Communities can transform care

Don Redding is Director of Policy at National Voices, one of a consortium of organisations working alongside the Health Foundation and Nesta to deliver ‘Realising the Value’. He spoke to us about how the project is laying the groundwork for person-centred care to be spread at scale across the NHS.

What is ‘Realising the Value’ aiming to do, and how?

It’s an attempt to resource people in the health care system with evidence models and tools to help them take person-centred approaches into the mainstream.

There’s no shortage of evidence that person-centred approaches can be effective, but there is difficulty in producing evidence of their cost-effectiveness. Realising the Value will be applying cost-benefit analysis to some successful examples, and we’ll work with commissioners to look at what they need for modelling new approaches and developing resources.

What has been done in the project so far, and what are the next steps?

At the moment we’re coming out of the planning phase. Very soon we should have an evidence review from health economists at Newcastle University, looking at the effectiveness of various person-centred interventions, and an initial discussion paper, exploring concepts of value and how we get better at achieving it.

We’ll want to get feedback and to involve people in refining our work. We’ve just held an initial stakeholder event (you can read the Storify round up from the day here), and there will be plenty more opportunities for people to help shape the project’s final recommendations and products.

What are the biggest challenges in engaging and involving people in their own care?

We’re at a very interesting point in the evolution of this process. Historically, it was a relatively small group of interested organisations talking about person-centred care. Now the interest is more widespread, and people are discovering that person-centred planning matches what patients want. The challenge is mainstreaming.

One of the high steps to get over is being clear about the value proposition involved in person-centred care. But it needs to be tried at scale before we can have proof of it working at scale.

Can you talk about the value of peer support?

We know that many people dealing with a health problem express a desire to meet ‘someone like me’. We’ve found that peer support can contribute strongly to emotional and psychological wellbeing, and help to build people’s confidence. I recently heard someone speak about how surprised she was by coming up against the limits of medical care when dealing with rheumatoid arthritis. She said the three most valuable things for her were: a GP who listened and helped her solve problems, a course of self-management education, and a peer support group. That trinity of health care, education and peer support is quite powerful.

What form will the project’s interventions take?

We’re waiting for the results of the literature review, which will guide us on which interventions are backed by the strongest evidence. We’ll then make a selection of around five specific interventions for further study. We’ll be looking for local exemplars that have demonstrated success, and trying to understand what’s been most important in achieving that success, so we can find key ingredients for replicability. And we’ll be doing further cost-benefit analysis.

Do you think the NHS really can save billions by working to increase patient engagement and involvement?

Martin McShane, NHS England’s Director for Long-Term Conditions, has estimated that the NHS could save around £10bn per year through a ‘House of Care’ approach. That includes £2bn through the reduction of hospital admissions, around £1bn in prescribed drugs, £1–1.6bn through shifting activity, for example visiting the pharmacy instead of the GP, and £5.5bn by promoting health through wellness programmes.

What do you see as the most important factors in helping health care providers to change their habits, and bring about a culture shift?

The time horizons set around this are important. If we simply leap on a solution to reduce hospital admissions, we’re set up to fail. Over the next five to ten years it will be as much about organisational process change as anything else, so there must be time to go through the necessary cycles of planning, implementing and reviewing.

Both at local and national levels, the health system is working increasingly with adult social care. Over the past ten years, adult social care has been on a journey towards personalisation, and they bring that experience with them. So a lot can be learned quickly, if the health service is open and humble enough to hear those lessons.

Find out more

Realising the Value is funded by NHS England and led by Nesta and the Health Foundation, working in partnership with Voluntary Voices (made up of National Voices, Regional Voices, NAVCA and Volunteering Matters), the Institute of Health and Society at Newcastle University and the Behavioural Insights Team. Find out more about the project.