BMJ: Changing the narrative around self-management (2)

9 May, 2021

HIFA colleagues,

Fully agree Richard Fitton’s point about self-care forming a further level of care to join the traditional primary, secondary and tertiary levels.

In England the NHS has long been encouraged to strengthen support for self-care- see for example the Department of Health publication of nearly 20 years ago "Self Care – A Real Choice, Self Care Support – A Practical Option. (available at That publication emphasises that self-care is not a fourth level of care but rather the first level. As the NHS Plan 2000 said "Most health care starts with people looking after themselves and their families at home. The frontline in health care is in the home.”

More widely and recently the importance of supporting self-care has been recognised by the WHO in its 2019 publication. "WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights" (available at in which the WHO Director General states: "The provider-to-receiver model that is at the heart of many health systems must be complemented with a self-care model through which people can be empowered to prevent, test for and treat disease themselves."

Needless (for HIFA colleagues, though not more widely, see e.g. ) to say, universal access to essential healthcare information is a foundation for such empowerment.

Geoff Royston

HIFA Profile: Geoff Royston is an Independent Health Analyst and Researcher, former Head of Strategic Analysis and Operational Research in the Department of Health for England, and Past President of the UK Operational Research Society. His work has focused on informing the design, implementation and evaluation of policies and programmes in health and social care, and on fostering the capabilities of others to work in these areas. Associated activities have included modelling for understanding the performance of complex systems, analysis and communication of risk, and horizon scanning and futures thinking. He has also worked on information and communication technology in the health sector, notably in leading the design and national launch of the telephone and online health information and advice service NHS Direct. He has served on both scientific and medical UK Research Council panels, and as an impact assessor for the UK higher education Research Excellence Framework. He is a member of the editorial board for the journal Health Care Management Science and in 2012 was Guest Editor for its special issue on Global Health. He has been a consultant for the World Health Organisation, is a long standing member of the EURO Working Group on Operational Research Applied to Health Services, and is an expert adviser to the mHIFA (mobile Healthcare Information for All) programme. He is also a member of the main HIFA Steering Group and the HIFA working group on Evaluating the Impact of Healthcare Information.

geoff.royston AT