Boosting patients’ abilities could save the NHS millions
Knowledge and confidence are a potent mix. That much has been made clear this morning, as new research from the Health Foundation shows that if people with long-term conditions are better supported to manage them, a staggering 436,000 emergency hospital admissions and 690,000 A&E attendances could be avoided entirely.
The findings confirm the conclusion I reached with Professor Mike Trenell of Newcastle University in 2015: that when people know what to do and they feel they can do it, they can achieve incredible things. It was on that basis that we founded Changing Health, delivering behaviour change programmes for people with Type 2 diabetes.
Many people with Type 2 don’t know how to properly manage their condition. There’s a wealth of information to take in, with too much misinformation online, and GPs rarely have enough time to give their patients much further guidance than a stack of leaflets.
But if we could give everybody with Type 2 diabetes a comprehensive understanding of diet, exercise and how lifestyle impacts on the condition – and then empower them to act on that understanding – the implications for public health are enormous.
The Health Foundation report makes a number of recommendations on how to achieve this: primarily health coaching, peer support and greater access to apps. All have been shown to improve patients’ PAM (Patient Activation Measure) scores, which predict an individual’s engagement with their health and healthcare based on over 400 peer-reviewed studies.
Indeed, a trial of Changing Health’s programme in the North West London Collaboration of CCGsfound that personalised support for diabetes, including lifestyle coaching and digital education, results in a 10-point PAM increase – enough to boost patients’ score by one level (out of a total four).
According to the Health Foundation, if we can give just the lowest ability patients (level 1) the knowledge and the confidence to manage long-term conditions as well as those at level 2, we could prevent 504,000 A&E attendances, and 333,000 emergency admissions per year. That equates to 5% of all emergency attendances, and 6% of all emergency admissions in England each year.
On an individual level, we see this science in action every week as more people with Type 2 diabetes put their condition into remission. Once people know how, for example, complex carbohydrates affect their blood sugars, and they’re given a motivational boost on a regular basis, they’re often able to cut out the bread and the pasta – and begin reducing their HbA1c. It’s simply a matter of providing that support in the first place.
Fortunately, we’re seeing increasing recognition among healthcare providers that, as the Health Foundation points out, there’s a very broad spectrum of ability and confidence among people to manage long term conditions, and different approaches are needed accordingly. At the same time, technology is enabling the delivery of more personalised support for such conditions, improving patients’ self-efficacy in managing them and, as a result, living happier, healthier lives.
For Type 2 diabetes the outlook does, then, look promising. But diagnoses are still rising, and the clock is ticking. We must act fast.