What Matters To You Day 2018
Posted by See Me, 4 June 2018
What Matters to You Day on Wednesday 6th June presents an opportunity to reflect on the importance of asking and acting upon the things that people say are important to them. For example, by providing care, treatment, advice, support and/or signposting, through offering compassion and a listening ear to enable people to achieve their own goals, or by tackling the structural inequalities that exist that prevent them from realising their rights and aspirations themselves.
More than 90% of health care interactions begin and end in Primary Care, and therefore it should prove a particularly fertile ground for the early identification, intervention and prevention of mental health issues. However, we know from the Scottish Association of Mental Health’s 2014 survey of GPs[1] regarding treatment of people with mental health problems that:
- 84.6% believe there are gaps in local service provision;
- 81.6% would like more resources to support self-management;
- 73.3% would like more information on non-pharmaceutical options.
The new GP contract in Scotland creates opportunities to transform Primary Care to ensure it is mental health inclusive, to trial and propagate new models of care that support self management and build on people’s strengths and interests, and to connect people into their communities. An example would be the incremental rise of link workers, reflective of the Scottish Government’s commitment to recruiting at least 250 to work within GP practices across Scotland by 2021[2].
There is also the opportunity to come up with a strategic approach to Primary Care provision that will impact other areas of the system, including the engagement of a wide array of disciplines in the delivery of community-based care, through Primary Care Improvement Plans. For example, finding new ways to more adequately support people with High Health Gain potential[3], or those who frequently present at A & E, by paying careful attention to why they are there in the first place (as in the High Intensity User programme in England, which cut admissions of that group by 90% in Blackpool[4], by focusing on what they said mattered to them).
Innovative work through the iHub – The Practice Administrative Staff Collaborative[5] – also opens new possibilities for more effective and efficient triage via enhanced roles of receptionists and other practice staff as care navigators, supporting individuals to self manage and link in with appropriate community resources (video – showing an example of what this might look like in practice). However, it’s vitally important that, whilst much of the focus is on workflow, attention is also paid to any detrimental attitudes or behaviours that practice staff may harbour or demonstrate towards people with mental health issues and that these are addressed, for example, through supporting staff to gain enhanced skills in engaging with people compassionately and listening to what matters to them.
Through Making it Easier, Scotland’s Health Literacy Action Plan 2017-25[6], there is also an emphasis on connectors such as those already mentioned within Primary Care settings, but also within social welfare and library services. By broadening the scope of our engagement with the public on wellbeing and ensuring health literacy responsiveness beyond traditional health and social care settings we are more likely to improve the outcomes of individuals currently underserved.
Realistic Medicine[7], a policy ambition of the Scottish Government, is about moving towards shared decision making within health and social care and building a personalised approach to care. Practising Realistic Medicine[8], fittingly, starts with a poem, “A note to patients when all else fails[9]”, which ends, after every tried intervention is deemed inappropriate:
“Then I have to ask you what to do
Which is what you might
have wanted all along.”
Finally, despite the possibilities presented by exciting and innovative approaches to supporting mental wellbeing, we mustn’t lose sight of the structural inequalities that exist – if we’re to improve the wellbeing of the nation, it’s not simply new models of care we need, but new ways of living.
A quick tour of the NHS Information Services Division’s Data Explorer tool, using deprivation as a factor, provides a sobering visualisation of why: a steady gradient can be seen for every type of activity (with the most deprived areas having the most activity in terms of use of healthcare services; or to put it another way: the worst health).
Thus we must ensure that we are all supported to connect with others and with our interests, given opportunities to find and sustain decent work[10] and good housing, and are provided with social welfare that enables outcomes that matter to us.
And when, despite this, we encounter difficulties with our mental health, health and social care services should be able to respond appropriately, effectively taking account of what matters to us – with the system flexing around us and our loved ones, and not the other way around.
Benj
[1] https://www.samh.org.uk/documents/A_SAMH_Survey_of_general_practitioners_in_Scotland.pdf
[2] https://beta.gov.scot/publications/connected-scotland-tackling-social-isolation-loneliness-building-stronger-communities/pages/11/
[3] https://spark.adobe.com/page/Ox4cbqCfbhxut/
[4] https://metro.co.uk/2018/05/21/paramedic-single-handedly-cut-ae-visits-90-7565286/
[5] https://ihub.scot/gp-practice-administrative-staff-collaborative/
[6] http://www.gov.scot/Resource/0052/00528139.pdf
[7] http://www.gov.scot/Resource/0049/00492520.pdf
[8] http://www.gov.scot/Resource/0053/00534374.pdf
[9] http://www.scottishpoetrylibrary.org.uk/poetry/poems/playing-god
[10] https://policy-practice.oxfam.org.uk/publications/what-makes-for-decent-work-a-study-with-low-paid-workers-in-scotland-600955