The plan is a commendable step forward, but misses some of the most fundamental barriers to change
My colleagues and I recently met Jackie Kennedy and her labrador, Kingston, at a King’s Fund conference about the increasing personalisation of care.
Jackie was a police officer who was attacked during a criminal incident, leaving her wheelchair-bound and with life-changing head injuries. Her experience of health services during her recovery was not always positive. While her treatment was provided by well-meaning professionals, she felt that some aspects of it were done “to” her, and that her care was impersonal and disjointed. She was left feeling bereft and depressed, which led to frequent visits to the GP, a series of hospital admissions and the consumption of a huge range of medicines.
One day, Jackie decided she had had enough, and looked into taking more ownership of her healthcare. She found out about and then set up her own personal health budget (PHB).
The next conversation she had with a health professional was very different. Somebody visited her at home and asked a simple question that made her burst into tears: “What matters to you, Jackie?”. Nobody had asked her that before.
That was a turning point. Jackie became front and centre of her own care, while still working closely with health and care professionals who supported the decisions that she took for herself. The biggest single change was the arrival of Kingston. Jackie told the conference that she is now “living, not existing”. She now only visits the GP about once every six months, and has drastically reduced her medicine use, saving the NHS an estimated £120,000.
As the 70th birthday of the NHS approaches, there will be great celebrations and justly so. For it to thrive for another 70 years and beyond, care will need to become much more personalised out of necessity. The nature of illness and disease has changed, and people are living longer. As a result, they often have multiple long-term conditions, so there is a need to treat clusters of illness. In the words of Dr Charles Alessi, ‘the medicine of body parts’ will no longer cut it.
Over recent years, we have learned much about the way non-clinical or social factors affect health. Exercise, social isolation, social engagement, diet, changes in the weather, housing, household income, big life events, living conditions and management of medicines all have a role to play. We also now know that the more engaged someone is with their own health, the less treatment they need, and the faster they recover.
The other big forces driving this shift are public expectations and capabilities. Increasingly, people expect to be more involved in running their lives because they know more about them than anybody else. Technology-savvy patients are often able to use different tools and interact with people on social media to take more control of their own care.
Standing still on personalising care is not an option. Every year, there are 300 million visits to GPs and 23 million visits to acute hospitals. The system simply cannot cope when this is business as usual, and stressed GPs and other practice staff need to get off this treadmill.
Jackie’s amazing story – or indeed any other example of successful personalisation – rests on getting a lot of operational things right behind the scenes:
- Identifying the right patients
- Engaging and motivating patients to build confidence
- Building high quality individual care plans with patients (across health, social care and other services)
- Designing multi-disciplinary teams that really work
- Developing care coordination and navigation
- Creating social prescribing that works
- Calculating personal budgets based on existing spend
- Building a market of services that patients can draw on
- Making it easy to use and manage the system
- Establishing how to shift from current commissioning to personalised commissioning
- Ensuring there are robust governance and performance management systems in place.
None of this is easy, but it has all successfully been done before, so what is stopping rapid progress?
Our work across health and social care indicates that that personalisation is not usually perceived as a strategic solution. However, the reality is that it is a viable and effective way of meeting funding, resourcing and societal needs.
The ‘aggregation effect’ of personalisation will significantly shift the nature of demand, and enable the NHS to redistribute funds where they have the most impact.
A couple of years back, NHS England commissioned iMPOWER to support the expansion of personalised care, drawing on many years of expertise in national policy and local delivery. We played a leading role in designing and implementing individual budgets in social care. Having led personalisation at scale before, we know it can be done again.
James Sanderson, Director of Personalised Care, NHS England, said:
“The Personalised Care Group at NHS England have worked with iMPOWER on two projects to support the scaling up of innovative approaches to putting people at the heart of the health and care system across England. We have been very impressed by their approach and their strong track record in health and social care, including helping the Department of Health to scale up individual budgets.
“iMPOWER have been engaged with this agenda for many years and have an impressive network of contacts which helps with spreading key messages effectively. The iMPOWER team includes senior figures who, due to previous high profile appointments, command significant respect across the health and care system, and additionally have experience of implementing personalised care at both a national and local level.
“iMPOWER supported the team in building public demand for personalised care, and also to increase the level of professional and political engagement which has enabled us to strengthen our overall delivery approach. The range of their expertise and their ability to understand our wide ranging work has been hugely valued. We have particularly appreciated iMPOWER’s ability to frame our messages in a tailored and objective way for people who were not already fully engaged with our agenda. We envisage the relationship with iMPOWER to continue as we build our plans to scale up personalised care across the health and social care system.”
To find out more, contact Kieran Brett, Sarah Atkinson or myself via firstname.lastname@example.org or sign up to our fortnightly iNSIGHT newsletter.