Do you remember your last GP appointment? What was it like? Did you feel you were given the information you needed? Were you involved in decisions about your treatment or care? Did you have to repeat information you had already told other health professionals? Were you treated as a person, or a set of symptoms? And, if the clinical care you receive is good, does any of this actually matter?
Well, yes. Person-centred care  is important – not just a ‘nice-to-have’. When care is person-centred, people not only have a better experience, but it can improve their quality of life and health outcomes. There is also some evidence that it can help achieve better value for money – for example, people often choose less invasive and costly treatment when they engage in shared decision-making with their healthcare professionals.
There are a number of indicators, drawn primarily from the NHS Inpatient and GP Survey questions, that give a brief glimpse into how patients feel about their experiences in hospital or when visiting their GP. Quality Watch includes a domain on person-centred care and experience, recognising that it is a key aspect of quality overall and allowing us to monitor how much – or little – this has changed over time.
Recent reports have welcomed improvements in a number of the indicators of person-centred care. But, if we look a bit deeper, we might wonder if the headline statistics are making us a bit complacent about how much work is needed to ensure that the care people receive is truly person-centred.
Digging deeper than the headlines
Let’s start with a simple issue: staff talking in front of patients as if they were not there. In 2011/12 there was a decrease in the proportion of hospital inpatients reporting that staff talked in front of them as if they weren’t there, from 23% to 19% for nurses, and from 26% to 24% for doctors. These figures stayed the same in 2013. On the surface, things are heading in the right direction. But, if you look at it from the other side, this means that almost one quarter of patients reported that during their recent stay in hospital, doctors spoke in front of them as if they weren’t there and a fifth felt the same about nurses.
Now let’s look at another indicator. The NHS Inpatient Survey asks people if they were involved as much as they would have liked in decisions about their care. In the 2013 survey, 90% of people answered ‘Yes’. So it appears that the NHS is doing pretty well on this score. But is this really the case? The survey question gives people the option of ‘Yes, always’ and ‘Yes, to some extent’. If we break the survey results down, we realise that only 55% of people are always involved as much as they want to be in decisions about their care and treatment. And this figure has barely changed since 2005.
Finally, the GP Survey asks, 'In the last six months, have you had enough support from local services or organisations (not just health services) to help you to manage your long-term health condition(s)?’ There has been faster progress in this area compared with the other questions: the percentage of people who responded positively has increased from 56% in 2009 to 64% in 2014. But this includes 24% who answered ‘Yes, to some extent’. While we should welcome the positive improvements in this area, the fact remains that more than one in 10 patients said they had not been supported by any organisation to manage their long-term condition in the past six months.
If this was about a clinical outcome or safety issue, such as the proportion of patients getting a pressure ulcer, would we be happy to accept this? Or would there be a regional and national focus to ensure much quicker action to improve?
Small changes can make a big difference
But there is much cause for optimism. There are teams all over the UK working hard to improve patient experience and embed person-centred care, whether that is by introducing shared decision making into child and adolescent mental health services or improving the conversations health professionals have with patients and families about end of life care to name just two. For these teams, working in partnership with patients to make decisions about their treatment and care, and treating them as individuals first and foremost, is ‘the way we do things around here’. But this isn’t yet the norm across all health services. And, as the indicators show, progress is slow.
To support the teams who are striving to make care more person-centred, it is important that we continue to collect and critically examine indicators of person-centred care to make sure we really understand what difference we are making. In addition, we need to work to improve the data we collect to make sure we are measuring what really matters to patients (perhaps a topic for another blog).
It is true that some of the changes required to make person-centred care a reality are complex. Changing the education and training of healthcare professionals; commissioning new roles such as peer support workers; or, at a systems level, reforming payment and incentive systems can all end up in the ‘too hard’ basket.
But change doesn’t have to be big. The #hellomynameis campaign is a powerful reminder that the small things we do as individuals can make a huge difference.
(1) Person-centred care means treating people with dignity, compassion and respect; providing coordinated and personalised care and support and enabling people to be active partners in their health and care. See Measuring what really matters: towards a coherent measurement system for person-centred care, The Health Foundation, 2014.