Shared Decision Making

LTP Priority: Personalised Care

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Shared Decision Making

Major driver of health inequalities in your area of work

Chapter one of the Long Term Plan sets out personalised care as one of the five major changes that will establish the new service model for the NHS. Personalised care means people have choice and control over the way their care is planned and delivered, based on ‘what matters’ to them and their individual strengths, needs and preferences. This happens within a system that supports people to stay well for longer and makes the most of the expertise, capacity and potential of people, families and communities in delivering better health and wellbeing outcomes and experiences. As a result of personalised care, healthcare is tailored to what matters to the individual, in the context of their whole life, such that personalised care can support programmes and systems to address inequalities in access, experience and outcomes.

Personalised care is listed as part of one of the five major, practical changes to the NHS Service Model over the next 5 years: People will get more control over their own health, and more personalised care when they need it.

The LTP sets out that 2.5 million people will benefit from the Comprehensive Model for Personalised Care. This includes the following commitments across six components of personalised care (in addition to a number of other commitments that rely on personalised care):

  • Accelerate roll out of Personal Health Budgets… Up to 200,000 people will benefit from a PHB by 2023/24 (para 1.41)
  • Over 1,000 trained social prescribing link workers by 2020/21 and 900,000 people referred to social prescribing link workers by 2023/24 (para 1.40)
  • Ramp up support for people to self-manage their own health (para 1.38)
  • People have choice of options for quick elective care, including choice at point of referral and proactively for people waiting for six months (para 3.109
  • Support and help train staff to have personalised care conversations (para 1.37)
  • Use decision-support tools (para 3.106) and ensure the least effective interventions are not routinely performed… potentially avoiding needless harm (para 6.17viii))

Below we expand on how each of these commitments can support the approach to reducing health inequalities.

Target groups

People living in deprived areas

Details of the recommended intervention.

Intervention

Shared Decision Making

Description

Shared decision-making means people are supported to a) understand the care, treatment and support options available and the risks, benefits and consequences of those options, and b) make a decision about a preferred course of action, based on evidence-based, good quality information and their personal preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing people’s informed preferences.

Evidence

Shared decision making (SDM) can create a new relationship between individuals and professionals based on partnership (Mulley et al, 2012).

People want to be more involved than they currently are in making decisions about their own health and health care (Care Quality Commission inpatient survey, 2017).

Both individuals and clinicians tend to consistently overestimate the benefits of treatments and underestimate the harms (Hoffman, 2017).

It has the potential to enhance allocative efficiency and reduce unwarranted clinical variation (Mulley et al, 2012).

It is a legal requirement and health professionals now must take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment and of any reasonable alternative or variant treatments”. (Health and Social Care Act 2012, Medical Protection Society, 2015, Montgomery v Lanarkshire Health Board (Scotland) 2015 UK Supreme Court).

It is intrinsic in professional codes of conduct/standards (General Medical Council, 2013; Nursing and Midwifery Council, 2018)

SDM ensures that individuals are supported to make decisions based on their personal preferences and are, therefore, more likely to adhere to evidence-based treatment regimes, more likely to have improved outcomes and less likely to regret the decisions that are made. By paying attention to individuals’ informed preferences we can support people to achieve outcomes that matter to them. Aggregating the decisions of informed individuals to a population level means we can commission and provide services that informed people want and therefore allocate resources more efficiently. A systematic review found that SDM interventions significantly improve outcomes for disadvantaged people. By addressing people’s level of health literacy when sharing decisions, we can also reduce health inequalities. Staff should use health-literate decision support materials (when such materials are available) and tailor their conversations to take account of low health literacy by using specific techniques, building on the national health literacy toolkit.

Guidance for Commissioners