Older People Living with Cancer

Peer advocates supporting older people affected by cancer

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Person-centred care and support – a moment of opportunity (part two) – Martin Routledge

Martin continues his two part blog to ask the question – What else can we do?

So what else can we all do to make sure that Vanguards and IPC help light the blue touch paper for person-centred care rather than fizzling out like a damp squib?

I have read a number of sceptical but persuasive pieces raising understandable doubts about both the ability of pilots (by whatever name) and top down initiatives to actually drive desired changes to delivery and culture across services and systems. As someone who has worked for more than 30 years at both local and central levels and as part of efforts to drive user-driven change I generally sympathise with this kind of analysis. The problem is they rarely offer real world solutions – sometimes suggesting over-simple alternative routes to achieving broad based change or ones that will be clearly impossible to bring about.

For those who are seriously committed to person-centred care, engagement with the (inevitably messy) real world and multi-faceted approaches to making deep change happen will be necessary. We need thoughtful action at the ‘top’, the ‘bottom’ and in the middle!

So, while the national initiatives themselves will not transform health and care services, they are inevitably an important part of the picture and we need to help them to play the best part they can. We will have to powerfully and persuasively describe how person-centred approaches are necessary to achieving their objectives and how they can be delivered.

In parallel though, we will need to do a number of other things. In very brief outline these include:

  • Connecting (in a two way process) what is happening and being learnt in the programmes to a broader group of people and places, who want to see person-centred care at the heart of future public services, so they are not waiting for ’results’ from central initiatives but can offer and use learning in real time. This will include supporting ’early adopters’ outside of national programmes – who have some advantages in being able to act outside of programme constraints.
  • Supporting people using health and social care to themselves drive change at local levels, through groups and organisations looking to co-produce support and shift services in the direction of person-centred care. This is about gradually building a powerful movement that will demand and support better forms of public service delivery, based on real partnerships between people and professionals and better use of all types of resources.
  • Work with professional leaders, groups and networks: sharing person-centred solutions to the problems they face in their work and energising their shift to co-production with those they serve. Linking these professionals to the growing movement of people using public services to become a joint force for person-centred support.
  • Act to ’create the conditions’ for person-centred care in a range of ways, including sharing powerful evidence in different ways and influencing professional bodies and funders of training and development to prioritise person-centred approaches. We will have to support commissioners to prioritise person-centred care and increasingly support the building of non-traditional, non-medical supports and capacity. Action to create the right conditions also includes helping policymakers to see person-centred care as core to what they are trying to achieve and how they can pull system levers to support and incentivise them

None of these things will be easy to do and it is not any single group or organisation’s job to do them. This focus on person-centred approaches will be hard to achieve in an environment of unprecedented financial pressures, competing priorities and the current lack of experience within the health system in particular.

This is why the Coalition for Collaborative Care came together and launched in November of last year. We are a voluntary alliance of organisations and people with an unapologetic focus on person-centred care and support. We are bringing our energies and influence together to achieve, over time, a sea change in how people with long-term conditions and professionals work together. We are modelling this by working in co-production with people with long-term conditions, carers and professionals. We don’t have a multi-million pound budget and we don’t want one – our model for action and influence will be through the activity of our partners and members and our support and assistance to them. If you are interested in hearing more please see here, and there are still a few places left at our gathering in Manchester on Thursday May 21.

So, in conclusion, will the Vanguards and Integrated Personal Commissioning transform health and care and initiate the era of person-centred care? No, of course they won’t, on their own. But those of us who want to see this new era should take the opportunity they offer us with both hands. The Vanguards and the IPC programme are an opportunity to show what is possible if we really put people at the heart of public services and work in partnership, together. C4CC will be doing all we can to take this opportunity – please join with us and help build the person centred health and care system of the future.


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Engaging with the Dorset Clinical Commissioning Group

Graham Willetts, chair of Dorset Macmillan Advocacy’s Cancer in Older People Development Group has participated, along with other group members, volunteer advocates and staff, in recent consultations by Dorset Clinical Commissioning Group (CCG) about Cancer and End of Life services.

Two Public, Patient and Carer consultation events asked ‘What is good about current services and what could be better?’ and the Stakeholder (service providers from NHS and other sectors) consultation event asked participants to consider the collected responses to this question and to discuss in groups five areas including:

  • What does it mean to plan and tailor cancer care around patients and carers?
  • Do we need to focus more on survivorship? What do we need to do to support increasing number of patients living with cancer for 5 years or more?

The Cancer and End of Life Services clinical commissioning programme (CCP) is one of six set up by the Dorset CCG. The CCP is reviewing the priorities set in 2013 and looking to future trends and challenges, including the Better Together programme for integrated locality health and social care teams. The Dorset CCG will also launch a Clinical Services Review in the autumn.

Within the groups and during the closing plenary we described the benefits of independent advocacy to cancer patients and their carers and distributed copies of the case studies publication Every Step of the Way. Tracy Street, Regional Macmillan Involvement Coordinator, described the benefits of support groups.  Tracy and Paula Bond, Regional Macmillan Development Manager, were invited to facilitate two of the discussion groups.

In summing up Dr Lionel Cartwright, a local GP and clinical chair of the Cancer and End of Life CCP, said he was encouraged by the discussions. He also said that he would like people to be empowered in terms of deciding the type of care that they want.


Sarah Turner and Graham Willetts at CCG Stakeholder event 3  September

 Pictured Sarah Turner, Principal Programme Lead, Dorset CCG and Graham Willetts

Kathleen Gillett, Dorset Macmillan Advocacy