Care planning

Care planning is a process that puts people at the centre of their care, it is a way of providing them with better support to more effectively self manage their condition and therefore improve quality of life and achieve better health outcomes.

Supported self management recognises that people with diabetes are the primary decision makers about the actions they take in relation to the management of their condition.  Emphasis moves away from the clinician doing things ‘to’ the person to a partnership approach that delivers tailored personal support to develop the confidence and competence the person needs. 

Effective care planning relies on three interdependent elements within the healthcare system

• An engaged, empowered patient
• Healthcare professionals committed to partnership working
• Systematic and robust organisational systems

If one element is weak or lacking, the approach will not deliver the desired outcomes.

A fourth element – commissioning provides the foundation upon which this approach can be built.  Information needs to be captured and used to ensure the appropriate local services are commissioned to support the needs and choices of the population. 

The care planning consultation replaces the annual review with a more effective dialogue between patient and healthcare professional.  This in turn shapes the delivery of care over the year giving it more structure and focus to achieve better use of time and resources.

The Year of Care Programme has demonstrated how to deliver personalised care in routine practice for people with diabetes using diabetes as an exemplar.

See also the Department of Health care planning information.