22.12.17
Person-centred care: is it really happening?
Source: PSE Dec/Jan 2018
Laura Bell of National Voices, the coalition of health and care charities, analyses the state of person-centred care and whether government rhetoric has matched reality.
For the last 20 years, policymakers have been talking about delivering ‘person-centred’ care – care that focuses on what’s important to the individual, is co-ordinated around their needs and involves them in decisions. Yet how much of a difference has this actually made for the people using adult health and social care services? We wanted to find out.
Using service user reported data from 19 national surveys, National Voices’ report, ‘Person-centred care in 2017,’ attempts to discover whether aspects of person-centred care are happening across health and care services in England.
What did we find?
Person-centred care means something different to everyone, because we are all individuals with our own different priorities and needs. However, we looked at the five key indicators of person-centred care: good information, good communication, involvement in decisions, care co-ordination and care planning.
We found that personalisation of care is more advanced in adult social care than in the NHS, with 89% of adult social care users reporting that the care and support they received helped them to have control over their daily life.
Similarly, 63% of people using a social care personal budget said that this had improved their ability to make everyday decisions. It is important to note, however, that in 2017 27% of personal budget-holders said they could not fully decide how their personal budget was spent, and anecdotally we are hearing of personal budgets being taken back or being restricted. These restrictions do not allow people control over their own healthcare.
Participation and control of decisions is well-established in adult social care, with just over 90% of those using community adult social care saying they were involved in decisions about their care and support needs.
It is a less positive picture in the NHS: in primary care, only 39% of patients said their GP was ‘very good’ at involving them in decisions. What’s more, personalised care planning doesn’t really happen. Only 3% of GP patients with one or more long-term conditions reported having a written care plan, suggesting that opportunities to deliver personalised care in the NHS are being missed. Similarly, although the Care Act 2014 embeds personalised care and support planning in adult social care, there is no national data collected on this, so it’s impossible to see if it is really happening.
What about the co-ordination of care?
With an ageing population where people increasingly have multiple needs or conditions, they are likely to need a range of health and social care support from different services.
To be person-centred, that care needs to work together to wrap around all the needs of the individual in a holistic way. Sadly, our report found that neither the NHS nor adult social care can demonstrate co-ordination of care, despite ‘integrated care’ being a key goal of all national and local leaders over the past five to 10 years.
The way health and care services work must change to reflect the needs of the population. It would be a start to recognise that co-ordination of care is an important factor, and that we need to be measuring whether it is happening.
It is clear from our report that a strategic overhaul of how care is measured is needed. Rather than single-service, single-setting, activity measures, more credence needs to be given to the experiences of the people who rely on services. Only then can we help local systems succeed in offering personalised, integrated and holistic care.
Whilst there have been some advances in the delivery of person-centred care, there is still a long way to go before the policy rhetoric matches the reality experienced by people.
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