The tools of choice in person-centred care

Print 06 March 2017
Linda Banks / Deep Dive

The tools of choice in person-centred care

NHS England’s chief executive, Simon Stevens, recently stated that focus must be put on care in the community and in the home to tackle the huge deficits facing NHS trusts. Here Sir Jonathan Asbridge, Clinical Director of Healthcare at Home and President of the European Society for Person Centred Healthcare, explains to pharmaphorum’s Linda Banks how such a shift to ‘person-centred’ care can help health services and pharma manage finite budgets and improve outcomes.   

As the Government’s former ‘tsar’ for patient experience, and with a long career built on the front line of nursing, Sir Jonathan Asbridge knows the problems the health system faces first-hand – but also what changes can be made to care to make a positive impact.

He prefers the term ‘person-centred’ over ‘patient-centred’ when defining such care, saying, “It’s about building services around individual people, making the person the centre of all the activities that we undertake.”

Healthcare at Home specialises in person-centred care and bringing clinical services directly to people in their own homes. Beyond this, it also builds services around the clinicians who are providing care, because, as Sir Jonathan points out, they are people too. This means supporting them with specialist relationship training.

Sir Jonathan expands on the various services offered, which he believes can help both patients and the NHS: “One is dispensing specialist, life-changing and life-enhancing medicines, which we then deliver to patients’ homes. This includes providing medicines to patients who require education and training to ensure they take their medicines correctly, and ensures they are motivated to stay on therapy. Adherence and persistence represent a very important component of our person-centred approach.

We also provide comprehensive medical services to patients with cancer in their own homes, including chemotherapy

The third strand of care involves working with patients and people to prevent them being admitted to hospital by providing acute nursing rehabilitation in their own homes, or shortening the length of time people stay in hospital by providing the same care in their own homes, when it is safe to do so.

Of the 150,000 patients supported each year, across 50 therapy areas, most come to them via consultant referral, with some GP referrals and others from clinical nurse specialists.

Sir Jonathan emphasises the importance of seeing patients as people first. “The people we serve are individuals with various conditions, which means they need support to live their lives as they wish to live them,” he explains. Therefore, services must be designed to help them do that, whether this means supporting them to rehabilitate from an acute illness at home, to receive their cancer treatment at home, or to remain at home when the only alternative is hospital.

“They’re not passive patients to be done to, but individuals who choose to use our services in ways that suit their needs, rather than having to fit around our services.”

Traditionally, decisions about treatment and care solutions for patients were made by the clinician – the nurse, the pharmacist, the doctor. Now, although healthcare professionals are recognised as experts in therapy areas, it is generally accepted that patients know their condition better than anyone else, he asserts. 

“We need to listen to their narrative, so we can help them and support them to make choices. People who have their story heard can make much better decisions on the service they need and then our interventions are more effective too.”

Joining up services between hospital and home brings many benefits for patients, the health service and the pharma industry (see infographic), improving adherence and health outcomes, streamlining processes, reducing time in hospital and offering data and real-world evidence so that clinicians and the pharma industry can improve treatments and prove value.

Putting the individual in the driving seat and taking evidence-based practice across the doorstep, into people’s homes, means people are supported to make choices and put their own care package together. They, and their families, find it more convenient and those with rare diseases or long-term conditions usually prefer the option of being in the comfort of their own homes, Sir Jonathan points out.

We can go to the workplace and provide treatment in the lunch break or at another time that is convenient

Healthcare in the workplace

As collaborators with the NHS, which values offering people choice, another aspect of care is the provision of therapy for people at work. This means they don’t take time off sick and, in many cases, keep their jobs, avoiding poor sick records or having to take holiday days for hospital treatment.

“We can go to the workplace and provide treatment in the lunch break or at another time that is convenient.”

Similarly, children can be visited in school for treatment. They are not forgotten in the home setting either. Sir Jonathan recounts how this is making a positive difference in the life of a little girl called Kimberley: “Previously she couldn’t get a gold star for attendance at school but, because we now provide her with therapy at home, after school, she has just received the gold star, which was very important to her. We were delighted to help her achieve that.”

Wins for pharma

Sir Jonathan sees specific benefits for pharma too, believing that it makes business sense for the industry to focus on person-centred care to drive health outcomes.

He describes clinical care in the home as “a unique patient interface” that is an ideal – and unique – setting to nurture effective engagement.

“It’s much more difficult to gather data from 29 patients on an inpatient ward, for example,” he points out. “Providing services to people as individuals over a long period on a one-to-one basis ultimately helps with research, evidence of medication efficacy, as well as improving patient outcomes, which support market access and reimbursement.”

Pharma can partner with them to co-design person-centred services, which are proven to increase activation and adherence, as well as providing valuable insights along the way. Healthcare at Home provides coaching and motivational support to patients to help them understand the value of the medication that they are taking. This represents real value to the industry as, through their patient support programmes, they help people understand and manage any side effects, comprehend how their medication works and why they need to take it in a certain way. They also monitor their choices, which, Sir Jonathan says, results in patients staying on treatment for longer, less medicine being wasted and better adherence.

“While developing tailored patient support programmes,” he says, “We can be ambassadors for the industry – not because we’re selling pharma, but because we’re able to have dialogue with individual people about their experiences and the impact of the medicines that they’re taking as part of an overall person-centred therapeutic regimen.

“We’re at the forefront of providing not only the best care for the patient, in a way that they choose, but also collating patient insights and building real-world evidence, which we can feed back to industry so it can continue to modify therapies and treatments.”

Working so closely with people also means they are on the front line with adverse event reporting, taking on the regulatory responsibility of pharma companies when dealing with their patients. “Our programmes have the potential to support the product journey from the clinical trial phase all the way through to administration or real-world implementation,” Sir Jonathan affirms.

He believes collaboration is essential for pharma to design services and solutions with patients in mind. “We provide the glue between different healthcare organisations and other stakeholders. As an independent provider, we cross all those boundaries and siloes. Often, we are one of several organisations building a service around an individual person and I am keen that we are a role model in those circumstances, helping other providers see the benefits of always putting the person’s wishes first.”

While the overarching goal is delivering person-centred care, Sir Jonathan notes the increasing importance of demonstrating value, in terms of patient outcomes and cost saving. Evidence is growing that shows providing clinical care in the home in partnership with health services like the NHS can help prove that value.

“You don’t just abandon someone with a load of information; you sit alongside them and support them to make choices and take actions which really will help them live their lives. With this foundation at the heart of our approach, we can assist people individually, while also bringing so many wider benefits to society,” he concludes.

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