Originally published on 10 January 2018. Republished courtesy of the author and HSJ.
Health and social care are often described as two sides of the same coin. For those trying to hold social care together, it can feel like it’s: “Heads health wins, tails social care loses”.
The recent Budget did nothing to change that feeling. Will health and care be papering over the cracks and relying on short term expedients to preserve services and standards?
The Five Year Forward View hit the nail on the head when it said the NHS is “prone to operating a ‘factory’ model of care and repair, with limited engagement with the wider community, a short sighted approach to partnerships, and underdeveloped advocacy and action on the broader influencers of health and wellbeing.”
So, how can public services harness what Simon Stevens calls the “renewable energy” of people and communities? How do we shift power to citizens, plus strengthen communities and improve wellbeing?
Looking to communities
We need to enable the greatest possible number of people to act reciprocally, giving and receiving services for the wellbeing of the whole community. We need to reinforce personal and community resilience, reciprocity and responsibility, to prevent and postpone dependency and promote greater independence and choice.
We need to innovate our way to a new “business as usual”.
What we urgently need is a culture that embraces, adopts and scales proven innovations
Over the last few months the Social Care Institute for Excellence has been leading a programme of research looking at ways of scaling up innovative models of adult health, care and support. It is often said we need more innovation. Yes, we do, but what we urgently need is a culture that embraces, adopts and scales proven innovations.
For innovation to flourish, we need better ways of helping people scale up their ideas. The findings of SCIE’s research are published in a new report, Growing innovative models of health, care and support for adults. Together with NESTA, Shared Lives Plus and consultants PPL, who co-authored the report, we’ve set out five critical success factors for innovation to take root.
First, a shared ambition is needed to embed person centred and community centred ways of working using the best available tools and evidence; second, co-producing solutions and services is required, with the people who have the greatest stake in them; not merely by consultation or as an afterthought; third, modelling leadership behaviours has to occur, based on collaboration and humility; four, adopting investment and commissioning approaches is needed, which shift resources to achieve the shared ambition; and five, it’s important to set in place agreed outcome measures, effective monitoring and the harnessing of data to drive change.
A shared ambition is needed to embed person centred and community centred ways of working using the best available tools and evidence
Most of these critical success factors are already in evidence around the country in the best of the NHS and local government, but they are not evenly distributed yet.
Time to scale up innovation
So, what are the routes to scaling this all up? Interviews with a range of stakeholders – who are trying to build and grow innovations in health, care and support – have highlighted a number of barriers and enablers of scaled innovation. None of them should come as a surprise to HSJ readers.
We should make co-production the default behaviour in service design and innovation; and then clearly articulate the change being sought and the core features and benefits of the innovation proposed to achieve it. We should be clear about what evaluation and evidence standards are being set. Leaders that model behaviours that create and sustain shared ambition and purpose, whilst fostering the conditions for people to think and feel differently, can try new things and scale them.
We should make co-production the default behaviour in service design and innovation; and then clearly articulate the change being sought
The new report proposes four system wide change methodologies that have the potential to help areas break the innovation glass ceiling. If the emerging accountable care systems are to avoid another Groundhog Day and fulfil their ambitions for population health, they must be at the forefront of adopting these new approaches to signal a decisive break with the past.
In 2014, Simon Stevens said that “muddling through” was not a ”sustainable strategy” and that what was required was a health and care system that is more preventive, proactive and personalised in its approach. Scaling up innovation in adult social care is an essential first step.
Paul Burstow is chair of the Social Care Institute for Excellence and the Tavistock and Portman NHS Foundation Trust.