Reflections on #NCASC – let’s start with people

For the last three days I’ve been in London for #NCASC – the National Children and Adult Services Conference. A considerable focus of the conference was #integratedcare and the need for #health and #socialcare systems to work closer together, set within the current economic situation and reduction of resources. I think its fair to say that at times at conference you’d have been forgiven for forgetting that what we are all really interested in is improving life for people who need to use health and social care services. I guess that understanding is absolutely implicit, and the challenges are great at the moment, so much so that it would be easy to reach a state of being overwhelmed with the magnitude of the challenge, and disillusioned with what can actually be done.

So, I’d like to share a good news story.

While I was going about life at conference, back in sunny Devon unbeknownst to me (because my Mum didn’t want to bother me when I was working), my Dad was getting increasingly breathless. For anyone reading this blog for the first time, my Dad has cholangiocarcinoma (bile duct cancer), and he has a terminal diagnosis. Just over a week ago we had an appointment with his consultant (you can read the post I wrote the day before we went) where he told us that one of his tumours had shrunk slightly (and the reaction). This is great news as we’d tried to prepare ourselves to hear that the cancer had spread to his lungs given his difficulties to breathe and recover from the slightest of physical activity. We were told that Dad was anaemic, and the relationship between tumours needing blood supplies and the tumour shrinking was gently explained. More blood tests were taken, the possibility of an endoscopy floated, iron tablets and vitamins promised once the results were available.

On Thursday Mum decided they could wait no longer, Dad didn’t want to hassle (neither of my parents ever do) but Mum balanced up the possibilities of Dad’s health deteriorating sharply over the weekend (anyone who has had to rely on our health or social care systems knows not to get ill at the weekend) and the need to just gently nudge the system. One phone call from Mum to the Oncology Dept revealed that they had the results and someone would phone back with them. Hours later a chance inquiry into Dad’s health by their GP when dealing with my 93yo Grandad led to him getting involved and prescribing iron tablets and following up with Oncology too. A day later Dad has a course of iron tablets and a blood transfusion booked for Tuesday because his haemoglobin levels were so low. I’m confident that we have that outcome for two reasons, because my Mum didn’t wait until things got worse and chose to take action herself (in spite of how uncomfortable that makes her feel) and because our GP knows enough about my family to ask about my Dad when dealing with my Grandad. I’d like to think that his information recording computer system is good enough that when he looks at my Grandad’s notes he is able to see that he lives with his 91yo wife next door to their daughter and son-in-law who provide them with care and support, one of whom also happens to be terminally ill. I know I’m pipe dreaming but you know what I mean.

So what has this got to do with NCASC?

Well, as I sit here musing on Saturday, the words that made the most impression on me were from people who I know and respect, all of whom focused on people as part of the solution. These were Councillor Sue Anderson from Birmingham City Council who addressed a session on Health and Well-being Boards #hwb and focused on the need to focus on good relationships rather than bureaucracy. She wasn’t suggesting that the systems and strategy are not important, she was however stressing the need to start with relationship building and trust.

Next up on my thought provoking list has to be Richard Jones. The Director from Lancashire CC and former ADASS President took the floor in the Think Local Act Personal session #TLAP on the final day and challenged #socialcare to focus, arguing that we were getting caught on second order conversations about #integration and #resources and forgetting the people at the centre. Making it Real the new publication from TLAP will prove useful for anyone working on #personalisation to judge their progress against the end results that citizens have identified they need. Sue Bott also talked a *lot* of sense in the TLAP session, with a humour and personality to her delivery that few before her in conference had managed – she even got a room full of conference weary delegates to raise a virtual toast to Making it Real!

My final sense talker has to be Peter Hay, the Director of Adult Services in Birmingham and this year’s ADASS President who took the floor a number of times at conference. He joined the panel in the final session that focused on #integratedcare and the work of the Future Forum and again brought the focus back to those who use #socialcare services, reiterating a challenge from Lord Crisp at the conference opening to build services around #life not around #care or #health.

Isn’t that all a bit naive and over simplistic? 

I’d like to think not. We are without doubt in need of large scale system change, #Dilnot challenges us all to consider our own future and how we will provide for our old age or social care costs, whatever your view on the Health Bill the creation of Health and Well-being Boards present an opportunity, our demographics are changing, as is our technology, our family life and our expectations. None of this is new though, not really, the likes of @RichardatKF can tell you all you need to know. Surely, we have known for long enough what works and doesn’t work with regards to integration and we must know by now that people just want to feel well and live their lives as independently as possible. Maybe it’s just me but I’ve yet to meet someone who cares which budget their support comes out of, people just want to live their lives.

So what can we do?

This was my third time at NCASC and each year I leave exhausted with a lot more to think about (and a head full of more ideas) than when I arrived. I usually meet a few people in person that I’ve not met before, my favourites this year were @jaimeelewis @mroutled and @philblogs and I was also delighted to see far more real life networking inspired by twitter connections. [As an aside I do believe that the #socialcare sector is finally realising the potential of #socmed]. I’m sitting here believing that change can happen, we have clear evidence around these challenges, we have enough people with enough experience to move on some of this. Personally I believe that this requires commitment and leadership, from those at the top of government (I too struggle to see how bin collections are more important than social care) to match those from the sector who I’ve mentioned above. As much as I welcome any attempts to engage people on the future of care and support (6 weeks left to contribute) I do wonder whether what we really need is a commitment to action.

The one consistent in all of these discussions and system challenges is the person who is trying to live their life. Start with the person, they (and their carers or family members) are the lynchpins in all of these systems and services. Let’s start improving services now, we can’t afford to wait.

NB: Just a thought, #socialcare readers of this might be interested in an earlier post What is Service Design? – the comments and discussion especially may help unearth some thoughts for how we can move on such large scale system redesign, without forgetting the end user or person who uses them.