Self Care Hub & Empowering Patients & Communities Better Together Vanguard Event Self Care Hub & Empowering Patients & Communities Sarah Collis & Jon Richmond – Self Help UK

What is self care? “…the individual taking responsibility for their own health and well-being” (Source: ‘Common Core Principles to Support Self Care – a guide to implementation’ Skills for Care/Skills for Health 2008)

Why support self-care? Of 8,760 hours in a year, a patient with a long term condition will spend around 4 hours with a clinician – let’s support people to maximise their time managing their own health and care Activated patients have better outcomes and a lower impact of service use ‘Assets’ within communities, e.g. skills & knowledge, networks and community organisations building blocks for good health Self Care is a key requirement of an Accountable Care System (Next Steps Five Year Forward View Delivery 2017) Case for change People who have knowledge, skills and confidence (patient activation) tend to do better (outcomes) than does wo have lower levels – PAM is a tool for measuring activation level Community assets… ‘ look at what’s strong within a community, not what’s wrong’ As we move towards an Accountable care system – Greater Notts is – requirement to have population health management, supported slef care and patient activation…

Framework for Self Care Support The Welsh Assembly Self Care Framework identifies four main aspects of self care: Self Care Information & Signposting Skills Training Assistive Technology – talk more about this eg FLO text message prompts to exercise, take meds or things like stairlifts – needs motivating and prompting Self Care Support Networks On a flipchart show 3 layers: 1st self management courses, assistive tech, 2nd SHGs, Slimming World, New Leaf 3rd Click Nottingham, welfare rights, community transport

Background PRISM Integration of self care advisors in to MDTs Newark & Sherwood 2013 Connect to Health Service 2015 “Beyond Medicine” approaches to supporting people with LTCs Self Care Hub launched November 2015 Ashfield Health & Wellbeing Centre launched same month

The Self Care Hub Telephone, drop-in & 1:1 appointments Holistic needs assessments Signpost to non-medical self care support services in Mid-Notts Follow up after 2 months

From New Economics Foundation But this is not just about engaging patients, its about how we stay well too Comment on link to 5 a day campaign Play short SHN video on the role of groups in the 5 ways to wellbeing Connect Be Active Take Notice Keep Learning Give Above help to take action to improve wellbeing. Measure impact, assess need and incorporate more wellbeing – promoting activities in lives. New Economics Foundation: UK think tank promoting social, economic and environmental justice. Transform economy so it works for people and the planet.

Strengths A conduit for voluntary and statutory health & wellbeing services across Mid Notts to engage with patients, the public and other professionals. Coordination of health & wellbeing events Outreach to communities Collaboration with LICTS Embedded in long term conditions pathways

Weaknesses Limited to one Hub location in Kirkby Requires a collaborative approach with primary care that requires workforce training & support Information governance between Hub & LICT team Issues of 3rd Sector access to System 1 Challenge of (3rd sector organisation) working within NHS setting –culture shift (on both sides)

Opportunities Social Prescription Patient Activation Measure Utilise IT Utilise Volunteers

Threats Lack of collaboration Lack of funding Self Care Agenda being lost No buy-in from health services

Empowering People & Communities Guided by Chapter 2 of the NHS Five Year Forward View – “… a more engaged relationship with people, carers and citizens…” Follows the People and Communities Board’s six principles that define good person-centred, community-focused health and care

9 Key Actions to Empower People and Communities Building public health through community engagement 1 Identify and map community resources at locality level 2 Mobile/ grow these resources to improve health and wellbeing 3 Connect through a network of community health champions Supporting self-care and patient activation 4 Implement the patient activation measure to enable identification of people with long term conditions by level of activation 5 Support patient activation through health coaching and/ or self management and maintain activation in community through social prescribing (people with diabetes) 6 Delivery of systematic self-care support for people with COPD or heart disease 7 Delivery of systematic self-care support for people with multiple conditions (3 or more conditions) 8 Delivery of approach to identification and support of carers 9 To consider integrated personal commissioning /personal health budgets, where this is already being implemented (optional) Working in partnership with communities to build public health and wellbeing Mapping community activities and resources, such as walking clubs – and connecting them at a locality level Growing these resources, creating solutions to improve public health and wellbeing, such as healthy eating, physical activity and social connectedness – in response to local need Building a network of community health and wellbeing champions to reach people most in need of support. Supporting self-care for people living with long-term conditions Putting in place the patient activation measure – to identify people with long-term conditions who need more support to manage their health and wellbeing Delivering systematic and tailored self-care support; this includes a single point of access, care and support planning, self-management education and/or health coaching, and access to community resources – such as peer support – and group-based activities, through social prescribing. This will start with people in the following groups and then will aim to extend to all people with long-term conditions, who might benefit: Diabetes COPD or heart disease People with multiple (three or more) conditions Proactivelf identifying and supporting carers Considering the interrelationship with integrated personal commissioning and personal health budgets.

Patient Activation Measure (PAM) A validated tool to measure a person’s level of knowledge, skills and confidence to manage their health and wellbeing It is used as a tailoring tool and an outcome measure – some areas just use for the latter! Individuals are asked to complete a short survey and receive a PAM score (between 0 and 100). The resulting score places the individual at one of four levels of activation NHS England has purchased 1.8 million licences from Insignia There are six learning set sites – access to 3000 licences in Principia Contains 13 questions Best used as part of an ongoing relationship with a health coach or link worker, who can provide care and support planning, social prescription and referral to self-management education or health coaching as required. Tailored support depending on levels of knowledge, skills and confidence. Administer it every 6 months

The four levels of knowledge, skills and confidence Level 1 – predisposed to be passive recipients of care ‘my doctor takes care of me’ ‘I don’t understand the cause, I just know I have diabetes’ Level 2 – individuals lack confidence and understanding of their health In terms of management of medicine, ‘I don’t understand what they do but I understand their side effects’ Level 3 – key facts and taking action – lack confidence and skills to support behaviours Level 4 – adopted new behaviours but maintain them in terms of stress ‘My doctor can only do so much; I can manage my own health’ Level

Measuring activation: the means not the end Simply measuring patient activation is unlikely to bring about change. But understanding a person’s level of knowledge, skills and confidence can help to: Shift consultation conversations from ‘what’s the matter?’ to ‘what matters to you?’ Understand the effectiveness of interventions to increase activation (PAM as an outcome measure) How is it used The PAM can be used as a tailoring tool and an outcome measure.   Tailoring tool: the PAM score acts as an indicator to the service to help tailor their offer of support; i.e. for lower scores, more intensive support should be offered. The diagram below shows how a clinician can better focus their resources where they are needed. For example, a patient with higher levels of activation and low medical complexity probably does not need health coaching but may benefit from other less intensive interventions. Whereas a patient with lower levels of activation and high medical complexity would probably find a course of self-management education too much to handle, until their activation level has increased. Outcome measure: As a quantifiable measure, PAM can be used at scale and to assess whether the services/interventions are providing effective and tailored support to people’s needs. The survey is taken near the start of a relationship with a patient. A few months after the initial PAM, a second measure is then taken again in a follow up session. If the score has increased it shows that the interventions have had a positive effect. The PAM is best used as part of an ongoing relationship with a health coach or trained allied health professional as part of personalised care and support planning conversations, who can offer social prescription and referral to self-management education or health coaching as required.

Health Coaching Works well for people with low levels of knowledge, skills and confidence It is a person centred process that involves setting goals that are determined by the person Requires person centred skills and approaches. Health coaching is helping people gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals. By providing clinicians, (and peer coaches) with new skills that help people identify what’s most important to them, and tapping into their own internal motivation, evidence shows health coaching can also address health inequalities, improve health behaviours including medication compliance and reduce avoidable admissions.

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