Activating the NHS: reablement and patient collaboration
OPM recently played host to a range of NHS stakeholders at our patient engagement seminar. Amongst the lively discussion highlighting the need to include patients throughout the NHS, an emphasis was placed on shifting from passive engagement to active collaboration.
With the advent of social media and the new found ease of providing input and opinion, it is easy for service providers and users alike to feel they are engaged without actually changing processes in a meaningful way. For example, a local GP surgery may now hold regular patient participation groups, produce a practice newsletter, run patient surveys and offer a multitude of feedback mechanisms including online via NHS Choices; but in practical terms how much input are patients having in the provision of their own care?
As the breakfast seminar demonstrated, the NHS is making strides in attempting to including patients, or ‘citizens’ in the macro decision making structures of healthcare. However, it is important we also consider the need to include individuals from the bottom up. Patient engagement is about including the public in shaping the NHS as a whole, but it is also about including individuals in shaping their own healthcare. One way of doing this is through reablement.
Reablement is increasingly being used by local authorities as an adult social service that works with individuals instead of for them. In practice, this means assisting people with illness or disability to regain the capacity to live as independently as possible. As well as providing physical support, reablement is also about a person’s psychological and social health, building a person’s confidence and improving well-being. In this way, reablement is an active means of including patients in their care by setting shared goals and allowing people to own their individual recovery.
As well as feeding into the current trend of NHS patient ownership, reablement has gained government support. In 2011 Andrew Lansley emphasised the need to keep ‘people as independent and in good health for as long as possible’ and recent funding has been provided for adult social care services that have added health benefits; the so-called ‘256 monies’. There are clear reasons behind this policy support for reablement, not least in terms of individual well-being. On top of the benefits to individual quality of life that clearly come from being able to decide whether you wish to remain at home and being given the opportunity to relearn skills following injury; reablement also eases the pressure on acute services and saves the NHS money. For example, a study in Leicestershire found that 62% of people who had reablement did not need any ongoing care package after six weeks, compared to 5% of people who had conventional home care. By supporting people to do things themselves, reablement provides the tools for individuals to improve their health at a pace that meets their own needs and goals, thus decreasing the likelihood of future health problems and ongoing care. Independence is valuable at both the local and institutional levels.
The advantages of patient engagement in making individual, small choices are therefore just as clear as the advantages of including ‘citizens’ in making big, NHS wide decisions. However, as reablement shows, this needs to be done by actively, including individuals through collaboration in their care. The reablement ethos of ‘doing with’ rather than ‘doing for’ should be integrated throughout all levels of health and social care in order to truly engage patients in a meaningful way. Approaches such as reablement are able to reap rewards from the bottom up that can feed into the overarching workings of the NHS.