In the latest of our series of blogs on Personal Health Budgets, Stuart Lane explains why as both a clinician and someone who has supporting commissioners and providers he is passionate about the opportunities they offer to people and how they can transform the lives of those with long-term conditions:
I am immensely proud of my clinical background.
As a physiotherapist, I have been fortunate to meet a huge number of people and their families whose lives have been shaped by the gradual or sudden onset of long-term disability.
The demand for high quality, effective rehabilitation continues to grow at a time when services are often limited in the degree and depth to which they can provide the necessary support.
Physiotherapy can, and does, play an important part in making people’s lives better. However, during my clinical practice, I was increasingly aware that although my therapy skills were valued and needed, there were often much more profound things that really mattered to the individual and their families in order to live a ‘good’ life.
Being with loved ones, a home, a purpose, being able to make a contribution, to have dreams, hopes, aspirations and to not become defined by their symptoms or diagnosis. All too frequently, the limit of my practice boundaries led to making yet another referral – more professionals becoming involved with whom their story was to be told yet again.
It was this frustration at a disease-focussed, pathway-driven, performance indicator-following system that sparked my interest in the notion of self-directed support in health care. What if we could facilitate those things that were really important to and for people?
I have been fortunate to be involved in the development of person-centred care and personal health budgets in the NHS almost from their beginnings. As lead for one of the in-depth evaluated pilots and within subsequent work programmes, I’ve seen broad scope for their successful introduction to long-term conditions, mental health and NHS Continuing Healthcare.
This has enabled me to witness at first hand the profound impact they can have on people’s lives, the benefits to clinicians and opportunities for commissioners.
The ability to work with individuals in determining what really mattered to them in living with their long-term conditions is hugely rewarding. It has led to solutions that would previously have been impossible – a canine partner, access to specific assisted technology and specialist equipment or tailored rehabilitation services.
Often, these interventions go beyond symptom management and contribute towards people being able to lead better and more fulfilling lives with their long term condition. It is truly, a whole person approach and one which often benefits those closest to the individual too.
Over recent years, and through the tireless dedication of many, the picture has slowly begun to evolve. Personal health budgets are now a reality for more people and those with the most significant health needs, eligible for NHS Continuing Healthcare, have the right to have one.
There are increasing examples of wonderful stories for how this has improved people’s lives.
Intentions for further expansion in long-term conditions and mental health have been clearly set out which see them as one of a range of options towards supporting greater choice and control. And yet, fundamental conversations at all levels and the scope of real terms choice and control still require development and transformation.
There is no doubt that this is difficult to achieve and there is a risk that new approaches revert to known historical boundaries – clinically led with patients required to comply and conform, following pre-determined pathways designed against service deliverables. This brings about a situation where new services, desperate to be different, need to follow established protocols. Where a new transaction, but a self-limiting one, may return us to precisely where we began.
The NHS is wonderful and deserves much praise. However, it understandably struggles to support people to live the lives they want. As part of new approaches to designing how care is delivered, it will be imperative to share the solution with people and realise an honest, trusting relationship where individuals can exert real choice and control in those areas which matter most to them.
Chances are, physiotherapy will remain highly important to many people and clinicians can thrive on delivering high quality outcomes with those fully engaged as equal partners.
So, as new models of person centred, integrated care emerge, let’s avoid building those that ultimately resemble the ones people used before. Changing a name or moving the location of services do not in themselves result in the changes necessary. Both people and professionals have important things to contribute.
It also demands letting go of certain historical mind-sets, from the perspective of both parties. The question is, can they?