Developing a Self Care Support Strategy
Department of Health (UK)
When developing a self care support strategy for your area, the following should be considered:
- Involve patients and the public through new and established mechanisms – any strategy needs to be based on their requirements and preferences.
- Assess the self care information and support networks which already exist within your health economy. Are there any gaps in knowledge, availability and quality?
- Ensure that the EPP is fully integrated into your strategy.
- Invest in people and resources to support partnership-building across health and social care communities.
- Make good use of Local Strategic Partnerships.
- When re-designing your services, work with all agencies, the community, the voluntary sector and people with long term conditions and their carers.
- Involve patients, lay experts and appropriate local professionals in identifying best practice in approaches to needs, information and communication.
- Think about the best way of commissioning self care support approaches to meet local needs.
- Work with your Local Pharmaceutical Committee to ensure that community pharmacists are using the new contractual flexibilities to support self care and medicine management.
- Explore what national initiatives link into self care support initiatives, for example: assistive technologies, integration with Social Services, Partnerships for Older People Projects, Connecting for Health, Community Pharmacy/Medicines Management, Patient Choice and the National Primary Care Development Team (NPDT).
Why we need to focus on self care support
When someone has been diagnosed with a long term condition, even though this may not be clear to them at the time, they will be embarking on a life-long journey. This journey will involve the development of an understanding of their needs in terms of both internal resources and external support in order to incorporate the condition and its management into their lives such that they can enjoy as full a quality of life as possible.
This journey requires several fundamental psychological and social changes to engage in active participation and collaborative relationships with their families or carers and a range of health and social care professionals.
A strategy to support people with long term conditions to self care should reflect these psychological and social changes and incorporate a wide range of approaches and models of self care support, including finding ways of providing funding, information, facilities, equipment and technology to forge its development.
Not everyone wants to take a proactive part in their own care. It’s important that individual preferences about who takes decisions about different aspects of health and healthcare are respected too.
How we will achieve sustained self care
We need to promote a change in perception about the role of everyone involved in supporting people with long term conditions. These changes in role need to take place not just within the health and social care services, but in the individuals with a long term condition and their carers.
To achieve this we need to recognise and understand what motivates people to take care of themselves. The impact of any long term condition and the individual’s ability to optimise self care are related to:
- The perceived or actual severity and nature of their underlying condition.
- The short, medium and long term impact of the condition on the individual’s ability to undertake normal activities of daily living.
- The person’s beliefs, understandings and expectations around the condition – and the perceived role health and social care can play in providing a cure, care or support.
- How much the patient participates in or avoids active self caring as a result of these beliefs.
- The effect of symptoms, loss of control and loss of role on a patient’s morale and mental health and the way in which they want to live their lives (their aspirations).
- Healthcare professionals’ beliefs and expectations in providing care, cure or support.
People with long term conditions will not fully engage with self care until each of the above has been discussed and they have a clear understanding of the role of each factor in their overall condition. People can only begin to embrace self care once they have become reconciled to the fact that their condition is being optimally managed medically.
If we are to embed this approach into our systems and change processes and their outcomes, we need to think differently and train differently.
Putting people at the centre of our services
A new approach based on outcomes for people, and health and social care professionals working together requires a radical shift in the balance of power, with the patient at the centre.
A patient-led system can be achieved by:
- Fully involving and consulting with people to plan their care according to their understanding, abilities, needs and preferences.
- Organising flexible, responsive services based on a person’s needs and preferences.
- Recognising that health and social care professionals are part of an interdependent system where visions, objectives and resources are shared.
- Ensuring there are no artificial boundaries between agencies and organisations, so that individuals experience a seamless care pathway.
Providing people and their carers with choice as to how their care is personalised is a central tenet of a patient-led NHS.
Integrating care and support across sectors
We must work together across care services to deliver high-quality, modern health and social care. Quite often, people have a range of health and social needs. For example, incorporating self care of a long term condition into someone’s life may require psychological support, advice about retraining, adaptation, employment, benefits and housing advice.
There is a growing body of evidence showing that social care can reduce, prevent or replace the need for hospital services. Studies have found that an increase in the use of community social and health services reduces the use of hospital services – an increase in the provision of these services can improve not only people’s immediate outcomes, but also their future health outcomes.(13) For example, one primary care trust with a specialist falls service reduced the number of people admitted to hospital after a fall by 12%, saving around 1,000 bed days a year.(14) The National Falls Collaborative, in 2003, achieved a reduction in falls of 32% and is now in its third year. This is something we cannot ignore.
Timely diagnosis and treatment, plus rapid access to services when necessary
There are some conditions, such as rheumatoid arthritis and schizophrenia, for which early diagnosis and treatment can make all the difference to a person’s quality of life. If the condition gets worse, everything should be done to ensure it is dealt with quickly: prompt diagnosis, pain and symptom management, appropriate treatment and information all have short- and long-term benefits. Enabling people to access healthcare as they require it is a powerful incentive for people in terms of self care.
Getting patients involved
One of the best ways to build a patient-centred health and social care service is to get patients involved in shaping it.
People who have lived with long term conditions have the valuable knowledge and experience of living with their condition which they can share. By involving and consulting with them during the process of developing local healthcare policies and practices, we can gain a unique perspective not available to most healthcare professionals.
The delivery of services can often be improved through imaginative solutions that ensure people’s needs are met. Self care is by definition undertaken by and for the benefit of the individual – so services should be developed to support this.