Improving health and social care systems – are we forgetting something?

I’m writing this as a patient, parent, potential service user and change professional.  I  wonder anxiously what impact the latest round of NHS and social care reform will deliver, against the current political background.

My biggest anxiety is, will I and my friends and family be understood and actually helped, when we interact with the health and social care system?  Can professionals change their behaviour, and win time with patients, to understand and help them help themselves?

New structures, groupings, plans and governance are all being developed in the light of recent NHS changes.  Local Sustainability and Transformation Plans have “significant central money attached”, and new initiatives are being rolled out as a result.

Local authorities and CCGs are exploring new ways of interacting with the community such as Asset Based Community Development (ABCD) and Local Area Co-ordination (LAC).  These are ways of getting the community ready and aligned to help itself with the help of co-ordinators.  In the Three Conversations Model, it is only in the third conversation with a care professional that a care plan is agreed with a budget.  All these ways of working should involve a different, empowering relationship between professional and those in need of help, and the identification and support of community networks and groups.

This is all great – but to save significant amounts of money, and actually help people, there also needs to be support for professionals to work differently.  There are some great examples emerging, such as Reinvigorating Social Work in Dorset and new relationship-based practice in social care education.

But how will this actually happen in practice?  All these models need behaviour change at the front line, and this takes time, to un-learn old habits and learn new ways of interacting.   I work with a range of public sector and charitable organisations, and the staff have less and less time to pause, reflect or even listen.  Managers have bigger spans of control and a case-load.  Doctors and nurses we know say they have had no voice in the change process in their  Trust and CCG – not because they are complaining, but because I asked them what their experience of change was.

It’s hard enough to change behaviour.  There is a risk that new roles, such as community or local area co-ordinators, will be expected to act in the new person-centred way, whilst social care and health professionals keep doing more or less what they have always done.  There needs to be understanding and ownership of what this new relationship is like, and simple ways of trying new ways of interacting, supported by effective leadership and management.

Real life examples where small differences made a big difference

Professor Arvind Singhal tells the story of how his premature son needed many operations in his early days.  He noted how most nurses and anaesthetists would take his son away, put him on the bed and try and inject him, as he screamed and wriggled to get away.  However, a few nurses would let Arvind or his wife continue to hold and distract their son, whilst they inserted the cannula.  This was far easier, less distressing and quicker.

A social worker in Sussex was working with a mother with serious alcohol problems, who had problems getting her children to school.  Normal practice would have been to get a taxi for the two children who were still in her care.  However, the social worker remembered training with us, to seek what worked for the family.  The older girl, who was 13, replied that it would be worse to have a taxi than not, because the authority would only be able to provide it for a short time.  She asked her mother just to get up and prepare breakfast, because that was enjoyable for all of them, and she could commit to that.  And this worked, and was still working some months later.

What is needed?

These examples show that small, no-cost changes in response can make a huge difference in the relationship between professional and patient.  It’s about asking the right questions, finding what works and challenging in a positive way.

New ways of talking with patients and potential service users will enable professionals, as well as community co-ordinators, to identify better ways of supporting people and also saving money.  Many small savings together add up, and increase confidence of professionals in using these techniques .

The ingredients for doing this are all well-known and in the public domain.  They include storytelling, facilitation techniques such as World Cafe, and coaching-style questioning where the power balance is equal and the relationship is “adult to adult”.  Hidden Insights is a group facilitation process that brings together these techniques in a specific “recipe” for behaviour change.

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