The Daily Telegraph's front page headline reads: "Patients told: treat yourself to save NHS cash"
The tone of the story
is that an outrageous cost-cutting scam is being hatched by the Department of Health (DH) to oblige people with chronic health conditions (like MS, asthma, arthritis, diabetes, chronic depression, back pain and so on) to monitor their own heart activity and blood pressure, report information to doctors by email, administer to their own pain management drugs, and use relaxation techniques to relieve stress.
But should we be worried? Surely this is a good news story, that government is responding to the great UK health challenge of the 21st century in new and imaginative ways?
The concept of "self care" which apparently so worries the Telegraph is not new. Indeed, it dates back to the 1970's, when researchers and doctors realised that many chronic disease sufferers had amassed huge knowledge and understanding of their conditions, and how to cope with them (and indeed in many cases knew more about their conditions than their GP).
Self management programmes have develped provide patients with the training, skills, information and support to enable them to manage routine health interventions without having to go into hospital or make an appointment with the GP. The DH effectively bought into self care in a serious way with the publication of this 2001 report
Just over a year ago Expert Patients Programme (EPP), a social enterprise, was tasked with expanding the concept throughout the NHS. We covered it in Society Guardian here.
The evidence suggests that involving the patient with their own care (known as "co-production") has beneficial effects: EPP claims from an (admittedly small) sample of its course questionaires, that four to six months after completing the course, GP consultations decreased by 7%, outpatient visits decreased by 10%, A&E attendances decreased by 16%, Pharmacy visits increased by 18%. The DH's internal evaluation found co-production led to: reduced severity of symptoms; significant decrease in pain; improved life control and activity; improved resourcefulness and life satisfaction.
There's some useful anecdotal accounts from patients on the EPP website patients about how the programme changed their lives here .
There's also some valuable accounts on the same page by NHS professionals, who understandably regard EPP with suspicion. One by a GP called Nicola Jones is worth extracting
from:
Doctors should see expert patients as people who really complement their skills. Some doctors may be resistant because they fear demanding patients. They perceive knowledgeable patients as scary, articulate, with yards of stuff off the internet, asking questions we don't know the answers to. That is quite a big challenge to a doctor's skills, and perhaps their ego. But there are a lot of new expectations about healthcare providers and a shift in thinking is needed. Doctors will find that they are asked questions they cannot answer. Medicine is so complex: it is arrogant for us to think we can know everything, and an unreasonable expectation. There is a difference between a 'demanding patient' and a patient who makes 'appropriate demands', which is what an expert patient will come with. They are so satisfying to a clinician.
Not all evidence is so positive. The Guardian reported last July a British Medical Journal study which claimed that self care was overhyped. You can read an extract here
What is interesting about the Guardian report is that the DH spokesperson admits that the programme, while "cost effective" is not intended primarily to divert patients from expensive hospital care. "Our own evaluation has shown that the programme can reduce service usage by patients, but it should be remembered that changes to service use are a secondary outcome rather than being the main aim of the scheme."
Has anyone told HM Treasury?
