Posted by: ayrshirehealth | March 20, 2013

A person centred NHS and why successful change takes time by @simonSRN

A person centred NHS and why successful change takes time

At the heart of the 2010 Healthcare Quality Strategy for NHS Scotland was an ambition to ensure a person centred, safe and effective health service. While significant progress has been made in some areas, most notably through the much lauded Patient Safety Programme, it’s harder to demonstrate how this central plank of Scottish Government health policy has so far impacted person centredness.

Like many, on a personal level I’ve seen the best and worst of worlds when it comes to person centred health care. I can think of times where I’ve experienced the most flexible and compassionate care, where practitioners have really gone the extra mile to make me feel heard and comfortable. I can also recount what, at the time, felt like the startling insensitivity and ignorance of a doctor who in reality probably just didn’t have the skills to share bad news.


Professionally I also have a keen interest in the efforts to put people first in health – efforts which have become figural with the recent publication of the Francis Report, which identified an institutional, and ultimately fatal, breakdown in compassion.

As the Director of the Scottish Recovery Network since 2004 I’ve been closely involved in efforts to ensure that our mental health services are focused on the lived experience of recovery.

Recovery Indictors

While there is certainly no room for complacency when it comes to the recovery focus of our service system there have been tangible shifts in a relatively short space of time. Nurse training programmes have been redesigned around recovery and values-based principles, services routinely assess their policy and practice against a set of recovery indicators, using the SRI tool, and the role of hope, strengths and empowerment are now given prominence in a way perhaps unimaginable ten years ago.


Harvard leadership guru and author, John Kotter, described eights steps to successful change in his in his seminal 1996 book Leading Change.

I’ve found it helpful to reflect on these steps in our continuing efforts to promote and support recovery and think the model may offer some clues as to how to successfully develop person centredness more widely.  I once described the shift towards a recovery focused mental health service system as akin to turning an oil tanker – it takes time and energy – and in mental health recovery this is something we’ve fortunately been granted, both through support from successive Governments and by a service sector which has been open to new ways of working.

Urgency for person-centredness

For Kotter an important first step in any successful change is to establish a sense of urgency – without this people might reasonably ask why they are being expected to change.  The urgency for person centredness has perhaps been boosted by recent scandals in the NHS where systems have come before people. Kotter’s next step is to create a guiding coalition.  In mental health this has very much been the role of the Scottish Recovery Network, strategically positioned to bring together individuals and organisations to share and develop learning – not part of the service system but working closely in partnership.

Step three for successful change, says Kotter, involves developing a clear shared vision and in my experience it is vital not to underestimate its importance.

KotterRecovery and person centredness are, on the face of it, simple concepts and the sort of thing we all want to see. Scratch the surface on each, however, and you pretty quickly get into complex debates about their nature and characteristics and how best to realise them in practice.  They are both concepts that are necessarily unique to each of us and so any description will always have to be a condensing of collected individual experiences.


To ensure authenticity in this experiences and views must be gathered from people in receipt of the services we seek to transform and personalise.  For SRN this step involved a detailed and long-term narrative research project to help us better understand and share the experience of personal recovery – a process that I have yet to see in relation to person centredness in the wider NHS.   Only once we had been through this learning process could we move on with the change process and build our interventions directly from lived experiences, rather than imposing our expert view on the best interventions and messages.

– Walking Alongside

In recovery communicating the vision, Kotter’s next step, has always been a central part of our work and probably always will be. It matters because, as with person centredness, a recovery focused approach creates a different dynamic in services – new types of relationships where professionals do not necessarily always know best. We want to see people walking alongside practitioners and collaborating for health. Notwithstanding existing good practice, this can be new stuff so it needs to be explained, communicated and indeed negotiated.  It’s at this stage Kotter suggests we empower people to act on the vision and only then to move into short term wins, build on gains and ultimately institutionalise the changes.

There is something about Kotter’s ordering which resonates for me. Rush to short term wins or attempt to institutionalise change without, for example, having firstly clarified the vision then I fear that the welcome efforts to enhance person centredness could falter and lose credibility. In taking time and considering change processes we are also better placed to negotiate the inevitable and rational resistance that accompanies any change process.  Surely this is time well worth spending for all our future health and happiness.

@simonSRN is Network Director at the Scottish Recovery Network.

Next week:  @ginaAAlexander returns with her second blog on ayrshirehealth


  1. I agree that with Simon Bradstreet’s strapline that change can take time, especially cultural change in an organisation or instititution like psychiatry that has been used to doing what it likes behind closed doors. And I speak as both a survivor of psychiatric treatment and a carer of family members who use psychiatric services, having completely recovered from ‘mental illness’, psychiatric drug use and labels which have been placed in perpetuity.

    I think the test of recovery focused practice is whether the person at the receiving end believes they can recover and remain mentally well. However the challenge may be to do with what psychiatric diagnosis or label is given as to whether recovery is thought possible from the professional’s perspective or if recovery is only for some people and not for others. A two-tier recovery agenda where mental illness excludes some people from the level playing field.

    I don’t like the term ‘institution’ for it smacks to be of conformity and obedience, to the will of the person in power. It also suggests a regime of rules and expected behaviour or there will be a case to answer, resulting in the use of exclusion, compulsion and even force. And I believe that forced treatment is the very thing that makes the playing field not level, the treatment not person centred and the relationship between a person and the system not therapeutic.

    I am therefore now an activist and campaigner in mental health matters, with a focus on human rights in psychiatric treatment, the issues around forced treatment and the biomedical model which leads to a profusion of psychiatric drug prescribing rather than therapeutic alliances and a holistic approach to working with people in mental distress. Putting people first and last.

  2. […] A person centred NHS and why successful change takes time by Simon Bradstreet on the Ayrshire Health blog. […]

  3. […] to the Ayrshire Health blog (and to Weekly Blog Club), Simon Bradstreet, thought about A person centred NHS and why successful change takes time and quotes John Kotter’s ‘Eight Steps to  Successful Change’ which has […]

  4. […] A person centred NHS and why successful change take time @simonSRN writing on the Ayrshirehealth blog explore progress already made in making healthcare in […]

  5. […] year @SimonSRN wrote for Ayrshirehealth on the Scottish Recovery Indicator (SRI2) and national priorities of SPSP and NHS Quality Strategy, […]

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