In this blog, Simon Chapman, newly appointed Deputy Director of Personalised Care at NHS England, looks to the growing importance of personalised care and working with local communities to secure the future of health and social care.
“Watch for the big wave”, my Dad would say as we stood with our body-boards in the Atlantic off North Cornwall, in the days before wetsuits were readily and cheaply available.
Many things need to come together to make great surf. Wind (it is better after a storm), “fetch” (the length of water the wind has blown over), tide, current, moon, local conditions and geography. Even then, not every wave is the same. You need to watch for the weight and pace of water as it rises towards you. Get the right wave and you’ll have an exhilarating ride all the way into shore. The wrong one will tail off disappointingly. It’s sometimes said that the big wave comes once in every seven. Miss your wave, and you’ll have to wait a while for your next opportunity.
Arriving in the Personalised Care Group, and joining NHS England after 15 years in the voluntary sector advocating for people to have greater voice, choice and control in decision-making about their care, I have the same sense of anticipation and excitement that I have when watching a great sea building. A weight is rising beneath personalised care, of evidence, commitment, technical know-how, take-up and support. Mass and momentum are growing; we need to catch our wave.
What do I mean by that? First, there’s greater coherence in understanding what personalised care is. In the past it’s been fragmented, with different voices contending for example for social prescribing, personal health budgets, self-management, or patient activation. We can now see that these approaches are not competing but complementary. Nationally we have developed a comprehensive model for personalised care, which demonstrates how these different components work together to create an effective whole-population approach. It is encouraging to note that the Integrated Personal Commissioning programme, which brings together the components of personalised care, has already enabled over 70,000 people to benefit from a personalised care and support plan.
Similarly the penny is dropping that if we are to break the endless cycle of failed attempts to integrate systems, we need to try something different. Specifically, that means integrating and aligning organisations around the needs of people, and the complex ecology of their lives and communities, not the needs of the system. Integration needs to start with personalised care. This is not just technocratic jargon. Giving people greater choice and control is about social justice and rights. It helps tackle unfairness and inequality. It improves outcomes. It changes the relationships between the system and the people it’s there to serve. In a modern open society, this transformed relationship is essential.
Next, and crucially, personalised care is not being left to fend for itself. This year there are plans to work with a number of areas across the country who will receive funds and support to expand personalised care locally, and demonstrate how the comprehensive model works across their population. In linked work, other localities, with experience and expertise for example in personal health budgets, are sharing their knowledge and mentoring colleagues in other CCGs across the country. There is a growing community of practitioners.
This is emphatically not to say that’s it’ll be an easy ride from here. There are rocks to watch out for. For example, not every part of the NHS has lost the institutional muscle memory that reflexes inwards to focus solely on its own priorities and resources, and shuts down collaboration. Dedicated work is required to build the muscle groups necessary to work effectively in partnership outside the statutory health system, and let go of some power and control. This is advancing in some places, but much more remains to be done. Similarly the renewable energy of people and communities will not renew all by itself. Commissioners need to invest strategically in local voluntary and community groups.
I am optimistic. The tide is changing. Conversations are shifting from “why” to “how” should we do this? There is a groundswell not just of enthusiasm, but tangible commitment and proactive determination to change the way things are done, and to work very differently with people and communities.
Taking end of life care, where I’ve worked for the last 15 years, as an example. Next week is Dying Matters Awareness Week, and my former colleagues are asking all of us “What Can You Do…in your community?” to support people through dying, death and bereavement. Public health palliative care is disrupting traditional models of practice. Recognising and respecting the expertise and resource within people and communities is critical not just in end of life care but for the future of the whole health and care system.
Coming back to my Dad. He died very suddenly last summer from a brain haemorrhage. The strength and depth of kindness, love and practical support my Mum has received from her friends and community has been extraordinary, and a real help to her in the shock of sudden grief and bereavement. This compassionate community response has made a true difference.
For all of us who want to see personalised care woven through the warp and weft of the NHS: this is our moment to ask ourselves: What can I do next, to make this happen?