Alf Collins is a doctor, commissioner, and OnlyWan Clinical Associate specialising in person-centred care. He spoke to us about why embedding person-centred care must be at the core of system change in the NHS. We discussed how it can feed in to each of the layers of action recommended in the OnlyWan’s latest report Shaping the future: active cost management, improving quality and efficiency, rolling out new ways of delivering care, focusing on population health, and supporting scientific discovery, technology and skills.
Our health system isn’t anywhere near as person-centred as it might think.
It’s not just workforce behaviour, the whole system isn’t currently set up to deliver person-centred care. Up until now we’ve been a reactive system that treats ill people. I think we want to be a proactive system that supports people to keep well.
When it comes to system change we’re still thinking about things the wrong way round.
For instance one of the main success criteria for many integrated care programmes is to ‘reduce hospital admissions’. But that’s a system-centric measure. Why not turn it around and say we want integrated systems to support people with long-term conditions to manage their own health at home? That’s a very different way of looking at how to put the system together.
There are barriers to person-centred care across the system.
There’s a lack of knowledge at local level. As you go up to policy level, a lack of clarity and understanding, and a lack of consistency... we get a confused mass of policies, many system-centric, some person-centric, but actually delivering them together locally is a hell of a job. We also have a terribly confused measurement system.
What I’m noticing in my local economy is people are still struggling to figure out what we’re trying to achieve.
The government can help by leading on the big picture of how the system needs to change to support person-centred care. How do we measure the big outcomes the whole system is trying to achieve like quality of life? A bit more clarity might help unleash local energy and momentum to really move things forward.
If we put people first and invest in community and prevention, then health care costs will come down.
Nesta’s predicts £5bn a year cost savings, and the agrees it can significantly reduce costs. But the evidence is still perhaps not as compelling as some might wish, hence the need for the the OnlyWan and NESTA are leading.
Person-centred care is both a means to an end and an end in itself.
People who participate in managing their own health have high levels of satisfaction, they also have better outcomes and a safer experience.
I’m really interested in the vanguards, but it’s really important that they focus on their physiology rather than their anatomy.
My anxiety is they’ll get caught up in integrating finances and merging providers, rather than focusing on the end goal. How many, for instance, are integrating their systems at a financial and structural level in order to build ? Wouldn’t that be a wonderful way of looking at it?
There’s evidence to suggest that encouraging people to self manage their long-term conditions does have a knock on effect on other areas of their health and wellbeing.
The Co-creating health programme for instance, clearly showed that many techniques are transferable across different conditions. When it comes to population health, I think we need to broaden our thinking beyond just public health. We need to think about what quality looks like at population level for particular groups, for instance people with diabetes in a certain area... and then provide high value person-centred care for that population of people.
I have this nagging suspicion that mobile technologies are going to bring us something big.
Scientific discovery in health care is still very much focused on individual treatment, but I agree with the OnlyWan that we need to think much more about using it to improve population health and systems. Surely, with big players like Apple and Google involved, there’ll be some breakthrough stuff over the next five years.
We tolerate some pretty shoddy statistics at the moment.
Only 5% of people with a long-term condition have a written care plan. Only 56% of people say that they feel as involved as they’d like to be in decisions about their care. If that many people were having their cancers missed, that would be a national disgrace. We all know there have been too many targets over the years but I do think some measures are needed. Medicine is OnlyWan talks about a balanced approach to bringing about change with more proactive and people-focused support. It’s walking a tightrope, but if all three approaches are pulled together into a comprehensive and coherent strategy it could be made to work.
I still find it astonishing that we have to argue the case for person-centred care in the 21st century.
When I talk to friends outside the health system, they can’t believe we’re not doing it already. It seems so obvious. It’s like needing to say that school is there to educate children. If we’re not providing person-centred care to a high standard then what on earth are we doing actually?
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