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Tag: person-centred health

by Clare Jacklin, Chief Executive, NRAS

I heard a good joke during the Christmas break –

Question: What do you think next year will bring?
Answer: How would I know…? I don’t have 2020 vision!

Albert Einstein is widely credited with saying, “The definition of insanity is doing the same thing over and over again but expecting different results.”

Now, I’m not for a moment saying we’re all going insane but I wonder how many of you reading this feel (as I do) a sense of déjà vu that we’ve heard the same thing over and over but little change has occurred. We hear so much rhetoric about ‘shared decision making’, ‘patient centricity’, ‘shared care’ etc. but still our NRAS helpline gets far too many calls from people who feel excluded from their own treatment and care! These are people without power to choose or influence or contribute to their own therapy.

NRAS has been leading the way since 2001 for the rights of those living with RA and JIA to have access to the right care, at the right time provided by the right people. This is a challenge that is still ongoing; despite so many promises and policies being made by various stakeholders over this last decade, there is still blatant evidence of the UK being victim to postcode lottery health care.

People living in the UK with inflammatory arthritis have access to the very best of medicines, the very best of multi-disciplinary team care but only if they happen to live in certain areas of the country. Too often we are hearing from people who not only struggle with the day to day issues of living with RA or their child with JIA, but are battling to get appointments, fighting to get onto particular treatments or being denied choice or input into their care. So, who or what is making these decisions? Not surprisingly in my opinion it is the loudest voice of all that calls the shots… money! That old adage ‘money talks’ has never been more evidently true than it is today. Short term gains are prioritised over long term improvements to individuals’ lives, the NHS as a whole and the UK economy.

Within the first half of 2020, NRAS will be launching our two new websites (one for NRAS and one for JIA at NRAS), as well as the first of our e-learning modules. All of which along with our informative resource booklets are aimed at giving people living NRAS logo with RA or JIA the knowledge, tools and confidence to keep on demanding what is rightfully theirs… the right to be part of their own care and treatment. The NRAS Right Start New2RA service (launched at BSR conference 2019) is also evidencing that giving individuals the right information at the very beginning of their journey with RA is making a significant difference to their prognosis and outcomes. Better outcomes for patients leads to less demand on NHS services, improved adherence to treatment which in turn reduces wastage of medicines, individuals who have the right care at the right time also are more likely to stay working hence contributing to the economy which in turn is reducing the strain on the welfare system but most importantly improving their quality of life and reducing the risk of developing depression and anxiety. So, if ‘money talks’ then surely all of this is currency for conversation!

This is why I was keen that NRAS re-joined ARMA so that collaboratively with all our fellow ARMA Members we can be bold and brave as we enter this new decade to bring about and support new initiatives that can contribute to efficiency savings and investment in projects such as the First Contact Practitioners initiative. I am hopeful that by engaging with and offering supportive training to practitioners in primary care that NRAS, along with other ARMA Members, can bring about earlier diagnosis for many with inflammatory arthritis which in turn can contribute to all of the above.

In summary, my 2020 vision is to banish those déjà vu moments of the last decade and see clear change for the better, living up to the NRAS strapline of Changing Minds, Changing Services and Changing Lives for all those living with RA and JIA.

by Simon Chapman, Deputy Director, Personalised Care Group, NHS England.

Twelve years ago I was working for a charity just north of Kings Cross. My office looked out on a derelict area of forgotten buildings and toxic land. Over the next 10 years, things gradually changed as the infrastructure was renewed: old buildings were renovated and new spaces and buildings were created for people and communities to visit, use and inhabit. Now, where there was wasteland, parents watch their children play in the Granary Square fountains. It’s a terrific example of well-designed development infrastructure providing a framework that enables life, community and wellbeing to flourish.

And NHS England is taking a similar approach to expanding social prescribing, as part of an expanded team of people working in general practices. We are definitely not approaching it from a standing start, and we are not taking the credit for what is a vibrant social movement that many have worked in for decades. Across the country people have been working in communities to support activities that are good for people’s wellbeing. But, like the landscape I saw from my old office, social prescribing in primary care needs some design principles and infrastructure to be resilient, robust and widespread.

Our commitment in the Long-Term Plan is to have at least 1000 trained social prescribing link workers in primary care networks (PCNs) by 2020/21, and more beyond that, so that at least 900,000 people can be referred to social prescribing by 2023/24. This is the largest investment in social prescribing made anywhere by a national health system. And it’s not happening in isolation: social prescribing is one of six components of the NHS’s comprehensive model of personalised care.

We intend to secure a sustainable future for social prescribing in primary care so that it’s available for all who need different forms of support. Community approaches and social prescribing are at the heart of the NHS’s vision for its next 70 years. No longer nice to do; central to the future. That’s why we have built funding for the new link workers into the new GP contract so that it has contractual protection.

Social prescribing may not be new, but our ambition to make it universally available is. Achieving this means we must keep to some clear principles. Building on existing know-how for what makes effective social prescribing, we have worked with current social prescribers, as well as the voluntary sector and people with lived experience, to co-produce a standard model for social prescribing. It’s captured in a summary guide.

Perhaps the most radical thing about link workers is that they are employed to give people time. They will have the time and the space to work alongside people often with complex needs and life circumstances. They can help people who may become isolated, whose innate gifts have become buried deep, providing time and relationships that are critical to building confidence and reconnecting. Or they might support people for whom movement is difficult and life is challenging, by helping them to connect with walking, dancing, gardening – or other forms of community activity that helps to keep them moving and connected.

Link workers in primary care will become part of the networks of support that exist in communities. Although the GP’s surgery is often a place people come to when they don’t know where else to go, health services are only part of the picture. It’s been estimated that at least 20% of people consult GPs for what is primarily a social rather than a health issue. Link workers will be able to connect people with debt, benefits and financial advice, housing support, as well as community-based activities and support. There are many possibilities, depending on the person’s priorities and what’s available locally, including: walking and other outdoor activities; arts, singing and cultural groups; sport and exercise; lunch clubs.

Successful social prescribing in primary care will work alongside what’s already happening in communities and the local system, enabling people to build on strengths that are already present.

by Sue Brown, CEO ARMA

I write this reflecting on my day yesterday, which was unexpectedly dominated by discussions on pain. Pain is, of course, something we all talk about a fair bit in the MSK health world, as it’s one of the shared factors that cuts across all MSK conditions. I’m increasingly realising it is something we don’t always deal with particularly well.

My day yesterday began with reading New Scientist on the train, including an article about UK doctors’ concerns that we will follow the US into an opioid crisis. The question raised in the article was: is there a risk we will take things the other way, so that when someone does need opioids, they won’t be able to get them? The day ended at a wide-ranging lecture by Simon Stevens, Chief Executive of the NHS, including a slide showing opioid prescription rates by region: a wide variation, with London the lowest, and the North East the highest.

My discussions throughout the day all touched on pain in some way, but with a much broader agenda. Pain is rarely a simple matter which can be solved by pills alone. Yet that’s the only option offered to so many people. ARMA promotes a person-centred, integrated, biopsychosocial approach for anyone who experiences chronic pain. The prevalence of chronic pain is highest in the North East of England, and lowest in London (43.1% vs 29.0%). There is something going on here which is not just physical. We know that there are strong links between physical and mental health, which is why ARMA recently organised a roundtable on mental health. It is clear from my discussions yesterday that this is crucial in the context of chronic pain.

My issue with the debates about opioids is that they are about opioids. It seems to me that this is starting in the wrong place. The question is not what can we do about the increase in opioid prescription but what can we do about the increase in chronic pain? We need a much more sophisticated discussion. If pain is complex and individual, then the solutions must be personalised and multidisciplinary. We need to be able to refer people for psychological support. That might be IAPT psychological services for people with MSK pain. It might be health psychology in the context of a specialist pain service. We need to have appropriate peer support and social prescribing offers. We need to look at the underlying causes of pain and treat those where possible. The best pain services in the world are not useful if what the patient really needs is joint replacement surgery or rapid access to physiotherapy. And we need appropriate prescribing, and clinicians confident to discuss the different options and engage in good shared decision making with their patients.

This is not an issue which can be addressed by one profession. Patients in chronic pain may need GPs, rheumatologists, surgeons, pharmacists, psychologists, physiotherapists and others, working together. As with so much else in MSK healthcare at the moment, this support doesn’t join up and in the case of psychological support, too often isn’t available at all. This is why ARMA has made mental health a priority for this year. Together with our members, we will be pushing for improved access to joined-up, multidisciplinary personalised biopsychosocial support for people in chronic pain. We’ve already had some webinars on the subject, including how to deliver an integrated pain service and how to integrate mental health into physical health services. We’ve held a roundtable and produced our report. Look out for more activity including webinars and our annual lecture in November that push this agenda forward.

Join with us in calling for action to provide comprehensive services which address chronic pain from all angles. Patients with chronic pain deserve nothing less.