The challenges facing the NHS are well understood:
- The number of older people and people living with long-term conditions is increasing. Yet, historically, services are designed for reactive, episodic care, rather than on providing care that supports people with long term conditions to manage their own health and recover from setbacks.
- Whilst often excellent at delivering an ‘episode’ of care (e.g. a knee operation), in the past there has been only a limited focus on supporting people to develop the skills and resilience to make a good recovery, or to sustain their health on an on-going basis.
- Our understanding of what services should be seeking to achieve is developing. In the past services focused narrowly on clinical outcomes, whereas now achieving the outcomes that are important to people are understood as central to high quality care.
- There is an increasing focus on the importance of patient experience, which has highlighted that care is often fragmented and seems to be designed and delivered in ways that ‘suit the system’ rather than respond to individuals’ needs and preferences.
If we are to provide high quality care that affords people the best possible quality of life, we need to rethink the relationship between people and the services that provide care. Person-centred care – with its focus on providing care that is personalised, enabling, and co-ordinated and that treats people with compassion and respect – provides a framework for addressing these challenges.
The wider environment within which services are provided is both driving and enabling the development of more person-centred care. Organisations like National Voices (the coalition of health and social care charities) and the Coalition for Collaborative Care (an alliance of major charities and voluntary organisations, professional and leadership bodies in health and social care, and leading development agencies) provide a strong voice for patients and organisations beyond the statutory sector. They are creating a more coherent understanding of what person-centred services are, why services should be person-centred and how they can be provided. They are driving person-centred care through their work influencing policy and are enabling it through their work sharing learning on how services can be more person-centred in practice.
Effective person-centred care has the potential to achieve the following things.
Meeting people’s needs and expectations
There is evidence that most people want to play an active part in their own care, and expect health professionals to help them to do so.1 2 Person-centred approaches, such as shared decision making and self-management support, specifically aim to enable people to play a more active role in defining the outcomes that are important to them, deciding the treatment and support that is best for them, and managing their health and care. There is evidence that people who have the opportunity and support to make decisions about their treatment and care in partnership with their health professional(s) are more satisfied with their care.
Improving clinical outcomes
Person-centred approaches can improve clinical outcomes. For example, various types of self-management support have been found to improve physical symptoms or clinical outcomes in people with arthritis, asthma, diabetes, hypertension, heart disease, heart failure, stroke, cancer and other conditions, at least in the short term. 3 Evidence for improved clinical outcomes as a result of shared decision making is often the result of improved adherence to medication.
Increasing staff satisfaction and morale
There has been some research showing that offering care in a more person-centred way can improve outcomes for professionals. A review of seven studies about professionals delivering person-centred care in nursing homes found that this approach improved job satisfaction, reduced emotional exhaustion and increased the sense of accomplishment amongst professionals. 4
There are a range of studies showing that person-centred approaches such as self-management support and shared decision making can reduce service usage. For example a Cochrane review of 36 self-management trials found that self-monitoring and agenda setting reduced hospitalisations, A&E visits, unscheduled visits to the doctor and days off work or school for people with asthma. 5 There is also evidence that when people are fully informed about care and treatment they choose less invasive and costly treatments.
Responding to national policy
While health policy across the UK nations diverges in many respects, all four countries have identified strengthening individual and collective involvement in health care as a key goal. Policy generally focuses on three broad aspects of person-centred care:
- Improving people’s experiences of care: In England, patient experience is one of the five domains of the NHS Outcomes Framework, alongside which are evidence-based quality standards for patient experience in adult NHS services and service user experience in mental health. One of the six quality outcomes for the NHS in Scotland is that ‘Everyone has a positive experience of healthcare’.
- Individuals participating in their own treatment and care: Policy focuses on increasing opportunities and support for people to play a more active role in their own health and health care, under the slogan ‘Nothing about me, without me’. Specific national initiatives include shared decision making, care planning, and personal budgets.
- Collective involvement in service design, delivery and improvement: There is a drive for people to have a stronger influence on how health services are planned and provided in order to foster greater local oversight and accountability. Engaging people at this level is also seen as a vehicle for transforming services by encouraging providers to be more responsive to community-defined needs and priorities. There are a wide range of approaches and mechanisms already in use, from patient partnership groups through to employed roles, such as the Patient Director at Sussex MSK Partnership NHS Trust.
Our sections on Why do shared decision making and Why do self-management support contain further information and there are also a number of research studies and other references in our Resources directory.
2 Leadership and Engzgement for Improvement in the NHS, by the King’s Fund
3 Helping people help themselves, the Health Foundation
4 van den Pol-Grevelink A, Jukema JS, Smits CH. Person-centred care and job satisfaction of caregivers in nursing homes: a systematic review of the impact of different forms of person-centred care on various dimensions of job satisfaction. Int J Geriatr Psychiatry 2012;27(3):219-229.
5 Gibson PG, Powell H, Coughlan J et al (2004) Self management education and regular practitioner review for adults with asthma (Cochrane Review).