In social care, attempts to create greater personalisation of services have included direct payments, individual budgets, person-centred planning and self-directed support. The primary aim of many of these developments has been to promote people’s involvement in the care and support they receive. The challenges of doing so are greater when the person has a severe intellectual or developmental disability or dementia, and in these cases it is often necessary to involve a close family member or advocate.
In health care, efforts are underway to improve the clinical management of long-term conditions by enhancing patients’ confidence and skills for self-management, and involving them in planning and implementing care. This usually involves careful elicitation of the patient’s view of his/her problems, concerns, values and preferences; sensitive sharing of relevant evidence-based information about treatment options and behaviour change strategies; discussion to find common ground and agree priorities; and the development and implementation of a mutually-agreed care plan. This can be challenging for clinicians because it reflects an explicit shift in control to the patient.
The Coalition Government has announced its intention to strengthen people’s involvement in their care by promoting shared decision-making. Effective shared decision-making requires:
- Access to balanced, evidence-based information outlining treatment or management options, outcomes and uncertainties tailored to the individual’s level of health literacy
- Decision support counselling to clarify options and preferences, either face-to-face, by telephone, or by electronic communication
- A system for recording, communicating and implementing people’s preferences, including patient access to medical records