Seizing the initiative on self-management

This year, self-management has gone from a minority sport to premier league status in health policy. This shift began with prime minister Gordon Brown's speech on the NHS in January, and continued through to health minister Lord Darzi's recent report. In both, we have seen consistent recognition that changing the doctor/patient relationship and redesigning our system of care is vital to improving the lives of people with long-term conditions.

The Health Foundation has recently been reflecting on the first eight months of its Co-creating Health initiative at a national forum with more than 100 participants. The initiative aims to put support for self-management at the centre of mainstream health services. It is a£5m, three-year demonstration project working with eight local health economies across the UK. The eight sites are working in pairs focusing on one of four conditions - depression, diabetes, musculo-skeletal pain and chronic obstructive pulmonary disease.

What is clear from the initiative is that, although self-management support is on everyone's lips, it is challenging to implement. It is not simply an add-on and requires deliberate activities to support clinicians and health systems, as well as patients, through change. What is also clear is that even at this early stage, Co-creating Health is having an impact.

Self-management partners

Supporting self-management means fundamentally transforming the patient/clinician relationship into a collaborative partnership. This means both doctor and patient have to change. Through the programme, more than 2,000 patients will participate in training that helps them understand how to change their behaviour to improve their lifestyle and get the most out of their time with clinicians.

One patient summed up their new doctor/patient relationship by saying: "I have to do my bit, the doctors can only do so much, I need to meet them half-way." Clearly, educating and informing patients is an important part of the support they need. But behaviour change is difficult and people need support from their healthcare providers to make needed changes.

To achieve this, clinicians need to change the way they think and act. Through Co-creating Health, more than 500 clinicians will undertake a nine-month advanced development programme to strengthen the skills they need to work in partnership with patients. This involves a clear shift in their understanding of their role. To one clinician, this shift "initially felt like trying to write with my left hand".

Service improvement

Training patients and clinicians alone, however, is not enough. Service improvement is also crucial. Because these services are often complex, changes mean redesigning the delivery system and adopting new ways of thinking and acting to integrate self-management support into systems of care.

The initiative is supporting these changes by providing sites with information about self-management support systems as well as intensive change management support. This is provided through consultancy, facilitation and quality improvement training. Although all sites in the initiative are already committed to providing self-management support, they need new, practical strategies that make the right thing the easy thing to do for busy, frontline clinicians.

The project is teaching us that changing the traditional relationship between clinicians and patients is not easy and takes time. It requires tangible changes to health systems and the development of new skills and approaches by clinicians and patients. Once the talking is over, politicians and practitioners in the NHS will have to look at how to make good their commitments to supporting patients to self-manage. Co-creating Health would be a good place to begin looking for answers.