Claire Lemer- Health systems should work around the patients

UK paediatric consultant shares insight into the NHS and her experience innovating clinical health care for children and families

When a car collided with Claire Lemer in December 2017, the program deputy director and head of clinical transformation for the Children and Young People’s Health Partnership saw life through the lens of a patient. Several days in hospital and 10 weeks in a wheelchair did not faze her nor diminish her appreciation for the National Health Service (NHS). Lemer was encouraged to continue facing challenges head-on and continue innovating children’s health care.

Lemer is one of 17 health and health care professionals who make up the first cohort of Sciana: The Health Leaders Network. The Network was launched by the Health Foundation, Robert Bosch Stiftung, and Careum Stiftung in collaboration with Salzburg Global Seminar. Lemer returned to Schloss Leopoldskron for the third meeting of the Sciana 2017 group on June 12, 2018.

Members met just under a month before the National Health Service turns 70. The institution has been a driving force for Lemer, both as a clinician and on a more personal level.

She said, “My experience as a patient has very much been how extraordinarily wonderful it is to be cared for by people who genuinely care, whether it was the health care assistant on the ward who learned what sorts of biscuits I liked with my tea and coffee… to doctors who wheeled me about [the] fracture clinic, to and from x-ray, to nurses who were unbelievably caring and compassionate. To do that without ever worrying about how I was going to pay for things or what impact that would be having on my future is an amazing privilege.”

In comparing the NHS with other health care systems around the world, how they deliver patient care and how that relates to societal dynamics, Lemer stressed health care systems are designed to mirror the values of the systems in which they work.

“I am immensely proud of a health care system that continues to deliver amongst the best health care in the world, and it does that in a way that values equity,” Lemer continued. “I think that’s a really unique privilege, and I think it’s one that the British public holds really dear to their hearts. The NHS is probably amongst the top three institutions that the public really values and I think that says a lot.”

However, no system is perfect. By weighing anecdotal evidence of her experience with the NHS against insight into how it could improve, Lemer underlined the importance of building systems which attain optimum care.

“There were often things that relied on me being an eloquent, English speaking, health care knowledgeable advocate for myself. Otherwise, things might not have happened on time or [things] would have gotten lost. And I don’t believe we should have systems that are dependent on patients; the systems should work around the patients… it’s just about how we build these systems so that they’re fail-safe and so that things we want to, and actually could do, actually happen.”

Lemer has made honest efforts to re-design such health care systems for communities in Southwark and Lambeth, in London.

One of her first endeavours involved creating a more cohesive and sustainable post-natal ward by converting an unused dining hall into a space which allowed mothers and babies to be more efficiently discharged. This venture also involved adapting a food trolley to use as an informal meal delivery service within the hospital to avoid any safety concerns when mothers brought hot meals from the dining hall into their rooms. This left the dining hall free to use as a discharge area.

“We set up a very nice space, with a waiting area and there was a television there so we could show some public health promotion, how to breastfeed, those sorts of things,” Lemer said. “That whole process kicked off and really taught me a huge amount about the challenge, but also the innovation that is possible [and] the resilience that is required.”

Throughout her time as a member of the Sciana Network, Lemer has crystallised her ambition to think harder and more in-depth about her patient group of children and their families, and how she can “not just engage them in the superficiality of change, but really let them be the change-drivers.”

Lemer added, “I think what has inspired me is listening to things different people have done or the way they think. That might be participants or that might be people who have come to speak to us. That’s really been very useful then to take away and try and use.”

Drawing off her experience at the Sciana meeting in November, 2017, when they had patients and people involved in supporting patients’ engagement, Lemer launched a project which changed the way outpatients were structured.

Instead of having patients anxiously queuing at reception and waiting in a noisy waiting room for their appointments to be called out, they established a computerised system. A check-in desk was set up, and all appointment letters had a barcode for people to scan upon arrival. A series of television screens were also erected in the outpatient department, and names of patients would show up, along with a room number to meet the doctor. Lemer noted, “It’s only if you listen and really engage with families that you can get that spectrum of opinion, you can get the innovation, you can get the insight. So for me, the benefit in the day job has definitely been because of the interactions with participants and speakers.”