Holiday reflections on Personalised Care

There is nothing like a holiday to give you some space to reflect. It’s a bit like rebooting your computer, closing all those windows and letting the operating speed catch up. I wanted to use that window of clarity to reflect on the progress of Personalised Care in the NHS, and what next. I see it as a crucial feature the NHS needs to develop, to become more sustainable and effective.

At this point I reflect we have made tremendous progress along a very ambitious path, but things are fragile and vulnerable. There is so much to be proud of and to celebrate, but with that, the risk we could lose so much if we don’t keep protecting and developing.

Personalised Care in the NHS can be defined by the policies and contracts and how that has driven resource allocation. Most recently this has been spearheaded by the NHS 10-year plan, where Personalised Care was articulated as a central ambition of how the NHS operates. This was supported by the ‘how to’ guidance in the Universal Model of Personalised Care. These built on imaginative and bold work over many decades, but crystalised theoretical ideas into an action plan. Leaders like Alf Collins , James Sanderson , Aimee Robson , (and so many others) have negotiated for and implemented new ways of operating. A major manifestation of progress has been the 3 new roles in the NHS, Social Prescribing Link Workers, Health Coaches, and Care Co-ordinators. A brand-new dedicated workforce, with innovative job descriptions who are tangibly bring Personalised Care to life. Through their roles we see real actions, different conversations, support, and mobilisation of new approaches.

I’m an action person, I believe we learn most by doing. But I also think it’s important to maintain clear perspective on what we are trying to achieve and why. Many of us see Personalised Care as a culture shift. It’s a fundamental upgrade of how we pursue care as a whole. I believe it’s central to health care services but should also be indistinguishable from how we act in other services like social care and education, and how we interact as communities and a society. For me it sits as a foundation for how we are with each other and reflects a commonality across many fields.

I wouldn’t want to suggest it’s a political creed or fully defined set of rules to follow or not follow.? That risks adding to the destructive polarisation we currently see in politics and policy right now. Personalised Care has to be flexible and at times a little messy, to enable it to create room for all.? It should be a unifying call to how humanity can interact in ways that enhances everyone’s lives, in the best ways we can.

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I hope I haven’t lost you already, and that is often the trouble, this is a significant mindset shift, and can be hard to articulate. People often work well with simple ideas, with clear definitions and specific actions. I think the simple idea that sits at the heart of Personalised care comes with 2 complimentary principles – like a ‘ying and yang’. On the one hand it is valuing people as unique individuals, creating the right conditions for their minds and bodies to flourish. On the other hand, in doing this we need to operate with compassion for each other. This second part can get lost amid personal choice and individual rights, which are of course very important, but we only really flourish if we do so as mutually supportive communities.

I chose that word compassion carefully. I have learnt from Michael West and Michael Marmot that it is a powerful and dynamic word. To be compassionate to each other we must understand each other. We must take time to listen and appreciate our unique strengths and accept our differences. For reasons personal to us we’ll have different beliefs, capabilities, backgrounds, hopes and aspirations. Our creativity will show up in different ways, our confidence more or less established in different aspects of our lives.

Compassion is an action word though; it means we seek to empathise and take action to create positive change. In this way Personalised Care seeks to enhance individuals progress in the context of a thriving community. We must help each other to help ourselves. As far as possible there should be opportunity, and even an expectation, that each person contributes to the wellbeing of all. My observation from practicing as a GP is a key part of feeling good about yourself, is understanding how you add value to wider humanity, no matter how small that contribution maybe.

It is so easy to neutralise someone’s sense of worth and meaning by over caring for them. As Cormac Russell consistently teaches us in #AssetBasedCommunityDevelopment (#ABCD), the most powerful ‘services’ are those that enable as much as possible to be done by people and communities themselves…. not being done to. Compassion can be about getting out of the way, enabling, and allowing opportunities, believing in people.

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To come back to the action. I’ve been closely involved through Peak Health Coaching and my role as a Primary Care Network Clinical Director in training, implementing, supervising, and supporting these 3 new roles in the NHS. Peak is one of several excellent NHS approved and regulated providers of training through Personalised Care Institute . We are evolving and learning as a training community. Peak has experience of training, assessing and supporting thousands of people across these roles. What stands out is how much people love the work…..as long as they are allowed to do it. By this I mean when staff are allowed time and are supported to listen, give people space to focus on what matters to them, and to enable and encourage people, it gives them deep satisfaction and meaning in their work. We hear time and again “This is what I always wanted to do…..this is the sort of way we should support people”. But we also recognise that traditional targets and expectations often get in the way of working like this.

?Perhaps that’s to be expected, transitioning to personalised ways of working is different and ?it does require different prioritisation on time and resources. There are challenges as people learn new skills and both professionals and patients take on new responsibilities and ways of thinking and doing. New approaches require trial and error and there will be mistakes. Inexperience brings nervousness and vulnerability. New approaches require reassurance, nurturing, good support and supervision. We must have the confidence to know what it’s reasonable to do less of, while we grow time and space for new ways of working.

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Finally, I reflect on what enables the mindset shift. ?The shift in thinking that has to happen to underpin all the action. What do we need to give us all confidence we are doing the right thing? None of us want to be championing ‘The Emperor’s new clothes’. We want to know we are putting our efforts into things that matter. The trouble is assessing personalised care doesn’t fit into the evidence-based approach we’ve become conditioned to. It’s not like trailing a discreet medicine or surgical technique, to state the obvious it’s very personal. I’ve heard Cormac Russell say many times, “this is inch wide, mile deep”. Often funding is draw towards scalable interventions, where we might spread ‘miles wide’, but only go ‘inch deep’. I can see the appeal of funding interventions we can spread across populations like prescribing statins or signing people up to self-care apps. A small percentage gain, adds up to a big population benefit. Appealing to an economist, but less meaningful at the level of the individual.

?Assessing personalised care is like assessing being in love. Sometimes you just know, it’s obvious, you see people walking on clouds. Other times you’re not so sure, it’s harder and takes more work. It’s a longer-term slow burn but can lead to something so deep and meaningful it gives you a framework on which you define yourself. What vague sentences! But just like assessing love, defining, measuring, proving personalised care is often very complex, easy to misinterpret. It can be quite subtle, and always subjective. How do you capture something that just feels right to individual people across a large population?

To be a little more concrete, I come back to staff doing the work they want to do. I say we trust the caring professions. In my experience they start with compassion, it’s what draws them to the professions. When people know they are doing meaningful work from the interactions they have on the ground, it is a powerful barometer of our system.

?Let’s also invite everyone to contribute, in fact let’s expect them to. If there is one thing I’d value in our new Health Minister Wes Streeting , it would be a brave and ambitious narrative about the NHS. Wouldn’t it be great if the consistent message from Politicians to The Public, is “We need you to join in, and we will create opportunities for you to do so”.

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I believe in optimism, I find it inspires hope, and creates fertile grounds for positive progress. But I appreciate the flip side to that is delusion and denial. I hope I’m not being delusional in believing we can build on our achievements, but I do recognise there is much sustained effort needed. We are just getting going, but I look at our progress with great optimism.