Changing the conversation about health
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Centre for Self Management Support

 GlossopNHSTrustUNP011  The CSMS comprises a unique highly skilled, expert team of clinicians, managers, researchers and patients. Our aim is to develop, test and promote self management support (SMS) amongst patients, carers and workforces. We use rigorous evaluation methods to establish the quality, efficacy and health economic impacts of such work.We are committed to collaborative partnership working, supporting patients to be successful in managing their own health and to sharing our learning with others.
Year established
2007
Number of staff
2.5 FT equivalent
Number of users
This varies depending on the projects the team is working on.We are currently working with workforce teams across eight health economies within primary and secondary care and CCGs. These cover multiple long term condition pathways including COPD, diabetes, stroke rehabilitation, oncology and palliative care. The team also provides expert support to national organisations undertaking self management support initiatives and works with third sector organizations such as The British Lung Foundation.
Project user demographics
Patients and carers with long term conditions. We have a specific focus on patients with COPD, type 2 diabetes, stroke and heart disease.Local and national multi-disciplinary workforce teams in primary care, acute trusts, specialist teams, community services, undergraduate/post graduate students.
What makes your project sustainable?
Our aim is for our projects to be funded through a variety of sources including grant funding, consultancy and philanthropic fundraising. We are also exploring building on a number of opportunities (including provider opportunities) to commercialise our work.
Quotes from service users

 

 “The breathing techniques have really helped me. Once you start losing your breath, just get it all out and take a few deep breaths and then we’ll carry on a little bit longer…. and I don’t worry about getting the panics” “I used to carry on as far as I could and then be in a panic at the end, near crippling myself. Now I walk 10 yards then stop a minute then carry on. It’s a lot better.” “Now when I visit the nurse of doctor I make sure they understand what I want, not what they’re telling you. I’m getting to like it. This is it now” “Everyone had the same problem, so it made you feel you weren’t alone… Reassurance that I’m not the only one.” “I managed to walk up Sherringham Hill without sitting down on a bench, you know to the beach” Workforce quotes: “Since attending the workshop and adjusting my approach, pt’s leave appointments clearly more motivated and happy. They report that feel they have been listened to and have a plan of action which puts them back in control. They return to follow up appointments having tried out the techniques and having found benefit from them” “May I first of all state that I have found this course to date extremely beneficial & enlightening. Although identified as an area for personal development, I have been unable to obtain any such training previously”

“I have altered the way I approach consultations with patients in two ways. Firstly, using open ended questions to elicit more from the patient than just one-word answers & encouraging them to explore thoughts/feelings which are integral to their behaviour. This is taking me time to master but I feel I am making progress.

Secondly, asking them to identify what is concerning them & what issues they feel it is important to cover at the start of the contact.

This has helped to prioritise the issues that need resolving & often provides an indication of the motivation level of the patient which can be picked up on later in the conversation”

“This can only have a positive effect on our cardiac rehab service. The patients will benefit in being listened to and their needs addressed”

“I went with my trainee, and we both found the training exceptionally good – I would rate it as the best PCT-arranged course I have been on. I think it works well for GPs particularly as it links in well with consultation models that we are familiar with. Though the tools are for long term self care, they are essentially motivational in nature and so are applicable to all consultations”

“For me the training cracked motivational training in a way no other lecture/course/book has done”

Innovation

 

Costs to the UK health economy of LTCs are increasing and estimated to reach over £16 billion during the next ten years. People with LTCs utilise a disproportionate amount of the healthcare budget in England. This is not sustainable.Our aim is to;

  • bridge the widening gap between potential health and well being outcomes and those currently experienced by people living with LTCs
  • enhance patients’ health related quality of life
  • maximize resource utilisation
  • robustly evaluate all interventions and disseminate learning
  • impact populations affected by conditions with known associated health inequalities e.g. COPD.

Challenges include:

  • measuring the impact of self management support
  • identifying appropriate patient reported outcome measures (PROMs)
  • acknowledgement of the impact of social factors on patients’ self management capabilities in addition to the psychological focus of many established self management programmes
  • developing bespoke approaches which can challenge commissioning models
  • building a shared understanding of self management.
  • Successes include: Integration of self management support within rehabilitation programmes
  • increases in levels of patient activation for self-management
  • new training programmes for clinicians and workforces
  • shifts in workforce attitudes and beliefs in favour of collaborative partnership approaches
  • new tools to support self management, patient engagement and service user involvement.

 

Patient-Centred, whole person preventative approach

 

Our projects focus on delivering models of supported self management in which people become confident to manage their own condition and to retain responsibility for their own health. Our team takes an integrated, holistic approach, recognising that patients develop expertise in managing their condition in a manner that meets their needs, and are not merely passive recipients of care. One size does not fit all and patients benefit from support to live well in the context of their everyday lives and to be confident in achieving the goals that are important to them.

  • All our education programmes incorporate the values of co-production.
  • Patient representation is a core element of our work, including developing education packages, tools and project steering.
  • We strive to find new ways to meaningfully integrate self management support into patient pathways, supporting patients and workforces through this change.
  • Testing new models of integration and finding new ways to inform commissioning structures of what patients really want and need to support themselves. For example, we have tested a process to enable citizen led change and identify priority needs for COPD services. – patients, clinicians, commissioners and the third sector worked together in a co-production workshop which resulted in mutually agreed actions for commissioners to take forward.
  • We are building in self management support into current patient education programmes. This adds value and recognises the patient as an expert in their own health at minimal additional cost.
  • We put the patient at the centre of everything we do – what’s important to me as well as what’s important for me.
 

Evidence informed practice/audit and evaluation

 

We have conducted quantitative and qualitative evaluations of our interventions.Here are some abstracts from the research:Investigating the feasibility of an online health resource with nurse coaching to support self-management in COPD

Supporting patient involvement in service development: eliciting patient-centred information to inform commissioning of COPD services

Patient agenda setting and clinic efficiency in outpatients An individual randomized controlled trial

Investigating the feasibility of an online health resource integrated with nurse coach support for those with advanced COPD

Abstract for submission to BPS Division of Health Psychology conference, September 2013

 

 

 

Multi-disciplinary collaboration, communication and professional practice
We work with a range of multi-disciplinary teams across different project sites and health economies.We have a commitment to undergraduate and postgraduate education and seek to achieve relevant accreditation for workforce and patient programmes.All self management development work is designed to work synergistically with traditional medical pathways and/or is embedded into them. We recognize that there will always be some patients who are unable to, or choose not to, adopt a more holistic approach to their health care and strive to maintain equity for all.Where appropriate, programmes are matched to the knowledge and skills framework.
Contact details
Box 146
Cambridge University Hospitals NHS Foundation Trust
Hills Road
Cambridge
CB2 0QQt: 07590 485906
e: kate.homan@addenbrookes.nhs.uk