Published: 30/06/2005, Volume II5, No. 5962 Page 20

Elizabeth Bayliss, executive director, Social Action for Health

We work in east London with people from minority communities. There is a higher than average prevalence of chronic conditions in some of these communities which means people are suffering strokes and heart attacks in their 40s. The trend is worsening.

So I would challenge Professor Mike Bury's dismissal of 'self-care, like personal responsibility' as merely plausible (Debate, pages 18-19, 17 March).

Social Action for Health has worked for the last four years on selfmanagement within a community development context. We have trained around 700 people from the Bengali community and are now extending our work into other communities.

This work has been rigorously evaluated by Queen Mary's, University of London, involving 500 participants, with clear improvements in self-efficacy.

Self-efficacy is highly significant to the health of people from excluded communities. Bengali and Somali people tell us repeatedly how securing the appropriate health service for themselves or their families is an entirely random matter.

Reaching the GP is becoming a major task, with appointments having to be made on the day, communications with GPs is hit and miss and expectations are not being met (people expect to be examined).

Through a self-management programme, run by tutors who themselves have a chronic condition, in the mother-tongue of the group, participants learn how to problem-solve, forward plan and communicate in terms that will ensure their needs get met. The programme teaches people tactics that give them more control over their lives.

The health service is struggling to cope with demand, so why would anyone want to stop the means by which patients can learn to make better use of services and even reduce their use?

Self-management is not a cure-all, but it is one means by which patients gain a more realistic understanding of what treatment can do for them, and what they need to do for themselves. A virtuous circle can emerge that also encourages clinicians who are demoralised by the sheer scale of unsatisfactory communication and frustration they encounter each day.

The cost of self-management is negligible - the cost of a frustrated GP giving up practice because they are spending too little time practising medicine is high. Instead of quibbling fruitlessly about numbers, why doesn't Professor Bury set up a five-year long-term cost-benefit analysis on self-management? In the meantime, let us do this constructive work with interested patients.