Person-centred care &

Sources of Health and

Demographic

Information

Patrick Elder

What is person-centred care?

Four definitions given in our lecture:

• Person-centred care is ‘treating patients as they want to be treated’ (Person-Centred Practice, 2008)

• ‘… providing care that is responsive to individual, personal preferences, needs and values and assuring that patient values guide all clinical decisions (Evidence into Practice, NHS Scotland)

• ‘ … putting patients and their families at the heart of all decisions’ (The Health Foundation)

• ‘No decision about me, without me’ (Liberating the NHS: Equity and Excellence, 2010)

I’d at least learn the top two!

What are the 6 key components of

person-centred care?• Seeing (and getting to know) the patient as a person rather than the

person as a patient – person’s own experiences are valued

• Putting the person’s needs and preferences, as they define them, first and above those as identified by clinicians - person’s definition of the situation that is important

• Shared decision making: patients and doctors as partners in decision-making and management of conditions

• Recognising the person’s strengths in self-care and management of their condition

• All interactions and care underpinned by values of compassion, dignity and respect

• Patient and public involvement in the design and delivery of services.Terrible mnemonic: SPS RAP / Sean Paul RAPS

Why is person-centred care considered

important? (3)

• Evidence of positive outcomes for patients

• Social and political drivers

• Concurs with ethical principles underpinning duties of a doctor

Name four social and political

drivers behind person-centred care • Wider society: less hierarchical

relationships, less deference, more critical and questioning public → patients want to be involved

• Patient dissatisfaction with the NHS: evidence from surveys

• Spiralling economic cost of NHS: better outcomes for patients may control costs (currently no UK evidence of reduction in costs)

• Recent reports on appalling care standards at Mid Staffordshire NHS Trust (Francis report in 2013) and Serious care review of Winterbourne View Hospital (2012)

What effect have these social and

political drivers had on health focus?• Together these have increased health policy focus*

on:

• Delivering safe, dignified and compassionate care

• Putting the person at the centre of their own care

• Patient and public involvement in service planning

*See Health and Social Care Act(2012), Liberating the NHS :Equity and Excellence (2010), NHS Constitution

Not sure if you need to learn this, but it’s worth being aware of it

What are the 5 ethical principles and

values that underpin person-centred

care?• Respect

• Autonomy

• Dignity

• Care

• Consequences

How to remember them:

CRACD (or RADCC if you’re unimaginative)

What are the 3 conditions of autonomy?

Three common conditions of autonomy

• Capacity (age 16 and over assume capacity)

• Freedom (requires freedom from interference and opportunities for choices)

• Authenticity ( consistent with personal identity and values)

There are definitions for all of the principles in the lecture, but I wouldn’t worry about knowing them too well.

What are the 5 elements of

dignity?Elements of dignity:

• Respect

• Privacy

• Self-esteem

• Freedom from unnecessary pain

• Autonomy

What underpins the principle of care in a

healthcare context?  3 things

Beneficence (doing good…but from whose perspective?)

Best interests

- Best interests test in Mental Capacity Act 2005

An ethic of care (relationships and responsibility)

What are the four consequences that underpin

the ethics of person-centred care?

Better patient outcomes

Fewer complaints

Less litigation

Increased trust in the medical profession

Sources of demographic

and health information

Which tool do we use to assess the

quality of health information?

The CARTA framework:

Completeness

Accuracy

Representativeness / relevance

Timeliness

[Accessibility]

What is a population census?

A census is:

“the simultaneous recording of demographic data by the government at a particular time pertaining to all the persons who live in a particular territory” (United Nations)

Census describes both households and people

UK Census history: who carries it out, and

how often? When did it start?

Office for National Statistics (ONS) in England and Wales

Every 10 years since 1841

Legal requirement to complete it

How accurate is the Census?

Explain your answer

Complete source of population info - 98%

Why not 100%? 

Low enumeration groups e.g. students, babies, travelling families etc. - hard to get data from them

Accuracy: England &Wales: 52 million ± 0.2% (2001) - so highly accurate

How much does the Census cost?

2011 Census: £480 million

How is the census information submitted?

2011: Online completion (or post back)

What are the 5 categories of data

that we can obtain from the census?

Demographic data - age / sex

Cultural Characteristics - ethnicity / religion

Material deprivation - employment / home ownership / overcrowding / car access / lone parents / lone pensioners

Health – General, long-term illness, unpaid care

Workplace & Journey to work

How is UK Census data useful for healthcare workers? 3

Population size & structure: young, old, ethnic minorities service needs

Base population (denominator) rates

Measures of material deprivation:

identify & target inequalities

Strength & Weakness – UK CensusStrengths Weaknesses

Completeness 98% complete Low enumeration of some groups

Accuracy Check of forms, coverage survey: population +0.2%

Self reported – religion ‘Jedi’ !!

Representative/relevance

Data available for different levels (200 people to country)

Low enumeration of some groups

Timeliness 10 years. Takes time for release.

Access www.ons.gov.uk/Local councils

Individual returns confidential 100yr

Describe the process of Birth Registration

Office for National Statistics (ONS) – Birth Statistics

Birth Registration – by parent(s) within 42 days

Birth Notification

– by birth attendant (usually midwife) within 36 hrs - to Health Authority (child health record, health visitor)

Local Registrar for Births, Marriages & Deaths

Describe the process of Death Registration

– certifies the fact of death

Death Certificate issued by Doctor - age, place of death

- information on cause of death

– by informant (usually relative) within 5 days Death Registration - Local Registrar for Births, Marriages & Deaths

Office for National Statistics (ONS) – Mortality Statistics

DefinitionsWhat is the Crude Birth Rate?

Crude Birth Rate = live births / 1,000 popl.

What is the General Fertility Rate?

General Fertility Rate = live births / 1,000 women aged 15-44 yrs (child bearing lifespan)

What is the Total Fertility Rate?

Total Fertility Rate = “average number of live children that a group of woman would have if they experienced the age-specific fertility rates of the calendar year in question throughout their child-bearing lifespan”

Birth and death data

Strengths (2)

Complete coverage in UK (births as well)

Important information on health of the population

Weaknesses (4)

•Accuracy? e.g. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality.

•Not reliable as picture of morbidity

•Ethnicity not collected

•Derivation of socio-economic status - posthumous inflation of status

How do we use population estimates and projections?Why ?

Used for planning services / resource allocation

In the past: to understand what has been happening to the population

The present: to make sense of present activity

In the future: to predict what is going to change

When would you make a population

estimate, and how would you do it?

Estimate of population size & structure between census – no point doing it in a census year because it’ll give you the data

Applies what is known on births/deaths/migration to present

Census baseline + births – deaths + migration

What are the strengths and

weaknesses of population

estimates?Strengths (2)

• more up to date than the census

• more accurate than projections

Weaknesses (3)

• less reliable with time from census

• poor information on migration

• says nothing about the future

What is the purpose of population projections? What

assumptions are they based on? (3)

Forecast future population size and structure

Based on assumptions about: mortality

fertility

migration

What are the strengths and

weaknesses of population projections?

Strengths (1)

Can be used for longer term planning

Weaknesses (2)

• Less accurate the further ahead they look

• Unforeseen changes of past trends can invalidate projections

What are the 3 main sources of

morbidity data in the UK?Cancer registration system

Cancer diagnosis triggers registration

Notifications of infectious diseases

NHS activity data

Hospital Episode Statistics (HES)

QOF data

What are the main sources of information about

determinants of health? 2

Range of information available e.g.

socioeconomic, deprivation (census)

lifestyle factors e.g. smoking, diet (surveys)