Blog written by Caroline Abrahams, Charity Director, Age UK
The eagle has landed: today the Personalisation Plan is published, something which its supporters have looked forward to for a long time. At first glance it is a conventional NHS England document but don’t be deceived by the relatively sober wrapping – a radical heart beats within.
It’s not that the idea of personalisation is new, since up and down the country there are many health and other professionals who have been reshaping how they deliver services in line with its principles for a number of years. However, they have often done so despite the system, not because of it. Today is important because it marks the moment when instead of being the insurgency trying to influence from outside, ‘personalisation’ becomes part of the mainstream, with approval from on-high.
Some will observe that there is a big gap between a well thought through framework for delivery, which is effectively what this Plan is, and tangible improvements experienced by real people in the real world. Others will say that the Plan doesn’t have enough money behind it to deliver improvements for all who stand to gain with real pace. Both points are fair but at the very least the Plan is an important and essential step in the right direction -and what’s more it fizzes with intent.
Moreover, if you had suggested a few years ago that NHS England would endorse the highly progressive approach to healthcare you would never have been believed. This shows how much attitudes have changed in some places that really matter; indeed, it could be argued that personalisation is currently quite ‘hot’. Those who believe in personalisation, among whom I count myself as an individual and Age UK more generally, need to capitalise on its well-deserved place in the sun.
Why the change? I think partly because of a sense that we can’t go on as we are and hope to meet the needs of our growing, ageing, ever more diverse and, sadly, starkly unequal population, or improve either patient outcomes or experiences, as both the public and policymakers are entitled to expect. If you keep doing what you always do you get what you always get.
Another reason is that there is now a lot more evidence to support the benefits of involving people in their own healthcare, of putting them in the driving seat when it comes to decision making, and currently more openness to the scarcely novel evidence of the direct connection between people’s social and economic circumstances and their health. For example, it is now widely recognised that chronic loneliness weakens resilience to illness and disease. Therefore, helping to tackle loneliness by signposting people to support is legitimate NHS business.
The Royal College of GPs’ championing of the Plan is another distinctive difference from what has sometimes come before and it makes a lot of sense. It must be utterly soul destroying as a GP to have someone in front of you with a plethora of non-medical factors heavily contributing to their physical and mental health problems, armed with few if any tools with which to respond. Over time the Plan should start to change this, not least through social prescribing, so it holds promise for professionals as well as for the rest of us too.
The clarion call in the NHS Long Term Plan is the need to construct a new model of healthcare fit for the 21st century. Implementing the comprehensive model of universal personalised care, reducing health inequalities and seeking ways of shifting more towards prevention are other central components.
An additional core strand of this new model of care the Long Term Plan envisions is the programme I was involved in developing, which aims to give frail and unwell older people a much more effective and joined up health and care service in the community, based on a multi-disciplinary approach. In time we hope this initiative can be appropriately refined and expanded to benefit people of all ages with multimorbidity, greatly increasing its impact and reach.
If you put these strands of the Long Term Plan together – personalisation, tackling inequalities, shifting to prevention and integrating care for older people – they cross over in many different ways and draw on a set of common values and beliefs, among them the commitments to making care fit the person and not the other way round, and to working across traditional boundaries, including with communities and the VCS. Another common factor is the co-dependency with the activities of local government, especially social care but also place shaping & councils’ work to support local jobs & drive economic prosperity.
We would certainly have a very different system of care for the population we are today and are increasingly becoming if all of these components in the Long Term Plan could be put fully into effect – they have the capacity to be mutually reinforcing. This is more likely to happen I think if their various constituencies come together and push for the changes in culture and behaviour they all need as one.
After all, each of these programmes is a challenge to the status quo and disruptive in the best sense of the word. As a result, they have more chance of succeeding if they are consciously developed and championed in combination, not one by one.
Perhaps then we need to create a coalition of the willing among all of us who believe in building the new model of care fit for the 21st century described in the NHS Long Term Plan. Today, with the publication of this very welcome Personalisation Plan, is an excellent time to start.