1. Developing people powered health care: some experiences from the NHS
Paul Corrigan
Future Health Summit
May

2. Developing people powered health care: some experiences from the NHS
The success and the problem of the British National Health Service
The success and the problem of medicine
The changed nature of the burden of disease Long term conditions and aging
What is different for patients with long term conditions
Why do we mean by people powered health?
Different parts of the NHS with different needs of people power
Problems of implementing people powered health
Some mechanics of people powered health
Technology in our lives technology in health
The material argument for patient powered care will win where the moral one doesn’t

3. The success and the problem of the British National Health Service
69 years of the principle of equal access for all free at the point of need as the guiding driver of the NHS
Problems with access and money but mainly loved by the public
But the 1948 paradigm of a centrally organised service created within a social democratic paradigm has NOT been one that involves the patients
(Our models of nationalised industry created at the time did not have any workers influence. They were state owned top down models)
There has been very very little patient influence either on the health service as an organisation and also little experience of services that the empower patient as consumers. Given the nature of the organisational form patients are less empowered in the NHS than consumers are in most other industries

4. The success and the problem of medicine
Medicine as a practice and as a branch of knowledge has been is immensely successful
It has done so by pursuing knowledge and practice with little thought of how that knowledge might be shared with patients. Researchers and doctors develop knowledge by talking with each other in a black box.
Progress has only involved patients as passive recipients of the service without much transfer of knowledge. This paradigm of knowledge and practice has saved millions of lives
BUT This practice about how this works makes the knowledge at the core of medicine very difficult to share and most doctors see little point in the struggle to do so

5. The changed nature of the burden of disease Long term conditions and aging
The nature of the disease that health services have to deal with has changed from ones that could be treated episodically to one that needs long term condition management.
Much of this is caused by people living longer and being ill in the last 15 years of their lives. In the UK 50% of over 75s have 2 or more long term conditions
But there are also new long term diseases that are the result of successes in acute care. Heart attacks do not kill as often and people then have heart disease for decades. More than 50% of people survive cancer and then live for decades with a greater chance of re- emergence. These are now long term conditions
Our health services have to change their orientation to deal with very different diseases that people don’t ‘recover’ from
Two thirds of NHS resources are spent on Long Term Conditions
An aging population means an increase in demand for health care every year and across the world there is not the medical staff to treat all this new demand in the way in which the old demand has been treated.

6. What is different for patients with long term conditions?
Asthma, diabetes, arthritis, Lung trouble, dementia, high blood pressure depression,
By definition you have them for a long time and therefore over time gain knowledge about your body and mind
The have are social, psychological and physical medical aspects
You have them all the time – 5800 waking hours a year
Unless you are very ill you will see the health service for at the most for 10 hours a year
For nearly all of the time you self manage your condition BUT mainly you don’t do it very well
We need to increase the productivity of those 5800 hours in improving you, your family and your communities capacity to self manage

7. Why do we mean by people powered health?
Improving the capacity of patients with long term conditions to better self manage their conditions
In England this is 16 million plus people
This needs a recognition by the health services and the medical staff who work with patients with long term conditions the power has shifted to the patient and their self management. If they self manage well, the health service can survive and thrive the increased demand from older people with co morbidities.
If most patients self manage badly the health service cannot survive.
The task of a health service and of medical professions is to use the time that the health service have with the patients to invest in improving the patients capacity to better self manage.
To make better self management work the medical staff need to uncover motivation as a set of assets to be invested in.
And to assume that having a condition which can be better managed provides some motivation.
To move from the tradition What is the matter with you? to What matters to you?

8. Different parts of the NHS with different needs of people power
After the patient has been diagnosed with a long term condition the motivation of the patients is very different from the moment before.
I am shocked to be ill what can I do that you can help me with. (before that moment I will never get ill)
At that moment you want to be able to discuss what to do for a long time. The doctor has 7 minutes and you are frightened of them
At the moment of diagnosis discussing what this disease means with some like yourself for an hour is very useful (Peer to peer discussion)
After a while when you are self managing discussing with a group is useful. (Expert patient groups)
If you have survived an acute episode how do I better live my life to ensure no recurrence (group consultation not individual)
Long term management needs community support from the full range of voluntary organisations (social prescribing)

9. Problems of implementing people powered health
Health services are provided in fragmented episodes which do not understand the whole person. If you have three co morbidities you will probably have three consultant specialists. Each of these will own the patient with little thought of the other conditions. If there is a fight for ownership it is between them and NOT with the patient, their family or their community
Sharing information between services is legally and technologically very hard
Each physical disease is treated with no understanding of the psychological and each psychological disease is treated with no understanding of the physical. Neither has any understanding of the social
Each specialist sees the patient as a deficit with no idea of the assets they, their family of their community may have
Listening and negotiating with patients is thought to take much more time than telling patients, and there is no time
Nearly all medical staff assume that they have nearly all of the knowledge so why listen and negotiate with the patient.

10. Some mechanics of people powered health
Patient Activated Measurement (PAM) How capable are you as an individual in being active in your own care. How can we over a year increase your activation measurement.
Shared decision making
Social prescribing
Peer support . How do we help to organise patients who have experienced the disease to better support patients who have just been diagnosed.
Self-management investment/education Everyone self manages their disease and most do it with a weird mixture of folk memory, family and cultural ideas, and hit and miss internet. Education can transform capacity to manage better without emergency care
Health coaching/ trainers.
Group activities to support health and wellbeing
Asset-based approaches in a health and wellbeing context

11. Technology in our lives:- technology in health service
Most of the public (and most people who work in the health service)live much more technology enabled lives outside of the health service than within it. They personal lives depend upon new technology for their organisation
The front end of modern software can be shaped around who you are so that you are enticed to use it and to work with and through it (Gamification)
Modern software can learn from you personally the more that you personally use it (Amazon know what books I want to read in July more than I do)
There are thousands of apps which work but are rarely linked to the health services IT

12. The material argument for patient powered care will win where the moral one doesn't
For years people have argued morally for aa more patient centred NHS and this has been policy for some time. Patients should be in charge
But organisation and medical practice still hold power in health and organisational practice
Given the proportion of health resources now spent on long term condition and the growth of that need and demand for the next few decades
Given the fact that self management is the main method of working with those conditions
Either health service staff and organisations recognise this change in the organisation of care and invest in self management and a changed NHS will thrive OR
The change is power is not recognised and the NHS will never have enough medical resources to meet the need and it will fail.
This is a material not an ideological issue.

13. Further reading
The biggest English patient groups (Macmillan, Diabetes UK, Age UK, Red Cross etc ) all work as a single group on a number of issue. They have come together to work with the NHS in improving patients capacity to self manage . The URL is
Over a number of years I have worked with pplconsulting on people powered health. They have expertise both in making the case for improving the capacity of patients to self manage and on carrying out that activity.
investment-case-for-person-and-community-centred-care-approaches