Quango Tango: NAO Dances Around NHS
Another quango tango: dancing around the problem of Integrating Health and Social Care. Here's my high-level commentary on the NAO Report - first The Problem, then The Solution.
The Problem
- This document is like all other government/quango reports: a passive observation of the 'Why's' and 'When's' of a challenging topic - but little about the 'What's' and nothing about the 'How's'. It is a commentary on the problem, when what is needed is a 'Blueprint' for creating the solution.
- The statement in the NAO Report that DH and NHS HQ do not prescribe how to integrate health and social care is very revealing. This is a total abdication of responsibility or accountability for results: from Secretary of State through NHS CEO down to an enormous, over-employed, dysfunctional management structure in both NHS and local government.
- The report is full of false objections and inhibitions to health and social care integration: lack of money; data-sharing rules; etc. This is not a money issue and data-sharing rules are clear and easy to implement against enabling citizen rights and cyber security best practices.
- The report rightly criticises the NHS-orientation of the Better Carer Fund-based initiatives towards integrating health and social care - sidelining the views of citizens and local government. But this just highlights the big problem here: People - specifically, the digital illiterates who pervade the NHS and often display little empathy with 'outsiders' - e.g. patients and local government!
The Solution
- The answer to Health and Social Care Integration is all about three things, and in this order: People; Processes; and, Platforms. To quote from the NAO Report of the 'Seven Domains' that make up this topic, it's number one that matters as the key enabler: 'Digital Interoperability'.
- The Sustainability and Transformation Plans (STPs) submitted by the 44 Footprints (regions) of NHS England lack any coherent measures for Current State or goals for Future State of integrated health and social care. Digital Interoperability is what's needed as the underpinning of meaningful STPs. You could call these the Digital Footprints and these become the tangible answers to the key questions about Processes and Platforms.
- The People are the key to transforming NHS and enabling integrated health and social care. This can be a programme of work built on the principles of Design Thinking to engage all stakeholders in integrated health and social care in designing and prototyping the Digital Footprints - Processes and Platforms. This can follow the Stanford d.school process: Empathize, Define, Ideate, Prototype, and Test. The key change here is: action! We need to move from endless abstract planning to doing!
- Since the real barriers to integrated health and social care are People - not money, not data sharing or security - we can achieve real change, and real collaboration by paying great attention to the first step in the Stanford d.school process: Empathize. This means NHS, local government, private care agencies and citizens coming together with digital enablers to end up with Tests of tangible Digital Footprints - and therefore, ultimate success in a more timely integration of health and social care.