Falls Prevention with @clareRCGP on Twitter

Holistic care

As regular readers will know, my main practice interest is in mental health, however, all OTs are trained in both mental and physical health. Providing holistic care to the people I’m working with is enhanced by this training. For instance, in mental health services for older people, falls are as relevant as in orthapaedic OT, so it’s always useful to revisit other practice area specialities and share knowledge within the profession. 

Professional Development

With this in mind, it is always a pleasure to get drawn in to chats on Twitter about areas of practice that use knowledge that would otherwise become rusty due to lack of use: and it’s an exciting challenge for me to revisit my knowledge of falls prevention and to participate in #fallschat recently, on Twitter. 

I was excited to be asked by Dr Clare Gerada (who had attended a workshop on falls prevention) to contribute to her weekly RCGP Blog about falls prevention. I sent her my “Ten Top Tips for Falls Prevention”, repeated below. 

My 10 Top Tips for Falls Prevention:

1. Make sure the hallway and stairs have working lights- if possible, replace with low-energy light bulbs and keep lights on overnight. 
2. Wear slippers with an appropriate heel, so that they stay firmly on the feet.
3. Regular, gentle exercise can help reduce risk of falling and also fear of falling. Exercise such as Tai Chi is particularly helpful at improving balance. 
4. Check out signs that a person is unsure on their feet such as “furniture walking”, or clear dirty marks where walls are used for support. Having grab rails installed at key sites around the home or at the entrance to the home can be arranged by local community OT services.
5. Fasten any torn bits of carpet or lino down- gaffer tape is ideal for this, if an older person can’t afford to replace floor coverings.
6. Tripping over the edges of rugs is really common- either remove rugs, or fasten down the edges to reduce this risk.
7. Medication management- GPs are well placed to review medications and watch for interactions, non-compliance etc.
8. Check for use of alcohol- which increases falls risk and may  interact  with medications, or even be used to self-medicate undiagnosed depression.
9. Poor foot care can be a reason for not wearing slippers, and can contribute to falls. GPs can check if a person would like a Chiropody referral, if foot care is difficult for an individual.
10. Multi-disciplinary teamworking can solve many issues- so don’t be shy about asking for help! Occupational therapists, physiotherapists and chiropodists can be really useful contacts for falls prevention.

A Few Falls Facts: 

1. A fall at home that leads to a hip fracture costs the state £28,665 on average (726 million a year in total). This is 4.5 times the average cost of a major housing adaptation and over 100 times the cost of fitting hand and grab rails to prevent falls (Heywood et al 2007).
2. The provision of a home safety programme and exercise programme delivered by occupational therapists was found to reduce falls significantly (Campbell AJ et a, 2005).
3. A community based occupational therapy based falls prevention service cut the number of falls among older people by half according to evidence published in the BMJ“

(from COT website available at http://www.cot.co.uk/ot-helps-your-client/falls-prevention)

Can I use the “Top 10 Tips” as a resource for my work/ care setting?

The “10 Top Tips and a Few Falls Facts” post is available as a free-to-use PDF that you may print off and use in your care setting (or as a reminder when visiting an older relative?) please see the following link:

http://binscombe.net/blog/wp-content/uploads/2013/02/10-Top-Tips-for-Falls-Prevention.pdf

Further learning

I was delighted that the post was so warmly received by many health professionals and carers, who said they would be interested in using it. I was also pleased to hear further information from professionals with expertise that I don’t possess- from Optometrists, Pharmacists, Telecare consultants and Cardiac Doctors- who all had further info to share. I bookmarked Tweets that contained further links, so that I could share them with you, here.

8th Feb from @Vision2020UK: Really good stuff from the @CollegeOptomUK re vision and falls well worth talking to them http://bit.ly/m2ZCyx  Top 20!

8th Feb from @helen_whiteside: NECESSARY drugs increase falls risk too- need reg. review/monitor. ref selection 4 ur doc Google scholar search for medications and falls

8th Feb from @ClarkMike: Falls tip -make sure any daily living equipment is well-maintained and meets your needs – secondhand could be poor quality/unsafe

8th Feb from @ClarkMike: Falls tip - #telecare can turn on lights when you get out of bed or raise the alarm if you fall or don’t return to bed

8th Feb from @ClarkMike: “Falls tip- telecare and falls- Exploring the use of Telecare  

10th Feb from @cardiacdoc1: “Don’t forget this… The overlap between syncope and falls in the elderly“ Shaw and Kenny (1997) The overlap between syncope and falls in the elderly. Postgrad Med J. 1997 October; 73(864): 635–639.

Lessons learned

Obviously, no quick “Top 10 Tips” guide can ever be a substitute for good multi-disciplinary assessment and intervention to prevent and manage falls. I thought our experiment in crowd-sourcing tips from the was a big success. It stimulated discussion among healthcare professionals who self-select to collaborate on Twitter, and was widely spread through their networks. It was critiqued as being quite basic, but the point of it was to show how small actions can help to keep someone safer at home- it was never meant to be a piece of post-graduate medical education.

And yes, next time, I’ll be sure to add in tips about how regular sight checks, telecare solutions, and underlying medical explanations can all add to our understanding of falls prevention! Perhaps we could see similar guides produced by others with more education about these areas than I?

#Occhat Nov 20th- Using equipment to facilitate occupation

I’m in the hotseat for the #occhat Twitter discussion tonight- and it’s been a while since I was able to facilitate, so I am looking forward to it and feeling anxious about it in equal measure!

Why are we looking at equipment?

One of our core skills as OTs is the prescription of environmental adaptations including adaptive equipment, so of course, we’re always interested in gadgets and things to make life easier.

As a disabled woman, I’m very grateful for some of the equipment that has become part of my everyday life, like my mobility scooter, or my bed stick. But equipment is much broader than just the stuff you can get through your local equipment store.

I consider my eye-Pad to be one of the best bits of adaptive equipment I have. It’s a multi-functional entertainment system, so if I’m ill, I can watch TV in bed, or catch up with my friends on social networks. If I have light sensitivity, I can alter the settings to make using it more comfortable. If there is nothing for it but to keep my eyes firmly closed, I can switch to listening to radio comedy or drama. This is brilliant for keeping me entertained and distracted from the pain when I am ill!

My children are able to use the features of the tablet to pinch, select, turn and type emails to their family, using a simple email app. They also play with their Moshi Monsters, dance to films on YouTube, and draw and make videos. They can do all this with me in my bed, when I’m ill- there is no bit of kit in the equipment store that you could say that about! So a tablet computer can help me to perform the life role of “Mum”, even when I have a disability that makes some activities very difficult indeed.

I know people who use Siri as speech recognition software- where they have spasm or pain in their fingers, for instance. (p.s. if you have Siri, do ask him/her “Who let the dogs out?”- it’s very funny!)

But this isn’t an advert for Apple, and yes, other tablet computers are available (my partner loves his Google Nexus). We’re thinking about equipment in it’s broadest sense, and how it enables us to perform occupations and life roles.

COT partnering with Boots

We’re also prompted to consider this topic in the light of the recent announcement by the COT of the new partnership they have developed with Boots- please see http://www.cot.co.uk/homepage/new-partnership-puts-occupational-therapy-high-street

Do we think this promotes the benefits of OT to a wider audience?

Are there concerns related to this?

Does it help or hinder the public perception of OT to be linked so explicitly with equipment provision- after all, we do so much more?

I know you will have lots of brilliant examples of how equipment helps you to live life your way. You may also have opinions about COT partnering with Boots. To join in the conversation, please join us for our Twitter chat tonight at 8-9pm.

Just add #occhat to your tweets, so we can all see them. And do please remember your responsibilities related to your HPC registration when you Tweet.

See you there!

What would a “Recovery Hub” look like?

I’m currently starting to ask people in online spaces that I visit what would be useful tools for them in their recovery from periods of mental distress.

I want to post a copy of some conversations going on in groups I’m a member of on Facebook, where some really interesting points have been made. Do join in with this discussion- the question posed is:

I wondered if you would be interested in helping me to start a conversation about what services and resources are useful to people who are in recovery after experiencing mental distress?

I’m hoping to be able to prove that service users and carers have some great ideas that they should try to develop- can I ask you to share any ideas you have?

Some initial thoughts-

• Physical space in a non nhs setting to meet up for a coffee
• Education/self management resources available to look at or take away
• Computers and online access to search for your own resources, or build your support networks
• Staff could arrange to meet you there for appointments, if you didn’t want to go to an nhs building
• Training for you to develop and run your own groups to support each other
• Help with getting funding for mental health projects you’ve thought of
• Access to volunteering
• Access to paid work, delivering training, speaking about mental health, as peer support workers
• An online resource, maybe a social network? you could log in from your phone or at home?

None of these solutions would be right for everyone, and I’m sure you’ve got your own ideas- what do you think would be helpful?

The results in so far:

if you suffer with social anxiety the thought of being placed in a group with other people is enough to put some one back in hospital.

me:  if someone has social anxiety, is it helpful to have a range of resources online rather than recommend them come to a physical group?

more services that do home visits would be good – if you have social anxiety, for example, it would help to get to know someone in a “safe” place like your own home, talk about barriers to getting out and then have support (for as long as needed) to go out and meet people.

me:  like a “parachute” service that could be called out to visit at home? would this be mental health staff, or trained peer workers?

main thing would be consistency so you can learn to trust someone and they can take you to different places – maybe with the aim of being able to meet up with people who have similar problems in future

One of my bugbears is the lack of recognition that if you are chronically sick you are more likely to be socially isolated and suffer from depression

me: And equally, people with mental health diagnoses have poor physical health- perhaps we could include this too?

i live in a part of the city where there are very few facilities if you have mental health problems apart from GPs. the support groups, charities, outreach centres etc are mainly on the other side of the city which don’t necessarily have direct bus routes from where i live. buses are difficult when you have social anxiety, going to places you don’t know can be too frightening, and i can’t drive because i have epilepsy. The churches don’t provide much if you’re under 60 but don’t have young children. it’s easy to lose touch with friends when you don’t go out to work and can’t cope with going to the pub.

A consortium of employers in the regional areas that can come together and universally employ an individual in that the individual isn’t committed to a single one employer. This would benefit those employers during there occasional busy days or seasonal times and have a higher success rating for actually being able to maintain some form of employment for the individual.

me: this is exactly what mobility DLA is for to cover costs due to your disability such as taxis for trips to support centres (I know it’s a rotten time to be a DLA applicant, btw) So, for people with social anxieties, it’s important to either have safe ways to travel to a physical centre or hub- or there could be “parachute” visits out into community, or there could be a certain amount of online support for days when physical travel is just too hard? Does that reflect what you’re saying well enough?

me: That’s interesting, xxxxxx, so in your model, people would be “signed up” a bit like signing up to an employment agency? Then they could be allocated work for days that they feel able to do work? Like, sign in by 10 am for today’s work? I’m guessing those people would have to keep records- would they be self-employed, or employed on zero hours contracts?

a friend of mine said a couple of weekends ago there must be loads od small, medium and large companies that have all manner of tasks on projects that someone working from home could do that are hugely time critical but in alarge project needs doing at some point, but project workers, managers etc wouldnt employ someone to do one task,l but if lots of employer could do to an agency that is task focused with all manner of people with skills and knowledge. they work for the agency and the agency make sure the work is done…

I’m against be forced to do work I don’t want just because I feel well on a good day, I want to work but it has to be stuff I want to do other wise my mental state suffers, and being poked and prodded to do work is just putting pressure on people which they don’t need when they are ill, they need to get well first.

me: Yes, the power should sit with the person who has the difficulty as they are best placed to know their own limits. But lots of people want to get back into it- even feel that forced inactivity makes them worse, so lets not assume that this is all part of a sinister way to shove everyone off benefits- I genuinely want to have this conversation and hope to develop a DPULO to respond to this.

me: A bit like this, http://www.taskrabbit.com/?

I make stuff at home I have about one good week in 3 where I manage to do stuff, the rest of the time I’m away with the fairy’s with anxiety much of the time or just resting as I suffer burn out. I would love to make money with my creativity, I have the skills but don’t produce enough of anything to make a living at this time.

Not an employment agency Claire they are a cost to the employers but a consortium of employers themself’s. More in the lines of a sponsorship employment.

yes in effect but for projects, businesses etc . My friend is a project manager, he has a tutorial guide to write, he doesn’t have time to do it but it has to be done before the project goes live. so he thought if he could assign it to an agency, who then finds the right person or offers it up to its clients and they say yes. then as long at is done by the end of the project say in 1 months time it doesn’t matter how long it takes as long as its done. there must be loads of tasks that need doing but no point employing 1 person for what is ordinarily a half-day job but to us is a big thing..

me: I was thinking WE could develop our own “agency” and supply people to work on projects? as part of the recovery process? would have to check out with DWP etc how it would work- but there should be a way of ensuring self-employment as a way for people to do some limited work, with Working Tax Credits as a back-up?

i have mobility DLA, but atm i’m too anxious to go somewhere that i don’t know at all. we could also do with drop-in centres for people who are fighting self-harm urges where they can get support and company. they could also have the ingredients to make that cake that the care team suggested you try …

an agency run by and for people with physical and mental health problems would be great.

Much of those things are already in place from the point of being a hospital patient to work therapy especially in my area any ways.

Not sure self-employment is the way forward especially with all the complexity of paperwork. Many simply wont be able to handle that.

if you have a problem with authority of any sort be self-employed, is an option, you can always get other people to do the paper work

The costs involved in forming agency’s will out weigh purpose and eventually fail.

At least if employers themself’s set this up people will have confidence that those employers are going to provide supportive environments from the outset.

me: I hope it’s okay with you guys, I’m capturing this (anonymised) conversation to keep it on record on my blog at claireot.wordpress.com

me: I agree, there are costs involved. It would be important to ensure we got funded to cover those costs. I think you’re right, we would have to get “sign up” from employers to provide work, but perhaps this would be an extension of the “Mindful Employer” project, or simply as part of their drive to reflect the diversity of the populations they work with?

An example. 33 employment positions I’ve been through in the past maintaining employment due to illness has been the biggest barrier. 18 of those employment positions had been with the same employer this despite walking out on that employer each of those 18 times due to having an illness. In between each of those employment positions faced sanctions of benefits time and time again. On the balance due to the sanctions it wasn’t actually worth carrying on with trying to gain employment as monies over the year balanced out no more than benefits any way.

me: yes, I think this experience is one many people will have shared. We started to work on this at the “Benefits Camp Hackday”. Our team were prototyping an app to use to enable people to show on a weekly basis what work they were able to do, and get their benefits calculated for weeks when they needed more support.

some where that would help do their paper work would encourage more people to start-up for themselves, and if someone failed to earn enough one week and some sort of system that paid and made up for the bad weeks would be good.

Very difficult to calculate an illness Claire one can be ill for months on end with no break then maybe only have a couple of good days. especially if part of the illness is that one is not able to measure time or unaware of time going by.

me: Yes, it is xxxxx and that’s why I think flexibility, and not “pushing” people before they’re ready would be important. But equally, it is important to set a “just right” challenge for people (e.g. as an OT that’s what the rehab would be aiming for) to help people along in their recovery. Perhaps what you’re picking up here is another, separate need, for early access to increased support when you feel like it’s slipping back again? Is that an accurate interpretation of what you’re saying?

Employer sponsorship at minimum based on existing individuals levels of benefits as an outset. With further sponsorship being paid above an achieved hours gained. With all sponsorship based on the level of minimum wage.

me: Hmm, I think this would need some thinking through. I’m not clear what employers would see that as a “good deal” for them, and it sounds a bit like “Workfare Plus”, can we have a bit of a think about how that would be attractive to employers to sign up?

I’d love to help in anyway I can and I think it’s a fantastic idea x

Far from workfare. If a group of employers came together and employed one individual in a coup sponsorship it would actually be cheaper for them all round paying the rate of minimum wage.

In another group, asking the same question,

having bosses who are supportive when you are going thru depression i had to walk from my job because i was not getting any support at all it was on ly when i did what i did then the support came but it was little bit late

me: That’s a great point. So, could a service be provided that helps employees to approach their mental health needs with their employers/ and a complementary service that educates employers how to manage sickness/ support for employees with mental health be part of the package (and stuff about Equality Act etc)? Could it be this is delivered by people who have been through it, who could call on staff expertise as needed? Or just staff? Or just peers?

i think bosses need to be sent on awareness courses to pick up on the first signs of depression it would have helped me big style if i was given the help from the get go i really would like to help others who are going thru what i went thru would like some more info claire it’s so good that your able to help people i wanna do the same maybe volunteering

me: I think for anyone with long-term illness or experience of mental distress, there’s so much we can offer to others who are going down the same road. And you’re right, there’s so much we could do to raise awareness for employers about how to retain staff who become well. Or better still, how to put things in place to protect their workers from becoming ill, if at all possible! So, I see there being a training need (we could deliver to employers) an advice need (for people going through it or carers) and a peer support or “buddy” need (to keep you going when times are tough)- but access to volunteering and even paid work opportunities to get involved with this stuff, not just sharing our stories for free.

I’m serious about this project. It’s clear to me that people with experiences of distress have every right to be involved in service re-design and they have valuable skills and experiences to contribute. I’m actively continuing to continue this conversation, and I would love to hear your views in the comments. Do feel free to comment anonymously if you prefer.

#MindTech- Thoughts and Reflections

This post discusses the recent Mind Tech Unconference, a transcript of the back channel discussing the day can be found in my previous post http://claireot.wordpress.com/2012/03/31/mindtech-the-unconference-grabchat/

There are several issues that I immediately wished to comment on, namely, commissioning criteria in the new health economy, how this is impacted on by the ides of  #mentalhealthpound, the scope of using Apps to support mental health, social prescribing, and the place of the social enterprise in poulation based mental health promotion activity.

Commissioning

This point in time is fairly unique, in terms of the transitions happening in healthcare commissioning I was reliably informed at the #AHPNorth Conference this week by very senior members of the Department of Health just how the new commissioning environment is likely to work. Currently, the system of tariffs for work done has contributed to the “Cinderella” nature of mental health services, as well as thorny issues in attempts to implement Payment by Results etc. One of the salient points is that rather than rely on these historic tariffs as a system for commissioning care, we are more likely to see population based commissioning coming to the fore. Now, one of the advantages of this is that (in theory) it then becomes possible for a successful mental health promotion service to be commissioned, if they can show an effect at  population level for reducing the incidence of mental illness, and a reduction on other areas of the service such as inpatient admissions. This has huge implications for the work of organisations working to promote good mental health such as Moodscope and Mindapples, who both presented information at the Mind Tech event. I’m not clear about the outlined ideas of the #mentalhealthpound presented at the event, but look forward to exploring these and looking at how this in combination with the commissioning environment means we can address funding issues relating to many fantastic projects that many people like myself wish to engage with.

Apps

We all know that the recent MapsandApps project run by the Department of Health was a huge success, and that it really shifted some thinking about how to use crowdsourcing and technology to help to address health inequalities, and to promote good health. In my opinion, this benefit has hardly been touched on in health services, and particularly in mental health services. There are concerns with the Informatics agenda related to this. Who owns the information uploaded by the patient? What are the ethics of allowing the app development company to be selling this (anonymised) information on as another income stream? If these issues are worked out, how do they impact on how our statutory services are funded-will they be expected to pursue similar revenue streams using their valuable data?

It is also worth noting that apps and devices that can take advantage of gaming theory could have an impact on adherence to treatment regimens, perhaps even medications compliance. We know that there is a cost impact to this- as people adhering to treatment regimes and medications schedules are cheaper to engage in health services. If we see the wholesale adoption of gamification in tech applications in health and mental health, how will this affect the bottom line of organisations delivering care?

We know the future is co-morbidity. In the same way that we are now comfortable with APIs that mash up data from several social networks, could we see implications in Telecare and Telemedicine as APIs are developed that mash up data gathered by different specialists, different healthcare providers, that bring personalised, granulated information down to the point of care delivery by doctors and healthcare providers? What does it mean for the de-professionalisation of medical and therapeutic services when these APIs become available to the general public? Will they result in greater self-care, or will they result in people choosing to treat themselves rather than engage in formal healthcare provision?

Social Prescribing- or Occupational Therapy?

I was interested to read one of the first blogs produced upon reflection of the Mind Tech event, by Puffles (working, as ever, with his Bestest Buddy). To read the blog, please see here http://adragonsbestfriend.wordpress.com/2012/03/30/mind-tech-unconference-30-march-2012/

I can’t resist adding one of my favourite photos from Mind Tech: here is @Puffles

Picture from @Gandy’s FlickR site, used with thanks.

Bestest Buddy has frankly documented his own difficulties with managing his menetal health, and gives us a great insight into tunderstanding of the nature of mental illness. He describes:

one of the big challenges I faced was getting away from the idea that a short course of medication was going to solve things. It didn’t and it hasn’t. If anything, it’s made me realise that medication in my case has only suppressed the worst of the symptoms and that a longer term recovery is only going to be achieved through a tailored/personalised combination of other things.

Bestest Buddy relates his idea

Conditions such as moderate to mild depression and anxiety by their nature affect and are affected by the lifestyles that we lead. Every time I’ve been through an acute period of anxiety, depression or generally being ‘a mess’ I’ve tried to pick myself up by trying new actions and activities to deal with it.

When I read this sentence, I was struck by the notion that if I had been asked to define what mental health occupational therapy does, my definition would have been very close to that of Bestest Buddy’s idea of social prescribing.

giving patients and GPs the option of looking at what activities might be beneficial for patients I think would be brilliant. Rather than a course of medication and a few sessions of counselling alone, what about things that can complement such treatments? And how about making them on the NHS? This could include things like exercise classes, cooking classes covering things such as foods that help and hinder conditions such as anxiety. It’s one thing saying ‘avoid X,Y & Z’ but quite another to build it into a lifestyle.

It is clear that despite the wish of the public for activity based intervention to mediate mental health difficulty, this is not associated with Occupational Therapy treatment We have to ask ourselves as a profession, why is this? Despite our rich and growing evidence base within the profession and the related dicipline of occupational science, why is the message not getting through to the general public about what we do? How can it be that people who are engaged in mental  health treatment, and who are in attendance at events with other members of clinical staff are not being informed that what they are talking about is occupational therapy?

This is a topic we may cover on the #OTalk #occhat hashtags on Tuesday nights as part of our regular weekly peer-supervision Tweetchats. I think its an issue that deserves some of our attention. The analysis, prescription, and grading of activity to facilitate health really is the bread and butter of what we as OTs can offer. In the new health ecology, we need as a profession to start to stand up and define ourselves in terms that the public can understand- perhaps social prescribing should be added to our list of core competencies? I certainly believe that this is in line with advice I have taken on board from Karen Middleton, the Chief Health Professions Officer at DH after listening to her rousing speech at the AHP North conference.

Social Enterprises in Population Based Commissioning

Taking on board the Section above looking at commissioning, it becomes clear that this is a real opportunity for ex-NHS staff, service uers, mental health activists, and social entrepreneurs who want to make a shift into promoting mental health rather than waiting for mental illness to develop. It’s my belief that this commissioning environment will start to have an impact on the number of Social Enterprises, and the reach that they will have- moving out from community development activities into health promotion, and hopefully into peer-support networks commissioned to mediate mental illness.

I’m working on an interesting Social Enterprise idea which uses peer-support, in combination with appropriate APIs and my Occuaptional Therapy background to both promote good mental health and to catch the early warning signs of mental illness developing. Although it is a worrying time for people who care about healthcare in our Country, I am beginning to think that if we do get this sea-change in the nature of commissioning decisions, then we can see the stage opening up for players like myself and many others, who find their innovative ideas are very difficult to develop within traditional statutory services, and within the big voluntary sector organisations. We are nimble and agile in our peer-to-peer solutions to these issues, perhaps our time has come?

#AHPNorth Conference- Just Do It!

I was fortunate enough to attend the AHP North Conference in Leeds held on 28th March 2012. We gathered from across the North of England in order to examine the role of AHPs (Allied Health Professionals) in the new health environment we face, with particular referene to the QIPP (Quality, Innovation, Productivity, Prevention) agenda, the new Commissioning situation, and Service Redesign that we must now get involved with.

Prominent speakers included Prof Ieuan Ellis, Dean of the Faculty of Health Sciences and Professor in Healthcare Education, Leeds Metropolitan University: Co Chair of the AHP Professional Advisor Board, Edna Robinson, MD of the NHS Clinical Commissioning Community, Bob Ricketts CBE: Director of Provider Policy (DH), Karen Middleton, the Chief Health Professions Officer (DH), Sir David Nicholson, the NHS and National Commissioning Board Chief Exec.

We all are aware of a sea change in health and social care. It’s not just about the recent Health and Social Care Act (DH 2012), we know the demographic challenges ahead for the country mean that our health and social care systems are no longer fit for purpose. We are particularly concerned to move the focus away from hospitals and into the community, in recognition that better support for the frail elderly and for people with mental health issues, who are not served well by our hospitals.

I was able to use the power of social media in order to open up the proceedings of the conference to the wider public- resulting in a comment from Sir David Nicholson, the Chief Executive of the NHS, that he had never been asked a question by the public through Twitter, and perhaps it is time that he was!

I hope you will find it interesting to read the impressions of the day surrounding the #AHPNorth tag- I feel it gives a sense of what went on. If anyone would like to generate a Storify of the prominent themes they notice, please do so, and please do leave your comments below.

Please find below the grabchat of the day’s Tweets.

Involved …

Top resources …

http://www.rightcare.nhs.uk/index.php/2012/03/nhs-could-save-money-and-provide-better-care-by-involving-allied-health-professionals/
http://www.improvement.nhs.uk/SevenDayWorking.aspx
http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=RJk4n5%2fG6wk%3d&tabid=56
http://www.leeds.nhs.uk/Downloads/Corporate/Health%20and%20Wellbeing%20Board%20Fact%20Sheet%20November%202011.pdf
http://www.commissioningboard.nhs.uk/files/2012/02/Commissioning-Intelligence-Model-v13.pdf
http://www.guardian.co.uk/healthcare-network/2012/mar/21/nhs-reform-radical-approach-co-production
http://digihealthcon.wordpress.com/about/

Related tags …

#ahpnorth #nhs #leeds #ahp #socent

See Twitter for more tweets, people, videos and photos for #AHPNorth

@claireOT	Here at #AHPnorth . Filter me if you don’t want to read about it!(Wed, 28 Mar 2012 09:05:17 +0000)
@claireOT	When you (clinicians) use an NHS resource, you are acting as a commissioner of services in the new system – Edna Robinson #AHPNorth (Wed, 28 Mar 2012 09:16:37 +0000)
@claireOT	Being good doesn’t lead to long term stability- the people in the NHS have no idea how insecurity feels, compared to SocEnts etc. #AHPNorth (Wed, 28 Mar 2012 09:17:28 +0000)
@claireOT	Ahp’s aren’t great at marketing themselves, what’s the added value you bring? #AHPNorth (Wed, 28 Mar 2012 09:18:46 +0000)
@claireOT	Note to self: I really need to have a conversation with my CCG! #Leeds #AHPNorth (Wed, 28 Mar 2012 09:19:52 +0000)
@claireOT	Commissioners really want clinicians to lead and be involved with SocEnts to provide services in the new system #AHPNorth (Wed, 28 Mar 2012 09:20:28 +0000)
@claireOT	It may be worthwhile to contact the individual clusters of GPs to have conversations about clinical commissioning #AHPNorth (Wed, 28 Mar 2012 09:21:28 +0000)
@claireOT	The ordinary, everyday needs, not the big, sexy, elaborate needs are what the commissioners want to hear about #AHPNorth (Wed, 28 Mar 2012 09:23:26 +0000)
@claireOT	Only 40% of the practice list ever walk through the door of the GP surgery. #AHPNorth (Wed, 28 Mar 2012 09:24:58 +0000)
@claireOT	What about talking to practice managers about the ordinary, every day needs of people you see? Call it “”volume”" #AHPNorth (Wed, 28 Mar 2012 09:25:47 +0000)
@claireOT	The public are wise.nthey will work out how to influence the new commissioning environment #AHPNorth (Wed, 28 Mar 2012 09:26:39 +0000)
@claireOT	Am I the only person tweeting from #AHPNorth ?(Wed, 28 Mar 2012 09:26:58 +0000)
@claireOT	Fantastic context in those tweets via Edna Robinson, MD of the NHS Clinical Commisioning Network. Any questions? #AHPNorth (Wed, 28 Mar 2012 09:28:01 +0000)
@claireOT	Come on, there must be people wondering about how #socent s work in the new system? #AHPNorth (Wed, 28 Mar 2012 09:29:04 +0000)
@claireOT	Half of GPs haven’t been in practice for 5 years. They are not Gods! Don’t be shy- speak up! #AHPNorth (Wed, 28 Mar 2012 09:30:06 +0000)
@mikechitty	@claireOT #AHPNorth CCGs attitudes to #socent and risk will be fascinating to watch.(Wed, 28 Mar 2012 09:30:30 +0000)
@claireOT	Difference in attitude, to a socent, 3 years is stability. The NHS is used to *permanence* #AHPNorth (Wed, 28 Mar 2012 09:34:09 +0000)
@claireOT	Sustainability comes from a range of patrons, scale will help with sustainability not just panic marketing #AHPNorth (Wed, 28 Mar 2012 09:34:56 +0000)
@claireOT	The work providers might well end up employing AHPs #AHPNorth (Wed, 28 Mar 2012 09:35:55 +0000)
@MarkOneinFour	That’s a very good point RT @claireOT Difference in attitude, to a #socent , 3 years is stability. The NHS is used to *permanence* #AHPNorth (Wed, 28 Mar 2012 09:36:17 +0000)
@claireOT	We have to be fleet of foot, stop hanging on to dinosaur leaders, and promote the innovators! #AHPNorth (Wed, 28 Mar 2012 09:36:36 +0000)
@claireOT	How do the health and wellbeing boards work? … #AHPNorth (Wed, 28 Mar 2012 09:37:44 +0000)
@claireOT	… It’s all about the local leaders, of orgs, of local authority, who is advocating for you? Anywhere? Reputation not funding #AHPNorth (Wed, 28 Mar 2012 09:38:34 +0000)
@claireOT	Community services are critical to new ways of working, keeping people out of hospital #AHPNorth (Wed, 28 Mar 2012 09:42:19 +0000)
@mikechitty	@claireOT what are the scale of aspirations to shift investment from secondary to primary care? #AHPNorth #manyhavetried (Wed, 28 Mar 2012 09:43:20 +0000)
@claireOT	Crumbs, he’s going to talk about The H&SC Act…. Not exactly a sympathetic crowd, I would imagine…. #AHPNorth (Wed, 28 Mar 2012 09:43:45 +0000)
@claireOT	Easy to read guide to the Act on provider side, please see links given at the end- ill tweet it later for you guys x #AHPNorth (Wed, 28 Mar 2012 09:44:35 +0000)
@claireOT	Provider agenda- FTs will have more freedom from Monitor, it will promote fair competition, will prevent cherry-picking, #AHPNorth (Wed, 28 Mar 2012 09:45:30 +0000)
@claireOT	…FT will be able to undertake partnerships with SocEnts as a result of the income cap from private work. #AHPNorth (Wed, 28 Mar 2012 09:46:09 +0000)
@claireOT	Frail, older people are not provided well in community, leading to admissions to hospital. We have to solve this #AHPNorth (Wed, 28 Mar 2012 09:46:46 +0000)
@claireOT	Long term conditions, improve primary care, but involve service users in self management, use technology #AHPNorth (Wed, 28 Mar 2012 09:47:19 +0000)
@claireOT	10% of Mental health nhs services are now provided by SocEnts of ex-NHs staff #AHPNorth (Wed, 28 Mar 2012 09:49:43 +0000)
@claireOT	Personal budgets in health, and choice of service, and direct payments, to ensure the care commissioned by people #AHPNorth (Wed, 28 Mar 2012 09:51:04 +0000)
@claireOT	Publishing quality information for public, for commissioners. Or you won’t be commissioned. Stark. #AHPNorth (Wed, 28 Mar 2012 09:53:04 +0000)
@claireOT	Integrated services will be commissioned, whole pathway approach, rather than each individual element. Will promote partnerships #AHPNorth (Wed, 28 Mar 2012 09:54:27 +0000)
@claireOT	People don’t want to die in hospital. Need joined up care for end-of-life #AHPNorth (Wed, 28 Mar 2012 09:54:56 +0000)
@mikechitty	@claireOT How does this work for new startups who will have no data to share? Do they need 3 years accounts too? #AHPNorth (Wed, 28 Mar 2012 09:55:46 +0000)
@claireOT	McKinsey report was spot on in terms of where we need to transform services to cope with less money in the system #AHPNorth (Wed, 28 Mar 2012 09:56:19 +0000)
@claireOT	@mikechitty suspect they want them to get in bed with established partnerships and submit joint bids. Will ask, tho #AHPNorth (Wed, 28 Mar 2012 09:57:04 +0000)
@claireOT	@claireOT @mikechitty long answer… Basically, procurement systems will be simplified to open up to any qualified providers #AHPNorth (Wed, 28 Mar 2012 10:02:14 +0000)
@claireOT	@claireOT @mikechitty so this will be easier than previously. But they will not negotiate on quality, services must prove they #AHPNorth (Wed, 28 Mar 2012 10:03:05 +0000)
@claireOT	@claireOT @mikechitty can meet minimum national standards. Or can be subcontracted by big providers if can undercut nHS provision #AHPNorth (Wed, 28 Mar 2012 10:03:46 +0000)
@claireOT	@claireOT @mikechitty or, can form consortia, which may be with other SocEnts or vol sector, or event FTs #AHPNorth (Wed, 28 Mar 2012 10:04:16 +0000)
@claireOT	@claireOT @mikechitty finally, take business advice at every stage! #AHPNorth (Wed, 28 Mar 2012 10:04:32 +0000)
@claireOT	Difficulty with tariffs when trying to bring in tele- consultations with consultants and telemedicine this will now change #AHPNorth (Wed, 28 Mar 2012 10:05:38 +0000)
@claireOT	Nhs commissioning board and monitor will drive increasingly aggressive tariff reform in 2014-15, to push for this #AHPNorth (Wed, 28 Mar 2012 10:06:26 +0000)
@claireOT	Current tariffs are not working to drive innovation. Local groups could go after population commissioning on a pathway basis, #AHPNorth (Wed, 28 Mar 2012 10:07:10 +0000)
@claireOT	Heres the outcomes I want, here’s my population, who gives me an overall cost efficient solution for a long term contract? #AHPNorth (Wed, 28 Mar 2012 10:07:45 +0000)
@claireOT	Creative ways to guarantee the clinicians prevent hospital admissions, taking tariffs away from treatment towards outcomes #AHPNorth (Wed, 28 Mar 2012 10:09:00 +0000)
@mikechitty	@claireOT the value of ‘business advice’ in such a new environment is questionable. #AHPNorth (Wed, 28 Mar 2012 10:09:26 +0000)
@claireOT	Now up, Karen Middleton, the most senior Govt advisor representing AHPs Chief Health Professions Officer #AHPNorth (Wed, 28 Mar 2012 10:10:58 +0000)
@claireOT	AHPs are known as a professional group the downside, is that we don’t put ourselves forward! #AHPNorth (Wed, 28 Mar 2012 10:12:39 +0000)
@claireOT	“”get down and dirty”" was a bit too much, so we have decided “”just do it”" is our driving statement #AHPNorth (Wed, 28 Mar 2012 10:13:25 +0000)
@claireOT	No more talk about the Bill, or the system architecture, we just have to get on with the context we’re working in #AHPNorth (Wed, 28 Mar 2012 10:14:12 +0000)
@claireOT	Middleton says “”Adapt or Die”"- previous paper #AHPNorth – this is true, if a bit dramatic!(Wed, 28 Mar 2012 10:15:08 +0000)
@claireOT	@BAOTCOT you might be interested to follow my #AHPNorth tweets today, very interesting speakers!(Wed, 28 Mar 2012 10:15:46 +0000)
@claireOT	Number of over 85s will double in the next 20 years and over 65s will represent 20% of the population #AHPNorth (Wed, 28 Mar 2012 10:17:59 +0000)
@claireOT	The future is co- morbidity. Multiple problems that need solving concurrently #AHPNorth (Wed, 28 Mar 2012 10:18:21 +0000)
@claireOT	Over 50% will be musculoskeletal, over 20% mental health #AHPNorth (Wed, 28 Mar 2012 10:19:00 +0000)
@claireOT	The impact of digital technology can cancel out these pressures #AHPNorth (Wed, 28 Mar 2012 10:19:21 +0000)
@claireOT	Fantastic- she’s blowing the minds of everyone here by talking about granularity in personalisation of care #AHPNorth (Wed, 28 Mar 2012 10:20:22 +0000)
@claireOT	Patients testing themselves at home. Porting imaging to anywhere in the world #AHPNorth (Wed, 28 Mar 2012 10:20:48 +0000)
@claireOT	This isn’t a five year QUIPP programme. This is radical and permanent re-definition of delivery of health services #AHPNorth (Wed, 28 Mar 2012 10:22:51 +0000)
@claireOT	We just have to get on with providing seven- day services #AHPNorth it also saves money. Length of stay is reduced.(Wed, 28 Mar 2012 10:30:13 +0000)
@claireOT	Start to use cost- benefit analysis. You must understand your business model #AHPNorth (Wed, 28 Mar 2012 10:31:07 +0000)
@claireOT	What is being professional about? It includes using the money wisely! Every pound results in better quality care #AHPNorth (Wed, 28 Mar 2012 10:32:43 +0000)
@claireOT	Salami slicing and cuts is not the aspiration of QUIPP. This is unsustainable. We’ve got to be radical. #AHPNorth (Wed, 28 Mar 2012 10:34:01 +0000)
@mikechitty	@claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 10:35:02 +0000)
@claireOT	Not to speak up if you see or hear bad practice is colluding and is itself unprofessional have “”the conversation”" #AHPNorth #OTalk (Wed, 28 Mar 2012 10:54:34 +0000)
@claireOT	Professionalism extends onto social networking sites. If you see an AHP or nurse in compromising position on Fb, you should talk #AHPNorth (Wed, 28 Mar 2012 10:56:03 +0000)
@claireOT	I’m in a QIPP workshop now at #AHPNorth , expect a tweet pic with some kind of chart on it before lunch!(Wed, 28 Mar 2012 11:02:00 +0000)
@WhoseShoes	Interesting tweets: claireOT from #AHPNorth – incl great providers needing excellent approach to business as well as caring #socialcare (Wed, 28 Mar 2012 11:03:04 +0000)
@claireOT	RT @mikechitty : @claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 12:16:17 +0000)
@claireOT	Now Sir David Nicholson: chief exec of NHS and national commissioning board #nhs #AHPNorth (Wed, 28 Mar 2012 12:29:47 +0000)
@claireOT	This guy is very warm in his manner, and he is breaking with tradition and is not in a suit! #AHPNorth (Wed, 28 Mar 2012 12:30:40 +0000)
@claireOT	Reminding us to focus on outcomes for patients in the face of the Act #AHPNorth (Wed, 28 Mar 2012 12:31:25 +0000)
@claireOT	Demand for services goes up about 4% each year, due to demographics, tech advances and expectations of patients #nhs #AHPNorth (Wed, 28 Mar 2012 12:33:47 +0000)
@claireOT	No healthcare system has ever succeeded in meeting the challenge that is asked of us. We have to go down the innovation route #AHPNorth (Wed, 28 Mar 2012 12:34:30 +0000)
@claireOT	1st element only we can do some things, nationally, e.g. Management cost reductions. Generates a third of the saving #nhs #AHPNorth (Wed, 28 Mar 2012 12:35:54 +0000)
@claireOT	2 a third from everyday efficiencies #nhs #AHPNorth (Wed, 28 Mar 2012 12:36:16 +0000)
@claireOT	3 a third from service change, service redesign. We have to do this, or more has to come from cuts. #nhs #AHPNorth (Wed, 28 Mar 2012 12:36:54 +0000)
@claireOT	Up to a third of people in hospital beds don’t need to be there, if we had better community services and social care #AHPNorth (Wed, 28 Mar 2012 12:37:37 +0000)
@claireOT	Specialisation, I.e. concentrating specialists in one location e.g stroke in specialist units #nhs #AHPNorth (Wed, 28 Mar 2012 12:38:22 +0000)
@claireOT	We can move away from the medical model and therefore speed up the way we rehabilitate people #nhs #AHPNorth (Wed, 28 Mar 2012 12:38:59 +0000)
@InHealthAssoc	@claireOT intrigued that not one speaker has mentioned working WITH patients and communities? #AHPNorth (Wed, 28 Mar 2012 12:39:35 +0000)
@claireOT	GP practices are population based. This is the basis of the commissioning. Huge contact with pts, 90%of all contact in 1ry care #AHPNorth (Wed, 28 Mar 2012 12:41:30 +0000)
@InHealthAssoc	@claireOT sorry to bang on: but language is interesting “”WE have to speed up way WE rehabilitate people”". Us and them. #AHPNorth (Wed, 28 Mar 2012 12:41:41 +0000)
@claireOT	GP practices can make small changes which have a massive impact across the system #AHPNorth (Wed, 28 Mar 2012 12:42:36 +0000)
@claireOT	But, primary care must work with other profs in CCG to try to define the population based re-commissioning underway now #AHPNorth (Wed, 28 Mar 2012 12:43:31 +0000)
@claireOT	Soe services are huge- we need to build networks, we need to strengthen them, support them #AHPNorth #nhs (Wed, 28 Mar 2012 12:44:11 +0000)
@claireOT	Clinical senates- looking at huge geographical regions to see how care is working #nhs #AHPNorth (Wed, 28 Mar 2012 12:44:52 +0000)
@claireOT	We need to find a mechanism to impove community services. We’re trying to do this through AQP #AHPNorth (Wed, 28 Mar 2012 12:48:23 +0000)
@claireOT	“”We need to engage with public and patients to make t his happen”" good! #AHPNorth #NHS (Wed, 28 Mar 2012 12:49:18 +0000)
@claireOT	Work together as teams across the system. Build clinical networks. Build clinical senates #AHPNorth (Wed, 28 Mar 2012 12:51:22 +0000)
@claireOT	Never forget mid-staffs. We. Can never allow this to happen. Focus your attention on patient care #AHPNorth (Wed, 28 Mar 2012 12:52:50 +0000)
@claireOT	“”Engage people in the process, so that they feel part of it”" <I’m doing my best! #AHPNorth (Wed, 28 Mar 2012 12:53:28 +0000)
@claireOT	Seek out disadvantage and make sure they get the same healthcare as anyone else. Fantastic ending. Questions? #AHPNorth (Wed, 28 Mar 2012 12:54:13 +0000)
@claireOT	@InHealthAssoc take some comfort from the fact he is the big guy…. #AHPNorth (Wed, 28 Mar 2012 12:54:36 +0000)
@claireOT	Question re starting a clinical dialogue with GPs when the orgs are stopping/ trying to control it? #AHPNorth (Wed, 28 Mar 2012 12:55:39 +0000)
@claireOT	I am in the same room as the guy in charge of the #NHS . If you want me to ask him anything, now is the time! #AHPNorth (Wed, 28 Mar 2012 12:56:17 +0000)
@claireOT	@InHealthAssoc he comes over really well, I’m probably not making it clear. He’s wearing a jumper #radical #AHPNorth #NHS (Wed, 28 Mar 2012 12:57:18 +0000)
@claireOT	Foundation trusts that haven’t re-designed services on innovative lines, they will be in big trouble. Rethink business model #AHPNorth (Wed, 28 Mar 2012 12:58:36 +0000)
@claireOT	local, integrated, community based, focussed on recovery, this is the future #AHPNorth (Wed, 28 Mar 2012 12:59:25 +0000)
@claireOT	Incentives and payments are being changed to reflect this I.e. getting back to work not completing an operation #AHPNorth (Wed, 28 Mar 2012 12:59:56 +0000)
@claireOT	@RobWebster_LCH any q’s for the nhs big guy? #AHPNorth (Wed, 28 Mar 2012 13:00:59 +0000)
@claireOT	Ooh he is talking about the leaked risk register #AHPNorth (Wed, 28 Mar 2012 13:01:23 +0000)
@rose_red_121	RT @mikechitty : @claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 13:01:27 +0000)
@claireOT	We have to share resources across the system #AHPNorth (Wed, 28 Mar 2012 13:02:34 +0000)
@claireOT	@InHealthAssoc he has never been asked a question by a tweet before! #AHPNorth (Wed, 28 Mar 2012 13:09:09 +0000)
@claireOT	This is a hugely important part of the service redesign we want to see, patients are the experts! E.g diabetics #AHPNorth (Wed, 28 Mar 2012 13:10:40 +0000)
@claireOT	@InHealthAssoc investing in expert patients is a critical part of this, it will be driven by CCGs #AHPNorth (Wed, 28 Mar 2012 13:11:06 +0000)
@claireOT	@InHealthAssoc also, get involved with your local health and wellbeing boards, this is where you may effect change #AHPNorth (Wed, 28 Mar 2012 13:11:35 +0000)
@claireOT	@InHealthAssoc citizens panels might be used to come up with radical and interesting ideas through the health & wellbeing boards #AHPNorth (Wed, 28 Mar 2012 13:12:20 +0000)
@claireOT	Gandhi room is our venue. We can take advice from him. Be the change. #AHPNorth (Wed, 28 Mar 2012 13:13:05 +0000)
@claireOT	Doing a bit of paradigm shifting in the room, they are all reacting about the idea of tweeting what were talking… #AHPNorth (Wed, 28 Mar 2012 13:13:57 +0000)
@claireOT	@InHealthAssoc yes, I think he meant “”people”", anyone can get involved in H&W boards #AHPNorth (Wed, 28 Mar 2012 13:35:01 +0000)
@claireOT	@InHealthAssoc no, the tariffs are still reflecting the old situation but they are addressing this and it will change soon #AHPNorth (Wed, 28 Mar 2012 13:35:57 +0000)
@claireOT	@InHealthAssoc well, it is true. But there is no reason why they can’t go AQP and bid or subcontract to deliver services, now #AHPNorth (Wed, 28 Mar 2012 13:37:49 +0000)
@claireOT	*waves* to @naomimcvey good to see you at #AHPNorth today, do @ me anytime for a chat x(Wed, 28 Mar 2012 13:39:35 +0000)
@NHSImprovement	Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:15:25 +0000)
@claireOT	That’s your lot from #AHPNorth , #spoonie #fail I’m on my way home for a nap x(Wed, 28 Mar 2012 14:17:02 +0000)
@FestivalofPHUK	RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:23:27 +0000)
@NaomiMcVey	RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:29:40 +0000)
@NaomiMcVey	@claireOT good to meet you at #AHPNorth – great use of social media for Sir David Nicholson Q&A!(Wed, 28 Mar 2012 14:33:26 +0000)
@claireOT	RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:43:30 +0000)
@claireOT	” @NHSImprovement : AHP North of England – helping develop services for patients: 7 day working: http://t.co/81aw5EXM #7dayworking ” #AHPNorth (Wed, 28 Mar 2012 14:44:48 +0000)
@claireOT	” @NHSImprovement : #AHP North National Commissioning Picture, Edna Robinson, NHS Clinical Commissioning Community #Leeds ” #AHPNorth (Wed, 28 Mar 2012 14:45:24 +0000)
@claireOT	” @NHSImprovement : AHP North of England – developing #stroke services for patients: psychological care: http://t.co/UklcWdBh ” #AHPNorth (Wed, 28 Mar 2012 14:45:44 +0000)
@claireOT	” @dgfoord : “”NHS could save money and provide better care by involving Allied Health Professionals”" http://t.co/5aXgOLXJ #QIPP ” #AHPNorth (Wed, 28 Mar 2012 14:46:35 +0000)
@claireOT	” @NHSImprovement : #AHP North of England – Karen Middleton: AHPs – just do it! @DHgovuk ” #AHPNorth (Wed, 28 Mar 2012 14:46:50 +0000)
@claireOT	” @NHSImprovement : #AHP : Number of very old people will significantly increase in future – impact on #NHS services we deliver” #AHPNorth (Wed, 28 Mar 2012 14:47:03 +0000)
@claireOT	” @NHSImprovement : #AHP : 2 priorities – drive up quality of services and deliver savings to meet future demand” #AHPNorth (Wed, 28 Mar 2012 14:47:19 +0000)
@claireOT	” @NaomiMcVey : @claireOT good to meet you at #AHPNorth – great use of social media for Sir David Nicholson Q&A!” < thanks very much (Wed, 28 Mar 2012 14:48:10 +0000)
@claireOT	MT”" @CIHM_Becky : @claireOT @inhealthassoc depends what HWBB thinks it’s for. keep asking what value they intend to generate” #AHPNorth (Wed, 28 Mar 2012 14:49:06 +0000)
@claireOT	@CIHM_Becky you know me, I’m a “”disrupter”" in the Health system #Christensen #AHPNorth (Wed, 28 Mar 2012 14:50:19 +0000)
@claireOT	@CIHM_Becky next time, I suspect more Tweeting will happen @robwebster_lch #AHPNorth (Wed, 28 Mar 2012 14:51:01 +0000)
@claireOT	RT @NaomiMcVey : Interesting day #AHPNorth , key themes: get in there, transform services & focus on outcomes, patient engagement & QUALITY @claireOT @thecsp (Wed, 28 Mar 2012 14:51:09 +0000)
@claireOT	” @mikechitty : This Health and Wellbeing Board factsheet should make everything clear http://t.co/7bLKy4vC #Leeds ” #AHPNorth (Wed, 28 Mar 2012 14:51:44 +0000)
@claireOT	@CIHM_Becky @mikechitty so, how do I get in to talk to the HWBB? #Leeds #AHPNorth (Wed, 28 Mar 2012 14:52:41 +0000)
@claireOT	” @GdnHealthcare : NHS reform: a radical approach through co-production? http://t.co/8H28Tyxe ” #AHPNorth (Wed, 28 Mar 2012 14:53:06 +0000)
@claireOT	Also managed to do a bit of promo for #digihealthcon at #AHPNorth http://t.co/Goijz1mL @digihealthcon (Wed, 28 Mar 2012 15:04:12 +0000)
@claireOT	@anniecoops there was a little muttering about “”journalists”", but overall the reaction was positive #littlewin #AHPNorth (Wed, 28 Mar 2012 15:23:53 +0000)
@claireOT	” @mikechitty : @claireOT @CIHM_Becky This one is lovely as well http://t.co/fHl7Dac3 ” <er, that helps #AHPNorth (Wed, 28 Mar 2012 15:24:49 +0000)
@FlmCd	RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 16:57:32 +0000)

#MedEdMOOC, #HCPMOOC or #HealthMOOC?

The process of developing the MOOC for HCP continues apace, but there are still issues we need to hammer out in order to see the maximum possible engagement in the event, and the greatest possible learning opportunities presented to the greatest possible number (at least, that’s where I’m coming from).

There are currently 240 000 Allied health professionals in the UK alone, and over 350 000 nurses and midwives. But the focus of the MedEdMOOC, from the naming of it onwards seems to reflect almost exclusively the narrow group that is concerned with the education of Medics. I am glad that Dean Jenkins picked up on this idea in his recent blog, and that it is reopened for discussion.

But, how did this happen? Is it that medics are ahead of other HCP groups in their use of online technology? Is it that medical educators are a particularly technologically gifted group? Is it that other HCPs dont yet have an understanding of the potential of online technology? Is it that somehow we are excluding other HCP from the development process? I’m not sure of the answers to these questions, but I think it is useful for me to frame them such that I may reflect on them throughout the process and beyond. If you have any views about this, I would love to hear them in the comments.

The topics we are planning to cover over a six week spread are based around these working titles:

Week 1. Theory- Connectivism vs constructionism

Week 2. Learning- where are we now on the social web?

Week 3. Doing- Improving healthcare delivery in a networked world

Week 4. Collaborative Models (including CPD in social spaces)

Week 5. Barriers- what are they and how can we overcome them?

Week 6. Content to be decided by participants.

Now, looking at these titles for the weeks’ content, there is nothing that is exclusive to medics- in fact, all these topics can be used by any healthcare professionals. As a MOOC is likely to contain more content than any one person wishes to engage with, it may be that there are profession specific items that appeal more to one profession than another. But it is interesting to me that event though I have been involved in the planning of the event, I am holding prejudices about the process; doubts about whether my professional skills are of value to the process; wondering why more Allied Health Professionals are not on board with the development of the MOOC.

For what it’s worth here are my thoughts.

The name MedEdMOOC is an exclusive title, implying that content to be developed must be relevant to medical practice and be concerned with the education of medical practitioners. In my view, we could re-visit this naming decision to reflect a more inclusive title.

The development team is composed largely of medics. This means every decision is taken through that filter. Decisions are unconsciously made using the frame of reference from within medicine and medical education.

I’m excited about taking advantage of the principles of the MOOC to explore connectivity, horizontal flows of information, networked learning and professional developments that include exposure to the broad range of models used in healthcare delivery. But, to do that successfully, we either need a broader range of HCP involved in the planning, or very committed participants from different disciplines, who will then generate further content.

I also believe that the event will benefit from some real life experiences that participants can choose to be a part of. Myself and two colleagues are delivering a “Social Media Surgery” at our professional conference in Glasgow during the MOOC. This will provide us with the opportunity to explore either LiveStreaming an element of the workshop, or at least utilising Skype chat facility or similar to ensure people outside the room can be included. We may also choose to deliver an additional session for the participants online (venue and organisers’ indulgence permitting!)

I am planning an event in Leeds towards the end of June. I aim to get together the community of practice surrounding the #nhssm Tweetchat and some health and social care stakeholders. I hope that this event will similarly be able to be integrated into the MOOC, perhaps as an opportunity to ask questions, perhaps to hack some solutions to challenges we have identified in the uptake of some of these technologies.

Please do engage in the debate surrounding these ideas- we know this is the first health related MOOC planned, and its success is entirely dependent on how well we can identify and meet your learning needs!

Nhssm at the Nursing and Midwifery Council for Social Media Week #smwldn #smwnmc #nhssm

I was delighted to see that as part of this year’s Social Media Week, the Nursing and Midwifery Council (NMC) played host to a live #nhssm event. This was entitled “Talking with patients online: what are the boundaries?” and it featured some great speakers from the intersection between digital and new media and modern Nursing practice. It was accompanied by an article in the Guardian promoting the event.

“Nhssm” is a weekly Tweetchat that discusses the challenges and opportunities posed by using Social Media within the NHS. There is an accompanying blog, which hosts summaries of the weekly chats, and there are regular contributors to the body of knowledge in this area- if you would like to know more, simply search for the #nhssm hashtag on Twitter to see the most recent Tweets.

This is one of the earliest communities of practice that I joined on Twitter, and it has been a fantastic experience to connect with people who share my dedication to examining the issues presented by increasing use of digital and social media within the NHS. I have regularly contributed to the weekly chats for a few years, I’m one of the “old guard” of the group now- a strange thing to be saying in relation to the use of social media within the NHS!

My thoughts about this event:

• The event was “live-Tweeted” through both the @nmcevents and @nhssm accounts- this means that both accounts were used to capture and publish snippets of what was said during the chat. The advantage of this was that it meant important statements were more likely to be picked up and amplified. Because the team members who were behind the accounts were experienced in this use of social media, they functioned as true engagement tools, rather than simply broadcasting the event. Our regular weekly #nhssm Tweetchat was scheduled during the event, and so our contributors who were unable to make it in person to the event were able to engage with the format by asking and answering questions, and by offering informed opinions. Alex of nhssm blogged about his impressions of the event, and also feels that using two accounts to live Tweet the event worked particularly well.
• Using digital as part of our NHS communications toolbox is new in itself- using social media as part of the toolbox of clinical staff within the NHS is newer still. Formal policies and procedures are available, but in this emerging field, we are still sketching out the agreed boundaries of practice. I disagreed with Anne Marie (@amcunningham) during the chat as I felt that conventions do exist within these spaces. On reflection, I think that I must be careful not to assume that just because I am aware of subtle differences in culture between platforms that other people, particularly newer people to this space, are as aware as I am. So, I concede your point, Anne Marie!
• We have no agreed method for disseminating examples of best practice in the use of social media by clinical staff. Although communities will develop their own norms of behaviour, it is my experience that staff need to have a mentor, coach, or social media “surgeon” available to assist them in their understanding of how to use these tools. This can presently be frequently found informally within communities of practice online. It is my hope that more NHS Trusts and professional organisations will begin to see the value in having formal training and e-learning opportunities for their staff available as part of their professional development planning. I believe that formalising this process will add value to the use of these tools by staff, and enable outcomes in engagement and participation of client groups to be generated.
• I believe that social media communication channels should be offered to patients and carers of people needing NHS services. I believe that we have a responsibility to make information flow in the way that is most convenient for the patient, whilst recognising our special responsibilities for Information Governance and professional practice. I love Agency Nurse’s blogged reflections of how she aims to use her clinical skills in forming good quality therapeutic relationships through the newer media that we use- and I couldn’t agree more! Part of the issue is that many of our clinical leaders and people within the upper reaches of NHS heirarchy are not fluent with the use of these tools. They may, therefore, not see the benefit that others (perhaps particularly the networked generation) take for granted every day, whether patients or staff.

Here’s the transcript of the event. By looking at he analytics regarding the event, we can see that we had 97 participants in the conversation (surely some kind of #nhssm record?) and a total of 627 Tweets within the timeframe of the event plus an hour each way. This shows just how active and engaged the audience were. The most popular links shared were:

1. The Agency Nurse fantastic blog- “Getting Nurses Talking” which contained a very useful Guide to Twitter, applicable to many HCPs, not just nurses, I’m sure!
2. Agency Nurse coming up trumps (again!) with a great presentation showing how nurses can create a community of practice online by curating Tweets under the #nurseuk banner
3. The weekly #Nurchat Tweetchat and accompanying blog. Another great event hosted by Agency Nurse. This discusses relevant content that changes each week. It is on Tuesdays at 8pm on Twitter.
4. Link to the NMC presence on Social Media, with further link to their guidance on social media use for nurses and midwives.

Once more, I feel encouraged and supported on my own journey into social media by this fantastic community built around the use of a social network. I hope that you join in with our next chat, too.

If you would like to talk to me about how I can help your organisation deliver training and coaching around the use of these tools by your clinical or corporate support staff, do get in touch by email to tech4health (at) gmail.com or by leaving a comment.

Great to see further write up here in the guardian by @PamNelmes007 http://www.guardian.co.uk/healthcare-network/2012/feb/16/social-media-nurses-communicate-public?newsfeed=true

What should be included in a #MedEdMOOC? Social Media in Continuing Professional Development

After previously considering what a MOOC for OT, and indeed for healthcare should look like, I am delighted to report that plans are underway to develop the first MOOC for Healthcare Professionals and other interested people, and the name chosen is MedEdMOOC (Medical Education MOOC).

One of the things to be considered, is what content we would wish to see included in the MOOC. I’m hoping to use some posts to record my hopes and fears for the MOOC, and I look forward to reading your comments about what I’ve written.

First, a quick reminder of what a MOOC is.

Social Media in CPD (Continuing Professional Development) for HCP (Healthcare Professionals)

One of my passions is the use of online technology and social media by HCPs to enhance and update their skills and experience, in order to offer the very best care to their patients. This can take many forms, and perhaps one of the nearest “real life” analogies I have is that of a peer supervision group.

Within peer supervision, a group of people without large differentials in status and seniority come together to share their thoughts, feelings, challenges and successes around their practice. Whilst patient confidentiality is observed during such sessions, challenges in particular cases may be shared with the group in order to get renewed insights and ideas about how to move the treament on. Additional insight may feed back into the case formulation, and therefore affect the future direction of treatment. Similarly, where a success has been hard won by our clients, the delight of the therapist involved might be shared with the group, who might be invited to help reflect on what the critical factors might have been.

Other ideas can be introduced, for example in a Journal Club, where people discuss and critically evaluate as a group recent research relevant to their treatment area(s). New assessments may be discussed, evaluated, or even tried out on each other. Audit tools, ways to collate evidence and interpret statistical information- anything at all that affects the way we can provide care is up for discussion.

Peer supervision is a time efficient way of supporting occupational therapists and HCPs in practice, using the benefits of group process in addition to the benefits of the individual reflective process. In some ways, it can be seen as the equivalent to a therapeutic group as used within OT practice- in that group process and support from peers is as important as the quality of the supervision received.

I see many parallels in the use of peer supervision offline and the use of communities of practice that form online through social media use, or by clustering around topics of mutual interest. One of the differences is that in the online space through the use of social media, this process often happens in a public space, rather than a private one. This changes the experience of membership of the group.

It contains opportunities as well as challenges:

Opportunities

• By extending the membership beyond natural boundaries such as the employer or the physical location, groups may coalesce around mutual interest where before insufficient members were present in any single location.
• Groups can be flexible, and a fluid membership can mean that new members can join the group at any time.
• The non-heirarchical nature of the medium supports the formation of a group of “peers”, despite differences in status that might be apparent in “real life”. This can offer new opportunities to freely share with each other.
• Groups can offer opportunities to develop confidence and skills in presenting information in an online format.
• Group membership can lead to “real-life” relationships and support in an offline setting.
• The public nature of the setting may serve as a reminder of acceptable public behaviour and mores related to professional role, embedding these behaviours in further online activity such as social networking; in line with professional guidance.
• The public nature of the group means that insights from experts can be fed directly into the group, ensuring accuracy of the information and relevance of the opinions present.
• The transparency of this approach may be attractive to HCPs who find it in line with their personal philosophy.
• Patients and the public may be reassured to understand that this process is part of the “back end” of therapeutic work or medicine, ensuring the support they receive is evidence based, and the basis for clinical decision making may be better understood as a result.

Challenges

• The public nature of the group can inhibit the most frank discussions of difficulties in practice.
• Where social media guidance is lacking or insufficient, mistakes around information governance, or exposure of the individual practitioner to risk, may occur.
• Rich information captured in body language and non-verbal cues in the “real-life” group setting may be lost in the online group.
• Engagement in the activities may not be valued by the employer and traditional line-management structure, undermining the value of the process.
• Participants could undervalue the process because of the fluidity and ease of membership, thus “drop out” before real benefits are gained.
• Disruptive influences could “flood” the online space making positive progress of the group within the space difficult.

It is my hope that the MOOC will offer space not only to develop CPD for HCP, but also offer a structure around which HCP can reflect and discuss these challenges and opportunities presented by CPD in a community based in an online environment.

These are my initial thoughts about the value of looking at CPD within a healthcare MOOC, what are yours?

Paradigm shifts in healthcare- the rise of the e-patient

I’ve been thinking about the challenges and opportunities brought to us by considering the new paradigm represented by the rise of the e-patient. By this, I mean the emergence of the patient with the expectation of being a true partner in their care. Someone who is networked, and by having conversations outside the traditional therapeutic relationship, has new expectations of the healthcare professional (HCP).

This new way of seeking and developing knowledge is not news to my friends and colleagues in the digital sector, who have been aware of this shift for some time. It is not news in the USA, where e-patients have been on the increase (notably e-patient Dave, who is a remarkable individual with an incredible story to share). It may, however, be completely new to some of my colleagues in the health and social care sectors in the UK- and particularly in the mental health and learning disability field. I hope that what I have to say is interesting and relevant to you.

This new paradigm is about things being done in a new way. In this world, the old heirarchies fall away. Under the old paradigm, knowledge was located in the health professional. The patient was expected to attend an appointment, and like a supplicant attending a religious service, knowledge and advice would be dispensed like a sacrament in a one-way fashion by the health professional.

So what changes under this new paradigm?

The answer is: EVERYTHING

Every thing about the rise of the e-patient, Dr Google, patient forums, Patient Opinion, and a networked population challenges the old heirarchy.

Previously, of course, the very best HCPs were always happy to admit where their knowledge was out-of-date or absent, and would refer to a textbook or professional guidelines about the correct treatment decisions to take. But there existed a sub-set of HCPs who felt threatened by patients whom they failed to comprehend, and who would find it almost unbearable to admit they didn’t know. They may have relied on out-of-date evidence or training from their student days, or may even have allowed prejudice and personal opinions to have influenced the care they provided.

Fast forward to the current situation, and most people will have searched online for information about their health before they see the HCP (please see this survey for evidence). They may have accessed NHS resources such as NHS Direct, or even already have a view about the treatment they would prefer after consulting NHS Choices. They may have Googled their symptoms, and (for better or for worse) may therefore have already got ideas about their possible diagnoses, treatments and outcomes before visiting the health professional.

And how does this change practice?

Our role as health professionals is different under the new model. We are no longer expected to hold all the relevant information in our heads all the time (just as well, since thousands of new pieces of evidence are published every week) and our role may have changed to become more akin with the role of a tour guide. By that, I mean that our role should now be to  assist our patients to navigate the information and advice that is out there. We can share our skills in critical evaluation of evidence to show which sources of information are more reliable than others, and clearly explain our reasons for thinking so.

We can show our patient how to safely navigate the online spaces whilst searching for information, and how to access support and advice when the surgery is closed, or when in another city or country.

We can share our delight that the experiences of patients are being given their due prominence in the reiews of hospitals and doctors, and add that knowledge to our own understanding of clinical outcomes. We can be glad that this new relationship challenges the power imbalance inherent in the therapeutic relationship.

We can share our knowledge and skills more widely with our peers and with the general population by using social media. We can use the many free two-way conversation platforms to have real debates with our patients and public and understand each other more clearly as a result.

Whilst we can’t be expected to know everything, we can build networks over huge physical distance, and make contact with experts in many fields to ask for their views. Critically, SO CAN OUR PATIENTS! We can share the benefits of our network’s wide reading of topics of interest, and value that they are constantly curating new content for us to consider. The networked patient will also be able to do this- and so may be aware of the most recent evidence in support of the intervention we wish to follow- and any alternatives.

So, is this change welcomed with open arms? Of course not. Any change is scary (even for HCPs!) and any change requires a period of adjustment and re-negotiation. But, there is no doubt that a paradigm shift has occurred, the question is only, what are we going to do about it?

We may wish to consider new ways of ensuring participation of the populations we serve. We may want to explore new and more convenient ways to communicate, like email, social media, or Skype. We may want to explore electronic patient records, to ensure all the relevant information is available at the point of care. We could locate the responsibility for the health record with the patient, and no longer with the HCP. We may wish to ensure that the health information available to our patients online is accurate and up-to-date, by updating Wikipedia or blogging about our practice. We may wish to use web 2.0 technology to ensure our practice is current, through the many opportunities for continuing professional development that it provides.

Let’s make sure that we and our patients are not left behind, because everything has changed. One way to take part in the conversation is to join in with the #nhssm Tweetchat on Wednesdays from 8pm to 9pm, write ups available on the blog. I hope to see you there, next time.

Little Feet pursues PALS- an update in the Mental Health Inpatients Blogging debate

As I wrote in an earlier post, blogger @ChaosandControl, or Little Feet, was recently prevented from blogging whilst an Inpatient in an Acute Mental Health Unit by staff who confiscated her phone to prevent her having access.

Without my knowledge, staff read through the archives of my blog and my twitter stream…

…During a subsequent meeting with staff, I was notified that the archives of my blog and twitter stream had been read. I was asked to stop blogging and my mobile phone was confiscated for 24 hours. I agreed to stop blogging for the duration of my admission. While I did not want to stop blogging, I agreed to because I felt to do otherwise might have been detrimental to the care I was receiving. I enquired as to whether it would be possible to retain my mobile phone but agree with staff not to blog. I was informed that this would not be possible because a team decision had been made to confiscate my mobile phone.

As a result, she has had to re-evaluate her existence as an award winning mental health blogger and may feel unable to continue to operate her Chaos and Control blog.

She has updated her blog readers with the news that she has emailed her Trust PALS (Patient Advice and Liaison Service) with a view to gaining clarity about the decisions made in this case, and to highlight what may be a misguided interpretation of current guidance from the Care Quality Commission about Inpatient’s rights to communication.

Little Feet also makes clear that she has no wish to apportion blame to the staff who made this decision, since they were not in possession with up to date training in the ethics and guidance in this area.

She also points out the potential risks faced commonly by whistleblowers and has (as we would expect from an accomplished blogger) a fair-minded assessment of the internet convention for right to reply, in this case by the Trust concerned.

I feel it important that I pursue this matter through local channels in the first instance. I do not want to cause detriment to my current or future care I may need by skipping straight to national media and social networking sites. I believe the Happyvillesire Mental Health Trust should have the opportunity to respond to my request for clarification of policies.

As was pointed out during the #nhssm Tweetchat this week:

The ‘Streisand effect‘ is the inverse relationship between the attempt to surpress information and the internet’s tendency to make the information freely available and easily searchable due to the interest such decisions provoke.

So, the Trust concerned is now decidedly on the back foot in terms of managing the message about their brand, and only Little Feet’s sensitivity in leaving them unnamed is holding back the opprobrium of the blogging community. I need hardly point out the irony of this, since confidentiality was cited as a justification for the Trust’s actions!

As we saw in my last post, the Trust’s reactions in this case were probably due to a lack of preparedness for the new networked reality. We saw how they are occupying the bottom layers of Maslow’s hierarchy, whilst Little Feet comfortably negotiates higher levels.

How could the Trust learn from this matter, and put in place measures to prevent this kind of publicity and negative brand association in future?

The organisation, or at least some individuals within the organisation need to make their journey up the levels of this pyramid to improve their business readiness for a future scenario.

Traditionally, the individuals within a Trust organisation concerned with the perception of their brand are located within the corporate Communications structure. We can see that in this instance, as in many other potential scenarios, this is a risky situation. Communications professionals are not embedded into practice areas, where these judgments will, increasingly, have to be made by clinical staff and managers. So, even if a Trust had a competent communications structure that was conversant with the conventions and corporate risks inherent in social media, they may not be available to consult with clinical staff in a timely manner.

It becomes clear that in fact it is the clinical, customer facing roles that must develop capacity and be sufficiently strategically resourced and trained in current corporate policy in this area. This flies in the face of the traditionally centralized business model for corporate communications within the NHS.

What is the solution?

Communications through social media are an organisational game-changer. We must move with the times and adopt a new way of doing business, where we empower clinical staff with the training and resources they need to support the efforts towards self-actualisation of people in recovery.

How do we do this? We must re-visit our centralised model of corporate communications, following on from the lead shown by notable public sector organisations such as Monmouthshire County Council, who recently allowed all employees to respond directly to customer enquiries. We should all prepare to move towards a “honeycomb” communications model, where all members of an organisation are empowered to understand the rules and conventions that govern response in the social space. Staff should be resourced such that they are able to identify which communications should be handled by communications professionals, and feel confident to handle the rest as the excellent brand ambassadors that NHS staff invariably are.

The Slideshare presentation linked to in the last post includes an excellent triage flowchart for staff using Social Media by Jeremiah Owyang. This could be used as a baseline for your policy.

Source:DavidArmano,Edelman  (http://www.flickr.com/photos/7855449@N02/5042953763)

@HelReynolds of Monmouthshire County Council and ReynoldsPR.com has some tips- I recommend the article.

What do you think?

If you would like me to help your business change the centralised communications culture, and train your staff in how to respond on the social web, please don’t hesitate to contact me tech4health(at)gmail(dot)com.