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Making the case for the personalised approach

By Juliet Bauer, James Sanderson and Jacqui White, 25 January 2018


Younger woman puts arm around elderly man in wheelchair photographed from behind

There are over 26 million people in the UK who live with at least one LTC and 10 million who have two or more. Their ongoing and complex needs are currently met by an already overstretched health and social care system.

One of the challenges facing the NHS is the fact that more people are living longer but not necessarily healthier lives. Advances in healthcare have brought greater life expectancy, and as people age they are more likely to have one or more LTC.

Recent figures also suggest around 41% of people attending A&E do not need to be there. There are many reasons for this but it is clear that we need to divert people to more appropriate support and then service them better when they do arrive.

People with LTCs are particularly relevant here as they account for 50% of all GP appointments and 70% of hospital beds. In addition, 70% of each health and social care pound is spent on supporting people with LTCs.

These are staggering figures to comprehend.

The Five Year Forward View also makes our focus abundantly clear that  ‘long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the longer term rather than providing single, unconnected “episodes” of care.’

So what can change?

For people with a LTC, we have strong evidence that self-care can play a key role in improving their health and wellbeing outcomes. Yet 45% of people with a LTC are not confident self-managers and tend to make more use of both elective and urgent services than the 55% who are confident self-managers.

In addition we know that there is a growing general demand for health empowerment, both from patients, who rightly demand increased choice and control over their health and care, and from system leaders, clinicians and commissioners, who recognise the opportunities that come from tapping into the renewable assets that individuals and communities can bring to the table.

We also need to focus on prevention and prioritise our efforts on both premature morbidity and mortality. Prevention is often considered ‘longer term’ for both investment and outcomes, and there are many measures that we can put into place that can have a quick impact.

Therefore, supporting people with LTCs on a journey of activation will help them feel more in control; live a better life; and ensure they make more informed and, therefore, less use of elective and urgent care services.

This is where a universal approach to Personalised Care and Support comes in.  It is an approach that fundamentally changes the relationship for patients and the system – a change that moves from an agenda of ‘what’s wrong with you?’ to one that asks ‘what matters to you?

Personalised Care is about providing a more balance relationship, one in which the person in need of care and support is put at the centre of that support. Services are then designed around the individual, rather than being rigid in approach, and in a way that the individual person understands and can truly engage with.

Personal Health Budgets are good example of this approach and already 22,846 people with complex, long term needs are now benefiting from this new way of working.

One good example of how this works is how digital services and tools can help people to better manage their LTCs. Digital services are convenient for patients, efficient for the NHS and can get people the right care as quickly as possible.

GP online services enable people to book appointments, order repeat prescriptions and access their records online. David is a patient with diabetes and having ongoing access to his online test results and health records has helped him to better manage his condition.

Paul uses an online app called myCOPD which helps him to manage his chronic obstructive pulmonary disease (COPD). The app includes a complete pulmonary rehabilitation programme delivered in his home and evidence is emerging that this app is having a real and positive impact on COPD patients.

But this is just the beginning, and these connected apps and online tools are just one example of how a personalised approach can revolutionise care and support people better.

It’s time to start working differently by making new health and care partnerships with patients themselves but also making the most of social and community-based services that are already available.

Together we can provide better health outcomes for people with LTCs as well as building a stronger, more efficient NHS.

Last edited: 15 January 2020 9:25 am