About Co-creating Health Natalie Grazin Assistant Director The Health Foundation

2 Diabetes The Whittington Hospital and Haringey and Islington PCTs Guys & St Thomas and Southwark PCT COPD Addenbrokes and Cambridgeshire PCT NHS Arran and Ayrshire Depression SW London MH Trust and Wandsworth PCT Torbay Care Trust and PCT Chronic Pain Calderdale and Huddersfield Trust and Kirkees PCT A model for all LTCs A model for all long-term conditions

3 What is needed for effective self-management?

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5 The Integrated CCH Model ©The Health Foundation 2007

An Integrated Approach 6 ProgrammeWhoRole changeFocus Patient From passive patient to self-management Activation and partnership: confidence and skills Clinician From expert who cares to enabler who supports self- management Building the knowledge, skills and attitudes needed to provide effective self- management support 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 Self-management Programme Practitioner Development Programme Service Improvement Programme

7 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

Self Management Programme outcomes 8... producing statistically significant changes in: positive engagement with life constructive attitude/approach towards condition more positive emotional well being using self-management skills and techniques “I used to go to the doctor only when they summoned me, and then say ‘What are you going to do to fix my problem?’. But now I’m saying like, ‘I’m not sure these particular painkillers are working the way we hoped, can we try something else? What could I do myself? ’ “ Person living with a long-term condition Skills developed.... Setting the agenda Setting goals Problem solving Develop the confidence Understand their condition Develop skills

Practitioner Development Programme outcomes 9 Practice positively influenced: patients’ confidence to self manage agenda setting setting own goals collaborative problem solving goal follow up patients’ experience Community matron Clinician tutor “It’s a change from the traditional approach where say ‘You need to do this”, and the patient says “you’re the boss”, but doesn’t actually do it. We used to wonder why that wasn’t working” “Now I use agenda setting with my patients and I start by asking ‘what do you want us to do today?’ Patients appreciate this different approach because you are giving them the power. You work out the goals and the steps together and they are empowered to carry on and work on it on their own. So you may need to see them a bit more at first, but in the long run you need to see them less often.”

Patient Confident in Self Management Organisational Changes Pre-visit changes During visit changes Post-visit changes Primary Drivers Secondary Drivers Outcome Service Improvement Programme The 3 Enablers Agenda Setting Goal Setting Goal Follow Up Adapted from Robert Lloyd and Richard Scoville, Better Quality through Better Measurement

11 ©The Health Foundation Conclusion Person living with a long-term condition ‘I’d like to thank you both for giving me back the life I thought I’d lost, its made me realise I was holding myself back’

More information Visit our self management support resource centre on the Health Foundation’s website: Presentation title set in header 12