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Authors: Jules Horton, Bevan Advocate, Chris Roach, Self Management Programme Manager, 1000 Lives Improvement, Public Health Wales, Tom Howson, Swansea University Medical School, Hannah Thomas, Bevan Commission, Dr Tom Powell, Bevan Commission


The Bevan Commission worked with Swansea University, Gwent Association of Voluntary Organisations (GAVO) and 1000 Lives Improvement to analyse 1,400 patient responses to the Education for Patients Programme (EPP).

Executive Summary

The Bevan Commission has recognised the unsustainability of the current healthcare system in Wales which predominantly treats ill-health at the expense of promoting health and wellbeing. This has recently been reinforced through its Prudent Social Model of Health series. This sets out how health is everyone’s responsibility, not just the NHS. It cannot be based on fixing people when they become ill in the traditional way, but must be one which is sustainable and engages people and their ideas, making them jointly responsible to produce their own health and wellbeing.

Education Programmes for Patients (EPP) is a successful and widespread programme of patient empowerment and self-efficacy in Wales. It provides a prudent method consistent with the principles of value based healthcare. Its problem solving exercise provides a valuable way to access the views and experiences of patients and their carers. This report describes the outputs from 93 EPP courses with 797 participants setting out over 1400 issues and challenges that they face on a regular basis. The outcomes of this work provide a rich and unique source of the wide-ranging challenges that people with chronic disease in Wales can face. The solutions proposed by the participants were broadly grouped around either how to change the system or how patients could be better prepared to interact with it.

There also appeared to be an overestimation of the expectations, particularly regarding the role of GPs. While many patients would often be better suited to meeting with a specialist best placed to meet their needs, e.g. pharmacist, chronic condition nurse, Occupational Therapist, physiotherapist or social worker, it appears that many people are unaware of this and the avenues to access support. This would suggest that there is a clear need for greater understanding and awareness of how the system operates, and how patients might be empowered to help manage their care and their expectations.

This report sets out the following key recommendations:

  • Emphasise the importance of the patient as co-creators of their own health and well-being with patients and professionals.
  • Enable patients to become custodians of their own health information, through cloud-based patient records and other tools that can be amended by the patient.
  • Increase health literacy and knowledge of how the system works to help make shared decisions and manage expectations.
  • Undertake further research for future EPP courses, to look at driven by geography and deprivation.