Key points
Personalisation – that is, the shaping of services around the individual needs of the patient or user – is a key objective of the government’s health care reforms in general and the
NHS Next Stage Review in particular. It proposes, among other things, that all 15 million people with long-term conditions will be offered a personalised care plan by 2010. The care plans will be agreed by the patient and a named professional and will be the basis for health and social services to organise care around the individual’s needs. A number of three-month pilots began in March 2009.
- The Next Stage Review also says that personal health budgets could be given to people with predictable long-term conditions – along similar lines to individual budgets and direct payments in social care. The budgets would be voluntary, and the intention is to give patients greater control over the services they receive and over who provides those services. The publication of Personal Health Budgets: First Steps in January 2009 announced that personal budgets would be piloted in PCTs and that powers were being sought in the Health Bill to allow piloting of direct payments in health care. There is still considerable uncertainty about how personal health budgets will work in practice. They are modelled on individual budgets and direct payments in social care but, unlike social care, the NHS is a universal system. It is unclear what, if any, limits will be placed personal health budgets.
- Patients and users should also have a greater say in how and where they are treated. Assistive technology and remote monitoring can help patients to lead more independent lives, often in their own home. A £31 million ‘Whole System Demonstrators’ pilot has been funded by the Department of Health to assess the benefits of telecare and telehealth to people with long-term conditions.
- People coming to the end of their lives should be able to decide where they die and to stipulate how they wish to be treated through advance care planning. The 2008 National End of Life Care Strategy spells out an action plan to achieve this.
- Empowerment of patients by providing more information is another key theme. Patients armed with greater knowledge are ‘more likely to take greater responsibility for their own health’, says the review. In fact personalisation is closely allied to self-care and responsibility. The NHS Constitution outlines a number of rights all patients should be entitled to but balances this with the responsibilities people have to the NHS. Your Health Your Way contains guides for people living with long-term conditions, designed to empower them to take control of their lives.
- The expert patient programme aims to give people with a range of chronic conditions greater control over – and responsibility for – their own health. The Department of Health’s own small-scale research suggests those involved are making fewer visits to GPs, A&E and outpatients. But a British Medical Journal study in 20071 said that while increasing patients’ confidence the programmes had had little impact on hospital admissions or other NHS activity. A similar programme for carers, now known as Caring with Confidence, aims to support carers to enable them to exercise greater choice and control in key areas of their lives.
- The regional reviews that fed into the Next Stage Review all stressed the importance of treating people with dignity and respect. The government has been running a respect and dignity campaign across hospital and primary care services aimed particularly at the care of elderly people. The new inspection body, the Care Quality Commission, also has a specific brief to examine whether people are being treated with dignity and respect. The King’s Fund’s programme The Point of Care is working to enable staff in hospitals to deliver the quality of care they would want for their own families.
1How effective are expert patient (lay led) education programmes for chronic disease?
BMJ 2007;334:1254-1256 (16 June), doi:10.1136/bmj.39227.698785.47
