Abstract
Personal and public involvement in healthcare provision has become an essential part of the governance framework of the National Health Service (NHS) today. Patient safety, quality, and responsiveness of care are the main priorities of national healthcare providers. Yet in practice, there are significant limitations to the introduction of a true patient- or person-centred approach, which will be described in this chapter. Two case studies have been included to illustrate the challenges to implementing a true person-centred approach in the NHS. The first relates to the Mid-Staffordshire Hospital Trust where hundreds of patients died as a result of sub-standard levels of care. The second focuses on a family's struggle to access a joined-up package of care for a Parkinson's disease sufferer in a primary care setting.
TopThe Origins Of Patient- Or Person-Centred Healthcare
The Health Foundation has traced the origins of person-centred healthcare and attributed this expression to psychologist Carl Rogers (1951) who used the term in relation to psychotherapy. In the late 1970s, the American psychiatrist George Engel promoted a bio-psychosocial model of health; that is a person-centred model of healthcare. It is not necessarily the definition adopted by the NHS today but it did put focus on the need for empathy and for the professional to be prepared to suspend judgment and appreciate the services user’s or patient’s perspective (The Health Foundation, 2013).
The World Health Organisation (WHO) explains that while there have been significant health improvements over the last century, despite increasing health expenditure and advances in health services, people are not really any healthier in body or mind and they are not on the whole any happier with the health services they receive. However, patient safety and quality and responsiveness of care should be a national health provider’s priority. In order to ensure a people-centred approach to healthcare within the governance framework of health services, the WHO has called upon governments to take into consideration the rights and needs as well as the responsibilities and capacities of all health constituents and stakeholders (WHO, 2007). The organisation thus prepared a framework for ‘people-centred health’ to ensure the inclusion of the patients themselves. The statement was endorsed by WHO Member States during the 58th session of the Regional Committee for the Western Pacific, held in the Republic of Korea in September 2007. Such a framework sets some general principles and guidance for countries to take policy reforms at the national and local level in order to ensure the provision of people-centred health services.