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Health and Wellbeing

Co-producing healthier outcomes

Learning from a bike crash in Belgium

I recently travelled to Belgium for a cycling weekend.  I was showing off by riding over some cobbles when I crashed.  Luckily, one of my friends was carrying a portable medical kit, and promptly put on some latex gloves, cleansed my wounds, and administered industrial quantities of pain killers.

I was promptly re-installed on my bicycle, until I decided to call it a day and managed to find a local train station.  Just as I was about to board the train to Brussels a local handyman offered me a lift to the local Accident and Emergency Department. I was pleasantly surprised to be seen after a few minutes.

I was then bandaged up by nurse and doctor, and given a tetanus injection.  The only problem was that my cycling kit was splattered in blood and sweat, and I didn’t have any spare clothes with me.  It was a Sunday in rural Belgium and all the shops were shut.  I used my powers of persuasion and managed to leave wearing a crisp white nurse’s outfit.  Over the last few years I have spent a lot of time thinking about the role of patients in health care innovation, but this wasn’t exactly what I had in mind!

My recovery in the UK

In 2012, I had predicted that many of us would become much more active in our managing our own health care.  I argued that many people would seek out knowledge and expertise from their peers, and online, as well as consulting their doctor.  Well, this crash gave me the chance to put my ideas into practice. 

When I returned home, I sought advice from internet forums and my cycling friends about the best way to treat “road rash”, as we cyclists call abrasions caused by hitting the road.  But in the end, I decided I need help from the experts, and I went to a local “NHS walk-in centre.”  My walk-in centre in Peckham, South London was lot busier than rural Belgium. It would be more accurate to call it a “walk in and sit down for a while” centre, but once I was seen, the nurse who saw me gave me her full care and attention as she changed my dressing, and we shared some stories about our lives, in the fifteen minutes we spent together. 

The help of this nurse, who I saw every few days after this, was crucial in aiding my recovery.  This reminded me of how important it is that clinical staff and patients work together to achieve real outcomes together. There is a real risk that this human relationship, which requires compassion and genuine empathy, is often neglected in modern health systems and innovations. Indeed, Darian Leader has uncovered evidence that the majority patients visit their GP due to psychological distress, rather than for any medical reason.    

Need for a new form of collaboration between patients and clinicians

Nevertheless, the interaction of the patient and clinicians is an area that is ripe for change.  Genuine co-production between clinicians and patients can provide opportunities for better outcomes, experiences and improved efficiency.

 A number of organisations and individuals have been grappling with the question of how patients and clinicians need to work together.  The King’s Fund has argued that the UK needs to unleash a wave of innovation to find new ways to relate to patients in managing their health care conditions. The blogs from patients and experts on Time to Think Differently make the point that clinicians need to find out what patients want, and show why patients need to take more responsibility for their own care.

Often, this can be achieved through very small changes in conversational approach.  For instance, a London based GP reports that she is much more likely to start with “What are we working on today?” rather than “How are you today?”  Her experience was that the result of this shift is that patients are much more thoughtful about their own role in managing their long-term condition. The Health Foundation’s Co-creating Health Programme, has provided clinicians support to rethink about they work with patients with long-term conditions.  A key finding has been that patients respond constructively to jointly set agendas around how best to manage their care. 

Over the last few years I have been talking to clinicians, commissioners and patients around the country about how they can work together more closely as part of the NESTA People Powered Health Programme.  We set out with the idea that co-production was a marginal approach in health care, but we wanted to find out if it could produce real results if it was scaled up.

We need to test and try out creative new approaches

We worked with Professor Chris Drinkwater and GP Dr Guy Pilkington to support doctors to provide “social prescriptions” – linking patients to local activities to give them a sense of purpose and meaning.  We talked to commissioning manager Nick Dixon about how to help adults move out of inpatient psychiatric care and find support from peers who were in recovery themselves.  We worked with colleagues in Leeds to think about how to create multi-disciplinary teams that helped people with many long-term conditions.  We listened to clinicians and service users about how to use group consultations for individuals experiencing chronic pain.  We worked with a primary care centre in Earl’s Court to think about how to get patients to benefit from nurse coaches, and join a time bank to support other patients. My overall experience was that whilst there are many powerful political and professional barriers to giving patients a greater role, there are also interested clinicians and commissioners who are willing to try new ideas and develop new approaches. 

One such co-production champion is Paul Ballard, Deputy Director of Public Health of NHS Tayside. He has been heavily involved in the drive to embed co-production within all areas of work, including the design and implementation of a new Health Equity Strategy. This will imply a much stronger focus on asset-based approaches and behaviour change: As Paul states, “… during this process I have extensively used the Co-production Star which has proved to be an excellent resource to support our co-production work”.

Co-production offers a financial solution

Not only is there a moral case for co-production, there is also a financial case.  If we were to reshape the health service, so that it had a whole range of support for patient groups, peer to peer support, alternatives to medical care, new forms of medical consultation, and other co-produced forms of health and well-being, we could realise savings of at least £4.4 billion or 7% of the NHS budget.  This doesn’t always require the most expensive medicines, equipment or buildings. But it does require the public and professionals to show the will to re-think and re-imagine what the future of health care looks like. 

If you are interested in exploring how to think creatively about how to bring together clinicians and patients to co-produce healthier outcomes check out our co-production case studies and do get in touch.



Ajay Khandelwal, Associate, Governance International 




16. August 2012


Volunteering at the Olympics

Governance International Associate John Tatam reports about his volunteering experience at the Olympics 2012 in London.

I had heard a lot about the impact of volunteers on the Olympics, particularly in Sydney, so when we won the bid I leapt at the chance to be involved at least to some extent, on the inside.

The application process was surprisingly complex and extended. Around a quarter of a million people applied; some hundred thousand plus were interviewed; and seventy thousand finally selected, which despite my feeble responses to questions like ?When have you gone the extra mile?? included me.

There were many roles available from supporting particular sports to back room jobs like media relations and driving the fleet of four hundred BMWs! As a keen cyclist I had opted for the cycling team. It turned out that over fifteen hundred volunteers were needed for the two road races (the biggest events of the games), several hundred for the time trials and the mountain biking, but just a few for the velodrome.  I got shifts on the road races and time trial.

Being a volunteer gave just a glimpse of the sheer scale of the Olympic venture: all the volunteers and fifty thousand paid staff were put through an orientation day at Wembley arena. There were thousands there on my day ? yet this was just a tenth of the total number; attending uniform measurement and distribution was also an eye opener. The lead up to the Olympics was full of the usual moans and groans about organisation from the media and elsewhere. I just thought: ?What do they know??

The orientation and the ?venue specific? training focused principally on motivation, making us feel vital to the success of the Olympics, and of course being positive with the public. Given that we were volunteers and that some of the tasks we would be given would inevitably be less than exciting I can see that setting the right mood was essential. After all we heard that lots of G4S paid staff failed to show. I would guess that the level of absenteeism among volunteers was minimal.

The men?s road race was on the first day ? and Team GB was of course fancied. We were driven out in coaches to our sectors of the route and as we passed gathering crowds (some cheering us!) town greens with big screens and picnickers already assembling, flags, bicycles hanging out of windows or on roofs, and a primary school?s witty display of wicker cyclists on bikes (some with dogs on the back) it really felt like something significant was happening. Something very unusual was stirring in Surrey.

I had a very rural sector but large numbers of people slowly gathered and the mood was fun and relaxed with  the endless succession of Police and official?s motor bikes coming through and high fiving the crowds. My particular job was ?flagging? a bridge where the road narrowed from double to single lane and bales protected the bridge parapet. Some of the crowd were open about having chosen this spot in the hope of seeing a crash. The men?s race passed through fine in a lead group of twenty odd and a peloton of about one hundred and thirty ? though, of course, passing inches from my nose. The women were less successful.

As the women?s peloton of about sixty approached at, I guess, around thirty miles an hour, I suddenly realised they were not all going to make it despite my frantic whistle blowing. I must have closed my eyes and jumped to the side before hearing the sound of cycles hitting the ground and thinking ?Oh no, not on my patch!? I opened my eyes to see four cyclists and bikes on the ground in front of me and a Brazilian ten feet down in the ditch (with one of the bales)  but already trying to clamber out. I helped her and her bike at which point the TV picked up the scene? they simply had not seen her disappear down the hole. I was then undecided whether or not I should be helping the other women sort out their bikes or maybe ringing for help. I was conscious that I was probably on TV at this point and ought to be looking decisive! (My family, who had been watching on television inevitably focused on this ?Mr Bean? moment rather than my heroic rescuing of the Brazilian cyclist.) It was all over in no time. What had felt to me like a serious incident was just a blip in their race!

On the Wednesday I was at the Time Trials and really lucky to be based right in Hampton Court. This meant I was able to see the start, the finish, the return of the cyclists, Brad?s victory lap and medal ceremony. A fantastic privilege to be there at the point where it all started to go right for Team GB!

I was also able to attend a number of events ? free and ticketed ? as a spectator. (This included standing three feet from where a Canadian cyclist took a bad cart wheeling fall in the men?s triathlon, so I am now being seen as jinxed).  Clichéd though it is, the London Olympics was a once in a lifetime experience, and I am grateful that I have had the chance to experience it, and be absorbed in it from the outside and, a little, from the inside. I now have six days of Paralympic cycling down at Brand?s Hatch.

So does this mean there will be more volunteering from me and others? That is not so clear. I got the impression that many of my cycle team colleagues were already involved in local clubs etc and the Olympics was a very high profile one off event. It is too early to tell what the long term impact might be.



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