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Professional Resources

Framework for supporting self management

Health & Wellbeing

The health and wellbeing of people living with long term conditions depends on a positive relationship between professionals, the individual and their unpaid carers.  This relationship involves:

  • discussing changes in the individual’s condition(s)
  • identifying actions that need to be taken
  • exploring the impact of changes on the individual/their unpaid carers
  • keeping them informed about how and where to seek assistance and how to cope with any changes in their health and wellbeing

This will help to:

  • work in partnership with individuals and unpaid carers to promote health and wellbeing
  • ensure individuals and unpaid carers are well supported during significant life events and transitions
  • enable individuals and unpaid carers to cope with changes to their health and wellbeing
  • enable individuals and unpaid carers to access psychological support
  • NHS Education for Scotland have developed a tool ‘Emotion Matters’. The aim of this resource is to increase understanding and awareness of the psychosocial implications of living with a long term condition as well as provide some skills that will enable holistic, collaborative and person centred care.  Emotion matters is for all health and social care professionals working with adults with long term physical health issues.

Behavioural Change

Supporting people with long term conditions to make positive lifestyle choices can improve their quality of life.  Professionals can help reduce longer term complications by addressing health related behaviours including diet, lifestyle and physical activity.

The role of the professional is to work with the individual to identify goals and a plan for change, where required. This is achieved through discussion and agreement.

The aim should be to:

  • enable individuals’ learning and behaviour change through coaching
  • support individuals to change their behaviour to reduce the risk of complications and improve/maintain their quality of life
  • provide information and advice to support individuals in taking up occupational and non-occupational activities

Support Networks

Professionals should support individuals to access the support networks best suited and available to them.  A wide range of networks are available and each can meet an individual’s needs in a different way.  A key aspect is to promote diversity and encourage support networks to be effective, inclusive and self managing.  Support networks can include unpaid carers, family or friends, as well as social care, health and voluntary sectors.

Professionals should:

  • empower individuals and their unpaid carers to express their views and organise their own support, assistance or action
  • assist individuals and their unpaid carers to evaluate and contact support networks

Promoting Independence

To promote an individual’s independence, professionals should encourage and support them to take part in social, economic and cultural activities and join networks in the community. Independence means self determination, respect and equal opportunity.  People living with one or more long term conditions have the right to decide what support they need and from whom.

To promote independence, professionals should:

  • enable individuals and their unpaid careers to take part in a range of activities and join networks in the community
  • help individuals to use equipment to aid their independence

Partnership Working

Individuals and their unpaid carers should be full, active and respected partners. This means responding to the aspirations of individuals who want as much control as they can of their condition(s) and treatment.  The professional should partner the individual and other organisations (social, voluntary, health) to ensure a personalised, supported and coordinated approach to self management.

Professionals should work to:

  • build a partnership between the team, individual and unpaid carer
  • assess, plan and implement specific parts of an individual’s self management plan
  • empower families, unpaid carers and others to support individuals

Things to check

  • Are all your practitioners aware of the “Gaun Yersel” national strategy for self management?  Have you developed a local action plan to take forward its suggestions?
  • Are you aware of, and do you utilise, the voluntary sector for support and experience in your area?
  • Has your team seen the document “Guidance for Partnerships between the NHS and Community and Voluntary organisations for anticipatory care”?  If so, are you working to take it forward?

ALLIANCE Scotland - Health & Social Care Alliance Scotland