In the first of our blogs, responding to your feedback so far, we will discuss Person-centred care. To do so, we hear again from Shaun Maher, a Strategic Advisor for Person-Centred Care and Improvement, in the Scottish Government.
Firstly, a reminder of some of your feedback in this area. You told us about the importance of being involved in the decision-making process, both in relation to your own care and the care of your loved ones. To be well informed and kept up to date. To feel respected, and treated as an individual, not as a number or a condition. You also told us about the importance of being in control and feeling supported to self-manage your own health conditions.
These are all very valuable points, which Shaun explores further below:
It might seem strange that we need to talk about how we can make our health and social care system more person-centred. What is it centred on if it isn’t person-centred you might ask? That’s a good question!
Health and social care services have developed in the modern era from a time, less than a hundred years ago, when there was little or no state support for anyone. In those times the only support, care or treatment that was provided was based either on your ability to pay or the good hearted generosity of charitable organisations and individuals. Over the last 100 years or so, state-funded health and social care services have gradually developed into what we see around us in the world today.
These services have their origins in a time when “doctor knew best” and things were done “to you” without too much recourse to your personal preferences or inherent strengths or capabilities. This paternalistic culture of thinking “we know best” has survived down to the present day and means that often decisions are still made on the basis of what someone else thinks is best for you, without very much knowledge about you as a person and what makes you tick. Of course the health and social care system today is focused on people, but the perspective is still predominantly one which is all about doing things “to” people or “for” people. This way of thinking can only get us so far. The signs around us, and as you have been feeding back to us, indicate that we need to do something different for the 21st century.
So, when we talk about person-centred care, or person-centredness we aren’t just talking about being nice to people, important though that is. Neither are we are implying that the current activity of the health and social care system isn’t focused on people; it very much is. But the current perspective is still too much in the “we know what’s best for you” mode of thinking. Not enough attention is paid to the inherent strengths and capabilities that every person has, their personal preferences and values, and the relationships (or lack of) that surround them in their life. This is what we mean when we talk about person-centred care.
The impact of this shift in perspective has the potential to be very significant, transforming health and social care in new and creative directions, but the scale of the task should not be underestimated. This different way of interacting with people and understanding what truly matters to them in the context of their life requires new skills, new and creative ways to measure, a much stronger focus on people and relationships and new ways of working. This is generational shift and it will perhaps feel challenging and uncomfortable for some at times, but these feelings of difficulty and discomfort are a good sign and indicate that we are moving out of our comfort zone into new ways of doing things
The Scottish Government has a dedicated Person-centred and Quality team. The team supports the work that is underway with health and social care services and other partners across Scotland, to support and develop new ways of thinking about and delivering person-centred care.
Some current examples of this include:
- The five Must Do With Me principles of care (see diagram below), which together will help to ensure that all of the interactions between people using services and the staff delivering them are characterised by listening, dignity, compassion and respect..
Staff at The Royal Hospital for Sick Children in Glasgow, for example, are using this approach to have meaningful conversations with children and their families about their care. When admitted, children are asked to draw, or write what matters to them. This information is displayed next to their bedside, where it helps staff to engage with the child about the things that are important to them.
- Work to support self-management, including a dedicated Self-Management fund, administered by the Health and Social Care Alliance Scotland (the ALLIANCE), to help local communities develop new ideas and projects that support people to live well, on their own terms, with whatever conditions they may have.
- Making it Easy, A Health Literacy Action plan for Scotland, which sets out actions to help NHS Scotland rise to the challenge of responding to people’s health literacy needs, so that we can all be active partners in our care. This recognises that the language of modern health and social care services can be hard to understand, and many of us lack the knowledge, understanding, skills, and confidence to take an active role in our own wellbeing, despite a strong desire to do so. That’s why The Health Literacy Place has been developed as the main source of health literacy information and resources in Scotland.
- ALISS (A Local Information System for Scotland), which provides an online resource that helps to signpost people to useful sources of support within their local communities. ALISS has been developed with people with long term conditions and professionals. It offers not only a technology solution, but also a means for communities to work together to gather, maintain and share information.
- Planning for care preferences when time becomes short is an important feature of Scotland’s Strategic Framework for Action on Palliative and End of Life Care, which was published at the end of 2015. The Framework recognises the need to create a culture of openness about death, dying and bereavement in Scotland. As you have told us, to deliver services that are truly person-centred, we need to listen deeply, with respect and empathy, to what people are telling us about the support, care or treatment they receive. Over the past year, we have been working with our partners to develop Our Voice. Our Voice will support people to engage meaningfully with health and social care services. Approaches will include peer networks that will support people to take part in local planning processes; and new approaches to involving you in local and national issues. We’ll say more about Our Voice in a future blog.
Shaun Maher, Strategic Advisor for Person-Centred Care and Improvement
Health Quality and Strategy Directorate | Scottish Government