One Size Fits None: Recognising Differences to Achieve Person Centred Care

Charli Bevan, QNI Digital Marketing Officer & QNI Community Nursing Executive Network Coordinator attended The 2018 National Voices Conference on the 14^th March. In this blog she discusses the importance of acknowledging diversity when it comes to person centred care.

Helen Stokes-Lampard, chair of the Royal College of General Practitioners, speaking at the 2018 National Voices Conference, highlighted a major barrier to providing person centred care – that ‘Political Correctness’  has led to us sweeping important issues under the rug. In order for care to be tailored we need to appreciate and discuss what makes people unique.

Diversity, minority and multi-cultural are not bad words, and people who are described like this are certainly not ‘hard to reach’. Although as one Twitter user pointed out on the day, they are often easy to ignore.

Those responsible for providing care should ensure services reach people wherever they are, without the expectation that patients will seek out support themselves. As conference panel member Mr Shahid M.Sardar pointed out, ‘BAME’ (Black, Asian and Minority Ethnic) is not one size fits all – policy makers and health professionals must take notice of the specific needs of patients in the unique communities they are working with.

Caroline Dinenage, Minister of State at the Department of Health and Social Care recognised the importance of person-centred care in her opening keynote address. She thanked the roomful of National Voices members for the vital role the voluntary and third sector play when it comes to personalised care, stating that the department for Health and Social Care are keen to undertake collaborative work with the sector to help shape reform in upcoming green papers.

Had the minister remained in the room she would have heard the delegate response which challenged the idea that the third sector should be the ones responsible for picking up the pieces and educating central services when it comes to person centred care.

This led to a debate about diversity within the voluntary sector. Smaller organisations make a big difference to patient groups locally, but struggle to secure funding on the same scale as national charities, which often have relationships with the government and policy makers.

Smaller charities have a unique role in offering person-centred support, really understanding the care needs of minority communities and making them not so ‘hard to reach’. Grass roots charities are often seen as the answer but do not always get adequate payment or recognition when they do provide support for national policies, projects and initiatives.

What would happen if they ceased to exist?

In the same way that smaller charities often find themselves overlooked when it comes to recognition, minority patient groups across the country continue to battle to be heard. Minority doesn’t have to mean ethnic or cultural difference – person centred care needs to accommodate individuals, regardless of whether they have a disability, facial disfigurement, come from a low socio-economic background or have an ‘invisible’ condition. Different doesn’t have to mean the colour of our skin or where our ancestors were born – we need to change the narrative of care to accommodate each and every person who feels like a square peg battling to fit into the round holes of health and social care policy.

Henrietta Spalding head of advocacy at Changing Faces, a charity that campaigns to end facial discrimination, led an insightful breakout session at the conference. The interactive workshop explored the impact of unconscious bias, how to address this and feel confident with difference.

Perhaps the most interesting comment from a participant was, ‘It doesn’t matter who they are, if they are different to us we are in danger of acting differently towards them’ – but how can we prevent this and work towards an open and inclusive community?

As individuals or organisations we can tell ourselves that we are ‘blind’ to difference, we treat everyone equally and treat people as people… In reality implicit bias is an unconscious, psychological reaction based on past experiences, memories or knowledge from sources such as the media which we have limited conscious control over.

Henrietta discussed coping mechanisms which allow us to recognise and acknowledge our own bias exists, and work towards ensuring it doesn’t affect how we interact with others. Such coping mechanisms can be as simple as finding a neutral discussion point when you find yourself with a stranger in a coffee queue, or as complex as confronting someone’s differences head-on in a job interview, with an open but direct conversation. Of course boundaries must be set and respect should always be shown, but recognising that differences exist, making an effort to interact with those who are different to us and being mindful of our own unconscious bias is the most important starting point when working towards personalised care and support. Studies have shown that actively setting goals such as ‘Don’t discriminate against people who are different – if I see someone who is different I will smile’ can help us display positive behaviour which eventually will become automatic.

In order to become aware of bias and ultimately reduce it, individuals need to be exposed to people from all backgrounds and walks of life to educate themselves on difference… and perhaps discover similarities.

Peer support groups are a fantastic way to achieve this. At the National Voices conference we heard from  Arthritis Research UK , Mind & Men Tell Health , Mental Health Foundation, Together for Mental Wellbeing  and Self Help UK who each discussed their use of peer support groups to improve the lives of those who need it most (you can download an easy to read peer support toolkit from Mind, Men Tell Health and other collaborating charities here.)

Peers are people with similar lived experiences, in this case a certain health condition. Peer support groups are designed for both participants and session leaders to work together, forming positive relationships to discuss experiences and how they can support each other further – but who’s to say a ‘peer’ for one aspect of your life is a ‘peer’ in all aspects?

Research from Arthritis Research UK found 77% of people expressed interest in receiving peer support from someone who had similar experiences to them. By recognising diversity within a peer support group we can open doors to advice that people may never have been exposed to within their own culture or locality.

Micro-communities such as peer support sessions are a fantastic way to break down the barriers of difference, making it easy for individuals from all walks of life within a local community to interact with each other and focus on a common goal.

Barbara Keeley MP, Shadow Minister for Mental Health and Social Care closed the day by highlighting the fact that she feels the UK is in crisis when it comes to health and social care. A good care system meets practical, social and emotional needs, treating patients with dignity and respect – but demand is increasing, with growing numbers of older people and more working age people with complex needs.

On the day The QNI Tweeted a line from Barbara’s speech which was met with approval in the Twittersphere:

But it was the replies to the Tweet which sparked the idea for this blog.

‘I agree, but also the people with complex needs have capacity, strengths & assets that can help others.’ Said Heidi De Wolf. The Thyroid Trust agreed: ‘Empowering and supporting those people to help each other more surely has to be an effective strategy.’

‏At The Queen’s Nursing Institute we promote excellent nursing care for everyone, provided by nurses and their teams with specific skills and knowledge. Our vision is that all people are provided with the best possible nursing care, by the right nurse with the right skills, in homes and communities, whenever and wherever it is needed.

Community nurses play a huge part in patient empowerment. District nurses and health visitors have the privilege of practicing in patients’ homes, entering their most private space to provide care which fits into unique environments and daily routines. General Practice Nurses and School Nurses are often the link between patients and peer support groups they may never have been aware of otherwise.

The QNI regularly supports community nurse led projects through its fund for innovation. This year’s projects are focused around improving the lives of those who are experiencing homelessness or who are living in vulnerable or temporary housing, including recent migrants, street homeless, people in custody, and Gypsy, Roma and Traveller populations.

One of the ten projects promotes nurse outreach teams, bringing skilled nurses who are trained to deliver personalised care directly to those who need it within their own environment. Another aims to support Gypsy, Roma and Traveller communities by tailoring care to take into account cultural norms and often unusual housing and community set ups. Each of the projects have one main focus: The patients and their own specific needs. The QNI is proud to support such diverse and innovative ideas which promote excellent care for all.

So to finish where I began, with a word from Helen Stokes-Lampard, chair of the Royal College of General Practitioners:

The key to patient centred care is recognition, acceptance and education around our differences to drive forward a system which is personalised and inclusive. Let’s celebrate diversity, empowering patients and health professionals to ask questions and learn from each other.

After all ‘one size’ fits none.