The role of communities: There is more to person-centred care than health services

A lot can change in a year.

I wrote this blog almost a year ago. I’d just attended a conference on person-centred care at the King’s Fund and was inspired by the discussions on the importance of communities for individuals’ health. But then the blog remained a draft - somehow I couldn’t place those thoughts into the current health and care context and it just felt too aspirational and too far removed. But a year later and that context is changing.

The importance of communities for individuals’ health is not entirely groundbreaking – after all, it’s been articulated by people working in the community for some time. But it’s not something that had been discussed very much in the context of person-centred care in research and policy circles, and I was surprised to hear a few delegates championing it at the conference a year ago. Until then, we had mainly been talking about person-centred care as an issue of individuals and their health care providers.

So firstly, why are communities important for person-centred care?

There’s growing recognition that health assets exist at the community level. Social or community capital describes the links that connect people within communities (indicated in Dahlgren and Whitehead’s representation of the wider determinants of health). It’s these networks that are essential for individuals’ health: they can help to build resilience, encourage health-seeking behaviour, reduce loneliness and improve health and wellbeing.   

Imagine you are 85 years old and widowed. You live in a friendly neighbourhood and meet every Tuesday and Thursday morning with some of your elderly neighbours to knit at each other’s houses. Now imagine that same person lives in an area where there aren’t enough jobs, people have turned to crime and you’re too afraid to go out of the house. What impact might each of these circumstances have on your health and wellbeing?

Community engagement can empower individuals to become more in control of their own health and care, to support individuals to have a voice with their health services and to become more engaged. It can support people with long term conditions to manage their own care and give individuals the confidence to share decision-making with health care professionals. Communities can also better shape and co-create the local services that best suit their community’s needs. This all makes sense when you think that people spend their whole lives living in communities and only a fraction using health services.

There are clearly convincing economic, moral, sustainability and quality arguments for strengthening the social fabric of communities for the sake of individuals’ health and wellbeing.

There’s a growing evidence base on the benefit of communities for individuals’ health, much of which comes from social epidemiology. It’s a notoriously difficult area to research and almost impossible to evidence causality between community and individuals’ health, but this is improving with continuing interest in the topic. We added to the emerging evidence base earlier this year with a review of the evidence and some case studies on asset-based approaches.

We’ve also supported some work in this area. Our Co-creating Health programme, which supports shared decision making, inspired one participant to form a walking group. The group chat and share jokes, and the founder of the group felt that the social interaction benefitted his health. Our work in Fife also emphasised the importance of communities for elderly people with long term conditions.

So finally, what’s changed in a year?

The policy debate has shifted. NHS England published the Five Year Forward View towards the end of last year and signalled the NHS and policy circles’ use of a new type of language and way of thinking about health and health care. NHS England and other health policy makers and influencers are now talking about ‘new models of care’ for promoting health and wellbeing, having new relationships with patients and communities and focusing on the sustainability of the NHS through prevention. None of these concepts or language is new and there have been other seminal reports that have championed the role of the community (e.g. Fair Society Healthy Lives by Sir Michael Marmot) but there has clearly been a change in tide in the NHS.

In that time we have also launched our Realising the Value programme with Nesta and NHS England. The programme is working to enable people to take an active role in their own health and care, in particular through engaging and harnessing community assets. It will collect evidence on the impact of different approaches, develop and test ways to embed these approaches, and on the back of this make recommendations for change.

Shifting the debate about the role of communities to make it more mainstream has taken public health decades to achieve. We should take this window of opportunity and start applying it to our concept of person-centred care, seeing it as something more than just individuals and their health services but rather as empowered and engaged people living within the context of their communities. 

Angelina is a Strategy & Policy Officer at the Health Foundation, twitter.com/angelinaetaylor