How much do we know about the achievement of personalisation across health and social care services?

Featured article - 11 October 2017
By Don Redding, Director of Policy at National Voices: the coalition of 160 charities that stands for people being in control of their health and care

Head-shot of the author, Don Redding, Director of Policy at National Voices: the coalition of 160 charities that stands for people being in control of their health and care

National Voices’ recent report, Person-centred care in 2017, is the first attempt to judge this across services, based on the reports of service users, patients and carers.

In adult social care, the personalisation agenda is firmly established, with 89% of service users saying their care and support helped give them control over everyday life, and 63% of personal budget holders saying they could make better everyday decisions.

In the NHS, too, there was progress. Large proportions (over 70%) of general practice patients and hospital inpatients say that information is good, staff listen, and they get good explanations of tests, treatments and procedures.

Participation and control of decisions is less advanced in the NHS, but has improved over time.

A worry, though, is that recent NHS scores have dipped, perhaps due to increasing pressure on staff and services.

Adult social care should also beware of realities that may not yet show up in national surveys. Anecdotally we are hearing about personal budgets being taken back, or budget holders’ choice being restricted.

A key deficit area is personalised care planning, which still doesn’t really happen in the NHS. In social care, it is not clear from survey data how well it is practised, and the CQC has found that in some services, such as some residential settings, it is lacking or not person-centred.

Initiatives like SCIE’s work on personalisation in care homes, which extend personalisation beyond budget holding – and the encouraging results shown by care home vanguards – are important here.

Most care is provided by informal carers, and a majority still report poor experiences, with only 23% getting social care assessment, and 69% saying their GP has not acted to support them.

Secondary analysis of patient surveys is showing up inequalities in experience, with lower scores for person-centred care from people who are over 75, from a BAME background, LGBT, or have mental as well as physical health conditions.

Adult social care should think about how it could provide good national data on such inequalities.

Our main recommendation is to address a number of such failings in the measurement system. These prevent us knowing whether person-centred care across services – a major goal of integrated local care models – is being achieved.

Indeed, neither the NHS nor social care can demonstrate, through user feedback, the extent to which they are coordinating people’s care successfully.

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