‘Person-centred service design’ – What is it, and how do we implement it?
On a rainy and windy evening in London, the latest Cambridge Health Network event on ‘people centred service design’ took place at the Royal Society of Medicine. Speaking about the challenges of conceptualising and implementing truly person-centred care were Dr Matthew Dolman, Somerset CCG, Betsy Fields, IDEO and Dr James Featherstone, Healthcare at Home.
The session kicked off with a discussion around the developments occurring in the Southwest’s first vanguard site. There was talk around how collaboration between different system actors, from GPs, hospitals, community staff and social workers has made person-centred care possible. How the region is tackling its particular challenges – Somerset’s elderly population is significantly higher than the national average – and how the local system is meeting these by planning and reacting to local needs together through shared resources and expertise was discussed.
In order to achieve truly person-centred care, the system, communities and people will have to forge partnerships; moreover, design and commissioning will have to be outcome based and value driven. One significant component of this is to mobilise the personalisation agenda. It was highlighted how self-management is actually the normal mode of care. On average a person only spends 5 – 10 hours a year with a NHS / social care professional, the rest of the time it is down to the individual. The Patient Activation Measure (PAM) measures an individual’s knowledge, skill, and confidence for self-management. People who are more activated are significantly more likely to attend screenings and check-ups, and to adopt positive behaviours.
This theme was continued when it was highlighted that to generate healthier people, we need to design for health services where life happens. Some of the examples used in the talk were about designing accessible housing for disabled veterans, to designing and building a health system from scratch in Latin America, and to the ‘Give to Get’ programme in the US. It was argued that ‘we can’t leave our health up to healthcare’. Indeed, the shift from viewing health as receiving care to a more holistic approach of wellbeing is exactly what the NHS needs to promulgate. The need to find radical new partners to enable this new form of care to exist was raised.
Healthcare at Home’s latest report, Bringing the Hospital Home is about how virtual wards can support integrated care models, contribute to admission avoidance, and fit care around where patients feel most comfortable and happy – in their home. The report was proposed as an evidence-based programme to implement care around people. The argument was made that virtual wards have the potential to contribute to the delivery of the five year forward view. This is through building services around patients and making treatment only a small part of a person’s life, not the focal point.
The golden thread running through the evening’s discussion was the need to engage people in their own care and to build systems around the individual. The point was made that the voice of the patient is not loud enough yet, but we are getting there. Meanwhile providers and commissioners will have to continue to be creative and build the partnerships that are needed to support truly person-centred care.