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Improving CareImproving Lives

Self Care – A Real ChoiceSelf Care Support – A Practical OptionSelf care was highlighted in the NHS Plan as one of the key building blocks for apatient-centred health service. More recently self care featured as a keycomponent of the model for Supporting People with Long Term Conditions.Research shows that supporting self care can improve health outcomes,increase patient satisfaction and help in deploying the biggest collaborativeresource available to the NHS and social care – patients and the public.Helping people self care represents an exciting opportunity and challenge forthe NHS and social care services to empower patients to take more controlover their lives.

What do we mean by self care?

Self care is a part of daily living. It is thecare taken by individuals towards theirown health and well being, and includesthe care extended to their children,family, friends and others inneighbourhoods and local communities.

Self care includes the actions peopletake for themselves, their children andtheir families to stay fit and maintaingood physical and mental health; meetsocial and psychological needs; preventillness or accidents; care for minorailments and long-term conditions; and

maintain health and wellbeing after anacute illness or discharge from hospital.

The spectrum of care

Any particular example of care lies on aspectrum (see Fig 1) ranging from 100% self care (e.g. brushing teethregularly) to 100% professional care(eg neurosurgery). In between these isshared care where individuals or familiespartner with practitioners in the care ofthe individual; practitioners include alliedhealth professionals (AHPs), nurses,doctors, social workers and pharmacists.Supporting self care has always been

This communication sets out the current position and is aimed at PCT, NHSTrust, SHA and social care management teams as well as health and socialcare professionals and practitioners.

Its purpose is to:

l provide information on the developing policy on support for self care andthe reasons why it is important (the why);

l suggest what practical action can be taken by those delivering health andsocial care (the what);

l provide some ideas on how to support self care (the how).

This document has benefited from consultation with a wide range ofstakeholders.

Supporting Self Care

Fig 1: Spectrum of Care

part of good practice, especially forAHPs, nurses and pharmacists.

The case for self care support

Society is changing. People want moreinformation, choice and control over theirlives and this is no different for health.The public’s attitude to looking after theirown health is beginning to change.There is a shift towards independenceand there is a range of personalisedchoices for patients and various optionsfor provider agencies. Patients and thepublic have said that they want moresupport to self care.

In terms of episodes and hours, mostcare in daily life is self care. Forexample, people with diabetes have onaverage about 3 hours contact with acare professional and do self care for the remaining 8757 hours in a year (see Fig 2) using the advice given by

professionals during the 3 hours or usingskills learnt through structured self careeducation programmes such as DAFNEand DESMOND (www.dafne.uk.com).

Fig 2: Hour by Hour Care of Diabetes

But there is scope for more self careacross the whole spectrum of care.Around 40% of GP consultations are forminor ailments; 75% of A&E attendancesare for minor illness or injury. Withextended support for self care, many ofthese episodes could be better taken careof by people themselves.

There is growing evidence to showthat supporting self care leads to:

n improved health and quality of life

n rise in patient satisfaction

n significant impact on the use ofservices, with fewer primary careconsultations, reduction in visitsto outpatients and A&E, anddecrease in use of hospitalresources.

Impact on patients

l better symptom management, suchas reduction in pain, anxiety,depression and tiredness

l improved feeling of well being

l increase in life expectancy

l improvement in quality of life withgreater independence.

Impact on care services

l visits to GPs can decrease by 40%

l outpatient visits can reduce by 17%

l A&E visits can reduce by up to 50%

l hospital admissions can be halved

The Expert Patients Programme

EPP participants say that they wantto do more self care:

“I have learnt that I need to takeresponsibility for my health insteadof leaving it all to the GP.”

“The Programme has really helpedme to take more control of not justmy arthritis, but also my life.”

Less complex cases More complex cases

100%

0%

0%

100%% professional care

% self care

Self Care

Professional Care

1ryhealth care

and mediumsocial care

2ry & 3ryhealth care

and intensivesocial care

Most care is shared care and can involvea small or large component of self care

Professional Care


l hospital length of stay can be halved

l medicines intake is regulated orreduced

l days off work can reduce by 50%.

(References for the research evidenceare available on our website athttp://www.dh.gov.uk/SelfCare)

Different types of self care support

Support for self care involves increasingthe capacity, confidence and efficacy ofthe individual for self care by providing arange of options (see Fig 3), including:

n appropriate and accessible adviceand information

n individual care plans for adults andchildren

n self-diagnostic tools, self-monitoringdevices and self care equipment

n first aid training in schools for children

n health education, for examplethrough the Skilled for Healthprogramme of DfES to provide basicskills and health literacy training

n self care skills training, for examplethrough Expert Patients Programme

n multi-media multi-lingual self carefacilities and information materials

n campaigns and training on lifestyleissues to change behaviours,promote good health and prevent illhealth; such as by lay self caretrainers; or health trainers proposedin the Public Health White PaperChoosing Health

n utilising networks of peers withexperience and memory of healthyliving and of caring for a minor, acuteor long-term condition

n building social capital and self caresupport capacity in the community

n participation of the public in designand implementation of localprogrammes

n education to change attitudes andbehaviours of practitioners and publictowards self care

n training of practitioners in when andhow to use approaches to supportself care

n initiatives to develop partnershipsbetween professionals and thepublic.

Self Care ofMinor Ailments

Professional Care of Minor Ailments

Self Care ofLong-term Conditions

self monitoringself treatment

taking medicines

ProfessionalCare of

Long-termConditions

Professional Careof Acute Illness

Self Care ofAcute IllnessSelf Care Support

patient educationself care skills training

health and social care informationcare plan approachself diagnostic tools

self monitoring devicespeer support networks

home adaptations

Self Care for Maintenance of Good Health and Lifestyle and

Prevention of Ill Healthhealth literacy

prevention of ill healthmaintenance of physical and mental well being

self diagnosisproblem solving

effective communicationactive citizenship

Fig 3: Self Care Support and Self Care


The strategic fit

Self care is consistent with our policy ofputting the patient first. Individualinvolvement and empowerment are nowkey to NHS and social care delivery. Selfcare was highlighted in the NHS Plan asone of the key building blocks in its visionof a health service designed around thepatient. Self care also features in theNHS Improvement Plan and in theNational Standards (D10).

Strategic priorities for the NHS over thenext 5 years will be care of long-termconditions, improved access and patientexperience together with greater choiceand personalisation of care. Self care isintegral to all of these priorities.

Where can support for self carebe useful?

Promotion of good health andprevention of ill health

Stopping smoking, cutting alcohol intake,doing physical activity and regularexercise, following a balanced diet,using a care plan or regularly monitoringhealth are all examples of self care andare important to promote good healthand prevent illness and injury. The newPublic Health White Paper ChoosingHealth sets out a programme of action toimprove the nation’s health by providingself care skills training to people.

Care of long-term conditions

The increased incidence of long-termconditions presents a major challenge tothe NHS:

l In GB, 17.5 million people may beliving with a long-term condition.

l Around 6 in 10 adults in thehousehold population report someform of long-term health problem.

l Around 80% of GP consultationsrelate to long-term conditions ofwhich a quarter are minor complaints.

l Care of long-term conditionsaccounts for 60% of bed days inhospitals.

l By 2030, incidence of long-termconditions in the over 65s isestimated to more than double.

To deal with this volume of expectedactivity, care of long-term conditions isnow a key priority for the Department ofHealth, NHS and social care services.Support for self care of long-termconditions is a fundamental element ofthis work.

With the right support people can beempowered and learn to be activeparticipants in improving existingsymptoms, avoiding flare-ups, slowingdeterioration & preventing developmentof complications and other conditions.This can help them in achieving a better quality of life while living with and taking care of their conditions.

The majority of people with long-termconditions fall in the lower base of thecare triangle (see Fig 4); even a small %increase in self care of long-termconditions can have a huge impact ondemand for professional services.

Advice for patients about medicines is atype of support for self care for peoplewith long term conditions. This includesinformation to improve patients’understanding of the usefulness andaction of medicines; of side effects andhow to take care of these effects.

Self Care in the NHS Plan

“Most health care starts with peoplelooking after themselves and theirfamilies at home. The frontline inhealth care is in the home.”

“The NHS will become a resourcewhich people routinely use everyday to help look after themselves.”

NHS Plan (2000) Chapter 1 para 1.9


Fig 4: People with Long-termConditions requiring Self andProfessional Care

The Department of Health strategy forcare of long-term conditions and regularupdates on the strategy can be found atwww.dh.gov.uk/Publications .

áMen could be getting more than just ahaircut at their local barber’s, thanksto a health initiative by AiredalePrimary Care Trust. Chris Bradleyand Mehzar Iqbal, working for theHealth of Men project are holdinghealth drop-in sessions at a barber’sshop. They hope to encourage southAsian men a group with a traditionallyhigh incidence of heart problems tohave a health check. In the picture,Mehzar Iqbal, project worker forAiredale PCT, gives a customer ablood pressure check while barberAzhar Mahmood looks on. Initiativeslike this are aimed at preventingonset of disease.

s el f c a

r e

professional care

complex cases with co-morbidities

high risk cases

high % ofprofessional

care

equally shared care

high % ofself care

70-80% of the people with long-term conditions

Examples of schemes toreduce prescribing in generalpractice and increase patients’understanding of medicines

Planned face to face review ofmedicines for people with long-term conditions can help themcare for themselves byunderstanding their medicinesand taking them more effectively.Recent research has shown thatpatients suffering adversereaction to medicines use 4% ofhospital beds*, and review ofmedicines can help prevent thisfrom occurring by identifyingpotential interactions and sideeffects and taking actionbeforehand to resolve them.

Medicines Partnership haspublished ‘Focus on YourMedicines’, a patient guide tomedicines review. This isdesigned to help patients to getthe maximum benefit from areview by preparing theirquestions in advance. 400,000copies of the guide have alreadybeen distributed via PCTs. InSeptember 2004, a specificversion of the guide for peoplewith epilepsy was published,including an epilepsy diary forpatients to complete prior to areview.

The guides have beenextensively tested with patients,who felt that these would reallyhelp them to get more out of areview. Copies are available fromthe Medicines Partnershipwebsite at www.medicines-partnership.org

*BMJ, 3 July 2004, 329:15-19.


Care of minor ailments

l Minor illness and injuries account foraround 75% of A&E attendances;around 15% of these have thepotential to be taken care of bypeople themselves according toevidence from NHS Direct. Also goodquality written information providedduring visits to A&E prevents revisitsto outpatients or admission tohospital.

l 40% of GP time is spent dealing withpatients with minor self-treatableillness; when provided support for selfcare, people can take care of theseailments themselves.

l Almost two-thirds of GP consultationsresult in a prescription being writtenwhich could have been treated byover-the-counter medicines providedby pharmacists or no medicine at all.Self care advice empowers people totreat themselves appropriately andavoid unnecessary medicine intake.

l Pharmacists have an increasing roleas a source of advice on self care.There are now many effectivepharmacist-led minor ailmentschemes throughout the country.

Acute and Intermediate Care

Self care is crucial following discharge ofpatients from hospital. Information onself care will be included as part of thecare plan given to patients when theyleave hospital. This will help ensure thatgoing home from hospital is a positiveexperience and readmission is avoided.

Supported and enhanced self care canalso help prevent acute illness, such asan injury from falls. Another example isthe possibility of preventing strokes,such as by doing appropriate self care inone’s own home by closely selfmonitoring symptoms after a transientischemic attack (TIA).

Therapists in intermediate care can giveself care advice for secondaryprevention and where possible after ahospital episode for rehabilitation in thehome environment.

‘My Health Calendar’ is aninformation booklet developed byUniversity of Moncton, Canada toexplain what to expect after a daysurgery; this is likely to reduce GPand outpatient visits for complaintsof pain and other minor symptoms.

Pharmacists in Tyne & Wear

A pharmacy scheme in Tyne & Wearcovers 46 GP practices and 64community pharmacies serving over265,000 people. Patients are givenleaflets with information on self careof minor ailments and advice onwhen to seek professional help.These leaflets are available in eightlanguages. The scheme has beenshown to be safe and cost-effectiveand has proved popular with bothpatients and professionals, who arenow working together as part of NHSLive to extend the range of illnessescovered.

A&E and Self Care

In Norfolk & Norwich Hospital patientinformation booklets for knee andankle injuries have shown topromote self care after dischargefrom A&E.

A study at St Thomas’s in Londonshowed that around 10% of A&Epatients could have got self careadvice from pharmacists.


Self Care with Social Support

Feedback from GPs indicates that minorailments for which people seek servicesof GPs and practice nurses often includesocial and emotional problems. Carehomes, home visitors, social workersand community networks of lay peoplecan also have a role in providing selfcare advice and support whereappropriate for such problems.

In Wigan and Kirklees, the ‘MovingMore Often’ programme in settingssuch as residential homes andsheltered housing not only aims toprovide opportunities for physicalactivity for older people, it is also alearning and social support network forthem. Among others, there is an activitycalled “Just Me!” which provides skills toolder people for self care and to be“active on one’s own”.

Health Incidents

999Self care advice for Category C Patients

Own HomeExamples of self care in your own home: - healthy lifestyle, exercise, diet - change light bulbs/prevent falls - use DiTV/internet - use self care guides - use care plans - self diagnosis - self monitoring - use home adaptations - extra care housing - peer support groups

PharmacySelf care advice for

minor ailmentsInformation leaflets

NHS DirectWalk-in Centres

Self care advice for minor ailmentsLifestyle advice

OutpatientsTelephone advice and follow-up in groups toprovide self care advice

Day CasesCare plan and peer

support upon dischargeLIfestyle advice

General Practice– referral to self care support such as EPP, DAFNE or DESMOND– encourage and advise patients to do self care

Intermediate CareStep up and step down

support for self care

Therapists support

ElectiveInpatients

Care plan and peer support upon discharge

Lifestyle advice

A&ETriage of patients withminor injury or illnessfor advice on self care

Promote self careprior to A&E

EmergencyInpatients

Care plan and peer support upon discharge

ResidentialCare

Self care skills trainingfor groups of residents

Home CareSelf care skills training

for people withlong-term conditions Nursing Care

Self care skills trainingfor people with

long-term conditions

Fig 5: Self Care Support in the Whole System of Health and Social Care

Self Care Support in the Whole System/Pathway of Care

As indicated above, there is potential to support self care at various points in the caresystem. The diagram below illustrates some of the types of self care support that maybe provided in different parts of the care system. (See local examples of self caresupport at http://www.dh.gov.uk/SelfCare).

These self care support initiatives can, however, be successfully embedded in the caresystem only if they are integrated in its routine business and have the full backing ofcare professionals, practitioners and managers. Campaigns to raise awareness andschemes to provide training for professionals will need to be put in place. Some trainingresources already exist for increasing the skills of professionals to help them embracenew thinking in health and social care such as the choice agenda, copying letters topatients, Expert Patients Programme, etc. (See examples at www.4ps.com).


Self Care Skills and Techniques

People need skills and techniques totake care of themselves. These include:l Problem solving l Planning, decision making and taking

actions to fulfil plansl Controlling and taking care of

symptomsl Utilising supportive resourcesl Developing effective partnerships

with practitioners.

These techniques are not only used inan illness or injury. Most people usethem routinely in daily living. Butproviding the right support is importantso that people can learn to use them,have the right motivation to choose theright approach to care and becomehealth literate.

Factors influencing involvement ofthe individual in their health

It is for the individual to decide how theywant to be involved in their own care.We should encourage more individualresponsibility where this is appropriateand where the person has the capacityand desire to contribute to their ownhealth as well as that of their childrenand families. But we must not forget thatit is for the individual to make that choice.

Role of individuals and care agencies

What the individual & families can do

‰ follow a healthy lifestyle

‰ become health literate; exercise

choice

‰ be willing to participate in own care

and that of children and others in the

family

‰ take care of minor ailments

‰ monitor own long-term condition

‰ seek out and use relevant information

effectively

‰ develop skills and learn to use

techniques for empowerment and

to develop self confidence

‰ work in partnership with practitioners.

What NHS and Social Care agencies

and practitioners can do

Professionals, practitioners, staff and

statutory agencies can work together

with patients and the public on an

integrated programme of self care

support:

„ design and implement a PCT or

SHA wide strategy to support self

care using a mix of approaches

described in this communication

„ work with other local statutory bodies

e.g. local authority, education and

leisure sectors

„ disseminate evidence and inform

practitioners on benefits of self care

support for patients and the public

and how it can help achieve targets

„ re-train professionals and staff to

provide self care advice, education

and training to patients

„ develop health trainer or self care

trainer role

Factors contributing to people makingself care as their choice include:l history and personal experiencesl existing knowledge l values and beliefs l cultural backgroundl literacy and cognitive abilityl confidence, self-esteem and self efficacyl perceived controll availability of real, personalised choicel availability of information and the form

in which it is presentedl availability of useful tools and equipment l evidence on benefits of self care supportl encouragement/support by practitioners.


„ patient segmentation and targetingspecific groups of patients

„ provide care plans for all patientson discharge from hospital

„ provide condition-specificpersonalised care plans for peoplewith long-term conditions

„ promote community pharmacyschemes

„ develop partnerships betweenagencies in the community toprovide user-led social support

„ encourage community peers toprovide help to others on how touse health information

„ encourage people with similarproblems to keep in touch andsupport each other in the community

„ support families to increase theirhealth literacy and to educatechildren on health issues.

Building partnerships: contributionof private, voluntary andcommunity sector agencies

The voluntary and community sectorshave significant expertise in supportingself care, especially patientorganisations in the care of long-termconditions. Opportunities exist to work inpartnership with these groups, e.g.developing joint training and educationprogrammes for care of people withspecific health conditions.

There are also many varied localcommunity groups which may beavailable to support self care activities,e.g. Faith groups to help in forming selfcare support networks and in sustainingthe self care skills learnt.

The private sector also has acontribution to make, e.g. a major localemployer where there will be interest topromote health and well-being; HighStreet pharmacies and super marketswhere there will be mutual interest toattract customers as well as to support

them in annual health checks and selfdiagnosis and in forming peer networks.

Risks

As with any care service provision, selfcare support carries with it risks. Thesewill need to be considered fully by careprofessionals and agencies whenintroducing new self care supportinitiatives in their areas as these will alsobe of concern to people before theymake their choices. Issues forpractitioners and service providers toconsider include:

l appropriateness of self care supportin terms of clinical risks and patientsafety

l public and patient capacity to selfcare which can often be underminedby factors such as poverty, access toresources or poor housing

l ensuring equality of access

l lack of availability of local socialcapital and capacity to deliver selfcare support

l there may be need for a ‘graduatedlearning and access’ approach to selfcare.

Initiatives to support self care

There is a great deal already happeningat both national and local levels tosupport self care. Existing initiativesinclude:

1. National Service Frameworks(NSFs) that have a strong focus onprevention and on role of theindividual and family in their owncare, such as Diabetes NSF andChildren’s NSF

2. The Supporting People with longTerm Conditions Model has selfcare as a key element

3. roll-out of Expert PatientsProgramme: generic lay led selfcare skills training programme


4. condition-specific patient educationprogrammes, such as

– DESMOND for people with Type 2diabetes (www.cgsupport.nhs.uk/downloads/NDST/DESMOND_newsletter.pdf)

– DAFNE for people with Type 1diabetes (www.dafne.uk.com)

5. Public Health White Paper ChoosingHealth proposal to introduce healthtrainers to train patients and thepublic in self care skills to improvehealth

6. developments in IT: procurement ofan Integrated Care Record Serviceled by the National Programme for IT(NPfIT)

7. the choice and personalised careagenda

8. new GMS contract and the Qualityand Outcomes Framework providefinancial incentives for primary careto support initiatives such as self careinterventions to reduce demand inprimary care

9. National Health Information Strategy,NHS Direct Online, telephonehelpline, healthcare guide and Digitalinteractive TV provide self careadvice and information

10.Skilled for Health partnershipprogramme between DfES and DHprovides self care education toimprove health literacy and adultbasic skills.

Developing self care supportprogrammes

The Department of Health aims to helpdevelop good self care support initiativesthat can be organised locally with accessto a national strategy and set ofprinciples. This will entail developing anintegrated programme of work thatcombines a range of approachesmentioned previously.

Good self care support offers realopportunities for improvements inservice capacity and building socialcapital. What strategies are deployed willbe for local decision based on localneeds and priorities. The Department ofHealth will help provide the evidence, therange of options and share good practiceexamples and innovation.

The forward work programme

Over the coming months we will:

l provide a number of local NHS andsocial care based as well as othergood practice examples in self caresupport with contact details; a firstsurvey of such activities across thewhole system of care is available onthe self care support website athttp://www.dh.gov.uk/SelfCare

l support the development of threeprogrammes funded by the new GMSContract on developing onlinedirectories of self care supportintiatives and community networks

l provide emerging evidence on thebenefits of the Expert PatientsProgramme

l provide published research evidenceon the effectiveness of differentapproaches to self care support

l provide examples of self care supportnetworks in local communities

l encourage health promotioncampaigns, e.g. stopping smoking,cutting alcohol intake, physicalexercise, healthy eating

l ensure that self care support featuresin all policy development

l update this communication about self care support onhttp://www.dh.gov.uk/SelfCare.


Caroline Brock Ayesha DostSelf Care Support Workstream Lead Principal Analyst and Policy Adviser

Issued: January 2005

For more information visit our webpage at http://www.dh.gov.uk/SelfCare

A self care vision:

llll individuals and carers have self care as a real choice

llll choice includes a range of self care options –available, accessible, convenient

llll the right support is provided for that choice.

Gateway 4401

© Crown copyright 2005

Produced by COI for the Department of Health

266332 1p 2k Jan 05 (CWP)

If you require further copies of this title quote 266322/Self Care – A Real Choice contact:DH Publications OrderlinePO Box 777London SE1 6XHTel: 08701 555 455Fax: 01623 724 524E-mail: [email protected]

08700 102 870 – Textphone (for minicom users) for the hard of hearing 8am to 6pmMonday to Friday

www.dh.gov.uk/SelfCare

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