Personalising care offers hope for the whole system

By industrialising our healthcare system to manage soaring demand we’re losing sight of its primary purpose – to care for people as individuals. Personalised care provides a powerful mechanism to get it back on track, say Joe Fraser and Josh Hutchison

The demand crisis requires quality, not quantity

While some services are at breaking point, others aren’t, which is worth considering. The public may view it as crisis all over the NHS, but it’s important to acknowledge where we are innovating and where trusts, ICBs, regions and NHS England are leading the way.

One of the best examples and biggest opportunities can be found in personalised care.

We believe giving it greater prominence can help to steer the NHS and wider system onto a more sustainable path.

At the moment, there is too much emphasis on ‘throughput’ – getting people through the system as quickly as possible – leading to conveyor belt care. Or put another way, we focus too much on quantity and not enough on quality. The pathways being delivered by the NHS’s current model doesn’t account for each person's individual needs.

The solution can’t be more quantity as we know resource is limited. It’s about improving quality and that’s where personalised care comes in.

When combined with the digital technologies we have now, it offers a powerful way to strategically address patients health and wellbeing in full. This would improve outcomes and reduce both waste and the demand created by not addressing a person’s needs fully in the first place.

Tailoring care, not just treating disease

Personalised care takes account of the wider needs, constraints and desires of patients when offering treatment. That way, instead of only helping patients when they get ill, we can support patients to better manage their health and wellbeing in a way that makes sense to them. Imagine a healthcare system that delivers tailored support based on a clear, joined-up picture of your life. Not only is that the care you want as a patient, but it would have a massive impact on demand in the system too.

This isn’t some abstract notion; arguably it was the norm when local GPs could offer continuity of care. It’s also been around for the last quarter of a century in UK health policy. The Wanless Report talked about the need to recognise “people are not all the same” and that the NHS needs to “meet people’s needs as individuals” back in 2002. There has been some progress: we’ve seen personal health budgets implemented, social prescribing set up in primary care networks, and personalisation cited in the NHS Long Term Plan and in more recent policy.

Understanding the implications of intervention

A personalised healthcare system not only treats people as individuals and gives them choice, but also ensures they understand the choices available and their implications.

For example, if you’ve been recommended a knee replacement but you’re a keen runner then that needs to be factored in. It’s not just your marathon time that will be disrupted (!) but your social life, and your sense of self. Those sound like ‘nice-to-have’ outcomes, but they can impact people’s wellbeing and lead directly to poor health if not properly managed.

Other options might suit a person better holistically, even if surgery would give the best outcome from a clinical perspective. For others, the consequences may be more drastically direct: having to stop caring responsibilities or to stop managing a business, with knock-on effects for them and their families.

Targeting care proactively

Personalised care also provides the ideal mechanism to embed a population health approach, focusing support on patients at risk of the worst outcomes. We know demand isn’t spread evenly across society; the wider determinants of health, significantly linked to deprivation, account for 80% of health outcomes and are leading to ever-greater inequalities. For example, Diabetes UK research shows an almost 40% rise in the number of people under 40 with Type 2 diabetes in London and the south-east. Those from the most deprived areas were least likely to meet treatment targets and were more likely to develop severe complications.

The approach of personalised care seeks to understand the challenges patients face, supports them to address them and fits healthcare into their lives as an enabler to having a better life rather than the end goal in and of itself. ?

Personalised care in the NHS now

We can see pockets of personalised care happening: social prescribing, self-management education and health coaching are the kinds of interventions that empower people to take control of their health and wellbeing. This is, however, happening variably at local levels rather than as a core part of treatment.

The?Personalised Care Institute, established to be the standard setting body and home for all personalised care education for the NHS workforce in England, echoes our sentiments and is calling for more investment and prioritisation of system level adoption of personalised care within its recently published report, ‘A Manifesto for Putting Personalised Care at the Centre’.

We now have technologies which can accelerate progress for personalised care. They can, for example, open the door to much more effective and accessible communication with patients, from remote consultations – and preparing people for consultations – to bringing information together into one easily accessible place, and accessing education and coaching digitally.

To maximise the impact of this technology we need to: redesign care pathways as part of a transformation process; engage with the market to ensure innovation matches needs on the ground; and develop clear strategies that target the cohorts who would most benefit from technology-enabled support.???

Opportunity

The threat is clear, as the Diabetes UK report highlights, but we argue so is the opportunity. Through personalisation, we can make care more meaningful and impactful. If you have diabetes, forget the disease for now – what are your needs and how can we tailor the way we manage your glucose to fit with your life? Speak to people with long-term conditions. They will tell you this is what they want, but just weren’t able to articulate it within the clinically-bound services they use.

Personalised care at scale would enable a systematic approach to supporting people’s wider needs – addressing the ‘caring’ side that we have lost sight of in our relentless focus on the importance of ‘health’.

·????? This is the first of a three-part series of articles on the possibilities offered by personalised care. Next up: the art of the possible – how personalised care can have an impact on everything from hospital discharge to managing long-term conditions.

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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.