Personalising Healthcare

[Barrie Ledbury]

 

At Cwm Taf Local Health Board in South Wales, we've embarked on a project called `Personaling Healthcare' (the title may well change as it is sometimes confused with personalised healthcare budgets, which is entirely different).

 

The purpose of raising this via the discussion forum is to seek co-production members views relating to the project, to find out whether anyone is aware of similar work that I could liaise with, and if in fact this is unexplored territory, then to seek forum members own thoughts and advice as to the most effective way to move this forward within say a 12 month timescale, and subsequently measure/monitor outcomes. This project has already been widely discussed/debated at a our local NHS level, but clearly the forum provides an opportunity to widen the debate with members who are already interested in exploring different approaches relating to public services, and also particularly in relation to how recipients of services can engage in design and delivery.  

 

The project is intially grounded in the public sector duties to promote equality and human rights, and consequently the initial focus is to engage with patients who are particularly vulnerable to disadvantage and can therefore be targeted to identify their specific personal needs. It is anticipated that lessons learnt here will then clearly be transferable to the wider population (However equalities itself is a broad church, so the initial target of the project is on patients who are hard of hearing).

 

Anyway, here's the overall research question (although I'm trying not to get too caught up in  a formal research approach):

 

`Would the identification, capture, and sharing of the top three issues for each individual patient, significantly improve their experience of healthcare provision, if we were able to meet their own prioritised requirements'?

 

Basically, the current approach to the equalities agenda is very `generic' in nature, and there is an expectation that the plethora of all-embracing schemes, action plans, training programmes, and impact assessments will make a difference to an individual's patient experience. The project however turns this on its head and puts the patient first.

 

There is a bargain to be struck with the public though in that they need to be able to identify the three issues (as we simply can't do everything); that they are then willing for us to hold the information (we've already got millions of pounds worth of I/T systems to do this); and that they will agree to who can then access the information (taking account of consent, confidentiality, and security issues).Note that the intention is that this would be non-clinical information, rather than clinical information, although there is a wealth of evidence that shows that the `softer' non-clinical issues can have a consequent effect on clinical outcomes - examples:

 

Examples:

– inaccessible information causes missed appointments. 22% of respondents to a Dr Foster survey said that they had missed an appointment due to information being sent in a format they could not read themselves

- 24% of deaf patients have missed a G/P appointment due to communication problems(such as staff calling out their names) – 19% of whom missed more than five appointments

33% of BSL users were either unsure about instructions for medication, or had taken too much or too little of a medication because of a communication problem. 

A Simple Cure: A national report into deaf and hard of hearing people’s experiences of the NHS

 

These examples relate only to patients who are hard of hearing/deaf, have poor eyesight/blind, of are unable to read information - however there is also plenty of evidence that patients of any individual/multiple equality profile have unique healthcare needs, yet we simply don't always know. Yes they'll probably know in the audiology or opthalmology dept, but this doesn't then get shared wherever patients engage with the service. Yes it might be in the case notes, but the case notes aren't always with the patient. And even if they are, an entry which says a patient is hard of hearing, isn't always acted on correctly by everyone. And yet the `all-embracing' answer to this is for staff to attend relevant training courses - I already have a list of 750 training courses that staff need to attend!

 

However if we hold the information at point of contact, then the opportunity arises for a co-production conversation relating to the personal delivery of services. Additionally, if we get to know such individual or aggregated information in advance, then the organisation can plan its arrangements, rather than the current inefficient knee-jerk reaction to specific requirements.

 

Measurement and monitoring also becomes a lot easier as we are only concentrating on their top three issues, which can be aggregated and analysed if I/T is used.

 

NHS organisations put a lot of effort in capturing feedback which obviously is after the event - the principle of this is `feed-forward' so we get to know in advance patients top-three specific requirements. The principle of all this may well be relevant to other public service organisations as well.

 

We are now at the stage in the project of engaging with patients to capture their issues - clearly a make-or-break stage! However it's also a good point in time to float the principle of it with co-production members. There is a lot of supporting, background documentation available and I'd be more than happy to share it if required. We have already learnt some fascinating issues along the way and have had lots of scenarios thrown at us which couldn't have been anticipated - these are however welcomed as they have helped to progressively refine the project.

 

Any views, thoughts, advice, queries or criticism will be more than welcome

 

Regards

 

Barrie