Fiona Adshead is advising PHG Foundation on wellbeing and person-centred care as part of My Healthy Future.
Fiona is an independent expert advisor on wellbeing, sustainability and public health. Formerly she was Bupa’s Chief Wellbeing and Public Health Officer, responsible for leading global commercial strategy on workplace health and wellbeing, prevention, behaviour change, partnerships, and sustainability. Before joining Bupa, Fiona was Deputy Chief Medical Officer and Director General in the UK Government responsible for Health Improvement and Health Inequalities followed by being Director of Chronic Disease and Health Promotion at the World Health Organisation. She is a visiting Professor at UCL, and a Senior Associate at Cambridge University’s Sustainability Leadership Programme, where she teaches regularly, and Chairs the UK Health Forum.
(Interview with Rebecca Bazeley)
R: Wellbeing or wellness are they the same?
F: So for me wellbeing and wellness are quite different. Wellbeing is a much broader concept – it is about a life well lived if you like. It’s best captured, certainly in national surveys, by the concept of ‘are people satisfied with their life?’ So it’s very much about are people flourishing, a deep sense of wellness which is connected to the social, spiritual, economic, and other much broader concepts of what it is to live a good life.
Wellness, on the other hand, while it can also have a very sound basis in evidence and can be a useful label for preventative approaches that promote people’s health, becomes a problem when it gets applied to everything from weird and wonderful diets to bizarre interventions. So like anything that gets overused it begins to lose its meaning and is not always a useful concept.
Wellbeing is a much more solid concept and it’s being adopted by governments in moves towards actually measuring wellbeing as a complement to GDP – Robert Kennedy said (more or less) ‘GDP measures everything except that which is worthwhile’. Wellbeing is very much a core concept for what we can do in society to create the conditions for people to flourish.
R: So, is wellbeing just about being happy?
F: No for me it’s not, happiness is a much more transient emotion, hopefully for some people it’s more long lasting! I think wellbeing is more an underpinning sense of flourishing really, whereas happiness is something that comes and goes.
R: Where does person centred healthcare sit within the concept of wellbeing?
F: It’s absolutely at the heart of it – if healthcare is delivered in a person centred way it can promote wellbeing. At its best person centred healthcare is really about responding to a patient’s physical, emotional and social needs as well as providing evidence based care. It’s about ensuring that interactions with healthcare staff are informative, empathetic and empowering and it’s really about taking in to account what matters to people and their preferences and values.
Allowing people a sense of autonomy and control is absolutely critical for people’s own sense of wellbeing.
R: What do you think has changed in practice?
F: I suppose in the last 20 years, people have started talking about care that is person centred in a much more explicit way. It’s been acknowledged as a value, and that might be partly because we’ve perhaps lost something around healthcare as humanised and compassionate. So wellbeing, within the context of healthcare isn’t necessarily new, but it’s about reinventing it in an age that it can be very technologically driven and dehumanising.
Of course as our own work and discussions in Cambridge show person centred healthcare means many things to different people, but at its centre it’s a very powerful movement within the clinical sphere to drive care to be much more compassionate and responsive to people’s needs, and because it is, actually in the long run care is more effective because patients are more likely to want to embrace health interventions and make them part of how they live their lives rather than being something they feel is being done to them.
R: Ok, the conversation is happening, but what’s happening in the clinic, in the 10 minute consultation, is there still some way to go yet?
F: Well to some extent it’s what great primary care is already about – but often processes get in the way. Now, we’re starting to see how technical precision medicine could allow doctors to spend less time focussing on what specific care a patient needs to receive and more time thinking about how it works for them as a person.
Certainly much more needs to be done, but the fact that there’s broad based interest is important, and I think the PHG Foundation roundtables and workshops that are being held in Cambridge at the moment are exactly exploring that question, around why does it matter for people today, and how do we move person centred healthcare on for professionals and patients alike.
Choices in care have always been about trading off different outcomes. For patients outcomes are more than just what they want to achieve for their health – they may be concerned about impact on family, independence, work for example. A person-centred approach can reduce uncertainty because patients will have a much clearer idea of the implications of different interventions. The patient has more information, can make a more informed choice about what is going to work for them.
R: Which takes us to our last question: when it comes to maintaining your own wellbeing, what works for you?
F: Well I’m good at doing things like eating a healthy diet, lots of fruit and veg. I’m also a passionate walker so I walk for 12 hours a week, that’s my personal goal, I love doing that, I just really love walking! I find though, the whole thing of wellbeing an ongoing struggle, because things like enough sleep and finding time to meditate and mindfulness is always a challenge. I think for me it goes back to where we started about wellbeing itself, the clue is in the word, it’s about ‘being’ and being is not so easy, but if you can make it part of your daily life it gives you a great sense of achievement and balance.
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