Debra Westlake presents: Person-centred approaches: are we all falling through the gaps?
This paper explores the role of social interaction in notions of person centredness, drawing on primary analysis of data from an evaluation of the Integrated Personal Commissioning programme in the southwest of England. The IPC programme is part of a movement in the NHS towards promotion of person-centred care. It aims to break with paternalistic, biomedical tradition by engaging in a guided narrative and collaborative planning process with people with long term conditions to consider ‘what matters to you rather than what is the matter with you’ and to identify what they want to achieve in social and psychological, as well as physical, wellbeing. A health budget may be allocated to achieve their goals.
In this study, participants did not always find it easy to express their aspirations and identify how the programme could best support them, finding ‘empowerment’ unfamiliar in this context. They engaged in discourses of candidacy and ethics and since they were familiar with a national narrative of scarcity, suspected ulterior motives of the service. One of the unanticipated outcomes of the process was the formation of social networks among the participants, who were identified by a health selection process as people who ‘fall through the gaps’ of care, such that the participant group itself became an unintended resource of the programme. The findings balance a model of ‘person’ centredness that focuses on the uniqueness of the individual, with a relational perspective that considers the person within a social context, which also includes the health professional.
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