1. COLLABORATING FOR OUTCOMES: Sustaining and spreading self-management support International Forum on Quality and Safety in Healthcare Paris 2014

2. Conflicts of interest Presentation title set in header 2

3. How important is it to you that we support people to manage their own health and healthcare? 0-not at all important10-extremely important

4. How confident are you that you/your support(s) people to manage their own health and healthcare? 0-not at all confident10-extremely confident

5. What led you to say the numbers you said?

6. Conflicts of interest Presentation title set in header 6 Once upon a time …

7. 7 Self management support can be viewed in two ways: -a portfolio of techniques and tools that help patients choose healthy behaviours; -a fundamental transformation of the patient-caregiver relationship into a collaborative partnership.” Bodenheimer T, MacGregor K, Shafiri C (2005). Helping Patients Manage Their Chronic Conditions. California: California Healthcare Foundation. What is self-management support?

8. NB : People may also be accessing a wide variety of other support e.g. from within their communities Life with a long term condition: the person’s perspective Interactions with the service: planned or unplanned Why support self- management?

9. The job … People are supported to make informed and personally relevant decisions about managing their own health and healthcare and to enact them Should I take that pill today? Am I going to stick to that exercise regime? Do I really want that heart operation?

10. The problems: Lack of care coordination Lack of active follow-up Patients inadequately trained to manage their illnesses ‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’ Supporting people on their journey of activation Understanding have role; confident and capable in role The Chronic Care Model Developed by the MacColl Institute ACP-ASIM Journals and Books 10

11. 11 NHS Ayrshire and Arran Calderdale and Huddersfield NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Whittington Health SW London & St George’s Mental Health NHS Trust Guy’s and St Thomas’ NHS Foundation Trust Torbay Care Trust and Devonshire Partnership Trust The teams

12. 12 Co-creating Health

13. An integrated approach 13 ProgrammeWhoRole changeFocus Patient From passive and reactive patient to proactive, leading role Activation and partnership: confidence and skills Clinician From expert who cares to enabler who supports self- management Building clinicians’ skills and addressing attitudes Service From clinician-centred services to services that have self- management support as their organising principle Embedding the 3 enablers into everyday practice by building them into systems and care pathways

14. 14 Agenda setting – Identifying issues and problems – Preparing in advance – Agreeing a joint agenda Goal setting – Small and achievable goals – Builds confidence and momentum Goal follow-up – Proactive – instigated by the system – Soon – within 14 days – Encouragement and reinforcement Becoming an active partner Making change Maintaining change The three enablers

15. 15 http://personcentredcare.health.org.uk/

16. Here are some things you can talk about at your next appointment…. Blood glucose monitoring Taking medications Losing weight Daily foot care Depression  Smoking Skin care Taking insulin Diet

17. Co-production Presentation title set in header 17 An equal and reciprocal relationship Partnership AdherenceIndependent Working together

18. 18 Bovaird’s Co-production Framework FULL CO- PRODUCTION

19. 19 Delivering Shared agenda setting, shared goal setting, follow up Co-delivery of training for patients and for clinicians Overcoming challenges Shaping Emergent PDSA cycles – My Health Plan Researchers in evaluation Reference group – beyond Co-creating Health Co-production in Co-creating Health

20. Conflicts of interest Presentation title set in header 20 Once upon a holiday …

21. Changing habits: embedding in routine practice Presentation title set in header 21 Target whole teams and groups of clinicians in the same service Critical mass Reinforcement Common language, common conversations, common approaches – from biomedical markers to patient goals Follow up to training Action learning sets Buddying One-to-one support E-learning

22. Changing habits: peer support Presentation title set in header 22 Reunions Torbay newsletter Guy’s St Thomas’ Walking Group Ayrshire and Aran buddying Working with the voluntary sector Nesta: People Powered Health

23. Changing the context Presentation title set in header 23 Engage influential clinical leadership Influence Board Support staff Supportive systems and processes Supervision Audit Part of monthly meetings Education and training Undergraduate education Continuing professional development Routes in – gold, silver and bronze

24. Following the path of least resistance Presentation title set in header 24 Tools, templates and IT systems Calderdale and Huddersfield SystemOne: reminders and reinforcement Results to patients in advance Text follow up Link to other initiatives Cambridge – pulmonary rehabilitation Ayrshire and Aran – telehealth care pathway Calderdale and Huddersfield – Year of Care Work across sectors and with partners My Health Plan

25. A dose of reality Presentation title set in header 25 The business case Cost vs value What’s the matter vs what matters And some hard outcomes

26. Some key messages Presentation title set in header 26 Whole system change Interrelated elements – training and improvement Pathways cross organisational boundaries – understanding and approach need to also Don’t forget the voluntary and community sector Co-production – partnership builds power

27. Some key messages Presentation title set in header 27 Whole system change Strategic approach to implementation Build into local strategies Piggy-back on existing initiatives Use local levers Draw upon policy frameworks

28. Some key messages Presentation title set in header 28 Whole system change Strategic approach to implementation Adopt a targeted but flexible approach to delivery Train teams and groups of clinicians Have a menu of training and follow-up support for patients Have a menu of training and follow-up support for clinicians

29. Some key messages Presentation title set in header 29 Whole system change Strategic approach to implementation Adopt a targeted but flexible approach to delivery

31. Thank you Presentation title set in header 31 Firefly The Co-creating Health Sites – clinicians, managers, people living with long-term conditions You

32. 32 Some resources