The way we’re supported to manage our health is changing, fast. That much was made clear in the NHS Long Term Plan, published last month, which set out a blueprint to make the health service “fit for the future” by combining the latest tech. with a renewed focus on prevention to save an additional half a million lives.
One of the most welcome elements of the Long Term Plan is a pledge to make a comprehensive model of personalised care “business as usual” across the NHS. One-size-fits-all approaches are rarely the most effective when it comes to population health – and will no longer be the norm as health professionals prioritise what matters most to each person when making care decisions, allowing individuals to play a more active role in managing their own health.
According to the Long Term Plan, a comprehensive model of universal, personalised care comprises six key components:
- Shared decision making
- Enabling choice
- Personalised care and support planning
- Social prescribing and community-based support
- Supported self-management
- Personal health budgets and integrated personal budgets
The rationale for greater personalisation is clear: more than 40% of people want to be more involved in decisions about their care. Only around half (55%) of adults who live with long term conditions such as diabetes feel they have the knowledge, skills and confidence to manage their own health and wellbeing on a daily basis.
Giving people more of the knowledge, skills and confidence they need to manage their health improves their “patient activation”. Individuals with a higher level of activation, typically gauged by Patient Activation Measure (PAM) scores, are more likely to benefit from health interventions, adopt healthy behaviours, and see positive health outcomes and lower costs to their health economies.
Research by the University of Oregon suggests the annual cost differential between a patient who stays high in activation and one who stays low in activation over a 12 month period, once demographics and health status are accounted for, totals $2,000. That’s a 31% difference.
For our part, we’ve learnt at Changing Health that what’s absolutely fundamental to improving our service users’ activation, shaping healthy lifestyle behaviours and ultimately, preventing Type 2 diabetes at scale, is to make it simple. That means guiding people to fit positive changes – such as aiming for 10,000 steps a day, reducing carbohydrate intake, whatever they need to do – into their own existing routine.
But of course, everyone’s routine is different. That’s where the psychology is crucial; to facilitate change, you first need to understand which behaviours you’re trying to change and what kind of behaviours they are. Helping somebody to avoid an intentional unhealthy behaviour, underpinned by a certain attitude – “I know I shouldn’t have that cake at the coffee shop, but I’ll burn it off later!” – requires a different approach to helping them break out of a habit – eating lunch on the go each day – because the two behaviours are undertaken at different levels of awareness.
Gaining a thorough understanding of each Changing Health user’s own individual behaviours, then offering personalised lifestyle recommendations, is how we make long-term behaviour change sustainable for each person.
The outcomes speak for themselves. In a trial of digital behaviour change programmes for Type 2 diabetes management conducted by the North West London Collaboration of CCGs, a personalised approach increased Changing Health users’ PAM scores by an average of 10 points. That equates to a 20% lower risk of hospitalisation and 20% greater medication adherence, alleviating the strain on scarce healthcare resources in an area of the UK with a diabetes population of around 130,000.
As the NHS rolls out this new model of care across the health system, millions of people stand to benefit. Individuals will enjoy a more positive experience with their healthcare provider and improved quality of life. Clinicians will, research suggests, see improved job satisfaction. Health inequalities, meanwhile, are likely to fall as people in areas with greater socioeconomic challenges, who are more likely to live with long term conditions and stand to benefit the most from improving their activation, gain a better understanding of their health. These are exciting times.
Meet the author John Grumitt, Changing Health Chief Executive, on our team page. Attending Diabetes UK Professional Conference 2019? Come and say hello at stand F42, and pick up a white paper on the psychology of lifestyle interventions, personalisation and Type 2 diabetes.