HIGH IMPACT CHANGE 3
Domain: Self-management support
Maps to LTC Toolkit Section: Standard 1 - Organisation of Long Term Conditions Management; Standard 2 - Patient Information and Supported Self Care.
Maps to HEAT Targets: T6 - reduce LTC admissions/bed days for COPD/Diabetes/Asthma/ CHD, T7 - improve quality of healthcare, A7 - reduce A&E rates and waits, T12 - reduce emergency inpatient bed days for 65+.
Maps to Community Care Outcome Themes: User Satisfaction; Support for Carers.
HIGH IMPACT CHANGE 3
We commission peer support groups for people with long term conditions and their carers and provide relevant, accessible information.
Rationale
Community and voluntary groups play an important role in boosting people's confidence and getting them involved in their community. Many are formed to support people living with specific conditions; provide specific and detailed advice and information; arrange respite care and support for carers and relatives; provide disease-specific education and training; allow peer support with people in similar circumstances; provide advocacy support; and lobby for service change and improvements xvi. In order to better self manage their health, patients need be able to find out about national and local support groups and organisations xvii.
- Make a range of peer support groups available and accessible, e.g. cardiac rehabilitation, Arthritis Care model, DESMOND and DAFNE, neurological groups. Ensure that staff are able to signpost these to people with long term conditions.
- Make a range of carer support groups available and accessible. That means improving health and social care support, ensuring that carers are able to access education and leisure opportunities, and making sure that people with caring responsibilities have the chance to work flexibly so as to combine work with their caring roles xviii.
- Provide buddying options, e.g. the Scottish Diabetes Buddy Service. This is a patient-led service run in four Health Boards (Fife, Grampian, Lothian and Tayside). Contact is made by face-to-face, telephone, letter or email means xix. Make sure that staff are able to advise patients and carers of these.
- Build effective working relationships with colleagues in agencies, e.g. Benefits Agency, housing, employment, pensions planning, advocacy, Healthy Working Lives.
- Offer a choice of generic, or condition specific supports, e.g. to cater for disease-specific education and training, or ethnic minority groups where language and culture can be a barrier for example. Ensure staff are aware of these and signpost them to people with long term conditions tailored to their individual needs.
- Work with NHS24 and local PFPI groups. Agree and promote a simple, accessible and integrated approach to an information portal for patients and the public including e.g.NHS24 resources and service developments, telephone advice, self help and links to health library resources.
- Develop an information directory. Signpost people to information and support services for long term conditions that meet quality standards. Make use of the resources of the Long Term Conditions Alliance for Scotland ( LTCAS). The Alliance consists of a wide number of voluntary organisations and patient groups from across Scotland. Work with MCNs, local PFPI leads, voluntary sector and full range of community planning partners e.g. Paths to Health/Green Gym groups, community education, leisure and social opportunities. An example of this is Glasgow Help Services who provide a web-based directory of services covering health, social care and voluntary sector support available in the City xx.
- Work with local community pharmacies. Build on the public health and Minor Ailments Service to spread health messages to support people to self manage their long term conditions xxi.
- Introduce personalised information records and passports, e.g. My Stroke Book, My Heart Book. Make use of resources already developed by MCNs or voluntary groups and include links/signposting to additional resources.
- Recognise that people understand and learn things in different ways. Tailor information to fit individual needs and understanding. Provide information in a range of formats and multi-media - e.g. face to face, telephone, text/email messaging, written information, pictorial diagrams and translated to other languages.