SORRY for the multiple, long posts! This one might belong elsewhere.
Just reading up on '
self management', '
coproduction' and
service design and found "
Shared responsibility for health: the cultural change we need" by the Kings Fund. Lots of context explaining what self management is supposed to be, a mention of service codesign (bold, below) and some links to more practical case studies from within the article
There is good evidence for people taking greater responsibility to manage their own health where they have the capabilities and motivation to do so. ...Putting shared responsibility into practice requires people to be offered support tailored to their needs, preferences...
There are many examples of expert patients who are denied requests for protected tests and treatment despite that the request is often rooted in evidence - often denial is because the test/treatment isn't the most evidence based intervention for a population, but it might well be worth a try and worth the risk for the individual patient when weighed against their individual circumstances. If going all in for 'self-management', we need individualised decisions and better access to resources for those individuals.
They do say that the old model where "professionals control care" needs to become "the patient as a source of control" but I wonder where they feel the line is drawn, and where indeed it ought to be drawn.
They also point out that;
Improving health and wellbeing is far easier for some individuals and communities than others, as demonstrated by work on patient activation (Hibbard and Gilburt 2014).
Indeed. And far easier for those with conditions that have a range of treatment options.
There is evidence that health coaching can support self-management and behaviour change, although evidence of its impact on physical outcomes is mixed.
Physical functioning is particularly valuable to those who don't have enough of it. Like money.
Goal setting has to recognise that for patients with multiple health problems functional status and social participation may matter more than clinical targets.
Yes, important for *clinicians* to recognise this where patients are less interested in their X levels and more interested in whether they have the ability to leave the house. I guess I could say my goals have been ignored and dismissed by GPs who have been far more interested in celebrating my normal test results, or in ordering a test that I personally don't feel is needed, and remaining disinterested in other requests for help that would help me reach my goal to be able to leave the house more.
Much of the knowledge and expertise required to self-manage long-term conditions is not held by professionals, but by people with experience of the condition. Peer-based approaches can be a powerful tool in building people’s capabilities to manage their health.
Yes, and a lot of us are getting on with that (and professionals don't always like to hear it!). But the point to note here is that patients are often the experts and should be listened to.
It does then go on to say that;
People with first-hand experience of a mental or physical health condition can also play a vital role in educating professionals. This requires a shift in the prevailing view of the professional as the expert, to one where both patients and professionals recognise and value the skills and expertise that they each bring.
And says that this is crucial;
Having patient leaders on system redesign boards, running co-production workshops with members of the public or using specific methods such as experience-based co-design.
I think that's where we want to be getting stuck in.
Lastly, here's a quote for the bank;
...the most important cultural change is in the relationship between patients and the health care professionals who care for them. For this to happen, all involved must fundamentally change their behaviours and attitudes by moving to genuine partnerships in which patients and professionals engage with each other as equals.
Will somebody let the RCPSYCH (or other) reps who worked on the NICE guidelines know? You know, the ones who felt the process relied too heavily on patients.
Here's a nice graphic that explains everything..I mean nothing
View attachment 15716
