As the health services face louder calls for a greater focus on person-centred, co-ordinated care, and more integrated services, Professor David Oliver highlights the key policy priorities for the RCP.
A greater focus on person-centred, co-ordinated care, more integrated services designed to deliver this, and greater value for money in delivering outcomes that matter most to patients are key policy priorities for the RCP, not least in our recently published “Top Tips for Person-Centred Care” developed in conjunction with our Patient and Carer Network.
These components might seem like simplicity itself and intuitive to experienced physicians. Yet all too often, our health services aren’t able to deliver these central components to patients and their families. We need to continue to push to make these elements the norm for most patients, most of the time.
This focus aligns closely with key national policies in health systems across the UK and in other nations where our fellows and members work. It’ also central to the RCP’s published vision for defining and improving the quality of care.
As our population ages and as we get progressively better at preventing or treating previously fatal conditions, the core business of healthcare is increasingly the care of adults with long-term medical conditions – with multiple long-term conditions increasingly the norm. This applies both in outpatient and acute inpatient settings where physicians work. It applies in the care of those nearing the end of life. And for physicians in specialities whose work spans community healthcare settings.
The greater emphasis for clinical professionals on “what matters to me?” and not just “what’s the matter with me?” is also driven by changing public expectations, societal values and the democratisation of clinical information.
Across the breadth of the RCP’s 33 specialties and the Acute and General Internal Medicine so many of our members and fellows provide, it’s hard to think of one where a focus on person centred care is not relevant.
The greater emphasis for clinical professionals on “what matters to me?” and not just “what’s the matter with me?” is also driven by changing public expectations, societal values and the democratisation of clinical information. But delivering it has potential for a “win/win” situation for patients, their families and for health systems.
Value based healthcare
The RCP has recognised the importance emphasising “Value based healthcare” – which underpins national initiatives such as NHS Improvement’s “Getting it right first time” (GIRFT) programme, “Prudent Healthcare” in Wales or “Realistic Medicine” in Wales, in which we must deliver strongly on outcomes that matter to patients for the finite resource we expend. Physicians have a key stake in this as individual decision-makers and system leaders.
In addition, the RCP’s Future Hospital report from 2012 required physicians and the clinical teams or organisations they work in or lead to prioritise new ways of working in order to make more person-centred care a reality.
I suppose if we were re-writing ’Future Hospital’ now we might call it “Future Healthcare System” as hospitals aren’t Islands and being at hospital – either as an inpatient or outpatient - is a relatively rare occurrence for most patients, who live with and manage their own medical problems.
Of course, we welcome the growing focus on care and support planning, shared decision making and supported self -management for people with one or more long-term conditions set out for instance by the Coalition for Collaborative Care.
However, as the RCP we also have a key role in ensuring that once acutely ill patients are admitted to hospital, that the care we supervise remains person-centred, that we support their families and that their transition back out of hospital is well planned. This very much includes the large number of adults in hospital who because of their acuity, dependency or cognitive impairment are not able to advocate or plan for themselves.
Read some of Health Watch England’s recent reports and you’ll see that we don’t always get this right.
Although there are many great examples of services delivering person-centred care in the UK ... there are still major gaps and variation, not helped by the current workforce crisis and growing workload on which the RCP has campaigned relentlessly.
Although there are many great examples of services delivering person-centred care in the UK and our systems rate highly on many international metrics, there are still major gaps and variation, not helped by the current workforce crisis and growing workload on which the RCP has campaigned relentlessly. Time speaking and listening to patients is an increasingly scarce commodity.
National Voices 2017 update report on delivering Person Centred Care showed that it’s implementation for most patients, most of the time is still far from the norm, despite all the policy initiatives.
Person centred care and the RCP
The RCP remains very active in this field in a variety of ways.
We continue to lobby parliamentarians and work closely with national health system leadership bodies, other colleges, charities and specialist clinical societies on person-centred care, integrated service models and value-based care. Our concerted push to revive medical generalism and modernise training curriculae speaks to the need for less-disjointed, more continuous care.
We repeatedly showcase examples of clinically-led service improvements with patient outcomes, priorities and experiences to the fore – for instance in our Excellence in Care Awards, our Chief Registrar Programme, the Future Hospital Development Sites and “Tell us your Story” initiative. We also published a themed issue of Future HealthCare Journal
Our National Clinical Audit and Accreditation Schemes and the work of our newly established Quality Improvement Hub all incorporate a clear focus on patient-reported experience and outcomes. Members of our patient and care network are integral to numerous RCP workstreams and were key participants in our Future Hospital Exemplar Sites, both in designing the service changes and the patient feedback.
Finally, the specialities and specialist clinical societies which belong to the RCP family have a variety of workstreams, educational initiatives and campaigns of their own which we should support, learn from and share more widely.
Person-centred, co-ordinated care is likely to be increasingly important in the RCP’s work and I daresay my successors will still be banging the drum in years to come.
Professor David Oliver is a consultant in geriatrics and general internal medicine, and clinical vice president of RCP London. You can follow him on twitter at @mancunianmedic