The importance of personalised care

Personalised Care Week, organised each year by the Personalised Care Institute, is always an opportunity to talk about personalised care – what it is and why it matters.

In many ways, it is extraordinary that in modern health services we need to. After all, what could be more personal than health? What other service needs to be so uniquely tailored to your life?

The decline of individualised healthcare

But over the past century, healthcare has been less individualised – as we focus on better science and better efficiencies, healthcare has become less personal, more remote, and much more transactional than ever before.

In the late 20th century, when New Public Management approaches grew, the NHS, like many organisations, sought to make sure they used their skills, capabilities and resources to the best effect for our populations. So far so good, perhaps.

Except key elements of the market approach fall down in healthcare.

Efficiency and productivity vs. personalised care

In the last few years, conversations about health and care have been resolutely focused on the pressures and demands.

We have been more focused on efficiency and productivity than ever before. And it is impossible to conclude anything other than this is not working.

We are better at pathways, better at flow, have better medicines, more skilled clinicians, better hospital sites. But the health of our nation is failing, and in the words of our own health secretary, the NHS feels broken.

At the heart of this we find an issue illuminated by the language of design – we have fallen in love with solutions, rather than the problem.

With 80% of the determinants of health sitting outside of healthcare services, our focus on better tech, quicker care, slicker pathways may be misguided. In fact, we may be increasing demands – both on services and on the people who receive them.

The role of personalised care in treating multi-morbidities

So Personalised Care Week is a good time to remember this, especially as we focus on multi-morbidities. If you are living with two or more long-term health conditions (like 15% of the population), nothing will be more important than someone taking the time to understand what will improve your health, and how treatment can fit your life.

To deeply understand rather than assume what the problem is, by spending time with those affected. These insights lead to very different definitions of what the challenges are, unlocking solutions that will allow us to tailor healthcare for each and every one of us.

Hospices have always formed part of my landscape. For a time in Sydenham, St Christopher’s was my next door neighbour, where I grew up in Cornwall, our little back lane now leads to the beautifully designed and uniquely delivered Little Harbour, and I now drive past the stunning new build of St Catherine’s on my way back and forth to my office.  

As a healthcare professional, I have long been inspired by the way palliative services resolutely embody the very best of personalised care – with a relentless focus on living, on what is important, on what matters to you and those around you as life comes full circle.  

Supporting the hospice sector

Watching the challenges in the hospice sector over the past year has been heartbreaking when you see so clearly the powerful work they do, both to individuals who need their love and care, and to systems who need training, reminders, and inspirational examples of how care can and should be different.  

As an organisation Here’s purpose is ‘Exceptional care, for everyone’. We deliver services, but over the years we have also developed offers to support others to deliver exceptional care.

Our focus on data and analytics has long underpinned our innovative services.

Partnering with St Gemma’s Hospice

When we work in partnership we seek likeminded organisations, and it is no surprise that we have started to find these in the hospice sector. We feel privileged to support the work of St Gemma’s Hospice and to share our learning in this new partnership.

In our work with St Gemma’s, we want to bring the full breadth of our experience into the partnership. We will provide a mixture of infrastructure (a cloud-based data warehouse, Power BI), coupled with analytics and other technical expertise.  

Our goal is twofold: to streamline St Gemma’s existing reporting processes for greater efficiency, and to harness data-driven insights to better quantify and demonstrate their impact.

By harnessing this data analytics work, we want to help other organisations work more efficiently, empowering them to provide exceptional care not only to the people they support but also to the dedicated staff who deliver care.

Think we could support your organisation? Feel free to get in touch at collab@hereweare.org.uk if you’d like to discuss working in partnership with us.

“By creating a mission around health equity, we can connect our staff to a bolder vision for their work, with healthcare workers as agents of social change, making a difference to our world rather than processing an endless chain of individuals passing through.”

In 1834 Britain passed the Poor Law, an act of Parliament partially creating a safety net for all, but also enshrining a principle of deterring people from making unnecessary demands on public funds that remains present in today’s national debate.  

The infirmaries that grew from the poor house would soon be described as “a disgrace to our civilisation” (Lancet 1865) and served as inspiration for the alternative visions of Beveridge and Bevan a generation on.  

The Marmot review in 2010 and ten years on (2020), along with the desperately disproportionate impact of COVID show how slow our progress has been.

Health inequalities today

In today’s Britain, healthy life expectancy remains widely divided between rich and poor with inequities widening since 2010 English indices of deprivation 2019 – GOV.UK

Nye Bevan’s vision for the NHS was a far-reaching reform of access to healthcare, with a more dramatically socialist root than is widely spoken of.

In providing universal access to healthcare, free at the point of delivery, Bevan viewed the NHS as part of an infrastructure that would dismantle division of class and wealth.

When we talk about health inequalities today, we often think of correcting poorer health outcomes, and less about social justice.

There is a risk that we fail to recognise in real terms the need to deliver more (and different) health and social care interventions for some people, rather than just making sure there is equal access to the traditional offer.

Shifting the language from health inequalities to creating health equity

More insidiously, at times of high demand, services can pivot to the quick wins, trying to reduce overall waits or meet blunt targets. At these times, delivering care to groups with different needs can feel more challenging, ‘complex’, and bypassed on route to the ‘low hanging fruit’.

Wider than this, we know the presence of health conditions or caring responsibilities adds disadvantage over time, a vicious cycle where 54% of carers report their own health had suffered, and 44% had put off seeking health treatment because of their responsibilities. For these groups ‘equal’ access to treatment as usual will not meet their need.  

Shifting the language from health inequalities to creating health equity paints a much broader picture.

It engages our services in recognising that part of the mission of the NHS is a social justice one, that we are a part of how wealth is re-distributed, by providing safe, universal, free access to healthcare, we can balance the accident of birth. As Marmot says, “if health has stopped improving, it is a sign that society has stopped improving”. 

Healthcare workers agents of social change

By creating a mission around health equity, we can connect our staff to a bolder vision for their work, with healthcare workers as agents of social change, making a difference to our world rather than processing an endless chain of individuals passing through.

From this lens, we are stretched to consider what more we can do, taking proactive approaches to the delivery of health, seeking out places and populations who we know are disadvantaged, and playing our part in levelling the playing field.

With this focus, our task is shaped differently. No longer do we look at access data in terms of whether it is representative of our population, but whether it is representative of our population need. 

Our programs and services spend more in areas of deprivation, understand that delivery methods than may be more expensive, and focus on the value this represents in lifting the disproportionate distribution of wealth (in its widest sense).

Doing things differently for a better world

More contentiously it could mean sifting through these long waiting lists differently – to identify those who are disproportionately impacted, less advantaged, less resilient, less able to wait, in service of a fairer society.

It is as much part of our social mission as it is our commissioned services, and we want to do more. We are not alone. Despite all of the pressures within the NHS, we know there is a growing emphasis and commitment to the pursuit of a better world, a drive for health equity at every stage of our lives.  

Through our data dashboards and outreach programs (Vax and CAD), we have learned about how to deliver healthcare differently. Delivering quick, efficient healthcare to the many, and bespoke, targeted offers to the few.

We believe we’re stronger together. If you’d like to work with us to find new and innovative ways of growing health equity then we would love to hear from you.

Get in touch: collab@hereweare.org.uk

As a social enterprise our purpose is to create exceptional care, for everyone.

We are incredibly proud of the services we deliver, and sharing our learning is an important part of our culture.

Many businesses talk about growth, for us, we measure that in terms of impact, as well as delivery.

That’s why we were so excited about our New Local webinar this morning, talking about our Community Appointment Day innovations in Sussex.

Today over 270 people were on the call, with the wonderful Natalie Blunt and Laura Finucane talking about how they got the CAD up and running, and what impact it had.

Whilst we are still tracking our data, and learning what works, what I’m left with this morning is the incredible news that across the country, CADs are popping up like mushrooms.

What started as a ‘what if’ conversation in our teams, is becoming an accepted idea – fuelled by a desire to experiment, to try something different, knowing that doing what we’ve always done will not solve the problems we face.

Its not just in MSK, and its not about waiting lists. Creating new ways to deliver truly personalised care is an idea our systems are ready for. Common sense innovation, that anyone can read about and think – how might we do that around here?

As a social enterprise, this is what we are about. Business for good. We’re excited to connect with others who are exploring this idea. We’re happy to share, and importantly we’ll learn from how this idea develops in other places.

Creating exceptional care for everyone is going to take change on a new scale. Strength based, community powered health.

Whether you’re daunted, deliberating or determined to try, we’d love to be connected.

Medical approaches to health commonly diverge around acute and chronic presentations. What I need after an unexpected accident, a short illness or a new concern is very different from when I am living with a condition long term.

In an acute illness, rapid, transactional models of care are effective – even welcome – lives are at stake, care is short term, and expertise largely sits with the trained professional.  

Translating this mode into chronic care is filled with risk. A chronic condition affects our whole lives, from morning to night, throughout the seasons. Any treatment approach cannot be simply prescribed from professional to patient, and compliance monitored. We need to flip the lens – any treatment regime needs to ‘comply’ with our lives – what is important to us and what can be sustainably incorporated into our unique set of circumstances.

This challenge of what makes the right health collaboration is what makes us tick at Here. We are inspired and driven by the right combination of skills that builds health – the collaboration between experts–by–experience and health professionals, that has peak potential in working with long term conditions.  

Now more than ever before, this is where we focus our time.  So what sits at the heart of this approach?  

It breaks into 4 key pillars:

1: What Matters To You

This is at the heart. Conversations, not consultations. Every contact with every patient is started focused on knowing what matters most – an honest and safe space to match their personal experience, hopes, aspirations and obstacles, with the knowledge and skills a professional might provide. It sounds simple, and it many ways it is. It takes a commitment to putting your needs as a clinician, an administrator, a busy health professional second place, making sure value to the patient is the offer on the table.

2: True collaboration

Every individual conversation is a collaboration. Shared decisions with people seeking care are made and ways forward devised. Then we learn, we change, the service and our partnerships evolve. The people who use our services become part of our infrastructure – with paid roles bringing deep expertise. 

This isn’t ‘representation’, we invest time and resource in people who have the skills we need – we co-design, improving the services we provide because we have access to a secret weapon – the inside track of what it is like to receive them. We do this, not just because it is the right thing to do, but because it is the smart thing – our services are better – for the people who use them, the people working in them, and the communities they serve. 

3: Our data

We believed our approach would be better. Now, we know that it is with real time data, available to all, that tracks outcomes. It tells us what works, and what our populations need. It lets us manage our resources well, particularly in services under pressure. Our data enable us to create equity by design. All our services generate and report data on who uses them, and who doesn’t, driving us to take action to reach the people who may need us most, and who are least often served well. Smart data system drives real change in the world.

4: Our approach is sustainable

A temporary pilot, that leaves no lasting legacy of change waste opportunity, effort and resource. Our world is changing, and that’s why we have a continuous approach to innovation and improvement. We have to take the best of the innovations and bake them in to our service design. Complex repetitive tasks are prone to human error, we use the best technology to free precious time for clinicians and care staff to invest in human and unhurried connections.

We share what we find, taking pride when others adopt approaches we have road–tested. Working with partners, we can step in, and out of delivery. We work alongside anchor institutions and community groups who may be taking this work forward long after our role is complete.

If it sounds right, intuitive, that might be because it speaks to what you would want to build a healthy life. Driving these principles through what we do every day, is what keeps us here, working in health, every day.

It inspires us to better things, and it’s the beating heart of exceptional care, for everyone.

Common sense innovation is one of our by-words at Here – we believe in innovation, and doing things differently – we also believe in simple ideas that have great impact.

Community Appointment Days (CADs) are a simple idea, built on a bedrock of partnership, personalised care and devolved decision making. With all eyes on the growing NHS waiting lists, anything that serves to get people quickly to the care they need is gathering attention.

But what makes them work? Could this happen anywhere?  

These are my reflections on the story so far:

Partnership is key

As a social enterprise, we’ve been working hand in hand with our Sussex Community Foundation Trust (SCFT) colleagues for over ten years. At the CAD you can tell. Everyone introduces themselves as MSK Partnership staff. One team, not several. Everyone pulling together.

We draw on the agility and creativity of a small social enterprise and join forces with the expertise and credibility of the NHS. A perfect example of the whole becoming more than the sum of its parts.

MSK practitioners at a Community Appointment Day (CAD)

Personalisation is the difference

As an organisation our calling card is exceptional care for everyone. We specialise in personalised care approaches to long term conditions. We constantly ask the question – is this care exceptional – both in terms of the standard of care, and our ability to make an exception to respond to a particular set of needs.

The MSK partnership has a mission too – putting patients at the centre of their healthcare journey. Why does this help? It means we focus only on understanding what really matters to someone, and this has been the beating heart of the CAD.

Making sure we understand, and quickly respond to the things that are going to make a difference, and not wasting any time offering or pursuing pathways that just don’t suit.

Devolved decision making

If you are going to really be person-centred, and allow for shared decision making with people, your clinical team will need the autonomy and independence to enact creative thinking every day. By baking in clear vision and values in every part of the system, you can trust teams to do what matters. 

As a clinician you know that so long as you are holding true to the values, you have a great deal you can offer. Good for managers, good to staff, good for people.

Simple rules let you work with complex problems – and when it comes to caring for people, each and everyone of us arrives with our own complexities to understand.  

A learning culture

You know the saying, ‘Culture eats strategy for breakfast?’ If we’d set out two years ago with a strategic plan to reduce our wait list, it’s unlikely we’d have come up with this. If we’d had board sign off from all our partners, this idea would still be sitting on a table waiting for final governance sign off or a pilot.

By creating a culture of working in teams to solve day to day problems together, guided by principle but supported by robust data and learning, we have teams who are unusually used to trying out new things.  This ability to quickly learn, try and fail, change tack means we are improving all the time.

The CAD days evolved from a clinical validation approach that wasn’t working well. Our approach to learning meant we identified the piece that was working – the what matters to you conversation – sowed the seed for a whole day focused around this one conversation.

Find out what people had to say after attending a Community Appointment Day here.

Download the Community Appointment Day Essential Ingredients.

Download the Community Appointment Day Information Sheet.

About Sussex MSK Partnership Central

Sussex MSK Partnership Central is a joint venture between Here, & Sussex Community NHS Foundation Trust. This is a prime contracting model supporting musculoskeletal (MSK) health for a population of 650,000 covering physiotherapy, orthopaedics, rheumatology and chronic pain. The service operates across central Sussex; including Brighton & Hove, Horsham and mid Sussex and Crawley.

Website: www.sussexmskpartnershipcentral.co.uk

Interested in finding out more about the Community Appointment Days?

Email collab@hereweare.org.uk or use the form below.