All posts by Emma Bearman

Linking Up Services to Support People’s Needs








Linking Up Services to Support People’s Needs – a conversation proposed by Kath Dyer of St. Andrew’s Court (Exemplar)

This was to a large extent a discovery conversation – swapping notes on local food growing projects and networks, talking about Social Prescribing – for staff working for two new services. These were a residential home for people with complex needs and a multi-disciplinary outreach team for Modality, a company which has recently taken over the running of four GP Practices.

Kath described the facilities at St. Andrew’s Court and gave the example of an elderly man with dementia who was incontinent, needed 3 people to bathe him, was anxious and who had been sleeping in a chair rather than a bed for many months. He is now much less anxious, sleeps in his bed, and often needs fewer people to help bathe him. This level of care is expensive. The group discussed the fact that it is possible to have “all the bells and whistles” in terms of buildings and equipment, but doing activities and making sure that people are looked after and stimulated doesn’t always happen because of staff shortages and attitudes of staff. Members of the group involved in Social Prescribing talked about the practicalities of St. Andrew’s Court, for example transport, whether the home can take direct referrals or referrals through social services, how easy it has been to recruit staff.

The philosophy of the home was that workers were in the residents’ home, rather than residents being in the workers workplace. Activities, timetables and everything other than medication schedules are built around the residents. If they want a lie-in, they have one. Activities need to be useful, entertaining and meaningful, including baking, a sensory herb garden, plans for raised beds in the garden providing vegetables for meals, a probable cat, visits from dogs and a possible llama!

What do we do if the connectivity isn’t there?

What do we do if the connectivity isn’t there? How do we overcome?

This conversation was proposed by Kerry and soon took the form of an interactive art installation made up of knives, forks and soup bowls arranged on the floor – our Open Space event caters for all learning styles!

Some of what was discussed in this conversation was about infrastructure – rural areas have a lot less connectivity than urban – but some of it was about access, which inevitably includes issues such as GDPR and professional status/permissions.

There was also some conversation about how lots of things are linked, but there is always another nook and cranny to find out about, and that is why there is a role for a link person or Care Navigator. There was some frustration – “the system is shit” – but also the (age-old?) realisation – everything is really linked, we all really need each other, we just need better communication.

Kerry created a model in which everything was connected to everything else – so no vertical siloes, just data flowing everywhere in every direction, which she thought would be a good thing, and she asked “Am I being naive?” The answer from Adam Jennison, from Hull City Council’s Smarter Cities agenda, was “Yes”. Kerry was quite happy with this answer, and determined in future that she would direct her attention and energy to smaller number of data hubs, rather than shouting out to everybody! The next question for her was – so which hubs?

Social Prescribing

Social Prescribing (and how to meet people’s needs by connecting to community groups and activities) was a conversation proposed by Jade Whitelock and Joanna Smith of Modality.

Nobody turned up for the first part of this conversation, thus proving another of the laws of Open Space (whoever turns up is the right people!) so the proposer and notetaker had a chat about Social Prescribing in general, and then this conversation merged with another conversation, the one about what we do if Connectivity isn’t there.

Social Prescribing is a new approach for the GPs, which arose from ConnectWell commissioned by the CCG in partnership with Citizens Advice. It was designed to address social needs, loneliness, isolation, sometimes arising from medical needs, mental health needs, poverty. Activities such as gardening, going outdoors, crafts, and art therapy are known to support people’s overall health and wellbeing – what else is going on?

The conversation moved on to a little incident that had happened on Facebook the day before, where an elderly man had asked the group One Hull of a City what he could do to overcome his isolation and lonelinesss, on 2 or 3 days of the week. There were 67 replies, signposting him to Men in Sheds, All For One choir, arts and crafts and social activities all over the city. So what if there is already a fantastic network of social capital, social prescribing, working organically through social media? The man in question said it had been hard to reach out as he did, but he did it. What about those who don’t manage to do that, and what about those elderly people who do not want to learn how to use computers and smartphones, or learn how to use social media? For some, computers are causing isolation and loneliness, and there is a digital generation gap.

Shared Language (on all levels)

Shared Language (on all levels) was a conversation proposed by Louise. At first glance, it appeared that this conversation might be a familiar one, about specialist language and jargon and how it plays its part in multidisciplinary teams. It may even have started out that way.

What it turned out to be, or turned into, was a profound conversation about the necessity for the “team around the person” to be just as person-centred in relation to one another as they are (or aim to be) in relation to the patient. “Everyone’s humanity is part of the team, not just the professionals and their training”.

The conversation started by talking about domain-specific language and the challenges of moving a multi-disciplinary team “into GP-land”, whilst designing services to all be in one place, built around the person rather than sending people from pillar to post. The Protected Time for Learning that is a keystone of the Primary Care Network’s way of working was seen as precious and essential, especially to other disciplines that did not have that integral element of peer- learning, CPD and self-care embedded. Part of the Shared Language conversation became about “What brought you to the profession in the first place?”, the importance of one-to-ones with each patient, the need to take care of your own personal resources and vulnerabilities, and acknowledge this humanity, especially in the context of burnout in Health and Social Care.

“Thank you for seeing us as human beings not just healthcare professionals”.

This led to another strand in the conversation about changing culture, using a conversational model rather than solely a medical model, acknowledging the presence of hierarchy and jargon, and the kind of language expected in reports, but also the value of “gut feeling” and not just the DSM. The “signs of safety” model was seen as a positive, simple, conversational tool to identify what is working well, and what is not, whilst the words “parental capability” and “issues” got the thumbs down!

Technology, Productivity and Workforce in health and care

Technology Productivity Workforce in health and care was a conversation proposed by Dorothy Montgomerie who had a particular interest in how technology impacts the workforce in the context of an ageing population.

This conversation drew the largest number of attendees in the first instance and soon developed smaller eddies around the central emerging theme, which was about drug management, and the ways that people work with, and sometimes confound, the technology.

One of the attendees introduced the newest version of the Medi-Clear medication management system, which the manufacturers are aim to connect up to an app via an RFID tag, to make it part of the Internet of Things. The conversation went into some of the challenges – medication stashers, carers feeling like naggers, the push towards independent living, the way we can all become immune to alarms once we get used to them, and the gloriously detailed data from the Bar Code Medication Administration – which nobody then does anything with. It was acknowledged that sometimes, knowing that a seal has been broken and some medicine has been removed from the pack is not enough, you don’t know if has been taken or not, so there is always another step that has to be taken, by someone skilled and authorised to do so. But the first critical information piece of information – the seal has not been broken, so the medicine definitely hasn’t been taken – provides an alert.

This led to the issue of, for example, recalibrating Warfarin dosages, and ensuring that carers providing domiciliary care, often out in rural settings, were able not only to get the necessary information about dosage changes, but also the right sized doses themselves. It was suggested that Amazon (or another delivery service) could get these out to where they were needed more quickly and efficiently than carers (who have other things to do!). This would then raise the issue of who is responsible when something goes wrong, at what point someone senior signs it off, and who pays for it (and how).

There was a very strong sense in this conversation that there were easier, cheaper ways of doing this (managing care in people’s homes) that we could learn from private sector businesses, that this was the kind of thing that NHSX and NHSDigital should be doing – but that it would all fall down if we don’t have the internet connectivity.

Who is not in the room?

Who is not in the room?

This conversation emerged in part from the Smart Cities one, and the stream that was interested in the initial design of research being informed by local communities, as early as possible in the process.

This conversation ranged widely and made the point that if you want to reach the kind of people who don’t usually come to these kinds of things, then don’t put on another of These Kinds Of Things especially for them. Be creative. Piggyback onto something that is already happening, in places like East Park events like The Big Malarkey, or smaller free events near people’s homes. Bug people in queues. Be creative about how to reach people with mental health issues or mental disabilities. Decide who it is that you want to speak to and reach them through a gatekeeper. Recognise that there are other rings of people outside those know to your gatekeepers – social media can be away to get beyond the initial coterie.

The point was made that what designers of research programmes are looking for is a different perspective – not just a new or good idea from inside their own professional and lived experience – but information from outside that experience. So rather than asking why people are readmitted to hospital, what they might really need to be asking is “what happens when you get home?”. These shifts of emphasis can be crucial. What would you ask people in Bransholme in your shipping container, for example? Not big, open questions. Specific, something meaningful, for example, about the lived experience of a cancer diagnosis, such as how to you travel to and from your treatment, what is that like? If you have to attend an appointment Castle Hill, and it’s 2 buses, in winter, and the appointment is scheduled for 8 am…


Technology – Smart Cities

Technology – Smart Cities

How can it help you? What’s needed? What’s missing?

This was a conversation proposed by Adam Jennison from Hull City Council.

There were two streams flowing through this conversation – one from the NHS that said “There is a problem with data – we have a lot of it, but it is not used as it could be, as it should be, to design services” and one from the local authority that said “In a couple of year’s time, Hull will have the solution to a lot of the data problems, our focus is on the Smart Cities agenda and how data can help you solve real-world problems”.

Strangely enough, these two streams reflected one of the problems that the conversation recognised and raised, discussing as it did the way that data tends to sit vertically in silos, rather than across all services – they didn’t entirely connect with one another. The NHS stream was looking for a human designer to find ways to interrogate qualitative and quantitative data, to bring it to life and make it useful, and through doing, to also decide what level, what depth of data would be useful to gather in future. The Hull City Council stream was saying “no need, just carry on gathering all of the data, on everything, then we will put all the data from all the silos together and patterns will emerge, and that will tell us how to re-design services. “It’s all about measuring, and managing, and once we have this Big Data repository, we can look at which processes we can automate – automating the feedback loop..”

There was some discussion about the development of Contactpoint, a database that was created a part of the Every Child Matters agenda following the failings of multi-agency working demonstrated in the case of Victoria Climbié, and which fell foul of misunderstandings about data protection. Misunderstandings about GDPR still have to be faced to ensure that an Open Data approach can be put to work to reduce gaps, eliminate duplication and improve services, particularly in mutli-disciplinary working.

The other stream said “But what about the questions we haven’t asked, the things we haven’t yet measured, the data we don’t gather, the other, qualitative wisdom in the system, how do we incorporate that into the design of our research studies?” That stream went off and asked some more questions about who is and isn’t in the room…

Progress School – New Dates added and rumours of a party

Mike has been running Progress School for 10 years now, and we think that calls for a bit of a celebration.  The next dates are Tuesday October 29th and Thursday 28th November.  You can register to attend either here. There’s a choice of morning or post work timings to suit.

Oh and about that 10 year thing…

Because we think it’s cause for celebration, we’d like to invite all that have attended Progress School over the last ten years to  our November date for a knees up,  a catch up, a chance to find out what progress has looked like for you over the last ten years. Please do join us at Playlab at the St John’s Centre for a BYOB type party and we’ll celebrate, share and hear the good, the bad and the interesting times together.  Hopefully we’ll get our diaries out and book dates in for 2020 to continue connecting and becoming, If you want to bring something or someone along with you please do. (Emma says she’s got a box of Naked Wines she can’t drink alone so will donate these to the get together)

What if you didn’t come to Progress School but would like to come party anyway? Be our guest

RSVP here