What is the Buckinghamshire Integrated Care System?

I attended the Buckinghamshire Health and Social Care Integration Summit in November 2017 when the new Integrated Care System was discussed by representatives from the local authorities, health care system, local charities & the voluntary sector and some members of the public (me included). 

Sadly the presentations went over time so there was no time for questions (not good!) but I did send my questions into the organisers.  I have now received the response to those questions.

Of course the name of the new system has been changed in the meantime.  However the purpose of the new system remains the same.  So for Accountable Care System (ACS) please read Integrated Care System (ICS).

Q1. Is there any extra funding for Buckinghamshire ACS to invest in Public Health & community services?

Answer: NHS England is offering Accountable Care System (ACS) transformation money to support us to meet our priorities and go further, faster. Opportunities to bid for further funds do often arise.

In addition to monies that may be made available through the ACS, we are investing £1 million in community services, bringing together nurses, therapists, social workers, GPs and other relevant organisations to provide 24/7 cover for people who need the greatest health and care support and give them better, more coordinated care in their homes. 

Q2. ‘Accountable’ to whom? How can the public hold this new organisation, which most know nothing & were not consulted on, to account?

Answer: The ACS is not a new organisation, it’s about further developing our system way of working, which supports:

•       Joined up working between health and social care services to provide better care and help people to stay healthier

•       Staff to work together easier across our provider and commissioner organisations

•       More local control and freedom to make decisions

•       Extra support to go further and faster in improving services

It will allow us to have stronger local relationships and partnership work based on common understanding of local priorities, challenges and next steps.

Q3. How will the public know that the ACS has achieved its purpose, indeed what is its purpose?  What baseline measures do you have for outcomes, organisational, financial and patient outcomes, so we can compare the improved public health & other outcomes in the future?

Answer: The purpose of our system working is to achieve our vision for “One Buckinghamshire, one integrated health and care system”, by further developing our community-focused approach to integrating services and collaborative working across the county. 

We have a track record of success on working collaboratively to improve quality, transform service models and build financial sustainability. Some of our successful working to date includes:

A system wide Primary Care Strategy,  agreed in 2015 and with strong clinical leadership across primary care that has seen the development of a nationally recognised innovative alternative, the Quality and Outcomes Framework, with outcomes that build a ‘fit for purpose’ future primary care service. This has established a care and support planning approach in primary care resulting in Buckinghamshire being the best for diabetic glucose control in the country.

A Buckinghamshire Provider Alliance agreed between FedBucks, Oxford Health NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust, with a commitment to integrate seamless services for patients;

Care Closer to Home – Integrated Adult Community Healthcare teams have provided 24/7 services since 2012. Locality led initiatives include the introduction of the Airedale model remotely supporting care homes and enhanced primary care teams supporting frail elderly people developed from our system work on Multi Agency Groups;

We are piloting the development of Community Hubs including increased community based services, short term packages and a new frailty assessment service, reducing the use of overnight community beds;

A collective approach to engagement – with a single communications and engagement team across Buckinghamshire County Council and the Clinical Commissioning Groups working closely with colleagues in provider trusts.

Q4. One example of an ACS in Canterbury in New Zealand. This has taken ten years to achieve its aims and required extra funding for public health, community services & social care.  We do not have the luxury of time not it seems any investment.  We need improvements now to maintain the quality of care services & to improve outcomes. Can this ACS do in a short time what took Canterbury 10 years to achieve & without extra funding?

Answer: We do recognise that like Canterbury, we are not going to be able to achieve what we want overnight. Some work streams will take longer than others. However in the meantime we are equipping ourselves with the lessons learnt from the Canterbury project, as we have been able to meet with them and apply this where appropriate to our work.   We have also set ourselves some priorities to deliver for 2017/18, which include:

•       Providing more joined-up care closer to home, through community hubs and integrated teams working with groups of GPs, tailoring care to the needs of their local communities.

•       Making it easier for people to get urgent care when they need it, including out of hours.

•       Improving and simplifying care for diabetes and musculoskeletal problems.

•       Improving and increasing access to mental health services, including for children and young people.

•       Improving the prevention, diagnosis and treatment of cancer.

Q5. How will the Bucks ACS improve retention and recruitment of staff? What is the effect of the ACS on the working conditions of staff, on their Terms and Conditions, GP surgery & Pharmacy contracts etc.?

Answer: Staff will continue to be employed by the organisation they currently work for and as such there will be no changes to their terms and conditions or contracts as a result of Buckinghamshire becoming an ACS.

We hope that being an ACS will help to improve retention and recruitment of staff in a number of ways.  By working closer together across the system it will make it easier to make sure we’ve got the right people in the right place at the right time. Job satisfaction will increase as together we will be able to provide better care in the community, at home or in hospital, helping people to stay healthier.  There will also be greater career development opportunities for our people, as they will have the opportunity to work in integrated teams or rotate across different health and care settings. As one of the first ACS we believe the opportunity to get involved in something that is exciting and innovative will also be an attractive prospect for some.

Q6. What will be done to improve access to Primary Care Services & GP services, especially in places like High Wycombe and the rural parts of Buckinghamshire?

Answer: Improving access to primary care services and GP services is central to NHS England’s Five Year Forward View (FYFV) and General Practice Forward View (GPFV) and so is a key part of much of the work at Aylesbury Vale and Chiltern CCGs.  We also have a number of work streams in place specifically designed to ensure the population of Buckinghamshire have timely access to appropriate primary medical services. This work is being done in the context of the development of an ACS for Buckinghamshire which encourages partnership working across the whole health and social care system and whose benefits are already positively impacting on improved access for primary care services.

NHS England launched the General Practice Resilience Programme (GPRP) as part of the GPFV, which is designed to secure sustainability of GP surgeries by tackling many of the issues that are creating pressures on general practice and threatening the viability of practices. A key part of the GPRP in Buckinghamshire is to encourage practices to work together in clusters on a range of projects which improve access to primary care services, for example, developing integrated teams with a focus on integration with other primary care professionals (nurses, pharmacists) or improved working with the voluntary sector, addressing the needs of high intensity users of primary care, out of hours services and A&E by better working with social services. We now have thirteen such clusters beginning to form local plans across Bucks.

In addition, GPRP funding is being used to train care navigators in general practice. Care navigators provide front of house signposting of patients to ensure they receive the right care from the right healthcare professional, or alternatively are able to access social care or services from the voluntary sector.

Many practices are also using or developing alternative methods for patients to access primary medical services such as on-line booking of appointments, Skype and telephone consultations.

So that access to primary care services in and out of hours is seamless for patients, we are also in the process of commissioning extended access into primary care services whereby patients will be able to book an appointment with a healthcare professional 8am to 8pm Monday to Friday.  We will also be looking at whether we need to commission this type of service at the weekend (although experience from elsewhere suggests that routine appointments for primary care services at the weekend are poorly utilised).  We anticipate that 100% of the Buckinghamshire population will be covered by this new service by March 2019.

The extent of the work means that all residents of Buckinghamshire should see an improvement in access to primary care services whether they live in a town or rural area. A key part of cluster working is for practices to understand and plan for the needs of their local area, including how different groups access services. As the CCGs develop working as part of the ACS this locality focus will widen out to other health and social care providers to create an integrated care system with timely and appropriate access at its heart.

Q7. Buckinghamshire has already squeezed the local health economy and has, just about managed its finances but there are now signs of stress in that a deficit is forecast for this year.  Is the ACS really just a means to balance the books rather than improve quality of care? Buckinghamshire has already made many changes to remain within the financial targets so what other changes can be made in the way that hospitals deliver acute care more efficiently?

Answer: Becoming an ACS is certainly not just a means to balance the books although we are hoping that by working better together we can find ways of delivering higher standards of care more cost efficiently.  For Buckinghamshire Healthcare NHS Trust, being part of an ACS is about how we can work with our partners in the system to ensure the residents of Buckinghamshire stay healthier for longer - now and in the future. Research shows that it is in the best interests of patients to stay at home and receive treatment locally. We are working as a system to achieve this, ensuring that acute care is there for those that really need it and that all patients are seen at the right time, in the right place, first time.   We believe greater transparency and openness between organisations – working towards a common goal – means that we would reduce duplication and stop moving money around the system, instead focussing on where the greatest support and investment is required.

Q8. There is a mismatch between what senior managers/civil servants NHSE say and the views of those providing and reviewing care on the wards, in outpatients & GP surgeries!  We need to bridge that gap – what is being done to do so?

Answer: We take the views of our staff extremely seriously and hold regular informal and formal feedback sessions to understand any issues or to hear suggestions for how we can improve things.

We know that our staff have the solutions and so an important principle for our ACS is for there to be strong clinical and staff leadership, and that we actively involve and engage our patients and communities to co-design future services.

Improving Mental Health Services - the fifth priority

Mental Health Services have to be specifically included in the Sustainability and Transformation Plan for Buckinghamshire.  These services are already provided across Buckinghamshire by a range of providers, the main Trust covering both Bucks and Oxfordshire already.

The priority for the Clinical Commissioning Groups (CCGs) is:

"Mental Health development to improve the overall value of care provided."

They describe this as :

"Develop a network of providers of specialist mental health care across a larger footprint of STPs coordinating inpatient and community based services."

What do I think this means?

Well this is a guess but I reckon this means they want to increase the number of organisations that provide specific services. They want to do this across a bigger area than they do at present. This might mean that patients have to travel further for their mental health care.

They realise that this means an increase in the number of organisations providing services and that they will be spread across the SE of England. This in turn means that this care needs to joined up and seamless. Good communications are essential as is an improvement in transport for patients across our poor road & transport network.

Do they have the resources to coordinate the fragmented nature of this care? Will they be able to influence the Councils responsible for roads and public transport to improve the roads and buses?

I am not sure!

What is STP and what does it mean for Buckinghamshire?

The STP is is short for Sustainability and Transformation Plan. However I guess that doesn't really help does it?

Well it is really the last hope we have to save the NHS because the Government does not want to spend any more of our tax on our healthcare. So instead they want to split England into 44 regions and have told these regions to changes the way services are provided. Our region includes Oxfordshire, West Berkshire as well as Buckinghamshire. But really our plan is a Buckinghamshire plan.

Apparently if we continue to carry out healthcare activity in the way we have been doing it over the last 20 years it will cost £107 million more over the next 5 years than we have money to pay for it. The costs will be much more than our income!

The aims of the plan is to improve outcomes by 2020/21.

The Bucks plan has seven priority areas.

I will try to  explain what they mean - but I cannot promise that my view is the correct one so I suggest you write and ask for the official version.

The Famous seven are:

"Shift the focus of care from treatment to prevention"
"Access to the highest quality primary, community and urgent care"
"Collaboration of the three footprint acute trusts to deliver equality and efficiency"
"Maximise value and patient outcomes from specialised commissioning"
"Mental health development to improve the overall value of care provided"
"Establish a flexible and collaborative approach to workforce"
"Digital interoperability to improve information flow and efficiency"

You can see that the language is a bit 'management speak' and I will try to explain what I think each one means as best I can. I will do a separate blog for each priority.

I write this on a ward in a specialist centre as I wait for my operation tomorrow. I hope that I will be able to complete all seven blogs over the next week as I recover.

Don't just talk - do something.

Have you ever talked about your GP surgery over dinner, sitting in a café, standing in the checkout at the supermarket….?

Well you are not alone!

A Million people a day use their GP surgery and most of those will have something to say about the experience.

Most of those experiences are good.

However sometimes us patients have ideas about how to make the experience of talking with a GP or practice nurse better.

There can be problems with the phone service, making appointments isn’t always easy, seeing your own GP can mean waiting weeks, no privacy at the reception desk, access can be difficult for those with disabilities and as for car parking…!

So instead of talking about things on your own – join your Practice Patient Participation Group (PPG) and do something about them.

A patient participation group is a bunch of volunteers who want to make a difference.  They work with the practice to gather information from patients and to make suggestions about improvements.

They look at the surgery and ask:

What works well?

What works less well?

Are there services that are not provided but would benefit patients?

They also run an annual patient survey, hopefully the questions are set by the patients not the surgery.

Sadly General Practice is going to have to change. Being part of your PPG is one way you can help to make sure we keep the best bits of General Practice

Your voice on its own is very quiet.

But the voice of the many people in the PPG is much louder and will be listened to.

Please join your Practice Patient Participation Group.

Ask at reception or look on the practice website.  Maybe there is a social media page?

Has General Practice passed the tipping point?

Is this the future?

Unless something dramatic or revolutionary happens at the Department of Health after the election have we seen the end of General Practice as we know it?

Here are three possible scenarios.

Scenario 1.

GPs become consultants in the management of patients with complex and unsorted symptoms. Everything else i.e. minor illnesses, uncomplicated long term conditions, social issues, work related problems, etc. will be managed by other members of the Primary Care Team: Pharmacists, advanced nurse practitioners and physician assistants.

The GP will assess, investigate and sort out patients presenting with undifferentiated symptoms and look after patients with multiple co-morbidities and complex needs.

Patients will no longer have direct access to a GP.

Scenario 2

GPs will become disease specific consultants working in the community.  All acute patients will be managed by pharmacists, NHS 11, nurse clinics & physician assistants.

 Patients will no longer have direct access to a GP.

Scenario 3

Co-payments. Patients will pay for their primary care, perhaps with government paying for a set number of  consultations per year.

Personally I do not think that civil servants and politicians do ‘revolutionary’!

I am sure there are others scenarios.  Please suggest some.

How have the public influenced commissioning of healthcare in Aylesbury?

I asked my local Clinical Commissioning Group (Aylesbury Vale CCG) a question about providing examples of how the public has influenced commissioning in advance of their board meeting in public on Thursday April 10th.

Here is the reply from their clinical leads:

My Question: Can you please give examples of where the voice, opinions and experiences of patients and the public has influenced decisions made when commissioning services?

Christine Campling:

We did extensive public consultation on the inter mountain project by focus groups and questionnaires. There was full support for changing the range of options on outpatients to a mixture of face to face, telephone and Skype like consultations. We are currently running questionnaires on pain clinic projects, as we are redesigning the pain pathway.

Stuart Logan:

We have met with Patient Groups in the South Locality for their input into Live Well particularly the Haddenham Patient Participation Group.

We are involving Diabetes UK in the diabetes service redesign. They will have patients at the Stakeholders meeting in May inputting into the redesign process from day 1.

Juliet Sutton:

When they were doing a full review of Occupational Therapy and Speech & Language Therapy services for children, they went out and spoke to a lot of parents of children using the service.  Parents wanted shorter waiting times, a more responsive service, improved technology and access to health professionals in settings closer to them e.g schools and children's centres. All these views were incorporated into the new service design and there have been great improvements in the service since then. The children's physiotherapy service is currently under review and once again the views of parents and carers are being taken into consideration when making recommendations for service improvements.

We are currently undertaking a review of the services provided for children with complex needs/disabilities. Parental feedback is a large part of this process and their comments are being taken very seriously when planning future more integrated care. Single point of access is a recurrent theme from the feedback we have received and this will be one of our main objectives with future recommendations.

Lesley Munro-Faure:

commissioning plans are driven by localities and each locality has members of the public sitting on them who input into all the decisions that are made.

My comments: 

I had hoped that I might get a list of things the patients & public has said or suggested and a another list showing what the CCG had done as result of the comments from patients. 

I had also hoped that I would get examples showing actual changes in how services are commissioned instead I seem to have got examples of consultations & involvement in redesigning services. And there is nothing wrong in seeing examples of patient participation in redesign.

There are examples of good work especially with the work done by the therapy services for children.

The last paragraph of their reply puzzles me.  There are three localities in the CCG and I know that one of them does include members of the public in the group.  But the other two locality groups consist of clinicians only.  Anyway this last paragraph does not give examples of how the public have influenced commissioning.

I will follow up this answer at the board meeting and I will blog about it if anything new is mentioned.

Better Care Fund - Mission Impossible?

The government having just made the biggest re-organisation of the NHS is now insisting that local health and social care economies now embark on another! 

Health and Wellbeing Board which only came into existence 12 months ago are now developing plans to use the Better Care Fund.   This fund is drawn from existing funds from health and social care commissioners. The total could be around £4 billion for England and in Buckinghamshire the fund will be nearly £100 million. This is three times the size of the fund that other areas are implementing!  Are they being too ambitious?

What will this fund do?

The Better Care Fund is to be used to integrate health and social care services, especially for older people.  It is hoped that this integration will reduce costs and improve the quality of care (in that order).

Many of us have asked for a closer integration of health and social care and so we should be welcoming this new work.  But should the timer scale for developing the project be longer than 12 months?  Can these new organisations, barely out of nappies, successfully implement such a big change in the way services are commissioned?

 Patients, especially those with long term conditions  & the elderly need care and support and they get that support from many different agencies – the NHS, Social services, the voluntary sector, the private sector, families and friends to name a few. Currently some care is called health care and some is called social care. But patients don’t really care what it is called. Or who commissions & funds it.  What they want is for it to be provided without any gaps, when and where they need it.  

They don’t want to have to go to one lot of people for one sort of care and then go through another assessment for more support! They just want to go to one point to ask for help.

So this Better Care Fund sounds as if it a good idea. But some say it will not save money and will not improve services.  They say there is no evidence that it will achieve these objectives.

I am also concerned that locally the public and patients have not been involved in the design of this new service.   As usual we will be involved and consulted with in the middle of the process rather than at the beginning.   Who is to carry out that involvement?  It is Healthwatch Buckinghamshire who are virtually unknown to the population of Buckinghamshire.   Will they be able to carry out a meaningful engagement with the public, let alone real involvement in the design of the new service?

Finally who is going to manage this fund, who will monitor the quality (and quantity) of the care? Who will be accountable?

It’s a mystery!

You can see the latest update on Buckinghamshire Health and Wellbeing Board's plans here

Here is a review of the evidence recently published by the University of York which suggests that these schemes should be rolled out cautiously and may increase overall costs.

A&E issues in Buckinghamshire

There are a lot of unhappy people in the south of Buckinghamshire, especially in the High Wycombe area.  They want their A&E and other hospital services back! The sad truth is that this is unlikely to happen.

As I have written about previously (What is happening to my hospital)  the A&E service closed down in 2005 and first there was the Emergency Medical Centre then in 2012 there was the Minor injuries and Illness Unit (MIIU). This must have felt like a downgrading of services each time there was a change.

The authorities did not do a good job in explaining the reasons for these changes to the residents of High Wycombe and the surrounding area.

As part of their inquiry into the actions being taken as a result of the Keogh inquiry into Buckinghamshire Healthcare NHS Trust the county Council health and social care select committee is going to examine the provision of A & E services.

I am predicting that they will say something along these lines:

• Better facilities for A & E should be provided at Stoke Mandeville Hospital.
• More permanent  Consultants, junior doctors and nurses in A&E are needed at Stoke Mandeville Hospital.
• Better parking is needed  at Stoke Mandeville Hospital.
• Better transport links (roads and public transport) between High Wycombe and Aylesbury are needed.
• An effective and regular publicity campaign about the appropriate service to use (A&E, MIIU, Pharmacies, GP surgeries etc.) is needed.

They may use a few more words though.

See press articles

http://www.bucksfreepress.co.uk/news/healthnews/10718683.Campaigner_calls_hospital_crash_response__a_joke_/

See Steve Baker MP for High Wycombe Blog

http://www.stevebaker.info/2013/10/farce-at-wycombe-hospital/

What is a 'Benefits Realisation'?

In the summer I asked some questions at our local council Health Overview and Scrutiny Committee about how would the public know that the planned reconfiguration of services at our two local hospitals would benefit patients and what were the baseline measures for the specific services being changed.

The answer I got from the PCT was "in relation to the Better Healthcare in Buckinghamshire programme, a benefits realisation performance dashboard was being developed".

At the time this went straight over my head and all I could think about was that they had not answered my question on baseline measures.  I have described my effort to get the information in a previous blog (Like getting blood from a stone).

Recently there was a twitter discussion (#NHSchange) on measurement for improvement and someone used the phrase 'benefits realisation' in a tweet.  I complained about the use of jargon but was challenged to find some alternative wording.

I had to think a bit but did come up with some suggestions for a patient friendly version.

"Is my experience as a patient better now than it was before the change/redesign/reconfiguration?"

"Is my outcome (better health, less pain, ability to work, feel better) improved as a result of the change in service provision?"

I also did a bit of research and even went back to a PCT paper on benefits realisation.  In the document it said "Better Healthcare in Buckinghamshire will begin the development of a business case from which the benefits realisation plan can be further developed". However I could find no trace of such a plan in the public domain.

The paper also said that it was important to set current baseline against which to measure benefits.  This is, of course, what I was asking about in my question to the scrutiny committee. But it did not appear to have been done.  Luckily I have a meeting with the Trust to discuss this issue in a few days and I can use this information in my discussions with them.  I will report on what happens at the meeting.

As part of my research I googled 'benefits realisation' and first up was the NHS Institute for Innovation and Improvement's (NHSIII) website where they have a paper on the topic. It is interesting and worth a read. http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/benefits_realisation.html

In their view a benefits realisation is

"a tool to make sure you actually get the intended benefits originally planned for your project". 

I like that! Clear and concise.

Further on it says

"A benefits realisation should be a fundamental part of any improvement project running from the projects beginning to the end and beyond".

Now that confirms my view that you need to know the baseline so you can measure the effects of the change you are implementing. It seems so obvious.

*****************

So if you are running an improvement programme and you want to know if it has worked I suggest you read the NHSIII paper and make sure you have a benefits realisation framework established at the beginning of the project.

Like getting blood from a stone

It started like this.....

Our local Hospital Trust and the Primary Care Trust (PCT) decided that they needed to reconfigure services across two of its three sites. I guess that there are many reasons why they should choose to consider such a redesign. There is the European working hours directive for doctors, medical training requirements &  Royal College recommendations etc etc., all of which suggest that some services needed to be centralised on one site and some on the  other site.

A few years ago they held a public consultation on the general principles of such a change and it passed without too much fuss. Obviously they then went away and developed proposals on how the reconfiguration might look, A number of options were identified, including leaving services as they were. This option appraisal then went out for another extensive round of public consultation.

The consultation agreed with the preferred option (surprise!) but once the implications of the proposals were known and discussed in the press the public began to express their concerns about the effects of the changes at a local level. 

These concerns were a) that it seemed that one of the two hospitals seemed to be reduced in size and in services, b) its A&E becoming an Emergency Medical Centre, and c) the issue of poor transport links between the two hospitals, especially for those living in the villages outside the major towns.

There was an extensive campaign by the local press and a 'Save our Hospital' group held meetings.  Managers from the hospital Trust and the PCT attended these meetings, made statements to the press and a useful debate took place. One of the interesting statements made was that the changes were designed to improve the quality of care and had nothing to do with money.  "Its all about quality".

This got me thinking about how we , as members of the public and patients, would know that the changes have achieved their desired outcome, that of improving the quality of care.  As a scientist and part time 'change manager' I realised that we needed a baseline measurement of the current quality of care provided by the existing services.  So I asked the question.

The County Council Health Overview and Scrutiny Committee was being updated on the reconfiguration and so I asked a question about getting quality information into the public domain.

The important part of the question was:

"Given that the aims of the changes.....are all about improving the quality of care ...can the Hospital and PCT provide the current level of quality of those services in a form that the public can understand."

Their answer in full (names and details removed to protect the innocent) (from the PCT director of communication and engagement) was:

"Quality reports are routinely considered at meetings in public of the PCT cluster Board. These look at issues such as waiting times, levels of hospital acquired infections and delayed transfers of care. In relation to the changes proposed by the programme, a 'benefits realisation' performance dashboard is being developed. This will contain a number of indicators which will be monitored to ensure that any changes are producing a better experience and better outcomes for patients.  This will look at factors such as patient satisfaction, mortality rates, length of stay and admission and readmission rates of these services which have been changed."

Now I know I am just a member of the public but I did spend two years teaching science to GCSE students and I reckon that comes under the category of 'this student did not answer the question'.

Now in my role of 'a stone in the shoe' I had a email conversation with the Trust representative ('the messenger') which resulted in no improvement and so I was allowed to re-ask the question at the next Overview and Scrutiny meeting .

This is the next answer, given by a senior clinician from one of the two embryonic local Clinical Commissioning Groups:

"At the moment a large amount of data is collected the Trust.  This includes data on length of stay, readmission rates and mortality rates. However the way in which this data is currently analysed and reported reflects the current arrangement of services not the proposed new reconfiguration. The Hospital Trust is currently undertaking an exercise to analyse the data to reflect the changes and to determine benchmarks from which outcomes can be monitored. Once this is completed the key indicators will be published and monitored in the public domain".

Once again it seems to me that they have avoided answering the question. In fact they seem to have missed the point about establishing the quality of the current services, entirely. Yet at the same time they say that the way the data is analysed at the moment does reflect the current services!  If this is so they should be able to give some indication of the quality of the current services.

Each time I go over the answers I see more confusion and lack of information.

It seems to me common sense that the baseline for measuring quality improvements should be taken before the changes are implemented and are an essential piece of information that any organisation should use when managing change. 

The more I look at what has happened over the last few months the more concerned I am about the ability of the local health services to understand the quality of service that it provides for the local population. They do not seem to understand the process for monitoring the change process either!

We are being told to choose the health care provider that gives the best quality care but if they cannot give us the information on quality how can we choose?

Or is it that they do not want to tell the public what is happening?

Why?

Why have I called my blog "A stone in the shoe"?

You know what it feels like when you have a stone in your shoe? Every step you take it irritates, you can feel it, it niggles! You try to wriggle your foot and hope it moves to somewhere else in your shoe.  Then you try kicking your feet in an attempt to move it.

Finally you have to stop, take off the shoe and give it a good shake .

Even then once you put the shoe back on you find the bit of grit is stilll there.  Or is it another piece?

Off with the shoe
Off with the sock
shake it all about

Put them all on again and suddenly you are comfortable.  Walking is a pleasure again.

Well.

That is what I feel I am to the local health authorities. An irritant, a stone in the shoe that just will not go away.

I want them to remember that there are patients involved in the 'businesses' that they run.

I want them to remember that they need to provide evidence that the changes they implement will benefit patients (and staff).

I want them to remember to manage change properly.

I want them to design and redesign patients pathways involving patients (and staff) early and often in the process.

I want them to build the process of implementing the new designs into the design process, not tack it on afterwards.

I just want them to do things properly.

So I ask questions at board meetings and Council Health Overview and Scrutiny committee meeetings.

I persist until I get an answer that members of the public can understand AND that answers the question.

Its not easy.

So I try to be that stone.  Always there.  A reminder to do things properly, in an evidence based way, using language that people can understand.