In health and care, 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. We look for innovative approaches, highlighting that the status quo can’t continue and that change is paramount. What is sometimes missed, however, are the underlying behaviours and approaches which, regardless of the systems or structures, determine whether someone has a positive or negative experience of the health and social care system.
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. Support must be coordinated so it has the effect of being a single, easily navigated, offer, not a collection of individual and siloed 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, those most disenfranchised or experience inequalities are often those that services find hardest to reach. To have direct impact on the lives of people experiencing inequality can require different and often non-service-based approaches.
The fourth principle is that ‘Carers are identified, supported and involved’. Carers, including young carers, remain consistently under-recognised in terms of their contribution. and the impact. Of all the roles people fulfil in communities, this is one of the most human (or humane) and something which underpins a society.
These principles all intersect with the fifth principle, that ‘Voluntary, community and social enterprise, and housing sectors are involved as key partners and enablers’. When health and care services combine with voluntary and community organisations their reach is far greater. At all times we should ask the question of who is best placed to provide support. I suspect the answer will frequently 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.
The sixth principle looks at the relationship with the voluntary sector from a different perspective. ‘Volunteering and social action are recognised as key enablers’, and underlines the need for building and sustaining community capacity. People will be involved in (formal or informal) volunteering or social action in their community for many different reasons, ranging from pure altruism to a feeling of social responsibility, for example, We can be fairly sure, however, that they are not motivated by the desire to prop up statutory services.
People don’t need 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 is a range of support to grow the valuable work of volunteers and help them to connect with people who could benefit. We need to listen to the unique insight that they have into what is and isn’t working, or what would help at a community level.
A definition of the relationship itself
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.
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 of more responsive services, rather than the driving force, our priorities would be far more aligned with those of the communities we serve.