This document discusses shared decision making initiatives in England. It describes 3 key programs - the Health Foundation's MAGIC program which developed decision aids and trained clinicians, the NHS Right Care program which created 38 online decision aids for conditions like cancer and joint replacements, and Bupa UK's treatment options service which engaged over 10,000 members through health coaching. It outlines successes of each program like cost savings, high patient satisfaction, and policy influence, but also challenges of sustainability, embedding in healthcare systems, and overcoming cultural barriers. The document advocates for further adoption of shared decision making in the NHS, expanding decision aid availability, and building awareness among patients.

1. Shared Decision Making in England
Angela Coulter
Director of Global Initiatives
January 2013

2. Overview
• Foundation’s role
• Policy context
• Three SDM programmes
• Health Foundation
• NHS
• Bupa
• What next?
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3. Urology Decision Aids
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4. Influencing the Policy Agenda
4

5. No Decision About Me Without Me
“The Government’s ambition is to achieve
health care outcomes that are amongst the
best in the world.This can only be realised by
involving patients fully in their own care, with
decisions made in partnership with clinicians,
rather than by clinicians alone.”
Department of Health. Equity and Excellence: Liberating the NHS, July 2010
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6. Patients’ rights
• You have the right to make choices about
your NHS care and to information to support
these choices.
• You have the right to be involved in
discussions and decisions about your
healthcare, and to be given information to
enable you to do this.
• You have the right to be given information
about your proposed treatment in advance,
including any significant risks and any
alternative treatments which may be
available, and the risks involved in doing
nothing.
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7. Good Medical Practice: Duties of a doctor
• You must work in partnership with patients
• Listen to patients and respond to their concerns and preferences
• Give patients the information they want or need in a way they can
understand
• Respect patients' right to reach decisions with you about their
treatment and care
• Support patients in caring for themselves to improve and maintain
their health General Medical Council 2009
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8. NHS Patients’ Experience
46 46 47 47 48 49 48 48 48 48
0
10
20
30
40
50
60
70
80
90
100
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
%
Wanted more involvement in treatment decisions
Source: NHS inpatient surveys
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9. Health Foundation
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Newcastle – RichardThomson
Cardiff – Glyn Elwyn
Specialties: general practice, obstetrics, breast surgery, ENT, urology
• Option Grids
• Clinical skill development
• Action learning sets
• Measurement and feedback
• Ask 3 Questions campaign
• Engaging organisations and teams

10. 10

11. Ahmed H et al. BMJ 2012;344:bmj.e3996
©2012 by British Medical Journal Publishing Group
Breast Cancer Decision Explorer
BresDex: www.bresdex.com
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12. Social Marketing: Ask 3 Questions
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13. 13
www.shareddecisionmaking.health.org.uk

14. MAGIC: Successes and Challenges
Successes
• Training programmes and
materials
• Brief PtDAs, inc Option
Grids
• Decision quality measures
and metrics
• Ask 3 Questions
• Resource centre
• Policy influence
Challenges
• Sustainability of training
• Cultural/organisational
barriers
• Decision quality measures
need more work
• Standardising tool
development
• Patient engagement
strategies
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15. QIPP Right Care
www.rightcare.nhs.uk
1. Developing tools to support SDM
• 38 web-based patient decision aids + mobile apps
• Telephone health coaching service
2. Embedding SDM in NHS systems
• Integration into IT systems
• Guidance for commissioners
3. Creating a receptive culture for SDM
• Training for clinicians and demonstration sites
• Involving patient advocates, developing metrics
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16. 16

17. NHS Right Care Decision Aids
Available now To come To come
Established kidney failure Multiple sclerosis Depression
Kidney dialysis Localised bladder cancer Atrial fibrillation
Kidney transplant Pregnancy after C section Sciatica
Cataracts Heavy menstrual bleeding Inguinal hernia
AAA repair Rheumatoid arthritis Acne
AAA screening Carpal tunnel Cholecystitis
OA hip Localised breast cancer Obesity
OA knee Otitis media Antenatal screening
LUTS Tonsillitis End of life care
PSA testing Type 2 diabetes
COPD Smoking cessation
Localised lung cancer Cholesterol
Stable angina Localised bowel cancer
Localised prostate cancer Blood pressure 17

18. Right Care: Successes and Challenges
Successes
• PtDAs developed to tight
timescale
• Clinician involvement
• Linkages and system
support
• Policy influence
Challenges
• Short-term funding
• Sustainability
• Embedding in system
• Cultural/organisational
barriers
• Decision quality measures
need more work
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19. Bupa UK
Treatment Options Service
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• 9 nurses target members by phone
• Supported 10,292 members to dateProgramme
• SDM
• ‘Whole person’ health coachingProcess
• MSK, cardio, cancer, gastroenterology
• Urology, derma, mental, post-surgeryConditions
• Patients like it, costs covered
• Company contract for weight managementBenefits

20. 3
5-7% gross cost savings 3
months post engagement
(RCT)
Called 34,386 members
Reached 25,877 (75%)
Engaged 10,292 (40%)
Savings hold up at least 1.5
years post engagement
Cost Outcomes

21. Positive Reaction from Patients
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“I found the decision aid on
chronic low back pain
fantastic and have discussed
this with my GP. He has
reviewed my medications
and reduced my analgesia,
and I have also started
exercising at a local gym.”
“The DVD and book was
absolutely brilliant. I
have cancelled my
operation and found a
positive way to deal with
pain which gave me an
option other than
surgery. Thank you so
much for all your help.”

22. Bupa: Successes and Challenges
Successes
• Saving of 5-7% covers cost
of provision
• Great feedback – 79%
extremely or very satisfied
• Provides right care and
advice
• Demonstrates Bupa’s
leadership
Challenges
• Engaging clinicians
• Referrals into the team
from clinicians
• Promoting use of SDM by
clinicians
• Bupa members only
(private medicne, not NHS)
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23. What Next in England?
• Adoption by NCB and CCGs
• Mainstreaming in clinical practice
• Wider range of PtDAs
• PtDA certification
• Metrics and DQM
• ICD10 code for provision of PtDA
• Wider availability of training
• Building patient awareness
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