Who's Responsible?

It takes two...

Democratisation and political rhetoric raise expectation within the general population.

Self-management is, in part, about rationalising expectation using ‘smart’ thinking, whereby expectations and outcomes as jointly sought by clinicians and patients are:


Self-management is not about a fight for control.  The advent of personal health budgets is testament to this.

Wherever possible self-management is about patients and clinicians being able to competently and fully share information thus ensuring that the best clinical decisions are made.

Self-management is about clinician and patient working closely together to ensure patient lifestyle supports clinical decision making, maximising clinical and personal outcomes for practitioner and beneficiary respectively.

Self-management is not for everyone.

Taking a broad social perspective for example, a positive chance blaming personality type is better suited to acquiring and easily implementing self-management skills than a self-blaming personality type.  This being the case, some beneficiaries of direct payments gain more from the system than others.  In some cases, a legally designated carer takes control of the beneficiaries’ funds.

An individual suffering from the most severe clinical depression would certainly not be a candidate for self-management training unless the depression is stabilised, including ongoing clinical support.

In corporate terms the debate is eloquently framed by James Heskett in Working Knowledge, a weekly newsletter from the Harvard Business School.