Personalised care: beyond rhetoric

For too long, personalised care has been seen as just a linguistic flourish in policy. But embracing it offers a way to reduce waiting lists, improve hospital discharge and curb avoidable admissions, says Joe Fraser and Josh Hutchison

For those who have heard of it, personalised care often gets characterised as ‘being nice’.? The change it requires feels too distant, the end ill-defined, the benefits blurry, the work required too large, and the finances too pressured.

?Contrary to that view though, personalised care is measurable, its impact concrete and quantifiable, and it pays for itself if you invest enough to address the known need. ?

Tackling personalised care challenges

At present, the NHS is trapped in a vicious cycle. Demand is rising, people are waiting longer for treatment, which leads to a higher level of need – and more demand.

To break the cycle and slow the rate of deterioration, it needs to:

1.??????? Keep people well while they’re on elective waiting lists

2.??????? Expedite safe hospital discharge

3.??????? Help people with long-term conditions to improve outcomes (and thereby slow the rate of hospital admission).

Personalised care can help to deliver on all three. But embedding system-wide changes to make that happen is unrealistic when services are struggling to cope. The solution? An incremental shift towards personalised care that targets the drivers of demand: prioritising those with the highest need and greatest risk of escalation; and personalising support to prevent the need to use services.

Personalised care has struggled to move beyond policy and into practice, but it isn’t impossible and there are examples of it addressing those issues across the country. ?

1. Personalised support for waiting well

For elective waiting lists, health coaching provider Surgery Hero takes a personalised approach, working with NHS trusts to identify high-risk patients to reduce their risk of deterioration. Patients experience shared decision making as part of ‘proactive, personalised support’, including screening for non-clinical risk factors and coaching to improve health before surgery.[JF2]?

In one London Integrated Care Board (ICB), the approach was applied to 569 people deemed unfit for surgery. After Surgery Hero’s input, 327 were fit for surgery, meaning 57% of the group could have life-altering procedures, while dramatically improving service efficiency.

In other areas, they’ve seen the average length of hospital stay falling by 33%, and a 72% reduction in post-op complications.

As well as clear benefits for the patient, the implications for the NHS are significant.

Cancellations to surgery cost the NHS ￡400m a year but are less likely to occur for patients supported with health coaching. The average cost per surgical complication is ￡3,500 and these are less than half as likely after this personalised support.

Imagine the dent that could be put in the waiting list if this type of support was commissioned at scale.

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2. Personalisation improving patient flow

The benefits of personalisation are just as evident when applied to patient flow. By augmenting discharge to assess with social prescribing, understanding people’s needs and connecting them with community-based support, readmission drops significantly. Home & Healthy in Warrington & Halton took this approach and 81% of patients did not re-appear in the hospital within 12 months. That service had 2,634 referrals over two years and saved an estimated ￡321,880 thanks to lower service usage.

In some areas, discharge teams have begun offering a personalised care plan and following it up with a one-off personal health budget (PHB). These are used to purchase practical, low-cost, items and services without which a patient’s discharge would be delayed. The PHB is enabled with an e-wallet to ensure transparency, speedy payment and easy access.

?In just one year, North West London ICB saved 681 bed days (equivalent to almost ￡330,000) by spending ￡10,835 via PHBs. Across three ICBs in London, ￡46,685 was spent through one-off PHBs in 2022- 23, and saved an estimated 1,409 bed days. Put crudely, this meant ￡33 enabled one bed day to be accessed by someone who needed it more. Cheap, impactful, tech-enabled and personalised: are you starting to see a pattern emerging?

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3. Personalised population health management

The previous examples are still based in our traditional ‘firefighting’ paradigm. But instead of helping people when they fall ill, a personalised approach can support patients to cope better, enjoy a better quality of life and reduce demand on the NHS.

Pilot studies in health coaching show up to 80% of a cohort can increase their capability to manage (known as patient activation) from being ‘overwhelmed’ to ‘struggling’.

This has a direct impact on bio-clinical indicators: reduced hypertension (equivalent to taking medication), significant weight-loss, 11% reduction in cholesterol, and sustainably improved diabetes control.

To see what impact this could have, we analysed population data within one integrated care system (ICS) for patients with hypertension, a common co-morbidity for people with long-term conditions. Some 34% of 181,000 patients (c.62,000) could not keep within healthy limits. As a consequence, they had high demand. If these patients used services at the same rate as those who could manage, the ICS would save 101,000 bed days a year (over half a hospital’s capacity) and achieve efficiencies of ￡201m (8% of the ICS budget).

We compared service usage for this group with that from a Health Foundation study on patient activation. If 80% of the sub-optimal group improved their ability to manage from being ‘overwhelmed’ to ‘struggling’, the reduction in service usage would be staggering. Using robust modelling, the analysis calculates a personalised care approach for this group would reduce currently unmitigated demand by 34%, save 35,000 bed days, and create ￡69m of efficiencies in-year. Conservatively, this support could cost an additional ￡20m, but if just 24% of patients were helped to stop being ‘overwhelmed’ then the investment pays for itself.

If personalised care could achieve this impact with one cohort in one ICB, imagine what it could do if it was embraced across all 42 in England. We need to take the principles behind these services and employ them throughout the health and care system.

·????? This is the second of a three-part series of articles on the possibilities offered by personalised care. Next up: what is needed to enable tech-enhanced personalised care to become business as usual.

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Joe Fraser is Head of Healthcare Inequalities Improvement, Personalisation and Prevention for the NHSE London Region and Josh Hutchison is a Partner at Channel 3 Consulting.

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