Summary
Co-creating Health (CCH) aims to make self-management an integral part of care for people with long-term conditions. The Health Foundation selected Whittington Health, working in partnership with local patients, as a diabetes demonstration site.
Patients participated in a self-management programme and clinicians undertook consultation skills training, provided by clinical and lay tutors.
Service improvement projects included an agenda/goal setting tool and adapting diabetes templates to support self-management. CCH took a holistic approach, transforming patient–clinician interactions into a collaborative partnership.
Whittington Health is embedding CCH into the care of all patients with long-term conditions.
Results
- Around 260 patients completed 25 SMPs, delivered by 12 tutors. SMP reunion groups were established. Feedback was overwhelmingly positive and all would recommend SMP to others. Audit showed significant improvement in diabetes control (HbA1c -0.7 per cent) and LDL-cholesterol (-0.6 mmol/l) after SMP.
- Around 150 clinicians completed 12 ADPs, delivered by 11 tutors. Clinicians reported the ADP “offers practical ways of engaging patients actively in their own care”. Some 91 per cent implemented parts of the ADP into daily professional practice.
- Around 14 teams tested service improvement initiatives, including designing a confidence ruler (to measure confidence achieving a goal) and sending results before review (so patients can plan their consultation).
CCH is spreading, involving Respiratory and Musculoskeletal Pain teams. Self-management support is now a core principle in Whittington Health’s philosophy.
Challenge
Whittington Health serves a deprived, ethnically diverse population in London (Islington and Haringey), where the impact of poor diabetes management is significant. Local clinicians understood the critical importance of self-management, but there was not enough support to help people manage their own condition through self-care.
Whittington Health wanted to bring about a fundamental change in local diabetes care, transforming the patient–clinician interaction into a collaborative partnership and redesigning healthcare services to support self-management.
By adopting a whole systems approach, the aim was to embed and sustain a new model of care that puts self-management at the heart of diabetes services.
Solution
Health Foundation chose Whittington Health as a diabetes site for its Co-creating Health Initiative (CCH). Whittington Health’s objectives were to:
- Involve patients at every stage
- Change the clinical consultation into a partnership
- Spread change across healthcare services.
A Steering Group, including patients, clinicians, enthusiasts and opinion leaders, directed the project. An active communications programme generated interest and recruited patients.
Clinician and patient/lay tutors were trained to provide courses, working in equal partnership. A self-management programme (SMP) for patients and an advanced development programme (ADP) for clinicians were established. These focused on learning agenda setting, problem solving, goal setting and action planning.
Clinicians who attended the ADP instigated service improvement initiatives.
Client Verdict
A Whittington Health patient said: “Co-creating Health means we are motivated and involved in our care. It gives rewards for the NHS, because we visit the doctor less and need less medication, like happened to me. It gives better health for the patient and improved quality of life. I am in control of my diabetes and I am much, much better.”
