Person-centred care: from ideas to action Health Foundation summary and analysis October 2014 For more information and to download or order the full report, please visit: www.health.org.uk/pccideasaction 2 THE HEALTH FOUNDATION In 2013, the Health Foundation commissioned a review to synthesise current knowledge on shared decision making and self-management support and how to make these an integral feature of health care. The full research report, Person-centred care: from ideas to action, draws together and analyses the research, policy, empirical evidence and evidence from programmes. There is also an accompanying learning report, Ideas into action: person-centred care in practice, which focuses on how to implement change locally. To download and order these reports, please visit www.health.org.uk/pccideasaction This ‘In brief ’ looks at the implications of the research for policy makers and those responsible for providing strategic direction to assist them in moving person-centred care and support from an aspiration to an actuality. The issues considered in document are relevant in the four UK countries. To illustrate our analysis, we have drawn upon the specific roles of those responsible for the strategic oversight, direction and regulation of the health care system in England. Putting aspirations into practice The gap between commitment and practice There is increasing and welcome recognition that people who use health services can no longer be viewed as passive recipients of care but rather are active coproducers of their own health, including through decisions about whether and what treatments to accept or by taking on day-to-day management of their health and care. This recognition is manifesting itself in a growing alignment between government, clinical and managerial leaders, patient groups and commentators across the four nations of the UK, behind the aspiration of a more person-centred health service (see Figure 1). Supporting this aspiration is a growing empirical and practical evidence base – from the work of the Health Foundation and others – on the impact of shared decision making and self-management support, what gets in the way and what needs to be in place to enable them to become normal practice. Yet there remains a stubborn gap between the commitment to person-centred care and support and the reality on the ground: – Only around half of people are involved as much as they want to be in decisions about their health care, a figure that has remained stubbornly constant for the past 10 years. – Only 3% of people living with a long-term condition report involvement in their care plan. – There are fewer places on self-management programmes available each year than there are people newly diagnosed with a long-term condition. Why does this gap persist? It is perhaps not surprising that the gap between commitment and practice exists: person-centred care and support is still novel. It is multifaceted (as shown by Figure 1). It involves, as does any change, asking individuals to change their roles and their behaviours and organisations to change their culture. It is one part of a complex NHS system, where energy is often drawn towards structural change at the expense of quality improvement. It is one of many priorities of professional and system stewards and regulators who have many other priorities on their plate which are more intuitively part of their history and expertise.1 The research draws our attention to a number of barriers, discussed below, that have held back shared decision making and self-management support from becoming ‘business as usual’. Paying attention to these points can inform a more coherent and effective approach to implementing person-centred care and support. 1 By system and professional stewards we mean those public bodies that are responsible for the strategic oversight, direction and regulation of the health care system and the development of health care professionals. This includes central government departments, their arm’s length bodies, royal colleges and similar bodies. Figure 1: What is a person-centred health system? We can discern four principles of person-centred care and support. P e rson is treated with... dignity, compassion, respe ct Care is... enabling Care is... coordinated Care is... personalised The four principles of person-centred care Where would we start if care and support were person-centred? – We would start by understanding what matters to the patient – Every encounter would be one which embraces the patient as person rather than object – We would explore their health beliefs, motivations, knowledge, skills, learning styles and familial and social context as well as according to their disease and demography – Interventions would be targeted and tailored based on these insights to support people where they are at to achieve their goals – The NHS will measure: • how far people’s preferences are supported; • how confident and able people are to manage their long-term conditions better; • the extent to which the NHS has been successful, working in partnership with others such as social care, housing and the voluntary sector, supporting people to achieve their outcomes. Shared decision making and self-management support are core activities that support the translation of these principles into practice. In particular, they are enabling activities that support people to have agency over their health and decisions about their health care. IN BRIEF: PERSON-CENTRED CARE: FROM IDEAS TO ACTION 3 – Only 3% of people living with a long-term condition report involvement in their care plan. – There are fewer places on self-management programmes available each year than there are people newly diagnosed with a long-term condition. Why does this gap persist? It is perhaps not surprising that the gap between commitment and practice exists: person-centred care and support is still novel. It is multifaceted (as shown by Figure 1). It involves, as does any change, asking individuals to change their roles and their behaviours and organisations to change their culture. It is one part of a complex NHS system, where energy is often drawn towards structural change at the expense of quality improvement. It is one of many priorities of professional and system stewards and regulators who have many other priorities on their plate which are more intuitively part of their history and expertise.1 The research draws our attention to a number of barriers, discussed below, that have held back shared decision making and self-management support from becoming ‘business as usual’. Paying attention to these points can inform a more coherent and effective approach to implementing person-centred care and support. 1 By system and professional stewards we mean those public bodies that are responsible for the strategic oversight, direction and regulation of the health care system and the development of health care professionals. This includes central government departments, their arm’s length bodies, royal colleges and similar bodies. Figure 1: What is a person-centred health system? We can discern four principles of person-centred care and support. P e rson is treated with... dignity, compassion, respe ct Care is... enabling Care is... coordinated Care is... personalised The four principles of person-centred care Where would we start if care and support were person-centred? – We would start by understanding what matters to the patient – Every encounter would be one which embraces the patient as person rather than object – We would explore their health beliefs, motivations, knowledge, skills, learning styles and familial and social context as well as according to their disease and demography – Interventions would be targeted and tailored based on these insights to support people where they are at to achieve their goals – The NHS will measure: • how far people’s preferences are supported; • how confident and able people are to manage their long-term conditions better; • the extent to which the NHS has been successful, working in partnership with others such as social care, housing and the voluntary sector, supporting people to achieve their outcomes. Shared decision making and self-management support are core activities that support the translation of these principles into practice. In particular, they are enabling activities that support people to have agency over their health and decisions about their health care.