When Health Care Needs a Centre, When It Doesn't, and Why It Matters.

This paper examines the concept of centredness in health care, with a particular focus on person-centred care. While the principle of centring care is widely accepted, the concept of a 'centre' remains ambiguous, complicating its implementation. The paper defines centredness, questions the necessity of a central focus and explores alternative models. It suggests that while centredness has helped to address historical imbalances, it risks oversimplification, reducing care to a binary structure of centre and periphery. It also excludes non-persons and lacks cultural sensitivity. Alternative frameworks, such as distributed care, shift away from a singular focus toward a more dynamic, networked approach. Distributed care offers flexibility and inclusivity, but it raises challenges about coordination and the potential emergence of a new implicit centre: distribution itself. Hybrid models combining elements of centred and distributed care offer a path forward. Empirical research is needed to compare these approaches, with the aim of developing more responsive and adaptable systems to address diverse and complex needs for health care.