The self-management of long-term conditions undertaken by people in their own homes has been attributed with increasing importance in health care policy. Interventions based on self-skills training have been introduced as a means of promoting and increasing levels of self-care practises in the population which have been informed by psychological models and concepts of change such as in the case of the national policy of the Expert Patients Programme (EPP) self-efficacy. Evidence to date suggests modest or equivocal effectiveness and there may be a number of reasons for this. One of the reasons is a failure to give due attention to the perspectives and work that patients themselves undertake in self-management interventions. Whilst the notion of an Expert Patient conveys a sense of what a new health policy centred on long-term condition management hopes to achieve, an important corollary is understanding the conditions necessary to accommodate and embed new techniques in the routine elements of illness ‘work’ undertaken by patients living with a long-term condition. This paper explores the health policy context of self-management, including the evidence and adequacy of the organizing concepts and outcomes associated with the EPP, and suggests that a greater focus on illness work and the social and domestic contexts is required in future innovation and research in the area of long-term condition management.
