| Linda Hutchinson
Blog: C’mon NHS, make us proud
On the Ideas Hub we celebrate stories that show how people have used collaboration and coproduction to flip the power dynamic, develop community owned solutions, change people’s lives. So far these have been mostly in care sectors – homelessness, children and young people, domiciliary care. We don’t have many stories from the NHS.
The terms self-management, patient activation and person centred care are now in frequent use in the NHS. This was not the case 10 years ago; the direction of travel is good. Yet I was struck recently by a video I saw of a multidisciplinary team in action in a GP surgery. It was trailed as a great example of a new way of working but I was left feeling disappointed. How much progress has really been made?
A multidisciplinary team from 2003
Back in the early 2000s, in my then role as Director of Education and Workforce Development in a hospital trust, I was invited to attend a cancer multidisciplinary team meeting – a weekly event where staff discussed people who had recently been referred or diagnosed with cancer in order to develop management plans for each. I was to observe, meet the team and then advise the Head of Department about possible team development opportunities.
There were about 20 people including doctors, nurses, allied health professionals and health professions students. Only 3 people spoke – the consultant surgeon, pathologist and radiologist. They discussed 3-4 patients. The focus was on X-rays, diagnosis, staging and therapy scheduling. No patient or carer was present, no-one inputted their views or preferences. There was no discussion about the patient’s circumstances, housing, support network, family.
I was treated with hostility from the consultant surgeon, accused of challenging his expertise by suggesting that he needed any development. My advice to the Head of Department later was that this was a team only in name and that there was work to do to be able to consider any team learning opportunities.
A multidisciplinary team in 2017
Fast forward to 2017 and here is what I saw in the video of a similar team in a GP practice.
There were about 12 people including doctors, nurses, allied health professionals, social worker, a third sector link worker and an administrator. Two GPs did most of the talking while 3 others, the nurse, therapist and social worker, responded to specific questions. They discussed 3-4 patients. The focus was on diagnoses and medical needs. No patient or carer was present, no-one inputting their views or preferences. There was little discussion about their circumstances, housing, support network, family although there was a reference to likelihood of admission or returning home based on medical status.
It was patient condition centred rather than person centred
I don’t want to dampen enthusiasm or miss that progress has been made. The recent experience was definitely more multidisciplinary but it still felt ‘clinical’ and a long way from asset and strength based approach. It was patient condition centred rather than person centred. I heard statements such as “patients are not always receptive”, “we need to decide what the next steps are”, “I can’t see any way he is able to go home” – paternalistic, judgemental, deficit focused.
I am not saying that medical aspects aren’t very important. Of course they are and everyone needs good clinical advice and treatment. But these issues dominate the content and the people who are the experts in them set the tone of the meeting. This means changing the focus is hard. I am sure there were people in both rooms who would have been fully capable of leading a much more holistic and inclusive conversation. They just never got the chance.
Here at the Ideas Hub we would be thrilled to publish stories or videos of truly holistic, asset based, person centred examples that includes clinical staff. Let’s show that it can be done, is being done and has benefits all round.