Power to the people: Coproducing the National Musculoskeletal Strategy
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This guest blog was coproduced by :-
Mark Agathangelou, Lived Experience Group member;
Aimee Robson, Head of Personalised Care (Clinical, Workforce & Quality);
Andrew Bennett, National Clinical Director MSK conditions;
Cristina Serrao, Lived Experience Ambassador;
and Helen Lee, Experience of Care Professional Lead.
In this blog, Musculoskeletal (MSK) leads within NHS England and Improvement and people with lived experience consider why coproduction is the golden thread of achieving the highest quality care that is valued by all.
Our vision is to enable lifelong MSK health within all communities through the delivery of evidence-informed, personalised and high-quality healthcare which is of value to all.
We often focus on economic value, striving to maximise the use of our constrained resources to deliver the highest quality of provision. But whilst this remains a significant consideration, we also need to focus on the social value of our provision, especially given that we are responding to a pandemic which has impacted the lives of everyone.
Coproduction means that all involved feel engaged in a collaborative healthcare approach with a shared commitment to quality, where everyone is treated with respect and dignity and everyone feels that their needs matter. To attain this, it is essential that patients and members of the public are engaged in all aspects of MSK healthcare through a co-productive approach to planning, delivering and improving services; and this is what we are striving to do.
The NHS has a duty to continuously improve quality, encompassing effectiveness, experience and safety, and a parallel duty to involve patients, carers and the public in planning and changing services (NHS Constitution 1). A CQC report in 2018 identified that putting the patient at the centre of quality improvement (QI) sharpened the focus on delivering high-quality patient care, and to deliver this, patients must be involved and enabled as true and equal partners 2. Yet, organisations often assume this is difficult to do and that it often takes a long time 8.
We know that when people are given choice, control and are empowered through personalised care, that this improves outcomes and wellbeing, reduces health inequalities and enhances the experience of care 3,4,5,6. This is why the “what matters to me” approach of the Universal Comprehensive Model of Personalised Care 7 is one of the fundamental changes and is a core part of the NHS Long Term Plan and even more important now.
During the pandemic, we exercised this approach in practice. Mark Agathangelou explains what being a Lived Experience Member of the MSK Lived Experience Group means:
“I came to the Group through lived experience of a chronic MSK condition (persistent pain), being active as a patient organiser (for a chronic pain self-help support group) and engaging as a patient partner with my local NHS.
Preliminary conversations with Group organisers reassured me that this would be a genuine forum for coproduction, working in a spirit of equality. On joining, I was impressed by the informal, friendly atmosphere and by the readiness to hear from everybody in the Group, irrespective of their background; to have a genuine exchange. I didn’t detect any sense of hierarchy of speaker or in the weight attached to contributions. There is a good representation of people with lived experiences, from organisations representing the patient voice and an awareness of the need to ensure proper diversity in the group.
Tough questions are addressed, such as the perennial one of whether this body has a real say in policy development? In the first instance I would say that this inclusive tone of meetings is persuasive; a lived experience of good practice. Further, the NHS members are clearly genuinely committed and sincere in their conviction that coproduction needs to be at the heart of the process.
We already have an example of co-produced output: the work done on some existing feedback from patients, carers and the voluntary sector. The Group was asked to convert this into a form that could be more impactful. Patients and stakeholders successfully worked with the Lived Experience Ambassador to produce a short essential summary of the document.
But arguably the real proof of the pudding is that this temporary body, designed to capture the lessons of COVID-19, is being developed into a standing Lived Experience Group, intended to be at the heart of the MSK decision-making process for NHS England and Improvement.
This is still a relatively new group and it is transforming itself into an even newer form. So, it is too early to say if it will succeed in this objective. But the signs are promising and it’s a fascinating journey which I feel privileged to be part of.”
Cristina Serrao, Lived Experience Ambassador, is also playing a lead role in this work:
“The beauty of the work we describe has been that there are no hidden agendas; these are for all to see. This is a level of transparency I haven’t witnessed before. Maybe the urgency of dealing with a pandemic led to the stripping of perceived hierarchy through titles and position?
After all, baring your lived experience means leaving yourself exposed to vulnerability, and the impact of COVID-19 has hit us all – we have lived that feeling of vulnerability and uncertainty together.
Finally, we have that level playing field. Now we need to embed this way of working as the new normal.”
To deliver the vision described, we must coproduce MSK services with people with relevant lived experience as patients, service users or their carers based upon “what matters to me” for people and populations, which are the tangible evidence-based components of the Universal Comprehensive Model of Personalised Care.
So, what next? We call you to action by inviting you to participate further in this important discussion.
TWEETCHAT Power to the people – Coproducing MSK 21 Sept 2020, 7-8pm #MSKCoPro
Join @WeAreARMA and the #MSKLeg members for a TweetChat all things #MSK in these #COVID times.
-  https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
-  https://www.cqc.org.uk/sites/default/files/20180911_QI_hospitals_FINAL.pdf
-  https://www.health.org.uk/publications/person-centred-care-made-simple
-  https://qualitysafety.bmj.com/content/27/12/989
-  https://pubmed.ncbi.nlm.nih.gov/24736389/
-  http://www.ejpch.org/ejpch/article/view/1845
-  https://www.england.nhs.uk/publication/universal-personalised-care-implementing-the-comprehensive-model/
-  http://www.ihi.org/communities/blogs/co-producing-covid-19-recovery