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Professional Resources

Where people need support

Each person living with a long term condition is on a personal journey – it starts with the diagnosis and then goes through a series of key stages:

Key Stage


Impact of self management


  • By this point someone’s life and ability to manage may already have been seriously affected by symptoms.
  • People feel challenged about their place in the world and the reality of their situation.
  • Helps people come to terms with diagnosis.
  • Key to helping people reconnect with themselves and others.
  • Helps people make better decisions about treatment options.

Living for today

  • People need information and skills to maintain optimum wellbeing.
  • Serious risk of social exclusion.
  • Supports people to navigate an often difficult journey.
  • Challenges social exclusion by helping build bridges back into society and social roles.


  • Cycle of illness and wellbeing arising from luctuations iin condition.
  • Increasing severity of symptoms.
  • Struggle to get addition support during flare-ups.
  • Possible loss of capacity.
  • Helps to avoid (or minimse the extent of) flare-ups.
  • Enables people to recognise early warning signs and react effectively.
  • Tackles pyschological impact of flare-ups or progression.
  • Supports changing needs.


  • Moving between services, sometimes to different levels/types of support.
  • Dealing with multiple needs/conditions and therefore a range of services.
  • Often a stressful time and this can have serious impact, including on a preson’s condition.
  • Supports person to manage transition processes.
  • Maintains focus on person’s needs ensuring services are organised around these.
  • Provides person with control at a time when this can be undermined.

End of life

  • Difficult time involving complex challenges.
  • Death may be premature.
  • Person may have to cope with symptoms of condition alongside additional challenges of end of life.
  • Supports person to meet range of challenges and maintain control.
  • Addresses broader needs e.g. emotional, family and lifestyle.

It is important that:

  • support is flexible and that individuals can choose what type of support they need to help them manage their condition

  • the provision of support is a fluid process and depends on the choices and decisions people make around their personal needs

ALLIANCE Scotland - Health & Social Care Alliance Scotland