News and Comment

Person-centred care: putting patients in control

Tuesday 31 March 2015

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In England, more than 15 million people have a long term condition. Improving the treatment and management of long term conditions (LTCs) is one of the most important challenges facing the NHS. This requires a shift towards models that are proactive, holistic and preventive where people with LTCs are encouraged to play a central role in managing their care.

Working with rather than doing to

The Health and Social Care Act (2012) requires CCG Boards to promote the involvement of patients, their carers and representatives (if any) in decisions which relate to the prevention and diagnosis of illness, as well as their care or treatment. As recognised by, amongst others, Nesta: people living with long-term conditions face significant challenges, but they also have strengths and abilities including the capacity to manage their own health, given the right support.

While the benefits of person-centred care are increasingly recognised, changes to practice remains patchy and inconsistent (Nesta). King’s Fund (2013), amongst others, argued strongly that encouraging better support for self-management and better use of community assets could create greater value at a cost lower than is possible with the current fragmented network of services. Their call is that CCGs will need to be ambitious if they are to change traditional ways of working and realise the benefits in terms of better outcomes and greater value for money.

Supporting patients to be more active and engaged in their own health

OPM has been commissioned by South East Commissioning Support Unit to develop an online menu of resources – toolkits, training and support, to help commissioners develop transformational models of integrated, personalised care co-designed with patients and carers to better manage long term conditions, reduce emergency admissions and promote prevention.

One of the resources is a an online searchable directory to support self-management, bringing together a useful selection of well known evidence-based tools to encourage and support patients to manage their own health through, for example, shared decision making, social prescribing and personal health budgets.

A directory of online resources alone won’t develop the culture, systems and processes to make the vision of patients in control a reality. To truly put patients at the centre of their own care, attitudes and practice of commissioners, clinicians and patients need to change. It will also require capacity building efforts and CCGs identifying what might provide the most value in their local area.

Creating a better understanding of local offer to support person centred care

Support may not be confined to those normally supplied by traditional health services. To be useful in a local context, GPs and other clinical staff need to have a much better understanding of what’s available locally to support patients in managing their own health and care. Commissioners should be encouraged to work with their local partners (NHS, voluntary and community sector organisations or private sector) to map local social prescribing options in any local area.

Islington is one area where there has been a concerted effort over a number of years to support patients to take a more active role in their care. Islington was a pilot site for the Co-creating Health programme to transform local diabetes care. As one of the first wave national integrated care and support pioneers, Islington have been working with people who have long term conditions such as COPD and diabetes to develop self-management plans, looking at their goals and wishes around care. This has involved more referrals to self-management support programmes, and longer appointments to ensure that better conversations take place in primary care. Islington also recognised the need for greater collaborative working across the area, and one approach has involved commissioning a VCS organisation to run a Health Navigator service that identifies and signposts to different sources of support locally to help improve patient quality of life and maintain independence, in turn delaying the need for more intensive health and social care services.

“Across the country colleagues are embarking on similar projects based on the evidence that shows what a difference person centred care makes to people’s lives… The challenge for commissioners is to respond to this and work with colleagues inside and outside of NHS structures to move person centred care in to the mainstream of healthcare provision.” Dr Katie Coleman, a GP and Vice-Chair of Islington CCG

So, to put patients in control of managing their own health and care there is a clear role for community services and self help. This requires identifying a portfolio or menu of local services for people to choose from, and a willingness on the part of commissioners to fund non-traditional services.

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This is the first in a series of blogs to be published following the development of a set of online tools and resources by OPM in support of the person-centred care agenda for South East Commissioning Support Unit. The second is entitled: Person-centred care: measuring impact and the third: Patients in control: ‘assume it’s possible’.