Scale values not organisations: how to spread self management in Scotland

Written by: Sara Redmond, Partnership and Practice Programme Development Manager, the ALLIANCE

Published: 15/05/2015

Sara outlines the case for investing resources in spreading and sustaining self management across support and services.

I recently read an article titled ‘Transform the System’ in which two points really struck me: to change a system we need to seed a movement not an organisation and scale the values we want to spread.  Transforming the health and social care system is core to our vision at the ALLIANCE and our work in self management is at the heart of this.  Our latest publication is an attempt to describe the journey so far and where we still need to travel.

As Programme Manager of the Self Management Partnership and Practice Programme, my role is to deliver a programme that promotes and spreads the learning from the Self Management Impact Fund and the work of our members.  We developed this publication to provoke some critical thinking about the progress we have made in developing self management approaches in Scotland and importantly what we feel still needs to change for self management to be central to the support available for people with long term conditions and carers.

Self Management: Lived Experience, Driving Change in Health and Social Care focuses around 5 key messages and presents some case studies to help draw out the learning. It should be of interest to people working in health and social care, policy makers and particularly people who are trying to promote self management.

The Impact Fund was established to invest in new ideas in self management; to try them out and learn about the difference they make. In this, the Fund is able to take some of the risk of trying out new things so we can collectively learn what helps people to self manage.

Yet too often these ideas and initiatives struggle to be sustained and source continued investment, even when there is evidence of positive outcomes.  Therefore there is a bigger risk that this vital learning about self management is not being fully used or shared and that these approaches are not presently being spread and sustained.

Self management must be understood as an asset based approach – a way of working that promotes and strengthens the resources, skills and experiences of people and communities.  This also means we have to spend time understanding people’s life experiences and address the structural, material, social and relational barriers to individuals and communities being able to self manage.  We must invest in the capacity of communities to support their own wellbeing.

Health and social care integration is a significant driver of change.  It will require a minimum of 62% of total health and social care spend to be delegated to Integration Authorities. Self management must be integral to discussions being held by health and social care partnerships if the aims of integration are to be realised.

And yet considerations about how to gather data and evidence about third sector activity and its contribution to the national health and wellbeing outcomes still appear to be at an early stage. Data can be a lever but at the moment it feels like the gap in data relating to third sector activity is extremely significant if the aim of integration is to shift the balance of care into the community and towards prevention and self management.

And so what next?

We must make sure we invest in what we have learned about good practice to ensure this learning is spread and the good practice becomes embedded. What do I mean by this?

For me it means applying this good practice to how we go about spreading it.  It has been suggested to me that perhaps this process looks more like ‘infecting through building relationships’ It’s not the ‘thing’ that needs to spread, but the encouragement and hope people gain from being able to see that something can work differently, from hearing the experiential learning from the people involved, and by creating a learning community that can make and sustain the changes. This might look like:

  • Create a collective feeling of ‘let’s just go and do it’
  • Having space and opportunity to discover and think through ideas in partnership with others
  • Practical examples of where similar approaches have been tried, and
  • Help to join the dots

Let’s start by creating the expectation that people, their families and the third sector will be involved from the very outset in helping to coproduce the next steps and see where we go from there.

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