‘Self-management support’ is increasingly being seen as the answer, but there remains a lack of understanding about what a system of effective self-management support looks like. The Health Foundation has just published ‘A practical guide to self-management support’ setting out the five key components we believe are needed to truly support and enable people.
Through our work developing the Guide and on the ground with services, it feels as if three of the elements are reasonably well recognized – even if they are still hard to put in place, and there is still learning to be done on how best to do them. The first is that people with long term conditions and their carers are supported – through courses or coaching for example – to develop the knowledge, skills and confidence to take control in managing their own health and its impact on them. The second is that health professionals, health coaches and others who support people with long term conditions have a good understanding of their role in supporting and enabling people to self-manage and are trained in the specific skills and techniques known to be effective. And the third is that organisational systems and processes across different services are joined up and work in ways that support people to self-manage (such as sending them test results ahead of their appointment) and that help professionals to support them (such as on-screen prompts to refer people to self-management training).
The final two elements – peer and community support, and commissioning – are less well explored.
As well as losing the skills and confidence to self-manage over time, people with long-term conditions and their carers often experience other challenges, such as social isolation, that have an impact on their health. People therefore need a range of support that complements their clinical care and that may, at times, seem tangential to their health. This support generally falls into three categories: support that encourages and enables self-management behaviours; social and emotional support; and support to address the wider social and lifestyle issues, such as financial worries, that impact on people’s health and wellbeing.
We are not starting at ground zero trying to create these different kinds of support. Local voluntary and community sector organisations are generally, to a greater or lesser extent, already doing all three. They also usually have a good understanding of local needs and are trusted by the communities they work with. Despite many good intentions they are rarely, however, effectively linked in to the health care people actually receive.
And that’s where commissioning comes in. It’s complex at the best of times, but for self-management support, the commissioning approach needs to recognize the social as well as medical aspects of long term health conditions. Commissioners need to ensure there is a network of support within the local voluntary and community sector that is both specific to a person’s condition and that can address the broader issues that impact on people’s health and wellbeing. Easy to say, but when budgets are tight, investing in services that are health-related but not health-specific can seem like a luxury. Partnership boards and forums, and mechanisms like Joint Strategic Needs Assessments, are key. They provide a platform to influence how other organisations and sectors spend their money, and may give health the biggest bang for someone else’s buck.
And it’s not just funding that’s a challenge. This broader support then needs to be routinely integrated into the healthcare system and care pathways. Two approaches that are increasingly being tried, and where we are learning all the time, are social prescribing and signposting, for example through ‘care navigators’. Both these approaches require up-front investment as well as work on the care pathway.
In their recent review of the evidence for peer support Nesta and National Voices concluded that peer support is worth investing in, and more evidence is needed to better understand why peer support works better in some contexts and for some groups. The Realising the Value programme includes work on the ground to explore these issues. We would argue that more learning is also needed on how best to knit peer support together with health services to ensure we optimise the impact of investment and provide care that is truly holistic.