Self management: it’s easy, isn’t it?

My colleagues often laugh at my mantra for integrating self management skills into mainstream health: ‘it’s like pushing water uphill’. But for those of you who have worked in this area it must feel the same sometimes. Still, I continue because I have witnessed how, when we get it right, self management support makes a real difference to patients’ lives when living with a long-term condition.

So what are we doing that’s different? It’s clear that in a healthcare system where money is tight and we fight for every penny, trying to fund stand alone self management programmes for patients is going to be difficult. Instead, we must find ways of building these skills into everyday care, making it the norm to support patients to self manage, helping them to see that we have joint responsibility for their health.

Surely if we can integrate self management support into one healthcare pathway, we can do it across all long-term conditions? Not only making a difference but also making it mainstream, cost effective and easy for clinicians to support and for commissioners to buy.

To do this, we must look at existing patient education and ask some questions: Does it support self management? What will patients do differently afterwards and for how long? How can we embed the skills they need to make the changes in the long term?

We know already with some programmes, such as pulmonary rehabilitation, that if patients are unable to maintain a minimum level of activity and build this into their daily lives then the health benefits that they gained will be lost.

We also know that if we can help patients to understand the benefits of self management, support them to develop the skills and encourage them to set and follow up on small achievable goals, they can become more confident in living with their condition.

But self management is complicated. All patients self manage to some degree already because they have to – most of the time they are not meeting with doctors or nurses and they have to manage their condition at home. Where they are doing this successfully then the challenge is helping them to recognise this, and where they are struggling the challenge is to support them in making behaviour changes. 

In terms of implementation, building these skills into current mainstream education can be done - I have spent the last 12 months developing such programmes and providing training. I have run programmes for patients with COPD and for type 2 Diabetes that have integrated self management support into existing programmes. It’s more than possible.

These programmes are currently being evaluated and the formal results will be available towards the end of the year. In the meantime, I have seen how patients benefit when they are on the programme: they get to practice new skills, they goal set and we follow up, they see others succeed and are motivated by it. Even the most unlikely patients make some change by the end of the programme.

They find the answers for themselves and become problem solvers and we support them to do it. The programmes still run for the same amount of time, they just have more in them and importantly patients go away with some skills and tools to support them to continue in the longer term.

Our challenge going forward is to understand the extent to which patients maintain this when they no longer have the support of a structured programme, and how we can best support those who struggle with this. Indeed, if self management support becomes part of every healthcare encounter, then that is one way that it can be continuously reinforced.

Let’s think outside the box and build these skills into our everyday practice. Let’s teach some of these skills when patients come into hospital and send them home not just with pills but a skill that might help them to stay out of hospital next time. Let’s encourage patients to question why, consider peer support work and group appointments. Why not challenge the current patient programmes and consider integrating self management skills into them, you might get more for your money!

Tracy Watts is the Lead for Patient Education at Addenbrooke’s Hospital, Cambridge and is part of the Centre for Self Management Support.