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The importance of self-care

Lynn Young
Primary Healthcare Advisor
RCN

The NHS is our most precious of commodities, along with democracy, but for both of these to serve the public well transformation has to happen now.

I love all things relating to people being far more informed about self-care and looking after themselves and their families. This is the route to an effective and affordable NHS, rather then reorganising it every few years, which brings nothing but anxiety, confusion and a horrible waste of precious public funds. Money is far better spent on doing what is necessary to enable people to be self-caring and indulging in a healthy lifestyle, than the ludicrous current state of affairs - that of discarding structures, abandoning talented staff and thinking up rather bizarre new organisations.

This is what the NHS is tragically addicted to - rounds of significant reorganisations, which demand the change of notepaper, the adoption of a different language and frantic energy being used on writing new job descriptions. The level of disruption caused by politicians who believe that success lies in a brand new structure is costly in terms of staff morale and the standard of care provided to patients, whether they are in hospital or being cared for at home.

Take the latest round of English health reforms as an example. Mr Lansley talks incessantly about the reasons behind them - an ageing population, increase in the incidence of long-term conditions, the level of preventable lifestyle diseases, technological advances and the need to make financial savings. Many of us are still incapable of integrating the challenges with the new structures and wonder if they will be any more effective then the ones being dismantled.

On the other hand, just imagine the difference that could be achieved if we developed a successful campaign that encouraged people to look after themselves and to use healthcare services appropriately. We all want an affordable, sustainable and effective NHS - one that is there for us when we are incapable of looking after ourselves and that provides the skills and technology to improve and extend our lives.

The NHS does not need to be reorganised, but it certainly requires full-scale transformation. 'Transformation', according to the Oxford English Dictionary, means a change in essence and/or character, but says nothing about moving structures around. Basically, it is time that we called for a stable NHS, but one that is able to move towards transformation where people will:

• Be enabled to manage their long-term conditions.
• Be educated to manage conditions, such as coughs and colds.
• Understand what is normal for their conditions and have less need to seek permission from health professionals.
• Know why it is important for them to take their medicines and how to do so.
• Be aware of where and when to get further advice and help.
• Be directed to reliable information, eg www.patient.co.uk as well as schemes designed to deal with minor ailments in their areas.
• Understand what help they can receive at local pharmacies.¹

Successfully changing from a dire lifestyle to a healthy one poses the greatest of challenges. Even in the developing world the biggest killer is no longer communicable diseases, but the Western styled long-term condition - more often then not, as a result of obesity.

It would be a wonderful thing if 500,000 nurses had a basic understanding of Prochaska's 'six steps to change' and be empowered to work with their patients to help them towards the path of healthy living.² Being complacent and resisting transformation could mean that healthcare of the future is only available to those who personally pay up at the point of need.

References
1. Cross S. The role of practice nurses in educating patients to self-care. Primary Health Care 2011;21(7).
2. Prochaska et al. Changing for Good. A Revolutionary Six Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. London: Harper Collins; 2006.

Your comments (terms and conditions apply)

"Empowering patients to improve their self-care skills has long been an integral part of the Practice Nurses' (PN) role. The suggestion of 'developing a successful campaign' appears to be out of touch with the reality of self-care developments over many years. For example, I was a presenter, alongside representatives from more than 40 PCTs, at the 8th Self-care Conference organized by PAGB, WIPP and the NHS in 2005.

The key gap in self-care for LTCs is that of staff training.  Evidence from surveys (for example Upton et al, Primary Care Respiratory Journal, 2007) shows that many PNs are expected by their employers to work beyond their competency, a dilemma which has been highlighted in several NIP articles.  This has the knock-on effect that some patients with LTCs are
being 'short-changed' by having their annual review carried out by inadequately trained nurses.

There are two actions the RCN could take. One is to support every nurse who resists unfair pressure from their employer to carry out work for which they are not trained. The second is to support nurses in developing clinical leadership skills by implementing the evidence in the Prime Minister's Commission on the Future of Nursing and Midwifery in England, 2010. The first recommendation of which was for nurses
'…to renew their pledge to tackle unacceptable variations in standards and deliver high quality compassionate care'. The RCN would do well to stand by its input to the Commission rather than re-inventing campaigns and steps from the past." - Catherine Gleeson, West Yorkshire