Transforming participation in health and social care briefly sets out the case for shared decision making and self-management support and a summary of the requirements of CCGs in England in delivering both, as well as more detailed resources on the legal duties for commissioners and the policy context.
Shared decision making
In shared decision making patients are actively supported to make informed choices about their care that reflect what is important to them. It can take place between a patient and any of the healthcare professionals involved in their treatment and care. It is relevant at any decision point along the patient’s care pathway and is particularly relevant where reasonable options and choices are available, including the choice to do nothing. Shared decision making means that services provide ‘the care that people need and no more, and the care that they want and no less'1
There is strong evidence that when we work this way, patients are more satisfied, intervention rates are often reduced and cost savings can be realised.
Our section on Why do shared decision making briefly sets out the arguments that:
- Patients want more involvement in decision-making than they currently have
- Shared decision making improves outcomes for patients
- Shared decision making is recognised as good clinical practice
- Shared decision making reduces inappropriate interventions and unwarranted variation
- Shared decision making can improve value and cost effectiveness
- National policy promotes shared decision making
QUESTION: What kinds of evidence do you think will convince commissioners that they need to commission shared decision making?
- How much detail do you think commissioners want around the business case for investing in shared decision making? For example, do commissioners want high level or evidence of detail of changes in intervention rates for different treatments?
- What kind of information do commissioners need to help them understand what and how they can use commissioning to embed shared decision making i.e. what kind of training and provider development support; how they might use contracting to set specifications, outcomes and quality standards around shared decision making?
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All those living with long term conditions make decisions, take actions and manage a broad range of factors that contribute to their health all the time. Self-management support is the help given to people that enables them to manage their health well and to their best ability on a day-to-day basis. It is about moving away from patients as passive recipients of care and towards a collaborative relationship where patients are active partners in their own health.
Our section on Why do self-management support briefly sets out the arguments that self-management support:
- Enables and empowers patients.
- Improves their experience of care.
- Improves clinical outcomes.
- Maximises the value of investment in services
- Aligns services with national policy
QUESTION: What kinds of evidence do you think will convince other commissioners that they need to commission shared decision making and self-management support?
- How much detail do you think commissioners want around the business case for investing self-management support? For example, do commissioners want high level or evidence of changes in outcomes for specific conditions?
- What kind of information do commissioners need to help them understand what and how they can use commissioning to embed and improve self-management i.e. what kind of services work? What kind of training and provider development support works? How they might use contracting to set service specifications, outcomes and quality standards around supporting self-management?
Post your comments in the box below.
 Dr Al Mulley, International Visiting Fellow at the King’s Fund and an international leader in the field