The Council Conclusions on the Economy of Wellbeing, adopted by the European Council in its Employment, Social Policy, Health and Consumer Affairs Council configuration (EPSCO) in October, represent yet another step towards the vision of people-centred healthcare.
The current policy narrative referring to patient-centricity and in other cases to people-centricity is, arguably, part of the same vision. As the WHO puts it: “Occasionally, all citizens have to make important health decisions that affect health outcomes. Strategies to support patient education and engagement should therefore be a fundamental plank of health policy. Also, patients can play an important role in understanding the causes of illness, protecting their health and taking appropriate action, choosing appropriate treatments for acute episodes of ill health, and managing chronic illness. These roles must be recognised and supported.”
A people-centred approach recognises that before becoming patients we all need to be able to promote and protect our own health
The diffusion of “citizen science” has accelerated citizens’ participation in the scientific research process, for instance in analysing and providing data. Improved stakeholder engagement can stem from this process of “democratisation of science”, for instance in advocating for policy recommendations.
In healthcare policy, patient-centricity has been identified as one of six attributes of high quality healthcare, the others being safety, timeliness, effectiveness, efficiency and equity. However, while the patient-centred approach addresses issues of quality and holistic healthcare, it does not meet some of the broader health challenges.
The people-centred approach meets these broader challenges by recognising that before people become patients, they need to be informed and empowered in promoting and protecting their own health. People have to be engaged well beyond the clinical setting, and the approach has to include families, communities, civic organisations, and of course health practitioners. A people-centred approach involves a balanced consideration of the rights and needs as well as the responsibilities and capacities of all the constituents and stakeholders in the healthcare system. It promotes shared decision-making between patients, families and providers to design and manage a personalised care plan.
What are the practical implications of people-centred care?
As with other forms of value-based healthcare, patient/people-centred care requires a shift in the way health systems are designed, managed and funded. Increasingly, long-term conditions will be managed at home rather than in hospitals, with the help of personalised medicine, digital technologies and new medical devices, among others.
Against this background, the European Patients’ Forum (EPF) held its first milestone congress on 12-14 November, with some 300 participants and a substantive programme that highlighted the need for collaboration, partnership and active engagement. It was a perfect opportunity to reaffirm the central role that patients should play in shaping healthcare – and also to put in context the need for truly visionary wellbeing policies that consider prevention, screening and early diagnosis as well as healthy lifestyles as part of the strategic framework.
More responsive, efficient and effective health systems can only be created through multi-stakeholder collaboration
The increasing attention given to patient-reported outcomes to measure what really matters to patients – both as endpoints in clinical trials and to assess real-world performance of treatments, healthcare providers and entire health systems – offers a good example of an interconnected ecosystem. As a reference, the work of the OECD on the PaRIS initiative launched in 2017 is noteworthy.
Various initiatives and projects undertaken across different European countries reflect the strategic vision to enable a people/patient-centred policy approach. A recent example was the first Silver Economy Forum in July 2019, convened by the Government of Finland and the Global Coalition on Aging. The Forum also coincided with the EU Economic and Financial Affairs Council meeting and occurred on the cusp of the WHO’s Decade of Healthy Ageing. Another pioneering example is the Active Citizenship Network across Europe (and its promoter in Italy, Cittadinanzattiva), which launched in 2002 a European Patients’ Rights Charter and a European Patients’ Rights Day, an annual event that offers a civic perspective on critical issues. It recognises the role of citizens at the centre of health policies, not only as “users or consumers” of health services or “patients” with a specific disease, but rather as an active community participating in policymaking as essential stakeholders.
Health is impacted by physical, socio-economic, cultural and environmental factors, hence it is critical to look at it in a broader context, with all stakeholders involved. The core value of healthcare, which is health and wellbeing of all people, requires a more holistic and people-centred approach, and a balanced consideration of the rights and needs as well as the responsibilities and capacities of all health constituents and stakeholders. Health systems, therefore, need to evolve.