As a health and care system, we often make bold statements about redefining what it is we are, or should be doing to create a sustainable set of arrangements to meet future demand. Often we look for innovative approaches, highlighting that the status quo can not continue and that change is paramount. But what is sometimes missed is the underlying behaviours and approaches, regardless of the systems or structures, which determine whether someone has a positive or negative experience of the health and social care system.
As part of the supporting the ‘new relationship with people and communities;’ as set out in the Five Year Forward View, the People and Communities Board, with support from National Voices, developed a set of 6 principles for engaging people and communities. Of course, engaging the very people who use services should be part of what we do, but often it is seen as a step in a process, rather than a definition of the relationship itself. By looking at what we would measure and what successful engagement would look like, the principles help to guide the development of support which truly reflects a different relationship – where the person is the centre of the arrangements.
The first principle is that “Care and support is person-centred: Personalised, coordinated, and empowering”. The last word is perhaps the most important. If a person needing support is truly empowered to make the most of their strengths, skills and ideas, following their own personal choices of what would improve their life, then the support around them must be flexible enough to reflect that. And to be easily navigable, the support must be coordinated so it has the effect of being a single suite of support, not a collection of individual services.
The second principle, “Services are created in partnership with citizens and communities”, means that those who will use services are the driving force in determining the nature of the service. To me, this also includes a question about whether a “service” is the best solution. We know people are best supported by maximising their resilience to prevent issues arising and stay strong if they do. It also reflects recognition that those who understand the communities needs the best, are the communities themselves.
The third principle “Focus is on equality and narrowing inequalities” may sound obvious to many of us who work in public services. However, it is worth considering that, often, those most disenfranchised or experience inequalities are the hardest to reach from a service perspective. To have direct impact on the lives of people experiencing inequality can require different and often non-service-based approaches. This links closely to the fifth principle, that “Voluntary, community and social enterprise, and housing sectors are involved as key partners and enablers”. The reach of a health or care service will be limited by various parameters, but the combined reach of the voluntary and community sector alongside services is far greater. At all times we should ask the question of who is best placed to provide support. Often, I suspect the answer will be that those already living and working in communities are best placed to provide or coordinate support. But we must recognise that this does not come for free; investment in building and sustaining community capacity is critical.
This relationship with the voluntary sector is crucial. The sixth principle “Volunteering and social action are recognised as key enablers” recognises this. It’s important to remember, however, why people volunteer (formally or informally) or decide to take action in their community. It will be for many reasons, ranging from pure altruism to a feeling of social responsibility, for example, but we can be fairly sure it won’t be with the desire to prop up statutory services. What people don’t need is statutory services trying to dictate what they should or shouldn’t do in communities or pigeon-holing them to a certain remit. Instead, what is needed, at times, is a range of support to grow the valuable work of volunteers and help them to connect with people who could benefit, and for us to listen to the unique insight that they have as to what is and isn’t working, or what would help at a community level.
Finally, the fourth principle, that “Carers are identified, supported and involved”. It’s often noted how carers are a group consistently under-recognised in terms of their contribution to the health and social care system and the impact (particularly financial) were they not to provide the care they do. Whilst a stark cost comparison, it is in itself an unflattering way to describe the physical and emotional commitment which people make to help those they love and care for. Involvement and support must not be predicated on a fear that people will stop caring, but a recognition that of all the roles people fulfil in communities, this is one of the most human (or humane) and something which underpins a society.
There’s no doubt in my mind that if all services were designed with these principles in mind, we would be a long way towards achieving a health and social care system which reflected the needs of those using it. If this was seen as the goal, with system-wide financial sustainability a by-product rather than the driving force, our priorities would be far more aligned with those of the communities we serve.