For ever and a day we have talked about the NHS moving to a model for real person-centred care. Most of us in the NHS, and wider related sectors, understand the value that it would bring and the opportunities it would enable for a better health outcomes and happier lives. However, the reality is that we currently still work within a system that reinforces (and even rewards) organisational focus and fragmented care experiences.
With a future of formalised Integrated Care Systems on the horizon, we have an opportunity to actually start the shift to a person-centred approach. An approach, that bases wellness choices on the entirety of a person, and their individual needs and wants, rather than based on how our organisations are set up.
Core to understanding people as individuals, as well as providing opportunities for personalised care, will be Tech Enabled Care.
Done well, technology enabled care (TEC) offers us opportunities to positively disrupt how we currently deliver health and care. It provides us with opportunities to create learning relationships based on dialogue and partnership rather than the transactional ‘done to’ approach we have now. It opens up new ways to communicate, new timely data from which to make decisions. It can help people feel more in control of their own health destiny, support care in the best location for them and more. To fully activate the potential of Tech Enabled Care there are a number of things we are considering in Norfolk and Waveney ICS.
We cannot deliver person-centred care by fragmenting the digital solutions people are offered by organisation or pathway. This has to be something that is supported and coordinated at system level, around the person. We can not think about what TEC can do for prevention and then discharge and then certain diagnosis separately. Doing it that way will lead to one person being given a multitude of devices from different parts of health and care and be utterly overwhelmed and inefficient financially.
In Norfolk and Waveney, we have a new citizen digital group that aims to bring together all the key people working pan public sector to look at the potential of TEC and make sure we are coordinated and considered in our approach.
Tech can be massively enabling but it can also be excluding if not done properly. Most of the technology we have currently enabled in the NHS is actually creating digital divides and excluding the people that are most at need. If we roll out new TEC without active consideration of those that will be digitally excluded we will create further inequity in health outcomes.
As inspired by the work of mHabitat, I would love to see at least 10% of every digital health project assigned to ensuring we are being digitally inclusive and that is an aim we are working towards as part of our wider Digital Inclusion approach.
Co-production has become a real buzz word in the world of public services but like all things, we know we need to do it, and in some cases are trying to do it, but mostly not doing it well at all. This is because, once again, we take an organisational lens to co-production. We ask people to come to us, to answer our questions, to test our ideas and by nature of that process we limit who can engage and exclude diversity of thought and therefore limit the possibilities.
True co-production involves going to where the people are, where they feel safe, building relationships and trust, actively listening and, most importantly, being open to what comes out as the need and working to get as close to that as possible rather than doing your own idea anyway. We are working across the system to build up our co-production capability and grow more equity of voice into our work through ideas like paid digital patient, or lived experience leaders.
Person-centred care needs a shift of thinking from our current paternalistic medical model to one where the patient and professionals work together in partnership and dialogue. TEC provides the tools and means to help shift the relationship by providing new ways to capture information and communicate interactively but we need to build a workforce ready to embrace this new way. This comes through our learning and development practices but also via culture change and changes to the way in which activity is counted.
We are developing our Clinical Digital Network (CxIOs) to help foster this culture through their understanding and passion for digital and their want to make things better for their communities.
Finally, person centred care requires choice. People having access to options and being able to decide what works best for them to be able to flourish is core to success. Currently, Norfolk County Council are piloting the idea of a TEC Lending Library where people can understand the options available to them and trial different devices before the decide to use them or not. We are looking at how we could extend this to TEC across health and care giving people greater ability to find what works for them but also allowing us to constantly learn about the products that work and do not work and why.
The TEC landscape is vast, the options are plentiful. We are in the infancy of our journey around the potential of TEC and how it can support person centred care, but it looks like an exciting path ahead.