Published: 14/04/2005, Volume II5, No. 5951 Page 3

There is a tendency to deride initiatives which seek to engage patients in the management of their own condition.

Critics argue that they are simply a lowcost but spurious alternative to 'proper' medical-led care whose initial impact on patient well-being soon dissipates, while the evidence that it produces better health outcomes is hard to find.

No doubt more research into selfmanagement is justified, but so - increasingly - is its expansion. The learning that is emerging from the expert patients programme shows not only a positive impact on the ability to manage symptoms and improve the quality of consultations with healthcare professionals, but also a reduction in the need to access NHS services (news, page 8).

Targets to reduce waiting lists or emergency bed days loom large in health service managers' minds, but there is another government-inspired goal which should loom even larger. That is achieving the 'fully-engaged scenario' in which the public take a greater degree of responsibility for their own health. Treasury advisor Sir Derek Wanless, whose 2002 report provided the intellectual ballast for the huge increase in NHS funding, argued this was the only way to justify continued universal healthcare in the UK that is free at the point of delivery.

In other words, patient engagement programmes like the EPP are not a replacement for medical care; they are a way of helping the country afford it.

Of course, the EPP is not relevant for all - perhaps a quarter of those developing long-term conditions each year. And, like case management, the idea will have to be continually adapted to achieve the best results.

It also needs to be part of an NHS armoury of engagement stretching from disease-specific programmes to making sure engagement is facilitated through policies developed by local and central government which give the public the best opportunity to live healthy lives.

Only this approach can help the NHS achieve Sir Derek's promised land.