Why Self Management?

The Big Picture

Research by Carr et al. notes a positive association between ill health and deprivation, the more intense the deprivation the higher the risk of health problems [7].

Although not all chronic conditions exist within areas of deprivation, there is a clear link between poor health and deprivation.  This link has recently been recognised by the Lisbon Agenda.  The Lisbon Agenda is now one of the main drivers behind European economic developmental thinking.  The Agenda explicitly recognises a direct link between economic growth and community development, hence placing less emphasis than in the past on community capacity building.  Sustainable development and/or regeneration require a healthy community.  Implicitly, this is now seen as fundamental to capacity also.

The World Bank recognises similar links.  Its model of sustainable regeneration comprises four elements:
1.    Physical Capital - buildings, schools, roads, housing, shops and facilities.
2.    Environmental Capital - green space, air, water, attractive surroundings.
3.    Human Capital - education, skills training, health. 
4.    Social Capital (Bonding, Bridging, Linking) - reciprocity, trust, civic engagement, networks, community safety, community                spirit. 

Social capital ...refers to the features of social organisation, such as trust, norms and reciprocity, that can improve the efficiency of society by facilitating co-coordinated action, (Putnam, 1993), [6].

Accepting the link between health, social capital, economic development and/or regeneration and a higher incidence of chronic conditions than in the past the health agenda, particularly the promotion of self-management, offers huge potential for positive contribution to developing social capital, sustaining a healthier workforce, improving social inclusion and the sustainability of communities.

Through group activity, Manage-Able™ courses for example improve communication skills, problem solving and the management of difficult emotions. Courses promote trust and reciprocity among participants as they work together supporting each other in an environment that excludes the 'quid pro quo' mentality so often associated with the preservation of social deprivation.  Cognitive Behaviour Therapy (CBT), of which Manage-Able™ is a form, is also closely linked with empowerment and people taking control of their own lives, mitigating the sense of dependency that accompanies psychological and economic stress [8].

This analysis represents a fundamental philosophical shift in the perspective of society at large, which the NHS is expected to reflect.  This shift is best defined by the emergence of the 'social model' of disability and a move away from the' medical model'.  The emergence of Clinical Governance represents the NHS policy commitment to this shift.  The adoption of clinical governance commits all commissioners and providers of services to… the social model of disability and being fully committed to delivering services that enable choice, control, autonomy and participation [10].  Indeed, even Socrates believed that individuals learn best when they feel they have ownership of circumstance, taking some sort of personal responsibility for outcomes – a core feature of Manage-Able™ courses.

Hence, derived services that have successfully supported a shift from hospital to community care have a number of common features [9]:
•    empowering people to take responsibility,
•    supporting people to manage their own care,
•    and involving users in planning and development.

It is these derivatives that allow Carr and Moffett to report, patient involvement in the decision making process has been shown to stimulate autonomy and control, leading to more positive health outcomes [11].

The core subjects of a Manage-Able™ course are designed to enable the emergence of these derivatives and outcomes through the practise of problem solving, action planning, communication, cognitive symptom management, dealing with difficult emotions, depression and working with health care professionals.  Participation in a Manage-Able™ programme also leads to greater social involvement for participants.  Increased social involvement within communities is important.  People who speak to their neighbours more regularly tend to report better physical and mental health than those who speak infrequently to neighbours [6].

Hence acquiring the Manage-Able™ skill set is important for individuals with LLI's, especially those experiencing socio-economic stress, if they are to contribute to the development of such a national strategy by making maximum use of the changing health agenda within their own personal contexts.  Manage-Able™ is unique in documenting measurable individual evidence of this process.

By definition then, community health is a precursor of community capacity.  Beyond this, healthy community capacity is an essential prerequisite for positive corporate cultures within any given community.  As such, the skills promoted by a Manage-Able™ course are synonymous with positive corporate culture, i.e. problem solving, good communication and managing difficult emotions to list a few.

Indeed, such skills are only set to grow in value as policy and legislation regarding stress and health & well-being at work converge with the development of the Disabilities Discrimination Act into The Equalities Act; the Health and Safety Executive's new stress management framework and the Government's 2005 'Strategy for the health and well-being of working age people' aims to, "build a world which rehabilitates rather than rejects people when they experience illness or disability" [12].

According to the Confederation of British Industry, workdays lost due to sick leave average between six (6) days per annum in the private sector and eight and a half  (8.5) days in the public sector.  This amounts to a total of £13bn or £531 per employee each year [13].

Hence, for these reasons, the workplace may be seen as offering an ideal setting to realise opportunities for improved health and wellbeing [14].  GP's report the workplace has a significant impact on the health of employees.  Stress is the biggest cause of ill health in the workplace (76%), followed by back pain (63%) and depression (57%) [15].

Self-management has a lot to offer in lessening the impact of these issues.  Improved communication skills alone can often help reduce stress and depression.  Action planning and problem solving are also recognized Cognitive Behaviour Therapy techniques used to combat stress and depression.

In 2005 Centrica introduced a self-management programme that focused on back pain.  More than 300 employees participated in the workshops with encouraging results.  Sixty seven per cent of those attending the workshops during the first six months of the year were less often absent, with 55% not being absent at all because of back pain in the following six months [16].

To conclude, in April 2005 a new performance framework was introduced for the NHS driven by the Standards for Better Health.  This framework is a guide, meant to enable NHS organisations and other stakeholders to contribute to economic success and community cohesion as a result of better working practice.  Embedded in this framework is the recognition that partnership working is essential to improving health and reducing health inequalities.  CCG's alone cannot possibly tackle the deprivation that typically creates health inequalities.  Manage-Able™ is now one of those stakeholders, able to take the practise of Self-Management beyond the traditional boundaries of NHS service and maximize its impact community wide, while uniquely, providing hard evidence of its efficacy in 'real time' fashion.