Realising the value: what matters most to people?

By Don Redding, Director of Policy, National Voices

Featured article – 22 September 2015

Photo of Don Redding

National Voices brings the voices of patients, service users and carers to bear on national health and social care policy in England.

At a recent health event, very senior NHS leaders were talking about active and engaged patients and service users. A ‘patient leader’ immediately put up their hand and said, ‘I’m an activated patient, but I can’t find an activated clinician to work with me’.

The delegate was making the point that, despite the developing evidence for the effectiveness of person-centred interventions, and the growing numbers of people asking for support for their self-management, in the mainstream of the health service the value she could contribute to her own wellbeing was not understood or made use of.

But a new programme called ‘Realising the Value’ is attempting to tackle this challenge, working towards a new definition of what ‘value’ means by September 2016.

We will be developing evidence-based tools and recommendations, informed by local practice, to help system leaders and managers to achieve it. It is so important, because we want to see people working with communities to sustain health and social care services.

Aligning value

Now that it’s clear that the future direction for health and social care includes increasing integration, they need to align their value systems – not only for joint working, but to ensure that together they address what matters most to people and communities.

And with resources tightening while demand grows, new frameworks must be created to capture and promote the value which individuals and communities contribute to people’s wellbeing. As a first step, we have helped produce a discussion paper called: ‘How should we think about value in health and care?’ (See under ‘links’ below). This sets out some initial propositions and asks for your views and experiences to help shape them further.

The paper argues that the health service has been dominated by concerns about financial value, with a trend towards ‘business-like’ models; and it’s often been dominated by clinical outcomes, which may not be the same as outcomes for the person; and also by accounting for ‘unit-level’ activities, rather than the combined outcomes of different services working with the same person or their community.

To see past this we looked at various critiques of the classical methods of accounting for value, and alternatives that have been developed. We drew upon adult social care’s long march towards personalisation, based on working with people to identify the outcomes important to them; and we looked at various ways of defining and measuring these.

Our propositions

We are asking people to respond to a set of propositions about a future ‘aligned value framework’. We suggest this should focus on the overall impact that services have on people’s lives. We’re referring to the sum of the outcomes of services and support that people receive, all working together. These need to be longer term outcomes, embracing issues of wellbeing, independence, social connection and so on, rather than looking at single episodes of care.

Outcomes, and their evaluation, should be co-produced and responsive to what matters most to people and communities. This must allow both for the hard, quantifiable and comparable outcomes, and also for those which are more based what people say and qualitative in nature. Clinical outcomes will remain a very significant part of achieving what matters to people, but need a new place in the new ‘value hierarchy’.

How you can help

We would love to hear from you about:

  • what you think of the full set of propositions;
  • your experience of working to align values across services and communities (for example, for ‘integration’);
  • any programmes, methods or approaches which can help to deliver more person-centred and community-centred values and outcomes;
  • any case studies that can help bring to life an expanded concept of value in practice.

The discussion paper contains full details of how to respond. And do visit our website over the coming month for a series of blogs from leaders responding to the themes in the paper. And if you’d like to follow the progress of Realising the Value – including a forthcoming report consolidating existing knowledge, evidence and practical approaches to set out the case for a person-centred and community-based health and care system– sign up via the website.

I’d love to be able to tell that delegate, who was so frustrated about engagement, that I for one am cautiously confident about the future.

Realising the Value is a programme funded by NHS England and led by Nesta and the Health Foundation, with other partners including National Voices.