Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

Chapter One: Providing a unifying framework - the role of government

Patient self-management. Spotlight: England

Patients need to be equipped with the tools and skills required to cope effectively with their conditions on a daily basis. A range of health-care workers and lay people can successfully teach these skills to individuals or groups, by telephone or electronically.

Implementation step and suggested milestones

STEP 1 CORE: Basic information about risk factors and (as appropriate), chronic diseases, is provided to patients. Patients with chronic disease are informed about their role in self-managing, and about community-based resources.

STEP 2 EXPANDED: Educational and skill-building workshops/group appointments on chronic disease management are provided to patients.

STEP 3 DESIRABLE: Computerized patient self-assessment is used to generate individualized self-management plans. Patients with chronic diseases are provided with supplementary self-management support by telephone or through the Internet.

Spotlight: A patient-centred approach in England and Wales

More than 17 million people in England and Wales have a chronic disease, which has a considerable impact on the National Health Service (NHS) and social care services. People with chronic health problems are more likely to see their general physician, be admitted as inpatients, and stay in hospital longer than those without these conditions.

The NHS Improvement Plan set out the government’s strategy to improve care for people with chronic diseases, by moving away from reactive care based in acute systems, to a systematic, patient-centred approach. The national Public Service Agreement target focuses on improving health outcomes for people with chronic diseases by offering a personalized care plan for people most at risk, and reducing emergency bed days by 5% by 2008 through improved care in primary and community settings. For the majority of people with chronic diseases, significant benefits follow when they receive increased support for managing their own symptoms and medication. To this end an Expert Patient Programme has been developed in the NHS. The programme has already involved many Primary Care Trusts across the country and has supported many thousands of patients and will be applied throughout the NHS by 2008.