A digital place for people who access services, carers, staff and partner agencies, to share ideas around care co-ordination & care planning in mental health


Care plans are often on my mind, but this week more so.  Why? well first I have an ongoing internal battle with the term ‘care plan’ that I must declare. I find the term reinforces the sick role (needing care) and as such is counter to the values underpinning wellbeing and recovery – that said, being ‘caring’ is an essential attribute to health care workers and providing evidence based, person centred care is central to building a culture of compassionate care.

Back to care plans on my mind, this week two things happened:

Thing 1. I participated in an event – Using data to improve care – where I met and was involved in a conversation with Reg Race from Quality Health (they conduct the National Mental Health Service User Survey).  Reg spoke about the national picture of about one third of service users reporting that they have a care plan. He suggested that care plans should be no more than a couple of pages long. 

Thing 2. I was pointed to a blog posted by @ermintrude2: Care Plans – Now and Future Me. Ermintrude’s blog was prompted by reading another blog (so yes, thats two to read, stick with the link). They illustrate the importance of language through highlighting how the terms used in health and social care (plans) can be dehumanising and reductionist. That the interpretation of a care plan can result in choice becoming limited, static in a moment in time. I could point to a list of best practice in relation to care planning; or something similar but on this occasion I urge you to read then mull, ponder, reflect or just give it some thought.

These two things together remind me of the importance of stepping back and reflecting on what we do and how we do it.  The Care Programme Approach care plan in Leeds and York Partnerships NHS Foundation Trust is more than a couple of pages long. For sure.  And how easy is it to ditch the jargon, to write in straightforward, Plain English? It’s hard, it’s letting go of a lot of what we are familiar with, its giving up some professional identity and perceived ‘power’ that goes with it ( if you have not already done so).

I’m leaving it there for now. Time to ponder.

Donna

 

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Comments on: "Rethinking care plans…………?" (3)

  1. There needs to be a balance between structured content and the free text. We should be aware that anything unstructured will not be available for analysis and grouping together for management and commissioning purposes. One of the key findings from the Francis Report was that whilst care plans existed for some patients, they frequently did not get referred to or used in the care and the management of care, to the detriment of patients. It is vital more intelligent information is available to indicate where additional resource is required to meet the needs and complexity of care required but there is also a need to personalise/contextualise this to the individual. It should not just be bean counting, but approximately 25% of nursing time is currently occupied by meeting the needs of returns of professional and other audits which could be met by deriving more information from a structured clinical record.

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  2. Thank you, Reg made some really insightful suggestions at the workshop last week.
    I think it is really important to “separate” the assessment of the person from the care plan itself. The assessment may well be far more comprehensive than is achievable in a “couple of pages”; however a summary of needs and goals for the majority of people could achieve this. Similarly the FULL care plan including all activities for someone with complex needs is unlikely to be fitted to this limited space, but a summary of what is immediately needed by an individual person (patient or professional) may well be summarised to this or less.

    Intelligent use of technology could allow very complex care plans and pathways to be presented in a very straightforward and understandable way, but a common understanding and framework is required, because people move during their care between different providers. We have made a start along this journey http://www.infostandards.org/careplanning but ensuring all needs are adequately reflected may take some time. Using a structured terminology like SNOMED CT can ensure all people involved can have a common view of the care plan. Whilst some language used may be clinical in nature, if we are adequately discussing the care plan with involved lay people (including the recipient of care), then this should not be an impediment to understanding. There may be a need for other measures for people with impaired capacity, but this applies to most care plan representations.

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    • Hi Zac, thanks for commenting. I agree, care plans can be complex or straightforward, there are lots of variables that influence this. Care Planning is a professional and organisational requirement too which adds to the mix. Restricting the length of care plan would be no guarantee of improved quality though it would likely release time to care. So perhaps its about having the right tools to support care planning? At LYPFT we are developing Integrated Care Pathways (ICP’s), these support the care coordinator in identifying the best care, support and treatment based on national guidance, this then forms the basis for the discussion/negotiation around what the person wants to work on to acheive their goals, culminating in a care plan. The ICP should give the opportunity to produce a more concise care plan as the ‘need’ areas have already been explored (via ICP).

      I do have reservations about SNOMED CT, structured terminology is service facing and this would be an approach contrary to supporting wellbeing and recovery. In my opinion, when the person is not writing their own care plan, we should be using the persons own words to describe experience & preference, using plain english etc. Using language in care plans that then needs translating is missing the point (purely personal view).

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