COVID-19: Personalised care in a time of crisis

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Jun 10 2020 Blogs

The ‘nice-to-have’ that is now more important than ever.

Person centred care is often seen as a ‘nice to have’; something to focus on when pressures are lower, or a system is working at its most efficient. Something that can be de-prioritised in times of crisis. This is perhaps because the benefits are hard to quantify, making it hard to get buy in, or because there is no easy-win or quick fix; in simple situations it is easy to be person-centred but when it gets complicated there are many challenges to overcome. However, now more than ever, we need to make sure we are not forgetting our person-centred principles and working in partnership with our patients and their families.

So we need to take the most compassionate route, to be open and honest with people and to work with people, not against them. We need to engage with patients and their families about the risks and benefits of treatment, for themselves and for their loved ones. To ask what matters most. When we are asking everyone to keep their distance physically, we need to make sure that we are not also asking people to keep their distance emotionally. These are difficult conversations and they are important conversations; for helping people feel connected and supported, for helping healthcare professionals make the right decision with each patient. We need to support patients to have these conversations with healthcare professionals, and we need to support the healthcare professionals too.

The new normal

As we begin to see the light over the peak, healthcare – just like every other part of life – needs to find it’s “new normal”. Let’s use this an opportunity to make person centred care a truly central part of that new normal.

In all those cases where treatment has been postponed I hope that those patients have understood they are not forgotten, that their patience is part of the fight. All around the country people still need care and support and as the crisis begins to ease we can make sure they get the best support and care for them. As we plan to restart treatment for all these people, there is a need to make sure we are providing the best, most appropriate care for everyone, using NHS resources as efficiently and effectively as we can.

People who were previously self-managing their health and conditions with confidence may feel vulnerable (not least because they have been labelled so) and helpless. In the midst of the crisis I spoke with a cystic fibrosis specialist nurse who said they were receiving four times as many calls as normal, from patients worried about what to do, how to cope. She reassured them that they are well practiced for this; they are good at looking after their own health and preventing infections and this is no different. This is why we need healthcare professionals to help people recognise their own strengths and assets, to keep people feeling confident and well, and to manage their own health.

Services won’t be going back to the same way of working we had before and in many cases that is because we have developed a better way. We’ve had the courage to try something out and it has worked. In other cases we will be changing practice to include social distancing measures, to reduce the risk of transmission for all staff and patients. Through all this, we need to make sure we don’t lose the human touch. Especially as services move to virtual clinics to reduce the risk of infection. We might be staying two metres or two computer screens apart but we can still be personalised and caring.

Lockdown helped to keep the NHS from breaching its critical care capacity, now we need to start turning our attention to the NHS’s capacity for routine and elective care. It is going to be stretched, even more so than usual. Treatments that were previously on offer might be taken off the table, especially if they are considered of low clinical value, whilst waiting times for other procedures will be protracted. There is a risk that people will feel like they’re getting short-changed; we need to make sure that this is not their experience. We need to work with those people to develop a plan together.

Many people might be happy to get whatever they can given the circumstances; the same people that gladly accepted whatever groceries were available and did not worry that their usual preferences weren’t on the shelves. Having a different brand of soup for a week is quite a different sacrifice to accepting care that isn’t the best for you. We can have honest conversations with people about waiting times and capacity (just as many healthcare professionals were doing daily before coronavirus struck). There is a risk that these people will unwittingly get short-changed and we need to make sure that is not their experience. We need to encourage open and honest conversations about their preferences, priorities and needs. We need to work with those people to develop a plan together.

Some people will be anxious about contracting coronavirus and so will be nervous about any treatment that requires them to attend hospitals or clinics. We need to reassure them of all the procedures in place to protect them, but we also need to let them know that it is ok to request a delay on treatment for now. It is completely reasonable to say the balance of their preferences and values has shifted, and what was once deemed the best treatment for them now comes with an unacceptable risk. We can help those people to look at alternative options, and to consider how they can keep themselves as well as possible until the risk from coronavirus is no longer a worry. We need to work with those people to develop a plan together.

For all these people, whatever the treatment option chosen, there will be new ways of working in the NHS that we need to support people to embrace. Whether it is behaviour change to support better long term condition management, to prevent coronavirus transmission, or to ensure a swift enhanced recovery, we need to acknowledge that behaviour change is not easy. Any change requires effort and support. There are important decisions to be made and we need to share in that decision making with the people themselves.

Supporting self management and shared decision making are not new skills to the NHS. At AQuA we have worked with hundreds of healthcare professionals to help them improve their person-centredness and it is always the same challenge; the people are willing and able to be compassionate, considerate and caring. It is the system that gets in their way. I hope that in this time of crisis the professionals’ care can shine through and who knows, perhaps we will see some great innovations and revolutions.

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