The challenges

By 2020 public health services in the UK will have only 60% of the resources available than would have been expected if normal rates of health cost inflation had still applied.

NHS expenditure in 2011 at £103.8bn is budgeted to rise to 129.6bn in 2020

compared to £207bn, based on projections of NHS inflation over last 10 years

(NHS figures)

Conventional health spending is clearly unsustainable - this is a conclusion widely accepted across the developed world. Health services will not be able to meet current expectations, let alone from an aging population. This will translate in the UK into longer waiting lists, shorter hospital stays, 'postcode lotteries' of patchy services, overworked staff, more outsourcing to private contractors with reduced regulatory oversight ...

People will NEED to sort out more of their problems themselves.

However there are many factors that inhibit more self care. There are still substantial blocks even to eating and exercising well and ignorance of even basic information about health.

The self care effectiveness gaps

• There is a lot of good information that does not deliver changes in self care because people do not read or act upon it
• The health services are overstretched in facilitating self care in many cases where people could look after themselves with the right tools and guidance: they therefore turn to prescriptions as a quicker alternative.
• Most self care expertise is in the hands of pharmacists who are nevertheless constrained in their businesses to supplying products rather than the full support services they often would like.
• Whereas conventional over-the-counter medicines remain a key part of self care there is a persistent interest in products that appear more homely: there are high quality natural products that could be popular options for informed self care and which could save public resources, but which are buried in a jungle of misleading information and confusing competition.
• Manufacturers are restricted in making specific claims for individual products and so fully informing their customers: therefore both public and health professionals are confused, and ethical manufacturers are crowded out by less regulated market activities
• There are not enough well-informed guides to self care who can make the difference in people's lives.

What the evidence on self care says*

• People are more likely to improve their self care when they are nudged to do so by their health professional.
• People are more likely to improve their self care through talking with other people.
• Self care support is best provided in hubs and networks, even on health care premises.
• Health care professionals should become facilitators as well as prescribers.
• Health centres should have dedicated Health Facilitators to act as community coordinators.

[*Conclusions from UK Department of Health reports and from a DH-supported Self Care project Integrated Self Care in Family Practice led by Sustaincare CIC 2008-2011]

OurMedicine sustainable solutions

1. Accessible and meaningful information for the public that is interactive and based in community and networks.
2. Resources, education and training for health professionals to improve their ability to facilitate self care.
3. A guide to reliable self care goods and services.
4. Cooperative purchasing models.
5. Packages and protocols for healthcare professionals and community leaders to take back to their practices and groups and act as advocates in their own communities.

Our demonstration

• Take a community.
• Give it a HUB
• Build local networks of community champions and healthcare services.
• Find the most reliable and trusted resources.
• Provide good independent information that makes sense and that anyone can use.
• Train and equip health professionals to support self care.
• Then ROLL OUT to other locations.

Our products

• Natural Choices

The self care approaches that are most likely to be adopted are those in which the user is able to do or prepare the treatments at home, and can buy products and services that are like home remedies. Our first information resource builds on our strengths in complementary and herbal medicine to provide a hard-nosed review of such approaches as a simple toolkit for everyday use. It is being trialled on the ground in our demonstration hub and community networks and through our practitioners. This will extend into a full online Natural Choices Catalogue. Goods and services will be selected by identifying available quality assurance and meeting evidence specifications, and to pass the 'health professional comfort test'. It will be an opportunity for responsible providers of self care to be highlighted and promoted.

Natural Choices will also be a take-home service for healthcare professionals attending our -

• Self care programmes

Sustaincare will run a series of workshops for health professionals and community leaders interested in extending their self care skills and resources Topics will include self care oriented practice management, finding your community, how to be a health facilitator, motivational consultation techniques, using self care resources, learning about self medication and OTC products, and protocols for adding them to practice services.

• CommunityPrescriber

In leading a major multi-centre Department of Health project Integrated Self Care in Family Practice in 2008-2011 we built an online calendar of self care events uploaded by local community leaders. With a Health Facilitator to monitor these activities we developed an early pop-up application for family doctors wishing to make more effective social prescriptions. This will be further developed in our demonstration site.

• Our HealthShare network

Working with the national signposting charity StartHere, this will provide access to community resources, a forum to share experiences, and will promote Natural Choices and other tools for community and network leaders to support self care in their groups.

• The SelfCare Cooperative

A new consumer co-operative will give its membersonline access (www.selfcare.coop) to best price deals from the Natural Choices Catalogue.

COMING SOON:

a new website (www.ourmedicine.net) with a range of tools available to anyone who wishes to make the most informed choices about how to look after themselves and their families, and the professional who wish to support them