Conclusions

At a time when the NHS is under strain, there is a danger that the importance of supporting patients to manage their own health care might be neglected.

Our research suggests this might have negative consequences because supporting patients with long-term conditions to improve their self-management capability might reduce demands on both primary and secondary care, freeing up capacity within health care teams. Although the potential impact is hard to assess, one estimate, based on our research, is that if the patients who are currently least able to manage their conditions could be supported to manage their conditions as well as those most able then the impact on the NHS could be as large as a reduction of 333,000–436,000 emergency admissions per year – or 6% to 7% of the total number of these admissions. Not only would this save NHS resources, but it could reduce the exposure of patients to the potential strains of hospital stays, such as infections, and allow them to spend more time living well at home.

Overall, our findings show the importance of considering the variable ability of patients to manage their conditions when developing health policy across all sectors of care. Over 60% of all emergency admissions in England are from patients with at least one long-term condition. Yet, in this research just 13% of patients with long-term conditions felt knowledgeable about their health condition and said they were able to engage in healthy behaviours and confidently plan their care. In contrast, 22% of patients were likely to feel overwhelmed by the demands of their long-term condition and not take an active role in their own care. Without properly supporting patients, national policy makers may not achieve their goals to reduce the growing demand for emergency care in the NHS.

National and local decision makers, including commissioners and those designing urgent care services nationally in the NHS, need to:

  • Recognise that there is a very broad spectrum of ability and confidence among people to manage their health condition, and this has consequences for health service use.
  • Measure the knowledge, skills and confidence of patients to manage their own health condition. Measurement is needed both to track whether there have been changes over time for the population and to help NHS teams to tailor care to the needs of their patients. While PAM is currently used in 60 areas in England, continued and expanded investment in measurement, using PAM or another method,, is needed and would be most powerful if routinely linked with patients’ electronic health records.
  • Implement approaches to support patients to manage their own health conditions. Some areas are implementing health coaching and goal setting with patients with long-term conditions – and NHS England is encouraging more areas to do this. The NHS could also do more to encourage patients to access peer support, including via online platforms.
  • Understand that not all patients may be able to fully engage with emerging opportunities in digital care without additional investment to improve their knowledge and confidence to manage their conditions.
  • Ensure that interventions are carefully evaluated, so that NHS teams can learn from the experience of implementing these approaches and make further improvements to the quality of the care delivered. One successful model is the Improvement Analytics Unit, which is an innovative partnership between the Health Foundation and NHS England that provides a free evaluation service to NHS providers, their partners and commissioners.
  • Plan for the variable ability of patients to manage their conditions when implementing any policies to manage demand for NHS care.

For more information about our research, see the full paper, published in BMJ Quality & Safety and available to download from their website: http://qualitysafety.bmj.com/lookup/doi/10.1136/bmjqs-2017-007635

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