We have been talking about the chronic care model (the Wagner model) in this country for about a decade now and truth to tell, most health economies have struggled with it perhaps because it seems quite conceptual. Successive attempts at refinement by policy teams have failed to mould it into something that could be used to inform frontline delivery. So despite national recognition that we need to transform public services for people who live with long term conditions, progress over the last decade has been limited.
Now we have the House of Care, which you could argue is derivative of the Wagner model but it is a distinct improvement, primarily because it can be used as an implementation checklist by health and social care teams. It makes system transformation doable.
When the House is built, it represents a transformed public service delivery system for people who live with long-term conditions and it also shifts the system from being reactive and disease centric towards being proactive and person centric. This is important because teams can begin to work in prevention mode, rather than always working in treatment mode. This is a shift in role for the workforce that we should not under-estimate.
The teams who implement the House recognise that people who live with long-term conditions are the principal actors when it comes to managing their health – usual management is self-management. They recognise that self-management support is more than an expert patient programme and is an organising principle for the system – the House is a gateway to services that support people with long term conditions to become knowledgeable, confident self managers. This is because the bottom line is that we can only implement self-management support effectively in a proactive system; in a reactive system, patients visit their healthcare professionals only when their self-management resources are exhausted
So, let’s stop thinking of self-management support as a fringe activity, let’s stop putting it at the bottom of our shopping list and (crucially) let’s stop thinking that we don’t need to fuss with self-management support as long as we buy a few expert patient programmes. In short, let’s stop thinking that self-management support is what somebody else does; self-management support is everybody’s job and the House is the perfect delivery system to put self-management support in its rightful place – centre stage.
Alf Collins, Clinical Associate, The Health Foundation