Lets change the system!
There is a growing consensus that making progress in improving opportunities for people facing multiple and complex needs will require ‘system change’. This is particularly vital, so it is said, in a time of austerity when introducing new interventions is less achievable.
Revolving Doors is working with local authorities and their partners in a number of areas with a view to identifying and achieving changes in systems against this backdrop. Without identifying the areas at this stage, over the next few weeks I want to reflect on some of the themes that seems to be emerging from these processes and explore what this might tell us about making progress in the future.
Complexity and change
People experiencing multiple and complex needs interact with and need help from a broad range of services – police, NHS, housing, drug services to name a few. Each of these service types operates within a ‘system’ of its own, with its own legal framework, driven by distinct government policy and regulation, its own goals and commissioning structures and with delivery agencies with distinct cultures, practices and pressures.
The shape of these services in local areas is driven by decision makers located at different levels which means that cooperation, even where desired, can be difficult to achieve. This is exacerbated where geographic boundaries for services or commissioners are not coterminous. This creates complexity enough. But when you add in the fact that each of these systems is experiencing different degrees of change and reform, our operating landscape becomes even more difficult to comprehend and navigate.
To illustrate, just as the new structures in the NHS are settling down, the probation service is experiencing a period of deep structural change which is inevitably disrupting many of the relationships and partnerships that exist at the local level. Making sense of ‘the system’ given these factors is an enormous challenge and beyond the specialism of any one player at any level.
Service user involvement
Given this how can we come at the problem in a way that actually makes sense to anyone?
One answer which we are using in our work in local areas, is to consider ‘the system’ from the point of view of the users of services. Some crucial lessons can emerge when you create opportunities to hear about this experience firsthand. For example, we have heard how many of the people who are often assumed to be “hard to reach” are actually clamouring for help from services, but are doing so in places that are not able to respond and don’t see it as their responsibility to connect people to alternatives that do exist but are located somewhere else. Once you understand this it does open up opportunities to consider shifting local arrangements.
Creating collaborative learning spaces
In some areas, as part of our support to local areas, we have facilitated collaborative learning events bringing together service users, frontline workers and managers from services, commissioners and policy leaders. These events create new conversations and opportunities which allow the different stakeholders to consider where things are working well and where things can improve.
In future blogs I will explore more about some of the themes that have come from these discussions and how these are pointing to opportunities for change that may involve making better use of existing services or support networks, increasing opportunities for sharing information and improving partnerships among others.
Leadership
A central emerging theme is the importance of leadership. We have seen how senior leaders in different roles can start the process of system change including police and crime commissioners (PCCs), directors of public health, local authority directors, chief executives or Councillors, NHS commissioners and so on.
However, real momentum is achieved where these leaders come together to share a new vision and commitment to achieving change.
