Becoming part of behind the scenes: patients' experiences of co-learning with primary health care teams.

Current debates about the involvement of health service users in service delivery, research and education focus on the purpose of their involvement, the methods of their involvement, barriers to their involvement and the impact of their involvement. There is little reported about the experience of service user involvement from the service user perspective although some reports are beginning to emerge. This research study explored the experiences of a group of health service users (patient representatives) who brought their experience of being a patient to contribute to an educational initiative about quality improvement and back pain. That study – the Learning to Improve the Management of Back Pain in the Community (LIMBIC) project, utilised a mixed methods approach to evaluate the impact of the educational initiative on clinical practice and patient outcomes for the management of back pain. Eleven patient representatives, uniquely placed as co-learners, participated with general practice teams learning about quality improvement principles and methods and implementing quality improvements in practice. To build on this learning initiative, the current study used semi-structured interviews to explore the patient representative experience and integrated the findings with existing LIMBIC data. The study illuminated aspects of the service user experience which led to the proposal for a model for co-learning with service users to bring about change. It contributes to the wider knowledge of service user involvement by identifying features of their experience that worked well for them and features that could be improved. The co-learner role is a new direction for service user involvement and represents a new movement in the field of inquiry about opportunities for service user involvement in the future. A debate has been opened about managing expectations of service users and about their potential for leadership and influencing change

Asset rich cash poor in the economic downturn: the financial challenges facing retired older people

Older people are thought to be particularly vulnerable during times of economic downturn. Little is currently understood of the impact of the current economic downturn on the financial circumstances and wellbeing of retired people and the nature of the services and support needed to enable them to cope financially and maintain their wellbeing and quality of life. Retired people are not a homogenous group. Therefore, this study explores the impact of the downturn on a specific group: house owners over the age of 65, not in receipt of means tested state benefits and living on modest incomes. This group may be described as “asset rich cash poor” (ARCPs). It is thought that this group is particularly vulnerable as they are not eligible for state support but are insufficiently well off to be living comfortably. Findings from this research, although focused on retired people with specific circumstances, may have wider relevance in relation to retired people with different financial circumstances. The purpose of this study is to investigate the experiences of asset rich cash poor older people in the economic downturn, in order to establish: • how they manage their financial circumstances in these times; • the impact of the downturn on their wellbeing and quality of life; and • whether services and support available to this group and other older people could be improved. The study comprised two phases. In phase one, the perspectives of older people were explored by carrying out 28 semi-structured interviews with older people in the asset rich cash poor category, permanently resident in Dorset, some of whom lived in a conurbation and others in rural areas. In phase two, the study explored perspectives of key financial advice/information/service providers through four focus groups comprising: health and social care professionals; financial advisors from the private sector; and professionals from the third (not for profit) sector. 6 ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN The study has shown that the economic downturn is having a marked impact on the financial, social, mental and physical wellbeing of this sample of asset rich cash poor older people in Dorset. For many, the level of income that they had expected when planning for retirement had not come to fruition and they feel poor in relation to their previous lifestyle and retirement expectations. The key findings and policy implications of the study are: Key finding 1: Many ARCP older people particularly women, had done little retirement planning. Many ARCP older people had insufficiently planned for their retirement. In particular some women had relied on their husbands to manage all finances and had not provided for their own pensions. This reflects the findings of earlier studies on the older generation. Policy implications The independent Money Advice Service (formerly the FSA Consumer Financial Education Board) should commit greater financial resource to the awareness raising and skill development of future generations to help people plan more carefully for their retirement. Although the findings of this study show a widespread need among older people for information and advice, resources should be targeted particularly at women, especially those who have had extended periods out of workplace. Private, public and voluntary sector services should respond to this increased investment through developing and testing out models of financial capability training, with an emphasis on financial planning, as well as its mode of delivery. There may be potential in raising awareness of the need for retirement planning and associated training to non-working women through health visiting or child care services. For older people who have planned ahead, pensions and savings have been traditionally seen as a key way to plan responsibly for one’s retirement future. But these are not risk free as has been played out in the recent years of economic downturn, with the associated low interest rates and return on investment. People planning ahead for retirement need to be reminded of the impact of any future recession and the risks of this if it coincides with their planned retirement date. ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN 7 Key finding 2: Older people, in the ARCP category, tended to manage the money they had very carefully, despite the economic downturn, and had an aversion to debt. This finding mirrors the quantitative study of Atkinson et al. (2006) who found older people to be better at managing money than the younger generations. In discussion of the financial pressures placed upon them in term of escalating essential and non-essential expenditure, no interviewees referred to having resorted to unsecured debt. Policy implications Managing money is identified in this study and earlier studies as a strength within older people. Therefore, financial capability training for this age group should focus on the other dimensions of financial capability where older people are less skilled, for example choosing financial products and staying informed. Older people should be considered an asset in society and their strong skills in managing money should be utilised. Those organisations wishing to develop and deliver financial capability curricula for younger people could consider intergenerational programmes in which older people participate as guest speakers, sharing their experiences in managing money with younger generations. These educators could be encouraged to work together with the Money Advice Service and the Department of Health and financial advice and information providers to bring various age groups together. Key finding 3: The combination of reduced income from investments, increases in pensions which do not keep pace with inflation, combined with increases in costs for essential and non-essential expenditure, is having an impact on social, physical and mental wellbeing and is causing noticeable life style changes. The effects of the economic downturn on ARCP older people’s wellbeing was highlighted by both older people themselves and service providers. In both phases of the research, reference is made to feelings of anxiety, worry, fear, depression and concern. 8 ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN Policy implications Reduced wellbeing during the economic downturn in this age group is likely to put an increased demand on health and social care services. Policy makers in the Department of Health have a vested interest therefore in developing strategies to counter this negative impact. One recommendation to enhance social wellbeing is that the Money Advice Service, the Department of Health and local councils fund national and local initiatives to further support and develop social clubs or other groups for older people, with an emphasis on financial planning and management. This would help sustain wellbeing and provide a network of peers with whom older people might exchange financial experiences and information. Third and private sector organisations such as care homes and age related charities are well-placed to contribute to the development of these programmes. Key finding 4: The economic downturn is impacting on older people indirectly though cuts to public and third sector services. The economic downturn has been associated with cuts in funding to many services previously relied on by older people for their physical, social and mental wellbeing. Library closures were a cause of concern and a particular worry was the risk of withdrawal of bus passes. Policy implications Private sector service providers will need to fill the gap in services that currently support the health and wellbeing of older people, a gap left by the increased withdrawal of public and third sector services. A reduction of these services in particular will have a strong impact on the social, mental and physical wellbeing of older people. Key finding 5: Older people, in the ARCP category, do not always access enough or appropriate financial information. Many choose to seek financial information from trusted health and social care providers, their family and/or friends rather than from financial professionals. Older people, and professionals that support them, reported that older people are not always accessing the sound financial information which they may need, whether it be on financial products, forward financial planning or how to obtain the benefits they are entitled to. Lack of trust in financial advisors was widespread. Independent financial advisors indicated that older people on lower incomes were using their services less frequently. Some were either self-reliant by researching ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN 9 on the internet or using the media, or tapped into sources of social capital found within their social networks. Policy implications More effort and resource needs to be put in place to address these very serious concerns about access to advice and support by older people. Older people are approaching health professionals for financial advice, despite the fact that these professionals may not be best placed to provide this. Health professionals need to be able to direct these queries to trained financial service providers. Financial services within the private sector should therefore form interagency partnerships with more trusted public and third sector services in order to improve access to the services they provide. There is a very significant concern about lack of trust in advisors and banks. The need to rebuild reputation must be addressed by regulators, the advisors and banks themselves, with an increased emphasis being placed on the value systems of financial services and the role they can play in promoting community and individual wellbeing. The strength of the social networks of older people should also be harnessed, suggesting again that there is potential in targeting or developing social clubs for older people as locations to enhance financial capability. Key finding 6: In order to make ends meet, some older people in the ARCP category may take greater financial risks or be more vulnerable to abuse in an economic downturn. The professionals that support older people expressed concerns that the economic downturn may push older people towards riskier behaviours without them fully understanding the implications of the risks. There is also a risk of older people becoming more vulnerable to financial abuse. Policy implications Policy makers need to ensure that older people are made aware of the risks of financial abuse. As older people are often turning to more trusted health and social care providers for advice on financial matters, health/social care providers as well as financial service providers should both develop means to keep their older clients regularly informed of potential financial risk within the current economic climate. As financial support is not the remit of many of the health care providers and financial services is a regulated activity, it is advisable they form partnerships with the finance sector, in order to better inform their patients/clients of current financial risks or to be able to refer them on to qualified support. Service providers may also 10 ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN offer a helpline in which older people feel safe to disclose, anonymously if need be, any concerns of financial abuse they may be exposed to. Charities already offering these services (e.g. Age UK and Action on Elder Abuse-AEA) should be supported in these endeavours through encouraging partnerships between financial service providers on the one hand and health/social care providers on the other in order that the latter can provide accurate and up to date information on financial risk to its partners. A recent partnership between local financial advisors and the charity Age UK is an excellent example of this (Age UK, 2012). It is also essential that the Money Advice Service raises awareness of this risk. As the provision of financial services is a regulated activity, it is important to ensure that any activities undertaken by health/social care providers are not in breach of financial services regulations. Key finding 7: Older people made no reference to the Money Advice Service or the Financial Services Authority (FSA) as a source of help or advice. At the time of this study none of the interviewees of the focus groups made any reference to the role of the Financial Service Authority (FSA) or the Money Advice Service in providing information or advice about financial matters to older people. Policy implications Although the Money Advice Service is now independent of the FSA, and is endeavoring to target a wider population, it is not clear why our interviewees never referred to it. It may either be due to a lack of awareness of the service, a serious indictment of the outreach of the FSA, or alternatively a lack of IT expertise in older people, demonstrated also by their very limited use of online banking. In either event, older people may be denied access to key forms of help and advice on financial matters. Resources need to be devoted to either increasing IT literacy among older people, or alternatively providing help and support using traditional forms of communication and/or increasing the reach of the Money Advice Service by targeting this age group specifically. In conclusion, therefore, older people in this study reported being affected markedly by the current economic downturn. Members of the financial sector, including accountants, and the Money Advice Service have a responsibility to support older people during this and future downturns. They must reflect on ways in which they might tailor their support towards this group. One way of doing so is by actively seeking collaborative interagency partnerships with third and public sector health and social care professionals to improve their access and understanding of older ASSET RICH CASH POOR IN THE ECONOMIC DOWNTURN 11 clients. These more trusted professionals will be able to direct financial enquiries to accountants and financial advisors who older people may otherwise not have had the confidence, knowledge or trust to approach directly. Accountants and other financial services should also be aware of the particular challenges facing asset rich but cash older people and adapt their advice accordingly when dealing with this group. They should reflect in their consultations that many older people are fully capable of managing their money but are in greater need of advice on how to invest their money and plan ahead for their future. They should also think outside of the box in providing support, considering ways, for example, in which the power of existing social networks might be harnessed. 12 ASSET RICH CASH POOR IN THE ECONOMIC DOWNTUR

Translating research into practice: Evaluation of an e-learning resource for health care professionals to provide nutrition advice and support for cancer survivors

Background Nurses and other allied health professionals are in a key position to provide appropriate and consistent advice on nutritional issues to support cancer survivors. However gaps in their nutrition knowledge and education warrant the need for enhanced learning as part of their Continued Professional Development (CPD). In the UK there are currently no formally recognised nutrition education programmes. Therefore e-learning offers a solution to provide flexible learning to target this need. Aims This study aimed to develop and evaluate the efficacy of a freely available, internet-based learning resource, for nurses and allied health professionals who provide nutrition, diet and lifestyle advice for cancer survivors. It sought to explore the attitudes and conceptions of the resource and current knowledge base of those involved in the care pathway for cancer survivors. Method The design and development of the e-learning resource were informed by the best available research and policy evidence and in a format to facilitate on-line learning. A robust evaluation strategy incorporated focus groups and telephone interviews to gain in depth insights into the experiences of using the resource. Results Themes included ‘Plugging a Gap’ which shows an improved knowledge base for nutrition. Information was ‘All in One Place’ showing that the resource was valued as being within a ‘trusted’ organisation. ‘Everyone Benefits’ illustrates how learners felt that the resource provided them with an evidence base, whilst the ‘Current and Live’ theme captured how professionals felt about the information being up-to-date. Conclusions The project has shown the benefits of interprofessional working to develop an e-learning resource for Health Care Professionals to support cancer survivors in following healthier lifestyles. Positive attitudes and potential improvements in the knowledge base and changes for professional practice were demonstrated. Further research is required to gauge sustained impact in the work environment by embedding the resource as part of CPD

Intersectoral interagency partnerships to promote financial capability in older people

From the second quarter of 2008, the UK economy entered a period of economic decline. Older people are particularly vulnerable during these times. To promote ways in which older people can be better supported to maintain their financial well-being, this study explored the sources older people utilize to keep themselves financially informed. Interviews with older people (n = 28) showed that older people access trusted sources of information (e.g. healthcare professionals) rather than specialist financial information providers (e.g. financial advisors) which highlighted the need for interagency working between financial services in the private, public and voluntary sectors. An example of how such interagency partnerships might be achieved in practice is presented with some recommendations on directions for future research into interagency working that spans public, private and voluntary sectors

Self Management and Telehealth: Lessons Learnt from the Evaluation of a Dorset Telehealth Program

Dorset Clinical Commissioning Group

Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.</p> <p>Methods</p> <p>We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation.</p> <p>Results</p> <p>Data for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups.</p> <p>Conclusions</p> <p>GP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN30420389">ISRCTN30420389</a></p

A Student approach to using Educational Memes as an outlet to enhance learning.

Memes are visual images, or video clips, often humorous in nature that can be easily (and rapidly) shared via social media. Having defined memes and their potential within the context of learning environments, this submission is developed from a ‘snap shot’ presentation at the Social Media for learning in Higher education Conference (2019) at Edge Hill University. The work presents a reflective account of the lived experiences of an ex-sixth form (now a first year undergraduate) student on the educational use of ‘memes’ to engage learners and enhance learning. &nbsp