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Pritti Mehta, national lead for empowering people and communities at NHS England explains why we should be supporting people and communities to self-care.
Self-care is arguably the primary form of care. It is the action that we each take to look after our own health and wellbeing, in order to stay well and to manage long term conditions.
For me, it is taking some time out each week to run to help me ‘reset’ and look after my mental and physical wellbeing. For my dad, it is the small steps he takes each day to manage his type 2 diabetes.
People who have the skills and confidence to self-care or who are more ‘activated’, have healthier lives, better outcomes, better experience of care and a lower impact on services.
And the assets or resources within our communities, such as the skills and knowledge, social networks and community organisations, are key building blocks for good health and wellbeing. It was a community group that got me running!
It therefore follows that we should support people and communities to self-care. Not only is it is the right thing to do, but it is also a key step towards achieving the triple aim of better care, better health and better value.
We know that one of the best ways to build community resilience is to start with a very practical understanding of what resources are already strong in our communities, such as the walking clubs and knit and natter groups, and help people to connect with them. This is sometimes called ‘social prescribing’.
We also know that approaches such as health coaching and self-management education, help people with long term conditions to build self-management skills. We can put these key ingredients together to set out what a good recipe of self–care support might look like. This recipe forms part of an overarching model to empower people and communities, including people with complex care needs, to have much greater control of their health, wellbeing and care.
However, apart from a few examples of good practice, support for self-care still remains at the margins, rather than the ‘way we do things round here’.
To help change that, we are working with 15 new care models across the country to test how we can deliver support for self-care, systematically and at scale. We hope that the learning we generate will support the wider health and care system, in particular accountable care systems (ACSs) and sustainability and transformation partnerships (STPs), where self-care is central.
By working with these new care models, we hope to offer tailored self-care support to 25,000 – 30,000 people by end of March 2018, delivered through health coaching/self-management education and social prescribing. As part of this we are embedding the Patient Activation Measure (PAM) – to enable practitioners to understand where people are starting from in terms of their ‘level of activation’, and how this changes following self-care support.
Since October 2016, Fylde Coast Local Health Economy, has supported over 1000 people with multiple conditions to self-care, through health coaching. And it has already met with some notable results.
The PAM assessment and health coaching was initially introduced to complement the vanguard’s extensive care service, which is a new model of care for people with highly complex needs. Because empowerment, self-care and patient activation are core to the ethos of such new services, the PAM provides some structure for the healthcare professionals involved, guiding them in delivering on these values.
Staff use the results of a PAM assessment to tailor self-care support; and the process is helping to identify people’s problems at a much earlier stage. It is also more accurately informing the type of care that is needed, leading to targeted and more efficient use of resources. At a glance you can see who needs more intense support and who needs less.
The vanguard is starting to see some great improvements, with 55% of people at their three months follow-up appointment having improved their skills and confidence to self-care and 35% maintaining their level.
Fylde Coast has begun to embed the PAM and health coaching across its service by ensuring it is discussed at caseload reviews and multidisciplinary team meetings, and as part of supervision and shadowing. This helps ensure a consistent approach across all staff.
The PAM has now been championed by the associate director of nursing and accepted by the divisional board at Blackpool Teaching Hospitals NHS Foundation Trust to roll out across all community health services. The next steps are to implement PAM awareness sessions, alongside a health coaching skills development programme, where six members of staff will be trained to deliver health coaching training to the rest of the workforce.
Fylde Coast is doing really well in making support for self-care the ‘way we do things round here’. It is delivering results and it is showing how support for self-care can be integrated into a service setting.
We will continue to work together with Fylde Coast and with our other intensive sites, sharing learning, as we go. By working with and through this vibrant network we hope to make support for self-care business as usual.
Follow Pritti on Twitter @pritti_mehta