Clarifying the people and values that enable self-management support to happen

Self-management support is becoming more and more accepted as part of the way health care should bedelivered. 

This week the Health Foundation has published A practical guide to self-management support, building on that acceptance and providing a practical resource that clarifies what self-management support is, and some of the important aspects to consider when trying to implement it in practice. 

As authors of the guide, we have spent much time recently exploring and reflecting on self-management support and the opportunity to articulate it more clearly.

Part of this opportunity is to frame self-management support in the language that fits with the principles of person-centered care – it is about enabling people who live with long term health conditions, rather than treating patients and is rooted within the quality of our relationships with people, rather than things that we do to people.

We’ve broadened the concept of the 'workforce’ in line with the latest thinking in this area.  Although traditional clinical roles are still important, other non-clinical roles such as health coaches, peer support workers and health navigators can also effectively support self-management. This isn’t an ‘either/or’ situation, since along their journey with a health condition, people will need a range of support from a skilled workforce. 

As with any area of health care, the topic of quality is important. However, as with other areas of the health service, quality in the context of self-management support is not only about the processes that are used, but the outcomes they lead to (primarily for the individual themselves, and secondarily for the system) and the value that that creates. 

The guide has been written by a collaborative team, whose experience includes living with long term health conditions, supporting others with long term health conditions through coaching and courses, nursing, physiotherapy, service delivery and evaluation, academia and research, and training of health care professionals. 

Even with this extensive experience, marrying up the theory and rhetoric into practical advice for implementation has been hard. Put simply, there isn’t a single approach or technique that works for every area and every person…and nor should there be.  

 We feel that this reflects a more common challenge in the NHS, where collectively we can be good at the rhetoric and talking about general principles, but struggle to systematically turn that into a tangible reality for people delivering and using our services. This is a challenge that can be really exciting - ultimately sharing the benefits of self-management support with everyone with long term health conditions!

Self-management support and the principles underpinning its implementation in practice are still relatively new and constantly evolving. One thing that is clear from our discussions is that supporting self-management should be conceptualized as a value-driven approach that we embed within our practice, our reflections and our thinking, rather than being prescriptive about how to make this work. We hope this guide helps people take a step closer to the former.

Anya de Iongh, Petrea Fagan, Julie Fenner, Lisa Kidd

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