The NHS Long-Term Plan sets out a commitment to rolling out the comprehensive model for personalised care so that it reaches 2.5 million people by 2023/24 (NHS England and NHS Improvement, 2019). This model aims to support a more individualised approach to health care by reframing the relationship between people/patients and clinicians. It advocates a better balance between ‘what's the matter with you?’ and ‘what matters to you?’. It focuses on wellness, not just illness, and the social determinants of health. Although personalised care is not new, by drawing together different approaches—shared decision-making; personalised care and support planning; supported self-management; choice; social prescribing and community-based approaches; and personal health budgets, the model seeks to fundamentally change the way that care is planned and delivered (NHS England and NHS Improvement, 2019).
Personalised care helps a range of individuals, from those with complex needs to those managing long-term conditions, mental health issues, or struggling with social issues that affect their health and wellbeing. It helps decision-making about managing health, so people can live the life they want to, working with information from the professionals who support them. It represents a fundamental shift in the traditional patient–clinician power balance.
Nurses are professionally bound to deliver personalised care. The Code (Nursing and Midwifery Council, 2018) states we should prioritise, listen and respond to people's preferences and concerns and in doing so:
The Royal College of Nursing (RCN) (2019): advocates: ‘Being person-centred is about focusing care on the needs of the person rather than the needs of the service … [People] have their own views on what's best for them and their own priorities in life. So as health care workers, we have to be flexible to meet their needs—we have to make our system suit them, rather than the other way round.’
Many nurses strive to give great personalised care. However, system or structural barriers may prevent them from doing so. Evidence from national patient surveys suggests that people do not always feel involved in their health care, and this can lead to a mismatch in the clinician's and the individual's agenda. The General Practice Survey showed that 60% of people with a long-term condition had not had a conversation with a health professional about what is important to them when managing their condition(s). Of these, 40% did not have an agreed a plan with a health professional to manage their condition(s) (NHS England, 2019a).
Evidence also suggests that what people/patients want and what clinicians think they want can be very different (The King's Fund, 2012). Better conversations that balance the power dynamic and address what is important to the individual, as well as what is wrong with them, need to be had. This requires knowledge, skills and confidence which nurses do not always develop in pre- nor post-registration education and development. There is an expectation that nurses should deliver personalised care, but the infrastructure to enable them to do this isn't always there. Universal Personalised Care (NHS England, 2019b) sets out to address this in several ways. It includes training programmes to develop professional skills and behaviours so that 75 000 health and care staff will be trained by 2023/24 to use the approach. We will be offering a range of learning opportunities which nurses will be able to access from April 2020. We are also working to support the system infrastructure, so staff are better able to put skills and behaviours into practice in an environment which sustains personalised care.