Week note – what does working differently mean?

‘…we cannot provide the care people need by asking our staff to work even harder. We cannot bridge the gap just by making gradual improvements to our services or by continually expanding the capacity of services. Even if we had the financial resources, we would struggle to recruit numbers of extra staff needed to rapidly expand the services SO…we need to work and lead differently…easy to say harder to do’. (NHS Providers CEO)

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What do you hear when you read this???????????????????????????????????????

I hear that the answer to our current care challenges does not lie in creating efficient processes or in making new jobs.? I hear recognition from NHS providers that the answer does not lie in expanding or creating new services.

Where then should innovation, research and new initiatives focus their attention? Where should the limited resources available to Integrated Care Systems be directed? How do we go about creating real transformation (disruptive, radical, systemic) rather than incremental change? Why is much thinking about the challenges facing the NHS and Social Care focussed on workforce and redesign of services?

There are people looking at how, by digging deeper into the data we hold on people’s health, their conditions and the resources they currently draw on, we can effectively target resource on those that ‘cost’ the system most. Others talk about making the most of what we currently have. But I don’t hear enough talk about what we can do to create healthy communities, about how we help people to help themselves, their families and their neighbours. I don’t hear enough talk in Health and Social Care about truly preventative work – and what I do hear often follows on from ‘yes, well we have to create more beds, more ambulances, more, more, more... before we can do that’.

Yes, people will talk about how, once somebody is known to the doctor or A&E or to a specialist service, they are prevented from getting worse and we might talk about supporting somebody to stay in their home for longer when discharged from hospital. You might say but we have social prescribing and that helps people to stay well. Yes, and no. It can help people to get involved in things that keep them healthy though usually it is once they are already significant users of the Health and Social Care system. I want to know how we can make real use of the community, the know how and passion, the everyday activities and spaces to CREATE healthy communities supporting people to be healthy from birth through to a dignified end of life – managed with compassion and support throughout.

My view is that within Integrated Care Systems there remains too much emphasis on the ‘treatment’ of ‘patient’s’ and their ‘medical conditions’ rather than holistically ‘supporting the wellbeing of people’. Treatment of conditions is without doubt an important part of the Integrated Care System but it is only one part. I wonder what we might design if we considered the ‘treatment of conditions’ as the part of the system that we resort to when we have collectively ‘failed’ to support the person to live a healthy life? What would change if we think of it as the ‘backup plan’ for when things go wrong? How can we do more to stop people needing to access the backup plan? And perhaps we should frequently remind ourselves that it is the Integrated Care System not the Integrated Health System.

This week note is one of an occasional series of 'thought notes' - short papers triggered by what I read - sometimes random, often not fully thought through, always shared with the intent of encouraging further thinking and conversation, never about creating division.