Jacquie White is Deputy Director for Long Term Conditions, Older People and End of Life at NHS England, and tweets at @jaqwhite1. In this blog, she discusses person-centred care and NHS England’s new “Our Declaration” campaign.
Person-centred care seems to be the latest thing the NHS has suddenly started to get excited about, but is it of value, will it last, or is it just another fad?
A famous quote by the physican William Osler (1849 – 1919) reminds us that “the good physician treats the disease; the great physician treats the patient who has the disease”, so the basic concept of person-centred care is not so new.
The term itself has different definitions, but the consensus is that person-centred care takes into account service users’ needs, preferences and strengths, and enables people who are using services to make informed decisions about their care and treatment, in partnership with their health and social care practitioners. The Health Foundation define it as “personalised, co-ordinated, and enabling… treating people with dignity, compassion and respect”.
Many people see person-centred care as nice to do, but retain a level of cynicism about its value, the impact it can have, and the ability of both patients and clinicians to “do” person-centred care. This is despite some pretty compelling evidence that it improves clinical outcomes, quality of life and can reduce cost; more importantly, it can help people living with long term conditions thrive rather than just survive.
Even when the power of person-centred care is recognised, it can be incredibly difficult for clinicians and patients to change how they work together, in a system where demand is increasing, time is precious and ways of working seem to be entrenched. I recently heard a GP in Ealing say that the current form of health care provision is nowism: treating what’s in front of you at that point in time or, to use another well-known phrase, “putting a sticking plaster over the problem”.
But it doesn’t have to be like that. There are some great examples of person-centred care in action: patients using a plan on a page to support consultations; clinicians writing letters with the patient in the room; care and support plans that are owned by the patient and taken with them wherever they hit the system; care co-ordinators helping individuals to navigate around the system. We want to help this way of working together with patients become the norm.
There are certainly system changes that need to be made. However, there are also simple actions that individuals can take that can have a huge impact. As a starting point we have just published “Our Declaration: Person-centred care for Long Term Conditions” which sets out to help describe what person-centred care should look like. It was developed with people with lived experience of long term conditions, clinicians and many other stakeholders. We’re asking people who want to see real change towards person-centred care sign up and pledge their own actions; to make their personal declaration.
We want to encourage people to think about what person-centred care means to them, talk to others about it, and practice being person-centred in their interactions as clinicians and patients. Perhaps even a simple change for both from asking “what’s the matter with you/me” to “what matters to you/me today” could help a different conversation happen, with different results for all concerned.
My own declarations are both personal and work based. On a personal level, I have pledged to support my family and friends (who between them have a significant numbers of LTCs under their belt) to understand what person-centred care means to them, and how they can work with their local clinicians to co-produce their care. In my role within NHS England, I have pledged to continue to raise awareness of the importance of person-centred care, and to progress national actions to facilitate real change on the ground: for instance, the results of our recently commissioned ethnographic research project.
So what do you believe: is person-centred care fantasy, fad or far-reaching in its potential? And if the latter, what will your declaration be? Tell us at www.engage.england.nhs.uk/survey/ltc-declaration
Image credit: Jeffrey Smith via flickr