The evidence for personalised care

1. Shared decision making and self management
2. Social Prescribing
3. PHBs

 

The evidence base for personalised care continues to grow, demonstrating a positive impact on people, the system, professionals and finances. Shared decision making between people and clinicians about their tests, treatments and support options leads to more realistic expectations, a better match between individuals’ values and treatment choices, and fewer unnecessary interventions.

Personalised care also has a positive impact on health inequalities, taking account of different backgrounds and preferences, with people from lower socioeconomic groups able to benefit the most from personalised care.

Other highlights from NHS England include:

A recent systematic review of 73 studies of personal budgets in health and social care across the globe found “positive effects on overall satisfaction, with some evidence also of improvements in quality of life and sense of security. There may also be fewer adverse effects. Despite implementation challenges, recipients generally prefer this intervention to traditional supports”.

• From tracking over 9,000 people with long-term conditions across a health and care system, evidence has shown that people who are more confident and able to manage their health conditions (that is, people with higher levels of activation) have 18% fewer GP contacts and 38% fewer emergency admissions than people with the least confidence.
•  A literature review of over 1,000 research studies found peer support can help people feel more knowledgeable, confident and happy, and less isolated and alone.

For an overview of the evidence highlighted above, view this NHS England diagram 'The Evidence for Personalised Care'.

Shared decision making and self management

An individual’s participation in personalised care, and in particular shared decision making, is an essential component of its success. There is growing evidence that patient participation in discussions (that they fully understand) improves outcomes, and improves patient and staff satisfaction. It facilitates self-management and self-care and reduces complications. It is also a useful strategy for tackling over-diagnosis and over-treatment. Shared Decision Making ensures that individuals are (Hoffman, 2017):

1. supported to make decisions based on their personal preferences
2. more likely to adhere to evidence-based treatment regimes
3. more likely to have improved outcomes, and
4. less likely to regret the decisions that are made.

‘Prepared patients’ – those who are better involved in their care - have 18% fewer GP appointments. (The Health Foundation 2018.)

Shared decision-making is effective. Evaluations of various forms of shared decision-making show that it can lead to the following benefits (from Making shared decision-making a reality, The King's Fund publication, July 2011):

1. improved knowledge and understanding
2. more accurate risk perceptions
3. greater comfort with decisions
4. more participation
5. fewer patients choosing major surgery
6. better treatment adherence
7. improved confidence and coping skills
8. improved health behaviours
9. more appropriate service use.

However, we know that people can be reluctant to question clinicians because they: 

1. don’t want to take up a busy health professional’s time
2. don’t want to appear “difficult”
3. are embarrassed to tell us they don’t understand for fear of appearing “stupid”
4. want the clinician to tell them what to do.

We also know that 'health literacy' is an issue, and between 43 – 61% of the English working age population do not understand health information they are given (Institute of Health Equity/Public Health England 2015).

We consider how to 'change the conversation' here.

Social Prescribing - evidence of impact and cost reduction

Leeds CCG: Social Prescribing reducing A&E attendances and admissions

The cohort of patients supported by this service were more likely to consume GP based resources than attend accident and emergency or be admitted to hospital. Evidence from their risk profiles, and counts of activity back up this expectation. As a consequence the largest potential savings are likely to be in terms of GP time, rather than commissioner savings through reduced activity in the secondary sphere. This is especially the case for the cohort receiving social prescribing from Connect Well which has a much lower level of A&E attendances than the GP based cohort before intervention- 0.5 attendances in 2015 against 1.0. There is evidence in the consortium supported cohort that a long term, plan based social prescribing intervention can help reduce the number of A&E attendances.

Full report: Connect Well Leeds North Social Prescribing Evaluation

The Impact of social prescribing on demand for acute care in West Kent
A summary of report findings

February 2023 

Social prescribing schemes in West Kent have been found to significantly reduce demand on NHS acute care, especially A and E attendances, by up to 23%.

Four social prescribing schemes delivered by Involve Kent were analysed; data was reviewed for patient usage 6 months prior to the social prescribing intervention, and 6 months post, for 5908 people. View the findings in the full report here.

Building the economic case for social prescribing

National Academy for Social Prescribing

Dr Marie Polley, Dr Helen Seers, Olivia Toye, Todd Henkin, Dr Hannah Waterson, Dr Marcello Bertotti, Professor Helen Chatterjee

October 23

A review of 19 robust studies measuring the economic impact of social prescribing, using at least one of five methods (eg Social Return on Investment), provided good evidence of the potential cost savings associated with social prescribing. These included:

• An evaluation of a national social prescribing scheme which served 2,250 people at risk of loneliness reported a SROI of £3.42 for every £1 invested.
• The PrAISED (Promoting Activity, Independence, and Stability in Early Dementia) feasibility study generated SROI ratios ranging from £3.46 to £5.94 for every £1 invested, using a control group to accurately attribute this finding.
• The evaluation of City and Hackney’s social prescribing scheme conservatively generated an SROI of £3.51 for every £1 invested. The researchers estimated a potential SROI of £8.56 for the overall population of 2,000 service users.

Read the briefing report here.

Read the full report here.

Personal Health Budgets

• In a recent independent survey, 86% of people with a personal health budget said that they had achieved what they wanted with their PHB and 77% of people would recommend PHBs to others.
• PHBs in NHS Continuing Healthcare (CHC) have also been shown to achieve an average 17% saving on the direct cost of home care packages. Whilst we do not expect this 17% saving to be repeated in a system operating at scale, it creates a compelling case to change the approach to delivering CHC home care.
• A 2019 internal analysis of NHS Continuing Healthcare data showed that care and support accounts for 94% of PHB costs. 89% is direct personal care, activities of daily living and delegated healthcare tasks and support to achieve wellbeing outcomes. A further 5% is for the remaining care and support elements of the personalised care and support plan, such as physiotherapy, respite and other clinically approved initiatives.

We have a growing repository of case studies which you can view and download on our Case Studies page - if you have any to add, please get in touch with geh.cwpersonalisation@nhs.net. Thank you.

Contact us

For any enquiries about Personalised Care, please contact us here and a member of the Personalisation team will be in touch with you as soon as possible.
 

Personalisation in cancer care - Mary's journey

From Macmillan Cancer Care