Healthcare Commissioning Forum

The current culture of the delivery of health care remains all too often 'do to' rather than 'work with'. There are challenges around widely shared expectations and behaviours:

The balance of power in encounters; "I don't know, you're the doctor."

That the professionals will 'cure' or at least 'fix' the individual.

That mental health issues are split off- people with mental health issues are less likely to be able to self-manage effectively and people with multiple LTCs are more likely to be overwhelmed by disease burden and become anxious/ depressed.

A problem-saturated view, where an individual's strengths and the assets in their community are not explored or acknowledged.

One of the core aims of encounters between people with LTCs and professionals needs to become the improvement of the knowledge, skills and confidence of the individual to self-care which requires a respectful partnership based approach: "Over 90% of people with LTCs say they are interested in being more active self-managers and over 75% would feel more confident about self-management if they had help from a healthcare professional or peer. Despite this, many people with LTCs have limited knowledge of, or influence over their care. Despite considerable efforts to tackle the most important area, namely the effectiveness, quality and focus of consultations between patients and clinicians, the most significant problem is the reluctance of clinical staff to provide active support for patient engagement. Unfortunately, shared decision making for example, is less common in the UK than in many other countries."