Following on from her last blog on the importance of Person Centred Care, our Programme Manager Brook Howells continues the series by looking at how we’ve been working with members to implement this approach, and why the NHS has struggled with it in the past.
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| Brook Howells, AQuA Programme Manager |
AQuA has been working with clinical teams across the North West to support improved Person-Centred Care (PCC) for a number of years and, has seen a subtle but significant change in the challenges we face.
Previously, we focused on helping people know what choices were available and giving them opportunity to be involved in that decision. We now recognise that in the majority of cases, where there is a simple choice between two comparatively similar options, clinicians are very good at providing the detail and making sure the right treatment for that individual is selected. The challenges arise when risk becomes a more significant part of the equation.
The prevailing culture in the NHS of ‘do no harm’ and to some extent the attitude of always-put-a-brave-face-on-it, often combine to make us shy away from conversations about potential problems; be they painful side effects or the possibility that a cure cannot be found.
This reluctance to discuss the negative aspects of healthcare, or ill-health in general, make it difficult to have an honest conversation about choice; one in which we talk about both the risks and benefits of each option available.
Risk is a tricky concept in itself to discuss; we can only give an idea of the probability of something occurring, and we cannot know how significant that probability is to each different individual.
Where one person might be quite happy to take a chance on a treatment that has a 25% risk of a side effect, another may opt against even a 1% risk of harm. It is all personal and relative to the situation; and that is exactly why we need to get better at talking it through with the very people who will be affected; the patients.
What makes this task harder is the sense that governance structures can sometimes prevent us from allowing any sort of risk to be taken. Governance exists to help us achieve our primary aim (to get people better and keep them safe), but we need to bear in mind that to deny someone their autonomy – their right to decide what happens to their body – is just as much a cause of harm as the more obvious problems like not preventing a fall or the spread of infection.
To this end, much of the work AQuA does with teams now focuses on helping them to see where their responsibilities lie, and how Shared Decision Making can actually help them fit within governance; whilst still giving patients autonomy and personalised care.
We help people to understand the Mental Capacity Act and how it supports people to make decisions, as well as giving healthcare professionals confidence, to allow people to take risks and to offer up all the options, not just the safest ones.
This is no easy feat and it requires a much greater shift in mindset than just remembering to tell people about each option, or to hand out an Ask Three Questions postcard. We still advocate both those things; we just appreciate that there is a lot more to supporting Shared Decision Making and therefore a lot more work to be done.
You can share your thoughts with Brook on Twitter via @BrookH_AQuA or @AQuA_NHS, or feel free to leave a comment below.
In our next blog, our other Programme Manager Rachel Bryers looks at implementing Person Centred Care in practice, and its implications around the Mental Health Capacity Act.
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