Monday 27th January Milford Hospital

Yesterday I accompanied 2 carers and a person living with dementia to a NHS quality improvement event to help shape services going forward, based on what works and what does not work well. This involved a room full of about 8 people sitting around a dozen tables to use a novel way of listening and capturing people‘s views about their experience of using services and engaging with the wider system of health and care.

The participants comprised health professionals including a consultant geriatrician from the Acute Hospital, therapists, nurses and managers from the health and Social Care Services along with different members of the public over the age of 65. There were refreshments including home made cakes!

The idea was to use the game to help people to discuss experiences using an interactive conversational game. This had questions relating this topic which enabled frank conversations about issues and ideas and identify opportunities for change.

The Cranleigh team included the Royal Surrey Geriatrician and all were thoroughly engaged in the questions. Suggestions were put onto post it notes and then passed to a facilitator/cartoonist who captured key messages in a highly visual format. From this further feedback with food for thought for what needs to change was fed back to the wider group at the end of the session.

Key themes were used within the game to extract the underlying messages behind answers. These were:

· Choice and Control

· Quality of life

· Health and wellbeing

· Positive contribution

· No discrimination

· Dignity and respect

· Economic wellbeing

These resonate well with the IWE approach, based on Patient Reported Outcome Measures used in Primary Care, and created for social prescribing by Dr Jill Rasmussen and myself.

WHOSE SHOES GAME IN ACTION

Key points captured:

The importance of having protected time to listen to prevent things going wrong down the line
People need help to know what the system comprises and how to connect with it
They also need a simple navigator to help them manage it
Professionals need to pay attention to their language and the abbreviations and acronyms they use
Carer support – both peer to peer, social prescribing and other initiatives important to prevent social isolation
Post discharge from hospital- prevent isolation in different ways when people go home (this reminds me of the Care Rooms initiative where this can be done with the assistance of technology)
Care planning must be person centred as the older we become the more different we are
Choice and control – support informed choices regarding services and use advocacy
See ME- seeing the whole person rather than one aspect
There are challenges around having a team of different professionals working with an individual and how the communication loops can be more effective between all parties, joining things up better
Partnerships with patients and carers. Hierarchy within the NHS is unhelpful. A flatter approach is recommended along with learning from other sectors
Systems can create artificial boundaries with teams working in silos
The value of having an Admiral Nurse working across Guildford and Waverley as part of a prevention strategy

Final surprise

Our lovely Cranleigh resident living with dementia wanted to speak about his experience at the end. His message was clear that he needed help to keep him on track and aid his memory and to keep focused on the topic in hand. He said how helpful the pictures were and how good it was to be involved in something like this. While he was talking the artist captured what he said behind him. We all were thrilled at our table and he received an standing ovation from the audience who found his story moving and helpful.

Rosemary Hurtley 28-01/20