Consult and involve citizens to create more effective and sustainable healthcare services

23rd June 2015

Many would claim patients already are the centre of attention in our health systems. But for the most part, this is as passive recipients of care. It is time to end the lip service and support patients to be active partners in managing their own health and to start assessing quality of health services in terms of outcomes, not activity

While the idea of people-centred health systems may be embraced in principle, it is also regarded by many as a woolly and nebulous concept that is hard to pin down, make concrete, or put into effect.

But if it is far from clear what a people-centred healthcare system would look like, the objectives – of improving prevention and outcomes – are simple enough to grasp. Furthermore, the key ingredients – of community-based prevention and health promotion; empowered patients, public involvement in the development of health policies and programmes; and healthcare services that are accessible to all citizens – are acknowledged.

Establishing a people-centred health service is not a single one-off project, but a multi-stranded, long-term programme, to recalibrate systems, shift the balance of power away from the bricks and mortar institutions and the professional bodies, and generate the will and the ability to change.

Perhaps the best place to start is by improving health literacy, both to enable citizens to articulate their views, to be involved in service design and planning, and to improve prevention and outcomes. The need is underlined by the fact that when there are equal opportunities for access, for example, free cancer screening, socioeconomic deprivation is a predictor of participation, with the lowest groups the least likely to attend. Yet prevention delays the onset of disease, reduces healthcare costs and simultaneously adds to economic growth, by allowing people to remain productive.

There is an existing model of effective prevention – in the level of attention that is given to the prevention and control of infectious diseases. The prevention and control of risk factors for chronic diseases deserves the same focus. A people-centred health system would prioritise prevention and improve health literacy to ensure the benefits are equitably distributed.

Cultural and behavioural change

Prevention is known to be cost effective. But there is a hurdle, in that it requires cultural and behavioural change. As a result prevention programmes take longer to play out than other measures. Now however, social media are providing new tools for delivering and personalising information and allowing people to make their opinions heard. This raises the prospect that cultural shifts could happen over shorter time frames.

A number of health prevention and promotion measures are known to be effective. There is an opportunity to use the power of social media to turbo-charge delivery and intensify the impact. At the same time there should be a focus on translating new research and epidemiology into policy formulation and behaviour change.

Health literacy and patient empowerment go hand-in-hand

A recent analysis of the impact of the EU Directive of Patients’ Rights in cross-border healthcare shows that while the systems are in place, there has been limited uptake of these rights. Given the Directive’s potential contribution to increasing patient empowerment – by providing a greater choice of healthcare, more health information and the easier use of prescriptions across borders, people should be encouraged to take advantage of these rights.

The Directive should also be promoted as a means to help member states in establishing more people-centred delivery, through the use of eHealth tools, sharing of heath technology assessments and the pooling of clinical expertise. While the Directive has opened up the possibility of creating transnational centres of expertise, more needs to be done to encourage this.

Discontinuity of care is neither people-centred nor cost effective

Across Europe there remains a discontinuity in healthcare systems in Member States, from primary care at one end, to district care and onto specialist care in university hospitals. The service delivery models layered on this linear structure are patently no longer appropriate to needs, being designed for the treatment of acute diseases, rather than the provision of all-round care for people with long-term conditions.

Evidently, there are structural rigidities and vested interests to be dealt with here, but putting the patient at the centre provides the inspiration and acts as the driver for reshaping service delivery.

This is not just about change for change’s sake, because people-centred is in fashion, but because these reforms can make Europe’s healthcare systems more resilient, responsive and cost-efficient. There are huge variations in costs and use of resources in the different tiers of health systems both within and between health systems. At the same time, health systems as a whole are acknowledged to be delivering at less than their full capacity. Configuring services around patients creates a logic for process improvements that do not require capital investment and which will enable healthcare systems to extract more value from available resources.

People-centred care also puts a different complexion on performance monitoring. Rather than assessing healthcare in terms of volume of inputs or the level of activity taking place in the system, it is judged by the quality of outcomes – which is surely the most appropriate yardstick by which to judge any service.

Promoting a shift from acute care to community care will reduce costs and improve outcomes. Furthermore, giving people a greater sense of ownership and participation in their own care makes them feel better. And there is a further advantage, in that people become more careful users of services, attending appointments and adhering to treatment plans.

Encompassing the carers and the volunteers

An existing body of evidence shows that listening to patients’ preferences and involving them in decision-making leads to better outcomes at lower costs. It is time to make a systematic effort to capture these benefits.

It will then be possible to go one step further, capturing a further benefit of people-centred community-based health delivery services, which is that they can encompass volunteers and unpaid carers, and help patients to access non-clinical services. The voluntary sector in many member states provides services and skills that sit alongside statutory provision, but because they are not part of the formal structure, patients may have difficulties in accessing them.

By facilitating the voluntary sector in making its contribution and supporting carers’ groups, people-centred health systems can promote the development of supportive communities, empower patients to manage long-term conditions and provide holistic care.

Health is for the people – it should be people-centred

What we have at the moment are provider-driven models of healthcare. While there are no clean sheets of paper on which to redesign healthcare systems, there is a common starting point for reform, which is to open up to enable citizens to participate and empower patients to take a more active role in managing their health. The people-centred principle provides the logic around which to structure coordinated and integrated services in which everything from health promotion to social care sits under the same umbrella.