Last year was characterised by sudden, unpredicted change. Some certainties unravelled overnight, as polls turned out not to reflect votes, others had been building for some time.
The crisis in health and care services is being dangerously accelerated by cuts, but you can trace its roots back to decades-old failure to take seriously the ever-growing gap between what services can deliver and the growing demands on them. It is easy to believe that all the future holds is the loss of services. But the future will be whatever we choose to make it.
There is a time for tweaking and refining the existing model, but perhaps the middle of the widespread collapse of health and care services is not that time. We need significant central government investment to avoid crisis becoming catastrophe, but then what?
Sustainability and transformation plans (STPs), which were the big headline of NHS change in 2016, are for the most part prime examples of how we lack a model for radical change in public services. They are the system responding to crisis by doing what we always do – just faster, at bigger scale and with more anxiety. The more urgent and important the work, the less leaders feel able – or obliged – to involve a wide group of organisations, let alone people who use services and their families.
Most STPs express what leaders were already intending to do, with little of the involvement of new people that would have led to new aims, approaches and behaviour. Lack of collaboration has bred suspicion, but they are not the secret cuts plans they have been dubbed: they are more likely to avoid talking about cuts that have been inevitable for years.
Where they say the right things about community-based care or prevention, many are essentially works of fiction with no model for the culture, power and economic changes needed.
There is much talk of scale in public service delivery, but nearly always this is the industrial age’s need to operate in large units. Our large organisations, silted up with the governance requirements that must accompany any big budget, are not the place where change will happen.
The real challenge is to scale those bureaucracies down to be human and family-sized again. The lesson of successful models – such as personal budgets, Shared Lives, community enterprise, Buurtzorg, local area coordination and Homeshare – is that we avoid the prototype-then-replicate approach and instead create enough infrastructure for people to form similar but entirely individual relationships everywhere. This is the scaling model of the internet age.
The only kind of change you can make happen suddenly, on a large scale, is destruction, whereas creation of anything real and valuable starts small, but ambitious. For real change to take hold, you need to involve people who don’t always agree with each other and you need a tolerance for messiness: the neater the plan, the more fictional it is.
There many kinds of people who care about each other and who already change the world around them: hundreds of Homeshare households, thousands of community entrepreneurs, 10,000 Shared Lives carers, tens of thousands of timebankers and millions of unpaid family carers. Can those overlooked groups join together, gradually and messily, to become a national movement that chooses to build a better, more human future? Do we still have time?
Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.
For change in social care to bring value, it must be messy
Hiç yorum yok:
Yorum Gönder