Personalisation: giving people power to control their own care and have shared responsibility for achieving better health

In this briefing we will share some of the evidence we hold about the kinds of choices people want and how the power to choose can give people more control over their own health. We will highlight the positive impact of cases where people are currently given these choices and demonstrate that these choices are not currently always available to people. 

Our evidence shows that giving people flexibility and control over how they receive care leads to better patient experience. We also highlight how giving people the right information and technological tools can support people to make informed and empowered choices.

Yet people are not always aware of their right to choose healthcare providers or participate in shared decision-making about their own treatment. They are not always supported to take a lead in decision-making about their own care. Crucially, even when people are offered these choices, they are not always meaningful. A choice may exist on paper, but not be genuinely accessible to people. This includes examples where people are offered a choice of provider, but cannot access appointments at any of them. 

While personalised care and choice remain important to people, in many cases a baseline quality of care or access to services are more important than having a choice of provider. In many areas of the NHS, a laudable ambition to provide personalised care is not being delivered due to wider staffing shortages, for example in maternity care, where targets to provide universal continuity of carer were suspended due to staffing problems. Improving access to health services across the board should underpin NHS policy on personalisation and choice going forward. 

The key messages around personalisation emerging from our evidence review across all service areas include: 

• People want flexibility in appointment types, times, and type of professional. This is often not a matter of personal preference but essential to access due to communication requirements or work or caring commitments.
• People are open-minded about seeing different services or professionals, as long as they are informed about their options and these options are genuinely accessible. More could be done to increase awareness of alternative services like NHS 111 First.
• While choice in service provider is helpful, this is usually motivated by the desire to access care more quickly and is not meaningful if there are significant barriers to access at all possible services. Commitment to patient choice must be underpinned by improvements to access across the system.
• Continuity of care is more important to some than others but is essential in some areas like maternity care. Continuity of care does not always have to mean a single professional if there is a sense of a continuous service.
• Good communication and being supported to make decisions about their own care is the most important contributor to personalised secondary care, especially while long waiting lists for care are a reality.
• Making choices about their own care is empowering to patients, but these choices need to be meaningful. Private care is not a choice for many, and neither is being given the option of different providers if none have capacity to treat them.
• Online tools, such as referrals trackers or texting with GP practices can give people a more personalised and continuous experience of care, as long as they are joined up and two-way, allowing for escalation to live communication where needed.