By Andrew McCracken, head of communications at National Voices.
For at least 20 years, policy makers have been aspiring to deliver ‘person-centred’ care.
There have been revised definitions of quality, national commitments, and phrases like “people at the heart” and “empowered communities” have become ubiquitous.
So what difference, if any, have policymakers’ stated ambitions made to the experiences of people who need and use services and support? We wanted to know.
National Voices’ report, ‘Person-centred care in 2017’, is the first attempt to judge personalisation and choice across health and social care services, based on the reports of service users, patients and carers.
Person-centred care means different things to different people, but the common ingredients are good information, good communication, involvement in decisions, care coordination and care planning.
Our research uncovered a mixed picture across health and care.
First, the good news: some aspects of person-centred care have improved, notably information and communication. 87% of general practice patients said their GP was good at listening to them, and 76% of inpatients who had an operation or procedure said that what would happen was ‘completely’ explained.
There was also good news in social care, where we found that 33% of people using adult social care said they had as much control over their daily lives as they wanted, whilst a further 44% had ‘adequate’ control.
There was, however, some bad news too. We found little evidence of personalised care and support planning, with only 3% of GP patients living with a long term condition saying they had a written care plan.
We also found it extremely difficult to assess care coordination because it simply is not measured. The best measures we have reveal a poor state of affairs: 46% of hospital inpatients said they did not get enough further support to recover or manage their condition after leaving hospital.
There are worrying signs that family involvement is not central, and most carers need better support. Only a quarter of carers responding to the Sate of Caring survey report having a social care assessment, despite it being their right.
We also found some evidence showing inequalities, with lower scores for person-centred care from people who are over 75, from a BAME background, LGBT, or have mental as well as physical health conditions.
So what does this mean for pharmacists?
There is an obvious role for community pharmacy in creating a more person-centred health and care system. Pharmacy has an important (and only part-realised) role in supporting people to manage their long-term conditions. Pharmacists are embedded in communities and can bring continuity and aid coordination. They are also one of the few health professions which see people when they are feeling well.
Earlier this year, National Voices and the RPS teamed up to run a workshop with a number of national charities to better understand the role that pharmacy can play. Though anecdotal and not based on scientific sampling, the event revealed some interesting insights which you can read in more detail here.
Overall, people had a narrow understanding of what pharmacists can offer. There were misconceptions about the clinical knowledge and competence of pharmacists, there was scepticism about pharmacists’ connectivity with the wider system (“it feels separate”), and some raised concerns about the suitability of community pharmacy premises for sensitive discussions.
At the same time, some of the discussions explored how pharmacists can provide even more support for person-centred care. This included Medicines Use Reviews to ensure people get the most from their medicines, recognising early signs and symptoms of long-term conditions, as well as signposting to other local services.
Pharmacy has significant unrealised potential, and one of the main barriers to realising it is perception.
If we can more closely connect pharmacy to other health and care services and be proactive and assertive in promoting the skills and services of pharmacists, then I suspect we would start to see an increase in the figures on person-centred care.
Andrew McCracken works for National Voices, the coalition of health and care charities that stands for people being in control of their health and care.