What is supported self-management?

Supported self-management means increasing the knowledge, skills and confidence a person has in managing their own health and care by putting in place interventions such as: peer support, self-management education and health coaching.

Peer support happens when people with similar long-term conditions, or health experiences, come together to support each other, either on a one-to-one or group basis. Peer support is enabled through relationships that build mutual acceptance and understanding.

Self-management education is any form of formal education or training for people with long-term conditions focused on helping them to develop the knowledge, skills and confidence they need to manage their own health care effectively.

Health coaching focuses on supporting people to make more informed and conscious choices about their health. It enables people to develop the knowledge, skills, and confidence to take opportunities to become active participants in their care.

Everyone living with a physical or mental health condition can benefit from supported self-management, including the 15 million people in England living with multiple long-term conditions, who could potentially benefit from:

• proactive, personalised and intensive support to enable them to become active participants in their own care
• evidence-based interventions specifically designed to increase knowledge, skills and confidence
• increased self-efficacy and ability to make conscious and informed decisions.

Supported self-management is arguably one of the most underutilised evidence-based, cost-effective health interventions available to the NHS. Supported self-management is one of the six core components of personalised care.

Evidence base for supported self-management

Low levels of self-management, health literacy and activation are linked to increased cost, faster disease progression, early mortality and increased multi morbidity. However, these trends can be reduced/reversed through evidence-based interventions to increase levels of self-management and health literacy.

Accessing one or more of the three supported self-management interventions significantly increases the likelihood that people will adopt behaviours and approaches that positively contribute to their health and wellbeing. A study from the Health Foundation suggests that if patients who currently feel least able to manage their conditions were supported to manage them as well as those who feel most able, this could prevent 436,000 emergency admissions to hospital and 690,000 attendances at A&E each year.

There is additional evidence that supported self-management has a positive impact on the health and care system. An independent evaluation found that people who had the highest knowledge, skills and confidence had 19% fewer GP appointments and 38% fewer A&E attendances than those with the lowest levels of activation [1]. This finding was corroborated by a Health Foundation study which tracked 9,000 people across a health and care system [2].

What good supported self-management looks like for people

• What matters to them is recognised and they are seen within the context of their whole life, including relationships, interests and challenges they may face.
• They are valued as an active and equal partner in conversations and decisions about their health and wellbeing and recognised as experts in their own lives.
• They are supported to find solutions, make plans and break down their health and care goals into manageable steps.
• Support focuses on their goals; not what others think those goals should be.
• Support helps to increase their capability to self-manage and gives them the motivation and opportunity to do so.
• They can access support to improve clinical outcomes and physical wellbeing, for example, blood pressure, blood sugar, symptoms of their condition.

What are the benefits for staff and the system of supported self-management

• Understanding people’s knowledge, skills and confidence around their own condition can support commissioners to understand better the needs of the local population (for example, segmentation and stratification). It is therefore a key element of population health management approaches.
• Related to the above, understanding the level of people’s self-efficacy can support commissioners to put in place approaches to meet their population’s needs more appropriately. This can include targeting and allocation of resources more appropriately to provide more in-depth support to those people with low knowledge, skills and confidence to self-manage.
• Supported self-management approaches are commissioned by integrated care system and and local authority commissioners, working closely with the voluntary, community and social enterprise sector and people with lived experience.
• The workforce is trained, through e-learning, webinars and group training, in administering approaches to identifying a person’s level of knowledge, skills and confidence.
• Understanding people’s needs enables members of the workforce to tailor approaches to people to best support self-management. Related to this, the workforce is more able to raise awareness of supported self-management and enable people to take ownership and responsibility for their health.
• The workforce receives appropriate training and support to work in ways that support self-management, including health coaching, as part of their existing role.
• Typically, there may be additional roles alongside the traditional workforce, such as health and wellbeing coaches, care coordinators, and social prescribing link workers. Health coaching averages 6 to 12 contacts, which can be done in a variety of ways, depending on people’s preferences.
• Supported self-management can impact on the wider economy with people getting back into employment or volunteering and managing their whole life, such as finances and housing.