Fundamentally, health and social care is about people. It can feel bureaucratic and dry and impersonal to pull conversations away from that to focus on things like business processes, IT systems and data.
However, despite the best efforts of often heroic frontline staff who are trying their best to provide the best service they can to the people they are responsible for, they are often doing that despite the business environment they’re working in. They’re often working against business processes and systems that are not set up to help them do their jobs well.
If social care and health was a private business producing widgets and profits, it wouldn’t be accepted. It should be even less acceptable in a care environment where the implications of getting it wrong are so fundamentally more important on a personal, and human scale.
We probably all have personal stories, or have heard stories and anecdotes where people have struggled to access the right support or have been directly failed and let down by ‘the system’.
For clarity, when we talk about integrated services, we’re thinking broadly about the whole experience of integrated public services – so potentially touching local authority services, housing services, and also the vital support provided by the third sector.
The boundaries that exist between those agencies and departments are historic and often artificial; but complicated by history and law and regulations and budgets. They don’t easily support the care and support that a person needs to be considered holistically and a joined-up plan to be put in place.
If we were starting from scratch now to design public services, and if that was to be designed around what people need, health, social care and wider public services would look very different to how they do now.
We would consider what people need and remove the artificial barriers that make things more difficult to navigate between services. And this comes fundamentally to the issues of business processes and data.
The case studies described below highlight failure on so many levels, but they’re only examples. Unfortunately, similar experiences could be documented for:
– older people being discharged from hospital back into the community and needing a package of care and support around them;
– people with learning disabilities –
almost any scenario you can envisage where a specialist care and support package is needed to substantially support or improve the quality of life for a person; that level of integration across complex public services is needed if they are to have any chance of succeeding.
This is the context in which services need to be reviewed and redesigned in the future. We have to always remember the people at the heart of everything and decisions that are made and inefficiencies that exist, impact lives.
When discussions are focusing on IT or systems, or processes or data, they must never lose sight of this core objective: to deliver better services and improved outcomes for patients, service users and their families and carers.
That design principle needs to be at the core of discussions.
So, in that context of negativity, what can be done – and how?
We don’t have the luxury of starting from scratch. It’s a huge task – a bit overwhelming – to begin imagining what services would look like if they were working the way we would truly want them to, so we focus on three key points:
1. to question the ‘myth’ of data which is often cited as the key blocker of joined up working.
It’s often suggested that data protection doesn’t let us share data. But data can be processed for the purpose it was collected.
Legislation is not intended to be a blocker of good service delivery or progress. On one level there is a simple fix to that: review and redefine the purpose.
It’s also said that users wouldn’t agree to let us share data. As Jack’s mum, sharing of data is the least of my worries. I WANT them to share data. I WANT them to speak to each other and use their professional experience and influence to help me. To help my son.
I don’t want the GP to decide not to because of their fears of a legislative consequence.
If we can be clear about the purpose for sharing data and the value the individual and their family will get from that – to help people to deal with problems in times of greatest crisis – it is difficult to believe that the majority of people will not recognise the need and value of working in that way. We need openness, transparency and integrity so that people understand the value of consenting to the sharing of their data.
2. Secondly, we have a technical capability to conceive of services differently than we did even five years ago – and that will only increase. So, we have to use that.
Cloud technology. Master data management. Wearable sensors that have enabled remote care in a clinic for cancer patients during Covid lockdown for example. They allow us to conceive of services completely differently. We have the potential to locate a personal data record in the cloud and design end to end business processes that join up different services and types of support, without getting sucked into the traditional IT systems that sit within different services and departments. Taking Jack’s example, simplistically what this means is:
3. How do you eat an elephant? Bite size chunks.
Identify opportunities, get some good practice examples in place – prove that it works. Prove that people benefit from thinking and working in this way. And then build on momentum.
It’s not easy and it’s never going to be easy. But we have the capability and not to try and grasp that nettle would be wrong. There are examples of this way of thinking getting some traction.
The Greater Manchester Combined Authority are thinking in this way and have some examples of services being redesigned to join up. Digitised development records for children have connected over 800 professionals – such as health visitors, school health staff and children’s services teams across 10 boroughs. This gives them the ability to work together and provide better support to children and their families.
Good work is being done to join up Care Records and provide a single view of the patient.
This is great and its definitely what’s needed. But those digital records are only a support and only an enabler. To have an impact for patients and service users – and to deliver better outcomes for people – these TOOLS need to be used to reimagine, re-vision services and HOW they are delivered.
I live in Wales and a new Centre for Digital Public Services has been set up to do exactly this. They are establishing a small number of ‘crack squads’ to work directly with particular public services to look at what the joined up end-to-end service would look like from the user perspective if it was to work for them. That might potentially cut across health, social care, housing, third sector. They want to get momentum and traction to have examples which others can use to replicate and build upon.
Also in Wales, there is a piece of legislation called the Future Generations Act and it places a duty on public bodies to make decisions directly considering the implications of those decisions on the quality of life and opportunity for future generations.
This problem will not be resolved overnight. However, if we continue to identify bite size chunks and develop examples which demonstrate what good looks like; that will start to build momentum. We can’t ignore the challenge because it falls into the ‘too hard’ bucket.
We have the tools we need and we have an ethical and moral duty both to current and future generations to improve the way we deliver -arguably – the single most important services society needs.
It has to happen. If we don’t do it now, when will we do it?
With our expertise in social housing, care and local government we understand and we want to make a difference. If you want to talk to One Consulting about how we can help, get in touch.
The case studies below are real examples of how it goes wrong sometimes and the impact it has on real people and their lives.