Listening to the chief executive of a highly successful Australian mental health organisation encouraged me to consider the key role of ‘disruptive influences’ in the field of health and social care.
If we think about the impact of other recent disruptive influences such as the ability to Skype or face-time people anywhere in the world, or Airbnb, we quickly see the challenge that such change brings to the established order. Organisations with responsibility for areas of ‘public good’ may feel directly challenged, find themselves reacting slowly and not really embracing these creative influences, seeing them as threatening, unhelpful or downright dangerous.
Never has the time been more conducive for ‘positive’ disruptive influences because by and large we remain stuck in a pattern of traditional commissioning of services to try to meet needs at the point they are deemed significant.
Among other challenges, we face:
- A clear mismatch between available funds and demand and expectations in both health and social care
- A growing minority of dissatisfied communities
- Concerns about quality and performance;.
All this, and more, gives rise to a system under significant pressure that is struggling to evolve, adapt or change more radically at the scale required. People working in social care - both commissioners and providers - have a great deal to be proud of in ensuring the scarce public pound is well spent. And let’s not forget that the majority of people who need our support, representing many in the most vulnerable circumstances in society, get good-quality care at the best possible price. For many, this is transformative. We have a strong, contemporary social policy narrative in the form of the Care Act, widely owned by the sector.
But there is a pressing need to develop greater opportunities to affect the limited market for social care: for example where micro-commissioning, the role of volunteers and vehicles to empowerment such as individual service funds remain novelties. These are small-scale, localised initiatives that require more oxygen to thrive.
Digital transformation: an opportunity
Let’s look at what is happening in the Netherlands, where an increasingly large proportion of the population goes online to retrieve information about health, order repeat prescriptions and book appointments. Some 15 years ago, this just did not happen. Now, over 65% of people utilise such opportunities. Where might this go next? In health in the UK, however, 'big data' is still some distance away; for social care, it seems an even more distant prospect.
In England, what we have not yet seen is a growth in use of visual media for people receiving such services when the rest of society has moved a long way to the likes of Skype. What else might be done if we developed our thinking a little bit further and provided people with an opportunity to be connected to each other? Is this something we should countenance, and if not, why not?
Personalisation and micro- commissioning
So where does innovation arise in social care: is it state-induced, organisationally/professionally driven, or generated by individuals acting imaginatively in a way that public bodies (including regulators) and professional organisations find difficult?
Pete is 36 and lives with his elderly parents in a rural area. He has a number of long-term conditions so needs personal care and support. He wants to live independently, but the local authority has not been able to secure alternative accommodation and meet his care and support needs at a reasonable price. He does not have a personal budget because he doesn't think he has any options, or at least thinks he could not generate any if he had a budget. He worries that his parents are becoming frailer and he will eventually need to consider moving into a residential unit.
But one day Pete meets two other men at a day centre and discovers that they are in a similar position. They start to talk about 'clubbing together' and renting something for themselves so as to keep within their personal budgets and secure a level of independence that individually had eluded them.
It is essential that public bodies and professional organisations act in a way that avoids undue controls or unduly fetters the commissioning activity of the individual, or groups of individuals, with eligible needs for social care. So the challenges are clear: if we are to encourage greater creativity and competition in organising care and support, individuals or small groups of people will need more opportunity and encouragement - and support - to stretch the boundaries of convention, bureaucracy and regulation.
The NHS and social care recognise the need for more risk-taking and yet, for good reason, have avoided the issue in anything other than localised form. Without such an approach, we might continue to see health and social care services commissioned against a formulaic template, serving needs in a particular way but lacking the creativity – and disruptive influences – that are so badly needed in finding solutions within and between communities that state-run bodies can find so difficult.