The head of NHS England gets his blood pressure tested. Photo: Getty
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How people-powered personalisation could lead the NHS to recovery

The NHS needs a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities.

It’s been an important month for personalisation in the NHS. For the first time, around 60,000 adults eligible for Continuing Health Care now have the legal right to a personal health budget. Health and social care leaders have been finalising applications to participate in the potentially ground breaking Integrated Personal Commissioning Project seeking to blend social health and social care funding for individuals and allow them to direct how it is used. And publication of the NHS’s Five Year View set a course for the organisation that commits the organisation to enabling patients to have far more control over their care, including but not only through greater control over shared budgets.

Encouragingly, these moves towards personalisation appear to be based on a deep understanding of why producer-led forms of provision have had their day. The Five Year View makes a strong defence of the values and professionalism of today’s NHS, but makes no bones about where it has fallen short, operating as if health and wellbeing can be delivered to people, rather than achieved in partnership with them. 

It warns that the NHS has been prone to "operating" a "factory model of care and repair" instead of harnessing what it calls the "renewable energy represented by its patients and communities". At a point when 70 per cent of today’s health spend is on long term conditions, rather than isolated health problems that might respond to one-off "repair", agreeing forms of support that fit with people’s own lives and aspirations, and plug into their own resources, could hardly be more important. 

So, as health prepares to speed up its journey to personalisation, it makes sense to look at what can be learned from the experience of other sectors, particularly the sector in which personalisation was born – social care. Much of that learning is very encouraging. We now have detailed evidence of the impact of personal budgets, for example, on the lives of those who use them. 

This month saw the publication of the Third National Personal Care Survey. In line with previous research it shows that the overwhelming majority of budget users believe that their lives have improved in terms of independence, dignity and family and paid relationships. As Alex Fox has noted in a new report for the RSA, people who make long term use of social care have repeatedly demonstrated over the past two decades that they are often better than highly trained professionals at making effective use of public resources. 

Yet personalisation remains highly controversial as a philosophy and as a set of practices. Critics worry about colluding with neo-liberal models of individual choice and control, about the de-professionalisation and fragmentation of the workforce, about creeping inequities, and about abnegating proper risk management. Even some of those who are well-disposed towards its aims are concerned that personal budgets in particular have become expensive bureaucratic thicket in which rationing and provider-interest continue to thrive.

For Alex Fox, the way of resolving these problems is to go back to the roots of personalisation and recognise the true challenge it presents, which is not one of administrative adjustment but of profound culture change. Far from being founded on an individualised view of wellbeing, personalisation rests on a deep understanding and respect for how we thrive or falter as people who are embedded in families and communities. So personalisation must go wider than budgets and individual choices, as clearly recognised back in 2007 in the government’s Putting People First concordat. For personalisation to succeed it needs to be part of a shift towards prevention and the development of inclusive and supportive communities.

The RSA’s own research and practice supports this approach. Our work on social isolation and drug and alcohol recovery, for example, is based on building trust in the capability of individuals, families and communities to forge solutions that are right for them, with the support of services that are re-shaped to respect and support the support ecosystems – formal and informal – of the places they serve. 

For example, the RSA’s Whole Person Recovery Team in West Kent is testing, at scale, a service delivery model that fosters community networks in order to support sustainable, long-term recovery from drug and alcohol abuse. The service attempts to build people’s "recovery capital" by connecting them with the people, groups and places who can become their support ecosystem.  It is a highly personalised and co-productive approach that calls on the creative collaboration of individuals, families and communities. 

Ironically, given the aspirations of the NHS Four Year View, Whole Person Recovery explicitly rejects a medicalised model of addiction and recovery – a reminder, if one were needed, of the  and scale of the task ahead if the health service truly wants to embrace personalisation. For social care, the culture change challenge has been huge. For health, it is likely to be even greater.

Paul Buddery is director of RSA 2020 Public Services

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Work with us: Wellcome Scholarship at the New Statesman

Be one of our 2016 science interns.

Britain needs more great science writers – particularly from backgrounds which have been traditionally under-represented in the media.

To address this, the New Statesman and Wellcome Trust, in partnership with Creative Access, have come together to offer annual placements to student or graduates from an ethnic minority background*.

The final 2016 placement will take place this Autumn/Winter (the exact date is flexible) and will last for four weeks.

Over the course of the placement, the successful applicants will:

  • Work alongside the New Statesman web and magazine team, learning about the editorial and production process, and how articles are conceived, written, edited and laid out;
  • Undertake a data-driven journalism research project on a scientific topic, which will be published on the New Statesman website
  • Visit Parliament and learn about how science-based legislation is developed and debated in the select committee system
  • Have an opportunity to interview a leading scientist or policy-maker
  • Write a regular bylined science blog on the New Statesman website
  • Receive regular feedback and editing from the editorial team
  • Meet journalists at other titles in the sector (previous Wellcome Scholars have met writers for the Atlantic, and presenters for the BBC)

Over the course of the placement, you will be paid London living wage.

To apply for the placement, follow the steps below and apply direct to the New Statesman. 

Please write an 800-word blogpost on a recent or upcoming scientific development which you feel has the potential to change lives significantly, explaining clearly and concisely what stage the research is at, and how it is likely to proceed. It should be written as if for the NS audience - interested, intelligent laypeople.

Please also write up to 200 words on why you are right for this placement and what you would hope to get out of it. You don't need to send a CV.

Please only use Word files, or paste your text into the body of an email. 

Send your application by email to Helen Lewis (Helen @ newstatesman co uk) with the subject line “Wellcome Scholarship 2016”. 

Applications close on 30 September 2016. Interviews will take place soon after.

This is a positive action scheme under the Race Relations Act.