Growing Old Together—the challenge facing us all
Lynne Bowers, 17 February 2016
The drum beat sounding the need for radical change in health and social care grows ever louder.
Hardly a day passes without some new evidence, and a recent report from the NHS Confederation — Growing old together -- Sharing new ways to support older people -- provides some of the most compelling.
Well written and well researched, the report is the work of key system champions. Yet, barely a fortnight after it was published, it's not too soon, unfortunately, to wonder what impact it will have.
Previous reports with the same essential message continue to gather dust, although there are good people throughout the system trying to ‘turn the oil tanker’ in the Force 8 gale of demographic, societal, and technological change, as the report points out.
‘Some people will make choices that health and social care professionals feel are better for the individual, but which current systems don’t allow to work in practice,’ it states (page 20). ‘There are leaders quietly encouraging and supporting frontline staff to make changes.'
These are unsung heroes who respond to systemic obstacles by just doing it anyway!
The report suggests that any professional (including non-registered) should measure their practice, and any manager or policy maker their performance, against the following list:
- Respect the wishes and goals of the individual and their carer(s).
- Support medical and non-medical care in the most appropriate setting.
- Use the right resources – clinical or social to support the delivery of care. (The resources need to be created or funded!)
- Prevent escalation to any inappropriate services.
- Seek to use the right alternatives to resolve a crisis as early as possible, to avoid major disruption to a person’s life.
- Provide a clear plan to the individual of what the immediate and long term steps are when acute care is required.
It goes on to describe many significant initiatives — from ‘Whose Shoes’ to the Five Year Forward View's vanguard projects — and to highlight ‘must haves’:
- The person is an equal partner.
- The need for change from reacting to crises to proactive planning.
- The space to build relationships – for both leaders, and for people.
- Someone to co-ordinate or navigate the system on behalf of the person.
- Multidisciplinary and multiagency teams because they deliver better outcomes for people.
- Staff provision and skills to reflect modern-day requirements.
- Leadership should empower staff and collaborate across boundaries.
- Performance metrics should capture experience, and create common purpose and accountability.
- The use of improvement methodologies.
Speak to anyone in the system and they are unlikely to disagree – so why are such innovations still the exception rather than the norm?
‘It will take ambition and bravery to do things at scale’, says the report, but what an indictment on something, somewhere, that courage is needed to implement what overwhelming evidence, demand, and professional advice is indicating is essential!
Stephenson’s locomotive transformed performance by creating 90 individual steam chambers instead of further modifications to the existing steam engine model – simple but radical change in its time.
That might have been Rocket science — but changing health and social care isn’t!
Perhaps the key conclusion to draw is that none of us can leave responsibility for the radical change to everyone else. Each of us can power one of the steam chambers that add up to system change.
- Lynne Bowers, a former NHS clinician and manager, is an independent consultant.