1. So what is Care Planning anyway? Care Planning Support Pack 2014 1

2. So what is care planning anyway? Why? Care Planning meets UK national standards, policy and guidelines: 2011 NICE Quality Standard 3 ‘people with diabetes participate in annual care planning which leads to documented goals and an action plan’ 2010 DH White Paper there was a commitment to ‘shared decision making’ and ‘choice’ as part of the care planning process 2001 National Service Framework for Diabetes Standard 3 encourages participation in the decision-making process 2008 Darzi High Quality Care for All advocates use of jointly agreed personalised care plans 2006 Department of Health and Diabetes UK provides theoretical basis for care planning Translates into real self care behaviour change Professionals report greater job satisfaction, improved skills and time efficiency

3. ‘The NTA expects all service users to have a written care plan which is developed and reviewed on a regular basis with them’ ‘A 12 page Medicare document for residents’ ‘Under Petshealth Care Plan … incidents relating to the consumption of contaminated pet food are covered’ ‘A comprehensive plan of medical care insurance’ (in Labrador) ‘A written means of planning patient care and discharge’ ‘A "road map" of sorts, to guide all who are involved with a patient's care’ So what is care planning anyway? What?

4. So what is care planning anyway? What? Care planning is a way of making sure time spent between patients and healthcare professionals is used in the best possible way, so that when they come together they can: Set goals Have a record of these Follow up and talk about progress These are what we are calling the minimum standards of care planning. This means that every adult living with diabetes in Lambeth and Southwark should receive these at every diabetes appointment.

5. “Hello, nice to see you again. I hear you’ve been told you need to start insulin.” “Hello, oh have I?” This patient needs to go on insulin I really don’t want to go on insulin So what is care planning anyway? Is this Care Planning?

6. “So we need to talk about what insulin might suit you. Do you eat your meals at about the same time every day?” “Yes, I eat my meals usually at the same time.” I wonder when’s the best time for the patient to take the insulin? I really don’t want to go on insulin. I don’t always eat meals at the same time every day. I wonder if that matters? So what is care planning anyway?

7. “Well I’m not really that keen but 2 injections is better than 4 I guess.” I’m sure I’m busy with something else on Monday… Another successful consultation! “Good, we can start you on two injections a day on Monday. Does that sound OK with you?” So what is care planning anyway?

8. Care plan template CARE PLANNING TEMPLATECodesComments  Goal identification 67L  Identifying barriers to goal achievement 67RFree text box  Goal achieved drop down  Goal not achieved 67L0 (zero) 67L1 Free text box Not appropriate for first care plan  Follow up arranged drop down  Follow up in 1 month  Follow up in 2-4 months  Follow up in 4-6 months  Follow up in 1 year 8H8 8H87 8H88 8H89 8H8B  Personalised Care Plan completed 8CMD

9. My Health Plan