Blog – From Patient to Practitioner – My Lived Experience of Working with AQuA – Carl O’Loughlin

Carl O’Loughlin has been a member of AQuA’s Lived Experience Panel since 2015. As he starts his training to become a qualified mental health nurse, he shares his experience of working with us for the past three years.

Carl O'Loughlin

I first came into contact with AQuA in June 2015, when I was working as an involvement representative on a peer support project in the Cheshire and Wirral Partnership NHS Foundation Trust (CWP). Through this project I met Paul Greenwood, AQuA’s Mental Health Improvement Advisor; who was running a Restraint Reduction initiative on one of the CWP inpatient wards.

During our meeting, I shared with him my work with CWP, together with my own lived experience of using mental health services and my professional background; where I had experience of quality improvement.

Paul also told me that AQuA was forming a Lived Experience panel and after applying to join this and an interview, I was pleased to be offered the role as one of five Lived Experience Affiliates on this panel.

At my first Panel meeting, it was evident each of us on the panel had a significant and varied range of lived experience of healthcare services. Since then, we’ve all been welcomed by AQuA staff as a fundamental and key part of the organisation.

We’ve also had quarterly meetings with either the Chief Executive or Directors, to update them on the work we do with programmes and AQuA members; which demonstrates how important AQuA value the work the panel does.

Since joining, I’ve received significant training on everything from Human Factors, Introduction to Improvement, Shared Decision Making, Dementia Awareness, Safety and Mortality and Motivational Interviewing. AQuA has also facilitated my Experience Based Design Coaches training.

My presentation and report writing skills have also improved significantly, together with my knowledge of health and social care services and how they are organised and operate.  All of this training, skills development and knowledge will prove invaluable to my nursing studies and any future nursing roles.

During this time I’ve had the privilege to work on a range of programmes, including Whole System Flow, Mental Health, Restraint Reduction, Safety, Academy and Shared Decision Making.

There’s a range of work that I’m proud of from my time with AQuA.  The most prominent of these is our work with three systems as part of the 2017/18 Whole System Flow programme. Together as a Panel, we’ve spent the last six months visiting and interviewing service users and carers from each of the three systems.

This work has given us a deep insight into what it is really like to be a service user or carer using each system, and allowed us to produce a detailed lived experience report for each system.

Each of their project teams have fed back that these ‘real’ experiences gathered by the Panel has been the most important part of each project. It’s been clear that diagnosing issues and problems in each of these systems wouldn’t have been possible without these insights.

This piece of work has been incredibly rewarding and enjoyable personally; with the patients really valuing the opportunity to share their experiences with us.

All in all, it’s been an absolute pleasure to work with AQuA as a Lived Experience Affiliate for the last three years.  I’ve found AQuA to be a highly forward-thinking organisation at all times, especially with regard to quality improvement and co-production.

Staff have really welcomed all members of the Panel, and have actively worked to co-produce and embed lived experience into their programme design and delivery. They practice ‘real’ co-production, are happy to receive challenges and feedback from panel members, and use this to actively improve their work.

I’m certainly going to miss working for AQuA and everyone that I work with there, but I’m also excited to be starting a new chapter in my life with my nursing studies about to commence.

Feel free to share your thoughts and comments with Carl, or wish him good luck with his nursing training, via Twitter @Carloloughlin1 or @AQuA_NHS. 

Blog – Person Centred Care – Walking the Tightrope – Rachel Bryers

In the third blog of our Person Centred Care series, our other Programme Manager Rachel Bryers discusses the fine balancing act between supporting patients to be autonomous in their decisions on care, with protecting their health and reducing harm.

Rachel Bryers

‘Professional training provides a foundation for understanding the importance of Person Centred Care but it does not prepare you for the reality of managing complex decision making with patients; supporting their right to autonomy and choice, against balancing risk and fear of litigation.’

This is often the response we hear from health professionals when exploring how they can embed Person Centred Care within their practice.

As a team manager of an intermediate care service, we explored these ethical dilemmas; reflecting on our attitudes and practice when managing the complexities of risk, safety and wellbeing but most importantly ensuring that what mattered to the patient was the principal factor in decision making. This was paramount in getting to the crux of how we delivered Person Centred Care.

Tensions between autonomy and protection can be seen across all aspects of healthcare and more must be done to guide and support health care professionals with these challenging and testing conversations.

Recognising our paternalistic approach, albeit with our best intentions for the patient, is fundamental. When a patient makes a decision that we are not comfortable with it is difficult to support their wishes; more so when we feel it isn’t the option that will most optimise their health and reduce the risk of harm.

Health professionals want to be able to provide the care that responds to patient’s priorities but tell us they feel stifled, disempowered and scared by a system where governance and risk does not support this.

We all have different attitudes to risk, values and preferences, and should be supported to choose the option which matters to us. For health professionals, the fear of litigation and being held accountable for a decision which may prove to be unwise often results in labelling patients as ‘non-compliant’, or prompting them to sign a disclaimer form for ‘going against advice’.

How can we move away from this culture, to one which gives us ‘permission’ to support the patient’s choice by standing alongside the patient, listening and understanding what matters to them and feeling confident to act on it; with the support of our organisation? 

Clinicians who have a better understanding of The Mental Capacity Act and how it underpins clinical practice can feel more protected and equipped to support complex decision making.

When a patient chooses a course of action that the clinician would feel uncomfortable with, it enables them to take a Person Centred approach; leading to better outcomes for patients, as defined by the patient.

An example of this can be seen in our work with North West Boroughs Healthcare NHS Foundation Trust (previously Five Boroughs Partnership NHS FT). Professionals involved in the decision making must ensure they have the knowledge and expertise to understand the implications of the Mental Capacity Act in clinical practice, as not adhering to the legal framework of the Mental Capacity Act could be regarded as wilful neglect.

In my current role as an Improvement Facilitator working with health professionals to support Person Centred Care in practice, it is clear that more support and guidance is needed to understand their role in decision making.

You can share your thoughts with Rachel on Twitter via @Rachel_Bryers  or @AQuA_NHS, or feel free to leave a comment below.

In our next blog we hear from one of our members, Norah Flood, Assistant Director Clinical Networks, North West Boroughs Healthcare NHS Foundation Trust, on the importance of early adopters of Person Centred Care.

Stay tuned to our news page for more updates!

Joanna Bircher Joins the AQuA Board

We’re delighted to welcome Dr Joanna Bircher, GP and Clinical Director for the Greater Manchester GP Excellence Programme as a new member of our Board.

Dr Joanna Bircher

Our Board plays a vital role in helping to set our overall vision for our work with members and customers, and Joanna joins as the sixth of our Directors taken from our member organisations across the North West; alongside four external independent Directors.

Speaking on the announcement, Chief Executive David Fillingham said:
“We’re delighted to welcome Joanna to the Board. She has wealth of experience not just as a GP in Tameside, but also as a clinical leader across the region and on a number of national projects.

“Our Board have a real range of experience across health and care, which we benefit from massively in terms of our work with our members and customers. We’re really looking forward to working with her in the coming weeks and months, and adding her knowledge and skills to the team.”

Adding to this, Joanna said:

“I am so pleased to be joining the AQuA board at a time when it is being increasingly recognised that supporting UK General Practice to develop Quality Improvement capability may help the NHS to respond to the current challenges.

"I hope to bring with me the ‘eyes and ears’ of a working GP, with experience in applying QI methods at the front line to support AQuA in its mission to improve health and care quality.”

In addition to her role with Greater Manchester Health and Social Care Partnership, Joanna is a fellow for The Health Foundation’s prestigious Generation Q, and Quality Improvement Clinical lead for NHS Tameside and Glossop Clinical Commissioning Group.

She has also been a GP partner at Lockside Medical Centre, Stalybridge, since qualifying as a GP in 1998, and combines her clinical duties with GP training for the North West Deanery.

In addition, she has also been a Clinical Support Fellow for Quality Improvement at the Royal College of GPs since 2014, as well as their joint clinical lead for the college’s work on the National Diabetes Audit.

Joanna is highly passionate about quality improvement in general practice, and used her Generation Q fellowship to explore ways to support frontline staff across GP practices to deliver improvements.

Joanna regularly shares her thoughts and updates on Twitter via @JoannaBircherQI. For more information on our Board, please visit our website.

Blog – Person Centred Care - A Risky Business – Brook Howells

Following on from her last blog on the importance of Person Centred Care, our Programme Manager Brook Howells continues the series by looking at how we’ve been working with members to implement this approach, and why the NHS has struggled with it in the past.

Brook Howells, AQuA
Programme Manager

AQuA has been working with clinical teams across the North West to support improved Person-Centred Care (PCC) for a number of years and, has seen a subtle but significant change in the challenges we face.

Previously, we focused on helping people know what choices were available and giving them opportunity to be involved in that decision. We now recognise that in the majority of cases, where there is a simple choice between two comparatively similar options, clinicians are very good at providing the detail and making sure the right treatment for that individual is selected. The challenges arise when risk becomes a more significant part of the equation.

The prevailing culture in the NHS of ‘do no harm’ and to some extent the attitude of always-put-a-brave-face-on-it, often combine to make us shy away from conversations about potential problems; be they painful side effects or the possibility that a cure cannot be found.

This reluctance to discuss the negative aspects of healthcare, or ill-health in general, make it difficult to have an honest conversation about choice; one in which we talk about both the risks and benefits of each option available.

Risk is a tricky concept in itself to discuss; we can only give an idea of the probability of something occurring, and we cannot know how significant that probability is to each different individual.

Where one person might be quite happy to take a chance on a treatment that has a 25% risk of a side effect, another may opt against even a 1% risk of harm. It is all personal and relative to the situation; and that is exactly why we need to get better at talking it through with the very people who will be affected; the patients.

What makes this task harder is the sense that governance structures can sometimes prevent us from allowing any sort of risk to be taken. Governance exists to help us achieve our primary aim (to get people better and keep them safe), but we need to bear in mind that to deny someone their autonomy – their right to decide what happens to their body – is just as much a cause of harm as the more obvious problems like not preventing a fall or the spread of infection.

To this end, much of the work AQuA does with teams now focuses on helping them to see where their responsibilities lie, and how Shared Decision Making can actually help them fit within governance; whilst still giving patients autonomy and personalised care.

We help people to understand the Mental Capacity Act and how it supports people to make decisions, as well as giving healthcare professionals confidence, to allow people to take risks and to offer up all the options, not just the safest ones.

This is no easy feat and it requires a much greater shift in mindset than just remembering to tell people about each option, or to hand out an Ask Three Questions postcard. We still advocate both those things; we just appreciate that there is a lot more to supporting Shared Decision Making and therefore a lot more work to be done.

You can share your thoughts with Brook on Twitter via @BrookH_AQuA or @AQuA_NHS, or feel free to leave a comment below.

In our next blog, our other Programme Manager Rachel Bryers looks at implementing Person Centred Care in practice, and its implications around the Mental Health Capacity Act.

Stay tuned to our news page for more updates!