How must we change care systems to meet the needs of the future patient?

We deliberately kicked off our Time to Think Differently debate by focusing on the future patient. What could be more important than patient needs and preferences to the discussion about the future of health and social care? We are delighted by the quality and number of contributions to the debate and grateful to everyone for helping to shape our thinking.

In his guest blog, Ben Page says most people do not worry about the NHS. But we do worry about our own and our loved ones’ health and wellbeing, about being old and poor, about losing our minds and faculties, and about the possibility of having to depend on strangers who may be incompetent, uncaring or worse. The media know this, which is why the Chief Nursing Officer’s ‘6Cs’ made headlines for a whole day and also why the Secretary of State knows he needs to tackle care, compassion and the culture of NHS services – watch his recent speech at our 2012 Annual Conference.

The words care and compassion are everywhere but, in his guest blog, Finbarr Martin challenges five assumptions underpinning what he calls the ‘new orthodoxy’.  I want to add one more to his list: ‘People prefer being cared for at home rather than in hospital'. No doubt, many, perhaps most people would prefer to be ill at home rather than in hospital but where is the data to supports the statement? People who have frightening symptoms like severe breathlessness, common in respiratory conditions, and angina, common in coronary heart disease, which affects 2 million people, understandably may feel safer in hospital. In 29 per cent of UK households, people live alone.  When you are ill, do you want to be on your own? If you live in a care home, when you are ill you are likely to be stuck in your room. Is that better than being in the company of others, in hospital? If you have a long-term condition, the likelihood is you will be depressed, and possibly socially isolated and lonely. If you are depressed and lonely as well as ill, do you always want to be at home?

Another, associated, worry is that if care in hospital is as bad as that suffered by Ann Clwyd MP’s husband, how bad might it be at home, when you are on your own, hidden from view, and at the mercy of people coming in to care for you?

At our Time to Think Differently launch event, Stephen Dorrell talked about the need 'to re-imagine health services'. The system we have is designed to deliver episodes of care fornormally health people; however, the majority of patients are people with long-term requirements, often with multiple problems, who are 'signing on for the rest of their lives'. Quoting Mike Farrar, 'What we have these days is a medical system with care in support. What we need is a care system with medicine in support'.

In her care, guest blogger Christina Patterson wants an equal partnership with health professionals who treat her like an adult, provide information and advice when she needs it and do not make her feel their time is more important than hers. When she is ill, she still wants to be treated like an adult, she wants access to clinical expertise and skill, and she wants people to be kind, and to treat her ‘in the same way they would treat their mother, friend or child’.

To achieve this, she is calling for radically different organisations and services from those we have now and radically different relationships between patients and professionals, and between professional colleagues.

This vision of a care system is profoundly challenging for two reasons. First, because the system we have now is pretty good at improving transactional processes: reducing waits in A&E, reducing lengths of stay, and so on. But it needs to learn how to transform both transactional and relational care simultaneously.

Second, because a system based on care not medicine needs to draw on the knowledge and skills of people who have minor parts in the current system: people such as health psychologists, behavioural scientists, sociologists, health coaches,  advocates and so on. In shared decision-making, motivational interviewing, decision-making support, co-creation with patients and health coaching are important. In supportive and palliative care, counselling, and psychological and emotional support for patients and for staff are important.

So if we want a care system we have to become more serious about both the design and the execution of it than we have been to date. We have some of the prototypes we need – in the year of care, Wagner’s chronic care model, palliative care,  the recovery model in mental health, and tools such as experience-based co-design and patient and family-centred care). At our Annual Conference, Chris Trimble, an international expert in making innovation happen in large organisations, offered the metaphor of mountaineering. Question: ’What is the difference between the novice and the expert mountaineer?’ Answer: ‘The novice celebrates when she reaches the top, the expert celebrates when she gets back to the bottom.’ We are near the top now, we know what needs doing. It is the way down the mountain – executing the vision, implementing the change – that needs serious attention.  

See more on the changing patient


#39732 Nick Pahl
British Acupuncture Council

I'd still like to see a recognition that within any locality there are a huge range of health professionals who are often unknown to "mainstream" health, such as acupuncturists, who can provide effective care.

Harnessing such people to support improved care is cost effective and evidenced based.

#39733 Susan Woodman

Ditto for chiropodists - in our area patients are told there are no hospital or GP podiatry services; they must find a private chiropodist. Is the body now increasingly separated into differently provided services: eg eye tests, tooth care, foot care - all to be paid for privately, in spite of the links with conditions in other parts, especially diabetes.

#39734 Kellie Thomas
Business Manager (and patient engagement support)
NWL Integrated Care Pilot
The power of the patient (service user) voice; their voice matters! I am in full agreement that it is imperative to involve patients in the co-design of their future health system, especially at the start of new/improved initiatives. As much as there are multiple networks at a local level in terms of patient engagement forums, the NHS needs to go a step further and imbed patient perspective properly within clinical commissioning groups’ agenda that are fully represented of the wider community. This approach should include reaching out to the views of ‘invisible’ patients that are isolated, may have communication barriers and may not speak English as a first language. We need to find and reach out to these patients too and ensure their voice is heard. Pockets of community centres that often understand the cultural and diverse needs of patients is a starting point. To impact on patient outcomes and meet their needs properly and to change their experience, we need to understand what they want to stand any chance. I believe this is a priority, but action into practice needs to be at the top of the list and this takes drive, commitment, dedication and financial resource on a long term basis.
#39748 Christina Patterson
Writer and Columnist
The Independent

What a fascinating summing up! In my blog, I outlined a vision, because that's what I was asked to do, but it's so interesting to hear more detail, from someone who knows a lot about it, about how that might work. I was, for example, particularly interested in the idea that people who currently play quite a minor role in the health service - psychologists, counsellors, coaches - would play a much bigger role. I think that what the King's Fund has launched here is really important, and I hope very much that it will shape future thinking about the NHS. I want to help, if I can.

#39749 Yamini Kumar
Integrated Design Consultant
YA Design Project

Very valid and valuable discussion. As an architect believing in the therapeutic aspects of design, the care modules need revamping to bring it back to the community level. Old age looks for company, familiar faces and comfort in illness. How about piloting a 'care-sitting circle' program similar to a baby-sitting circles to create srlf-sustained communities. Introducing this feeling of 'Relax' into 'Care' can be the way forward....

#39774 Charlie Young
Patient Experience Designer
Transform Ltd

Really valuable column and feedback from people. I'm currently involved in a project with a Trust to turn Outpatients on it's head. The level of staff engagement is considerable and what's been interesting as we've done our work, we realised that we were actually giving the Trust divisions a means for contextualising, and further validating, their slightly silo-based strategies for improving Outpatients. This was unexpected as we had felt our work was to address the needs of the patients, but in fact we now potentially see a long term roadmap that will hopefully keep the patient at the very centre. Much of what i see here affirms exactly what we've been able to set out in our work. Very exciting times indeed!

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