A8: Providing person-centred care

• A8.1 The purpose of the Mental Capacity Act (2005) plus Amendment (2019) in relation to healthcare: 

  • Purpose – to protect rights, safeguard and support individuals over the age of 16, who may lack the mental capacity to make choices about their own treatment or care.
• Empowerment

  Individuals should be supported to make their own decisions based on best possible information
• Protection


  Service users who are in greatest need of support and protection
• Prevention

  Better to take action before harm occurs
• Proportionality

  Actions should be proportionate to the risk: being overprotective can disadvantage service users to be able to make their own decisions
• Partnership

  Working with a range of professionals, groups and communities to prevent, detect and report neglect or abuse
• Accountability

  Healthcare and social care professionals need to be accountable for any activities in relation to safeguarding
• The key principles of the Care Act 2014 are: Empowerment, Protection, Prevention, Proportionality, Partnership, and Accountability
• • Stages of human development across the lifespan: 
  • Birth and infancy 0 to 2 years 
  • Early childhood 3 to 8 years 
  • Adolescence 9 to 18 years 
  • Early adulthood 19 to 45 years 
  • Middle adulthood 46 to 65 years 
  • Later adulthood 65 years onwards 
  • Typical care needs: 
  • Nutrition and hydration 
  • Personal care 
  • General health and wellbeing
  • Positive relationships 
  • Self-esteem
  • Personal growth
  • Independence
• NHS core values (from NHS constitution)

  • compassion
  • improving lives
  • respect and dignity
  • commitment to quality of care
  • working together for patients
  • everyone counts
• 6 principles produced by the People and Communities Board

  • care and support are person-centred (being personalised, coordinated and empowering)
  • services are created in partnership with citizens and communities
  • focus is on equality and narrowing inequalities
  • carers are identified, supported and involved
  • voluntary, community and social enterprise and housing sectors are involved as key partners and enablers
  • volunteering and social action are recognised as key enablers
• Person-centred care and support


  Being personalised, coordinated and empowering
• Personalisation Agenda 2012

  To put the individual first in the process of planning, developing and providing care. Creating tailored support to the individual needs and desires when treating those with long term illnesses and conditions.
• Holistic approaches

  • Person-centred planning (PCP)
  • Person-centred care (PCC)
  • Hierarchy of the individual's needs (Maslow's hierarchy of needs theory)
  • Advanced care planning (for example end of life care)
  • Integrated working
  • Do Not Resuscitate directive (DNR)
• Importance of using holistic approaches

  • Ensuring that any care provided is in the individual's best interest
  • Complying with autonomous practice
  • Encouraging engagement with healthcare and social care professionals and organisations
• Range of communication techniques

  • Verbal (for example spoken word and sound)
  • Nonverbal (for example gestures, facial expression, body language, Makaton and British Sign Language)
• Barriers to communication

  • Sensory disorder (for example speech, hearing or sight)
  • Mental health condition
  • Language barriers (for example jargon, spoken language or accents)
  • Time pressures
  • Noisy environment
  • Positioning of the individual from the healthcare professional (for example proximity)
  • Tension or conflict
• Overcoming barriers to communication

  1. Actively listen to the individual about their communication needs/preferences

  2. Active involvement from the individual in how/when/where and in which way they are communicated to meet their needs

  3. Access to information that is understandable to the particular individual

  4. Choice of communication aids or supports that match the needs and preferences of the individual

  5. Access to a range of support options and choice given to individual
• Mental Capacity Act (2005) plus Amendment (2019)

  Legislation that includes 5 principles:

  1. Begin by assuming the individual has capacity
  2. Support individuals to make decisions
  3. Recognise that unwise decisions do not mean lack of capacity
  4. Decisions must be taken in individual's best interest
  5. Consider whether a decision can be made in a way that is less restrictive of an individual's freedom
• Liberty Protection Safeguards (LPS)

  1. The person lacks the capacity to consent to care arrangements
  2. The person has a mental disorder
  3. The arrangements are necessary to prevent harm for the individual
  4. The arrangements must be proportionate to the likelihood and severity of harm
• Conditions or illnesses

  • Medical conditions (for example cancer)
  • Neurological conditions (for example dementia)
  • Physical disabilities (for example a wheelchair user)
• Considerations when providing person-centred care

  • Social model of disability and inclusion
  • Ongoing treatments
  • Overall wellbeing
  • Follow the person-centred plan
  • Co-morbidity and the impact on the individual and their family
  • Assessment of need
  • Discharge planning
  • Mental capacity
  • Individual's rights and wishes (for example advocacy)
  • Access to community provision
  • Access to additional secondary services (for example counselling)
  • Financial circumstances
  • Carer's assessment (for example support for informal carers)
• How mental health conditions, dementia and learning disabilities can influence a person's needs in relation to overall care

  • Increased support requirements
  • Behaviour support
  • Comprehension factors
• Increased support requirements

  1. Physical support requirements (for example care support worker)

  2. Communication support requirements

  3. Reduced ability to self-care

  4. Increased monitoring requirements (for example from specific healthcare and social care professionals)
• Behaviour support

  Recognition of triggers that raise anxiety
• Comprehension factors

  • Anxiety around care
  • Lack of understanding of the care to be provided
  • Impaired rationality around the condition or support requirements
  • Dissociative conditions
  • Awareness of possible abuse
  • Refusal of treatment
  • Perceived stigma attached to conditions and disabilities
• How to promote independence and self-care

  1. Individuals to have involvement, choice and control over their own self care

  2. Individuals to have access to support networks, appropriate information, a range of learning and development opportunities and understand the range of options available to them

  3. Support in risk management and risk taking to maximise independence and choice

  4. Individuals to be supported to identify their strengths, assess their needs and gain the confidence to self-care

  5. Assistive technology is made available to support in an individual's ability to live independently
• Positive impact on the healthcare sector

  • Improving self-esteem and independence of the individual
  • Improved partnership working
  • Improved efficiency of staff time within healthcare service
• Terms used in relation to death and bereavement

  • End of life care
  • Palliative care
  • Hospice
  • Expected death
  • Sudden or unexpected death
  • Grief
  • Bereavement
• End of life care

  Care provided to those who are in the last months or years of their life, refers to the care provided when the efforts made to successfully treat or control a disease has ceased
• Palliative care

  Palliative care relieves suffering through an approach that improves quality of life for patients (adults and children) and families who are facing a progressive, life threatening illness, relates to symptom management and improving the quality of life for those with a serious illness
• Hospice

  Place or organisation that provides care for people who are dying
• Expected death

  Result of acute or gradual deterioration in an individual's health often due to advanced disease or terminal illness
• Sudden or unexpected death

  Death without warning (for example an accident, heart attack or act of violence)
• Grief

  A response to loss and often described as intense sorrow, used in the context of having lost a person who has died
• Bereavement

  Sense of loss when someone close passes away
• Role of healthcare professionals in providing person-centred care for the individual during the active dying phase

  1. Provide support to both the individual and to family/carers

  2. Providing information on what they might expect during this time

  3. Addressing questions and concerns honestly

  4. Taking time to be an active listener

  5. Understanding the stages of grief (for example the Kubler-Ross model) and providing emotional support or advice

  6. Recognising when someone may be entering the last few days and hours of life

  7. Involving the individual and families in decisions about their care and wishes, this may include specific wishes in relation to culture and religion

  8. Involvement of multi-agency teams where required in the care of the individual

  9. Advocating patients' rights and wishes

  10. Safeguarding the individual
• How to support people with bereavement and how to communicate with families

  1. Providing a safe and comfortable environment and suitable resources (for example tissues, refreshments)

  2. Provide emotional support (for example by listening, allowing the person to talk/cry)

  3. Understand families may have an emotional reaction and how to handle those situations (for example anger or aggression)

  4. Duty of candour (for example accurately representing the situation)

  5. Acknowledgement of cultural/religious rituals with a bereaved individual

  6. Sign posting to applicable services (for example bereavement care, national charities for bereaved people)
• The 6 Cs in relation to person-centred care

  • Care
  • Compassion
  • Communication
  • Courage
  • Commitment
  • Competence
• Practicing and promoting the 6 Cs in relation to demonstrating person-centred care skills, through own actions and promoting the approach with others

  1. Providing choice and gaining consent

  2. Ensuring privacy and dignity

  3. Respecting individuals' equality, diversity and inclusion, sexuality, faith, cultural needs and preferences, rights, confidentiality

  4. Following the duty of care

  5. Dealing with conflicts between rights and duty of care

  6. Ensuring partnership working

  7. Ensuring honesty

  8. Prevent discrimination through promoting inclusion and an inclusive environment

  9. Escalating concerns