What is Person-Centred Care?

Person-centred care is a fundamental principle of the caring profession. It essentially means that any care is focused on the needs of the individual, rather than the organisational needs of the service.

In previous generations, patients and people in care or hospital were content to sit back and accept whatever type of care was given to them, regardless of whether it actually suited their needs or not. Today most people have their own opinions of how they wish to be treated so any caregiver or organisation needs to be flexible and make the system suit the person needing care, rather than the other way around.

Policy makers at the NHS have been working to introduce the principles of patient-centred care for at least the last 20 years. And according to statistics, some areas have seen a marked improvement.

In cancer care, for example, 76% of patients undergoing treatment reported that this was fully explained and they felt involved with decisions and treatment.

However, not all sectors of the caring profession have delivered such positive findings, and with the difficulties of gaining accurate feedback from vulnerable patients, especially from those with mental health issues, it can be hard to evaluate where improvements can be made.

So let’s examine the principles of person-centred care and find out why it is so important to work in a person-centred way.

What is person-centred care?

Person-centred care is one of the fundamental principles and standards of care as laid down by the Care Quality Commission – the independent regulator of health and social care in England.

There are 13 principles in all and they all need to be implemented when working in care or the health profession. They are all equally important and are as follows:

Person-centred care – all treatment or care must be suitable for the patient’s own individual needs and preferences. This should be in their best interests and not be implemented solely to fit in with the structure of the organisation.

Dignity and respect – this is a fundamental human right that ensures that everyone using the service is treated in an equal respectful manner and in ways that does not cause them a loss of dignity. This will include protecting people’s privacy when assisting with dressing or visiting the toilet. It also includes the way that patients are addressed.

Consent – all people undergoing care must give their consent before treatment is carried out. If this is not possible, the patient should have someone who makes these decisions for them, such as a family member or someone working for their best interests.

Safety – healthcare providers have a duty to keep patients in their care safe and free from harm. This means that all staff should be adequately trained and have professional levels of competence, qualifications and training.

Safeguarding – this helps protect the vulnerable from abuse, neglect or degrading treatment. Safeguarding helps ensure that patients or people in care do not have their liberty curtailed any more than strictly necessary. To find out more, check out our article on Deprivation of Liberty Safeguards.

Food and drink – all people in care or undergoing treatment should receive enough food and drink to keep them well and free from hunger or thirst. In some cases, people need assistance to eat and to drink and this should always be provided by staff. There have been cases where food has been left in front of people unable to feed themselves, so simply delivering the food to the patient is not always enough.

Good governance – this covers everything from care plans which must be maintained for all patients or people in care, to the safety and welfare of patients and staff alike. There should be clear governance in place so that the service can function in a consistent way in all areas and improve where necessary.

Complaints – there should be an effective complaints procedure so that if a patient or patient’s representative such as a family member has cause for complaint there is a system in place. The service should take any complaints seriously and be able to investigate the problem, taking action if any problems are highlighted.

Premises and equipment – all care facilities, hospitals, nursing homes and anywhere else that provides care for patients, should be fit for purpose. All equipment needs to be in good order and the premises clean and in good condition.

Suitability of staff – all staff working in the service should be proven to be fit and proper. This means that they should be fully trained to be able to carry out their responsibilities correctly and that they should have a current DBS check to ensure that they are suitable for this type of work.

A strong recruitment policy is crucially important and all applicant backgrounds should be thoroughly checked out before they start working with vulnerable people. See our guide to DBS checks to find out more.

Staff training and legislation – staff need to be fully supported in order to carry out their caring responsibilities. This means that they should be properly trained and supervised. Aspects of care such as moving and handling should conform to all legislation and all staff should be fully trained in safe practices to avoid any injuries to themselves or the patients.

Duty of candour – all aspects of care need to be open and honest. That way, if something does go wrong, and after all sometimes things do happen, you can explain and apologise to the patient and provide support. If there is this candour within the facility, your patients will feel that they are safe and that you are not hushing up or protecting practices or staff which are questionable.

A care facility must display their CQC ratings – all healthcare providers must display their CQC ratings where they can be seen, including in the premises and on the website. The Care Quality Commission carries out inspections of all healthcare facilities.

There are four ratings:

• Outstanding – the service is performing exceptionally well.
• Good – the service is performing well and meets expectations.
• Requires Improvement – the service is not performing as well as expected and has received notifications of how to improve.
• Inadequate – the service is performing badly and action has been taken against the providers.

How do you provide person-centred care?

To provide person-centred care you need to consider the needs of the individual, so how you do this will depend upon each person you deal with. However, the principles are always the same; you have to respect that each person has his or her own views on what is best for them and that they have their own values and priorities that need to be respected.

Working in a person-centred way is rewarding for both you and the person you care for. By getting to know and to understand the person you care for, you can involve them in any decisions. These do not always have to be big decisions, but for the person in care they are certainly life-enhancing.

Small acts like involving your patient in clothes choices for the day instead of laying out your chosen outfit for the day gives them a degree of autonomy. Asking them which of the menu choices they prefer keeps them in control of their own diet.

Person-centred care is important for the daily well-being of the patient. For example, you might know that someone enjoys watching the birds from their window so you might ask them if they would like to sit by it for a while, rather than wheeling them into the TV lounge as a matter of course. Go wild – try filling the bird feeders to encourage the birds to come! These types of small actions may not seem very important to you but they are extremely important for patient well-being.

It is also essential that you always ask the patient beforehand. After all we all have different moods on different days. Your birdwatching patient might like to do this sometimes but other times may prefer to do something else. It is not enough to say, “Alf likes birdwatching so staff should always put him there!” He might not always feel like it, so be mindful before you make assumptions.

When it comes to more serious care decisions, taking time to explain the options will enable the patient to choose what is best for them. After all, being treated like an individual rather than an object or job of work to fit into a busy schedule is very demeaning and undignified and goes against the 13 principles of the Care Quality Commission.

Why is person-centred care important for patients?

The benefits of person-centred care for patients are enormous, so let’s take a look at a few of these:

• The patient will trust you and feel confident in your care: if you treat someone with dignity and respect and help them retain their independence as much as possible, it will make the whole experience far more comfortable and easier for both of you.
  For example, asking your patient if they are ready to be lifted in the hoist is far less alarming than just raising it suddenly without giving them a warning or asking for their consent. Once your patient trusts that you will not carry out fast unexpected actions without their consent they can relax and trust you with their care.

• Patient-centred care improves quality of life: by meeting the emotional, social and practical needs of your patient you can help them enjoy life. Disabilities, old age, special needs all have their unique challenges but this does not mean that people cannot live rich and fulfilling lives to the best of their abilities. Getting to know your patient and respecting their tastes and preferences greatly improves quality of life in care.

• Getting to know your patients helps you understand them: often people have difficulties in communicating such as with people suffering from dementia, those with learning difficulties or people with communication difficulties such as stroke victims.
  With person-centred care you can learn to understand their mode of communication as well as knowing what makes them tick, so can help them maximise their quality of care experience. Without taking time to understand, your patient may become frustrated, angry, aggressive or tearful, when all of this could have been so easily avoided if you had just taken the time to understand and get to know the person.

• Person-centred care improves independence and confidence: if your patient is fully involved in decision-making, he or she is far more likely to stick to the care plan and take medication, do exercises or anything else the care plan entails. This is not always possible but if you and the patient are on the same side, it will improve their independence, and it gives them some control over their treatment. It improves confidence too because they feel that any decisions come down to them.

Why is person-centred care important for healthcare workers?

Do you know the old adage, “you can take a horse to water but you can’t make him drink?”

As people, we are all exactly the same when it comes to doing this and most of us find it much easier to do something we want to do, rather than doing something we are told to do without explanation. Let’s take a further look at some of the benefits of person-centred care for healthcare workers.

• Person-centred care makes the whole job much easier – When you are working in a person-centred way and respect the individual needs and wishes of the patient, your job is much easier because you will be working with the patient rather than against him or her.

• Person-centred care helps people stick to their own care plans – As outlined above, if your patient is fully involved in decision-making, he or she is far more likely to stick to the care plan and take medication, do exercises or anything else the care plan entails.

• Person-centred care makes for a happier working environment – If your patients are happy it has a positive effect upon the morale of your healthcare team and the whole environment of the home or care facility.

• Person-centred care save money and time – Tailoring the care and medication to suit the patient means that they are more likely to stick with the care plan and actually take their medication or use their disability aids. If someone has been involved and has agreed to a care plan they are less likely to go against it. After all, if somebody feels a care package has been foisted upon them without their own permission they are far less likely to stick to it.

• Person-centred care improves the strain on the NHS – If people feel they are being listened to and are confident in your care they are far less likely to try to admit themselves to hospital via A and E or to turn to costly private treatment.

• It is the right thing to do – Working in healthcare can be rewarding but only if you consider the well-being of the patient before everything else. Put simply, it is the right thing to do. Doing the best job you can do for your patients not only makes them feel happy, you can sleep easy at night knowing that you have made a difference to many people’s lives in a positive way.

Case study of person-centred care

Mary is an elderly woman of 83 who suffers from mild dementia but was happy living at home with care support. Everything was fine until the support team noticed that she began to struggle with the food that was served to her, refusing to eat and drink and spitting things out, sometimes making herself sick. As a result, her health and weight deteriorated and it seemed likely that she would need to move to a nursing home.

The family and care team felt this would be a shame as she was otherwise happy and managing at home with support, so they looked for a solution. They encouraged Mary with the aid of pictures to talk about foods that she liked and the sort of things she ate when younger. And with the assistance of a key worker, Mary was encouraged to make dietary choices and participate in the preparation of the food. Once the new food plan was initiated, Mary stopped refusing food and her weight and health has improved as a result.

What are the principles of person-centred care?

There are four principles of person-centred care which have been outlined by the Health Foundation. These should be adhered to whenever you work to support and care for patients.

1. Always treat people with respect, compassion and dignity

Just because someone is now in the position where they need care and support, this doesn’t mean that they are now irrelevant or without their own thoughts, feelings, ideas or beliefs.

You should always treat your patients with respect, compassion and dignity. It is important for all of us to feel validated, and when people in care feel that they have a voice and are respected as individuals, their physical and emotional health will improve.

2. Provide coordinated support

It is important that person-centred care is delivered on a consistent level and this means keeping records. That way the various agencies and care providers who may be working together to care for the patient can deliver consistent care without interruptions. It means that medication is not disrupted and that carers can share information between themselves. It is important that patient confidentiality is always respected, but communication between professionals should always be open and transparent.

3. Provide personalised care to each person

We are all different. We all have different motivations, requirements, likes and dislikes and the same goes for your patients. This means it is important to treat each patient as an individual. If you offer a standardised approach to all your patients you risk damaging their self-esteem and quality of life.

For example, some nursing homes mistakenly believe that playing World War 2 songs back to back is good for their elderly residents. Yet most people in care are not only too young to remember this time, but they will have their own tastes, and it is unlikely they would all choose to listen to this type of music themselves.

4. Help patients realise their strengths and abilities so they can retain some degree of independence

The importance of person-centred care should help patients keep some control over their decisions and to do as much as they can for themselves. However, this can be a fine line between providing good quality care and with asking too much from your patients.

If you require too much from your patients they may feel that you don’t care and cannot be bothered to help them. Too much help will cause dependence and will erode their abilities.

The answer is good communication. Try and encourage your patients to do as much as possible for themselves but provide support when necessary.

Summary

The benefits of person-centred care are far reaching. Not only is it good for the patient to retain as much independence as possible and be treated as an individual, it helps the healthcare professional if the patient or resident is happy and consents to treatment.

If you are an overstretched health worker it can be difficult to think of the well-being of all your charges. But if everyone in your service keeps to the ethos of providing good quality person-centred care, this will make your job easier. Communicating and record keeping is paramount between professionals, and actually taking time to get to know your patients is very rewarding and will help you provide good quality care.

At the end of the day, person-centred care is the right thing to do. It is a fundamental human right to be treated with respect and dignity whatever our circumstances. And as a caregiver or healthcare professional you have the power to make a positive difference to your patients’ lives.