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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Commons Confidential: Dave's picnic with Dacre

Revenge is a dish best served cold from a wicker hamper.

Sulking David Cameron can’t forgive the Daily Mail editor, Paul Dacre, for his role in his downfall. The unrelenting hostility of the self-appointed voice of Middle England to the Remain cause felt pivotal to the defeat. So, what a glorious coincidence it was that they found themselves picnicking a couple of motors apart before England beat Scotland at Twickenham. My snout recalled Cameron studiously peering in the opposite direction. On Dacre’s face was the smile of an assassin. Revenge is a dish best served cold from a wicker hamper.

The good news is that since Jeremy Corbyn let Theresa May off the Budget hook at Prime Minister’s Questions, most of his MPs no longer hate him. The bad news is that many now openly express their pity. It is whispered that Corbyn’s office made it clear that he didn’t wish to sit next to Tony Blair at the unveiling of the Iraq and Afghanistan war memorial in London. His desire for distance was probably reciprocated, as Comrade Corbyn wanted Brigadier Blair to be charged with war crimes. Fighting old battles is easier than beating the Tories.

Brexit is a ticket to travel. The Independent Parliamentary Standards Authority is lifting its three-trip cap on funded journeys to Europe for MPs. The idea of paying for as many cross-Channel visits as a politician can enjoy reminds me of Denis MacShane. Under the old limits, he ended up in the clink for fiddling accounts to fund his Continental missionary work. If the new rule was applied retrospectively, perhaps the former Labour minister should be entitled to get his seat back and compensation?

The word in Ukip is that Paul Nuttall, OBE VC KG – the ridiculed former Premier League professional footballer and England 1966 World Cup winner – has cold feet after his Stoke mauling about standing in a by-election in Leigh (assuming that Andy Burnham is elected mayor of Greater Manchester in May). The electorate already knows his Walter Mitty act too well.

A senior Labour MP, who demanded anonymity, revealed that she had received a letter after Leicester’s Keith Vaz paid men to entertain him. Vaz had posed as Jim the washing machine man. Why, asked the complainant, wasn’t this second job listed in the register of members’ interests? She’s avoiding writing a reply.

Years ago, this column unearthed and ridiculed the early journalism of George Osborne, who must be the least qualified newspaper editor in history. The cabinet lackey Ben “Selwyn” Gummer’s feeble intervention in the Osborne debate has put him on our radar. We are now watching him and will be reporting back. My snouts are already unearthing interesting information.

Kevin Maguire is the associate editor (politics) of the Daily Mirror

Kevin Maguire is Associate Editor (Politics) on the Daily Mirror and author of our Commons Confidential column on the high politics and low life in Westminster. An award-winning journalist, he is in frequent demand on television and radio and co-authored a book on great parliamentary scandals. He was formerly Chief Reporter on the Guardian and Labour Correspondent on the Daily Telegraph.

This article first appeared in the 23 March 2017 issue of the New Statesman, Trump's permanent revolution