We are all familiar with the endless headlines setting out the difficulties in the current health and social care system. Over-run Accident and Emergency departments, increasing demand in GP practices, carers working long hours, care providers handing back contracts to local authorities as they are no longer economically viable. Most of all, the harrowing stories of people suffering in their homes or in hospitals.
To contrast with these headlines however, it is important to realise that nobody in the health and social care system wants this to happen. I have been privileged to work for many years in these systems, and everybody wishes to help the people of Wales. The difficulty is that the system within which they work makes that very difficult.
Consider what a social worker needs to do their job: training, access to accurate information, ICT that supports not hinders, the opportunity to discuss cases with a critical friend, and measures that help them understand and improve the work, etc. How many of these are within the control of the social worker? If any of these get in the way of the social worker doing their job – affecting their ability to achieve good outcomes for families – there is very little they can do about it. These issues are part of the system they work within, not within the control of the social worker. This is true of all those working in the wider health and social care system.
This situation is compounded when multiple organisations are involved, with their own specific policies and procedures, referral methods, assessment teams, etc.
Once we accept it is the system we need to challenge, our solutions become more focused. In addition, it forces us to question the assumptions behind the design and management of the current system.
Studying our system from the perspective of the people of Wales, enables us to draw a picture of the current system. This picture normally looks quite complex, with many departments, lines of responsibility, professional teams, organisational boundaries, commissioning arrangements, etc.
With this in mind, we have a great opportunity in Wales. Rather than tinker with the current system, we could test something very radical. This would mean, going back to the Purpose and Principles we feel should define the health and social care system we want. This goes well beyond integration. This is a fundamental redesign of the entire system.
Below is a proposed concrete alternative to the current health and social care system based on studying and redesigning this system over many years. It is intended to help us reflect on how radical we are prepared to be with our thinking. If we are, we can experiment with the model below and see what we learn.
Local Geographic Team Practical Detail:
- Team Members are directly accountable to their local population. Power lies with the local community – who pull help from the team as needed.
- The local community is facilitated to build on its own strengths as a priority over service provision.
- Composition of local geographic team will include resident expertise and less frequently required expertise on pull (i.e. they are available as required, in contrast to ‘referring’ to less frequently required expertise). This replaces the current distinction between primary and secondary care.
- The composition of the team will be determined based on what is predictably needed to enable people to overcome the predictable underlying causes of any issues, rather than just their presenting issues.
- The team is based on what is required in a geography, and is in contrast to a team based on professional roles or function. As such, leadership is placed in the geography, not along professional or functional lines.
- Team drawn from current roles including, support workers, community volunteers, third sector expertise, community connectors, GPs, OTs, social workers, community nurses, physiotherapists, CPNs, OOH workers, etc. All in the team work to the above purpose and principles.
Change can feel threatening, especially radical change. However, in this case, it can be an opportunity to remove the frustrations and issues that those working in, and experiencing this system, have been struggling with for years. The above is intended to help us identify where and with what we may wish to experiment. This can be done in a structured but rapid way.
Let us test our assumptions behind the design and management of our current health and social care system. Let us design the system we want, rather than continue to try and modify the system we have.
If you would like to discuss this article further, please get in touch with Simon Pickthall.
Simon formed Vanguard Consulting Wales Ltd 10 years ago – applying the Vanguard Method for Systems Thinking developed over the past 30 years by John Seddon. He has been fortunate to have worked with many leaders in Wales to help them understand their organisations from a Systems Thinking perspective – and improve them as a consequence. He has been invited to speak on numerous occasions regarding his work in Social Care and Wellbeing, including at party political conference level. Simon was also a member of the Munro Review of Child Protection, and has taught on the Leadership for Collaboration and 20Twenty Leadership Courses at Cardiff Metropolitan University.