The responsibility of the patient for the day to day management of his/her life and the condition.

The Chronic Disease Self-Management Course (CDSMC) was developed at Stanford University Patient Education Research Centre. UK: British Liver Trust; MS Society; National Endometriosis Society; Diabetes UK; Haemophilia Society; Manic depression fellowship. •People with chronic conditions must deal not only with their disease(s), but also with the impact these have on their lives and emotions •Lay people with chronic conditions, when given a detailed manual, can teach the CDSMC as effectively, if not more effectively than health professionals •The process or way the CDSMC is taught is as important, if not more important than the subject matter

Although disorders classed as chronic are diverse in nature there are many factors that affect the way we live with our illness and these are not always related to the illness specifically.

The Symptom/Pain cycle stems from the illness itself, but it can become a perpetuating circle unless we do something to break the chain. Living with illness causes stress and anxiety which makes us angry and depressed. The discomfort of pain and the inability for us to be able to do what we wish enhances negative repercussions of the illness. The circle remains unless we learn to self-manage problems caused by the illness in a positive and productive way.

The course content is extremely varied and focuses on reducing negative symptoms. The course consists of short talks, discussions, group work, free thinking sessions and building confidence by using action plans and problem solving. Many of the techniques are simple but effective and each person decides what they want to do and this is achieved at their own specific pace. Concerning ‘exercise’, it is always stressed that the individual must begin where they are now – exercise does not have to mean a mega workout at the gym.

An increase in positive self-management successfully reduces the negative impact of living with a chronic condition.

It is the ‘expertise’ of the individual living with the disorder that is explored within the group.

The overall aim of the programme is that it affectively enhances the individuals quality of life. In a five year randomised study of the programme (evaluated by Stanford University) involving more than 1000 participants it was shown that individuals who had taken the programme, when compared with those who had not taken a programme had: •Improved their healthful behaviours (exercise, cognitive symptom management, coping skills and communication with health professionals) •Improved their health status (self-reported health, fatigue, disability, social activities and stress levels) •Decreased their visits to health professionals and reduced the length of hospital admissions

The Department of Health is introducing some disease specific add on sessions for this course which will also be evaluated. The current emphasis is on the generic course as it is evidence based.

Volunteer tutors are currently managed by ourselves, but eventually PCT’s will take over this role. They are the lifeline of the programme. Volunteers commit themselves to running a minimum of two/four courses per year for each PCT.

Fully trained to deliver this copyrighted programme. All tutors are assessed on delivering their first two courses and yearly assessments follow this initial stage. The training is quality assured and all trainers have undergone a full training programme themselves. The experience is rewarding (and this is not just my statement regarding this). Seeing individuals regain their confidence is a wonderful experience.