Aligning System Levers to Enable Person-Centred Care for People with Long-Term Conditions

C4CC aims to help make person-centred care the norm for people living with long-term conditions. To achieve this, the overwhelming majority of the changes we need can only happen at the local level. But decisions made at a national level also have an impact, either to support or hinder the ability of people locally to work in a person-centred way.

Decisions made at a national level, which have an impact on how things happen throughout the health and care system, are often referred to as “system levers”.

System levers include:

  • Legislation
  • Targets and standards
  • Measurement
  • The NHS payment system
  • National financial incentives
  • Rules about competition
  • Regulation
  • National demonstrator programmes (for example the Vanguards and Integrated Personal Commissioning)

Discussion of system levers can quickly become technical and complex. This paper attempts to keep things simple, so that we can plan and take action. It addresses three questions:

  • What do we mean by system levers?
  • What does this mean for person-centred care for people living with long-term conditions?
  • What needs to be done, and how might C4CC help?

In summary, we suggest that the C4CC partnership should aim to:

  • Get really clear on what the problems are
  • Work with system leadership bodies to align levers to enable person-centred care
  • Work with national demonstrator programmes to ensure the new models of care are person-centred

Download System Levers Discussion Paper (PDF)

Feedback on the paper is welcome. Please send any comments to, by Friday 6 November 2015.

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