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Blog: Sometimes it’s the simple things that help

Diane Kennedy, Depute Director, ESS shares a nugget of wisdom: ‘keeping things simple can often be best’ which she was reminded of when working on Threading the Needle in Glasgow.

I’ve had the pleasure of working with Glasgow Health & Social Care Partnership for a year[i], with a focus on the third sector role in developing anticipatory care plans (ACPs).

I know that the work has been helpful and we’ve learnt lots about the potential role of the third sector, the benefits of keeping an eye on long term outcomes and how to support front line staff. But it seems that the biggest impact has been about how to think about health care pathways. 

We drew together a range of professionals to review the current pathway and to think about how to make that pathway more person and less service centred. We developed some really simple questions based on potential patient experience. Questions like:

  • How will the person hear about ACP?
  • How will the person access the paperwork?
  • What help might that person need to fill in a plan and to identify their needs and potential services and support?
  • How can the person link this plan to other relevant plans?
  • How can the person put key information onto the GP’s summary?
  • How will the person be reminded to update their plan?
  • How can the person be sure that their plan will be used by acute staff.

This helped us to see that the pathway had to be flexible to allow

  • People to do things for themselves
  • Complete an ACP with help
  • Have an ACP initiated by a professional.

Jean Blackwood (Service Manager for Older People and Primary Care) found she could use these simple questions to have conversations with organisations who could help. For example, Southside Housing Association are exploring how they might help sheltered housing residents to complete ACP’s. Jean noted:

“It helps to have really simple questions to frame the discussion, like ‘how will people hear about ACP?’ and ‘how will it link to other plans?’  It keeps you focussed on the practicalities.”

It shows that keeping it simple works. It’s not difficult to start with the person when designing services. You just need simple questions.

[i] I helped the ACP team to think about the theory of change for the one year programme and how they might evaluate their impact.  I ran focus groups with staff, people with long term conditions and third sector organisations. I also facilitated a session to redraw the pathway for ACP and facilitated a local call for action.

More information about Threading the Needle here

Threading the Needle resources:

Three learning points:

·        We need to talk about data and evidence

·        We need to build the focus on outcomes

·        We need to understand where third sector evidence fits

How to explore decision making and the role of evidence

From the source to the sea

The story of Threading the Needle in:

·        Glasgow

·        Fife

·        North Ayrshire

·        Perth & Kinross

Reviewing the pathway (Anticipatory Care Plan, Glasgow)

North Ayrshire Monitoring and Evaluation Form