Consultation on Common Core Principles for Self Care

1. Background

There are over 15 million people in England with complex and longer term health and care needs. They are a large and growing group who have better lives when they are supported to take care of their conditions themselves.

If people have a clear understanding of their condition and care needs and what they can do, they are more likely to take control themselves. This is what people have told the Department of Health that they want – one of the priorities from participants in the ‘Your health, your care, your say’ consultation was for services to be based around their needs which help them take control of their health, support their well-being and enable them to lead an independent and fulfilling life. Many patients/service users are experts in their own condition already. They need to be empowered to manage their own care with the help of skilled health and social care staff.

To facilitate this, the ‘Our health, our care, our say’ white paper gave a specific commitment to take forward work that not only creates a clear self care competency framework for staff, but embeds key elements, including values and behaviours around assessment and support, in job descriptions, appraisal, continuing professional development requirements and training and education commissioning. Skills for Care (SfC) and Skills for Health (SfH) have been given the task to develop this framework.

2. Self Care definition

Empowering and encouraging people to take responsibility for protecting their own health is widely seen as the best way to ensure the sustainability of health care systems in a time of technological progress and increasing demand (WHO 2000).

Self care is defined by the Department of Health as being ‘about individuals taking responsibility for their own health and well-being. This includes; staying fit and healthy, both physically and mentally; taking action to prevent illness and accidents; and better use of medicines and treatment of minor ailments’. Self management which is best conceptualised as a sub set of self care relates specifically to those people living with a long term condition and has been defined as ‘the individual’s ability to manage the symptoms, treatment and physical and psychological consequences and lifestyle changes inherent in living with a long term disorder.

The common core principles developed by this project will support self care in its broadest sense and will include but not be limited to those patients/service users and carers living with a long-term condition or complex need.

3. Purpose of the common core of principles

The principles have been developed by SfC, SfH, the Department of Health and a group of stake holders which included service user and carer organisations as a common core that should be integral to the skills of every member of the health and social care workforce.

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They are described in terms of the competence, the context in which it lies and the expected behaviours/attitudes that the individual should be able to demonstrate. The associated knowledge individuals need to have to support the behaviours is only indicative and will be fully developed once the behaviours are agreed, as part of the consultation process.

It is expected that once agreed these common core of principles can be mapped against health and social care competence frameworks /national occupational standards with a view to embed them in health and social care practice, identify any gaps and develop any work needed to meet need. In addition it is anticipated that they will guide and influence the commissioning of training and education across the health and social care workforces at all levels.

These principles are predicated on the seven outcomes for people who use services expected of adult services:

4. Values

Key to this project is how we will achieve a shift of values from professionals knowing best to them supporting and empowering patients/services users to be in control of their condition/care/support needs.

The benefits in relation to greater ownership of decisions by individuals and therefore greater participation in the care process are clear. There needs to be an explicit understanding that this signals a shift in the power relationship between practitioners and individuals - a sharing of responsibility and of rights over decision making (these values will underpin competent practice). These principles have to be underpinned by an approach to health and social care practice which is based on partnerships, is non-judgemental and supportive. Key to the development of these principles is to receive feedback from patients/ service users, carers and employers about how this shift of values can be implemented in practice.

5. Links to other agendas

This work has links to (among others) the dignity agenda and the development of competences for assistive technology work.

6. Consultation

The project aims to consult with a wide range of stakeholders. Field testing activities are planned alongside focus groups with people who use services/patients and carers. The principles and a questionnaire will be posted in both SfC and SfH websites. In accordance with the project communications plan key stake holders will also be made aware and asked to contribute to this consultation using both sector skills councils other internal and external mechanisms. Consultation is to take place between January and March 2007.

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7. Next Steps

The aim of this project is to deliver a report with a set of core common principles for self care agreed by the sector and people who use services/patients/cares as result of consultation to underpin modern health and social care practice. A set of recommendations about how to take this work forward will also be included in the report. This will be presented to the project’s steering group and the Department of Health who will consider the next steps.

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To maximise self-care the following principles need to form a common core to be embraced by all those who work with patients / people who use services across health and social care services.

Empower people who use services/ patients to make informed choices to manage their condition * and care needs more effectively

Context:

The worker/clinician encourages and supports the service user/patient in accessing appropriate information, and where possible provides the relevant and evidence based information in an appropriate medium providing sufficient choice/options.

Empowerment is described as elements of:

1. - Control

2. - Information and Education

3. - Mutually respectful relationships

4. - Choice

5. - Motivation to Change

6. - Self Esteem

7. - Confidence and skills

Indicative behaviours expected of the workforce:

1. • Ensure that practice is service user/patient centred

2. • Support the privacy and dignity of the individual

3. • Demonstrate the ability to find out the history, preferences, wishes and needs of the people using services

4. • Enable and support individuals to assert their views, control their own lives and make informed choices about the services they receive

5. • Enable individuals to make informed decisions about the support they require and how to meet the outcomes they have identified

6. • Support positive risk taking as a way of enhancing people’s experience

7. • Understand that risk should not be seen as a reason not to do something- risks can be broken down into manageable chunks

8. • Understand that risk averse practices or a safety first approach are not empowering and should not dominate the approach

9. • Support individuals who want to make the choice to manage the risk as long as they have the capacity to do so

10. • Use a ‘why not ‘ approach to ensure that the ‘perceived risk’ is actually the risk which needs to be managed

11. • Ensure that the individual is asked how they think the risks should be managed and what solutions they have

12. • Support individuals to find motivation to participate in self care

13. • Empower families, carers and others to support self care

Indicative Knowledge (to be further developed once the behaviours have been consulted and agreed):

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1. • Working knowledge of the social model, approaches to empowerment and approaches to person centred practice

2. • Working knowledge of methods, tools and techniques for assessing and evaluating individual’s health and care needs, concerns, personal context and priorities

3. • Working knowledge of enabling interview techniques and their application in a health and social care contexts

4. • Working knowledge of approaches to risk assessment, risk taking and risk management

5. • Working knowledge of the effect which people’s current level of knowledge and understanding, personal beliefs and preferences, experiences and use of services and life context may have on their needs and interests

6. • Working knowledge of how to respect and acknowledge people’s priorities in relation to self management of their condition/care/support needs in both short and long term

7. • Working knowledge of holistic concepts and approaches to health and social well-being

Communicate effectively to enable people who use services/ patients to develop and gain confidence in their self care skills

Context:

The worker/clinician applies communication and relationship skills which encourage and support the service user/patient to work with professionals to identify strengths and abilities as well as problems and to find solutions together building on existing skills

For successful interventions to take place, the style must be:

1. - non judgemental

2. - empathic

3. - genuine

4. - collaborative

5. - supportive

1. - Reflection

2. - Legitimisation

3. - Support

4. - Partnership

- Respect

Indicative behaviours expected of the workforce:

1. • Enhance understanding, skills and confidence to interact with individuals to address their conditions/care/support needs

2. • Develop a more equal relationship between people who work in the field and those who use services and their carers

3. • Help modify the way people seek help by challenging their beliefs about their health and care needs using approaches that promote independence and contemplation of change

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1. • Work in partnership with patients/service users to sustain care plans to manage their condition/ care/support needs

2. • Provide information on risk and risk management

3. • Follow procedures to agree and document risk management and communicate this effectively

4. • Work in partnership with people to manage minor ailments, their health/care and well being

5. • Work in partnership with families and carers to support individuals to gain confidence in their self care skills

Indicative Knowledge (to be further developed once the behaviours have been consulted and agreed):

1. • Working knowledge of communication theories and techniques

2. • Working knowledge of how to communicate effectively with individuals in ways which meet their individual needs

3. • Working knowledge of counselling techniques and interview methods and their application in a health and social care contexts

4. • Working knowledge of the type and range of information available to meet special communication needs

5. • Working knowledge of approaches to risk assessment, risk taking and risk management

Enable and support people who use services/ patients to use technology to support self care

Context:

The worker/ clinician ensures appropriate equipment and devices are discussed and when appropriate puts the service user/patient in touch with the relevant agency

from where they can procure the item(s), and where possible provides the relevant tools and devices. The worker/ clinician also engages with the service user/patient/carer to support and enable the use technology.

Indicative behaviours expected of the workforce:

1. • Enable individuals to access and use assistive devices and assistive technology

2. • Support and enable the use of technology

3. • Support and enable individuals to obtain and maintain equipment and materials

4. • Support and enable individuals to adopt self-care procedure(s)

5. • Work in partnership with other professionals and agencies to ensure service users/patients/carers have access to technology to support self care

6. • Support and enable families and carers in the use of technology

Indicative Knowledge (to be further developed once the behaviours have been consulted and agreed):

1. • Working knowledge of the range of delivery methods and supporting technology available

2. • Working knowledge of requirements for medication, aids, support or other facilities related to the individual’s condition/care needs

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1. • A working knowledge of the range, type and likely effectiveness of aids, support and interventions to assist the individual in managing their condition/care needs

2. • Working knowledge of the nature, extent and boundaries of your work role and its relationship to others in the organisation

3. • Working knowledge of the roles of other health and social care practitioners and how they relate between and across agencies

Enable and support people who use services/ patients to develop skills in self care

Context:

The worker/clinician facilitates access to appropriate training and skills within or outside their organisation in order to develop the service user/patients' confidence and competence to self care. The worker/clinician also delivers support to service users/patients in developing self care/support skills.

Indicative behaviours expected of the workforce:

1. • Identify the learning needs/preferred styles of service users/ patients and carers to enable management of the condition/care/ support

2. • Assess attitudes to self care and to managing risk

3. • Support the development of self care/support skills

4. • Support individuals to participate in formal programmes, e.g. Expert Patients, mainstream training (employment law, financial management), skills training programmes

5. • Develop learning tools and methods for individuals and groups to promote and enable self care

6. • Work collaboratively with other professionals/agencies to maximise training opportunities

7. • Enable individuals/carers to access and evaluate relevant training opportunities

Indicative Knowledge (to be further developed once the behaviours have been consulted and agreed):

1. • Working knowledge of the key theories of learning and development and their application in healthcare and social care contexts

2. • Working knowledge of how education can enable individuals to improve their health, well-being and self care skills

3. • Working knowledge of individual learning styles and the factors influencing effective learning

4. • Working knowledge of the skills required by individuals to ensure their effective self-management of their condition/care needs

5. • Working knowledge of how to propose changes in existing structures, systems and methods to improve learning and training opportunities

6. • Working knowledge of methods of evaluating learning and development against a range of criteria

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Enable and support people who use services/ patients to participate in service planning and to access support networks

Context:

The worker/clinician promotes and encourages involvement of the service user/patient /carer in the planning and evaluation of services they receive and enables participation in appropriate support networks both to receive from and give support to others.

Indicative behaviours expected of the workforce:

1. • Empower individuals/carers to represent their views and organise their own support, assistance or action

2. • Support individuals/carers to participate in service planning and the evaluation of service delivery

3. • Support individuals who are actively managing and determining their own care package, e.g. in managing individual budgets, direct payments, contracts, staff employment

4. • Enable individuals/carers to access and evaluate support networks

5. • Support individuals to participate in formal programmes, e.g. Local Involvement Networks, NHS Trust and Local Authority patient and public involvement programmes

6. • Promote the social inclusion of individuals/carers by enabling them to participate in social, economic and cultural activities and networks

Indicative Knowledge (to be further developed once the behaviours have been consulted and agreed):

1. • Working knowledge of person centred and evidence based practice and their role in improving patient/service user participation in the design and evaluation of services

2. • Working knowledge of how to propose changes in existing structures, systems and methods to improve patient/service user participation

3. • Working knowledge of how to support /service users to manage their own services

4. • Working knowledge of how to identify the resources that are needed to support the development of support networks

5. • A working knowledge of the range and type of support networks available

The term "condition" applies to long term conditions as well as other illnesses, including minor illnesses.

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COMMON CORE PRINCIPLES FOR SELF CARE

FEEDBACK

CONSULTATION QUESTIONS

1. 1. Do these principles sufficiently address the behaviours and attitudes you would expect from a health/social care worker in supporting self care?

1. 2. Is there anything missing? If so, what is it?

1. 3. What needs to be added to the Knowledge section?

1. 4. Do you have any suggestions for how these common core principles might be implemented and embedded in the health and social care workforce?

Any further comments:

Name: Organisation:

Are you providing feedback as an individual or on behalf of your organisation?

Your feedback should be sent to:

Judith Nockolds