1. Health and community care reforms: Person centred and coordinated care. Emeritus Professor Rae Walker La Trobe University

2. Changing policy focus Person centred & coordinated care In national and Victorian policy eg  National PHC Strategic Framework  PCP Program Logic Manifest across sectors eg  Health  Human services and programs eg:  Chronic disease  Mental health  Disability  Aged care

3. Consumer aspirations Consumers want their experience of health conditions, service provision, and service settings, to be a defining element in the planning and delivery of health care. They want services to not only be technically competent but also caring about the user’s wellbeing. Competence and caring about clients are the foundations of trust in health services.

4. Provider/consumer partnership Person-centredness is about ‘discussions and decision-making.... a consensus on an approach to care that goes beyond informed consent’ (Epstein et al cited in Blacker2011a:13).

5. The example of care coordination Care coordination is a complex process Effective care coordination is built on trust between:  Consumers and practitioners  Different practitioners  Different services  Different organisations.

6. Trust Trust is: “confidence in the reliability of a person or system, regarding a given set of outcomes or events, where that confidence expresses a faith in the probity … of another, or in the correctness of abstract principle (technical knowledge)” (Giddens 1990).

7. Trust continuum (Walls et al (2004) Health, Risk & Society 6(2):133-150) Trust Uncritical emotional acceptance (trust) Critical trust as: reliance + scepticism Rejection (distrust)

8. Peoples’ readiness to trust (Covey & Merrill 2006; Epstein 1994) Propensity to Trust (experiential information processing ie emotion) Gullibility Readiness to trust unwisely Judgement or smart trust Readiness to trust in trustworthy contexts Indecision Neither trust nor distrusts Suspicion Reluctance to trust at all Analysis (rational information processing)

9. Trust between providers Groups of variables ability to undertake the work (competence, discretion, judgement) ability to relate well across organisational boundaries (cooperation, communication, discretion) values and motivations that support joint activity (individual’s and organisational processes)

10. Care coordination network (Walker et al 2013) AJPH In press) Client Goals Community Health - OT Physio HACC Provider- Home care Social support RDNS Nursing GP Client, family & carers

11. Consumer responsibilities (tasks) Understand their health conditions Participate in decision-making and make informed choices Follow a care plan and monitor changes in health conditions Manage the impacts of conditions on daily life Confidently engage with services ( Consumers Health Forum 2008)

12. How IT systems can support consumers Client sections of websites with links to credible information about health conditions, procedures, medications, care options, and consumer supports including self help and consumer advocate organisations. Client access to their care plans and health records Links from care plans to relevant consumer information

13. How IT systems can support consumers Tayloring information for clients. Enabling providers to assemble information from across IT systems and organisations to prepare care plans and client information. Enable multi channel communication – web, SMS, email, taylored social media, letters, phone, for example. Governance of privacy to maintain trust.