OUTCOMES FROM THE JOINTSelf-management workshop

Focolare Centre

10th June 2014

Initial thoughts• Ways of engaging patients essential to get

them to engage

• Self management resources for acute illnesses e.g. leaflets on where to go and how to manage a sore throat are a quick win

• Resources are diverse so embedding them in pathways makes it easier for clinicians, patients and carers

Good outcomes

• Professionals with skills and knowledge to motivate and refer on

• Patients feeling they can manage themselves and know where and how to go

• People feel signposted• Carers feel empowered• People can deal with whole disease not just

mental health aspects

Some Principles• Pathway approach• Behaviourist as well as cognitive tools – psychology of resilience• Self-serve (net, leaflets etc) easy access essential• Take away barriers to help (e.g. IAPT – empowering people not

assessing psychological morbidity)• Health Psychology skills across health and social care• Revisit how we commission holistically• Revisit IAPT (outcomes, processes, pathways, skills of IAPT

providers) to deal with resilience aspects of long term conditions not just mental health aspects

• Capacity and scope to respond to variety of needs and challenges• Ensure we join up the conversations continually

The Big 4 Things

1. Engage patients in their own care and management and make it easier (so use 3rd sector, websites etc)

2. Pathways

3. Look wider than anxiety/depression and into resilience

4. Widen skill sets of practitioners to deliver motivation/mindset resilience as well as having specialist places to go (IAPT?)

Some models.1. Pathways – clinicians having enough

patient/professional interaction psychology to motivate patients

2. Sessional health psycholgists in practices with some skills in professionals?

3. One person in each team with ehnanced skills?

4. The Cambridge diabetes model – skilled patients with professional support doing the work (health education model)

5. The HIV model – newly diagnosed etc

Groupwork 1 - Feedback• Signposting of resources • Psychological and insightful marketing to people you’d

like to engage in self management to get people on board

• Ownership across the system – continuity between conversations on self management across the system. Integration and planned elements of personal health plans

• Every point the patient hits self management gets picked up (all clinicians are responsible for health and wellbeing of patient AS A WHOLE) - ownership

Groupwork 1 – Feedback (2)

• Tendency for system as a whole to make you feel completely powerless, which is not good

• Evidence base being better shared to get engagement – so why self management is important, and what the impact of it can be

• Disseminating evidence AND impact• ALL health professionals in system not just

GPs –anyone in a carer position

Groupwork 1 – Feedback (3)

• Engendering a general philosophy as people that the first approach to any issue is what am I doing myself – is there scope for schools work? (Cultural change. I am in control)

• Find a way of supporting families (parenting skills to help parents empower kids to be resilient)

• Professionals understanding that many will eventually make the change but many havent necessarily had much power, so small changes – need to believe it will work – Positive psychology interventions with professionals

• Takes time

Groupwork 1 – Feedback (4)• Debating between a self management service one

could refer into (eg as bolster to IAPT to get people motivated from step 1)

• A patient questionnaire for patients to consider how activated they are?

• Setting some torchbearers running in some conditions like cardiac rehab and different patient groups to make it fashionable and exciting – “market leaders”

• Culture and whole system change• Signposting and resources being the norm

Groupwork 1 – Feedback (5)• Ultimate aim is decrease in LTC prevalence

and complications and increase in motivation and wellbeing

• Depression and hopelessness linked to this which mitigates against people wanting to do anything for themselves– Meaning and purpose (if life is meaningless why

live till tomorrow?)

• Invest in culture change – staff and patients across whole system

Groupwork 1 - Some quick wins• Website to loads of different resources for patients,

carers and professionals – leaflets, videos, sources etc

• Embed some specific things into pathways like respiratory tools for respiratory pathways etc

• Training professionals in evidence and behaviour change

• Employers – encourage employers to do healthy things

• Community navigators as part of the discharge team, self management as part of discharge

Next Steps….

• Co-production with users and carers and public– Into vol sector strategy and commissioning for

outcomes

• Localities and patient participation groups in each ccg– Enhccg planned programme board– Hvccg to planned and primary and integration

• Hcc integration group• Don’t call it self management

Better Care Fund• Expand on the self management and prevention line in the BCF

paper, get it through everyone and then back to HWBB• A quick strategy• DPH please• Self management workstream• Keeping the conversation very open• What are the top 20 things we know about already that are really

cool that people are doing• Activitists we can rope in• Care homes doing better basics – HCPA needs to be round table• Tim and daniel have a look at website then come back to jim –

conversation with michael francis

To remember

• Social isolation

• Prevention

• Schools

• (not in direct scope, but make links)

Some process points• Jim McManus – paper and project plan, project lead• Tim Anfilogogg - activists• Raj and Linda– 20 things already doing• Rachel – sense check• Michelle – write up• Jim –convene task group• -2% most vulnerable patients – make this work relevant to it to get

buy in from practices – word in a way it supports that – • Gerry and MarieAnne and Daniel as checkers of the plan for this

“handle” identify where this will be most useful for implementations. Four top long term conditions and weight loss and stop smoking