Saturday, 30 July 2016

Self-Management Support: Everyone's responsibility but no-one's job?

At an event recently of very senior Trust types, I started my talk by asking how many of those in audience had self-management support in their organisations - specifically a service, or someone with a role to facilitate it. In a room of about 70 or so, there were about 5-10 hands tentatively raised.

Are we in the era of self-management being 'everybodys responsibility but nobody's job'?

That’s Not My Job 

This is a story about four people named Everybody, Somebody, Anybody and Nobody.  There was an important job to be done and Everybody was sure that Somebody would do it.  Anybody could have done it, but Nobody did it.  Somebody got angry about that, because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn’t do it.  It ended up that Everybody blamed Somebody when Nobody did what Anybody could have.
I can't help feeling that the fifth figure of the right is how we feel as patients in this situation... and am reminded of the saying about elephants fighting and the grass getting trampled.

I know/hope that it is now established that self-management isn't something a Trust can "do", but that their role is to support patients to have the knowledge, confidence and skills to do that (along with non-NHS organisations, who can be brilliant!). I bet most of the Trusts represented in the room had some sort of strategy on self-management support and empowerment for their patients with long-term conditions. On a shelf, board room, or glib poster somewhere... And many of the staff had something relating to it in their role descriptions, and service aims etc.... 'cos we all know these are nice-sounding sentiments and buzz words...

So I think we are at the stage now where self-management support is everyones responsibility... but perhaps no-one feels its their job? And should it be a "job"?

As a self-management coach, working in a self-management support service, I clearly fall under the "job" category. This is the focus of my work with people with long-term health conditions. Having this provision in my local area is brilliant, but by our existence, do we reduce the need for other parts of the NHS to make supporting self-management their 'job' too? Are we running the risk of hearing local HCPs saying...

"Well, we don't need to do that, we can just refer to them..."

"There is a service that does that, so we don't have to..."

"Phew, they can do the self-management support, and we can carry on with our job"

As people with long-term health conditions, our self-management might be directly supported by a local service specialising in it, but is also about the overall result of all the interactions we have with the NHS. If we prepare for appointments and work towards goals, and have both of these at worst undermined or at best ignored by an interaction with the NHS, we aren't too much further along the line. The brain of the NHS is running the risk of using its left hand to support patients to adopt behaviours and simultaneously using its right hand to (unwittingly) keep patients in old habits and behaviours.

We need self-management support to be everyones responsibility - a responsibility which they fundamentally understand and hold to be important.

AND it needs to be part of everyones job too. This is where training for HCPs in skills and key enablers that they can weave into their current practice, system/service co-design to facilitate support and care planning (to name a few are) so important. Specialist services are necessary but not sufficient to support self-management in local areas.

On an aside, the event mentioned in the first paragraph was also an event when before taking part in the panel discussion, the chair asked if I was going to be "doing a nice patient story"... I curtly responded NO. I would be sharing the relevant learning from being a self-management coach, patient leader and living with long term conditions. Humph. When introducing myself on stage, I joked that I was the 'patient', we can all relax now that box is 'ticked'... not as many laughs as I hoped for... did they realise I was making a joke?! 


  1. Thank-you so much for this! After a recent experience during a planned hospital stay, I was left feeling that the staff were not only unhelpful when it came to my self-management, they were verging on resentful of it. Too often it feels like I am labelled as "self-diagnosing" or an "internet expert" or just "being difficult", when actually I am simply trying to limit the impact of procedures on my condition.I still haven't found my way of getting my needs across (still find I have a tendency to get frustrated and tearful, which isn't helpful), but this post is really useful.It's not just me - phew! Hilary

  2. Many charities have case workers to assist with 'self management' support. In more serious injury cases or long term conditions its beginning to be routine to have a case manager work with the client to bridge the gap between hospital services, community care and more. So my feedback is to review the Case Management Society UK and look at various work roles being advertised in the NHS. It is all coming, just a little slower in the UK where the profession of case manager is in it's infancy especially compared to the US, Australia & Canada.

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