By: Jonathan Scrutton and Ed Harding

Ageing populations across the world have resulted in health and social care services coming under increasing pressure as they attempt to treat and look after greater numbers of older people. In addition, social commentators have noted changing expectations amongst older people, an increasing number of whom expect to be more directly engaged in decisions about their health, and to be supported to self-manage their health, and in particular chronic conditions.

Person-centred care has been understood as many things, an ethical and humanistic framework certainly, but also a solution to these pressures by rethinking the relationship between people and the services they use, and through facilitating high quality, efficient care that affords people the best possible quality of life. However, while there is promising evidence that many aspects of person-centred care are improving people’s lives and making healthcare more effective, there is still confusion about what person-centred care really stands for, and why we need it today.

In response, the Health Foundation commissioned an international environment scanto identify some of the key organisations activein the field,and to build an overarching picture of the state of play in person-centred care.

The research chose to define person-centred care as that which affords people dignity, respect and compassion; offers coordinated and personalised care, support or treatment; and care which is enabling. However, there is in fact no established global definition of person-centred care, and conceptual frameworks and best practice have evolved differently across different disciplines. However, the report was able to find three highly visible themes that are often present across the many definitions of person-centred care.

The themes were:

• Viewing person-centred care as framework for a suite of complementary approaches and processes, such as shared decision making, care planning, patient information, and integrated or multi-disciplinary care

• Emphasising the importance of partnership, mutuality and trust between the person using services, and health professionals

• Applying a philosophical understanding and value of personhood in everyday care settings

Perhaps unsurprisingly, different areas of care have moved forwards in person-centred practice in different ways, often reflecting the needs of particular care groups. For example, dementia care has provided many leading practice models and measures that aim to uphold personhood in the face of the progression of the disease, while cancer care has led many examples of shared decision making and communication between patient and health care professionals.

This diversity has created a significant opportunity for fields to learn from each other – but also a risk that person-centred practice becomes increasingly divergent across different fields.

Integrated care and health IT were also highlighted as significant enablers of person-centred care, with health information technology forming a key part of integrated and person-centred approaches (models include patient registries, shared care records, and self-management support). As such, the recent move by government to create a more integrated health and social care system, as laid out in the Five Year Forward View, has the potential to aid in facilitating person-centred practices across the UK.

However, the mainstream implementation of person-centred care was found to be a continuing challenge. Peer behaviours and workplace cultures are a major factor in whether initiatives translate from aspiration into established practice, and the healthcare workforce may currently be lacking the skills and expertise needed to carry out person-centred care. Equally, mainstream implementation cannot occur without patients cast in a strategic role, yet they were found to be rarely fully involved in research, measurement, organisational change or professional training.

While person-centred care has been enshrined into formal policy and guidance in many countries and fields, the overall message from the research is the implementation of person-centred approaches is still tentative and limited to specific settings or conditions, and as such lags behind the current policy drive in this direction. If person-centred care is going to be the balm that soothes some of the health and social care pressures we face, and a consistently applied model that delivers tangible improvements to older people in this country, a comprehensive and whole system approach must be taken that involves the patient at every stage.

Jonathan Scrutton, Research Fellow, ILC-UK

Ed Harding, Co-Director, The Health Policy Partnership

This research resulted in two main outputs:

• A directory of key organisations active in person-centred care around the world:

See: https://personcentredcare.health.org.uk/around-the-world

• A global synthesis report (‘The state of play in person-centred care’). To read the full report, and a 12 page summary see: www.healthpolicypartnership.com/person-centred-care/

To find out more, please click on the links above.