The NHS should learn from best practice within the social care sector and become more personalised and convenient to use, with more power, information and choice given to patients according to a pamphlet from Shared Lives Plus and the RSA.
The report, People Powered NHS, concluded that with over a quarter of us living with a long term condition and 2.9m living with three or more conditions by 2018, the key challenge is not to treat the symptoms of long term conditions such as diabetes, mental health problems or obesity, but to help individuals to live well and manage their conditions.
The report recommended that the NHS moves away from a culture of ‘doing to’ rather than ‘collaboration with’ people with long term conditions, and the commensurate culture of dependency and disempowerment amongst people using those services.
It argued that a service may be essential in order to live well, but it never creates the ‘good life’ on its own. Instead, the NHS should embrace the transformative effects of personalisation, and introduce services which are designed to complement the support provided by people’s families, communities and social networks.
This is not a case of ‘dumping’ greater responsibility upon individuals or families, the report said, but about moving away from ‘one size fits all’ services which struggle to respond to individual or fluctuating needs. Currently there is a poor fit between service interventions and the lives and relationships of people who need to have ongoing contact with those services.
Author of the report, Alex Fox, argued that there is no evidence that personal budget control will lead to greater demands, costs, or even waste or fraud. The report also dismissed fears that personal budgets would ‘fragment’ previously centrally-organised services, arguing that concerns about this risk are based upon a false opposition between centralised planning and individual choice.
It concluded that whilst there is a variable picture of how the vision and practices of personalisation have been embedded within the social care sector, the NHS should learn from best practice and rapidly get to grips with the approach.
Outlining the steps needs to be taken to introduce personalisation to the NHS, the report concluded the sector should look to an ‘asset-based’ or capabilities-based approach, where medical professionals look first for what people can or could achieve, alongside considering their needs, conditions and challenges.
Commenting on the report, Chief Executive of Shared Lives Plus, Alex Fox said:
“Most people with long term support wish to take some degree of responsibility for their own wellbeing and care, but health systems are not designed to enable and maximise these contributions sustainably. The language of healthcare is of ‘compliance’, not collaboration and the recent vision for NHS commissioning has been based on a power shift from professional managers towards clinicians, not citizens.With growing numbers of people suffering from long-term conditions, it’s vital the government gets up to speed with best practice and considers how personalised services might be introduced across other sectors.”
RSA Director of Institutional Reform, Anthony Painter, said:
"Public services are weighed down by the need to identify enormous savings. The old efficiency models are struggling to adapt. Meanwhile expectations of a sense of power over the services we use are increasing. Our argument is simple: give away power to ensure services work with people to improve their lives."
“There are successful innovations. If we understand these then new approaches that change our experience of public services open up. Given the tough times we're in, such creativity may be our greatest hope. It's at least worth debating."
Today’s report was published as a contribution and discussion paper to the RSA's 'Power to Create' work which is looking at fundamental change in the relationship between people and the state. The report concluded that in order to personalise the NHS there would need to be some deep changes in culture and expectations within the sector and in the expectations of people coming into contact with it. Three changes are particularly important:
A collaborative approach to reforming supply as well as demand. To build a new range of interventions, the NHS must collaborate with citizens through:
Building advocacy and brokerage into all Personal Health Budget development.
A new model of commissioning in which citizens and communities are involved as well as clinicians and managers.
Working with councils to include Personal Health Budget holder and health providers in local marketplaces created for social care personal budget holders, with promotion of collective purchasing.
Identifying and commissioning new models of provision which have the most potential to deliver wellbeing and resilience outcomes.
Build trust in the capabilities and potential of individuals. Professionals and systems will need to value different forms of expertise alongside (not instead of) clinical expertise. To begin this culture change, the NHS needs to:
Train all health professionals to build their listening skills and planning support skills.
Routinely involve citizens and representatives of people with long term conditions in planning and commissioning, including through peer support roles and trained, paid roles.
Start a debate with the public about the responsibility we all need to take fore our own wellbeing and the expectations citizens should be able to have of their health professionals.
Service systems reshaped to fit within support eco-systems
There is a need to build ‘networked’ models of support in which services are designed to complement and support people’s informal networks. For the NHS to move beyond its 1948 roots as a hospital-centred illness treatment service and become a world-leader in creating health and wellbeing, it must:
Formally recognise unpaid family carers as partners in care, with a guaranteed offer of information sharing, involvement in planning, training, advice and emergency backup.
Commission for a new expectation for all health providers that they measure their impact upon people’s wellbeing and resilience, alongside clinical outcomes.
Become funding partners in a programme of asset based community development which is measured upon the creation of wellbeing and resilience.
Notes to editors