My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Some more examples of services aimed at improving NHS patient capacity to self-manage.

Filed Under (Patient involvement, Self Management) by Paul on 14-01-2013

Quite a lot of my day-to-day work with the NHS now centres on the ways in which NHS services need to be reconstructed to increase the capacity of patients to add much more value to their own health care. Last week I argued that the primary provider of most NHS healthcare was not the GP nor the GP practice nurse, nor even the community pharmacist, but was rather the patient and their family carer – who primarily cared for themselves.

GPs in the room responded with interest to this challenge. Indeed one community pharmacist pointed out that the failure to realise the importance of patients as primary carers means that a high percentage of drugs prescribed never actually get into the patient. If we better appreciated that patients need some training in what is going on when they are prescribed medication, a larger proportion of the billions that we waste putting drugs into bathroom cabinets (rather than into people) would be saved.

One comment I received made the point that patients had other things to do with their lives than being trained to be primary care workers. If I had in fact been saying that every patient had to go on a 12 year course to become a GP this would be a very strong point. But I think that just a small amount of thought and resource invested in the education and training of patients to increase their capacity to self-mange would realise very considerable returns. This example of the failure of the NHS to give patients any training about taking their drugs is a case in point.

What is interesting is just how many new examples of resource spending on improving patient self-management there are in the NHS at the moment. Some critics of this investment will say that while it may be acceptable to depend upon patient self-care for conditions that are not life threatening, it has no role to play when it comes to the big killers such as cancer and heart disease.

The answer to this argument comes loudly and clearly from the excellent campaigning charity Macmillans. Macmillans are not just famous for campaigning, lobbying and raising money for better services for people with cancer (although they are nevertheless justly famous for all these) but they also develop their own services for NHS patients. Most people I know who have had a loved one die of cancer remember through the pain of their loss, the professionalism, kindness and the caring of the Macmillan nurse. From organising someone to help move a bed downstairs, to making sure that relatives know that the time to say the last things they want to say will be this afternoon, the work of the Macmillan nurses is an example to all of us that aspire to such professionalism.

So I was interested to discover that Macmillan had been running a number of health and well-being clinics for patients recovering from cancer. A glance at their website will tell you that Macmillan, whilst still recognising and campaigning about cancer as a killer, are now emphasising survival. Every year more and more people survive cancer and this happy outcome brings with it the twin aims of living as full a life as you can, and reducing the chance of recurrence to the lowest possibility.

To achieve these the more you know about cancer and its interaction with your mind and body the better.

There are now 1.8 million people living in England who have had a cancer diagnosis. By 2030 it is anticipated that there will be 3 million people living with and beyond cancer. Such people often have specific support needs which, if not met, can be detrimental to both their long-term prognosis and their ability to lead an active and full life. In 2010 Macmillan Cancer Support developed the concept of health and well-being clinics. This was a new service model designed to bring together a range of service providers from health, social, community and voluntary services into a single event or fair to facilitate the transition of people living with cancer through leaving hospital, to recommencing their life after treatment.

The clinics were designed to provide aftercare once treatment is complete. They were in no way a substitute for a thorough assessment and care planning process. Volunteers played a key role in the clinic model, working alongside health and other professionals to offer support to attendees. Health and well-being clinics were designed to promote people’s awareness of cancer survival knowledge, their sense of empowerment and confidence, and their self-management skills.  The clinics could be distinguished from other forms of treatment and care in that they provided the opportunity for patients and carers to cover specific issues – for example colostomy and prosthetic care, body image and sexuality.

There was a considerable degree of flexibility and variability in clinics, not only in terms of size and location (some in hospitals, some in other health organisations, and some in community-based and other non-clinical environments) but also in terms of the professions involved, types of cancer, and groups served.

The Office of Public Management carried out an independent review of the clinics and reported in the summer of last year. Their top line findings were that:

“The evaluation generated evidence that patients who attended a clinic where they receive supportive information and have access to networking opportunities benefit in a number of ways. They report increased knowledge of symptoms and treatment options as well as increased confidence to self-manage their health.

They report reduced use of health services.”        

Macmillan is now looking to commissioners to commission such clinics as a part of their cancer pathways.

This is another example where a small investment in increasing the capacity of patients to manage their own condition provides not just better care, but less reliance on the more expensive professionally based services.


One Response to “Some more examples of services aimed at improving NHS patient capacity to self-manage.”

  1. Rheumatology is just one specialty which has been emphasising for decades the importance of self-management and understanding drug regimens. Cardiac rehab? Asthma self-management education? Diabetes? Much of this has been the work of specialist nurses who have been very much under threat from the recent cuts.
    Macmillan are an excellent example in this as many other things but don’t undercut or dismiss the other excellent work going on.

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