Comment

Person-centred care: rhetoric or reality?

Andrew McCracken of National Voices, the coalition of health and care charities, takes a closer look at the state of person-centred care in present times.

“Step by step over the next 10 years the NHS must be redesigned to be patient-centred – to offer a personalised service... by 2010 it will be commonplace.”

That’s a line a from the NHS Plan, published by the government in 2000. In 2002, Derek Wanless published a report in which he argued that only by people becoming ‘fully engaged’ in their own care can we hope to limit the escalating costs of health and social care. By 2008, ‘patient experience’ had become a key part of the national definition of quality in healthcare. By 2013, the Department of Health and all the system-leading bodies in England declared a shared commitment to making ‘person-centred coordinated care’ the norm.

But enough of the history. What difference, if any, have 20 years of policy aspiration on person-centred care actually made to the experiences of people who need and use services and support? We at National Voices wanted to find out.

The good news…

Person-centred care means different things to different people, but the common ingredients are good information, good communication, involvement in decisions, care coordination and care planning. We analysed patient and service user reported data from 19 national surveys to create a snapshot of person-centred care in 2017.

First, the good news: some aspects of person-centred care have improved, notably information and communication. Around 87% of general practice patients said their GP was good at listening to them, and 76% of inpatients who had an operation or procedure said that what would happen was ‘completely’ explained.

There was also good news in social care, where we found that 33% of people using adult social care said they had as much control over their daily lives as they wanted, whilst a further 44% had ‘adequate’ control.

…and the bad

It’s not all rosy, however. In mainstream healthcare and some residential settings, levels of involvement remain low. For example, only 39% of general practice patients said their GP was ‘very good’ at involving them in decisions. Some specific groups of patients did rate their involvement in decisions more highly, notably cancer and women who had used maternity services.

We also found that 33% of people using adult social care said they had as much control over their daily lives as they wanted, whilst a further 44% had ‘adequate’ control.

Some of the more negative statistics emerged when we looked at care planning. Just 3% of GP patients living with a long-term condition said they had a written care plan.

Interestingly (and frustratingly), we found it difficult to assess care coordination because it simply is not measured. The best measures we have reveal a poor state of affairs, with, for example, 46% of hospital inpatients reporting that they did not get enough further support to recover or manage their condition after leaving hospital.

Although it wasn’t the focus of our study, we also found evidence that family involvement is not central, and most carers need better support. Just 23% of carers report having had a social care assessment, despite it being their right under the Care Act 2014.

There were also some indicators of inequality between groups and communities. Where data was available, lower scores for person-centred care were reported by people who are over 75, from a BAME background, LGBT, or have mental as well as physical health conditions.

Becoming mainstream

So what are we to make of these mixed results? There has been a longstanding ambition to deliver person-centred health and care services, yet often it is in the ‘nice to do’ box.

We are living in an era of multimorbidity, with 70% of the NHS budget being spent on supporting people with long-term conditions. Care needs to be planned, coordinated and built around people’s own goals. All the evidence points to it being better for patents and more cost-effective for the system. Person-centred care needs to be mainstream.

Yes, there have been advances towards more person-centred services, but for now, the policy rhetoric is not quite matching the reality experienced by people.

Top image © ipopba

FOR MORE INFORMATION
‘Person-centred care in 2017’ is available at:
W: www.nationalvoices.org.uk