Our role in patient activation

NHS England has conducted a survey of over 1,750 clinicians to understand their support for patient activation.

The survey explores clinicians’ attitudes and beliefs, their self-reported behaviours and practices, and provides insight into their perceived barriers and support needs.

The findings of this survey are published today in a  report, ‘How much do clinicians support patient activation?’.

Dr Alf Collins, national policy advisor in person-centred care, explains the important role clinicians have to play in building people’s skills, knowledge and confidence, and supporting them to self-manage their conditions:

When did you last eat five portions of fruit and vegetables in a day and manage 30 minutes of exercise?

You might be one of those rare people who routinely does this but, let’s face it, most of us aren’t totally engaged in managing our own health all of the time. And if you live with long-term conditions or a disability, keeping as healthy as possible can often feel like really hard work.  There sometimes aren’t enough hours in the day.

We’d like to think that public services recognise that living with long-term conditions can be hard work. We’d like to think that they’d strive to reduce the burden of living with long-term conditions. But they often seem to add to that burden – more pills, more appointments, more tests. And well-meaning clinicians sometimes seem to just nag us, rather than ‘meeting us where we are’ and supporting us to make small positive steps towards living as full a life as we can.

We are beginning to understand that it should be the job of public services – and broader communities – to support people with long-term conditions to develop the knowledge, skills and confidence to manage their own health and healthcare.

Activation is one way of conceptualising this; it taps into our self-concept of our ability to manage our own health and can be measured by using a 13 point scale: the Patient Activation Measure. By using this measure, we know that around 4 in 10 people who live with a long-term conditions in this country have low levels of knowledge, skills and confidence to manage their own health, i.e. low levels of activation. As a result of this low level of activation, they experience poorer health outcomes and cost public services a lot more than those at a higher level of activation.

Yet we know how to support people on a journey of activation; peer support – either 1:1 or in a group – and tailored coaching can both be remarkably helpful, especially for those with the most to gain. In order to provide this tailored support, we need to meet people where they are – we need to understand their activation level. But just understanding their activation level isn’t enough. We also need a workforce that is prepared to support people on their journey of activation. In other words, we need an activated workforce.

There is a parallel measure of clinician support for patient activation (the CS-PAM) that taps into clinicians’ attitudes to patient activation. It helps clinicians think through their own attitudes, values and beliefs about working in partnership with patients in order to support them to manage their own health and healthcare.

NHS England has recently worked with four Royal Colleges and other health and care organisations to use the CS-PAM to survey their members – nearly 1,800 clinicians responded.

Although this is a very small sample of the entire workforce, what is encouraging is just how person-centred the respondents were. They genuinely do want to meet people where they are – although they recognise that the system sometimes gets in the way of them doing this and many of them also recognised that they needed further training in communication or coaching skills to become fully activated themselves.

The Five Year Forward View presented a radical vision of people being engaged in managing their own health and the system re-orienting itself in order to support them to fulfil this role. Translating that vision means supporting our population on a journey of activation but critically it also means supporting our workforce on a parallel journey.

It’s been 15 years since Sir Derek Wanless told us that the survival of the NHS depended on a public who were fully engaged in managing their own health. In 2015, we know what that means, we know how to measure it and we know how to support our workforce to develop the skills to help bring it about. We just need to get on and do it this time.

If you would like to find out more about the CS-PAM survey, please contact the Person-centred Care Team at

Alf Collins

Professor Alf Collins is NHS England’s Clinical Director, Personalised Care Group.

He was a community consultant in pain management and in parallel worked for a decade with the Health Foundation. He has researched and published widely on self-management support, shared decision making, care planning, co-production, patient activation and patient engagement.

He has honorary fellowships from the Royal College of Physicians and the Royal College of General Practitioners and is a Visiting Professor at Coventry University.