Delivering on person-centred fundamental care: how far have we (really) come? A 10-year retrospective.

The last decade has seen substantial efforts directed towards improving how fundamental care is delivered and experienced. This work was catalysed by landmark inquiries that demonstrated the devastating impacts of poor-quality fundamental care delivery. Much public and academic scrutiny ensued, including our own 2016 discussion paper, which argued that fundamental care was poorly delivered because it was invisible and devalued across healthcare systems. We proposed six strategies for overcoming this issue, ranging from re-conceptualising the value of fundamental care, to enhanced metrics and conceptual clarity. However, reports of poor-quality fundamental care remain, with adverse consequences for healthcare recipients, professionals, organisations, and systems alike. The significant challenges and tensions that have characterised the last decade, including workforce shortages, global pandemics, and geopolitical tensions, have put our healthcare systems under incredible strain, complicating the work of fundamental care transformation. Given these pervasive challenges, it is timely to reflect on the strategies we proposed ten years ago and ask: when it comes to delivering on fundamental care, how far have we (really) come? In this retrospective, we outline the contextual forces shaping our healthcare systems globally and propose what must be done over the next ten years to achieve our vision. We argue that fundamental care must be positioned not as an additional problem to be solved but as a solution to be implemented, one that is foundational to safe, high-quality, effective person-centred care, and which can work to address persistent system issues. Reframing fundamental care in this way requires the resolution of three key tensions: 1) task-driven versus relationship-driven approaches to care, 2) siloed and reductionist versus holistic approaches to care; and 3) incrementalist approaches to change predicated on individuals as the change agents versus whole-system redesign based on an ethics and humanity of care. These tensions create false dichotomies and competing priorities that monopolise energy and resources. The inevitable result is that fundamental care is distanced or isolated from the core work of healthcare systems, undermining its value and purpose. Resolving these tensions in ways that align with healthcare recipient and professional preferences will enable continued work on the strategies we proposed 10 years ago and precipitate a much-needed shift in our healthcare systems and the values underpinning them, seeing us one step closer to our goal of embedding an ethos of person-centred fundamental care in healthcare systems globally.