July 11, 2016
PAM’s licence to thrill – NHS England blog post from Professor Alf Collins
NHS England’s National Clinical Advisor for the Personalisation and Choice Group delights in today’s announcement that 37 sites, including Integrated Personal Commissioning sites, will receive Patient Activation Measure licences:
How engaged are people in managing their health and care?…was the title of a Health Foundation publication in 2005.
This followed from Sir Derek Wanless’ 2002 report for Gordon Brown – who was then at the Treasury – that the very survival of the NHS depended on people being ‘fully engaged’ in managing their own health and care.
Subsequent to this landmark paper, a number of influential commentators including Chris Ham (now at The Kings Fund) and David Colin Thome (at the time a GP in Cheshire) went to America and saw how health management organisations were adopting evidence-based systems to rise to the challenge of long-term conditions.
Many were using the ‘chronic care model’ which had been developed in Seattle, and it seemed to work. On this basis, the model was adapted and introduced into the UK, and it became official UK policy in 2006 for people to be supported to manage their own health and wellbeing, that is, supported to self-care, and to be ‘fully engaged’.
So, what demonstrable progress have we made over the last 10 years?
Well, Chapter Two of the Five Year Forward View reiterated the Wanless challenge, but to be perfectly honest, we don’t know about progress because we haven’t had a national metric to track patient engagement. So let’s go back to that Health Foundation paper which looked at how engaged people were in 2005.
In that paper, the authors used a (then) new measure called the Patient Activation Measure. We now understand this to be the best measure of ‘how engaged’ people are in managing their health, if they live with long-term medical conditions. In 2005, the authors showed that around a third of our population have low or very low levels of engagement, in other words, low levels of knowledge, skills and confidence to manage their health. Because of this, there is a tendency for them to develop more and more long-term conditions, a worsening quality of life and for them to cost more than those who are more engaged.