Planning and delivering integrated health and social care: guidance

2. Takes account of the particular needs of different service-users

No two people are the same and the outcomes that matter will often be different for different people. Very rarely will a ‘one-size-fits-all’ approach deliver effective, person-centred care and support.

People themselves are best placed to know what matters to them, what their circumstances are, what supports they have already and what barriers they face. People using services and health and social care staff need time to work together to identify a person’s desired outcomes and make choices about support that will best help meet these. Both people accessing services and those providing and delivering services may require support to make informed and creative choices about how needs can be met.

Many people will have a range of supports through family, friends and the wider community that help them manage and improve their health and wellbeing. People, their carers and those providing and delivering services need to work together to design services which focus on autonomy and empowerment, and which complement rather than replace existing supports. Where people do not have these social supports, health and social care staff should have the time and knowledge to help people to develop them.

People’s needs, and the capacity of their existing networks to provide support, will also change over time. Services must be flexible and allow ongoing dialogue between staff, people using services and unpaid carers. In these discussions it is important that staff are sensitive to the information people want to share. People accessing services need to be clear about why particular questions are being asked and about any impact the answers they give may have on their support.