Changing the habits of health care

Half of all GP appointments, and £7 in every £10 spent on health and social care, is taken up caring for people living with long-term conditions. As the population ages, the proportion of people affected and the demand on health and social services will continue to rise.

For these people, the purpose of health care is no longer simply to treat and care, it is to support them to manage their own health on an ongoing basis. And a growing body of evidence shows that, done properly, a system that supports people with long-term conditions to manage their own health has benefits for the person, their health and for health services.

But this means asking both patients and the health service to change how they behave.

Changing our habits is hard. It requires a recognition of what we need to change, the skills and motivation to make the change, the confidence that we can do it, and the time. Changing the way health care is delivered – redefining the role of professionals and patients and putting in place processes and infrastructure that support new ways of working – is also hard.

As Martin McShane says in his perspective article for us this month, ‘the management of long-term conditions is the biggest challenge facing health care systems worldwide’. The House of Care metaphor he uses describes the integrated and person-centred approach the government understands it needs to take in order to tackle this problem, with actions at all levels and in all aspects of the health service.

We welcome this approach. The House of Care, rooted in the Chronic Care Model, provides a framework 21st century health services, one that focuses health services on both providing patients with treatment and supporting them to better manage their own health and health care.

Over the last five years, the Health Foundation has invested £5m in testing and developing our Co-creating Health model for introducing and embedding self-management support. This ambitious project successfully piloted ways to change the behaviour of patients, clinicians and health services to ensure better support for people with long-term conditions.

What works to embed self-management support?

Our newly published evaluation of phase two of the programme shares learning about what works to embed self-management support and to secure its wider uptake within routine health care.

The report’s findings are profoundly important to the providers, commissioners and policy makers who are striving to put in place the mechanisms that will transform our health system. Primary amongst the evaluation’s conclusions is the need for a strategic, whole-system approach to implementation. This is not about bolting on; it’s about fundamentally reframing clinicians’ and patients’ roles and health service activities.

The report highlights some common features that those wanting to change their health services can learn from, including:

• the benefits of training teams rather than individuals
• the importance of support from senior leadership within the clinical community
• the added value of integrating with concurrent initiatives
• the value of providing support for both patients and clinicians after their initial self-management training as they seek to embed new habits.

The journey to change the habits of a reactive, disease-centred health care service to a proactive and person-centred health support service is not going to be an easy one. Our case study this month highlights how one Co-creating Health site is integrating self-management support into existing programmes and pathways, not only better supporting people with the confidence, knowledge and skills to manage their COPD, but also demonstrating a real valuing of patients’ time. It demonstrates the successes and continuing challenges associated with trying to embed this new way of working into mainstream care pathways.

We are heading in the right direction. Our Co-creating Health programme has shown that with the right motivation, knowledge and effort it is possible to sustain and spread self-management support. And the rewards for patients and clinicians alike can be immensely rich.