Is it just me or does it feel like the end of a decade does bring forth a certain shift and sense of forward movement? In the NHS it can feel that real change happens at a glacial pace, but actually glaciers exert huge forces and sculpt the landscape they leave behind so I think it’s not wholly a negative analogy. Particularly now, at the turn of the decade, when there is a sense of shift and change in NHS policy around self-management and genuine partnership-working with patients and families.
I’ve been working for Bridges helping to deliver the workshops for a number of years now, but I recently joined the Bridges team in a full-time capacity as Innovation and Co-production Lead. You know what it’s like when you start a new job, there’s always that period at the start when you are super keen but there is a calm before the impending storm of work to come as you are finding your feet. As part of that process I was nudged in the direction of re-reading the NHS Long Term Plan (when will they come up with more jazzy titles for these things?)
If you have read the Long-Term Plan and you know Bridges a little, then you could be forgiven for thinking that Bridges had been involved in its creation. I was so surprised by how closely the language mirrors the Bridges principles:
‘Patients to have more control over their health and care as they do in every other aspect of their life’ – check!
‘Power of individuals as the best integrators of their care’ – check!
‘Focusing on ‘what matters’ to the individual’ – check, check!
Don’t get me wrong, terms like ‘patient-centred care’, ‘empowerment’ and ‘self-management’ have been around for a long time but they are so often ascribed to in principle but not actually happening in practice. For the first time it feels like self-management support isn’t about manipulating and changing patients, as ‘other’ to the clinician, but instead recognising the power patients have within that symbiotic relationship of patient and clinician. As Billy (a stroke survivor and friend) said ‘the group (medical and therapy team) could not function without my active engagement’. He put himself at the centre of his team, but to have the confidence and the skills to do that as a patient within a system that can feel depersonalised and factory-like is hard, and brave. Often the volume of patient-power and agency is somewhat drowned out by the noise of targets, time pressures and processes.
Whilst I thought Billy’s use of the term ‘active engagement’ was a useful phrase I’m not such a fan of terms like ‘patient activation’. This is because for me this still gives the impression that patients are ‘other’ entities which require something to ‘activate’ them, rather than just being people who react to social situations in just the same way as the rest of us. I prefer to think of our job as being to support patients to become the CEO of their healthcare and their life.
The question is how do we take this language used in the Long-Term Plan and this renewed focus on patients as individuals who required personalised healthcare, and turn it into something tangible? Well this is the exciting bit because this is exactly what Bridges has been doing for over a decade, working with some amazing teams and clinicians and using the ‘Bridges Principles’ as a framework to shape services and support staff to support self-management.
Not only is working in this way important for patients but it’s also important for staff. The Interim People’s Plan, another long NHS policy document which I read in my first week, details a plan to combat the dire issues around recruitment and retention in the NHS. For me working in a ‘bridges way’ unlocked something, an ability to connect with patients and work on what really matter to them. And why was I still using precious annual leave 7 years on to help deliver Bridges workshops rather than taking an extra week in the sun? Quite simply because it feels good. No, it feels great. To be able to work with people and find out what is truly meaningful to them, like being able to transfer and sit on the sofa and watch Strictly with your wife of 40 years who doesn’t have long left, that feels so, so different to working on ‘being able to transfer with assistance of one’. I suspect this is the reason most of us chose to do this job in the first place, and so enabling clinicians to tap into that in their practice despite ongoing and building pressures could have a vital role in tackling low staff morale, finding and keeping NHS staff. Who are, after all, the most important resource the NHS has.