Building the House of Care in Grampian

Written by: Chris Littlejohn, Interim Deputy Director of Public Health, NHS Grampian
and Linda Duthie, Public Health Manager, NHS Grampian

Chris Littlejohn and Linda Duthie from NHS Grampian reflect on the process of building House of Care in Grampian.

During 2018 GPs and practice nurses across Grampian have begun using care and support planning, as part of wider changes that promote a person-centred approach to health and healthcare. The health system is increasingly linking itself to the wider community and social assets that underpin quality of life and wellness. This is the short story of how we’ve reached this point in Grampian.

We had strong foundations to build on

NHS Grampian had been exploring support for self-care and self management for over ten years. We knew increasing numbers of people were living with long-term health conditions, and that having multiple conditions was becoming the norm. We wanted to make sure that our health services were best able to help people to live well with, and despite, long-term health conditions. We knew that there was more to this than simply getting people’s medicines right.

We found our existing champions

We already knew that many health professionals took the time to really listen and understand the people they were working with. During 2015 we took the time to go and speak to them. Everyone we spoke to was able to help us find others we needed to see. We heard of frustrations with systems that limited their time with people, and of complex systems that can be difficult to navigate.

We also made contact with colleagues in our Third Sector Interfaces, and with local charity and voluntary organisations who worked to support people with long-term conditions. We began to understand how the health system looked from their perspective and how things might be better.

We had the support of those who had done this before

At the same time we made contact with the ALLIANCE Scotland. Colleagues from the ALLIANCE made multiple journeys to Aberdeen to meet with us, discuss what we were learning, and help us to make sense of what we were hearing. The ALLIANCE brought their national self management networking event to Aberdeen for the first time at the start of 2016. Over one hundred people attended and encouraged us that we were heading in the right direction.

We brought everyone together to create a shared vision

By 2016 we had brought health professionals, healthcare managers, local third sector professionals and national third sector representatives together. Over two workshops we had developed a shared understanding of supported self management and what would be required to deliver it. Without intending to, we had described the house of care.

We valued this grassroots approach…

We knew that supported self management could not be imposed on professionals ‘from above’. We realised how valuable it was for practitioners to be able to come together, share ideas and experiences, and support one another to implement changes in their work. We nurtured the Grampian self management network, by arranging three sessions a year, hosted by a local organisation and comprising presentations and updates from the wide membership.

…but also saw that grassroots change needed strategic ‘buy-in’

In 2016 we presented our work to NHS Grampian Health Board. Our work was supported, and we included it as a strategic priority in the Grampian Clinical Strategy as it was developed that year.

Wider changes in the health system were also timely

During this time the integration of health and social care had happened. The new health and social care partnerships had prevention, wellness and health at the top of their agendas. Both operationally and strategically there was a growing sense of willingness to work differently.

The house of care

During 2017 we began the process of setting up a programme board to oversee the implementation of the clinical strategy. That same year, colleagues from the ALLIANCE and Scottish Government presented house of care at a meeting of the Grampian self management network. The enthusiastic response to this, not least from one GP who said this was the reason they came into medicine, persuaded us we had to find a way to bring the house of care to Grampian.

During 2017 we identified funding and made the arrangements for Year of Care (This link will take you away from our website) to provide training and support to our GP practices in Grampian. We’d hoped for six to agree to try the approach, but in the end we had nine practices who volunteered! The process of training, process mapping, IT adaptions and system changes began in early 2018. Additional GP practices have voiced their enthusiasm for the approach and support has also been offered to them.

We’re at the start of a new way of working. It hasn’t happened overnight, but the time invested in growing the grassroots support, securing the strategic buy-in, and developing national links and our local network has been worth it.

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