Self care has been defined as “the actions people take for themselves, their children and theirfamilies to stay fit and maintain good physical and mental health; meet social and psychologicalneeds; prevent illness or accidents; care for minor ailments and long-termconditions; and maintain health and well-being after an acute illness or discharge from hospital.”(DoH, 2005), Self care encompasses a range of methods enabling people to manage their ownhealth, including self monitoring, self help and support groups, self management educationprogrammes, patient access to personal medical information, easy access to high qualityinformation on conditions and services and patient-centred telecare.Figure 11.1Self-care encompasses both minor and long term illness. Specific training can help mitigate the impacton lifestyle by providing individuals with skills to manage their illness.The proposed indicators will help ensure that core information on health and well-being, selfcare,and access to appropriate NHS services is provided for all patients. This will support peopleto adopt healthy choices and take responsibility for their own health.It is proposed that the core content of the PCT Practice leaflet template will include informationin a range of languages informing people of their right to interpreting services duringappointments. Content of the leaflets will also be designed to support increasing uptake ofpreventative services, the appropriate use of services, and identification of undiagnosed chronicconditions.70
Priority and relevance to national policyImproving self care for people, including those who live with a long-term condition, is a majorpolicy goal in health in the UK. It is estimated that more than 15 million people in the UK live witha long term condition (DoH, 2006), and long term conditions account for a high proportion of NHStime and resources. Approximately 80% of GP consultations are thought to relate to chronicdisease and patients with chronic disease or complications account for 60% of hospital bed days(DoH, 2004). Health professionals have a vital role in ensuring that patients understand theircondition, and supporting them to self-manage it.Self care includes both self care and self management and was highlighted in the NHS Plan (DoH,2000) as one of the key building blocks for a person-centred health service. The white paper ‘OurHealth, Our Care, Our Say’ (DoHh 2006) also emphasises supporting self care. Supporting Peoplewith Long Term Conditions to Self Care (DoH, 2006) highlights the importance of changing theunderlying culture of health and social care to promote individuals’ empowerment and self care.The Department of Health has recently issued the Common Core Principles to Support Self Carefor the health and social care workforce. Other national policies highlighting the role of self carein the management of long term conditions include the Expert Patients Programme (EPP), theNHS in England: the operating framework 2008/09 (DoH, 2007), and the introduction ofinformation prescriptions following a commitment from Our Health, Our Care, Our Say. Theprinciples of self-care and self-management are strongly emphasised in the recently publishedHigh Quality Care for All, the final report of the NHS Next Stage Review by Lord Darzi (2008). Thisreview is clear in its message that improved patient information is central to enabling patients tomake more choices in accessing healthcare and this is also seen as a means of addressing currentvariation in the quality of services. Achievement of these indicators would provide practiceassurance of the following Healthcare Commission core standards: C7e and C16.Local contextLocal patient consultation exercises have consistently shown that patients want improvedinformation about their GP practice and healthcare services available in the local area.According to Hammersmith and Fulham’s PCT’s Public Health Report 2006 (Carpenter andMayers, 2006), approximately 15% of residents state they have a limiting long-term illness. Theburden of long-term conditions in Hammersmith and Fulham is likely to increase as a result of theageing local population. It is therefore crucial to develop projects and strategies addressing selfmanagementof their conditions, which includes provision of high quality patient information,ensuring that patients are aware of the range of services and support available locally.All GP practices are required under the GMS contract to make information available to theirregistered population through a practice leaflet. In August 2008 the Primary Care Trust’sPerformance Monitoring Group reviewed the current leaflets provided by each of the 30 localsurgeries in Hammersmith and Fulham. The group found wide variation in quality both in terms ofthe content and format of leaflets. Leaflets vary greatly in quality of production and the amountof information that they contain. Some are simply a black and white photocopy, or printed-offsheet. Some are folded pull-outs; some are A5 brochures in colour, with additional informationabout self treatment for common conditions, and advice on the content of a family medical chest.71