On NAPC POSITION – NHS Founding Principle – Putting Patients at the heart of everything
On first look at a person-centred NHS there can be little to disagree with in a statement that patients should be anything other than at the heart of everything.
At the same time the term “patient” brings with it an association with dependency, illness and receipt of treatment at the cost of person activation/citizen empowerment, creation of health and self-care. It can augment a power imbalance between professionals and people.
In a truly person-centred system, based on what matters to people across the breadth of their health & wellbeing, perhaps we would serve them better to focus on putting people at the heart of what we do.
Our NHS perspective often leads to this being described as “having the patient in the centre” or “wrapping the team around the patient”. Perhaps if we genuinely wish to put people at the heart of everything then we should regard them as being part of a team whose common purpose is to achieve what matters to them. Such a partnership would be more akin to “patients” being the centre forward of the team and the team working to support them in scoring their own goals.
NAPC POSITION – NHS Founding Principle – working across organisational boundaries in partnership
In a person-centred NHS, health and care services should be designed and delivered in- keeping with the needs of individuals and communities. Better understanding the health & wellbeing needs within our communities enables us to better work with them to develop new models of support and care. These models determine the skills needed within the teams to deliver this support & care effectively. This then informs our workforce planning in the types of training and roles required.
The important thing to remember in all of this is that as a result of adopting a person-centred approach, the make up of a person-centred team should not be determined by institutional, professional or contractual boundaries, but by the health & wellbeing needs of the populations that we serve.
Based on Professor Michael West’s research within the NHS, working in “real teams” which are defined as having a common purpose, working together to deliver the support needed and evaluating how they are doing together is the ONLY team working that delivers greater benefit to people/patients. Anything less, a “pseudo team”, threatens significant harm. In a person-centred approach, our “choice” is not whether we are in a person’s team, as this is defined by their needs, but whether we choose to be a ”real team” or a “pseudo team”.
There is no place for ivory towers within a person-centred NHS. Working across boundaries should be a given and a situation in which organisational partners are able to succeed individually without succeeding collectively causes harm. Perhaps this should be less of a principle and more of an absolute necessity that underpins all of the other principles.
NAPC POSITION – NHS Founding Principles – Achieving the highest standards of excellence and professionalism
Finally, a principle for everyone to support wholeheartedly, who wouldn’t want this? Or is it?
Perhaps the definition of excellence is at the heart of hesitancy just to pass over this principle. Perfection is well known to be the enemy of good and it is often the last few percent to achieve excellence, that costs the most and can distract resources from other areas within an institution. This results in a patchwork quilt of excellence that delivers an overall outcome that falls well below an aspiration of excellence.
Professionalism at one level could result in someone carrying out a procedure with utmost expertise and excellence (doing things right) but for that procedure not to have been the preferred choice of the recipient of excellent care (doing the right thing). This is especially true in the real world where the wider determinants of health might contain a more positive impact for individuals and communities. The sense of professionalism required to achieve the best population health outcomes has to reach well outside of any individual professional’s area of expertise.
Maybe in a person-centred NHS, excellence should refer to being person-centred in the way previously described and in pursuit of highly effective team working across all partners to deliver the best possible population health outcomes from the collective resources available.
NAPC POSITION – NHS Founding Principles – providing best value for taxpayers’ money
Within an NHS funded through collective contributions this has to be at the heart of how the NHS operates. The question is which aspect of taxpayer’s money. Should it just be the money that finds its way into the NHS budget, or the total public purse whether raised by national or local government. And what about the taxpayer’s money that remains in their pocket that is then spent on healthcare within the NHS as well as privately.
In reality, this principle expresses itself mainly in valuing financial balance within institutions almost above and beyond the nature of value itself. At one level this can hardly be surprising as each and every system is perfectly designed to deliver the outcomes it does. The needs of institutions, professions and contracts, drives the sense of what is best value within the NHS otherwise we wouldn’t need to be in the conscious pursuit of a person-centred NHS.
Defining what we value and what is of value is essential to determining best value. There will always be conflicting interests and political drivers within a state funded health system, or indeed any healthcare system. Seeking a common purpose that stands the test of time against which to determine delivery and value then becomes a necessity.
NAPC POSITION – NHS Founding Principles – Accountability
Following on from value, we must look at the issue of accountability. It is not simply as an opposite to everyone being unaccountable but the NHS being accountable for what?
At present accountability across NHS partners is often not aligned and sometimes directly at odds with each other. As such the chances of this ever resulting in highly effective team working as the norm across the NHS is about as close to zero as you could ever get. Only “real teams” deliver value above and the NHS is banking on Integrated Neighbourhood Teams to address most of the major challenges that it is currently facing. Therefore, we are potentially building something on very unstable ground.
There needs to be a common purpose, a common accountability, that applies to all NHS partners to raise the quality of our team working and therefore people’s/patients experience of the NHS. In a person-centred approach this has to be about what matters to people in their state of health and wellbeing, encompassing their own personal activation as advocates for their own health and therefore the wider determinants of health. This doesn’t have to mean that everyone in the NHS is responsible for everything but everyone needs a level of accountability to maximise their collective ability to deliver the best value from the available resources.
