Doing things differently….systems and services

I’m going to start by apologising for what will not be my most reflective, coherent or considered blog post ever!

I’ve just had the privilege of spending 24 hours in the company of Directors of Adult Social Care and representatives from some of their management teams. This was at @ripfa‘s Directors Policy Forum – will blog about it over at the ripfa blog as soon as my mind has recovered to enable me to be offer a considered reflection.

For now though I’m just sat back in my office considering and reflecting on the massive challenges ahead for anyone receiving support from adult social care, and the staff that are involved in providing that support. At the same time @enabledby are having an event at The Design Museum looking to reframe the disability and ageing agenda by focusing on design for all; you can follow the discussion over on the #WeEdD hashtag.

I’ve just dropped into the discussion and am drawn (*disclaimer* from afar, without context so apologies if I’m missing the point) by the focus on design and systems and the need to pass control to the service user to design a system that works for them. Sounds like there are workshops from @thinkpublic and @sidekickstudios and a great focus on service design. I was delighted to see on the event blog that Adil from Sidekick had made a point about the need to negotiate between what’s right for the user and what the system can embed.

I’d take it further and ask what the system should embed or support?

It is apparent from the conversations we’ve been having over the past two days that there is a really bumpy ride ahead; there are massive cuts looming (and started) for Adult Social Care. To that end I’m wondering whether we should be focusing on moving the public sector reform discussion into a broader debate with the public.

We’re all likely to require some support for an adult social care need at some stage of our lives – whether due to illness, disability or just through getting older. The reality is that the services are having to change, the support will no longer be available in the current form and therefore we all need to decide what we expect to support our friends, families and communities with, and what we expect the system or service to provide.

I’m not yet convinced whether service design has the answers. I’m bloody certain existing services, staff and service users don’t all have the answers! Controversial maybe but I think we need to think differently. We need to start with an even more basic discussion, not about service improvement, but about values and requirements. We need to figure out exactly *what* support people need and then have a grown up and adult conversation about whose responsibility it is to provide that support.

Having heard Charlie Leadbetter speak last week I know that there is much more food for thought coming so I’m going to go rest my brain but if anyone is interested in continuing this discussion please do get in touch. Thanks to everyone who is there for sharing the discussion with those of us who couldn’t make it.

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6 thoughts on “Doing things differently….systems and services

  1. I completely agree. Part of the difficulties of the present paradigm of adult care is that it is based in an industrial/post-war phase of care delivery. Even the personalisation agenda has been hijacked somewhat and although it offers something very different for some people – it by no means goes far enough. I suspect it is because the money isn’t there and a lot of the future debate will have to be tied into to how the funding comes about and what expectations exist about what the state may or may not supply.
    What is really needed is creative thinking and the bravery to throw away a lot of the previously held systems. Why can’t older adults who need residential 24 hour care (and there are lots who do, despite the move away from residential care in general) be cared for in smaller more ‘homely’ homes – of course there is an issue of cost efficiency but I think if more non-profits and grass-roots community projects were involved rather than the ‘big business’ of companies such as Southern Cross and Care UK who are beholden to shareholders, there might be another way of doing things.
    The problem is, while these discussions are happening at strategic levels, what is happening in the adult care teams today? There is such overwhelming levels of work that the professionals on the ground and on the ‘front line’ rarely have the scope or ability to join the debate. It feels sometimes like fanciful and unworkable projects are all that ever come from the think tanking.

  2. Thanks for commenting. You’ve inspired me to spend some time this weekend writing up the Directors Policy Forum we had this week and some of the conversations there. It’ll go up on http://ripfa.wordpress.com We discussed eligibility and FACS, statutory responsibility, hearts and minds changes v structural and procedural.

    I’ll also at some stage get around to writing a blog post about our change project, SDS360 – it’s looking at the culture of change required for self-directed support and we’re developing a resource to support frontline staff. We’ve involved a number of frontline staff in it’s development and I hope it would pass the not-fanciful and not-unworkable test 😉 What we can’t provide though is the guaranteed time that it takes for people to be able to reflect and change practice…depressingly it looks like that is getting rarer by the minute.

  3. I harbour a deep scepticism about service users designing services for themselves. The most vulnerable often don’t make nearly as many demands of services as they should because they or those close to them don’t have an idea about how things should be. That is true of health care and from what I see it is true of social care too; though I have much less exposure.
    Is there any evidence that the most vulnerable can make adequate use of ‘personalisation’?

  4. Hi Anne Marie, thanks for the comment.

    It is (relatively) early days with regards to evidence around personalisation. There have been some large scale studies, the most often quoted is IBSEN – the evaluation of the Individual Budget Pilots, the full report is available on the DH website http://bit.ly/cLnrlY

    Most evidence to date, researched and anecdotal, suggests that people have very mixed experiences:
    * Some find that they have the freedom and flexibility that they have wanted for years and many people who require support with physical disabilities absolutely love the improvements that have come as a result of these changes (I can think of one or two people whose lives truly have been transformed)
    * Some people with fluctuating needs as a result of an illness or disability that changes over time such as someone with a ‘long term condition’ or needs linked to mental health, again can see the potential of having a more flexible approach to support
    * Some older people have found it hard to adapt to the new system (people will frequently quote the IBSEN findings with regard to this but there really wasn’t enough time between when people were actually given an IB and assessed about their experiences in most cases, in my opinion) but others can clearly articulate why it would work for them

    What we do know is that very little work has been done looking at how personalisation can work for people with most complex needs. As I said above it is relatively early days and people are working at it – but few solutions out there yet. I think it links to CB’s point about the personalisation agenda being hijacked and not going far enough.

    In fact in my opinion CB hits the nail on the head with her comment that “What is really needed is creative thinking and the bravery to throw away a lot of the previously held systems” …I see lots of people trying to redesign the current system into something resembling what was originally intended by personalisation. It seems that the focus has switched from one of the values underpinning personalisation to an agenda of efficiency and delivery mechanisms.

    So in response to your point, we don’t know yet. I think there is a long way to go on this journey. There is great potential for positive change but I think we need to start with what is the role of social care before we try to go any further!

  5. Thank you- that is very useful. I am not so clear about what the values underlying personalisation were/are. I don’t think that there is anything wrong with drives for efficiency. Waste drives me mad! And it does not bother me if this is an underpinning value for ‘personalisation’.
    But I think your question about what are the values underlying social care is the important one. Then we can see whether a personalisation agenda fits with those values.

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