How the development and implementation of a Choice and Equity Policy in Sussex improves healthcare decision-making.
What is a Choice and Equity Policy?
Choice and Equity policies guide Integrated Care Boards (ICBs) in making commissioning decisions fairly and consistently. It aims to empower individuals with the freedom of choice while maintaining fairness, responsible financial practices, and equitable access to health and care based on assessed needs. The Choice and Equity Policy seeks to address the challenge of providing unlimited choices by advocating for service restructuring that meets patient need, departing from the previous practice of commissioning solely based on patient requests.
What are the primary goals and objectives of a Choice and Equity policy?
The policy centres around evidence-based decision-making, prioritising individual choice without compromising care quality or equity. Its primary goals include providing choice, achieving fair commissioning, balancing individual preferences with equitable care, and dispelling misconceptions about its sole focus on financial efficiency. However, it is the taxpayer’s money so we should be responsible for every pound that we are given and make sure we're using it in an efficient, effective and equitable way. All of that aligns with the NHS constitution, it emphasises the responsible use of public funds, recognising the duty to provide care that is free at the point of access. For Sussex, our ambitions of the policy are to ensure that we're offering choice to our patients, but underpinned by equity and fairness, so staff feel supported in their commissioning conversations and interactions with patients.
What challenges or issues does this policy address?
The implementation of the Choice and Equity Policy challenges old practices and cultural norms, supporting clinicians' decision-making and fostering proactive, compassionate conversations to tackle health inequalities. The policy aims for a holistic approach to individual needs while maintaining a population health-based approach to health and care. The policy provides a lever for standardised decision-making, offering clear guidance to stakeholders and highlighting the importance of balancing cost-effectiveness with patient choice and quality of care.
What steps were taken to ensure that the policy was effectively implemented?
First, we focused on how we developed the policy. We knew we needed to engage staff and patient stakeholders; we did this through stakeholder workshops. These stakeholders played a crucial role in co-designing the policy – particularly the language that was used. Collaborative efforts with subject matter experts and internal governance structures were instrumental in shaping the policy, ensuring that it met the requirements whilst also being reflective of the voices of the staff and patient stakeholders.
We also then re-benchmarked service offerings, looking at how we could optimise the workforce, placements and services, in line with the local service landscape. This not only informed the policy but also led to the development of a qualified provider model and framework. This element of the work – triangulated with the stakeholder feedback - has enabled a reconsideration of the Sussex service offering, an example being that there is now a commitment to trying to provide placements within an hour’s drive of the family home. Affording opportunities to explore and forge new relationships with Providers.
What was the biggest challenge faced in the development and implementation of the policy?
Changing staff culture, and overcoming perceptions of cost-saving initiatives, were significant challenges in the development and initial implementation phases. Ongoing efforts focus on embedding the policy in decision-making processes, standardising approaches across teams, and allowing for flexibility during periods of intense change.
How would you describe the policy impact and future vision?
The Choice and Equity Policy serves as a mechanism to empower staff in making informed, fair, and efficient decisions considering patient needs, financial constraints, and the wider system impact. With the continued embedding of the policy, we can be confident that a service underpinned by fairness and equitable decision-making. The goal now is to ensure the policy is consistently embedded as a fundamental guide in decision-making processes, ensuring equitable provision of person-centred care across diverse communities. Although it's not a one-size-fits-all approach, the policy is there to allow for an evolving situation where we can be confident of high-quality services underpinned by fairness and good decision-making. Where we are at the forefront of tackling health inequalities not driving them and we tackle them by good, fair decision making.
Were there any unexpected outcomes?
The policy envisions proactively supporting patients in long-term health and care considerations and has prompted the ICB to evaluate the procurement of services from existing providers, emphasising value and high quality at a reasonable cost.
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