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

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Part of Time to Think Differently

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


Sarah Volpe

Registered nurse,
Comment date
08 December 2012
This is a really interesting article. I am a nurse who wants to see these positive changes in healthcare also. I left my previous post because I felt to challenge of delivering the level of care I wanted to my patients was becoming too difficult, and out of my control.

I think whilst you could criticize and claim some healthcare professionals do not care, I believe this is not always true. Most nurses care so much and are so disappointed with the staffing levels and lack of support they are receiving, to deliver the level of care all patients deserve it affects them in their personal lives. However I feel the system is letting not only patients down but healthcare professionals also.

Charles Kemp

Retired NHS DFO & International consultant,
Comment date
14 December 2012
I had been a carer for my wife for 10 years. Recently we were re-assessed and she was taken into care because of immobility and dementia. She is well looked after but does not recognise me any more. If I could have had 6 assistance visits a day instead of 3 I could have coped - her mental state would be better and I would be happpier. (Ages - myself 83, wife 86. Friends for 80 years).

Sarah buckley

Social worker,
Comment date
09 January 2013
Since my son was diagnosed with cancer over a year ago I have seen life from the other side of the bed so to speak. At work I am a social worker in a hospital setting, however this last year I have been the main carer for my son, who has undergone vigorous treatment to combat cancer. I've stayed in hospital with him and so have a very current perspective on service delivery in and out of hospital. The services are not there to be able to be supportive when illness becomes more critical when at home, well not when continuing health care or palliative care has been assessed. Post radiotherapy my son was a mess, lost significant weight, had severe sickness and diahrrhea. I spent a lot of time discussing his situation to professionals on the phone, but received very little input from professionals within our home. Our son was admitted for 2 short stays within a week of each other before being admitted for 2 1/2 weeks eventually to finally really address his health and manage it. Being at home was frightening, exhausting and overwhelming. Once our son was admitted for the longer period I finally felt supported and felt the huge responsibility for his health issues lift.
What I am saying is that I agree, home is not always the best place to be. Perhaps if the appropriate care and support can be given, but community care is stretched too. Hospital is needed at times when repetitive admissions occur to provide a place for appropriate assessments to take place and not just a 'sticking plaster' of a nights stay. Home is best, but only when the appropriate care can be provided and given the continued cuts, this will never be in place!

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