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The pathway to personalisation

The NHS is following the lead of the social care sector in rolling out 'personalisation' for people living with long-term health conditions. Are there important lessons to be learned from the social care experience?

'No decision about me, without me' was the slogan used by the Government to launch its drive towards personalisation in health and social care, an idea originally inspired by the lobbying of disabled people and their families. The Care Act 2014 enshrined the principle of personalisation into social care and the concept of 'personal budgets' has already begun to revolutionise the way care is provided. Now the NHS is following suit by trialling 'personal health budgets', with the aim of giving patients more choice and control, particularly those suffering from long-term conditions. A personal health budget can be used to pay for a wide range of items and services, including occupational therapy, physiotherapy, personal care and equipment.

In a recent article for The Guardian, Alex Fox, CEO of social care charity Shared Lives Plus, highlights the importance of consultation and collaboration to ensure that the NHS strategy is informed by the experiences of the social care sector. He warns that personal budget control is “meaningless unless supply is also reformed”, pointing out that some councils have introduced personal budgets without proper reference to procurement and commissioning practices. "The promise and challenge of personalisation is not to create new rights," he argues, "but real and meaningful ways to share responsibility."

A new way of thinking

Fox believes that health managers and procurers, such as clinical commissioning groups (CCGs), will need to think differently if personalisation is to be effective. He sees their role changing from prescribers to facilitators and networkers, helping people with long-term conditions and their families to identify and access the support they need to live well.
The Social Care Institute for Excellence seems to agree: "Personalisation means thinking about care and support services in an entirely different way. This means starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives."

While some doctors have expressed concerns about wholesale implementation of personal care budgets, arguing that they are not appropriate for all patients, there has been widespread support amongst the allied health professions. For example, The College of Occupational Therapists believes that the 'core values, beliefs and skills' of occupational therapists mean they are 'ideally placed to help people make choices, take control of their health and well-being and achieve personally meaningful outcomes'.

The Chartered Society of Physiotherapy takes a similar view. In a 2014 press release, its Chief Executive Professor Karen Middleton comments, "Personal budgets can give people control over how they manage their condition and enable them to continue leading full, independent lives. That is a principle we support and results from pilot schemes involving physiotherapists have been encouraging." However, she also warns that personal budgets must not be used a smoke-screen for funding shortfalls or poor access to services, pointing out that self-referral to physiotherapy may empower people, but is not widely available.
Mental health issues.

Evidence suggests that one of the key areas where personal health budgets may encounter stumbling blocks is mental health, despite the fact that outcomes are generally positive. Analysis by the National Development Team for Inclusion (NDTi) has shown that people with mental health issues are less likely than other eligible groups to use their personal budgets. "Our work around the country suggests that the barriers are attitudinal and organisational," wrote the NDTi's Chief Executive (Rob Greig) in a recent article for The Guardian. "Professionals still see risk in people with mental health problems controlling their own budgets."

Greig believes that, even in the social care sector where personalisation has already become firmly embedded in policy, mental health services lose out because of lack of commitment from local authorities. "Nationally there is a lack of social care mental health leadership and few commissioning strategies that address personalisation in its full concept," he claims.

Of course, it's not just NHS management and staff who need to adopt new practices to successfully implement personalisation. Many healthcare providers need to rethink the way they supply services, while there may even be a need for new types of providers to enter the marketplace. Once again, they should look for guidance to the social care sector, where new social enterprises have come into being to respond to the demands of the personalisation agenda. For example, Community Catalysts works closely with local councils, health trusts and CCGs to 'provide imaginative solutions to complex social issues'.

The role of technology

Another key issue is technology. In November 2014, the National Information Board (NIB) published Personalised Health and Care 2020, a 'framework for action' focusing on the use of data and technology to transform outcomes for patients. Responding to the launch of the report, Chief Nursing Officer Jane Cummings said, "The practical application of technology on the frontline will allow our nurses and other health workers to concentrate on what is important – giving meaningful and compassionate care to patients."

However, it's not just about empowering healthcare professionals to deliver more personalised care. One of the report's key objectives is to consider how the NHS can enable patients themselves to make the right health and care choices by having full access to their own care records, as well as to NHS-accredited health and care apps and digital information services. NIB Chairman Tim Kelsey sums it up: "We must embrace modern technology to help us lead healthier lives, and if we want, to take more control when we are ill."

According to the King's Fund, around 15 million people in England have a long-term health condition, while the number of people with three or more long-term conditions is predicted to rise to 2.9 million by 2018. Promoting patient choice and control in the right ways, based on experience in the social care sector, not only has the potential to make healthcare more appropriate and efficient; it could also help smooth the way towards a fully integrated health and social care system.

Are you a doctor, nurse or allied health professional with views on the issues raised in this article? Leave your comments below.

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