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Personalised care: what matters to me

At 70 years old, I hope to feel much the same as I do now – but maybe with a few more wrinkles, certainly less hair, the scars of some of the things I’ve lived through and, hopefully, the resilience to cope with the inevitable aches and pains that come with ageing. 

Who knows how that will work out!

And when I look at the NHS at 70 I think I see some of those same signs. The ambition is still the same: to be there so that “everyone – rich or poor, man, woman, or child – can use it or any part of it”. But there are definitely a few more wrinkles and maybe a few scars.

The opportunity of a birthday gives us pause for thought about how we face the decades ahead with the benefit of experience and the energy to face different challenges.

Experience has taught us many things. In 1948 when the NHS was born the average life expectancy for a man of my age was 65, with half of all men dying before they reached that age.  Now life expectancy is 79.2 years, thanks to advances in medicine, the brilliant care and support provided by NHS staff every day, and public health advancements such as the smoking ban in public places and the legal requirement to wear seatbelts in cars.

But despite living longer, we are not necessarily living healthier, or happier, lives. Perhaps the most significant shift over the past 70 years has been the increase in long term conditions (LTCs): seven in every 10 hospital beds are occupied by someone with a LTC, and £7 in every £10 is spent on supporting LTCs.

By 2035 two-thirds of adults are expected to be living with multiple health conditions and 17% will have four or more conditions. One million people over the age of 65 report being lonely. Such loneliness and social isolation, which affects people of all ages, leads to poorer health, higher use of medication, increased falls, and increased use of GP services.

Life is not great at 70 – or any age – if you cannot live life the way you want, and experience has taught us that there is not a pill for every ill.

Now the time has come to reframe the conversation and to move beyond the purely clinical: to support people to live their lives in a way that matches what matters to them.

Over the last few years evidence has been mounting that for many people, community-based support focused on meeting psychosocial needs can make a huge difference to their wellbeing, and to the way in which NHS resources are used.

We know that by supporting people to develop the knowledge, skills and confidence to manage their own health and wellbeing, they will experience better quality of life and, not only that, but they will also need fewer interventions by formal services.

A recent study by the Health Foundation found that patients who were most able to manage their health conditions – what was described as the most ‘activated’ – had 38% fewer emergency admissions than the patients who were least able to; had 32% fewer attendances at A&E; were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere; and, had 18% fewer general practice appointments.

When we look at the resources available to the NHS, perhaps we sometimes miss one of the greatest resources we have – the very people using the service.

A recent review by the University of Westminster looked at the impact of social prescribing on healthcare demand. This showed average reductions following referrals to social prescribing schemes of 28% in GP services, 24% in attendance at A&E and statistically significant drops in referrals to hospital.

And an analysis of spending by people who were eligible for conventional NHS Continuing Healthcare (CHC) who took up a personal health budget (PHB) showed an average saving of 17% on the direct costs of home care.

The evidence is mounting, and we have used it to develop our comprehensive model of personalised care. Care that recognises we need to start with what matters to people, ‘from the cradle to the grave’. And that needs to be true whether they are trying to maintain good health, whether they are managing long term conditions or if they are living with complex chronic conditions.

The personalised care model meets people at their point of need: social prescribing, personal health budgets, shared decision making, personalised care and support planning, patient activation, and Choice all make up the model.

Taken together systematically and at scale, we can ensure that our population and our NHS are fit to face the future decades.

James Sanderson

James Sanderson is the Director of Personalised Care at NHS England, working within the Strategy and Innovation Directorate to oversee the strategy and delivery for a range of programmes that are helping to empower people to have greater choice and control over their care. This includes the Personal Health Budgets programme, Integrated Personal Commissioning (IPC), Shared Decision Making, Person-Centred Care, Maternity Pioneers and developing and implementing new models of delivering patient choice.

James joined NHS England in November 2015, and was formerly Chief Executive and Accounting Officer for the Independent Living Fund (ILF). The ILF was used to support disabled people across the whole of the UK to live independent lives through the provision of direct payments enabling the purchase of personal assistance support.

After graduating, James embarked on a career in the private sector before joining the ILF in 2002 to undertake a number of senior roles including Operations Director with responsibility for front line service delivery, and Business Development Director with responsibility for performance development, change management and information governance.

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  1. Neeta says:

    It is very well to have all the policy in place, but the CCG’s are making their own agenda, putting cap on care/ funding. There is nothing anyone can do. I would like to share my experience with you, you may be horrified when you discover how patient are treated under the PHB scheme. My son has been in a hospital for the past 14 months due to PHB issue and insufficient fund, instead of talking to us it is very likely we will loose the PHB. How can NHSE is able to meet their target on PHB, when patient like my son is treated so poorly. I am happy to meet you face to face to discuss issues with PHB.