Self Care - developing a systematic approach in Grampian

1. Self Care - developing a systematic approach in Grampian Linda Duthie

2. What is self care • All that people, patients and carers do to: • maintain health • prevent illness • seek and adhere to treatment • manage symptoms and side effects • accomplish recovery and rehabilitation • manage the impact of chronic illness and disability

3. The Case for Self Care Support • People want more information, choice and control over their health. • Chronic illness is the biggest problem facing health care systems world-wide - 1 in 6 people in Grampian. • NHS focus managing acute episodes of care • poor management of chronic illness leads to wasteful use of high intensity services • 3/4 patients suitable to be cared for in alternative setting have a chronic condition

4. HOUR BY HOUR OF DIABETIC CARE

5. The Case for Self Care Support • Impact on patients • Better symptom management • Improved feeling of well-being • Increased life expectancy • Improvement in quality of life with greater independence

6. The Case for Self Care Support • Impact on care services • Visits to GPs can reduce by over 40% for high risk groups • Outpatients visits decrease by 17% generally • Medication intake more appropriate • A&E visits can be reduced • Days off work can reduce by as much as 50% for people with arthritis.

7. The Case for Self Care Support • Economic Case • For every £100 spent on encouraging self-care £150 benefits can be delivered in return (Wanless) • DAFNE - £545 per patient - net cost saving £2679 over 10 year period (NICE)

8. Lessons from Elsewhere • Reconfigured Health Systems • Veterans Health Administration • Kaiser Permanente • Canada • Disease Specific • Diabetes - DAFNE/DESMOND • Self Management - asthma, arthritis, MS, manic depression

9. Types of Self Care Support • Appropriate and accessible advice and information • Patient and carer education about self management of their illness, helping them to understand what to do, how to adjust their medication dose and how and when to use health care. • Prompts and reminders for when they should be doing something and attending for care. • Support from a knowledgeable patient (often, but not always an expert in their disease) and broader networks, including attending practices as part of a group of patients with the same condition.

10. Self Care Support and Self Care

11. The Strategic Fit • Consistent with PFPI agenda • Priority to develop integrated treatment of long-term conditions - quality of care and volume of activity • Self care as part of whole system/pathway of care

12. Self Care in the Whole System of Health & Social Care • Pharmacy • Health Education • Support Services e.g. SAS • Advice • Outpatients • Telephone advice • Group follow-up • Care Plan • Day Cases • Lifestyle Advice • Care Plan • Peer support upon • discharge • NHS 24 • Self Care Advice • Triage for GMED Health Incidents • Intermediate Care • Step up and step down • support for self-care • Therapist support • Elective Inpatients • Lifestyle advice • Peer support upon discharge • Care Plan • General Practice • Advice on self-care • Referral to support • groups • 999 • Advise self- • care if • appropriate • Emergency In-patients • Care Plan • Peer support upon • discharge • A & E • Promote self care prior to A & E • Triage patients and advise self- • care if appropriate • Residential Care • Self-care skills training • for groups of residents • Individual/Own Home • Examples of Self-care • Healthy lifestyle • Falls prevention • Electronic information • Self-care guides/books • Care Plans • Self monitoring • Self diagnosis • Home adaptions/support • Support groups • Home Care • Self care training for • people with long term • conditions • Nursing Care • Self care skills training • for people with long term • conditions

13. Next Steps • Stock take of current understanding and practice • Develop strategy • Feasibility study of what we know works - DAFNE/DESMOND • Pilot projects set up in areas of: healthy living, hospital attendance & unscheduled care • Audit of long-term conditions (CHPs) • Social marketing

14. References • Alliance self care research - www.ascr.ac.uk • Department of Health - www.dh.gov.uk

15. Workshop Questions • How does this contribute to improving health? • How can you contribute to this? • What actions are required across the Public Health system to take this forward?