Foundations for self-directed support in Scotland
Foundations for self-directed support in Scotland

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Foundations for self-directed support in Scotland

Self-managing long-term health conditions

So far in this section we have mainly been discussing examples of how an outcomes-based approach can be achieved in relation to social care. There are also changes in thinking about health care outcomes in Scotland; one example of this is a shift towards the principles of self-managing long-term conditions such as diabetes, heart disease and arthritis. The Long Term Conditions Alliance Scotland (now the Health and Social Care Alliance Scotland) defines self-management as:

The successful outcome of the person and all appropriate individuals and services working together to support him or her to deal with the very real implications of living the rest of their life with one or more long-term condition.

(Scottish Government/Long Term Conditions Alliance Scotland, 2009, p. 2)

There is consistent evidence that self-management has benefits in relation to quality of life, as well as clinical symptoms and use of healthcare resources. Self-management has many guises – and can mean anything from providing information to people to a transformational change in relationships between health care professionals and patients (de Sliva, 2011). It is in this change in power relationships between service providers and service users that we see the connections between the impetus behind personalisation in (mostly) social care, and self-management in health settings.

‘Gaun Yersel!’, The Self Management Strategy for Long Term Conditions in Scotland [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] proposes:

A more holistic approach, less emphasis on a model of medical interventions and specific outcomes and a shift towards care environments that are both clinical and therapeutic. These principles are a valuable contribution to the discussion about taking forward a mutual NHS in Scotland which affirms people as partners rather than recipients of care. They will help us create a cultural change that balances our emphasis on evidence-based technical interventions with the humanisation of care.

(Scottish Government/Long Term Conditions Alliance Scotland, 2009, p. 3)

Activity 3.8: The experience of self-management

Timing: (Allow about 20 minutes)

What does 'self-management' mean in practice? Watch this short video (about four minutes) in which Chris talks about her experience of managing chronic pain.

  • What were the outcomes that Chris was able to achieve through self-management?
  • How do these outcomes relate to the Talking Points Outcomes Framework that you explored earlier?

Use your learning log to record your responses.


You will probably have recorded a range of outcomes for Chris, for example:

  • Quality of life outcomes such as being able to sleep and regaining a sense of well-being and of her ‘connectedness’ with others.
  • Process outcomes arising from Chris's positive experiences of talking to others about how she felt, of being respected for her abilities, learning ways to manage pain and how she became involved in enabling others to manage pain.
  • Change outcomes for Chris included, crucially, a reduction in pain and an associated increased in confidence and sense of self-efficacy (a person’s belief in his or her ability to succeed in a particular situation). At the end of the video Chris reflects on how this self-belief has enabled her to achieve in other ways, including completing a degree and finding employment.

This activity is an important reminder that aspects of personalisation and outcomes-based practice are visible in health, as well as education and other services, but they may have different names and be used in different contexts. You can find out more about self-management, personalisation and self-directed support in health services by following the links below.

Find out more

NHS Knowledge Network: Self-directed support

Asset based approaches for health improvement: redressing the balance

NHS Education for Scotland: Self Management

Evaluation of Self-Directed Support Test Site: Mental Health Cohort .


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