked over the past year to balance this with community input and challenge alongside managerial support.
Following a shared diagnostic process with top team members, OPM was invited to further work with NEL to deliver a series of development interventions which were designed to:
- Clarify how the triangles connect with other parts of NEL’s governance structure
- Create a common understanding of the role and remit of the triangles and of each participant’s role within them, with an emphasis on developing mutual respect and an appreciation of the value-adding potential of different contributions.
- Connect the triangles to the wider CCG membership, building skills to create engagement and deliver change.
- Ensure that the managerial and support functions of the CCG are aligned with the work of the triangles.
What we did
To address these aspirations OPM facilitators worked first with the three groups of clinical leads, lay members and managers separately to explore how each group saw the contribution of each of the three roles and what helped and what hindered from their perspective. These group discussions surfaced a great deal of previously unspoken confusion, a lack of clarity about the extent of their discretion to make decisions, some uncertainty about what those in other positions could contribute, and a real acknowledgement of how little conversation had so far taken place about this fundamentally important aspect of the CCG’s operation.
We then arranged and facilitated meetings with the three members in each of the eight service area triangles, invited them to reflect on a share their thoughts about the earlier group meetings, and then worked through a typical cycle of commissioning tasks and their roles and likely contributions at each stage with them. Through this process of more informed, open and focused discussion, differences were discussed and greater clarity about roles, responsibilities and areas for development emerged. Feedback to and discussion with the top team about their role in modelling ‘triangle’ thinking , behaviour and culture set the scene for a whole system workshop which brought all the triangle members together with the senior team to agree the key elements of future work in NEL and the means to their achievement.
From the perspective of early 2014, we feel confident that the challenge and support we contributed to NEL’s organisational development has led to some longer term changes, in line with the CCG’s strategic intentions. The clinical chief officer has recently commented that: ‘The way care is delivered has shifted to be responsive to community wishes and priorities – it’s no longer only about clinical priorities’.
Thursday, February 20, 2014
Breakfast Seminar: Realising the power of patients to produce tangible and radical reforms – Moving from the possible to the essential in the new NHS
Since the Health and Social Care Act came into force last year, engaging patients and the public in the future of the NHS is no longer an option for commissioners, but an obligation. But simply knowing that engagement must be done is not the same as knowing how to do it. Considering patient engagement as simply an obligation overlooks the transformative power of understanding patients’ experiences and perspectives.
If the vision of a health service shaped by patients is to become a reality, then patients must be successfully and meaningfully engaged at all levels of the system – shaping policy and system reforms, directly involved in service delivery changes and transforming the dynamic between patients and their healthcare providers.
This may sound simple, but the methods used to engage patients will vary considerably depending on what patients are being engaged about.
The challenge then for health professionals is to put in place engagement methods that are best suited to different contexts – and to do so in a way that maximises efficiency and effectiveness. With resources increasingly scarce, this challenge can both seem daunting and unaffordable.
At this seminar we’ll hear from patient engagement experts about the challenges and opportunities they face, and learn from innovative examples of engagement already underway in the health service and beyond.
Olivia Butterworth, Head of Public Voice, NHS England
Dr David Tomson, Collingwood Health Group, and north east primary care lead for the Health Foundation’s MAGIC Programme.
Mark Webb, non-clinical Chair, North East Lincolnshire CCG
Dr Tim Williams, co-founder, myClinicalOutcomes
The seminar will be held at Body & Soul, a five-ten minute walk from Angel tube station. Breakfast and registration starts at 8.30am (ready for a 9am start) and the seminar will be finished by 11am. If you have any special access or dietary requirements, please let us know and we’ll do our best to accommodate them.
If you have any questions, please get in touch with Rosie Keefe at email@example.com or on 020 7239 7816.