Diabetes Personalised Care Planning – background and overview
Introduction
There is nothing new about the idea of care planning in health care. Care plans have been routinely made in hospitals for many years, and more recently in community settings, care plans have been used in mental health care, to document how people will take medication, seek regular review and so on. However, the term ‘personalised care planning' has been coined more recently in health care policy for people with diabetes and other long term conditions, to indicate a shift from people having care plans made FOR them, to them being much more centrally involved in what the care plan contains.
Personalised care planning and health policy
Personalised care planning reflects a policy of greater involvement of people with long term conditions, such as diabetes, in the day to day management of their condition, and greater collaboration with health care professionals in decisions made about their treatment. This is because for the vast majority of the time, people with these long term conditions need to make their own day to day decisions about taking medication, exercise, self testing (for example of blood glucose) and other aspects, without the presence of a health professional. It recognises that people are much more able to stick to decisions they make themselves, than those made by others on their behalf. Consultations with health professionals in the personalised care planning approach therefore need to become more focussed on giving people useful information to help them feel more confident about making their own decisions.
The collaborative approach that personalised care planning advocates is in contrast to the more traditional medical consultation, where the health professional would be seen as the expert, giving advice and instruction about how to manage an illness. In years gone by, there were more acute illnesses where this approach was appropriate, but today there are many more chronic, or long term conditions that require much more self-care than acute care.
Diabetes and personalised care planning
In relation to diabetes, then, the personalised care planning approach means that someone with the condition would be encouraged to be the main manager of their diabetes, with an annual review with a health professional to have relevant medical tests and a discussion about what they need to manage their diabetes successfully. As a result of their discussions, the care plan is created, with actions for both according to what the person wishes to achieve. Central to this discussion is that the results of the medical tests (for example, blood tests and foot checks) are available for the person to reflect on prior to the consultation. In this way, they are much more prepared to participate in the discussion than if they received the results on the day.
Pilot project
The idea of transforming the annual review into a personalised care planning consultation is being tested out in three localities in England, in a venture called the Year of Care project. This pilot has been running since 2008 and is due to report its findings in 2011. It is looking at the feasibility of introducing into regular diabetes care a process including the following components:
- Raising awareness of care planning among people with diabetes
- Inviting people to attend for 2 appointments – one for relevant routine tests and investigations, and one for the discussion of the results
- Providing people with diabetes with the results of their tests and investigations in advance of their discussion appointment
- Making the discussion much more collaborative and based on the person's own ideas about what aspects of their condition they wish to focus on as well as the health professional's opinion of the priorities
- Creating an action plan (care plan) that will meet the person's needs
The Year of Care is collecting data on all aspects of the care planning process and its findings will also form a blueprint for the care of other long term conditions. Diabetes was chosen as the example for the pilot project as it has all the features of other long term conditions and it is an extremely common condition with its own National Service Framework, a 10 year plan with standards including one which focuses on empowerment of people with the condition.
Implementation in other areas
Outside the pilot areas, many health organisations around the UK are also implementing personalised care planning. This is partly because since 2009, NHS standards now include the need for all people with long term conditions to have an agreed and shared care plan in place by mid-2011. It is also partly because the number of people affected by long term conditions in general and diabetes in particular is huge, far outstripping the capacity for health professionals to make decisions for everyone in the traditional way. This means that changing systems to promote people's ability to look after themselves is essential.
Reaction among both health professionals and people with diabetes has been mixed – many welcome the idea although some find that changing longstanding behaviours in relation to giving or receiving healthcare is difficult. Some people with diabetes say they were always able to make their own decisions and it was the healthcare systems that got in their way, so their patience in waiting for these to catch up with them has finally been rewarded! One thing is for sure, the policy of personalised care planning is here to stay - it features prominently in the new UK Governments plans for health care reform, summed up by the phrase ‘no decision about me, without me'
About the Author
I am the Education Director of our company, based in the UK. Successful Diabetes is an independent company, providing specialist information via workshops, ebooks and books, for people with diabetes and for health professionals. We are specialists in learner centred education and in motivation and behaviour change.
Diabetes care plan
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