Values in Mental Health Legislation 1 Values and Values-based - - PowerPoint PPT Presentation

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Values in Mental Health Legislation 1 Values and Values-based - - PowerPoint PPT Presentation

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Values in Mental Health Legislation 1 Values and Values-based Practice 12.10.2016 Bill Fulford and Tamsin Waterhouse Ashok Handa Collaborating Centre for Values-based Practice St Catherines College, Oxford Wednesday 25 th November 2015

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Values in Mental Health Legislation 1 Values and Values-based Practice 12.10.2016 Bill Fulford and Tamsin Waterhouse

Ashok Handa Collaborating Centre for Values-based Practice St Catherine’s College, OxfordWednesday 25th November 2015

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Outline

  • 1. Values and values-based practice
  • 2. Values-based surgery
  • 3. Montgomery
  • 4. Summary
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Outline

  • 1. Values and values-based practice
  • 2. Values-based radiography
  • 3. Montgomery
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First Exercise - what are values?

  • 1. Write down three words (or very short

phrases) that mean ‘values’ to you …

  • 2. Then compare with your neighbour …
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What are Values?

  • Principles
  • Needs
  • Wishes
  • Preferences
  • Hopes
  • Ambitions
  • Concerns
  • Virtues
  • Etc!
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What are Values?

Values are individually diverse

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What are Values?

Values are about

‘what matters’ or ‘is important’ to you

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Resources for working with values

  • Ethics
  • Medical humanities
  • Decision analysis
  • Health economics
  • Etc
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Values-Based Practice adds to these ….

……. skills for working with individually diverse values

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Values-based practice

Ten Key Process Elements

  • 4 Clinical Skills
  • 2 Aspects of the model
  • f service delivery
  • 3 Strong links between

VBP and EBP

  • Partnership in decision-

making

Together these support balanced dissensual decision making within frameworks of shared values

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Values-based practice

Ten Key Process Elements

  • Awareness Skills
  • 2 Aspects of the model
  • f service delivery
  • 3 Strong links between

VBP and EBP

  • Partnership in decision-

making

Together these support balanced dissensual decision making within frameworks of shared values

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Second Exercise - It’s your decision …

  • Imagine you have developed early symptoms of

a potentially fatal disease …

  • NICE has approved two possible treatments
  • TREATMENT A - gives you a guaranteed period
  • f remission but no cure
  • TREATMENT B - gives you a 50:50 chance of

‘kill or cure’

  • Your decision – how long a period of remission

would you want from Treatment A to choose that treatment rather than go for the 50:50 ‘kill or cure’ from Treatment B?

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It’s your decision …

“How long a period of remission would I want from Treatment A to choose that treatment rather than go for the 50:50 ‘kill or cure’ from Treatment B?”

  • Write down your own answer thinking about your

decision from own point of view and in your own particular circumstances

  • Then compare your answer with your

neighbours’ answers

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Choosing treatment A over B …

15 7 8 4 3 3 2 1 No! >6m >1y >1<5 5-10 >10 >25 >80

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Values-based Practice links science with people

Values Based Practice Evidence Based Practice

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David Sackett’s definition of evidence- based medicine … … the integration of ~best evidence ~clinical experience ~patient values

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‘By patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.’

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Values-based Practice links science with people

Values Based Practice Evidence Based Practice

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VBP and EBP are partners in the delivery

  • f person-centred care

Values Based Practice Evidence Based Practice

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Collaborating Centre

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Summary

  • 1. Values and values-based practice
  • Values are about what matters to you (individually diverse)
  • Values-based practice – skills for working with individually

diverse values

  • As a partner to evidence-based practice
  • 2. Values-based surgery
  • 3. Montgomery
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Outline

  • 1. Values and values-based practice
  • 2. Values-based surgery
  • 3. Montgomery
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From mental health

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From mental health to values-based surgical care

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Ashok Handa

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What surgery is about: ‘every man should know his limitations’

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What surgery is NOT about: ‘feeling lucky today punk?’

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Surgical seminars

  • 7 seminars to date
  • Content of 3 word and forced choice

exercises

  • Case based discussions
  • Multi-disciplinary teams
  • Patients and patient groups actively involved
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How VBP has changed surgical practice

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How VBP has changed surgical practice

‘What would you do doctor?’

  • Pre-VBP: answer based on surgeon’s values
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How VBP has changed surgical practice

‘What would you do doctor?’

  • Pre-VBP: answer based on surgeon’s values

‘What’s important to you?’

  • Post-VBP: answer based on patient’s values
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How VBP changes applying mental health legislation

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How VBP changes applying mental health legislation: this afternoon

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How VBP changes applying mental health legislation: this afternoon

A VBP ‘tweak’ to my practice

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Summary

  • 1. Values and values-based practice
  • 2. Values-based surgery

My individual ‘tweak’

  • 3. Montgomery
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Summary

  • 1. Values and values-based practice
  • 2. Values-based surgery (and MH legislation)

My individual ‘tweak’

  • 3. Montgomery
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Outline

  • 1. Values and values-based practice
  • 2. Values-based radiography
  • 3. Montgomery
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The Montgomery Ruling Montgomery (Appellant) v Lanarkshire Health Board (Respondent), April 2015

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How this will change everyone’s practice

The Montgomery Ruling Montgomery (Appellant) v Lanarkshire Health Board (Respondent), April 2015

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Background

  • Mrs Nadine Montgomery’s case:

– High risk pregnancy (diabetes) under care of Dr McLellan – Baby born with shoulder dystocia – Child left with serious disabilities

  • The facts:

– Mothers with diabetes are more likely to have a large baby – 10% risk of shoulder dystocia

  • Mrs Montgomery had raised concerns about vaginal delivery, but Dr

McLellan's policy was not routinely to advise diabetic women about shoulder dystocia

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Supreme Court Ruling

  • Patient should have been told about risk of shoulder dystocia
  • Judgment as a whole marks shift from ‘prudent clinician’ to ‘prudent

patient’ test of consent in health and social care

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Supreme Court Ruling

  • Patient should have been told about risk of shoulder dystocia
  • Judgment as a whole marks shift from ‘prudent clinician’ to ‘prudent

patient’ test of consent in health and social care

  • This is NOT about:

~ ‘bombard(ing) patients with technical detail’ ~ offering ‘futile’ treatments

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Supreme Court Ruling

  • Patient should have been told about risk of shoulder dystocia
  • Judgment as a whole marks shift from ‘prudent clinician’ to ‘prudent

patient’ test of consent in health and social care

  • This is NOT about:

~ ‘bombard(ing) patients with technical detail’ ~ offering ‘futile’ treatments

  • What it IS about:

1. Clinicians engaging in ‘dialogue’ with their patient to the point that 2. they have sufficient understanding of the risks and benefits of the

  • ptions available to make a choice that

3. takes into account ‘her own values’

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Supreme Court Ruling

  • What it IS about:
  • 1. Clinicians engaging in ‘dialogue’ with

their patient to the point that

  • 2. they have sufficient understanding of

the risks and benefits of the options available to make a choice that

  • 3. takes into account ‘her own values’
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Montgomery is about …

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Montgomery is about … Values-based clinical care

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MONTGOMERY AND ME: IMPLEMENTING THE NEW STANDARD FOR CONSENT TO TREATMENT IN MEDICINE

AND HEALTHCARE

  • WHERE? ST. CATHERINE’S COLLEGE, OXFORD
  • WHEN? FRIDAY OCTOBER 28TH 2016

CONFIRMED SPEAKERS INCLUDE

  • Baroness Hale, Deputy President of the Supreme Court and one of

the Montgomery judges

  • Professor Sir John Bell, Regius Professor of Medicine, University of

Oxford

  • Professor Jonathan Herring, Professor of Law, University of Oxford
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Summary

  • 1. Values and values-based practice
  • 2. Values-based surgery
  • 3. Montgomery consent

…about values-based clinical care

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Overall Summary

  • 1. Values and values-based practice
  • 2. Values-based surgery
  • 3. Montgomery
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Overall Summary

  • 1. Values and values-based practice
  • Values are about what matters to you (individually

diverse)

  • Values-based practice – skills for working with

individually diverse values

  • As a partner to evidence-based practice
  • 2. Values-based surgery
  • 3. Montgomery
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Overall Summary

1. Values and values-based practice

  • Values are about what matters to you (individually diverse)
  • Values-based practice – skills for working with individually

diverse values

  • As a partner to evidence-based practice
  • 2. Values-based surgery

My individual ‘tweak’ (this afternoon)

  • 3. Montgomery
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Overall Summary

1. Values and values-based practice

  • Values are about what matters to you (individually diverse)
  • Values-based practice – skills for working with individually

diverse values

  • As a partner to evidence-based practice
  • 2. Values-based surgery

My individual ‘tweak’ (this afternoon)

  • 3. Montgomery

…about values-based clinical care

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LEARN MORE The Collaborating Centre valuesbasedpractice.org

Ashok Handa Collaborating Centre for Values-based Practice St Catherine’s College, OxfordWednesday 25th November 2015