People and communities hold the key

Sara Redmond reflects on the relationship between co-production and self management.

I have worked within the ALLIANCE’s self management team for over four years and through this have had time to reflect on the relationship between co-production and self management.

I have described elsewhere that co-production is a key determinant of developing a culture favourable to self management. What I mean by this is that the learning in Scotland consistently shows that people and communities hold the key to developing successful self management approaches.

I also believe that our learning about self management can teach a lot about co-production – particularly when considering how to address the power imbalance that exists between people who use and those who deliver services.

Asking ourselves what helps to support wellbeing is an important starting point. What needs to be done in order that everyone is able to self manage and live well on their terms?

At the heart of self management is a belief in each person being the leading partner in their health and wellbeing.  That everyone has strengths, resources, skills and experience that supports their health and wellbeing.  And yet this reality doesn’t always feel empowering, especially when you are living with long term conditions.

During some recent work, a person described how overwhelming it can feel when you become ill and are trying to adopt strategies that help you through this.  I often hear people talking about acceptance, or that self management is about acknowledgement – not being ‘free from’ the long term conditions they live with but feeling able to manage the impact of them.

I believe that people are very aware of this reality; of the personal responsibility they have for managing their health and wellbeing. Yet we all experience barriers and hurdles in life – some within us and some external. We all need support at times. We are increasingly understanding that all forms of empowerment – including being able to take action individually or with others, being kept informed by services, being consulted, being involved in decision making – is associated with mental wellbeing[1]. Therefore, supporting people to feel empowered in their health and wellbeing – to feel like they are the leading partner – is an important aspect of self management.

We know that the health and social care system can feel disempowering at times for people, including for staff, and that stigmatising attitudes and behaviours can exist that can undermine peoples’ sense of self efficacy. Yet we also know the value that people place on a quality relationship with health and social care professionals as a core part of their self management.

Underpinning our learning about self management is an implication about the power dynamic that must form the foundation for a different type of relationship between people using and those delivering support and services.

For me, this means recognising that self management is not a service to be delivered to people – they are already doing it in their lives. It’s about recognising that a core function of the role of health and social care professionals is to support people in their self management; making it part of what staff are doing anyway.

If we make sure we focus our support and services on helping people to realise and grow their sense of capability for self management – to feel able to live well on their terms, then people will feel empowered, and recognise and believe in the power they have.

For me, nurturing this in individuals is an important building block in ensuring we have communities who believe in their power to design and deliver the services they use based on their own experiences.

[1] GCPH 10 years of evidence

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