Instead of reforming structures, policymakers should try to put patients and communities at the heart of the health service
The year 2015 will bring not only an election, but also an anniversary: it will be 15 years since a UK government first declared the intention to create a “patient-centred NHS”.
Are we any closer to that goal? Looking at the continued fragmentation of health and care services, the lack of significant support to people’s self-management, the persistence of reactive and crisis-oriented approaches, and some high profile failures to provide compassionate care, it would be hard to say so.
Two recent statistics tell a story. Only 3% of people with long-term conditions report having a care plan (General Practice Patient Survey); and only 3% of GP patients have access to their medical records online .
Both are essential mechanisms to help deliver the person-centred interventions, such as supported self-management and developing health literacy, which we know, through the best worldwide evidence, would effectively help people to improve:
• Their knowledge and understanding of their health
• Their experience of care
• Their health behaviours
• Their appropriate use of limited healthcare resources, and
• Their health outcomes
Significantly, both represent the failures of successive governments to meet policy goals from the centre.
That is because governments typically deliver “reforms” that are structure- and system-dominated, and which carry the assumption that what is said in central policy will happen in frontline practice.
This cannot continue. As the health select committee concluded this year:
“… the straightforward savings which are possible have now been made, and the transformation of care that will be required to make the NHS sustainable … has yet to take place.”
A consensus on the necessary transformation is growing. The 2015 Challenge, for instance, has united stakeholders across the NHS and social care, including National Voices, in calling for “care closer to people’s homes … joining up all parts of the health and care system so care revolves around the needs and capacities of individuals, families and communities”. We will hear more from this consortium soon.
But in National Voices’ view, representing 140 national charities in health and social care, simply describing elements of this change is not adequate: the goal must be clear.
In our position statement for the next five years, Person Centred Care 2020, we ask that government and care system leaders set an urgent and overriding goal to achieve genuine person-centred, co-ordinated care, co-produced with communities.
We describe what that would look like in terms of the experience people will have of care, treatment and support.
We suggest some key changes in the way service are run. These should be expectations in every local area and include:
• Defining outcomes as what matters most to people – for example, supporting the independence and wellbeing of older people – and making sure these are what gets measured;
• Bringing support together around the person to achieve these – with the voluntary and community sector seen as the key third partner to health and social care, and housing also integrated;
• Enabling the “informal workforce” of carers, friends, neighbours and community assets to be supported to care; and much greater emphasis on prevention, early diagnosis and intervention, and integrating public health with other services.
The next government will need to lead with strength but flexibility. It should use all available levers to point the statutory and voluntary sectors towards the ambition for person-centred care, while allowing local leaders to determine the appropriate shape of local services, in partnership with their communities.
Government must play its role in public health, through regulatory and other measures; and help to drive national programmes to develop, model and spread person-centred interventions such as shared decisions about treatments, care and support planning, action on health literacy and supported self management.
Above all, it should give the system a clear guarantee of adequate funding over a five-year settlement, tied to the ambition, sufficient to fund the transformation, and including building the capacity of the voluntary and community sector to play its multiple roles.
The changes we seek should be driven by “coproduction”. That means the involvement of people and communities as leaders and equals – in planning, designing, commissioning, delivering and evaluating the services they need and in social action beyond formal services.
Commissioners can boost co-production by, for example, investing in lay leadership development; using the Social Value Act 2012; establishing community development mechanisms; securing “social prescribing” (referral to non-traditional support); and shaping a local market where user-led groups, NHS mutuals, and the voluntary sector infrastructure are strengthened.
Like everyone across the care sectors, National Voices wants no further large-scale, top-down, structural reorganisations. We are asking for a different kind of reform: people-powered and person-centred.