A self care strategy was published two years ago in Manchester. Since then the city council and its partners have started implementing changes that should see a revolution in self care. This forms part of our resource on self care.
Manchester City Council, working with the local NHS and voluntary sector, published a Self Care Strategy in 2016, which promised to place the issue at the heart of the city’s approach to health and wellbeing.
The strategy set out four basic aims:
- encourage people to access, understand and use the information they need to care for and support their own health and wellbeing
- enable people to identify lifestyle changes and goals for themselves, improving their physical and mental wellbeing and preventing ill-health
- promote collaborative decision making between people with physical and mental long-term conditions, their carers and the teams that work with them
- facilitate the changes in the system required for enabling self care.
It recommended taking an asset-based approach with organisations and frontline practitioners forming new relationships with the people they work with to enable self care. To achieve this, it recognised it would require “large-scale cultural and behavioural change”.
The steering group overseeing the strategy put Sharon West, the Population Health Programme Manager at the Manchester Local Care Organisation, a partnership between the Manchester City Council, NHS Manchester University Trust and Greater Manchester Mental Health Trust and Manchester Primary Care Partnership, in charge of implementation.
One of her first steps was to introduce a training programme, Person, Partner, Place (PPP) at the start of 2017 with funding from Health Education England North West. A consortium of The Big Life Group, Manchester Metropolitan University and The Performance Coach was chosen to deliver it.
It is comprised of three modules – an introduction, learning how to facilitate asset-based care and having self care conversations. Staff from the community, primary care, social care, housing, health and voluntary sector have all been taking part.
Ms West said: “It is a different way of working so we knew the most important thing to do first was to support our staff to encourage self care. We wanted to help them better understand asset-based approach to care, how to tap into those local resources and what the impact on people’s health will be if they do. Then we wanted to build their skills and knowledge and capacity to successfully deliver these approaches to people.”
More than 300 staff have taken part in the programme so far. An evaluation, which looked at the first 118 through the course, concluded it had had a “good impact” and resulted in a “significant shift in learning, awareness and skill development”.
The report said attendees found the training interactive and informative and a majority of those who responded to questions about impact on practice, reported that the training had led to them adapting their approaches and they had noticed a positive impact with their clients.
Some 80 per cent of those who took part in module one said they had applied their learning into practice within two weeks, while 100 per cent of those who completed the final module said they would recommend it to practitioners.
Meanwhile, 78 per cent of those who completed the second module reported they had a good or high level of skills to help empower patients to self care.
Feedback from individuals who took part was also incredibly positive. One described the course as “fantastic and inspirational”, while another said it would help them implement the new way of working with “passion, commitment and dedication”.
Ms West said you have to accept cultural change is hard to implement and requires patience. She cites an example shared by a falls specialist nurse who has undertaken the training. The training has encouraged him to take a holistic approach, to find out what else is going on and what’s important to the individual.
“However, what comes out of the conversation is that the fall, the reason for the assessment, is not the key issue as far as the patient is concerned. The predicament is that he has to complete a falls assessment because he has targets to meet while his organisation has a key performance indicator (KPI) that it needs to to meet.
“The system is sometimes a barrier. How do you solve that? It takes time. At the moment the focus is on solving the presenting problem, in this case the fall the reason the person was referred to the service in the first instance. We have to accept that change takes time and will not happen overnight.”
How is the approach being sustained?
While the commissioned training course has now finished, a number of staff who took part have been on train-the-trainer training to ensure the skills and knowledge can be cascaded across the workforce.
“This will help it to become sustainable,” said Ms West. “A PPP trainers practitioners’ forum has also been set up which meets regularly and provides staff with a place to discuss what they have learned.”
Going forward, Manchester PPP programme is turning the attention to the final strand of this work – empowering patients. “It is in the early stages,” said Ms West. “We are looking for funding. We want people with long-term conditions to be able to access and own their own records wherever they are – whether they are in a hospital, in another city or just at home.
“We need to make it easy to understand so it is useful to help them manage their condition by including information such as the medicines they are taking. However, we have to consider what information is appropriate and take into consideration an individual’s situation. For example it would be highly inappropriate for a person to see a cancer diagnosis in their records before they have had a conversation with their doctor. We have to be mindful of how this is managed in the future.”
Sharon West Population Health Programme Manager
Manchester Local Care Organisation