I’m wondering what records you keep personally, or can access online, to help you keep track of your life and I’m especially thinking about personal health?
Keeping track of my appointments, medications, symptoms
As some of you know my health took a downturn in my mid 40s and since then I have been managing a few Long Term Conditions. As I became a more experienced patient I realised that no one NHS organization had the full record of my health history and so I began to keep a simple record on my laptop that detailed dates of appointments, which clinician I’d seen, what had been said (that I could remember) and if there was any follow-up or monitoring to do.
I did this just for my own peace of mind as I was always asked what medication I was taking, what operations/procedures/blood tests/results I’d had and when, and what my current symptoms were etc.
As my history became more complex I used my own record as an aide memoire for me to take with me to appointments and it also came in useful as a briefing sheet for any new consultants/clinicians I met.
Then I heard that nationally the NHS was going to give patients access to the records that were kept by GPs and I thought great that will be an enormous help.
Online access to shopping and banking
As I have become physically disabled with arthritic and spinal problems I have come to use online services for many aspects of my life including shopping and banking. I started cautiously with banking online over 15 years ago and now the only thing I can’t do online is take money out or pay in cheques!
I’m not the only one as in 2015 the people who use internet banking was around 56% according to the Office for National Statistics.
And before anyone says it’s too much for the more advanced in age the British Banking Association(BBA) reported in the Way We Bank Now that there are millions of “Silver Surfers” using mobile and internet banking with nearly 2.3 million people aged between 70 and over 100 years old using internet banking. The study also shows that more than 450,000 customers over 60 are harnessing banking apps on smart phones, iPads and other tablets.
Now the banking industry made these changes so that their customers could more easily use their banking services and keep track of their finances.
There is no doubt that internet use has changed the way many people manage different aspects of their lives. In 2015 the Office for National Statistics said that the internet was accessed every day, or almost every day by 78% of people in Great Britain with online shopping and use of services being the most popular of their use. And that 86% of households in Great Britain had internet access.
So back to health.
You can imagine how delighted I was to hear about the National NHS Patient Online programme and I quickly signed up for the facility to order my monthly repeat prescriptions online which saved me monthly trips to the GP surgery and saved receptionist time receiving paper requests and finding my prescription scripts for me.
From the 31st March 2016 all GP practices across England should be offering online services to their patients which include, ordering repeat prescriptions, booking appointments online, access to summary information (immunisations, allergies, medication) test results and lastly access to detailed coded information held in patients’ records.
This seemed to me to be really good news for people and especially for those, like me, with Long Term Conditions who want to be active in self managing their life whenever possible and if support is needed can do this in partnership with healthcare professionals.
I must confess that I was a bit disappointed when I did get finally get access to the coded information in my records, a few weeks ago, as I didn’t get my past history so I will only have access to future events. Thankfully I still have my own record to rely on and hope that future generations will get this straight away so they will have a chronological record to use.
Who knows about this and how do you get access?
This seems to be a problem in some places where not many patients are aware that online services are available or what this could mean to them personally. If they do know people report that it can be difficult to find out how to do this at their own surgery, as information doesn’t appear to be always readily, or easily, available.
Here are some Frequently Asked Questions for patients from NHS England.
Equally it seems that some GP practices do not yet see the potential of how online services could free up time for them and more importantly enable their patients to be more informed and self-managing partners.
Frequently Asked Questions for GP practices
There has been a lot of publicity nationally in England from the Patient online team and support is available for practices where there are local needs but this isn’t enough as there still appears to be a huge gap between what is ‘technically’ available and what is promoted to patients and made easily available at practice level.
For me personally I can only see benefits and a friend of mine Ingrid Brindle has built up her knowledge over a few years of having full access to her records at the forward thinking Haughton Thornley Medical Centre in Hyde (led by Dr Amir Hannan) Greater Manchester where she is Chair of the Patient Participation Group. Listen to Ingrid talking about her experiences at The Kings Fund in 2014.
If you’re still not sure and want to know more you can watch, and listen to, these short case studies snapshots, which include different views from GPs, practice managers, receptionists and more patients. You can hear again from Ingrid and just below Ingrid is another colleague of mine Trevor Fossey who talks about how useful it is to him and his wife, who he cares for, to have online access to their records.
For me having online access to my records, test results, medications, and prescription ordering isn’t really about gadgets or Information Technology (IT).
It’s about me being responsible and empowered in being as informed as I can be to make decisions about my most valuable asset, my health.
I’m really pleased to be re-blogging this piece written by Shahana Ramsden who is the Senior lead for co-production at the Coalition for Collaborative Care. http://coalitionforcollaborativecare.org.uk
I am member of the co-production group which is made up of a wide range of people with Long Term Conditions(LTCS) and carers of people who have LTCs. The main assets of the group, who all have many skills and expertise, is the passion each individual has to make a difference in health and social care which is the reason that drives me.
I learn something new from each individual every time we meet or work together but must say that I have benefitted the most from Shahana’s lead, direction and diplomacy. Thank you Shahana- it is a pleasure to re-blog your piece on co-production here.
Shahana Ramsden blogs for us today on her 5 ingredients for co-production. She is the Senior Co-Production Lead NHS England and the Coalition for Collaborative Care (Co4CC). Shahana’s 29 year career includes supporting co-production with people who use services and carers and leading equalities programmes. Prior to her role with NHS England and Co4CC, Shahana worked as a Patient and Public Voice Manager for NHS England’s Patient Online programme. Shahana has been recognised by the Health Service Journal as a BME pioneer and was highlighted as one of 100 virtual change activists for Health and Social Care through NHS IQ (The Edge).
Working in Co-production with patients, people who use services and carers can be simultaneously simple and complex. It is messy, not linear. When it works well we have to prepared for a change in culture so that we avoid fitting people into boxes and are prepared to position the organisation…
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This year I’m attending EXPO 2015 as a member of the People’s Panel which is a group of people who are patients or carers and who have lived experience in learning to deal with their own Long Term Conditions or as a carer, and who have also become expert in navigating the sometimes complex world of health and social care.
The fact that the planning for EXPO has included patients and carers is demonstrating the drive and commitment of NHS England and the Five Year Forward View to develop “..a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health”. https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
This new relationship will be exemplified by members of the People’s Panel to show how working together, or coproduction, can happen in practice between patients, carers, and organisations and hopefully usefully bring a ‘reality check’ to the many conversations and debates that will take place over two days.
Working together or true coproduction is not as easy as it sounds in reality. Often I have found myself being used for a consultation or engagement event where I know that nothing I say will change anything and all that is really required by the organisation is an endorsement so that they can ‘tick’ the patient/carer/public engagement box.
That kind of exercise is so short-sighted as no one really gets anything positive from it- the organisation doesn’t get the insight they need to be really effective and for me, as a patient expert, all I’m left with if a feeling of frustration, having had my time and limited energy wasted.
I’m pleased to say my experience with EXPO15 and the Coalition for Collaborative Care, http://coalitionforcollaborativecare.org.uk
where I am a coproduction member, has been positively different. Specifically in the planning of the event:
- Patient/carer views were listened to seriously, discussed and acted upon;
- Proactive advice and suggestions were welcomed;
- Patient/carers were valued as equal members of the planning team.
Equally I have respect for the professionals who have key roles in planning such a high profile, national event with tight deadlines, a zero budget and small team. This is indeed evidence of developing better ways of true partnership and really working together from design to implementation.
It has been said that this year’s EXPO 2015 “..will be challenging, and will deal in reality not theory”. As a person who has Long Term Conditions I deal with the reality of that every day which includes chronic pain, limitations in mobility and lack of stamina on the negative side but also includes positive insight into personal resilience, into health and social care organisations and how simple changes could make big difference to people’s lives.
So I’m really looking forward to taking part in the two days in Manchester, my home city, on 2 and 3 September and particularly working in partnership with other members of the People’s Panel, the Coalition for Collaborative Care and the people I meet.
I’m looking forward to listening, learning and hopefully influencing too so that I can feel I have made a positive difference in the drive to ensure that true partnership working becomes embedded across health and social care so that person centred care can become a reality for everyone.
In other words the ‘get real’ factor – hope it helps.
Have you ever visited your GP or A&E, been in excruciating pain that your doctor agrees is awful and which will definitely get worse without any urgent advice or treatment?
I must confess this has happened to me on numerous occasions as I’ve suffered broken bones, many slipped discs and a ruptured disc in my back – which was definitely off the 1-10 pain scale! – and had me shuffling slowly and painfully with sweat dripping off me until I’d been operated on.
On those and other occasions, which I won’t bore you with, when I suffered physical health problems I found the response of doctors and other healthcare practitioners to be pretty responsive, compassionate and keen to do something about the problem quickly.
But what a shock I had when faced with mental ill health 16 years ago and was diagnosed with severe clinical depression. I had subsequent recurring major episodes that endured for more than ten years. I now know I was ‘lucky’ to even get diagnosed and I have a GP to thank for that, who knew me well. I was also ‘lucky’ in being able to access psychological therapies and ‘only’ having to wait five months for that.
But I wasn’t so lucky in the following years when these episodes reoccurred or I hit crisis points. I discovered that services had been restructured since the last time I’d needed help, so the phone number I’d been given to call had been changed or someone had left.
Trying to navigate NHS structural and administrative changes when you’re feeling very ill is pretty difficult when you’re physically ill, but is almost impossible when mentally unwell.
Recovery for me was a slow and painful process, and I couldn’t have done it without professional help, medication, expert advice, mindfulness meditation and a strong support base of friends.
According to the Mental Health Policy group, who recently launched a Manifesto for Better Mental Health see here
“between 4,000 and 4,500 people take their own lives in England each year”.
Furthermore, “only a third of people with depression get any help, and even fewer get the full range of recommended NICE treatments.”
The report goes on to say that currently, “referrals to mental health services continue to increase. Monthly referrals to community mental health teams were up 13 per cent in 2013, and up 16 per cent for crisis services”. But money for mental health services has fallen in real terms.
I fully support the manifesto and the organisations who have come together to try to exert some influence in the mental health world and really hope that it is an additional lever to get some much needed improvements in mental health across the country.
I find it shocking that in 2014 mental health is treated differently to physical health and that access to the scarce range of treatments available is so poor. When I had broken bones I wasn’t asked to go home and wait for a number of months or years and then go back for treatment.
So why is it OK for someone with a severe mental health problem to be told to do just that?
I’ve never heard of anyone who was suffering from a life threatening physical problem, say a heart attack, who was locked up in police cell for safety because there was no medical help available?
Yet that happens frequently for people who are suicidal and in fact the police are often the only emergency service who offer help – so I’m not knocking them, just pointing out how truly shocking this is.
But what is more shocking to me is that we tolerate this state of affairs, as it has become the norm.
While the Parity of Esteem call to action by NHS England is welcome, I fear it will remain an aspiration that is never realised.
So what needs to be done?
Well, I think a seismic shift is urgently needed in commitment, funding and attitude to make any appreciable change in mental healthcare, which includes research, treatments and interdependencies with physical health.
This shift needs clear leadership at national, regional and local levels spanning government, NHS Commissioners, providers and the third sector.
No huge reviews need doing – just listen to the people who currently work flat-out in NHS mental health services and they will explain what’s needed.
Listen to charities such as Mind and Rethink, who do magnificent work helping people who are left without any access to treatments but have life-changing and life-limiting conditions.
Listen to the people who have lived life experience of mental health problems. Recovery is possible but many people never get the chance to find out.
Any new investment needs to be additional, designated finance and not become a contest for short-changing any other existing area of care.
Tolerating the norm is no longer an option – people’s health, quality of life and futures depend on the shift being made – and made quickly.
For further reading and evidence I recommend the report by the Royal College of Psychiatrists from March 2013- Whole-person care: From rhetoric to reality – Achieving parity between mental and physical health.
I was fortunate to attend the recent NHS Confederation conference and exhibition in Liverpool last week. I felt privileged to be able to see and network with many people from a range of organisations involved in health and social care.
Everyone I met or listened to was keen to share their experiences, and sharing for me was a constant theme throughout the three days.
I always reflect on what I’ve heard, who I meet and write up notes from sessions attended for information to share with my colleagues at http://gmcsu.co.uk.
I thought it might be useful to share more widely what, and who, stood out for me during the three days. I’ve put related links in so that if you weren’t there and are interested you can check them out in your own time.
So here are the ones I’m still thinking about:
This was a really impressive speech, which encouraged everyone to get off the ‘burning platforms’ and embrace a ‘burning ambition’ for changes needed in the future. Rob emphasised the need to support sharing of information and the collaboration of genuine co-commissioning.
2. One patient, different perspectives, many different outcomes: NHS Leadership Academy
I took part in this interactive session, taking on the role of a GP, where enthusiastic participants (who took on other health and social care roles) shared views, and discussed and debated many practical, ethical and real issues of commissioning and providing good health and social care.
Thanks to Helen Stevens, Head of Engagement, from the NHS Leadership Academy and her colleagues for their excellent facilitation of this activity. It brought out many of the complexities of systems leadership and certainly made me think further about integrated care for older people.
3. Dr Patrick Soon-Shiong: Transforming models of care – this time it’s personal
Dr Soon-Shiong is a physician, surgeon, scientist, businessman and philanthropist whose presentation completely blew me away. Firstly, this was for the clinical breakthrough he’s making in cancer diagnosis and personalised treatments using genetics, genomics and cracking the DNA of different cancers.
Secondly, for the work he is doing with NANTHEALTH on an interoperable system, which links data, knowledge, and information in an interactive way. The system can be added to any platform and can accelerate the coordination of health and social care data, and information for patients in real time, and in a cost effective way.
Kate Granger was the last person to speak at the conference and you could have heard a pin drop in the hall as everyone concentrated on what she had to say. Kate is now famous for starting the #hellomynameis campaign to remind healthcare practitioners to introduce themselves to patients. http://hellomynameis.org.uk
She talked about the ‘little things’ that make a big difference to her as a patient and gave examples of the kindness she has received and reflected on her experience.
Kate is actively raising money for the Yorkshire Cancer Centre and has written two books ‘The Other Side’ and ‘The Bright Side’ http://theothersidestory.co.uk
She has raised over £100,000 to date but has £250,000 in her sights before she dies. She plans to jump out of a plane in August to raise further funds.
She is a truly remarkable, compassionate and determined young woman.
These top four speakers demonstrated the art of sharing in different ways that can help to improve and/or change health and social care for the better.
Other people who made an impression on me included:
Helen Bevan, NHS Improving Quality
Lisa Rodrigues, Chief Executive, Sussex Partnership NHS Foundation Trust
Ceinwen Giles, Patient Leader and Trustee, Shine Cancer Support http://www.shinecancersupport.co.uk @ceineken
I’m interested to know if you were at NHS Confederation – what stood out for you and how do you share the work you do?
If you weren’t at the conference I hope you’ve found my thoughts and links interesting. Is there something you would like to share from your experience in health and social care that could benefit others?
The NHS, most public services and indeed many other organisations are living through and undergoing change of one sort or another, which is largely driven by financial, political, social or technological needs.
In the speech that Simon Stevens, Chief Executive of NHS England, made on April 1 said:
“Today we face new challenges, and will need new solutions – while holding on to the vital gains of the past.”
It is not surprising to note how frequently the words ‘innovation’ and ‘different’ are used in the media and elsewhere with the expectation that doing something new or different will make a positive difference in work that needs to be done.
In the same speech Simon Stevens went on to say;
“ … I agree with MIT’s Eric Brynholfsson and Andy McAfee that, ‘the best way to accelerate progress is to increase our capacity to test out new combinations of ideas.’ Inevitably some of them won’t work out, and there’ll be criticism and honest disagreement along the way.”
Now I know Simon Stevens was thinking about large strategic, systems-led solutions but even those start with one person having an idea, sharing it, debating it and testing it out before anything happens.
One of the strategies being used by Greater Manchester Commissioning Support Unit (GMCSU) is through the work of a newly appointed Innovation Advocate, to encourage colleagues from anywhere in the organisation to think of different ways of doing or improving things. Or to come up with something completely new that will add value to the work of the organisation or its customers.
An innovation hub is being established at GMCSU so that all ideas can be considered, discussed and may be progressed and implemented – quickly if a simple idea, or if more complex, a business case may need to be developed before the idea is submitted for approval.
So how do you make sure that individual ideas are heard and used in your organisation? Do you have specific strategies to enable this to happen or particular times or events that encourage ideas to flow? Or is it as simple as really listening to a colleague as you work together and take further any ideas that arise?
I think it is worth reflecting in any organisation, and particularly now in the NHS, about how individuals are enabled to voice and share ideas and views on doing things differently or trying something new.
On a smaller, individual scale I do believe we can all make a difference in how we interact and react with each other, the public and anyone we come into contact with professionally or personally.
I started working in the public service of education, driven by the desire to make a difference to others. I’m now working part-time in the NHS with GMCSU as a Business Advisor/Lay member and that same desire drives me.
This drive is something I have seen from the many people I have worked with over the years in different public, voluntary and some private organisations and it is clearly apparent in the work of my current GMCSU colleagues who are making a difference directly and indirectly to the lives of others.
If you ever doubt your individual power to make a difference consider this quote by American, Christine Todd Whitman:
“Anyone who thinks that they are too small to make a difference has never tried to fall asleep with a mosquito in the room.”
And to end on a more positive note a quote by John F Kennedy
“One person can make a difference and every person should try.”
On Monday, 3 March NHS Change Day was celebrated. Hundreds of people in the NHS all over the country made pledges about something they would do to improve how they work. Or another way to put it is to make changes, however small, to benefit others.
At the NHS Health & Care Innovation Expo 2014 in Manchester last week I was able to see many of the pledges which were displayed there, but more importantly the enthusiasm and commitment of the people attending.
Many of the stands at the event displayed innovations using technology to integrate health and care information and to improve support for professionals and patients in many ways. It struck me that it was all about making better connections of information as well as ways to connect people too so they don’t feel isolated or alone if suffering ill health that restricts them.
One patient who felt that professionals weren’t connecting with her as a human being was Dr Kate Granger – a doctor, and a terminally ill cancer patient. In September 2013 Kate blogged and tweeted challenging health professionals to remember to introduce themselves when seeing a patient.
The #hellomynameis campaign took off and went viral in a very short space of time. Professionals across the NHS rose to the challenge to ensure that professionals demonstrated compassion by connecting with patients in this simple and human way.
To hear more about the outcomes of this initiative I recommend you spend a few minutes watching this video.
Small changes, connecting compassionately with patients and the people we work with can make a positive difference so do take a look at the pledges already made and see if you’d like to sign up for one or more of them or make your own. You’ve got until 31 March to do so here.
I’ve joined two pledges for NHS Change day. The first is “I pledge to develop my wellbeing and emotional resilience and encourage those around me to do the same”, set by Dr Alys Cole-King.
This pledge struck a chord with me as I know from experience how looking after your own wellbeing and resilience can often take a back seat when you’re striving to see some piece of work through or to help others. This is not ‘soft and fluffy stuff’, but, I’d suggest, a necessity to be a healthy human being and effective professional.
For example, I know that I need to pay attention to getting enough sleep, as lack of stamina is a big issue for me due to chronic pain, and I’m wondering what you do to help yourself to maintain your wellbeing when the going gets tough?
The second pledge I joined is “to make every contact count every day”, set by Debbie Holman from Greater Manchester West Mental Health NHS Foundation Trust.
This pledge made me wonder – am I really aware of the potential impact I can have on the people I connect with, whether that is at home, work, volunteering, shopping or through social media? I’m reflecting on how positive an experience I make these. Who have you connected with today and how did that go?