By Accountable Care Journal-
The advances in personalised medicine are exciting in terms of creating the optimal medical pathway according to an individual’s genetic profile, whilst personalised care is about tailoring care according to an individual’s values and preferences.
Personalised care means people have choice and control over the way their care is planned and delivered. One of the key elements of this is that it shifts the focus of the discussion between a person and their clinicians from “what is the matter with you? ” to “what matters to you”. Through this process, people are encouraged to take more control of their healthcare and shape their support, so it fits their lives and what they want to achieve.
Personalised care helps a range of people who are suffering from poor health and wellbeing ranging from those with chronic illnesses and complex needs to those managing long-term conditions and mental health issues.
It empowers these people to make decisions about managing their health so they can live the lives they want to live based on what matters to them. This is in response to a one-size-fits-all health and care system that simply cannot meet the increasing complexity of people’s needs and expectations. Evidence shows that people will have better experiences and improved health and wellbeing if they can actively shape their care and support.
All elements of the personalised care model focus on this change in relationship and ensuring people have the knowledge, skills and confidence they need to manage their own healthcare.
A national evaluation of personal health budgets (PHB), led by the University of Kent, demonstrated improved care-related quality of life. Reliance on unplanned care, such as A&E admission, was also reduced as well as generating savings of £3,100 per person per year for the NHS.
Consequently, a legal right to have a PHB was introduced in 2014 for everyone in receipt of adult NHS Continuing Health Care (CHC) and Children and Young People’s Continuing Care. Since 1 April 2019, there has also been an expectation that everyone eligible for NHS CHC who is in receipt of a homecare package will have this delivered as a PHB. This is seen as the next step in increasing the choice and control people have over their care and support.
The NHS Long Term Plan states that personalised care will become “business as usual” for 2.5 million people across the UK by 2024. Outside of the groups who already have the right to a PHB, local Clinical Commissioning Groups (CCGs) have the flexibility to set out their own plans, informed by local demographics.
At the end of 2018/19, CCGs had delivered 54,143 PHBs for people across England. This was an increase of over 48 per cent on the end of year figures for 2017/18. Figures were boosted by the rapid expansion of personal wheelchair budgets (PWB) that replaced the wheelchair voucher scheme, with thousands of people now benefitting from a PWB across the country. There has also been a significant growth in the number of people in receipt of a PHB for mental health, learning disabilities and/or autism, along with jointly funded arrangements between health and social care.
Aligning with integration agenda
Personalised Care is a crucial part of system-level integration. A total of 2.5 million people will benefit from it by 2023/24 and the recently published Universal Personalised Care has set the ambition to double this to five million people within a decade.
Primary care networks will be essential to enable this expansion. The intention is for social prescribing and shared decision-making to be mainstream in primary care, and personalised care and support plans to be rapidly expanded to 2.5 million people with long-term conditions and complex needs.
As the NHS Long Term Plan sets out, personalised care will underpin maternity care for pregnant women and also for people with dementia, as well as being central to improvements in end-of-life care. It is also fundamental to NHS ambitions for cancer. For example, by 2021, where appropriate, every person diagnosed with cancer will have access to personalised care, including a needs assessment, a care plan, health and wellbeing information, and support, all delivered in line with the Comprehensive Model for Personalised Care.
It is the combination of quantity and quality that ensures the maximum gains in people’s outcomes, experiences and value to the system.
When this is in place, we will see how personalised care is an irreducible element of the integration work being done at the level of the system, neighbourhood and place through sustainability and transformation partnerships (STP), integrated care systems (ICS) and primary care networks (PCNs) respectively.
Personalised care will enable people to be the best integrators of their care.
James Sanderson is the new Director of Personalised Care at NHS England and NHS Improvement.
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