This is a crucial moment for person-centred care. Let’s not screw it up.
In particular, let’s not screw it up by imposing concepts, ideals and models on people.
The working lives of staff and professionals – in a misfiring, fragmented, overwhelmed and wrongly resourced health service – are already stressful enough.
Person-centred care (or ‘personalisation’, as some prefer) is not an ideology. It is an evidence-based, practice-tested route to better outcomes for people – and, as we are beginning to see, better working lives for staff.
And those should be our two key metrics for progress in the coming years: whether a) people achieve better health and wellbeing, and b) staff and teams achieve more work satisfaction, through redesigning care to put people at the centre.
Why I am I saying this now?
For the last seven years National Voices has had person-centred care at the heart of its mission.
At high national levels, with our members, we have fought battles and formed fruitful partnerships to shift the policy agenda.
From the legal duty for commissioners to ensure people are engaged in all decisions about their health and care; through coproducing and spreading a person-centred vision for coordinated (‘integrated’) care; to the landmark outputs from the Realising the Value programme -- we have provided the evidence, shaped the arguments and helped to ‘popularise’ this vision.
But over the last 12 months we have looked again at our strategy, and it is clear that it’s time to move beyond ‘policy’, for two main reasons.
First, ‘person-centred care’ has moved well beyond the early circles of academics, quality improvement projects and policy nerds like me.
‘Out there’ among local leaders, planners, professional networks and enlightened commissioners, there is much greater awareness and appetite to adopt and implement person-centred approaches.
For the first time, we have what has long been wished for: clinical champions and leadership bodies who are ready to support the spread of, for example, shared decision making, care planning, and the use of community assets.
Second, this has happened ‘culturally’ through networked diffusion, as much as through system-driven change.
National programmes such as the integration pioneers and the new care models have provided opportunities to reconsider the design of care. But people want to do this because they know it’s right, and it makes sense of their caring vocation.
So this is a crucial time because the opportunity is there to support organisations and their workforces to redesign care models and to feel empowered to change the way they work.
We kill the things we love
I once heard a commissioner observe: ‘We kill the things we commission.’
I took that to mean that the innovation, dynamism and genuine buy-in that you find in pilots and pathfinders can be destroyed by formalised programmes.
This is certainly the very point at which we could kill person-centred care.
Here are my own thoughts on some ’dos and don’ts’ for system leaders to consider:
- Don’t dogmatically transfer language and approaches from ‘personalisation’ in adult social care. Do acknowledge that the health context is different – for both people (‘patients’) and professionals – and has its own history of developing person-centredness.
- Don’t cook up big new programmes and ‘roll them out’. Do continue to support new learning about taking the approaches to scale, in local areas with genuine enthusiasm to try.
- Don’t confuse the issue by setting directions for system-centred reform, by constantly focusing on ‘benefits to the system’ and service use metrics. Do work on the outcomes and indicators around which people and their professionals can unite.
- Don’t start from scratch on workforce training. Do buy into the expertise of people who have spent years testing and proving learning methods.
- Above all, work through authoritative clinical champions to develop and support new waves of professional enthusiasm and adoption.
We can continue to learn from the pioneering work of the vanguards and pioneers as we move towards a more joined up, person-centred model of care. We should do so by building on the intrinsic motivation of staff and service users to get it right.