1. Making a Great Planning Process Thinking about Outcomes in Four steps:-- new ways of relating to achieve a new relationship and a fully owned personal health plan.

2. Making a great planning process-Critical Factors...  Feeling that something different is possible, and having hope that it could be made real  Knowing the money and the “deal”  Believing that there will be sufficient information and support to enable me to both manage the money and put the plan into action effectively.  Having an agreed way to measure how the process, and the planned outcomes are working, in an ongoing way.

3. Tilting the balance of power Its about shifting power and creating an improved relationship, with changes on both “sides”. Central focus is improving the dialogue between the citizen and the professional to create:  Greater mutual respect & understanding  Better quality decision-making  Better outcomes This should produce a Personal Plan which is co-signed by the citizen and professional

5. Step one- developing a trusting relationship So how does the support planning lead to outcomes and action? What are the steps of the process to agree outcomes and actions?  We need to start with the person’s unique view of their life and health condition  We need to actively listen and quieten our own usual ways of working, and not assume we know immediately what will work best, even if we’ve worked with hundreds of people with the same diagnosis  We need to trust people to have a good understanding of what is working and not working in their lives. This is where we start.

6. Step one- developing a trusting relationship  For people with long term health conditions – their health needs are woven through their life:- they are not a separate thing and so we needn’t worry that people will talk about random or irrelevant things when they identify what’s working and not working well in their lives.  This is a new way of talking together. The point at which the health professional’s views are incorporated is really important.  The health professional’s view is NOT put in at the very beginning nor at the end.....

7. Step two: actively engaging  The first step is exploratory discussion, active listening and respectful questioning and reflection- finding out the most important things which are working and not working.  The next step is to consider together, within those things, what is important to the person in terms of what matters most to them, and also what matters for their health.

8. Step two: actively engaging The person themselves is the only one who can know what matters to them; and the person themselves, (unless perhaps newly diagnosed), will also have a good idea of what’s important for their health. What matters most to some-one can be accepted- it simply does! We can of course ask, and it will be useful to understand, what it is about that something which matters – but we should avoid being drawn into debate about whether something should or shouldn’t matter, or describing some things as wants and some things as needs.

9. Step two-Synthesis not two tracks  If it matters it matters- but we do need to understand more about the essence of what matters, in order to be able to write a specific outcome and an action plan linked to that.  In thinking together about what’s important to and important for some-one, the health professional can helpfully contribute, where necessary, their expert knowledge about the specific “important for” information.- For example- the person may be well aware that they need to keep their blood sugar at a certain level- the professional can give specific detail about the correct level for their particular illness, age and context.  So it is at this second stage where the health professional can most usefully begin to input their ideas and expertise.

10. Step three: developing a deeper understanding and identifying emerging outcomes  Having started with listening hard to what’s working and not, and then going on to consider what’s important to and for some-one, some clear priorities will begin to emerge.  What we need to ensure is that all of the priorities and the outcomes which flow from these, are the person’s own outcomes.  We cannot add on “health outcomes” at the end just as we can’t impose them at the beginning.  If the outcomes are not recognised and owned by the person then this isn’t their plan and something has gone wrong with the conversation. We need to talk more.

11. Step three: developing a deeper understanding and identifying emerging outcomes.  The prioritising stage will pull together, from the conversation, what are the joint priorities agreed by the person and the health professional. There will have been a synthesis of ideas, and a clarification of top priorities for action, including risk enablement/contingency planning.  The health outcomes need to come from the person. The health professional’s role is to help support the identification of the person’s own outcomes and to contribute to making them as specific and individually relevant as possible.  The actions which follow are then fully and clearly linked to the specific outcomes

12. Step four: agreeing outcomes and actions  The ideas about how to achieve the outcomes will again be a bringing together of what some-one has come up with as their own solution, is willing to commit to and is motivated to do; with the health professional's expertise about what might have proved useful for others and what research suggests too.  We need to trust people’s own solutions-. This is at the heart of the shift in the relationship – people exploring what matters and finding their own ways to achieve change/maintenance, actively and fully participating.  This can be seen to be a significant shift from the traditional assessment/prescription/ passive recipient model.

13. Starting somewhere different to end somewhere better. To summarise: Step one- Developing a trusting relationship:- listening with empathy and respect, to the person’s experience of their health condition. Helping some-one describe what’s working and not working in their life. Step two,-Actively engaging- Developing an understanding of what’s important to and for some-one –exploring what helps and hinders their health. Offering in professional knowledge about specific relevant aspects of an emerging outcome.( but not telling some-one what they should do). Step three- Developing a deeper understanding-Linking and integrating individual issues and problems into themes and priorities. Identifying emerging outcomes. Step four- Agreeing outcomes and Action planning to meet them. Supporting the person to identify clear outcomes linked to the priorities and move through creative thinking, problem solving and decision making to a clear plan of specific actions.

14. Having a live in PA The physiotherapy and exercise that help my stamina Less hospital stays Playing wheelchair rugby My social life has improved Not seeing enough of my family and friends My stamina not being what I want it to be The pain in my hands Living in a shared environment and not having any privacy

15. What are your priority issues Important to important for Working /not working Decision making If I could I would Perfect week Relationships What I bring Good day bad day Priority Issues Person centred outcomes Creative solutions Costed Plan

16. Priority Issues Improving my fitness and stamina Finding a place to live Managing my pain Improving my general health and avoiding hospital admission Maintaining and developing my independence Seeing more of my family and friends

17. Developing outcomes  Beware thinking of services and therapies too soon! Outcomes are not services, treatments or therapy nor attending those.  Outcomes are changes in or sustaining of physical behaviours, or mental states/emotions.  We need to describe clearly what we’re aiming for- in specific terms. - What will be working better or be avoided?  This can include what we’re hoping for even in a deteriorating health condition, or at the end of life.

18. How I receive my additional oxygen is not working for me as it is stopping me going out of the house To be able to spend time with my friends each week when I am well To maintain my oxygen saturation at above 96% When I am well to go out and spend time with my friends twice a week and maintain my oxygen saturation at above 96% when I am out.

19. Improving my fitness and stamina To be strong enough to use a manual wheel chair all the time. To be able to do more than one thing per day without getting too tired Not being too tired to go out in the evenings To improve my general health through exercise Not to get socially isolated because I am too tired to see family and friends To be able to tolerate 12-14hrs per day in my manual wheelchair without being too tired and having to go to bed. This would enable me to do more things during the day and evening