Personalisation of care: this matters

It is incredibly rewarding when your personal passions and values are aligned to what you are being asked to do in your professional remit.  When you are tasked with something that you really believe in and want to make happen.  When you can see the tangible benefits and are determined to overcome the barriers that are in your path because this matters to you.

This is why I am delighted that the Nottingham and Nottinghamshire STP area was named nationally as both an Integrated Pilot Site and a Personalised Care Demonstrator earlier this year.  This national support, and the additional funding that comes with it, gives us a real opportunity to 'super boost' some of the excellent integration and personalisation work already underway. 

But importantly for me, taking forward the personalisation agenda is something I very much believe has value, based on a professional understanding of the current complexity of people's needs but also through my own personal experience. 

I had a really good friend back in my university days.  His name was Paul.  He and I spent much of our student days watching the rugby and drinking beer.  After a while, we became quite close and would often have big chats about what we wanted from life, sharing our aspirations for the future.  During one of these conversations, Paul told me that all he really wanted was to get a job, have a place of his own, find someone to settle down with and start a family. 

This is all pretty standard stuff you might think, but when I heard this from Paul my heart sank.  You see, Paul had been living with Cerebral Palsy since birth.  Back in those days, there was no real opportunity to for him to live an independent life.  Realistically, he was facing being confined to a residential care setting as, at the time, there were very few other options for people in Paul’s situation.

Thankfully this story has a happy ending.  With help and encouragement from friends, he managed to get a housing association tenancy and we did the place up for him.  Paul was supported by a number of community service volunteers over the years, enabling him to live independently, in his own home. 

A few years later, I had the immense privilege of being Paul’s best man at his wedding and am also Godfather to his second child. His journey has impacted me immensely, both personally and professionally, because it shows that outcomes like Paul’s are possible. 

When personal budgets for social care support became available in 2003, Paul became one of the first recipients in the country.  His story, and others, are evidence that the right support - tailored specifically to a person's distinct requirements - can be incredibly effective in helping people with on-going needs to live happier, fulfilled lives on their own terms.  Giving people a sense of control and choice in how their care is delivered is also empowering and motivating.

But personalisation isn’t a recent, top down innovation.  Whilst it may appear to be the latest narrative of policy makers and ministers - it very much came from the bottom up.  This agenda came from the disability rights movement in the 1970s and 80s, from attitudes changing to institutionalised care, from people like Paul being willing and determined to be trailblazers and pioneers - breaking down barriers for those who came after them. 

But it’s taken a long time for the health and care system to catch up and organise itself to deliver truly effective integrated, personalised care.  Too many years of health and social care teams working in silo.  Too many years of professionals (albeit in good faith) deciding what’s best for the individual, rather than asking: "What matters to you?"

However, I’m pleased to say that in Nottinghamshire we are the converted. We’ve already made great strides in the right direction by vastly increasing the number of Personal Health Budgets.

'The NHS Five Year Forward View' pushed personalisation up the agenda, acknowledging that a 'one size fits all' approach was no longer relevant or likely to deliver the best outcomes.  The subsequent pilot sites and demonstrator programmes are now facilitating joint working between health, care and the voluntary sector in a way that just hasn't been possible before. 

The benefits of personalisation to the individual are clear.  The benefits to the system are both long term and short term – preventing ill health and reliance on services in the future but also the immediate benefits of people feeling in control and empowered enough to say:  "No, I don’t need that service right now, but I could do with this type of support." The key to successful personalisation is ensuring that people - however frail and with however many physical, psychological or social issues - are in charge of their lives and the main decision-makers about the outcomes they want to achieve.

Being identified as a demonstrator and a pilot site to establish this agenda in practice gives us a fantastic opportunity drive increased personalisation for local people and I am convinced that something exciting is afoot.  Public and voluntary services are building new relationships with the people and communities they serve - assessing people's needs and their level of ability and motivation in order to tailor support and meaningfully improve their skills, confidence and knowledge.

I am looking forward to a future, not that far away, where care planning is consistently joined-up across health and social care.   Our focus is now on making shared decision-making with patients and their families the foundation of our services, and basing the care and support we provide on conversations that start with: "What matters to you?"