Easier INC

Personalised Care In Dorset - Setting The Scene

 

This blog is co-authored with Saskie Dorman (a consultant in palliative medicine from Dorset) and Karen Stratford (a system lead for personalised care in Dorset).

Early February saw people and public services in Dorset come together for an intensive kick start event, focused on developing truly personalised care and support through a trio of exemplar programmes linked to 3 PCN (Primary Care Network) areas. The event was structured over 4 days (spread across 2 weeks) with around 40 people in attendance from a wide range of roles, organisations, services and communities, including those with lived experience as recipients of current services and support. We wanted to move beyond the model of equating help with services so much of our focus was on discovering the role that the economic resources of the state can play in nurturing, supporting, growing - and sometimes just getting out of the way of - the social resources that are already present in people and communities.

This short blog series provides an overview of what we did and discussed, what we learned and what we think we achieved… although, of course, the real test will be in what happens next.

In this blog (“Setting the Scene”):

• Why we did it this way.
• What we think personalised care and support is and is not.

In blog 2 (“Finding Our Focus”):

• From initial ideas to clarity of purpose.
• From everything that could be managed to a focus on core capabilities.

In blog 3 (“The Move to Action”):

• Action as learning.
• Staying connected.

Setting The Scene

We chose to invest a lot of time and resources; 4 intensive days of work from 40 people is no small ask. The rationale was simple enough:

• We could spend weeks and months having meetings which repeated themselves, snatched conversations, doing shuttle diplomacy back-and-forth between partners, herding and re-herding the proverbial cats, all the while knowing that the pace this would dictate would be slower than the pace at which context would shift. We would be running to go backwards.

OR

• We could swallow hard, grit our teeth and invest in bringing as many of the key partners together, providing them with the time, space and opportunity to examine the really tough questions that need to be asked and to build a shared and genuine commitment to an approach of their own making.

We figured that the latter was worth a punt!

Day 1 of 4 opened by exploring stories of what personalised care and support does and doesn’t look like in practice. We asked, “What might happen if public services were bespoke by default?”.

Isn’t it just too expensive to do this?

Right out of the gates we started busting myths. Listening to Fran’s story (the video below) we reflected together about how learning to do ALWAYS, ONLY and EXACTLY what matters is both better and cheaper… 

…but also deeply challenging to the status quo; especially where defensive and risk averse practices may have arisen in response to how public services are managed and configured or because of how public servants are held to account.

We acknowledged that these are tough challenges to rise to but took inspiration from the example of North Devon where, as a consequence of understanding stories such as Fran’s, they have reduced patient testing by as much as 40% without reducing the amount of pathology they discover. In other words, they are helping those who need it without incurring the costs and harms of testing those who don’t. An inspiring example of how to do always, only and exactly what matters.

But we can’t just give everyone what they ask for, can we? 

Fran’s story helped us to surmise that an effective, systematic approach to personalising care and support may see us move from over to under…

OVER…

• testing
• treating
• diagnosing
• referring
• prescribing
• providing

UNDER…standing

So how can we understand what really matters to people and what this means for the help and support that they may require? We explored this through a second story, this time about an 86 year old lady living in local authority housing. She had arrived at her local housing department asking for them to move her to a new home. She was at loggerheads with her downstairs neighbours (she lived on the first floor). They had a young daughter and were fed up with the dangerous mess that her backyard had become. She wasn’t able to maintain the yard and so, out of options, she had decided that she would have to move.

The standard process was not bespoke-by-default and would have seen this lady being handed a form and placed in a queue to await a decision. Today though, she was in luck. A project team that were exploring more bespoke and effective ways of working met with her in order to understand her request; why was she asking to move house and what really mattered to her? They discovered that moving house wasn’t what really mattered to her but living peaceably with her neighbours was. She just didn’t see any way to achieve that… but the team did.

They:

• Contacted the neighbours, who said they would maintain the yard if they could have the use of it so that their daughter could play safely.
• Agreed this with the elderly lady.
• Arranged for a one-off clearance of the garden so that the neighbours had a fresh start.

Pretty simple. Very cheap. Enormously effective. Entirely bespoke and completely outside the scope of any service that was normally on offer. Importantly also not at all what the 86 year old lady had asked for.

Prompted by this story we reflected that public services have an important role to play and that making the most of this role may require them to think first of how they can support solutions within communities then only secondly about where ’providing services’ may be necessary to enable this.

We surmised, from this and other stories, that to be effective it’s often necessary to understand “the who behind the why behind the what”…

We also reflected that this can be skilled work, the things that are often most important also being the things that are least visible…

This is BIG!!!

The energy in the room was palpable. There was also a sense that taking on the challenge of engaging with “the who behind the why behind the what” would be taking on a HUGE challenge. We leaned into it.

Borrowing from Toby Lowe’s work on the failures of New Public Management we heard the story of a family that were facing multiple, very complex challenges and where one daughter had been referred to a dietician with a diagnosis of being obese. Using the Foresight System Map for Obesity (below) we reflected on whether it was realistic to suppose that a sole dietician - or a dietician service - could ever expect to deliver the outcome of reduced obesity.

As just one node in over 150 known causes of obesity could a dietician on their own be expected to make the definitive difference? OR, if we are really invested in supporting better outcomes, is there a need to think radically differently NOT JUST about how public services work BUT ALSO about how they work together, including how they may need to work well beyond the normal parameters of public service systems to be active across whatever scope is necessary to make a difference?

Scary? Yes but exciting too.

Closing Reflections

Our morning’s work together on day 1 of our 4 day kick-start event was challenging and exploratory. The aim wasn’t to find answers but to tune into the sorts of questions and challenges we would need to wrestle with in order to make our time together worthwhile; an opportunity to ask ourselves if we were prepared to challenge the perspective, design and unintended consequences of the status quo in order to explore what else could be possible…

IN BLOG 2: Finding Our Focus - from ideas and challenges to identifying shared purpose and core capabilities.

Thanks for reading!

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Format: Blog

Tags: Client Story

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