Like many people I notice that the first section in a NICE TAG is on patient centred care – but I turn the page without reading it. I assume that I know what it says and I assume that I know what this means.
It is about time that we either kicked this phrase into touch or really did something about it.
Patient centred care should reflect some very simple principles or facts.
- The patient is the person that owns the disease/condition and is responsible for choosing their fate (within obvious limitations when certain choices may be detrimental to other’s health)
- Many treatments are not curative or do not significantly change the course of the condition. Many give symptomatic relief and often in situations where a change in lifestyle or life situation would give equal or larger benefits
- Health and wellbeing are seldom achieved purely through medicines. In fact many people would gain significant improvements in health and wellbeing through other means
- Medicines can make things worse and can cause a dependency, both psychological and physical that prevents a patient getting ‘better’
Having said this why do we continually put the GP as the lead role in many issues, the one responsible for creating the care plan and base everything on a GP registered list? I just don’t know. We seem to have to medicalise everything, believing that the GP and a pill have the answer.
I don’t want to reflect on Marmot and the WHO determinants of ill health or blame the government for the crazy policies. Norman Lamb said that while healthcare has improved it is the rich who are reaping the benefits. I am not sure about that while I am hearing the phrase ‘property rich, cash poor’, quite often describing older people living in their own home, but without the cash to keep them warm and well fed. And I am sure that poverty is increasing and people are finding it harder to live an acceptable life.
Marmot tells us we need to focus on education, housing, management of access to unhealthy foods and social security protection as key. But I would like to add to that safety and social isolation. I am sure that you can add a few more.
So does that mean that the local authority should really take the lead, bringing in local service providers including fire and police and the very important third sector organisations to make sure that people have the ability to make the right choices and appropriate support to enjoy health and wellbeing? Would this create a social care model around individuals and communities? Should we then add in practice nurses, community pharmacists, optometrists and dentists to manage long term conditions and common acute conditions? The GPs would act as general consultants working in a seamless team with specialist consultants and delivering out of hours and emergency care?
I know that it is all too easy to prescribe a pill and ignore the determinants and causes of that illness. Sometimes there is just no wonder that the pills don’t work.
If you work in public health within a local authority – then this is a subliminal message – you are leading the revolution – just waiting for you to start!