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As I have been going round the country I have met a number of people who have been on the programme, on a visit last week to Liverpool as well as in other areas, and they have told me what a difference the programme has made to their lives.

I would like to start off by taking you back to the second half of the 20th century, which was a period of profound changes in the age structure of the population in Britain and elsewhere. Up to the 1950s an increasing proportion of people lived into middle and old age, and after that time more people lived into their seventies, eighties and beyond as the quality of life and medical care improved.

Compared to the early part of the 20th century when infectious diseases were the main cause of death, often early in life, chronic illnesses such as coronary heart disease and cancer grew steadily in importance as a cause of death over the course of the century. 

Alongside these shifts in the pattern of death was a corresponding change in the pattern of disease with an increased burden of conditions characteristic of middle and older age. So the predominant disease pattern in most developed countries, became one of chronic or long-term illness rather than acute disease.

Those trends continued right up into the last years of the 20th century and are still continuing.  

Furthermore, although there is still a large reservoir of undetected and untreated illness in the community, more and more of those people suffering from such chronic diseases are seeking help.

These facts have had a number of important consequences.  Firstly, they have resulted in increasing numbers of people in the population affected by varying degrees of disability particularly among older people and in the lower social class groups.

Secondly, as a result of these disabilities, the quality of people's lives has been increasingly impaired.

Thirdly, although the illnesses that cause disability such as mental disorders and musculoskeletal disease account for a comparatively small number of years of life lost, they account for a large share of health expenditure.

So this then was the challenge that England and many other countries faced towards the end of the last century.

In this situation doing nothing simply is not an option.  The health system has to change and adapt to the changed circumstances in which it finds itself.  But how?

As you know professor Kate Lorig and her colleagues at Stanford university in California had developed the chronic disease self-management programme which recognised that people with chronic illness deal with common issues such as pain management, stress and a need to develop coping skills on a daily basis.

Most interesting of all was the evidence that suggested that the programme could produce surprisingly good results with patients who reported better health and improved communication with their doctors.

So here we had a possible solution to the challenge of chronic disease: a new partnership between patients and professionals and one, which potentially could be of benefit to both. 
In the case of the patients there was evidence that attending the course improved their confidence in their ability to cope with their illness or in other words their  'self-efficacy' and a sense of control over their life. 

In the case of the professionals and the health system as whole a chance to focus on those aspects of health care that they were best trained to deal with whilst working in partnership with an increasingly sophisticated and well-informed client group.  

In Britain, voluntary sector organisations pioneered the use of structured lay led self-management programmes throughout the 1990's. LMCA's 'living with long-term illness project' (funded by the Department of Health) began in 1998 and increased the availability of lay led self-management interventions for people living with long-term conditions.

The scene was set, and building on this base the 1999 Saving Lives: Our Healthier Nation white paper proposed a programme to provide NHS-based training in techniques of 'self-management', allowing people with chronic conditions to develop these skills in partnership with their health and social care professional.

A task force of voluntary, professional and clinical representatives, and health service users and carers, was chaired by the chief medical officer, Professor (now Sir) Liam Donaldson with a remit to design a new programme that would bring together the valuable work of patient and clinical organisations in developing self-management initiatives.

One of the things that the task force did was to commission a review of the evidence on self-management programmes and this served only to confirm their conviction that this was an approach that had a great deal to offer to the national health service and its patients.

At around the same time the Department of Health in England published the NHS plan which aimed to put patients at the centre of their own care and promised a health service designed around their needs.

It also included the specific commitment that the expert patients programme, which was then still in embryo would be expanded.

All this formed the basis for the expert patients report which was published in September 2001.  The report referred to a number of key principles which included the facts that: 

The key question therefore was not whether self-management worked to a considerable extent that had already been demonstrated by Kate Lorig in the us and by the voluntary sector in Britain.

The crucial question was could self-management work in the context of a health care system that was publicly funded like the NHS and could it be provided to all along with all the other services that the NHS was responsible for?

This was the question, which no one then knew the answer to, but the report boldly stated that this should be our aim.

Now in addition to these questions of principle, the expert patients report also contained a number of specific recommendations including the following significant one:

'ensure that each primary care trust area has arrangements for user-led self-management programmes for key chronic conditions to be delivered or commissioned'

Shifting the Balance of Power meant new responsibilities.  More funding would be allocated directly to Primary Care Trusts, though their performance would be managed by a group of strategic health authorities that would be specially created for this purpose.

Now this change in the way in which the NHS was organised represented both a challenge and an opportunity for the expert patients programme.

It represented a challenge because it helped to set in motion a sea change in the NHS including the formation of primary care trusts with far more power and autonomy.

It was an opportunity because most of the ill-health in the population that gets into the health care system is dealt with in primary care and shifting the balance of power reflected this in terms of the importance it attached to primary care.

Thus the self-management movement reflects a number of converging and complementary trends in health care including the increasing prominence of chronic illness, the importance of primary care, and the need to ensure that patients and the public are given as much choice and control as possible over decisions affecting their health and their lives.    

But turning the expert patients programme into a reality was a formidable challenge. You have heard already from Jean Thompson and Jim Phillips about the events of the last two years during which the programme has been piloted in PCTs up and down the country.  They were, as you know, supported by a network of trainers and other staff, and I would like to pay tribute to the dedication of all those who have worked on the programme since its inception.

I am aware however that there are a number of challenges that face the programme in the years ahead.  Inequalities, for example, are a problem for nearly all major industrialised countries in the world and this country is no exception.

The difference between the areas with the highest life expectancy and the lowest is nearly nine years for men and about 7 years for women.

In fact at around the time the expert patients programme was being initiated the government had set two major national targets for the reduction of inequalities.  One of these targets was specifically on life expectancy and the need to reduce the inequalities in this from one place to another.

PCTs have in fact now given their agreement in principle to take part in the expert patients programme, and almost as many are either already involved in running courses or are planning to do so in the near future. 

Of course their participation was rightly a priority during the pilot phase.  As the programme moves into mainstreaming it will be important to ensure that the message about self-management reaches those in disadvantaged groups as well as, or even more than, the more articulate, affluent middle class patients who traditionally have always taken good care of their health.  I believe some courses are delivered in languages other than English to serve people from ethnic minorities.  Some expert patients courses have also been delivered in prisons.

There are however no grounds for complacency. We know for example that we have a lot of work still to do to increase awareness and participation amongst both patients and professionals.

Last year for example the chief medical officer, Sir Liam Donaldson, wrote to all of the royal colleges asking for their help in explaining the benefits of self-management to professional groups.

Perhaps the biggest single challenge the programme faces is ensuring that the progress that we have made is sustained in the long term.

The expert patients report committed us to mainstreaming the programme throughout the NHS by 2007. And today I am very pleased to announce that Harry Cayton, director for patients and the public at the department of health will be taking strategic leadership for the next phase of the programme.  Harry will be chairing a strategic management board  for the EPP which has a significant proportion of patient and voluntary sector organisations on its membership.  This group will ensure the successful implementation of the EPP and that quality standards are applied effectively.  It will oversee and advise the EPP implementation group. This will be chaired by Sarah Squire, director for patient experience of the clinical governance support team. Mainstreaming  of the programme will now be through the modernisation agency who are best placed to work with local NHS organisations.

This includes acute trusts as well as primary care trusts though up to now our main focus has been on primary care because of the importance attached to this in shifting the balance of power.

One important document that has followed the publication of the latter is the priorities and planning framework, which sets out key areas for the NHS and targets.

One important area within the current framework is that of patient experience and this forms a potentially powerful hook on which to hang the work of the expert patents programme. 

The new GMS contract for general practitioners also provides a strong financial incentive for practices to consider the patient's experience and recognises that a strategy is needed to use clinician's time effectively, whilst improving the availability of services to patients.

A new Commission on Public and Patient Involvement in Health was set up last year and the health and social care act also makes it a legal requirement for health care organisations to involve patients and the public in decisions about how health care is delivered.

The national service frameworks are also another important vehicle for ensuring that self-management becomes part of mainstream NHS delivery.

All of these factors will i hope increase the chances that in the long run the programme will be a success and be adopted by the NHS as an integral part of the service which it offers, and not just a pilot study which it has been up to now.

 In the meantime the feedback we have had so far tells us that the expert patients programme is an effective and innovative way of managing chronic illness. Furthermore it has the potential to engage both patients and professionals many of whom have felt frustrated by their incapacity to do more for patients with chronic illness.  The programme offers them something which could help meet this need. As such it should be seen as relevant to the core business of the health service and to public health in general.

It is this last point that I would now like to consider in more detail.

One of my responsibilities as minister for public health is the delivery of specific policies and programmes such as the prevention of coronary heart disease and cancer.  We are already making progress with a 23% fall in CHD deaths in the last 6 years and a 10% fall in cancer deaths in the same timeframe.

The concept of 'self-efficacy' is central to self-management of chronic illness but many studies have shown that self-efficacy also predicts whether or not an individual will give up smoking or eat the right sort of diet. In other words whether they will take the sort of steps that will prevent them from developing the sorts of diseases which we are the biggest killers in our society today.

Two years ago Derek Wanless produced a report, and more recently a final report, in which he described a fully engaged scenario associated with relatively good health outcomes. Earlier this year he produced a second report describing this in more detail.  As the term 'fully engaged' implies it is dependent on individuals playing an active part in looking after their own health both to prevent illness and to manage it once it develops. 

Together the prevention of disease and self management of established illness could improve the health of the population and reduce the relentless upward pressure of demand on the health care system.

One should not however underestimate the scale of the challenge that we face if this is to be achieved.  Although important advances have been made in public health over the last few decades, for example in reducing adult smoking levels, new scourges such as the rising trend of obesity threaten to derail our attempts to improve the health of the nation.

This is why we have recently launched a consultation on a new public health white paper. The paper is called 'choosing health' and the title should be of interest to all those attending this conference and all those interested in self-management.  The expert patient programme is intended I know to give those with chronic illnesses a sense that they are in charge of their own lives and a degree of control over their own illness rather than simply being at the mercy of them.

The same principle should be true of the whole population and it is the duty of government to help every individual make the choices that will enable them to live healthier lives.  I also believe that the principles of self-management may have a great deal to teach us about how this can be achieved. During the consultation, which ends on 28 May, we would be very interested to hear from those in the self-management community in this country and abroad about your experiences and whether you know of instances where the concepts underlying the self-management of chronic disease have been successfully applied to help people who are not yet ill to stop smoking for example or to eat a healthier diet.

 When we publish the white paper in the summer I would like to see the experience that we have gained from the expert patients programme over the last two years, and from the self-management community as a whole reflected in it.  I would like to see the vision that has inspired you all to try to improve the lives of those affected by chronic illnesses applied to the whole population.  I would like to see a blueprint for a society in, which every individual feels they have a chance to live a healthy and fulfilled life.