Open Dialogue: The Case for Change Yasmin Ishaq Service Manager EIPS Kent and Medway NHS and Social Care Partnership Trust

Contents 1. Outcomes based Transformation 2. Asset based approach to care planning 3. Listening to what service users and their families want 4. Tangible difference in our clinical/social practice 5. The Kent perspective

Multispecialty community providers Integrated primary and acute care systems New approaches to viable smaller hospitals Enhanced health care in care homes 1. Outcomes based Transformation Focus on meeting local population need Investment and flexibility The NHS Five Year Forward View: New Care Models Dissolve traditional barriers to manage systems of care Patient Involvement Local Ownership Clinical Engagement Focus on the quality of the transaction Co-design services and apply learning across health systems National Support

2. Asset based approach to care planning Relationships are the Immune System of Society (NEF 2009) Building community capacity, and developing knowledge of diverse communities and their networks

2. Social network approach: Birmingham example Healthy villages are partnership toward complete care System design Designed across the system Involving the Mental Health Trust, CCG, Voluntary Sector and Acute Trust Identification of the local topology Individuals at the centre of the model Descriptors of individual by postcode Modelling by socioeconomic group Map prevalence of certain conditions Ring of care  Ring of confidence Includes everyone seeing the patient Engaging housing, community groups etc Bio-psychosocial model Shifts emphasis from caring to coping and feeling well Evaluation Multiple points of analysis Success set out by all co producers of the system Integration and mobilisation of assets across the community to address not only care but also coping and wellbeing Leads to less GP visits and hospital appointments

3. Listening to what service users and their families want Communication just didn’t happen at the time we needed it Professionals don’t always believe what carers say Confidentiality can be a real pain Can we make access to services faster? The first contact is of critical important

3. Listening to what service users and their families want Open Dialogue

4. Tangible difference in our clinical practice 1.Immediate response the first contact is of critical importance 2.Social network perspective work in partnership with families 3.Dealing with uncertainty giving space to people to speak 4.‘Dialogicity’ care individualised utilising a range of options in the community Principles of Open Dialogue Are we ready for transformation on this scale? There are a number of questions for Organisations… Is there professional risk in this approach? How do we reconfigure functionally driven teams and navigate interfaces? How do we get different agencies involved throughout? Can we risk a performance dip through the change? Peer Led

4. Tangible difference in our clinical practice

5. The Kent Perspective CPNs OTs Social Workers Psychological practitioners Psychiatrists Support workers Carers Peer Support Workers Practitioners have worked in groups of 3-4, with the care coordinator and one psychological practitioner in each group Families have been identified from the Early Intervention in Psychosis Service

own visionTo develop their own vision for a good life own strengthsTo recognise their own strengths and real wealth on their ownTo get information about what is available that they can use on their own own networksTo make use and build on their own networks own voicesto strengthen their own voices own practical actionsTo take their own practical actions for change of their ownTo create new opportunities of their own within the community 5. The Kent Perspective Social Work Perspective (asset based)

…there is a need to develop a dialogue friendly environment that addresses the worries of others 5. The Kent Perspective Challenges for Practice Managers Service users and carers Professionals and agencies Support

Any questions?