1.35. When the NHS was set up seventy years ago, the first choice patients were offered was which GP practice to register with, and that choice continues In the intervening seven decades, informed consent and changing social attitudes have significantly expanded the choices and control that people have over their own care – from maternity to end-of-life. And in the 2000s the NHS successfully extended patient choice to elective care, so that people could choose where and when to have their outpatient appointment or planned operation. As set out in Chapter Three, as part of a renewed focus on short waits for routine operations, patients will continue to have choice at point of referral and anyone who has been waiting for six months will be specifically contacted and given the option of faster treatment at an alternative provider, with the NHS money following the patient to fund their care.
1.36. Advances in precision medicine also mean treatment itself will become increasingly tailored to individuals, and patients will be offered more personalised therapeutic options. For example, this summer new research showed that, based on their tumour genetics, thousands of women with breast cancer could now avoid chemotherapy. And this autumn the NHS became the first national health system in Europe to give the go ahead to a breakthrough cancer treatment based on modifying a patient’s own CAR-T cells. Chapters Three and Six set out how the NHS is going to be capitalising on further opportunities like these.
1.37. But the NHS also needs a more fundamental shift in how we work alongside patients and individuals to deliver more person-centred care, recognising – as National Voices has championed – the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes. Creating genuine partnerships requires professionals to work differently, as well as a systematic approach to engaging patients in decisions about their health and wellbeing. We will support and help train staff to have the conversations which help patients make the decisions that are right for them.
1.38. For many health conditions, people are already taking control themselves supplemented with expert advice and peer support in the community and online. As part of wider move to what The King’s Fund has called ‘shared responsibility for health’, over the next five years the NHS will ramp up support for people to manage their own health . This will start with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support, and online therapies for common mental health problems.
1.39. The NHS Comprehensive Model of Personalised Care, developed in partnership with over 50 stakeholder groups, is now being implemented across a third of England. By September 2018, over 200,000 people had already joined the personalised care programme and over 32,000 people had Personal Health Budgets (PHBs) – nearly a quarter of which were jointly funded with social care. We will roll out the NHS Personalised Care model across the country, reaching 2.5 million people by 2023/24 and then aiming to double that again within a decade.
1.40. As part of this work, through social prescribing the range of support available to people will widen, diversify and become accessible across the Link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then.
1.41. We will accelerate the roll out of Personal Health Budgets to give people greater choice and control over how care is planned and delivered. Up to 200,000 people will benefit from a PHB by 2023/24. This will include provision of bespoke wheelchairs and community-based packages of personal and domestic support. We will also expand our offer in mental health services, for people with a learning disability, people receiving social care support and those receiving specialist end of life care.
1.42. With patients, families, local authorities and our voluntary sector partners at both a national and local level, including specialist hospices, the NHS will personalise care, to improve end of life care. By rolling out training to help staff identify and support relevant patients, we will introduce proactive and personalised care planning for everyone identified as being in their last year of life. A consequence of better quality care will be a reduction in avoidable emergency admissions and more people being able to die in a place they have chosen.
17. Ham, C., Charles, A. & Wellings, D. (2018) Shared responsibility for health: the cultural change we need. The King’s Fund. Available from: https://www.kingsfund.org.uk/publications/shared-responsibility-health