Getting personalisation right in the NHS

Last week saw the publication of the prospectus for the Integrated Personal Commissioning (IPC) Programme. Think Local Act Personal are pleased to be partners with NHS England in this new initiative, alongside ADASS and the LGA. The IPC Programme aims to combine population level integration of health and social care funding with individual level integration, so that people can direct all the resources available to them through holistic person-centred planning and the option of personal budgets.

For us at TLAP, this means Getting serious about personalisation in the NHS (opens new window), which is why we published a report of the same name alongside the prospectus, which we hope provides some useful context to the ambitions of the IPC programme and some pointers from what we know works that can inform the way ahead. The cultural changes the new programme is seeking to accelerate in the NHS are clearly grounded in many years of learning and experimentation for what works in empowering patients and people with care and support needs to be active partners in their own care, not least the long history of personalisation in social care.

The IPC programme reflects a growing recognition that people are perhaps the greatest untapped resource in the health and social care system. Indeed, all the evidence suggests people want to be more actively engaged as partners, that services frequently underestimate their willingness and that the potential impact of harnessing this contribution could have huge economic and social value.

Integrated personal commissioning will equip the health and social care sector to:

• create fundamentally different relationships between patients, the NHS and other services they need,
• cultivate shared decision-making and active support for self-management as well as extend the use of personal care and support planning and personal budgets.

While this is great news, the next phase of personalisation will not be without risks. However it certainly feels like the time is right to make some real and lasting changes for the better towards a truly person-centred NHS.

Part of getting this right will mean learning the lessons from the experience so far - our Getting serious paper condenses these into 10 key messages for personalisation in the NHS:

1. Keep the person at the centre - engaging people meaningfully in the design, delivery and evaluation of care and support is intuitively right to ensure it works in the best way possible. But services are often bad at this and genuine coproduction with people as active partners in their care is challenging in practice. This is an ongoing journey in social care, but there is growing evidence of the benefits.

2. Culture over process - personalisation is primarily an ethos requiring profound cultural change and different ways of thinking and working, but getting bogged down by process is easy to do. Much of the early story of personalisation in social care revolved around protracted efforts to devise the perfect method of resource allocation, with very mixed results. Getting the process right is important - but shifting the culture of care should be the primary goal.

3. Evolution not revolution - it is impossible to shift culture overnight and immediate change risks destabilizing things that are working well. There have been benefits to urgency and a place for targets in the social care story, but the transformation envisaged was always going to take a generation to deliver and the same will be the case in health.

4. Create a common language - the proliferation of different terminology surrounding personalisation in social care has caused confusion. Agreeing a common, jargon free language will help convey the benefits to people, staff and the public. New ways of thinking may need new language, but being person-centred shouldn't require a thesaurus!

5. Build awareness - People with health and care needs should understand their rights, know what to expect and be able to explore the potential benefits of personal care and support planning and personal budgets. Insufficient attention was paid to building demand for personal budgets in social care, but there can be no stronger lever for change.

6. Information is the key - a lack of clear and accessible information and advice is always part of the problem when things don't go well, yet is rarely top of the list of priorities. Universal information and advice is an essential building block for personalisation and the Care Act presents the opportunity to build on the learning from social care and take a more strategic, joined up approach.

7. Social capital is not a sideline - personalisation has always involved a broader range of paradigm shifts than individualising funding, but some of these have had less attention than others in social care. The importance of focusing on building community capacity and recognising and strengthening people's social capital is integral to the model and should be built in from the outset.

8. Choice doesn't just happen - for personal budgets to deliver greater choice and control there need to be a greater range of options available. While markets do adapt over time to different purchasing decisions, commissioners have an important role to play in shaping what is available locally and working with providers to redesign services. This requires a different and more facilitative sort of commissioning - social care is only just starting to make this shift.

9. Get providers on board early - personalisation is not just about commissioning differently, it has significant implications for providers and how services operate. This means it is important that providers are part of how the change is planned and delivered. In social care this focus was not sufficiently clear at an early stage leading to unnecessary anxiety and services delivering more of the same.

10. Measure what matters - across the breadth of the agenda and starting from what is important to people with health and care needs rather than just measuring the things that are easiest to quantify. The social care experience has been instructive about the limitations of measuring culture change through the blunt instrument of personal budgets numbers. The Narrative provides a useful starting point.