In the UK as in Australia, the developments in healthcare and public health initiatives over recent decades mean that we are living longer lives than ever before. This is clearly a huge positive. But we also know that whilst we are living longer we are not necessarily living healthier lives, and the growing complexity of multi-morbidity is creating ever increasing pressure on our health and care services. We are also seeing the health inequalities gap widen, and people in both countries report that they are not involved as much as they would like to be in their care and treatment options, nor do they universally have the skills, knowledge and confidence to manage their health in a way that supports them to live the lives they want.
In a digitally connected and consumer driven world, people have also come to expect the same levels of choice and control over their healthcare as they appreciate in all other aspects of life. We also know that people bring multiple personal strengths and relationships into a consulting room that regularly go unnoticed or unused, and which could be key to enabling their ability to thrive.
A fundamental part of the solution to this complex challenge is to think beyond system-driven services to approaches that begin with the person, and that move away from a one-size-fits-all approach to a one-size-fits-one agenda.
In England, we are doing this through the implementation of our Comprehensive Model for Personalised Care. Personalised Care means giving people choice and control over the way their care is planned and delivered, based on what matters to them, and building on their individual strengths. Our aim through the model is to improve health and well-being outcomes by changing the relationship between people and their own health and between people, professionals and the health system.
Clinicians will always be experts in conditions and diseases, but people are experts in themselves.
The Comprehensive Model does this by bringing together six evidence based components to act as enablers to drive change in the system.
Shared Decision Making is the starting point for a new conversation. Enabling people to engage differently in their care and treatment options has been shown to reduce costly and risky treatments by up to 20 per cent. Clinicians will always be experts in conditions and diseases, but people are experts in themselves. It is the combination of this expertise that can unlock different routes of care.
People need to be able to make a fully informed choice as part of this process. It is not necessarily about looking to provide the most extensive list of options but maximising the opportunities to mould the solution more effectively towards individual need – even something as simple as being able to choose the day for an ongoing treatment can make a huge difference to outcomes.
For people with long term conditions, Personalised Care and Support Planning is critical to discovering what matters to the individual, who they would like to be involved in their care, and how the strengths they bring, along with their family and community around them, can be mobilised to enhance the care required.
Beyond these gateway enablers, we are introducing three new models of care provision that will sit alongside traditional biomedical approaches.
The first is Social Prescribing and Community Based Support. At least one in five primary care appointments in England are taken up by someone with a non-medical need, with General Practitioners estimating that this figure is much, much higher. Developing a universal mechanism for supporting people with their psychosocial needs, caused by issues such as housing problems, loneliness, debt, poor relationships, is also a necessary step in reducing an over medicalised system. To facilitate this, we are making a significant investment in a considerable workforce of Link Workers, who will sit within primary care systems and work with people by linking them to community groups, based on the person’s own interests, who can support their particular need, for example, a gardening group, walking group, or community choir.
We are also working to improve and support people’s ability to Self-Manage, by building their skills knowledge and confidence through patient activation, peer support, self-management education, and health coaching. These approaches have been proven to significantly reduce GP appointments and hospital admissions, whilst improving the connection people have with their own health.
The mechanism shifts the focus from someone being a passive consumer of services who is “done to”, to being an active owner of their care.
And finally, we are significantly ramping up our programme to provide people with Personal Health Budgets – a sum of money, tailored to individual need, that enables the person to individually purchase their care and support. The mechanism shifts the focus from someone being a passive consumer of services who is “done to”, to being an active owner of their care. Consequently, we are seeing an 88 per cent satisfaction rating in the support provided, at the same time as a saving of 18 per cent of the cost of traditionally commissioned block contract services.
Implementing the Comprehensive Model requires a significant shift in thinking – a new cultural approach to health and well-being. Making the shift has taken time, coproducing solutions bringing together from multiple agencies, clinicians and commissioners, policy makers, voluntary secret organisations, and most importantly people with lived experience. We also spent time making connections, recognising there were disparate strands of work and fragmented programmes across the country that, whilst separate, shared a common ethos. By forging these links, we multiplied the force of the movement. Alongside the creation of demonstrator systems and regional champions, we also created networks and opportunities to collaborate through and used these to build momentum.
Personalised care is now at the heart of the National Health Service’s Long-Term Plan…
Structural levers have also been needed. Ensuring legislation, policy and guidance is in place and aligned, as well as putting in place system incentives. It has been important to shift personalised care from a “nice to have” to a “must do” in delivery of the health service.
Personalised care is now at the heart of the National Health Service’s Long-Term Plan: it is one of the five major, practical changes to create a new service model for the 21st century. We have committed that 2.5 million people will benefit from these approaches over the next five years and continue to increase the numbers beyond this, until we achieve Universal Personalised Care.
We have a long way to go, but we have also taken the bold step of acknowledging that this fundamental cultural shift is needed to ensure healthcare services remain, effective, relevant and sustainable for the future.