A Critical Appraisal of Person-Centred Approaches and Service

Person-centred care (PCC) can be referred as one of the fundamental principles as well as the standards of the care set by the care Quality Commission (CQC). It is concerned with a specialised care delivery process that prioritises the personalised needs of service users in terms of promoting their holistic wellbeing. This essay will present an evaluation and critical appraisal of different person-centred approaches (PCA) and processes of services user’s involvement to care. Through presenting this evaluation of the person-centred approaches this essay will discuss how service users can learn from the person-centred approaches. In this essay, different theories of service user's involvement (SUI) will be discussed in terms of analysing how different person-centred philosophies impact health and social care. Then the essay will present a critical analysis of the empowerment, partnership and advocacy in relation to the ideology of the service users' involvement. Finally, in the conclusion, the essay will draw a summary of the content in which the importance of the services user’s involvement as well as person-centred care, different service delivery methods and the implications of person-centred care will be discussed.

Person-centred care can be defined as the set of approaches that are designed to meet the individual health needs of services users thereby improving their overall quality of living (Oppert et al. 2018). Evidence suggests that, although the concept of person-centred care is mainly concerned with setting a holistic care plan for people suffering from critical illness, in modern healthcare this care process is widely used by the care providers in promoting the positive health and wellbeing of services users. In this context Park (2020) mentioned that person-centred care is associated with providing personalised support to not only the people suffering from critical illness, but also to people residing in different sections of the society who suffer from marginalisation, disempowerment and discrimination. Services users involvement (SUI) is advocated as the specialised care framework, in which service users are involved in the decision making of their care and treatment process. As mentioned by Bristowe et al. (2019), SUI is the important element of the person-centred care, through which care providers can involve the services users in discussing the process, outcomes and the possible risk associated with their treatment and care plan.

While it comes critically appraise the PCA and SUI it is crucial to discuss the historical context of this PCC in the UK. The concept of person-centred care had been created in the UK to provide personalised care to disabled people in society. The person-centred philosophy was first introduced in 1940 by the founder of the humanistic concept, Carl Rogers. He primarily focused on making a therapeutic relationship with his client by taking a person-centred approach. After this initiative, the comprehensive practice on PCC was developed that has been continuously evolved and refined to become modernised (Byers, 2017). With the development of person-centred therapy, therapists moved away from the idea of developing a mere clinical regime for critically ill patients rather they focus on setting a holistic care plan in which all kinds of patient’s needs were considered. On the contrary, Nolte (2017) argued that, although person-centred therapy was introduced there were a lack of systematic approaches to implement the person-centred plan effectively to meet the needs of services users. This was due to the poor infrastructure of NHS hospitals, lack of evidence-based approach and lack of experiences and highly skilled care professionals. In this context Oppert et al. (2018) argued despite all the criticism regarding the person-centred approach in the ancient UK, it must be acknowledged that this care approach has modernised the way care providers deal with patient’s health needs and develop the effective care plan. The report Building on Progress: Public Services 2007 mentioned that the person-centred approach had been proved to be the most effective care framework in which specialised care services were tailored to the personalised health needs of the services users. On the contrary Bristowe et al. (2019) argued that, along with the development of the PCA, the government must focus on empowering people by shaping their lives, living standard and self-management skill. UK government’s report “Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care (2007)” mentioned that person-centred care is not just about health and social care but it is one of the most important central care agenda of UK government for public reform. The New Deal that had been conducted during 2008 had officially integrated the idea of PCA and SUI into the adult health and social care framework of the UK. As mentioned by Naldemirci et al. (2018), although the person-centred approach has been modernised and refined throughout the decades, still it needs continuous improvement to determine the ever-changing health needs of services users. Although the concept of person-centred care that had been introduced by Roger and his colleagues was mainly based on psychotherapy, in the modern context, the person-centred approach is applied in wide ranges of clinical aspects such as physical development, social development, emotional development and improvement of living standard.

There is a set of well-structured statutory guidelines that the care professional in the UK follow to implement the person-centred approach to meet the holistic needs of services users. Under NICE (2018) guidelines, the person-centred approach must have a holistic approach in which care professional will considers all kind of individual health needs of service users [NICE, 2018]. As mentioned by Byers (2017), the holistic approach is the widely used process in the modern medical field, which emphasize promoting wellbeing on the entire body and mind of a person rather than focusing only on a specific health need. NICE (2018) sets four principles for the PCC based on which care professional would set the entire care plan for service users [NICE, 2018]. These principles are, treating each people with respect, compassion and dignity, the care must be personalised, the entire care must be coordinated and supportive towards meeting health needs and the care must enable people to shape their abilities and strength to live an independent life (Nolte, 2017). The care quality commission (CQC) ensures that care professional in the UK must follow the Health and Social care regulation (2008) Regulated activities 2014: regulation 9 [NICE, 2018]. Under this regulation, the people in the UK must be provided care that meets their personalised health needs (Naldemirci et al. 2018). CQC make sure that people proper person-centred treatment and care that are entirely based on their specific needs and preferences. Doh [ Department of Health, UK] provides the authority to CQC to cancel the registration of the care professionals who are unable to comply with this above-mentioned regulation (Morton and Sellars, 2019). Under the PCC policy set by doh, care providers must be involved in partnership working with services users thereby determining their personalised needs, such as physical, emotional, social, psychological and physical needs. By determining these needs, care professionals must make effective adjustment as well as modification in the care plan. Under NICE (2018) guidelines for PCC, care professional must provide proper support to the services users to make them understand the objectives methods and associated outcomes of the entire care process. Under the guidelines care professional must ensure that services users give their valuables informed consent regarding their treatment and care. As mentioned by Bristowe et al. (2019) while providing PCC to service users care providers must consider the ability of service users in terms of giving valuable informed consent. NHS (2018) mentioned there are two core values of PCA such as self-management support to the services users and shared decision making. Care providers must ensure that there two cores values are implemented into practice while providing the PCC to the service users. NHS (2018) recommends that through providing PCC to service users, care to provide must evaluate that how the people’s personalised needs are met and how much they become able to manage their critical or long-term health condition. In this context, Oppert et al. (2018) argued that rather than one times evaluation of the care outcomes regular overhauling of the treatment process is better in case of identifying whether the person-centred approach is appropriately implemented in case of patients with long term health condition. Under doh (2018) guidelines for PCC care providers must ensure that they provide proper care advice and health education to the service users in terms of developing the self-management skill that will assist them to improve their quality of living.

While implementing PCA (person-centred approach) into the healthcare setting the care providers must consider some factors that may act as the potential barriers for PCA (Oppert et al. 2018.). Lack of service user’s involvement in his or her care process is a potential barrier to PCA. Evidence suggests young people with mental illness and children and less involved in their treatment process (Park, 2020). Despite a strong emphasis on service user's involvement (SUI), there is a lack of cooperation from the young people and children towards providing informed consent to the treatment. In the case of mentally ill people, they cannot actively be involved in the treatment process because they cannot understand the aim, process and outcomes of the treatment. In this context Bristowe et al. (2019) mentioned, lack of cooperation from service uses regarding their involvement in the treatment pose barre is on effective implementation in PCA because in these cases services users cannot be involved in the shared decision-making process. Shared decision-making is the most important aspects of the PCA, which assist care providers to determines the preferences, choice for treatment, psychology, perspectives and decision of the service users.

Another potential barrier to PCA is the lack of a systematic information sharing process. As mentioned by Bölenius et al. (2017), appropriate implementation of PCA is strongly dependent on how efficiently all the updates regarding patients' health is transferred to the health professionals and other health staffs at right time. NMC (2018) mentioned that while delivering PCC, care providers must ensure that an appropriate amount of patient-related information has been shared with all the members of a multidisciplinary team at the right. As argued by Naldemirci et al. (2018), despite the emphasis of NHS on improving the information sharing during providing PCC, there are many cases of delayed information transfer and poo quality of information management that interfere with the effective implementation of PCA. On the contrary, Nicholson (2017) argued that not only the poor information sharing but also many other crucial factors that need to be considered for effective implementation of PCA. One of these factors is support and training to the care professionals.

Training, skilled development and support to the care professionals are the most important factors that assist them to provides high-quality PCC to services users. Evidence suggests that there are many cases in the NHS hospital, in which care providers are unable to implement the PCA inro practices due to the lack of resources, poot clinical infrastructure and lack of training and knowledge development of care providers. In this context, Burton et al. (2017) mentioned that care professionals must be provided with the proper clinical infrastructure and resources that they need to determine the holistic needs of a service user. NHS (2018) mentions that care professional must be provided with proper support to develop the necessary skill, confidence and knowledge that are required to adapt to critical health needs of services users.

As mentioned by Gondek et al. (2017), stereotype, culture and social perspectives are also the factors that pose potential barriers to SUI and PCA. In this modern health world, there are may instance ibn which people are more intended in the traditional and backdates healthcare perspectives. These traditional clinical perspectives mainly confined to only promoting the physical wellbeing of people rather than promoting their positives holistic wellbeing. As mentioned by Scales et al. (2017) care professionals face a lack of cooperation and support from the people who prefer to undertake the traditional treatment rather than undertaking a PCA based care plan. However, the issues regarding the choices of services users to undertake the traditional treatment process can be solved by discussing the outcomes and cost-effectiveness of PCC as compared to the traditional treatment process. Critics argued that in the modern medical era, service users get more updates and well-informed therefore they chose the best option for their treatment and care rather than being obstinate to choose the traditional care process. According to Kortteisto et al. (2018), during promoting SUI and providing PCC, care providers must consider some other factors that can act as potential barriers to the PCC. These factors are the relationship between the care providers and service users, the ability of service users to be involved in the PCA,

While discussing the SUI, it needs to be acknowledged that a number of theories or models have been presented by different theorists. These philosophical approaches regarding SUI are presented on these models and their impacts on the way services users involved in that treatment and PCC are delivered to the services users. Arnstein’s ladder of participation is one of the famous models that had been introduced by Sherry Arnstein in 1969. This model presents the most effective innovate tool that is widely used by modern therapist and health professionals while applying the PCA to promote positive SUI (Gaber, 2019). The philosophical concept that is presented in this model assist the health professionals to conceptualise how an effective SUI would look like. The main concept of this model is power distribution to the citizen and services users. This model is based on the philosophy that the ability of people to reveal the power agendas in the representation of the degree of power. According to Gaber (2019), through Arnstein’s model, the philosophy of power distribution among citizens to give the authority to take an active decision there in their own wellbeing and treatment. Arnstein’s model presents a descriptive continuum of citizen’s partnership, which shows how the power transfer from the non-participation to the degree of tokenism and then to the degree of citizen participation. As mentioned by Slotterback and Lauria (2019), Arnstein’s model is based on the philosophy that, participation that does not include the redistribution of power is meaningless and it develops a high level of frustration for the people who are lack any power (Ciaffi, 2019). Based on the philosophy it can be stated that, through maintaining a continuous process of power distribution, among citizens, it is possible to motivate them to be involved actively in their holistic wellbeing. On supporting the concept of Arnstein’s model, Gaber (2019) mentioned that, through providing the authority or power to the services users to take an active part in decision making regarding their treatment, care providers can maintain a shared decision framework. In this shared decision-making framework, care providers can provide the authority to the service users to express their decision regarding the types of treatment, their choice for particular PCA and rights to confidentiality. Based on this the philosophy presented in Arstein’s model, different aspects of SUI have been identified such as co-production, codesigning, consulting, engaging, educating, informing and coercing (Slotterback and Lauria, 2019). Care professionals must apply the concept of all these aspects of SUI to promote the active participation of the service users. There are many criticisms regarding Arnstein’s model. Tritter and McCallum pointed out the fact that the linear hierarchical model of power distribution is failed to present the evolutionally and dynamic nature of service users’ involvement (Mccarthy and Muthuri, 2018). They also mentioned that this Arnstein’s model also fails to recognise the agency of service users, the different ways of involvement and the process of dealing with different issues regarding their involvement in their treatment. On supporting this criticism, Laverack (2019) mentioned that Arnstein’s model mainly focuses on presenting the distribution or authority or power among the citizen in which it fails to highlight the factors that affect the authority and power of service users and how these factors can be eliminated to promote positive involvement of service users into their treatment process.

Another famous model of SUI is Cornwall’s participatory Method. This model presented different methods of SUI that can be applied by the care providers int practices to improve the care outcomes of PCA. These models of participation are co-option, compliance, consultation, cooperation, co-learning and collective action. As mentioned by Glomsås et al. (2020), similar to Arnstein’s model, this model presents the different view of services user’s participation activities. In the modern healthcare setting, this model can be applied by the care providers to consider the different level of participation of the services users and choose the best PCA and SUI options that fit the health condition and health need of the services users. However, there are many criticisms regarding the application of this philosophy into practices while providing PCC and promote SUI in modern healthcare. On the contrary to the concept of SUI presented in Cornwall's participatory Method, Laverack (2019) argued that there are not the fixed modes of service users’ participation rather care providers must consider associated factors such as the current holistic needs of service users to choose the relevant involvement model. In this contest, Cornwall’s participatory Method fails to describe the factors that can affect the services users’ participation. On the contrary to the criticism, Barnes (2019) mentioned that Cornwall’s participatory Method introduces a wide range of participation models that can assist today’s care professionals to use different SUI approaches to promote the active involvement of service users. The author also mentioned that Cornwall’s participatory Method presents the fact that participation in the unfolding process keeps changing and modifying with the inclusion of evidence-based approaches in terms of promoting better engagement of service users each time.

White’s typology of participation is the other important model that present two types of participations such as representatives, instrumental and transformative participation (Glomsås et al. 2020). In this model, participation is characterised as a dynamic process that is not constant. Based on this philosophy presented in this model, to promote effective SUI, services users must understand the types of needs and demand of the services users. Based on this model, participation is different in the case of different services users that affect the way they are involved in the practices (Mccarthy and Muthuri, 2018). Instrumental participation of this model presents the concept that can be applied by the social care professionals while working with people in infrastructural projects. Here social workers must focus on the needs of the project workers such as the cost-effectiveness of that project to improve their quality of living. As mentioned by Adams et al. (2020), the representative philosophy on this mode; can be widely used in modern health and social care in which people would be provided with the facilities to improve their decision making and self-management skill that assist them to improves their quality of living. This concept can also be used in applying PCA to a services user with a critical health condition, in which care professional can promote his or her holistic wellbeing through improving the self-management skill of their service users (Wurm and Napier, 2017). The philosophical consent of the transformative participation impacts the ways care professional will empower service users thorough providing them with the resources as well as opportunities to bring about effective changes in their lifestyles and living standard. Despite the useful impact of this model on SUI and PCA, there are many criticisms regarding the application of this model. Skene (2021) present an argument to the concept of transformative participation by stating that, this type of participation does not follow the equal and systematic sharing of power and authority by the citizens. Critics also mentioned that this model assist care professionals to use SUI that is relevant to services user’s needs, it is failed to highlight the challenges that care professional can face while applying transformative or representative participation.

While discussing the SUI and PCA, it is important to present a comprehensive discussion n the empowerment and advocacy that are strongly associated with effective service user’s involvement. Adams (1990) defines empowerment as the process that assists communities to make effective management of their circumstances thereby achieving the goals that help them to improves the quality of living. In modern health and social care, care professionals must use the concept of empowerment while promoting the SUI and PCA to provide the services users with an opportunity to shape their skill and abilities to live a healthy life. Croft and Beresford (1993) defined empowerment as the process through which people can exercise and share power thereby having more control over their activities and lives. Based on this concept, empowerment is the systematic process that assists individual to have the power to have a greater voice on agencies and intuitions that have potential impacts on their lives. Based on this philosophy of empowerment it can be stated that, while promoting effective SUI, care professional must ensure that power is provided with service users in such a way that assists them to exercise and share the power to achieve their life goals thereby improving their ability to self-manage their health needs (Tanekenov et al. 2018).

Advocacy can be defined as the integration of the social and individual actions that are designed to avail the policy support political commitments, system support and social acceptance for a particular health goal or program [WHO, 2018]. Both the process of empowerment and advocacy have sets of principles that care professionals must follow while applying the concept of PCA and SUI. Empowerment has five major principles which are collectively termed as SHARE (seek, help, asses, reach and evaluate) (Keselman et al. 2019). While conducting SUI is seeking patient’s participation, in which informed consent is taken from patient’s regarding their participation in the treatment process. As mentioned by Akpotor and Johnson (2018), care professional must help service users by providing the opportunity to compare and choose among different treatment options. By providing the choices for treatment to services users, care professionals can improve the level of service users’ engagement to their self-management. Assessing patient’s values and participation is important for the care professionals while delivering PCC. While conducting SUI, care professional must discuss the treatment process with services users and then reach a good decision with the service users. On the contrary Tanekenov et al. (2018) in the case of patients with mental illness, it is difficult for care professionals to follow this principle of discussing the treatment with the patient. After deciding with the patient, care professionals must evaluate the possible outcomes and associated risk of the decision to ensure the safe delivery of PCC.

Empowerment and advocacy present the way in which care professional work in partnership with service users thereby providing them with opportunities to shape their self-management skill thereby improving their overall quality of living (Brophy, 2020). Some many theories and philosophies present the process of advocacy and empowerment of services users. The New care Models present six principles such as care must be personalised, there must be the partnership of services users with communities and citizens, PCA and SUI will emphasize narrowing health inequality, cares must be supportive and involved, involve voluntary participation of different agencies int participation and volunteering social actions. As argued by Keselman et al. (2019), care professionals in mots of times can not follow all the principles due to many barriers such as lack of cooperation from the patient, poor communication and lack of resources. The New care models fail to discuss these barriers that care professionals must consider promoting partnership with service users.

Based on the Individual Professional Advocacy model, the advocacy is carried out by the train, professional, unpaid or paid people who are not dependent on any agency or providers (Akpotor and Johnson, 2018). By applying the philosophical approach presented in this model care professionals can work in partnership with this individual to conduct qual distribution opportunities and power to the services users in terms of improving their self-management skill. As argued by Keselman et al. (2019), while applying this model into practices, care professionals must consider the diverse opinion, work process and perspectives of different agencies and individuals to avoid the chances of a conflict.

The citizen advocacy model is a widely used framework in model health and social care in which ordinary people are encouraged to be involved in promoting the welfare of the deprived and marginalised people in the society who need social and health care support (Adams et al. 2020). Another importance model is the Collective Advocacy Model that present the philosophy of collaborative effort in self-empowerment. Based on this model, health and social care professions must encourage a group of needy and deprived people to work collaboratively to raise their voices regarding their needs (Akpotor and Johnson, 2018). Based on these two models, care professionals must be involved in the partnership with the people who needs holistic development, thereby empowering them by providing them with the opportunity to self-management.

From the entire discussion, it can be concluded that person-centred care is a widely used care approach by which the personalised needs of services users are met. There are different types of person-centred approaches. Care professionals must choose such a PCA that can be highly relevant to the needs of service users. Service user’s involvement is strongly associated with PCC, in which care professionals provide them with the opportunity to share their skill and ability in managing their own needs. There are different philosophical approaches to PCA and SUI, which present different ways of person-centred care. Empowerment and advocacy are associated with shaping the skill, decision making and knowledge of service users by involving in partnership with them thereby enhancing the ability to manage their own needs.

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