Four Nations Self-Management Summit
The grass always appears greener on the other side, and I was aware as I flew up to Edinburgh for the Four Nations Self-Management Summit, organised by the Alliance Scotland, that I was setting myself up to feel envious of how they do self-management north of the border.
It was a day to hear how the other four nations drive the self-management agenda from a policy and practical perspective.
To be fair, in England, our numbers are far greater (with the additional complexity and variety of our NHS) than in Northern Ireland, Scotland or Wales. But self-management is about people, after all, so it's the same conversations at the heart of it.
The importance of a shared understanding of what self-management is was discussed early on, with the need for clarity. We may understand what self-management is, but are we really clearly able to articulate what we ‘do’ that ‘is’ self-management support? I admit to finding this hard, explaining exactly what we ‘do’ in our self-management service in Dorset to professionals and people with LTCs alike. Fluffy abstract language is a real-turn off to many in the medical model we are desperate to engage.
No conversation about health and social care is immune from the funding issue, and self-management support is no exception. Some of the funding structures shared enable small-scale pilots that are innovative and stem from communities.
The challenge seems to be across all four nations to take proven pilots and turn them into systematic opportunities for people with long-term conditions. There was a feeling that the money was there to evaluate these pilots, but not the money to commission anything further, or front-line self-management support services.
The point on evidence was further explored. I found myself oscillating through the day, feeling like we have enough and then sure we don’t have enough evidence in this field. Maybe it comes down to the type of evidence… there is no denying the power of those ‘Goosebumps’ stories for the 20% but do we share enough about what happens to the 80%? This feels crucial to realistic commissioning, but is a brave thing to do in such an already sidelined area. Perhaps I need to be more patient – we were told that it takes an average of 17 years from a randomised control trial to implementation for other clinical interventions, and the hierarchy of evidence works against us in this field.
Policy vs practice
Scotland has an enviable policy landscape around self-management support, but the question was rightly raised – ‘does policy change anything’? That chasm between policy level rhetoric and people’s individual experiences still exists, and is hard to square with increasing resources on policy influencing at the expense of service delivery. I was left with a renewed sense that the policy is necessary but far from sufficient in supporting self-management implementation.
I found the day very motivating and it challenged my thinking. I bounced to and fro from feeling very positive to a bit overwhelmed by the scale of the challenge. I wasn't the only one in the room feeling like this: I heard several people talk about how people’s lives are changing because of self-management, and also that for many not getting this support, their lives aren’t changing at all.
A better future for self-management
At the end of the day, the Chair asked us to complete this sentence in 6 words: For me, a better future for self-management means…
There was lots about the approach and values that underpin self-management, which mean so much to me. But we are all aware of these. We need to put this into practice and enable more people to benefit from these approaches and values.
My 6 words were “implementation beyond pilots at scale/pace”
I know self-management is too powerful and positive to be patient about.